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There is a wealth of evidence regarding nutritional supplementation aimed at preventing the onset and progression of frailty. Not only randomized controlled trials (RCTs) have been conducted, but systematic reviews (SRs) and meta-analyses have also been conducted relatively frequently. Therefore, in this HQ, we conducted an umbrella review, a method of comprehensively searching the literature for systematic reviews and meta-analyses. Five systematic reviews and meta-analyses were identified that examined the effects of nutritional supplementation alone or in combination with exercise in older adults, including those with frailty (Figures 1 and 2) [1]. An SR (including eight studies, intervention period 6–12 months) of studies that compared the effects of exercise and exercise plus nutritional counseling (any type of nutritional counseling aimed at preventing obesity and frailty) with a control (usual care) group, with changes in body composition as the outcome, in obese older people with frailty (mean age 69.7 years) showed that nutritional counseling can safely reduce weight even in frail older people [2]. An SR (including 25 studies, intervention period 8–24 weeks) of studies that compared the effects of resistance training combined with nutritional intervention (containing at least one physiologically useful nutrient) with resistance training alone in people including healthy older people aged 60 years or older showed no additional effect of nutritional intervention on muscle mass, muscle strength, or physical function [3]. An SR (including 19 studies, intervention period 7–24 weeks) of studies examining the effects of nutritional interventions (nutrition education, nutritional prescriptions, use of energy and/or protein oral nutritional supplements [ONS], etc.) on pre-frail or frail older people (60 years or older) living at home or in nursing facilities found no benefit of nutritional interventions on any outcomes, including muscle strength, physical function, frailty, or outcome [4]. An SR of 28 studies examining the effects of nutritional interventions (adequate calorie intake and/or protein supplementation) alone or in combination with other treatments (resistance training, balance training, stretching, cognitive training, and androgen therapy, etc.) on muscle mass, muscle strength, physical ability, and hospitalization and rehospitalization rates on community-dwelling older people, including frail people aged 65 years or older, found that the combination of nutritional interventions with other treatments for frail or sarcopenic older people is useful for improving muscle mass, muscle strength, and physical function; however, there was insufficient data to conclude the effects on hospitalization and re-hospitalization rates [5]. In an SR (including six studies, intervention period 3 months to 20 years) comparing the effects of milk or dairy product intake on frailty, sarcopenia, and cognitive function in community-dwelling older people aged 60 years or older with a group that consumed less of them, they found that milk or dairy product intake improved limb muscle mass and balance ability, and that intake of milk or dairy products seven or more times a week significantly reduced the risk of frailty compared with intake of milk or dairy products once or less times a week (odds ratio 0.52) [6]. From the above, it is not possible to conclude at this time whether nutritional supplementation or the combination of nutritional supplementation and exercise prevents the onset or progression of frailty, due to the inconsistency of the nutritional intervention content, the content of the exercise used in combination, and the intervention period, but no reports suggest that it worsens the condition. Therefore, the recommendation level of this HQ is weak, the certainty of the evidence is low, and it is weakly recommended (suggested) that nutritional supplementation or the combination of nutritional supplementation with exercise be used to prevent the onset and progression of frailty in older people. Of the SRs adopted, the study using dairy products concluded that high intake in women or in middle age was associated with cognitive decline; therefore, caution is required in this regard. However, there were no reports that nutrition or the combination of nutrition and exercise are harmful. Nutrition, or the combination of nutrition and exercise, can be implemented in conjunction with medical or nursing care insurance, and the cost disadvantages are considered to be minimal. Citizen representatives participated in the meeting to formulate healthcare questions and vote on the recommendations, which were decided based on their wishes as much as possible. No relevant papers. Although there is a lot of evidence on nutritional supplementation for preventing the onset and progression of frailty, the reason why a strong recommendation was not obtained is thought to be due to the fact that the subjects, type and amount of nutritional supplementation, and duration are not consistent, and the support system for continuing the intervention is affected; so it is necessary to create evidence that takes these factors into consideration. This document is the official English translation of the Japanese version published by the Japanese Association for Sarcopenia and Frailty and the National Center for Geriatrics and Gerontology in March 2025 [1]. This work was supported by the Japan Agency for Medical Research and Development (AMED) under the project “Project for Establishing Research and Development Infrastructure for the Social Implementation of Prevention and Health Promotion/Healthcare Social Implementation Infrastructure Development Project” (Management Nos. 22rea522005s1001, 23rea522005h0002, and 24rea522005h0003). K.S. has disclosed financial relationships with Kyowa Kirin Co. Ltd. and Tanabe Mitsubishi Pharma Corporation. M.A. has disclosed financial relationships with Daiichi Sankyo Co. Ltd., MSD K.K., Toa Eiyo Co. Ltd., Towa Pharmaceutical Co. Ltd., Eisai Co. Ltd., Kracie Pharmaceutical Co. Ltd., Tsumura Pharmaceutical Co. Ltd., Tanabe Mitsubishi Pharma Corporation, Chugai Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Astellas Pharma Inc., Bayer Yakuhin Ltd. The other authors declare no conflicts of interest.

Guideline · Nutritional Supplementation · Obesity · Older people · Psychological intervention · Randomized controlled trial · Sarcopenia · Weight loss · Frailty in Older Adults · Nutrition and Health in Aging · Nutritional Studies and Diet