ILSI Southeast Asia's seminar Compass Skyview Hotel, Bangkok, Thailand May 3, 2017 "Re-assessing Macronutrient Needs Requirement, Quality and Health Impact" The Role of Dietary in the Sarcopenia of Aging Shuichi Machida, Ph.D. Associate Professor Graduate School of Health and Sports Science, Juntendo University, Japan Increasing aging population Percentage of aged 65 years or older 7% 2013 2050 Data from World Population Prospects :The 2006 Revision Population Database Japan Italy Germany France England Sweden United states China Developing countries Expected Healthcare Cost in Japan Outlines Billion Yen 85 years or older 80-84 years 85 years or older 80-84 years 75-79 years 74 years or younger 75-79 years 74 years or younger 33.1% 56.5% 1. What is Sarcopenia? 2. The Role of Nutrition in Sarcopenia Prevention 3. The Role of Exercise in Sarcopenia Prevention 4. Combination of Exercise and Nutrition for Greater Muscle Hypertrophy 5. What is Whey? (Future Estimation of Healthcare Cost and Financial )
Sarcopenia Sarcopenia is the involuntary loss of skeletal muscle mass and strength that occurs with aging, resulting in physical frailty. -4% per decade -10% per decade Progression of sarcopenia with age. What is the prevalence of sarcopenia in Japan? 30 25 20 15 10 27.1 16.4 20% 19.9 17.2 21.8 22.1 20-30 40-50 60-70 80-90 Age (years) (Data adapted from Lexell et al, 1988) (Images from sarcopenia.com) 5 0 Shimokata et al.(2014) Tanimoto et al.(2012) Yamada et al.(2013) What is the prevalence of sarcopenia in Japan? A large-scale cohort study reported the prevalence to be in 36.2% of Sarcopenia In Japan, percentage of aged 65 and older population was 25% in 2013. 60 45 (n=472) (n=472) 41.3 38.0 53.7 How can we prevent sarcopenia Intervention 30 21.7 23.5 19.3 24.1 27.9 15 0 65-69 70-74 75-79 80 Age (years) Data from National Institute for Longevity Science, Longitudinal Study of Aging (NILS-LSA) (2006-2008) Physical frailty Loss of independent daily living Lifestyle-related diseases High health care costs age To define specific interventions that can attenuate, prevent, and potentially reverse sarcopenia
Higher protein intake helps to maintain muscle mass in elderly people N=2066, men and women aged 70-79 y for 3 years intake 10.9% 12.7% 14.2% 15.9% 18.6% (% of energy) 0.8 g 0.7 g 0.8 g 0.9 g 1.2 g (kg/day How much protein do Japanese consume? Are they eating more than recommended level? 40% Is consumed protein different by sex, age, etc? (Houston et al., 2008) (g/day) Decreasing protein consumption Annual changes in average values for protein intake by sex and age group (g/day) : recommended dietary allowance (Data from the National Health and Nutrition Survey Japan) Dietary protein allowance is sufficient among Japanese men and women. Sex Age N Energy Energy (g) N (kcal) (kcal) (g) Total 3839 2047 73.2-4408 1660 61.6-1-6 209 1316 46.1 20-30 185 1242 43.5 20-30 7-14 352 2018 71.8 30-60 368 1853 67.0 30-55 15-19 193 2439 82.9 60 187 1820 65.8 55 20-29 259 2136 76.7 60 328 1595 57.6 50 30-39 479 2117 72.7 60 525 1651 59.0 50 40-49 480 2090 72.6 60 558 1668 60.5 50 50-59 521 2118 76.2 60 555 1726 64.7 50 60-69 600 2141 78.9 60 749 1692 66.4 50 70 746 1936 71.8 60 953 1595 60.2 50 20 3085 2076 74.6 60 3668 1654 61.8 50 (Dietary protein data from the National Health and Nutrition Survey Japan, 2011 ) ( data from the Journal of Nutritional Science and Vitaminology, 59: S36-S43, 2013)
Dietary protein allowance is sufficient among Higher protein intake may be insufficient to Japanese men and women (g/day) maintain lean mass in aged 70 and older 90 1.2 g 80 1.2 g (kg/day N=2066, men and women aged 70-79 y for 3 years 70 intake 60 50 40 30 20 10 10.9% 12.7% 14.2% 15.9% 18.6% (% of energy) 0.8 g 0.7 g 0.8 g 0.9 g 1.2 g (kg/day 0 20-29 30-39 40-49 50-59 60-69 70 (Data from the National Health and Nutrition Survey Japan, 2011 ) Resistance-type exercise training Skeletal muscle area 2 (Houston et al., 2008) Resistance exercise enhances both synthesis and breakdown of muscle protein 3hr after exercise + (Amino acid) Young (Petrella et al. 2006) Resistance exercise increases skeletal muscle area regardless of age and sex. Older Synthesis Breakdown Net balance (Biolo et al., 1995)
Exercise How to enhance muscle hypertrophy? Sarcopenia prevention How to produce better results with the same exercise? Rest Nutrition Synergistic Effect Resistance Exercise Resistance Exercise Nutrient Intake Relationship between the amount of consumed protein and rate of muscle protein synthesis Young Older Timing of protein intake impacts muscle growth with resistance exercise in older adults Resistance exercise: 3 times/week for 12 weeks More than 25 g of protein for each consumption Not effective as young Amount of consumed protein (g) (Breen et al., 2011) Immediately after exercise 2 hours after exercise (Esmarck et al., 2001)
Impact of Source on Changes in Muscle Mass Whey protein more effective than other protein source at stimulating muscle protein Milk Whey Soy CHO/placebo supplement Why whey protein? Benefits of whey protein: (Phillips et al., 2009) Excellent source of high-quality protein Naturally rich in a branched-chain amino acid (BCAA) called leucine Promotes muscle protein synthesis Easy to consume for older adults because it can be mixed to meal or drink (Tang et al., 2009) Whey protein stimulates muscle protein synthesis more effectively in older men. Casein Casein Hydrolysate Whey (Pennings et al., 2011)
Sarcopenia: A public health concern Muscle mass is lost progressively after mid-adulthood Muscle mass correlates with strength. Low strength is a hallmark of disability. Many disabling conditions are associated accelerated with the loss of lean mass. Expectation to functional foods To develop interventions that can attenuate, prevent, and potentially reverse sarcopenia + Resistance exercise Functional foods Supplements Our challenge No more Sarcopenia