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Nutrition Strategies to Protect Muscle Health During Aging: The Value of Protein
Douglas Paddon-Jones, Ph.D., FACSMSheriden Lorenz Distinguished Professor of Aging and Health
Department of Nutrition and Metabolism, Center for Recovery, Physical Activity and Nutrition
University of Texas Medical Branch, Galveston, TX, USA
May 22-23, 2018
Redacted version from the original presentation given at the seminar.
Disclosures
I have received funding, participated on a Scientific Advisory Board or Speaker’s Bureau for:
• National Dairy Council
• US Dairy Export Council
• American Egg Board
• National Cattlemens Beef Association
• Abbott Nutrition
• Agropur
• Leprino Foods
• Sabra Wellness
• National Space Biomedical Research Institute
Act
ivit
y
Ph
arm
aco
logy
Inflammation
Disease
Inactivity
Mitochondrial
Dysfunction
Inadequate
Nutrition
Aging
Perfusion
Outline
How much protein do we need ?
+ when, why, how and who….
How much protein per meal do we need ?
- a message of moderation -
* *
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Fasting 30 g protein
Pro
tein
Synth
esis
(%
/h)
* *
Fasting 90 g protein
Young
Old
90 g protein30 g protein
References: Symons et. al. AJCN, 2007
Symons et. al. JADA. 2009
* *
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Fasting Protein meal
Pro
tein
Syn
thesis
(%
/h)
0.16
0.18
Young
Elderly
* *
Protein + Exercise
50% increase
100% increase
Synergistic Effect of Protein and Exercise
Reference: Symons et. al. JNHA, 2010
Net M
uscle
Pro
tein
Synth
esis
(mg P
he/le
g)
More than ~25 g protein
Reality: Age-related dose-response
0
10
20
30
40
50
60
Young
Elderly
Less than ~15 g protein
5 g
8 g
6 g
6 g
Reference: Katsanos et. al. AJCN, 2005
Protein Quantity and Daily Distribution
Total Protein
90 g
Ca
tab
oli
sm
An
ab
oli
sm
10 g
maximum rate of protein synthesis
15 g 65 g
~ 1.3 g/kg/day
Reference: Paddon-Jones and Rasmussen 2009
Concept: Skewed / typical protein intake
We can’t store excess protein for later anabolism
Usable Protein
55 g ?
Concept: Optimizing protein at each meal ?C
ata
bo
lis
mA
na
bo
lis
m
maximum rate of protein synthesis
30 g 30 g 30 g
Total Protein
90 g
→ greater 24 h protein synthesis response ?
~ 1.3 g/kg/day
Usable Protein
90 g
Reference: Paddon-Jones and Rasmussen 2009
*
*
10 - 15 - 65 g
Protein distribution impacts muscle protein synthesis
Reference: Mamerow, et.al. J. Nutr. 2014
30 - 30 - 30 g
25%
Sarcopenia
Cruz-Jentoft AJ et al. Sarcopenia: European consensus on definition and diagnosis. Report of the European
Working Group on Sarcopenia in Older People. Age Ageing 2010
Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality
of life and death.
Catabolic crisis model
15
17
19
21
23
25
27
29
31
40 44 48 52 56 60 64 68 72 76 80 84 88
Age (y)
Reference : English and Paddon-Jones. Curr Opin Clin Nutr Metab Care. 2010
Muscle
ma
ss (
kg)
Bed rest / disuse in clinical settings
Inactive
(0 steps/min)
Low Activity
(< 15 steps/min)
0
10
20
30
40
50
60
70
80
90
100
% Time
Nutrition and Metabolism
Inactivity and Muscle Loss
-1500
-1000
-750
-500
-250
0
Lo
ss o
f le
an
le
g m
ass (
g)
-2000
Young Older
28 Days
Middle-aged
14 Days 10 Days
Older
Patients
4 Days
Paddon-Jones et. al. 2004
English et al., 2014
Kortebein et al. 2007
Paddon-Jones , Pilot Data
- Bed Rest -
|-------------------- best case situation----------------------|
Leucine (4 g/meal): partially protects muscle function
-20
-15
-10
-5
0
Pe
rcen
tage
ch
an
ge
%
Muscle endurance
English, et al. 2015 AJCN
Control
Leucine
Aerobic capacity Muscle strength
Healthy middle-age adults; 14 days bed rest
Note: Testosterone did not protect strength
during bed rest
Zachwieja, et al. 1999 JCEM
Leucine: partially / temporarily protects muscle mass
-1000
-750
-500
-250
0
Whole
body lean m
ass (
g)
Day 7
(mid-point)
Control
Leucine
Day 14
(end bed rest)
-1250
English, et al. 2015 AJCNHealthy middle-age adults; 14 days bed rest
Protein source Leucine
whey protein isolate 13 %
milk protein 10 %
egg protein 8.5 %
muscle protein 8 %
soy protein isolate 8 %
wheat protein 7 %
collagen 2 %
Leucine content of common foods / supplements
Recommendations: Prevention and Treatment
For all healthy adults….
Establish a dietary framework that includes a moderateamount of high quality protein at each meal.
Modify as necessary to accommodate individual needs:
- energy requirements- physical activity- health status- body composition goals- dentition, satiety
Recommendations: Prevention and Treatment
React aggressively with targeted
nutrition interventions to preserve
muscle health and reduce the
negative metabolic consequences
of physical inactivity.
Acknowledgements
• Emily Arentson-Lantz
• Elfego Galvan
• Adam Wacher
• Elena Volpi
• Charles Mathers
• Blake Rasmussen
• Heather Leidy
• Wayne Campbell
• Don Layman
Funding
• RO1 NR012973
• R21 AR062479
• NSBRI (NNJ08ZSA002N)
• National Cattlemens Beef Association
• National Dairy Council
• UTMB Claude D. Pepper Older
Americans Independence Center