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RESPONSE |
University of Connecticut Center on Aging Farmington, Connecticut
Few studies have addressed interventions to counteract or prevent sarcopenia or frailty. Exercise, specifically resistance training, has been the most explored intervention and found to be beneficial in very old, frail nursing home residents (1) as well as in younger elderly men and women (2,3). Recently, a "prehabilitation" program in frail individuals living at home focused on exercise and minimizing physical barriers and demonstrated less functional decline (4). There is an innate attractiveness of nutrition interventions to prevent or treat sarcopenia, as outlined by Dr. Wilson (5). Poor nutrition or malnutrition is frequently cited as a contributor to muscle loss or frailty. But the lack of scientific benefit from the few nutrition supplement studies leaves clinicians unclear as to what nutritional program to recommend or prescribe. Fiatarone and colleagues did not find that protein supplementation improved strength or energy intake in frail nursing home residents—the same people who had marked benefit from exercise (1). The control group in the "prehabilitation" program received counseling on good nutrition, and continued functional decline was reported (4). There is evidence of benefit from calcium and vitamin D supplementation to strengthen postmenopausal women with low vitamin D stores (6), but not in men with normal vitamin D status (7). Most likely, treatment of poor nutrition status will require a multifactor approach, as is typical of geriatric syndromes, to address depression and other disease interactions, early satiety, protein adequacy, and whether or which supplements are sufficient in the place of whole food. We agree with Dr. Wilson that, while we await the unveiling the pathogenesis of sarcopenia or frailty, we should control the negative impact of risk factors, and nutrition should be pivotal in this control. But as clinicians, we continue uncertain in recommendations and approach regarding nutrition without evidence of their effectiveness.
Acknowledgments
Address correspondence to Anne M. Kenny, MD, Center on Aging, University of Connecticut Health Center, Farmington, CT 02030-5215. E-mail: kenny{at}nso1.uchc.edu
REFERENCES
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