Nutrition Strategies to Protect Muscle Health During Aging: The Value of Protein

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1 Nutrition Strategies to Protect Muscle Health During Aging: The Value of Protein Redacted version from the original presentation given at the seminar. Douglas Paddon-Jones, Ph.D., FACSM Sheriden Lorenz Distinguished Professor of Aging and Health Department of Nutrition and Metabolism, Center for Recovery, Physical Activity and Nutrition University of Texas Medical Branch, Galveston, TX, USA May 22-23, 2018

2 Disclosures I have received funding, participated on a Scientific Advisory Board or Speaker s Bureau for: National Dairy Council US Dairy Export Council American Egg Board National Cattlemens Beef Association Abbott Nutrition Agropur Leprino Foods Sabra Wellness National Space Biomedical Research Institute

3 Activity Pharmacology Outline Inactivity Disease Inflammation Mitochondrial Dysfunction Inadequate Nutrition Aging Perfusion

4 How much protein do we need? + when, why, how and who.

Protein Synthesis (%/h) How much protein per meal do we need? - a message of moderation - 30 g protein 90 g protein 0.14 0.12 * * * * 0.

5 Protein Synthesis (%/h) How much protein per meal do we need? - a message of moderation - 30 g protein 90 g protein * * * * Young Old 0 Fasting 30 g protein Fasting 90 g protein References: Symons et. al. AJCN, 2007 Symons et. al. JADA. 2009

Protein Synthesis (%/h) Synergistic Effect of Protein and Exercise 0.18 0.16 0.14 0.12 100% increase * * * * 0.1 0.

6 Protein Synthesis (%/h) Synergistic Effect of Protein and Exercise % increase * * * * % increase Young Elderly 0 Fasting Protein meal Protein + Exercise Reference: Symons et. al. JNHA, 2010

7 Net Muscle Protein Synthesis (mg Phe/leg) Reality: Age-related dose-response 60 6 g 50 Young Elderly 5 g 8 g 0 More than ~25 g protein Less than ~15 g protein 6 g Reference: Katsanos et. al. AJCN, 2005

8 Protein Quantity and Daily Distribution

protein synthesis 10 g 15 g 65 g Total Protein 90 g Usable

9 Concept: Skewed / typical protein intake We can t store excess protein for later anabolism Catabolism Anabolism maximum rate of protein synthesis 10 g 15 g 65 g Total Protein 90 g Usable Protein 55 g? ~ 1.3 g/kg/day Reference: Paddon-Jones and Rasmussen 2009

10 Catabolism Anabolism Concept: Optimizing protein at each meal? maximum rate of protein synthesis 30 g 30 g 30 g Total Protein 90 g Usable Protein 90 g ~ 1.3 g/kg/day greater 24 h protein synthesis response? Reference: Paddon-Jones and Rasmussen 2009

11 Protein distribution impacts muscle protein synthesis 25% * * g g Reference: Mamerow, et.al. J. Nutr. 2014

Sarcopenia Sarcopenia is a syndrome characterized by

strength with a risk of adverse outcomes such as physical

12 Sarcopenia Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death. Cruz-Jentoft AJ et al. Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010

13 Muscle mass (kg) Catabolic crisis model Age (y) Reference : English and Paddon-Jones. Curr Opin Clin Nutr Metab Care. 2010

14 Nutrition and Metabolism Bed rest / disuse in clinical settings % Time Inactive (0 steps/min) Low Activity (< 15 steps/min)

15 Loss of lean leg mass (g) Inactivity and Muscle Loss - Bed Rest - 0 Young Middle-aged Older Older Patients Days 14 Days 10 Days 4 Days best case situation Paddon-Jones et. al English et al., 2014 Kortebein et al Paddon-Jones, Pilot Data

Testosterone did not protect strength during bed rest Control Leucine Healthy

17 Percentage change % Leucine (4 g/meal): partially protects muscle function 0 Muscle endurance Aerobic capacity Muscle strength Note: Testosterone did not protect strength during bed rest Control Leucine Healthy middle-age adults; 14 days bed rest English, et al AJCN Zachwieja, et al JCEM

18 Whole body lean mass (g) Leucine: partially / temporarily protects muscle mass 0 Day 7 (mid-point) Day 14 (end bed rest) Control Leucine Healthy middle-age adults; 14 days bed rest English, et al AJCN

19 Leucine content of common foods / supplements Protein source Leucine whey protein isolate 13 % milk protein 10 % egg protein 8.5 % muscle protein 8 % soy protein isolate 8 % wheat protein 7 % collagen 2 %

20 Recommendations: Prevention and Treatment For all healthy adults. Establish a dietary framework that includes a moderate amount of high quality protein at each meal. Modify as necessary to accommodate individual needs: - energy requirements - physical activity - health status - body composition goals - dentition, satiety

21 Recommendations: Prevention and Treatment React aggressively with targeted nutrition interventions to preserve muscle health and reduce the negative metabolic consequences of physical inactivity.

22 Acknowledgements Emily Arentson-Lantz Elfego Galvan Adam Wacher Elena Volpi Charles Mathers Blake Rasmussen Heather Leidy Wayne Campbell Don Layman Funding RO1 NR R21 AR NSBRI (NNJ08ZSA002N) National Cattlemens Beef Association National Dairy Council UTMB Claude D. Pepper Older Americans Independence Center

Protein & Healthy Aging: Challenging Current Recommendations

Protein & Healthy Aging: Challenging Current Recommendations Douglas Paddon-Jones, Ph.D., FACSM Sheriden Lorenz Distinguished Professor of Aging and Health Department of Nutrition and Metabolism, Center