All Proteins are not Created Equally Nutritional and Exercise Strategies to Attenuate Sarcopenia

Transcription

1 All Proteins are not Created Equally Nutritional and Exercise Strategies to Attenuate Sarcopenia Innovative Nutrition Strategies for Healthy Aging Canadian Association on Gerontology Annual Conference Oct 16 th, 2014 Dr. Michaela Devries-Aboud, PhD Postdoctoral Fellow, Exercise Metabolism Research Group,

2 We re Getting Older

3 Overview What am I going to talk about today: What is sarcopenia and how and why does it develop How does protein consumption and resistance exercise attenuate sarcopenia Why are some proteins better at promoting positive nitrogen balance than others

4 Muscle mass (AU) What is Sarcopenia? Healthy ~0.8% per year 50 Age (years) 90

5 Thigh cross-sections (MRI)

6 Leg Strength and Survival - Men The Gerontological Society of America Newman, J Gerontol A Biol Sci Med Sci, 2006

7 Why Does Sarcopenia Occur?

8 Muscle proteins are constantly B R E A K D O W N turning over MUSCLE PROTEIN free AA AA S Y N T H E S I S

9 Rate of PS and PB Why Does Sarcopenia Occur? protein protein protein Time (h) PS PB Stuart M Phillips 2012

10 Muscle mass (AU) Acute disuse events punctuate the normal sarcopenic decline in muscle Healthy Disuseaccompanied Threshold of disability 50 Age (years) 90 Goodpaster et al., J Gerontol (2006) English and Paddon-Jones, Curr Opin Clin Nutr Metab Care (2010)

11 Five weeks of disuse reduces postabsorptive MPS * Gibson et al. Clinical Science. 72: , 1987

12 The decline in MPS with disuse 1. This is a reproducible finding: Bed rest Ferrando and Paddon-Jones Knee brace-mediated immobilization Glover ULLS de Boer 2. The decline in muscle mass, as well as the decline in MPS, can be completely ablated by electrical stimulation (Gibson, Lancet, 1988; Dirks, Clin Sci, 2014) What happens with feeding?

13 10d of immobilization blunts the rise in feedinginduced MPS Glover E I et al. J Physiol 2008;586:

14 What about just putting your feet up?

15 Two weeks of Step-Reduction 76% Breen, JCEM, 2012

16 Short-term step-reduction Pre Post P value Daily steps 5962 ± ± 110 < PA > 3 METs (min) 32.1 ± ± 2.4 < Energy expenditure (kcal) 1921 ± ± 130 < Weight (kg) 81.8 ± ± Fat mass (kg) 26.3 ± ± Body Fat (%) 31.9 ± ± Trunk fat mass (kg) 4.5 ± ± Fat-free mass (kg) 53.6 ± ± Leg Fat-free mass (kg) Leg skeletal mass (kg) 16.1 ± ± 1.5 < ± ± 1.0 < Breen, JCEM, 2012

17 Step Reduction Influenced Insulin Sensitivity Breen, JCEM, 2012

18 % change from pre-intervention Inflammation 50 TNF- IL-6 CRP * * 0 Stuart M Phillips 2012 Breen, JCEM, 2012

19 Induced Anabolic Resistance Breen, JCEM, 2013

20 Etiology of Sarcopenia Summary Sarcopenia = loss of muscle mass, strength and/or function Imbalance between MPS and MPB anabolic resistance Amino acids less able to stimulate MPS Insulin less able to decrease MPB Short-term disuse/step-reduction accelerates sarcopenia, which older people have a harder time recovering from

21 What strategies could be used to prevent/slow down sarcopenia?

22 Resistance Exercise

23 Rate of PS and PB Resistance Exercise protein protein protein Time (h) PS PB

24 Resistance Exercise - Considerations 1) Load 2) Sets 3) Repetitions

25 Bigger Weights Bigger Muscles The key is lifting to FAILURE 2012 by American Physiological Society Mitchell C J et al. J Appl Physiol 2012;113:71-77

26 Bigger Weights = Greater Strength? 2012 by American Physiological Society Mitchell C J et al. J Appl Physiol 2012;113:71-77

27 How about in older adults? Devries, in preparation, 2014

28 How about in older adults? Devries, in preparation, 2014

29 Resistance Exercise to Attenuate Sarcopenia - Summary Resistance exercise can prevent/attenuate sarcopenia Doesn t have to be heavy weight to improve muscle mass and strength Lifting to failure is key!!

30 Protein

31 Protein consumption in Older Adults The RDA for protein may not be enough to maintain lean mass in older adults

32 Adjusted lean mass (LM) loss by quintile of energy-adjusted total protein intake. 0.7g/kg/d (11.2%) 0.7g/kg/d (12.7%) 0.8g/kg/d (14.1%) 0.9g/kg/d (15.8%) 1.1g/kg/d (18.2%) Houston D K et al. Am J Clin Nutr 2008;87:

33 How much protein do we need per meal?

34 Moore, J Gerontol A Biol Sci Med Sci, 2014 Older adults need more protein to maximally stimulate MPS

35 So what is that per meal? 60 kg older adult 24 g 70 kg older adult 28 g 80 kg older adult 32 g X 3 meals/d = 1.2 g/kg/d Protein RDA - 0.8g/kg/d. Older adults need more than the RDA

36 What about the relationship between protein dose and timing of intake?

37 Amount & Timing of Protein Ingestion Areta J L et al. J Physiol 2013;591:

38 Amount & Timing of Protein Ingestion Areta J L et al. J Physiol 2013;591:

39 What about in older adults?

40 Rate of PS and PB Imbalanced protein meals are also an issue PS PB protein protein protein Time (h) 8g 12g 50g

41 What about in older adults? Arnal, AJCN, 1999 Bouillane, Clin Nutr, 2013 Skewed Breakfast: 4g Lunch: 51g Dinner: 9g Balanced 16g x 4 meals Result TOTAL: 64g TOTAL: 64g FFM lost in balanced, FFM maintained in skewed Breakfast: 4g Lunch: 48g Dinner: 2g Pre-Bed: 11g Breakfast: 12g Lunch: 20g Dinner: 13g Pre-Bed: 20g TOTAL: 65g TOTAL: 65g FFM lost in balanced, FFM gained in skewed

42 What about in older adults? The jury is still out Skewed vs. Balanced distribution of protein intake Bauer, JAMDA, 2013

43 Protein Intake - Summary Aging is associated with reduced food intake, predisposing to energy-protein undernutrition (Morley, AJCN, 1997) Muscle area & strength decreased in older adults fed an isocaloric diet containing the protein RDA (Campbell et al, J Gerontol, 2001) Older adults may need more protein than the RDA g/kg/d to reach N equilibrium greater benefit may be seen with higher intakes Older adults are not consuming these intakes!

44 Resistance Exercise & Protein Intake

45 FSR (%.h -1 ) Resistance Exercise + Protein 0.12 Non-exercised Exercised * # * Ingested whey protein (g) Yang, Br J Nutr, 2012

46 Protein: The Nitty Gritty Not all proteins are created equal

47 What proteins are we going to talk about?

48 NB AUC nmol Phe 100 ml leg -1 3h -1 Milk vs. Soy post exercise 25 * MLK SOY Wilkinson et al. Am J Clin Nutr 2007;85:

49 What about long term?

50 Milk promotes greater lean mass gains during 12 weeks of resistance training Lean body mass (kg) 4 3 * * * CON SOY MLK Hartman et al. Am. J. Clin. Nutr. 86(2):373-81, 2007 Hartman et al. Am. J. Clin. Nutr. 86(2):373-81, 2007

51 FSR (%h -1 ) Short-term nutrition- and exercisebased changes in MPS predict longerterm phenotypic changes Milk Soy * Exercise 3h Recovery Lean body mass (kg) 4 * 3 * * CON SOY MLK

52 Why is Milk so good at promoting positive nitrogen balance? Whey Amino Acids Casein

53 Whey Protein stimulates MPS best Tang et al. J. Appl. Physiol. 107, 2009

54 Whey vs. Soy Yang et al. Nutr Metab 14;9(1):57, 2012

55 Whey vs. Soy Both whey and soy are rapidly digested proteins so why do they differ in their ability to stimulate MPS?

56 Blood Leucine ( M) EAA ( M) Rise in Blood Amino Acids Whey Casein Soy 1400 Whey 1200 Casein Soy time (min) time (min) Tang et al. J. Appl. Physiol. 107, 2009

57 Whey vs. Soy vs. Casein Is the rapid rise in aminoacidemia responsible for the greater MPS response following whey ingestion?

58 [EAA] ( mol l -1 ) Pulse versus Bolus protein ingestion 1500 * 1000 Bolus (1 x 25g) * # # # Pulse (10 x 2.5g) Pre Time (min) Stuart M Phillips 2012 West et al. Am J Clin Nutr 2011;94:

59 [EAA] ( M 320min) Identical net exposure to essential amino acids Bolus Pulse Stuart M Phillips 2012 West et al. Am J Clin Nutr 2011;94:

60 Myofibrillar FSR (% h -1 ) Bolus protein ingestion promotes more rapid and greater myofibrillar protein synthesis Bolus Pulse * * 0.04 A A 0.02 A 0.00 Rest 1-3h 3-5h Stuart M Phillips 2012 West et al. Am J Clin Nutr 2011;94:

61 Myofibrillar FSR (% h -1 ) What about in older adults? Casein * Whey * FED EX-FED Burd et al. Br.J. Nutr., 2012

62 Corroboration from colleagues Pennings B et al. Am J Clin Nutr 2011;93:

63 What amino acids are important? Churchward-Venne T A et al. Am J Clin Nutr 2013;99:

64 IC [Lecuine] Muscle Protein Synthesis Leucine trigger Whey Soy Casein Leucine Trigger Time (min)

65 What about in older adults? Katsanos C S et al. Am J Physiol Endocrinol Metab 2006;291:E381-E387

66 All of these data suggest that whey, containing high leucine, would be much more beneficial to stimulate anabolism in aging skeletal muscle

67 Tieland, JAMDA, 2012

68 Tieland, JAMDA, 2012

69 Where s the beef? 12g 24g 36g Robinson, Appl Physiol Nutr Metab, 2012

70 Where s the Beef? Symons, J Am Diet Assoc., 2009

71 What I ve told you 1. Skeletal muscle is an important tissue 2. Sarcopenia in aging is problematic and can be accelerated by short-term periods of reduced activity/immobilization 3. It doesn t take much to induce anabolic resistance in older adults 4. Changes in muscle protein synthesis are determined by protein ingestion and resistance exercise and changes in skeletal muscle mass are predicted by these changes 5. Milk-based proteins are a special case: whey is the active component and the key ingredient in whey is leucine 6. Increased protein intake and resistance exercise are important for healthful aging.

72 McMaster Dr. Stuart Phillips Todd Prior Tracy Rerecich Dr. Nick Burd Dr. Dan West Dr. Yifan Yang Dr. Leigh Breen Dr. Tyler Churchward-Venne Dr. Cameron Mitchell Dr. Sarah Wilkinson Mr. Jason Tang The EMRG Crew

73 Thank you! Contact info: