Association between dietary intake and resistance exercise with change in body composition and physical function among elderly

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1 Association between dietary intake and resistance exercise with change in body composition and physical function among elderly O G Geirsdóttir, Ramel A, Chang M, Jonsson PV, Thorsdottir I University of Iceland & The Icelandic Geriatric Research Institute

2 CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report Research Support: Icelandic Technology Development Fund (No ) Research Fund of the University of Iceland Landspitali University Hospital Research Fund Helga Jónsdóttir & Sigurliði Kristjánsson, Geriatric Research Fund The Icelandic Gerontological Research Institute Consultant: None Discussion of Off-Label, Investigational, or Experimental Drug Use: None This study does not necessary reflect the views of the sponsors.

3 Background Body composition is an important factor in the development of disease. Lean body mass 1,2,3,4 Fat mass 5,6 Distribution Underlying mechanisms Inadequate food intake 8 Inactivity 9 Altered endocrine function 1,2 Inflammation 7 Aging is associated with changes in body composition 1.Cree, M.G., et al. 2004, The Journal of clinical endocrinology and metabolism. 2.Roriz-Cruz M, Rosset I, Wada T, et al J Am Geriatr Soc. 3.Harris, T., Kovar, et al. 1989, American Journal of Public Health. 4.Guralnik, J.M., Simonsick, et al. 1994, Journal of gerontology. 5.Singh, J.A. & Strand, V. 2009, The Journal of rheumatology. 6.Berger, M.J. & Doherty, T.J. 2010, Interdisciplinary topics in gerontology. 7.Lenk, K., Schuler, G. & Adams, V. 2010, Journal of cachexia, sarcopenia and muscle. 8.Walrand, S. & Boirie, Y. 2005, Current opinion in clinical nutrition and metabolic care. 9.Guo, S.S., Zeller, C., et al. 1999, Am JCN 3

4 IceProQualita study The overall aim was to increase knowledge on physical activity and nutrition among older adults and to investigate how these factors possibly modify body composition, muscle strength, physical function and other health parameters Research question to characterize participants who did not respond to the resistance training with regards to lean body mass. 1) Geirsdottir OG, Ramel A, Chang M, Briem K, Jonsson PV, Thorsdottir I. J Food Nutr Disor 2016,5:2. 2) Ramel A, Geirsdottir OG, Jonsson PV, Thorsdottiri I. J Nutr Health Aging. 2015;19: ) Arnarson A, Ramel A, Geirsdottir OG, Jonsson PV, Thorsdottir I. J Nutr Health Aging, 2015;19: ) Geirsdottir OG, Arnarson A, Ramel A, et al.. Scandinavian Journal of Public Health 2015;43:76-8 5) Arnarson A, Ramel A, Geirsdottir OG, Jonsson PV, Thorsdottir I. Aging Clin Exp Res. 2014;26: ) Geirsdottir OG, Arnarson A, Ramel A, Jonsson PV, Thorsdottir I. Nutr Res. 2013;33: ) Arnarson A, Geirsdottir OG, Ramel A, Briem K, Jonsson PV, Thorsdottir I. European Journal of Clinical Nutrition 2013;67:

5 Study overview 6-, 12- & 18 months after endpoint Baseline (n=237) Intervention (12 weeks) Endpoint n=213 > 12% dropout Follow-up n=149 > 30% dropout Measurements; Questionnaires; Nutrient intake Six training groups of participants in each group from October 2008 to December 2009 Measurements; Questionnaires; Nutrient intake June 2010

6 Methods Baseline (n=237) -> Endpoint (n=213) Measurements; Blood sample Anthropometry BMI Waist Body composition DXA Physical function 6MWD TUG Muscle strength Quadriceps strength Questionnaires; Demographic status Health & medication MMSE HRQL Physical activity Nutrient intake; 3 day weighed food diary FFQ

7 Methods Resistance exercise for 12 weeks 3 times /week min. warm-up 10 resistant exercise in equipment 3 sets, 6-8 repetitions»60% of 1-RM first week, 75-80% of 1-RM second week»load 5-10% /week min. stretching exercise Supervised Double blind intervention with 3 different isocaloric supplement Milk protein Whey protein Carbohydrate 20 g protein /serving 176 kcal/serving 40 g CHO /serving Whey protein n = 83 Analyzed at endpoint n = 66 Randomized n = 236 Milk protein n = 75 Analyzed at endpoint n = 67 Control n = 78 Analyzed at endpoint n = 75

8 Participants Recruited by advertisements in the Reykjavik area Inclusion criteria Community dwelling adults 65 years and older Apparently healthy MMSE score > 19 points 8

9 Characteristics of the participants All (n=237) Male (n=99) Female (n =138) Age (years) 73.6 ± ± ± 5.5 BMI [kg/m 2 ] 28.8 ± ± ± 4.9 Medication [count] 2.1 ± ± ± 1.6 HRQL (t-score) 54.9 ± ± ± 6.1 MMSE (points) 27.5 ± ± ± 2.0 PA [kcal/week] 2093 ± ± ± 1907 Mean ± SD 9

10 Dietary intake Supplementation did neither affect total energy- nor protein intake.

11 Anthropometrical changes after the intervention Changes in ASM are around 2/3 of total LM changes Geirsdottir OG, Arnarson A, Briem K, Ramel A, Jonsson PV, Thorsdottir I. J Gerontol A Biol Sci Med Sci. 2012

12 BUT - 19% did not gain LM 17.6% P = %

13 Characteristics of LM losers (n= 42) and gainers (n= 169) Gainers Loosers P Energy [kcal] 1724± ± CHO [g] 176±54 162± Fat [g] 71±26 63± Protein [g] 80±25 69± Protein [g/bw] 0.98± ±

14 LM losers and gainers multivariate regression Independently for statistical models, protein intake (g/kg BW) remains a significant predictor of gaining ASM with an OR mostly between 7 and 9

15 Improvement in physical function No significant differences between losers and gainers.

16 Conclusion In elderly community-living a 12 week resistance exercise program increase lean body mass, muscle strength and physical function. There is no added benefit from post-exercise ingestion of 20 g of protein beyond what is achieved by ingesting isocaloric carbohydrates. Arnarson A, Geirsdottir OG, Ramel A, Briem K, Jonsson PV, Thorsdottir I. European Journal of Clinical Nutrition 2013;67:821-6.

17 Conclusion According to our results, dietary intake predicts whether you lose or gain ASM. Loss in ASM does not translate into poorer function after 12 weeks. Long term consequeces? Physical activity is an important factor in healthy aging, however without proper dietary intake it could be questionable

18 Thank you!

19 Acknowledgements Principal Investigators: - Inga Þórsdóttir - Alfons Ramel - Ólöf Guðný Geirsdóttir Co-authors: Atli Arnarson Kristín Briem Pálmi V. Jónsson Milan Chang Other co-workers: Steinunn Guðnadóttir Hafsteinn Þórðarson Björn S. Gunnarsson Ólafur Unnarsson Bryndís Elfa Gunnarsdóttir Tinna Eysteinsdóttir Svandís Erna Jónsdóttir Óla Kallý Magnúsdóttir Ása Vala Þórisdóttir Cindy Mari Imai Ólöf Helga Jónsdóttir Margrét Þóra Jónsdóttir Aníta Gústavsdóttir Erna Héðinsdóttir Elísabet Margeirsdóttir Hrund Valgeirsdóttir Hrafnhildur Eva Stephensen Rakel Dögg Hafliðadóttir Hrafnhildur Guðjónsdóttir Fimleikafélagið Björk MS Iceland Dairies 20