The Evolution of Muscle Health: Could this be the most important determinant for healthy ageing?

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1 The Evolution of Muscle Health: Could this be the most important determinant for healthy ageing? John Burstow Director, Sales & Business Development TSI Pharmaceuticals

2 Imagine you are Weight Blood pressure Blood tests Cognitive decline Macular degeneration Osteoporosis

3 Sarcopenia and Muscle Health Sarcopenia is an age-related syndrome characterised by a loss of muscle mass, strength and function The average person loses between 8-15% of muscle mass each decade with acceleration after age 40 Baier, S et al. J Parenteral and Enteral Nutrition 2009, 33:1:72-82

4 So what does muscle loss look like? McLeod, M. et al. Biogerontology 2016, 17:

5 Why is Muscle Health so important? Responsible for all movement and support functions Muscles are our metabolic powerhouses it s how we dispose of glucose that we eat and how we metabolise most of the calories in our body. By having good muscle health, our bodies are able to regulate our blood to healthy levels so that other organs are not under additional stress Abundant evidence suggests that altered muscle metabolism plays a role in nearly all pathological conditions and chronic diseases

6 Muscle Strength and Mortality Ruiz, J. et al. BMJ 2008, 337:a439

7 No single feature of age-related decline is more striking than the decline in lean body mass which affects ambulation, mobility, energy intake, overall nutrient intake and status, independence and breathing Dr Irwin Rosenburg

8 The History of Osteoporosis Test 1990/ 1993 First/ Second International Symposia on Osteoporosis 1995 Fosamax approved by the FDA 1994 It s official: Osteoporosis is officially classified a disease 1996 First World Congress on Osteoporosis & First World Osteoporosis Day 1997 International Guidelines for Diagnosis and Management of Osteoporosis 1998 International Osteoporosis Foundation Established 2004 The US Surgeon General issues the first report on osteoporosis in the USA 2006 Actonel approved by the FDA 2008 The Fracture Risk Assessment Tool is implemented Today Osteoporosis diagnosis and treatment is relatively high HCP & patient awareness is high Many consumers proactively seek preventative solutions through supplementation, diet and exercise

9 The Evolution of Sarcopenia... Test 2010 European consensus on definition and diagnosis of Sarcopenia 2016 It s official: WHO officially classifies Sarcopenia as a disease! 2018 Research and interest in Sarcopenia continues to accelerate at an exponential rate 2011 First International Conference on Frailty & Sarcopenia Research First ANZ Society for Sarcopenia and Frailty Research Annual Meeting 2017 First Sarcopenia GP Education Program implemented in Victoria by the Australian Institute for Musculoskeletal Science (AIMSS) Years to come Sarcopenia diagnosis and treatment is relatively high HCP & patient awareness is high Many consumers proactively seek preventative solutions through supplementation, diet and exercise

10 5 Key steps to the evolution of a mature market Osteoporosis Sarcopenia 1. Disease Classification 2. Diagnostic Guidelines 3. HCP Awareness 4. Consumer Awareness 5. Preventative and Treatment options

11 How does Sarcopenia align with the current growth drivers within healthcare? Test 1. An ageing population Teichner, W. & Lesko, M. Cashing in on the booming market for dietary supplements, McKinsey & Co 2013, December

12 How does Sarcopenia align with the current growth drivers within healthcare? Test 1. An ageing population 2. Increased consumer awareness of preventative healthcare Teichner, W. & Lesko, M. Cashing in on the booming market for dietary supplements, McKinsey & Co 2013, December

13 How does Sarcopenia align with the current growth drivers within healthcare? Test 1. An ageing population 2. Increased consumer awareness of preventative healthcare 3. The rise of the self-directed consumer Teichner, W. & Lesko, M. Cashing in on the booming market for dietary supplements, McKinsey & Co 2013, December

14 The next great wave is Sarcopenia and muscle health

15 What can we do to preserve muscle mass beyond lifestyle interventions?

16 Introducing HMB

17 HMB is the Solution to Preserving Muscle Health as we age Beta-hydroxy-betamethylbutyrate (HMB) is a naturally occurring metabolite of the essential amino acid leucine Found naturally within human muscle cells Muscle mass is the sum of muscle protein synthesis and breakdown HMB enhances muscle protein synthesis and decreases muscle protein breakdown Protein Synthesis Protein Breakdown Albert F et al.: Usefulness of β-hydroxy-β-methylbutyrate (HMB) supplementation in different sports: an update and practical implications. Nutr Hosp 2015, 32(1):20-33

18 A case for HMB Supplementation HMB blood levels decline with age In order to benefit from HMB, supplementation is needed as only 5% of leucine is converted to HMB 3 grams of HMB is roughly equal to 600 grams of protein or 60 grams of leucine It is found within food, but only in trace amounts 3 grams of CaHMB is equal to about 6,000 avocados

19 HMB: Clinical Studies Meta-analysis - Sport Nutrition Test

20 HMB Improves Functionality in Older Adults Test Randomized, double-blind, placebo-controlled design 35 elderly men and women (HMB 71±5 years, Placebo 74±4 years) 3.0 g of Ca-HMB/ placebo provided daily for 8 weeks Resistance training protocol Conclusion: HMB significantly improved functional ability in GUG (Get up and Go Test) over control Panton, L et al. Effect of β-hydroxy-βmethylbutyrate and resistance training on strength and functional ability in the elderly. Med Sci Sports Exerc 1998, 30:S194.

21 HMB Improves Body Composition Test Randomized, double-blind, placebocontrolled, parallel design Thirty-one 70-year-old adults 3.0 g of Ca-HMB/ placebo provided daily for 8 weeks Prescribed exercise program (5 days/ week) Conclusion: HMB supplementation: Reduced body fat percentage more effectively than placebo Increased fat free mass gain Altered body composition with exercise in 70 year old adults Vukovich, M et al. Body Composition in 70-Year-Old Adults Responds to Dietary β- Hydroxy-β-Methylbutyrate Similarly to That of Young Adults. J Nutr 2001, 131:

22 HMB Improves Muscle Strength even without exercise Test Randomized, double-blind, placebo-controlled design Men and women 65 years and older Phase 1 Two non-exercise groups: 3g Ca-HMB consumed daily & placebo 24 weeks Change in leg extension strength and leg muscle quality for Ca-HMB group was significantly higher than placebo Phase 2 Resistance exercise introduced to both groups Resistance exercise significantly improved total lean mass, leg extension/flexion, handgrip strength, and get-up-and-go HMB + exercise group had the best outcomes Conclusion: HMB improves strength and muscle quality even without resistance exercise Stout, J et al.: Effect of calcium β-hydroxy-β-methylbutyrate (CaHMB) with and without resistance training in men and women 65+yrs: a randomized, double-blind pilot trial. Exp Gerontol 2013, 48(11):

23 HMB Prevents Muscle Loss During Bed Rest Test Randomized, double-blind, placebocontrolled, parallel design 24 healthy older (60-76 years) adult subjects (20 women, 4 men), confined to complete bed rest for ten days 3.0 g of HMB were provided starting 5 days prior to bed rest till the end rehabilitation phase. Conclusion: HMB supplementation preserves muscle mass during 10 days of bed rest Deutz, N et al. Effect of β-hydroxy-β-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults. Clin Nutr 2013, 32(5):

24 HMB: Summary Test Reduces muscle protein breakdown and increases muscle protein synthesis Benefits: Functionality Body composition Muscle strength Muscle mass Rehabilitation and recovery

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26 Thank you!

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