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Amlashi MA, Jafarpour A, Eirdmousa MH, Homayounfar R, Farjam M, Askari A. Association between diet protein score comprising plants to animal protein ratio and body composition in an Iranian population. Sci Rep 2024; 14:28092. [PMID: 39543353 PMCID: PMC11564702 DOI: 10.1038/s41598-024-79982-z] [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: 07/21/2024] [Accepted: 11/13/2024] [Indexed: 11/17/2024] Open
Abstract
Obesity is increasingly recognized as a leading cause of death and is associated with various comorbidities. This study evaluates the relationship between protein score, characterized by the plant-to-animal protein ratio (PAR) and total protein per calorie (Pro%), and body composition: fat percentage (FATP), fat mass (FATM), and fat-free mass (FFM). We categorized 4512 individuals (55.2% female) into tertiles based on their protein score and its components. Male participants in the highest and middle protein score tertiles exhibited significantly greater FFM in both adjusted and crude models, and lower FATP and FATM in adjusted model 2. FFM was elevated in the top (P < 0.001) and middle (P = 0.002) Pro% tertiles in males in both adjusted models and only in the top tertile of all models in females (P = 0.003). The analysis of male participants revealed significantly lower FATP and FATM in the highest tertiles of Pro% in adjusted models. Among female participants, only the highest PAR tertile was associated with significantly lower FATM in adjusted model 1 (P = 0.042). Our findings indicate that protein score and its components are associated with favorable body composition differences. Health administrators may leverage these insights to refine dietary guidelines.
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Affiliation(s)
- Manoochehr Amin Amlashi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Jafarpour
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Hafezi Eirdmousa
- Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Reza Homayounfar
- Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Alireza Askari
- Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Orthopedics Hospital, Iran University of Medical Sciences, Tehran, Iran
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Muroga Y, Kaga H, Bui TH, Sugimoto M, Someya Y, Kakehi S, Tabata H, Naito H, Abudurezake A, Shi H, Otsuka H, Yoshizawa Y, Kawamori R, Watada H, Tamura Y. Dietary characteristics of urban community-dwelling older adults with low muscle mass: the bunkyo health study: a cross-sectional study. BMC Geriatr 2024; 24:614. [PMID: 39026160 PMCID: PMC11256605 DOI: 10.1186/s12877-024-05218-4] [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: 02/10/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND With the aging of the population worldwide, extending healthy life expectancy is an urgent issue. Muscle mass has been reported to be associated with physical independence and longevity. This study aimed to investigate the characteristics of food intake in urban community-dwelling older adults with low muscle mass. METHODS This cross-sectional study used baseline data from the Bunkyo Health Study, which included 1618 urban community-dwelling older adults aged 65-84 years. All participants underwent measurement of body composition using bioelectrical impedance analysis and evaluation of nutrient and food intake using the brief-type self-administered diet history questionnaire. Participants were stratified by sex and divided into robust or low skeletal muscle mass index (SMI) groups according to the Asian Working Group for Sarcopenia criteria to compare differences in nutrient and food intake. RESULTS The mean age and body mass index were 73.1 ± 5.4 years and 22.6 ± 3.1 kg/m2, respectively. The prevalence of low SMI was 31.1% in men and 43.3% in women. In men, all food intake, including total energy intake, was similar between the low SMI group and the robust group. In women, the low SMI group had less total energy intake, and consumed lower amounts of energy-producing nutrients (protein, fat, and carbohydrates), but there were only small differences in the intake of specific foods. CONCLUSIONS There were sex differences in food intake characteristics between urban community-dwelling older adults with low SMI and those who were robust. Advising women to increase their energy intake may be important in preventing muscle loss, and further research is needed in men.
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Grants
- KAKENHI (18H03184) the Ministry of Education, Culture, Sports, Science, and Technology of Japan
- KAKENHI (18H03184) the Ministry of Education, Culture, Sports, Science, and Technology of Japan
- KAKENHI (18H03184) the Ministry of Education, Culture, Sports, Science, and Technology of Japan
- KAKENHI (18H03184) the Ministry of Education, Culture, Sports, Science, and Technology of Japan
- the Mizuno Sports Promotion Foundation
- the Mitsui Life Social Welfare Foundation
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Affiliation(s)
- Yukiko Muroga
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hideyoshi Kaga
- Department of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Thu Hien Bui
- Department of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mari Sugimoto
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuki Someya
- Department of Sportology Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Saori Kakehi
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Sportology Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroki Tabata
- Department of Sportology Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Center for Healthy Life Expectancy, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hitoshi Naito
- Department of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Abulaiti Abudurezake
- Department of Sportology Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Huicong Shi
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hikaru Otsuka
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yasuyo Yoshizawa
- Department of Center for Healthy Life Expectancy, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryuzo Kawamori
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Sportology Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hirotaka Watada
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Sportology Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshifumi Tamura
- Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Metabolism and Endocrinology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Sportology Center, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Center for Healthy Life Expectancy, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Chen S, Lin X, Ma J, Li M, Chen Y, Fang AP, Zhu HL. Dietary protein intake and changes in muscle mass measurements in community-dwelling middle-aged and older adults: A prospective cohort study. Clin Nutr 2023; 42:2503-2511. [PMID: 37922694 DOI: 10.1016/j.clnu.2023.10.017] [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: 05/27/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND & AIMS Increasing dietary protein intake can be an efficient strategy to prevent sarcopenia. Nevertheless, due to the discrepancy in the population and their dietary pattern, evidence suggested the effects of dietary protein amount or source on sarcopenia prevention varies. This prospective cohort study investigated the correlation between dietary protein intakes or sources and changes in muscle mass measurements. Additionally, the study explored the link between dietary protein and the prevalence of sarcopenia. METHODS Participants aged 40 to 75 were from Guangzhou Nutrition and Health Study (GNHS) 2011-2013 and returned in 2014-2017. Validated 79-item food frequency questionnaires were applied to calculate the amount of total, animal, and plant protein intakes and animal-to-plant protein ratio (APR). The body composition was examined by dual-energy x-ray absorptiometry (DXA) to calculate the appendicular lean mass (ALM) and its index (ASMI). Sarcopenia was diagnosed based on the 2019 Asia Working Group of Sarcopenia's criteria. ANCOVA was utilized to compare the differences of Δ ALM and Δ ASMI across the quartiles of the dietary protein, and linear regression was employed to examine dose-response associations. Multilinear mixed-effect models were employed to evaluate whether protein intake relates to annual changes in ALM and ASMI. Multivariable logistic regressions were performed to analyze the associations between dietary protein and sarcopenia. RESULTS In total, 2709 participants during the 3.2-year follow-up period were considered eligible for analysis. Higher dietary protein intakes (total, animal, plant) in both sexes could preserve more ALM and ASMI in a dose-response manner (all P-trend < 0.05). The annual estimated preservations of ASMI were greater in the highest dietary protein intakes (total, animal, plant) quartile than the lowest (0.05-0.13 kg/m2/y, all P < 0.05). In women, the risk of sarcopenia was reduced by 35%-50 % in the highest protein intake (total, animal, plant) quartile than the lowest. The APR did not display any significant associations. CONCLUSIONS Higher dietary protein intake, regardless of animal or plant sources, is associated with less muscle loss and a lower prevalence of sarcopenia in middle-aged and older Chinese, particularly women. CLINICALTRIALS GOV IDENTIFIER NCT03179657.
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Affiliation(s)
- Si Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xinlei Lin
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jingfei Ma
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Mengchu Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuming Chen
- Department of Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ai-Ping Fang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Hui-Lian Zhu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Lin Y, Wang X, Wu R, Zhou J, Feng F. Association between segmental body composition and bone mineral density in US adults: results from the NHANES (2011-2018). BMC Endocr Disord 2023; 23:246. [PMID: 37940909 PMCID: PMC10634103 DOI: 10.1186/s12902-023-01506-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE The association between segmental body composition and bone mineral density (BMD) remains uncertain. The primary aim of this cross-sectional investigation was to elucidate the connection between segmental body composition and BMD within the United States adult population. METHODS We selected a cohort of 10,096 individuals from the National Health and Nutrition Examination Survey (NHANES) database, with a mean age of 39 years and a mean BMI of 28.5 kg/m². The parameter of segmental body composition was achieved by quantifying body fat and lean mass percentages across various anatomical regions, including the torso, Android, Gynoid, arms and legs. We conducted a weighted multivariate linear regression analysis to investigate the association between segmental body composition and total BMD. Additionally, subgroup analysis was performed based on age and gender. RESULTS We found an inverse association between fat proportion in each anatomical region and total BMD, with the arm and leg regions demonstrating the most significant negative correlation. Conversely, a positive correlation was observed between lean mass and BMD across all anatomical regions. These associations remained consistent in subgroup analyses. CONCLUSION Our investigation revealed a negative association between adipose levels in various anatomical regions and BMD among Americans aged 20 to 59. Importantly, higher fat proportion in the extremities exerted the most deleterious impact on BMD. Furthermore, an increase in lean mass within each anatomical region was ascertained to confer a positive effect on bone health. Consequently, the evaluation of segmental body composition is well-positioned to predict bone health status.
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Affiliation(s)
- Yanze Lin
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xun Wang
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ruiji Wu
- Orthopedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, China
| | - Jinlei Zhou
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fabo Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
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5
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Tay W, Quek R, Lim J, Kaur B, Ponnalagu S, Henry CJ. Plant-based alternative proteins-are they nutritionally more advantageous? Eur J Clin Nutr 2023; 77:1051-1060. [PMID: 37580584 DOI: 10.1038/s41430-023-01328-1] [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: 12/23/2022] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The transition towards sustainable nutrition as well as the exploration of alternative sources of protein have been at the forefront of thinking in the 21st century. However, further research is required to ascertain if a diet composed of alternative plant-based proteins has similar nutritional advantages to a plant-based diet. This study aims to model the replacement of a diet consisting of animal-based proteins with plant-based alternatives (PBA), in a group of Asians. METHODS A 4-day food record was collected from 50 individuals residing in Singapore and nutrient profiles were generated for each individual. Food records were analysed, and meat, dairy, and seafood ingredients were substituted gram-for-gram with their PBA. The original and replaced nutrient profiles were compared against each other and the differences in macro and micronutrients were analysed. RESULTS A significant increase in carbohydrates, dietary fibre, as well as in micronutrients such as sodium and calcium was observed. Conversely, there was a significant decreased intake in overall energy, protein and fat (p < 0.005). CONCLUSIONS The significant nutritional impact of substituting animal-based proteins for PBA may present benefits for bone health and individuals on a caloric restriction diet. However, higher sodium levels may be undesirable for individuals with cardiovascular conditions and hypertension, and the low bioavailability of iron in plant-based sources may present issues for iron deficient populations. Bearing some of these key findings in mind, researchers and manufacturers need to consider these when developing alternative protein products to meet consumer demands for palatable and nutritious plant-based products.
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Affiliation(s)
- Wesley Tay
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Rina Quek
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Joseph Lim
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Bhupinder Kaur
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Shalini Ponnalagu
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore.
- Department of Biochemistry, National University of Singapore, 8 Medical Drive, Singapore, 117596, Singapore.
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Hiol AN, von Hurst PR, Conlon CA, Beck KL. Associations of protein intake, sources and distribution on muscle strength in community-dwelling older adults living in Auckland, New Zealand. J Nutr Sci 2023; 12:e94. [PMID: 37649694 PMCID: PMC10465299 DOI: 10.1017/jns.2023.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
Protein intake, sources and distribution impact on muscle protein synthesis and muscle mass in older adults. However, it is less clear whether dietary protein influences muscle strength. Data were obtained from the Researching Eating Activity and Cognitive Health (REACH) study, a cross-sectional study aimed at investigating dietary patterns, cognitive function and metabolic syndrome in older adults aged 65-74 years. Dietary intake was assessed using a 4-d food record and muscle strength using a handgrip strength dynamometer. After adjusting for confounders, in female older adults (n 212), total protein intake (β = 0⋅22, P < 0⋅01); protein from dairy and eggs (β = 0⋅21, P = 0⋅03) and plant food sources (β = 0⋅60, P < 0⋅01); and frequently consuming at least 0⋅4 g/kg BW per meal (β = 0⋅08, P < 0⋅01) were associated with higher BMI-adjusted muscle strength. However, protein from meat and fish intake and the coefficient of variance of protein intake were not related to BMI-muscle strength in female older adults. No statistically significant associations were observed in male participants (n = 113). There may be sex differences when investigating associations between protein intake and muscle strength in older adults. Further research is needed to investigate these sex differences.
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Affiliation(s)
- Anne N. Hiol
- School of Sport, Exercise and Nutrition, Massey University, North Shore City 0632, New Zealand
| | - Pamela R. von Hurst
- School of Sport, Exercise and Nutrition, Massey University, North Shore City 0632, New Zealand
| | - Cathryn A. Conlon
- School of Sport, Exercise and Nutrition, Massey University, North Shore City 0632, New Zealand
| | - Kathryn L. Beck
- School of Sport, Exercise and Nutrition, Massey University, North Shore City 0632, New Zealand
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Khan J, Chattopadhyay A, Shaw S. Assessment of nutritional status using anthropometric index among older adult and elderly population in India. Sci Rep 2023; 13:13015. [PMID: 37563173 PMCID: PMC10415320 DOI: 10.1038/s41598-023-39167-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Malnutrition poses a significant risk to the older population globally, highlighting the critical role of nutrition in healthy aging. In this study, the aim is to estimate the prevalence of malnutrition among older adults aged 45-59 years and the elderly population aged 60 years and above based on their socioeconomic and demographic characteristics. Furthermore, the study examines the risk factors within a multivariate framework. A sample of 59,073 individuals aged 45 years and above from the Longitudinal Aging Study in India (LASI), Wave 1 survey constitutes the study population. This study adopts a cross-sectional design. Bivariate cross-tabulation analysis and multivariate logistic regression analysis are employed to understand the prevalence and determinants of nutritional status. About 25% of males and 37% of females below the age of 60 years are overweight (including obese), while among those aged 60 years and above, 28% of males and 25% of females are underweight. The elderly male population carries a comparatively higher burden of underweight (28%) prevalence than the females (25%) in the same age group. Overall, the urban population is less likely to be underweight [AOR: 0.41, C.I 0.38-0.43] and more likely to be overweight [AOR: 2.41, C.I 2.32-2.52]. Older adults from low economic and social strata are more likely to be underweight. In terms of bio-physical factors, individuals aged 60 years and above with infections to endemic diseases [AOR: 1.24; p-value < 0.01] and those with edentulism [AOR: 1.29; p-value < 0.01] are more likely to be underweight. As evident from the study, nutritional status among older adults is a complicated manifestation of multiple risk factors and requires potential nutritional intervention. Initiating a routine screening program at the grassroots level can effectively identify older adults and the elderly in India, facilitating the provision of nutritional care.
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Affiliation(s)
- Junaid Khan
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Aparajita Chattopadhyay
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Subhojit Shaw
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
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Chen Y, Wu J, Yu D, Liu M. Plant or Animal-Based or PLADO Diets: Which Should Chronic Kidney Disease Patients Choose? J Ren Nutr 2023; 33:228-235. [PMID: 35809890 DOI: 10.1053/j.jrn.2022.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 12/27/2022] Open
Abstract
Nutrition therapy is the cornerstone treatment for chronic kidney disease (CKD). Although much attention has been given to dietary protein intake in CKD patients, many findings now demonstrate that the type of dietary protein intake may be more critical for CKD patients. In protein bioavailability and malnutrition prevention, many physicians recommend that CKD patients adhere to a low protein diet and restrict their plant foods, such as vegetables, fruits, and soybeans. However, nephrologists should not ignore the potential benefits of plant foods for CKD patients. It is not advisable to restrict the intake of plant foods in the later stage of CKD simply to prevent the development of hyperkalemia and malnutrition. This article highlights the benefits and possible problems of a plant-dominant low protein diet (PLADO) diet, defined as an LPD with dietary protein intake of 0.6-0.8 g/kg/day with at least 50% plant-based source for CKD patients. We hope to provide new opinions for clinical work and CKD patients.
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Affiliation(s)
- Ye Chen
- Department of Nephrology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinlan Wu
- Department of Nephrology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dan Yu
- Department of Clinical Nutrition, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Maodong Liu
- Department of Nephrology, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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van der Heijden I, Monteyne AJ, Stephens FB, Wall BT. Alternative dietary protein sources to support healthy and active skeletal muscle aging. Nutr Rev 2023; 81:206-230. [PMID: 35960188 DOI: 10.1093/nutrit/nuac049] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
To mitigate the age-related decline in skeletal muscle quantity and quality, and the associated negative health outcomes, it has been proposed that dietary protein recommendations for older adults should be increased alongside an active lifestyle and/or structured exercise training. Concomitantly, there are growing environmental concerns associated with the production of animal-based dietary protein sources. The question therefore arises as to where this dietary protein required for meeting the protein demands of the rapidly aging global population should (or could) be obtained. Various non-animal-derived protein sources possess favorable sustainability credentials, though much less is known (compared with animal-derived proteins) about their ability to influence muscle anabolism. It is also likely that the anabolic potential of various alternative protein sources varies markedly, with the majority of options remaining to be investigated. The purpose of this review was to thoroughly assess the current evidence base for the utility of alternative protein sources (plants, fungi, insects, algae, and lab-grown "meat") to support muscle anabolism in (active) older adults. The solid existing data portfolio requires considerable expansion to encompass the strategic evaluation of the various types of dietary protein sources. Such data will ultimately be necessary to support desirable alterations and refinements in nutritional guidelines to support healthy and active aging, while concomitantly securing a sustainable food future.
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Affiliation(s)
- Ino van der Heijden
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alistair J Monteyne
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Francis B Stephens
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Benjamin T Wall
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Mey GM, Mey JT. Emerging Nutrition Approaches to Support the Mind and Muscle for Healthy Aging. RECENT PROGRESS IN NUTRITION 2022; 2:10.21926/rpn.2204022. [PMID: 36686500 PMCID: PMC9850802 DOI: 10.21926/rpn.2204022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This narrative review highlights recent advances and ongoing trials using nutrition approaches for healthy aging. Focus will be placed on nutrition therapies that target cognition ("the mind") and mobility ("the muscle"), both critical components to maintaining a high quality of life for older adults. For "the mind," two seemingly incongruent therapies are being investigated to improve cognition-the MIND diet (high in carbohydrates and anti-oxidant fruits and vegetables) and the ketogenic diet (low in carbohydrates, high in fats). For "the muscle," a focus on protein and energy intake has dominated the literature, yet a recent clinical trial supports the use of whole-grains as a tool to improve whole-body protein turnover-a primary regulator of lean body mass and muscle. Finally, emerging data and clinical trials on caloric restriction have solidified this strategy as the only nutritional approach to slow intrinsic factors of whole-body aging, which may positively impact both "the mind" and "the muscle."
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Affiliation(s)
- Gabrielle M Mey
- Lerner Research Institute, Department of Neurosciences, Cleveland Clinic, Cleveland, OH, 44195 USA
| | - Jacob T Mey
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808 USA
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Makura-Kankwende CBT, Gradidge PJ, Crowther NJ, Ratshikombo T, Goedecke JH, Micklesfield LK, Norris SA, Chikowore T. Association of Longitudinal Nutrient Patterns with Body Composition in Black Middle-Aged South African Women: A Five-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12792. [PMID: 36232088 PMCID: PMC9565998 DOI: 10.3390/ijerph191912792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to evaluate the association of longitudinal nutrient patterns with body composition in a cohort of 132 black South African middle-aged women over five years. Nutrient patterns were identified using principal component analysis at baseline and follow-up 5 years later. Associations between nutrient patterns and repeated body composition measures were evaluated using generalized estimating equations, before and after adjusting for baseline education and repeated measures of age, socio-economic status, physical activity and employment. The animal-driven nutrient pattern was associated with increases in repeated measures of visceral adipose tissue (VAT) (β coefficient, 5.79 [95% CI, 0.01-11.57] cm2), fat mass index (FMI) (0.47 [0.01-0.93] kg·m-2) and lean mass index (LMI) (0.50 [0.18-1.17] kg·m-2) (p < 0.05) after adjustment. Vitamin C, sugar, and potassium-driven nutrient pattern was associated with higher FMI (0.50 [0.12-0.88] kg·m-2) and LMI (0.58 [0.07-1.10] kg·m-2) before and after adjustment (p < 0.05). These findings suggest that dietary interventions to curb obesity in black middle-aged South African women should focus on attenuation of nutrient patterns centred on added sugar, animal fat and animal protein.
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Affiliation(s)
- Caroline B. T. Makura-Kankwende
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Philippe J. Gradidge
- Department of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2192, South Africa
| | - Tshifhiwa Ratshikombo
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Julia H. Goedecke
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town 7505, South Africa
- University of Stirling, Stirling FK9 4LA, UK
| | - Lisa K. Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
- School of Human Development and Health, University of Southampton, Southampton SO17 1BJ, UK
| | - Tinashe Chikowore
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2198, South Africa
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12
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Ewy MW, Patel A, Abdelmagid MG, Mohamed Elfadil O, Bonnes SL, Salonen BR, Hurt RT, Mundi MS. Plant-Based Diet: Is It as Good as an Animal-Based Diet When It Comes to Protein? Curr Nutr Rep 2022; 11:337-346. [PMID: 35194768 DOI: 10.1007/s13668-022-00401-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Protein is a macronutrient that is responsible for multiple functions in the human body and is made up of twenty amino acids. Nine amino acids are not synthesized in the human body and require dietary ingestion to prevent deficiency. These essential amino acids are easily obtained through animal-based proteins but can be in limited quantities through plant-based protein sources. With the obesity epidemic rising, great attention has turned to plant-based protein diets and their health and environmental implications. The differences in plant and animal protein sources have been explored for their effects on general health, sarcopenia, and muscle performance. This review discusses the benefits and drawbacks of a plant-based diet, as well as some of the latest literature on muscle protein synthesis between animal- and plant-based dietary intakes of protein. RECENT FINDINGS High meat consumption is associated with increased saturated fat intake and lower dietary fiber intake. As a result, meat consumption is correlated with obesity, heart disease, metabolic syndrome, and gastrointestinal cancers. However, animal-based diets contain higher amounts of leucine and other essential amino acids which are associated with increased anabolic potential and muscle protein synthesis. Yet, multiple studies show conflicting results on the true benefits of animal-based diets, suggesting total protein intake may be the best predictor for preserving lean muscle mass and increasing muscle performance. While many studies support animal protein sources superior to plant-based diets on intracellular anabolic signaling, other studies show conflicting results regarding the true benefit of animal-based protein diets on overall performance and effect on sarcopenia. The health benefits seem to favor plant-based protein sources; however, further research is needed to examine the effects of protein from plant- and animal-based diets on muscle mass and protein synthesis.
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Affiliation(s)
- Matthew W Ewy
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ankitaben Patel
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Marwa G Abdelmagid
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Sara L Bonnes
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bradley R Salonen
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
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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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14
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Ramadas A, Law HH, Krishnamoorthy R, Ku JWS, Mohanty P, Lim MZC, Shyam S. Diet Quality and Measures of Sarcopenia in Developing Economies: A Systematic Review. Nutrients 2022; 14:nu14040868. [PMID: 35215518 PMCID: PMC8874949 DOI: 10.3390/nu14040868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Abstract
Sarcopenia refers to common age-related changes characterised by loss of muscle mass, strength, and physical performance that results in physical disability, poorer health status, and higher mortality in older adults. Diet quality is indicated as a potentially modifiable risk factor for sarcopenia. However, the association between diet quality and sarcopenia in developing economies appears to be conflicting. Hence, we conducted a systematic review of the literature from developing economies examining the relationship between diet quality and at least one of the three components of sarcopenia, including muscle mass, muscle strength, and physical performance, and the overall risk of sarcopenia. No restrictions on age and study design were employed. We identified 15 studies that met review inclusion criteria. There was heterogeneity among the studies in the diet quality metric used and sarcopenia-related outcomes evaluated. Longitudinal evidence and studies relating diet quality to a holistic definition of sarcopenia were lacking. Although limited and predominantly cross-sectional, the evidence consistently showed that diet quality defined by diversity and nutrient adequacy was positively associated with sarcopenia components, such as muscle mass, muscle strength, and physical performance.
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Affiliation(s)
- Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia; (A.R.); (H.H.L.); (J.W.S.K.); (M.Z.C.L.)
| | - Hian Hui Law
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia; (A.R.); (H.H.L.); (J.W.S.K.); (M.Z.C.L.)
| | - Raanita Krishnamoorthy
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Malaysia;
| | - Jordan Wei Shan Ku
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia; (A.R.); (H.H.L.); (J.W.S.K.); (M.Z.C.L.)
| | - Parimala Mohanty
- Department of Community Medicine, Institute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), K8 Lane, Kalinganagar, Bhubaneswar 751003, India;
| | - Matteus Zhen Chien Lim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia; (A.R.); (H.H.L.); (J.W.S.K.); (M.Z.C.L.)
| | - Sangeetha Shyam
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
- Centre for Translational Research, IMU Institute for Research and Development (IRDI), International Medical University, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
- Correspondence:
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15
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Domić J, Grootswagers P, van Loon LJC, de Groot LCPGM. Perspective: Vegan Diets for Older Adults? A Perspective On the Potential Impact On Muscle Mass and Strength. Adv Nutr 2022; 13:712-725. [PMID: 35108354 PMCID: PMC9156387 DOI: 10.1093/advances/nmac009] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/17/2021] [Accepted: 01/31/2022] [Indexed: 12/22/2022] Open
Abstract
Consumers are increasingly encouraged to consume more plant-based foods and lower their consumption of foods from animal origin. Concurrently, older adults are recommended to consume an adequate amount of high-quality dietary protein for the prevention of age-related muscle loss. In the current Perspective article, we discuss why it may not be preferred to consume a vegan diet at an older age. Our perspective is based on the proposed lower bioavailability and functionality of proteins in a vegan diet due to the matrix of the whole-food protein sources, the lower essential amino acid (EAA) content, and specific EAA deficiencies in proteins derived from plant-based foods. We propose that a vegan diet increases the risk of an inadequate protein intake at an older age and that current strategies to improve the anabolic properties of plant-based foods are not feasible for many older adults. We provide recommendations for further research to substantiate the remaining knowledge gaps regarding the consequences of a vegan diet on skeletal muscle mass and strength at an older age.
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Affiliation(s)
| | - Pol Grootswagers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Luc J C van Loon
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands,Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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16
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Exercise and Nutrition Impact on Osteoporosis and Sarcopenia-The Incidence of Osteosarcopenia: A Narrative Review. Nutrients 2021; 13:nu13124499. [PMID: 34960050 PMCID: PMC8705961 DOI: 10.3390/nu13124499] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.
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17
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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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18
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Yao H, Dohzono S, Sasaoka R, Takamatsu K, Nakamura H. Prognostic value of psoas major muscle density in patients with breast cancer metastases to bone: a retrospective single-center cohort study. Jpn J Clin Oncol 2021; 52:8-13. [PMID: 34642753 DOI: 10.1093/jjco/hyab166] [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: 04/09/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although sarcopenia is associated with poor prognosis for cancer patients, the relationship between muscle quantity and quality, and prognosis of breast cancer patients with bone metastases is unclear. This study aims to evaluate the association of muscle parameters, muscle area and density, and overall survival (OS) from the diagnosis of bone metastases in breast cancer patients with bone metastases. METHODS This study retrospectively investigated the prognostic value of muscle area and density in 90 women who were diagnosed with breast cancer with bone metastases between September 2005 and June 2018. We measured psoas major muscle and paravertebral muscle area and density on single axial computed tomography images at the L3 level and subgrouped the patients into higher or lower groups for each muscle measurement, using median values as cutoffs. We evaluated associations between OS and muscle parameters, using a Cox proportional hazards model adjusted by age and prognostic score for bone metastases (modified Katagiri score). RESULTS Median OS among patients with lower psoas major muscle density (25 months) was significantly shorter than in the higher psoas major muscle density group (61 months; hazard ratio: 1.79, 95% confidence interval: 1.01-3.16, P = 0.045). However, muscle area and paravertebral muscle density were not associated with OS in this setting. CONCLUSION Lower psoas major muscle density was a predictor of poor prognosis in patients with breast cancer metastases to bone. The association between psoas major muscle density and prognosis allows wider research into interventions that can prevent loss of muscle density.
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Affiliation(s)
- Hana Yao
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Sho Dohzono
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Ryuichi Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Kiyohito Takamatsu
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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19
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Monteyne AJ, Dunlop MV, Machin DJ, Coelho MOC, Pavis GF, Porter C, Murton AJ, Abdelrahman DR, Dirks ML, Stephens FB, Wall BT. A mycoprotein-based high-protein vegan diet supports equivalent daily myofibrillar protein synthesis rates compared with an isonitrogenous omnivorous diet in older adults: a randomised controlled trial. Br J Nutr 2021; 126:674-684. [PMID: 33172506 PMCID: PMC8110608 DOI: 10.1017/s0007114520004481] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Animal-derived dietary protein ingestion and physical activity stimulate myofibrillar protein synthesis rates in older adults. We determined whether a non-animal-derived diet can support daily myofibrillar protein synthesis rates to the same extent as an omnivorous diet. Nineteen healthy older adults (aged 66 (sem 1) years; BMI 24 (sem 1) kg/m2; twelve males, seven females) participated in a randomised, parallel-group, controlled trial during which they consumed a 3-d isoenergetic high-protein (1·8 g/kg body mass per d) diet, where the protein was provided from predominantly (71 %) animal (OMNI; n 9; six males, three females) or exclusively vegan (VEG; n 10; six males, four females; mycoprotein providing 57 % of daily protein intake) sources. During the dietary control period, participants conducted a daily bout of unilateral resistance-type leg extension exercise. Before the dietary control period, participants ingested 400 ml of deuterated water, with 50-ml doses consumed daily thereafter. Saliva samples were collected throughout to determine body water 2H enrichments, and muscle samples were collected from rested and exercised muscle to determine daily myofibrillar protein synthesis rates. Deuterated water dosing resulted in body water 2H enrichments of approximately 0·78 (sem 0·03) %. Daily myofibrillar protein synthesis rates were 13 (sem 8) (P = 0·169) and 12 (sem 4) % (P = 0·016) greater in the exercised compared with rested leg (1·59 (sem 0·12) v. 1·77 (sem 0·12) and 1·76 (sem 0·14) v. 1·93 (sem 0·12) %/d) in OMNI and VEG groups, respectively. Daily myofibrillar protein synthesis rates did not differ between OMNI and VEG in either rested or exercised muscle (P > 0·05). Over the course of a 3-d intervention, omnivorous- or vegan-derived dietary protein sources can support equivalent rested and exercised daily myofibrillar protein synthesis rates in healthy older adults consuming a high-protein diet.
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Affiliation(s)
- Alistair J Monteyne
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Mandy V Dunlop
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - David J Machin
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Mariana OC Coelho
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - George F Pavis
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Craig Porter
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Andrew J Murton
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
- The Claude D. Pepper Older Americans Independence Center University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Doaa R Abdelrahman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Marlou L Dirks
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Francis B Stephens
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Benjamin T Wall
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
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20
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Association between Diet Quality and Sarcopenia in Older Adults: Systematic Review of Prospective Cohort Studies. Life (Basel) 2021; 11:life11080811. [PMID: 34440555 PMCID: PMC8399213 DOI: 10.3390/life11080811] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/01/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022] Open
Abstract
(1) Background: Nutrition is a key determinant of sarcopenia in later life. (2) Methods: A systematic review of prospective cohort studies examining association of diet quality with muscle mass (MM), muscle strength (MS) or physical performance (PP) among older adults was conducted. A total of 22,885 results were obtained from a literature search in MEDLINE via PubMed and EMBASE up to November 2020. Inclusion criteria included diet quality assessment via dietary indices or statistical approaches, a sample of adults aged 45 years and over at baseline in a longitudinal study design. (3) Results: Of the 22,885 cohort studies, 14 studies were eligible. Meaningful results were obtained for the Mediterranean diet and Nordic diet regarding the decrease of sarcopenia risk, however results from non-European countries were inconsistent. In addition, due to the insufficient number of studies on Japanese Food Guide Spinning Top (JFG-ST), dietary variety score (DVS), and dietary quality index-international (DQI-I), effectiveness was difficult to prove. Studies using factor analysis to examine dietary patterns suggested that the risk of sarcopenia is increased with a high in saturated fat diet such as westernized pattern etc. (4) Conclusion: In this systematic review it was found that various diet qualities are meaningful to a decreased risk of sarcopenia.
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21
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Mertz KH, Reitelseder S, Bechshoeft R, Bulow J, Højfeldt G, Jensen M, Schacht SR, Lind MV, Rasmussen MA, Mikkelsen UR, Tetens I, Engelsen SB, Nielsen DS, Jespersen AP, Holm L. The effect of daily protein supplementation, with or without resistance training for 1 year, on muscle size, strength, and function in healthy older adults: A randomized controlled trial. Am J Clin Nutr 2021; 113:790-800. [PMID: 33564844 DOI: 10.1093/ajcn/nqaa372] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Protein supplementation alone or combined with resistance training has been proposed to be effective in counteracting age-related losses of muscle mass and strength. OBJECTIVES To investigate the effect of protein supplementation alone or combined with light-intensity or heavy-load resistance exercise on muscle size, strength, and function in older adults. METHODS In a 1-y randomized controlled trial, 208 healthy older adults (>65 y) were randomly assigned to 1 of 5 interventions: 1) carbohydrate supplementation (CARB); 2) collagen protein supplementation (COLL); 3) whey protein supplementation (WHEY); 4) light-intensity resistance training 3-5 times/wk with whey protein supplementation (LITW); and 5) heavy resistance training 3 times weekly with whey protein supplementation (HRTW). Protein supplements contained 20 g protein + 10 g carbohydrate, whereas CARB contained 30 g of carbohydrates. All intervention groups received the supplement twice daily. The primary outcome was change in the quadriceps cross-sectional area (qCSA). Secondary outcomes included measures of lower extremity strength and power, functional capabilities, and body composition. RESULTS There were 184 participants who completed the study. COLL and WHEY did not affect any measured parameter compared to CARB. Compared to WHEY, HRTW improved the qCSA size (between-group difference, +1.68 cm2; 95% CI, +0.41 to +2.95 cm2; P = 0.03), as well as dynamic (+18.4 Nm; 95% CI, +10.1 to +26.6 Nm; P < 10-4) and isometric knee extensor strength (+23.9 Nm; 95% CI, +14.2 to +33.6 Nm; P < 10-5). LITW did not improve the qCSA size, but increased dynamic knee extensor strength compared to WHEY (+13.7 Nm; 95% CI, +5.3 and +22.1 Nm; P = 0.01). CONCLUSIONS Recommending protein supplementation as a stand-alone intervention for healthy older individuals seems ineffective in improving muscle mass and strength. Only HRTW was effective in both preserving muscle mass and increasing strength. Thus, we recommend that future studies investigate strategies to increase long-term compliance to heavy resistance exercise in healthy older adults. This trial was registered at clinicaltrials.gov as NCT02034760.
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Affiliation(s)
- Kenneth H Mertz
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Reitelseder
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Bechshoeft
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jacob Bulow
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Grith Højfeldt
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mikkel Jensen
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon R Schacht
- Vitality Centre for Good Older Lives, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mads Vendelbo Lind
- Vitality Centre for Good Older Lives, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Morten A Rasmussen
- Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Inge Tetens
- Vitality Centre for Good Older Lives, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Søren B Engelsen
- Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Dennis S Nielsen
- Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Astrid P Jespersen
- Copenhagen Center for Health Research in the Humanities, Saxo-Institute, University of Copenhagen, Copenhagen, Denmark
| | - Lars Holm
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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22
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Li C, Meng H, Wu S, Fang A, Liao G, Tan X, Chen P, Wang X, Chen S, Zhu H. Daily Supplementation With Whey, Soy, or Whey-Soy Blended Protein for 6 Months Maintained Lean Muscle Mass and Physical Performance in Older Adults With Low Lean Mass. J Acad Nutr Diet 2021; 121:1035-1048.e6. [PMID: 33612439 DOI: 10.1016/j.jand.2021.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies have investigated the effect of long-term protein supplementation alone on muscle health in older adults with low lean mass. OBJECTIVE To determine the effect of whey, soy or whey-soy blended protein supplementation on lean muscle mass and physical performance in older adults with low lean mass. DESIGN A 4-arm randomized controlled trial. PARTICIPANTS/SETTING Chinese older adults (n = 123, 65-79 years) with low lean mass (appendicular skeletal muscle index < 7.0 kg/m2 in men and < 5.4 kg/m2 in women) living in the urban area of Guangzhou participated between October 2015 and June 2016. INTERVENTION Participants were randomly assigned to receive approximately 16 g/d of whey, soy, or whey-soy blend protein or maintained habitual diets in control group for 6 months. MAIN OUTCOME MEASURES Lean mass, handgrip strength, and physical performance (gait speed, chair stand test, and Short Physical Performance Battery) were assessed at baseline and 6 months. STATISTICAL ANALYSES Two-way analysis of variance with the main effects of treatment and time and treatment × time interaction and analysis of covariance was used to determine differences in outcomes. RESULTS Appendicular skeletal muscle index, lean mass, percent lean mass in legs and appendicular areas, gait speed, and Short Physical Performance Battery score were maintained in the treatment groups and decreased in the control group, resulting in significant reduction in these variables from baseline in the control compared with treatment groups (all P < .01; percent differences between treatment and control groups ranged from 80% to 156%). The chair stand test time at month 6 decreased from baseline in the treatment groups and increased in the control group, resulting in a significant increase in the control compared with treatment groups (all P < .01; percent differences between treatment and control groups ranged from 132% to 155%). Handgrip strength remained unchanged. There were no significant differences in outcomes among treatment groups. CONCLUSIONS Supplementation with whey, soy, or whey-soy blended protein for 6 months equally maintained lean muscle mass and physical performance in older adults with low lean mass.
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Affiliation(s)
- Chunlei Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Clinical Nutrition, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Huicui Meng
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Shangling Wu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Aiping Fang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Gongcheng Liao
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xuying Tan
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Peiyan Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyan Wang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Si Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Huilian Zhu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
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23
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Verzola D, Picciotto D, Saio M, Aimasso F, Bruzzone F, Sukkar SG, Massarino F, Esposito P, Viazzi F, Garibotto G. Low Protein Diets and Plant-Based Low Protein Diets: Do They Meet Protein Requirements of Patients with Chronic Kidney Disease? Nutrients 2020; 13:E83. [PMID: 33383799 PMCID: PMC7824653 DOI: 10.3390/nu13010083] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 02/06/2023] Open
Abstract
A low protein diet (LPD) has historically been used to delay uremic symptoms and decrease nitrogen (N)-derived catabolic products in patients with chronic kidney disease (CKD). In recent years it has become evident that nutritional intervention is a necessary approach to prevent wasting and reduce CKD complications and disease progression. While a 0.6 g/kg, high biological value protein-based LPD has been used for years, recent observational studies suggest that plant-derived LPDs are a better approach to nutritional treatment of CKD. However, plant proteins are less anabolic than animal proteins and amino acids contained in plant proteins may be in part oxidized; thus, they may not completely be used for protein synthesis. In this review, we evaluate the role of LPDs and plant-based LPDs on maintaining skeletal muscle mass in patients with CKD and examine different nutritional approaches for improving the anabolic properties of plant proteins when used in protein-restricted diets.
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Affiliation(s)
- Daniela Verzola
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (D.P.); (M.S.); (P.E.); (F.V.)
| | - Daniela Picciotto
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (D.P.); (M.S.); (P.E.); (F.V.)
- Clinica Nefrologica, Dialisi, Trapianto, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy
| | - Michela Saio
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (D.P.); (M.S.); (P.E.); (F.V.)
- Clinica Nefrologica, Dialisi, Trapianto, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy
| | - Francesca Aimasso
- Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy; (F.A.); (F.B.); (S.G.S.); (F.M.)
| | - Francesca Bruzzone
- Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy; (F.A.); (F.B.); (S.G.S.); (F.M.)
| | - Samir Giuseppe Sukkar
- Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy; (F.A.); (F.B.); (S.G.S.); (F.M.)
| | - Fabio Massarino
- Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy; (F.A.); (F.B.); (S.G.S.); (F.M.)
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (D.P.); (M.S.); (P.E.); (F.V.)
- Clinica Nefrologica, Dialisi, Trapianto, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (D.P.); (M.S.); (P.E.); (F.V.)
- Clinica Nefrologica, Dialisi, Trapianto, IRCCS Ospedale Policlinico San Martino, 16142 Genoa, Italy
| | - Giacomo Garibotto
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy; (D.V.); (D.P.); (M.S.); (P.E.); (F.V.)
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24
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Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. GeroScience 2020; 42:1547-1578. [PMID: 33001410 PMCID: PMC7528158 DOI: 10.1007/s11357-020-00272-3] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.
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Affiliation(s)
- Richard Kirwan
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Deaglan McCullough
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Tom Butler
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, 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
| | - Claire Stewart
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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25
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Montiel-Rojas D, Nilsson A, Santoro A, Bazzocchi A, de Groot LCPGM, Feskens EJM, Berendsen AAM, Madej D, Kaluza J, Pietruszka B, Jennings A, Fairweather-Tait S, Battista G, Capri M, Franceschi C, Kadi F. Fighting Sarcopenia in Ageing European Adults: The Importance of the Amount and Source of Dietary Proteins. Nutrients 2020; 12:nu12123601. [PMID: 33255223 PMCID: PMC7760110 DOI: 10.3390/nu12123601] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/21/2022] Open
Abstract
While an adequate protein intake is important for the maintenance of muscle mass during ageing, the amount and source of protein necessary for optimal prevention of sarcopenia remains to be determined. The present study aimed to investigate the influence of the amount and source of dietary proteins on sarcopenia risk in a cohort of 65–79-year-old European adults within the frame of the NU-AGE study. A total of 986 participants were included in the analysis. Skeletal muscle index (SMI), assessed by dual-energy X-ray absorptiometry (DXA), and handgrip strength (HG) were employed to create a continuous sex-specific sarcopenia risk score (SRS). Total amount together with animal- and plant-derived sources of proteins were obtained from a 7-day food record. Differences in SRS were analysed across groups of total protein intake (<0.8 g/body weight (BW); 0.8–<1.0 g/BW; 1.0–<1.2 g/BW; and ≥1.2 g/BW). The association between SRS and the different sources of protein was assessed using isocaloric substitution models adjusted by demographic, medical, and lifestyle factors. A significant linear dose-response relationship was observed, with a lower SRS linked to higher protein intakes. Based on the isocaloric substitution modelling, a reduced SRS was observed when increasing plant protein to the detriment of animal protein, while holding total protein intake constant. Further, this result remained significant after stratifying the analysis by adherence to different levels of protein intake. Our findings suggest that older adults may benefit from increasing protein intakes above current recommendations. Besides total amount, protein source should be considered when promoting health dietary habits in older adults for the prevention of sarcopenia.
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Affiliation(s)
- Diego Montiel-Rojas
- School of Health Sciences, Örebro University, 702 81 Örebro, Sweden; (D.M.-R.); (F.K.)
| | - Andreas Nilsson
- School of Health Sciences, Örebro University, 702 81 Örebro, Sweden; (D.M.-R.); (F.K.)
- Correspondence: ; Tel.: +46-19-303553
| | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.S.); (G.B.); (M.C.); (C.F.)
- Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, 40126 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Lisette C. P. G. M. de Groot
- Department of Human Nutrition and Health, Wageningen University, 6708WE Wageningen, The Netherlands; (L.C.P.G.M.d.G.); (E.J.M.F.); (A.A.M.B.)
| | - Edith J. M. Feskens
- Department of Human Nutrition and Health, Wageningen University, 6708WE Wageningen, The Netherlands; (L.C.P.G.M.d.G.); (E.J.M.F.); (A.A.M.B.)
| | - Agnes A. M. Berendsen
- Department of Human Nutrition and Health, Wageningen University, 6708WE Wageningen, The Netherlands; (L.C.P.G.M.d.G.); (E.J.M.F.); (A.A.M.B.)
| | - Dawid Madej
- Department of Human Nutrition, Warsaw University of Life Sciences-SGGW, 02-776 Warsaw, Poland; (D.M.); (J.K.); (B.P.)
| | - Joanna Kaluza
- Department of Human Nutrition, Warsaw University of Life Sciences-SGGW, 02-776 Warsaw, Poland; (D.M.); (J.K.); (B.P.)
| | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences-SGGW, 02-776 Warsaw, Poland; (D.M.); (J.K.); (B.P.)
| | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (A.J.); (S.F.-T.)
| | - Susan Fairweather-Tait
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (A.J.); (S.F.-T.)
| | - Giuseppe Battista
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.S.); (G.B.); (M.C.); (C.F.)
| | - Miriam Capri
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.S.); (G.B.); (M.C.); (C.F.)
- Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, 40126 Bologna, Italy
| | - Claudio Franceschi
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.S.); (G.B.); (M.C.); (C.F.)
- Department of Applied Mathematics, Institute of Information Technology, Mathematics and Mechanics (ITMM), Lobachevsky State University of Nizhny Novgorod-National Research University (UNN), 603950 Nizhny Novgorod, Russia
| | - Fawzi Kadi
- School of Health Sciences, Örebro University, 702 81 Örebro, Sweden; (D.M.-R.); (F.K.)
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26
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Hashimoto Y, Kaji A, Sakai R, Takahashi F, Kawano R, Hamaguchi M, Fukui M. Effect of Exercise Habit on Skeletal Muscle Mass Varies with Protein Intake in Elderly Patients with Type 2 Diabetes: A Retrospective Cohort Study. Nutrients 2020; 12:nu12103220. [PMID: 33096793 PMCID: PMC7589605 DOI: 10.3390/nu12103220] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022] Open
Abstract
Exercise has been reported to be effective in maintaining and recovering muscle; however, the effect of exercise combined with adequate or inadequate protein intake on muscle mass is not clear. Therefore, this study investigates the effect of exercise habit on changes in muscle mass, with adequate or inadequate protein intake. This retrospective cohort study included 214 elderly patients with type 2 diabetes. The rate of skeletal muscle mass index (SMI) change (%) was defined as ((SMI at follow-up minus SMI at baseline)/(follow-up years [kg/m2/year] × SMI at baseline [kg/m2])) × 100. Adequate protein intake was defined as protein intake ≥1.2 g/kg ideal body weight/day. During a mean follow-up duration of 18.0 (7.1) months, the rate of SMI change was −1.14 (4.10)% in the whole sample. The rate of SMI change of non-habitual exercisers with inadequate protein intake, habitual exercisers with inadequate protein intake, non-habitual exercisers with adequate protein intake, and habitual exercisers with adequate protein intake was −1.22 (3.71), −2.31 (3.30), −1.88 (4.62), and 0.36 (4.29)%, respectively. Compared with patients with exercise habit and adequate protein intake, the odds ratio for decreasing SMI was 2.50 (0.90–6.90, p = 0.078) in patients with no exercise habit and inadequate protein intake, 3.58 (1.24–10.4, p = 0.019) in those with exercise habit and inadequate protein intake, and 3.03 (1.27–7.22, p = 0.012) in those with no exercise habit and adequate protein intake, after adjusting for covariates. Therefore, exercise habit without adequate protein intake was associated with an increased risk of decreasing SMI compared with exercise habit with adequate protein intake.
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27
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Dorrington N, Fallaize R, Hobbs DA, Weech M, Lovegrove JA. A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK. J Nutr 2020; 150:2245-2256. [PMID: 32510125 DOI: 10.1093/jn/nxaa153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 01/16/2023] Open
Abstract
Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however, there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65 y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) a literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2 g·kg-1·d-1), calcium (1000 mg·d-1), folate (400 μg·d-1), vitamin B-12 (2.4 μg·d-1), and fluid (1.6 L·d-1 women, 2.0 L·d-1 men) for those ≥65 y. UK recommendations for carbohydrates, free sugars, dietary fiber, dietary fat and fatty acids, sodium, and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy aging.
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Affiliation(s)
- Nicole Dorrington
- Hugh Sinclair Unit of Human Nutrition and Institute of Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
| | - Rosalind Fallaize
- Hugh Sinclair Unit of Human Nutrition and Institute of Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Ditte A Hobbs
- Hugh Sinclair Unit of Human Nutrition and Institute of Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
| | - Michelle Weech
- Hugh Sinclair Unit of Human Nutrition and Institute of Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute of Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
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Coelho MOC, Monteyne AJ, Dunlop MV, Harris HC, Morrison DJ, Stephens FB, Wall BT. Mycoprotein as a possible alternative source of dietary protein to support muscle and metabolic health. Nutr Rev 2020; 78:486-497. [PMID: 31841152 DOI: 10.1093/nutrit/nuz077] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The world's population is expanding, leading to an increased global requirement for dietary protein to support health and adaptation in various populations. Though a strong evidence base supports the nutritional value of animal-derived dietary proteins, mounting challenges associated with sustainability of these proteins have led to calls for the investigation of alternative, non-animal-derived dietary protein sources. Mycoprotein is a sustainably produced, protein-rich, high-fiber, whole food source derived from the fermentation of fungus. Initial investigations in humans demonstrated that mycoprotein consumption can lower circulating cholesterol concentrations. Recent data also report improved acute postprandial glycemic control and a potent satiety effect following mycoprotein ingestion. It is possible that these beneficial effects are attributable to the amount and type of dietary fiber present in mycoprotein. Emerging data suggest that the amino acid composition and bioavailability of mycoprotein may also position it as a promising dietary protein source to support skeletal muscle protein metabolism. Mycoprotein may be a viable dietary protein source to promote training adaptations in athletes and the maintenance of muscle mass to support healthy aging. Herein, current evidence underlying the metabolic effects of mycoprotein is reviewed, and the key questions to be addressed are highlighted.
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Affiliation(s)
- Mariana O C Coelho
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alistair J Monteyne
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Mandy V Dunlop
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Hannah C Harris
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom.,School of Medicine, Dentistry and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Scottish Universities Environmental Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Douglas J Morrison
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom.,Scottish Universities Environmental Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Francis B Stephens
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Benjamin T Wall
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Yuan M, Pickering RT, Bradlee ML, Mustafa J, Singer MR, Moore LL. Animal protein intake reduces risk of functional impairment and strength loss in older adults. Clin Nutr 2020; 40:919-927. [PMID: 32753351 DOI: 10.1016/j.clnu.2020.06.019] [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] [Received: 02/18/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Protein intake has been shown to lower risk of aging-related functional decline. The goal of this study was to assess long-term effects of weight-adjusted animal (AP) and plant protein (PP) intakes on aging-related change in functional status and grip strength. METHODS Framingham Offspring Study participants (n = 1896, 891 men and 1005 women), ≥age 50, were followed for an average of 14.4 years. Protein intake derived from two sets of 3-day diet records (exams 3 and 5) was expressed as both weight-adjusted intake (from residuals) and per kilogram of body weight (g/kg/d). Seven tasks from two standardized assessments (Nagi and the Rosow-Breslau scales) were selected to determine functional status at exams 5-9. Functional impairment was defined as failure to complete (or having a lot of difficulty completing) a given task. Grip strength was assessed by dynamometer at exams 7-9. RESULTS Participants with higher (vs. lower) weight-adjusted intakes of AP and PP maintained higher functional scores (p = 0.001 and p < 0.001, respectively). After accounting for baseline skeletal muscle mass (SMM) and physical activity, only AP was linked with lower risks of functional impairment. Higher AP intake among sedentary individuals led to 29% (95% CI: 0.51-1.00) reduced risks of impairment; among subjects with lower SMM, higher AP was associated with 30% (95% CI: 0.49-0.98) reduced risks. Physical activity and SMM were independently associated with reduced risks of functional impairment, regardless of protein intake. Finally, higher AP intake led to 34% and 48% greater preservation of grip strength in men (p = 0.012) and women (p = 0.034). Results were similar for protein intake expressed as g/kg/d. CONCLUSIONS Higher AP intake and higher levels of physical activity and SMM were independently associated with lower risks of functional impairment and greater preservation of grip strength in adults over the age of 50 years.
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Affiliation(s)
- Mengjie Yuan
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - R Taylor Pickering
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - M Loring Bradlee
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jabed Mustafa
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Martha R Singer
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Lynn L Moore
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
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Elstgeest LEM, Schaap LA, Heymans MW, Hengeveld LM, Naumann E, Houston DK, Kritchevsky SB, Simonsick EM, Newman AB, Farsijani S, Visser M, Wijnhoven HAH. Sex-and race-specific associations of protein intake with change in muscle mass and physical function in older adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 2020; 112:84-95. [PMID: 32520344 PMCID: PMC7326591 DOI: 10.1093/ajcn/nqaa099] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Protein intake recommendations advise ≥0.8 g/kg body weight (BW)/d, whereas experts propose a higher intake for older adults (1.0-1.2 g/kg BW/d). It is unknown whether optimal protein intake differs by sex or race. OBJECTIVES We examined the shape of sex- and race-specific associations of dietary protein intake with 3- and 6-y changes in appendicular lean mass (aLM) and gait speed and also 6-y incidence of mobility limitation in community-dwelling older men and women. METHODS We used data on men (n = 1163) and women (n = 1237) aged 70-81 y of the Health, Aging, and Body Composition Study. Protein intake was assessed using an FFQ (1998-1999). aLM and gait speed were measured at baseline and at 3 and 6 y. Difficulty walking one-quarter mile or climbing stairs was measured every 6 mo over 6 y. Prospective associations were evaluated with linear and Cox regression models, comparing fit of models with and without spline functions. All analyses were stratified by sex and additionally by race. RESULTS Mean ± SD protein intake was 0.94 ± 0.36 g/kg adjusted body weight (aBW)/d in men and 0.95 ± 0.36 g/kg aBW/d in women. There were no strong indications of nonlinear associations. In women, higher protein intake was associated with less aLM loss over 3 y (adjusted B per 0.1 g/kg aBW/d: 39.4; 95% CI: 11.6, 67.2), specifically in black women, but not over 6 y or with gait speed decline. In men, protein intake was not associated with changes in aLM and gait speed. Higher protein intake was associated with a lower risk of mobility limitation in men (adjusted HR per 1.0 g/kg aBW/d: 0.55; 95% CI: 0.34, 0.91) and women (adjusted HR: 0.56; 95% CI: 0.33, 0.94), specifically white women. CONCLUSIONS Associations between protein intake and physical outcomes may vary by sex and race. Therefore, it is important to consider sex and race in future studies regarding protein needs in older adults.
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Affiliation(s)
- Liset E M Elstgeest
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, the Netherlands
| | - Linda M Hengeveld
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Elke Naumann
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- European Federation of the Associations of Dietitians (EFAD), The Hague, the Netherlands
| | - Denise K Houston
- Sticht Center for Healthy Aging and Alzheimer's Prevention and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention and Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samaneh Farsijani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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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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Dasi T, Selvaraj K, Pullakhandam R, Kulkarni B. Animal source foods for the alleviation of double burden of malnutrition in countries undergoing nutrition transition. Anim Front 2020; 9:32-38. [PMID: 32002272 PMCID: PMC6951863 DOI: 10.1093/af/vfz031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Teena Dasi
- Clinical Division, National Institute of Nutrition, Hyderabad, India
| | | | - Raghu Pullakhandam
- Division of Biochemistry, National Institute of Nutrition, Hyderabad, India
| | - Bharati Kulkarni
- Clinical Division, National Institute of Nutrition, Hyderabad, India
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Protein intake per day and at each daily meal and skeletal muscle mass declines among older community dwellers in Japan. Public Health Nutr 2019; 23:1090-1097. [DOI: 10.1017/s1368980019002921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:To examine associations between protein intake per day and at different meals and skeletal muscle mass declines.Design:Two-year prospective cohort study among older community dwellers.Setting:National Institute for Longevity Sciences–Longitudinal Study of Aging (NILS-LSA) in Japan.Participants:Older men (n 292) and women (n 363) aged 60–87 years who participated in the baseline (2006–2008) and follow-up studies (2008–2010) of NILS-LSA and did not exhibit low skeletal muscle mass at baseline. Muscle mass was assessed using dual-energy X-ray absorptiometry at baseline and follow-up. Low muscle mass was defined as skeletal muscle mass index <7·0 kg/m2 for men and <5·4 kg/m2 for women at follow-up. Daily protein intake and protein intake at each meal were calculated from 3 d dietary records at baseline and sex-stratified tertiles were determined.Results:Mean (sd) protein intake at breakfast, lunch and dinner was 22·7 (7·8), 26·7 (9·3) and 37·4 (10·5) g for men and 19·3 (6·3), 23·2 (7·3) and 28·5 (7·0) g for women, respectively. After adjusting for age, baseline skeletal muscle mass and other confounders in logistic modelling, greater total protein intake was associated with lower prevalence of skeletal muscle mass decline among men at follow-up (P = 0·024). Particularly, the OR (95 % CI) for high lunchtime protein intake was low (0·11 (0·02, 0·61); P = 0·01). No significant association between total protein intake and prevalence of skeletal muscle mass decline was found among women.Conclusions:High total protein intake, particularly at lunchtime, is associated with retention of skeletal muscle mass in men.
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Du Y, Oh C, No J. Advantage of Dairy for Improving Aging Muscle. J Obes Metab Syndr 2019; 28:167-174. [PMID: 31583381 PMCID: PMC6774446 DOI: 10.7570/jomes.2019.28.3.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/12/2019] [Accepted: 08/13/2019] [Indexed: 12/22/2022] Open
Abstract
The risk of sarcopenia increases with aging. Malnutrition in the elderly population is an important risk factor for sarcopenia. Calcium (Ca), phosphate (P), vitamin D and protein are key nutrients for the human body and affect muscle mass and quality. Dairy products are rich in these nutrients, which implicates that dairy products might be ideal for elderly population. This systematic review highlights the effects of dairy products on muscle mass, muscle strength and body performance in the elderly population in the perspective of Ca, P, vitamin D and protein.
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Affiliation(s)
- Yang Du
- Department of Food and Nutrition, Kyungsung University, Busan, Korea
| | - Chorong Oh
- Department of Food and Nutrition, Kyungsung University, Busan, Korea
| | - Jaekyung No
- Department of Food and Nutrition, Kyungsung University, Busan, Korea
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Berrazaga I, Micard V, Gueugneau M, Walrand S. The Role of the Anabolic Properties of Plant- versus Animal-Based Protein Sources in Supporting Muscle Mass Maintenance: A Critical Review. Nutrients 2019; 11:E1825. [PMID: 31394788 PMCID: PMC6723444 DOI: 10.3390/nu11081825] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023] Open
Abstract
Plant-sourced proteins offer environmental and health benefits, and research increasingly includes them in study formulas. However, plant-based proteins have less of an anabolic effect than animal proteins due to their lower digestibility, lower essential amino acid content (especially leucine), and deficiency in other essential amino acids, such as sulfur amino acids or lysine. Thus, plant amino acids are directed toward oxidation rather than used for muscle protein synthesis. In this review, we evaluate the ability of plant- versus animal-based proteins to help maintain skeletal muscle mass in healthy and especially older people and examine different nutritional strategies for improving the anabolic properties of plant-based proteins. Among these strategies, increasing protein intake has led to a positive acute postprandial muscle protein synthesis response and even positive long-term improvement in lean mass. Increasing the quality of protein intake by improving amino acid composition could also compensate for the lower anabolic potential of plant-based proteins. We evaluated and discussed four nutritional strategies for improving the amino acid composition of plant-based proteins: fortifying plant-based proteins with specific essential amino acids, selective breeding, blending several plant protein sources, and blending plant with animal-based protein sources. These nutritional approaches need to be profoundly examined in older individuals in order to optimize protein intake for this population who require a high-quality food protein intake to mitigate age-related muscle loss.
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Affiliation(s)
- Insaf Berrazaga
- UNH, Unité de Nutrition Humaine, CRNH, Université Clermont Auvergne, INRA, Auvergne, 63000 Clermont-Ferrand, France
- IATE Agropolymer Engineering and Emerging Technologies, Univ. Montpellier, INRA, CIRAD, Montpellier SupAgro, 34060 Montpellier, France
| | - Valérie Micard
- IATE Agropolymer Engineering and Emerging Technologies, Univ. Montpellier, INRA, CIRAD, Montpellier SupAgro, 34060 Montpellier, France
| | - Marine Gueugneau
- UNH, Unité de Nutrition Humaine, CRNH, Université Clermont Auvergne, INRA, Auvergne, 63000 Clermont-Ferrand, France
| | - Stéphane Walrand
- UNH, Unité de Nutrition Humaine, CRNH, Université Clermont Auvergne, INRA, Auvergne, 63000 Clermont-Ferrand, France.
- Service de Nutrition Clinique, Centre Hospitalier Universitaire (CHU) Gabriel Montpied, 63000 Clermont-Ferrand, France.
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Le B, Bůžková P, Robbins JA, Fink HA, Raiford M, Isales CM, Shikany JM, Coughlin SS, Carbone LD. The Association of Aromatic Amino Acids with Incident Hip Fracture, aBMD, and Body Composition from the Cardiovascular Health Study. Calcif Tissue Int 2019; 105:161-172. [PMID: 31115639 PMCID: PMC6663558 DOI: 10.1007/s00223-019-00562-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
In 5187 persons from the Cardiovascular Health Study, there was no significant association of dietary intakes of aromatic amino acids (AAA) with areal BMD of the hip or body composition. However, those who had the lowest dietary intakes of AAA were at increased risk for incident hip fractures. Prior studies of the association of protein intake with osteoporosis are conflicting and have not directly examined the relationship of aromatic amino acids (AAA) with fractures, areal bone mineral density (aBMD), and body composition. We sought to determine the relationship of dietary intakes of AAA with osteoporosis parameters in elderly men and women. 5187 men and women aged ≥ 65 years from the Cardiovascular Health Study (CHS) with dietary intakes of AAA (tryptophan, phenylalanine, tyrosine) estimated by food frequency questionnaire (FFQ) were included. We examined the relationship between a one-time estimate of daily dietary AAA intake with risk of incident hip fractures over a median of 13.2 years of fracture follow-up. A subset (n = 1336) who had dual energy X-ray absorptiometry (DXA) performed were included in a cross-sectional analysis of the association of dietary AAA intake with aBMD of the total hip and measurements of body composition. In multivariable models adjusted for demographic and clinical variables, medication use, and diet, higher dietary AAA intake was not significantly associated with incident hip fractures. All hazard ratios (HR) were less than one (tryptophan, HR 0.14, 95% CI 0.01 to 1.89; phenylalanine, HR 0.60, 95% CI 0.23 to 1.55; tyrosine, HR 0.59, 95% CI 0.27 to 1.32), but confidence intervals were wide and included no difference. However, in post hoc analyses, the lowest quartile of intake for each AAA was associated with an increased risk for hip fracture compared to higher quartiles (p ≤ 0.047 for all). Dietary AAA intakes were not significantly associated with total hip aBMD or any measurements of body composition. Overall, there was no significant association of dietary AAA intake with hip fractures, aBMD of the hip, or body composition. However, there may be a subset of elderly individuals with low dietary intakes of AAA who are at increased for hip fractures.
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Affiliation(s)
- Brian Le
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - John A Robbins
- Department of Medicine, University of California - Davis, Sacramento, CA, USA
| | - Howard A Fink
- Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Mattie Raiford
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - Carlos M Isales
- Department of Medicine, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven S Coughlin
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
- Department of Medicine, J. Harold Harrison MD Distinguished University Chair in Rheumatology, Medical College of Georgia, Augusta University (formerly Georgia Regents University and Georgia Health Sciences University), Augusta, GA, USA.
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Impact of dietary protein intake and obesity on lean mass in middle-aged individuals after a 12-year follow-up: the Korean Genome and Epidemiology Study (KoGES). Br J Nutr 2019; 122:322-330. [PMID: 31177993 DOI: 10.1017/s000711451900117x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The present study investigated the association between protein intake and lean mass according to obesity status over a 12-year period. Data on 4412 participants aged 40-69 years were obtained from the Korean Genome and Epidemiology Study. The usual dietary protein intake of these participants was assessed at baseline using a semi-quantitative FFQ. Body composition was measured using bioelectrical impedance analysis at baseline and after a 12-year follow-up. Linear mixed-effects models were used to examine the associations between lean mass after a 12-year follow-up and protein intake at baseline. After adjusting for covariates and lean mass at baseline, comparisons between the highest and lowest tertiles revealed that dietary protein intake was positively associated with lean mass in both men (β = 0·79, P = 0·001) and women (β = 0·28, P = 0·082) after the 12-year period; however, those differences were attenuated after additional adjustment for fat mass at baseline and were stronger in the normal-weight group (men, β = 0·85, P = 0·002; women, β = 0·97, P < 0·001) but were not detected in the obese group. In the obese group, age (men, β = 4·08, P < 0·001; women, β = 2·61, P < 0·001) and regular physical activity (men, β = 0·88, P = 0·054; women, β = 0·76, P < 0·001) were significantly associated with lean mass after 12 years of follow-up. The results of the present study showed that protein intake may contribute to the prevention of ageing-related lean mass loss; however, the impact of this intake may vary depending on obesity status. Therefore, the maintenance of a healthy body weight during ageing through enhanced protein intake is likely to confer health benefits.
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Li CY, Fang AP, Ma WJ, Wu SL, Li CL, Chen YM, Zhu HL. Amount Rather than Animal vs Plant Protein Intake Is Associated with Skeletal Muscle Mass in Community-Dwelling Middle-Aged and Older Chinese Adults: Results from the Guangzhou Nutrition and Health Study. J Acad Nutr Diet 2019; 119:1501-1510. [PMID: 31080071 DOI: 10.1016/j.jand.2019.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Current literature does not indicate if the amount and animal vs plant protein are equally important in the prevention of muscle loss in middle-aged and older Chinese adults. OBJECTIVE The aim of the study was to examine the associations between amount or animal vs plant protein and skeletal muscle mass in Chinese adults aged 40 to 80 years. DESIGN A cross-sectional analysis of a prospective, community-based cohort was performed. PARTICIPANTS/SETTING Participants included 1,044 men and 2,169 women aged 40 to 80 years from the Guangzhou Nutrition and Health Study 2011-2013 with body composition measurements by dual-energy x-ray absorptiometry. MAIN OUTCOME MEASURE The skeletal muscle index (SMI) was defined as appendicular skeletal muscle mass divided by body weight. Participants in the lowest quartile of the sex-specific SMI were considered to have low muscle mass (LMM). STATISTICAL ANALYSIS Analyses of covariance were performed to estimate the SMI across quintiles of relative dietary intake of total, animal, and plant protein and the ratio of animal-to-plant protein. Logistic regression models were applied to assess the associations between quintiles of protein intake and LMM. RESULTS The SMI increased significantly across quintiles of relative dietary intake of total, animal, and plant protein (all P trends<0.001). Odds ratios (95% CIs) for LMM among participants in the highest (vs lowest) quintile were 0.3 (0.2, 0.4) for total protein, 0.3 (0.2, 0.5) for animal protein, and 0.4 (0.3, 0.7) for plant protein, respectively (all P trends<0.001). However, the ratio of animal-to-plant protein was not associated with either the SMI or the presence of LMM. CONCLUSION Higher dietary intakes of total, animal, and plant protein, regardless of the ratio of animal-to-plant protein, are associated with greater skeletal muscle mass in community-dwelling middle-aged and older Chinese adults with a mean protein intake above the current recommendation for protein of 0.8 g/kg per day.
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Kuzuya M, Sugimoto K, Suzuki T, Watanabe Y, Kamibayashi K, Kurihara T, Fujimoto M, Arai H. Chapter 3 Prevention of sarcopenia. Geriatr Gerontol Int 2019; 18 Suppl 1:23-27. [PMID: 29745459 DOI: 10.1111/ggi.13321] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University School of Medicine, Nagoya, Japan
| | - Ken Sugimoto
- Department of Geriatric Medicine, Osaka University School of Medicine, Suita, Japan
| | - Takao Suzuki
- Research Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan
| | - Yuya Watanabe
- Faculty of Health and Sports Science, Doshisha University, Kyoto, Japan
| | | | - Toshiyuki Kurihara
- College of Sport and Health Science, Hikone, Ritsumeikan University Shiga, Japan
| | - Masahiro Fujimoto
- College of Sport and Health Science, Hikone, Ritsumeikan University Shiga, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Richter M, Baerlocher K, Bauer JM, Elmadfa I, Heseker H, Leschik-Bonnet E, Stangl G, Volkert D, Stehle P. Revised Reference Values for the Intake of Protein. ANNALS OF NUTRITION & METABOLISM 2019; 74:242-250. [PMID: 30904906 PMCID: PMC6492513 DOI: 10.1159/000499374] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Following a timely update process, the nutrition societies of Germany, Austria, and Switzerland (D-A-CH) revised the reference values for the intake of protein in 2017. The Working Group conducted a structured literature search in PubMed considering newly published papers (2000- 2017). SUMMARY For infants < 4 months, the estimated values were set based on the protein intake via breast milk. Reference values for infants > 4 months, children, adolescents, pregnant, and lactating women were calculated using the factorial method considering both requirement for growth and maintenance. For adults, reference values were derived from nitrogen balance studies; for seniors (> 65 years), reports on metabolic and functional parameters under various protein intakes were additionally considered. Reference -values (g protein/kg body weight per day) were set as follows: infants < 4 months: 2.5-1.4, children: 1.3-0.8, adults < 65 years: 0.8, adults > 65 years: 1.0. Key Messages: The reference values for infants, children, adolescents, and adults < 65 years are essentially unchanged compared to recently published values. Scientifically reliable data published between 2000 and 2017 guided the D-A-CH Working Group to set a higher estimated value for adults > 65 years. Since the energy consumption continuously decreases with age, this new estimated protein intake value might be a challenge for the introduction of food-based nutrition concepts for older people.
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Affiliation(s)
| | - Kurt Baerlocher
- Ostschweizer Kinderspital St. Gallen, St. Gallen, Switzerland
| | - Jürgen M Bauer
- Agaples Bethanien Hospital, University of Heidelberg, Heidelberg, Germany
| | - Ibrahim Elmadfa
- Department of Nutrition Sciences, University of Vienna, Vienna, Austria
| | - Helmut Heseker
- German Nutrition Society, Bonn, Germany
- Department of Sports and Health, University of Paderborn, Paderborn, Germany
| | | | - Gabriele Stangl
- Department of Agriculture and Nutritional Sciences, University Halle-Wittenberg, Halle, Germany
| | - Dorothee Volkert
- Department for Biomedicine of Aging, University of Erlangen/Nürnberg, Nürnberg, Germany
| | - Peter Stehle
- Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
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Verreijen AM, Engberink MF, Houston DK, Brouwer IA, Cawthon PM, Newman AB, Tylavsky FA, Harris TB, Weijs PJM, Visser M. Dietary protein intake is not associated with 5-y change in mid-thigh muscle cross-sectional area by computed tomography in older adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 2019; 109:535-543. [PMID: 30850837 PMCID: PMC6408207 DOI: 10.1093/ajcn/nqy341] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/06/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A higher protein intake is suggested to preserve muscle mass during aging and may therefore reduce the risk of sarcopenia. OBJECTIVES We explored whether the amount and type (animal or vegetable) of protein intake were associated with 5-y change in mid-thigh muscle cross-sectional area (CSA) in older adults (n = 1561). METHODS Protein intake was assessed at year 2 by a Block food-frequency questionnaire in participants (aged 70-79 y) of the Health, Aging, and Body Composition (Health ABC) Study, a prospective cohort study. At year 1 and year 6 mid-thigh muscle CSA in square centimeters was measured by computed tomography. Multiple linear regression analysis was used to examine the association between energy-adjusted protein residuals in grams per day (total, animal, and vegetable protein) and muscle CSA at year 6, adjusted for muscle CSA at year 1 and potential confounders including prevalent health conditions, physical activity, and 5-y change in fat mass. RESULTS Mean (95% CI) protein intake was 0.90 (0.88, 0.92) g · kg-1 · d-1 and mean (95% CI) 5-y change in muscle CSA was -9.8 (-10.6, -8.9) cm2. No association was observed between energy-adjusted total (β = -0.00; 95% CI: -0.06, 0.06 cm2; P = 0.982), animal (β = -0.00; 95% CI: -0.06, 0.05 cm2; P = 0.923), or plant (β = +0.07; 95% CI: -0.06, 0.21 cm2; P = 0.276) protein intake and muscle CSA at year 6, adjusted for baseline mid-thigh muscle CSA and potential confounders. CONCLUSIONS This study suggests that a higher total, animal, or vegetable protein intake is not associated with 5-y change in mid-thigh muscle CSA in older adults. This conclusion contradicts some, but not all, previous research. This trial was registered at www.trialregister.nl as NTR6930.
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Affiliation(s)
- Amely M Verreijen
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Mariëlle F Engberink
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Denise K Houston
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ingeborg A Brouwer
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Ann B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Frances A Tylavsky
- Health Science Center, Preventive Medicine, University of Tennessee, Memphis, TN
| | | | - Peter J M Weijs
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Nutrition and Dietetics, Department of Internal Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Nagano A, Nishioka S, Wakabayashi H. Rehabilitation Nutrition for Iatrogenic Sarcopenia and Sarcopenic Dysphagia. J Nutr Health Aging 2019; 23:256-265. [PMID: 30820514 DOI: 10.1007/s12603-018-1150-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sarcopenia is a very important issue in rehabilitation medicine and nutritional care. The prevalence of sarcopenia in older people is approximately 50% in the rehabilitation setting, and also approximately 15% of inpatients without sarcopenia upon admission developed sarcopenia during hospitalization. There is a concern that secondary sarcopenia may occur iatrogenically during hospitalization. Iatrogenic sarcopenia is defined as sarcopenia caused by the activities of medical staff including doctors, nurses, or other health care professionals in healthcare facilities. Iatrogenic sarcopenia is categorized into activity-related, nutrition-related and disease-related-iatrogenic sarcopenia. Especially in acute phase hospitals, concentrating on the treatment of diseases with less attention to nutrition and activity is more likely to cause iatrogenic sarcopenia. Sarcopenic dysphagia is also an important aspect in rehabilitation medicine and nutritional care. Sarcopenic dysphagia is characterized by swallowing difficulty because of a loss of mass and function in whole-body skeletal and swallowing muscles. Sarcopenic dysphagia can be diagnosed using a 5-step algorithm for the condition. Iatrogenic sarcopenia and sarcopenic dysphagia are affected by nutrition, activity and diseases in a complex manner. Therefore, treatment of iatrogenic sarcopenia and sarcopenic dysphagia requires comprehensive interventions through nutrition management and rehabilitation. Rehabilitation nutrition is effective for preventing and treating iatrogenic sarcopenia and sarcopenic dysphagia. Rehabilitation nutrition can be practiced more effectively and comprehensively by using the rehabilitation nutrition care process, which is a systematic problem-solving method. Further research is required to verify the efficacy of rehabilitation nutrition for preventing or improving iatrogenic sarcopenia and/or sarcopenic dysphagia.
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Affiliation(s)
- A Nagano
- Hidetaka Wakabayashi, Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami ward, Yokohama, Kanagawa, Japan, Tel: +81-45-261-5656 Fax: +81-45-253-9955, E-mail:
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Weijzen MEG, Kouw IWK, Verschuren AAJ, Muyters R, Geurts JA, Emans PJ, Geerlings P, Verdijk LB, van Loon LJC. Protein Intake Falls below 0.6 g•kg-1•d-1 in Healthy, Older Patients Admitted for Elective Hip or Knee Arthroplasty. J Nutr Health Aging 2019; 23:299-305. [PMID: 30820520 PMCID: PMC6399806 DOI: 10.1007/s12603-019-1157-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/07/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Hospitalization is generally accompanied by changes in food intake. Patients typically receive hospital meals upon personal preference within the framework of the food administration services of the hospital. In the present study, we assessed food provision and actual food and snack consumption in older patients admitted for elective hip or knee arthroplasty. DESIGN A prospective observational study. SETTING Orthopedic nursing ward of the Maastricht University Medical Centre+. PARTICIPANTS In the present study, n=101 patients (age: 67±10 y; hospital stay: 6.1±1.8 d) were monitored during hospitalization following elective hip or knee arthroplasty. MEASUREMENTS Energy and protein provided by self-selected hospital meals and snacks, and actual energy and protein (amount, distribution, and source) consumed by patients was weighed and recorded throughout 1-6 days. RESULTS Self-selected meals provided 6.5±1.5 MJ•d-1, with 16, 48, and 34 En% provided as protein, carbohydrate, and fat, respectively. Self-selected hospital meals provided 0.75±0.16 and 0.79±0.21 g•kg-1•d-1 protein in males and females, respectively. Actual protein consumption averaged merely 0.59±0.18 and 0.50±0.21 g•kg-1•d-1, respectively. Protein consumption at breakfast, lunch, and dinner averaged 16±8, 18±9, and 20±6 g per meal, respectively. CONCLUSIONS Though self-selected hospital meals provide patients with ~0.8 g•kg-1•d-1 protein during short-term hospitalization, actual protein consumption falls well below 0.6 g•kg-1•d-1 with a large proportion (~32%) of the provided food being discarded. Alternative strategies are required to ensure maintenance of habitual protein intake in older patients admitted for elective orthopedic surgery.
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Affiliation(s)
- M E G Weijzen
- Prof. L.J.C. van Loon, Ph.D., Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, the Netherlands, E-mail: , Tel: +31 43 388 1397, Fax: +31 43 367 0976
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Traylor DA, Gorissen SHM, Phillips SM. Perspective: Protein Requirements and Optimal Intakes in Aging: Are We Ready to Recommend More Than the Recommended Daily Allowance? Adv Nutr 2018; 9:171-182. [PMID: 29635313 PMCID: PMC5952928 DOI: 10.1093/advances/nmy003] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022] Open
Abstract
The Dietary Reference Intakes set the protein RDA for persons >19 y of age at 0.8 g protein ⋅ kg body weight-1 ⋅ d-1. A growing body of evidence suggests, however, that the protein RDA may be inadequate for older individuals. The evidence for recommending a protein intake greater than the RDA comes from a variety of metabolic approaches. Methodologies centered on skeletal muscle are of paramount importance given the age-related decline in skeletal muscle mass and function (sarcopenia) and the degree to which dietary protein could mitigate these declines. In addition to evidence from short-term experimental trials, observational data show that higher protein intakes are associated with greater muscle mass and, more importantly, better muscle function with aging. We are in dire need of more evidence from longer-term intervention trials showing the efficacy of protein intakes that are higher than the RDA in older persons to support skeletal muscle health. We propose that it should be recommended that older individuals consume ≥1.2 g protein · kg-1 · d-1 and that there should be an emphasis on the intake of the amino acid leucine, which plays a central role in stimulating skeletal muscle anabolism. Critically, the often-cited potential negative effects of consuming higher protein intakes on renal and bone health are without a scientific foundation in humans.
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Affiliation(s)
- Daniel A Traylor
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Stefan H M Gorissen
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Stuart M Phillips
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada,Address correspondence to SMP (e-mail: )
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Bhasin S, Apovian CM, Travison TG, Pencina K, Moore LL, Huang G, Campbell WW, Li Z, Howland AS, Chen R, Knapp PE, Singer MR, Shah M, Secinaro K, Eder RV, Hally K, Schram H, Bearup R, Beleva YM, McCarthy AC, Woodbury E, McKinnon J, Fleck G, Storer TW, Basaria S. Effect of Protein Intake on Lean Body Mass in Functionally Limited Older Men: A Randomized Clinical Trial. JAMA Intern Med 2018; 178:530-541. [PMID: 29532075 PMCID: PMC5885156 DOI: 10.1001/jamainternmed.2018.0008] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022]
Abstract
Importance The Institute of Medicine set the recommended dietary allowance (RDA) for protein at 0.8 g/kg/d for the entire adult population. It remains controversial whether protein intake greater than the RDA is needed to maintain protein anabolism in older adults. Objective To investigate whether increasing protein intake to 1.3 g/kg/d in older adults with physical function limitations and usual protein intake within the RDA improves lean body mass (LBM), muscle performance, physical function, fatigue, and well-being and augments LBM response to a muscle anabolic drug. Design, Setting, and Participants This randomized clinical trial with a 2 × 2 factorial design was conducted in a research center. A modified intent-to-treat analytic strategy was used. Participants were 92 functionally limited men 65 years or older with usual protein intake less thanor equal to 0.83 g/kg/d within the RDA. The first participant was randomized on September 21, 2011, and the last participant completed the study on January 19, 2017. Interventions Participants were randomized for 6 months to controlled diets with 0.8 g/kg/d of protein plus placebo, 1.3 g/kg/d of protein plus placebo, 0.8 g/kg/d of protein plus testosterone enanthate (100 mg weekly), or 1.3 g/kg/d of protein plus testosterone. Prespecified energy and protein contents were provided through custom-prepared meals and supplements. Main Outcomes and Measures The primary outcome was change in LBM. Secondary outcomes were muscle strength, power, physical function, health-related quality of life, fatigue, affect balance, and well-being. Results Among 92 men (mean [SD] age, 73.0 [5.8] years), the 4 study groups did not differ in baseline characteristics. Changes from baseline in LBM (0.31 kg; 95% CI, -0.46 to 1.08 kg; P = .43) and appendicular (0.04 kg; 95% CI, -0.48 to 0.55 kg; P = .89) and trunk (0.24 kg; 95% CI, -0.17 to 0.66 kg; P = .24) lean mass, as well as muscle strength and power, walking speed and stair-climbing power, health-related quality of life, fatigue, and well-being, did not differ between men assigned to 0.8 vs 1.3 g/kg/d of protein regardless of whether they received testosterone or placebo. Fat mass decreased in participants given higher protein but did not change in those given the RDA: between-group differences were significant (difference, -1.12 kg; 95% CI, -2.04 to -0.21; P = .02). Conclusions and Relevance Protein intake exceeding the RDA did not increase LBM, muscle performance, physical function, or well-being measures or augment anabolic response to testosterone in older men with physical function limitations whose usual protein intakes were within the RDA. The RDA for protein is sufficient to maintain LBM, and protein intake exceeding the RDA does not promote LBM accretion or augment anabolic response to testosterone. Trial Registration clinicaltrials.gov Identifier: NCT01275365.
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Affiliation(s)
- Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Caroline M. Apovian
- Department of Medicine, Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston, Massachusetts
| | - Thomas G. Travison
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine/Preventive Medicine and Epidemiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karol Pencina
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lynn L. Moore
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
| | - Grace Huang
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Wayne W. Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Zhuoying Li
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew S. Howland
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ruo Chen
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Philip E. Knapp
- Department of Medicine, Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston, Massachusetts
| | - Martha R. Singer
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
| | - Mitali Shah
- Department of Medicine, Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston, Massachusetts
| | - Kristina Secinaro
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Richard V. Eder
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kathleen Hally
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Haley Schram
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Richelle Bearup
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Yusnie M. Beleva
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ashley C. McCarthy
- Department of Medicine, Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston, Massachusetts
| | - Erin Woodbury
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jennifer McKinnon
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Geeta Fleck
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Thomas W. Storer
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Shehzad Basaria
- Research Program in Men’s Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women’s Hospital, Boston, Massachusetts
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Bradlee ML, Mustafa J, Singer MR, Moore LL. High-Protein Foods and Physical Activity Protect Against Age-Related Muscle Loss and Functional Decline. J Gerontol A Biol Sci Med Sci 2017; 73:88-94. [PMID: 28549098 DOI: 10.1093/gerona/glx070] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/22/2017] [Indexed: 01/28/2023] Open
Abstract
Background Some clinical trials suggest that protein supplementation enhances the effects of resistance exercise on skeletal muscle mass (SMM); fewer studies examine the effects of diets rich in protein-source foods on SMM and functional status among community-dwelling adults. Methods Data from the Framingham Offspring study including diet (three-day records, exams 3 and 5), physical activity (exams 2 and 4), percent SMM (%SMM) (exams 6 and 7), and functional performance (exams 5 through 8) were used to evaluate independent and combined effects of physical activity and high-protein foods on adjusted mean %SMM (using analysis of covariance) and risk of functional decline (using Cox proportional hazard's models). Analyses were adjusted for such factors as age, education, height, smoking, and fruit and grain consumption). Results Higher intakes of protein-source foods (red meat, poultry, fish, dairy, and soy, nuts, seeds and legumes) were associated with higher %SMM over 9 years, particularly among women. Men and women with higher intakes of foods from animal sources had a higher % SMM regardless of activity; beneficial effects of plant-based protein foods were only evident in physically active adults. Active subjects with higher intakes of animal or plant protein-source foods had 35% lowest risks of functional decline. Among less active individuals, only those consuming more animal protein-source foods had reduced risks of functional decline (HR: 0.7l; 95% CI: 0.50-1.01). Conclusion Higher intake of animal-protein foods, alone and especially in combination with a physically active lifestyle, was associated with preservation of muscle mass and functional performance in older adults.
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Affiliation(s)
- M Loring Bradlee
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Jabed Mustafa
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Martha R Singer
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Lynn L Moore
- Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Massachusetts
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Characterising the muscle anabolic potential of dairy, meat and plant-based protein sources in older adults. Proc Nutr Soc 2017; 77:20-31. [DOI: 10.1017/s002966511700194x] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The age-related loss of skeletal muscle mass and function is caused, at least in part, by a reduced muscle protein synthetic response to protein ingestion. The magnitude and duration of the postprandial muscle protein synthetic response to ingested protein is dependent on the quantity and quality of the protein consumed. This review characterises the anabolic properties of animal-derived and plant-based dietary protein sources in older adults. While approximately 60 % of dietary protein consumed worldwide is derived from plant sources, plant-based proteins generally exhibit lower digestibility, lower leucine content and deficiencies in certain essential amino acids such as lysine and methionine, which compromise the availability of a complete amino acid profile required for muscle protein synthesis. Based on currently available scientific evidence, animal-derived proteins may be considered more anabolic than plant-based protein sources. However, the production and consumption of animal-derived protein sources is associated with higher greenhouse gas emissions, while plant-based protein sources may be considered more environmentally sustainable. Theoretically, the lower anabolic capacity of plant-based proteins can be compensated for by ingesting a greater dose of protein or by combining various plant-based proteins to provide a more favourable amino acid profile. In addition, leucine co-ingestion can further augment the postprandial muscle protein synthetic response. Finally, prior exercise or n-3 fatty acid supplementation have been shown to sensitise skeletal muscle to the anabolic properties of dietary protein. Applying one or more of these strategies may support the maintenance of muscle mass with ageing when diets rich in plant-based protein are consumed.
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48
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Phillips SM. Nutrition in the elderly: a recommendation for more (evenly distributed) protein? Am J Clin Nutr 2017; 106:12-13. [PMID: 28592608 DOI: 10.3945/ajcn.117.159863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stuart M Phillips
- Department of Kinesiology, Physical Activity Centre of Excellence, McMaster University, Hamilton, Ontario, Canada
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Phillips SM. Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults. Front Nutr 2017; 4:13. [PMID: 28534027 PMCID: PMC5420553 DOI: 10.3389/fnut.2017.00013] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/18/2017] [Indexed: 12/21/2022] Open
Abstract
Protein needs for otherwise healthy individuals older than 19 years are defined by the recommended dietary allowance (RDA) at 0.80 g protein/kg/day. There is no recommendation in the current RDA for subpopulations of older adults or people in various pathological situations. Despite the lack of a separate recommendation, there exists a growing body of evidence that is strongly suggestive of an increased need and/or benefit for protein in older persons. That is, intakes beyond the RDA are, in older persons, associated with benefits. In addition, a number of catabolic states including critical illness also result in a sharp elevation in the needs for protein and amino acids. An underappreciated issue in protein nutrition is the impact of protein quality on clinically relevant outcomes. The introduction of a new protein scoring system-the digestible indispensable amino acid score (DIAAS)-for protein quality has raised a forgotten awareness of protein quality. The DIAAS, which replaces the protein digestibility-corrected amino acid score (PDCAAS), is based on ileal digestibility of protein and a different test protein than PDCAAS and has values greater than 1.0. The aim of this article is a brief review and summary recommendations for protein nutrition and protein requirements in populations who would benefit from more protein than the RDA. The emphasis of the review is on muscle protein turnover, and there is a discussion of the impact of protein quality, particularly as it applies to commercially available protein sources. The evidence for more optimal protein intakes is considered in light of the potential health risks of consumption of protein at levels greater than the RDA.
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Houston DK, Tooze JA, Garcia K, Visser M, Rubin S, Harris TB, Newman AB, Kritchevsky SB. Protein Intake and Mobility Limitation in Community-Dwelling Older Adults: the Health ABC Study. J Am Geriatr Soc 2017; 65:1705-1711. [PMID: 28306154 DOI: 10.1111/jgs.14856] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The current Recommended Dietary Allowance (RDA) for protein is based on short-term nitrogen balance studies in young adults and may underestimate the amount needed to optimally preserve physical function in older adults. We examined the association between protein intake and the onset of mobility limitation over 6 years of follow-up in older adults in the Health ABC study. DESIGN Prospective cohort study. SETTING Memphis, Tennessee and Pittsburgh, Pennsylvania. PARTICIPANTS Community-dwelling, initially well-functioning adults aged 70-79 years (n = 1998). MEASUREMENTS Protein intake (g/kg body weight/d) was calculated using an interviewer-administered 108-item food frequency questionnaire at baseline. Mobility limitation was assessed semi-annually and defined as reporting any difficulty walking one-quarter of a mile or climbing 10 steps on 2 consecutive 6-month contacts. The association between protein intake and incident mobility limitation was examined using Cox proportional hazard regression models adjusting for demographics, behavioral characteristics, chronic conditions, total energy intake, and height. RESULTS Mean (SD) protein intake was 0.91 (0.38) g/kg body weight/d, with 43% reporting intakes less than the RDA (0.8 g/kg body weight/d). During 6 years of follow-up, 705 participants (35.3%) developed mobility limitations. Compared to participants in the upper tertile of protein intake (≥1.0 g/kg body weight/d), participants in the lower two tertiles of protein intake (<0.7 and 0.7 -<1.0 g/kg body weight/d) were at greater risk of developing mobility limitation over 6 years of follow-up (RR (95% CI): 1.86 (1.41-2.44) and 1.49 (1.20-1.84), respectively). CONCLUSION Lower protein intake was associated with increased risk of mobility limitation in community-dwelling, initially well-functioning older adults. These results suggest that protein intakes of ≥1.0 g/kg body weight/d may be optimal for maintaining physical function in older adults.
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Affiliation(s)
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katelyn Garcia
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Susan Rubin
- University of California, San Francisco, California
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