MTOR signaling and ubiquitin-proteosome gene expression in the preservation of fat free mass following high protein, calorie restricted weight loss

Lifelong dietary protein restriction accelerates skeletal muscle loss and reduces muscle fibre size by impairing proteostasis and mitochondrial homeostasis

The early life environment significantly affects the development of age-related skeletal muscle disorders. However, the long-term effects of lactational protein restriction on skeletal muscle are still poorly defined. Our study revealed that male mice nursed by dams fed a low-protein diet during lactation exhibited skeletal muscle growth restriction. This was associated with a dysregulation in the expression levels of genes related to the ribosome, mitochondria and skeletal muscle development. We reported that lifelong protein restriction accelerated loss of type-IIa muscle fibres and reduced muscle fibre size by impairing mitochondrial homeostasis and proteostasis at 18 months of age. However, feeding a normal-protein diet following lactational protein restriction prevented accelerated fibre loss and fibre size reduction in later life. These findings provide novel insight into the mechanisms by which lactational protein restriction hinders skeletal muscle growth and includes evidence that lifelong dietary protein restriction accelerated skeletal muscle loss in later life.

Carica Papaya Reduces High Fat Diet and Streptozotocin-Induced Development of Inflammation in Adipocyte via IL-1β/IL-6/TNF-α Mediated Signaling Mechanisms in Type-2 Diabetic Rats

The prevalence of obesity in contemporary society has brought attention to how serious it is all around the world. Obesity, a proinflammatory condition defined by hypertrophied adipocytes and immune cells that reside in adipose tissue, is characterized by elevated circulating levels of proinflammatory cytokines. The pro-inflammatory mediators trigger a number of inflammatory pathways and affect the phosphorylation of a number of insulin-signaling pathways in peripheral tissues. In this work, we pointed the outcome of the leaves of Carica papaya (C. papaya) on the inflammatory molecules by in vivo and in silico analysis in order to prove its mechanisms of action. Adipocytokines, antioxidant enzymes, gene and protein expression of pro-inflammatory signaling molecules (mTOR, TNF-α, IL-1β, IL-6 and IKKβ) by q-RT-PCR and immunohistochemistry, as well as histopathological analysis, in adipose tissues were carried out. C. papaya reinstated the levels of adipocytokines, antioxidant enzymes and mRNA levels of mTOR, TNF-α, IL-1β, IL-6 and IKKβ in the adipose tissues of type 2 diabetic rats. Molecular docking and dynamics simulation studies revealed that caffeic acid, transferulic acid and quercetin had the top hit rates against IKKβ, TNF-α, IL-6, IL-1β, and mTOR. This study concludes that C. papaya put back the altered effects in fatty tissue of type 2 diabetic rats by restoring the adipocytokines and the gene expression.

Synergistic Effect of Increased Total Protein Intake and Strength Training on Muscle Strength: A Dose-Response Meta-analysis of Randomized Controlled Trials

Background

Protein supplementation augments muscle strength gain during resistance training. Although some studies focus on the dose-response relationship of total protein intake to muscle mass or strength, the detailed dose-response relationship between total protein intake and muscle strength increase is yet to be clarified, especially in the absence of resistance training.

Objective

We aimed to assess the detailed dose-response relationship between protein supplementation and muscle strength, with and without resistance training.

Design

Systematic review with meta-analysis.

Data Sources

PubMed and Ichushi-Web (last accessed on March 23, 2022).

Eligibility Criteria

Randomized controlled trials investigating the effects of protein intake on muscle strength.

Synthesis Methods

A random-effects model and a spline model.

Results

A total of 82 articles were obtained for meta-analyses, and data from 69 articles were used to create spline curves. Muscle strength increase was significantly augmented only with resistance training (MD 2.01%, 95% CI 1.09–2.93) and was not augmented if resistance training was absent (MD 0.13%, 95% CI − 1.53 to 1.79). In the dose-response analysis using a spline model, muscle strength increase with resistance training showed a dose-dependent positive association with total protein intake, which is 0.72% (95% CI 0.40–1.04%) increase in muscle strength per 0.1 g/kg body weight [BW]/d increase in total protein intake up to 1.5 g/kg BW/d, but no further gains were observed thereafter.

Conclusion

Concurrent use of resistance training is essential for protein supplementation to improve muscle strength. This study indicates that 1.5 g/kg BW/d may be the most appropriate amount of total protein intake for maintaining and augmenting muscle strength along with resistance training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-022-00508-w.

Skeletal muscle gene expression in older adults with type 2 diabetes mellitus undergoing calorie-restricted diet and recreational sports training - a randomized clinical trial

AIMS

This study aimed to evaluate the impact of a 12-week calorie-restricted diet and recreational sports training on gene expressions IL15, ATROGIN1 and MURF-1 in skeletal muscle of T2D patients.

METHODS

Older adults with T2D (n = 39, 60 ± 6.0 years, BMI 33.5 ± 0.6 kg/m²) were randomly allocated to Diet+Soccer (DS), Diet+Running (DR) or Diet (D). The training sessions were moderate-to-high-intensity and performed 3 × 40 min/week for 12-weeks. Gene expression from vastus lateralis muscle obtained by qRT-PCR, dual-energy X-ray and fasting blood testing measurements were performed before and after 12-weeks. Statistical analysis adopted were two-way ANOVA and Paired t-test for gene expression, and RM-ANOVA test for the remainder variables.

RESULTS

Total body weight was reduced in ~4 kg representing body fat mass in all groups after 12-weeks (P < 0.05). HbA1c values decreased in all groups post-intervention. Lipids profile improved in the training groups (P < 0.05) after 12-weeks. ATROGIN1 and MURF-1 mRNA reduced in the DS (1.084 ± 0.14 vs. 0.754 ± 1.14 and (1.175 ± 0.34 vs. 0.693 ± 0.12, respectively; P < 0.05), while IL15 mRNA increased in the DR (1056 ± 0,12 vs. 1308 ± 0,13; P < 0.05) after 12-weeks intervention.

CONCLUSION

Recreational training with a moderate calorie-restricted diet can downregulates the expression of atrophy-associated myokines and increases the expression of anti-inflammatory gene IL15.

Fundamentals of Membrane Lipid Replacement: A Natural Medicine Approach to Repairing Cellular Membranes and Reducing Fatigue, Pain, and Other Symptoms While Restoring Function in Chronic Illnesses and Aging

Membrane Lipid Replacement (MLR) uses natural membrane lipid supplements to safely replace damaged, oxidized lipids in membranes in order to restore membrane function, decrease symptoms and improve health. Oral MLR supplements contain mixtures of cell membrane glycerolphospholipids, fatty acids, and other lipids, and can be used to replace and remove damaged cellular and intracellular membrane lipids. Membrane injury, caused mainly by oxidative damage, occurs in essentially all chronic and acute medical conditions, including cancer and degenerative diseases, and in normal processes, such as aging and development. After ingestion, the protected MLR glycerolphospholipids and other lipids are dispersed, absorbed, and internalized in the small intestines, where they can be partitioned into circulating lipoproteins, globules, liposomes, micelles, membranes, and other carriers and transported in the lymphatics and blood circulation to tissues and cellular sites where they are taken in by cells and partitioned into various cellular membranes. Once inside cells, the glycerolphospholipids and other lipids are transferred to various intracellular membranes by lipid carriers, globules, liposomes, chylomicrons, or by direct membrane-membrane interactions. The entire process appears to be driven by 'bulk flow' or mass action principles, where surplus concentrations of replacement lipids can stimulate the natural exchange and removal of damaged membrane lipids while the replacement lipids undergo further enzymatic alterations. Clinical studies have demonstrated the advantages of MLR in restoring membrane and organelle function and reducing fatigue, pain, and other symptoms in chronic illness and aging patients.

Effects of Different Dietary Energy Intake Following Resistance Training on Muscle Mass and Body Fat in Bodybuilders: A Pilot Study

The purpose of this study was to determine the effects of different amounts of energy intake in combination with progressive resistance training on muscle mass and body fat in bodybuilders. Eleven male bodybuilders (26.8 ± 2.3 years, 90.1 ± 9.7 kg, and 176.9 ± 7.1 cm) were randomly assigned into one of two groups: a group that ingested higher amounts of energy (G1, 67.5 ± 1.7 kcal/kg/d, n = 6), and a group that ingested moderate amounts of energy (G2, 50.1 ± 0.51 kcal/kg/d, n = 5). Both groups performed resistance training 6 days per week over a 4-week study period. Measures of body composition were assessed before and after the intervention period. For body fat, only the G1 presented significant changes from pre- to post-training (G1 = +7.4% vs. G2 = +0.8%). For muscle mass, both groups showed significant increases after the intervention period, with G1 presenting a greater increase compared to G2 (G1 = +2.7% vs. G2 = +1.1%). Results suggest that greater energy intake in combination with resistance training induces greater increases in both muscle mass and body fat in competitive male bodybuilders.

Impaired proteostasis during skeletal muscle aging

Aging is a complex phenomenon that has detrimental effects on tissue homeostasis. The skeletal muscle is one of the earliest tissues to be affected and to manifest age-related changes such as functional impairment and the loss of mass. Common to these alterations and to most of tissues during aging is the disruption of the proteostasis network by detrimental changes in the ubiquitin-proteasomal system (UPS) and the autophagy-lysosomal system (ALS). In fact, during aging the accumulation of protein aggregates, a process mainly driven by increased levels of oxidative stress, has been observed, clearly demonstrating UPS and ALS dysregulation. Since the UPS and ALS are the two most important pathways for the removal of misfolded and aggregated proteins and also of damaged organelles, we provide here an overview on the current knowledge regarding the connection between the loss of proteostasis and skeletal muscle functional impairment and also how redox regulation can play a role during aging. Therefore, this review serves for a better understanding of skeletal muscle aging in regard to the loss of proteostasis and how redox regulation can impact its function and maintenance.

Correlations between resistance training-induced changes on phase angle and biochemical markers in older women

The main purpose of this study was to investigate the effects of 12 weeks of resistance training (RT) on phase angle (PhA), inflammatory and oxidative stress biomarkers, and to evaluate whether these RT-induced adaptations are related to PhA changes. Fifty-one older women (70.6 ± 5.1 years; 26.9 ± 4.2 kg/m² ) were randomly allocated into a training group (TG) that performed 12-week RT or a nonexercising control group (CG). The PhA (Xitron), body composition (DXA), and blood sample measurements (after a 12 hours fast) were performed before and after the intervention. The TG showed a significant (P < .05) increase in PhA (TG: +7.4±5.9% vs CG: -3.6 ± 8.8%), and interleukin-10 (IL-10; TG: +51.8 ± 71.1% vs CG: -46.6 ± 38.0%), and a decrease in tumor necrosis factor alpha (TNF-α; TG: -15.2 ± 11.1% vs CG: +6.9±17.7%), interleukin-6 (IL-6; TG: -17.9 ± 17.8% vs CG: +6.1 ± 24.8%), and C-reactive protein (CRP; TG: -24.1 ± 19.9% vs CG: +43.8 ± 31.1%). Moreover, TG upregulated catalase (TG: +11.4 ± 15.0% vs CG: -6.7 ± 10.2%). Changes in TNF-α (r = -.71), CRP (r = -.65), lower advanced oxidation protein products (r = -.55), and catalase (r = +.73) after RT were correlated with changes in PhA (P < .05). These results suggest that RT improves PhA, inflammatory and oxidative stress biomarkers, and the changes in inflammatory and oxidative damage markers are correlated with changes in PhA.

Resistance training during a 12-week protein supplemented VLCD treatment enhances weight-loss outcomes in obese patients

BACKGROUND

This investigation evaluated the efficacy by which resistance training enhances body composition, metabolic, and functional outcomes for obese patients undergoing a 12-week medically supervised hypocaloric treatment.

METHODS

This was a single-blind, randomized, parallel-group prospective trial. Morbidly obese patients were prescribed a 12-week proprietary very low calorie diet (VLCD) treatment (Optifast^®) with supplemental protein (1120 kcals/day) and were placed in one of two groups for 14 weeks: 1) Standard Treatment Control (CON) (n = 5) or 2) Resistance Training (RT) (n = 6). Both groups underwent a pedometer-based walking program; however only RT performed resistance training 3 days/week for 12 weeks. Body composition, resting energy expenditure (REE), neuromuscular function, and serum biomarkers were measured at weeks 0, 6, and 13.

RESULTS

Both groups exhibited a significant loss of total body mass (TBM) (CON: -19.4 ± 2.3 kg, p = 0.0009 vs. RT: -15.8 ± 1.5 kg, p = 0.0002) and fat mass (FM) (CON: -14.7 ± 1.8 kg, p = 0.0002 vs. RT: -15.1 ± 2.1 kg, p = 0.0002) with no group differences. CON lost 4.6 ± 0.8 kg (p = 0.004) of lean mass (LM) while RT demonstrated no changes. Group differences were found for the relative proportion of total weight-loss due to FM-loss (CON: 75.6 ± 3.4% vs. RT: 96.0 ± 6.0%, p = 0.03) and LM-loss (CON: 24.4 ± 3.2% vs. RT: 4.0 ± 6.5%, p = 0.03). CON demonstrated a 328.6 ± 72.7 kcal/day (-14.3 ± 2.4%) (p = 0.02) decrease in REE while RT exhibited a non-significant decrease of 4.6 ± 1.6% (p = 0.78). RT demonstrated greater improvements in all measures of contractile function and strength when compared to CON (p < 0.05). At post-treatment, RT exhibited greater serum free fatty acids (p = 0.01), glycerol (p = 0.003), and β-hydroxybutyrate (p = 0.005) than CON.

CONCLUSION

Resistance training was advantageous for weight-loss composition by preservation of LM without compromising overall weight- or fat-loss in morbidly obese men and women undergoing a protein supplemented VLCD. These changes accompanied positive adaptations for resting metabolism and muscular function.

Acute and Long-Term Impact of High-Protein Diets on Endocrine and Metabolic Function, Body Composition, and Exercise-Induced Adaptations

BACKGROUND

High-protein diets have been shown to improve body composition through alterations in satiety, muscle protein synthesis, and the thermic effect of food.

AIM

Given these findings, the purpose of this review is to discuss the integration of the specific hormonal and metabolic effects of high-protein diets following both acute and long-term usage, especially with regard to body composition.

METHODS

Full-text articles were obtained through PubMed by using the terms "high-protein diet and body composition," "high-protein diet and exercise," "high-protein diet risk," "high-protein diet side effects," "protein quality PDCAAS," "RDA for protein," and "daily protein recommendation." Articles were initially screened according to their title and abstract; careful evaluation of the full manuscripts was then used to identify relevant articles.

RESULTS

The higher satiety exerted by high-protein diets is generated through increments in anorexigenic, as well as decrements in orexigenic hormones. Improvements in muscle mass are achieved by activation of muscle protein synthesis acting through the mTOR pathway. High thermic effect of food is caused due to necessary deamination, gluconeogenesis, and urea synthesis caused by high-protein diets. Interestingly, high-protein diets in both hypo- and normocaloric conditions have shown to improve body composition, whereas in combination with hypercaloric conditions does not seem to increase fat mass, when the excess energy comes from protein.

CONCLUSIONS

High protein diets effectively improve body composition by acting through different pathways.

Membrane Lipid Replacement for chronic illnesses, aging and cancer using oral glycerolphospholipid formulations with fructooligosaccharides to restore phospholipid function in cellular membranes, organelles, cells and tissues

Membrane Lipid Replacement is the use of functional, oral supplements containing mixtures of cell membrane glycerolphospholipids, plus fructooligosaccharides (for protection against oxidative, bile acid and enzymatic damage) and antioxidants, in order to safely replace damaged, oxidized, membrane phospholipids and restore membrane, organelle, cellular and organ function. Defects in cellular and intracellular membranes are characteristic of all chronic medical conditions, including cancer, and normal processes, such as aging. Once the replacement glycerolphospholipids have been ingested, dispersed, complexed and transported, while being protected by fructooligosaccharides and several natural mechanisms, they can be inserted into cell membranes, lipoproteins, lipid globules, lipid droplets, liposomes and other carriers. They are conveyed by the lymphatics and blood circulation to cellular sites where they are endocytosed or incorporated into or transported by cell membranes. Inside cells the glycerolphospholipids can be transferred to various intracellular membranes by lipid globules, liposomes, membrane-membrane contact or by lipid carrier transfer. Eventually they arrive at their membrane destinations due to 'bulk flow' principles, and there they can stimulate the natural removal and replacement of damaged membrane lipids while undergoing further enzymatic alterations. Clinical trials have shown the benefits of Membrane Lipid Replacement in restoring mitochondrial function and reducing fatigue in aged subjects and chronically ill patients. Recently Membrane Lipid Replacement has been used to reduce pain and other symptoms as well as removing hydrophobic chemical contaminants, suggesting that there are additional new uses for this safe, natural medicine supplement. This article is part of a Special Issue entitled: Membrane Lipid Therapy: Drugs Targeting Biomembranes edited by Pablo V. Escribá.

Protective effects of restricted diet and antioxidants on testis tissue in rats fed with high-fat diet

Background:

A high-fat diet (HFD) promotes the oxidative stress formation, which in turn has hazardous effects on reproductive system and fertility. The present study examines the potential positive effects of a restricted high-fat diet (RHFD) and antioxidants consumption on sperm parameters and testis tissue in rats.

Methods:

Male rats (n = 48) were divided into four groups (12 in each group): control group (Cont), HFD group, RHFD, and RHFD with astaxanthin and vitamins E and C group (RHFDA). After 12 weeks, serum analysis and sperm parameters study were performed. Sections of fixed testes were stained with Hematoxilin and Eosin to study the histological changes. A one-way ANOVA was used to compare the data.

Results:

HFD fed animals presented significant increase in weight load and serum low density lipoprotein (LDL-C) levels (P < 0.05). The sperm count in RHFD was lower than three other groups (P < 0.05) and sperm motility of RHFDA group was significantly higher than HFD and RHFD groups (P < 0.05). The histological study was showed a significant increase in spermatogonium number in RHFDA compared to three other groups (P < 0.05). The number of spermatocyte I and spermatid in RHFD was significantly (P < 0.05) lower than Cont and HFD groups.

Conclusion:

HFD and obesity can affect sperm parameters and spermatogenesis and antioxidants consumption may improve their quality. Although the RHFD is a benefit way in weight loss and decrease of LDL-C of serum, but it is suggested that is not effective on sperm quality improvement.

A case study evaluation of competitors undertaking an antarctic ultra-endurance event: nutrition, hydration and body composition variables

Background

The nutritional demands of ultra-endurance racing are well documented. However, the relationship between nutritional consumption and performance measures are less obvious for athletes competing in Polar conditions. Therefore, the aim of this study was to evaluate dietary intake, hydration status, body composition and performance times throughout an 800-km Antarctic race.

Methods

The event organisers declared that 17 competitors would participate in the South Pole race. Of the 17 competitors, pre-race data were collected from 13 participants (12 males and 1 female (M ± SD): age: 40.1 ± 8.9 years; weight: 83.9 ± 10.3 kg; and body fat percentage: 21.9 ± 3.8%). Dietary recall, body composition and urinary osmolarity were assessed pre-race, midway checkpoint and end race. Data were compared on the basis of fast finishers (the Norwegian team (n = 3) who won in a record of 14 days) and slower finishers (the remaining teams (n = 10) reaching the South Pole between 22 and 28 days).

Results

The percentage contribution of macronutrients to daily energy intake for all participants was as follows: carbohydrate (CHO) = 23.7% (221 ± 82 g.day⁻¹), fat = 60.6% (251 ± 127 g.day⁻¹) and protein = 15.7% (117 ± 52 g.day⁻¹). Energy demands were closer met by faster finishers compared to slower finishers (5,332 ± 469 vs. 3,048 ± 1,140 kcal.day⁻¹, p = 0.02). Average reduction in body mass throughout the race was 8.3 ± 5.5 kg, with an average loss of lean mass of 2.0 ± 4.1 kg. There was a significant negative correlation between changes in lean mass and protein intake (p = 0.03), and lean mass and energy intake (p = 0.03). End-race urinary osmolarity was significantly elevated for faster finishers compared to slower finishers and control volunteers (faster finishers: 933 ± 157 mOsmol.L⁻¹; slower finishers: 543 ± 92 mOsmol.L⁻¹; control: 515 ± 165 mOsmol.L⁻¹, p = 0.04).

Conclusions

Throughout the race, both groups were subjected to a negative change in energy balance which partly explained reduced body mass. Carbohydrate availability was limited inferring a greater reliance on fat and protein metabolism. Consequently, loss in fat-free mass was more prevalent with insufficient protein and caloric intake, which may relate to performance.

Nutritional strategies for the preservation of fat free mass at high altitude

Exposure to extreme altitude presents many physiological challenges. In addition to impaired physical and cognitive function, energy imbalance invariably occurs resulting in weight loss and body composition changes. Weight loss, and in particular, loss of fat free mass, combined with the inherent risks associated with extreme environments presents potential performance, safety, and health risks for those working, recreating, or conducting military operations at extreme altitude. In this review, contributors to muscle wasting at altitude are highlighted with special emphasis on protein turnover. The article will conclude with nutritional strategies that may potentially attenuate loss of fat free mass during high altitude exposure.

Selectively starving cancer cells through dietary manipulation: methods and clinical implications

As the link between obesity and metabolic syndrome and cancer becomes clearer, the need to determine the optimal way to incorporate dietary manipulation in the treatment of cancer patients becomes increasingly important. Metabolic-based therapies, such as caloric restriction, intermittent fasting and a ketogenic diet, have the ability to decrease the incidence of spontaneous tumors and slow the growth of primary tumors, and may have an effect on distant metastases in animal models. Despite the abundance of preclinical data demonstrating the benefit of dietary modification for cancer, to date there are few clinical trials targeting diet as an intervention for cancer patients. We hypothesize that this may be due, in part, to the fact that several different types of diet modification exist with no clear recommendations regarding the optimal method. This article will delineate three commonly used methods of dietary manipulation to assess the potential of each as a regimen for cancer therapy.

Lipid Replacement Therapy: a natural medicine approach to replacing damaged lipids in cellular membranes and organelles and restoring function

Lipid Replacement Therapy, the use of functional oral supplements containing cell membrane phospholipids and antioxidants, has been used to replace damaged, usually oxidized, membrane glycerophospholipids that accumulate during aging and in various clinical conditions in order to restore cellular function. This approach differs from other dietary and intravenous phospholipid interventions in the composition of phospholipids and their defense against oxidation during storage, ingestion, digestion and uptake as well as the use of protective molecules that noncovalently complex with phospholipid micelles and prevent their enzymatic and bile disruption. Once the phospholipids have been taken in by transport processes, they are protected by several natural mechanisms involving lipid receptors, transport and carrier molecules and circulating cells and lipoproteins until their delivery to tissues and cells where they can again be transferred to intracellular membranes by specific and nonspecific transport systems. Once delivered to membrane sites, they naturally replace and stimulate removal of damaged membrane lipids. Various chronic clinical conditions are characterized by membrane damage, mainly oxidative but also enzymatic, resulting in loss of cellular function. This is readily apparent in mitochondrial inner membranes where oxidative damage to phospholipids like cardiolipin and other molecules results in loss of trans-membrane potential, electron transport function and generation of high-energy molecules. Recent clinical trials have shown the benefits of Lipid Replacement Therapy in restoring mitochondrial function and reducing fatigue in aged subjects and patients with a variety of clinical diagnoses that are characterized by loss of mitochondrial function and include fatigue as a major symptom. This Article is Part of a Special Issue Entitled: Membrane Structure and Function: Relevance in the Cell's Physiology, Pathology and Therapy.

Considerations for protein supplementation in warfighters

Ingestion of dietary protein stimulates the synthesis of numerous body proteins. This effect is manifest via hyperaminoacidemia with insulin as a permissive factor. In a sedentary person in energy balance, it is possible to maintain nitrogen balance while consuming protein at an intake of 0.8 g protein · kg(-1) · d(-1). What is unclear is whether being in nitrogen balance is optimal for protein synthesis and not merely adequate and representative of adaptive strategies that could lead to accommodation in "stressed" physiological states. It is clear that being in negative energy balance results in reductions in lean mass and reduced rates of protein synthesis, which can be mitigated by consumption of higher (i.e., 2-3 times the RDA) dietary protein. That long-term practice of inadequate protein intake leads to reduced metabolic, physiological, and physical function provides the basic rationale for the consumption of more than merely adequate protein to prevent not only adaptation but accommodation. Warfighters engaged in combat have been shown to have high daily physical activity energy expenditure, engage in voluntary energy restriction, and are under high metabolic and mental stress. Thus, as a group warfighters would be at risk of consuming suboptimal protein intakes and therefore may benefit from higher amounts of dietary protein intake. Balanced against the potential risk of consuming higher protein, the scientific documentation for which is lacking, there is a strong rationale for the recommendation of higher protein intakes in warfighters who are engaged in field operations.