Cosa sono le proteine e perché ne abbiamo

bisogno?

Riccardo Calvani, PhD

Dipartimento di Geriatria, Neuroscienze e Ortopedia

Università Cattolica del Sacro Cuore

Outline

• Man is what he eats

• Nutrition, Protein and Hormesis

• Food protein role in “frail” life stages

• History of “enthusiasm” for protein

• Protein requirements

The doctrine of foods is of great ethical and political

significance. Food becomes blood, blood becomes heart and

brain, thoughts and mind stuff. Human fare is the foundation

of human culture and thought. Would you improve a nation?

Give it, instead of declamations against sin, better food. Man

is what he eats [Der Mensch ist, was er isst].

— Ludwig Andreas Feuerbach

Lehre der Nahrungsmittel: Für das Volk (1850).

PLoS ONE 7(10): e46414. doi:10.1371/journal.pone.0046414

PLoS ONE 7(4): e32452. doi:10.1371/journal.pone.0032452

Mitridate VI del Ponto

Nutrizione, Proteine e Ormesi

PEM – Protein Energy Malnutrition

Modificazioni con l’invecchiamento

Flakoll P, et al. Nutrition 2004

Baier S, et al. JPEN J Parenter Enteral Nutr 2009

After age 40, healthy adults can lose 8% of muscle every 10 years

Between 40 to 70 years old, healthy adults lose an average of 24% of muscle

% p

ea

k m

usc

le m

ass

Loss each decade

after age 70

15%

24% loss from age 40–70100

90

80

70

60

50

25 30 40 50 60 70

Modificazioni con l’invecchiamento

Sayer AA, et al. J Nutr Health Aging 2008

For optimal maintenance with aging, it is important to build muscle when young, maintain it in mid-life, and minimize loss in

older adulthood

Minimize LossMaintainBuild

Protein g/Kg/d 0.7 0.7 0.8 0.9 1.1

TNT Geriatric 2.0 Session 2 15

Low protein intake increases risk of frailty

Q2 Q3 Q4 Q5

1.0

0.9

0.8

0.7

0.6

0.5

Lower quintiles of protein intake are associated with higher risk of frailty

Od

ds

rati

o (

wit

h 9

5%

CI)

Risk of frailty by quintile of protein intake (% kcal) (n= 24,417)

Increasing dietary protein intake, % of kcal

70.8 g/day

72.8 g/day

74.4 g/day78.5 g/day

Beasley JM, et al. J Am Geriatr Soc. 2010;58:1063-1071.

J. Nutr. 116: 1364-1370.

Protein was truly nutritive,

whereas other organic

compounds were only

"respiratory.”

Justus von Liebig Carl von Voit Wilbur Olin Atwater

Voit recommended a dietary

protein intake of 118 g/d for

an adult human of average

weight doing moderate

muscular work.

“a general consensus of opinion

that the protein element should

amount to over 100 g a day, and

the energy value should be over

3000 calories.”

J. Nutr. 116: 1364-1370.

Russell Henry

Chittenden

“one-half of the 118 g of

protein food called for daily

by the ordinary standards is

quite sufficient to meet all

the real physiologic need of

the body, certainly under

the ordinary conditions of

life; and with most

individuals, especially

persons not leading an

active out-of-door life,

even smaller amounts of

will suffice”

“This meta-analysis provides new

recommendations for dietary

reference values, ie, an EAR

(median) and RDA (97.5th

percentile) for healthy adults of

105 and 132 mg N · kg -1 · d -1

(0.65 and 0.83 g good-quality

protein · kg -1 · d -1),

respectively”

Data for 235 individual subjects, each studied

at ≥ 3 test protein intakes, were gathered from

19 studies.

(WHO/FAO 2007)

“This Consultation recognises the

inherent limitations in currently accepted

values of protein and amino acid

requirements identified in this report as

amino acid scoring patterns. Further

studies are clearly needed that include

chronic disease related outcomes and

functional studies as delineated in Figure

2 of this report. It is also noted that with

very few exceptions, N-balance studies of

the protein requirement have not

included measures of specific

physiological outcomes. It is

recommended that future studies of the

protein requirement incorporate where

possible measures of specific

physiological outcomes.”

FAO 2013

Protein Quality = protein digestibility * indispensable amino acids content

Numero

soggetti

Apporti con gli alimenti

(g/die) (g/kg peso) (g/1000

Kcal)

Maschi 18-59 anni 976 90,0 1,2 38,7

≥60 anni 294 85,8 1,1 38,5

Femmine 18-59 anni 1122 75,3 1,2 39,5

≥60 anni 439 72,0 1,1 38,8

Apporti di Proteine dagli alimenti nella popolazione italiana

Dati INRAN-SCAI 2005-2006

Gruppi alimentari Contributo %

Cereali e derivati 29%

Carne e derivati 28%

Latte e derivati 21%

Pesce e prodotti della

pesca9%

Uova 3%

Verdure e ortaggi 4%

Frutta 2%

Legumi 1,4%

Fonti alimentari di proteine per la popolazione italiana

Dati INRAN-SCAI 2005-2006

2

Food vs you: How your dinner controls youBy Mark Peplow

… "The 'right diet' isn't the same for

everyone,”…

2

2The Journal of Frailty & Aging 03/2013; 2(1):38-53.

"I have had to eat my

own words many times,

and I have found it a very

nourishing diet.”

Sir Winston Churchill