2026 年 10 巻 1 号 p. 48-60
Background: Sarcopenia affects up to 50% of elderly populations globally, representing a critical unmet medical need without FDA or EMA-approved pharmaceutical treatments. The widespread adoption of GLP-1 receptor agonists (GLP-1 RA) has created new urgency, as studies suggest that 15–40% of weight lost consists of lean body mass, potentially accelerating sarcopenia in vulnerable populations. International variations exist in GLP-1 RA prescribing patterns for elderly patients create diverse implications for sarcopenia management strategies.
Objective: To conduct a narrative synthesis of current evidence for nutritional and emerging pharmacological interventions targeting sarcopenia, with particular focus on β-Hydroxy-β-methylbutyrate (HMB) and vitamin D₃ supplementation, and strategies for preventing muscle loss during medical weight loss across diverse healthcare systems.
Methods: Narrative review of clinical trials, meta-analyses, and mechanistic studies examining nutritional supplements, emerging pharmaceuticals, and muscle preservation approaches during medical weight loss, with analysis of international prescribing patterns.
Results: Available evidence suggests that combining HMB with vitamin D₃ may provide enhanced benefits compared to HMB monotherapy, with some studies indicating functional improvements in non-exercising older adults. For GLP-1 RA users, multimodal approaches incorporating protein optimization (1.2–1.6 g/kg/day), resistance training when feasible, and HMB+vitamin D₃ supplementation appear promising for minimizing muscle loss while preserving weight reduction benefits. International analysis reveals substantial disparities in GLP-1 RA accessibility and oversight, with varying implications for sarcopenia prevention strategies.
Conclusions: Current evidence suggests potential benefits of HMB+vitamin D₃ combination therapy (3g/day HMB + 800–2,000 IU vitamin D₃) over monotherapy, particularly for exercise-limited patients. International variations in GLP-1 RA accessibility necessitate tailored sarcopenia prevention strategies adapted to local healthcare contexts. While emerging pharmaceuticals show promise within 2–5 years, current evidence-based interventions may help bridge the therapeutic gap, though their integration requires careful monitoring and realistic expectations about efficacy.
