Whey for Sarcopenia; Can Whey Peptides, Hydrolysates or Proteins Play a Beneficial Role?

Nutrition of aging people with diabetes mellitus: Focus on sarcopenia

As populations age, chronic diseases accumulate, and new health conditions emerge. One noteworthy pair that warrants further evaluation is diabetes mellitus and sarcopenia, given that the latter occurs in 28 % of the population aged over 50 who have diabetes mellitus. The management of both entails nutritional interventions, making the development of unified dietary recommendations an alluring strategy. This review aims to elucidate the current recommendations for the combined management of sarcopenia and diabetes, while featuring elements that require further research. The goal of nutritional management is to improve muscle mass and strength while regulating metabolic risk and glucose levels. To ensure muscle synthesis in the elderly, recommendations align at daily calorie intake that exceeds 30 kcal/kg, with adjustments based on comorbidities. Additionally, a protein intake of at least 1-1.2 g/kg/d is essential, emphasizing both daily and per-meal intake, and can be achieved through diet or branched-amino-acids supplements. Specific considerations for diabetes include restricted protein intake in diabetic nephropathy and exploring the potential link between branched amino acids and insulin resistance. Further recommendations that both promote metabolic health and have demonstrated at least a potential to increase muscle strength include prioritizing polyunsaturated fatty acids as a fat source and maintaining adequate levels of vitamin D. Clinicians should consult their patients on dietary optimization, but evidence is insufficient to recommend additional supplementation. Lastly, an emerging challenge of diabetes and sarcopenia is sarcopenic obesity, which requires the combination of a hypocaloric diet with increased protein intake.

Comparing the efficacy of concomitant treatment of resistance exercise and creatine monohydrate versus multiple individual therapies in age related sarcopenia

Aging-related sarcopenia is a degenerative loss of strength and skeletal muscle mass that impairs quality of life. Evaluating NUDT3 gene and myogenin expression as new diagnostic tools in sarcopenia. Also, comparing the concomitant treatment of resistance exercise (EX) and creatine monohydrate (CrM) versus single therapy by EX, coenzyme Q10 (CoQ10), and CrM using aged rats. Sixty male rats were equally divided into groups. The control group, aging group, EX-treated group, the CoQ10 group were administered (500 mg/kg) of CoQ10, the CrM group supplied (0.3 mg/kg of CrM), and a group of CrM concomitant with resistance exercise. Serum lipid profiles, certain antioxidant markers, electromyography (EMG), nudix hydrolase 3 (NUDT3) expression, creatine kinase (CK), and sarcopenic index markers were measured after 12 weeks. The gastrocnemius muscle was stained with hematoxylin-eosin (H&E) and myogenin. The EX-CrM combination showed significant improvement in serum lipid profile, antioxidant markers, EMG, NUDT3 gene, myogenin expression, CK, and sarcopenic index markers from other groups. The NUDT3 gene and myogenin expression have proven efficient as diagnostic tools for sarcopenia. Concomitant treatment of CrM and EX is preferable to individual therapy because it reduces inflammation, improves the lipid serum profile, promotes muscle regeneration, and thus has the potential to improve sarcopenia.

Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery

Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.

Synergistic effects of MFG-E8 and whey protein on mitigating d-galactose-induced sarcopenia through PI3K/AKT/PGC-1α and MAPK/ERK signaling pathways

Milk fat globule epidermal growth factor 8 (MFG-E8) and whey protein have emerged as promising bionutrient supplements for enhancing skeletal muscle mass and function. In the present study, aging-related sarcopenia rat model was employed to elucidate the effects of the combined administration of MFG-E8 and whey protein on the catabolism and anabolism of gastrocnemius protein. Combined intervention led to notable enhancements in the antioxidative stress status and mitochondrial biogenesis capacity of gastrocnemius muscle fibers in the aging rats, concomitant with a significant inhibition of lipid accumulation. Moreover, the synergistic effect of MFG-E8 and whey protein was found to exert modulatory effects on key signaling pathways, including PI3K/Akt/PGC-1α pathway and MAPK/ERK signaling pathways in the gastrocnemius muscle of the aging rats. Specifically, this combined intervention was observed to promote mitochondrial biogenesis and regulate the expression of protein anabolism and catabolism-related regulators, thereby facilitating the alleviation of mitochondrial oxidative stress and enhancing biogenesis in gastrocnemius tissues. The findings of our study provide compelling evidence for the potential of MFG-E8 as a promising dietary supplement with antisarcopenic properties to ameliorate muscle protein metabolism disorders and mitigate mitochondrial-mediated myoblast apoptosis induced by oxidative stress.

Effect of Cucumis melo L. peel extract supplemented postbiotics on reprograming gut microbiota and sarcopenia in hindlimb-immobilized mice

Postbiotics made from lactic acid bacteria may ameliorate sarcopenia via the metabolic reprogramming of gut dysbiosis. This study investigated the anti-sarcopenic effect of postbiotics (WDK) produced from polyphenol-rich melon peel extract (Cucumis melo L. var. makuwa, KEE) and whey with Lentilactobacillus kefiri DH5 (DH5) in C2C12 skeletal muscle cells and hindlimb-immobilized mice. WDK significantly ameliorated palmitate-induced atrophy of C2C12 cells, restoring myotube length and diameter. It also upregulated the expression of myogenic genes including Atrogin-1, Igf-1, and MyoD. Hindlimb-immobilized C57BL/6J mice were randomly divided and orally administered 10 mL/kg body weight of saline (CON), Whey, Whey + DH5 (WD), DH5 + KEE, Whey + DH5 + KEE postbiotic (WDK) for three weeks (n = 10/group). Interestingly, WDK significantly improved muscle function in hindlimb-immobilized mice by restoring both the grip strength and the mass of the soleus muscle, which was closely related to the upregulation of the myoD gene. WDK increased microbial diversity and modulated the distribution of intestinal bacteria, particularly those involved in protein synthesis and the production of butyrate. There was a significant correlation between myogenic biomarkers and butyrate producing gut microbiota. Restoration of muscle mass and function following postbiotic WDK is strongly related to the regulation of myogenic genes by in part remodulating gut microbiota. In conclusion, these findings suggest that polyphenol- and whey-based postbiotics WDK may have potential as an effective manner to combat the progression of sarcopenia.

Benefits and side effects of protein supplementation and exercise in sarcopenic obesity: A scoping review

BACKGROUND

Protein supplements have been widely used among those who are struggling with sarcopenic obesity among older adults. However, despite their popularity, there is still a lack of concrete evidence on both the potential benefits and side effects of protein supplementation and exercise on sarcopenic obesity (SO).

OBJECTIVE

Thus, we aimed to determine the impacts of protein supplementation and exercise in older adults with sarcopenic obesity.

METHOD

A systematic database search was conducted for randomised controlled trials, quasi experimental study and pre-post study design addressing the effects of protein supplementation in improving sarcopenic obesity among older adults. This scoping review was conducted based on PRISMA-Scr guidelines across PubMed, Embase, Web of Science and Cochrane Library databases. To assess record eligibility, two independent reviewers performed a rigorous systematic screening process.

RESULTS

Of the 1,811 citations identified, 7 papers met the inclusion criteria. Six studies were randomised controlled trials and one study was a pre-post test study design. The majority of studies discussed the use of both protein supplements and exercise training. The included studies prescribed protein intake ranging from 1.0 to 1.8 g/kg/BW/day for the intervention group, while the duration of exercise performed ranged from 2 to 3 times per week, with each session lasting for 1 hour. Whey protein supplementation has been shown to be effective in improving sarcopenic conditions and weight status in SO individuals. The combination of exercise training especially resistance training and the used of protein supplement provided additional benefits in terms of lean muscle mass as well as biomarkers. The study also revealed a lack of consistency in exercise design among interventions for sarcopenic obesity.

CONCLUSION

Overall, it appears to be a promising option for SO individuals to improve their sarcopenic condition and weight status through the combination of resistance exercise and whey protein supplementation. However, it also highlights the need for caution when it comes to high amounts of protein intake prescription. Future research is warranted to investigate the optimal exercise design for this population, given the limited research conducted in this specific area.

Whey Protein Supplementation with or without Vitamin D on Sarcopenia-Related Measures: A Systematic Review and Meta-Analysis

The effects of supplementation with whey protein alone or with vitamin D on sarcopenia-related outcomes in older adults are unclear. We aimed to assess the effect of whey protein supplementation alone or with vitamin D on lean mass (LM), strength, and function in older adults with or without sarcopenia or frailty. We searched PubMed, Web of Science, and SCOPUS databases. Randomized controlled trials (RCT) that investigated the effect of whey protein supplementation with or without vitamin D on sarcopenia outcomes in healthy and sarcopenic or frail older adults were included. Standardized mean differences (SMDs) were calculated for LM, muscle strength, and physical function data. The analysis showed that whey protein supplementation had no effect on LM and muscle strength; nevertheless, a significant improvement was found in physical function (SMD = 0.561; 95% confidence interval [CIs]: 0.256, 0.865, n = 33), particularly gait speed (GS). On the contrary, whey protein supplementation significantly improved LM (SMD = 0.982; 95% CI: 0.228, 1.736; n = 11), appendicular lean mass and physical function (SMD = 1.211; 95% CI: 0.588, 1.834; n = 16), and GS in sarcopenic/frail older adults. By contrast, co-supplementation with vitamin D enhanced LM gains (SMD =0.993; 95% CI: 0.112, 1.874; n = 11), muscle strength (SMD =2.005; 95% CI: 0.975, 3.035; n = 11), and physical function (SMD = 3.038; 95% CI: 2.196, 3.879; n = 18) significantly. Muscle strength and physical function improvements after whey protein supplementation plus vitamin D were observed without resistance exercise (RE) and short study duration subgroups. Moreover, the combination of whey protein and vitamin D with RE did not enhance the effect of RE. Whey protein supplementation improved LM and function in sarcopenic/frail older adults but had no positive effect in healthy older persons. By contrast, our meta-analysis showed that co-supplementation with whey protein and vitamin D is effective, particularly in healthy older adults, which is likely owing, we propose, to the correction of vitamin D insufficiency or deficiency. The trial was registered at https://inplasy.com as INPLASY202240167.

Potential of Food Protein-Derived Bioactive Peptides against Sarcopenia: A Comprehensive Review

Sarcopenia is an age-related progressive muscle disorder characterized by accelerated loss of muscle mass, strength, and function, which are important causes of physiological dysfunctions in the elderly. At present, the main alleviating method includes protein supplements to stimulate synthesis of muscle proteins. Food protein-derived peptides containing abundant branched-chain amino acids have a remarkable effect on the improvement of sarcopenia. Understanding the underlying molecular mechanism and clarifying the structure-activity relationship is essential for the mitigation of sarcopenia. This present review recaps the epidemiology, pathogenesis, diagnosis, and treatment of sarcopenia, which facilitates a comprehensive understanding of sarcopenia. Moreover, the latest research progress on food-derived antisarcopenic peptides is reviewed, including their antisarcopenic activity, molecular mechanism as well as structural characteristics. Food-derived bioactive peptides can indeed alleviate/mitigate sarcopenia. These antisarcopenic peptides play a pivotal role mainly by activating the PI3K/Akt/mTOR and MAPK pathways and inhibiting the ubiquitin-proteasome system and AMPK pathway, thus promoting the synthesis of muscle proteins and inhibiting their degradation. Antisarcopenic peptides alleviate sarcopenia via specific peptides, which may be absorbed into the circulation and exhibit their bioactivity in intact forms. The present review provides a theoretical reference for mitigation and prevention of sarcopenia by food protein-derived bioactive peptides.

Protein Supplementation with Short Peptides Prevents Early Muscle Mass Loss after Roux-en-Y-Gastric Bypass

Introduction: A significant reduction in fat-free mass (FFM) following bariatric surgery (BS) has been reported, and adequate protein intake is recommended for FFM preservation. Current guidelines of nutritional management after BS recommend complex protein (CP) compounds. However, Roux-en-Y-gastric bypass (RYGB) has a negative impact on CP digestion, leading to protein malabsorption. At present, there is no data regarding the impact of early supplementation with short peptide-based (SPB) or hydroxy methylbutyrate (HMB)-enriched formulas on the evolution of the FFM after the BS. Aim: The aim of this study is to evaluate the effect of nutritional products based on CP, HBM-enriched, or SPB formulas on the FFM of patients that undergo RYGB. Material and methods: This is a prospective interventional study, including three groups of patients (according to the type of protein product) as candidates for BS, recruited between December 2021 and April 2022, matched by age, gender, and BMI. All patients underwent evaluations at baseline and one month post-BS, including: medical history, physical and anthropometric evaluation, bioimpedance, and biochemical analysis. Results: A total of 60 patients were recruited: 63% women, mean age 43.13 ± 9.4 years, and BMI 43.57 ± 4.1 kg/m2. The % of FFM loss from total weight loss (TWL) was significantly lower in the SPB group than CP and HMB groups despite the major %TWL in this group (40.60 ± 17.27 in CP, 34.57 ± 13.15 in HMB, and 19.14 ± 9.38 in SPB, p < 0.001). TWL% was 9.98 ± 1.82 vs. 9.83 ± 2.71 vs. 13.56 ± 4.30, p < 0.001, respectively. Conclusion: In our study, the SPB supplementation prevented almost 50% FFM lost from the TWL than the CP- or HMB-enriched compounds at one month post-BS. These results are significant in the setting of muscle mass preservation after the BS, and have the potential to change the current guidelines for the management of nutritional supplementation after BS.

Nutrition in the prevention and management of sarcopenia - A special focus on Asian Indians

Sarcopenia, characterized by loss of muscle mass and strength, is common in advanced old age but can be accelerated by chronic disease, malnutrition and physical inactivity. Early initiation of intervention to achieve and maintain a higher peak muscle mass and strength may allow for prevention or delay of sarcopenia and facilitate independent living even in old age. In this context, malnutrition, a significant contributor to sarcopenia, is often overlooked among the Indian population. Maintenance of an optimal energy and protein balance with adequate physical activity level is essential to preserve physical function in the aging population. However, research on the role of micronutrients in muscle maintenance, is still in its infancy. This narrative review, therefore, aims to explore the current status of International and Indian research on the role of nutrition in sarcopenia mitigation and the way forward.

Beneficial effects of whey protein peptides on muscle loss in aging mice models

Aging-related muscle loss is a hallmark of aging and is the cause of some negative outcomes. An optimized diet and supplements have a positive effect in slowing down the process of muscle loss. D-galactose(d-gal) has been used widely to develop aging model. This study explored the beneficial effects of whey protein peptides (WPPs) on sarcopenia in d-gal-induced aging mice. A total of 72 SPF male C57BL/6N mice were used in this study. Sixty mice were modeled by injected intraperitoneally with d-gal (100 mg/kg body weight for 6 weeks), and the other 12 mice were used as control, and injected with the same amount of normal saline. After 6 weeks, the modeled mice were randomly divided into the model control group, whey protein group (1.5 g/kg^*bw), and three WPPs intervention groups (0.3 g/kg^*bw, 1.5 g/kg^*bw, 3.0 g/kg^*bw), according to serum malondialdehyde (MDA) level. The test samples were orally given to mice by daily garaged. During the 30 days intervention period, the model control group, whey protein group, and WPPs group continued receiving intraperitoneal injections of d-gal, whereas the control group continued receiving intraperitoneal injections of normal saline. The results showed that WPPs could significantly improve the grip strength of aged mice. WPPs could significantly increase lean mass of aged mice and increase muscle weight of gastrocnemius and extensor digitorum longus. WPPs could significantly increase the level of insulin-like growth factor-1 (IGF-1) and reduce level of interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF-α) in serum. WPPs could affect the muscle fiber size in d-gal-induced aging mice. Its specific mechanism may be related to the activation of IGF-1/Akt/mTOR protein synthesis signaling pathway and reduction of the level of inflammation. These results indicate that WPPs can improve aging-related sarcopenia. Compared with whey protein, WPPs supplement seems a better form for sarcopenia.

Protein and Sport: Alternative Sources and Strategies for Bioactive and Sustainable Sports Nutrition

Nutrition and sport play an important role in achieving a healthy lifestyle. In addition to the intake of nutrients derived from the normal diet, some sport disciplines require the consumption of supplements that contribute positively to improved athletic performance. Protein intake is important for many aspects related to health, and current evidence suggests that some athletes require increased amounts of this nutrient. On the other hand, society's demand for more environmentally friendly products, focus on the search for alternative food sources more sustainable. This review aims to summarize the latest research on novel strategies and sources for greener and functional supplementation in sport nutrition. Alternative protein sources such as insects, plants or mycoproteins have proven to be an interesting substrate due to their high added value in terms of bioactivity and sustainability. Protein hydrolysis has proven to be a very useful technology to revalue by-products, such as collagen, by producing bioactive peptides beneficial on athletes performance and sport-related complications. In addition, it has been observed that certain amino acids from plant sources, as citrulline or theanine, can have an ergogenic effect for this target population. Finally, the future perspectives of protein supplementation in sports nutrition are discussed. In summary, protein supplementation in sports nutrition is a very promising field of research, whose future perspective lies with the search for alternatives with greater bioactive potential and more sustainable than conventional sources.

Beneficial Effects of Walnut Oligopeptides on Muscle Loss in Senescence-Accelerated Mouse Prone-8 (SAMP8) Mice: Focusing on Mitochondrial Function

Aging-related muscle loss is a hallmark of aging and is the cause of some negative outcomes. An optimized diet and supplements have a positive effect in slowing down the process of muscle loss. This study was designed to evaluate the beneficial effects of walnut oligopeptides (WOPs) on aging-related muscle loss and explore the possible underlying mechanism in Senescence-Accelerated Mouse Prone 8 (SAMP8) Mice. SAMP8 mice were randomly divided into four groups (n = 15/group), including one group which was the SAMP8 age control group and three groups those were WOP intervention groups. Meanwhile, Senescence Accelerated Resistant Mouse 1 (SAMR1) mice (n = 12), which had normal senescence rates, were used as model controls. During the six-month intervention period, the age control and normal control groups were given sterilized water, while the three WOP intervention groups were given WOP solution with low (110 mg/kg·bw), medium (220 mg/kg·bw) and high concentrations (440 mg/kg·bw), respectively. The results showed that WOPs could significantly increase muscle mass and improve physical performance (wire hang and catwalk behavioral tests) in aging mice. Moreover, WOPs could significantly reduce the levels of IL-1β, IL-6 and TNF-α in serum and gastrocnemius tissues and increase the mitochondrial DNA content, as well as the expression levels of AMPK, PGC-1α, NRF-1 and TFAM in the gastrocnemius muscle of aging mice, which was speculated to be the specific mechanism related to mitochondrial function improvement and inflammation reduction. These results indicate that WOPs can improve aging-related muscle loss, in term of both muscle mass and physical performance, and WOP supplements seems to be potentially effective in elderly individuals.

Evaluation of the anti-osteoporotic effect of a low-phenylalanine whey protein hydrolysate in an ovariectomized mice model

A phenylalanine (Phe)-restricted diet is indispensable to control the blood Phe for individuals with phenylketonuria (PKU), who are also confronted with progressive bone impairment. Thus, the development of a low-Phe protein substitute that could positively regulate bone metabolism is desired for their bone health. Our previous study reported the preparation of a low-Phe containing whey hydrolysate (LPH) from a selected whey protein hydrolysate (TAH). However, the effect of LPH on the bone status is unknown. In this study, we used an ovariectomized (OVX) mice model to evaluate the anti-osteoporotic potential of oral administration of whey protein concentrate (WPC, protein control), TAH, and LPH on bone physiology and bone metabolism. The results showed that after 12 weeks of treatment, the decreased bone mineral density, the deteriorated trabecular microarchitecture, and the reduced ultimate load due to ovariectomy were significantly attenuated by two whey protein hydrolysates (TAH and LPH); meanwhile, the body weight, uterine weight, bone composition, and the femoral elastic load of OVX mice had not been significantly affected by whey samples. In addition, LPH and TAH dual-regulated bone remodeling in OVX mice through triggering osteogenesis (promoted the expression of runt-related protein 2 (Runx2) and osteoformation markers) and inhibiting osteoresorption as well as inflammation. The modulated mitogen-activated protein kinase signaling and the inhibited nuclear factor κB signaling by LPH and TAH might relate to the dual-regulatory activities on bone. Overall, in the OVX mice model, LPH exerted higher osteoprotective potential than TAH of the same dose by activating the bone formation markers and inhibiting the inflammatory status. The current study demonstrated for the first time the potential use of a low-Phe whey hydrolysate, a protein substitute for PKU individuals, in the prevention of osteoporosis.

Paradigm shift in gastrointestinal surgery − combating sarcopenia with prehabilitation: Multimodal review of clinical and scientific data

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes. These included an increased risk of total complications, major complications, re-admissions, infections, severe infections, 30 d mortality, longer hospital stay and increased hospitalization expenditures. A program to enhance recovery after surgery was meant to address these complications; however, compliance to the program since its introduction has been less than ideal. Over the last decade, the concept of prehabilitation, or “pre-surgery rehabilitation”, has been discussed. The presurgical period represents a window of opportunity to boost and optimize the health of an individual, providing a compensatory “buffer” for the imminent reduction in physiological reserve post-surgery. Initial results have been promising. We review the literature to critically review the utility of prehabilitation, not just in the clinical realm, but also in the scientific realm, with a resource management point-of-view.

Impact of Cooking Preparation on In Vitro Digestion of Eggs Simulating Some Gastrointestinal Alterations in Elders

This study aimed to in vitro assess the impact of the cooking process of eggs (hard-boiled, poached, and omelet) on nutrients digestibility and vitamins A and D3 bioaccessibility under elderly gastrointestinal (GI) conditions. Three elderly digestion models were mimicked: oral (E1); oral and gastric (E2); and oral, gastric, and intestinal (E3), and a healthy adult model (C). Proteolysis extent reduced after digestion of omelet under the E3 model (p < 0.05) (up to 37% of reduction). Thus, hard-boiled and poached were more recommendable to enhance protein digestibility in elders. Altered GI conditions negatively influence neither the absorbable lipid fraction nor the cholesterol stability. Finally, vitamin A bioaccessibility was not affected but D3 slightly decreased with the elderly (E3). Hence, the digestion of nutrients was dependent on the resulting matrix, poached being the greater supplier of protein and lipid end-digestion products. Poached and omelet, however, offer a high net supply of bioaccessible vitamin D3 for elders.

An examination of contributions of animal- and plant-based dietary patterns on the nutrient quality of diets of adult Canadians

Dietary guidance and Canada's 2019 Food Guide encourage increased consumption of plant-based foods as a source of dietary protein. However, there is an absence of recent data on protein and nutrient intakes and quality of Canadian dietary patterns that might occur with increased plant protein intakes. This study compared food sources and nutrient intakes of Canadian adults within groups of increasing plant protein-containing diets. The CCHS 2015 Public-Use Microdata File of single 24-hour dietary recalls of males and females ≥19 years (n = 6498) or ≥70 years (n = 1482) were examined. Respondents were allocated into 4 groups defined by their protein intake percentage coming from plant-based foods (i.e., group 1: 0-24.9%, group 2: 25-49.9%, group 3: 50-74.9%, group 4: 75-100%). Protein intake in adults averaged 63.3% animal and 36.7% plant protein. Where plant protein contributed >50% protein, higher intakes of carbohydrate, dietary fibre, folate, dietary folate equivalents, iron and magnesium (p < 0.001) but lower intakes of total and saturated fat, protein, vitamin D, vitamin B12, riboflavin and niacin (p < 0.0001) were reported. In contrast, group 1 had higher total and saturated fat, protein, vitamin B12, thiamin, niacin, and zinc, but lower carbohydrate, dietary fibre, and magnesium. Balancing plant- with animal-based protein foods leads to healthier dietary patterns with more favourable nutritional properties when compared with diets based on either high animal or high plant protein content. Novelty: Combinations of animal- and plant-based proteins improve nutrient quality of Canadian diets. The source of protein influences diet quality.

A Call to Action: Now Is the Time to Screen Elderly and Treat Osteosarcopenia, a Position Paper of the Italian College of Academic Nutritionists MED/49 (ICAN-49)

Aging is a risk factor for the development of multiple chronic diseases, including cardiovascular disease, cancer and dementia. Life expectancy has increased in certain countries but this phenomenon is associated with a reduction of years of healthy life. Aging is associated with a number of physical and functional changes, especially sarcopenia. Sarcopenia is a clinical condition associated with a decrease in skeletal muscle and muscle strength, however, sarcopenia is a reversible condition. On the basis of the current scientific literature, sarcopenia could more appropriately capture an individual's vulnerability to negative health-related outcomes since it represents an early form of the chronic diseases. Recognition of this clinical condition can improve the management of older individuals in many different clinical settings. Despite the limitations of the indirect methods used to study body composition, the Italian College of the Academic Nutritionists ME/49 recommends that health authorities and health professionals around the world should make a greater effort to diagnose sarcopenia earlier and to manage it more effectively. In line with the development of cancer screening, the use of two diagnostic tools for sarcopenia (BIA and DXA) should be implemented.