This study aimed to determine the impact of nutrition supplementation (whey protein, fish oil, vitamin D) and physical exercise (resistance and aerobic exercise) on muscle mass, muscle strength and fat mass among sarcopenic elderly. Participants (N = 241) with sarcopenia (aged >= 60 y) enrolled from 2 centers were randomized into groups undergoing nutrition supplementation (Nutr), physical exercise (Ex), nutrition combined with exercise (Nutr+Ex), or routine consultation for 12 weeks. Muscle-related indicators, grip strength as well as fat-related indicators were compared pre- and post-intervention. The per-protocol analysis showed that all indicators were significantly different between groups (p < 0.001). Further pairwise comparisons showed that compared with controls, appendicular muscle mass and grip strength were significantly higher in Nutr (p < 0.001, 95% CI 0.578 to 1.475; p < 0.001, 95% CI 3.614 to 9.118), Ex (p = 0.010, 95% CI 0.157 to 1.153; p < 0.001, 95% CI 2.904 to 8.732), and Nutr+Ex (p < 0.001, 95% CI 0.564 to 1.471; p < 0.001, 95% CI 3.441 to 8.907) groups, while fat mass was significantly lower in the Nutr (p < 0.001, 95% CI -4.676 to -2.358) and Nutr+Ex (p < 0.001, 95% CI -4.717 to -1.790) groups. When compared with Ex, fat mass decreased significantly in the Nutr (p = 0.001, 95% CI -4.856 to -1.359) and Nutr+Ex (p = 0.005, 95% CI -4.810 to -0.878) groups. The findings indicate that nutrition supplementation and physical exercise could improve muscle mass, strength and fat mass among sarcopenic elderly. Nutrition supplementation might be better at decreasing fat mass in this population. ClinicalTrials.gov registration number NCT02873676.

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