Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group

Abstract

The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function. With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made: (1) for healthy older people, the diet should provide at least 1.0 to 1.2 g protein/kg body weight/day (2) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2 to 1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (3) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.

Nutrition and physical activity for the prevention and treatment of age-related sarcopenia

“…Immobilisation induces resistance of muscle to anabolic stimulation (66) . Age-related muscle loss is primarily due to decreased postprandial muscle protein synthesis rather than increased breakdown (11,65) . Inactivity induces anabolic resistance (65) , and a reduction of physical activity for 2 weeks was shown to induce anabolic resistance in older adults, with decreased postprandial protein synthesis, decreased insulin sensitivity, and decreases in leg muscle mass (67) .…”

“…The relationship between age-related loss of muscle mass and strength is often independent of body mass. When muscle mass is lost but fat mass is elevated the state is called sarcopenic obesity and a suggested definition is 'deficiency of skeletal muscle relative to fat tissue' (11,12) . Loss of muscle mass and function can be caused by multiple mechanisms.…”

“…In ageing, this anabolic response decreases, though available data suggest that muscle protein anabolism can still be stimulated in the elderly by higher amino acid availability (60)(61)(62) . Thus, the prevailing nutritional strategy to overcome this 'anabolic resistance' and maintain muscle mass and function is to increase amino acid (leucine) availability, in combination with physical activity, especially resistance exercise (11) . In addition to the amount of protein ingested in a meal, postprandial amino acid availability depends on factors such as rate of digestion, absorption and splanchnic extraction.…”

Mediterranean Diet attenuates risk of frailty and sarcopenia: New insights and future directions

“…Moreover, the need for more dietary protein with ageing is in part due to a compromised ability to efficiently utilize amino acids for MPS, resulting in a blunted muscle protein synthetic response to an anabolic stimuli, a phenomenon termed anabolic resistance [105,106]. As of consequence, evidence based recommendations for protein intake in older adults have recently been published [107,108]. Despite the potential role of dietary protein in relation to muscle preservation and function, an important determinant of MPS is not only an adequate intake of dietary protein but also the signalling of anabolic molecules [109].…”

Peanuts or Pretzels? Changing Attitudes about Eating on Hemodialysis

“…My experience matches the dietitians in the survey who described eating as a teaching opportunity, because boiled peanuts, pretzels, extra-large colas, and nacho cheese corn chips make great food for discussion about healthy food choices. Most studies showing benefit of feeding on dialysis have used nutritional supplements, but studies in other settings suggest that mixed meals of similar composition could be equally beneficial (20,21). Benner et al (19) developed sensible suggestions (shown in the supplemental material in ref.…”