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Increasing Muscle Mass in Elders through Diet and Exercise: A Literature Review of Recent RCTs. Foods 2023; 12:foods12061218. [PMID: 36981144 PMCID: PMC10048759 DOI: 10.3390/foods12061218] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
This study aimed to review the current evidence on the independent and combined effects of diet and exercise and their impact on skeletal muscle mass in the elderly population. Skeletal muscle makes up approximately 40% of total body weight and is essential for performing daily activities. The combination of exercise and diet is known to be a potent anabolic stimulus through stimulation of muscle protein synthesis from amino acids. Aging is strongly associated with a generalized deterioration of physiological function, including a progressive reduction in skeletal muscle mass and strength, which in turn leads to a gradual functional impairment and an increased rate of disability resulting in falls, frailty, or even death. The term sarcopenia, which is an age-related syndrome, is primarily used to describe the gradual and generalized loss of skeletal muscle mass (mainly in type II muscle fibers) and function. Multimodal training is emerging as a popular training method that combines a wide range of physical dimensions. On the other hand, nutrition and especially protein intake provide amino acids, which are essential for muscle protein synthesis. According to ESPEN, protein intake in older people should be at least 1 g/kgbw/day. Essential amino acids, such as leucine, arginine, cysteine, and glutamine, are of particular importance for the regulation of muscle protein synthesis. For instance, a leucine intake of 3 g administered alongside each main meal has been suggested to prevent muscle loss in the elderly. In addition, studies have shown that vitamin D and other micronutrients can have a protective role and may modulate muscle growth; nevertheless, further research is needed to validate these claims. Resistance-based exercise combined with a higher intake of dietary protein, amino acids, and/or vitamin D are currently recognized as the most effective interventions to promote skeletal muscle growth. However, the results are quite controversial and contradictory, which could be explained by the high heterogeneity among studies. It is therefore necessary to further assess the impact of each individual exercise and nutritional approach, particularly protein and amino acids, on human muscle turnover so that more efficient strategies can be implemented for the augmentation of muscle mass in the elderly.
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Protein and Leucine Intake at Main Meals in Elderly People with Type 2 Diabetes. Nutrients 2023; 15:nu15061345. [PMID: 36986075 PMCID: PMC10053961 DOI: 10.3390/nu15061345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Background: The recommended protein intake for the elderly is 25–30 g at main meals, with at least 2500–2800 mg of leucine at each meal. There is still little evidence regarding the amount and distribution of protein and leucine intake with meals in the elderly with type 2 diabetes (T2D). In this cross-sectional study, we evaluated protein and leucine intake at each meal in elderly patients with T2D. Methods: A total of 138 patients (91 men and 47 women) with T2D, aged 65 years or older, were included. Participants performed three 24-h dietary recalls for the evaluation of their dietary habits and protein and leucine intake at meals. Results: The average protein intake was 0.9 ± 0.2 g/kg body weight/day, and only 23% of patients complied with the recommendations. The average protein intake was 6.9 g at breakfast, 29 g at lunch, and 21 g at dinner. None of the patients reached the recommended protein intake at breakfast; 59% of patients complied with the recommendations at lunch; and 32% at dinner. The average leucine intake was 579 mg at breakfast, 2195 g at lunch, and 1583 mg at dinner. The recommended leucine intake was not reached by any patient at breakfast, by 29% of patients at lunch, and by 13% at dinner. Conclusions: Our data show that, in elderly patients with T2D, the average protein intake is low, particularly at breakfast and dinner, and that leucine intake is remarkably lower than the recommended levels. These data raise the need to implement nutritional strategies capable of increasing protein and leucine intake in the elderly with T2D.
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Peters JC, Breen JA, Pan Z. Effects of Culinary Spices on Liking and Consumption of Protein Rich Foods in Community-Dwelling Older Adults. Nutrients 2023; 15:nu15051172. [PMID: 36904171 PMCID: PMC10005771 DOI: 10.3390/nu15051172] [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: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Insufficient protein intake is a common challenge among older adults, leading to loss of muscle mass, decreased function and reduced quality of life. A protein intake of 0.4 g/kg body weight/meal is recommended to help prevent muscle loss. The purpose of this study was to assess whether the protein intake of 0.4 g/kg body weight/meal could be achieved with typical foods and whether culinary spices could enhance protein intake. A lunch meal test was conducted in 100 community-dwelling volunteers; 50 were served a meat entrée and 50 were served a vegetarian entrée with or without added culinary spices. Food consumption, liking and perceived flavor intensity were assessed using a randomized, two-period, within subjects crossover design. Within the meat or vegetarian treatments, there were no differences in entrée or meal intakes between spiced and non-spiced meals. Participants fed meat consumed 0.41 g protein/kg body weight/meal, while the vegetarian intake was 0.25 g protein/kg body weight/meal. The addition of spice to the vegetarian entrée significantly increased liking and flavor intensity of both the entrée and the entire meal, while spice addition only increased flavor for the meat offering. Culinary spices may be a useful tool to improve the liking and flavor of high-quality protein sources among older adults, especially when used with plant-based foods, although improving liking and flavor alone are insufficient to increase protein intake.
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Affiliation(s)
- John C. Peters
- Anschutz Health and Wellness Center, 12348 E. Montview Blvd., MailStop C263, Aurora, CO 80045, USA
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Denver, Anschutz Medical Campus, 12801 E. 17th Ave., RC1 South Rm 7103, Aurora, CO 80045, USA
- Correspondence:
| | - Jeanne Anne Breen
- Anschutz Health and Wellness Center, 12348 E. Montview Blvd., MailStop C263, Aurora, CO 80045, USA
| | - Zhaoxing Pan
- Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, 13123 E. 16th Ave., B065, Aurora, CO 80045, USA
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Langley‐Evans SC. The Covid‐19 pandemic and publishing in nutrition and dietetics. J Hum Nutr Diet 2022; 35:1012-1015. [DOI: 10.1111/jhn.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Langley-Evans SC. Malnutrition should not be normal: The importance of protein for older adults. J Hum Nutr Diet 2022; 35:751-753. [PMID: 36099338 DOI: 10.1111/jhn.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 11/29/2022]
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Crabtree DR, Holliday A, Buosi W, Fyfe CL, Horgan GW, Johnstone AM. The Acute Effects of Breakfast Drinks with Varying Protein and Energy Contents on Appetite and Free-Living Energy Intake in UK Older Adults. Geriatrics (Basel) 2022; 7:geriatrics7010016. [PMID: 35200521 PMCID: PMC8871635 DOI: 10.3390/geriatrics7010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Proposed strategies for preventing protein deficiencies in older patients include increasing protein intake at breakfast. However, protein is highly satiating and the effects of very high protein intakes at breakfast on subsequent appetite and free-living energy intake (EI) in older adults are unclear. This study compared the acute effects of two breakfast drinks varying in protein and energy contents on appetite and free-living EI in healthy older adults using a randomized 2 × 2 crossover design. Participants (n = 48 (20 men, 28 women); mean ± SD age: 69 ± 3 years; BMI: 22.2 ± 2.0 kg·m−2; fat-free mass: 45.5 ± 8.0 kg) consumed two drinks for breakfast (high-protein (30.4 ± 5.3 g), low-energy (211.2 ± 37.1 kcal) content (HPLE) and very high-protein (61.8 ± 9.9 g), fed to energy requirements (428.0 ± 68.9 kcal) (VHPER)) one week apart. Appetite perceptions were assessed for 3 h post-drink and free-living EI was measured for the remainder of the day. Appetite was lower in VHPER than HPLE from 30 min onwards (p < 0.01). Free-living energy and protein intake did not differ between conditions (p = 0.814). However, 24 h EI (breakfast drink intake + free-living intake) was greater in VHPER than HPLE (1937 ± 568 kcal vs. 1705 ± 490 kcal; p = 0.001), as was 24 h protein intake (123.0 ± 26.0 g vs. 88.6 ± 20.9 g; p < 0.001). Consuming a very high-protein breakfast drink acutely suppressed appetite more than a low-energy, high-protein drink in older adults, though free-living EI was unaffected. The long-term effects of adopting such a breakfast strategy in older adults at high risk of energy and protein malnutrition warrants exploration.
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Affiliation(s)
- Daniel R. Crabtree
- Division of Biomedical Sciences, University of the Highlands and Islands, Old Perth Road, Inverness IV2 3JH, UK
- Correspondence: ; Tel.: +44-(0)-1463-279405
| | - Adrian Holliday
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK;
| | - William Buosi
- The Rowett Institute, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (W.B.); (C.L.F.); (A.M.J.)
| | - Claire L. Fyfe
- The Rowett Institute, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (W.B.); (C.L.F.); (A.M.J.)
| | - Graham W. Horgan
- Biomathematics and Statistics Scotland, Foresterhill Road, Aberdeen AB25 2ZD, UK;
| | - Alexandra M. Johnstone
- The Rowett Institute, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZD, UK; (W.B.); (C.L.F.); (A.M.J.)
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Houfek A, Garden-Robinson J, Hilliard E, Rhee Y, Stastny S, Belury MA, Cawthon PM, McGrath R. Older American Women May Especially Benefit from Distributing and Consuming Protein for Decreasing Odds of Functional Limitations. J Nutr Health Aging 2022; 26:1025-1032. [PMID: 36437771 DOI: 10.1007/s12603-022-1857-x] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Protein is a key macronutrient for preserving physical function, but the role of protein intake on functional status may differ in men and women. We sought to examine the associations of daily protein intake and distribution on functional limitations in older American men and women. DESIGN Cross-sectional. SETTING Population-based survey. PARTICIPANTS The analytic sample included 3,976 men and 4,081 women aged ≥60-years from the 2007-2016 waves of the National Health and Nutrition Examination Survey. MEASUREMENTS Participants reported their ability to perform basic activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility activities, and general physical tasks. Those reporting difficulty or an inability in completing such functional tasks were considered as having a functional limitation. Protein intake was determined with dietary recalls and participants revealed functional limitations. Protein recommendations of ≥0.80, ≥1.00, and ≥1.50 g/kg/day were used. Based on these cut-points, we also investigated distribution of protein across 4 eating occasions at ≥0.20, ≥0.25, and ≥0.38 g/kg/meal, respectively. RESULTS Older women meeting each recommendation had decreased odds for functional limitations: 0.55 (95% confidence interval (CI): 0.40-0.75) for ≥0.80 g/kg/day, 0.75 (CI: 0.58-0.97) for ≥1.00 g/kg/day, and 0.72 (CI: 0.55-0.94) for ≥1.5 g/kg/day. No significant associations were observed in older men. Further, older women with protein consumption ≥0.20 g/kg/meal had decreased odds for functional limitations: 0.24 (CI: 0.10-0.61) for 1 occasion, 0.20 (CI: 0.08-0.49) for 2 occasions, 0.16 (CI: 0.07-0.40) for 3 occasions, and 0.12 (CI: 0.04-0.32) for 4 occasions. A similar trend was observed for intake ≥0.25 g/kg/meal: 0.31 (CI: 0.16-0.62) for 2 occasions, 0.30 (CI: 0.14-0.61) for 3 occasions, and 0.31 (CI: 0.12-0.78) for 4 occasions. Women with 1 and 2 eating occasions at ≥0.38 g/kg/meal of protein had 0.66 (CI: 0.48-0.91) and 0.54 (CI: 0.37-0.79) decreased odds for functional limitations, respectively. CONCLUSION Trials that are powered to detect the effects of protein on functional status in women will help to establish causality.
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Affiliation(s)
- A Houfek
- Ryan McGrath, Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108-6050 Phone: 701-231-7474, Fax: 701-231-8872,
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Usual Protein Intake Amount and Sources of Nursing Home Residents with (Risk of) Malnutrition and Effects of an Individualized Nutritional Intervention: An enable Study. Nutrients 2021; 13:nu13072168. [PMID: 34202567 PMCID: PMC8308345 DOI: 10.3390/nu13072168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/29/2022] Open
Abstract
Nursing home (NH) residents with (risk of) malnutrition are at particular risk of low protein intake (PI). The aim of the present analysis was (1) to characterize usual PI (total amount/day (d) and meal, sources/d and meal) of NH residents with (risk of) malnutrition and (2) to evaluate the effects of an individualized nutritional intervention on usual PI. Forty residents (75% female, 85 ± 8 years) with (risk of) malnutrition and inadequate dietary intake received 6 weeks of usual care followed by 6 weeks of intervention. During the intervention phase, an additional 29 ± 11 g/d from a protein-energy drink and/or 2 protein creams were offered to compensate for individual energy and/or protein deficiencies. PI was assessed with two 3-day-weighing records in each phase and assigned to 4 meals and 12 sources. During the usual care phase, mean PI was 41 ± 10 g/d. Lunch and dinner contributed 31 ± 11% and 32 ± 9% to daily intake, respectively. Dairy products (median 9 (interquartile range 6–14) g/d), starchy foods (7 (5–10) g/d) and meat/meat products (6 (3–9) g/d) were the main protein sources in usual PI. During the intervention phase, an additional 18 ± 10 g/d were consumed. Daily PI from usual sources did not differ between usual care and intervention phase (41 ± 10 g/d vs. 42 ± 11 g/d, p = 0.434). In conclusion, daily and per meal PI were very low in NH residents with (risk of) malnutrition, highlighting the importance of adequate intervention strategies. An individualized intervention successfully increased PI without affecting protein intake from usual sources.
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Verreijen AM, van den Helder J, Streppel MT, Rotteveel I, Heman D, van Dronkelaar C, Memelink RG, Engberink MF, Visser M, Tieland M, Weijs PJM. A higher protein intake at breakfast and lunch is associated with a higher total daily protein intake in older adults: a post-hoc cross-sectional analysis of four randomised controlled trials. J Hum Nutr Diet 2021; 34:384-394. [PMID: 33190355 PMCID: PMC8048646 DOI: 10.1111/jhn.12838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND A protein intake of 30-40 g per meal is suggested to maximally stimulate muscle protein synthesis in older adults and could therefore contribute to the prevention of sarcopenia. Protein intake at breakfast and lunch is often low and offers a great opportunity to improve daily protein intake. Protein, however, is known for its satiating effects. Therefore, we explored the association between the amount of protein intake at breakfast and lunch and total daily protein intake in older adults. METHODS Protein intake was assessed by a 3-day food record in 498 community dwelling older adults (≥55 years) participating different lifestyle interventions. Linear mixed model analysis was used to examine the association between protein intake at breakfast or lunch and total daily protein intake, adjusted for sex, age, body mass index, smoking status, study and total energy intake. RESULTS After adjustment for potential confounders, a 10 g higher protein intake at breakfast was associated with a 3.2 g higher total daily protein intake (P = 0.008) for males and a 4.9 g (P < 0.001) higher total daily protein intake for females. A 10 g higher protein intake at lunch was associated with a 3.7 g higher total daily protein intake (P < 0.001) for males, and a 5.8 g higher total daily protein intake (P < 0.001) for females. CONCLUSIONS A higher protein intake at breakfast and lunch is associated with a higher total daily protein intake in community dwelling older adults. Stimulating a higher protein intake at breakfast and lunch might represent a promising nutritional strategy to optimise the amount of protein per meal without compromising total daily protein intake.
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Affiliation(s)
- A. M. Verreijen
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - J. van den Helder
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - M. T. Streppel
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - I. Rotteveel
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - D. Heman
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - C. van Dronkelaar
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - R. G. Memelink
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - M. F. Engberink
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - M. Visser
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Health SciencesFaculty of ScienceVrije UniversiteitAmsterdamThe Netherlands
| | - M. Tieland
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - P. J. M. Weijs
- Faculty of Sports and NutritionCenter of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Department of Nutrition and DieteticsAmsterdam University Medical CentersVrije UniversiteitAmsterdamThe Netherlands
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