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Optimal Protein Intakeand the RDA
Presents
Seminar Highlights from the Florida DieteticsAssociation Meeting
July 13, 2010
Orlando, FL
A Presentation Provided by The HealthSpan Institute andContinuing Education
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Optimal Protein Intakeand the RDA
The Scientific Basis for the Benevia ProductPortfolio and The Need for Superior HighLeucine/Essential Amino Acid Protein Blends asProvided in all Benevia Clinical NutritionProducts.
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Optimal Protein Intake
and the RDA
Robert R. Wolfe, Ph.D.
Professor, GeriatricsUniversity of Arkansas for Medical Sciences
Jul y 13, 2010. Orlando, Florida
Florida Dietetics Association Annual Meeting
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Current Guidelines Where Do They Come From?
Institute of Medicine
Food and Nutrition Board
Dietary Reference Intake (DRIs)
EAR
Estimate
AverageRequirement
RDA
Recommend
ed DietaryAllowance
UL + LL
Upper and
LowerLimits
AMDR
Acceptable
MacronutrientDistribution
Range
USDA Dietary GuidelinesOther
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N-Balance: The Primary
Tool for Determining DRI
N-balance determines the minimalamount of protein intake needed toavoid a progressive loss of body
protein.
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Current Recommendations
EAR- 0.66 gm protein / kg x day
RDA- 0.80 gm protein / kg x day
UL + LL - No Recommendations
AMDR - 10-35% of Energy of Intake
Taken from DRIs
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Relation Between
Recommended DietaryAllowance (RDA)and
Acceptable NutrientDistribution Range
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Acceptable MacronutrientDistribution Ranges
Range (% of energy)
Macronutrient Children, 1-3 y Children, 4-18 y Adults
Fat 30-40 25-35 20-35n-6 polyunsaturated fats
(linoleic acid)5-10 5-10 5-10
n-3 polyunsaturated fats*(-linolenic acid)
0.6-1.2 0.6-1.2 0.6-1.2
Carbohydrate 45-65 45-65 45-65Protein 5-20 10-30 10-35
SOURCE: IOM (2002a).
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Average Energy Requirement
35 kcal / kg x dayIf protein intake =
35% = 12.25 Kcal / kg x day
= 3gm protein / kg x day
10% = 3.5 Kcal / kg x day
= 0.89 gm protein / kg x day
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The RDA is Below the
Minimal AMDR for Protein
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Implication of AMDRs:
The optimal level of protein intakeis greater than the minimal needed
to avoid deficiency.
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We Should ConsiderMinimal and Optimal Levels
of Protein Intake
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Protein Intake Greater thanMinimal Requirements
Primarily Targets Muscle
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Muscle Protein Plays aCentral Role in Whole Body
Protein Metabolism
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Fasted
AminoAcids
Gut
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AminoAcids
Gut
Fasted + Stress
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AminoAcids
Fed
Aminoacid
s
Gut
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Is Adequate Muscle Mass
Important for Health?
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Midthigh Muscle Cross-Sectional Area PredictsMortality in Patients with COPD
Marquis et al, Am J Respir Care Med, 166: 809, 2002
Click to edit Master text stylesSecond level
Third level Fourth level
Fifth level
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There is a threshold effect of
loss of muscle and severity ofstress.
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21
Mortality and Strength
From Ruiz RJ, et al. BMJ 2008; 337(7661):92-95.
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Older individuals are much
closer to the dangerthreshold than young people
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How Does Ingested ProteinAffect Muscle Protein?
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Muscle Protein is in a ConstantState of Turnover
AMINO ACIDS
CELL
BLOOD
AminoAcids
PROTEINS
Oxidation
SynthesisBreakdown
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Protein intake stimulates
growth of muscle protein
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Response to a Single Serving of Beef
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
0.18
0.2
Basal 4 oz Basal 12 oz
MuscleProteinS
ynthesis%/h
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Dose Response to Protein Intake
There is a maximal effective singledose response to protein intake.
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Does increased protein intake
translate to more lean massand improved healthoutcomes?
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Dietary Protein Intake and Change inLBM over 3 y in Elderly (n= 2066)
From Houston DK et al. Am J Clin Nutr 2008; 87(1):150-155.
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Changes in Nutritional Status and Patternsof Morbidity among Free-Living Persons: a
10 year longitudinal study
Vellas BJ, et al. Nutrition 1997; 13:505-519.
304 subjects, age 72 at start
Results:Subjects with protein intakes greater than 1.2 g / kg day had fewer health problems over 10 years than
those with protein intakes less than 0.8 g / kg day.
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Protein Intake and
Cardiovascular Health
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Relative Risks (RR) of IschemicHeart Disease in 80,082 Women
1 2 3 4 5
Total Protein Intake 14.7 17.1 18.8 20.6 24.0
Multivariable RR 1.0 0.86 0.84 0.91 0.72
From: Hu et al. Am J Clin Nutr 1999; 70:21-227.
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Protein Supplements (20g/day) ReduceBlood Pressure in Hypertension
-14
-12
-10
-8
-6
-4
-2
0
Systolic Pressure Diastolic Pressure
From: Townsend et al. Am J Hypertension 2004; 17:1056
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Protein Intake and Bone Health
Protein under nutrition associated with low bone mineraldensity and greater fracture risk.
Geinoz G, et al. Osteoporos Int 1993; 3:242-248.
Heany RP. Am J Clin Nutr 2002; 75:509
Protein supplementation improves outcome after hipfracture.
Bonjou JP, et al. Bone 1996; 18:139S.
Tkatch L, et al. J Am Coll Nur 1992; 11:519.
Frost HM. J Bone Min Res 1997; 12:1-9.
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Benefits of Protein Intake inWeight Management
Thermogenesis
Satiety
Partitioning of nutrients to muscle
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How Much Protein Intake is
Optimal
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Estimation of Optimal
Protein Intake from MuscleMetabolism Studies
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Optimal Protein Intake fromMetabolic Studies
Maximal stimulation of muscle protein synthesis isachieved with 15 gm EAAs (35 gm protein).
Recommended intake for 70 kg man:
35 gm protein / meal x 3 meals / day
= 105 gm protein
= 1.5gm protein / kg x day
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Optimal Intake vs RDA
RDA = 0.8 gm protein / kg x day
Recommended from Metabolic Studies
= 1.5 gm protein / kg x day
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Dietary Recommendations
Protein intake by age NHANES, 2003-2004
Dietary GuidelinesLower AMDR Upper AMDR
1.5 g/kg/d
0
5
10
15
20
25
30
35
%
Calories
2-3 4-8 9-13 14-18
19-30
31-50
51-70
71+
Years
Protein
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Conditions Which May Increase the
Optimal Level of Protein Intake
Aging
Muscle wasting (eg, cachexia, sarcopenia, etc.Acute response to injury, critical illness
Diabetes
ObesityOsteoporosis
Exercise training
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Muscle Protein Synthesis
in Cancer
pLeu
500
pIle
200
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0 30 60 90
120
150
180
210
240
270
300
0
100
200
300
400
500EXP
Control
Time (min)
M
0 30 60 90
120
150
180
210
240
270
300
0
50
100
150
200EXP
Control
Time (min)
M
pVal
0 30 60 90 120
150
180
210
240
270
300
0
100
200
300
400EXP
Control
Time (min)
M
pPhe
0 30 60 90 120
150
180
210
240
270
300
0
50
100
150EXP
Control
Time (min)
M
There was a significant interaction and group effect for leucine (P
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meanFSR%
Postab
sorptiv
eFe
d
Delta
-0.05
0.00
0.05
0.10
0.15Control
EXP
%hour
Muscle protein fractional synthetic rate. A significant interaction was found for FSR (P=0.0269.
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What About the Kidney?
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There is no evidence that higher
protein intakes cause renal failurein healthy individuals
Institute of Medicine. Dietary Reference Intakes
for Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids.
Washington, D.C.: National Academy Press; 2005
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Lean Body Mass
Predicts Relative Risk of Death in ESRD
Lowrie and Lew, AJKD, 1990
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Effect of Dietary Protein Intake inKidney Disease (n=585)
From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.
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Effect of ProteinIntake on Incidence
of Kidney Failure(A) and compositeof Kidney Failure
and All-CauseMortality (B)
From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.
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Conclusion
A relatively high proportion (20% ormore of caloric intake) of protein intakebenefits muscle and other health
outcomes without significant healthrisks.
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