Optimal protein intake in the elderly

Effect of protein and amino acids supplements on muscle strength and physical performance: A scoping review of randomized controlled trials

Protein and amino acid supplementation is an effective intervention that significantly enhances physical function and reduces frailty and sarcopenia in older adults. This scoping review aims to map and synthesize the available evidence on the effects of various types of protein and amino acid supplementation in this population. Following the PRISMA-ScR guidelines, we conducted a literature search to identify clinical trials examining the effects of protein and amino acid supplementation, with or without physical exercise, on muscle strength, physical performance, and body composition in healthy, frail, or sarcopenic older adults. Our analysis of 80 trials with a total of 5290 participants examines the evidence for the effectiveness of protein supplementation in enhancing muscle strength and body composition. Whey protein, creatine, milk protein, leucine, essential amino acids, and soy protein were the most used types of protein, and our findings indicate that whey protein, creatine, and milk protein yield the best results when used in conjunction with resistance training. Additionally, leucine and milk protein have shown the potential to enhance body composition even without concurrent resistance training. In conclusion, studies on the effectiveness of whey protein in improving muscle strength and body composition in older adults with resistance training are inconsistent. More research is required to explore the potential benefits of soy and leucine-enriched supplements. Protein supplementation's impact on physical performance remains inconclusive. Further studies are needed to determine the effects of protein types and supplementation on muscle-related parameters in older adults.

A nutrient wide association study of cardiovascular disease prevalence in older adults from NHANES 2007 to 2018

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly among older adults. Identifying modifiable dietary factors associated with CVD prevalence is essential for prevention. This cross-sectional study analyzed 7,341 adults aged ≥ 65 years from NHANES 2007-2018. CVD was defined based on self-reported physician-diagnosed conditions, including coronary heart disease, heart failure, angina, heart attack, or stroke. A nutrient-wide association study (NWAS) evaluated associations between 56 dietary nutrients and CVD prevalence using multivariable logistic regression. Dose-response relationships were assessed using restricted cubic spline (RCS) models. Model discrimination was evaluated using receiver operating characteristic (ROC) analysis. Eight nutrients were significantly associated with CVD prevalence after adjusting for confounders and correcting for multiple comparisons: PUFAs 20:4 (OR 0.88, 95% CI 0.80-0.97, P = 0.024), 22:5 (OR 0.72, 95% CI 0.56-0.92, P = 0.019), and 22:6 (OR 0.92, 95% CI 0.87-0.99, P = 0.032); total choline (OR 0.96, 95% CI 0.93-0.99, P = 0.024); cholesterol (OR 0.89, 95% CI 0.82-0.96, P = 0.037); protein (OR 0.82, 95% CI 0.76-0.89, P = 0.040); vitamin A (OR 0.95, 95% CI 0.91-0.99, P = 0.045); and total sugars (OR 0.97, 95% CI 0.96-0.98, P = 0.049). Clustering analysis identified protective effects of fat-soluble vitamins and unsaturated fatty acids. The inclusion of these nutrients significantly improved model discrimination (P < 0.05). This study identified key dietary nutrients and clusters associated with CVD prevalence and characterized their dose-response relationships. Integrating these nutrients into predictive models enhances CVD risk discrimination, providing actionable dietary targets for prevention strategies in older adults.

Elderly Perception of Protein Products in Relation to Their Neophobic Attitude and Nutritional Protein Knowledge

This study examined the elderly response to protein-rich food measured in two contexts: Study 1, expected condition toward six commercial products; and Study 2, tasting the products (two protein breads) with special focus on the impact of individual food neophobia (FN) attitude and protein knowledge (PK). The initial study yielded findings indicating that the products were differentiated based on their similarity to the participants' usual dietary intake. Furthermore, differences were observed between participants with high and low levels of FN. In the first group, unfamiliar products were perceived as less healthy, less trustworthy, and more unusual than familiar products. Moreover, unfamiliar products elicited lower purchase intention. Similarly, low levels of PK also affected the perception of unfamiliar foods, albeit to a lesser extent. In Study 2, elderly individuals with a high level of FN also exhibited reduced purchase intention and a lower level of agreement that the product would be liked. Participants also perceived the products as less healthy, less satiating, and unsustainable for eating legumes. However, PK did not affect this response. These studies demonstrate the profound impact of FN on the aging process, influencing the rejection of protein-enriched products and impeding the ability to perceive the benefits of novel products.

Dietary protein requirements of older adults with sarcopenia determined by the indicator amino acid oxidation technology

Background

Although protein supplementation may be desirable in the management of sarcopenia, the appropriate protein requirements for older adults with sarcopenia are presently unclear.

Objective

The aim of this study was to determine the protein requirements of older adults (65-81 year) with sarcopenia by using the indicator amino acid oxidation (IAAO) technology.

Methods

Nine older adults with sarcopenia (four male participants and five female participants) participated in the study, with protein intakes ranging from 0.1 to 1.8 g/(kg·d). Each participant consumed an adapted diet with a protein level of 1.0 g/(kg·d) and 1.7 resting energy expenditure (REE) for 2 day. Day 3 was the oxidation day of the study. Diets that delivered energy at a 1.5 × REE were isocaloric. The amounts of phenylalanine and tyrosine maintained at a constant across intakes. Therefore, phenylalanine and tyrosine were added to the protein doses of 0.1-1.5 g/kg, which was based on the highest dose of lactalbumin content [1.8 g/(kg·d)]. Applying a non-linear mixed-effects model analysis of F13CO2, the protein requirement was determined by identifying the breakpoint in the F13CO2 data with graded amounts of dietary protein.

Results

The mean estimated average requirement (EAR) and recommended nutrient intake (RNI) of protein for older adults with sarcopenia were 1.21 (95% CI: 0.95, 1.46) and 1.54 (95% CI: 1.13, 1.95) g/(kg·d), respectively.

Conclusions

To our knowledge, this is the first study of protein intake in older adults with sarcopenia and indicates that older adults with sarcopenia may require a higher intake of dietary protein.

Clinical trial registration

http://www.chictr.org.cn, ChiCTR2200061383.

Optimizing Nutritional Management Before and After Bariatric Surgery: A Comprehensive Guide for Sustained Weight Loss and Metabolic Health

Obesity is associated with multiple comorbidities that contribute to increased mortality among affected individuals. There are multiple treatments for this condition, including nutritional interventions, pharmacological therapies, and surgical procedures. Within these, bariatric surgery is an effective treatment option that requires a multidisciplinary approach, both before and after surgery. Nutritional management prior to surgery aims to achieve metabolic control and reduce comorbidities associated with the procedure. Postoperative nutritional management focuses on preventing complications, ensuring adequate nourishment, and providing necessary supplementation for optimal recovery and long-term success. This narrative review examines all these critical aspects of nutritional management in bariatric surgery, including preoperative nutrition, postoperative nutrition and physical activity recommendation, different nutritional aspects according to the type of bariatric surgery, and future directions for investigation.

Alteration of Mastication Force via Intraoral Closed-loop Electrical Stimulation

Mastication plays an important role in effective food digestion and nutrient absorption. Therefore, regulating masticatory force in people with declining mastication function is significant for maintaining health and quality of life. In this study, we tested the effect of tactile augmentation on mastication force. To augment tactile feedback during mastication, we applied closed-loop electrical stimulation onto the mandibular vestibule using an intraoral tooth-borne electronic system. We hypothesized that closed-loop electrical stimulation, timed with mastication and applied to the nerves delivering tactile feedback to the brain, would evoke an increase in masticatory force. Experiments were completed using the intraoral system with six healthy human subjects who masticated soft and hard foods with and without stimulation during the experiment. Their mastication forces were recorded ten times per condition. The recorded mastication force profile showed that mastication force was higher with the harder food. Also, mastication force increased when electrical stimulation was applied, compared to the non-stimulated condition. These results support the hypothesis that tactile augmentation by intraoral closed-loop electrical stimulation will increase masticatory force. Other mastication parameters including period, spike width, and duty cycle are also changed by electrical stimulation. Further, stimulation left a strong aftereffect on these mastication parameters.

Testosterone and resistance training improved physical performance and reduced fatigue in frail older men: 1 year follow-up of a randomized clinical trial

OBJECTIVE

To improve health conditions among hypogonadal men ≥70 years of age using testosterone undecanoate (TU) injections, progressive strength training, and oral supplements of vitamin D, calcium, and protein.

METHODS

This study is a 1-year follow-up of a double-blind RCT lasting 20 weeks, including 148 older men ≥70 years old with low testosterone levels and mobility problems. During 52 weeks, 4 groups received either testosterone therapy (TU) or progressive resistance training (Training), both (Combo), or no intervention (Controls). Physiotherapists supported the training groups until week 20, while these participants continued trained on their own during weeks 21 to 52. The main outcome measure was the 30-s chair stand test.

RESULTS

The following numbers of participants completed the trial: 20 (Combo), 20 (Controls), 24 (TU), and 14 (Training). When examining 30-s chair stand test performance within each group at baseline, and at weeks 4, 20 and 52, only the Combo group improved (p = 0.001, Friedman Test). Compared to controls, only the Combo group experienced reduced fatigue and tiredness (p < 0.05).

CONCLUSIONS

Fifty-two weeks of testosterone supplementation combined with progressive resistance training may enhance physical performance, alleviate fatigue, and had no notable detrimental impacts among males aged ≥70 suffering from mobility issues and testosterone insufficiency.Trial registration - Clinical Trials NCT02873559.

Consideration of the role of protein quality in determining dietary protein recommendations

The quality of a dietary protein refers to its ability to provide the EAAs necessary to meet dietary requirements. There are 9 dietary amino acids that cannot be metabolically produced in the body and therefore must be consumed as part of the diet to avoid adverse metabolic consequences. These essential amino acids (EAAs) serve a variety of roles in the body. The amount and profile of the dietary EAAs relative to the individual EAA requirements and the digestibility of the dietary protein are the key factors that determine its quality. Currently the Digestible Indispensable Amino Acid Score (DIAAS) is the best available approach to quantifying protein quality. The most prominent metabolic role of dietary EAAs is to stimulate protein synthesis by serving as signals to activate molecular mechanisms responsible for the initiation of protein synthesis and, most importantly, to provide the necessary precursors for the synthesis of complete proteins. Current dietary recommendations generally do not consider protein quality. Accounting for protein quality in dietary patterns can be accomplished while staying within established ranges for dietary protein consumption. Poor protein quality can be compensated for to some extent by eating more low-quality protein, but to be effective ("complementary") the limiting EAA must differ between the low-quality protein and the base diet to which it is being supplemented. Adding a high-quality protein to a dietary pattern based on low-quality protein is more effective in meeting EAA goals than increasing the amount of low-quality protein, even if the low-quality proteins are complementary. Further, reliance entirely on low-quality protein food sources, particularly in circumstances that may benefit from a level of dietary EAAs greater than minimal requirements, is likely to include excessive caloric consumption. While protein consumption in high-income nations is generally perceived to be adequate or even excessive, assessment of dietary patterns indicates that a significant percentage of individuals may fall short of meeting optimal levels of EAA consumption, especially in circumstances such as aging in which the optimal EAA consumption is greater than basal values for healthy young individuals. The case is made that protein quality is an important consideration in meeting EAA requirements.

Effects and Mechanisms of TikTok Use on Self-Rated Health of Older Adults in China During the COVID-19 Pandemic: A Mediation Analysis

BACKGROUND/OBJECTIVES

During the COVID-19 pandemic, TikTok emerged as a significant app for entertainment and information acquisition for the general public, gradually extending its reach to the older population. Digital technology, exemplified by TikTok, has become an indispensable part of older adults' lives. However, while prior studies have extensively focused on the impact of internet use on older adults' health, research on the impact of TikTok during the COVID-19 pandemic remains insufficient.

METHODS

Utilizing data from the China Family Panel Studies (CFPS) 2020, this study explored the impact of TikTok use on older adults' self-rated health and its underlying mechanisms through multiple regression and mediation analysis.

RESULTS

The study found that (1) TikTok use had a significant positive effect on the self-rated health of older adults; (2) while TikTok use increased the exercise frequency of older adults, exercise frequency did not affect their self-rated health; and (3) TikTok use boosted older adults' protein intake, contributing substantially to their self-rated health, accounting for 38.7% of the total effect.

CONCLUSIONS

It is advisable to actively promote the popularity of short video apps such as TikTok among older adults, as they serve as an effective tool for disseminating health information and encouraging healthier lifestyles and behaviors.

Intragastric restructuring dictates the digestive kinetics of heat-set milk protein gels of contrasting textures

The gelation of milk proteins can be achieved by various means, enabling the development of diverse products. In this study, heat-set milk protein gels (15 % protein) of diverse textures were made by pH modulation and two gels were selected for dynamic in vitro gastric digestion: a spoonable soft gel (SG, pH 6.55' G' of ∼100 Pa) and a sliceable firm gel (FG, pH 5.65; G' of ∼7000 Pa). The two gels displayed markedly different structural changes and digestion kinetics during gastric digestion. The SG underwent substantial structural compaction during the first 120 min of gastric digestion into a denser and firmer gastric chyme (26.3 % crude protein, G* of ∼8500 Pa) than the chyme of the FG (15.7 % crude protein, G* of ∼3000 Pa). These contrasting intragastric structural changes of the gels reversed their original textural differences, which led to slower digestion and gastric emptying of proteins from the SG compared with the FG. The different intragastric pH profiles during the digestion of the two gels likely played a key role by modulating the proteolytic activity and specificity (to κ-casein) of pepsin. Preferential early cleavage of κ-casein in SG stimulated coagulation and compaction of solid chyme, whereas rapid hydrolysis of αS- and β-caseins in the FG weakened coagulation. This study provided new insights into controlling the structural development of dairy-based foods during gastric digestion and modulating digestion kinetics.

The effect of a nicotine-rich diet with/without redistribution of dietary protein on motor indices in patients with Parkinson's disease: A randomized clinical trial

BACKGROUND

The aim of designing this clinical trial is to investigate the impact of a nicotine-rich diet with/without protein redistribution on the motor indices of patients with Parkinson's disease (PD).

METHODS

We randomly divided 45 patients (age > 50) with PD into three groups including: nicotine-rich diet (20 µg per day) group (group N; n = 15), nicotine-rich diet with protein redistribution group (group N + P; n = 15), and control group (group C; n = 15). In all group, the diet was isocaloric, and participants received six meals and snacks. After 12 weeks, the Unified Parkinson's Disease Rating Scale part III (UPDRS), serum alpha-synuclein levels, serum apolipoprotein A1, serum cotinine, and anthropometric parameters were measured in the three groups before and 12 weeks after the beginning of the study.

RESULTS

All of the enrolled patients completed the study. The UPDRS score was improved by 1.47 and 1.95 units in the N and N + P groups compared to the placebo (P < 0.001). On the other hand, effect size of N and N + P diets for α-synuclein were -52.82 and -175.85, respectively. The differences were significant compared to the control group (P < 0.05). Also, the effect of the both diets on serum cotinine compared to the control group was significant (P < 0.05). Although the effect size for UPDRS, α-synuclein, and cotinine in N + P diet were higher than N group, the differences were not statistically significant (P > 0.05). Also, the obtained results showed that there were no significant effects on anthropometric variables and serum levels of Apolipoprotein A1 in diet-receiving groups (P > 0.05).

CONCLUSIONS

The results of our study indicated that nicotine consumption in an isocaloric diet, while preventing a decrease in anthropometric indices, leads to improvements in motor indices and a reduction in alpha-synuclein levels. Additional and larger controlled trials are required to validate these findings.

Nutritional intervention during a teleprehabilitation pilot study in high-risk patients with colorectal cancer: adherence, motivators, and barriers

PURPOSE

The preoperative period provides a window of opportunity to improve modifiable risk factors for treatment complications such as malnutrition, the so-called prehabilitation. Identifying factors related to adherence to nutritional interventions is essential for optimizing prehabilitation programs. The aim of this study is to evaluate a nutritional support module as part of a teleprehabilitation program in high-risk patients with colorectal cancer (CRC).

METHODS

A secondary analysis with a mixed method design of the nutritional support module of a pre-post teleprehabilitation pilot study was performed. Change in weight, complaints with intake, motivation, and subjective and objective adherence were evaluated.

RESULTS

Eleven patients were included. Subjectively, six patients (55%) were able to adhere to the nutritional advice. Despite that, nine of eleven (82%) patients experienced difficulties with the amount of food that was advised by the dietician. Six of eleven (55%) patients gained weight during the prehabilitation program. After prehabilitation, nine of eleven (82%) were able to reach 100% of their energy requirement and six of eleven (55%) were able to reach 100% of their protein requirement. Differences between patients in motivation and/or having complaints did not seem to be associated with protein and energy intake.

CONCLUSION

This secondary analysis of a pilot study provides insights into understanding patients' experiences with a nutritional support module as part of a teleprehabilitation program. With 82% of patients who were able to reach 100% of their energy requirement, teleprehabilitation seems to be feasible, while there is still room for improvement with respect to protein intake as only 55% of patients reached a sufficient intake.

Unveiling the Nutritional Quality of Terrestrial Animal Source Foods by Species and Characteristics of Livestock Systems

Background. It is well-established that a range of macronutrients, micronutrients and bioactive compounds found in animal-source foods play unique and important roles in human health as part of a healthy diet. Methods. This narrative review focuses on terrestrial animal source foods (TASFs). It particularly analyzes five groups: poultry eggs, milk, unprocessed meat, foods from hunting and wildlife farming, and insects. The objectives were as follows: (1) examine the nutrient composition of TASFs within and across livestock species, drawing on the country and regional food composition databases; (2) analyze the influence of intrinsic animal characteristics and production practices on TASF nutritional quality. Results. TASFs are rich in high-quality proteins and fats, as well as micronutrients such as vitamin B12, iron or zinc. This study found differences in the nutritional quality of TASFs by livestock species and animal products, as well as by characteristics of livestock production systems. Our findings suggest that there may be public health opportunities by diversifying TASF consumption across species and improving certain aspects of the production systems to provide products that are both more sustainable and of higher quality. Conclusions. Future research should adopt a more holistic approach to examining the food matrix and the dietary patterns that influence TASF digestibility. It is necessary to include meat from hunting and wildlife farming and insects in global food composition databases, as limited literature was found. In addition, scarce research focuses on low- and middle-income countries, highlighting the need for further exploration of TASF food composition analysis and how intrinsic animal characteristics and livestock production system characteristics impact their nutritional value.

Large Discordance between Creatinine-Based and Cystatin C-Based eGFRs is Associated with Falls, Hospitalizations, and Death in Older Adults

Key Points

A large eGFR discordance (i.e ., cystatin C–based eGFR >30% lower than creatinine-based eGFR) is common in older adults and increased with age. A large eGFR discordance was associated with increased risk of falls, hospitalization, and death, independent of kidney function. There are multiple ways to measure differences in creatinine and cystatin C; all produce similar associations with aging-related adverse outcomes.

Background

eGFR calculated using creatinine and cystatin C often differ in older adults. We hypothesized that older adults with cystatin C–based eGFR (eGFRcys) values significantly lower than creatinine-based eGFR (eGFRcr) values may have higher risk of aging-related adverse outcomes, independent of kidney function.

Methods

We conducted a longitudinal cohort study of adults 65 years and older from the Health and Retirement Study, a cohort of older American adults, to determine the relationship between eGFR discordance and aging-related adverse outcomes. We calculated eGFRcr and eGFRcys using baseline creatinine and cystatin C measurements. A large eGFR discordance was defined as eGFRcys >30% lower than eGFRcr. We assessed four aging-related adverse outcomes over a 2-year follow-up: falls, hip fractures, hospitalizations, and death. We fit separate multivariable regression models to determine the association between having a large eGFR discordance and each outcome adjusting for confounders, including kidney function.

Results

Of 5574 older adults, 1683 (30%) had a large eGFR discordance. Those with a large eGFR discordance were more likely to be older, female, and White. The prevalence of a large eGFR discordance increased with age, from 20% among those 65–69 years to 44% among those 80 years and older. Over a 2-year follow-up, there were 305 deaths (5.5%), 2013 falls (39.2%), 69 hip fractures (1.3%), and 1649 hospitalizations (32.2%). In adjusted analyses, large eGFR discordance was associated with a higher hazard ratio for death (hazard ratio, 1.43; 95% confidence interval [CI], 1.12 to 1.82) and significantly higher odds of falls (odds ratio, 1.32; 95% CI, 1.16 to 1.51) and hospitalizations (odds ratio, 1.32; 95% CI, 1.15 to 1.51). A large eGFR discordance was not associated with hip fractures.

Conclusions

In a large, nationally representative cohort of older adults, prevalence of eGFR discordance increased with age and was associated with higher risk of falls, hospitalization, and death, independent of kidney function.

Food provision in Australian aged care homes does not meet protein needs of residents: A call for reform

AIM

Malnutrition is common in older adults in aged care homes, partly due to inadequate protein intake. Menu planning guidelines are available however, adherence to guidelines is unknown. This study aimed to determine; (i) what are the average serving sizes of menu items provided and do they meet recommended portion sizes? (ii) does consumption from a 'typical' menu provide sufficient protein? and (iii) can substituting a 'typical' menu with high-protein options enable residents to achieve protein adequacy?

METHODS

This study involved 572 residents (73% female; aged 86.4 ± 7.3 years) from 60 aged-care homes in Australia involved in a 2-year cluster-randomised trial. During the trial, food intake was recorded quarterly using visual estimation of plate-waste and 42 061 foods analysed. As part of a secondary analysis of these data, portion sizes of foods were compared to guidelines by calculating the mean (95% confidence interval). Items were deemed inadequate if the upper 95% confidence interval remained below recommended portion sizes.

RESULTS

On average 47% of breakfast and 80% of lunch/dinner items were below recommended portion sizes. Relative protein intakes, from a typical menu (most consumed foods), was 0.9 g and 0.8 g/kg body weight/day for females and males; both below recommendations. Substituting regular items with higher protein equivalents increased protein intake to 1.3 g and 1.2 g/kg body weight/day, for females and males, respectively.

CONCLUSION

Aged care homes in Australia are not meeting menu planning guidelines resulting in insufficient protein being provided. Reform to menu guidelines including provision of high-protein foods, will ensure protein adequacy in older adults in aged-care homes.

Critical variables regulating age-related anabolic responses to protein nutrition in skeletal muscle

Protein nutrition is critical for the maintenance of skeletal muscle mass across the lifecourse and for the growth of muscle in response to resistance exercise - both acting via the stimulation of protein synthesis. The transient anabolic response to protein feeding may vary in magnitude and duration, depending on, e.g., timing, dose, amino acid composition and delivery mode, which are in turn influenced by physical activity and age. This review aims to: (i) summarise the fundamental metabolic responses of muscle to protein feeding, (ii) discuss key variables regulating muscle anabolic responses to protein feeding, and (iii) explore how these variables can be optimised for muscle anabolism in response to physical activity and ageing.

Low-Protein Diets Could Be Effective and Safe in Elderly Patients with Advanced Diabetic Kidney Disease

Low-protein diets (LPDs) seem to improve metabolic complications of advanced CKD, thus postponing kidney replacement therapy (KRT) initiation. However, the nutritional safety of LPDs remains debatable in patients with diabetic kidney disease (DKD), especially in the elderly. This is a sub-analysis of a prospective unicentric interventional study which assessed the effects of LPD in patients with advanced DKD, focusing on the feasibility and safety of LPD in elderly patients. Ninety-two patients with DKD and stable CKD stage 4+, proteinuria >3 g/g creatininuria, good nutritional status, with confirmed compliance to protein restriction, were enrolled and received LPD (0.6 g mixed proteins/kg-day) supplemented with ketoanalogues of essential amino acids for 12 months. Of the total group, 42% were elderly with a median eGFR 12.6 mL/min and a median proteinuria 5.14 g/g creatininuria. In elderly patients, proteinuria decreased by 70% compared to baseline. The rate of kidney function decline was 0.1 versus 0.5 mL/min-month before enrolment. Vascular events occurred in 15% of cases, not related to nutritional intervention, but to the severity of CKD and higher MAP. LPDs seem to be safe and effective in postponing KRT in elderly patients with advanced DKD while preserving the nutritional status.

The association between chrononutrition behaviors and muscle health among older adults: The study of muscle, mobility and aging

Emerging studies highlight chrononutrition's impact on body composition through circadian clock entrainment, but its effect on older adults' muscle health remains largely overlooked. To determine the associations between chrononutrition behaviors and muscle health in older adults. Dietary data from 828 older adults (76 ± 5 years) recorded food/beverage amounts and their clock time over the past 24 h. Studied chrononutrition behaviors included: (1) The clock time of the first and last food/beverage intake; (2) Eating window (the time elapsed between the first and last intake); and (3) Eating frequency (Number of self-identified eating events logged with changed meal occasion and clock time). Muscle mass (D3-creatine), leg muscle volume (MRI), grip strength (hand-held dynamometer), and leg power (Keiser) were used as outcomes. We used linear regression to assess the relationships between chrononutrition and muscle health, adjusting for age, sex, race, marital status, education, study site, self-reported health, energy, protein, fiber intake, weight, height, and moderate-to-vigorous physical activity. Average eating window was 11 ± 2 h/day; first and last intake times were at 8:22 and 19:22, respectively. After multivariable adjustment, a longer eating window and a later last intake time were associated with greater muscle mass (β ± SE: 0.18 ± 0.09; 0.27 ± 0.11, respectively, p < 0.05). The longer eating window was also marginally associated with higher leg power (p = 0.058). An earlier intake time was associated with higher grip strength (-0.38 ± 0.15; p = 0.012). Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults.

Quantification and interpretation of postprandial whole-body protein metabolism using stable isotope methodology: a narrative review

Stable isotopes are routinely applied to determine the impact of factors such as aging, disease, exercise, and feeding on whole-body protein metabolism. The most common approaches to quantify whole-body protein synthesis, breakdown, and oxidation rates and net protein balance are based on the quantification of plasma amino acid kinetics. In the postabsorptive state, plasma amino acid kinetics can easily be assessed using a constant infusion of one or more stable isotope labeled amino acid tracers. In the postprandial state, there is an exogenous, dietary protein-derived amino acid flux that needs to be accounted for. To accurately quantify both endogenous as well as exogenous (protein-derived) amino acid release in the circulation, the continuous tracer infusion method should be accompanied by the ingestion of intrinsically labeled protein. However, the production of labeled protein is too expensive and labor intensive for use in more routine research studies. Alternative approaches have either assumed that 100% of exogenous amino acids are released in the circulation or applied an estimated percentage based on protein digestibility. However, such estimations can introduce large artifacts in the assessment of whole-body protein metabolism. The preferred estimation approach is based on the extrapolation of intrinsically labeled protein-derived plasma bioavailability data obtained in a similar experimental design setting. Here, we provide reference data on exogenous plasma amino acid release that can be applied to allow a more accurate routine assessment of postprandial protein metabolism. More work in this area is needed to provide a more extensive reference data set.

Reevaluation of the protein requirement in Chinese elderly adults without sarcopenia with the indicator amino acid oxidation technique

It is now generally believed that elderly may have slightly higher dietary protein requirements than those of the young-middle-aged adults. We have previously conducted related studies by the indicator amino acid oxidation (IAAO) technique, but more research data are needed to revise the protein requirements of the elderly. The main objective was to reevaluate the dietary protein requirements of healthy Chinese adults (65-80 years) without sarcopenia by using the IAAO technique. Nine healthy adult men and seven healthy adult women participated in the study, with protein intakes ranging from 0·1 to 1·8 g/(kg·d). Diets that delivered energy at a 1·5 resting energy expenditure were isocaloric. The amounts of phenylalanine and tyrosine needed to remain constant for each protein dosage. By applying a nonlinear mixed-effects model analysis on the F13CO2 data, which revealed a breakpoint in F13CO2 in response to graded protein intakes, the mean protein requirement was calculated. The mean estimated average requirement (EAR) for healthy elderly Chinese adults without sarcopenia was determined to be 0·94 g/(kg·d). The protein recommended nutrient intake (RNI) determined using various derivation approaches ranged from 1·13 to 1·36 g/(kg·d). The EAR for Chinese adults without sarcopenia aged 65-80 years in this study is 6·8 % higher than the current recommended EAR (0·88 g/(kg·d)). The RNI derived using various derivation approaches are all greater than the current RNI (0·98 g/(kg·d)). This trial was registered with the Chinese clinical trial registry as ChiCTR2200061382.

Understanding age-related changes: exploring the interplay of protein intake, physical activity and appetite in the ageing population

Globally, we are currently facing a rapid demographic shift leading to an increase in the proportion of older adults within the population. This raises concerns about the potential increase in age-related diseases and their impact on our ability to provide adequate health and end-of-life care. To apply appropriate interventions, understanding the changes that happen with ageing becomes essential. Ageing is often accompanied by a decrease in appetite and physical activity, which may lead to malnutrition, resulting in decreased muscle mass, physical capabilities and independence. To preserve muscle mass, older adults are advised to increase protein intake and physical activity. However, protein's high satiating effect may cause reduced energy intake. Physical activity is also advised to maintain or enhance older adult's appetite. This review paper aims to discuss appetite-related changes that occur with ageing and their consequences. In particular, it will focus on investigating the relationship between protein intake and physical activity and their impact on appetite and energy intake in the ageing population. Recent studies suggest that physical activity might contribute to maintaining or enhancing appetite in older adults. Nevertheless, establishing a definitive consensus on the satiating effect of protein in ageing remains a work in progress, despite some promising results in the existing literature.

The Importance of Dietary Protein Quality in Mid- to High-Income Countries

In wealthy countries, the protein intake of adults is usually considered to be adequate, and considerations of protein quality are often deemed irrelevant. The objective was to examine dietary protein intakes of adults in developed countries in the context of dietary protein quality. An analysis of NHANES population data on actual protein intakes in the United States (a developed country) demonstrated that for a dietary Digestible Indispensable Amino Acid Score (DIAAS) of 100%, 11% of the adult (19-50 y) population had habitual protein intakes below the Estimated Average Requirement (EAR) and 22% below the Recommended Dietary Allowance. The percentage of the population with utilizable protein intakes potentially falling below the EAR increased as the assumed DIAAS declined. Analysis of the NHANES data and several other datasets also indicated that total protein intakes can be limiting or close to limiting for the elderly and some vegetarians and vegans. Here, lower dietary protein quality can potentially lead to inadequate utilizable protein intakes. For many people in specific physiological states (e.g., weight loss, endurance sports, resistance exercise) attempting to meet higher dietary protein targets often with accompanying lowered energy intakes, low dietary protein quality can lead to protein calories expressed as a proportion of total calories, falling outside what may be acceptable limits (maximum of 30% protein calories from total calories). In general, individuals within the adult population may be susceptible to macronutrient imbalance (whenever total protein intakes are high, daily energy intakes low) and for diets with lower protein quality (DIAAS <100%). Our analysis shows that dietary protein quality is relevant in mid- to high-income countries.

Protein digestibility and ACE inhibitory activity of fermented flours in older adults and standard gastrointestinal simulation

Consumption of essential amino acids responsible for muscle protein synthesis is important in preventing sarcopenia among older individuals. This population may experience gastrointestinal disorders that inhibit protein digestibility, making it crucial to address. Therefore, solid-state fermentation (SSF) using Pleurotus ostreatus and air drying has been suggested as a means of improving the protein digestibility of lentils and quinoa. SSF combined with air drying at 70 °C resulted in a slight increase in protein hydrolysis compared to unfermented samples. SSF was found to boost the proportion of small peptides to 35 %. Following digestion, SSF and drying yielded bioactive peptides of 1400 and 450 Da, with a range of 11 % to 28 %, respectively, and peptides < 190 Da making up 60 % of the total. SSF promoted valine, leucine, and isoleucine generation; however, hot air drying reduced free amino acids due to the amino acid-reducing sugar bonding but was never lower than the initial content of its unfermented counterpart. Furthermore, SSF and drying at 70 °C improved the release of hydrophobic amino acids (>70 mg/g dry basis) and negatively charged amino acids (>20 mg/g dry basis) in lentils during digestion. The SSF samples exhibited lower angiotensin converting enzyme (ACE) inhibitory activity, ≤35 %, compared to unfermented flours after digestion. However, the ACE inhibitory activity increased in SSF-dried samples, in part because of melanoidins generated during drying. Finally, lower values of protein digestibility and thus smaller peptides, amino acid profile, and ACE inhibitory activity of fermented flours were found in the older adult digestion model.

The rosetta stone of successful ageing: does oral health have a role?

Ageing is an inevitable aspect of life and thus successful ageing is an important focus of recent scientific efforts. The biological process of ageing is mediated through the interaction of genes with environmental factors, increasing the body's susceptibility to insults. Elucidating this process will increase our ability to prevent and treat age-related disease and consequently extend life expectancy. Notably, centenarians offer a unique perspective on the phenomenon of ageing. Current research highlights several age-associated alterations on the genetic, epigenetic and proteomic level. Consequently, nutrient sensing and mitochondrial function are altered, resulting in inflammation and exhaustion of regenerative ability.Oral health, an important contributor to overall health, remains underexplored in the context of extreme longevity. Good masticatory function ensures sufficient nutrient uptake, reducing morbidity and mortality in old age. The relationship between periodontal disease and systemic inflammatory pathologies is well established. Diabetes, rheumatoid arthritis and cardiovascular disease are among the most significant disease burdens influenced by inflammatory oral health conditions. Evidence suggests that the interaction is bi-directional, impacting progression, severity and mortality. Current models of ageing and longevity neglect an important factor in overall health and well-being, a gap that this review intends to illustrate and inspire avenues for future research.

The association between chrononutrition behaviors and muscle health among older adults: The Study of Muscle, Mobility and Aging (SOMMA)

Background

Emerging studies highlight chrononutrition's impact on body composition through circadian clock entrainment, but its effect on older adults' muscle health remains largely overlooked.

Objective

To determine the associations between chrononutrition behaviors and muscle health in older adults.

Methods

Dietary data from 828 older adults (76±5y) recorded food/beverage amounts and their clock time over the past 24 hours. Studied chrononutrition behaviors included: 1) The clock time of the first and last food/beverage intake; 2) Eating window (the time elapsed between the first and last intake); and 3) Eating frequency (Number of self-identified eating events logged with changed meal occasion and clock time). Muscle mass (D 3 -creatine), leg muscle volume (MRI), grip strength (hand-held dynamometer), and leg power (Keiser) were used as outcomes. We used linear regression to assess the relationships between chrononutrition and muscle health, adjusting for age, sex, race, marital status, education, study site, self-reported health, energy, protein, fiber intake, weight, height, and moderate-to-vigorous physical activity.

Results

Average eating window was 11±2 h/d; first and last intake times were at 8:22 and 19:22, respectively. After multivariable adjustment, a longer eating window and a later last intake time were associated with greater muscle mass (β±SE: 0.18±0.09; 0.27±0.11, respectively, P <0.05). The longer eating window was also marginally associated with higher leg power ( P =0.058). An earlier intake time was associated with higher grip strength (-0.38±0.15; P =0.012).

Conclusions

Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults.

GRAPHICAL ABSTRACT

Key findings

Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults.

Sensory properties of thickened tomato soup enhanced with different sources of protein (whey, soy, hemp, and pea)

Thickened soup formulations were created with different proteins (hemp, soy, pea, and whey) to improve protein and fluid intake. The formulations consisted of a control soup, and soups with 6% whey protein, 6% hemp protein, 6% pea protein, and 6% soy protein by volume. The suitability of the samples for those living with dysphagia was evaluated using the international dysphagia diet standardization initiative (IDDSI) spoon tilt test and a sensory trial (51 older adults and 51 younger adults). The sensory trial used nine-point hedonic scales and check-all-that-apply to evaluate the different formulations. The sample with the whey addition was not significantly different than the control in terms of liking of flavor and texture, but it decreased the participants' overall liking. The hemp, pea, and soy decreased overall liking as well as liking of flavor and texture. They were associated with off-flavors, aftertaste, and astringency. The responses from the older and younger adults were compared and significant differences were found in their liking of the texture, with the older adults finding the formulations' texture significantly more acceptable. Overall, the study identified that hemp, pea, and soy did not create acceptable thickened soup formulations and the hemp and pea formulations did not achieve a consistency level that is acceptable for those living with dysphagia.

Dietary protein recommendations to support healthy muscle ageing in the 21st century and beyond: considerations and future directions

This review explores the evolution of dietary protein intake requirements and recommendations, with a focus on skeletal muscle remodelling to support healthy ageing based on presentations at the 2023 Nutrition Society summer conference. In this review, we describe the role of dietary protein for metabolic health and ageing muscle, explain the origins of protein and amino acid (AA) requirements and discuss current recommendations for dietary protein intake, which currently sits at about 0⋅8 g/kg/d. We also critique existing (e.g. nitrogen balance) and contemporary (e.g. indicator AA oxidation) methods to determine protein/AA intake requirements and suggest that existing methods may underestimate requirements, with more contemporary assessments indicating protein recommendations may need to be increased to >1⋅0 g/kg/d. One example of evolution in dietary protein guidance is the transition from protein requirements to recommendations. Hence, we discuss the refinement of protein/AA requirements for skeletal muscle maintenance with advanced age beyond simply the dose (e.g. source, type, quality, timing, pattern, nutrient co-ingestion) and explore the efficacy and sustainability of alternative protein sources beyond animal-based proteins to facilitate skeletal muscle remodelling in older age. We conclude that, whilst a growing body of research has demonstrated that animal-free protein sources can effectively stimulate and support muscle remodelling in a manner that is comparable to animal-based proteins, food systems need to sustainably provide a diversity of both plant and animal source foods, not least for their protein content but other vital nutrients. Finally, we propose some priority research directions for the field of protein nutrition and healthy ageing.

A comparative intervention trial of deer milk and an oral nutritional supplement efficacy for improving older adults' nutritional status, muscle mass and physical performance

OBJECTIVES

To compare the effectiveness of deer milk (DM) for improving nutritional status, muscle mass and physical performance with that of a commercially available oral nutritional supplement (ONS) in older women.

METHODS

This study was an 11-week randomised, double-blind, parallel group study. Healthy women (N = 120) aged 65-80 years, the majority having a body mass index (BMI) < 25 kg/m2 were recruited. The women were randomly assigned to either 200 ml DM or a commercial ONS for 11 weeks. Data on habitual macronutrient intake, nutritional status (Mini Nutrition Assessment-Short Form, MNA-SF; ≤7 malnourished, 8-11 at risk of malnutrition, ≥12 normal nutrition), anthropometrics/body composition, and physical performance were collected. Blood samples were collected for metabolic markers.

RESULTS

102 women (DM 45, ONS 57) completed the study, of whom 29% had a dietary protein intake of <1 g/kg body weight per day, and 38% at risk of malnutrition. There were no between group differences in percentage change in MNA-SF score and body composition (P > 0.05), but a trend for a difference in handgrip strength (DM 11.7 ± 49.8% vs. ONS -2.42 ± 17.9%, P = 0.06). Further exploratory analysis showed that there was a trend for a between group difference in percentage change in MNA-SF score, favoring DM (DM 7.72 + 13.0% vs. ONS 0.63 + 9.25%, P = 0.06) only in women at risk of malnutrition. There was also a between group difference in percentage change in muscle mass (DM 1.68 ± 2.77% vs. ONS -0.18 ± 2.81%, P = 0.02) in women with BMI ≥25 kg/m2 and in handgrip strength (DM 10.6 ± 23.6% vs. ONS -5.03 ± 18.1%, P < 0.01) in women with BMI<25 kg/m2. Total cholesterol, LDL and LDL:HDL ratio did not change over time (P > 0.05), but there was a between group difference in percentage change in these markers (total cholesterol: DM 3.01 ± 6.97% vs. ONS -2.65 ± 9.92%, P < 0.01; LDL: DM 4.22 ± 14.9% vs. ONS -6.05 ± 17.6%, P < 0.01; LDL:HDL ratio: DM: 2.27 ± 16.4% vs. ONS: -5.78 ± 18.2%, P = 0.02).

CONCLUSION

Baseline nutritional status and BMI may modulate nutritional status, muscle mass and physical performance response to DM (as compared with ONS), suggesting DM may improve nutritional status and physical performance in women at risk of malnutrition and/or with lower BMI, and improve muscle mass in women with a higher BMI. The study was registered with the Australian New Zealand Clinical Trial Registry ACTRN12621000650897p.

Newly developed care food enhances grip strength in older adults with dysphagia: a preliminary study

BACKGROUND/OBJECTIVES

Maintaining total muscle mass in the older adults with swallowing difficulty (dysphagia) is important for preserving swallowing function. Increasing protein intake can help sustain lean body mass in the older adults. The aim of this study was to evaluate the effect of various high-protein texture-modified foods (HPTMFs) on muscle mass and perform dietary assessment in ≥ 65-yrs-old patients with dysphagia.

SUBJECTS/METHODS

Participants (n = 10) received the newly developed HPTMFs (average 595.23 ± 66.75 kcal/day of energy, 54.22 ± 6.32 g/day of protein) for 10 days. Relative hand-grip strength (RHS), mid-upper arm circumference (MUAC), body composition, mini nutritional assessment (MNA), mini dietary assessment (MDA), and Euro Quality-of-Life questionnaire 5-dimensional classification (EQ-5D) were assessed.

RESULTS

After 10 days, an increase in MUAC (26.36 ± 2.35 cm to 28.50 ± 3.17 cm, P = 0.013) and RHS (0.38 ± 0.24 kg/kg body weight to 0.42 ± 0.22 kg/kg body weight, P = 0.046) was observed. Although MNA, MDA, EQ-5D, subjective health status, muscle mass, and calf circumference showed a tendency to increase after intervention, no significant differences were found.

CONCLUSIONS

These results suggest that the HPTMFs can be used for improving the nutritional and health status in patients with dysphagia.

Evaluation of the sensory properties of thickened and protein-enhanced ice cream using check-all-that-apply and temporal check-all-that-apply

Ice cream formulations with varying amounts of added whey protein were created for those living with dysphagia in long-term care facilities (LTCs) to improve protein and fluid intake. The samples of thickened ice cream included a control (0% whey protein [WP]) and formulations with 6% (6WP), 8% (8WP), 10% (10WP), 12% (12WP) and 14% (14WP) added whey protein by volume. The consistency of the samples was assessed using the International Dysphagia Diet Standardization Initiative (IDDSI) Spoon Tilt Test, a sensory trial (n = 102) using hedonic scales and check-all-that-apply (CATA) and another sensory trial (n = 96) using temporal check-all-that-apply (TCATA). The whey protein increased the acceptability of the thickened ice cream except for the 12WP and 14WP formulations. The formulations with higher amounts of whey protein were associated with bitterness, custard/eggy flavor, and mouthcoating. The TCATA identified that the addition of whey protein led to slippery, gritty, and grainy attributes being perceived in the thickened ice cream. The study identified that 10% whey protein by volume can be added to thickened ice cream without impacting its' acceptability and the 6WP, 8WP, and 10WP formulations were liked significantly more than the control (without whey protein).

Plant Protein Can Be as Efficient as Milk Protein to Maintain Fat Free Mass in Old Rats, Even When Fat and Sugar Intakes Are High

BACKGROUND

Alternative, sustainable, and adequate sources of protein must be found to meet global demand.

OBJECTIVES

Our aim was to assess the effect of a plant protein blend with a good balance of indispensable amino acids and high contents of leucine, arginine, and cysteine on the maintenance of muscle protein mass and function during aging in comparison to milk proteins and to determine if this effect varied according to the quality of the background diet.

METHODS

Old male Wistar rats (n = 96, 18 mo old) were randomly allocated for 4 mo to 1 of 4 diets, differing according to protein source (milk or plant protein blend) and energy content (standard, 3.6 kcal/g, with starch, or high, 4.9 kcal/g, with saturated fat and sucrose). We measured: every 2 mo, body composition and plasma biochemistry; before and after 4 mo, muscle functionality; after 4 mo, in vivo muscle protein synthesis (flooding dose of L-[1-13C]-valine) and muscle, liver, and heart weights. Two-factor ANOVA and repeated measures 2-factor ANOVA were conducted.

RESULTS

There was no difference between protein type on the maintenance during aging of lean body mass, muscle mass, and muscle functionality. The high-energy diet significantly increased body fat (+47%) and heart weight (+8%) compared to the standard energy diet but had no effect on fasting plasma glucose and insulin. Muscle protein synthesis was significantly stimulated by feeding to the same extent in all groups (+13%).

CONCLUSIONS

Since high-energy diets had little impact on insulin sensitivity and related metabolism, we could not test the hypothesis that in situations of higher insulin resistance, our plant protein blend may be better than milk protein. However, this rat study offers significant proof of concept from the nutritional standpoint that appropriately blended plant proteins can have high nutritional value even in demanding situations such as aging protein metabolism.

Dietary protein requirements and recommendations for healthy older adults: a critical narrative review of the scientific evidence

Adequate protein intake is essential for the maintenance of whole-body protein mass. Different methodological approaches are used to substantiate the evidence for the current protein recommendations, and it is continuously debated whether older adults require more protein to counteract the age-dependent loss of muscle mass, sarcopenia. Thus, the purpose of this critical narrative review is to outline and discuss differences in the approaches and methodologies assessing the protein requirements and, hence, resulting in controversies in current protein recommendations for healthy older adults. Through a literature search, this narrative review first summarises the historical development of the Food and Agriculture Organization/World Health Organization/United Nations University setting of protein requirements and recommendations for healthy older adults. Hereafter, we describe the various types of studies (epidemiological studies and protein turnover kinetic measurements) and applied methodological approaches founding the basis and the different recommendations with focus on healthy older adults. Finally, we discuss important factors to be considered in future studies to obtain evidence for international agreement on protein requirements and recommendations for healthy older adults. We conclude by proposing future directions to determine 'true' protein requirements and recommendations for healthy older adults.

Nutritional status and the risk of malnutrition in older adults with chronic kidney disease - implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN

Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup.

Effects of dietary diversity on frailty in Chinese older adults: a 3-year cohort study

BACKGROUND

Frailty has emerged as a global health burden with increased population aging. A diverse diet is essential for an adequate and balanced supply of nutrients. However, limited evidence supports the relationship between dietary diversity and frailty. We therefore assessed the associations of dietary diversity with the risk of frailty.

METHODS

We used the Chinese Longitudinal Healthy Longevity Survey to analyze a prospective cohort of Chinese older adults. A total of 1948 non-frail older adults were included in the final sample. Participants were categorized into groups with high or low dietary diversity scores (DDSs) using a food frequency questionnaire. A Generalized Estimating Equation were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for determining frailty incidence.

RESULTS

Among 1,948 participants, 381 had frailty with the prevalence of 19.56% during the 3-year follow-up period. Compared with the low DDS group, the high DDS group exhibited a lower risk of frailty (RR, 0.72; 95% CI: 0.57-0.91). Compared with those with a consistently low DDS, the RR of participants with a consistently high DDS for frailty was 0.56 (95% CI: 0.42-0.74). Moreover, meat, beans, fish, nuts, fresh fruits, and fresh vegetables were inversely associated with frailty. In stratified analysis, a consistently high DDS, compared with a consistently low DDS, reduced the risk of frailty for people aged 65-79 years and those living in town and rural areas.

CONCLUSION

This study found a prospective association between dietary diversity and frailty among Chinese older adults. These findings stressed that it is important to improve dietary diversity for older adults to promote healthy ageing, particularly for young older adults and in town and rural areas.

Effects of Culinary Spices on Liking and Consumption of Protein Rich Foods in Community-Dwelling Older Adults

Insufficient protein intake is a common challenge among older adults, leading to loss of muscle mass, decreased function and reduced quality of life. A protein intake of 0.4 g/kg body weight/meal is recommended to help prevent muscle loss. The purpose of this study was to assess whether the protein intake of 0.4 g/kg body weight/meal could be achieved with typical foods and whether culinary spices could enhance protein intake. A lunch meal test was conducted in 100 community-dwelling volunteers; 50 were served a meat entrée and 50 were served a vegetarian entrée with or without added culinary spices. Food consumption, liking and perceived flavor intensity were assessed using a randomized, two-period, within subjects crossover design. Within the meat or vegetarian treatments, there were no differences in entrée or meal intakes between spiced and non-spiced meals. Participants fed meat consumed 0.41 g protein/kg body weight/meal, while the vegetarian intake was 0.25 g protein/kg body weight/meal. The addition of spice to the vegetarian entrée significantly increased liking and flavor intensity of both the entrée and the entire meal, while spice addition only increased flavor for the meat offering. Culinary spices may be a useful tool to improve the liking and flavor of high-quality protein sources among older adults, especially when used with plant-based foods, although improving liking and flavor alone are insufficient to increase protein intake.

Sarcopenia and Ageing

Musculoskeletal ageing is a major health challenge as muscles and bones constitute around 55-60% of body weight. Ageing muscles will result in sarcopenia that is characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes. In recent years, a few consensus panels provide new definitions for sarcopenia. It was officially recognized as a disease in 2016 with an ICD-10-CM disease code, M62.84, in the International Classification of Diseases (ICD). With the new definitions, there are many studies emerging to investigate the pathogenesis of sarcopenia, exploring new interventions to treat sarcopenia and evaluating the efficacy of combination treatments for sarcopenia. The scope of this chapter is to summarize and appraise the evidence in terms of (1) clinical signs, symptoms, screening, and diagnosis, (2) pathogenesis of sarcopenia with emphasis on mitochondrial dysfunction, intramuscular fat infiltration and neuromuscular junction deterioration, and (3) current treatments with regard to physical exercises and nutritional supplement.

Evaluation of a Dietary Supplementation Combining Protein and a Pomegranate Extract in Older People: A Safety Study

Malnutrition is a highly prevalent condition in older adults. It is associated with low muscle mass and function and increased occurrence of health problems. Maintaining an adequate nutritional status as well as a sufficient nutrient intake in older people is therefore essential to address this public health problem. For this purpose, protein supplementation is known to prevent the loss of muscle mass during aging, and the consumption of various pomegranate extracts induces numerous health benefits, mainly through their antioxidant properties. However, to our knowledge, no study has to date investigated the impact of their combination on the level of malnutrition in older people. The objective of this preliminary study was thus to evaluate the safety of a combination of protein and a pomegranate extract in healthy subjects aged 65 years or more during a 21-day supplementation period. Thirty older participants were randomly assigned to receive protein and a pomegranate extract (Test group) or protein and maltodextrin (Control group) during a 21-day intervention period. The primary outcomes were the safety and tolerability of the supplementation defined as the occurrence of adverse events, and additional secondary outcomes included physical examination and hematological and biochemical parameters. No serious adverse events were reported in any group. Changes in physical, hematological, and biochemical parameters between the initial screening and the end of the study were equivalent in both groups, except for glutamate-pyruvate transaminase (GPT) and prealbumin, for which a decrease was observed only in the Test group. Our initial findings support the safety of the combination of protein and a pomegranate extract in healthy elderly people. Future clinical trials on a larger sample and a longer period are needed to determine the efficacy of this combination.

Risk of all-cause mortality in subjects with varying degrees of renal impairment with or without dietary protein restriction

BACKGROUND AND OBJECTIVE

Low-protein diet (less than 0.8g/kg/day) has been practiced in the management of chronic kidney disease (estimated glomerular filtration rate [eGFR]<60ml/min/1.73m² or urine albumin-to-creatinine ratios [UACR] ≥30mg/g) for decades. However, its effect on all-cause mortality is unclear. We investigated the association between a low-protein intake and all-cause mortality in subjects with varying degrees of renal impairment.

MATERIALS AND METHODS

We analyzed participants in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2010. They were divided into four groups according to their eGFR (≥60 or <60ml/min/1.73m²) and UACR (≥30 or <30mg/g). Daily protein intake of the NHANES participants could be assessed using information from the dietary interview questionnaires. The mortality data was retrieved by linking to the National Death Index till the end of 2011. The hazard ratios for all-cause mortality were evaluated by the weighted Cox proportional hazards regression models.

RESULTS

A total of 8093 participants were analyzed. During a median follow-up of 4.7 years, participants with UACR≥30mg/g (with or without eGFR<60ml/min/1.73m²) had a higher risk of all-cause mortality compared with those having UACR<30mg/g and eGFR≥60ml/min/1.73m² (reference group). The higher risk of mortality in participants with UACR≥30mg/g was consistently observed in those with or without a low-protein intake.

CONCLUSIONS

A low-protein intake was not associated with a lower risk of all-cause mortality in subjects with varying degrees of renal impairment.

Development of an Abalone 3D Food Printing Ink for the Personalized Senior-Friendly Foods

Notably for seniors, 3D food printing is an appropriate processing method for creating customized meals that meet their unique nutritional requirements and textural preferences. This study attempted to develop an ink for food 3D printers containing abalone powder and several nutrition properties that meet the criteria for senior-friendly foods. The texture of the products was adjusted using gelatin. The ink consisted of abalone powder (10%), soybean protein (4.5%), polydextrose (2.5%), vitamin C (0.0098%), and gellan gum (1%). To examine the physicochemical properties of the ink, texture, water holding capacity, and rheological properties were measured. In addition, the suitability of the 3D printing was examined. As a result, 3% gelatin 3D food printing ink demonstrated optimal printability and could be converted into foods that could be consumed in one step (teeth intake), depending on the types of food for seniors.

Long-Term Food Variety and Dietary Patterns Are Associated with Frailty among Chinese Older Adults: A Cohort Study Based on CLHLS from 2014 to 2018

(1) Objective: To examine the association between posterior-derived dietary patterns, food variety, and frailty measured by frailty index (FI) in Chinese elderly. (2) Method: A cohort study based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2014 to 2018 was conducted among older adults. The food variety was defined by the food variety score (FVS), which was calculated using the frequency of food categories consumption. Dietary patterns were obtained using factor analysis. A FI composed of 38 health deficits was used to measure subjects' frailty status. Logistic regression analyses were performed to explore the correlation between dietary factors and the incidence of frailty. (3) Results: Compared with low FVS, a high dietary diversity score at baseline was not associated with a reduced incidence of frailty after four years. Regarding long-term food variety, compared with the low variety maintained group, people with high variety maintained were associated with a lower risk of frailty (0.59, 95%CI 0.39-0.90). Adherence to the "egg-bean-pickle-sugar pattern" and "fruit-vegetable-meat-fish pattern" was associated with a lower risk of frailty. (4) Conclusion: Maintaining high food variety and adherence to two patterns, i.e., the egg-bean-pickle-sugar pattern and fruit-vegetable-meat-fish pattern, could reduce the incidence of frailty among Chinese older adults.

Tracing metabolic flux to assess optimal dietary protein and amino acid consumption

There is a general consensus that a dietary protein intake of 0.8 g protein/kg/day will prevent symptoms of protein deficiency in young, healthy individuals. However, individuals in many physiological circumstances may benefit from higher rates of dietary protein intake. Stable isotope tracer methodology enables a variety of approaches to assessing the optimal dietary protein intake in humans. In this paper, we present an overview of a variety of tracer methods, with a discussion of necessary assumptions, as well as the clinical circumstances in which different methods may be preferable. Although we discuss the nontracer method of nitrogen balance, which has historically been used to estimate dietary protein requirements, this paper primarily focuses on tracer methods for estimating dietary protein and essential amino acid requirements under different physiological conditions. We will explain the following approaches: isotopic measurement of urea production; the arterial-venous tracer balance method; measurement of the fractional synthetic and breakdown rates of muscle protein; the indicator and the direct amino acid oxidation methods; and different approaches to measuring whole-body protein synthesis and breakdown. The advantages and limitations of each method are discussed in the context of the optimal approaches for use under different circumstances.

Both clinical and practical considerations should inform how dietary protein intake is tracked in individuals. Little is known about optimal dietary protein intake in humans under different physiological conditions including disease states, prompting a review of current monitoring methods by Robert Wolfe at the University of Arkansas, Little Rock, USA, and co-workers. Monitoring nitrogen balance provides estimates of dietary protein and essential amino acid (EAA) levels, but requires several days of strict diet control. Various techniques monitor the uptake or fate of a specific tracer molecule in the body, but some are very invasive. The less invasive single EAA infusion methods provide rapid results and are valuable for monitoring immediate response to a meal, or in studies comparing protein intakes to a person’s baseline over time. Using two methods concurrently could improve accuracy of results.

Dietary Meat, Trimethylamine N-Oxide-Related Metabolites, and Incident Cardiovascular Disease Among Older Adults: The Cardiovascular Health Study

BACKGROUND

Effects of animal source foods (ASF) on atherosclerotic cardiovascular disease (ASCVD) and underlying mechanisms remain controversial. We investigated prospective associations of different ASF with incident ASCVD and potential mediation by gut microbiota-generated trimethylamine N-oxide, its L-carnitine-derived intermediates γ-butyrobetaine and crotonobetaine, and traditional ASCVD risk pathways.

METHODS

Among 3931 participants from a community-based US cohort aged 65+ years, ASF intakes and trimethylamine N-oxide-related metabolites were measured serially over time. Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, other atherosclerotic death) was adjudicated over 12.5 years median follow-up. Cox proportional hazards models with time-varying exposures and covariates examined ASF-ASCVD associations; and additive hazard models, mediation proportions by different risk pathways.

RESULTS

After multivariable-adjustment, higher intakes of unprocessed red meat, total meat, and total ASF associated with higher ASCVD risk, with hazard ratios (95% CI) per interquintile range of 1.15 (1.01-1.30), 1.22 (1.07-1.39), and 1.18 (1.03-1.34), respectively. Trimethylamine N-oxide-related metabolites together significantly mediated these associations, with mediation proportions (95% CI) of 10.6% (1.0-114.5), 7.8% (1.0-32.7), and 9.2% (2.2-44.5), respectively. Processed meat intake associated with a nonsignificant trend toward higher ASCVD (1.11 [0.98-1.25]); intakes of fish, poultry, and eggs were not significantly associated. Among other risk pathways, blood glucose, insulin, and C-reactive protein, but not blood pressure or blood cholesterol, each significantly mediated the total meat-ASCVD association.

CONCLUSIONS

In this large, community-based cohort, higher meat intake associated with incident ASCVD, partly mediated by microbiota-derived metabolites of L-carnitine, abundant in red meat. These novel findings support biochemical links between dietary meat, gut microbiome pathways, and ASCVD.

Association of the Mediterranean Dietary Quality Index with handgrip strength and muscle endurance: A cross-sectional study

Mediterranean diet is a healthy eating pattern associated with various health advantages. Different scoring methods of adherence to this diet have been used to investigate the association between the Mediterranean diet and muscle outcomes. The present study aimed to investigate the association of the Mediterranean Dietary Quality Index (Med-DQI) with handgrip strength (HS) and muscle endurance (ME). The current cross-sectional study involved 268 Iranian adults aged 18-70 years. Anthropometric measures were evaluated. We used the 168-item food frequency questionnaire (FFQ) to develop the Med-DQI score. The Med-DQI score ranges from 0 to 14 (lower score suggests higher adherence to Mediterranean diet). HS was measured by a digital handgrip dynamometer, and ME was the amount of time to reach a maximum of 50% of grip strength. Multiple regression analysis was used to determine the association of Med-DQI and its components with HS and ME. Med-DQI score was not associated with mean handgrip strength (MHS) (p = .34) and mean muscle endurance (MME) (p = .69) in the crude model. The associations remained insignificant after the adjustment of covariates (p = .16, .31, respectively). Among the components of Med-DQI, cholesterol, meats, fish, and cereals were positively correlated with MHS (p < .001 for all). Meats (p = .02), olive oil (p < .001), cereals (p = .04), fruits and vegetables (p < .001 for all) were also positively correlated with MME. According to our findings, Med-DQI score is not associated with MHS and MME in a population of Iranian adults. Further longitudinal studies are required to confirm these findings.

Dietary Essential Amino Acid Intake Is Associated with High Muscle Strength in Korean Older Adults

The relationship between daily dietary intake of an individual or all essential amino acids (EAAs) and muscle strength in older adults is still inadequately characterized. This population-based cross-sectional study included 5971 participants aged ≥65 years from the 2014–2019 Korea National Health and Nutrition Examination Survey. Dietary information was derived from the 24 h recall data. Total essential amino acid score (EAAS) was calculated with an intake that satisfied the recommended nutrient intake (RNI) in each essential amino acid (EAA). The mean handgrip strength was estimated from triplicate measurements obtained using the dominant hand, and high muscle strength was defined as handgrip strength ≥28 kg for men and ≥18 kg for women. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. After multivariable adjustment, we found that a high total EAAS was associated with high muscle strength in Korean older adults (OR: 1.38, 95% CI: 1.07–1.79). High muscle strength was significantly enhanced with increased total EAA intake from animal sources (OR: 1.27, 95% CI: 1.02–1.58), but there was no significant association with total EAA intake from non-animal sources. EAA intake and high muscle strength are associated based on a positive dose-response relationship in which high muscle strength is further increased when the overall EAA intake meets the RNI. Thus, Korean older adults should ensure an adequate intake of all EAAs from various food sources (especially animal sources) to meet the RNI as a prerequisite for achieving high muscle strength.

Nutrition of older adults in the Republic of Kazakhstan

This article discusses a study on the nutrition specifics of older adults living in social service institutions in three major cities of the Republic of Kazakhstan: Nur-Sultan, Almaty, and Shymkent. The direction of the research meets the priorities of the World Health Organization to achieve goals on aging and health. The diets of older adults in the Republic of Kazakhstan were studied, food preferences were identified, and needs for basic nutrients were established. This article presents the results of sociological surveys of older adults who answered questions about nutrition, preferred foods, raw materials, and meat products. Based on the survey results, technologies of herodietic meat products aimed at enriching the diet with proteins were developed, along with practical recommendations for a balanced diet. This area of research is relevant due to the lack of products with a herodietic profile on the Kazakhstan market.

The role of nutrition in inflammaging

BACKGROUND

Old age is characterized by a peculiar low-grade, chronic, and "sterile" inflammatory state, which has been termed "inflammaging." This is believed to substantially contribute to the pathogenesis of many age-related diseases and to the progression of the ageing process. An adequate nutritional status is of great importance for maintaining proper immune system functionality and preventing frailty in the elderly.

METHODS

The purpose of this narrative review is to synthesize what is known about the interaction between inflammaging and nutrition, focusing on the role of the Mediterranean diet, gut microbiota and calorie restriction (CR) in reducing systemic inflammation and improving clinical outcomes.

CONCLUSIONS

Dietary components may affect inflammation directly, counteracting the low grade age-related inflammation. In this regard, healthy diets, including the Mediterranean diet, are associated with lower concentrations of inflammatory mediators, like C-reactive protein (CRP) and Tumor Necrosis Factor-α (TNF-α), that are hallmarks of inflammaging. Among the components of a healthy diet, a higher intake of whole grains, vegetables and fruits, nuts and fish are all associated with lower inflammation. One area of promising research is the microbiome-ageing interaction. Indeed, dysbiosis plays a role in sub-optimal metabolism, immune function and brain function and contributes to the poor health and impaired well-being associated with ageing. Modulation of the gut microbiota has shown promising results in some disorders. Additionally, the discovery of several molecular pathways associated with ageing, and the characterization of the beneficial effects of calorie restriction (CR) in modulating metabolic pathways and preventing inflammation, should encourage research on CR mimetics, drugs able to promote lifespan and extend healthspan.

Combined Effects of Pressure cooking and Enzyme Treatment to Enhance The Digestibility and Physicochemical Properties of Spreadable Liver Sausage

This study aimed to determine the effect of enzyme, guar gum, and pressure processing on the digestibility and physicochemical properties of age-friendly liver sausages. Liver sausages were manufactured by adding proteolytic enzyme (Bromelain) and guar gum, and pressure-cooking (0.06 MPa), with the following treatments: control, without proteolytic enzyme; T1, proteolytic enzyme; T2, proteolytic enzyme and guar gum; T3, pressure-cooking; T4, proteolytic enzyme and pressure-cooking; T5, proteolytic enzyme, guar gum, and pressure-cooking. The pH was high in the enzyme- and pressure-processed groups. The pressure-processed groups had lower apparent viscosity than other cooking groups, and it decreased during enzyme treatment. Hardness was lower in the enzyme- and pressure-processed groups than in the control, and the T4 was the lowest. Digestibility was the highest in T4 at 82.58%, and there was no significant difference with that in T5. The general cooking group with enzyme and guar gum also showed higher digestibility than the control (77.50%). As a result of the sodium dodecyl sulfate-polyacrylamide gel electrophoresis, the enzyme- and pressure-treated groups (T4, T5) were degraded more into low-molecular-weight peptides (≤37 kDa) than the control and other treatments. Viscoelasticity showed similar trends for viscous and elastic moduli. Similarly, combined pressure processing and enzymatic treatment decreased viscoelasticity, while guar gum increased elasticity but decreased viscosity. Therefore, the tenderized physical properties and improved digestibility by enzyme and pressurization treatment could be used to produce age-friendly spreadable liver sausages.

Relationship between Low Muscle Strength, and Protein Intake: A Preliminary Study of Elderly Patients with Hip Fracture

Background: The purpose of the present study was to assess the daily protein uptake and its relationship with sarcopenia, as defined by the Asian Working Group for Sarcopenia (AWGS), among elderly patients with hip fractures.Methods: Forty-seven elderly patients with hip fractures were enrolled in this retrospective observational study. The main outcome measures included protein uptake, muscle mass, and grip strength for sarcopenia in elderly patients. Sarcopenia was diagnosed according to AWGS. Wholebody densitometry was used to measure skeletal muscle mass, and muscle strength was evaluated using handgrip testing.Results: Of 47 patients with hip fractures (12 men and 35 women), 37 (79%) patients exhibited insufficient protein intake (range, 0.01-0.588 g/kg/day), and 10 (21%) patients exhibited excessive protein intake (range, 1.215-2.121 g/kg/day). The mean daily protein intake was 56.5 g (range, 7.2–136.0 g). Prevalence of low muscle strength (handgrip strength <18 kg in women and <26 kg in men) was detected in 13 (37%) women and 8 (67%) men (P=0.076). Sarcopenia (lower muscle mass and lower muscle strength) was detected in 9 (26%) women and 6 (50%) men (P=0.119). Although lower protein intake was marginally associated with sarcopenia (P=0.189), it was significantly associated with lower grip strength (P=0.042).Conclusions: The present study demonstrated that insufficient protein intake in elderly patients with hip fractures was common, and lower protein intake was significantly associated with lower muscle strength.