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Al-Rawhani AH, Adznam SN, Abu Zaid Z, Md Yusop NB, M Sallehuddin H, Alshawsh MA. Effectiveness of whey protein supplementation on muscle strength and physical performance of older adults: A systematic review and meta-analysis of randomized clinical trials. Clin Nutr 2024; 43:2412-2426. [PMID: 39303495 DOI: 10.1016/j.clnu.2024.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/03/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The efficacy of whey protein supplement (WPS) in improving muscle strength, physical performance, and body composition in older adults has been widely promoted. However, the results of randomized clinical trials in this regard have been inconsistent. We aimed to determine the impact of WPS, compared to a placebo, during or without training on muscle strength, physical function, and body composition in older adults. METHODS Randomized controlled trials were thoroughly searched using PubMed, EMBASE, the Cochrane Library Database, and Scopus databases up to June 2024. The analysis focused on key parameters such as handgrip strength (HS), leg press, knee extension, gait speed (GS), 6-min walking test (6MWT), Timed-up and go test (TUG), lean body mass (LBM), fat mass (FM), and appendicular skeletal muscle mass (ASM). A pooled effect size was calculated using a random-effects model based on standardized mean differences (SMD). RESULTS Thirty studies involving 2105 participants aged 60 and older met the inclusion criteria. The meta-analysis of 26 RCTs showed no significant positive effect of WPS on HS (n = 11, SMD: 0.18; 95% CI: -0.13, 0.49; I2 = 69%), 6MWT (n = 5, SMD: -0.08; 95%CI: -0.31, 0.16; I2 = 0%), GS test (n = 4, SMD: -0.08; 95%CI: -0.43, 0.28; I2 = 36%), TUG test (n = 9, SMD: 0.0, 95% CI -0.15, 0.14; I2 = 0%), LBM (n = 11, SMD: 0.02; 95%CI: -0.13, 0.17; I2 = 0%), FM (n = 15, SMD: -0.04; 95%CI: -0.18, 0.10; I2 = 0%). However, ASM significantly improved after WPS consumption but with high heterogeneity (n = 2, SMD: 0.39; 95%CI: 0.28, 0.51; I2 = 69%). In interventions incorporating RE, statistically significant positive effects of WPS on lower body strength were observed (n = 11, SMD: 0.25; 95%CI: 0.05, 0.45; I2 = 0%). CONCLUSION The present meta-analysis indicates that WPS, when combined with resistance training (RT), can enhance lower body strength but does not seem to have a significant beneficial effect on handgrip strength, physical performance, or body composition. Further large-scale studies are necessary to confirm these findings and elucidate the potential benefits of WPS in this population.
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Affiliation(s)
- Alaa H Al-Rawhani
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Siti Nur'Asyura Adznam
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Dietetics, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Zalina Abu Zaid
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Dietetics, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Nor Baizura Md Yusop
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Dietetics, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Hakimah M Sallehuddin
- Geriatric Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Malaysian Research Institute on Ageing, (MyAgeing) Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Mohammed A Alshawsh
- Department of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC, Australia.
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Varjan M, Žiška Böhmerová Ľ, Oreská Ľ, Schickhofer P, Hamar D. In elderly individuals, the effectiveness of sensorimotor training on postural control and muscular strength is comparable to resistance-endurance training. Front Physiol 2024; 15:1386537. [PMID: 39234306 PMCID: PMC11371677 DOI: 10.3389/fphys.2024.1386537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/06/2024] [Indexed: 09/06/2024] Open
Abstract
While classical resistance exercise is an effective way to improve strength and control postural sway, it may not be suitable for some elderly individuals with specific health disorders (e.g., aneurysms). Therefore, there is a need to explore alternative modalities. The study aimed to evaluate the effects of sensorimotor training on muscle strength and postural control in the female elderly population and subsequently compare these effects with a traditional combined resistance-endurance training program. A total of 34 healthy, active elderly women aged from 65 to 75 years, (average age 72.7 ± 4.4 years, height 161.6 ± 5.1 cm, and weight 66.9 ± 8.4 kg) were randomly assigned to three groups undergoing different 10-week interventions: the resistance-endurance training (RET, n = 11), the sensorimotor training (SMT, n = 12) and the control group (COG, n = 11). Prior to and after the interventions all participants underwent tests of maximal voluntary contraction of the dominant and non-dominant leg; postural sway tests with open and closed eyes; novel visual feedback balance test; 10-meter maximal walking speed (10 mMWS) and stair climb test. A T-test and repeated measures ANOVA were used, followed by the Bonferroni post hoc test, to compare the pre and post-measurements and assess differences in gains between groups. Results showed a significant main effect of time on strength (p < 0.001). In addition, significant differences in time × group interaction on strength (p < 0.01), postural control (p < 01), and ascendant and descended vertical speed (p < 0.001) were observed. Besides, the RET group improved significantly the maximal voluntary contraction of both dominant (16.3%, p ≤ 0.01) and non-dominant leg (10.9%, p ≤ 0.05). SMT group improved maximal voluntary contraction of both dominant (16.6%, p ≤ 0.001) and non-dominant leg (12.7%, p ≤ 0.01). In addition, they also improved mean velocity of the centre of pressure (COP) in postural sway test with eyes open (24.2%, p ≤ 0.05) as well as eyes closed (29.2%, p ≤ 0.05), mean distance of COP in novel visual feedback balance test (37.5%, p ≤ 0.001), ascendant and descended vertical velocity (13.6%, p ≤ 0.001 and 17.8%, p ≤ 0.001, respectively). Results show not only resistance training but sensorimotor intervention boosts strength too. This intervention also enhances postural control and functional abilities for both ascending and descending movements.
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Affiliation(s)
- Mikuláš Varjan
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
- Centre of Active Ageing, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Ľubica Žiška Böhmerová
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Ľudmila Oreská
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Schickhofer
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Dušan Hamar
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
- Centre of Active Ageing, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
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Sim J, Lim J, Ko E, Jang E, Jeong M, Park S. Development of a frailty prevention program including nutrition and exercise interventions for older adults in senior daycare centers in South Korea using a mixed methods research design. Nutr Res Pract 2024; 18:372-386. [PMID: 38854475 PMCID: PMC11156771 DOI: 10.4162/nrp.2024.18.3.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND/OBJECTIVES The growing aging population has led to an increased utilization of senior daycare centers. This study was conducted to design a program to enhance the health of older adults in senior daycare centers in Chuncheon City, South Korea. SUBJECTS/METHODS The study explored the health conditions and dietary patterns of older adults in senior daycare centers. Participants included staff and older adults from senior daycare centers in Chuncheon City. A mixed methods research design was used to obtain both qualitative and quantitative data. Qualitative insights were obtained through in-depth interviews with 26 staff members and older adults, coupled with observations made at 10 senior daycare centers. The quantitative component comprised structured questionnaires and physical measurements of 204 older adults at these centers. RESULTS Many of the older adults relied on the meals provided by the center due to their limited cooking abilities. Dental health issues and dysphagia were common. Interviews highlighted the budgetary constraints of the centers in providing wholesome meals and the need for government support to alleviate meal expenses and enhance quality. A structured survey of older adults showed that the average age was 83.3 yrs, with an average of 2 chronic conditions per participant. Frailty analysis of the participants revealed that 56.2% were prefrail and 32.0% were frail. Almost half of the participants (47.0%) used dentures. Based on these findings, a preventive intervention program was proposed, addressing the specific needs and challenges of older adults while promoting overall well-being and preventing frailty. CONCLUSION Tailored health promotion strategies are crucial in senior daycare centers. Recommended interventions include staff nutrition education, improved dietary plans, and cost-effective strength training programs. These interventions aim to reduce frailty and enhance the quality of life of older adults in the community via interventions in daycare centers.
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Affiliation(s)
- Jiwon Sim
- Department of Food Science and Nutrition, Hallym University, Chuncheon, Korea
- The Korean Institute of Nutrition, Hallym University, Chuncheon, Korea
| | - Jongguk Lim
- Department of Physical Education, Hallym University, Chuncheon, Korea
| | - Eunji Ko
- Department of Food Science and Nutrition, Hallym University, Chuncheon, Korea
- The Korean Institute of Nutrition, Hallym University, Chuncheon, Korea
| | - Eunjin Jang
- Department of Food Science and Nutrition, Hallym University, Chuncheon, Korea
- The Korean Institute of Nutrition, Hallym University, Chuncheon, Korea
| | - Minjeong Jeong
- Department of Food Science and Nutrition, Hallym University, Chuncheon, Korea
- The Korean Institute of Nutrition, Hallym University, Chuncheon, Korea
| | - Sohyun Park
- Department of Food Science and Nutrition, Hallym University, Chuncheon, Korea
- The Korean Institute of Nutrition, Hallym University, Chuncheon, Korea
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Jones D, Celis-Morales C, Gray SR, Morrison DJ, Ozanne SE, Jain M, Mattin LR, Burden S. Effect of Sustainably Sourced Protein Consumption on Nutrient Intake and Gut Health in Older Adults: A Systematic Review. Nutrients 2024; 16:1398. [PMID: 38732644 PMCID: PMC11085519 DOI: 10.3390/nu16091398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
Diet is integral to the healthy ageing process and certain diets can mitigate prolonged and deleterious inflammation. This review aims to assess the impact of diets high in sustainably sourced proteins on nutrient intake, gut, and age-related health in older adults. A systematic search of the literature was conducted on 5 September 2023 across multiple databases and sources. Studies assessing sustainably sourced protein consumption in community dwelling older adults (≥65 years) were included. Risk of bias (RoB) was assessed using 'RoB 2.0' and 'ROBINS-E'. Narrative synthesis was performed due to heterogeneity of studies. Twelve studies involving 12,166 older adults were included. Nine studies (n = 10,391) assessed habitual dietary intake and had some RoB concerns, whilst three studies (n = 1812), two with low and one with high RoB, conducted plant-based dietary interventions. Increased adherence to sustainably sourced diets was associated with improved gut microbial factors (n = 4640), healthier food group intake (n = 2142), and increased fibre and vegetable protein intake (n = 1078). Sustainably sourced diets positively impacted on gut microbiota and healthier intake of food groups, although effects on inflammatory outcomes and health status were inconclusive. Future research should focus on dietary interventions combining sustainable proteins and fibre to evaluate gut barrier function and consider inflammatory and body composition outcomes in older adults.
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Affiliation(s)
- Debra Jones
- School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (C.C.-M.); (S.R.G.); (M.J.)
| | - Stuart R. Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (C.C.-M.); (S.R.G.); (M.J.)
| | - Douglas J. Morrison
- Scottish Universities Environmental Research Centre (SUERC), University of Glasgow, Glasgow G75 0QF, UK;
| | - Susan E. Ozanne
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Addenbrookes Hospital, Cambridge CB2 0QQ, UK;
| | - Mahek Jain
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (C.C.-M.); (S.R.G.); (M.J.)
- Scottish Universities Environmental Research Centre (SUERC), University of Glasgow, Glasgow G75 0QF, UK;
| | - Lewis R. Mattin
- School of Life Sciences, University of Westminster, London W1W 6UW, UK;
| | - Sorrel Burden
- School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
- Salford Care Organisation, Northern Care Alliance NHS Trust, Stott Lane, Salford M6 8HD, UK
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Zeng Y, He X, Peng X, Zhao L, Yin C, Mao S. Combined Nutrition with Exercise: Fueling the Fight Against Sarcopenia Through a Bibliometric Analysis and Review. Int J Gen Med 2024; 17:1861-1876. [PMID: 38715745 PMCID: PMC11075762 DOI: 10.2147/ijgm.s462594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
Objective This bibliometric analysis and review aimed to examine the current research status and trends in the combination of nutrition and exercise training for sarcopenia. Additionally, it sought to provide researchers with future research directions in this field. Methods Relevant publications were obtained from the Web of Science Core Collection (WoSCC) database, covering the period from January 1995 to October 2023. The collected publications were analyzed using CiteSpace, VOSviewer, Bibliometrix, and Review Manager. Results Out of the 2528 retrieved publications, the United States emerged as the leading contributor in terms of publication volume. The University of Texas System was identified as the most productive institution. Luc J C van Loon emerged as the most published author in this field. Analysis of keywords revealed recent hot topics and emerging areas of interest, such as "gut microbiota" and "mechanisms". Upon further evaluation, resistance training (RT) and protein supplementation were identified as the most commonly employed and effective methods. Conclusion RT and protein supplementation are widely recognized as effective strategies. Future research should focus on investigating the molecular aspects of sarcopenia. Moreover, the potential therapeutic role of gut microbiota in sarcopenia requires further comprehensive investigation in human subjects to establish its correlation.
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Affiliation(s)
- Yixian Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, People’s Republic of China
| | - Xingfei He
- Wuxi Huishan District Rehabilitation Hospital, Wuxi, 214001, People’s Republic of China
| | - Xinchun Peng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, People’s Republic of China
| | - Li Zhao
- School of Sports Science, Beijing Sport University, Beijing, 100084, People’s Republic of China
| | - Chengqian Yin
- Department of Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, 100029, People’s Republic of China
| | - Shanshan Mao
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 100084, People’s Republic of China
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Hawley AL, Baum JI. Nutrition as the foundation for successful aging: a focus on dietary protein and omega-3 polyunsaturated fatty acids. Nutr Rev 2024; 82:389-406. [PMID: 37319363 DOI: 10.1093/nutrit/nuad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Skeletal muscle plays a critical role throughout the aging process. People living with sarcopenia, a progressive and generalized loss of skeletal muscle mass and function, often experience diminished quality of life, which can be attributed to a long period of decline and disability. Therefore, it is important to identify modifiable factors that preserve skeletal muscle and promote successful aging (SA). In this review, SA was defined as (1) low cardiometabolic risk, (2) preservation of physical function, and (3) positive state of wellbeing, with nutrition as an integral component. Several studies identify nutrition, specifically high-quality protein (eg, containing all essential amino acids), and long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), as positive regulators of SA. Recently, an additive anabolic effect of protein and n-3 PUFAs has been identified in skeletal muscle of older adults. Evidence further suggests that the additive effect of protein and n-3 PUFAs may project beyond skeletal muscle anabolism and promote SA. The key mechanism(s) behind the enhanced effects of intake of protein and n-3 PUFAs needs to be defined. The first objective of this review is to evaluate skeletal muscle as a driver of cardiometabolic health, physical function, and wellbeing to promote SA. The second objective is to examine observational and interventional evidence of protein and n-3 PUFAs on skeletal muscle to promote SA. The final objective is to propose mechanisms by which combined optimal intake of high-quality protein and n-3 PUFAs likely play a key role in SA. Current evidence suggests that increased intake of protein above the Recommended Dietary Allowance and n-3 PUFAs above the Dietary Guidelines for Americans recommendations for late middle-aged and older adults is required to maintain skeletal muscle mass and to promote SA, potentially through the mechanistical target of rapamycin complex 1 (mTORC1).
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Affiliation(s)
- Aubree L Hawley
- School of Human and Environmental Sciences, University of Arkansas, Fayetteville, AR, USA
| | - Jamie I Baum
- Center for Human Nutrition, Department of Food Science, University of Arkansas System Division of Agriculture, Fayetteville, AR, USA
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Yoshida S, Shiraishi R, Nakayama Y, Taira Y. Can Nutrition Contribute to a Reduction in Sarcopenia, Frailty, and Comorbidities in a Super-Aged Society? Nutrients 2023; 15:2991. [PMID: 37447315 DOI: 10.3390/nu15132991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Many countries are facing the advent of super-aging societies, where sarcopenia and frailty will become pertinent problems. The prevalence of comorbidities is a major problem in countries with aged populations as elderly people suffer from various diseases, such as diabetes, heart failure, chronic kidney disease and dementia. All of these diseases are associated with sarcopenia and frailty, and they frequently cause falls, fractures, and a decline in activities of daily living. Fractures in the elderly people are associated with bone fragility, which is influenced by diabetes and chronic kidney disease. Nutritional support for chronic disease patients and sarcopenic individuals with adequate energy and protein intake, vitamin D supplementation, blood glucose level management for individuals with diabetes, obesity prevention, nutritional education for healthy individuals, and the enlightenment of society could be crucial to solve the health-related problems in super-aging societies.
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Affiliation(s)
- Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
- Department of Health and Nutrition, Okinawa University, 555 Kokuba, Naha 902-8521, Okinawa, Japan
- Faculty of Health Sciences, Kinjo University, 1200 Kasama-machi, Hakusan 924-8511, Ishikawa, Japan
| | - Ryo Shiraishi
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yuki Nakayama
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yasuko Taira
- Faculty of Nutrition, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
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Xiang Q, Hu Y, Zheng J, Liu W, Tao J. Research hotspots and trends of exercise for sarcopenia: A bibliometric analysis. Front Public Health 2023; 11:1106458. [PMID: 36969670 PMCID: PMC10031062 DOI: 10.3389/fpubh.2023.1106458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
Exercise is an effective method for the prevention and treatment of sarcopenia, which can improve skeletal muscle mass, strength and physical function in individuals with sarcopenia to varying degrees. Moreover, exercise has an important role in improving ability to perform daily activities and quality of life on sarcopenia. In this study, articles and review articles on exercise interventions for sarcopenia from January 2003 to July 2022 were retrieved from the Web of Science core collection. Then, the number of annual publications, journal/cited journal, country, institution, author/cited author, references and keywords were analyzed using CiteSpace 6.1.R2. A total of 5,507 publications were collected and the number of publications increasing each year. Experimental Gerontology was the most productive journal and the most cited journal was J GERONTOL A-BIOL. The United States of America was the most influential country with the largest number of publications and centrality. Maastricht University in the Netherlands is the most productive institution. The author VAN LOON LJC has the highest ranking in terms of publications and CRUZ-JENTOFT A is ranked first in terms of cited authors. The most frequently occurring keywords in the field of exercise interventions for sarcopenia are “skeletal muscle,” “exercise,” “body composition,” “strength,” and “older adult”; the keyword “elderly men” showed the strongest explosive intensity. The keywords formed 6 clusters, namely “skeletal muscle,” “muscle strength,” “heart failure,” “muscle protein synthesis,” “insulin resistance” and “high-intensity interval training.” In conclusion, this study demonstrates a new perspective on the current state of research and trends in exercise interventions for sarcopenia over the past 20 years via the visualization software CiteSpace. It may help researchers to identify potential collaborators and partner institutions, hotspots and research frontiers in the field of exercise interventions for sarcopenia.
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Affiliation(s)
- Qing Xiang
- Rehabilitation Technology Innovation Center by Joint Collaboration of Ministry of Education and Fujian Province, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yue Hu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiaqi Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Weilin Liu
- Rehabilitation Technology Innovation Center by Joint Collaboration of Ministry of Education and Fujian Province, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- Rehabilitation Technology Innovation Center by Joint Collaboration of Ministry of Education and Fujian Province, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- *Correspondence: Jing Tao
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Choi EY. Association of Protein Intake with Handgrip Strength and Its Relation to Strength Exercise in Korean Adults Aged over 60 Years in the KNHANES (2014-18). Nutrients 2023; 15:nu15041014. [PMID: 36839373 PMCID: PMC9960000 DOI: 10.3390/nu15041014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Weak handgrip strength (HGS) is associated with many negative health outcomes in older adults. There is evidence that with strength exercise, high protein intake leads to increased HGS. The goal of this study was to examine the relationship between weak HGS in older adults and dietary protein and it's relation to resistance exercise. Data on 8497 Korean adults aged over 60 years from the Korea National Health and Nutrition Examination Survey (2014-18) were analyzed. Dietary protein intake measured by 24-h recall were categorized as three levels: low (<0.8 g/kg body weight (BW)), adequate (≥0.8 g/kg BW and <1.2 g/kg BW), and high (≥1.2 g/kg BW). Complex sample multiple logistic regression analyses were carried out. The prevalence of weak HGS was 18.3 (0.7)% in men and 28.8 (0.9)% in women. In a multiple logistic regression analysis, low protein intake was significantly associated with higher risk of weak HGS in men, as compared with adequate protein intake, but this relationship was not statistically significant in women. The risk of weak HGS was significantly reduced for both men and women who engaged in strength exercise and increased their dietary protein intake. In this study, based on a representative sample of Koreans aged over 60, men with low protein intake had a higher risk of weak HGS than did men with adequate protein intake. Men and women with a higher protein intake who also engaged in strength exercises had a lower risk of weak HGS. Increasing protein intake and engaging in strength exercises may be an effective way to preserve muscle strength in older men and women.
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Affiliation(s)
- Eun Young Choi
- Department of Family Medicine, School of Medicine, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan City 31116, Chungnam, Republic of Korea
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Kiesswetter E, Siebentritt HM, Schoene D, Kob R, Freiberger E, Sieber CC, Visser M, Wijnhoven HAH, Volkert D. Validation of the German version of the Protein Screener 55. Eur J Clin Nutr 2023; 77:579-585. [PMID: 36702924 PMCID: PMC10169657 DOI: 10.1038/s41430-023-01266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND/OBJECTIVES The Protein Screener 55 + (Pro55 + ) is a brief food questionnaire to screen older community-dwelling adults for low protein intake. The result is the predicted probability of protein intake <1.0 g/kg adjusted body weight (aBW)/d ranging from 0-1. For purposes of cross-cultural validation, we translated the Pro55+ into German and tested its discriminative accuracy in detecting low protein intake of older community-dwelling people in Germany. SUBJECTS/METHODS After translation and pilot-testing, the Pro55+ and the reference standard (3-day dietary record) were completed by 144 participants (81.6 ± 3.9 years, 61.8% female). Discriminative properties were tested by receiver operating characteristic curves and by calculating sensitivity and specificity for different cut-offs of predicted probability (>0.3/>0.5/>0.7) using <1.0 or <0.8 g/kg aBW/d to define low protein intake. RESULTS Protein intake was <1.0 g/kg aBW/d in 39.6% of the sample and <0.8 g/kg aBW/d in 17.4%. Area under the curve was 62.0% (95%CI 52.6-71.5) and 68.8% (58.1-79.4), respectively. Specificity was 82-90% using probability cut-offs of 0.5 and 0.7 for both protein thresholds. Sensitivity was poor for protein threshold of 1.0 g/kg aBW/d regardless of the used probability cut-offs. For protein threshold of <0.8 g/kg aBW/d, sensitivity was 88.0% (71.8-96.9) using a probability cut-off of 0.09. CONCLUSION The overall discriminative accuracy of the German Pro55+ to identify older community-dwelling people with low protein intake was poor. However, applying different probability cut-offs allows increasing specificity and sensitivity for 0.8 g/kg aBW/d to levels justifying the use for certain purposes e.g. excluding individuals with adequate protein intake. Further validation is needed.
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Affiliation(s)
- Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Hanna M Siebentritt
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Institute of Exercise and Public Health, Leipzig University, Leipzig, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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11
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HMGB1 Promotes In Vitro and In Vivo Skeletal Muscle Atrophy through an IL-18-Dependent Mechanism. Cells 2022; 11:cells11233936. [PMID: 36497194 PMCID: PMC9740799 DOI: 10.3390/cells11233936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Skeletal muscle atrophy occurs due to muscle wasting or reductions in protein associated with aging, injury, and inflammatory processes. High-mobility group box-1 (HMGB1) protein is passively released from necrotic cells and actively secreted by inflammatory cells, and is implicated in the pathogenesis of various inflammatory and immune diseases. HMGB1 is upregulated in muscle inflammation, and circulating levels of the proinflammatory cytokine interleukin-18 (IL-18) are upregulated in patients with sarcopenia, a muscle-wasting disease. We examined whether an association exists between HMGB1 and IL-18 signaling in skeletal muscle atrophy. HMGB1-induced increases of IL-18 levels enhanced the expression of muscle atrophy markers and inhibited myogenic marker expression in C2C12 and G7 myoblast cell lines. HMGB1-induced increases of IL-18 production in C2C12 cells involved the RAGE/p85/Akt/mTOR/c-Jun signaling pathway. HMGB1 short hairpin RNA (shRNA) treatment rescued the expression of muscle-specific differentiation markers in murine C2C12 myotubes and in mice with glycerol-induced muscle atrophy. HMGB1 and IL-18 signaling was suppressed in the mice after HMGB1 shRNA treatment. These findings suggest that the HMGB1/IL-18 axis is worth targeting for the treatment of skeletal muscle atrophy.
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12
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Functional Nutrients to Ameliorate Neurogenic Muscle Atrophy. Metabolites 2022; 12:metabo12111149. [DOI: 10.3390/metabo12111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Neurogenic muscle atrophy is a debilitating condition that occurs from nerve trauma in association with diseases or during aging, leading to reduced interaction between motoneurons and skeletal fibers. Current therapeutic approaches aiming at preserving muscle mass in a scenario of decreased nervous input include physical activity and employment of drugs that slow down the progression of the condition yet provide no concrete resolution. Nutritional support appears as a precious tool, adding to the success of personalized medicine, and could thus play a relevant part in mitigating neurogenic muscle atrophy. We herein summarize the molecular pathways triggered by denervation of the skeletal muscle that could be affected by functional nutrients. In this narrative review, we examine and discuss studies pertaining to the use of functional ingredients to counteract neurogenic muscle atrophy, focusing on their preventive or curative means of action within the skeletal muscle. We reviewed experimental models of denervation in rodents and in amyotrophic lateral sclerosis, as well as that caused by aging, considering the knowledge generated with use of animal experimental models and, also, from human studies.
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13
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Effects of Branched-Chain Amino Acids on Skeletal Muscle, Glycemic Control, and Neuropsychological Performance in Elderly Persons with Type 2 Diabetes Mellitus: An Exploratory Randomized Controlled Trial. Nutrients 2022; 14:nu14193917. [PMID: 36235570 PMCID: PMC9572134 DOI: 10.3390/nu14193917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/26/2022] Open
Abstract
Although branched-chain amino acids (BCAA) are known to stimulate myofibrillar protein synthesis and affect insulin signaling and kynurenine metabolism (the latter being a metabolite of tryptophan associated with depression and dementia), the effects of BCAA supplementation on type 2 diabetes (T2D) are not clear. Therefore, a 24-week, prospective randomized open blinded-endpoint trial was conducted to evaluate the effects of supplementation of 8 g of BCAA or 7.5 g of soy protein on skeletal muscle and glycemic control as well as adverse events in elderly individuals with T2D. Thirty-six participants were randomly assigned to the BCAA group (n = 21) and the soy protein group (n = 15). Skeletal muscle mass and HbA1c, which were primary endpoints, did not change over time or differ between groups. However, knee extension muscle strength was significantly increased in the soy protein group and showed a tendency to increase in the BCAA group. Homeostasis model assessment for insulin resistance did not significantly change during the trial. Depressive symptoms were significantly improved in the BCAA group but the difference between groups was not significant. Results suggested that BCAA supplementation may not affect skeletal muscle mass and glycemic control and may improve depressive symptoms in elderly individuals with T2D.
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14
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Murphy CH, Connolly C, Flanagan EM, Mitchelson KAJ, de Marco Castro E, Egan B, Brennan L, Roche HM. Interindividual variability in response to protein and fish oil supplementation in older adults: a randomized controlled trial. J Cachexia Sarcopenia Muscle 2022; 13:872-883. [PMID: 35191215 PMCID: PMC8977999 DOI: 10.1002/jcsm.12936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/21/2021] [Accepted: 01/17/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Precision nutrition is highly topical. However, no studies have explored the interindividual variability in response to nutrition interventions for sarcopenia. The purpose of this study was to determine the magnitude of interindividual variability in response to two nutrition supplementation interventions for sarcopenia and metabolic health, after accounting for sources of variability not attributable to supplementation. METHODS A 24 week, randomized, double-blind, placebo-controlled trial tested the impact of leucine-enriched protein (LEU-PRO), LEU-PRO plus long-chain n-3 PUFA (LEU-PRO+n-3) or control (CON) supplementation in older adults (n = 83, 71 ± 6 years) at risk of sarcopenia. To estimate the true interindividual variability in response to supplementation (free of the variability due to measurement error and within-subject variation), the standard deviation of individual responses (SDR ) was computed and compared with the minimally clinically important difference (MCID) for appendicular lean mass (ALM), leg strength, timed up-and-go (TUG), and serum triacylglycerol (TG) concentration. Clinically meaningful interindividual variability in response to supplementation was deemed to be present when the SDR positively exceeded the MCID. The probability that individual responses were clinically meaningful, and the phenotypic, dietary, and behavioural determinants of response to supplementation were examined. RESULTS The SDR was below the MCID for ALM (LEU-PRO: -0.12 kg [90% CI: -0.38, 0.35], LEU-PRO+n-3: -0.32 kg [-0.45, 0.03], MCID: 0.21 kg), TUG (LEU-PRO: 0.58 s [0.18, 0.80], LEU-PRO+n-3: 0.73 s [0.41, 0.95], MCID: 0.9 s) and TG (LEU-PRO: -0.38 mmol/L [-0.80, 0.25], LEU-PRO+n-3: -0.44 mmol/L [-0.63, 0.06], MCID: 0.1 mmol/L), indicating no meaningful interindividual variability in response to either supplement. The SDR exceeded the MCID (19 Nm) for strength in response to LEU-PRO (25 Nm [-29, 45]) and LEU-PRO+n-3 (23 Nm [-29, 43]) supplementation but the effect was uncertain, evidenced by wide confidence intervals. In the next stage of analysis, similar proportions of participant responses were identified as very likely, likely, possibly, unlikely, and very unlikely to represent clinically meaningful improvements across the LEU-PRO, LEU-PRO+n-3, and CON groups (P > 0.05). Baseline LC n-3 PUFA status, habitual protein intake, and numerous other phenotypic and behavioural factors were not determinants of response to LEU-PRO or LEU-PRO+n-3 supplementation. CONCLUSIONS Applying a novel, robust methodological approach to precision nutrition, we show that there was minimal interindividual variability in changes in ALM, muscle function, and TG in response to LEU-PRO and LEU-PRO+n-3 supplementation in older adults at risk of sarcopenia.
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Affiliation(s)
- Caoileann H Murphy
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland.,Teagasc Food Research Centre, Dublin, Ireland
| | - Claire Connolly
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Ellen M Flanagan
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Kathleen A J Mitchelson
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Elena de Marco Castro
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Brendan Egan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Lorraine Brennan
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland
| | - Helen M Roche
- School of Public Health, Physiotherapy and Sport Science, UCD Conway Institute, UCD Institute of Food and Health, University College Dublin (UCD), Dublin, Ireland.,Institute for Global Food Security, Queen's University Belfast, Belfast, UK
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15
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Kirwan RP, Mazidi M, Rodríguez García C, Lane KE, Jafari A, Butler T, Perez de Heredia F, Davies IG. Protein interventions augment the effect of resistance exercise on appendicular lean mass and handgrip strength in older adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 115:897-913. [PMID: 34673936 DOI: 10.1093/ajcn/nqab355] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increased protein intake is suggested as a strategy to slow or reverse the loss of muscle mass and strength observed in sarcopenia, but results from studies that directly tested this possibility have been inconsistent. OBJECTIVES We assessed the evidence on the effects of whole protein supplementation or higher-protein diets, without the use of amino acids or supplements known to stimulate hypertrophy, alone or in combination with resistance exercise (RE) interventions, on lean body mass (LBM) and strength in older adults. METHODS A systematic search was conducted using PubMed, Medline, Web of Science, and Cochrane CENTRAL databases from January 1990 to July 2021. Randomized controlled trials that assessed the effects of protein supplementation and/or higher-protein dietary interventions in older adults (mean age ≥50 y) on total LBM, appendicular lean mass (ALM), and handgrip (HG) and knee extension (KE) strength were included. RESULTS Twenty-eight studies were identified. In pooled analysis, compared with lower protein controls, protein supplementation did not have a significant positive effect on total LBM [weighted mean difference in change (WMD): 0.34; 95% CI: -0.21, 0.89; I2 = 90.01%], ALM (WMD: 0.4; 95% CI: -0.01, 0.81; I2 = 90.38%), HG strength (WMD: 0.69; 95% CI: -0.69, 2.06; I2 = 94.52%), or KE strength (WMD: 1.88; 95% CI: -0.6, 4.35; I2 = 95.35%). However, in interventions that used also RE, statistically significant positive effects of protein were observed for ALM (WMD: 0.54; 95% CI: 0.03, 1.05; I2 = 89.76%) and HG (WMD: 1.71; 95% CI: 0.12, 3.30; I2 = 88.71%). Meta-regression revealed no significant association between age, per-meal protein dose, duration, and baseline protein intake with change in any outcome. Subgroup analysis revealed the statistically significant effects on ALM occurred only in sarcopenic/frail populations (WMD: 0.88; 95% CI: 0.51, 1.25; I2 = 79.0%). Most studies (n = 22) had some risk of bias. CONCLUSIONS In older adults performing RE, increased protein intake leads to greater ALM and HG strength compared with lower protein controls. Without RE, protein has no additional benefit on changes in total LBM, ALM, or HG strength.
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Affiliation(s)
- Richard P Kirwan
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carmen Rodríguez García
- Department of Health Sciences, Faculty of Experimental Sciences, University of Jaén, Jaén, Spain
| | - Katie E Lane
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Alireza Jafari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Tom Butler
- School of Applied Health and Social Care and Social Work, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Fatima Perez de Heredia
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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16
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From the Bench to the Bedside: Branched Amino Acid and Micronutrient Strategies to Improve Mitochondrial Dysfunction Leading to Sarcopenia. Nutrients 2022; 14:nu14030483. [PMID: 35276842 PMCID: PMC8838610 DOI: 10.3390/nu14030483] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
With extended life expectancy, the older population is constantly increasing, and consequently, so too is the prevalence of age-related disorders. Sarcopenia, the pathological age-related loss of muscle mass and function; and malnutrition, the imbalance in nutrient intake and resultant energy production, are both commonly occurring conditions in old adults. Altered nutrition plays a crucial role in the onset of sarcopenia, and both these disorders are associated with detrimental consequences for patients (e.g., frailty, morbidity, and mortality) and society (e.g., healthcare costs). Importantly, sarcopenia and malnutrition also share critical molecular alterations, such as mitochondrial dysfunction, increased oxidative stress, and a chronic state of low grade and sterile inflammation, defined as inflammageing. Given the connection between malnutrition and sarcopenia, nutritional interventions capable of affecting mitochondrial health and correcting inflammageing are emerging as possible strategies to target sarcopenia. Here, we discuss mitochondrial dysfunction, oxidative stress, and inflammageing as key features leading to sarcopenia. Moreover, we examine the effects of some branched amino acids, omega-3 PUFA, and selected micronutrients on these pathways, and their potential role in modulating sarcopenia, warranting further clinical investigation.
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17
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Strategies to Prevent Sarcopenia in the Aging Process: Role of Protein Intake and Exercise. Nutrients 2021; 14:nu14010052. [PMID: 35010928 PMCID: PMC8746908 DOI: 10.3390/nu14010052] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Sarcopenia is one of the main issues associated with the process of aging. Characterized by muscle mass loss, it is triggered by several conditions, including sedentary habits and negative net protein balance. According to World Health Organization, it is expected a 38% increase in older individuals by 2025. Therefore, it is noteworthy to establish recommendations to prevent sarcopenia and several events and comorbidities associated with this health issue condition. In this review, we discuss the role of these factors, prevention strategies, and recommendations, with a focus on protein intake and exercise.
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18
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Hengeveld LM, de Goede J, Afman LA, Bakker SJL, Beulens JWJ, Blaak EE, Boersma E, Geleijnse JM, van Goudoever J(HB, Hopman MTE, Iestra JA, Kremers SPJ, Mensink RP, de Roos NM, Stehouwer CDA, Verkaik-Kloosterman J, de Vet E, Visser M. Health Effects of Increasing Protein Intake Above the Current Population Reference Intake in Older Adults: A Systematic Review of the Health Council of the Netherlands. Adv Nutr 2021; 13:1083-1117. [PMID: 35016214 PMCID: PMC9340973 DOI: 10.1093/advances/nmab140] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/07/2021] [Accepted: 11/17/2021] [Indexed: 01/06/2023] Open
Abstract
Whether older adults need more protein than younger adults is debated. The population reference intake for adults set by the European Food Safety Authority is 0.83 g/kg body weight (BW)/d based primarily on nitrogen balance studies, but the underlying data on health outcomes are outdated. An expert committee of the Health Council of the Netherlands conducted a systematic review (SR) of randomized controlled trials (RCTs) examining the effect of increased protein intake on health outcomes in older adults from the general population with an average habitual protein intake ≥0.8 g/(kg BW · d). Exposures were the following: 1) extra protein compared with no protein and 2) extra protein and physical exercise compared with physical exercise. Outcomes included lean body mass, muscle strength, physical performance, bone health, blood pressure, serum glucose and insulin, serum lipids, kidney function, and cognition. Data of >1300 subjects from 18 RCTs were used. Risk of bias was judged as high (n = 9) or "some concerns" (n = 9). In 7 of 18 RCTs, increased protein intake beneficially affected ≥1 of the tested outcome measures of lean body mass. For muscle strength, this applied to 3 of 8 RCTs in the context of physical exercise and in 1 of 7 RCTs without physical exercise. For the other outcomes, <30% (0-29%) of RCTs showed a statistically significant effect. The committee concluded that increased protein intake has a possible beneficial effect on lean body mass and, when combined with physical exercise, muscle strength; likely no effect on muscle strength when not combined with physical exercise, or on physical performance and bone health; an ambiguous effect on serum lipids; and that too few RCTs were available to allow for conclusions on the other outcomes. This SR provides insufficiently convincing data that increasing protein in older adults with a protein intake ≥0.8 g/(kg BW · d) elicits health benefits.
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Affiliation(s)
| | | | - Lydia A Afman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ellen E Blaak
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Eric Boersma
- Erasmus MC, University Medical Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Johanna M Geleijnse
- Health Council of the Netherlands, The Hague, The Netherlands,Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Johannes (Hans) B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Department of Pediatrics, Amsterdam, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jolein A Iestra
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stef P J Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands,Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Emely de Vet
- Department of Social Sciences, Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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19
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Yaegashi A, Kimura T, Hirata T, Tamakoshi A. Association of dietary protein intake with skeletal muscle mass in older adults: A systematic review. Geriatr Gerontol Int 2021; 21:1077-1083. [PMID: 34643981 DOI: 10.1111/ggi.14291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 12/16/2022]
Abstract
Protein supplementation has been shown to be effective in attenuating the loss of lean body mass and muscle mass in older adults; however, its benefits as dietary protein remain unclear. This systematic review of observational studies aimed to investigate the association of dietary protein intake with skeletal muscle mass (SM). Observational studies that investigated the association of dietary protein intake with SM in older adults were retrieved from MEDLINE, Web of Science and Cochrane-CENTRAL databases. Of the 26 analyses in the 17 studies, 18 showed a significant positive association. In cohort studies, 55.6% (five of nine analyses) showed a significant positive association. Of these, four analyses were adjusted for well-known confounding factors, used energy-adjusted protein intake, and used the amount of change of SM between baseline and follow-up as the outcome, with two of them showing a significant positive association. Although 69.2% (18 of 26 analyses) of the 17 studies showed a significant positive association between dietary protein intake and SM in older adults, most studies were cross-sectional and had at least one important methodological limitation. Therefore, we could not draw any conclusions. Thus, well-designed cohort studies are needed in future to identify the association between dietary protein intake and SM in older adults. Geriatr Gerontol Int 2021; 21: 1077-1083.
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Affiliation(s)
- Akinori Yaegashi
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Health and Nutrition, Faculty of Human Science, Hokkaido Bunkyo University, Eniwa, Japan
| | - Takashi Kimura
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takumi Hirata
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akiko Tamakoshi
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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20
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Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn's Disease. Gastroenterol Res Pract 2021; 2021:3267201. [PMID: 34608386 PMCID: PMC8487395 DOI: 10.1155/2021/3267201] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Sarcopenia is a prognostic factor of outcomes for various diseases, but reports on sarcopenia in patients with Crohn's disease (CD) are few. We aim to determine the prevalence of sarcopenia and assess the role of sarcopenia in postoperative complications in patients with CD at a tertiary referral center. Methods Patients who underwent intestinal surgery for CD from January 2013 to October 2019 were retrospectively enrolled. The L3 skeletal muscle mass index (SMI) was used to identify sarcopenia. Demographic data, preoperative laboratory data, surgical details, and hospital outcomes were recorded. The factors associated with postoperative complications were evaluated through univariate and multivariate analyses. Results One hundred and twenty-four patients were enrolled. Thirty-four of them (27.4%), including 11 males, were diagnosed with sarcopenia. Compared with patients without sarcopenia, sarcopenic patients had a significantly lower BMI (P < 0.001); lower preoperative serum albumin (P = 0.006), prealbumin (P = 0.030), and hemoglobin levels (P < 0.001); longer hospital stay (34.4 ± 26.8 days vs. 22.8 ± 15.6 days, P = 0.003); and more occurrences of complications (41.2% vs. 23.3%, P = 0.049). The overall incidence of postoperative complications was 28.2%. Infection (51.4%) and intestinal fistula (22.9%) were the most common among such complications. Through the multivariate analysis, sarcopenia was identified as an independent risk factor for major postoperative complications (odds ratio = 3.974, 95%CI = 1.171-13.489, P = 0.027). Conclusion Sarcopenia is common in patients with CD requiring bowel resection, and it significantly increases the risk of major postoperative complications.
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21
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The cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake: a randomized controlled trial. Eur J Nutr 2021; 61:505-520. [PMID: 34609621 PMCID: PMC8490609 DOI: 10.1007/s00394-021-02675-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 11/05/2022]
Abstract
Purpose To examine the cost effectiveness of dietary advice to increase protein intake on 6-month change in physical functioning among older adults. Methods In this multicenter randomized controlled trial, 276 community-dwelling older adults with a habitual protein intake < 1.0 g/kg adjusted body weight (aBW)/d were randomly assigned to either Intervention 1; advice to increase protein intake to ≥ 1.2 g/kg aBW/d (PROT, n = 96), Intervention 2; similar advice and in addition advice to consume protein (en)rich(ed) foods within half an hour after usual physical activity (PROT + TIMING, n = 89), or continue the habitual diet with no advice (CON, n = 91). Primary outcome was 6-month change in 400-m walk time. Secondary outcomes were 6-month change in physical performance, leg extension strength, grip strength, body composition, self-reported mobility limitations and quality of life. We evaluated cost effectiveness from a societal perspective. Results Compared to CON, a positive effect on walk time was observed for PROT; – 12.4 s (95%CI, – 21.8 to – 2.9), and for PROT + TIMING; – 4.9 s (95%CI, – 14.5 to 4.7). Leg extension strength significantly increased in PROT (+ 32.6 N (95%CI, 10.6–54.5)) and PROT + TIMING (+ 24.3 N (95%CI, 0.2–48.5)) compared to CON. No significant intervention effects were observed for the other secondary outcomes. From a societal perspective, PROT was cost effective compared to CON. Conclusion Dietary advice to increase protein intake to ≥ 1.2 g/kg aBW/d improved 400-m walk time and leg strength among older adults with a lower habitual protein intake. From a societal perspective, PROT was considered cost-effective compared to CON. These findings support the need for re-evaluating the protein RDA of 0.8 g/kg BW/d for older adults. Trial registration The trial has been registered at ClinicalTrials.gov (NCT03712306). Date of registration: October 2018. Registry name: The (Cost) Effectiveness of Increasing Protein Intake on Physical Functioning in Older Adults. Trial Identifier: NCT03712306. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02675-0.
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22
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Dedeyne L, Dupont J, Verschueren S, Koppo K, Tournoy J, Matthys C, Gielen E. Personalized Protein Supplementation Improves Total Protein, Leucine, and Energy Intake in (Pre)Sarcopenic Community-Dwelling Older Adults in the ENHANce RCT. Front Nutr 2021; 8:672971. [PMID: 34434950 PMCID: PMC8381276 DOI: 10.3389/fnut.2021.672971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Recommendations concerning protein quantity, source, and leucine intake for older adults are difficult to reach by regular dietary intake. This randomized clinical trial assesses in sarcopenic community-dwelling older adults (i) the regular (non-supplemented) daily protein and leucine intake; and (ii) the effect of personalized protein supplementation (aiming for an evenly distributed total protein intake of 1.5 g·kg-1·d-1 of body mass, accounting for energy intake) on regular and total (dietary and supplemental) intake. A preliminary feasibility study in participants of the ongoing Exercise and Nutrition for Healthy AgeiNg (ENHANce) study was performed with the objective to assess the intake and distribution of regular dietary protein and leucine, protein source and energy intake in (pre)sarcopenic community-dwelling older adults. Moreover, this study aimed to assess if personalized protein supplementation was feasible without negatively affecting regular dietary intake. ENHANce (NCT03649698) is a 5-armed RCT that assesses the effect of anabolic interventions on physical performance in (pre)sarcopenic older adults. In August 2019, n = 51 participants were included in ENHANce with complete available data on dietary intake at screening and thus eligible for inclusion in present analysis. Of these, n = 35 participants completed the intervention period of ENHANce at the moment of analysis, allowing an exploration of the effect of supplementation on regular dietary intake. The regular dietary protein intake of 51 (pre)sarcopenic adults (73.6 ± 6.5 years) was 1.06 ± 0.3 g·kg-1·d-1 of body mass. Protein supplementation (n = 20) improved total protein intake to 1.55 ± 0.3 g·kg-1·d-1 of body mass (P < 0.001) without affecting regular dietary protein (P = 0.176) or energy intake (P = 0.167). Placebo supplementation (n = 15) did not affect regular dietary protein intake (P = 0.910) but decreased regular dietary energy intake (P = 0.047). Regular leucine intake was unevenly distributed over the day, but increased by supplementation at breakfast (P < 0.001) and dinner (P = 0.010) to at least 2.46 g leucine·meal-1, without reducing regular dietary leucine intake (P = 0.103). Animal-based protein intake-the main protein source-was not affected by supplementation (P = 0.358). Personalized protein supplementation ensured an adequate quantity and even distribution of protein and leucine over the day, without affecting regular dietary protein or energy intake.
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Affiliation(s)
- Lenore Dedeyne
- Gerontology and Geriatrics, Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jolan Dupont
- Gerontology and Geriatrics, Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium
| | - Sabine Verschueren
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katrien Koppo
- Exercise Physiology Research Group, Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jos Tournoy
- Gerontology and Geriatrics, Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Endocrinology, UZ Leuven, Leuven, Belgium
| | - Evelien Gielen
- Gerontology and Geriatrics, Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium
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Tessier AJ, Lévy-Ndejuru J, Moyen A, Lawson M, Lamarche M, Morais JA, Bhullar A, Andriamampionona F, Mazurak VC, Chevalier S. A 16-week randomized controlled trial of a fish oil and whey protein-derived supplement to improve physical performance in older adults losing autonomy-A pilot study. PLoS One 2021; 16:e0256386. [PMID: 34424934 PMCID: PMC8382183 DOI: 10.1371/journal.pone.0256386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/09/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Low functional capacity may lead to the loss of independence and institutionalization of older adults. A nutritional intervention within a rehabilitation program may attenuate loss of muscle function in this understudied population. OBJECTIVE This pilot study assessed the feasibility for a larger RCT of a nutritional supplementation in older adults referred to an outpatient assessment and rehabilitation program. METHODS Participants were randomized to receive a supplement (EXP: 2g fish oil with 1500 IU vitamin D3 1x/d + 20-30g whey protein powder with 3g leucine 2x/d) or isocaloric placebo (CTR: corn oil + maltodextrin powder) for 16 weeks. Handgrip and knee extension strength (using dynamometry), physical performance tests and plasma phospholipid n-3 fatty acids (using GCMS) were evaluated at weeks 0, 8 and 16; and lean soft tissue mass (using DXA), at weeks 0 and 16. RESULTS Over 2 years, 244 patients were screened, 46 were eligible (18.9%), 20 were randomized, 10 completed the study (6 CTR, 4 EXP). Median age was 87 y (77-94 y; 75% women) and gait speed was 0.69 m/s; 55% had low strength, and all performed under 420m on the 6-minute walk test, at baseline. Overall self-reported compliance to powder and oil was high (96% and 85%) but declined at 16 weeks for fish oil (55%). The EXP median protein intake surpassed the target 1.2-1.5 g/kg/d, without altering usual diet. Proportions of plasma phospholipid EPA and DHA increased significantly 3- and 1.5-fold respectively, at week 8 in EXP, with no change in CTR. Participants were able to complete most assessments with sustained guidance. CONCLUSION Because of low eligibility, the pilot study was interrupted and deemed non-feasible; adherence to rigorous study assessments and to supplements was adequate except for long-term fish oil. The non-amended protocol may be applied to populations with greater functional capacity. TRIAL REGISTRATION ClinicalTrials.gov NCT04454359.
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Affiliation(s)
- Anne-Julie Tessier
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Julia Lévy-Ndejuru
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Audrey Moyen
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Marissa Lawson
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Marie Lamarche
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseé A. Morais
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
| | - Amritpal Bhullar
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | | | - Vera C. Mazurak
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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24
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Kim H, Kojima N, Uchida R, Somekawa S, Inoue N, Kobayashi H, Osuka Y. The additive effects of exercise and essential amino acid on muscle mass and strength in community-dwelling older Japanese women with muscle mass decline, but not weakness and slowness: a randomized controlled and placebo trial. Aging Clin Exp Res 2021; 33:1841-1852. [PMID: 32978751 DOI: 10.1007/s40520-020-01713-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exercise and essential amino acid supplementation have been separately shown to improve muscle mass in elderly people, however, the combined, added effects of both interventions have yielded inconsistent results on muscle mass, strength, and physical function improvement. AIMS To investigate the additive effects of exercise and essential amino acid supplementation on muscle mass, strength, and walking ability in older Japanese women with muscle mass decline, but not weakness and slowness. METHODS One hundred thirty women over 65 years of age were defined as having muscle decline and randomly assigned into two groups; exercise and amino acid supplementation (n = 65) or exercise and placebo supplementation (n = 65). The exercise group attended a 60-min comprehensive training program once a week and were encouraged to perform a home-based exercise program. The amino acid or placebo group ingested a 3 g supplement daily for 3-month. Body composition was determined by bioelectrical impedance analysis. Interview data and functional fitness measurements, such as muscle strength and walking ability were collected at baseline and after the 3-month intervention. RESULTS There were no significant group × time interactions in primary outcomes such as muscle mass and strength. However, interactions were observed in the degree of low back discomfort (P = 0.014). Percent change of low back discomfort was significantly greater in exercise + amino acid group compared with exercise + placebo group. CONCLUSIONS The combination of exercise and amino acid supplementation had a beneficial effect on low back discomfort. However, additional effects were not observed in primary outcomes including muscle mass and strength in this population.
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25
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Williams GR, Dunne RF, Giri S, Shachar SS, Caan BJ. Sarcopenia in the Older Adult With Cancer. J Clin Oncol 2021; 39:2068-2078. [PMID: 34043430 PMCID: PMC8260902 DOI: 10.1200/jco.21.00102] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Grant R. Williams
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Richard F. Dunne
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Shlomit S. Shachar
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bette J. Caan
- Division of Research, Kaiser Permanente, Oakland, CA
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26
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Kim HN, Song SW. Association between dietary protein intake and skeletal muscle mass in older Korean adults. Eur Geriatr Med 2021; 12:1221-1228. [PMID: 34156655 DOI: 10.1007/s41999-021-00530-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We investigated the association of low and high daily protein intakes on skeletal muscle mass status in Korean adults aged 60 years and older. METHODS This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey conducted between 2008 and 2011. The participants' dietary protein intake was assessed using the 24-h dietary recall method and was classified as low (< 0.8 g/kg body weight/day), moderate (0.8-1.2 g/kg/day), and high (> 1.2 g/kg/day). Amount of skeletal muscle mass was measured using whole-body dual-energy X-ray absorptiometry. Low skeletal muscle mass was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in men and < 5.4 kg/m2 in women. RESULTS The study included data from 4585 participants (2022 men and 2563 women). All skeletal muscle parameters in women and total lean mass in men decreased as the amount of protein consumed daily increased. However, there was no association between high or low protein intake and low skeletal muscle mass in men or women. CONCLUSIONS No association was found between the amount of daily protein intake and skeletal muscle mass status in older Korean adults. Gender-specific further studies focussing on the interactions of dietary protein intake under specific conditions including physical activity status and the daily distribution of protein intake and the quality and source of the protein are needed to evaluate the impact of protein intake status on muscle health in older Koreans.
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Affiliation(s)
- Ha-Na Kim
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi, 16247, Republic of Korea
| | - Sang-Wook Song
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi, 16247, Republic of Korea.
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27
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Abstract
In an ageing society, the preservation of health and function is becoming increasingly important. The present paper acknowledges that ageing is malleable and focuses on diets and key nutritional concerns later in life. It presents evidence for the importance of healthful dietary patterns and points towards specific nutritional concerns later in life and conveys three main messages: (1) considering health maintenance and malnutrition risk, both dietary quality in terms of healthful dietary patterns and dietary quantity are important later in life, (2) ageing-related changes in nutrient physiology and metabolism contribute to the risk of inadequacies or deficiencies for specific nutrients, e.g. vitamin D, vitamin B12 and protein and (3) that current food-based dietary guidelines propagate a shift into the direction of Mediterranean type of diets including more plant-based foods. Limited scientific evidence on nutritional requirements of older adults, along with envisaged shifts towards diets rich in plant foods, are challenges that need to be addressed in order to develop tailored nutritional recommendations and dietary guidance for older adults.
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28
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Papageorgiou M, Biver E. Interactions of the microbiome with pharmacological and non-pharmacological approaches for the management of ageing-related musculoskeletal diseases. Ther Adv Musculoskelet Dis 2021; 13:1759720X211009018. [PMID: 34104230 PMCID: PMC8172340 DOI: 10.1177/1759720x211009018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022] Open
Abstract
Despite major progress in the understanding of the pathophysiology and therapeutic options for common ageing-related musculoskeletal conditions (i.e. osteoporosis and associated fractures, sarcopenia and osteoarthritis), there is still a considerable proportion of patients who respond sub optimally to available treatments or experience adverse effects. Emerging microbiome research suggests that perturbations in microbial composition, functional and metabolic capacity (i.e. dysbiosis) are associated with intestinal and extra-intestinal disorders including musculoskeletal diseases. Besides its contributions to disease pathogenesis, the role of the microbiome is further extended to shaping individuals' responses to disease therapeutics (i.e. pharmacomicrobiomics). In this review, we focus on the reciprocal interactions between the microbiome and therapeutics for osteoporosis, sarcopenia and osteoarthritis. Specifically, we identify the effects of therapeutics on microbiome's configurations, functions and metabolic output, intestinal integrity and immune function, but also the effects of the microbiome on the metabolism of these therapeutics, which in turn, may influence their bioavailability, efficacy and side-effect profile contributing to variable treatment responses in clinical practice. We further discuss emerging strategies for microbiota manipulation as preventive or therapeutic (alone or complementary to available treatments) approaches for improving outcomes of musculoskeletal health and disease.
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Affiliation(s)
- Maria Papageorgiou
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle Perret Gentil 4, Geneva 1205, Switzerland
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29
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Murphy CH, Flanagan EM, De Vito G, Susta D, Mitchelson KAJ, de Marco Castro E, Senden JMG, Goessens JPB, Mikłosz A, Chabowski A, Segurado R, Corish CA, McCarthy SN, Egan B, van Loon LJC, Roche HM. Does supplementation with leucine-enriched protein alone and in combination with fish-oil-derived n-3 PUFA affect muscle mass, strength, physical performance, and muscle protein synthesis in well-nourished older adults? A randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2021; 113:1411-1427. [PMID: 33871558 PMCID: PMC8168361 DOI: 10.1093/ajcn/nqaa449] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Leucine-enriched protein (LEU-PRO) and long-chain (LC) n-3 (ω-3) PUFAs have each been proposed to improve muscle mass and function in older adults, whereas their combination may be more effective than either alone. OBJECTIVE The impact of LEU-PRO supplementation alone and combined with LC n-3 PUFAs on appendicular lean mass, strength, physical performance and myofibrillar protein synthesis (MyoPS) was investigated in older adults at risk of sarcopenia. METHODS This 24-wk, 3-arm parallel, randomized, double-blind, placebo-controlled trial was conducted in 107 men and women aged ≥65 y with low muscle mass and/or strength. Twice daily, participants consumed a supplement containing either LEU-PRO (3 g leucine, 10 g protein; n = 38), LEU-PRO plus LC n-3 PUFAs (0.8 g EPA, 1.1 g DHA; LEU-PRO+n-3; n = 38), or an isoenergetic control (CON; n = 31). Appendicular lean mass, handgrip strength, leg strength, physical performance, and circulating metabolic and renal function markers were measured pre-, mid-, and postintervention. Integrated rates of MyoPS were assessed in a subcohort (n = 28). RESULTS Neither LEU-PRO nor LEU-PRO+n-3 supplementation affected appendicular lean mass, handgrip strength, knee extension strength, physical performance or MyoPS. However, isometric knee flexion peak torque (treatment effect: -7.1 Nm; 95% CI: -12.5, -1.8 Nm; P < 0.01) was lower postsupplementation in LEU-PRO+n-3 compared with CON. Serum triacylglycerol and total adiponectin concentrations were lower, and HOMA-IR was higher, in LEU-PRO+n-3 compared with CON postsupplementation (all P < 0.05). Estimated glomerular filtration rate was higher and cystatin c was lower in LEU-PRO and LEU-PRO+n-3 postsupplementation compared with CON (all P < 0.05). CONCLUSIONS Contrary to our hypothesis, we did not observe a beneficial effect of LEU-PRO supplementation alone or combined with LC n-3 PUFA supplementation on appendicular lean mass, strength, physical performance or MyoPS in older adults at risk of sarcopenia. This trial was registered at clinicaltrials.gov as NCT03429491.
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Affiliation(s)
- Caoileann H Murphy
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Ellen M Flanagan
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Giuseppe De Vito
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland,Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Davide Susta
- School of Health and Human Performance, Dublin City University, Dublin, Ireland,Department of Normal Physiology, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kathleen A J Mitchelson
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Elena de Marco Castro
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Joan M G Senden
- Department of Human Movement Sciences, Maastricht University, Maastricht, Netherlands
| | - Joy P B Goessens
- Department of Human Movement Sciences, Maastricht University, Maastricht, Netherlands
| | - Agnieszka Mikłosz
- Department of Physiology, Medical University of Bialystok, Bialystok, Poland
| | - Adrian Chabowski
- Department of Physiology, Medical University of Bialystok, Bialystok, Poland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland,UCD Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | | | - Brendan Egan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Luc J C van Loon
- Department of Human Movement Sciences, Maastricht University, Maastricht, Netherlands
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30
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Chapple LAS, Dirks ML, Kouw IW. Stable isotope approaches to study muscle mass outcomes in clinical populations. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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31
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Dommerholt MB, Blankestijn M, Vieira‐Lara MA, van Dijk TH, Wolters H, Koster MH, Gerding A, van Os RP, Bloks VW, Bakker BM, Kruit JK, Jonker JW. Short-term protein restriction at advanced age stimulates FGF21 signalling, energy expenditure and browning of white adipose tissue. FEBS J 2021; 288:2257-2277. [PMID: 33089625 PMCID: PMC8048886 DOI: 10.1111/febs.15604] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/17/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
Dietary protein restriction has been demonstrated to improve metabolic health under various conditions. However, the relevance of ageing and age-related decline in metabolic flexibility on the effects of dietary protein restriction has not been addressed. Therefore, we investigated the effect of short-term dietary protein restriction on metabolic health in young and aged mice. Young adult (3 months old) and aged (18 months old) C57Bl/6J mice were subjected to a 3-month dietary protein restriction. Outcome parameters included fibroblast growth factor 21 (FGF21) levels, muscle strength, glucose tolerance, energy expenditure (EE) and transcriptomics of brown and white adipose tissue (WAT). Here, we report that a low-protein diet had beneficial effects in aged mice by reducing some aspects of age-related metabolic decline. These effects were characterized by increased plasma levels of FGF21, browning of subcutaneous WAT, increased body temperature and EE, while no changes were observed in glucose homeostasis and insulin sensitivity. Moreover, the low-protein diet used in this study was well-tolerated in aged mice indicated by the absence of adverse effects on body weight, locomotor activity and muscle performance. In conclusion, our study demonstrates that a short-term reduction in dietary protein intake can impact age-related metabolic health alongside increased FGF21 signalling, without negatively affecting muscle function. These findings highlight the potential of protein restriction as a strategy to induce EE and browning of WAT in aged individuals.
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Affiliation(s)
- Marleen B. Dommerholt
- Sections of Molecular Metabolism and NutritionDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Maaike Blankestijn
- Sections of Molecular Metabolism and NutritionDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Marcel A. Vieira‐Lara
- Sections of Systems Medicine of Metabolism and SignalingDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Theo H. van Dijk
- Department of Laboratory MedicineUniversity Medical Center GroningenUniversity of Groningenthe Netherlands
| | - Henk Wolters
- Sections of Molecular Metabolism and NutritionDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Mirjam H. Koster
- Sections of Molecular Metabolism and NutritionDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Albert Gerding
- Sections of Systems Medicine of Metabolism and SignalingDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
- Department of Laboratory MedicineUniversity Medical Center GroningenUniversity of Groningenthe Netherlands
| | - Ronald P. van Os
- Mouse Clinic for Cancer and AgingCentral Animal FacilityUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Vincent W. Bloks
- Sections of Molecular Metabolism and NutritionDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Barbara M. Bakker
- Sections of Systems Medicine of Metabolism and SignalingDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Janine K. Kruit
- Sections of Molecular Metabolism and NutritionDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Johan W. Jonker
- Sections of Molecular Metabolism and NutritionDepartment of PediatricsUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
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32
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Tallis J, Shelley S, Degens H, Hill C. Age-Related Skeletal Muscle Dysfunction Is Aggravated by Obesity: An Investigation of Contractile Function, Implications and Treatment. Biomolecules 2021; 11:372. [PMID: 33801275 PMCID: PMC8000988 DOI: 10.3390/biom11030372] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
Obesity is a global epidemic and coupled with the unprecedented growth of the world's older adult population, a growing number of individuals are both old and obese. Whilst both ageing and obesity are associated with an increased prevalence of chronic health conditions and a substantial economic burden, evidence suggests that the coincident effects exacerbate negative health outcomes. A significant contributor to such detrimental effects may be the reduction in the contractile performance of skeletal muscle, given that poor muscle function is related to chronic disease, poor quality of life and all-cause mortality. Whilst the effects of ageing and obesity independently on skeletal muscle function have been investigated, the combined effects are yet to be thoroughly explored. Given the importance of skeletal muscle to whole-body health and physical function, the present study sought to provide a review of the literature to: (1) summarise the effect of obesity on the age-induced reduction in skeletal muscle contractile function; (2) understand whether obesity effects on skeletal muscle are similar in young and old muscle; (3) consider the consequences of these changes to whole-body functional performance; (4) outline important future work along with the potential for targeted intervention strategies to mitigate potential detrimental effects.
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Affiliation(s)
- Jason Tallis
- Centre for Applied Biological and Exercise Sciences, Alison Gingell Building, Coventry University, Priory Street, Coventry CV15FB, UK;
| | - Sharn Shelley
- Centre for Applied Biological and Exercise Sciences, Alison Gingell Building, Coventry University, Priory Street, Coventry CV15FB, UK;
| | - Hans Degens
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Cameron Hill
- Randall Centre for Cell and Molecular Biophysics, New Hunt’s House, Guy’s Campus, King’s College London, London SE1 1UL, UK;
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33
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Impact of dietary protein intake on the incidence of low muscle strength in middle-aged and older adults. Clin Nutr 2021; 40:1467-1474. [PMID: 33740517 DOI: 10.1016/j.clnu.2021.02.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/17/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND A reduction in skeletal muscle strength is a prognostic indicator of negative consequences, such as physical disability, frailty, and mortality in older adults. Studies investigating associations between the risk of reduction in skeletal muscle strength and the amount of dietary protein which is a factor influenced muscle health are scarce, particularly in Asian populations. Therefore, we investigated the association between the amount and change in daily protein intake and the prospective risk of developing low skeletal muscle strength in middle-aged and older adults. METHODS This study used data from the Korean Genome and Epidemiology Study as an ongoing population-based cohort study of adults aged 40 years and over. The amount of daily protein consumed was assessed using a semi-quantitative food frequency questionnaire. Low skeletal muscle strength was measured with a handgrip strength dynamometer. RESULTS In total, 32,458 adults (11,358 males and 21,100 females) were evaluated. The amount of daily dietary protein consumed was not associated with the risk of low muscle strength over the 4-year follow-up period after adjusting for covariates. No associations between low muscle strength events according to the change in the amount of protein consumed from the baseline to the follow-up surveys were identified. CONCLUSIONS The amount of and change in dietary protein consumed were not associated with developing low muscle strength in middle-aged and older adults. Further studies with a focus on physical activity-protein intake interactions and specific conditions, such as mobility-limited adults or hospitalized patients, are warranted to clarify the relationship between protein intake status and the incidence of low skeletal muscle strength.
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Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women. BMC Musculoskelet Disord 2021; 22:192. [PMID: 33593350 PMCID: PMC7888167 DOI: 10.1186/s12891-021-04056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Good physical capability is an important part of healthy biological ageing. Several factors influencing physical capability have previously been reported. Long-term reports on physical capability and the onset of clinical disorders and chronic diseases are lacking. Decrease in physical capacity has been shown to increase mortality. This study focuses on the prevalence of chronic diseases. The primary objective of the study was to reveal the association between physical capability and morbidity. Secondary objectives included the validity of self-reported physical capability and the association between baseline physical capability and mortality. METHODS The OSTPRE (Kuopio Osteoporosis Risk Factor and Prevention Study) prospective cohort involved all women aged 47-56 years residing in the Kuopio Province, Finland in 1989. Follow-up questionnaires were mailed at five-year intervals. Physical capability questions were first presented in 1994. From these women, we included only completely physically capable subjects at our baseline, in 1994. Physical capability was evaluated with five scale self-reports at baseline and in 2014 as follows: completely physically capable, able to walk but not run, can walk up to 1000 m, can walk up to 100 m and temporarily severely incapable. The prevalences of selected chronic diseases, with a minimum prevalence of 10% in 2014, were compared with the change in self-reported physical capability. Additionally, associations between long-term mortality and baseline physical capability of the whole 1994 study population sample were examined with logistic regression. The correlation of self-reported physical capability with functional tests was studied cross-sectionally at the baseline for a random subsample. RESULTS Our study population consisted of 6219 Finnish women with a mean baseline age of 57.0 years. Self-reported physical capability showed statistically significant correlation with functional tests. Cardiovascular diseases and musculoskeletal disorders show the greatest correlation with decrease of physical capability. Prevalence of hypertension increased from 48.7% in the full physical capability group to 74.5% in the "able to walk up to 100 metres" group (p < 0.001). Rheumatoid arthritis showed a similar increase from 2.1 to 7.4% between these groups. Higher baseline body mass index (BMI) decreases long-term capability (P < 0.001). Women reporting full physical capability at baseline had a mortality rate of 15.1%, in comparison to 48.5% in women within the "able to walk up to 100 m" group (p = 0.357). Mortality increased steadily with worsening baseline physical capability. CONCLUSIONS The results of this study show that chronic diseases, particularly cardiovascular and musculoskeletal disorders, correlate with faster degradation of physical capability in the elderly. Similar results are shown for increase in BMI. We also demonstrate that the risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability.
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Powder coating and dissolution rate modification of L-leucine supplements with hydrophilic fumed SiO2 nanoparticles by ultrasonic irradiation in high-pressure liquid CO2. J Supercrit Fluids 2021. [DOI: 10.1016/j.supflu.2020.105104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Skrzypczak D, Ratajczak AE, Szymczak-Tomczak A, Dobrowolska A, Eder P, Krela-Kaźmierczak I. A Vicious Cycle of Osteosarcopeniain Inflammatory Bowel Diseases-Aetiology, Clinical Implications and Therapeutic Perspectives. Nutrients 2021; 13:nu13020293. [PMID: 33498571 PMCID: PMC7909530 DOI: 10.3390/nu13020293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Sarcopenia is a disorder characterized by a loss of muscle mass which leads to the reduction of muscle strength and a decrease in the quality and quantity of muscle. It was previously thought that sarcopenia was specific to ageing. However, sarcopenia may affect patients suffering from chronic diseases throughout their entire lives. A decreased mass of muscle and bone is common among patients with inflammatory bowel disease (IBD). Since sarcopenia and osteoporosis are closely linked, they should be diagnosed as mutual consequences of IBD. Additionally, multidirectional treatment of sarcopenia and osteoporosis including nutrition, physical activity, and pharmacotherapy should include both disorders, referred to as osteosarcopenia.
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Overdevest E, Dorhout BG, Nicolaou M, van Valkengoed IGM, Haveman-Nies A, Oztürk H, de Groot LCPGM, Tieland M, Weijs PJM. Dietary Protein Intake in Older Adults from Ethnic Minorities in the Netherlands, a Mixed Methods Approach. Nutrients 2021; 13:nu13010184. [PMID: 33435317 PMCID: PMC7827587 DOI: 10.3390/nu13010184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 01/10/2023] Open
Abstract
Optimizing protein intake is a novel strategy to prevent age associated loss of muscle mass and strength in older adults. Such a strategy is still missing for older adults from ethnic minority populations. Protein intake in these populations is expected to be different in comparison to the majority of the population due to several socio-cultural factors. Therefore, the present study examined the dietary protein intake and underlying behavioral and environmental factors affecting protein intake among older adults from ethnic minorities in the Netherlands. We analyzed frequency questionnaire (FFQ) data from the Healthy Life in an Urban Setting (HELIUS) cohort using ANCOVA to describe dietary protein intake in older adults from ethnic minorities in the Netherlands (N = 1415, aged >55 years, African Surinamese, South Asian Surinamese, Moroccan, and Turkish). Additionally, we performed focus groups among older adults from the same ethnic minority populations (N = 69) to discover behavioral and environmental factors affecting protein intake; 40-60% of the subjects did not reach minimal dietary protein recommendations needed to maintain muscle mass (1.0 g/kg bodyweight per day (BW/day)), except for Turkish men (where it was 91%). The major sources of protein originated from animal products and were ethnic specific. Participants in the focus groups showed little knowledge and awareness about protein and its role in aging. The amount of dietary protein and irregular eating patterns seemed to be the major concern in these populations. Optimizing protein intake in these groups requires a culturally sensitive approach, which accounts for specific protein product types and sociocultural factors.
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Affiliation(s)
- Elvera Overdevest
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (H.O.); (M.T.); (P.J.M.W.)
- Correspondence: ; Tel.: +31-6-21155667
| | - Berber G. Dorhout
- Division of Human Nutrition and Health, Wageningen University & Research, 6700 EW Wageningen, The Netherlands; (B.G.D.); (L.C.P.G.M.d.G.)
| | - Mary Nicolaou
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands; (M.N.); (I.G.M.v.V.)
| | - Irene G. M. van Valkengoed
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands; (M.N.); (I.G.M.v.V.)
| | - Annemien Haveman-Nies
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, 6700 EW Wageningen, The Netherlands;
| | - Halime Oztürk
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (H.O.); (M.T.); (P.J.M.W.)
| | - Lisette C. P. G. M. de Groot
- Division of Human Nutrition and Health, Wageningen University & Research, 6700 EW Wageningen, The Netherlands; (B.G.D.); (L.C.P.G.M.d.G.)
| | - Michael Tieland
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (H.O.); (M.T.); (P.J.M.W.)
| | - Peter J. M. Weijs
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (H.O.); (M.T.); (P.J.M.W.)
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, VU University, 1081 HV Amsterdam, The Netherlands
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The efficacy of essential amino acid supplementation for augmenting dietary protein intake in older adults: implications for skeletal muscle mass, strength and function. Proc Nutr Soc 2020; 80:230-242. [PMID: 33315000 DOI: 10.1017/s0029665120008010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The primary aim of this review is to evaluate the efficacy of essential amino acid (EAA) supplementation as a strategy to increase dietary protein intake and improve muscle mass, strength and function in older adults. A sufficient daily protein intake is widely recognised to be fundamental for the successful management of sarcopenia in older undernourished adults. In practice, optimising protein intakes in older adults is complex, requiring consideration of the dose and amino acid composition (i.e. a complete EAA profile and abundant leucine content) of ingested protein on a per meal basis, alongside the age-related decline in appetite and the satiating properties of protein. Recent studies in older adults demonstrate that EAA-based supplements are non-satiating and can be administered alongside food to enhance the anabolic properties of a meal containing a suboptimal dose of protein; an effect magnified when combined with resistance exercise training. These findings support the notion that EAA supplementation could serve as an effective strategy to improve musculoskeletal health in older adults suffering from non-communicable diseases such as sarcopenia. Compliance is critical for the long-term success of complex interventions. Hence, aspects of palatability and desire to eat are important considerations regarding EAA supplementation. In conclusion, EAA-based supplements enriched with l-leucine offer an alternative strategy to whole protein sources to assist older adults in meeting protein recommendations. In practice, EAA supplements could be administered alongside meals of suboptimal protein content, or alternatively between meals on occasions when older adults achieve their per meal protein intake recommendations.
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Lu Y, Wang YJ, Lu Q. The effect of oral nutritional supplement on muscle fitness of patients undergoing dialysis: A systematic review and meta-analysis. J Adv Nurs 2020; 77:1716-1730. [PMID: 33270269 DOI: 10.1111/jan.14684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/18/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022]
Abstract
AIM To summarize evidence regarding the effects of oral nutritional supplement on muscle fitness of patients undergoing dialysis. DESIGN A systematic review and meta-analysis. REVIEW SOURCES Five English databases (CENTRAL, PubMed, EMBASE, CINHAL, and Web of Science) and four Chinese databases (CNKI, WanFang, SinoMed, and VIP) were searched from inception to 31 July 2019 and only randomized controlled trials were included. REVIEW METHODS Two reviewers independently searched these databases, selected trials, conducted bias assessment, extracted the data. Random-effects meta-analysis was conducted to assess the effect size. The predetermined subgroup included type of oral nutritional supplement (a mixture of macronutrients, whey protein, essential amino-acids, and other nutrients) and intervention duration (over and less than 48 weeks). The subgroup analyses and sensitivity analyses were conducted to explore source of heterogeneity and robustness of results. RESULTS Sixteen studies (910 participants) meeting the inclusion criteria were identified and included in this systematic review. Subgroup analysis showed that supplying a mixture of macronutrients (MD [MD] = 2.36 kg, 95% CI [0.45, 4.26], I2 = 0.00%), an intervention duration of 48 weeks (MD = 4.05 kg, 95% CI [1.43, 6.67], I2 = 0.00%) had some effects on increasing lean body mass. No effects of oral nutritional supplement were found on improving muscle strength or physical performance. CONCLUSION A mixture of macronutrients and an intervention duration as long as 48 weeks had some significant effects on improving lean body mass of patients undergoing dialysis. No effect of oral nutritional supplement on muscle strength or physical performance were found but with limited evidence. IMPACT No existing reviews have ever focused on improving muscle fitness of patients undergoing dialysis. This systematic review and meta-analysis provided evidence of oral nutritional supplement on keeping muscle fitness of these patients and suggested possible type of oral nutritional supplement and intervention duration for clinical practice.
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Affiliation(s)
- Yue Lu
- School of Nursing, Peking University, Beijing, China
| | - Yu-Jie Wang
- School of Nursing, Peking University, Beijing, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China
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Reinders I, Wijnhoven HAH, Jyväkorpi SK, Suominen MH, Niskanen R, Bosmans JE, Brouwer IA, Fluitman KS, Klein MCA, Kuijper LD, van der Lubbe LM, Olthof MR, Pitkälä KH, Vijlbrief R, Visser M. Effectiveness and cost-effectiveness of personalised dietary advice aiming at increasing protein intake on physical functioning in community-dwelling older adults with lower habitual protein intake: rationale and design of the PROMISS randomised controlled trial. BMJ Open 2020; 10:e040637. [PMID: 33444206 PMCID: PMC7682452 DOI: 10.1136/bmjopen-2020-040637] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/18/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Short-term metabolic and observational studies suggest that protein intake above the recommended dietary allowance of 0.83 g/kg body weight (BW)/day may support preservation of lean body mass and physical function in old age, but evidence from randomised controlled trials is inconclusive. METHODS AND ANALYSIS The PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS) trial examines the effect of personalised dietary advice aiming at increasing protein intake with or without advice regarding timing of protein intake to close proximity of usual physical activity, on change in physical functioning after 6 months among community-dwelling older adults (≥65 years) with a habitual protein intake of <1.0 g/kg adjusted (a)BW/day. Participants (n=264) will be recruited in Finland and the Netherlands, and will be randomised into three groups; two intervention groups and one control group. Intervention group 1 (n=88) receives personalised dietary advice and protein-enriched food products in order to increase their protein intake to at least 1.2 g/kg aBW/day. Intervention group 2 (n=88) receives the same advice as described for intervention group 1, and in addition advice to consume 7.5-10 g protein through protein-(en)rich(ed) foods within half an hour after performing usual physical activity. The control group (n=88) receives no intervention. All participants will be invited to attend lectures not related to health. The primary outcome is a 6-month change in physical functioning measured by change in walk time using a 400 m walk test. Secondary outcomes are: 6-month change in the Short Physical Performance Battery score, muscle strength, body composition, self-reported mobility limitations, quality of life, incidence of frailty, incidence of sarcopenia risk and incidence of malnutrition. We also investigate cost-effectiveness by change in healthcare costs. DISCUSSION The PROMISS trial will provide evidence whether increasing protein intake, and additionally optimising the timing of protein intake, has a positive effect on the course of physical functioning after 6 months among community-dwelling older adults with a habitual protein intake of <1.0 g/kg aBW/day. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Helsinki University Central Hospital, Finland (ID of the approval: HUS/1530/2018) and The Medical Ethical Committee of the Amsterdam UMC, location VUmc, Amsterdam, the Netherlands (ID of the approval: 2018.399). All participants provided written informed consent prior to being enrolled onto the study. Results will be submitted for publication in peer-reviewed journals and will be made available to stakeholders (ie, older adults, healthcare professionals and industry). TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03712306).
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Affiliation(s)
- Ilse Reinders
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Satu K Jyväkorpi
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Merja H Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Riikka Niskanen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ingeborg A Brouwer
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kristien S Fluitman
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, The Netherlands
- Wallenburg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michel C A Klein
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lothar D Kuijper
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura M van der Lubbe
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Rachel Vijlbrief
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Tagawa R, Watanabe D, Ito K, Ueda K, Nakayama K, Sanbongi C, Miyachi M. Dose-response relationship between protein intake and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2020; 79:nuaa104. [PMID: 33300582 PMCID: PMC7727026 DOI: 10.1093/nutrit/nuaa104] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Lean body mass is essential for health, yet consensus regarding the effectiveness of protein interventions in increasing lean body mass is lacking. OBJECTIVE The aim of this systematic review was to evaluate the dose-response relationship of the effects of protein intake on lean body mass. DATA SOURCES The PubMed and Ichushi-Web databases were searched electronically, and reference lists of the literature included here and in other meta-analyses were searched manually. STUDY SELECTION Randomized controlled trials evaluating the effects of protein intake on lean body mass were included. DATA EXTRACTION Two authors independently screened the abstracts; 5 reviewed the full texts. RESULTS A total of 5402 study participants from 105 articles were included. In the multivariate spline model, the mean increase in lean body mass associated with an increase in protein intake of 0.1 g/kg of body weight per day was 0.39 kg (95%CI, 0.36-0.41) and 0.12 kg (95%CI, 0.11-0.14) below and above the total protein intake of 1.3 g/kg/d, respectively. CONCLUSIONS These findings suggest that slightly increasing current protein intake for several months by 0.1 g/kg/d in a dose-dependent manner over a range of doses from 0.5 to 3.5 g/kg/d may increase or maintain lean body mass. SYSTEMATIC REVIEW REGISTRATION UMIN registration number UMIN000039285.
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Affiliation(s)
- Ryoichi Tagawa
- Nutrition and Food Function Research Department, Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co, Ltd, Tokyo, Japan
| | - Daiki Watanabe
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Kyoko Ito
- Nutrition and Food Function Research Department, Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co, Ltd, Tokyo, Japan
| | - Keisuke Ueda
- Nutrition and Food Function Research Department, Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co, Ltd, Tokyo, Japan
| | - Kyosuke Nakayama
- Nutrition and Food Function Research Department, Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co, Ltd, Tokyo, Japan
| | - Chiaki Sanbongi
- Nutrition and Food Function Research Department, Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co, Ltd, Tokyo, Japan
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
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Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty. Nutrients 2020; 12:nu12113367. [PMID: 33139628 PMCID: PMC7693664 DOI: 10.3390/nu12113367] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction may be common mechanisms shared by frailty and cognitive impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, and malnutrition are important risk factors for cognitive impairment and frailty in older adults with diabetes. The impact of nutrients on health outcomes varies with age; thus, shifting diet therapy strategies from the treatment of obesity/metabolic syndrome to frailty prevention may be necessary in patients with diabetes who are over 75 years of age, have frailty or sarcopenia, and experience malnutrition. For the prevention of frailty, optimal energy intake, sufficient protein and vitamin intake, and healthy dietary patterns should be recommended. The treatment of diabetes after middle age should include the awareness of proper glycemic control aimed at extending healthy life expectancy with proper nutrition, exercise, and social connectivity. Nutritional therapy in combination with exercise, optimal glycemic and metabolic control, and social participation/support for frailty prevention can extend healthy life expectancy and maintain quality of life in older adults with diabetes mellitus.
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van Wijngaarden JP, Wojzischke J, van den Berg C, Cetinyurek-Yavuz A, Diekmann R, Luiking YC, Bauer JM. Effects of Nutritional Interventions on Nutritional and Functional Outcomes in Geriatric Rehabilitation Patients: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2020; 21:1207-1215.e9. [PMID: 32723538 DOI: 10.1016/j.jamda.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/19/2020] [Accepted: 04/13/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES It has been recognized that nutritional interventions play a role in improving the nutritional and functional status of older persons. This systematic review summarizes the evidence on nutritional and functional outcomes of nutritional interventions alone or in combination with physical exercise in geriatric rehabilitation patients. DESIGN Eight electronic databases were searched until July 1, 2019 to identify nutritional intervention studies in patients aged ≥60 years who were admitted to geriatric rehabilitation. A meta-analysis was performed to quantify intervention effects on serum albumin, muscle mass, and hand grip strength (HGS). RESULTS A total of 1962 studies were screened and 13 included in the systematic review. Studies were heterogeneous in interventions (4 nutritional interventions, 6 physical exercise + nutritional intervention, 1 timing of protein provision, 1 exercise + dietary advice, 1 nutrition-related nursing care) and outcomes. Among the 9 interventions that tested oral nutritional supplements (ONS) with protein, with or without exercise, 7 studies reported protein intake and 6 showed increased protein intakes, 2 of 5 studies showed increased albumin levels, and 5 of 9 reported an improvement in functional outcomes (BI, Functional Independence Measure, mobility). Meta-analyses showed no significant intervention effects on albumin [standardized mean difference (SMD) 0.45, 95% confidence interval (CI) -0.14, 1.04 (4 studies)], muscle mass [mean difference (MD) 2.14 kg, 95% CI -2.17, 6.45 (3 studies)], and HGS [SMD -0.04, 95% CI -0.55, 0.63 (3 studies)], but was based on a very limited number of studies. CONCLUSIONS AND IMPLICATIONS Only a limited number of studies with heterogeneous nutritional interventions and outcomes were available in the geriatric rehabilitation population. Studies that included ONS improved nutritional outcomes, especially protein intake and albumin levels. Functional outcomes improved in the majority of reporting studies. This indicates benefits of protein supplementation, with or without exercise, in this population. Future well-designed and well-powered clinical trials are needed to clarify existing controversial aspects.
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Affiliation(s)
| | - Julia Wojzischke
- Carl von Ossietzky Universität Oldenburg, Department of Health Services Research, Oldenburg, Germany
| | - Claudia van den Berg
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | | | - Rebecca Diekmann
- Carl von Ossietzky Universität Oldenburg, Department of Health Services Research, Oldenburg, Germany
| | - Yvette C Luiking
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, the Netherlands
| | - Jürgen M Bauer
- Center for Geriatric Medicine, and Network Aging Research, University Heidelberg, Heidelberg, Germany
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McKendry J, Currier BS, Lim C, Mcleod JC, Thomas AC, Phillips SM. Nutritional Supplements to Support Resistance Exercise in Countering the Sarcopenia of Aging. Nutrients 2020; 12:E2057. [PMID: 32664408 PMCID: PMC7399875 DOI: 10.3390/nu12072057] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022] Open
Abstract
Skeletal muscle plays an indispensable role in metabolic health and physical function. A decrease in muscle mass and function with advancing age exacerbates the likelihood of mobility impairments, disease development, and early mortality. Therefore, the development of non-pharmacological interventions to counteract sarcopenia warrant significant attention. Currently, resistance training provides the most effective, low cost means by which to prevent sarcopenia progression and improve multiple aspects of overall health. Importantly, the impact of resistance training on skeletal muscle mass may be augmented by specific dietary components (i.e., protein), feeding strategies (i.e., timing, per-meal doses of specific macronutrients) and nutritional supplements (e.g., creatine, vitamin-D, omega-3 polyunsaturated fatty acids etc.). The purpose of this review is to provide an up-to-date, evidence-based account of nutritional strategies to enhance resistance training-induced adaptations in an attempt to combat age-related muscle mass loss. In addition, we provide insight on how to incorporate the aforementioned nutritional strategies that may support the growth or maintenance of skeletal muscle and subsequently extend the healthspan of older individuals.
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Affiliation(s)
| | | | | | | | | | - Stuart M. Phillips
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada; (J.M.); (B.S.C.); (C.L.); (J.C.M.); (A.C.Q.T.)
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Gedmantaite A, Celis-Morales C, Ho F, Pell JP, Ratkevicius A, Gray S. Associations between diet and handgrip strength: a cross-sectional study from UK Biobank. Mech Ageing Dev 2020; 189:111269. [DOI: 10.1016/j.mad.2020.111269] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 12/13/2022]
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Phillips SM, Paddon-Jones D, Layman DK. Optimizing Adult Protein Intake During Catabolic Health Conditions. Adv Nutr 2020; 11:S1058-S1069. [PMID: 32666115 PMCID: PMC7360447 DOI: 10.1093/advances/nmaa047] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/12/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
The DRIs define a range of acceptable dietary intakes for each nutrient. The range is defined from the minimum intake to avoid risk of inadequacy (i.e., the RDA) up to an upper limit (UL) based on a detectable risk of adverse effects. For most nutrients, the minimum RDA is based on alleviating a clear deficiency condition, whereas higher intakes are often recommended to optimize specific health outcomes. Evidence is accumulating that similar logic should be applied to dietary recommendations for protein. Although the RDA for protein of 0.8 g/kg body weight is adequate to avoid obvious inadequacies, multiple studies provide evidence that many adults may benefit from protein quantity, quality, and distribution beyond guidelines currently defined by the RDA. Further, the dietary requirement for protein is a surrogate for the constituent amino acids and, in particular, the 9 considered to be indispensable. Leucine provides an important example of an essential amino acid where the RDA of 42 mg/kg body weight is significantly less than the 100-110 mg/kg required to optimize metabolic regulation and skeletal muscle protein synthesis. This review will highlight the benefits of higher protein diets to optimize health during aging, inactivity, bed rest, or metabolic dysfunction such as type 2 diabetes.
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Affiliation(s)
| | - Douglas Paddon-Jones
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX, USA
| | - Donald K Layman
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Uremic Sarcopenia: Clinical Evidence and Basic Experimental Approach. Nutrients 2020; 12:nu12061814. [PMID: 32570738 PMCID: PMC7353433 DOI: 10.3390/nu12061814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Sustained physical activity extends healthy life years while a lower activity due to sarcopenia can reduce them. Sarcopenia is defined as a decrease in skeletal muscle mass and strength due not only to aging, but also from a variety of debilitating chronic illnesses such as cancer and heart failure. Patients with chronic kidney disease (CKD), who tend to be cachexic and in frail health, may develop uremic sarcopenia or uremic myopathy due to an imbalance between muscle protein synthesis and catabolism. Here, we review clinical evidence indicating reduced physical activity as renal function deteriorates and explore evidence-supported therapeutic options focusing on nutrition and physical training. In addition, although sarcopenia is a clinical concept and difficult to recapitulate in basic research, several in vivo approaches have been attempted, such as rodent subtotal nephrectomy representing both renal dysfunction and muscle weakness. This review highlights molecular mechanisms and promising interventions for uremic sarcopenia that were revealed through basic research. Extensive study is still needed to cast light on the many aspects of locomotive organ impairments in CKD and explore the ways that diet and exercise therapies can improve both outcomes and quality of life at every level.
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Markofski MM, Jennings K, Timmerman KL, Dickinson JM, Fry CS, Borack MS, Reidy PT, Deer RR, Randolph A, Rasmussen BB, Volpi E. Effect of Aerobic Exercise Training and Essential Amino Acid Supplementation for 24 Weeks on Physical Function, Body Composition, and Muscle Metabolism in Healthy, Independent Older Adults: A Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2020; 74:1598-1604. [PMID: 29750251 DOI: 10.1093/gerona/gly109] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Essential amino acids (EAA) and aerobic exercise (AE) acutely and independently stimulate skeletal muscle protein anabolism in older adults. OBJECTIVE In this Phase 1, double-blind, placebo-controlled, randomized clinical trial, we determined if chronic EAA supplementation, AE training, or a combination of the two interventions could improve muscle mass and function by stimulating muscle protein synthesis. METHODS We phone-screened 971, enrolled 109, and randomized 50 independent, low-active, nonfrail, and nondiabetic older adults (age 72 ± 1 years). We used a 2 × 2 factorial design. The interventions were: daily nutritional supplementation (15 g EAA or placebo) and physical activity (supervised AE training 3 days/week or monitored habitual activity) for 24 weeks. Muscle strength, physical function, body composition, and muscle protein synthesis were measured before and after the 24-week intervention. RESULTS Forty-five subjects completed the 24-week intervention. VO2peak and walking speed increased (p < .05) in both AE groups, irrespective of supplementation type, but muscle strength increased only in the EAA + AE group (p < .05). EAA supplementation acutely increased (p < .05) muscle protein synthesis from basal both before and after the intervention, with a larger increase in the EAA + AE group after the intervention. Total and regional lean body mass did not change significantly with any intervention. CONCLUSIONS In nonfrail, independent, healthy older adults AE training increased walking speed and aerobic fitness, and, when combined with EAA supplementation, it also increased muscle strength and EAA-stimulated muscle protein synthesis. These increases occurred without improvements in muscle mass.
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Affiliation(s)
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Kyle L Timmerman
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Jared M Dickinson
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston
| | - Christopher S Fry
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston.,Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston
| | - Michael S Borack
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Paul T Reidy
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Rachel R Deer
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Amanda Randolph
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Blake B Rasmussen
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Internal Medicine, University of Texas Medical Branch, Galveston
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Effects of slow- v. fast-digested protein supplementation combined with mixed power training on muscle function and functional capacities in older men. Br J Nutr 2020; 125:1017-1033. [PMID: 32498755 DOI: 10.1017/s0007114520001932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Ageing leads to a progressive loss of muscle function (MF) and quality (MQ: muscle strength (MS)/lean muscle mass (LM)). Power training and protein (PROT) supplementation have been proposed as efficient interventions to improve MF and MQ. Discrepancies between results appear to be mainly related to the type and/or dose of proteins used. The present study aimed at determining whether or not mixed power training (MPT) combined with fast-digested PROT (F-PROT) leads to greater improvements in MF and MQ in elderly men than MPT combined with slow-digested PROT (S-PROT) or MPT alone. Sixty elderly men (age 69 (sd 7) years; BMI 18-30 kg/m2) were randomised into three groups: (1) placebo + MPT (PLA; n 19); (2) F-PROT + MPT (n 21) and (3) S-PROT + MPT (n 20) completed the intervention. LM, handgrip and knee extensor MS and MQ, functional capacity, serum metabolic markers, skeletal muscle characteristics, dietary intake and total energy expenditure were measured. The interventions consisted in 12 weeks of MPT (3 times/week; 1 h/session) combined with a supplement (30 g:10 g per meal) of F-PROT (whey) or S-PROT (casein) or a placebo. No difference was observed among groups for age, BMI, number of steps and dietary intake pre- and post-intervention. All groups improved significantly their LM, lower limb MS/MQ, functional capacity, muscle characteristics and serum parameters following the MPT. Importantly, no difference between groups was observed following the MPT. Altogether, adding 30 g PROT/d to MPT, regardless of the type, does not provide additional benefits to MPT alone in older men ingesting an adequate (i.e. above RDA) amount of protein per d.
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Reinders I, Visser M, Wijnhoven H. Two dietary advice strategies to increase protein intake among community-dwelling older adults: A feasibility study. Clin Nutr ESPEN 2020; 37:157-167. [DOI: 10.1016/j.clnesp.2020.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/13/2020] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
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