Dietary protein recommendations and the prevention of sarcopenia

Low-sodium dry-cured rabbit leg: A novel meat product with healthier properties

Dry-cured rabbit legs were produced with a 50% reduction or replacement of NaCl by KCl and with the addition of monosodium glutamate (MG). The effect of this reformulation on technological, nutritional, and sensory characteristics was evaluated. The sodium reformulation did not show a great impact on Aw, pH, weight loss, and volatile profile of the samples. The samples presented high protein (31.5 to 36.1%) and low fat contents (3.2 to 5.7%). In addition, all essential amino acids presented an amino acid score greater than 1.0. The reformulated samples showed a sodium reduction of 46.2% while the addition of KCl to the formulations provided a healthy Na/K ratio. Oleic acid was the major fatty acid (FA) (31.3% of total FA) and healthy lipid indexes were observed for all samples. Finally, the addition of MG was effective to compensate for the sensory defects caused by sodium reformulation.

Rationale and study protocol of the Physical Activity and Dietary intervention in women with OVArian cancer (PADOVA) study: a randomised controlled trial to evaluate effectiveness of a tailored exercise and dietary intervention on body composition, physical function and fatigue in women with ovarian cancer undergoing chemotherapy

INTRODUCTION

As a consequence of ovarian cancer and its treatment, many women with ovarian cancer have to deal with reduced physical function, fatigue, and loss of weight and/or muscle mass, compromising quality of life. Exercise and dietary interventions can positively influence body composition, physical fitness and function, and fatigue in patients with cancer. However, there are no data from randomised controlled trials on the effectiveness of exercise and dietary interventions in patients with ovarian cancer. Due to a complex disease trajectory, a relatively poor survival and distinct disease-induced and treatment-induced side effects, it is unclear whether exercise and dietary interventions that were shown to be feasible and effective in other types of cancer produce comparable results in patients with ovarian cancer. The aim of this article is to present the design of the multicentre randomised controlled Physical Activity and Dietary intervention in OVArian cancer trial and to describe how the exercise and dietary intervention is tailored to specific comorbidities and disease-induced and treatment-induced adverse effects in patients with ovarian cancer.

METHODS AND ANALYSIS

Adult women with primary epithelial ovarian cancer who are scheduled to undergo first-line (neo)adjuvant chemotherapy (n=122) are randomly allocated to a combined exercise and dietary intervention or a usual care control group during chemotherapy. Primary outcomes are body composition, physical function and fatigue. Outcome measures will be assessed before the start of chemotherapy, 3 weeks after completion of chemotherapy and 12 weeks later. The exercise and dietary intervention was tailored to ovarian cancer-specific comorbidities and adverse effects of ovarian cancer and its treatment following the i3-S strategy.

ETHICS AND DISSEMINATION

This study has been approved by the medical ethical committee of the Amsterdam UMC (reference: 018). Results of the study will be published in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

Netherlands Trial Registry (NTR6300).

Nutritional Biomarkers and Associated Factors in Community-Dwelling Older Adults: Findings from the SHIELD Study

Aging is associated with intrinsic and extrinsic changes which affect the nutrient intake and nutritional status of an older individual. Suboptimal nutritional status is linked with adverse health outcomes. There are limited data in this area for community-dwelling older adults who are not at risk of malnutrition. The objective of this study was to describe the nutritional biomarkers in 400 community-dwelling older adults (aged ≥65 years) with normal nutritional status (Malnutrition Universal Screening Test score of 0) in Singapore and to identify factors associated with these biomarkers. The majority of the participants had normal levels of pre-albumin, albumin, total protein, creatinine, zinc, corrected calcium, vitamin B12, ferritin and hemoglobin. Females had significantly higher levels of corrected calcium and vitamin B12 than males, whereas males had significantly higher levels of pre-albumin, albumin, creatinine, serum ferritin, 25-hydroxyvitamin D (25(OH)D) and hemoglobin than females. About half of the participants (52%) had low level of 25(OH)D (<30 μg/L) and 10% had low zinc level (<724 μg/L). Among those with low level of 25(OH)D, 74% had 25(OH)D insufficiency (20–<30 μg/L) and 26% had 25(OH)D deficiency (<20 μg/L). Younger age, female gender, non-Chinese ethnicity and no intake of vitamin D supplement were associated with lower serum 25(OH)D level, whereas higher body mass index (BMI) was associated with low zinc level. These findings highlight the problem of hidden nutritional insufficiencies can be missed in seemingly normal nourished community-dwelling older adults.

Nutritional Concerns for the Artistic Athlete

Performing artists are similar to sports athletes, with repeated patterns of training and performing. This requires that artistic athletes manage the dynamic interaction between energy/nutrient/fluid utilization and provision to assure long, healthful, and successful careers. Although sports athletes have an abundance of science-based nutritional guidance available, there are few nutrition-focused resources available to artistic athletes, which can result in failure to optimally satisfy the artistic athlete's individual nutritional needs. The purpose of this article is to review common nutritional issues faced by artistic athletes and to present science-based nutrition strategies that can aid in lowering nutrition-associated health and performance risks.

A 4-week exercise and protein program improves muscle mass and physical functioning in older adults - A pilot study

BACKGROUND

Prehabilitation might attenuate common surgery-induced losses in muscle mass and physical performance. Beneficial effects of physical exercise with protein supplementation have been reported in older adults, but typically after an intervention of at least 12 weeks. The time-window for pre-surgery training is often limited to around 30 days, and it is not known if it is possible to achieve comparable results in such a short time window.

OBJECTIVES

The aim of this study was to pilot-test the effectiveness of a controlled four-week combined exercise and protein supplementation program on skeletal muscle-related outcomes in a Dutch older adult population.

DESIGN

This study was a one-armed pilot trial.

PARTICIPANTS

Seventeen older men and women, aged 55-75y, not scheduled for surgery.

INTERVENTION

A 4-week intervention program consisting of a twice-weekly supervised resistance and high-intensity aerobic exercise training of 75 min, combined with daily protein supplementation (2 doses of 15.5 g/day at breakfast and lunch).

MEASUREMENT

After two and four weeks, isometric quadriceps maximal voluntary contraction (MVC) was assessed via Biodex and quadriceps cross-sectional area (CSA) via magnetic resonance imaging. Other outcome measures were handgrip strength, chair rise time and maximal aerobic capacity (VO₂-max), as assessed from a submaximal exercise test.

RESULTS

Compliance to the supervised training sessions (99.3%) and the protein supplementation (97%) was very high. The 4-week exercise and protein program led to an increase in quadriceps CSA of 2.3 ± 0.7 cm² (P = 0.008) in the dominant leg and 3.2 ± 0.7 cm² (P < 0.001) in the non-dominant leg. Isometric quadriceps MVC increased in the dominant leg (Δ14 ± 4 Nm, P = 0.001) and in the non-dominant leg (Δ17 ± 5 Nm, P = 0.003). Chair rise test time improved with -3.8 ± 0.5 s (P < 0.0001), and VO₂-max improved with 3.3 ± 1.1 ml/min/kg (P = 0.014). We observed no changes in body weight and handgrip strength.

CONCLUSION

A 4-week exercise and protein intervention led to improvements in muscle-related outcomes in older adults with low levels of physical activity.

Daily Protein and Energy Intake Are Not Associated with Muscle Mass and Physical Function in Healthy Older Individuals-A Cross-Sectional Study

Dietary protein has a pivotal role in muscle mass maintenance with advancing age. However, an optimal dose and distribution of protein intake across the day as well as the interaction with energy intake for the maintenance of muscle mass and physical function in healthy older adults remain to be fully elucidated. The purpose of this study was to examine the association between muscle mass, strength, and physical function, and the total amount and distribution of protein and energy intake across the day in healthy older individuals. The research question was addressed in a cross-sectional study including 184 Danish men and woman (age: 70.2 ± 3.9 years, body mass: 74.9 ± 12.1 kg, Body Mass Index (BMI): 25.4 ± 3.7 kg/m²) where a 3-day dietary registration, muscle mass, strength, and functional measurements were collected. We found that neither daily total protein intake nor distribution throughout the day were associated with muscle mass, strength, or physical function. Consequently, we do not provide an incentive for healthy older Danish individuals who already adhere to the current internationally accepted recommended dietary protein intake (0.83 g/kg/day) to change dietary protein intake or its distribution pattern throughout the day.

The provision of recipes and single-use herb/spice packets to increase egg and protein intake in community-dwelling older adults: a randomised controlled trial

OBJECTIVE

This study investigated the impact of recipe and single-use herb/spice packet provision on egg intake and protein intake in community-dwelling individuals aged over 55 years.

DESIGN

Using a randomised-controlled intervention design, 100 older adults were randomised to receive (n 53) or not receive (n 47) high-protein egg-based recipes and herb/spice packets through the post for 12 weeks, from June to December 2016. Egg intake, protein intake, adverse events, lean body mass and functional measures of lean body mass were measured at baseline, after the 12 weeks and after a further 12 weeks.

SETTING

Bournemouth, UK.

PARTICIPANTS

Community-dwelling older adults.

RESULTS

Intention-to-treat data were analysed using regression, controlling for various demographic and lifestyle characteristics. Ninety-three individuals (intervention, n 50; control, n 43) completed assessments at all three time points. Egg intakes increased by end of intervention in both groups (mean: 4-5 eggs/month). After a further 12 weeks, higher egg intakes were sustained in the intervention group, while egg intakes in the control group returned to baseline levels (between-group difference: β = -0·124, P = 0·047). No differences were found in other measures (largest β = -0·106, P = 0·12).

CONCLUSIONS

The provision of high-protein egg-based recipes and single-use herb/spice packets over 12 weeks increased egg intakes up to 12 weeks after end of intervention. Other factors may explain increased egg intakes during the intervention, but the sustained effects most plausibly result directly from recipe provision. Limited effects in other measures suggest that the recipes may have replaced as opposed to added to existing protein intakes.

The Potential Role of Fish-Derived Protein Hydrolysates on Metabolic Health, Skeletal Muscle Mass and Function in Ageing

Fish protein represents one of the most widely consumed dietary protein sources by humans. The processing of material from the fishing industry generates substantial unexploited waste products, many of which possess high biological value. Protein hydrolysates, such as fish protein hydrolysates (FPH), containing predominantly di- and tripeptides, are more readily absorbed than free amino acids and intact protein. Furthermore, in animal models, FPH have been shown to possess numerous beneficial properties for cardiovascular, neurological, intestinal, renal, and immune health. Ageing is associated with the loss of skeletal muscle mass and function, as well as increased oxidative stress, compromised vascularisation, neurological derangements, and immunosenescence. Thus, there appears to be a potential application for FPH in older persons as a high-quality protein source that may also confer additional health benefits. Despite this, there remains a dearth of information concerning the impact of FPH on health outcomes in humans. The limited evidence from human interventional trials suggests that FPH may hold promise for supporting optimal body composition and maintaining gut integrity. FPH also provide a high-quality source of dietary protein without negatively impacting on subjective appetite perceptions or regulatory hormones. Further studies are needed to assess the impact and utility of FPH on skeletal muscle health in older persons, ideally comparing FPH to ‘established’ protein sources or a non-bioactive, nitrogen-matched control. In particular, the effects of acute and chronic FPH consumption on post-exercise aminoacidaemia, skeletal muscle protein synthesis, and intramyocellular anabolic signalling in older adults are worthy of investigation. FPH may represent beneficial and sustainable alternative sources of high-quality protein to support skeletal muscle health and anabolism in ageing, without compromising appetite and subsequent energy intake.

Relationship between diet quality and sarcopenia in elderly Koreans: 2008-2011 Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES

Given the increasing proportion of the Korean population that is aged 65 years and older, the present study analyzed the relationship between diet quality and sarcopenia in elderly persons by using data from the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS

Data for 3,373 persons aged 65 years and over (men: 1,455, 43.1%) were selected from the 2008-2011 KNHANES. Sarcopenia assessments are based on a formula that divides a subject's appendicular skeletal muscle mass (ASM) by their weight (wt) and multiplies that result by 100 ([ASM/wt] × 100). Sarcopenia is present if the subject's result was less than one standard deviation (SD) below the sex-specific mean for a young reference group. For evaluation of diet quality, data obtained via the 24-hour recall method were used to calculate the Diet Quality Index for Koreans (DQI-K). A general linear model was applied in order to analyze general information and nutritional intake according to sarcopenia status. For analysis of the relationship between diet quality and sarcopenia, a binominal logistic regression analysis was undertaken.

RESULTS

The sarcopenia prevalence rate among the study subjects aged 65 years and over was 37.6%. The DQI-K of those without sarcopenia was 3.33 ± 0.04 points, while that of those with sarcopenia was 3.45 ± 0.04 points (P < 0.05). The relationship between diet quality and sarcopenia revealed that subjects aged 75 and older had a poor diet quality, and their odds ratio (OR) of sarcopenia presence was significantly higher (OR: 1.807, 95% confidence interval: 1.003-3.254, P < 0.05).

CONCLUSIONS

This study revealed that poor diet quality was related to sarcopenia presence in Koreans aged 75 and older. In order to improve the diet quality of the elderly (aged 75 and older), it is necessary to develop dietary improvement guidelines.

Understanding Muscle Protein Dynamics: Technical Considerations for Advancing Sarcopenia Research

Sarcopenia, which is the loss of muscle mass and strength that occurs with aging, involves imbalanced muscle protein turnover (i.e., protein breakdown exceeding synthesis), which in turn exacerbates other clinical conditions such as type 2 diabetes mellitus, obesity, osteoporosis, and cancer, thereby worsening the quality of life in older adults. This imbalance is attributed in part to the resistance of aged muscle to anabolic stimuli such as dietary protein/amino acids and resistance exercise known as anabolic resistance. Despite research efforts, no practical therapeutics have been successfully discovered possibly because of a lack of understanding of the dynamic nature of muscle protein, and the use of indirect assessments of muscle mass. Herein, we briefly discuss the regulation of protein turnover in response to the abovementioned anabolic stimuli with respect to anabolic resistance and optimal protein intake, followed by methodological considerations for advancing sarcopenia research, including assessments of muscle mass and dynamics.

Glucose and protein metabolic responses to an energy- but not protein- restricted diet in type 2 diabetes

AIMS

To test the effect of energy restriction with maintained protein intake on body composition and on insulin sensitivity of glucose and protein metabolism in adults with type 2 diabetes (T2D).

MATERIALS AND METHODS

After 3 days of an isoenergetic diet with 1.2 g/kg/d protein, obese adults with T2D (three women, two men) followed a 5-week diet providing 60% of energy requirements with 45% carbohydrate, and with protein maintained at pre-intervention level. Isotopic tracers were used to quantify whole-body glucose (3-³ H-glucose) and protein (¹³ C-leucine) metabolism pre- (day 4) and post-intervention (day 39), in the postabsorptive state and during a hyperinsulinaemic, isoglycaemic, isoaminoacidaemic clamp. Body composition was measured using dual-energy x-ray absorptiometry.

RESULTS

After energy restriction, 6% weight loss occurred via total body (11%) and visceral fat losses (25%), but lean mass was preserved. Fasting glucose level, serum insulin level, homeostatic model assessment of insulin resistance index and C-peptide level decreased significantly (29%, 38%, 54% and 38%, respectively) as did other cardiometabolic risk factors. Between clamp studies, postabsorptive protein turnover and oxidation rates decreased (12% and 32%), resulting in less negative net balance, consistent with protein conservation. The rates of glucose turnover decreased, and glucose metabolic clearance rate improved (24%). During the clamp, protein flux was lower (9%) and breakdown suppressed (12%), and net balance became less negative but not different. Although glucose turnover did not differ, metabolic clearance improved by 47%.

CONCLUSIONS

In obese adults with T2D, an energy-restricted diet with maintained protein intake of ~1.2 g/kg/d improved the kinetics of protein metabolism (particularly in the postabsorptive state), and preserved lean body mass and increased glucose metabolic clearance rate.

Breaking the vicious circle of diet, malnutrition and oral health for the independent elderly

Aging impairs senses, mastication, oral status and function, causing nutritional needs and diet insufficiencies. The present needs of independent older adults suggest that health research and oral health care should shift from reductionist disease management to integral and personal treatment plans, including lifestyle, psychological, nutritional and oral health coaching approaches. Dentists and other medical professionals that work in the field of gerodontology should be educated on the macro and micronutrient needs of the elderly and incorporate certain nutritional plans early in the life of their patients with their approval and cooperation, in order to postpone tooth loss and masticatory impairment. Old recipes such as the Mediterranean diet should be kept as a base for all the elderly and be enriched in a customized interpersonal way from the dentist as well as the medical professional according to the specific needs of one's oral and general health status. In this nonsystematic review paper, the basic aspects of the vicious cycle of nutrition and oral health status are discussed and suggestions of major nutrients' influence and needs for independent elders are reported. Based on the scientific data collected, suggestions are made for the food industry for better quality and dosage of foods for this category of individuals. Such strategies can be a whole new area of interest for the food industry in order to obtain better quality of food packaging for the independent OA with accepted texture, odor, colors, macronutrients and micronutrients' consistency and in specific portions.

Dietary Protein Intake and Determinants in Māori and Non-Māori Octogenarians. Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu: Life and Living in Advanced Age: A Cohort Study in New Zealand

Protein intake, food sources and distribution are important in preventing age-related loss of muscle mass and strength. The prevalence and determinants of low protein intake, food sources and mealtime distribution were examined in 214 Māori and 360 non-Māori of advanced age using two 24 h multiple pass recalls. The contribution of food groups to protein intake was assessed. Low protein intake was defined as ≤0.75 g/kg for women and ≤0.86 g/kg for men. A logistic regression model was built to explore predictors of low protein intake. A third of both women (30.9%) and men (33.3%) had a low protein intake. The main food group sources were beef/veal, fish/seafood, milk, bread though they differed by gender and ethnicity. For women and men respectively protein intake (g/meal) was lowest at breakfast (10.1 and 13.0), followed by lunch (14.5 and 17.8) and dinner (23.3 and 34.2). Being a woman (p = 0.003) and having depressive symptoms (p = 0.029) were associated with consuming less protein. In adjusted models the odds of adequate protein intake were higher in participants with their own teeth or partial dentures (p = 0.036). Findings highlight the prevalence of low protein intake, uneven mealtime protein distribution and importance of dentition for adequate protein intake among adults in advanced age.

Novel Essential Amino Acid Supplements Following Resistance Exercise Induce Aminoacidemia and Enhance Anabolic Signaling Irrespective of Age: A Proof-of-Concept Trial

We investigated the effects of ingesting a leucine-enriched essential amino acid (EAA) gel alone or combined with resistance exercise (RE) versus RE alone (control) on plasma aminoacidemia and intramyocellular anabolic signaling in healthy younger (28 ± 4 years) and older (71 ± 3 years) adults. Blood samples were obtained throughout the three trials, while muscle biopsies were collected in the postabsorptive state and 2 h following RE, following the consumption of two 50 mL EAA gels (40% leucine, 15 g total EAA), and following RE with EAA (combination (COM)). Protein content and the phosphorylation status of key anabolic signaling proteins were determined via immunoblotting. Irrespective of age, during EAA and COM peak leucinemia (younger: 454 ± 32 µM and 537 ± 111 µM; older: 417 ± 99 µM and 553 ± 136 µM) occurred ~60–120 min post-ingestion (younger: 66 ± 6 min and 120 ± 60 min; older: 90 ± 13 min and 78 ± 12 min). In the pooled sample, the area under the curve for plasma leucine and the sum of branched-chain amino acids was significantly greater in EAA and COM compared with RE. For intramyocellular signaling, significant main effects were found for condition (mTOR (Ser2481), rpS6 (Ser235/236)) and age (S6K1 (Thr421/Ser424), 4E-BP1 (Thr37/46)) in age group analyses. The phosphorylation of rpS6 was of similar magnitude (~8-fold) in pooled and age group data 2 h following COM. Our findings suggest that a gel-based, leucine-enriched EAA supplement is associated with aminoacidemia and a muscle anabolic signaling response, thus representing an effective means of stimulating muscle protein anabolism in younger and older adults following EAA and COM.

Improving Dietary Protein Quality Reduces the Negative Effects of Physical Inactivity on Body Composition and Muscle Function

BACKGROUND

Brief periods of physical inactivity can compromise muscle health. Increasing dietary protein intake is potentially beneficial but complicated by difficulties reconciling anabolic potential with a realistic food volume and energy intake. We sought to determine whether increasing dietary protein quality could reduce the negative effects of physical inactivity.

METHODS

Twenty healthy, older men and women completed 7 days of bed rest followed by 5 days of rehabilitation. Volunteers consumed a mixed macronutrient diet (MIXED: N = 10; 68 ± 2 years; 1,722 ± 29 kcal/day; 0.97 ± 0.01 g protein/kg/day) or an isoenergetic, whey-augmented, higher protein quality diet (WHEY: N = 10; 69 ± 1 years; 1,706 ± 23 kcal/day; 0.90 ± 0.01 g protein/kg/day). Outcomes included body composition, blood glucose, insulin, and a battery of physical function tests.

RESULTS

During bed rest, both groups experienced a 20% reduction in knee extension peak torque (p < .05). The WHEY diet partially protected leg lean mass (-1,035 vs. -680 ± 138 g, MIXED vs. WHEY; p = .08) and contributed to a greater loss of body fat (-90 vs. -233 ± 152 g, MIXED vs. WHEY; p < .05). Following rehabilitation, knee extension peak torque in the WHEY group fully recovered (-10.0 vs. 2.2 ± 4.1 Nm, MIXED vs. WHEY; p = .05). Blood glucose, insulin, aerobic capacity, and Short Physical Performance Battery (SPPB) changes were similar in both dietary conditions (p > .05).

CONCLUSIONS

Improving protein quality without increasing total energy intake has the potential to partially counter some of the negative effects of bed rest in older adults.

Effects of slow- v. fast-digested protein supplementation combined with mixed power training on muscle function and functional capacities in older men

Ageing leads to a progressive loss of muscle function (MF) and quality (MQ: muscle strength (MS)/lean muscle mass (LM)). Power training and protein (PROT) supplementation have been proposed as efficient interventions to improve MF and MQ. Discrepancies between results appear to be mainly related to the type and/or dose of proteins used. The present study aimed at determining whether or not mixed power training (MPT) combined with fast-digested PROT (F-PROT) leads to greater improvements in MF and MQ in elderly men than MPT combined with slow-digested PROT (S-PROT) or MPT alone. Sixty elderly men (age 69 (sd 7) years; BMI 18-30 kg/m2) were randomised into three groups: (1) placebo + MPT (PLA; n 19); (2) F-PROT + MPT (n 21) and (3) S-PROT + MPT (n 20) completed the intervention. LM, handgrip and knee extensor MS and MQ, functional capacity, serum metabolic markers, skeletal muscle characteristics, dietary intake and total energy expenditure were measured. The interventions consisted in 12 weeks of MPT (3 times/week; 1 h/session) combined with a supplement (30 g:10 g per meal) of F-PROT (whey) or S-PROT (casein) or a placebo. No difference was observed among groups for age, BMI, number of steps and dietary intake pre- and post-intervention. All groups improved significantly their LM, lower limb MS/MQ, functional capacity, muscle characteristics and serum parameters following the MPT. Importantly, no difference between groups was observed following the MPT. Altogether, adding 30 g PROT/d to MPT, regardless of the type, does not provide additional benefits to MPT alone in older men ingesting an adequate (i.e. above RDA) amount of protein per d.

Nutrition for Master Athletes: Is There a Need for Specific Recommendations?

Master athletes are often considered exemplars of successful aging, thanks to their capacity to maintain a high sports performance during their entire life. A high training capacity, regular participation in sporting competitions, and delayed alterations in body composition and physiological capacities have been listed among the main factors contributing to impressive master athletes' performances. However, there is a paucity of data on the metabolism and dietary habits of master athletes, and the question of whether they need to adapt their nutrition to the aging process remains open. Herein, the authors presented a contemporary overview of the metabolic challenges associated with aging, including the risk of low energy availability, anabolic resistance, and periods of metabolic crisis due to forced immobilization. After assembling scientific evidence to show that master athletes must adapt their dietary intake, the authors proposed a summary of nutritional recommendations for master athletes and suggested the next stage of research.

Invited review: Astringency in whey protein beverages

Astringency is the sensation of mouth drying and puckering, and it has also been described as a loss of lubrication in the mouth. Astringency is perceived as an increase in oral friction or roughness. Astringency caused by tannins and other polyphenols has been well documented and studied. Whey proteins are popular for their functional and nutritional quality, but they exhibit astringency, particularly under acidic conditions popular in high acid (pH 3.4) whey protein beverages. Acids cause astringency, but acidic protein beverages have higher astringency than acid alone. Whey proteins are able to interact with salivary proteins, which removes the lubricating saliva layer of the mouth. Whey proteins can also interact directly with epithelial tissue. These various mechanisms of astringency limit whey protein ingredient applications because astringency is undesirable to consumers. A better understanding of the causes of whey protein astringency will improve our ability to produce products that have high consumer liking and deliver excellent nutrition.

Distribution of daily protein intake across meals and lower extremity functioning in community-dwelling Spanish older adults: a prospective cohort study

PURPOSE

Total dietary protein intake has been associated with better physical function in older adults. However, it is unclear whether an even mealtime distribution of protein intake also has an impact on physical functioning. The aim of this study was to examine the prospective association between distribution of daily protein intake across meals and the risk of impaired lower extremity function (ILEF).

METHODS

We used information of 2975 individuals ≥ 60 years from the Seniors-ENRICA cohort. Habitual dietary protein intake was assessed in 2008-2010 with a validated diet history. For each participant, dietary protein intake across meals was determined using the coefficient of variation (CV) of the distribution. Study participants were followed up until 2017 to identify incident ILEF, assessed with the short physical performance battery (SPPB).

RESULTS

Over a median follow-up of 6.3 years, we identified 521 participants with ILEF (SPPB ≤ 6). After adjusting for potential confounders including total protein intake/kg/day, a higher CV (less even distribution) of protein intake did not show an association with the risk of ILEF [hazard ratios (HR) and 95% confidence intervals (CI) for second and third vs. the first tertile: 1.08 (0.87-1.34), and 1.06 (0.85-1.32), respectively; p trend = 0.60]. When assessing each component of the SPPB, a higher CV of protein intake was associated with higher risk of impaired standing balance (HR for tertile 3 vs. tertile 1: 1.26 (1.03-1.54); p trend = 0.02).

CONCLUSION

The mealtime distribution of protein intake was not associated with ILEF. The possibility of a detrimental effect of uneven distribution of protein on standing balance needs to be further investigated.

Protein intake pattern over the day and its association with low total protein intake in Dutch community-dwelling older adults

Objective:

Investigate protein intake patterns over the day and their association with total protein intake in older adults.

Design:

Cross-sectional study utilising the dietary data collected through two non-consecutive, dietary record-assisted 24-h recalls. Days with low protein intake (n 290) were defined using the RDA (<0·8 g protein/kg adjusted BW/d). For each day, the amount and proportion of protein ingested at every hour of the day and during morning, mid-day and evening hours was calculated. Amounts and proportions were compared between low and high protein intake days and related to total protein intake and risk of low protein intake.

Setting:

Community.

Participants:

739 Dutch community-dwelling adults ≥70 years.

Results:

The mean protein intake was 76·3 (sd 0·7) g/d. At each hour of the day, the amount of protein ingested was higher on days with a high protein intake than on days with a low protein intake and associated with a higher total protein intake. The proportion of protein ingested during morning hours was higher (22 v. 17 %, P < 0·0001) on days with a low protein intake, and a higher proportion of protein ingested during morning hours was associated with a lower total protein intake (P < 0·0001) and a higher odds of low protein intake (OR 1·04, 95 % CI 1·03, 1·06). For the proportion of protein intake during mid-day or evening hours, opposite but weaker associations were found.

Conclusions:

In this sample, timing of protein intake was associated with total protein intake. Additional studies need to clarify the importance of these findings to optimise protein intake.

Sarcopenia: A Contemporary Health Problem among Older Adult Populations

Sarcopenia, a geriatric disease characterized by a progressive loss of skeletal muscle mass and loss of muscle function, constitutes a rising, often undiagnosed health problem. Its prevalence in the elderly population is largely considered variable, as it ranges from 5% to 50% depending on gender, age, pathological conditions as well as diagnostic criteria. There is no one unified approach of treatment or assessment, which makes sarcopenia even harder to assess. There is a pressing need to provide better diagnosis, diagnostics, prevention, and individualized health care. Physical activity and nutrition are the main studied ways to prevent sarcopenia, and they also offer better outcomes. This review aims to report the prevalence of sarcopenia in older adults, its etiology, prevention, and treatment techniques.

Protein Requirements of Elderly Chinese Adults Are Higher than Current Recommendations

BACKGROUND

Due to a lack of research data on the protein requirements of the elderly in China, the estimated average requirement (EAR) and the recommended nutrient intake (RNI) of protein in the elderly remain the same as those in young and middle-aged people at 0.98 g/(kg·d).

OBJECTIVE

The objective of this study was to determine the protein requirements of healthy Chinese adults >65y old through use of the indicator amino acid oxidation (IAAO) method.

METHODS

Seven healthy adult men and 7 healthy adult women participated in the study, with protein intakes ranging from 0.3 to 1.8 g/(kg·d). The diets were isocaloric and provided energy at a 1.5 resting energy expenditure. Protein was given based on the lactalbumin. Phenylalanine and tyrosine were added to protein doses of 0.3-1.5 g/kg according to the highest dose of protein content [1.8 g/(kg·d)]. Phenylalanine and tyrosine concentrations were kept constant at each protein dose. The mean protein requirement was determined by applying a nonlinear mixed-effects model analysis to the F13CO2, which identified a breakpoint in F13CO2 in response to graded amounts of protein. This trial was registered with the Chinese clinical trial registry as ChiCTR-BOC-17010930.

RESULTS

Protein EAR and RNI for healthy elderly Chinese adults were determined to be 0.91 and 1.17 g/(kg·d), respectively, based on the indicator amino acid oxidation technique.

CONCLUSIONS

The estimates of protein requirements for Chinese adults >65 y in the present study are 3.4% and 19.4% higher than the current estimated requirements, 0.88 g/(kg·d) for EAR and 0.98 g/(kg·d) for RNI.

Protein intake in older people : Why, how much and how?

The protein intake of older people has gained increasing scientific interest as a potential factor to delay the age-associated decline in muscle mass and consequently to counteract the development of sarcopenia. The skeletal muscle of older people seems less responsive to the anabolic stimulus of protein intake. Therefore, higher protein needs are discussed to overcome this anabolic resistance and to maintain muscle mass as far as possible. Besides the total amount of protein consumed, the distribution, quality and timing in relation to physical exercise are considered relevant; however, deriving clear recommendations for clinical practice is still difficult as positive results of protein intake on muscle metabolism found in experimental trials cannot simply be transferred to everyday conditions and randomized controlled trials often failed to show improvements in muscular outcomes related to protein supplementation. The effectiveness of protein supplementation may depend on functional resources of the older persons and the habitual protein intake. There is still a need for studies with well-defined protocols and populations to further elucidate the role of protein in the prevention and treatment of sarcopenia.

Phenylketonuria, co-morbidity, and ageing: A review

Phenylketonuria (PKU) is a metabolic condition which, left untreated, results in severe and irreversible brain damage. Newborn screening and the development of the low phenylalanine (Phe) diet have transformed the outcomes for people with PKU. Those who have benefited from early treatment are now approaching their fifth and sixth decade. It is therefore timely to consider multi-morbidity in PKU and the effects of ageing, in parallel with the wider benefits of emerging treatment options in addition to dietary relaxation. We have conducted the first literature review of co-morbidity and ageing in the context of PKU. Avenues explored have emerged from limited study of multi-morbidity to date and the knowledge and critical enquiry of the authors. Findings suggest PKU to have a wider impact than brain development, and result in several intriguing questions that require investigation to attain the best outcomes for people with PKU in adulthood moving through to older age. We recognise the difficulty in studying longitudinal outcomes in rare diseases and emphasise the necessity to develop PKU registries and cohorts that facilitate well-designed studies to answer some of the questions raised in this review. Whilst awaiting new information in these areas we propose that clinicians engage with patients to make personalised and well-informed decisions around Phe control and assessment for co-morbidity.

Sarcopenia assessed by the quantity and quality of skeletal muscle is a prognostic factor for patients undergoing cardiac surgery

PURPOSE

Sarcopenia was assessed as a prognostic factor for patients undergoing cardiac surgery by evaluating the quantity and quality of skeletal muscle.

METHODS

Sarcopenia was assessed by perioperative abdominal computed tomography using the total psoas muscle index (TPI) and intra-muscular adipose tissue content (IMAC). Patients were classified into high- (HT, n = 143) and low- (LT, n = 63) TPI groups and low- (LI, n = 122) and high- (HI, n = 84) IMAC groups.

RESULTS

There were significantly more complications in the LT and HI groups than in the HT and LI groups. (HT 15.4% vs. LT 30.2%, P = 0.014) (LI 11.5% vs. HI 31.1%, P < 0.001). There were more respiratory complications in the LT group (HT 0% vs. LT 6.3%, P = 0.002) and more surgical site infections in the HI group than in the LI group (LI 0.8% vs. HI 7.1%, P = 0.014). A multivariable analysis showed that low TPI and high IMAC significantly predicted more major complications than other combinations (odds ratio [OR] 2.375; 95% confidence interval [CI] 1.152-5.783; P = 0.036, OR 3.973; 95% CI 1.737-9.088; P = 0.001).

CONCLUSIONS

Sarcopenia is a risk factor for complications. The quantity and quality of muscle must be assessed to predict operative outcomes.

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000027077.

The effect of nutritional counseling on muscle mass and treatment outcome in patients with metastatic colorectal cancer undergoing chemotherapy: A randomized controlled trial

BACKGROUND & AIMS

A low muscle mass before start of treatment and loss of muscle mass during chemotherapy is related to adverse outcomes in patients with cancer. In this randomized controlled trial, the effect of nutritional counseling on change in muscle mass and treatment outcome in patients with metastatic colorectal cancer during first-line chemotherapy was studied.

METHODS

Patients scheduled for first-line chemotherapy (n = 107) were randomly assigned to individualized nutritional counseling by a dietitian (NC) or usual care (UC). NC was aimed at sufficient protein- and energy intake, supported by oral supplements or enteral feeding if indicated. Furthermore, physical activity was encouraged. Outcomes were assessed at baseline (T0) and the time of the first (T1) and second (T2) regular follow-up computed tomography scans. The proportion of patients with a clinically relevant decrease in skeletal muscle area of ≥6.0 cm², measured by computed tomography, was the primary outcome. Secondary outcomes included body weight, quality of life, treatment toxicity and progression free and overall survival.

RESULTS

A total of 107 patients were enrolled (mean age, 65 years (SD, 11 years), 63% male). Mean change in skeletal muscle area from T0 till T1 was -2.5 (SD, 9.5) cm², with no difference between NC versus UC (p = 0.891). The proportion of patients with a clinically relevant decrease in skeletal muscle area of ≥6.0 cm² did not differ (NC 30% versus UC 31%, p = 0.467). NC compared with UC had a significant positive effect on body weight (B coefficient 1.7, p = 0.045), progression free survival (p = 0.039) and overall survival (p = 0.046).

CONCLUSIONS

NC of patients undergoing chemotherapy for metastatic colorectal cancer had no effect on muscle mass. However, we found that NC may increase body weight and improve progression free survival and overall survival compared to UC in this group of patients. These findings need further evaluation in future clinical trials.

CLINICAL TRIAL INFORMATION

ClinicalTrials.gov NCT01998152; Netherlands Trial Register NTR4223.

Sarcopenia in relation to nutrition and lifestyle factors among middle-aged and older Korean adults with obesity

PURPOSE

To examine the prevalence of sarcopenic obesity (SO) and its association with nutrition and lifestyle factors.

METHODS

Data from the 2008-2011 Korea National Health and Nutrition Examination Survey for 3937 Korean individuals aged 40 years or older with obesity defined by the modified Asia-Pacific criteria (BMI ≥ 25 kg/m²) were used. Sarcopenia was defined as an appendicular skeletal muscle mass divided by weight (%) of < 1 SD below the sex-specific mean for young adults. Logistic regression models were used for the associations controlling covariates.

RESULTS

The prevalence of SO was 52.5%. The SO group had insufficient energy intake, protein, and antioxidant micronutrients, a lower overall dietary quality, a lower physical activity, and higher rates of negative psychological factors than the non-sarcopenic obesity group (p < 0.05). After controlling for covariates, having high mean adequacy ratio scores which was calculated by averaging the sum of the nutrient adequacy ratios had a 94% lower prevalence of SO in the older individuals. Low participation in aerobic exercises had a 74% higher prevalence of SO in the older aged group, and high participation in flexibility exercises had a 11% lower prevalence of SO in the middle-aged group. Interestingly, negative psychological factors were found only in the middle-aged adults with SO (p < 0.05).

CONCLUSION

Sarcopenia was present in over half of the middle-aged and older Korean adults with obesity. Having high dietary quality, increased physical activity, and positive psychological health were associated with a low prevalence of SO.

The Role of Nutrition in Attenuating Age-Related Skeletal Muscle Atrophy

The elderly population is increasing rapidly worldwide, and we are faced with the significant challenge for maintaining or improving physical activity, independence, and quality of life. Sarcopenia, the age-related decline of skeletal muscle mass, is characterized by loss of muscle quantity and quality resulting to a gradual slowing of movement, a decrease in strength and power, elevated risk of fall-related injury, and often frailty. Supplemental, hormonal, and pharmacological approaches have been attempted to attenuate sarcopenia but these have not achieved outstanding results. In this review, we summarize the current knowledge of nutrition-based therapies for counteracting sarcopenia.

Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments

Sarcopenic obesity and diabetes are two increasing health problems worldwide, which both share many common risk factors, such as aging, and general obesity. The pathogenesis of sarcopenic obesity includes aging, physical inactivity, malnutrition, low-grade inflammation, insulin resistance, and hormonal changes. Nevertheless, there are two major reasons to cause diabetes: impaired insulin secretion and impaired insulin action. Furthermore, the individual diagnosis of obesity and sarcopenia should be combined to adequately define sarcopenic obesity. Also, the diagnosis of diabetes includes fasting plasma glucose test (FPG), 2-h oral glucose tolerance test (OGTT), glycated hemoglobin (A1C), and random plasma glucose coupled with symptoms. Healthy diet and physical activity are beneficial to both sarcopenic obesity and diabetes, but there are only recommended drugs for diabetes. This review consolidates and discusses the latest research in pathogenesis, diagnosis, and treatments of diabetes and sarcopenic obesity.

Exercise Countermeasures to Neuromuscular Deconditioning in Spaceflight

The mechanical unloading of spaceflight elicits a host of physiological adaptations including reductions in muscle mass, muscle strength, and muscle function and alterations in central interpretation of visual, vestibular, and proprioceptive information. Upon return to a terrestrial, gravitational environment, these result in reduced function and performance, the potential consequences of which will be exacerbated during exploration missions to austere and distant destinations such as the moon and Mars. Exercise is a potent countermeasure to unloading-induced physiological maladaptations and has been employed since the early days of spaceflight. In-flight exercise hardware has evolved from rudimentary and largely ineffective devices to the current suite onboard the International Space Station (ISS) comprised of a cycle ergometer, treadmill, and resistance exercise device; these contemporary devices have either fully protected or significantly attenuated neuromuscular degradation in spaceflight. However, unlike current microgravity operations on the ISS, future exploration missions will include surface operations in partial gravity environments, which will require greater physiological capacity and work output of their crews. For these flights, it is critical to identify physiological thresholds below which task performance will be impaired and to develop exercise countermeasures-both pre- and in-flight-to ensure that crewmembers are able to safely and effectively complete physically demanding mission objectives. © 2020 American Physiological Society. Compr Physiol 10:171-196, 2020.

The role of nutrition and physical activity in frailty: A review

Frailty is a clinical syndrome with a worldwide prevalence of 5-27% among those aged over 65 years. Frailty is characterised by loss of muscle strength and impaired physical function, and is associated with increased falls, hospitalisation and death. Nutritional deficiencies and low physical activity are common in this age group due to ill health, disability and reductions in enthusiasm, food intake and therefore, energy availability. Both low physical activity and inadequate dietary intake have a significant role to play in the onset and progression of frailty, primarily through bone and muscle health implications. Frailty is, however, preventable and reversible, and several interventions have been carried out to offset and reverse the condition. This article reports the recent evidence on the role of nutrition and physical activity in the pathogenesis of frailty and provides a critical review of previously implemented interventions focussed on physical activity and nutrition to prevent and reduce frailty among older adults.

Effect of Protein Supplementation on Physical Performance in Older People With Sarcopenia-A Randomized Controlled Trial

OBJECTIVES

To test the long-term effects of whey-enriched protein supplementation on muscle and physical performance.

DESIGN

A 12-month randomized controlled double blind trial with a 43-month of post-trial follow-up.

SETTING

Porvoo, Finland.

PARTICIPANTS

A total of 218 older (>74 years of age) community-dwelling people with sarcopenia.

INTERVENTION

(1) Control with no supplementation; (2) isocaloric placebo; and (3) 20 g × 2 whey-enriched protein supplementation. All participants were given instructions on home-based exercise, dietary protein, and vitamin D supplementation of 20 μg/d.

MEASUREMENTS

Physical performance was assessed by short physical performance battery and continuous summary physical performance scores. Hand grip strength and calf intracellular resistance based skeletal muscle index were measured by bioimpedance spectroscopy. The measurements were performed at 0, 6, and 12 months. The post-trial follow-up was performed by a postal questionnaire and national census record data.

RESULTS

The participants were older (75-96 years of age) and mostly women (68%). The test supplements had no significant effects on physical performance; the 12-month changes for short physical performance battery were -0.55, -.05, and 0.03 points in control, isocaloric, and protein groups (P = .17), respectively. The changes in continuous summary physical performance scores were similar between the intervention groups (P = .76). The hand grip strength decreased significantly in all intervention groups, and the 12-month changes in calf intracellular resistance-based skeletal muscle index were minor and there were no differences between the intervention groups. One-half of the patients (56%) in both supplement groups reported mild gastrointestinal adverse effects. Differences were found neither in the all-cause mortality nor physical functioning in the post-trial follow-up.

CONCLUSIONS

The whey-enriched protein supplementation in combination with low intensity home-based physical exercise did not attenuate the deterioration of muscle and physical performance in community-dwelling older people with sarcopenia.

Dietary Requirements for Proteins and Amino Acids in Human Nutrition

Background:

An optimal dietary Amino Acid (AA) intake is necessary for the growth of body proteins. A new method for protein quality evaluation called Digestible Indispensable AA Score (DIAAS) was established. Despite that the information about dietary AA requirements are available for different stages of life, in practical conditions, most people deal only with the dietary proteins, if ever.

Objective:

The aim of this mini-review was to analyze the protein quality of protein sources by DIAAS and to find AA and protein dietary requirements in human nutrition.

Methods:

A literature research was performed using the keyword “amino acid”, “diet”, “nutrition”, “human”, “muscle” and “requirement” individually or all together, in Scopus, Web of Science and Pubmed.

Results:

The optimum amount of dietary AA is necessary for AA utilization in the body and is limited by AA which is present in the lowest amount; the surplus of other AA is not utilized in the body. Food and Agriculture Organization reported requirements for dietary protein and AA intake for infants, children, however for adults (over 18) for maintenance. Most of the studies which are dealing with the dietary AA requirements in sports nutrition are aimed at the blends of AA and for branched-chain AA. Concerning the protein quality, at this time, there is little information about the protein quality evaluated by DIAAS method.

Conclusion:

Dietary intake of high-quality protein or a blend of different proteins will provide all AA to the body. However, studies on protein quality evaluation by DIAAS method are necessary to perform.

Dietary Protein and Amino Acids in Vegetarian Diets-A Review

While animal products are rich in protein, the adequacy of dietary protein intake from vegetarian/vegan diets has long been controversial. In this review, we examine the protein and amino acid intakes from vegetarian diets followed by adults in western countries and gather information in terms of adequacy for protein and amino acids requirements, using indirect and direct data to estimate nutritional status. We point out that protein-rich foods, such as traditional legumes, nuts and seeds, are sufficient to achieve full protein adequacy in adults consuming vegetarian/vegan diets, while the question of any amino acid deficiency has been substantially overstated. Our review addresses the adequacy in changes to protein patterns in people newly transitioning to vegetarian diets. We also specifically address this in older adults, where the issues linked to the protein adequacy of vegetarian diets are more complex. This contrasts with the situation in children where there are no specific concerns regarding protein adequacy because of their very high energy requirements compared to those of protein. Given the growing shifts in recommendations from nutrition health professionals for people to transition to more plant-based, whole-food diets, additional scientific evidence-based communications confirming the protein adequacy of vegetarian and vegan diets is warranted.

Study of the cartilage matrix production-promoting effect of chicken leg extract and identification of the active ingredient

BACKGROUND/OBJECTIVES

Osteoarthritis (OA) is a major public health issue in Japan and other countries, and foods that prevent or treat OA are in strong demand. Proteins and peptides in chicken meat and bones are known for being rich in functional and nutritional ingredients for the improvement of osteoporosis. We speculated that chicken legs, a food consumed in many regions of the world, may also contain such ingredients. In this study, we aim to (i) evaluate the effect of chicken leg extract (CLE) on the promotion of cartilage matrix production and (ii) identify the active ingredient in CLE that contributes to this function.

MATERIALS/METHODS

Artificial CLE digest was prepared, and the acid mucopolysaccharide production-promoting activity of the CLE digest was evaluated by alcian blue staining of ATDC5 cells. CLE was orally administered to rabbits with burr holes in the knee joint of the femur, and the degree of regeneration of cartilage matrix was evaluated. Furthermore, we investigated orally administered CLE-derived peptides in human plasma using LC-MS. From measuring the acid mucopolysaccharide production-promotion activity of these peptides, a molecule considered to be an active ingredient in the CLE digest was identified.

RESULTS

CLE digest promoted acid mucopolysaccharide production and facilitated regeneration of cartilage matrix in in vitro and in vivo experiments. Four peptides including phenylalanyl-hydroxyproline (Phe-Hyp) were detected as CLE-derived peptides in human plasma. The effect of CLE was inferred to be due to Phe-Hyp, which was confirmed to be present in the CLE digest.

CONCLUSIONS

It was shown that CLE stimulated the production of articular cartilage matrix both in vitro and in vivo, and that CLE could be an effective food for preventing or treating OA. Furthermore, only Phe-Hyp was confirmed as the active compound in the CLE digest, suggesting that the activity of CLE was due to Phe-Hyp.

Protein intake per day and at each daily meal and skeletal muscle mass declines among older community dwellers in Japan

Objective:

To examine associations between protein intake per day and at different meals and skeletal muscle mass declines.

Design:

Two-year prospective cohort study among older community dwellers.

Setting:

National Institute for Longevity Sciences–Longitudinal Study of Aging (NILS-LSA) in Japan.

Participants:

Older men (n 292) and women (n 363) aged 60–87 years who participated in the baseline (2006–2008) and follow-up studies (2008–2010) of NILS-LSA and did not exhibit low skeletal muscle mass at baseline. Muscle mass was assessed using dual-energy X-ray absorptiometry at baseline and follow-up. Low muscle mass was defined as skeletal muscle mass index <7·0 kg/m2 for men and <5·4 kg/m2 for women at follow-up. Daily protein intake and protein intake at each meal were calculated from 3 d dietary records at baseline and sex-stratified tertiles were determined.

Results:

Mean (sd) protein intake at breakfast, lunch and dinner was 22·7 (7·8), 26·7 (9·3) and 37·4 (10·5) g for men and 19·3 (6·3), 23·2 (7·3) and 28·5 (7·0) g for women, respectively. After adjusting for age, baseline skeletal muscle mass and other confounders in logistic modelling, greater total protein intake was associated with lower prevalence of skeletal muscle mass decline among men at follow-up (P = 0·024). Particularly, the OR (95 % CI) for high lunchtime protein intake was low (0·11 (0·02, 0·61); P = 0·01). No significant association between total protein intake and prevalence of skeletal muscle mass decline was found among women.

Conclusions:

High total protein intake, particularly at lunchtime, is associated with retention of skeletal muscle mass in men.

Advantage of Dairy for Improving Aging Muscle

The risk of sarcopenia increases with aging. Malnutrition in the elderly population is an important risk factor for sarcopenia. Calcium (Ca), phosphate (P), vitamin D and protein are key nutrients for the human body and affect muscle mass and quality. Dairy products are rich in these nutrients, which implicates that dairy products might be ideal for elderly population. This systematic review highlights the effects of dairy products on muscle mass, muscle strength and body performance in the elderly population in the perspective of Ca, P, vitamin D and protein.

A Vitamin D, Calcium and Leucine-Enriched Whey Protein Nutritional Supplement Improves Measures of Bone Health in Sarcopenic Non-Malnourished Older Adults: The PROVIDE Study

Alterations in musculoskeletal health with advanced age contribute to sarcopenia and decline in bone mineral density (BMD) and bone strength. This decline may be modifiable via dietary supplementation. To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of bone health. Participants (n 380) were participants of the PROVIDE study, a 13-week, multicenter, randomized, controlled, double-blind, 2 parallel-group study among non-malnourished older participants (≥ 65 years) with sarcopenia [determined by Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index (SMI; skeletal muscle mass/BW × 100) ≤ 37% in men and ≤ 28% in women using bioelectric impedance analysis] Supplementation of a vitamin D, calcium and leucine-enriched whey protein drink that comprises a full range of micronutrients (active; 2/day) was compared with an iso-caloric control. Serum 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), biochemical markers of bone formation (osteocalcin; OC, procollagen type 1 amino-terminal propeptide; P1NP) and resorption (carboxy-terminal collagen crosslinks; CTX), insulin like growth factor 1 (IGF-1) and total-body BMD were analysed pre- and post-intervention. Serum 25(OH)D concentrations increased from 51.1 ± 22.9 nmol/L (mean ± SD) to 78.9 ± 21.1 nmol/L in the active group (p < 0.001 vs. control). Serum PTH showed a significant treatment difference (p < 0.001) with a decline in the active group, and increase in the control group. Serum IGF-1 increased in the active group (p < 0.001 vs. control). Serum CTX showed a greater decline in the active group (p = 0.001 vs. control). There were no significant differences in serum OC or P1NP between groups during the intervention. Total body BMD showed a small (0.02 g/cm²; ~ 2%) but significant increase in the active group after supplementation (p = 0.033 vs. control). Consuming a vitamin D, calcium and leucine-enriched whey protein supplement for 13 weeks improved 25(OH)D, suppressed PTH and had small but positive effects on BMD, indicative of improved bone health, in sarcopenic non-malnourished older adults.

The ConsuMEER study: a randomised trial towards the effectiveness of protein-rich ready-made meals and protein-rich dairy products in increasing protein intake of community-dwelling older adults after switching from self-prepared meals towards ready-made meals

The risk of undernutrition in older community-dwelling adults increases when they are no longer able to shop or cook themselves. Home-delivered products could then possibly prevent them from becoming undernourished. This single-blind randomised trial tested the effectiveness of home-delivered protein-rich ready-made meals and dairy products in reaching the recommended intake of 1·2 g protein/kg body weight (BW) per d and ≥25 g of protein per meal. Community-dwelling older adults (n 98; mean age 80·4 (sd 6·8) years) switched from self-prepared to home-delivered hot meals and dairy products for 28 d. The intervention group received ready-made meals and dairy products high in protein; the control group received products lower in protein. Dietary intake was measured at baseline, after 2 weeks (T1), and after 4 weeks (T2). Multilevel analyses (providing one combined outcome for T1 and T2) and logistic regressions were performed. Average baseline protein intake was 1·09 (se 0·05) g protein/kg BW per d in the intervention group and 0·99 (se 0·05) g protein/kg BW per d in the control group. During the trial, protein intake of the intervention group was 1·12 (se 0·05) g protein/kg BW per d compared with 0·87 (se 0·03) g protein/kg BW per d in the control group (between-group differences P < 0·05). More participants of the intervention group reached the threshold of ≥25 g protein at dinner compared with the control group (intervention T1: 84·8 %, T2: 88·4 % v. control T1: 42·9 %, T2: 40·5 %; P < 0·05), but not at breakfast and lunch. Our findings suggest that switching from self-prepared meals to ready-made meals carries the risk of a decreasing protein intake, unless extra attention is given to protein-rich choices.

Nutritional Strategies to Combat Type 2 Diabetes in Aging Adults: The Importance of Protein

The prevalence of pre-diabetes (PD) and type II diabetes (T2D) has risen dramatically in recent years affecting an estimated 422 million adults worldwide. The risk of T2D increases with age, with the sharpest rise in diagnosis occurring after age 40. With age, there is also a progressive decline in muscle mass starting after the age of 30. The decline in muscle mass and function due to aging is termed sarcopenia and immediately precedes the sharp rise in T2D. The purpose of the current review is to discuss the role of protein to attenuate declines in muscle mass and insulin sensitivity to prevent T2D and sarcopenia in aging adults. The current recommended dietary allowance for protein consumption is set at 0.8 g/kg/day and is based on dated studies on young healthy men and may not be sufficient for older adults. Protein consumption upwards of 1.0-1.5 g/kg/day in older adults is able to induce improvements in glycemic control and muscle mass. Obesity, particularly central or visceral obesity is a major risk factor in the development of PD and T2D. However, the tissue composition of weight loss in older adults includes both lean body mass and fat mass and therefore may have adverse metabolic consequences in older adults who are already at a high risk of lean body mass loss. High protein diets have the ability to increase weight loss while preserving lean body mass therefore inducing "high-quality weight loss," which provides favorable metabolic changes in older adults. High protein diets also induce beneficial outcomes on glycemic markers due to satiety, lowered post-prandial glucose response, increased thermogenesis, and the ability to decrease rates of muscle protein breakdown (MPB). The consumption of dairy specific protein consumption has also been shown to improve insulin sensitivity by improving body composition, enhancing insulin release, accelerating fat oxidation, and stimulating rates of muscle protein synthesis (MPS) in older adults. Exercise, specifically resistance training, also works synergistically to attenuate the progression of PD and T2D by further stimulating rates of MPS thereby increasing muscle mass and inducing favorable changes in glycemic control independent of lean body mass increases.

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND

Frailty is common and associated with poorer outcomes in the elderly, but its prognostic value in acute coronary syndromes (ACS) requires clarification. We thus undertook a systematic review and meta-analysis to evaluate the relationship between frailty and poor prognosis in patients with ACS.

METHODS

We systematically searched PubMed, Embase to find literatures which studied the prognostic value of frailty in elderly patients with ACS. Our main endpoints were the all-cause mortality, cardiovascular disease (CVD), major bleeding and readmissions. We pooled studies using random-effect generic inverse variance method, and conducted three pre-specified subgroup analyses.

RESULTS

Of 1216 identified studies, 15 studies were included in our analysis. Compared with the normal group, frailty (HR = 2.65; 95%CI: 1.81-3.89, I2 = 60.2%) and pre-frailty (HR = 1.41; 95%CI: 1.19-1.66, I2 = 0%) were characterized by a higher risk of mortality after adjustment. Frailty also was associated with increased risk of any-type CVD, major bleeding and hospital readmissions in elderly patients with ACS. The pooled effect sizes in frail patients were 1.54 (95%CI: 1.32-1.79), 1.51 (95%CI: 1.14-1.99) and 1.51 (95%CI: 1.09-2.10).

CONCLUSIONS

Frailty provides quantifiable and significant prognostic value for mortality and adverse events in elderly ACS patients, helping doctors to appraise the comprehensive prognosis risk and to applicate appropriate management strategies.

POSSIBLE ROLE OF NUTRITION IN PREVENTION OF SARCOPENIA AND FALLS

Objective: In this review, we analyze the foundation of sarcopenia as a potentially modifiable risk factor for falls, and we try to formulate practical strategies for nutritional interventions aimed at reducing the risk for sarcopenia and falls in our elderly patients. Methods: An extensive literature search was performed using the PubMed and the Google Scholar databases. Results: Falls are a common and costly source of injury and death in elderly adults. A large proportion of injurious falls are due to a trip or slip, suggesting that muscular factors are major determinants of both fall risk and the risk for fall-related injury. Conclusion: An increasing body of evidence links sarcopenia, the loss of muscle strength and mass that occurs with advancing age, with an increased risk for falls. Nutritional factors, as well as exercise, can help with both prevention and treatment of sarcopenia and may reduce the risk of falls in the elderly. Abbreviations: 25-OHD = 25-hydroxyvitamin D; EAA = essential amino acid; IGF-1 = insulin-like growth factor 1; IU = international units; MPS = muscle protein synthesis; PUFA = polyunsaturated fatty acid.

Food avoidance is associated with reduced dentitions and edentulousness

OBJECTIVES

To investigate associations between food avoidance and dental status, age, gender, and socio-economic status (SES).

MATERIALS AND METHODS

The Chinese sample comprised 1463 dentulous (≥ 1 tooth in each jaw) and 124 edentulous (in one or both jaws) participants aged ≥ 40 yrs. The Vietnamese sample comprised 2820 dentulous and 253 edentulous participants aged ≥ 20 yrs. Food avoidance due to chewing difficulties was scored for regionally common 4 soft and 4 hard foods. Dental status was classified according to the multi-level hierarchical dental functional classification system (HDFC) based on the number and location of teeth and posterior occlusal pairs. Associations were analyzed using multivariate logistic regression analyses.

RESULTS

For dentulous participants, the chance of avoiding foods was significantly larger with < 10 teeth in each jaw (OR = 2.26 (Chinese sample), respectively 1.74 (Vietnamese sample)), incomplete anterior region (OR = 1.78, respectively 1.84), "impaired" premolar region (OR = 2.22, respectively 1.71), or "impaired" molar region (OR = 2.46, respectively 1.84). Edentulous participants had twice the chance of avoiding foods (OR = 2.01 respectively 2.20). Avoiding foods was significantly associated with higher age. Participants of low SES (Chinese sample, OR = 1.93) and females (Vietnamese sample, OR = 1.27) had a larger chance of avoiding foods.

CONCLUSIONS

Avoiding foods was significantly associated with reduced dentitions, edentulousness, and higher age; low SES only in the Chinese and being female only in the Vietnamese sample.

CLINICAL RELEVANCE

Incomplete anterior regions, "impaired" premolar or molar regions, and especially edentulousness can be considered significant risk indicators for food avoidance.