Whey protein, vitamin D, and epicatechin show strongest effects on sarcopenia outcomes in network meta-analysis

BACKGROUND & AIMS: Dietary anti-inflammatory interventions have shown promise in the prevention and management of sarcopenia. However, the efficacy of various anti-inflammatory diets/supplements in improving muscle strength, mass, and physical performance in patients with sarcopenia remains unclear. The objective of this study was to systematically assess the efficacy of various anti-inflammatory supplements in alleviating symptoms in patients with sarcopenia, thereby providing robust evidence to inform clinical practice and nutritional recommendations. METHODS: This study systematically searched 11 Chinese and English databases in August 2025 to include randomized controlled trials (RCTs) evaluating the intervention effects of anti-inflammatory diets or supplements on elderly patients with sarcopenia. Primary outcomes included handgrip strength, gait speed, the five times sit-to-stand test (FTSST), and the appendicular skeletal muscle mass index (ASMI). Secondary outcomes included the Short Physical Performance Battery (SPPB) score, fat-free mass (FFM), and laboratory parameters (triglycerides, high-density lipoprotein, low-density lipoprotein, and C-reactive protein). For primary outcomes, both pairwise and network meta-analyses were performed to compare the effects of different interventions. For secondary outcomes, only pairwise meta-analysis was conducted. RESULTS: Finally, 42 randomized controlled trials were included, involving 3063 elderly patients with sarcopenia, covering seven categories of anti-inflammatory supplements: combined supplements (combinations of at least two anti-inflammatory supplements), amino acids, whey protein, β-Hydroxy-β-methylbutyrate (HMB), Vitamin D, n-3 polyunsaturated fatty acids (PUFAs), and epicatechin. Network meta-analysis results indicated that whey protein (SMD=0.78, 95% CI: 0.07, 1.48), vitamin D (SMD=1.44, 95% CI: 0.76, 2.11), and Epicatechin (SMD=2.44, 95% CI: 1.69, 3.18) are the most effective measures to improve handgrip strength, gait speed, and ASMI, respectively. For FTSST, a significant improvement was only found for combined supplements in the pairwise meta-analysis (SMD = -0.34, 95% CI: -0.63, -0.05). Notably, combined supplements demonstrated positive trends in improving handgrip strength, gait speed, FTSST, and ASMI. CONCLUSIONS: This study confirms that anti-inflammatory supplements are effective in enhancing muscle strength, muscle mass, and physical function among sarcopenic patients. Combined supplementation strategies were identified as the most favorable intervention for achieving comprehensive improvement. It is recommended to develop personalized and multi-target nutritional intervention strategies based on the needs of patients with sarcopenia.