What nutritional interventions can effectively treat sarcopenia in older adults with cancer? A systematic review

Cancer primarily affects older adults, with a significant proportion also experiencing sarcopenia which is associated with poor clinical outcomes. In older adults with cancer, sarcopenia is not only age-related but also exacerbated by disease processes, inflammation, and the catabolic effects of treatments such as chemotherapy and radiotherapy. Its presence is linked to increased treatment toxicity, longer hospitalisations, reduced physical function, and poorer survival rates. However, diagnosing sarcopenia remains challenging due to inconsistent criteria and limited access to diagnostic tools. Emerging evidence suggests that nutritional interventions may help prevent or reverse sarcopenia. This review aims to evaluate the effectiveness of nutritional interventions in managing sarcopenia in older adults with cancer.

A systematic review was conducted using the PICO framework, targeting studies involving patients aged 65 and older with cancer and confirmed or likely sarcopenia. A total of 1439 studies were retrieved from databases and screened using Rayyan. Data extraction focused on outcomes related to body composition, physical performance, and nutritional intake. Risk of bias was assessed using RoB2, ROBINS-I, and ROBINS-E tools. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed using SWiM guidelines. Studies were grouped by design and intervention type, and the GRADE approach was applied to assess evidence certainty.

Nine studies (2016-2024) met the inclusion criteria. Interventions included dietary supplements, nutritional counselling, enteral feeding, and multimodal strategies. Most studies showed improvements in sarcopenia-related outcomes. Protein supplementation notably improved lean body mass and skeletal muscle index in some randomised control trials (RCTs). Observational studies found associations between certain dietary patterns-such as high fish and fat intake-and reduced sarcopenia risk.

Nutritional interventions show promise in managing sarcopenia among older adults with cancer. However, further large-scale, standardised research is needed. Meanwhile, promoting good nutrition and physical activity remains essential.