The importance of (dairy) protein for maintenance of muscle mass during aging & rehabilitation METTE HANSEN, Associated Professor INSTITUTE OF PUBLIC HEALTH SECTION OF SPORT SCIENCE AARHUS UNIVERSITY DENMARK [email protected] AARHUS UNIVERSITY 2013 EU: THE PORPORTION OF ELDERLY GROW AARHUS UNIVERSITY 2013 SOCIETY: FOR HOW LONG CAN THEY REMAIN INDEPENDENT OF HELP ? $$$ INDIVIDUAL: CAN I DO WHAT I WANT TO DO? AARHUS UNIVERSITY 2013 DAILY ACTIVITIES WALKING STAIR CLIMBING CHAIR RISING Physical function of the muscle skeletal system › Flexibility › Coordination / balance › Muscle endurance capacity › Muscle strength › Muscle power Muscle mass & Neural factors AARHUS UNIVERSITY 2013 REDUCTION IN: STRENGTH MUSCLE MASS Reduced by 0.5-2% /yr from 50-80 yrs Reduced by 1-1.5% /yr from 60-65 yrs Muscle fiber Maximal Isometric strength Loss of muscle fiber Smaller muscle fiber Vandervoort & McComas 1986, Spirdoso 1995 Spirduso, Physical dimensions of Ageing, 1995 Parise & Yarasheski, Curr Opin Clin Nutr Metab Care, 2000 AARHUS UNIVERSITY 2013 MUSCLE PROTEIN BALANCE Muscle Muscle Synthesis Breakdown AARHUS UNIVERSITY 2013 MUSCLE PROTEIN BALANCE Immobilization & disease Muscle Muscle Synthesis Breakdown Reduced energy & protein intake AARHUS UNIVERSITY 2013 ELECTIVE ABDOMINAL SURGERY DEPRESSES MUSCLE PROTEIN SYNTHESIS AND ACCELERATE MUSCLE LOSS 21 days, n=13 Body weight ↓11.8 kg Fat free mass ↓11.5 kg Arm- & leg muscles ↓5.3 kg Heart muscle Dage Petersson et al 1990 AARHUS It is difficult for elderly patients to UNIVERSITY 2013 regain muscle strength after Muscle strength immobilisation/disease (Sashika 1996, Aerobic Fitness Sherrington 1997, Trudelle-Jackson 2002) Functional capacity Immobilization Physically active /disease ageing Normal ageing Training Diseased/Inactive ageing Threshold for independence Age N Beyer 2002 AARHUS UNIVERSITY 2013 STRENGTH TRAINING HAS AN ANABOLIC EFFECT ON MUSCLE GROWTH AARHUS UNIVERSITY 2013 EFFECT OF ACUTE STRENGTH EXERCISE Muscle protein synthesis * 8 sets of 0,12 %/hrs 8 rep 80% of 1RM 0,1 * 0,08 * 0,06 Fractional synthesis rate 0,04 0,02 0 Rest 3h 24h 48h Philips et al, 1997 AARHUS UNIVERSITY 2013 EFFECT OF ACUTE STRENGTH EXERCISE %/hrs * 8 sets of 0,16 %/hrs * 8 rep 80% of 1RM 0,14 * * * 0,12 * 0,1 * Fractional 0,08 * synthesis rate Fractional 0,06 breakdown rate 0,04 0,02 0 Rest 3 hrs 24 hrs 48 hrs Philips et al, 1997 AARHUS UNIVERSITY 2013 MUSCLE PROTEIN BALANCE – EFFECT OF ENERGY & PROTEIN INTAKE Amino Acids Essential Acids (EAA) Energy + + - Muscle Muscle Synthesis Breakdown Carbohydrate + (?) Insulin BCAA AARHUS UNIVERSITY 2013 PROTEIN . Protein quantity . Protein quality (EAA, BCAA) . Timing of protein intake . Protein source AARHUS UNIVERSITY 2013 LOSS OF LEAN BODY MASS IN HEALTHY ELDERLY N=2066, 70-79 YRS, 3-YEAR PERIOD Houston DK, et al, 2008 11.2 12.7 14.1 15.8 18 Energy% 0.7 0.7 0.8 0.9 1.1 g protein/kg/day Among those who lost Gr 5 vs 1 weight over the 3-y period, lower 40% reduced protein intake was associated loss of LBM with greater loss of LM. Sammenhæng også signifikant ved vægtstigning Ingen sammenhæng med veg protein Scientific evidence suggests that a protein intake moderately higher than the current RDA of 0.8 g/kg/day may help support muscle and bone health in the elderly. Chaput et al, J. Nutr. Health Aging 11: 363, 2007. Meng, X., et al. J. Bone Miner. Res. 24: 1827, 2009. However, few studies have examined the effect of protein source on protein metabolism and body composition in older adults. In older women, protein breakdown in the absorptive state was inhibited in those consuming a highvegetable-protein diet to a lesser extent than in those consuming a high-animal-protein diet; the result was less net protein synthesis Animalsk protein gjorde udslaget among those in the former group than Veg NS – men ikke så stor among those in the latter group (22). In spredning i indtag studies contrasting the effect of a lactoovovegetarian diet and a meat- containing diet in combination with resistance training on changes in body composition in older men, results were mixed (23, 24). In the Health ABC Study cohort, we found significant associations between animal protein intake and changes in LM, but no such association with vegetable protein intake. However, the range of intake was much greater for animal protein than for vegetable protein, which may have limited our ability to detect a significant association between vegetable protein intake and changes in LM. There is some question regarding AARHUS UNIVERSITY 2013 PROTEIN . Protein quantity seems to matter . Protein quality (EAA, BCAA) . Timing of protein intake . Protein source AARHUS UNIVERSITY 2013 ENHANCED PROTEIN QUANTITY AND QUALITY DURING 60 DAYS BEDREST DO NOT REDUCE MUSCLE LOSS (healthy young women) 3 Meals a day C PRO Ex Gr 1: 1.6 g protein/kg/day (incl.7.2 g extra BCAA) Hypotese til forklaring af større tab af Gr 2: 1 g protein/kg/day (isocaloric to gr 1) muskel i kost-gruppen tilskrives Gr 3: 1 g protein/kg/day + Exercise in bed stimulering af muskelproteinnedbrydning. Quadriceps Isokalorisk C og kost, Ex mere energi svarende til energiforbrug under exercise surae Fordelt på 3 måltider per dag. – i paddon jones studie fik de både flere måltider, mere protein og mere energi i interventionsgruppen Triceps Trappe et al, Acta Physiol (2007) AARHUS UNIVERSITY 2013 PROTEIN . Protein quantity seem to matter . Protein quality (EAA, BCAA) . Timing of protein intake . Protein source AARHUS UNIVERSITY 2013 ENHANCED PROTEIN QUANTITY AND QUALITY DURING 28 DAYS BEDREST DO REDUCE MUSCLE LOSS (healthy young men) Paddon-Jones D et al, J Clin Endocrinol Metab (2004) 89: 4351–4358 AARHUS UNIVERSITY 2013 ENHANCED PROTEIN QUANTITY AND QUALITY DURING 28 DAYS BEDREST DO REDUCE MUSCLE LOSS (healthy young men) Muscle mass Muscle strength Paddon-Jones D et al, J Clin Endocrinol Metab (2004) 89: 4351–4358 AARHUS UNIVERSITY 2013 PROTEIN INGESTION DURING SLEEP IMPROVES WHOLE-BODY & MUSCLE PROTEIN BALANCE OVERNIGHT Res et al MSSE (2012) 44(8): 1560-9 40 g casein protein ½ hr before sleep Whole body protein kinetic Muscle protein synthesis Similar findings in elderly men after 40 g casein protein via nasogastric tupe during night sleep Groen BBL et al Am J physiol Endocrinol Metab (2012) 302: E52-60 AARHUS UNIVERSITY 2013 How much protein do we need to maximize muscle protein syntheis rate? AARHUS UNIVERSITY 2013 10 g EAA MAXIMIZE MYOFIBRILLAR PROTEIN SYNTHESIS ~20-25 g of high Cuthbertson et al, quality protein FASEB, 2005 (milk, eeg, meat, fish) Cuthbertson et al, FASEB J (2005) 19(3): 422-4 AARHUS UNIVERSITY 2013 ? + PROTEIN = AARHUS UNIVERSITY 2013 RESISTANCE EXERCISE PROLONGED THE PERIOD OF ENHANCED MYOFIBRILLAR PROTEIN SYNTHESIS RATE Moore DR et al, J Physiol (2009) 587(4): 897-904 AARHUS UNIVERSITY 2013 TIMING OF PROTEIN & TRAINING AARHUS UNIVERSITY 2013 TIMING OF POSTEXERCISE PROTEIN INTAKE IS IMPORTANT FOR MUSCLE HYPEORTROPHY (elderly men) 12 week of strength training (3 times per week) 10g protein + 7g CHO + 3.3g fat Gr 1 (P0) Time = 0 hr after exercise Gr 2 (P2) Time = 2 hrs after exercise Esmarck B et al, J Physiol (2001) 535(1): 301-311 AARHUS UNIVERSITY 2013 TIMING OF POSTEXERCISE PROTEIN INTAKE IS IMPORTANT FOR MUSCLE HYPEORTROPHY (elderly men) Muscle CSA Mean fiber areal Dymanic strength (5 RM) improved in both groups Isokinetic strength only improved in P0 Esmarck B et al, J Physiol (2001) 535(1): 301-311 AARHUS UNIVERSITY 2013 N=680 subjects, Resistance training > 6 weeks FFM <50 yr >50 yr ~12 weeks resistance training + protein = +1 kg greater gain in FFM Am J Clin Nutr (2012) 96:1454-64 AARHUS UNIVERSITY 2013 N=680 subjects, Resistance training > 6 weeks FFMFFM Am J Clin Nutr (2012) 96:1454-64 AARHUS UNIVERSITY 2013 Synthesis Balance breakdown Morning Morning Morning Morning before breakfast + protein + exercise + exercise (If no protein before bed) + protein AARHUS UNIVERSITY 20-25 G OF HIGH QUALITY PROTEIN 2013 MAXIMIZE MYOFIBRILLAR PROTEIN SYNTHESIS AARHUS UNIVERSITY 2013 PROTEIN . Protein quantity . Protein quality (EAA, BCAA) . Timing of protein intake . Protein source AARHUS UNIVERSITY 2013 RESISTANCE TRAINING-INDUCED ΔLBM IN STUDIES OF SUBJECTS RECEIVING SUPPLEMENTAL PROTEIN SOURCES 11 weeks of training (range 8-16 weeks) › Fra phillips 2012 All studies mean change (ci 95%) 3 studies 8 studies 3 studies 7 studies n=42 n=91 n=51 n=67 Phillips SM et al, J Am College Nutr (2009) 28(4): 343-354 AARHUS UNIVERSITY 2013 DIET PROTEIN AA AVAILABLE FOR SKELETAL MUSCLE PROTEIN SYNTHESIS AARHUS UNIVERSITY 2013 PROTEIN SOURCES QUALITY 1,4 Determined by: - EAA composition 1,2 - Digestibility Maximum score of 1 for PDCAAS 1 0,8 PDCAAS 0,6 DIAAS 0,4 FAO (1) recommends that the DIAAS metod replaces 0,2 PDCAAS as the preferred method to evaluate protein 0 quality Milk Whey Soy Barley Rice 1: Dietary protein quality evaluation in human nutrition. FAO FOOD AND NUTRITION PAPER 92. 2013. Data from Paul Moughan, Riddet Institute, Global Dairy Platform Workshop, San Francisco, USA, April 2012. AARHUS UNIVERSITY 2013 FAST OR SLOW DIGESTIBLE PROTEINS AA availability Whey Casein • Myofibrillar protein synthesis in elderly men Milkprotein Oxidation 20% Whey 20 g whey or casein 80% casein Whey Casein Boirie Y, et al , 1997, Burd et al 2012 AARHUS Milkprotein UNIVERSITY 20% Whey2013 80%Casein FAST(WHEY) OR SLOW (CASEIN) DIGESTIBLE PROTEINS – MOST BENEFICIAL? Likely to depend on: • Age Fast or a mix of slow/fast digestible proteins for elderly Slow digestible protein • Time of the day ? before sleep ?? Slow digestible proteins for • Energy status?