Postprandial whole-body protein metabolism after a meat meal is influenced by chewing efficiency in elderly subjects

Influence of food structure on dairy protein, lipid and calcium bioavailability: A narrative review of evidence

Beyond nutrient composition matrix plays an important role on food health potential, notably acting on the kinetics of nutrient release, and finally on their bioavailability. This is particularly true for dairy products that present both solid (cheeses), semi-solid (yogurts) and liquid (milks) matrices. The main objective of this narrative review has been to synthesize available data in relation with the impact of physical structure of main dairy matrices on nutrient bio-accessibility, bioavailability and metabolic effects, in vitro, in animals and in humans. Focus has been made on dairy nutrients the most studied, i.e., proteins, lipids and calcium. Data collected show different kinetics of bioavailability of amino acids, fatty acids and calcium according to the physicochemical parameters of these matrices, including compactness, hardness, elasticity, protein/lipid ratio, P/Ca ratio, effect of ferments, size of fat globules, and possibly other qualitative parameters yet to be discovered. This could be of great interest for the development of innovative dairy products for older populations, sometimes in protein denutrition or with poor dentition, involving the development of dairy matrices with optimized metabolic effects by playing on gastric retention time and thus on the kinetics of release of the amino acids within bloodstream.

Simulation of the gastric digestion of proteins of meat bolus using a reaction–diffusion model

A mathematical model predicts the gastric digestion of meat proteins and quantifies the impacts of physiological factors on digestibility.

In the elderly, meat protein assimilation from rare meat is lower than that from meat that is well done

Background: Meat cooking conditions in in vitro and in vivo models have been shown to influence the rate of protein digestion, which is known to affect postprandial protein metabolism in the elderly.Objective: The present study was conducted to demonstrate the effect of cooking conditions on meat protein assimilation in the elderly. We used a single-meal protocol to assess the meat protein absorption rate and estimate postprandial meat protein utilization in elderly subjects.Design: The study recruited 10 elderly volunteers aged 70-82 y. Each received, on 2 separate occasions, a test meal exclusively composed of intrinsically ¹⁵N-labeled bovine meat (30 g protein), cooked at 55°C for 5 min [rare meat (RM)] or at 90°C for 30 min [fully cooked meat (FCM)], and minced. Whole-body fluxes of leucine, before and after the meal, were determined with the use of a [1-¹³C]leucine intravenous infusion. Meat protein absorption was recorded with the use of ¹⁵N enrichment of amino acids.Results: Postprandial time course observations showed a lower concentration in the plasma of indispensable amino acids (P < 0.01), a lower entry rate of meat leucine in the plasma (P < 0.01), and a lower contribution of meat nitrogen to plasma amino acid nitrogen (P < 0.001), evidencing lower peripheral bioavailability of meat amino acids with RM than with FCM. This was associated with decreased postprandial whole-body protein synthesis with RM than with FCM (40% compared with 56% of leucine intake, respectively; P < 0.01).Conclusions: Whereas meat cooking conditions have little effect on postprandial protein utilization in young adults, the present work showed that the bioavailability and assimilation of meat amino acids in the elderly is lower when meat is poorly cooked. In view to preventing sarcopenia, elderly subjects should be advised to favor the consumption of well-cooked meat. This trial was registered at clinicaltrials.gov as NCT02157805.

The Satiating Properties of Pork are not Affected by Cooking Methods, Sousvide Holding Time or Mincing in Healthy Men—A Randomized Cross-Over Meal Test Study

Low temperature long time (LTLT) sous-vide cooking may modify meat proteins in a way that could promote satiety. We investigated the effects of (1) cooking method (LTLT 58 °C vs. oven 160 °C), (2) LTLT holding time (17 h vs. 72 min), and (3) pork structure, LTLT 58 °C for 17 h (minced vs. roast) on appetite regulation and in vitro protein digestibility. In a cross-over study, 37 healthy men consumed four meals containing pork: LTLT-cooked roast, 58 °C, 72 min; LTLT-cooked roast, 58 °C, 17 h; and, oven-cooked roast, 160 °C to a core temperature of 58 °C and LTLT-cooked minced patties, 58 °C, 17 h. Ad libitum energy intake (EI) after three hours was the primary endpoint. Moreover, subjective appetite sensations were assessed. Protein digestibility was determined in an in vitro simulated digestion model. Ad libitum EI did not differ between the meals. Furthermore, appetite ratings were not clearly affected. LTLT cooking for 72 min increased the proteolytic rate in the early gastric phase during digestion as compared to LTLT cooking for 17 h or oven cooking. In conclusion, LTLT cooking, LTLT holding time, and pork structure did not affect ad libitum EI. However, LTLT cooking at 58 °C for 72 min seemed to enhance in vitro protein digestibility.

Food ingestion in an upright sitting position increases postprandial amino acid availability when compared with food ingestion in a lying down position

Dietary protein digestion and absorption kinetics determine the postprandial increase in muscle protein synthesis. We recently demonstrated that body position during feeding can modulate the postprandial rise in plasma amino acid availability. Here we investigated whether protein ingestion in an upright sitting body position accelerates gastric emptying and improves dietary protein digestion and subsequent amino acid absorption compared with feeding in a supine lying body position. In a crossover design, 8 young males (age, 26 ± 1 years; body mass index, 24.0 ± 0.9 kg·m−2) ingested 20 g intrinsically l-[1-13C]-phenylalanine–labeled milk protein plus 1.5 g paracetamol while sitting in an upright position or lying down in a supine position. Blood samples were collected frequently during a 5-h postprandial period. Gastric emptying rates and dietary protein digestion and absorption were assessed using plasma paracetamol and amino acid concentrations as well as plasma l-[1-13C]-phenylalanine enrichments. Peak plasma leucine concentrations were higher when protein was ingested in an upright sitting versus lying position (213 ± 15 vs 193 ± 12 μmol·L−1, P < 0.05), which was accompanied by a trend for a greater overall leucine response (13 989 ± 720 vs 11 875 ± 1073 AU, respectively; P = 0.05). Peak plasma paracetamol concentrations were higher in the sitting versus lying treatment (11.6 ± 0.5 vs 9.3 ± 0.6 mg·L−1, P < 0.05). Protein ingestion in an upright sitting position accelerates gastric emptying and increases the postprandial rise in plasma amino acid availability by increasing protein digestion and amino acid absorption rates. Therefore, feeding in an upright body position as opposed to a lying position is an important prerequisite to allow proper postprandial muscle protein accretion.

Chewing bread: impact on alpha-amylase secretion and oral digestion

During chewing, saliva helps in preparing the food bolus by agglomerating the formed particles, and it initiates enzymatic food breakdown. However, limited information is actually available on the adaptation of saliva composition during the oral processing of complex foods, especially for foods that are sensitive to salivary enzymes. We addressed this question in the context of starch-based products and salivary alpha-amylase. The objectives were two-fold: (1) to determine if salivary alpha-amylase secretion can be modulated by the bread type and (2) to evaluate the contribution of the oral phase in bread enzymatic breakdown. Mouthfuls of three different wheat breads (industrial, artisan and whole-meal breads) were chewed by twelve subjects. Saliva samples were collected at rest and at different times corresponding to 33, 66 and 100% of the individual's chewing sequence. Alpha-amylase activity and total protein content were determined for all saliva samples that were collected. Additionally, the salivary maltose concentration was measured as a marker of bread enzymatic digestion. Boluses were collected at the swallowing time to evaluate the saliva uptake. Chewing industrial bread induced higher saliva uptake than the other breads despite a similar chewing duration. The evolution of salivary amylase activity tended to depend on the type of bread and was highly influenced by a large degree of inter- and intra-subject variability. The protein and maltose concentration steadily increased during chewing as a result of bread breakdown. The salivary protein concentration was mainly affected by the release of the water-soluble proteins of the bread. The salivary maltose concentration was found to be significantly lower for the whole-meal bread. When considering the weight of the mouthful, enzymatic breakdown was found to be most efficient for the breads ranking from industrial > artisan > whole-meal.

Whole dairy matrix or single nutrients in assessment of health effects: current evidence and knowledge gaps

Foods consist of a large number of different nutrients that are contained in a complex structure. The nature of the food structure and the nutrients therein (i.e., the food matrix) will determine the nutrient digestion and absorption, thereby altering the overall nutritional properties of the food. Thus, the food matrix may exhibit a different relation with health indicators compared to single nutrients studied in isolation. The evidence for a dairy matrix effect was presented and discussed by an expert panel at a closed workshop, and the following consensus was reached: 1) Current evidence does not support a positive association between intake of dairy products and risk of cardiovascular disease (i.e., stroke and coronary heart disease) and type 2 diabetes. In contrast, fermented dairy products, such as cheese and yogurt, generally show inverse associations. 2) Intervention studies have indicated that the metabolic effects of whole dairy may be different than those of single dairy constituents when considering the effects on body weight, cardiometabolic disease risk, and bone health. 3) Different dairy products seem to be distinctly linked to health effects and disease risk markers. 4) Different dairy structures and common processing methods may enhance interactions between nutrients in the dairy matrix, which may modify the metabolic effects of dairy consumption. 5) In conclusion, the nutritional values of dairy products should not be considered equivalent to their nutrient contents but, rather, be considered on the basis of the biofunctionality of the nutrients within dairy food structures. 6) Further research on the health effects of whole dairy foods is warranted alongside the more traditional approach of studying the health effects of single nutrients. Future diet assessments and recommendations should carefully consider the evidence of the effects of whole foods alongside the evidence of the effects of individual nutrients. Current knowledge gaps and recommendations for priorities in future research on dairy were identified and presented.

Impact of implant-supported prostheses on nutritional status and oral health perception in edentulous patients

BACKGROUND & AIMS

Improvement of nutritional status and perception of oral health are supposed to be different with complete conventional denture or implant-supported fixed or removable prostheses. Since no study has been conducted in Lebanon, the aim of our study was to assess the nutritional status and oral heath related quality of life (OHRQoL) in totally edentulous patients after treatment with complete denture or implant supported-prostheses.

MATERIAL AND METHODS

This was an observational clinical prospective study. A convenient sample of Lebanese people aged 60 years or more was selected between September 2013 and July 2015 from the Departments of removable and fixed prosthesis at Saint-Joseph University of Beirut. The treatment options included complete denture, implant-supported complete denture and implant-supported fixed prostheses. Nutritional status and OHRQoL were assessed with the Mini-Nutritional Assessment Index (MNA) and the Geriatric Oral Health Assessment Index (GOHAI) respectively at Baseline (first visit before treatment), 2-3 weeks after treatment (t1), 3 months (t2) and 6 months (t3) after treatment.

RESULTS

Fifty-one participants (mean age: 69.39 ± 7.164 years) were included. The results have shown an improvement over time in nutritional status and OHRQoL for all treatment groups. However, 2-3 weeks after treatment the number of participants at risk of malnutrition was higher with complete removable denture, intermediate with implant-supported complete denture and lower with implant-supported fixed prostheses (p-value = 0.049). Moreover, the mean GOHAI score was significantly lower over time with complete removable denture compared to implant-supported prostheses (p-value <0.05).

CONCLUSION

Our study has shown an enhancement in the quality of life and the nutritional status for implant supported-prostheses compared to conventional removable dentures. Therefore, it is fundamental that dentists communicate with their patients about implant treatment to understand their expectations, to explain the outcomes and achieve the desired clinical result.

Food Consumption and Nutrient Intake in Relation to Denture Use in 55- to 84-Year-Old Men and Women -Results of a Population Based Survey

OBJECTIVE

To study differences in consumption of foods and intake of nutrients attributable to denture status.

DESIGN, SETTING AND PARTICIPANTS

Data from a cross-sectional, nationally representative Health 2000 Survey, subjects aged 55-84 years (n=2,241).

MEASUREMENTS

Denture status (edentulous with full dentures, own dentition with removable dentures, own dentition with no removable dentures) was used as an explanatory variable. The consumption of foods and intake of nutrients was used as an outcome variable and was measured using a validated Food Frequency Questionnaire.

RESULTS

Denture status associated with food choices. Full denture wearers consumed less vegetables (p = 0.013 among men and p = 0.001 among women) and fruits (p = 0.001 among women), more sugary products (p = 0.012 among men and p = 0.008 among women), and their balance in fatty acids was less favourable than among dentate participants. Among dentate participants, the differences between the two groups were small and statistically significant differences were seen mostly in women.

CONCLUSIONS

Wearing full dentures appears to be associated with unhealthier food choices, lower consumption of some foodstuffs and lower intake of certain nutrients when compared to the food choices of dentate persons.

Bioavailability of milk protein-derived bioactive peptides: a glycaemic management perspective

Milk protein-derived peptides have been reported to have potential benefits for reducing the risk of type 2 diabetes. However, what the active components are and whether intact peptides exert this bioactivity has received little investigation in human subjects. Furthermore, potentially useful bioactive peptides can be limited by low bioavailability. Various peptides have been identified in the gastrointestinal tract and bloodstream after milk-protein ingestion, providing valuable insights into their potential bioavailability. However, these studies are currently limited and the structure and sequence of milk peptides exerting bioactivity for glycaemic management has received little investigation in human subjects. The present article reviews the bioavailability of milk protein-derived peptides in human studies to date, and examines the evidence on milk proteins and glycaemic management, including potential mechanisms of action. Areas in need of advancement are identified. Only by establishing the bioavailability of milk protein-derived peptides, the active components and the mechanistic pathways involved can the benefits of milk proteins for the prevention or management of type 2 diabetes be fully realised in future.

Chronic Powder Diet After Weaning Induces Sleep, Behavioral, Neuroanatomical, and Neurophysiological Changes in Mice

The purpose of this study is to clarify the effects of chronic powder diet feeding on sleep patterns and other physiological/anatomical changes in mice. C57BL/6 male mice were divided into two groups from weaning: a group fed with solid food (SD) and a group fed with powder food (PD), and sleep and physiological and anatomical changes were compared between the groups. PD exhibited less cranial bone structure development and a significant weight gain. Furthermore, these PD mice showed reduced number of neurogenesis in the hippocampus. Sleep analysis showed that PD induced attenuated diurnal sleep/wake rhythm, characterized by increased sleep during active period and decreased sleep during rest period. With food deprivation (FD), PD showed less enhancement of wake/locomotor activity compared to SD, indicating reduced food-seeking behavior during FD. These results suggest that powder feeding in mice results in a cluster of detrimental symptoms caused by abnormal energy metabolism and anatomical/neurological changes.

Developing pathways for oral care in elders: challenges in care for the dentate the subject?

OBJECTIVE

This paper reviews potential age-associated risk factors for satisfactory oral function and oral disease to inform the development of care pathways for the older person.

BACKGROUND

Alterations in dental status or both physical and biological change associated with age can impact on oral disease and oral function.

MATERIALS AND METHODS

Older people tend to have fewer teeth and some are edentulous. Physical and biological changes in bodily function with age can also affect oral health care either directly or indirectly.

RESULTS

Reductions in chewing ability impact on the foods people choose to eat because of perceived difficulty with chewing, with a potentially deleterious affect on dietary quality. This is worse in people with xerostomia where chewing and swallowing are impaired anyway. Change in the cell-mediated inflammatory response impacts on gingival and periodontal disease manifestation and progression. Sarcopenia makes the physical act of toothbrushing more challenging. Caries remains a clinical problem that affects both the crowns and the roots of teeth. Coronal lesions tend to be around existing restorations where there is no evidence base about care/prevention.

CONCLUSION

The physical and clinical changes that occur with ageing require an altered pattern of care for older people which is adjusted to their disease risk and encourage diversity of foods consumption.

High True Ileal Digestibility but Not Postprandial Utilization of Nitrogen from Bovine Meat Protein in Humans Is Moderately Decreased by High-Temperature, Long-Duration Cooking

BACKGROUND

Meat protein digestibility can be impaired because of indigestible protein aggregates that form during cooking. When the aggregates are subsequently fermented by the microbiota, they can generate potentially harmful compounds for the colonic mucosa.

OBJECTIVE

This study evaluated the quantity of bovine meat protein escaping digestion in the human small intestine and the metabolic fate of exogenous nitrogen, depending on cooking processes.

METHODS

Sixteen volunteers (5 women and 11 men; aged 28 ± 8 y) were equipped with a double lumen intestinal tube positioned at the ileal level. They received a test meal exclusively composed of 120 g of intrinsically (15)N-labeled bovine meat, cooked either at 55°C for 5 min (n = 8) or at 90°C for 30 min (n = 8). Ileal effluents and blood and urine samples were collected over an 8-h period after the meal ingestion, and (15)N enrichments were measured to assess the digestibility of meat proteins and the transfer of dietary nitrogen into the metabolic pools.

RESULTS

Proteins tended to be less digestible for the meat cooked at 90°C for 30 min than at 55°C for 5 min (90.1% ± 2.1% vs. 94.1% ± 0.7% of ingested N; P = 0.08). However, the particle number and size in ileal digesta did not differ between groups. The appearance of variable amounts of intact fibers was observed by microscopy. The kinetics of (15)N appearance in plasma proteins, amino acids, and urea were similar between groups. The amount of exogenous nitrogen lost through deamination did not differ between groups (21.2% ± 0.8% of ingested N).

CONCLUSIONS

Cooking bovine meat at a high temperature for a long time can moderately decrease protein digestibility compared with cooking at a lower temperature for a short time and does not affect postprandial exogenous protein metabolism in young adults. The study was registered at www.clinicaltrials.gov as NCT01685307.

Digestion and Postprandial Metabolism in the Elderly

The elderly are an increasing segment of the population. Despite the rapid gains in medical knowledge and treatments, older adults are more likely to experience chronic illnesses that decrease quality of life and accelerate mortality. Nutrition is a key modifiable lifestyle factor which greatly impacts chronic disease risk. Yet despite the importance of nutrition, relatively little is known of the impact of advancing age on the gastrointestinal function, the digestive responses, and the post-meal metabolic adaptations that occur in response to ingested food. Knowledge of the age-related differences in digestion and metabolism in the elderly is essential to the development of appropriate nutritional recommendations for the maintenance of optimal health and prevention of disease.

Older Adults Have Delayed Amino Acid Absorption after a High Protein Mixed Breakfast Meal

OBJECTIVES

To measure the postprandial plasma amino acid appearance in younger and older adults following a high protein mixed meal.

DESIGN

Cross-sectional study.

SETTING

Clinical research setting.

PARTICIPANTS

Healthy men and women aged 60-75 (n=15) years, and young controls aged 20-25 years (n=15) matched for body mass index and insulin sensitivity based on the homeostatic model assessment of insulin resistance.

INTERVENTION

High protein mixed meal of complete food products.

MEASUREMENTS

Circulating amino acid concentrations were determined hourly before and for 5 hours after meal ingestion.

RESULTS

There was no difference between cohorts in postprandial appearance of non-essential amino acids, or area under the curve of any individual amino acid or amino acid class. However, older adults had higher baseline concentrations of aspartic acid, glutamic acid, glycine, ornithine, threonine and tyrosine and lower baseline concentrations of hydroxyproline, isoleucine, leucine, methionine and valine compared to younger adults. Younger adults showed peak essential (EAA) and branched-chain amino acid (BCAA) concentrations at 1 hour post meal while older adults' peak EAA and BCAA concentration was at 3 hours. Similarly, peak total amino acid concentrations were at 3 hours in older adults.

CONCLUSION

Older adults digested and absorbed the protein within a mixed meal more slowly than younger adults. Delayed absorption of AA following a mixed meal of complete food products may suppress or delay protein synthesis in senescent muscle.

Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition

Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.

Slight chronic elevation of C-reactive protein is associated with lower aerobic fitness but does not impair meal-induced stimulation of muscle protein metabolism in healthy old men

Ageing impairs the muscle anabolic effect of food intake, which may explain muscle loss and an increased risk of sarcopenia. Ageing is also associated with low grade inflammation (LGI), which has been negatively correlated with muscle mass and strength. In rodents, the muscle anabolic resistance observed during ageing and sarcopenia has been ascribed to the development of the LGI. We aimed to investigate this relationship in humans. We studied protein metabolism and physical fitness in healthy elderly volunteers with slight chronic C-reactive protein. Two groups of healthy elderly volunteers were selected on the presence (or not) of a chronic, slight, elevation of CRP (Control: <1; CRP+: >2 mg l(-1) and <10 mg l(-1) , for 2 months). Body composition, short performance battery test, aerobic fitness and muscle strength were assessed. Whole body and muscle protein metabolism and the splanchnic extraction of amino acids were assessed using [(13) C]leucine and [(2) H]leucine infusion. The anabolic effect of food intake was measured by studying the volunteers both at the post-absorptive and post-prandial states. Slight chronic CRP elevation resulted in neither an alteration of whole body, nor skeletal muscle protein metabolism at both the post-absorptive and the post-prandial states. However, CRP+ presented a reduction of physical fitness, increased abdominal fat mass and post-prandial insulin resistance. Plasma cytokines (interleukin-1, interleukin-6, tumour necrosis factor α) and markers of endothelial inflammation (intercellular adhesion molecule, vascular cell adhesion molecule, selectins) were similar between groups. An isolated elevated CRP in healthy older population does not indicate an impaired skeletal muscle anabolism after food intake, nor an increased risk of skeletal muscle wasting. We propose that a broader picture of LGI (notably with elevated pro-inflammatory cytokines) is required to impact muscle metabolism and mass. However, an isolated chronic CRP elevation could predict a decrease in aerobic fitness and insulin resistance installation in elderly individuals.

Keeping older muscle “young” through dietary protein and physical activity

Sarcopenia is characterized by decreases in both muscle mass and muscle function. The loss of muscle mass, which can precede decrements in muscle function, is ultimately rooted in an imbalance between the rates of muscle protein synthesis and breakdown that favors a net negative balance (i.e., synthesis < breakdown). A preponderance of evidence highlights a blunted muscle protein synthetic response to dietary protein, commonly referred to as “anabolic resistance,” as a major underlying cause of the insipid loss of muscle with age. Dietary strategies to overcome this decreased dietary amino acid sensitivity include the ingestion of leucine-enriched, rapidly digested proteins and/or greater protein ingestion in each main meal to maximally stimulate muscle anabolism. Anabolic resistance is also a hallmark of a sedentary lifestyle at any age. Given that older adults may be more likely to experience periods of reduced activity (either voluntarily or through acute illness), it is proposed that inactivity is the precipitating factor in the development of anabolic resistance and the subsequent progression from healthy aging to frailty. However, even acute bouts of activity can restore the sensitivity of older muscle to dietary protein. Provided physical activity is incorporated into the daily routine, muscle in older adults should retain its capacity for a robust anabolic response to dietary protein comparable to that in their younger peers. Therefore, through its ability to “make nutrition better,” physical activity should be viewed as a vital component to maintaining muscle mass and function with age.

A review of the effects of nuts on appetite, food intake, metabolism, and body weight

Tree nuts and peanuts are good sources of many nutrients and antioxidants, but they are also energy dense. The latter often limits intake because of concerns about their possible contribution to positive energy balance. However, evidence to date suggests that nuts are not associated with predicted weight gain. This is largely due to their high satiety value, leading to strong compensatory dietary responses, inefficiency in absorption of the energy they contain, a possible increment in resting energy expenditure, and an augmentation of fat oxidation. Preliminary evidence suggests that these properties are especially evident when they are consumed as snacks.

Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group

The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function. With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made (a) for healthy older people, the diet should provide at least 1.0-1.2 g protein/kg body weight/day, (b) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2-1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (c) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.

Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood

Mastication efficiency is defined as the efficiency of crushing food between the teeth and manipulating the resulting particles to form a swallowable food bolus. It is dependent on the orofacial anatomical features of the subject, the coordination of these anatomical features and the consistency of the food used during testing. Different measures have been used to indirectly quantify mastication efficiency as a function of children's age such as observations, food bolus characterisation, muscle activity measurement and jaw movement tracking. In the present review, we aim to describe the changes in the oral physiology (e.g. bone and muscle structure, teeth and soft tissues) of children and how these changes are associated with mastication abilities. We also review previous work on the effect of food consistency on children's mastication abilities and on their level of texture acceptance. The lack of reference foods and differences in testing methodologies across different studies do not allow us to draw conclusions about (1) the age at which mastication efficiency reaches maturity and (2) the effect of food consistency on the establishment of mature mastication efficiency. The effect of food consistency on the development of children's mastication efficiency has not been tested widely. However, both human and animal studies have reported the effect of food consistency on orofacial development, suggesting that a diet with harder textures enhances bone and muscle growth, which could indirectly lead to better mastication efficiency. Finally, it was also reported that (1) children are more likely to accept textures that they are able to manipulate and (2) early exposure to a range of textures facilitates the acceptance of foods of various textures later on. Recommending products well adapted to children's mastication during weaning could facilitate their acceptance of new textures and support the development of healthy eating habits.

Oral processing effort, appetite and acute energy intake in lean and obese adults

Chewing reportedly contributes to satiation and satiety signals. Attempts to document and quantify this have led to small and inconsistent effects. The present trial manipulated oral processing effort though required chewing of gums of different hardness and measured appetitive sensations, energy intake, gastric emptying, GI transit time, and concentrations of glucose, insulin, GLP-1, ghrelin and pancreatic polypeptide. Sixty adults classified by sex and BMI (15 each of lean females, obese females, lean males and obese males) were tested in a randomized, controlled, cross-over trial with three arms. They chewed nothing, soft gum or hard gum for 15 min while sipping grape juice (10% of individual energy needs) containing acetaminophen and lactulose on one day each separated by 7 days. Electromyographic recordings and self-reports were obtained during and after chewing to quantify oral processing effort. Blood was sampled through an indwelling catheter and appetite ratings were obtained at baseline and at 0, 15, 30, 45, 60, 90, 120, 180 and 240 min after chewing initiation. Breath samples were collected at 10 min intervals for the first 2h and at 30 min intervals for the next 2h. No effects of chewing were observed for appetitive sensations or gut peptide concentrations. Energy intake tended to decline in lean and increase in obese participants so that daily energy intake differed significantly between the two groups when chewing either gum, while no difference was observed on the non-chewing day. Serum glucose and insulin were significantly lower at selected time points 90-240 min after chewing compared to baseline and the non-chewing day. These data indicate chewing effort does not affect appetitive sensations or gut peptide secretion, but may exert a small differential effect on acute energy intake in lean and obese individuals and lead to greater post-prandial declines of serum glucose and insulin. The efficacy of gum chewing as a substitute for eating for weight management remains uncertain.

Minced beef is more rapidly digested and absorbed than beef steak, resulting in greater postprandial protein retention in older men

BACKGROUND

Older individuals generally experience a reduced food-chewing efficiency. As a consequence, food texture may represent an important factor that modulates dietary protein digestion and absorption kinetics and the subsequent postprandial protein balance.

OBJECTIVE

We assessed the effect of meat texture on the dietary protein digestion rate, amino acid availability, and subsequent postprandial protein balance in vivo in older men.

DESIGN

Ten older men (mean ± SEM age: 74 ± 2 y) were randomly assigned to a crossover experiment that involved 2 treatments in which they consumed 135 g of specifically produced intrinsically L-[1-(13)C]phenylalanine-labeled beef, which was provided as beef steak or minced beef. Meat consumption was combined with continuous intravenous L-[ring-(2)H5]phenylalanine and L-[ring-(2)H2]tyrosine infusion to assess beef protein digestion and absorption kinetics as well as whole-body protein balance and skeletal muscle protein synthesis rates.

RESULTS

Meat protein-derived phenylalanine appeared more rapidly in the circulation after minced beef than after beef steak consumption (P < 0.05). Also, its availability in the circulation during the 6-h postprandial period was greater after minced beef than after beef steak consumption (61 ± 3% compared with 49 ± 3%, respectively; P < 0.01). The whole-body protein balance was more positive after minced beef than after beef steak consumption (29 ± 2 compared with 19 ± 3 μmol phenylalanine/kg, respectively; P < 0.01). Skeletal muscle protein synthesis rates did not differ between treatments when assessed over a 6-h postprandial period.

CONCLUSIONS

Minced beef is more rapidly digested and absorbed than beef steak, which results in increased amino acid availability and greater postprandial protein retention. However, this does not result in greater postprandial muscle protein synthesis rates. This trial was registered at clinicaltrials.gov as NCT01145131.

The pertinence of oral health indicators in nutritional studies in the elderly

BACKGROUND AND AIM

Studies concerning the more appropriate criteria for evaluating oral health in relation to nutrition in the elderly vary greatly. There is a need to identify the most relevant criteria for classifying dental indicators of mastication in nutritional studies, so these indicators may be considered for epidemiological and clinical purposes. The aim of this study was to explore the associations between nutritional deficit and measures of oral health in a group of elderly.

METHODS

A convenience sample of independent elderly aged 65 years or more attending two primary care clinics in Beirut, Lebanon was selected. Data were collected from a questionnaire including the Mini-Nutritional Assessment (MNA), Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia and chewing problems. The oral examinations recorded decayed, missing and filled teeth (DMFT), the prosthetic status and the number of functional units (FU).

RESULTS

The sample was composed of 121 women (mean age: 71.59 ± 5.97 years) and 80 men (mean age: 72.74 ± 6.98 years). They were allocated to two groups: 85 participants suffering from malnutrition (MNA score < 17, n = 17) or at risk of malnutrition (17 < MNA score < 24, n = 68) and 116 participants with a normal nutritional status (MNA score ≥ 24). Parameters that explain MNA variations were perception of xerostomia (OR = 3.49, 95% CI [1.66-7.34]), number of FU (OR = 2.79, 95% CI [1.49; 5.22]), and GOHAI score (OR = 2.905, 95% CI [1.40; 6.00]).

CONCLUSION

Further studies exploring factors affecting nutrition in the elderly should take into consideration perception of xerostomia, number of FUs and GOHAI score.

Effects of meat cooking, and of ingested amount, on protein digestion speed and entry of residual proteins into the colon: a study in minipigs

The speed of protein digestion impacts on postprandial protein anabolism. After exercise or in the elderly, fast proteins stimulate protein synthesis more efficiently than slow proteins. It has been shown that meat might be a source of fast proteins. However, cooking temperature, acting on the macrostructure and microstructure of the meat could affect both the speed, and efficiency, of protein digestion. This study aims to evaluate, in vivo, the effect of meat cooking on digestion parameters, in the context of a complete meal. Six minipigs fitted with an ileal cannula and an arterial catheter were used. In order to measure the true ileal digestibility, tested meat was obtained from a calf, the muscle proteins of which were intrinsically labelled with ¹⁵N-amino acids. Three cooking temperatures (60, 75 and 95°C; core temperature for 30 min), and three levels of intake (1, 1.45, and 1.90 g protein/kg body weight) were tested. Following meat ingestion, ileal digesta and arterial blood were collected over a 9-h period. The speed of digestion, evaluated from the kinetics of amino acid appearance in blood within the first 3 h, was greater for the cooking temperature of 75°C, than for 60 or 95°C. The true ileal digestibility, which averaged 95%, was not affected by cooking temperature or by the level of meat intake. The amino acid composition of the digesta flowing at the ileum was not affected by cooking temperature. These results show that cooking temperature can modulate the speed of meat protein digestion, without affecting the efficiency of the small intestinal digestion, and consequently the entry of meat protein residues into the colon.

Dietary guidance for people wearing removable prostheses

BACKGROUND

The authors identified and described dietary strategies appropriate for dental patients who receive dental care that includes the placement and maintenance of dental prostheses.

CONCLUSIONS

Identification of a patient's perception of food choices associated with placement of a dental prosthesis can lead to delivery of patient-focused dietary guidance for the promotion of targeted food choices to improve oral health and systemic health. An interview guide for assessment of patient satisfaction and a guide for suggested dietary choices and modifications are provided.

CLINICAL IMPLICATIONS

Dental professionals can tailor food modification strategies and promote healthful food choices, enhance patient satisfaction and improve health outcomes.

Cooking temperature is a key determinant of in vitro meat protein digestion rate: investigation of underlying mechanisms

The present study aimed to evaluate the digestion rate and nutritional quality of pig muscle proteins in relation to different meat processes (aging, mincing, and cooking). Under our experimental conditions, aging and mincing had little impact on protein digestion. Heat treatments had different temperature-dependent effects on the meat protein digestion rate and degradation potential. At 70 °C, the proteins underwent denaturation that enhanced the speed of pepsin digestion by increasing enzyme accessibility to protein cleavage sites. Above 100 °C, oxidation-related protein aggregation slowed pepsin digestion but improved meat protein overall digestibility. The digestion parameters defined here open new insights on the dynamics governing the in vitro digestion of meat protein. However, the effect of cooking temperature on protein digestion observed in vitro needs to be confirmed in vivo.

Postprandial metabolic responses to mixed versus liquid meal tests in healthy men and men with type 2 diabetes

AIMS

Compare metabolic responses after mixed versus liquid meals of similar caloric/nutritional content in healthy and type 2 diabetes (T2D) subjects.

METHODS

Ten healthy men and 10 men with T2D received mixed and liquid meals after an overnight fast. Classical (insulinogenic index; insulin/glucose areas under curves, AUC(insulin)/AUC(glucose)) and model-based (beta-cell glucose sensitivity; rate sensitivity; potentiation factor ratio, PFR) beta-cell function estimates were calculated. Between-meal differences in glucose, insulin, C-peptide, triglyceride (TG), beta-cell function and oral glucose insulin sensitivity (OGIS) and between-meal correlations for beta-cell function and OGIS were evaluated.

RESULTS

Among healthy subjects, beta-cell function and OGIS were similar between meals. C-peptide (p=0.03), insulin (p=0.002), AUC(insulin)/AUC(glucose) (p=0.004) and insulin secretion (p=0.04) were higher after the liquid meal. Among T2D subjects, glucose, insulin, C-peptide, beta-cell function, and OGIS were similar. PFR was higher (p=0.004) and TG increased more slowly (p=0.002) after the liquid meal. OGIS and beta-cell function were correlated during both meals in both groups (r=0.66-0.98), except incremental AUC(insulin)/AUC(glucose), rate sensitivity, and, in healthy subjects, PFR.

CONCLUSIONS

Metabolic responses after mixed or liquid meals of similar content were highly correlated in T2D and healthy subjects. In T2D, the liquid meal produced beta-cell function estimates generally similar to the mixed meal.

Effect of dental status on changes in mastication in patients with obesity following bariatric surgery

Background

Patients scheduled for bariatric surgery (BS) are encouraged to chew slowly in order to optimise the digestion process. The influence of dental status on patients' ability to comply with advice on chewing behaviour is poorly documented. This study aims to compare modifications of chewing function before and after BS in three groups of obese patients differing in dental status.

Method and Findings

A cohort of 46 obese women provided three groups: FD group: fully dentate (7–10 functional dental units [FU]); PD group: partially dentate (4–6 FU) without partial dentures; DW group: partial and complete denture wearers. Chewing time (CT), number of chewing cycles (CC), and chewing frequency (CF) were measured before and after surgery during mastication of standardised samples of raw carrot, peanuts, banana, apple and jelly. The median particle-size distribution (D50) of the pre-swallowed bolus was also evaluated for peanut and carrot. Before surgery, the PD and DW groups exhibited greater mean CCs and CTs than the FD group (SNK p<0.05) and produced a bolus with higher granulometry (SNK, p<0.05) than the FD group. After surgery, CT and CC increased for all groups and for all foods, but not statistically significant for jelly. The resulting changes in bolus granulometry observed depended on both food and dental status. The granulometry of carrot bolus remained as fine or as coarse in FD and DW groups respectively as it was before surgery while it was significantly decreased in the PD group (Student's test, p<0.001).

Conclusions

After bariatric surgery, all the obese patients, regardless of dental status modified their chewing kinematics. The effects of this chewing behaviour on bolus granulometry depended on dental status and type of food. Further studies are needed to understand better the impact of dental status on feeding behaviour and nutrition in patients with obesity.

New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre?

Epidemiological studies have clearly shown that whole-grain cereals can protect against obesity, diabetes, CVD and cancers. The specific effects of food structure (increased satiety, reduced transit time and glycaemic response), fibre (improved faecal bulking and satiety, viscosity and SCFA production, and/or reduced glycaemic response) and Mg (better glycaemic homeostasis through increased insulin secretion), together with the antioxidant and anti-carcinogenic properties of numerous bioactive compounds, especially those in the bran and germ (minerals, trace elements, vitamins, carotenoids, polyphenols and alkylresorcinols), are today well-recognised mechanisms in this protection. Recent findings, the exhaustive listing of bioactive compounds found in whole-grain wheat, their content in whole-grain, bran and germ fractions and their estimated bioavailability, have led to new hypotheses. The involvement of polyphenols in cell signalling and gene regulation, and of sulfur compounds, lignin and phytic acid should be considered in antioxidant protection. Whole-grain wheat is also a rich source of methyl donors and lipotropes (methionine, betaine, choline, inositol and folates) that may be involved in cardiovascular and/or hepatic protection, lipid metabolism and DNA methylation. Potential protective effects of bound phenolic acids within the colon, of the B-complex vitamins on the nervous system and mental health, of oligosaccharides as prebiotics, of compounds associated with skeleton health, and of other compounds such as alpha-linolenic acid, policosanol, melatonin, phytosterols and para-aminobenzoic acid also deserve to be studied in more depth. Finally, benefits of nutrigenomics to study complex physiological effects of the 'whole-grain package', and the most promising ways for improving the nutritional quality of cereal products are discussed.

An overview of the therapeutic effects of leucine supplementation on skeletal muscle under atrophic conditions

The characterization of the mechanisms underlying skeletal muscle atrophy under different conditions has been a constant focus of research. Among anti-atrophic therapies, amino acid supplementation, particularly with leucine, has received a lot of attention. Supplementation has been shown to have remarkable effects on muscle remodeling through protein turnover modulation. This may then impact physiological parameters related to muscle function, and even quality of life. In light of this, leucine supplementation could be a useful therapy for mitigating the atrophic effects of catabolic conditions. The purpose of this review is to present the major results of human studies evaluating the effects of leucine supplementation on structure and function of skeletal muscle in atrophic conditions such as muscle disuse, sarcopenia, and cancer.

Differences in muscle protein synthesis and anabolic signaling in the postabsorptive state and in response to food in 65-80 year old men and women

Women have less muscle than men but lose it more slowly during aging. To discover potential underlying mechanism(s) for this we evaluated the muscle protein synthesis process in postabsorptive conditions and during feeding in twenty-nine 65-80 year old men (n = 13) and women (n = 16). We discovered that the basal concentration of phosphorylated eEF2(Thr56) was approximately 40% less (P<0.05) and the basal rate of MPS was approximately 30% greater (P = 0.02) in women than in men; the basal concentrations of muscle phosphorylated Akt(Thr308), p70s6k(Thr389), eIF4E(Ser209), and eIF4E-BP1(Thr37/46) were not different between the sexes. Feeding increased (P<0.05) Akt(Thr308) and p70s6k(Thr389) phosphorylation to the same extent in men and women but increased (P<0.05) the phosphorylation of eIF4E(Ser209) and eIF4E-BP1(Thr37/46) in men only. Accordingly, feeding increased MPS in men (P<0.01) but not in women. The postabsorptive muscle mRNA concentrations for myoD and myostatin were not different between sexes; feeding doubled myoD mRNA (P<0.05) and halved that of myostatin (P<0.05) in both sexes. Thus, there is sexual dimorphism in MPS and its control in older adults; a greater basal rate of MPS, operating over most of the day may partially explain the slower loss of muscle in older women.