Research progress on the molecular mechanism and clinical evidence of glucagon-like peptide-1 receptor agonists in improving sarcopenia

Sarcopenia is an age-related syndrome characterized by a progressive and extensive decline in skeletal muscle mass and function, leading to serious impairment of the quality of life and poor health prognosis in older adults. As the global population ages, sarcopenia has become a serious public health challenge. Currently, effective treatments for sarcopenia are still very limited. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are gaining increasing attention as first-line agents for the treatment of diabetes and obesity, and with their potential to improve the muscle mass and function, they provide new ideas for the treatment of sarcopenia. This study aims to review the latest research progress in the application of GLP-1RAs in the management of sarcopenia, analyze its key molecular pathways, and explore its role in insulin resistance, mitochondrial function, inflammation, protein metabolism balance, autophagy, and the activation of related signaling pathways. Meanwhile, this article focuses on evaluating the evidence of the current effects of GLP-1RAs on patients’ body composition, muscle mass and function in clinical trials, deeply explores the “dual effects” and heterogeneity of its efficacy, and analyzes the translational dilemma existing between preclinical positive discoveries and clinical outcomes.Furthermore, for the elderly population, this article further discusses the tolerance and nutritional risks faced during the treatment of GLP-1RAs. Further combining nutrition and exercise intervention, the strategies of GLP-1RAs in the comprehensive management of sarcopenia were explored.Finally, this paper points out the future research directions in this field, emphasizing the need for more well-designed and high-quality clinical studies to clarify the exact role, suitable population and long-term safety of GLP-1RAs in the prevention and treatment of sarcopenia.