Review of 248 Studies Ranks Protein Plus Strength Training Top for Sarcopenia

The paper appears in The Journal of Nutrition (2026). It is a systematic review, not a new experiment. Dharmansyah and colleagues searched three databases for studies from January 2010 to April 2026. They found 2,543 records and included 248 studies in adults aged 60 and over. Of these, 236 were primary studies and 12 were systematic reviews or meta-analyses. The primary studies included 100 randomised trials, 62 cohort studies, 68 cross-sectional studies, 3 case-control studies and 3 quasi-experimental studies. The authors pre-registered their protocol.

The condition is sarcopenia: the loss of muscle mass, strength and physical performance with age. The authors say it affects 6 to 22 percent of adults aged 65 and over. They call it a leading driver of disability and mortality.

The team did not pool results into one number. Instead, they counted how often studies pointed toward benefit. Among randomised trials, 84 percent of singlenutrient trials reported a beneficial direction of effect. These were mainly trials of protein or leucine, an amino acid found in protein, and of vitamin D at 800 IU a day or more. The figure was 75 percent for whole-diet trials and 78 percent for guttargeted trials. Across all study designs, the figures were 70, 65 and 62 percent. The authors stress that these show direction only. They are not success rates.

From this, the authors built a ranking that also weighs how certain the evidence is. Protein-anchored strategies rated moderate-to-high certainty. That means at least 1.0 to 1.2 g/kg/day, leucine-enriched, paired with resistance training. Vitamin D repletion in older adults who are deficient rated the same. The authors say both align with existing guideline thresholds.

Mediterranean-style eating ranked next, with moderate certainty. That evidence is largely observational. In those studies, Mediterranean and MIND-style diets, higher protein quality and more dietary fibre were each inversely associated with sarcopenia. That is an association. It does not show that the diets prevent muscle loss.

Approaches aimed at the gut microbiome, the community of microbes in the digestive tract, ranked last. The authors call the gut-muscle link an emerging fourth pillar. Results leaned favourable but varied widely, and the certainty was low to very low. Proposed pathways include short-chain fatty acids and more Akkermansia and Faecalibacterium bacteria. The authors say targeting the microbiome is a research priority, not current practice.

There are limits. Studies used different diagnostic criteria and reported outcomes differently. The authors name this as the main barrier to firm clinical recommendations. Their conclusions apply to the general population aged 60 and over.

What to watch next

Large, standardised trials of gut-targeted approaches, and more consistent definitions of sarcopenia across studies.

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