Abstract
The protein intake of older people has gained increasing scientific interest as a potential factor to delay the age-associated decline in muscle mass and consequently to counteract the development of sarcopenia. The skeletal muscle of older people seems less responsive to the anabolic stimulus of protein intake. Therefore, higher protein needs are discussed to overcome this anabolic resistance and to maintain muscle mass as far as possible. Besides the total amount of protein consumed, the distribution, quality and timing in relation to physical exercise are considered relevant; however, deriving clear recommendations for clinical practice is still difficult as positive results of protein intake on muscle metabolism found in experimental trials cannot simply be transferred to everyday conditions and randomized controlled trials often failed to show improvements in muscular outcomes related to protein supplementation. The effectiveness of protein supplementation may depend on functional resources of the older persons and the habitual protein intake. There is still a need for studies with well-defined protocols and populations to further elucidate the role of protein in the prevention and treatment of sarcopenia.
Zusammenfassung
Die Proteinzufuhr gewinnt als potenzieller Faktor, um die altersbedingte Abnahme von Muskelmasse zu verzögern und der Entwicklung von Sarkopenie entgegenzuwirken, zunehmendes Interesse. Bei älteren Menschen scheint der Skelettmuskel weniger stark auf den anabolen Stimulus der Proteinzufuhr anzusprechen. Zur Überwindung dieser anabolen Resistenz und zur bestmöglichen Erhaltung der Muskelmasse wird daher ein höherer Proteinbedarf im Alter diskutiert. Neben der Gesamtmenge werden auch die Verteilung über die Mahlzeiten und die Proteinqualität sowie der Aufnahmezeitpunkt in Relation zu körperlicher Aktivität als relevant erachtet. Es ist jedoch immer noch schwierig, klare Empfehlungen für den klinischen Alltag abzuleiten, da die positiven Effekte kurzzeitiger Proteingaben auf den Muskelstoffwechsel nicht ohne Weiteres auf Alltagsbedingungen übertragbar sind und randomisiert-kontrollierte Studien oft keine Verbesserung von Muskelparametern durch eine Proteinsupplementation zeigen. Die Wirksamkeit scheint von den funktionellen Reserven der älteren Personen und der Höhe ihrer gewohnheitsmäßigen Proteinzufuhr abzuhängen. Es besteht nach wie vor Bedarf an Studien mit gut definierten Protokollen und Stichproben, um die Rolle von Protein in der Prävention und Behandlung von Sarkopenie zu klären.
References
Aubertin-Leheudre M, Adlercreutz H (2009) Relationship between animal protein intake and muscle mass index in healthy women. Am J Clin Nutr 102:1803–1810
Bauer J, Biolo G, Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14:542–559
Bauer JM, Verlaan S, Bautmans I et al (2015) Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 16:740–747
Berner LA, Becker G, Wise M et al (2013) Characterization of dietary protein among older adults in the United States: amount, animal sources, and meal patterns. J Acad Nutr Diet 113:809–815
Berrazaga I, Micard V, Gueugneau M et al (2019) The role of the anabolic properties of plant- versus animal-based protein sources in supporting muscle mass maintenance: a critical review. Nutrients 11(8):1825
Bo Y, Liu C, Ji Z et al (2019) A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: A double-blind randomized controlled trial. Clin Nutr 38:159–164
Breen L, Phillips SM (2011) Skeletal muscle protein metabolism in the elderly: Interventions to counteract the ‘anabolic resistance’ of ageing. Nutr Metab 8:68
Burd NA, Gorissen SH, Van Loon LJ (2013) Anabolic resistance of muscle protein synthesis with aging. Exerc Sport Sci Rev 41:169–173
Campbell WW, Trappe TA, Wolfe RR et al (2001) The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle. J Gerontol A Biol Sci Med Sci 56:M373–380
Coelho-Junior HJ, Milano-Teixeira L, Rodrigues B et al (2018) Relative protein intake and physical function in older adults: a systematic review and meta-analysis of observational studies. Nutrients 10(9):1330
Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31
Deutsche Gesellschaft für Ernährung (DGE), Österreichische Gesellschaft für Ernährung (ÖGE), Schweizerische Gesellschaft für Ernährung (SGE) (2018) Referenzwerte für die Nährstoffzufuhr, 2nd edn. DGE, ÖGE, SGE, Bonn (4. Aktualisierte Ausgabe)
Deutz NE, Bauer JM, Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 33:929–936
Duan Y, Li F, Li Y et al (2015) The role of leucine and its metabolites in protein and energy metabolism. Amino Acids. https://doi.org/10.1007/s00726-015-2067-1
European Food Safety Authority, EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) (2012) Scientific opinion on dietary reference values for protein. EFSA J 10:1–66
Farsijani S, Morais JA, Payette H et al (2016) Relation between mealtime distribution of protein intake and lean mass loss in free-living older adults of the NuAge study. Am J Clin Nutr 104:694–703
Finger D, Goltz FR, Umpierre D et al (2015) Effects of protein supplementation in older adults undergoing resistance training: a systematic review and meta-analysis. Sports Med 45:245–255
Geisler C, Prado CM, Muller MJ (2016) Inadequacy of body weight-based recommendations for individual protein intake-lessons from body composition analysis. Nutrients 9:23
Gingrich A, Spiegel A, Gradl JE et al (2018) Daily and per-meal animal and plant protein intake in relation to muscle mass in healthy older adults without functional limitations: an enable study. Aging Clin Exp Res 31(9):1271
Gingrich A, Spiegel A, Kob R et al (2017) Amount, distribution, and quality of protein intake are not associated with muscle mass, strength, and power in healthy older adults without functional limitations—an enable study. Nutrients 9:1358
Gorissen SHM, Witard OC (2018) Characterising the muscle anabolic potential of dairy, meat and plant-based protein sources in older adults. Proc Nutr Soc 77:20–31
Hengeveld LM, Pelgrom ADA, Visser M et al (2019) Comparison of protein intake per eating occasion, food sources of protein and general characteristics between community-dwelling older adults with a low and high protein intake. Clin Nutr ESPEN 29:165–174
Houston DK, Nicklas BJ, Ding J et al (2008) Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 87:150–155
Katsanos CS, Kobayashi H, Sheffield-Moore M et al (2006) A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Am J Physiol Endocrinol Metab 291:E381–E387
Kim CO, Lee KR (2013) Preventive effect of protein-energy supplementation on the functional decline of frail older adults with low socioeconomic status: a community-based randomized controlled study. J Gerontol A Biol Sci Med Sci 68:309–316
Kim IY, Deutz NEP, Wolfe RR (2018) Update on maximal anabolic response to dietary protein. Clin Nutr 37:411–418
Liao CD, Tsauo JY, Wu YT et al (2017) Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a systematic review and meta-analysis. Am J Clin Nutr 106:1078–1091
Loenneke JP, Loprinzi PD, Murphy CH et al (2016) Per meal dose and frequency of protein consumption is associated with lean mass and muscle performance. Clin Nutr 35:1506–1511
Lord C, Chaput JP, Aubertin-Leheudre M et al (2007) Dietary animal protein intake: association with muscle mass index in older women. J Nutr Health Aging 11:383–387
Mclean RR, Mangano KM, Hannan MT et al (2016) Dietary protein intake is protective against loss of grip strength among older adults in the Framingham offspring cohort. J Gerontol A Biol Sci Med Sci 71:356–361
Moore DR, Churchward-Venne TA, Witard O et al (2015) Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A Biol Sci Med Sci 70:57–62
Murphy CH, Oikawa SY, Phillips SM (2016) Dietary protein to maintain muscle mass in aging: a case for per-meal protein recommendations. J Frailty Aging 5:49–58
Paddon-Jones D, Rasmussen BB (2009) Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 12:86–90
Park Y, Choi JE, Hwang HS (2018) Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 108:1026–1033
Pennings B, Koopman R, Beelen M et al (2011) Exercising before protein intake allows for greater use of dietary protein-derived amino acids for de novo muscle protein synthesis in both young and elderly men. Am J Clin Nutr 93:322–331
Rosenberger C, Rechsteiner M, Dietsche R et al (2019) Energy and protein intake in 330 geriatric orthopaedic patients: Are the current nutrition guidelines applicable? Clin Nutr ESPEN 29:86–91
Shad BJ, Thompson JL, Breen L (2016) Does the muscle protein synthetic response to exercise and amino acid-based nutrition diminish with advancing age? A systematic review. Am J Physiol Endocrinol Metab 311:E803–E817
Ten Haaf DSM, Nuijten MAH, Maessen MFH et al (2018) Effects of protein supplementation on lean body mass, muscle strength, and physical performance in nonfrail community-dwelling older adults: a systematic review and meta-analysis. Am J Clin Nutr 108:1043–1059
Tieland M, Borgonjen-Van Den Berg KJ, Van Loon LJ et al (2015) Dietary protein intake in Dutch elderly people: a focus on protein sources. Nutrients 7:9697–9706
Tieland M, Franssen R, Dullemeijer C et al (2017) The impact of dietary protein or amino acid supplementation on muscle mass and strength in elderly people: individual participant data and meta-analysis of RCT’s. J Nutr Health Aging 21:994–1001
Tieland M, Van De Rest O, Dirks ML et al (2012) Protein supplementation improves physical performance in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 13:720–726
Veronese N, Demurtas J, Soysal P et al (2019) Sarcopenia and health-related outcomes: an umbrella review of observational studies. Eur Geriatr Med 10:853–862
Volkert D, Beck AM, Cederholm T et al (2019) ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 38:10–47
Wall BT, Gorissen SH, Pennings B et al (2015) Aging is accompanied by a blunted muscle protein synthetic response to protein ingestion. PLoS ONE 10:e140903
Wijnhoven Ha H, Elstgeest LEM, De Vet HCW et al (2018) Development and validation of a short food questionnaire to screen for low protein intake in community-dwelling older adults: The Protein Screener 55+ (Pro55+). Plos One 13:e0196406. https://doi.org/10.1371/journal.pone.0196406
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E. Kiesswetter, C.C. Sieber and D. Volkert declare that they have no competing interests.
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For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.
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Kiesswetter, E., Sieber, C.C. & Volkert, D. Protein intake in older people. Z Gerontol Geriat 53, 285–289 (2020). https://doi.org/10.1007/s00391-020-01723-4
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DOI: https://doi.org/10.1007/s00391-020-01723-4