Optimal protein intake in the elderly

Wolfe, Robert R.; Miller, Sanford A.; Miller, Kevin B.

doi:10.1016/j.clnu.2008.06.008

Cited by 380 publications

(289 citation statements)

References 98 publications

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“…Thus some argue that the conventional definition of the minimum intake to maintain the FFM as indicated by N balance is outdated and should be replaced by an optimal intake definition more related to health outcomes, with such a definition indicating the need by the elderly for higher protein intakes (27,28) . However, as reviewed by WHO (29) there is currently insufficient evidence to identify an optimal protein intake for the elderly or any population group.…”

Section: Anabolic Resistance: Dietary Protein Intakesmentioning

confidence: 99%

Nutrition and sarcopenia: evidence for an interaction

Millward

2012

Proc. Nutr. Soc.

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Nutritional interventions that might influence sarcopenia, as indicated by literature reporting on sarcopenia per se as well as dynapenia and frailty, are reviewed in relation to potential physiological aetiological factors, i.e. inactivity, anabolic resistance, inflammation, acidosis and vitamin D deficiency. As sarcopenia occurs in physically active and presumably well-nourished populations, it is argued that a simple nutritional aetiology is unlikely and unequivocal evidence for any nutritional influence is extremely limited. Dietary protein is probably the most widely researched nutrient but only for frailty is there one study showing evidence of an aetiological influence and most intervention studies with protein or amino acids have proved ineffective with only a very few exceptions. Fish oil has been shown to attenuate anabolic resistance of muscle protein synthesis in one study. There is limited evidence for a protective influence of antioxidants and inducers of phase 2 proteins on sarcopenia, dynapenia and anabolic resistance in human and animal studies. Also fruit and vegetables may protect against acidosis-induced sarcopenia through their provision of dietary potassium. While severe vitamin D deficiency is associated with dynapenia and sarcopenia, the evidence for a beneficial influence of increasing vitamin D status above the severe deficiency level is limited and controversial, especially in men. On this basis there is insufficient evidence for any more specific nutritional advice than that contained in the general healthy lifestyle-healthy diet message: i.e. avoiding inactivity and low intakes of food energy and nutrients and maintain an active lifestyle with a diet providing a rich supply of fruit and vegetables and frequent oily fish. Aging: Dynapenia: Inactivity: Anabolic resistance: DietIn a recent consensus paper sarcopenia (1) was defined as the age-associated loss of skeletal muscle mass and function, a complex syndrome associated with muscle mass loss alone or in conjunction with increased fat mass. It was argued that although cachexia may be a component of sarcopenia, the two conditions are not the same. What was not discussed in this paper was the difference between sarcopenia and dynapenia which is important in terms of the clinical relevance of the condition. Thus Jansonn (2) points out that the data on the functional implications of sarcopenia are inconsistent, possibly because we do not always recognise the distinction between sarcopenia, loss of muscle mass and dynapenia and loss of muscle strength. These, he argues, are physiologically different with dynapenia the main predictor of functional impairment and/or physical disability, chronic disease and mortality risk, to the extent that research and clinical emphasis should be placed more on dynapenia than on sarcopenia. In fact this argument can, to some extent be extended to include frailty, a much more general term for a collection

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Section: Anabolic Resistance: Dietary Protein Intakesmentioning

confidence: 99%

Nutrition and sarcopenia: evidence for an interaction

Millward

2012

Proc. Nutr. Soc.

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“…However, even with 20 % kilocalorie from protein, this is likely inadequate to maintain lean body mass (e.g., 20 % protein, 1,350 kcal/day, 90 kg bodyweight, 0.75 g protein/kg, below the current RDA). Recent reviews, noted below, suggest that for middle-aged and older adults, RT may be optimized by consuming~1.2 g of protein per kilogram of bodyweight, 108 g of protein per day for a person weighing 90 kg, with 20-30 g of protein in several meals throughout the day [20,21]. Moreover, following usual energy restricted, lower to moderate protein diets and usual physical activity, cycles of weight loss and regain can result in a loss of lean body mass and additional gains in body fat in middle-aged and older adults, even for longer-term programs that effectively reduce weight and only show minimal weight regain [22,23].…”

Section: Policymentioning

confidence: 99%

“…Studies suggest that the retention of skeletal muscle mass in middle-aged and older adults may require 1.2 g of protein per kilogram per day (or more) with regular daily meals containing 20-30 g of protein with 8-9 g of essential amino acids with meals distributed and consumed several times per day to optimize the stimulation of MPS [21,40,41]. Higher protein consumption but still within the acceptable macronutrient ranges accepted as healthy and within the context of an overall healthful nutrition pattern appears to decrease disease risk [12,20,39], and a recent meta-analysis showed that additional dietary protein improved strength and muscle hypertrophy adaptations to RT in middle-aged and older adults [42]. The acute rise in MPS also is somewhat blunted in older adults in response to the powerful stimulus from RT.…”

Section: Muscle Protein Synthesis Anabolic Resistance and Improvingmentioning

confidence: 99%

Developing a new treatment paradigm for disease prevention and healthy aging

Winett

Davy

Marinik

et al. 2013

Behav. Med. Pract. Policy Res.

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An increasingly prevalent pattern of risk factors has emerged in middle-aged and older adults that includes the presence of type 2 diabetes or prediabetes, overweight or obese weight status with central obesity and very high body fat, low cardiorespiratory fitness (CRF), low strength, and a low lean-body-mass-to-body-fat ratio. Traditionally, these problems have been approached with a low-fat and low-calorie diet and with lower to moderate intensity activity such as walking. While the treatment has some clear benefits, this approach may no longer be optimal because it does not reflect more recent findings from nutrition and exercise sciences. Specifically, these fields have gained a greater understanding of the metabolic and functional importance of focusing on reducing body fat and central obesity while maintaining or even increasing lean body mass, a quality weight loss, and how to efficiently and effectively increase CRF and strength. Evidence is presented for shifting the treatment paradigm for disease prevention and healthy aging to include the DASH nutrition pattern but with additional protein, higher intensity, brief aerobic training, effortbased, brief resistance training, and structured physical activity. Recent interventions based on social cognitive theory for initiating and then maintaining health behavior changes show the feasibility and efficacy of the approach we are advocating especially within a multiple health behavior change format and the potential for translating the new treatment paradigm into practice. KEYWORDSDiabetes, Quality weight loss, Treatment paradigm, Multiple health behaviors IMPORTANCE OF THE PROBLEM, USUAL TREATMENT, CHANGING THE TREATMENT PARADIGM A pressing public health problem is the high prevalence of engagement in multiple, poor health behaviors, creating patterns of high risk for morbidity and mortality and contributing to considerable individual and societal financial burden [1,2]. One pattern that is becoming increasingly prevalent is the combination of prediabetes, overweight or obese weight status, central obesity (increased visceral adipose tissue), and low cardiorespiratory fitness (CRF) with gradual loss of lean body mass and strength [3], which further increases the risks for type 2 diabetes (T2D), cardiovascular diseases, and some cancers, disabilities, and premature death [4]. The prevalence of T2D, based on fasting glucose or hemoglobin A1c levels in adults, aged 45-64 years old, is~14 %, and the prevalence of prediabetes for adults >20 years old is~35 % [5]. For adults over 65 years old, the prevalence of T2D is 27 % and the prevalence of prediabetes is~50 % [5]. Overweight, not just obesity weight status, is often comorbid for central obesity (waist circumference (WC) ≥102 cm for men and ≥88 cm for women) [3], which is associated with increased risk of T2D, especially for women [6]. Overweight individuals with large WC's, though at high risk, are often not identified for interventions [6,7]. The normal agerelated loss of lean body mass beginning in m...

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“…1·5 g/kg/d which equates to not more than 90 g/d in a woman weighing 60 kg. Recent suggestions are that older adults should consume 1·0-1·2 g/kg/d, although this is debated (259)(260)(261)(262)(263) . It has also been suggested that older people potentially divide protein intake during the day to consume 25-30 g high quality protein per meal in order to maximise protein synthesis (264,265) .…”

Section: Population Advicementioning

confidence: 99%

Nutritional influences on age-related skeletal muscle loss

2013

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Age-related muscle loss impacts on whole-body metabolism and leads to frailty and sarcopenia, which are risk factors for fractures and mortality. Although nutrients are integral to muscle metabolism the relationship between nutrition and muscle loss has only been extensively investigated for protein and amino acids. The objective of the present paper is to describe other aspects of nutrition and their association with skeletal muscle mass. Mechanisms for muscle loss relate to imbalance in protein turnover with a number of anabolic pathways of which the mechanistic TOR pathway and the IGF-1-Akt-FoxO pathways are the most characterised.

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Optimal protein intake in the elderly

Cited by 380 publications

References 98 publications

Nutrition and sarcopenia: evidence for an interaction

Nutrition and sarcopenia: evidence for an interaction

Developing a new treatment paradigm for disease prevention and healthy aging

Nutritional influences on age-related skeletal muscle loss

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