An Integrated Approach to Skeletal Muscle Health in Aging

Round 1

Reviewer 1 Report

The decline in muscle mass and function represents one of the most problematic changes associ-ated with aging, with dramatic effects on the autonomy and quality of life. Several factors con-tribute to the inexorable process of sarcopenia, such as mitochondrial and autophagy dysfunc-tions, and lack of regeneration capacity of the satellite cells. The physiologic decline in muscle mass and in motoneuron functionality associated with aging is exacerbated by the sedentary lifestyle that accompanies elderly people. Regular physical activity is beneficial to most people, but elderly need a well-designed and carefully administered training program that improves muscle mass and consequently both functional ability and quality of life. Aging also causes an alteration in the gut microbiota composition associated with sarcopenia and some advances elucidated that interventions via the gut microbiota-muscle axis have the po-tential to ameliorate sarcopenic phenotype. Several mechanisms are involved in vit Vitamin D muscle atrophy protection as demonstrated by the decreased muscular function related to Vitamin D its deficiency. Malnutrition, chronic in-flammation, vitamin deficiencies, and an imbalance in the muscle-gut axis are just a few of the factors that can lead to sarcopenia. Supplementing the diet with antioxidants, polyunsaturated fatty acids, vitamins, probiotics, prebiotics, proteins, kefir and short chain fatty acids could be potential nutritional therapies against sarcopenia. Finally, a personalized integrated strategy to counteract sarcopenia and maintain the health of muscle and skeleton is suggested in this review.

It is interesting topic and the manuscript is well organized. However, there still have some issues need to check. The reference should be updated.

1. Introduction part. These organelles also participate in cellular signalling pathways

through the production of reactive oxygen species (ROS) as well as being mediators

of apoptosis. Please cite this reference (Consumption of the fish oil high-fat diet uncouples obesity and mammary tumor growth through induction of reactive oxygen species in pro-tumor macrophages. Cancer Research, 2020, 80(12): 2564-2574.).

2. The mechanism about PI3K-AKT pathway should be supplement.

 

3. The relationship about BNDF and antioxidative stress should be discussed (Effects of peptides from Phascolosoma esculenta on spatial learning and memory via anti-oxidative character in mice. Neuroscience Letters. 2016, 631(19): 30-35.).

4. “4. Nutrition and Supplements”. Line 322-328. The nutrition and supplement should focus on the gut microbiota. The obesity and BMI, of which the diet factor play an important role in the process (Food & Function, 2022, 13(24), 12686-12696. Doi: 10.1039/d2fo01746f.).

5. Table 1. It is better to mention the probiotic role.

6. It’s better to check the expression issues and update the reference.

Author Response

• 1: The suggested reference has been cited.
• 2: The sentence regarding PI3k-AKT pathway has been deleted since introduction has been shortened, according to other referees suggestions.
• 3: The relationship about BDNF and oxidative stress has been briefly discussed and the reference cited.
• 4: What was requested in the introductory cap of Chapter 4 has been added, including the reference.

Reviewer 2 Report

The review entitled " An integrated approach for musculoskeletal health in aging” is well-presented and comprehensive. The manuscript provides a comprehensive review of the factors contributing to sarcopenia in the elderly population and proposes a personalized integrated strategy to combat this condition. However, several issues must be addressed before considering the manuscript for proceed.

1, Introduction: the authors spend a large space on the causes and mechanisms of “sarcopenia”. It would be beneficial if the author could condense the section by presenting them in a table format. This would make it easier for readers to understand and retain the information presented. And it will be more informative if the authors could introduce the purpose and significance of this review in the part of this section.

2, Page 4 line 163: “turning on motoneurons thus causing muscle weakness in the elderly [60,61],.”;

Page 8 table 1: “1 × 109 CFU/mouse/day”, “↑Oscillibacter”:

There are several issues with the use of punctuation and characters throughout the manuscript. The author should ensure that all punctuation marks are used correctly throughout the manuscript.

3, Page 8 table 1: Please define “CFU” when it occurred first in the table. Please note that all abbreviations in the table that occur first should be defined and listed at the bottom of the table.

 

Comments for author File: Comments.docx

Author Response

• 1: Introduction has been shortened retaining most important information and it is now more easily readable. The purpose and significance of this review has been better explained in this section.
• 2: Resolved in all manuscript.
• 3: we added the abbrevation at bottom of table.

Reviewer 3 Report

This article mainly reviews various methods for improving sarcopenia, and provides an integrated approach for muscular health in aging. This article has rich content and a large of citations. However, there are problems with paragraph allocation and logical structure, resulting in unclear ideas and repetitive contexts. In addition, there are some detailed issues related to syntax, punctuation. Specific comments are as follows:

1.      Abstract: Please do not split paragraphs

2.      Line 25-26: Incorrect word usage and grammar, such as "vit Vitamin D" and "Vitamin D its", please check and correct.

3.      The introduction is well written, but there is too much content. This article mainly reviews methods for treating musculoskeletal health during aging. However, the introduction contains too many descriptions of the sarcopenia development mechanism, which is somewhat off the topic. It is recommended to delete some content and retain the most illustrative content.

4.      Line 41: “%” cannot be omitted.

5.      Line 44: There is a problem with grammar and the subject is missing.

6.      Line 54: Missing punctuation. In addition, there are multiple missing punctuation marks in the full text, please check carefully.

7.      Line 80: There exists a problem with the statement.

8.      "3.1. Composition of the intestinal microbiota": This section contains a lot of content, however, the authors have not shown a correlation between intestinal microbial composition and muscle health, especially in the elderly. It is recommended to modify and improve it.

9.      The paragraphs in review are numerous and messy, and the main thrust of many paragraphs is unclear, especially in sections “3.2. Gut–muscle axis” and “4. Nutrition and Supplements”. Please carefully summarize and merge the relevant paragraphs to clarify the main thrust of each paragraph.

10.   “4. Nutrition and Supplements” cites a large number of references, but in the author's description, some references are not closely related to muscle health. Please delete them.

11.   The content about the formation of sarcopenia, intestinal microbiota, and Gut – muscle axis in “4.5. Probiotics” has been mentioned earlier in the first half of article, which content is verbose and should be directed to the topic to avoid repetition.

12.   This article mainly discusses measures to improve sarcopenia. Therefore, excessive statements about inducing sarcopenia should be avoided in each chapter to avoid avoiding the emphasis and deviating from the main idea.

Author Response

• 1: Resolved
• 2: Resolved 
• 3 Thanks for your suggestion. The introduction has been shortened and some content has been deleted retaining content related to mechanisms mentioned in other part of  the text.
• 4 Resolved.
• 5 Resolved.
• 6 Resolved.
• 7 This sentence has been deleted.
• 8: We improved the section regarding the correlation between muscle and microbiota in the elderly.
• 9: We have summarized and eliminated redundant parts.
• 10: references that do not involve muscle were useful to us in clarifying the relationship between nutrition/supplement and gut microbiota.
• 11: Resolved
• 12: Resolved

Round 2

Reviewer 1 Report

The author has responsed the reviewer's comment point by point. It can be accepted in current revision.

Reviewer 3 Report

• I am satisfied with the authors' reply.