The Potential for Fermented Plant-Based Foods to Aid in the Prevention and Management of Sarcopenia.

Abstract

The potential of fermentation was evaluated as a technological strategy to enhance the nutritional quality and anabolic properties of plant proteins specifically for the prevention and management of sarcopenia. Sarcopenia involves a progressive loss of muscle mass and function linked to "inflammaging," digestive changes, and anabolic resistance. Although plant-based proteins are increasingly popular and important for planetary health, their anabolic potential is traditionally limited by lower digestibility and suboptimal essential amino acid profiles, particularly low leucine levels. This review synthesizes evidence from in vitro models, animal studies, and human clinical trials to examine how fermentation transforms plant-based foods and influences muscle metabolism pathways. Evidence suggests that fermentation reduces antinutritional factors, alters amino acid profiles, and improves protein digestibility, leading to increased bioavailability of essential amino acids, notably leucine. Mechanistically, fermented plant products stimulate anabolic cell signaling pathways (eg, Akt/mTORC1) and suppress the catabolic ubiquitin-proteasome pathway (eg, atrogin-1 and MuRF-1). Fermentation also generates bioactive isoflavone aglycones and angiotensin-converting enzyme-inhibitory and other peptides that may improve muscle perfusion and reduce oxidative stress. Furthermore, fermentation modulates the gut-muscle axis via short-chain fatty acid production, which may mitigate the systemic inflammation and oxidative stress associated with muscle loss. Human evidence translating these findings is currently limited. Fermentation offers a sustainable approach to optimizing plant-based nutrition to support muscle maintenance. Mechanistic findings are promising; however, further long-term human trials are required to translate this evidence into formal clinical recommendations for sarcopenia.