{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:59:52Z","timestamp":1789999192661,"version":"4.0.1"},"reference-count":49,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"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\/Objectives: Exercise and nutrition are central to sarcopenia management, but Vietnamese evidence is limited. We compared exercise intervention (Ex) alone and Ex plus nutritional support against health education. Methods: In this study, a three-arm, parallel-group cluster-randomized controlled trial, three communities in Can Gio District were randomly selected and assigned 1:1:1 (one per arm) to health-education control, Ex, or combined intervention. Before allocation, 30 adults aged 60\u201370 years with AWGS 2019-defined sarcopenia were randomly selected from screening lists within each community (n = 90). Both active arms underwent 24 weeks of aerobic and resistance exercise, with weekly supervised sessions during weeks 1\u201312 and less-supervised home exercise thereafter. The combined arm also received weekly individualized nutrition counseling and a daily multinutrient oral supplement (270 kcal; 11 g protein) during weeks 1\u201312. Outcomes at baseline, 12 weeks, and 24 weeks were analyzed using sex-adjusted participant-level linear mixed-effects models. Results: At 24 weeks, adjusted differences in change (95% CIs) for Ex versus control and combined versus control were, respectively, 0.12 (0.02\u20130.22) and 0.01 (\u22120.09\u20130.11) kg\/m2 for the skeletal muscle index; 2.49 (1.57\u20133.42) and 2.23 (1.30\u20133.15) kg for handgrip strength; and 0.206 (0.132\u20130.279) and 0.053 (\u22120.017\u20130.123) m\/s for gait speed. Conclusions: Both active communities showed better handgrip strength than control; only the Ex community showed a gait-speed advantage, while muscle-mass changes were modest. With one cluster per arm, treatment and community were confounded; definitive treatment effects and the independent contribution of nutrition cannot be determined. Trial registration: ClinicalTrials.gov NCT07761091 (retrospectively registered on 12 August 2026).<\/jats:p>","DOI":"10.3390\/nu18183080","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3080","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Nutrition and Exercise Interventions Among Community-Dwelling Older Vietnamese Adults with Sarcopenia: A Cluster-Randomized Controlled Trial"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4650-3087","authenticated-orcid":false,"given":"Tan Duy","family":"Doan","sequence":"first","affiliation":[{"name":"Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72723, Vietnam"},{"name":"School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 116177, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huyen Thi Thanh","family":"Le","sequence":"additional","affiliation":[{"name":"HCMC Hospital for Rehabilitation\u2014Professional Diseases, Ho Chi Minh City 73023, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1033-4624","authenticated-orcid":false,"given":"Tuan Nhat","family":"Pham","sequence":"additional","affiliation":[{"name":"Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72723, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8915-7894","authenticated-orcid":false,"given":"An Thanh","family":"Truong","sequence":"additional","affiliation":[{"name":"Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 72723, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2913-7065","authenticated-orcid":false,"given":"Huong Thi","family":"Le","sequence":"additional","affiliation":[{"name":"School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 116177, Vietnam"},{"name":"Department of Clinical Nutrition, Vietnam National Cancer Hospital, Hanoi 11018, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1038\/s43587-025-01004-y","article-title":"A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update","volume":"5","author":"Chen","year":"2025","journal-title":"Nat. Aging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_3","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_4","doi-asserted-by":"crossref","unstructured":"Beaudart, C., Zaaria, M., Pasleau, F., Reginster, J.-Y., and Bruy\u00e8re, O. (2017). Health outcomes of sarcopenia: A systematic review and meta-analysis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0169548"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1002\/jcsm.12411","article-title":"Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis","volume":"10","author":"Yeung","year":"2019","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.clnu.2012.02.007","article-title":"Sarcopenia as a risk factor for falls in elderly individuals: Results from the ilSIRENTE study","volume":"31","author":"Landi","year":"2012","journal-title":"Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Cesari, M., Landi, F., Vellas, B., Bernabei, R., and Marzetti, E. (2014). Sarcopenia and physical frailty: Two sides of the same coin. Front. Aging Neurosci., 6.","DOI":"10.3389\/fnagi.2014.00192"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s41598-023-50979-4","article-title":"Community-based prevalence and associated factors of sarcopenia in the Vietnamese elderly","volume":"14","author":"Pham","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1002\/jcsm.13383","article-title":"Prevalence of and risk factors for sarcopenia in community-dwelling people: The Vietnam Osteoporosis Study","volume":"15","author":"Hoang","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.clnu.2022.01.024","article-title":"ESPEN practical guideline: Clinical nutrition and hydration in geriatrics","volume":"41","author":"Volkert","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_11","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_12","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jamda.2013.05.021","article-title":"Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group","volume":"14","author":"Bauer","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1002\/jcsm.12981","article-title":"Roles of nutrition in muscle health of community-dwelling older adults: Evidence-based expert consensus from Asian Working Group for Sarcopenia","volume":"13","author":"Chen","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/jcsm.12383","article-title":"GLIM criteria for the diagnosis of malnutrition\u2013a consensus report from the global clinical nutrition community","volume":"10","author":"Cederholm","year":"2019","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1002\/jcsm.13225","article-title":"Exercise for sarcopenia in older people: A systematic review and network meta-analysis","volume":"14","author":"Shen","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.maturitas.2020.12.009","article-title":"Exercise, nutrition, and combined exercise and nutrition in older adults with sarcopenia: A systematic review and network meta-analysis","volume":"145","author":"Wu","year":"2021","journal-title":"Maturitas"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"111773","DOI":"10.1016\/j.mad.2022.111773","article-title":"Which intervention is more effective in improving sarcopenia in older adults? A systematic review with meta-analysis of randomized controlled trials","volume":"210","author":"Park","year":"2023","journal-title":"Mech. Ageing Dev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zhao, R., Dong, Y., Zheng, Q., and Yao, J. (2025). Exercise and nutrition strategies for sarcopenia in older adults: Evidence from a network meta-analysis based on EWGSOP and AWGS criteria. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1685014"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1007\/s12603-018-1139-9","article-title":"International clinical practice guidelines for sarcopenia (ICFSR): Screening, diagnosis and management","volume":"22","author":"Dent","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1519\/JSC.0000000000003230","article-title":"Resistance training for older adults: Position statement from the national strength and conditioning association","volume":"33","author":"Fragala","year":"2019","journal-title":"J. Strength Cond. Res."},{"key":"ref_21","first-page":"57","article-title":"Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men","volume":"70","author":"Moore","year":"2015","journal-title":"J. Gerontol. Ser. A Biomed. Sci. Med. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E803","DOI":"10.1152\/ajpendo.00213.2016","article-title":"Does the muscle protein synthetic response to exercise and amino acid-based nutrition diminish with advancing age? A systematic review","volume":"311","author":"Shad","year":"2016","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1007\/s40279-016-0504-2","article-title":"What is the optimal amount of protein to support post-exercise skeletal muscle reconditioning in the older adult?","volume":"46","author":"Holwerda","year":"2016","journal-title":"Sports Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.3945\/ajcn.112.037556","article-title":"Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: A meta-analysis","volume":"96","author":"Cermak","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1532-5415.2011.03776.x","article-title":"Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial","volume":"60","author":"Kim","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1093\/ageing\/afy179","article-title":"Effects of exercise and nutrition supplementation in community-dwelling older Chinese people with sarcopenia: A randomized controlled trial","volume":"48","author":"Zhu","year":"2019","journal-title":"Age Ageing"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jamda.2015.05.021","article-title":"Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: A randomized, double-blind, placebo-controlled trial","volume":"16","author":"Bauer","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.clnu.2017.01.005","article-title":"Sufficient levels of 25-hydroxyvitamin D and protein intake required to increase muscle mass in sarcopenic older adults\u2013The PROVIDE study","volume":"37","author":"Verlaan","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"830","DOI":"10.3945\/ajcn.115.113357","article-title":"Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly","volume":"103","author":"Rondanelli","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.jamda.2012.05.020","article-title":"Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: A randomized, double-blind, placebo-controlled trial","volume":"13","author":"Tieland","year":"2012","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1056\/NEJM199406233302501","article-title":"Exercise training and nutritional supplementation for physical frailty in very elderly people","volume":"330","author":"Fiatarone","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wang, Z., Xu, X., Gao, S., Wu, C., Song, Q., Shi, Z., Su, J., and Zang, J. (2022). Effects of internet-based nutrition and exercise interventions on the prevention and treatment of sarcopenia in the elderly. Nutrients, 14.","DOI":"10.3390\/nu14122458"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.3945\/ajcn.116.143594","article-title":"Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: A systematic review and meta-analysis","volume":"106","author":"Liao","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1136\/bjsports-2017-097608","article-title":"A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults","volume":"52","author":"Morton","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Yang, Y., Pan, N., Luo, J., Liu, Y., and Ossowski, Z. (2025). Exercise and nutrition for sarcopenia: A systematic review and meta-analysis with subgroup analysis by population characteristics. Nutrients, 17.","DOI":"10.3390\/nu17142342"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"22265","DOI":"10.1038\/s41598-026-55850-w","article-title":"Systematic review and meta-analysis of the effects of exercise in older adults with sarcopenia","volume":"16","author":"Lucio","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1016\/S0140-6736(25)00672-5","article-title":"CONSORT 2025 statement: Updated guideline for reporting randomised trials","volume":"405","author":"Hopewell","year":"2025","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e5661","DOI":"10.1136\/bmj.e5661","article-title":"Consort 2010 statement: Extension to cluster randomised trials","volume":"345","author":"Campbell","year":"2012","journal-title":"BMJ"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"g1687","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"ref_40","unstructured":"Ltd InBody Co. (2023, July 18). InBody 770 Training Manual. Available online: https:\/\/inbodycanada.ca\/wp-content\/uploads\/2020\/04\/InBody-770-Training-Manual.pdf."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"13715","DOI":"10.1038\/s41598-020-70624-8","article-title":"Recalibration and validation of the Charlson comorbidity index in an Asian population: The national health insurance service-national sample cohort study","volume":"10","author":"Choi","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/BF03391611","article-title":"Future of multimorbidity research: How should understanding of multimorbidity inform health system design?","volume":"32","author":"Boyd","year":"2010","journal-title":"Public Health Rev."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Masnoon, N., Shakib, S., Kalisch-Ellett, L., and Caughey, G.E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatr., 17.","DOI":"10.1186\/s12877-017-0621-2"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1093\/gerona\/61.10.1059","article-title":"The loss of skeletal muscle strength, mass, and quality in older adults: The health, aging and body composition study","volume":"61","author":"Goodpaster","year":"2006","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.3945\/ajcn.2009.28047","article-title":"Longitudinal study of muscle strength, quality, and adipose tissue infiltration","volume":"90","author":"Delmonico","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_47","first-page":"28","article-title":"Dynapenia and aging: An update","volume":"67","author":"Manini","year":"2012","journal-title":"J. Gerontol. Ser. A Biomed. Sci. Med. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1249\/MSS.0b013e3181eb6265","article-title":"Influence of resistance exercise on lean body mass in aging adults: A meta-analysis","volume":"43","author":"Peterson","year":"2011","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1249\/MSS.0b013e3181c34465","article-title":"Dose-response relationship of resistance training in older adults: A meta-analysis","volume":"42","author":"Steib","year":"2010","journal-title":"Med. Sci. Sports Exerc."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3080\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:01:47Z","timestamp":1789995707000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":49,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18183080"],"URL":"https:\/\/doi.org\/10.3390\/nu18183080","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]}}}