Protein-energy homeostasis is a major determinant of healthy aging. Inadequate nutritional intakes and
physical activity, together with endocrine disturbances are associated with of sarcopenia and frailty.
Guidelines from scientific societies mainly address the quantitative aspects of protein and energy
nutrition in elderly. Besides these quantitative aspects of protein load, perspective strategies to promote
muscle protein synthesis and prevent sarcopenia include pulse feeding, the use of fast proteins and the
addition of leucine or citrulline to dietary protein. An integrated management of sarcopenia, taking into
account the determinants of muscle wasting, i.e. nutrition, physical activity, anabolic factors such as
androgens, vitamin D and n-3 polyunsaturated fatty acids status, needs to be tested in the prevention
and treatment of sarcopenia. The importance of physical activity, specifically resistance training, is
emphasized, not only in order to facilitate muscle protein anabolism but also to increase appetite and
food intake in elderly people at risk of malnutrition. According to present data, healthy nutrition in
elderly should respect the guidelines for protein and energy requirement, privilege a Mediterranean way
of alimentation, and be associated with a regular physical activity. Further issues relate to the
identification of the genetics determinants of protein energy wasting in elderly.