Physical activity, protein intake, and appendicular skeletal muscle mass in older men.

BACKGROUND: Aging is associated with physical inactivity, low energy intake, and loss of skeletal muscle mass. It is not clear whether regular physical activity and adequate dietary protein intake can attenuate the loss of skeletal muscle mass. OBJECTIVE: We hypothesized that the maintenance of physical activity and dietary protein intake would attenuate the age-related decline in total appendicular skeletal muscle mass. DESIGN: Total appendicular skeletal muscle mass was determined by dual-energy X-ray absorptiometry in 44 healthy, older white men aged 49-85 y. Physical activity level was determined by using a uniaxial accelerometer over a 9-d period. Dietary protein intake was estimated from a 3-d food record. RESULTS: Aging was inversely associated with total appendicular skeletal muscle mass in older men (r = -0.43; slope: -0. 119 +/- 0.039 kg/y; P < 0.01). An effect of age on appendicular skeletal muscle mass persisted after standing height and physical activity were controlled for (r = -0.34; slope: -0.120 +/- 0.052 kg/y; P = 0.03). Furthermore, an effect of age on appendicular skeletal muscle mass persisted after standing height and dietary protein intake per kilogram body mass was controlled for (r = -0.41; slope: -0.127 +/- 0.045 kg/y; P < 0.01). CONCLUSIONS: Maintaining regular physical activity and adequate protein intake may not offset the age-related loss of appendicular skeletal muscle mass in older men. Prospective studies are needed to confirm these results and to determine whether anabolic physical activity (eg, strength training) can attenuate the age-related loss of muscle mass in the elderly.     

Dietary protein intake affects albumin fractional synthesis rate in younger and older adults equally

Inclusion of dietary protein in meals and beverages affects the hepatic synthesis of the protein albumin. Besides dietary protein, several factors can influence albumin metabolism and affect plasma albumin. The role of aging in albumin synthesis is unclear. Recent research documents that albumin synthesis rate is influenced comparably in younger and older adults by dietary protein ingestion and changes in dietary protein quantity. This emphasizes the importance for all adults to consume an adequate amount of dietary protein.     

Inadequate energy and protein intake in geriatric outpatients with mobility problems

To individualize nutritional interventions for the prevention and treatment of malnutrition and sarcopenia, it is required to understand the nutritional needs of older adults. This study explores the nutritional needs of geriatric outpatients. We hypothesized that inadequate energy and protein intake is common in geriatric outpatients. Data were retrieved from 2 cohort studies encompassing community-dwelling older adults referred to geriatric outpatient mobility clinics in Amsterdam, The Netherlands and Melbourne, Australia. Indirect calorimetry and a food diary, respectively, were used to assess resting metabolic rate (RMR) and energy and protein intake. Total energy expenditure (TEE) was calculated by the RMR multiplied by an activity factor of 1.4. An energy deficit was defined as a relative difference >10% between TEE and energy intake. A protein deficit was defined as protein intake <1.2 g/kg body weight per day. Bland-Altman analysis assessed the agreement between energy and protein requirements versus intake at an individual level. Seventy-four outpatients were included (25 males, median age 78.9 [IQR: 72.8-86.1] years). The mean difference between TEE and energy intake was 292 (SD 481) kcal/d. An energy deficit was present in 46 outpatients. The median protein intake was 1.00 (IQR: 0.87-1.19) g/kg body weight per day and a protein deficit was present in 57 outpatients. There was a low agreement between energy and protein requirements versus intake at an individual level. In conclusion, over half of the outpatients had energy and/or protein deficits. Integrating dietetic services at geriatric outpatient mobility clinics could potentially improve nutrition- and muscle-related outcomes in a multidisciplinary approach.     

Inadequate dietary intake in patients with thalassemia

BackgroundPatients with thalassemia have low circulating levels of many nutrients, but the contribution of dietary intake has not been assessed.ObjectiveOur objective was to assess dietary intake in a large contemporary sample of subjects with thalassemia.DesignA prospective, longitudinal cohort study using a validated food frequency questionnaire was conducted.Participants/settingTwo hundred and twenty-one subjects (19.7±11.3 years, 106 were female) were categorized into the following age groups: young children (3 to 7.9 years), older children/adolescents (8 to 18.9 years), and adults (19 years or older); 78.8% had β-thalassemia and 90% were chronically transfused. This study took place at 10 hematology outpatient clinics in the United States and Canada.Main outcome measuresWe conducted a comparison of intake with US Dietary Reference Intakes and correlated dietary intake of vitamin D with serum 25-OH vitamin D and dietary iron with total body iron stores.Statistical analyses performedIntake was defined as inadequate if it was less than the estimated average requirement. χ², Fisher's exact, and Student's t test were used to compare intake between age categories and logistic regression analysis to test the relationship between intake and outcomes, controlling for age, sex, and race.ResultsMore than 30% of subjects consumed inadequate levels of vitamin A, D, E, K, folate, calcium, and magnesium. The only nutrients for which >90% of subjects consumed adequate amounts were riboflavin, vitamin B-12, and selenium. Dietary inadequacy increased with increasing age group (P<0.01) for vitamins A, C, E, B-6, folate, thiamin, calcium, magnesium, and zinc. More than half of the sample took additional supplements of calcium and vitamin D, although circulating levels of 25-OH vitamin D remained insufficient in 61% of subjects. Dietary iron intake was not related to total body iron stores.ConclusionsSubjects with thalassemia have reduced intake of many key nutrients. These preliminary findings of dietary inadequacy are concerning and support the need for nutritional monitoring to determine which subjects are at greatest risk for nutritional deficiency. Future research should focus on the effect of dietary quality and nutritional status on health outcomes in thalassemia.     

Marginal protein intake results in reduced plasma IGF-I levels and skeletal muscle fiber atrophy in elderly women

We investigated the effects of dietary protein on plasma IGF-I levels and muscle fiber cross-sectional area (CSA). Twelve healthy elderly women were randomly assigned to a weight-maintaining diet containing either 1.47 (marginal) or 2.94 (adequate) g protein/kg body cell mass (BCM)/d, (0.45 and 0.92 g/kg body weight/d, respectively) for 10wks. Plasma IGF-I levels and muscle fiber areas and distributions were evaluated at baseline and 10wks. After 10wks, both IGF-I and type I fiber CSA had declined significantly in subjects fed the marginal diet (30.1+/-2.1% and 32.7+/-7.9%, respectively) while they increased in those fed the adequate diet (19.5+/-7.0% and 22.3+/-7.5%, for IGF-I and type I CSA, respectively). The change in IGF-I was the only significantly associated with the change in type I fiber CSA (r2=0.70; p<0.03). These findings show that marginal dietary protein intakes will result in losses of muscle mass in the elderly and suggest a role for plasma IGF-I as a biochemical marker for the histological changes in skeletal muscle.     

Potential benefits of improved protein intake in older people

Ageing is associated with an increased incidence of diabetes, impaired immunity and numerous physiological, social and economic changes. Another under-recognised change to significantly impact on health outcomes and quality of life is the drastic loss of lean body mass. New concepts have recently emerged which indicate that different types of protein sources supply constituents differentially according to digestion rate, and that amino acids have roles additional to muscle synthesis. This review explores the benefits of higher protein intakes in older people and how the protein source may provide differential benefits. In particular, whey protein is more quickly digested than either casein or soy, and provides a faster and potentially greater net source of available nutrients and essential amino acids essential for maintaining better health.     

Limited and excess protein intake of pregnant gilts differently affects body composition and cellularity of skeletal muscle and subcutaneous adipose tissue of newborn and weanling piglets

Aim  

This study investigated whether dietary protein intake less (50%) or greater (250%) than requirements throughout gestation differently affects offspring body composition and cellular properties of skeletal muscle and subcutaneous adipose tissue (SCAT).     

Inadequate dietary protein increases hunger and desire to eat in younger and older men

Many older people experience changes in appetite and consume marginal or inadequate dietary protein. This study was designed to examine the appetitive responses to habitual protein intakes that span the range of adequacy in younger and older men. Twenty-two men (12 younger, aged 21-43 y and 10 older, aged 63-79 y) completed, in random order, three 18-d trials that involved consumption of individualized, isoenergetic menus providing 1.00, 0.75, and 0.50 g protein . kg BW(-1). d(-1), which were 125% (trial P125), 94% (trial P94), and 63% (trial P63) of the Recommended Dietary Allowance for protein. Near the end of each trial, the subjects recorded appetitive sensations hourly throughout one day using a visual analogue scale. Independent of age, ratings of hunger were lower for P125 (1.3 +/- 0.5 cm) than P94 (1.8 +/- 0.8 cm) and P63 (1.8 +/- 0.6 cm) (P = 0.037), and desire to eat was lower during the P125 trial (1.4 +/- 0.5 cm), compared with the P63 trial (2.1 +/- 0.7 cm) (P = 0.003), and P94 (1.8 +/- 0.7 cm) was not different when compared with P63 and P125. Protein intake did not influence fullness. These results show that younger and older men who consume inadequate protein experience appetite changes that may promote increased food intake.     

Early postnatal food intake alters myofiber maturation in pig skeletal muscle

We examined the effects of undernutrition on muscle development during the first postnatal week in pigs. Eighteen piglets were subjected to three nutritional levels (300, 200 or 100 g/(kg body. d) of colostrum then milk) between birth and slaughter at 7 d of age. Longissimus lumborum (LL), a fast-twitch glycolytic muscle, and rhomboideus (RH), a mixed slow- and fast-twitch oxido-glycolytic muscle, were taken for myofiber typing and biochemical analyses. Enzyme activities of lactate dehydrogenase (LDH), citrate synthase (CS) and beta-hydroxy-acyl-CoA-dehydrogenase (HAD) were used as markers of glycolytic, oxidative and lipid beta-oxidation capacities, respectively. Undernutrition selectively decreased (P < 0.001) hypertrophy of the future fast-twitch glycolytic fibers in LL. Contractile and metabolic maturation was delayed in the later maturing LL, as reflected by a decrease in muscle protein concentration (P < 0.01), an increase (P < 0.05) in the percentage of myofibers still expressing the fetal myosin heavy chain (MyHC), a lower postnatal increase in LDH activity (P < 0.001) and a delayed decrease in the percentage of IIa MyHC positive fibers (P < 0.001). Otherwise, restriction tended (P < 0.10) to increase the percentage of slow type I MyHC containing fibers in both muscles and of alpha-cardiac MyHC positive fibers in RH (P < 0.05). The LDH/CS ratio decreased dramatically (P < 0.001) after restriction, to a greater extent in LL than in RH. These changes denoted a more oxidative metabolism using fewer carbohydrates and more lipids in restricted pigs, as suggested by the increased activity of HAD (P < 0.001) and decreased respiratory quotient (P < 0.001).     

Protein intake for skeletal muscle hypertrophy with resistance training in seniors

Variability in protein consumption may influence muscle mass changes induced by resistance exercise training (RET). We sought to administer a post-exercise protein supplement and determine if daily protein intake variability affected variability in muscle mass gains. Men (N=22) and women (N=30) ranging in age from 60 to 69 y participated in a 12-wk RET program. At each RET session, participants consumed a post-exercise drink (0.4 g/kg lean mass protein). RET resulted in significant increases in lean mass (1.1 +/- 1.5 kg), similar between sexes (P > 0.05). Variability in mean daily protein intake was not associated with change in lean mass (r < 0.10, P > 0.05). The group with the highest protein intake (1.35 g x kg(-1) x d(-1), n=8) had similar (P > 0.05) changes in lean mass as the group with the lowest daily protein intake (0.72 g x kg(-1) x d(-1), n=9). These data suggest that variability in total daily protein intake does not affect variability in lean mass gains with RET in the context of post-exercise protein supplementation.     

A review of issues of dietary protein intake in humans

Considerable debate has taken place over the safety and validity of increased protein intakes for both weight control and muscle synthesis. The advice to consume diets high in protein by some health professionals, media and popular diet books is given despite a lack of scientific data on the safety of increasing protein consumption. The key issues are the rate at which the gastrointestinal tract can absorb amino acids from dietary proteins (1.3 to 10 g/h) and the liver's capacity to deaminate proteins and produce urea for excretion of excess nitrogen. The accepted level of protein requirement of 0.8g x kg(-1) x d(-1) is based on structural requirements and ignores the use of protein for energy metabolism. High protein diets on the other hand advocate excessive levels of protein intake on the order of 200 to 400 g/d, which can equate to levels of approximately 5 g x kg(-1) x d(-1), which may exceed the liver's capacity to convert excess nitrogen to urea. Dangers of excessive protein, defined as when protein constitutes > 35% of total energy intake, include hyperaminoacidemia, hyperammonemia, hyperinsulinemia nausea, diarrhea, and even death (the "rabbit starvation syndrome"). The three different measures of defining protein intake, which should be viewed together are: absolute intake (g/d), intake related to body weight (g x kg(-1) x d(-1)) and intake as a fraction of total energy (percent energy). A suggested maximum protein intake based on bodily needs, weight control evidence, and avoiding protein toxicity would be approximately of 25% of energy requirements at approximately 2 to 2.5 g x kg(-1) x d(-1), corresponding to 176 g protein per day for an 80 kg individual on a 12,000kJ/d diet. This is well below the theoretical maximum safe intake range for an 80 kg person (285 to 365 g/d).     

Adrenergic control of protein metabolism in skeletal muscle

This review summarizes evidence indicating that the sympathetic nervous system, through hormonal and neurotransmitter actions, produces anabolic, protein-sparing effects on skeletal muscle protein metabolism. Studies are reviewed which indicate that catecholamines secreted by the adrenal medulla have an inhibitory effect on muscle Ca(2+)-dependent protein degradation independently of other hormones. In addition, norepinephrine released from adrenergic terminals may increase the rate of protein synthesis in oxidative muscles, leading to increased protein accretion. Evidence is also presented that these effects seem to be mediated by beta(2)-adrenoceptors and cyclic adenosine monophosphate-dependent pathways. The understanding of the precise mechanisms by which endogenous catecholamines promote muscle anabolic effects may bring new perspectives for efficient treatment of muscle-wasting conditions and enhancement of growth efficacy in farm species.