{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T21:04:43Z","timestamp":1788383083196,"version":"build-2803163510"},"reference-count":229,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Sarcopenia and frailty are highly prevalent extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) and are strongly associated with reduced exercise tolerance, exacerbation risk, hospitalizations, and mortality. Beyond inflammation, oxidative stress, and physical inactivity, emerging evidence highlights nutrition as a major modifiable driver of muscle deterioration in COPD. Nutritional deficits impair anabolic signaling, exacerbate proteolysis, worsen mitochondrial dysfunction, and contribute to frailty progression. Methods: This narrative review synthesizes evidence from PubMed, Embase, Scopus, and Web of Science up to 2025, integrating mechanistic, metabolic, nutritional, and biomarker-related pathways underlying muscle dysfunction in COPD. Studies examining inflammation, hypoxemia, oxidative stress, hormonal imbalance, nutrition, and emerging biomarkers were included. Results: COPD-related sarcopenia results from converging inflammatory (TNF-\u03b1, IL-6), catabolic (FOXO, UPS), metabolic, and vascular mechanisms, compounded by energy deficiency, protein insufficiency, and micronutrient deficits. Inadequate intake of protein, vitamin D, antioxidants, and omega-3 fatty acids increase anabolic resistance, enhance muscle catabolism, and worsen frailty. Nutritional interventions, particularly high-protein supplementation, leucine-enriched formulas, vitamin D repletion, omega-3 fatty acids, and multimodal nutrition\u2013exercise programs, demonstrate benefits in muscle mass, strength, and physical performance. Biomarkers such as GDF-15, CAF22, and specific microRNAs reflect nutritional status and correlate with muscle health in COPD. Conclusions: Sarcopenia and frailty in COPD arise from a complex interplay of inflammatory, metabolic, nutritional, and lifestyle-related factors. Integrating nutritional assessment and targeted dietary interventions with exercise and pulmonary rehabilitation is essential to counteract anabolic resistance and improve functional outcomes. Advances in biomarker research may support earlier diagnosis and personalized nutrition-based therapeutic strategies.<\/jats:p>","DOI":"10.3390\/nu18122003","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:13:37Z","timestamp":1782195217000},"page":"2003","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sarcopenia and Frailty in COPD: Mechanisms, Relationship with Malnutrition and Potential Therapeutic Interventions"],"prefix":"10.3390","volume":"18","author":[{"given":"Saoussen","family":"Naas","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8632-2120","authenticated-orcid":false,"given":"M\u00f3nika","family":"Fekete","sequence":"additional","affiliation":[{"name":"Institute of Preventive Medicine and Public Health, Semmelweis University, 1089 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7507-7068","authenticated-orcid":false,"given":"Riad","family":"Bejta","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Bakos","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borb\u00e1la","family":"Szalai","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-1336","authenticated-orcid":false,"given":"J\u00e1nos Tam\u00e1s","family":"Varga","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e002489","DOI":"10.1136\/bmjph-2024-002489","article-title":"Burden of Chronic Obstructive Pulmonary Disease and Its Attributable Risk Factors in 204 Countries and Territories, 1990\u20132021: Results from the Global Burden of Disease Study 2021","volume":"4","author":"Cao","year":"2026","journal-title":"BMJ Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dutta, J., Singh, S., Greeshma, M.V., Mahesh, P.A., and Mabalirajan, U. (2024). Diagnostic Challenges and Pathogenetic Differences in Biomass-Smoke-Induced versus Tobacco-Smoke-Induced COPD: A Comparative Review. Diagnostics, 14.","DOI":"10.3390\/diagnostics14192154"},{"key":"ref_3","unstructured":"Kanchustambham, V., and Brown, B.D. (2026). Chronic Obstructive Pulmonary Disease (COPD). StatPearls, StatPearls Publishing."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Nici, J., Celli, L., Mannino, B.R., Rennard, D., Agusti, S.I., Lareau, A., Meek, S., O\u2019Donnell, P., Neder, D., and Wedzicha, J.A. (2026). A Brief History of COPD: As Told by Some of Its Senior Scientists and Clinicians. J. Clin. Med., 15.","DOI":"10.3390\/jcm15103914"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.ccm.2020.06.007","article-title":"Definition, Causes, Pathogenesis, and Consequences of Chronic Obstructive Pulmonary Disease Exacerbations","volume":"41","author":"Ritchie","year":"2020","journal-title":"Clin. Chest Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"325","DOI":"10.4046\/trd.2017.0085","article-title":"The Relationship between Airway Inflammation and Exacerbation in Chronic Obstructive Pulmonary Disease","volume":"80","author":"Perng","year":"2017","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.jare.2025.07.004","article-title":"Aging Induces Sarcopenia by Disrupting the Crosstalk between the Skeletal Muscle Microenvironment and Myofibers","volume":"82","author":"Wang","year":"2025","journal-title":"J. Adv. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"108635","DOI":"10.1016\/j.pharmthera.2024.108635","article-title":"Musculoskeletal Crosstalk in Chronic Obstructive Pulmonary Disease and Comorbidities: Emerging Roles and Therapeutic Potentials","volume":"257","author":"Mou","year":"2024","journal-title":"Pharmacol. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"289","DOI":"10.4046\/trd.2022.0074","article-title":"Long-Term Outcome of Chronic Obstructive Pulmonary Disease: A Review","volume":"85","author":"Jo","year":"2022","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European Consensus on Definition and Diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"927","DOI":"10.3904\/kjim.2025.057","article-title":"Current Perspectives on Sarcopenia: Diagnosis and Therapeutic Approaches","volume":"40","author":"Choi","year":"2025","journal-title":"Korean J. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1007\/s12603-020-1371-y","article-title":"Muscle Strength Definitions Matter: Prevalence of Sarcopenia and Predictive Validity for Adverse Outcomes Using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Criteria","volume":"24","author":"Chew","year":"2020","journal-title":"J. Nutr. Health Aging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.afos.2025.06.003","article-title":"Epidemiology of Sarcopenia: A Narrative Review","volume":"11","author":"Tseng","year":"2025","journal-title":"Osteoporos. Sarcopenia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1007\/s41999-021-00463-x","article-title":"Prevalence of Sarcopenia and Associated Factors in Older Adults Attending a Day Hospital Service in Ireland","volume":"12","author":"Connolly","year":"2021","journal-title":"Eur. Geriatr. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e70030","DOI":"10.1002\/mco2.70030","article-title":"Sarcopenia and Cachexia: Molecular Mechanisms and Therapeutic Interventions","volume":"6","author":"Wang","year":"2025","journal-title":"MedComm"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4103\/jfmpc.jfmpc_1748_25","article-title":"Frailty: An Overview","volume":"15","author":"Kalladi","year":"2026","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_17","first-page":"433","article-title":"Frailty Syndrome: An Overview","volume":"9","author":"Chen","year":"2014","journal-title":"Clin. Interv. Aging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1093\/gerona\/glaa267","article-title":"Physical Frailty Phenotype Criteria and Their Synergistic Association on Cognitive Functioning","volume":"76","author":"Chu","year":"2020","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_19","first-page":"453","article-title":"Fried Frailty Phenotype Assessment Components as Applied to Geriatric Inpatients","volume":"11","author":"Bieniek","year":"2016","journal-title":"Clin. Interv. Aging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1136\/thoraxjnl-2016-208460","article-title":"Physical Frailty and Pulmonary Rehabilitation in COPD: A Prospective Cohort Study","volume":"71","author":"Maddocks","year":"2016","journal-title":"Thorax"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chen, M., Li, Y., Du, Q., Yin, J., Xu, Y., and Li, F. (2025). Frailty in Older Adults with Chronic Obstructive Pulmonary Disease: Preliminary Findings of Prevalence and Care Priorities. BMC Geriatr., 26.","DOI":"10.1186\/s12877-025-06844-2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"455","DOI":"10.7861\/clinmedicine.16-5-455","article-title":"Sarcopenia and Frailty: New Challenges for Clinical Practice","volume":"16","author":"Dodds","year":"2016","journal-title":"Clin. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1152\/physrev.00061.2017","article-title":"Sarcopenia: Aging-Related Loss of Muscle Mass and Function","volume":"99","author":"Larsson","year":"2019","journal-title":"Physiol. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"6321","DOI":"10.1113\/jphysiol.2012.242396","article-title":"Compensatory vasodilatation during hypoxic exercise: Mechanisms responsible for matching oxygen supply to demand","volume":"590","author":"Casey","year":"2012","journal-title":"J. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5106","DOI":"10.1097\/MS9.0000000000003584","article-title":"Sarcopenia in Chronic Obstructive Pulmonary Disease: Mechanisms, Diagnosis, and Management Strategies","volume":"87","author":"Khan","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S2230","DOI":"10.21037\/jtd.2019.10.41","article-title":"Nutritional Support in Chronic Obstructive Pulmonary Disease (COPD): An Evidence Update","volume":"11","author":"Collins","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tramontano, A., and Palange, P. (2023). Nutritional State and COPD: Effects on Dyspnoea and Exercise Tolerance. Nutrients, 15.","DOI":"10.3390\/nu15071786"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1515\/jtim-2015-0021","article-title":"Nutrition in Chronic Obstructive Pulmonary Disease: A Review","volume":"3","author":"Rawal","year":"2015","journal-title":"J. Transl. Intern. Med."},{"key":"ref_29","first-page":"E93","article-title":"Main Nutritional Deficiencies","volume":"63","author":"Kiani","year":"2022","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1186\/s12967-026-07906-8","article-title":"Role of Mitochondrial Dysfunction in Muscle Wasting in Cancer Cachexia: A Narrative Review","volume":"24","author":"Su","year":"2026","journal-title":"J. Transl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Yoshida, T., and Delafontaine, P. (2020). Mechanisms of IGF-1-Mediated Regulation of Skeletal Muscle Hypertrophy and Atrophy. Cells, 9.","DOI":"10.3390\/cells9091970"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"17879","DOI":"10.2147\/JIR.S554850","article-title":"Comprehensive Review of Sepsis-Related Skeletal Muscle Atrophy: Mechanisms, Diagnosis and Therapeutic Strategies","volume":"18","author":"Wu","year":"2025","journal-title":"J. Inflamm. Res."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Norman, K., Ha\u00df, U., and Pirlich, M. (2021). Malnutrition in Older Adults-Recent Advances and Remaining Challenges. Nutrients, 13.","DOI":"10.3390\/nu13082764"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Naas, S., Fekete, M., Szendro, G., Komaromi, T., Rozgonyi, Z., Palmer, E., Polivka, L., Bakos, R., Szalai, B., and Muller, V. (2026). Multimodal Therapeutic Strategies for the Management of Sarcopenia and Frailty in Chronic Obstructive Pulmonary Disease: A Narrative Review. Nutrients, 18.","DOI":"10.3390\/nu18030543"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Henrot, P., Dupin, I., Schilfarth, P., Esteves, P., Blervaque, L., Zysman, M., Gouzi, F., Hayot, M., Pomi\u00e8s, P., and Berger, P. (2023). Main Pathogenic Mechanisms and Recent Advances in COPD Peripheral Skeletal Muscle Wasting. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24076454"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"8817404","DOI":"10.1155\/ijne\/8817404","article-title":"Circulating Muscle Markers for Sarcopenia in Peritoneal Dialysis","volume":"2025","author":"Xu","year":"2025","journal-title":"Int. J. Nephrol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ji, Y., Li, M., Chang, M., Liu, R., Qiu, J., Wang, K., Deng, C., Shen, Y., Zhu, J., and Wang, W. (2022). Inflammation: Roles in Skeletal Muscle Atrophy. Antioxidants, 11.","DOI":"10.3390\/antiox11091686"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Haberecht-M\u00fcller, S., Kr\u00fcger, E., and Fielitz, J. (2021). Out of Control: The Role of the Ubiquitin Proteasome System in Skeletal Muscle during Inflammation. Biomolecules, 11.","DOI":"10.3390\/biom11091327"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Jesus, F.R., Moraes, A.C.S., da Silva, I.L.N., Passos, F.C., Salles, C., Neves, M.C.L.C., and Baccan, G.C. (2024). Analysis of Endocrine and Inflammatory Markers in Preserved Ratio Impaired Spirometry. Med. Sci., 12.","DOI":"10.3390\/medsci12020018"},{"key":"ref_40","first-page":"230","article-title":"Anabolic and Catabolic Pathways Regulating Skeletal Muscle Mass","volume":"13","author":"McCarthy","year":"2010","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.bbrc.2015.02.026","article-title":"TNF Alpha Inhibits Myogenic Differentiation of C2C12 Cells through NF-\u03baB Activation and Impairment of IGF-1 Signaling Pathway","volume":"458","author":"Zhao","year":"2015","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Webster, J.M., Kempen, L.J.A.P., Hardy, R.S., and Langen, R.C.J. (2020). Inflammation and Skeletal Muscle Wasting During Cachexia. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.597675"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s41043-024-00709-x","article-title":"Association of Inflammation and Nutrition-Based Indicators with Chronic Obstructive Pulmonary Disease and Mortality","volume":"43","author":"Cao","year":"2024","journal-title":"J. Health Popul. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Madini, N., Vincenti, A., Beretta, A., Santero, S., Viroli, G., and Cena, H. (2024). Addressing Inflammaging and Disease-Related Malnutrition: Adequacy of Oral Nutritional Supplements in Clinical Care. Nutrients, 16.","DOI":"10.3390\/nu16234141"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Fekete, M., Cs\u00edp\u0151, T., Fazekas-Pongor, V., Feh\u00e9r, \u00c1., Szarvas, Z., Kaposv\u00e1ri, C., Horv\u00e1th, K., Lehoczki, A., Tarantini, S., and Varga, J.T. (2023). The Effectiveness of Supplementation with Key Vitamins, Minerals, Antioxidants and Specific Nutritional Supplements in COPD\u2014A Review. Nutrients, 15.","DOI":"10.3390\/nu15122741"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s13668-025-00613-8","article-title":"The Role of Nutrition and Nutritional Supplements in the Prevention and Treatment of Malnutrition in Chronic Obstructive Pulmonary Disease: Current Approaches in Nutrition Therapy","volume":"14","author":"Tuna","year":"2025","journal-title":"Curr. Nutr. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Gea, J., Orozco-Levi, M., Pascual-Gu\u00e0rdia, S., Casadevall, C., Enr\u00edquez-Rodr\u00edguez, C.J., Camps-Ubach, R., and Barreiro, E. (2025). Biological Mechanisms Involved in Muscle Dysfunction in COPD: An Integrative Damage\u2013Regeneration\u2013Remodeling Framework. Cells, 14.","DOI":"10.3390\/cells14211731"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1136\/thorax.58.9.752","article-title":"Muscle Force during an Acute Exacerbation in Hospitalised Patients with COPD and Its Relationship with CXCL8 and IGF-I","volume":"58","author":"Spruit","year":"2003","journal-title":"Thorax"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1165\/rcmb.2008-0382OC","article-title":"Cellular Markers of Muscle Atrophy in Chronic Obstructive Pulmonary Disease","volume":"42","author":"Plant","year":"2010","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1152\/japplphysiol.01017.2010","article-title":"Inflammatory Cells and Apoptosis in Respiratory and Limb Muscles of Patients with COPD","volume":"111","author":"Barreiro","year":"2011","journal-title":"J. Appl. Physiol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Brauwers, B., Spruit, M.A., Franssen, F.M.E., Vaes, A.W., and Machado, F.V.C. (2026). Lower-Limb Muscle Impairments in Patients with COPD: An Overview of the Past Decade. Cells, 15.","DOI":"10.3390\/cells15030220"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Baig, M.H., Ahmad, K., Moon, J.S., Park, S.-Y., Ho Lim, J., Chun, H.J., Qadri, A.F., Hwang, Y.C., Jan, A.T., and Ahmad, S.S. (2022). Myostatin and Its Regulation: A Comprehensive Review of Myostatin Inhibiting Strategies. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.876078"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Ahmad, S.S., Ahmad, K., Lee, E.J., Lee, Y.-H., and Choi, I. (2020). Implications of Insulin-Like Growth Factor-1 in Skeletal Muscle and Various Diseases. Cells, 9.","DOI":"10.3390\/cells9081773"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Gellhaus, B., B\u00f6ker, K.O., Schilling, A.F., and Saul, D. (2023). Therapeutic Consequences of Targeting the IGF-1\/PI3K\/AKT\/FOXO3 Axis in Sarcopenia: A Narrative Review. Cells, 12.","DOI":"10.3390\/cells12242787"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"100903","DOI":"10.1016\/j.jbior.2022.100903","article-title":"Gaining Insight into the Role of FoxO1 in the Progression of Disuse-Induced Skeletal Muscle Atrophy","volume":"85","author":"Vilchinskaya","year":"2022","journal-title":"Adv. Biol. Regul."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Liu, W., Meng, P., Li, Z., Shen, Y., Meng, X., Jin, S., and Hu, M. (2025). The Multifaceted Impact of Physical Exercise on FoxO Signaling Pathways. Front. Cell Dev. Biol., 13.","DOI":"10.3389\/fcell.2025.1614732"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"C974","DOI":"10.1152\/ajpcell.00292.2022","article-title":"Impaired Regenerative Capacity Contributes to Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease","volume":"323","author":"Jaitovich","year":"2022","journal-title":"Am. J. Physiol.-Cell Physiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/s41392-023-01502-8","article-title":"Inflammation and Aging: Signaling Pathways and Intervention Therapies","volume":"8","author":"Li","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Huang, Y., Wang, C., Cui, H., Sun, G., Qi, X., and Yao, X. (2025). Mitochondrial Dysfunction in Age-Related Sarcopenia: Mechanistic Insights, Diagnostic Advances, and Therapeutic Prospects. Front. Cell Dev. Biol., 13.","DOI":"10.3389\/fcell.2025.1590524"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2147\/COPD.S280540","article-title":"Towards Personalized Management of Sarcopenia in COPD","volume":"16","author":"Gosker","year":"2021","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1164\/rccm.200407-887OC","article-title":"Oxidative Stress and Respiratory Muscle Dysfunction in Severe Chronic Obstructive Pulmonary Disease","volume":"171","author":"Barreiro","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.bbadis.2013.11.001","article-title":"Classical NF-\u03baB Activation Impairs Skeletal Muscle Oxidative Phenotype by Reducing IKK-\u03b1 Expression","volume":"1842","author":"Remels","year":"2014","journal-title":"Biochim. Biophys. Acta BBA-Mol. Basis Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3838","DOI":"10.1378\/chest.128.6.3838","article-title":"Skeletal Muscle Adaptations to Interval Training in Patients with Advanced COPD","volume":"128","author":"Vogiatzis","year":"2005","journal-title":"Chest"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Zhong, Y., Xu, J., Chen, X., Lv, Y., and Zheng, X. (2025). Exercise and Epigenetic Regulation in COPD: Current Evidence and Potential Mechanistic Pathways. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262311392"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1007\/s00204-023-03562-9","article-title":"Reactive Oxygen Species, Toxicity, Oxidative Stress, and Antioxidants: Chronic Diseases and Aging","volume":"97","author":"Jomova","year":"2023","journal-title":"Arch. Toxicol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"637","DOI":"10.2147\/COPD.S4480","article-title":"Skeletal Muscle Dysfunction in Patients with Chronic Obstructive Pulmonary Disease","volume":"3","author":"Kim","year":"2008","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e20250047","DOI":"10.36416\/1806-3756\/e20250047","article-title":"Cross-Sectional Studies: Understanding Applications, Methodological Issues, and Valuable Insights","volume":"51","author":"Figueiredo","year":"2025","journal-title":"J. Bras. Pneumol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Kim, M.E., Lim, Y., and Lee, J.S. (2025). Mitochondrial Dysfunction and Metabolic Reprogramming in Chronic Inflammatory Diseases: Molecular Insights and Therapeutic Opportunities. Curr. Issues Mol. Biol., 47.","DOI":"10.3390\/cimb47121042"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e70268","DOI":"10.1002\/mco2.70268","article-title":"Oxidative Stress: Signaling Pathways, Biological Functions, and Disease","volume":"6","author":"Liu","year":"2025","journal-title":"MedComm"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2649064","DOI":"10.1080\/27694127.2026.2649064","article-title":"Autophagy Selectively Clears ER in TNF-\u03b1-Induced Muscle Atrophy","volume":"5","author":"Dueren","year":"2026","journal-title":"Autophagy Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13045-026-01780-z","article-title":"The Distinct Roles of ROS in Tumor Immunity: From Mechanisms to Immunotherapeutic Applications","volume":"19","author":"Li","year":"2026","journal-title":"J. Hematol. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Kowalczyk, P., Sulejczak, D., Kleczkowska, P., Bukowska-O\u015bko, I., Kucia, M., Popiel, M., Wietrak, E., Kramkowski, K., Wrzosek, K., and Kaczy\u0144ska, K. (2021). Mitochondrial Oxidative Stress\u2014A Causative Factor and Therapeutic Target in Many Diseases. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222413384"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"De Nicolo, B., Cataldi-Stagetti, E., Diquigiovanni, C., and Bonora, E. (2023). Calcium and Reactive Oxygen Species Signaling Interplays in Cardiac Physiology and Pathologies. Antioxidants, 12.","DOI":"10.3390\/antiox12020353"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1183\/09031936.00086306","article-title":"Mitochondrial Dysfunction in COPD Patients with Low Body Mass Index","volume":"29","author":"Rabinovich","year":"2007","journal-title":"Eur. Respir. J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.freeradbiomed.2007.03.002","article-title":"Free Radicals and Muscle Fatigue: Of ROS, Canaries, and the IOC","volume":"44","author":"Reid","year":"2008","journal-title":"Free Radic. Biol. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"965764","DOI":"10.1155\/2014\/965764","article-title":"Musculoskeletal Disorders in Chronic Obstructive Pulmonary Disease","volume":"2014","author":"Cielen","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Patel, N., and Baydur, A. (2026). Molecular and Structural Changes, and Skeletal Muscle Strength and Endurance in Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease: Practical Applications of Assessment and Management. Bioengineering, 13.","DOI":"10.3390\/bioengineering13030329"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Hyatt, H.W., and Powers, S.K. (2021). Mitochondrial Dysfunction Is a Common Denominator Linking Skeletal Muscle Wasting Due to Disease, Aging, and Prolonged Inactivity. Antioxidants, 10.","DOI":"10.3390\/antiox10040588"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Lian, D., Chen, M.-M., Wu, H., Deng, S., and Hu, X. (2022). The Role of Oxidative Stress in Skeletal Muscle Myogenesis and Muscle Disease. Antioxidants, 11.","DOI":"10.3390\/antiox11040755"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1093\/glycob\/cwad081","article-title":"The Intersection of HIF-1\u03b1, O-GlcNAc, and Skeletal Muscle Loss in Chronic Obstructive Pulmonary Disease","volume":"33","author":"Sekar","year":"2023","journal-title":"Glycobiology"},{"key":"ref_81","first-page":"289","article-title":"Factors Contributing to Muscle Wasting and Dysfunction in COPD Patients","volume":"2","author":"Degens","year":"2007","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1183\/09031936.02.00762001","article-title":"Skeletal Muscle Fibre-Type Shifting and Metabolic Profile in Patients with Chronic Obstructive Pulmonary Disease","volume":"19","author":"Gosker","year":"2002","journal-title":"Eur. Respir. J."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Ma, K., Huang, F., Qiao, R., and Miao, L. (2022). Pathogenesis of Sarcopenia in Chronic Obstructive Pulmonary Disease. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.850964"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1002\/jcp.24351","article-title":"mTOR Signaling for Biolog0ical Control and Cancer","volume":"228","author":"Alayev","year":"2013","journal-title":"J. Cell. Physiol."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"van Krimpen, S.J., Simons, S.O., Schols, A.M.W.J., Langen, R.C.J., and Gosker, H.R. (2026). Glucocorticoid-Induced Muscle Weakness in ECOPD: A Perspective on Mechanisms and Emerging Pharmacological Interventions. Expert Rev. Respir. Med., 1\u201313.","DOI":"10.1080\/17476348.2026.2620144"},{"key":"ref_86","first-page":"e96018","article-title":"The Role of Mammalian Target of Rapamycin (mTOR) and Adenosine Monophosphate-Activated Protein Kinase (AMPK) Signaling in Skeletal Muscle Hypertrophy: A Literature Review with Implications for Health and Disease","volume":"17","author":"Jeong","year":"2025","journal-title":"Cureus"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.chest.2022.11.040","article-title":"Differential Impact of Low Fat-Free Mass in People with COPD Based on BMI Classifications: Results from the COPD and Systemic Consequences-Comorbidities Network","volume":"163","author":"Machado","year":"2023","journal-title":"Chest"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Kalu\u017aniak-Szymanowska, A., Talarska, D., Tobis, S., Styszy\u0144ski, A., Cofta, S., Wieczorowska-Tobis, K., and Deskur-\u015amielecka, E. (2024). Body Compositions Phenotypes of Older Adults with COPD. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1449189"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s00223-025-01473-8","article-title":"The Inflammation-Energy Metabolism Axis: A Central Driver of Sarcopenia-Osteoporosis: A Narrative Review","volume":"117","author":"Jiang","year":"2026","journal-title":"Calcif. Tissue Int."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Bossio, S., Russa, D.L., Rago, V., Di Dio, M., Aversa, A., and Perri, A. (2026). Inflammaging: Immune\u2013Metabolic Crosstalk Between the Prostate\u2013Testis and Musculoskeletal System. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27083612"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Liang, Z., and Zhang, L. (2026). Chronic Inflammation as a Driving Factor for Sarcopenia: An Update on Pathophysiology and Future Therapeutic Targets. Front. Pharmacol., 17.","DOI":"10.3389\/fphar.2026.1733798"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Kleinov\u00e1, P., T\u00edmea, B., Matej, V., Gra\u0148\u00e1k, K., Andrej, K., Katar\u00edna, \u0160., and Dedinsk\u00e1, I. (2026). Nutritional and Metabolic Interventions to Prevent and Treat Protein\u2013Energy Wasting in Nondialysis CKD\u2014Narrative Review. Nutrients, 18.","DOI":"10.3390\/nu18030390"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Morales, F., Montserrat-de la Paz, S., Leon, M.J., and Rivero-Pino, F. (2023). Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children\u2019s Health Status: A Literature Review. Nutrients, 16.","DOI":"10.3390\/nu16010001"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.chest.2017.03.020","article-title":"Mitochondrial Dysfunction in Airway Disease","volume":"152","author":"Prakash","year":"2017","journal-title":"Chest"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Choi, E.-H., Kim, M.-H., and Park, S.-J. (2024). Targeting Mitochondrial Dysfunction and Reactive Oxygen Species for Neurodegenerative Disease Treatment. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25147952"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Tezze, C., Sandri, M., and Tessari, P. (2023). Anabolic Resistance in the Pathogenesis of Sarcopenia in the Elderly: Role of Nutrition and Exercise in Young and Old People. Nutrients, 15.","DOI":"10.20944\/preprints202308.0516.v1"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Paulussen, K.J.M., McKenna, C.F., Beals, J.W., Wilund, K.R., Salvador, A.F., and Burd, N.A. (2021). Anabolic Resistance of Muscle Protein Turnover Comes in Various Shapes and Sizes. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.615849"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Chen, M., Wang, Y., Deng, S., Lian, Z., and Yu, K. (2022). Skeletal Muscle Oxidative Stress and Inflammation in Aging: Focus on Antioxidant and Anti-Inflammatory Therapy. Front. Cell Dev. Biol., 10.","DOI":"10.3389\/fcell.2022.964130"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s11658-025-00771-1","article-title":"Perspectives on Mitochondrial Dysfunction in the Regeneration of Aging Skeletal Muscle","volume":"30","author":"Wang","year":"2025","journal-title":"Cell. Mol. Biol. Lett."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"C40","DOI":"10.1152\/ajpcell.00056.2021","article-title":"Mechanisms of Exercise as a Preventative Measure to Muscle Wasting","volume":"321","author":"Graham","year":"2021","journal-title":"Am. J. Physiol.-Cell Physiol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"108401","DOI":"10.1016\/j.rmed.2025.108401","article-title":"Sarcopenia as a Treatable Trait in COPD: From Mechanisms to Management","volume":"248","author":"Matera","year":"2025","journal-title":"Respir. Med."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Maciel, P., Lamas, C.B., Ara\u00fajo, A.C., Chagas, E.F.B., Guiguer, E.L., Curi, R., Pithon-Curi, T.C., Almeida, M.C.D.S., Sloan, K.C.P., and Sloan, L.A. (2026). Physical Exercise Counteracts Impaired Cognition by Improving Mitochondrial Function. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27104337"},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Nan, Y., Zhou, Y., Dai, Z., Yan, T., Zhong, P., Zhang, F., Chen, Q., and Peng, L. (2023). Role of Nutrition in Patients with Coexisting Chronic Obstructive Pulmonary Disease and Sarcopenia. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1214684"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Huhn, A., and Diel, P. (2025). Impact of Protein Intake on Training Response in Chronic Lung Disease. Nutrients, 18.","DOI":"10.3390\/nu18010041"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Jahan-Mihan, A., El Khoury, D., Brewer, G.J., and Chapleau, A. (2025). Current Perspectives on Protein Supplementation in Athletes: General Guidance and Special Considerations for Diabetes-A Narrative Review. Nutrients, 17.","DOI":"10.3390\/nu17223528"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.cmet.2018.08.013","article-title":"Leucine Signals to mTORC1 via Its Metabolite Acetyl-Coenzyme A","volume":"29","author":"Son","year":"2019","journal-title":"Cell Metab."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1002\/jcsm.12208","article-title":"Beta-hydroxy-beta-methylbutyrate Supplementation and Skeletal Muscle in Healthy and Muscle-wasting Conditions","volume":"8","year":"2017","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Ji, X., Ye, X., Ji, S., Zhang, S., Wang, Y., Zhou, Z., Xiang, D., and Luo, B. (2025). Whey Protein Supplementation Combined with Exercise on Muscle Protein Synthesis and the AKT\/mTOR Pathway in Healthy Adults: A Systematic Review and Meta-Analysis. Nutrients, 17.","DOI":"10.3390\/nu17162579"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/resp.12019","article-title":"Effects of Nutritional Supplementation Combined with Conventional Pulmonary Rehabilitation in Muscle-Wasted Chronic Obstructive Pulmonary Disease: A Prospective, Randomized and Controlled Study","volume":"18","author":"Gurgun","year":"2013","journal-title":"Respirology"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1093\/nutrit\/nuad007","article-title":"Nutritional and Exercise Interventions in Individuals with Sarcopenic Obesity around Retirement Age: A Systematic Review and Meta-Analysis","volume":"81","author":"Eglseer","year":"2023","journal-title":"Nutr. Rev."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.metabol.2011.02.013","article-title":"Resting Energy Expenditure and Protein Turnover Are Increased in Patients with Severe Chronic Obstructive Pulmonary Disease","volume":"60","author":"Kao","year":"2011","journal-title":"Metabolism."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"102834","DOI":"10.5492\/wjccm.v14.i3.102834","article-title":"Early Enteral Nutrition in Critically-Ill Patients","volume":"14","author":"Yanamaladoddi","year":"2025","journal-title":"World J. Crit. Care Med."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"9875","DOI":"10.1002\/fsn3.4519","article-title":"Chronic Obstructive Pulmonary Disease: The Role of Healthy and Unhealthy Dietary Patterns\u2014A Comprehensive Review","volume":"12","author":"Mohammadhasani","year":"2024","journal-title":"Food Sci. Nutr."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e25085","DOI":"10.2196\/25085","article-title":"Association Between a Low Carbohydrate Diet, Quality of Life, and Glycemic Control in Australian Adults Living with Type 1 Diabetes: Protocol for a Mixed Methods Pilot Study","volume":"10","author":"Paul","year":"2021","journal-title":"JMIR Res. Protoc."},{"key":"ref_115","first-page":"77","article-title":"Dietary Protein Intake and Chronic Kidney Disease","volume":"20","author":"Ko","year":"2017","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Russo, C., Valle, M.S., Casabona, A., Spicuzza, L., Sambataro, G., and Malaguarnera, L. (2022). Vitamin D Impacts on Skeletal Muscle Dysfunction in Patients with COPD Promoting Mitochondrial Health. Biomedicines, 10.","DOI":"10.3390\/biomedicines10040898"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Fuentes-Barr\u00eda, H., Aguilera-Egu\u00eda, R., Angarita-Davila, L., Rojas-G\u00f3mez, D., Alarc\u00f3n-Rivera, M., L\u00f3pez-Soto, O., Maureira-S\u00e1nchez, J., Berm\u00fadez, V., Rivera-Porras, D., and Contreras-Vel\u00e1zquez, J.C. (2025). Vitamin D and Sarcopenia: Implications for Muscle Health. Biomedicines, 13.","DOI":"10.3390\/biomedicines13081863"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"106","DOI":"10.3733\/ca.v065n03p106","article-title":"Dietary Omega-3 Fatty Acids Aid in the Modulation of Inflammation and Metabolic Health","volume":"65","author":"Zivkovic","year":"2011","journal-title":"Calif. Agric."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Liu, S., Zhang, L., and Li, S. (2023). Advances in Nutritional Supplementation for Sarcopenia Management. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1189522"},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Ren, Y., Lu, A., Wang, B., and Wang, C. (2023). Nutritional Intervention Improves Muscle Mass and Physical Performance in the Elderly in the Community: A Systematic Review and Meta-Analysis. Life, 14.","DOI":"10.3390\/life14010070"},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"He, Q., Yang, P., Wang, Y., Xu, W., Feng, Y., Xie, F., and Xu, G. (2025). Effects of Antioxidant Nutrients on Muscle Mass, Strength and Function in COPD Patients: A Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0316842"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"5135","DOI":"10.1113\/JP270654","article-title":"Do Antioxidant Supplements Interfere with Skeletal Muscle Adaptation to Exercise Training?","volume":"594","author":"Merry","year":"2016","journal-title":"J. Physiol."},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Simon, P., T\u00f6r\u00f6k, \u00c9., Szalontai, K., Kari, B., Neuperger, P., Zavala, N., Kanizsai, I., Pusk\u00e1s, L.G., T\u00f6r\u00f6k, S., and Szebeni, G.J. (2025). Nutritional Support of Chronic Obstructive Pulmonary Disease. Nutrients, 17.","DOI":"10.3390\/nu17071149"},{"key":"ref_124","first-page":"e81656","article-title":"Prevalence of Hypomagnesemia in ICU Patients at a Tertiary Care Center: A Prospective Observational Study","volume":"17","author":"Shekhar","year":"2025","journal-title":"Cureus"},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Amado, C.A., Ghadban, C., Ag\u00fcero, J., Lav\u00edn, B.A., Mart\u00edn-Audera, P., Guerra, A.R., Berja, A., Aranda, N., Guzun, A., and Insua, A.I. (2025). Non-Anemic Iron Deficiency Predicts COPD Exacerbations and Hospitalizations: Results from a Prospective Cohort. J. Clin. Med., 14.","DOI":"10.3390\/jcm14124154"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/s12603-022-1822-8","article-title":"A Review on the Role of Oral Nutritional Supplements in Chronic Obstructive Pulmonary Disease","volume":"26","author":"Huang","year":"2022","journal-title":"J. Nutr. Health Aging"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1017\/S0007114522000976","article-title":"Increased Energy and\/or Protein Intake Improves Anthropometry and Muscle Strength in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review with Meta-Analysis on Randomised Controlled Clinical Trials","volume":"129","author":"Bernardes","year":"2023","journal-title":"Br. J. Nutr."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"104870","DOI":"10.1016\/j.isci.2022.104870","article-title":"Randomized Controlled Trial for Time-Restricted Eating in Overweight and Obese Young Adults","volume":"25","author":"Zhang","year":"2022","journal-title":"iScience"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"e082007","DOI":"10.1136\/bmj-2024-082007","article-title":"Intermittent Fasting Strategies and Their Effects on Body Weight and Other Cardiometabolic Risk Factors: Systematic Review and Network Meta-Analysis of Randomised Clinical Trials","volume":"389","author":"Khan","year":"2025","journal-title":"BMJ"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1007\/s11357-024-01493-6","article-title":"Impact of Physical Activity and Exercise Training on Health-Related Quality of Life in Older Adults: An Umbrella Review","volume":"47","author":"Schwartz","year":"2025","journal-title":"GeroScience"},{"key":"ref_131","doi-asserted-by":"crossref","unstructured":"Shahnaz, T., Fawole, A.O., Adeyanju, A.A., and Onuh, J.O. (2024). Food Proteins as Functional Ingredients in the Management of Chronic Diseases: A Concise Review. Nutrients, 16.","DOI":"10.3390\/nu16142323"},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Castillo, \u00cd.M., Rueda, R., Pereira, S.L., Bouzamondo, H., L\u00f3pez-Chicharro, J., Segura-Ortiz, F., and Atherton, P.J. (2025). Age-Related Anabolic Resistance: Nutritional and Exercise Strategies, and Potential Relevance to Life-Long Exercisers. Nutrients, 17.","DOI":"10.3390\/nu17223503"},{"key":"ref_133","doi-asserted-by":"crossref","unstructured":"Brauwers, B., Machado, F.V.C., Beijers, R.J.H.C.G., Spruit, M.A., and Franssen, F.M.E. (2023). Combined Exercise Training and Nutritional Interventions or Pharmacological Treatments to Improve Exercise Capacity and Body Composition in Chronic Obstructive Pulmonary Disease: A Narrative Review. Nutrients, 15.","DOI":"10.3390\/nu15245136"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1016\/j.clnu.2024.08.004","article-title":"Functional and Metabolic Effects of Omega-3 Polyunsaturated Fatty Acid Supplementation and the Role of \u03b2-Hydroxy-\u03b2-Methylbutyrate Addition in Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial","volume":"43","author":"Engelen","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1183\/09031936.00070914","article-title":"Nutritional Assessment and Therapy in COPD: A European Respiratory Society Statement","volume":"44","author":"Schols","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1152\/japplphysiol.00613.2016","article-title":"Skeletal Muscle and Resistance Exercise Training; the Role of Protein Synthesis in Recovery and Remodeling","volume":"122","author":"McGlory","year":"2017","journal-title":"J. Appl. Physiol."},{"key":"ref_137","doi-asserted-by":"crossref","unstructured":"Beals, J.W., Burd, N.A., Moore, D.R., and van Vliet, S. (2019). Obesity Alters the Muscle Protein Synthetic Response to Nutrition and Exercise. Front. Nutr., 6.","DOI":"10.3389\/fnut.2019.00087"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ajcnut.2025.04.019","article-title":"Resistance Training Increases Myofibrillar Protein Synthesis in Middle-to-Older Aged Adults Consuming a Typical Diet with No Influence of Protein Source: A Randomized Controlled Trial","volume":"122","author":"Korzepa","year":"2025","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Oyama, Y., Tatsumi, H., Takikawa, H., Taniguchi, N., and Masuda, Y. (2024). Combined Effect of Early Nutrition Therapy and Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease Exacerbation: A Prospective Randomized Controlled Trial. Nutrients, 16.","DOI":"10.3390\/nu16050739"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1164\/rccm.201410-1830PP","article-title":"Smoking-Induced Skeletal Muscle Dysfunction: From Evidence to Mechanisms","volume":"191","author":"Degens","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"6644002","DOI":"10.1155\/2021\/6644002","article-title":"Oxidative Stress-Derived Mitochondrial Dysfunction in Chronic Obstructive Pulmonary Disease: A Concise Review","volume":"2021","author":"Antunes","year":"2021","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"E469","DOI":"10.1152\/ajpendo.00204.2014","article-title":"Skeletal Muscle Atrophy and the E3 Ubiquitin Ligases MuRF1 and MAFbx\/Atrogin-1","volume":"307","author":"Bodine","year":"2014","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_143","doi-asserted-by":"crossref","unstructured":"Li, Y., Yang, Y., and Yang, Y. (2022). Multifaceted Roles of Ferroptosis in Lung Diseases. Front. Mol. Biosci., 9.","DOI":"10.3389\/fmolb.2022.919187"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"12286","DOI":"10.1038\/s41598-021-91510-x","article-title":"Fourteen Days of Smoking Cessation Improves Muscle Fatigue Resistance and Reverses Markers of Systemic Inflammation","volume":"11","author":"Darabseh","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1111\/acer.12184","article-title":"Chronic Alcohol Induces M2 Polarization Enhancing Pulmonary Disease Caused by Exposure to Particulate Air Pollution","volume":"37","author":"Thevenot","year":"2013","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ajpath.2025.05.025","article-title":"Alcohol-Mediated Skeletal Muscle Adaptations and Their Impact on Comorbidities","volume":"196","author":"Molina","year":"2026","journal-title":"Am. J. Pathol."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"207","DOI":"10.35946\/arcr.v38.2.05","article-title":"Alcoholic Myopathy: Pathophysiologic Mechanisms and Clinical Implications","volume":"38","author":"Simon","year":"2017","journal-title":"Alcohol Res. Curr. Rev."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.apmr.2023.09.004","article-title":"Effects of Combined Endurance and Resistance Eccentric Training on Muscle Function and Functional Performance in Patients with Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial","volume":"105","author":"Pancera","year":"2024","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1378\/chest.125.6.2036","article-title":"Endurance and Strength Training in Patients with COPD","volume":"125","author":"Mador","year":"2004","journal-title":"Chest"},{"key":"ref_150","doi-asserted-by":"crossref","unstructured":"Kaczmarek, A., Kaczmarek, M., Cia\u0142owicz, M., Clemente, F.M., Wola\u0144ski, P., Badicu, G., and Murawska-Cia\u0142owicz, E. (2021). The Role of Satellite Cells in Skeletal Muscle Regeneration\u2014The Effect of Exercise and Age. Biology, 10.","DOI":"10.3390\/biology10101056"},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1038\/nm.3651","article-title":"Stem Cell Aging: Mechanisms, Regulators and Therapeutic Opportunities","volume":"20","author":"Oh","year":"2014","journal-title":"Nat. Med."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"100207","DOI":"10.1016\/j.jnha.2024.100207","article-title":"Association of Inflammatory Markers with Muscle and Cognitive Function in Early and Late-Aging Older Adults","volume":"28","author":"Haeri","year":"2024","journal-title":"J. Nutr. Health Aging"},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"162","DOI":"10.21037\/atm-22-377","article-title":"Myostatin Is Involved in Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease via Drp-1 Mediated Abnormal Mitochondrial Division","volume":"10","author":"Tan","year":"2022","journal-title":"Ann. Transl. Med."},{"key":"ref_154","doi-asserted-by":"crossref","unstructured":"Cha, S.-R., Jang, J., Park, S.-M., Ryu, S.M., Cho, S.-J., and Yang, S.-R. (2023). Cigarette Smoke-Induced Respiratory Response: Insights into Cellular Processes and Biomarkers. Antioxidants, 12.","DOI":"10.3390\/antiox12061210"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1136\/thx.2006.069310","article-title":"Effects of Rehabilitative Exercise on Peripheral Muscle TNFalpha, IL-6, IGF-I and MyoD Expression in Patients with COPD","volume":"62","author":"Vogiatzis","year":"2007","journal-title":"Thorax"},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1177\/1559827607300283","article-title":"The Anti-Inflammatory Actions of Exercise Training","volume":"1","author":"Flynn","year":"2007","journal-title":"Am. J. Lifestyle Med."},{"key":"ref_157","doi-asserted-by":"crossref","unstructured":"Sun, H.-R., Wang, S., Yan, S.-C., Zhang, Y., Nelson, P.J., Jia, H.-L., Qin, L.-X., and Dong, Q.-Z. (2019). Therapeutic Strategies Targeting Cancer Stem Cells and Their Microenvironment. Front. Oncol., 9.","DOI":"10.3389\/fonc.2019.01104"},{"key":"ref_158","doi-asserted-by":"crossref","unstructured":"Th\u00e9riault, M.-E., Par\u00e9, M.-\u00c8., Maltais, F., and Debigar\u00e9, R. (2012). Satellite Cells Senescence in Limb Muscle of Severe Patients with COPD. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0039124"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"65","DOI":"10.11005\/jbm.2019.26.2.65","article-title":"Sarcopenia Associated with Chronic Obstructive Pulmonary Disease","volume":"26","author":"Kim","year":"2019","journal-title":"J. Bone Metab."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"H217","DOI":"10.1152\/ajpheart.00716.2015","article-title":"Impact of Age on the Vasodilatory Function of Human Skeletal Muscle Feed Arteries","volume":"310","author":"Park","year":"2016","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_161","doi-asserted-by":"crossref","unstructured":"M\u0142ynarska, E., Bojdo, K., Frankenstein, H., Krawiranda, K., Kustosik, N., Lisi\u0144ska, W., Rysz, J., and Franczyk, B. (2025). Endothelial Dysfunction as the Common Pathway Linking Obesity, Hypertension and Atherosclerosis. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262010096"},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.resp.2004.12.009","article-title":"Effects of Aging on Microvascular Oxygen Pressures in Rat Skeletal Muscle","volume":"146","author":"Behnke","year":"2005","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1161\/01.RES.0000269183.13937.e8","article-title":"Direct Evidence of Endothelial Oxidative Stress with Aging in Humans: Relation to Impaired Endothelium-Dependent Dilation and Upregulation of Nuclear Factor-kappaB","volume":"100","author":"Donato","year":"2007","journal-title":"Circ. Res."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1113\/jphysiol.2003.057042","article-title":"Effect of Acute and Chronic Ascorbic Acid on Flow-Mediated Dilatation with Sedentary and Physically Active Human Ageing","volume":"556","author":"Eskurza","year":"2004","journal-title":"J. Physiol."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1113\/JP270594","article-title":"Reduced Blood Flow to Contracting Skeletal Muscle in Ageing Humans: Is It All an Effect of Sand through the Hourglass?","volume":"594","author":"Nyberg","year":"2016","journal-title":"J. Physiol."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"H2166","DOI":"10.1152\/ajpheart.00780.2011","article-title":"NADPH Oxidase-Derived ROS and the Regulation of Pulmonary Vessel Tone","volume":"302","author":"Frazziano","year":"2012","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s00424-023-02805-z","article-title":"Tobacco Smoking and Vascular Biology and Function: Evidence from Human Studies","volume":"475","author":"Hahad","year":"2023","journal-title":"Pflug. Arch."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1183\/09031936.00053512","article-title":"Blunted Muscle Angiogenic Training-Response in COPD Patients versus Sedentary Controls","volume":"41","author":"Gouzi","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1165\/rcmb.2019-0319ED","article-title":"Development of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease: Smoking, Inflammation, or Simply Disuse?","volume":"62","author":"Iepsen","year":"2020","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1113\/JP279135","article-title":"Determinants of the Diminished Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease: Looking beyond the Lungs","volume":"598","author":"Broxterman","year":"2020","journal-title":"J. Physiol."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"2552","DOI":"10.1097\/CM9.0000000000003831","article-title":"Exercise-Induced Angiogenesis and Lymphangiogenesis: A Potential Therapeutic Tool to Fight Aging and Disease","volume":"138","author":"Jiang","year":"2025","journal-title":"Chin. Med. J."},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"106736","DOI":"10.1016\/j.ejim.2026.106736","article-title":"Chronic Obstructive Pulmonary Disease (COPD) and Cardiovascular Comorbidities: Shedding Light on Key Interactions and Therapeutic Approaches","volume":"147","author":"Stella","year":"2026","journal-title":"Eur. J. Intern. Med."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1152\/japplphysiol.00178.2017","article-title":"Leg Blood Flow Is Impaired during Small Muscle Mass Exercise in Patients with COPD","volume":"123","author":"Iepsen","year":"2017","journal-title":"J. Appl. Physiol."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.3906\/sag-1909-36","article-title":"Frequency of Sarcopenia and Associated Outcomes in Patients with Chronic Obstructive Pulmonary Disease","volume":"50","author":"Cihan","year":"2020","journal-title":"Turk. J. Med. Sci."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1164\/rccm.201710-2140CI","article-title":"Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients","volume":"198","author":"Jaitovich","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_176","doi-asserted-by":"crossref","unstructured":"Linguiti, G., Granberg, V., Leonetti, G., Lassandro, G., Lassandro, M., Delvecchio, M., and Giordano, P. (2026). Beyond BMI: Nutritional Recovery and Functional Implications of CFTR Modulators in Cystic Fibrosis. Biology, 15.","DOI":"10.3390\/biology15040367"},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13054-015-0737-8","article-title":"Metabolic and Nutritional Support of Critically Ill Patients: Consensus and Controversies","volume":"19","author":"Preiser","year":"2015","journal-title":"Crit. Care"},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1136\/thoraxjnl-2020-215999","article-title":"Respiratory Exacerbations Are Associated with Muscle Loss in Current and Former Smokers","volume":"76","author":"Mason","year":"2021","journal-title":"Thorax"},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1016\/j.clnu.2022.09.011","article-title":"Nutritional Support after Hospital Discharge Improves Long-Term Mortality in Malnourished Adult Medical Patients: Systematic Review and Meta-Analysis","volume":"41","author":"Kilchoer","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_180","doi-asserted-by":"crossref","unstructured":"\u015acis\u0142o, L., Pluta, J., Kli\u015b-Kalinowska, A., G\u00f3rski, M., and Buczkowska, M. (2025). The Impact of Polypharmacy and Oral Nutritional Supplementation on Nutritional Status in Patients Residing in a Long-Term Care Facility. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1516103"},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.clnu.2014.04.007","article-title":"Protein Intake and Exercise for Optimal Muscle Function with Aging: Recommendations from the ESPEN Expert Group","volume":"33","author":"Deutz","year":"2014","journal-title":"Clin. Nutr."},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s40279-014-0258-7","article-title":"Dietary Protein Considerations to Support Active Aging","volume":"44","author":"Wall","year":"2014","journal-title":"Sports Med. Auckl. Nz"},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.cger.2016.08.002","article-title":"Pathogenesis and Management of Sarcopenia","volume":"33","author":"Dhillon","year":"2017","journal-title":"Clin. Geriatr. Med."},{"key":"ref_184","doi-asserted-by":"crossref","unstructured":"Pradhan, N., Kerner, J., Campos, L.A., and Dobre, M. (2025). Personalized Nutrition in Chronic Kidney Disease. Biomedicines, 13.","DOI":"10.3390\/biomedicines13030647"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.2337\/dc10-9990","article-title":"Exercise and Type 2 Diabetes","volume":"33","author":"Colberg","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_186","doi-asserted-by":"crossref","unstructured":"Esteban-Fern\u00e1ndez, A., Villar-Taibo, R., Alejo, M., Arroyo, D., Bonilla Palomas, J.L., Cachero, M., Joaquin, C., M\u00e9ndez Bail\u00f3n, M., P\u00e9rez-Rivera, J.\u00c1., and Romero-Vigara, J.C. (2023). Diagnosis and Management of Malnutrition in Patients with Heart Failure. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093320"},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00198-011-1891-8","article-title":"Extraskeletal Benefits and Risks of Calcium, Vitamin D and Anti-Osteoporosis Medications","volume":"23","author":"Body","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_188","doi-asserted-by":"crossref","unstructured":"Motevalli, M., and Stanford, F.C. (2025). Personalized Lifestyle Interventions for Prevention and Treatment of Obesity-Related Cancers: A Call to Action. Cancers, 17.","DOI":"10.3390\/cancers17081255"},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/ncp.11329","article-title":"Medical Nutrition Therapy in Chronic Obstructive Pulmonary Disease: A Narrative Review","volume":"40","year":"2025","journal-title":"Nutr. Clin. Pract."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"230003","DOI":"10.1183\/16000617.0003-2023","article-title":"The Role of Diet and Nutrition in the Management of COPD","volume":"32","author":"Beijers","year":"2023","journal-title":"Eur. Respir. Rev. Off. J. Eur. Respir. Soc."},{"key":"ref_191","first-page":"e97556","article-title":"Research Progress of Sarcopenia Index in Chronic Obstructive Pulmonary Disease: A Review","volume":"17","author":"Li","year":"2025","journal-title":"Cureus"},{"key":"ref_192","doi-asserted-by":"crossref","unstructured":"He, J., Li, H., Yao, J., and Wang, Y. (2023). Prevalence of Sarcopenia in Patients with COPD through Different Musculature Measurements: An Updated Meta-Analysis and Meta-Regression. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1137371"},{"key":"ref_193","doi-asserted-by":"crossref","first-page":"106286","DOI":"10.1016\/j.archger.2026.106286","article-title":"The Diagnostic Accuracy of Blood Biomarkers for Sarcopenia, Sarcopenic Obesity, and Osteosarcopenia: A Meta-Analysis","volume":"148","author":"Burton","year":"2026","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"3123","DOI":"10.2147\/COPD.S531935","article-title":"Prognostic Value of Biomarkers in Chronic Obstructive Pulmonary Disease: A Comprehensive Review","volume":"20","author":"Xu","year":"2025","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_195","doi-asserted-by":"crossref","unstructured":"Deng, M., Bian, Y., Zhang, Q., Zhou, X., and Hou, G. (2022). Growth Differentiation Factor-15 as a Biomarker for Sarcopenia in Patients with Chronic Obstructive Pulmonary Disease. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.897097"},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1002\/jcsm.12096","article-title":"Growth Differentiation Factor-15 Is Associated with Muscle Mass in Chronic Obstructive Pulmonary Disease and Promotes Muscle Wasting in Vivo","volume":"7","author":"Patel","year":"2016","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_197","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s40520-023-02396-w","article-title":"Effect of Targeted Intervention on C-Terminal Agrin Fragment and Its Association with the Components of Sarcopenia: A Scoping Review","volume":"35","author":"Kumar","year":"2023","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_198","doi-asserted-by":"crossref","unstructured":"Livshits, G., Tarabeih, N., Kalinkovich, A., Shalata, A., and Ashkenazi, S. (2025). Metabolic and Inflammatory Biomarkers Predicting Sarcopenic Obesity and Cardiometabolic Risk in Arab Women: A Cross-Sectional Study. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26125699"},{"key":"ref_199","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.hrtlng.2020.06.001","article-title":"NOVEL Antioxidant and Oxidant Biomarkers Related to Sarcopenia in COPD","volume":"50","author":"Matsumoto","year":"2021","journal-title":"Heart Lung"},{"key":"ref_200","doi-asserted-by":"crossref","unstructured":"Karim, A., Muhammad, T., and Qaisar, R. (2021). Prediction of Sarcopenia Using Multiple Biomarkers of Neuromuscular Junction Degeneration in Chronic Obstructive Pulmonary Disease. J. Pers. Med., 11.","DOI":"10.3390\/jpm11090919"},{"key":"ref_201","first-page":"369","article-title":"Physical Activity and Systemic Biomarkers in Persons with COPD: Insights from a Web-Based Pedometer-Mediated Intervention","volume":"11","author":"Berube","year":"2024","journal-title":"Chronic Obstr. Pulm. Dis."},{"key":"ref_202","doi-asserted-by":"crossref","first-page":"4027","DOI":"10.1200\/JCO.2009.22.3701","article-title":"Clinical Trial Designs for Predictive Biomarker Validation: Theoretical Considerations and Practical Challenges","volume":"27","author":"Mandrekar","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_203","doi-asserted-by":"crossref","unstructured":"Qaisar, R., Karim, A., Muhammad, T., and Shah, I. (2020). Circulating Biomarkers of Accelerated Sarcopenia in Respiratory Diseases. Biology, 9.","DOI":"10.3390\/biology9100322"},{"key":"ref_204","doi-asserted-by":"crossref","first-page":"103434","DOI":"10.1016\/j.redox.2024.103434","article-title":"DKK3 as a Diagnostic Marker and Potential Therapeutic Target for Sarcopenia in Chronic Obstructive Pulmonary Disease","volume":"78","author":"Wang","year":"2024","journal-title":"Redox Biol."},{"key":"ref_205","doi-asserted-by":"crossref","first-page":"e70188","DOI":"10.1002\/jcsm.70188","article-title":"Integrated Proteomic and Metabolomic Profiling for Developing Novel Plasma-Based Diagnostic Models of Sarcopenia","volume":"17","author":"Xu","year":"2026","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_206","doi-asserted-by":"crossref","unstructured":"Gao, J., Deng, M., Li, Y., Yin, Y., Zhou, X., Zhang, Q., and Hou, G. (2022). Resistin as a Systemic Inflammation-Related Biomarker for Sarcopenia in Patients with Chronic Obstructive Pulmonary Disease. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.921399"},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"450","DOI":"10.4168\/aair.2021.13.3.450","article-title":"Hemopexin: A Novel Anti-Inflammatory Marker for Distinguishing COPD from Asthma","volume":"13","author":"Winter","year":"2021","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_208","doi-asserted-by":"crossref","unstructured":"Jiang, Q., Ma, Z., Sun, J., and Li, Y. (2024). Association of Dietary Inflammatory Indices with Sarcopenia and All-Cause Mortality in COPD Patients. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1395170"},{"key":"ref_209","doi-asserted-by":"crossref","first-page":"805172","DOI":"10.1155\/2015\/805172","article-title":"Role of Inflammation in Muscle Homeostasis and Myogenesis","volume":"2015","author":"Costamagna","year":"2015","journal-title":"Mediat. Inflamm."},{"key":"ref_210","doi-asserted-by":"crossref","unstructured":"Tu, S., Hao, X., Xu, S., Jin, X., Liao, W., Xia, H., Wang, S., and Sun, G. (2025). Sarcopenia: Current Insights into Molecular Mechanisms, Diagnostics, and Emerging Interventional Approaches. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26146740"},{"key":"ref_211","doi-asserted-by":"crossref","unstructured":"Stumpf, F., Keller, B., Gressies, C., and Schuetz, P. (2023). Inflammation and Nutrition: Friend or Foe?. Nutrients, 15.","DOI":"10.3390\/nu15051159"},{"key":"ref_212","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1186\/s12967-025-07392-4","article-title":"Mitochondrial Dysfunction Acts as a Modulator of the Immunometabolic Route for Activating the Cytosolic DNA Sensor Pathway in Triggering Innate Immunosurveillance","volume":"23","author":"Algieri","year":"2025","journal-title":"J. Transl. Med."},{"key":"ref_213","doi-asserted-by":"crossref","unstructured":"Timasheva, Y., Korytina, G., Markelov, V., Nasibullin, T., Akhmadishina, L., Aznabaeva, Y., Zulkarneev, S., Kochetova, O., and Zagidullin, N. (2026). Integrative Analysis of Oxidative Stress and Cellular Senescence Pathways in Chronic Obstructive Pulmonary Disease. Genes, 17.","DOI":"10.3390\/genes17060685"},{"key":"ref_214","doi-asserted-by":"crossref","unstructured":"Careccia, G., Mangiavini, L., and Cirillo, F. (2023). Regulation of Satellite Cells Functions during Skeletal Muscle Regeneration: A Critical Step in Physiological and Pathological Conditions. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25010512"},{"key":"ref_215","doi-asserted-by":"crossref","first-page":"123966","DOI":"10.1016\/j.biomaterials.2025.123966","article-title":"Microenvironment-Engineered Hydrogels Drive Osteo-Angiogenic Coupling to Accelerate Osteoporotic Bone Regeneration","volume":"329","author":"Wang","year":"2026","journal-title":"Biomaterials"},{"key":"ref_216","doi-asserted-by":"crossref","first-page":"a040600","DOI":"10.1101\/cshperspect.a040600","article-title":"Signaling and Metabolism","volume":"13","author":"Chandel","year":"2021","journal-title":"Cold Spring Harb. Perspect. Biol."},{"key":"ref_217","doi-asserted-by":"crossref","unstructured":"Ny\u00e1ry, D., Fekete, M., Lehoczki, A., Fazekas-Pongor, V., Lip\u00e9cz, \u00c1., Cs\u00edp\u0151, T., Major, D., P\u00e9terfi, A., Cs\u00edk, B., and Z\u00e1b\u00f3, V. (2026). Inflammaging and Sarcopenia as Interconnected Hallmarks of Aging: Integrative Roles of Bioactive Compounds and Lifestyle Interventions. Nutrients, 18.","DOI":"10.3390\/nu18121920"},{"key":"ref_218","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1164\/rccm.201304-0732OC","article-title":"Autophagy in Locomotor Muscles of Patients with Chronic Obstructive Pulmonary Disease","volume":"188","author":"Guo","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_219","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1152\/japplphysiol.00893.2012","article-title":"Role of Autophagy in COPD Skeletal Muscle Dysfunction","volume":"114","author":"Hussain","year":"2013","journal-title":"J. Appl. Physiol."},{"key":"ref_220","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1186\/s12967-023-04369-z","article-title":"Mitochondrial Dysfunction: Roles in Skeletal Muscle Atrophy","volume":"21","author":"Chen","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_221","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12955-024-02324-0","article-title":"Assessing the Effectiveness of Measurement Scales in Evaluating the Health-Related Quality of Life in Rare Disease Patients after Treatment: A Systematic Review","volume":"22","author":"Dumbuya","year":"2024","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_222","doi-asserted-by":"crossref","unstructured":"Chin, H.S., Liu, L., Liao, P.-J., Wee, A.L.R.M., Kwek, X.-Y., Teh, B.T., and Koh, F.H. (2026). Molecular Mechanisms and Nutritional Modulation in Sarcopenia: A Narrative Review. Nutrients, 18.","DOI":"10.3390\/nu18071161"},{"key":"ref_223","doi-asserted-by":"crossref","unstructured":"Burtscher, J., Strasser, B., and Burtscher, M. (2024). A Mito-Centric View on Muscle Aging and Function. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1330131"},{"key":"ref_224","doi-asserted-by":"crossref","first-page":"115024","DOI":"10.1016\/j.isci.2026.115024","article-title":"Skeletal Muscle Metabolism in Health and Disease: Mechanisms, Interventions, and Clinical Perspectives","volume":"29","author":"Lin","year":"2026","journal-title":"iScience"},{"key":"ref_225","doi-asserted-by":"crossref","first-page":"479","DOI":"10.4103\/lungindia.lungindia_143_20","article-title":"Sarcopenia in Patients with Chronic Obstructive Pulmonary Disease: A Study of Prevalence and Associated Factors in Western Greek Population","volume":"37","author":"Tsekoura","year":"2020","journal-title":"Lung India Off. Organ Indian Chest Soc."},{"key":"ref_226","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1186\/s40001-025-03003-6","article-title":"Emerging Biomarkers for Early Cancer Detection and Diagnosis: Challenges, Innovations, and Clinical Perspectives","volume":"30","author":"Zafar","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_227","doi-asserted-by":"crossref","first-page":"e076746","DOI":"10.1136\/bmjopen-2023-076746","article-title":"Relationship between an Ageing Measure and Chronic Obstructive Pulmonary Disease, Lung Function: A Cross-Sectional Study of NHANES, 2007\u20132010","volume":"13","author":"Ruan","year":"2023","journal-title":"BMJ Open"},{"key":"ref_228","doi-asserted-by":"crossref","first-page":"100821","DOI":"10.1016\/j.jnha.2026.100821","article-title":"Outcomes in Clinical Trials on Sarcopenia: A Systematic Review and Meta-Analysis","volume":"30","author":"Rippl","year":"2026","journal-title":"J. Nutr. Health Aging"},{"key":"ref_229","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s43556-025-00340-0","article-title":"Multi-Omics Strategies for Biomarker Discovery and Application in Personalized Oncology","volume":"6","author":"Jiang","year":"2025","journal-title":"Mol. Biomed."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/2003\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T09:23:23Z","timestamp":1782206603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/2003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,20]]},"references-count":229,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18122003"],"URL":"https:\/\/doi.org\/10.3390\/nu18122003","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,20]]}}}