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