Supplements for seniors — what is really worth taking after sixty?

Aim of the study: The combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance in older adults with sarcopenia. This systematic review aimed to evaluate the effects of this combination on muscle mass, muscle strength, and physical performance in community-dwelling older adults with sarcopenia.

Results: The review included 7 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 854 participants aged 60 years and above. The study durations ranged from 10 weeks to 24 weeks. An analysis of standardized mean differences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD, 0.95; 95% confidence interval [CI], 0.13 to 1.78; p<0.05) and muscle strength (SMD, 0.32; 95% CI, 0.08 to 0.56; p<0.05). Although the limited number of randomized controlled trials restricts the robustness of our conclusions, the evidence suggests that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.

Aim of the study: This study aimed to compare the impacts of different nutritional supplements and drugs on older adults with sarcopenia.

Results: After screening 12,308 articles, we included 59 RCTs (N = 5543). Multinutrition [standardized mean difference (SMD), 0.65; 95% CI, 0.04-1.26], protein (SMD, 0.77; 95% CI, 0.38-1.17), and protein with vitamin D (SMD, 0.37; 95% CI, 0.03-0.72) probably improve the quality of life compared with usual care (moderate certainty). The combination of protein and vitamin D [mean difference (MD), 2.07 kg; 95% CI, 0.91-3.23] probably enhance handgrip strength (moderate certainty) and multinutrition (MD, 2.32 kg; 95% CI, 0.85-3.79) may improve handgrip strength (low certainty). However, the drug intervention does not yield significant improvements in handgrip strength (MD, 1.72 kg; 95% CI, -0.74 to 4.18), knee extension strength (SMD, 0.49; 95% CI: -0.05 to 1.03), or timed up and go tests (MD, 0.06; 95% CI, -0.98 to 1.11).

Aim of the study: Age-related sarcopenia and dynapenia have negative effects on strength and the ability to perform activities of daily living. Resistance training (RT) increases muscle mass and strength in older adults and is an established countermeasure for sarcopenia and dynapenia, and creatine may enhance this effect.

Results: The meta-analysis comprised 357 older adults (average ± SD Cr: 63.6 ± 5.9 yr, Pl: 64.2 ± 5.4 yr) with 12.6 ± 4.9 wk of RT. Cr + RT increased total body mass (P = 0.004) and fat-free mass (P < 0.0001) with no effect on fat mass as compared with RT alone. Cr + RT increased chest press (P = 0.004) and leg press (P = 0.02) one-repetition maximum to a greater extent than RT alone, with no difference in the effect on knee extension or biceps curl one-repetition maximum, isokinetic or isometric knee extension peak torque. Cr + RT had a greater effect than RT alone on the 30-s chair stand test (P = 0.03). Retention of muscle mass and strength is integral to healthy aging. The results from this meta-analysis are encouraging in supporting a role for Cr supplementation during RT in healthful aging by enhancing muscle mass gain, strength, and functional performance over RT alone; however, the limited number of studies indicates further work is needed.

Aim of the study: From an energy perspective, the brain is very metabolically demanding. It is well documented that creatine plays a key role in brain bioenergetics. There is some evidence that creatine supplementation can augment brain creatine stores, which could increase memory. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effects of creatine supplementation on memory performance in healthy humans.

Results: Creatine supplementation enhanced measures of memory performance in healthy individuals, especially in older adults (66-76 years).

Aim of the study: Magnesium supplementation is often purported to improve sleep; however, as both an over-the-counter sleep aid and a complementary and alternative medicine, there is limited evidence to support this assertion. The aim was to assess the effectiveness and safety of magnesium supplementation for older adults with insomnia.

Results: Three randomized control trials (RCT) were identified comparing oral magnesium to placebo in 151 older adults in three countries. Pooled analysis showed that post-intervention sleep onset latency time was 17.36 min less after magnesium supplementation compared to placebo (95% CI - 27.27 to - 7.44, p = 0.0006). Total sleep time improved by 16.06 min in the magnesium supplementation group but was statistically insignificant. All trials were at moderate-to-high risk of bias and outcomes were supported by low to very low quality of evidence. This review confirms that the quality of literature is substandard for physicians to make well-informed recommendations on usage of oral magnesium for older adults with insomnia. However, given that oral magnesium is very cheap and widely available, RCT evidence may support oral magnesium supplements (less than 1 g quantities given up to three times a day) for insomnia symptoms.

Aim of the study: The study evaluated how ingestion of nicotinamide mononucleotide (NMN) for 12 weeks by older adults affected blood nicotinamide adenine dinucleotide (NAD +) levels and physical function, particularly walking function. Information concerning sleep, and stress was also collected as secondary endpoints.

Results: The NMN group had improved sleep quality at 12 weeks relative to the placebo group as evidenced by lower scores for "Daytime dysfunction" and "Global PSQI" on the Pittsburgh Sleep Questionnaire. No adverse effects related to test substance consumption were observed. Together, these results indicate that NMN intake could increase blood NAD + levels, maintain walking speed, and improve sleep quality in older adults. Interventions involving NMN aimed at maintaining walking speed could contribute to extended healthy life expectancy.

Aim of the study: Probiotic supplements were shown to improve cognitive function in Alzheimer's disease (AD) patients. However, it is still unclear whether this applies to older individuals with mild cognitive impairment (MCI).

Results: Forty-two MCI patients (age > 60 years) were randomly divided into two groups and consumed either probiotics (n=21) or placebo (n=21) for 12 weeks. Various scale scores, gut microbiota measures and serological indicators were recorded pre- and posttreatment. After 12 weeks of intervention, cognitive function and sleep quality were improved in the probiotic group compared with those in the control group, and the underlying mechanisms were associated with changes in the intestinal microbiota. In conclusion, our study demonstrated that probiotic treatment enhanced cognitive function and sleep quality in older MCI patients, thus providing important insights into the clinical prevention and treatment of MCI.

Aim of the study: Sarcopenia, generally characterized by the age-related reduction in muscle strength, lean/muscle mass and functional ability, is also associated with reduced bone mass and strength and impaired brain health and function. One potential intervention which has received much 'hype' over the past few decades to countermeasure these negative consequences of biological aging is creatine monohydrate supplementation.

Results: From a skeletal muscle perspective, the combination of creatine monohydrate supplementation and resistance training provides 'hope' for older adults as it improves measures of lean mass, regional (limb) muscle thickness, upper- and lower-body muscle strength and functional ability. Further, there is some evidence that creatine (supplementation or habitual diet) provides a ray of 'hope' for improving some aspects of cognitive function. The majority of research suggests that creatine is more 'hype' than 'hope' for improving measures of bone mass in older adults. Creatine monohydrate supplementation provides some anti-sarcopenic benefits for older adults.

Aim of the study: Sarcopenia, defined as age-related reduction in muscle mass, strength, and physical performance, is associated with other age-related health conditions such as osteoporosis, osteosarcopenia, sarcopenic obesity, physical frailty, and cachexia. From a healthy aging perspective, lifestyle interventions that may help overcome characteristics and associated comorbidities of sarcopenia are clinically important.

Results: One possible intervention is creatine supplementation (CR). Accumulating research over the past few decades shows that CR, primarily when combined with resistance training (RT), has favourable effects on aging muscle, bone and fat mass, muscle and bone strength, and tasks of physical performance in healthy older adults. However, research is very limited regarding the efficacy of CR in older adults with sarcopenia or osteoporosis and no research exists in older adults with osteosarcopenia, sarcopenic obesity, physical frailty, or cachexia. Therefore, the purpose of this narrative review is (1) to evaluate and summarize current research involving CR, with and without RT, on properties of muscle and bone in older adults and (2) to provide a rationale and justification for future research involving CR in older adults with osteosarcopenia, sarcopenic obesity, physical frailty, or cachexia.

Aim of the study: Upper respiratory tract infections (URTIs) are common viral illnesses whose burden increases with age-related declines in innate immunity. Maitake mushrooms (Grifola frondosa) have immunomodulatory properties, but evidence in healthy humans, particularly regarding age-related innate immune responses, remains limited.

Results: While the overall incidence of URTI episodes did not differ between groups, symptom-specific analyses suggested strain-dependent differences. Y10M supplementation was associated with fewer cumulative days of fever and runny nose in both age groups and with sore throat in young adults, whereas C5304 showed limited effects. Notably, Y10M was associated with changes in innate immune parameters in middle-aged/older adults, including increased plasmacytoid dendritic cell frequency, activation of conventional dendritic cells, and upregulation of type I interferon-related gene expression and IL12A following ex vivo stimulation. These findings suggest that dietary maitake supplementation, particularly with the Y10M strain, may reduce the cumulative burden of selected URTI-related symptoms and modulate antiviral innate immune responses in healthy adults, with effects that may differ by strain and age cohort.