Topics. Dietary Approaches to Reduce Sarcopenia Risk

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1 (kg) Dietary Approaches to Reduce Sarcopenia Risk Satoshi Fujita, Ph.D. Faculty of Sport and Health Science Ritsumeikan University ILSI SEAR Philippine Country Committee Nutrition and Life Course Approach to Healthy Aging September 25 th, 218 Age-Associated Loss of Muscle Mass Topics 1. Definition of sarcopenia and its consequences 2. Daily protein intake and protein distribution on muscle mass 3. Exercise and muscle protein anabolism 4. Effective combination of protein intake and exercise to prevent/ameliorate sarcopenia Recommended Diagnostic Algorithm of Asian Working Group for Sarcopenia Sarcopenia: Loss of muscle mass and function 6 Lean mass 2yr Male Handgrip strength(hs) and gait speed(gs) 55 No low HS and No low GS Low HS and/or low GS yr Male Muscle mass measurement 4 35 Normal Low Age (yrs) 8yr Male No sarcopena No sarcopenia Sarcopenia Holloszy. Mayo Clinic Proceedings, 2 Chen et al. JAMDA, 214

2 Hazard ratio Odds ratio (Low Diabetes risk High VFA /BSA (cm 2 /m 2 ) Muscle mass Quick Check for Muscle Mass and Function Make a ring with your thumb and index fingers Check if the ring pass thorough calf Reduced muscle mass increases the risk for diabetes 3 25 WomenBMI<25kg/m P<.1 R=-.62 Muscle Strength Cross the arms and raise one leg off the ground Start at 4cm Kawakami et al. Geriatr Gerontol Int 214 Without momentum, stand up and hold for 3 seconds If successful, try the other leg, then reduce the height and try again What you should be able to achieve: 5 2 Men Women 2-29yrs 2cm 3cm 3-39yrs 3cm 4cm above 4 4cm 4cm Thigh circumference (cm) Lower limbs skeletal muscle weight/bw (kg/kg) Muranaga. Showa University J Medical Sci, 21 Jung et al. J Epidemiol 213 Yagi et al. Diabet&Met Syndrome 214 Prevalence of Diabetes in Men Sarcopenia increases the incidence of premature death Age-standardized Crude 5 4 Male Model 1 Model 2 Model NCD Risk Factor Collaboration, Lancet Thigh circumference (cm) Heitmann et al. BJM 29

3 Change from baseline (%) Life Expectancy of Japanese (years) Healthy Years Lost to Disability among Japanese (Years) Men yrs 86.3 Women yrs From Comprehensive Implementation of National Health Promotion Minister of Health, Labour and Welfare What is the Locomotive Syndrome? Bones Articular cartilage/ intervertebral disc Muscle/Nerve Osteoporosis Fracture Osteoarthritis Neuropathy Sarcopenia Loss of mobility (Gait disorder Disability Bedridden Life expectancy Healthy life expectancy Life without disability Healthy years lost to disability Amino Acids Stimulates Muscle Protein Synthesis Protein Synthesis Protein Breakdown 2 The Japanese Clinical Orthopedic Association Young Old Volpi et al. Am J Physiol, 1999

4 Protein Intake Amino acids net balance nmol/min/1ml leg Changes in Lean Mass (kg) Essential Amino Acids are Critical for Muscle Protein Anabolism Daily Protein Intake and Loss of Lean Mass 3 2 Baseline Amino Acids Intake Small Daily Protein Intake Large g Mixed Amino Acids 18g Essential Amino Acids -3 P <.5 vs baseline Volpi et al. Am J Clin Nutr, 23 Houston et al. Am J Clin Nutr, 28 (g Nutritional Intake of Japanese Daily Protein Intake Male 4s Female 2s Male 5s Female 3s (year (kcal Daily Caloric Intake 2 Male 4s Female 2s Male 5s Female 3s 213 (year National Health and Nutrition Survey Adapted from: Recommendations for Protein Intake from International Expert Groups Recommendation for Japanese (>7yrs) =1.6g/kg.8g/kg RDA Current 25-5% g/kg minimum protein intake for healthy individuals 5-88% g/kg acute or chronic disease 15% Up to 2.g/kg severe illness or injury, or marked malnutrition New Recommendations >65 years Adapted from: Bauer et al. JAMDA, 213 Deutz et al. Clinical Nutrition, 214

5 Protein intake (g/kg BW) Amount of Protein to Maximize Muscle Protein Synthesis Distribution of Proteins over Main Meals Maximal protein synthesis Moore et al. J Gerontol 215 BF Lunch Dinner BF Lunch Dinner Adapted from SM Phillips et al. 214 Skipping Breakfast May Reduce Muscle Mass in Young Frequency of breakfast intake / week Yasuda et al. Nutr Research 218 Summary 1 1. Sarcopenia increases the risk of diabetes and cardiovascular diseases Increased risk of disability Prevalence of diabetes in Southeast Asia is rising 2. Daily protein intake is critical for the prevention of sarcopenia New recommendation by International Expert Groups call for higher protein intake for older individuals 3. Uneven protein distribution over main meals may lead to sarcopenia Amount of protein for each meal should be considered

6 N m N m Muscle protein synthesis (%/hr) Long-term Resistance Training for Older Individuals Muscular strength Body composition (MRI, DXA) Pre-Test 3 times/wk Resistance Training Post-Test 12 (wks) Training Protocol Leg extension Leg flexion 7% 1-RM 1 reps x 3 sets Time Course of Muscle Protein Synthesis after a bout of Resistance Exercise RE Changes in Leg Strength after 12-wk Resistance Training Time after exercise (hr) P<.5 vs. hr Phillips et al. AJP 26 Changes in Leg Muscle Mass after Resistance Training Before training After training Leg extension Leg flexion P<.1 vs Before cm Quadriceps Hamstrings cm Before training After training P<.1 vs Before

7 Change in strength (%) Change in muscle CSA (%) Muscle CSA (cm 2 ) Comparison of Exercise Intensity: 7% 1-RM vs. 5% 1-RM Change in Muscle Mass after 12-wk Resistance Training in Older Subjects Total work of exercise is matched 1 Thigh muscle CSA 5%1RM i.e. 95 7%1RM When 1-RM is 1kg, then.. 9 7% 1-RM 7kg 1 reps 5% 1-RM 5kg 14 reps pre post Resistance Exercise using an Elastic Band Effect of Resistance Training using an Elastic Band 12 week period, 2 times/week Training intensity using RPE of (somewhat hard or hard) at 1th rep 4% 1-RM Leg Strength Leg Muscle Mass Control Exercise P<.5 vs. Control

8 Muscle Protein Synthesis (%/hr) Catabolism Anabolism Exercise Sensitizes Muscle to Nutrient Stimulus Comparison of Protein Quality Rest After exercise Protein Type Biological Value Protein Efficiency Ratio Net Protein Utilization Whey Protein Soy Protein Casein Beef Protein Net Balance = (Muscle Protein Synthesis) (Muscle Protein Breakdown) BCAA Content of Dietary Proteins Adapted from USDEC U.S. Dairy Proteins: High-quality and Complete Protein Sources Dose-response of Protein Intake on Muscle Protein Synthesis after Resistance Exercise Rest Rest - Soy Rest - Whey Whey protein 1 scoop 36g) Soy protein (1 scoop 36g) Sirloin steak (113g) Chicken breast (113g) Leucine Isoleucine Valine 3.2 g 1.8 g 1.7 g 2.4 g 1.5 g 1.5 g 2. g 1.1 g 1.3 g 2. g 1.4 g 1.4 g Ex Ex - Soy Ex - Whey # + + Adapted from USDA National Nutrient Database. P<.5 vs. Ex, + P<.5 vs. Rest # P<.5 vs. Ex + whey (2g) 2 Protein Intake (g) 4 Yang et al. Nutr Met, 212

9 Leg lean mass (g) Leg lean mass (g) Change in lean body mass (kg) Change in hamstring muscle CSA (%) Change in knee flexion strength (%) Combination of Protein Intake and Resistance Training Combination of Protein Intake and Interval Walking: Japanese study Baseline 3 month 6 month 9 month -2 Control Protein Control Protein Volec et al. J Am Coll Nutr 213 Okazaki et al. Scand J Med Sci Sports, 213 Meta-analysis on the effect of Protein Supplementation with Exercise Training-induced Change in Lean Mass and Daily Protein in Japanese Older Subjects 1 8 y = x R² =.381 p= y =.88 x R² =.483 p= Protein intake (g/day) Daily leucine intake (mg/day) Cermak et al. Am J Clin Nutr 212 Yoshii et al. J Nutr Sci Vitaminol. 217

10 Summary 2 1. Resistance exercise stimulates muscle protein synthesis and induces muscle hypertrophy Even low-intensity exercise can induce a significant muscle hypertrophy among older individuals 2. Exercise potentiates anabolic stimulus of protein More acute anabolic response and long-term increase in lean mass 3. Both the amount and quality of protein are critical to maximize the additive effect of exercise and protein intake Research Team and Collaborators Ritsumeikan University Takuma Arimitsu, Ph.D. Yasushi Shinohara, MD Toshiyuki Kurihara, Ph.D. Junya Takegaki Naomi Yoshii Jun Yasuda Maya Sakashita Atsushi Sawada Kohei Sase Sho Miyatake Shohei Nakayama Nobuaki Tottori Mana Yamamura Risako Mori McMaster University Stuart Phillips, Ph.D. Birmingham University Lars Holm, Ph.D. Maastricht University Luc van Loon, Ph.D. University of Texas Medical Branch Elena Volpi, M.D., Ph.D. Blake Rasmussen, Ph.D.