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Evidence-based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group.
Abstract
New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance- and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, ≥1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73m(2)), but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function.
Supplementary resource (1)
Data
February 2014
... Sarcopenia, a prevalent muscular disease in older adults, is characterized by significant declines in muscle strength and mass, leading to severe impairments in physical performance [1,2]. Lifestyle modifications, particularly changes in dietary habits, have been widely proposed to counteract sarcopenia's progression, with a notable focus on protein intake [3]. Over recent decades, substantial research has examined various aspects of protein consumption, including quantity, distribution, and sources ( Fig. 1). ...
... These findings have prompted the development of specific protein intake guidelines for older adults to ensure an adequate supply of AA [3,4]. Current recommendations suggest a minimum daily protein intake of 0.8 g/kg of body weight (BW) for adults, including older individuals. ...
... Current recommendations suggest a minimum daily protein intake of 0.8 g/kg of body weight (BW) for adults, including older individuals. However, these guidelines are based on nitrogen balance techniques, which have been criticized for their limitations in accurately assessing protein homeostasis [3,4]. Empirical evidence further challenges these recommendations, indicating that a minimum protein intake of 1.0 g/kg of BW/day is necessary to meet body protein requirements in a steady state [3,4]. ...
Sarcopenia is a prevalent neuromuscular condition among older adults, marked by significant reductions in muscle mass and strength, which result in notable impairments in physical performance. Modifications in lifestyle habits have been frequently highlighted as essential approaches to mitigate the progression of sarcopenia, with a particular focus on protein consumption. Over the past few decades, a wealth of knowledge has emerged, driven by both observational and experimental studies exploring various factors related to protein intake, such as amount, timing, and sources. This review provides a pauca verba overview of these findings, presenting a concise yet informative summary of key insights.
... Among older adults, relative anabolic resistance to dietary protein is prevalent (Moore et al., 2015;Wall et al., 2015). The PROT-AGE study group proposed to increase the protein intake recommendations for adults above 65 years of age who are exercising to at least 1.2 g/kg bodyweight/d (Bauer et al., 2013), and the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines advice a protein intake up to 1.5 g/kg bodyweight/d for older adults who are malnourished and/or those with acute or chronic illness (Deutz et al., 2014). Currently, Dutch older adults have a lower protein intake, with means for community-dwelling, frail and institutionalized older adults ranging between 0.8 and 1.0 g/kg bodyweight per day . ...
... The choice to aim for a larger sample size than needed for most of the General, all groups − Already using prebiotic fibres* − Use of laxatives that interfere with outcomes, as determined by study medical doctor − Not willing to stop using dietary supplements in high doses (high doses: 0.10*Upper Level or more)* − Following a structured, intense exercise programme (currently or in the last year)* − Allergic, intolerant or hypersensitive to milk/lactose (self-reported) − Dietary restrictions on milk/lactose/prebiotics/vitamin D/calcium consumption − Abnormal hepatic or renal laboratory parameters (estimated glomerular filtration rate <30 ml/min/1.73 m 2 (screening) or contra-indication by treating medical practitioner (data from hospital) (Bauer et al., 2013) − Diagnosis of disorders/diseases in which a high protein intake can be harmful, such as renal impairment or failure, liver disease, or diabetes associated with nephropathy (treating medical practitioner has the decisive voice). − Diseases, conditions or disorders which may affect the ability to follow the study protocol and which cannot be overcome with help of a caregiver: primary outcome measures will facilitate the exploration of heterogeneity in the adaptive responses to the intervention between individuals, and the different biological factors that may explain such heterogeneity. ...
... Breakfast is chosen because protein intake of older adults is especially low during breakfast Ocke MC et al., 2013). The pre-sleep moment is chosen to introduce an additional moment of protein ingestion as regular protein peaks throughout the day are proposed to be especially important for supporting muscle protein synthesis in older adults (Bauer et al., 2013). The morning powder contains 25 g whey protein, 5.5 g Biotis™ GOS, 800 IU vitamin D, and 250 mg calcium per portion. ...
... Adequate nutrition was linked to lower levels of physical and cognitive frailty, consistent with studies showing that nutritional deficiencies exacerbate functional decline and cognitive impairment [39,40]. Previous research, such as that by da Silva et al. [41,42] and Bauer et al. (2013) [43], has demonstrated how nutrient deficiencies accelerate muscle loss and frailty, contributing to a cycle of deteriorating health [44,45]. ...
... Adequate nutrition was linked to lower levels of physical and cognitive frailty, consistent with studies showing that nutritional deficiencies exacerbate functional decline and cognitive impairment [39,40]. Previous research, such as that by da Silva et al. [41,42] and Bauer et al. (2013) [43], has demonstrated how nutrient deficiencies accelerate muscle loss and frailty, contributing to a cycle of deteriorating health [44,45]. ...
Background and Objective: In the context of the rapidly aging global population, the older adult vulnerability poses a significant challenge for public health systems. Frailty, cognitive and nutritional status, depression, and grip strength are essential parameters for staging the vulnerability of older adults. The objective of this study is to identify a rapid but multidimensional geriatric assessment tool that can enhance the rehabilitation process for older adults, tailored to their specific needs. Materials and Methods: This pilot study examines the relationships between grip strength, nutritional status, frailty, depression, and cognition in a group of 80 older adults with a mean age of 69.6 years, 49 male and 31 female, using standardized geriatric scales and digital grip strength measurements. The study employed a digital dynamometer, a portable and reliable tool that facilitated quick and accurate grip strength measurements. Results: The analysis revealed significant correlations among the parameters. Greater grip strength was associated with better cognitive performance (r = 0.237, p = 0.034) and improved nutritional status (r = 0.267, p = 0.016), while it was inversely related to frailty (r = −0.313, p = 0.005). Nutritional status also played a key role, showing an inverse relationship with frailty (r = −0.333, p = 0.003) and depression levels (r = −0.248, p = 0.027). Furthermore, frailty and depression were strongly interconnected, with those experiencing higher frailty levels also displaying more severe depressive symptoms (r = 0.545, p < 0.001). Marital status was also relevant: married participants exhibited higher grip strength, lower frailty, and fewer depressive symptoms, suggesting that social support positively influences both physical and mental health in older adults. Conclusions: These findings not only emphasize the need for integrated care approaches that simultaneously address physical health, nutrition, and cognitive function, but also provide a foundation for the development of a rapid and multidimensional assessment protocol, which consists of using a digital dynamometer and four geriatric scales. Such a tool could play a crucial role in the early detection of frailty syndrome and guide the implementation of multidisciplinary, tailored therapeutic strategies aimed at preserving the autonomy and improving the quality of life of older adults.
... BW/day of protein for healthy older adults, 1.2-1.5g/kg BW/day for those with either chronic or acute illness, and 2.0g/kg BW/day for malnourished older adults, and those with severe illnesses (71) . At least 1.2g/kg BW of protein post-exercise has been recommended for active older adults to stimulate MPS (71) . ...
... BW/day for those with either chronic or acute illness, and 2.0g/kg BW/day for malnourished older adults, and those with severe illnesses (71) . At least 1.2g/kg BW of protein post-exercise has been recommended for active older adults to stimulate MPS (71) . However, in a meta-analysis conducted by the PROMISS (PRevention Of Malnutrition In Senior Subjects) consortium with four cohort studies and four national surveys from the EU and Canada in ~8,100 older adults (aged ≥55 years), the prevalence of low protein intake was high, especially for the higher recommendations (e.g., 46.7% and 70.8% for 1.0 and 1.2g/kg BW/day of protein, respectively) (72) . ...
Loss of skeletal muscle strength and mass (sarcopenia) is common in older adults and associated with an increased risk of disability, frailty, and premature death. Finding cost-effective prevention and treatment strategies for sarcopenia for the growing ageing population is therefore of great public health interest. Although nutrition is considered an important factor in the aetiology of sarcopenia, its potential for sarcopenia prevention and/or treatment is still being evaluated. Nutrition research for sarcopenia utilises three main approaches to understand muscle-nutrition relationships, evaluating: single nutrients, whole foods, and whole diet effects—both alone or combined with exercise. Applying these approaches, we summarise recent evidence from qualitative and quantitative syntheses of findings from observational and intervention studies of healthy older adults, and those with sarcopenia. We consider protein supplements, whole foods (fruits and vegetables), and the Mediterranean diet as exemplars. There is some evidence of beneficial effects of protein supplementation ≥0.8g/kg body weight/day on muscle mass when combined with exercise training in intervention studies of healthy and sarcopenic older adults. In contrast, evidence for effects on muscle function (strength and physical performance) is inconclusive. There is reasonably consistent epidemiological evidence suggesting benefits of higher fruits and vegetables consumption for better physical performance. Similarly, higher adherence to the Mediterranean diet is associated with beneficial effects on muscle function in observational studies. However, intervention studies are lacking. This review discusses how current evidence may inform the development of preventive and intervention strategies for optimal muscle ageing and nutritional public policy aimed at combatting sarcopenia.
... However, current pharmacological interventions have limited utility in clinical practice (15) . Appropriate nutrition and exercise are considered the optimal strategies to limit declines in muscle mass and function with ageing (18,19) . Adequate protein and dietary fibre intakes are essential for healthy ageing. ...
... Adequate fibre intake is associated with normal bowel function, reduced intestinal transit times and reduced risk of several noncommunicable diseases, among other health benefits (22)(23)(24) . For older adults, daily consumption of at least 1·0-1·2 g/kg body weight of protein (18,19) and 25-30 g of fibre (24,25) is recommended. However, intakes of both nutrients are often suboptimal in European older adults (23,(26)(27)(28)(29)(30)(31) , including in those with poor appetite (27) . ...
Reduced appetite with ageing is a key factor that may increase risk of undernutrition. The objective of this study is to determine the impact of innovative plant protein fibre (PPF) products within a personalised optimised diet (PD), a physical activity (PA) programme, and their combination on appetite, and other nutritional, functional and clinical outcomes in community-dwelling older adults in a multi-country randomised controlled intervention trial. One hundred and eighty community-dwelling adults (approximately sixty per trial centre in Germany, Ireland and Italy) aged 65 years and over will be recruited to participate in a 12-week, parallel-group, controlled trial. Participants will be randomised into one of four groups: 1, PD (incorporating two PPF products): 2, PA; 3, PD + PA; and 4, no intervention (control). The primary outcome is appetite measured by visual analogue scales and energy intake from an ad libitum test meal. Secondary outcomes include fasting and postprandial appetite-related gut hormones, Simplified Nutritional Appetite Questionnaire score, body composition, cardiorespiratory fitness, muscle strength, physical function and PA. In addition, self-efficacy, cognitive status, dietary restraint, depressive symptoms and compliance and acceptability of the intervention will be assessed. Metabolomic profiles, RMR, muscle motor unit properties and gut microbiome will also be assessed to explore potential underlying mechanisms. This multi-centre randomised controlled trial will advance knowledge on how PD (incorporating PPF products), PA and their combination influence appetite, nutritional status and related health outcomes in community-dwelling older adults and contribute to the prevention of undernutrition. Trial registration: Clinical Trials.gov Registry NCT05608707 (registered on 2 November 2022). Protocol Version: NCT05608707 Version 4 (registered on 29 September 2023).
... The assessment of these factors are important as plant-based diets typically contain less protein than animal products [7], with lower protein quality and bioavailability [8], potentially affecting muscle mass. Also, a higher bone fracture risk has been found in vegans compared to omnivores [9]. ...
... Yet, one-year after the PFJ intervention a small yet significant reduction in lean mass (À0.8 kg 95% CI -1.3 to À0.4) and appendicular skeletal muscle mass (À0.7 kg 95% CI -1.0 to À0.4) was observed within the MSOA group [28]. Therefore, while a plant-based diet combined with exercise can effectively aid weight loss while preserving muscle mass and strength, special attention to strength training and sufficient protein intake, potentially with supplementation, is necessary, especially in older adults and those with chronic inflammatory conditions [7,[29][30][31][32]. ...
Objective
The Plants for Joints (PFJ) intervention significantly improved pain, stiffness, and physical function, and metabolic outcomes, in people with metabolic syndrome-associated osteoarthritis (MSOA). This secondary analysis investigated its effects on body composition.
Method
In the randomized PFJ study, people with MSOA followed a 16-week intervention based on a whole-food plant-based diet, physical activity, and stress management, or usual care. For this secondary analysis, fat mass, muscle mass, and bone mineral density were measured using dual-energy X-ray absorptiometry (DEXA) for all participants. Additionally, in a subgroup (n = 32), hepatocellular lipid (HCL) content and composition of visceral adipose tissue (VAT) were measured using magnetic resonance spectroscopy (MRS). An intention-to-treat analysis with a linear-mixed model adjusted for baseline values was used to analyse between-group differences.
Results
Of 66 people randomized, 64 (97%) completed the study. The PFJ group experienced significant weight loss (−5.2 kg; 95% CI –6.9, −3.6) compared to controls, primarily from fat mass reduction (−3.9 kg; 95% CI –5.3 to −2.5). No significant differences were found in lean mass, muscle strength, or bone mineral density between groups. In the subgroup who underwent MRI scans, the PFJ group had a greater reduction in HCL (−6.5%; 95% CI –9.9, 3.0) compared to controls, with no observed differences in VAT composition.
Conclusion
The PFJ multidisciplinary intervention positively impacted clinical and metabolic outcomes, and appears to significantly reduce body fat, including liver fat, while preserving muscle mass and strength.
... On the other hand, protein consumption is crucial for various processes such as growth, muscle function, and immunity. Adequate intake can help minimize muscle mass loss and prevent impairment in physical functionality [7]. ...
... Recent evidence suggests that higher protein intake, within the recommended percentage range (AMDR) [12], can modulate systems involved in satiety, meaning that after consuming proteinrich meals, there is a reduction in hunger and an increase in perceived fullness due to a reduction in the hunger-stimulating hormone (ghrelin) and an increase in satiety-stimulating hormones (PYY and GLP-1) [26]. It is important to highlight that protein intake in older adults should be estimated individually, according to body weight and clinical conditions, and distributed evenly across the three main meals, as recommended by PROT-AGE [7]. However, in the same population of this study, Gaspareto et al. [27] found that the median intake was at the lower limit of the PROT-AGE recommended range, meaning that about 50% of individuals consumed less than 1.0g/kg/day, suggesting that the minimum percentage of 10% of the total energy value adopted by AMDR [12] may need to be re-assessed in studies of older adults' dietary intake. ...
Objective
To assess the relationship between the usual dietary intake of fats and proteins and associated factors in older adults.
Methods
A descriptive cross-sectional study carried out with 295 older adults living in the city of São Caetano do Sul, Brazil. Dietary intake was assessed using two 24-hour dietary recalls and adjusted using the Multiple Source Method to characterize habitual intake. Fats (total and saturated) were assessed according to the percentage contribution of nutrients to total dietary energy (%) and were associated with the studied variables: sociodemographic, economic, lifestyle, nutritional status, and health variables.
Results
Percentage of fat consumption decreased with age and increased according to income level, and protein consumption was lower among those without spouses (p≤0.05). A negative linear correlation was observed between protein intake (%) and total energy intake, and a positive linear correlation was observed between protein intake and saturated fat intake in grams (No-BreakpNo-Break≤0.05).
Conclusion
The findings indicate that fat and protein intake was influenced by sociodemographic variables, and the relationship between the intake of protein-rich foods may impact the increase in the availability of saturated fats. These findings demonstrate the importance of access to nutritional counseling that impacts diet quality, particularly in the choice of protein sources with lower amounts of total and saturated fats, in order to reduce the risk and/or prevent cardiovascular diseases.
Keywords
Aged; Elderly nutrition; Eating
... There is growing evidence to suggest that exercise, particularly resistance and aerobic training, can play a pivotal role in preventing and managing frailty [23][24][25][26][27][28][29][30][31]. Furthermore, a personalized nutritional intervention, placing particular emphasis on protein intake, hydration, and caloric balance, can positively affect various aspects of frailty [27,32,33]. In addition, screening tools for older persons' prescriptions (STOPP) and screening tools to alert them to the right treatment (START) criteria should be used to optimize medication management, especially in the context of frailty and old age [34][35][36][37]. ...
... We provided participants with customized caloric and protein support, including daily supplementation with 3 g of calcium β-hydroxy-β-methylbutyrate (Ca-HMB). The PROT-AGE study group and the European Society for Clinical Nutrition and Metabolism have proposed that older adults should consume between 1.0-1.5 g/kg/day of protein [33,47]. Furthermore, the leucine catabolite Ca-HMB has been shown to independently stimulate muscle protein synthesis [48,49] and, when combined with resistance exercises, resulted in greater fat loss and greater muscle strength gains in older adults [50,51]. ...
... Given the profound impact of DRM on the energy-protein requirements and the decreased intake due to the underlying pathology [11], patients with DRM need to adjust the consumption of nutrients to the requirements with an oral diet and, if necessary, with nutritional interventions. Several international guidelines recommended an energy intake of 30 kcal/kg body weight (BW)/day, with a high-quality protein intake of 1.2-1.5 g/kg BW/day [12,13]. The use of hypercaloric and hyperproteic oral nutritional supplements (ONS) is a usual practice to treat malnutrition, with established clinical and economic benefits [14], and it is recommended by many clinical guidelines for DRM [12,13]. ...
... Several international guidelines recommended an energy intake of 30 kcal/kg body weight (BW)/day, with a high-quality protein intake of 1.2-1.5 g/kg BW/day [12,13]. The use of hypercaloric and hyperproteic oral nutritional supplements (ONS) is a usual practice to treat malnutrition, with established clinical and economic benefits [14], and it is recommended by many clinical guidelines for DRM [12,13]. However, the selection of the appropriate ONS for patients with malnutrition is crucial, as higher or lower protein intakes may be harmful in specific subgroups of patients with DRM [15]. ...
Background: User-friendly tools for assessing nutrition status and interventions in malnourished patients are crucial. This study evaluated the effectiveness of a personalised nutrition intervention using a novel oral nutritional supplement and AI-supported morphofunctional assessment to monitor clinical outcomes in patients with disease-related malnutrition (DRM). Methods: This prospective observational study involved patients receiving concentrated high-protein, high-calorie ONS (cHPHC-ONS), per usual clinical practice. Comprehensive assessments were performed at baseline (B0) and three months (M3) post-intervention. Results: 65 patients participated in the study. Significant decreases were observed in the percentage weight loss from B0 (−6.75 ± 7.5%) to M3 (0.5 ± 3.48%) (p < 0.01), in the prevalence of malnutrition (B0: 93.4%; M3: 78.9%; p < 0.01), severe malnutrition (B0: 60.7%; M3: 40.3%; p < 0.01), and sarcopenia (B0: 19.4%; M3: 15.5%; p < 0.04). Muscle area increased (p = 0.03), and there were changes in the echogenicity of the rectus femoris muscle (p = 0.03) from B0 to M3. In patients aged ≥60, an increase in muscle thickness (p = 0.04), pennation angle (p = 0.02), and handgrip strength (p = 0.04) was observed. There was a significant reduction in the prevalence of malnutrition (B0: 93.4%; M3: 78.9%; p < 0.01) and severe malnutrition (B0: 60.7%; M3: 40.3%; p < 0.01). Conclusions: In patients with DRM, a personalised intervention with cHPHC-ONS significantly reduces the prevalence of malnutrition, severe malnutrition, and sarcopenia and improves muscle mass and function.
... insulin resistance, immobility, etc.), and greater need for protein (e.g. inflammatory disease) with aging results in a high risk of protein deficiency in the elderly population [19]. Lower protein levels are associated with chronic muscle wasting, functional loss, and frailty, and more than 30% of individuals 60 years and older and more than 50% of individuals 80 years and older are estimated to be sarcopenic [2]. ...
... Cutaneous findings of marasmus include wrinkled skin due to loss of subcutaneous fat, excess lanugolike hair, thin hair, and fissured nails [1]. Traditional dietary guidelines of protein intake of 0.8 g/ kg/day for all adults, regardless of age or sex, are inadequate in the elderly population [19]. Multiple studies recommend a range of 1 to 1.73 g/kg/day of protein intake in the elderly population for positive protein status and improved health status [2]. ...
Purpose of Review
This review article highlights cutaneous findings of nutritional deficiencies with a particular focus on conditions that impact the elderly population, who are at higher risk of developing these deficiencies.
Recent Findings
An increasing number of studies demonstrate the importance of adequate nutrition intake in regulating aging processes and the progression of key age-related illnesses.
Summary
Early recognition of dermatological manifestations associated with nutritional disorders can prompt appropriate supplementation and help prevent sequelae of cutaneous and systemic complications.
... A study conducted in nine European countries revealed that approximately 79.6% of women had 25OHD levels below 80 nmol/L, and 32.1% had levels below 50 nmol/L [31]. Furthermore, another study conducted in 11 European countries demonstrated that 25OHD levels were lower in winter, with values below 30 nmol/L in at least 50% of the population [32]. To date, data regarding vitamin D ingestion in the Italian population are very limited and poorly applicable to subjects at high risk of vitamin D deficiency, such as aging individuals or those with chronic debilitating disorders. ...
Background: The condition of vitamin D (25OHD) deficiency represents an important public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent paper, reporting data collected by a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary consumption of vitamin D, both in females and males, was far below the average. Methods: With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the amount and type of intake of foods containing ergocalciferol and cholecalciferol. It was submitted to 870 subjects, 627 females and 243 males, with an age range from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Results: The present data confirm previous observations: the global quantity of vitamin D intake in 14 days was 70.8 μg (±1.8 SE, ±54.4 SD) in females and 87.5 μg (±1.9 SE, ±57.1 SD) in males; the mean daily intake of vitamin D in females and males was 5.05 μg (±0.5 SE, ±3.8 SD) and 6.25 μg (±0.21 SE, ±4.1 SD), respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to an increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40–50 age group to 54.5 μg and 87.8 μg in the 71–80 age group, respectively. Conclusions: In conclusion, the present data, collected in a large Italian cohort, underscore that the daily intake of vitamin D is far below the recommended daily average, thereby contributing to the development of potential hypovitaminosis.
... There was a marked predominance of FSMPs containing animal proteins. While animal proteins have greater anabolic power [45], there is a pressing need to develop products containing a higher proportion of plant proteins to meet sustainability requirements. A combination of both protein sources could still be adequate to meet therapeutic needs [46,47]. ...
Background: Disease-related malnutrition, with or without inflammation, in older adults is currently emerging as a public health priority. The use of Foods for Special Medical Purposes, including Oral Nutritional Supplements, and supplements is crucial to support patients in achieving their nutritional needs. Therefore, this article aims to comprehensively provide an analysis of the adequacy of FSMPs in meeting the nutritional requirements of different age-related diseases and takes into account the emerging role of inflammation. Moreover, it provides an identikit of the ideal products, following the pathology-specific guidelines. Methods: Data on 132 products were gathered through face-to-face meetings with companies’ consultants. Specifically, information on energy, macronutrient, and micronutrient contents were collected, as well as on texture and flavors, osmolarity, cost, and packaging. Results: Most FSMPs met the daily recommendations for energy and protein intake. Nonetheless, few products contained β-hydroxy-β-methylbutyrate, optimal Branched-Chain Amino Acids ratios, arginine, glutamine, and omega-3 fatty acids. Furthermore, a marked predominance of FSMPs with a high osmolarity (85.7%), sweet taste (72%), and only animal protein content (79.5%) was observed. Cost analysis of FSMPs revealed a mean cost of EUR 5.35/portion. Products were mostly adequate for cancer, neurodegenerative diseases, diabetes, inflammatory bowel disease, end-stage kidney disease, dysphagiam and chronic obstructive pulmonary disease. However, gaps have been found for sarcopenia and abdominal surgery. Conclusion: In light of the current market landscape, there is a need for a comprehensive regulation that indicates the optimal composition of FSMPs and the production of such products to tackle disease-related malnutrition.
... As people age, there is an increased risk of muscle weakness and sarcopenia characterized by muscle atrophy and loss of physical function. Previous muscle mass reserves and increased frailty predict the extent of older adults' risk of muscle weakness and sarcopenia (40,41). People with obesity have a higher risk of frailty, heightening the nutritional vulnerability of this subpopulation and their subsequent nutrient needs (42). ...
The world faces a global challenge of how to meet the nutritional needs of a diverse global population through diets. This paper defines the relative nutritional needs across each stage of the life cycle to support human health and identifies who is nutritionally vulnerable. Findings in this paper suggest that there are biological nutritional vulnerabilities stemming from high micronutrient needs per calorie in certain phases of the life cycle, particularly for infants and young children, women of reproductive age, pregnant and lactating women, and older adults, particularly older women. The paper demonstrates the role of micronutrient-dense animal-source foods and plant-source foods important in meeting essential nutrient needs to support healthy growth, development, and aging across vulnerable stages of the life cycle.
... However, for older healthy adults, the recommended intakes are increased to 1.0-1.2 g/kg (Bauer et al., 2013). A recent review about this topic concludes that the effects of this amount of protein in both lean body mass and fat mass in older adults depend on the subject's basal status (de Camargo, 2023). ...
Function declines throughout life although phenotypical manifestations in terms of frailty or disability are only seen in the later periods of our life. The causes underlying lifelong function decline are the aging process "per se", chronic diseases, and lifestyle factors. These three etiological causes result in the deterioration of several organs and systems which act synergistically to finally produce frailty and disability. Regardless of the causes, the skeletal muscle is the main organ affected by developing sarcopenia. In the first section of the manuscript, as an introduction, we review the quantitative and qualitative age-associated skeletal muscle changes leading to frailty and sarcopenia and their impact in the quality of life and independence in the elderly. The reversibility of frailty and sarcopenia are discussed in the second and third sections of the manuscript. The most effective intervention to delay and even reverse frailty is exercise training. We review the role of different training programs (resistance exercise, cardiorespiratory exercise, multicomponent exercise, and real-life interventions) not only as a preventive but also as a therapeutical strategy to promote healthy aging. We also devote a section in the text to the sexual dimorphic effects of exercise training interventions in aging. How to optimize the skeletal muscle anabolic response to exercise training with nutrition is also discussed in our manuscript. The concept of anabolic resistance and the evidence of the role of high-quality protein, essential amino acids, creatine, vitamin D, β-hydroxy-β-methylbutyrate, and Omega-3 fatty acids, is reviewed. In the last section of the manuscript, the main genetic interventions to promote robustness in preclinical models are discussed. We aim to highlight the molecular pathways that are involved in frailty and sarcopenia. The possibility to effectively target these signaling pathways in clinical practice to delay muscle aging is also discussed.
... The PRO-TAGE study group also published a position paper, recommending the intake of 2.5-2.8 g leucine per meal for older adults [42]. It would be very worthwhile to repeat these interventions in the older adults. ...
Purpose
To meet the global dietary protein demands, a trend towards plant-based protein (PBP) sources to replace animal-derived protein is currently ongoing. However, PBPs may not have the same anabolic capacity to stimulate muscle protein synthesis (MPS) as dairy proteins. For vulnerable populations with specific medical needs, it is especially important to validate the anabolic properties of PBPs. In this study, a blend of pea and soy protein isolate, with or without additional leucine, was compared to whey protein isolate on MPS in aged mice.
Methods
25-Months aged C57BL/6J-mice received an oral gavage with 70 mg of whey protein isolate (W), PS protein isolate (PS; ratio 51:49), PS fortified with 19% leucine (PS + L), or 0.5mL water (F). Mice were subcutaneously injected with puromycin (0.04 µmol/g body weight, t = 30 min) and sacrificed 60 min thereafter. Left m. tibialis anterior (TA) was used to analyse MPS by the SUnSET method and mTOR signal transduction proteins. Amino acid concentrations were determined in plasma and right TA. Dried blood spots (DBS) were analysed for postprandial dynamics of amino acids at 10-20-45-60-min.
Results
MPS was significantly increased by W and PS + L (p < 0.003), however not by PS. Pathway protein 4EBP1 showed significant increases with W, PS and PS + L to F (p < 0.0002). W and PS + L increased plasma and muscle free leucine equally, which was confirmed by DBS.
Conclusion
A PS blend fortified with leucine stimulates MPS comparable to whey protein in this acute murine ageing model. Leucine appears to be the main driver for the anabolic responses observed.
... 236 Algunas investigaciones han mostrado que para maximizar la estimulación de la síntesis de la proteína muscular es importante el consumo de proteínas "rápidas", como el suero de leche, en comparación con las proteínas "lentas" como el caseinato; aunque ambas, suministradas dentro de los 60 minutos después del ejercicio, cuando hay mayor respuesta anabólica, pueden tener un efecto favorable, en comparación con la de soya. 237 En el consenso de expertos revisaron tres estudios los efectos de la suplementación de proteína de suero de leche; en uno de éstos se observó el efecto en 81 mujeres de edad promedio de 70.6 años, del ejercicio y 22.3 g de proteínas, con un promedio de la ingestión de proteínas ³ 1.2 g/kg/d en 3 grupos con ajuste de ejercicio, encontrando un incremento de la masa muscular en el grupo de ejercicio en el que se suministró proteína y esta suplementación de se hizo inmediatamente después del ejercicio de resistencia, en comparación con los que hicieron sólo ejercicio o sólo suplementación de proteínas. 236 La ingestión de 1 a 1.4 g/kg/d de proteínas durante 12 semanas, no se ha visto relacionada con efectos adversos, en particular de la función renal. ...
Revisión multidisciplinaria sobre sarcopenia para contribuir a la difusión del tema en la comunidad clínica, promover el diagnóstico temprano, el tratamiento oportuno y su asociación con otras enfermedades
... Previous studies carried out in older adults also found an inverse association between protein intake and mortality [18][19][20][21]. Inadequate protein intake in older adults contributes to frailty, sarcopenia, osteoporosis, and impaired immune responses [22][23][24]. The responsiveness to the anabolic stimulus of amino acid intake decreases by the increasing age [25]. ...
Background
Less is known whether the amino acid composition of dietary protein sources effects on long-term health outcomes. We aimed to evaluate the association between dietary amino acid composition and all-cause and cause-specific mortality.
Methods
This study used data from the Golestan Cohort Study, which was performed in the Golestan Province of Iran from January 2004 to June 2008. Mortality, which was the primary outcome, was ascertained through September 2022. The Cox proportional hazards regression models were used to determine the adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality according to the quintiles of amino acid consumption, taking the third quintile as the reference.
Results
A total of 47,337 participants (27,293 [57.7%] women) with a mean (standard deviation) age of 51.9 (8.9) years were included. During a median follow-up of 15 years, 9,231 deaths were documented. Regarding essential amino acid intakes, the HRs of all-cause mortality were 1.16 (95% CI, 1.07–1.26) in the first quintile, compared with the reference group (P for non-linear trend < 0.001). Similarly, non-linear associations were observed between risk of all-cause mortality and intake of branched-chain, aromatic, sulfur-containing, or non-essential amino acids (P for non-linear trend < 0.001 for all comparisons), with higher HRs for participants in the first quintiles. There was an age interaction for the associations between dietary amino acids and mortality (P for interaction ˂0.05). While high amino acid diets were detrimental in middle-aged adults (< 65 years), increased hazards of mortality were observed among older adults (≥ 65 years) with low amino acid intake.
Conclusions
This study showed the non-linear trend between amino acids intake and risk of mortality in the middle-aged and older Iranian population. Overall, our findings suggest that diets lower in amino acids were associated with increased hazards of mortality, particularly among older adults.
... A study conducted in nine European countries revealed that approximately 79.6% of women had 25OHD levels below 80 nmol/l, and 32.1% had levels below 50 nmol/l [32]. Furthermore, another study conducted in 11 European countries demonstrated that 25OHD levels were lower in winter, with values below 30 nmol/l in at least 50% of the population [33]. To date, data regarding vitamin D intake in the Italian population are very limited and poorly applicable to subjects 3 at high risk of vitamin D deficiency, such as aging individuals or those with chronic debilitating disorders. ...
The condition of vitamin D deficiency represents a significant public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent report performed to validate a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary intake of vitamin D, both in females and males, was far below the average. With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the type and amount of intake of foods containing vitamin D. It was submitted to 870 subjects, 627 females and 243 males, with age ranged from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Present data confirm previous observations: the global amount of vitamin D intakes in 14 days were 70.8 μg + 1.8 (SE) in females and 87.5 μg + 1.9 (SE) in males; the mean daily intakes of vitamin D in females and males were 5.05 μg + 0.17 (SE) and 6.25 μg + 0.21 (SE) for females and males, respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40-50 age group to 54.5 μg and 87.8 μg in the 71-80 age group, respectively. In conclusion, present data collected in a large Italian cohort underscore that the daily intake of vitamin D is far below the recommended daily average, so contributing to the development of potential hypovitaminosis.
... Regarding this last item, it is important to mention that even though a nutritional assessment was carried out in 2019 (MNA) and no volunteer presented risk of malnutrition, this assessment is particularly qualitative and not quantitative [35]. In fact, it is known that an adequate quantitative consumption of macronutrients, especially proteins, can mitigate the development and progression of both immunosenescence and inflammaging [44,45]. ...
Background: Inflammaging and physical performance were investigated in older adults before and after the COVID-19 pandemic. Methods: Older women (n = 18) and men (n = 7) (mean age = 73.8 ± 7.1) were evaluated before the COVID-19 pandemic (PRE), 12 months after the lockdown (POST), and 10 months after resuming exercise training (POST-TR). Physical tests [gait speed (GS) and timed-up-and-go (TUG)]; muscle strength (handgrip—HG); and serum cytokine levels were assessed. Results: Older women showed higher GS and TUG at POST than PRE and POST-TR but lower HG at POST-TR than PRE, whereas older men exhibited lower HG at POST and POST-TR than PRE. Both groups presented (1) lower IL-10 and IL-12p70 values in contrast to higher IL-6/IL-10 and IL-8/IL-10 ratios at POST than PRE; (2) higher IL-10 values and lower IL-8/IL-10 ratio at POST-TR than POST; (3) higher IL-12p70/IL-10 ratio at POST-TR than PRE and POST. Particularly, older women showed (4) lower IL-6 values at POST and POST-TR than PRE; (5) lower IL-8 and IL-10 values at POST-TR than POST; (6) and higher TNF-α/IL-10 and IFN-γ/IL-10 ratios at POST than PRE and POST-TR. Significant correlations between the variables were found in both groups. Discussion: During the COVID-19 pandemic, detraining and resumption of exercise training promoted distinct alterations in physical capacity and inflammaging among older women and older men.
... Adequate energy intake is reportedly important for improving physical function and ADL [12]. Furthermore, protein intake of ≥1.2 g/kg/day has been reported to be necessary for improving physical function, including skeletal muscle gain [13]. Therefore, appropriate nutritional management is needed for improving physical function and ADL in patients with cerebrovascular disease. ...
Currently, there is inadequate evidence on the effects of combined rehabilitation and nutritional therapy for patients with multimorbidity. Therefore, in this report, we describe a case of combined rehabilitation and nutritional therapies with favorable outcomes in a patient with duplicated musculoskeletal and cerebrovascular diseases. An 80-year-old female patient was admitted to a convalescent rehabilitation ward after undergoing left total knee arthroplasty. During hospitalization, the patient had a subcortical hemorrhage in the right temporal lobe. The patient was readmitted to a convalescent rehabilitation ward after treatment at an acute care hospital and underwent rehabilitation therapy. Upon readmission, the patient showed a decline in physical function and skeletal muscle mass and had a poor nutritional status. Additionally, the patient required assistance with activities of daily living. Comprehensive treatment combining rehabilitation therapy and nutritional therapy was carried out for five months, seven days a week. The patient's physical function, skeletal muscle mass, and nutritional status improved. It is important to combine rehabilitation and nutritional therapy for patients with multiple diseases.
... Recent meta-analyses have reported associations between fish intake and all-cause mortality as well as contributions of ω-3 FA intake in reducing cardiovascular mortality [2][3][4]. Daily protein intake of 1-1.5 g/kg helps offset age-related inflammation and catabolism, especially in older people [5]. ...
Background
The relationship between inflammatory response, fish consumption, and mortality risk in older individuals is unclear. We investigated whether C-reactive protein (CRP) levels ≥ 0.1 mg/dL, fish intake, and inflammatory responses are associated with all-cause mortality risk in older adults.
Methods
This prospective cohort study included older adults aged 85–89 years from the Kawasaki Aging and Wellbeing Project, who did not require daily care. Cohort was recruited from March 2017 to December 2018 (follow-up ended on December 31, 2021). Dietary assessment was conducted using the Brief Self-Administered Diet History Questionnaire. Multivariate Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality in the CRP ≥ 0.1 mg/dL group; the CRP < 0.1 mg/dL group was used for reference. Within CRP ≥ 0.1 and < 0.1 mg/dL groups, participants were categorized into tertiles of fish intake. HRs and 95% CIs for all-cause mortality in the other groups were estimated using the lower tertile group as a reference.
Results
The study included 996 participants (mean [standard deviation] age, 86.5 [1.37] years; 497 [49.9%] women) with a median CRP level of 0.08 (interquartile range [IQR] = 0.04–0.16). There were 162 deaths during 4,161 person-years of observation; the multivariable-adjusted HR for all-cause mortality in the CRP ≥ 0.1 mg/dL group was 1.86 (95% CI, 1.32–2.62); P < 0.001. In 577 individuals with median (IQR) fish intake of 39.3 g/1000 kcal (23.6–57.6) and CRP level of < 0.1 mg/dL, the multivariable-adjusted HR for all-cause mortality in the higher tertile group of fish intake was 1.15 (0.67–1.97); P = 0.59, non-linear P = 0.84. In 419 individuals with median (IQR) fish intake of 40.7 g/1000 kcal (25.0–60.1) and CRP level of ≥ 0.1 mg/dL, the multivariate-adjusted HR for all-cause mortality in the higher tertile group of fish intake was 0.49 (0.26–0.92); P = 0.026, non-linear P = 0.38, P-value for interaction = 0.040.
Conclusions
A negative association between fish intake and all-cause mortality was seen in older adults with elevated CRP levels, which is a mortality risk factor. While the results may be limited owing to stringent methods ensuring impartiality, they offer valuable insights for future research.
Trial registration
UMIN000026053. Registered February 24, 2017.
... Many studies report loss of muscle mass following energy restriction in both normal-weight and overweight individuals [56,57]. Weiss et al. [56] found that a 20% energy restriction over 12-14 weeks resulted in significant loss of muscle mass (−0.9 kg +/− 0.3; Protein also plays a significant role in MPS [58] with a growing body of literature recognising the importance of dietary protein to reduce age-related effects of skeletal muscle loss [15,16,54,59]. ...
Background
Loss of muscle mass and muscle strength are key characteristics of age‐related muscle decline. Dietary protein is a key nutrient that supports optimal muscle health. However, there is a strong argument to reduce intake of animal protein for health and environmental reasons. The effects of vegetarian diets on determinants of muscle health are not clear. This systematic review aimed to investigate the impact of vegetarian diets on muscle mass and muscle strength.
Methods
A systematic literature search of the CINAHL, Medline, Scopus and Web of Science Core Collection databases, as well as the Cochrane Central Register of Controlled Trials, was conducted according to PRISMA guidelines. Studies reporting the effects of vegetarian diets on muscle mass and strength were analysed.
Results
A total of three interventions and 11 observational studied were eligible to be included (n = 14) in this review. Five of the 12 studies that reported muscle mass found no difference in muscle mass between participants consuming an omnivorous versus vegetarian diet. One observational study reported higher muscle mass for vegetarians. Of the studies that reported muscle strength (n = 5), three reported no difference between participants consuming an omnivorous and vegetarian diet.
Conclusions
Half of the included studies reported no difference in muscle mass or strength between vegetarians and omnivores. Further high‐quality studies are needed to better understand the relationship between vegetarian diets and determinants of muscle health.
... According to the recommendations of the PROT-AGE research group, in order to maintain good health of the elderly (> 65 years of age), an average protein intake of 1.0 to 1.2 g of protein per kilogram of body weight per day is recommended. " In addition, endurance and resistance exercises selected and individually adjusted to the patient's capabilities are also recommended, and in the case of activities, a higher protein intake is recommended i.e., ≥ 1.2 g/kg of body weight/day [96]. Some limitations to our study should be acknowledged. ...
An active lifestyle is of key importance for reduction of obesity and inflammation, as well as circulating levels of adipokines. Therefore, the aim of our study was to assess the relationship of physical fitness with chronic inflammatory status, and to evaluate biomarkers useful in the analysis of adipose tissue dysfunction. Sixty-three older adults (69.6 ± 5.1 years) were allocated to a high n = 31 (women n = 23 and men n = 8 male) or low physical fitness n = 32 (women n = 29 and men n = 3) group based on gait speed values (1.4–1.8 m/s or ≤ 1.3 m/s). The gait speed correlated with hand grip strength (rs = 0.493, p = 0.0001) and with leptin level (R = -0.372, p = 0.003), which shows the benefits of physical activity on muscle strength and circulating adipokines. In low physical fitness group, 58.1% individuals had adiponectin to leptin ratio (Adpn/Lep) < 0.5 revealing dysfunction of adipose tissue and high cardiometabolic risk; 20% of the group were obese with BMI ≥ 30 kg/m². In high physical fitness group, 25.8% of individuals had Adpn/Lep ≥ 1.0 i.e., within the reference range. Markers of systemic inflammation were significantly related to physical fitness: CRP/gait speed (rs = -0.377) and HMGB-1/gait speed (rs = -0.264). The results of the ROC analysis for Adpn (AUC = 0.526), Lep (AUC = 0.745) and HMGB-1 (AUC = 0.689) indicated their diagnostic potential for clinical prognosis in older patients. The optimal threshold values corresponded to 1.2 μg/mL for Adpn (sensitivity 74.2%, specificity 41.9%, OR = 1.4, 95%Cl 0.488–3.902), 6.7 ng/mL for Lep (sensitivity 56.2%, specificity 93.5%, OR = 14.8, 95%Cl 3.574–112.229), 2.63 mg/L for CRP (sensitivity 51.6%, specificity 84.3%, OR = 4.4, 95% Cl 1.401- 16.063) and 34.2 ng/mL for HMGB-1 (sensitivity 62.0%, specificity 86.6%, OR = 12.0, 95%Cl 3.254—61.614). The highest sensitivity and specificity were observed for Leptin and HMGB-1. The study revealed changes in inflammatory status in older adults at various levels of physical fitness and demonstrated diagnostic usefulness of adipokines in the assessment of adipose tissue inflammation.
... Additionally [52], reported a protein-rich diet has a great effect on reducing liver fat than a low-protein diet largely due to reductions in hepatic fat uptake and lipid biosynthesis. A 6-month high-protein diet (1.87 g protein/kg body weight per day) in healthy individuals caused elevated fasting glucose levels, impaired hepatic glucose output suppression by insulin, and enhanced gluconeogenesis [53]. High plant protein intake showed a negative association with the risk of developing T2DM [54]. ...
Diet is the main modifiable risk factor underlying the progression of Type 2 Diabetes mellitus (T2DM). The African olive (Canarium schweinfurthii Engl.) of the family Burseraceae and genus Canarium is a source of food and medicine. This review summarized information on the nutritional and chemical composition of the Canarium schweinfurthii Engl. fruit pulp and explored its potential application in the management of T2DM. The literature search covered scientific databases comprising of Science Direct, Springer, Multidisciplinary Digital Publishing Institute, Science Hub and Google Scholar, from April 2023 up to January 2024. The following keywords were used: “Canarium schweinfurthii Engl.”, “Canarium schweinfurthii Engl. fruit pulp”, “Canarium schweinfurthii Engl. nutrition value, chemical composition and bioactive compounds”, “Canarium schweinfurthii Engl. against T2DM”, and “Nutritional requirements for T2DM”. This review evaluates the current state of research of global literature from 1992 to 2022 (n = 450) on Canarium schweinfurthii Engl. and T2DM. Data and information from literature (n = 115) was included in the review. The results of different studies showed that Canarium schweinfurthii Engl. fruit was composed of a wide range of nutritional and chemical components such as minerals, amino acids, fatty acids and vitamins. In addition, the fruit contains bioactive compounds reported to be effective against T2DM. Canarium schweinfurthii Engl. contains phytochemicals such as saponins, phenolics, alkaloids and flavonoids that have positive effects on cardio-metabolic health. Although the T2DM therapeutic effects of Canarium schweinfurthii bark stem extracts and fruit pulp oil have been reported, the therapeutic potential of the whole fruit pulp is yet to be reported.
Graphical Abstract
... In contrast, in a longitudinal study carried out in a Mediterranean population at high cardiovascular risk, both low and high dietary acid intakes, as assessed by potential acid load or net endogenous acid production, were associated with an increased low trauma fracture risk in a U-shape relationship [28]. In view of the impaired protein assimilation of older individuals, the RDA of 0.8 g/kg body weight per day has been recommended to be increased to 1.2 g/kg per day in this age group, or even higher in cases of severe diseases [29]. Thus, insufficient dietary protein intake in the frail elderly is likely to be a more severe problem than protein excess. ...
Purpose of Review
Osteoporosis affects 50% of women and 20% of men after the age of 50. Fractures are associated with significant morbidity, increased mortality and altered quality of life. Lifestyle measures for fragility fracture prevention include good nutrition including adequate protein and calcium intakes, vitamin D sufficiency, and regular weight bearing physical exercise.
Recent Findings
Dietary protein is one of the most important nutritional considerations as it affects bone mineral density, trabecular and cortical microstructure, and bone strength. When calcium intake is sufficient, higher dietary protein intake is associated with lower risk of fracture. Dairy products are a valuable source of calcium and high quality protein. Dairy product consumption, particularly fermented dairy products, are associated with a lower risk of hip fracture and vegan diets are associated with increased fracture risk. Other dietary factors associated with reduced fracture risk include at least 5 servings per day of fruits and vegetables, regular tea drinking, adherence to a Mediterranean diet and other dietary patterns which provide fibers, polyphenols and fermented dairy products. Such dietary patterns may confer health benefits through their effect on gut microbiota composition and/or function.
Summary
A balanced diet including minerals, protein, fruits and vegetables is an important element in the prevention of osteoporosis and of fragility fracture.
... Decreased anabolic response, exacerbation of catabolism due to acute fractures in addition to chronic underlying conditions, and underlying sarcopenia all can contribute to increased energy and protein requirements in elderly patients. While healthy geriatrics typically require around 25-30 kcal/kg of energy and 1 g/kg of protein per day, patients with hip fractures may require even higher amounts of energy and protein supply [17,18]. This study aimed to investigate whether providing a product containing 8.76 g of protein twice daily, without calculating weight-adjusted protein requirements, could improve the nutritional status of geriatric hip fracture patients and reduce postoperative complications. ...
Background/Objectives: Geriatric hip fracture patients have an increased risk of malnutrition. Proper nutritional supply in the perioperative period is very important for their recovery. Oral nutritional supplements (ONSs) are recommended in geriatric hip fracture patients to improve dietary intake and prevent complications. This study aimed to evaluate the efficacy of postoperative ONSs after total hip arthroplasty in geriatric hip fracture patients. Methods: A retrospective study of elderly patients who underwent total hip arthroplasty for hip fracture was conducted. Data from patients who received ONSs postoperatively until hospital discharge (ONS group, n = 69) were compared with patients who did not receive ONSs (control group, n = 168). Laboratory test results, including serum protein and albumin levels, length of hospital stay, and the incidence of postoperative medical complications of the two groups, were analyzed. Results: Preoperative serum protein and albumin levels were significantly higher in the control group (p = 0.002 and p = 0.010, respectively). However, the degree of decline for both protein and albumin levels was significantly less in the ONS group (p < 0.001 for both). Serum albumin levels were significantly higher in the ONS group at postoperative two-week follow-up (p = 0.006). The length of hospital stay was shorter in the ONS group (p < 0.001). The incidence of postoperative delirium was significantly higher in the control group (p = 0.007). Conclusions: In geriatric hip fracture patients, postoperative ONSs can improve postoperative nutritional status, shorten the length of hospital stay, and reduce the incidence of postoperative delirium.
... Protein requirements were based on a variety of international recommendations: 1.2 g/kgBW/ d was based on the Nordic Nutrition recommendations of 2012 [35], 1.5 g/kgBW/d on ESPEN 2014 and 2022 [12,17] and PROT-AGE 2013 [10]. No study aiming for 1.0 g/kgBW/d provided justification for their target protein intake. ...
... Participants were asked to consume the protein within 3 hours after exercise as muscle protein synthesis peaks during this time. 31 They were also advised to consume the protein between meals to minimise any effect on appetite. ...
Objective
To determine the feasibility of conducting a randomised controlled trial (RCT) to evaluate a prehabilitation programme for frail patients undergoing total hip replacement (THR) or total knee replacement (TKR).
Design
Randomised feasibility study with embedded qualitative work.
Setting
Three National Health Service hospitals.
Participants
Adults aged ≥65 years, frail and scheduled for primary THR or TKR.
Intervention
Appointment with a physiotherapist to individualise a home-based exercise programme. Participants were encouraged to do the home exercises daily for 12 weeks pre-operative and were provided with a daily protein supplement. Participants were supported by six telephone calls over the 12-week intervention period.
Outcome measures
Eligibility and recruitment rates, intervention adherence, data completion rates of patient-reported outcome measures, retention rates and acceptability of the trial and intervention. Qualitative interviews were conducted with participants and non-participants and analysed using thematic analysis.
Results
Between December 2022 and August 2023, 411 patients were sent a screening pack. Of the 168 patients who returned a screening questionnaire, 79 were eligible and consented to participate, and 64 were randomised. Of the 33 participants randomised to the intervention, 26 attended the intervention appointment. Eighteen participants (69%) received all six intervention follow-up telephone calls. Nineteen participants (73%) completed an intervention adherence log; 13 (68%) adhered to the exercise programme and 11 (58%) adhered to the protein supplementation. The overall retention rate was 86% (55/64 overall) at 12 weeks. The 12-week follow-up questionnaire was returned by 46 of the 55 participants (84%) who were sent a questionnaire. Interviews with 19 patients found that the trial processes and intervention were generally acceptable, but areas of potential improvements were identified.
Conclusions
This study demonstrated that a larger study is possible and has identified improvements to optimise the design of an RCT.
Trial registration number
ISRCTN11121506 .
... For older adults, consuming sufficient protein is of great importance as it prevents them from, among others, losing muscle mass [9]. When transitioning to a more sustainable diet, they might become at risk for an inadequate protein intake if either protein quantity or quality is insufficient. ...
Background: A more sustainable diet with fewer animal-based products has a lower ecological impact but might lead to a lower protein quantity and quality. The extent to which shifting to more plant-based diets impacts the adequacy of protein intake in older adults needs to be studied. Objectives: We simulated how a transition towards a more plant-based diet (flexitarian, pescetarian, vegetarian, or vegan) affects protein availability in the diets of older adults. Setting: Community. Participants: Data from the Dutch National Food Consumption Survey 2019-2021 of community-dwelling older adults (n = 607) was used Measurements: Food consumption data was collected via two 24-h dietary recalls per participant. Protein availability was expressed as total protein, digestible protein, and utilizable protein (based on digestibility corrected amino acid score) intake. The percentage below estimated average requirements (EAR) for utilizable protein was assessed using an adjusted EAR. Results: Compared to the original diet ($62% animal-based), utilizable protein intake decreased by about 5% in the flexitarian, pescetarian and vegetarian scenarios. In the vegan scenario, both total protein intake and utilizable protein were lower, leading to nearly 50% less utilizable protein compared to the original diet. In the original diet, the protein intake of 7.5% of men and 11.1% of women did not meet the EAR. This slightly increased in the flexitarian, pescetarian, and vegetarian scenarios. In the vegan scenario, 83.3% (both genders) had a protein intake below EAR. Conclusions: Replacing animal-based protein sources with plant-based food products in older adults reduces both protein quantity and quality, albeit minimally in non-vegan plant-rich diets. In a vegan scenario, the risk of an inadequate protein intake is imminent.
... 132 Ensuring adequate protein intake is necessary for senior people to maintain muscle mass and function. 133,134 Whey protein is a valuable source of high-quality protein due to its ease of digestion and richness in all essential amino acids, particularly leucine, a crucial activator of muscle protein synthesis. 135 According to a study by Ottestad et al, 136 protein- Vitamin D and leucine have been shown to have synergistic effects in promoting protein anabolism. ...
This article reviews the mechanisms and prevention strategies associated with vitamin D and sarcopenia in older adults. As a geriatric syndrome, sarcopenia is defined by a notable decline in skeletal muscle mass and strength, which increases the risk of adverse health outcomes such as falls and fractures. Vitamin D, an essential fat-soluble vitamin, is pivotal in skeletal muscle health. It affects muscle function through various mechanisms, including regulating calcium and phosphorus metabolism, promoting muscle protein synthesis, and modulation of muscle cell proliferation and differentiation. A deficiency in vitamin D has been identified as a significant risk factor for the development of sarcopenia in older adults. Many studies have demonstrated that low serum vitamin D levels are significantly associated with an increased risk of sarcopenia. While there is inconsistency in the findings, most studies support the importance of vitamin D in maintaining skeletal muscle health. Vitamin D influences the onset and progression of sarcopenia through various pathways, including the promotion of muscle protein synthesis, the regulation of mitochondrial function, and the modulation of immune and inflammatory responses. Regarding the prevention and treatment of sarcopenia, a combination of nutritional, exercise, and pharmacological interventions is recommended. Further research should be conducted to elucidate the molecular mechanism of vitamin D in sarcopenia, to study genes related to sarcopenia, to perform large-scale clinical trials, to investigate special populations, and to examine the combined application of vitamin D with other nutrients or drugs. A comprehensive investigation of the interconnection between vitamin D and sarcopenia will furnish a novel scientific foundation and productive strategies for preventing and treating sarcopenia. This, in turn, will enhance the senior people’s quality of life and health.
... It is well-recognized that sarcopenia can be improved by simple lifestyle interventions. These include oral nutritional therapy, such as a high-protein diet and supplementation of leucine and vitamin D, in combination with resistance exercise [37][38][39][40] . Our data propose that patient with PD may benefit from the lifestyle interventions for sarcopenia to reduce the risk of LID. ...
Previous observational studies suggested that sarcopenia is associated with Parkinson disease (PD), but it is unclear whether this association is causal. The objective of this study was to examine causal associations between sarcopenia-related traits and the risk or progression of PD using a Mendelian randomization (MR) approach. Two-sample bidirectional MR analyses were conducted to evaluate causal relationships. Genome-wide association study (GWAS) summary statistics for sarcopenia-related traits, including right handgrip strength (n = 461,089), left handgrip strength (n = 461,026), and appendicular lean mass (n = 450,243), were retrieved from the IEU OpenGWAS database. GWAS data for the risk of PD were derived from the FinnGen database (4235 cases; 373,042 controls). Summary-level data for progression of PD, including progression to Hoehn and Yahr stage 3, progression to dementia, and development of levodopa-induced dyskinesia, were obtained from a recent GWAS publication on progression of PD in 4093 patients from 12 longitudinal cohorts. Significant causal associations identified in MR analysis were verified through a polygenic score (PGS)-based approach and pathway enrichment analysis using genotype data from the Parkinson’s Progression Markers Initiative. MR results supported a significant causal influence of right handgrip strength (odds ratio [OR] = 0.152, 95% confidence interval [CI] = 0.055–0.423, adjusted P = 0.0036) and appendicular lean mass (OR = 0.597, 95% CI = 0.440–0.810, adjusted P = 0.0111) on development of levodopa-induced dyskinesia. In Cox proportional hazard analysis, higher PGSs for right handgrip strength (hazard ratio [HR] = 0.225, 95% CI = 0.095–0.530, adjusted P = 0.0019) and left handgrip strength (HR = 0.303, 95% CI = 0.121–0.59, adjusted P = 0.0323) were significantly associated with a lower risk of developing levodopa-induced dyskinesia, after adjusting for covariates. Pathway enrichment analysis revealed that genome-wide significant single-nucleotide polymorphisms for right handgrip strength were substantially enriched in biological pathways involved in the control of synaptic plasticity. This study provides genetic evidence of the protective role of handgrip strength or appendicular lean mass on the development of levodopa-induced dyskinesia in PD. Sarcopenia-related traits can be promising prognostic markers for levodopa-induced dyskinesia and potential therapeutic targets for preventing levodopa-induced dyskinesia in patients with PD.
In this opinion article, we advocate for the combination of creatine monohydrate supplementation and resistance training as a safe and effective non-pharmacological strategy to prevent and treat sarcopenia that should be internationally recognized by health practitioners and public health organizations.
Background: The relationship between protein intake and the long-term prognosis of elderly patients with heart failure remains poorly understood. We investigated the association between predischarge protein intake and long-term prognosis in hospitalized elderly patients with heart failure.
Methods and Results: A single-center, retrospective analysis of hospitalized patients aged ≥65 years with heart failure and reduced ejection fraction was conducted. Protein intake was evaluated by nutritionists based on visual measurements of the percentage of dietary intake obtained for 7 days before discharge by a nurse. A cutoff of 1.2 g/kg/day protein intake was used to compare the incidence of a composite endpoint, including all-cause mortality and heart failure rehospitalization within 1 year. Among the 100 patients (median age 79 years; 47% male), 56% had low protein intake (<1.2 g/kg/day). Patients with low protein intake had a significantly higher rate of composite endpoints than those with high protein intake (50% vs. 20%; log-rank test P=0.03). Multivariable Cox proportional hazards model revealed that low protein intake was independently associated with long-term prognosis with a hazard ratio of 2.73 and a 95% confidence interval of 1.10–6.80 (P=0.03).
Conclusions: Low protein intake in the predischarge phase was associated with long-term prognosis in hospitalized elderly patients with heart failure and reduced ejection fraction.
Eurasian clinical practice guidelines for dietary management of cardiovascular diseases include actual healthy diet recommendations and modern dietary approaches for prevention and treatment of cardiovascular diseases. Nutritional assessment and interventions based on pathogenesis of atherosclerosis and cardiovascular diseases are presented.
Modern nutritional and dietary recommendations for patients with arterial hypertension, coronary heart disease, chronic heart failure, heart rhythm disorders, dyslipidemia and gout are summarized in present recommendations. Particular attention is paid to the dietary management of cardiovascular patients with obesity and/or diabetes mellitus. This guide would be interesting and intended to a wide range of readers, primarily cardiologists, dietitians and nutritionists, general practitioners, endocrinologists, and medical students.
Dietary protein provides indispensable amino acids (IAAs) that the body cannot synthesise. Past assessments of total protein intake from vegan populations in western, developed countries were found to be low but not necessarily below daily requirements. However, plant-sourced proteins generally have lower quantities of digestible IAAs as compared to animal-sourced proteins. Simply accounting for protein intake without considering AA profile and digestibility could overestimate protein adequacy among vegans. This study quantified protein intake and quality, as compared to reference intake values among 193 NZ vegans using a four-day food diary. Protein and IAA composition of all foods were derived from New Zealand FoodFiles and the United States Department of Agriculture and adjusted for True Ileal Digestibility (TID). Mean protein intakes for males and females were 0.99 and 0.81 g/kg /day, respectively with 78.8% of males and 74.5% of females meeting the Estimated Average Requirement for protein. Plant-sourced proteins provided 52.9 mg of leucine and 35.7 mg of lysine per gram of protein and were below the reference scoring patterns (leucine: 59mg/g, lysine: 45mg/g). When adjusted to individual body weight, average IAA intakes were above daily requirements, but lysine just met requirements at 31.2 mg/kg of body weight/day (reference: 30 mg/kg/day). Upon TID adjustment, the percentage of vegans meeting adequacy for protein and IAA decreased and only approximately 50% of the cohort could meet lysine and leucine requirements. Hence, lysine and leucine were the most limiting IAAs in the vegan cohort's diet. Legumes and pulses contributed most to overall protein and lysine intake. An increased proportion of legumes and pulses can potentially increase these intakes but must be considered in the context of the whole diet. AA composition and digestibility are important aspects of protein quality when assessing protein adequacy and is of particular importance in restrictive diets.
The British Nutrition Foundation convened a roundtable event in January 2024 entitled ‘Meat and the Future of Sustainable Diets: Turning Challenges into Opportunities’, bringing together multi‐sector stakeholders to discuss the social, nutritional, public health and environmental aspects of meat consumption within a sustainable food system. Participants explored the challenge of the complexity of balancing nutrition and planetary goals, emphasising the need to navigate trade‐offs between various dimensions of sustainability. Whilst recognising the global nature of the issue, the roundtable primarily focussed on a UK perspective. The discussion highlighted the urgency of transforming the food system to achieve net zero, whilst ensuring broader environmental benefits, nutritional adequacy and dietary and health equity across all life stages. Concerns about poor dietary patterns, particularly among vulnerable groups were raised, with participants stressing the need for policies that promote healthy, sustainable and equitable diets without worsening inequalities. These policies should also enhance livelihoods and community wellbeing, foster resilience and support local economies.
On the supply side, participants called for better data within the agri‐food system, particularly at the farm level. They advocated for a multidimensional, holistic approach that goes beyond greenhouse gas emissions to encompass wider environmental impacts and whole‐farm benefits, such as enhancing soil health, promoting biodiversity, improving water management, supporting nutrient cycling and boosting farm‐level resilience through diversified cropping systems.
Roundtable participants acknowledged existing recommendations to reduce meat consumption for both environmental reasons, such as land use and greenhouse gas emissions, and health concerns, as evidence links red, particularly processed, meat consumption with increased colorectal cancer risk. Given the variation in meat consumption globally and even locally between individuals, the discussion explored the potential of targeted campaigns to reduce high meat intake, along with the role of public food procurement and the food industry in decreasing processed meat consumption. The consensus was that dietary changes must be framed within the context of a balanced diet and broader sustainability concerns. Despite some differing viewpoints on implementation, participants agreed that transitioning to healthier, more sustainable diets is a priority. Collaboration across the entire food chain, from farm to fork, with investment in innovation, robust data collection and research, alongside policy support, was emphasised as essential to achieving this goal.
Background and objective
Heart failure (HF) is a syndrome of increased intracardiac pressure or decreased cardiac output. There is a lack of conclusive evidence to recommend the regular use of any dietary supplement in patients with HF. However, certain studies have shown nutritional interventions to be beneficial for patients with HF. Therefore, the purpose of this systematic review was to understand and map the updates of dietary interventions and nutritional supplementation measures related to patients with HF over the past 5 years.
Study design
A systematic review.
Methods
The PubMed, Web of Science, Scopus, and Cochrane Library databases were searched for randomized clinical trials on the association between dietary interventions and nutritional supplements and HF published between 2018 and 2023. A total of 1755 documents were retrieved, of which 19 were finalized for inclusion.
Results
The findings suggest that individualized nutritional support reduces mortality and risk of major cardiovascular events in chronic heart failure inpatients at high nutritional risk. The Mediterranean diet improves functionality, quality of life, and cardiac function. Additionally, supplementation with thiamine, ubiquinol, D-ribose, and L-arginine enhances left ventricular ejection fraction. Probiotic yogurt may effectively improve the inflammatory and antioxidative status of chronic heart failure. Whey protein and melatonin have a positive effect on improving endothelial function in HF patients.
Conclusion
Certain dietary interventions and nutritional supplements may provide some benefit to patients with HF. However, there is no relevant definitive evidence on the impact of nutritional interventions on the prognosis of HF, and more high-quality clinical trials are needed for further in-depth studies.
Systematic review registration
Identifier, CRD42024510847
Sarcopenia is characterized by a decline in muscle strength, generalized loss of skeletal muscle mass, and impaired physical performance, which are common outcomes used to screen, diagnose, and determine severity of sarcopenia in older adults. These outcomes are associated with poor quality of life, increased risk of falls, hospitalization, and mortality in this population. The development of sarcopenia is underpinned by aging, but other factors can lead to sarcopenia, such as chronic diseases, physical inactivity, inadequate dietary energy intake, and reduced protein intake (nutrition‐related sarcopenia), leading to an imbalance between muscle protein synthesis and muscle protein breakdown. Protein digestion and absorption are also modified with age, as well as the reduced capacity of metabolizing protein, hindering older adults from achieving ideal protein consumption (i.e., 1–1.5 g/kg/day). Nutritional supplement strategies, like animal (i.e., whey protein) and plant‐based protein, leucine, and creatine have been shown to play a significant role in improving outcomes related to sarcopenia. However, the impact of other supplements (e.g., branched‐chain amino acids, isolated amino acids, and omega‐3) on sarcopenia and related outcomes remain unclear. This narrative review will discuss the evidence of the impact of these nutritional strategies on sarcopenia outcomes in older adults.
Background:
Acute sarcopenia refers to the swift decline in muscle function and mass following acute events such as illness, surgery, trauma, or burns that presents significant challenges in hospitalized older adults.
Methods:
narrative review to describe the mechanisms and management of acute sarcopenia.
Results:
The prevalence of acute sarcopenia ranges from 28% to 69%, likely underdiagnosed due to the absence of muscle mass and function assessments in most clinical settings. Systemic inflammation, immune-endocrine dysregulation, and anabolic resistance are identified as key pathophysiological factors. Interventions include early mobilization, resistance exercise, neuromuscular electrical stimulation, and nutritional strategies such as protein supplementation, leucine, β-hydroxy-β-methyl-butyrate, omega-3 fatty acids, and creatine monohydrate. Pharmaceuticals show variable efficacy.
Conclusions:
Future research should prioritize serial monitoring of muscle parameters, identification of predictive biomarkers, and the involvement of multidisciplinary teams from hospital admission to address sarcopenia. Early and targeted interventions are crucial to improve outcomes and prevent long-term disability associated with acute sarcopenia.
The intensive care unit (ICU) environment is one of the most challenging for skeletal muscle health. The atrophy associated with clinical care is distinct from that seen with inactivity or immobilization in the absence of disease and is exacerbated by aging. The substantial muscle loss in the ICU is likely due to the presence of inflammation, elevated proteolysis, bedrest, and undernutrition. Skeletal muscle parameters (e.g., mass, composition/quality) at admission are predictive of mortality and other clinically important outcomes. Treatment goals to mitigate muscle loss should be early mobilization and adequate nutrient supply, especially protein, using an individualized approach to support the maintenance and recovery of skeletal muscle.
Sarcopenia is the accelerated loss of skeletal muscle mass and function commonly, but not exclusively, associated with advancing age. It is observed across many species including humans in whom it can lead to decline in physical function and mobility as well as to increased risk of adverse outcomes including falls, fractures and premature mortality. Although prevalence estimates vary because sarcopenia has been defined in different ways, even using a conservative approach, the prevalence is between 5% and 10% in the general population. A life course framework has been proposed for understanding not only the occurrence of sarcopenia in later life but also influences operating at earlier life stages with potentially important implications for preventive strategies. Harnessing progress in understanding the hallmarks of ageing has been key to understanding sarcopenia pathophysiology. Considerable convergence in approaches to diagnosis of sarcopenia has occurred over the last 10 years, with a growing emphasis on the central importance of muscle strength. Resistance exercise is currently the mainstay of treatment; however, it is not suitable for all. Hence, adjunctive and alternative treatments to improve quality of life are needed. An internationally agreed approach to definition and diagnosis will enable a step change in the field and is likely to be available in the near future through the Global Leadership Initiative in Sarcopenia.
Resistance exercise and protein supplementation are recognized as effective treatment strategies for age-related sarcopenia; however, there are limited data on their feasibility, tolerability, and safety. The primary outcome of this study was feasibility, evaluated through the 15-item TELOS (Technological, Economics, Legal, Operational, and Scheduling) feasibility components and by recruitment, retention, and consent rates. Tolerability was measured by examining permanent treatment discontinuation, treatment interruption, exercise dose modification, early termination, rescheduling of missed sessions, losses to follow-up, attendance, and nutritional compliance. Safety was evaluated using the parameters provided by the European Medicines Agency, adapted for exercise interventions. Thirty-two subjects were recruited (average age 81.6 [SD 9.3] years). The TELOS components were assessed before the intervention; out of 15 questions relevant for successful implementation, 4 operational needs answers required specific actions to prevent potential barriers. The recruitment rate was 74%. Eleven patients (34.4%) had permanent treatment interruption (retention rate = 65.6%). Patients attended a mean of 23 (SD 12.0) exercise sessions, with a mean of 56 (SD 32.6) nutritional compliances. A total of 21 patients (65.6%) experienced adverse events unrelated to the intervention, while 7 patients (21.9%) presented adverse reactions to strength exercise. The main barriers to feasibility were operational components and recruitment challenges. Although the intervention was generally safe, the high rate of probable adverse effects, unrelated to the intervention but associated with the individual’s baseline health condition, may affect adherence to treatment programs of this kind.
Background/objective:
This study aims to analyze the effect of whey protein (WP) supplementation on glycemic control, muscle strength, quality of life, and body composition in older adults with non-insulin-dependent diabetes undergoing a resistance training program.
Methods:
A double-blind, placebo-controlled, randomized study was carried out with older adults with Type 2 diabetes. Body composition, food intake, muscle strength, glycemic profile, markers of renal function, cardiopulmonary capacity, and quality of life were evaluated. Older adults were randomized into a supplementation group with 33 g of WP consumed twice a week on days of resistance training for 12 weeks supplemented group and a placebo group.
Results:
In total, 39 older adults were randomized into two groups, 19 in the supplement group and 20 in the placebo group. Both groups showed improvement in muscle strength, with the WP group failing to exceed that of the control group. WP supplementation slightly increased blood urea compared with the placebo group (p = .05), but values remained within normal limits. The group that used WP showed a small improvement in mental health, according to the 12-Item Short-Form Health Survey questionnaire, but without clinically important improvements.
Conclusion:
Both groups showed improvements in muscle strength and mass, regardless of supplementation, showing that resistance exercises performed twice a week can contribute to the nonprogression of sarcopenia in older adults with Type 2 diabetes. More studies are needed to determine the safe and effective amount of supplementation to improve muscle strength without renal impairment in older adults with diabetes.
A (m,n)-bipartite graph is a bipartite graph such that one bipartition has
mvertices and the other bipartition has n vertices. The tree
dumbbell D(n,a,b) consists of the path together with a independent vertices adjacent to one pendent
vertex of and b independent vertices adjacent to the other pendent vertex
of . In this paper, firstly, we show that, among (m,n)-bipartite graphs , the complete bipartite graph has minimal Kirchhoff index and the tree dumbbell has maximal Kirchhoff index. Then, we show that, among all bipartite
graphs of order l, the complete bipartite graph has minimal Kirchhoff index and the path has maximal Kirchhoff index, respectively. Finally, bonds for the
Kirchhoff index of (m,n)-bipartite graphs and bipartite graphs of order l are obtained by computing the Kirchhoff index of these extremal
graphs.
Protein energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes, especially in individuals receiving maintenance dialysis therapy. A multitude of factors can affect the nutritional and metabolic status of CKD patients requiring a combination of therapeutic maneuvers to prevent or reverse protein and energy depletion. These include optimizing dietary nutrient intake, appropriate treatment of metabolic disturbances such as metabolic acidosis, systemic inflammation, and hormonal deficiencies, and prescribing optimized dialytic regimens. In patients where oral dietary intake from regular meals cannot maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is shown to be effective in replenishing protein and energy stores. In clinical practice, the advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic strategies such as anabolic steroids, growth hormone, and exercise, in combination with nutritional supplementation or alone, have been shown to improve protein stores and represent potential additional approaches for the treatment of PEW. Appetite stimulants, anti-inflammatory interventions, and newer anabolic agents are emerging as novel therapies. While numerous epidemiological data suggest that an improvement in biomarkers of nutritional status is associated with improved survival, there are no large randomized clinical trials that have tested the effectiveness of nutritional interventions on mortality and morbidity.Kidney International advance online publication, 22 May 2013; doi:10.1038/ki.2013.147.
Background:
Loss of muscle mass due to prolonged bed rest decreases functional capacity and increases hospital morbidity and mortality in older adults.
Objective:
To determine if HMB, a leucine metabolite, is capable of attenuating muscle decline in healthy older adults during complete bed rest.
Design:
A randomized, controlled, double-blinded, parallel-group design study was carried out in 24 healthy (SPPB ≥ 9) older adult subjects (20 women, 4 men), confined to complete bed rest for ten days, followed by resistance training rehabilitation for eight weeks. Subjects in the experimental group were treated with HMB (calcium salt, 1.5 g twice daily - total 3 g/day). Control subjects were treated with an inactive placebo powder. Treatments were provided starting 5 days prior to bed rest till the end rehabilitation phase. DXA was used to measure body composition.
Results:
Nineteen eligible older adults (BMI: 21-33; age: 60-76 year) were evaluable at the end of the bed rest period (Control n = 8; Ca-HMB n = 11). Bed rest caused a significant decrease in total lean body mass (LBM) (2.05 ± 0.66 kg; p = 0.02, paired t-test) in the Control group. With the exclusion of one subject, treatment with HMB prevented the decline in LBM over bed rest -0.17 ± 0.19 kg; p = 0.23, paired t-test). There was a statistically significant difference between treatment groups for change in LBM over bed rest (p = 0.02, ANOVA). Sub-analysis on female subjects (Control = 7, HMB = 8) also revealed a significant difference in change in LBM over bed rest between treatment groups (p = 0.04, ANOVA). However, differences in function parameters could not be observed, probably due to the sample size of the study.
Conclusions:
In healthy older adults, HMB supplementation preserves muscle mass during 10 days of bed rest. These results need to be confirmed in a larger trial.
a b s t r a c t Objectives: Protein supplementation has been proposed as an effective dietary strategy to increase skeletal muscle mass and improve physical performance in frail elderly people. Our objective was to assess the impact of 24 weeks of dietary protein supplementation on muscle mass, strength, and physical performance in frail elderly people. Design/setting/participants: A total of 65 frail elderly subjects were included and randomly allocated to either daily protein or placebo supplementation (15 g protein at breakfast and lunch). Measurements: Skeletal muscle mass (DXA), muscle fiber size (muscle biopsy), strength (1-RM), and physical performance (SPPB) were assessed at baseline, and after 12 and 24 weeks of dietary intervention. Results: Skeletal muscle mass did not change in the protein-(from 45.8 AE 1.7 to 45.8 AE 1.7 kg) or placebo-supplemented group (from 46.7 AE 1.7 to 46.6 AE 1.7 kg) following 24 weeks of intervention (P > .05). In accordance, type I and II muscle fiber size did not change over time (P > .05). Muscle strength increased significantly in both groups (P < .01), with leg extension strength tending to increase to a greater extent in the protein (57 AE 5 to 68 AE 5 kg) compared with the placebo group (57 AE 5 to 63 AE 5 kg) (treatment  time interaction effect: P ¼ .059). Physical performance improved significantly from 8.9 AE 0.6 to 10.0 AE 0.6 points in the protein group and did not change in the placebo group (from 7.8 AE 0.6 to 7.9 AE 0.6 points) (treatment  time interaction effect: P ¼ .02). Conclusion: Dietary protein supplementation improves physical performance, but does not increase skeletal muscle mass in frail elderly people. Copyright Ó 2012 -American Medical Directors Association, Inc. Frailty is a geriatric syndrome of decreased reserves and resistance to stressors that results in an increased risk for adverse outcomes, such as onset of disability, morbidity, institutionalization, and mortality. 1 An important and fundamental component of frailty is sarcopenia. 2 Sarcopenia is an age-related process characterized by the progressive loss of skeletal muscle mass, strength, and physical performance. The cause of sarcopenia is multifactorial and includes a sedentary lifestyle and inadequate dietary protein intake. 3e5 It has been well-established that dietary protein ingestion stimulates skel-etal muscle protein synthesis, 6e10 and inhibits protein breakdown, resulting in a positive protein balance 9,10 and net muscle protein
The speed of absorption of dietary amino acids by the gut varies according to the type of ingested dietary protein. This could
affect postprandial protein synthesis, breakdown, and deposition. To test this hypothesis, two intrinsically 13C-leucine-labeled milk proteins, casein (CAS) and whey protein (WP), of different physicochemical properties were ingested
as one single meal by healthy adults. Postprandial whole body leucine kinetics were assessed by using a dual tracer methodology.
WP induced a dramatic but short increase of plasma amino acids. CAS induced a prolonged plateau of moderate hyperaminoacidemia,
probably because of a slow gastric emptying. Whole body protein breakdown was inhibited by 34% after CAS ingestion but not
after WP ingestion. Postprandial protein synthesis was stimulated by 68% with the WP meal and to a lesser extent (+31%) with
the CAS meal. Postprandial whole body leucine oxidation over 7 h was lower with CAS (272 ± 91 μmol⋅kg−1) than with WP (373 ± 56 μmol⋅kg−1). Leucine intake was identical in both meals (380 μmol⋅kg−1). Therefore, net leucine balance over the 7 h after the meal was more positive with CAS than with WP (P < 0.05, WP vs. CAS). In conclusion, the speed of protein digestion and amino acid absorption from the gut has a major effect
on whole body protein anabolism after one single meal. By analogy with carbohydrate metabolism, slow and fast proteins modulate
the postprandial metabolic response, a concept to be applied to wasting situations.
High-quality proteins such as soy, whey, and casein are all capable of promoting muscle protein synthesis postexercise by activating the mammalian target of rapamycin (mTORC1) signaling pathway. We hypothesized that a protein blend of soy and dairy proteins would capitalize on the unique properties of each individual protein and allow for optimal delivery of amino acids to prolong the fractional synthetic rate (FSR) following resistance exercise (RE). In this double-blind, randomized, clinical trial, 19 young adults were studied before and after ingestion of ∼19 g of protein blend (PB) or ∼18 g whey protein (WP) consumed 1 h after high-intensity leg RE. We examined mixed-muscle protein FSR by stable isotopic methods and mTORC1 signaling with western blotting. Muscle biopsies from the vastus lateralis were collected at rest (before RE) and at 3 postexercise time points during an early (0-2 h) and late (2-4 h) postingestion period. WP ingestion resulted in higher and earlier amplitude of blood BCAA concentrations. PB ingestion created a lower initial rise in blood BCAA but sustained elevated levels of blood amino acids later into recovery (P < 0.05). Postexercise FSR increased equivalently in both groups during the early period (WP, 0.078 ± 0.009%; PB, 0.088 ± 0.007%); however, FSR remained elevated only in the PB group during the late period (WP, 0.074 ± 0.010%; PB, 0.087 ± 0.003%) (P < 0.05). mTORC1 signaling similarly increased between groups, except for no increase in S6K1 phosphorylation in the WP group at 5 h postexercise (P < 0.05). We conclude that a soy-dairy PB ingested following exercise is capable of prolonging blood aminoacidemia, mTORC1 signaling, and protein synthesis in human skeletal muscle and is an effective postexercise nutritional supplement.
Background and aims:
sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. We evaluated the impact of sarcopenia on the risk of all-cause death in a population of frail older persons living in community.
Methods:
we analysed data from the Aging and Longevity Study, a prospective cohort study that collected data on all subjects aged 80 years and older residing in the Sirente geographic area (n = 364). The present analysis was conducted among those subjects who were between 80 and 85 years of age at the time of the baseline assessment (n = 197). The main outcome measure was all-cause mortality over 7-year follow-up. According to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, the diagnosis of sarcopenia required the documentation of low muscle mass and the documentation of either low muscle strength or low physical performance. Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95% confidence intervals of death by the presence of sarcopenia.
Results:
using the EWGSOP-suggested criteria, 43 subjects with sarcopenia (21.8%) were identified. During the 7-year follow-up, 29 (67.4%) participants died among subjects with sarcopenia compared with 63 subjects (41.2%) without sarcopenia (P < 0.001). After adjusting for potential confounders including age, gender, education, activities of daily living (ADL) impairment, body mass index, hypertension, congestive heart failure, chronic obstructive pulmonary disease, number of diseases, TNF-α, participants with sarcopenia had a higher risk of death for all causes compared with non-sarcopenic subjects (HR: 2.32, 95% CI: 1.01-5.43).
Conclusions:
our results obtained from a representative sample of very old and frail subjects show that sarcopenia is associated with mortality, independently of age and other clinical and functional variables.
Background:
Protein is a macronutrient essential for growth, muscle function, immunity and overall tissue homeostasis. Suboptimal protein intake can significantly impact physical function and overall health in older adults.
Methods:
This article reviews the literature on the recommendations for protein intake in older adults in light of the new evidence linking protein intake with sarcopenia and physical function. Challenges and opportunities for optimal protein nutrition in older persons are discussed.
Results:
Recent metabolic and epidemiological studies suggest that the current recommendations of protein intake may not be adequate for maintenance of physical function and optimal health in older adults. Methodological limitations and novel concepts in protein nutrition are also discussed.
Conclusion:
We conclude that new research and novel research methodologies are necessary to establish the protein needs and optimal patterns of protein intake for older persons.
Background. Whey protein supplementation may augment resistance exercise-induced increases in muscle strength and mass. Further studies
are required to determine whether this effect extends to mobility-limited older adults. The objectives of the study were to
compare the effects of whey protein concentrate (WPC) supplementation to an isocaloric control on changes in whole-body lean
mass, mid-thigh muscle cross-sectional area, muscle strength, and stair-climbing performance in older mobility-limited adults
in response to 6 months of resistance training (RT).
The factorial approach is used to measure the dietary indispensable amino acid (IAA) requirements in children, although recent measurements based on the indicator amino acid oxidation (IAAO) method have begun to generate more direct evidence. Difficulties with the factorial method are that it depends on accurate estimates of the maintenance protein requirement, as well as of protein deposition during growth. Also, a value for the efficiency of utilizing dietary protein for deposition has to be selected, based on published Nitrogen (N) balance studies. In the recent 2007 WHO/FAO/UNU report, the amino acid requirement pattern for infants was taken to be similar to the amino acid composition of breast milk. For pre-school and older children, the factorial method gave values for the scoring pattern of protein that were fairly close to the earlier 1985 WHO/FAO/UNU report for children, since growth progressively became a smaller component of the factorial calculation as age progressed. However, given that there are several assumptions in the derivation of factorial estimates, direct experimental measurements of the amino acid requirement are desirable. The IAAO method, as it is non-invasive, as made it possible to measure the IAA requirements in children. Over the last decade, some of the IAA requirements have been determined by using the IAAO method in healthy school age children; however, the data on IAA requirements in developing country populations are still being conducted. In the elderly, there are not enough data to make a separate recommendation for IAA requirements from that of adults.
Muscle atrophy is associated with healthy aging (i.e., sarcopenia) and may be compounded by comorbidities, injury, surgery, illness, and physical inactivity. While a bout of resistance exercise increases protein synthesis rates in healthy young skeletal muscle, the effectiveness of resistance exercise to mount a protein synthetic response is less pronounced in older adults. Improving anabolic sensitivity to resistance exercise, thereby enhancing physical function, is most critical in needy older adults with clinical conditions that render them "low responders". In this paper, we discuss potential mechanisms contributing to anabolic impairment to resistance exercise and highlight the need to improve anabolic responsiveness in low responders. This is followed with evidence suggesting that the recovery period of resistance exercise provides an opportunity to amplify the exercise-induced anabolic response using protein/essential amino acid ingestion. This anabolic strategy, if repeated chronically, may improve lean muscle gains, decrease time to recovery of function during periods of rehabilitation, and overall, maintain/improve physical independence and reduce mortality rates in older adults.
Introduction
Intensive care-acquired weakness is a common problem, leads to significant impairment in physical functioning and muscle strength, and is prevalent in individuals with sepsis. Early rehabilitation has been shown to be safe and feasible; however, commencement is often delayed due to a patient's inability to co-operate. An intervention that begins early in an intensive care unit (ICU) admission without the need for patient volition may be beneficial in attenuating muscle wasting. The eRiCC (early rehabilitation in critical care) trial will investigate the effectiveness of functional electrical stimulation-assisted cycling and cycling alone, compared to standard care, in individuals with sepsis.
Methods and analysis
This is a single centre randomised controlled trial. Participants (n=80) aged ≥18 years, with a diagnosis of sepsis or severe sepsis, who are expected to be mechanically ventilated for ≥48 h and remain in the intensive care ≥4 days will be randomised within 72 h of admission to (1) standard care or (2) intervention where participants will receive functional electrical muscle stimulation-assisted supine cycling on one leg while the other leg undergoes cycling alone. Primary outcome measures include: muscle mass (quadriceps ultrasonography; bioelectrical impedance spectroscopy); muscle strength (Medical Research Council Scale; hand-held dynamometry) and physical function (Physical Function in Intensive Care Test; Functional Status Score in intensive care; 6 min walk test). Blinded outcome assessors will assess measures at baseline, weekly, at ICU discharge and acute hospital discharge. Secondary measures will be evaluated in a nested subgroup (n=20) and will consist of biochemical/histological analyses of collected muscle, urine and blood samples at baseline and at ICU discharge.
Ethics and dissemination
Ethics approval has been obtained from the relevant institution, and results will be published to inform clinical practice in the care of patients with sepsis to optimise rehabilitation and physical function outcomes.
Trial registration
Australian and New Zealand Clinical Trials Registry ACTRN12612000528853.
The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document.
The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity?
For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research.
Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
Here, we compared the traditional nutritional definition of the dispensable and indispensable amino acids for humans with categorizations based on amino acid metabolism and function. The three views lead to somewhat different interpretations. From a nutritional perspective, it is quite clear that some amino acids are absolute dietary necessities if normal growth is to be maintained. Even so, growth responses to deficiencies of dispensable amino acids can be found in the literature. From a strictly metabolic perspective, there are only three indispensable amino acids (lysine, threonine and tryptophan) and two dispensable amino acids (glutamate and serine). In addition, a consideration of in vivo amino acid metabolism leads to the definition of a third class of amino acids, termed conditionally essential, whose synthesis can be carried out by mammals but can be limited by a variety of factors. These factors include the dietary supply of the appropriate precursors and the maturity and health of the individual. From a functional perspective, all amino acids are essential, and an argument in favor of the idea of the critical importance of nonessential and conditionally essential amino acids to physiological function is developed.
Aging is associated with remarkable changes in body composition. Loss of skeletal muscle, a process called sarcopenia, is a prominent feature of these changes. In addition, gains in total body fat and visceral fat content continue into late life. The cause of sarcopenia is likely a result of a number of changes that also occur with aging. These include reduced levels of physical activity, changing endocrine function (reduced testosterone, growth hormone, and estrogen levels), insulin resistance, and increased dietary protein needs. Healthy free-living elderly men and women have been shown to accommodate to the Recommended Dietary Allowance (RDA) for protein of 0.8 g . kg(-1) . d(-1) with a continued decrease in urinary nitrogen excretion and reduced muscle mass. While many elderly people consume adequate amounts of protein, many older people have a reduced appetite and consume less than the protein RDA, likely resulting in an accelerated rate of sarcopenia. One important strategy that counters sarcopenia is strength conditioning. Strength conditioning will result in an increase in muscle size and this increase in size is largely the result of increased contractile proteins. The mechanisms by which the mechanical events stimulate an increase in RNA synthesis and subsequent protein synthesis are not well understood. Lifting weight requires that a muscle shorten as it produces force (concentric contraction). Lowering the weight, on the other hand, forces the muscle to lengthen as it produces force (eccentric contraction). These lengthening muscle contractions have been shown to produce ultrastructural damage (microscopic tears in contractile proteins muscle cells) that may stimulate increased muscle protein turnover. This muscle damage produces a cascade of metabolic events which is similar to an acute phase response and includes complement activation, mobilization of neutrophils, increased circulating an skeletal muscle interleukin-1, macrophage accumulation in muscle, and an increase in muscle protein synthesis and degradation. While endurance exercise increases the oxidation of essential amino acids and increases the requirement for dietary protein, resistance exercise results in a decrease in nitrogen excretion, lowering dietary protein needs. This increased efficiency of protein use may be important for wasting diseases such as HIV infection and cancer and particularly in elderly people suffering from sarcopenia. Research has indicated that increased dietary protein intake (up to 1.6 g protein . kg(-1) . d(-1)) may enhance the hypertrophic response to resistance exercise. It has also been demonstrated that in very old men and women the use of a protein-calorie supplement was associated with greater strength and muscle mass gains than did the use of placebo.
The present study was designed to assess the effects of dietary leucine supplementation on muscle protein synthesis and whole body protein kinetics in elderly individuals. Twenty healthy male subjects (70 +/- 1 years) were studied before and after continuous ingestion of a complete balanced diet supplemented or not with leucine. A primed (3.6 mu mol kg(-1)) constant infusion (0.06 mu mol kg(-1) min(-1)) of L-[1-C-13]phenylalanine was used to determine whole body phenylalanine kinetics as well as fractional synthesis rate (FSR) in the myofibrillar fraction of muscle proteins from vastus lateralis biopsies. Whole body protein kinetics were not affected by leucine supplementation. In contrast, muscle FSR, measured over the 5-h period of feeding, was significantly greater in the volunteers given the leucine-supplemented meals compared with the control group (0.083 +/- 0.008 versus 0.053 +/- 0.009% h(-1), respectively, P < 0.05). This effect was due only to increased leucine availability because only plasma free leucine concentration significantly differed between the control and leucine-supplemented groups. We conclude that leucine supplementation during feeding improves muscle protein synthesis in the elderly independently of an overall increase of other amino acids. Whether increasing leucine intake in old people may limit muscle protein loss during ageing remains to be determined.
This is an exciting time with great potential for discovering therapies to improve functional capacity and decrease the high prevalence of frailty and disability in older people. The FDA will need to consider how best to incorporate the geriatric perspective into its mission. Cooperation between aging researchers, pharmaceutical companies, and regulators will be required to establish guidelines for outcome measures for the coming generation of clinical trials in frail older persons. Ultimately, all stakeholders have the same goals: reducing the burden of chronic disease and disability in older persons while avoiding harm.
The "get-up and go test" requires patients to stand up from a chair, walk a short distance, turn around, return, and sit down again. This test was conducted in 40 elderly patients with a range of balance function. Tests were recorded on video tapes, which were viewed by groups of observers from different medical backgrounds. Balance function was scored on a five-point scale. The same patients underwent laboratory tests of gait and balance. There was agreement among observers on the subjective scoring of the clinical test, and good correlation with laboratory tests. The get-up and go test proved to be a satisfactory clinical measure of balance in elderly people.
Muscle mass declines with aging. Amino acids alone stimulate muscle protein synthesis in the elderly. However, mixed nutritional supplementation failed to improve muscle mass. We hypothesized that the failure of nutritional supplements is due to altered responsiveness of muscle protein anabolism to increased amino acid availability associated with endogenous hyperinsulinemia. We measured muscle protein synthesis and breakdown, and amino acid transport in healthy young (30 +/- 3 yr) and elderly (72 +/- 1 yr) volunteers in the basal postabsorptive state and during the administration of an amino acid-glucose mixture, using L-[ring-(2)H(5)]phenylalanine infusion, femoral artery and vein catheterization, and muscle biopsies. Basal muscle amino acid turnover was similar in young and elderly subjects. The mixture increased phenylalanine leg delivery and transport into the muscle in both groups. Phenylalanine net balance increased in both groups (young, -27 +/- 8 to 64 +/- 17; elderly, -16 +/- 4 to 29 +/- 7 nmol/(min.100 mL); P: < 0.0001, basal vs. mixture), but the increase was significantly blunted in the elderly (P: = 0.030 vs. young). Muscle protein synthesis increased in the young, but remained unchanged in the elderly [young, 61 +/- 17 to 133 +/- 30 (P: = 0. 005); elderly, 62 +/- 9 to 70 +/- 14 nmol/(min.100 mL) (P: = NS)]. In both groups, protein breakdown decreased (P: = 0.012) and leg glucose uptake increased (P: = 0.0258) with the mixture. We conclude that the response of muscle protein anabolism to hyperaminoacidemia with endogenous hyperinsulinemia is impaired in healthy elderly due to the unresponsiveness of protein synthesis.
IntroductionAdequacy of Current Dietary Protein Recommendations for Older AdultsThe Effect of Age on Protein Anabolism in Response to MealsProtein Quantity and QualityExercise and NutritionDietary Supplementation as an Adjunct Treatment for SarcopeniaPriority Areas for Targeted Nutrition InterventionsConclusion
AcknowledgementsReferences
IntroductionEvidences for a Role for Nutrition in SarcopeniaAnabolic Response to Physical Exercise in the ElderlyCombination of Nutritional and Training StrategiesConcluding Remarks and Future DirectionReferences
The role of dietary protein in osteoporosis is unclear, with previous studies having suggested both protection and harm. The associations of total, animal, and vegetable protein with bone mineral density (BMD) and the variations in these associations with calcium intake were studied in a community-dwelling cohort of 572 women and 388 men aged 55-92 years (Rancho Bernardo, California). Multiple linear regression analyses adjusted for standard osteoporosis covariates showed a positive association between animal protein consumption, assessed by food frequency questionnaires in 1988-1992, and BMD, measured 4 years later. This association was statistically significant in women. For every 15-g/day increase in animal protein intake, BMD increased by 0.016 g/cm 2 at the hip (p = 0.005), 0.012 g/cm 2 at the femoral neck (p = 0.02), 0.015 g/cm 2 at the spine (p = 0.08), and 0.010 g/cm 2 for the total body (p = 0.04). Conversely, a negative association between vegetable protein and BMD was observed in both sexes. Some suggestion of effect modification by calcium was seen in women, with increasing protein consumption appearing to be more beneficial for women with lower calcium intakes, but evidence for this interaction was not consistently strong. This study supports a protective role for dietary animal protein in the skeletal health of elderly women.
Purpose:
To study the effect of creatine (Cr) supplementation combined with resistance training on muscular performance and body composition in older men.
Methods:
Thirty men were randomized to receive creatine supplementation (CRE, N = 16, age = 70.4 +/- 1.6 yr) or placebo (PLA, N = 14, age = 71.1 +/- 1.8 yr), using a double blind procedure. Cr supplementation consisted of 0.3-g Cr.kg(-1) body weight for the first 5 d (loading phase) and 0.07-g Cr.kg(-1) body weight thereafter. Both groups participated in resistance training (36 sessions, 3 times per week, 3 sets of 10 repetitions, 12 exercises). Muscular strength was assessed by 1-repetition maximum (1-RM) for leg press (LP), knee extension (KE), and bench press (BP). Muscular endurance was assessed by the maximum number of repetitions over 3 sets (separated by 1-min rest intervals) at an intensity corresponding to 70% baseline 1-RM for BP and 80% baseline 1-RM for the KE and LP. Average power (AP) was assessed using a Biodex isokinetic knee extension/flexion exercise (3 sets of 10 repetitions at 60 degrees.s(-1) separated by 1-min rest). Lean tissue (LTM) and fat mass were assessed using dual energy x-ray absorptiometry.
Results:
Compared with PLA, the CRE group had significantly greater increases in LTM (CRE, +3.3 kg; PLA, +1.3 kg), LP 1-RM (CRE, +50.1 kg; PLA +31.3 kg), KE 1-RM (CRE, +14.9 kg; PLA, +10.7 kg), LP endurance (CRE, +47 reps; PLA, +32 reps), KE endurance (CRE, +21 reps; PLA +14 reps), and AP (CRE, +26.7 W; PLA, +18 W). Changes in fat mass, fat percentage, BP 1-RM, and BP endurance were similar between groups.
Conclusion:
Creatine supplementation, when combined with resistance training, increases lean tissue mass and improves leg strength, endurance, and average power in men of mean age 70 yr.