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• W2169043145 abstract "An adequate intake of dietary proteins is fundamental for muscle trophism by ensuring the provision of essential amino acids and by stimulating protein synthesis via the mammalian target of rapamycin pathway. Older adults are at high risk for inadequate protein ingestion. Moreover, the current recommended dietary allowance for protein (0.8 g/kg/d) may not be sufficient for preserving muscle mass in older individuals.1Wolfe R.R. Miller S.L. The recommended dietary allowance of protein: A misunderstood concept.JAMA. 2008; 299: 2891-2893Crossref PubMed Scopus (79) Google Scholar In the October 2012 issue of this journal, Tieland and colleagues2Tieland M. van de Rest O. Dirks M.L. et al.Protein supplementation improves physical performance in frail elderly people: A randomized, double-blind, placebo-controlled trial.J Am Med Dir Assoc. 2012; 13: 720-726Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar, 3Tieland M. Dirks M.L. van der Zwaluw N. et al.Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: A randomized, double-blind, placebo-controlled trial.J Am Med Dir Assoc. 2012; 13: 713-719Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar report the results of two trials on the effects of protein supplementation on muscle mass and physical performance in frail older people. They found that 24-week supplementation with a 15 g milk protein twice daily improved muscle strength and physical performance but did not increase muscle mass in frail elderly people. In contrast, a similar protein supplementation increased muscle mass when combined with resistance exercise training. These findings contribute to expanding our knowledge about the role of nutritional intervention in the management of sarcopenia. Nonetheless, a number of issues related to protein intake and supplementation in older subjects with sarcopenia are still to be addressed. Essential amino acids, especially leucine, are potent stimulators of muscle proteins synthesis via activation of the mammalian target of rapamycin signaling pathway.4Morley J.E. Argiles J.M. Evans W.J. et al.Society for Sarcopenia, Cachexia, and Wasting DiseaseNutritional recommendations for the management of sarcopenia.J Am Med Dir Assoc. 2010; 11: 391-396Abstract Full Text Full Text PDF PubMed Scopus (432) Google Scholar Milk-based protein contains a relatively high proportion of leucine, therefore representing an effective protein source for stimulating muscle anabolism.5Paddon-Jones D. Rasmussen B. Dietary protein recommendations and the prevention of sarcopenia: Protein, amino acid metabolism and therapy.Curr Opin Clin Nutr Metab Care. 2009; 12: 86-90Crossref PubMed Scopus (584) Google Scholar Recently, it has been demonstrated that β-hydroxy β-methylbutyrate, an amino acid metabolite of leucine, is able to give a considerable contribution to protein synthesis and to improve muscle strength and body composition.6Eley H.L. Russell S.T. Tisdale M.J. Attenuation of depression of muscle protein synthesis induced by lipopolysaccharide, tumor necrosis factor, and angiotensin II by β-hydroxy-β-methylbutyrate.Am J Physiol Endocrinol Metab. 2008; 295: E1409-E1416Crossref PubMed Scopus (82) Google Scholar, 7Vukovich M.D. Stubbs N.B. Bohlken R.M. Body composition in 70-year old adults responds to dietary β-hydroxy-β-methylbutyrate similarly to that of young adults.J Nutr. 2001; 131: 2049-2052PubMed Google Scholar However, there are limited data comparing the efficacy of different amino acid formulations on muscle anabolism.8Cruz-Jentoft A.J. Landi F. Topinková E. Michel J.P. Understanding sarcopenia as a geriatric syndrome.Curr Opin Clin Nutr Metab Care. 2010; 13: 1-7Crossref PubMed Scopus (380) Google Scholar Likewise, no definite evidence is available regarding the differential effects of animal-derived and plant-based proteins on muscle health in old age. This issue is of particular interest considering that proteins with different amino acid composition show specific absorption rates. Hence the concept of “fast” (eg, whey protein) versus “slow” protein (eg, casein and meat proteins) needs to be taken into consideration for the development of nutritional recommendations, as well as for the prescription of specific supplements.9Paddon-Jones D. Short K.R. Campbell W.W. et al.Role of dietary protein in the sarcopenia of aging.Am J Clin Nutr. 2008; 87: 1562S-1566SPubMed Google Scholar Independent of the type of protein and the source, it is important to underline that meals should contain a proper amount of high-quality protein. As previously mentioned, the current recommended dietary allowance for protein may not adequately protect older adults from development of sarcopenia.10Landi F. Russo A. Liperoti R. et al.Anorexia, physical function, and incident disability among the frail elderly population: Results from the ilSIRENTE study.J Am Med Dir Assoc. 2010; 11: 268-274Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar, 11Landi F. Laviano A. Cruz-Jentoft A.J. The anorexia of aging: Is it a geriatric syndrome?.J Am Med Dir Assoc. 2010; 11: 153-156Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar, 12Landi F. Liperoti R. Fusco D. et al.Sarcopenia and mortality among older nursing home residents.J Am Med Dir Assoc. 2012; 13: 121-126Abstract Full Text Full Text PDF PubMed Scopus (248) Google Scholar Indeed, older persons present a blunted muscle anabolic response to low amount of dietary proteins and amino acids. However, moderate to large servings of proteins or amino acids are capable of overcoming such anabolic resistance and stimulate protein synthesis to an extent similar to that achieved in young adults.9Paddon-Jones D. Short K.R. Campbell W.W. et al.Role of dietary protein in the sarcopenia of aging.Am J Clin Nutr. 2008; 87: 1562S-1566SPubMed Google Scholar For these reasons, many experts suggest that older people should increase their protein intake to 1.0 to 1.3 g/kg/d.4Morley J.E. Argiles J.M. Evans W.J. et al.Society for Sarcopenia, Cachexia, and Wasting DiseaseNutritional recommendations for the management of sarcopenia.J Am Med Dir Assoc. 2010; 11: 391-396Abstract Full Text Full Text PDF PubMed Scopus (432) Google Scholar, 9Paddon-Jones D. Short K.R. Campbell W.W. et al.Role of dietary protein in the sarcopenia of aging.Am J Clin Nutr. 2008; 87: 1562S-1566SPubMed Google Scholar Interestingly, in both trials presented by Tieland and colleagues,2Tieland M. van de Rest O. Dirks M.L. et al.Protein supplementation improves physical performance in frail elderly people: A randomized, double-blind, placebo-controlled trial.J Am Med Dir Assoc. 2012; 13: 720-726Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar, 3Tieland M. Dirks M.L. van der Zwaluw N. et al.Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: A randomized, double-blind, placebo-controlled trial.J Am Med Dir Assoc. 2012; 13: 713-719Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar when including the dietary protein supplements (30 g milk-based protein), the daily protein intake in the intervention group increased from 1.0 to 1.3–1.4 g/kg/d. The other major issue concerning protein intake is the identification of the optimal timing of protein consumption during the day and in relation to exercise. Considering that the ingestion of a large quantity of proteins in a single meal (eg, 90 g) is not able to enhance the anabolic response more than a moderate quantity (eg, 30 g), most experts suggest a daily protein distribution of 30 g at each meal.4Morley J.E. Argiles J.M. Evans W.J. et al.Society for Sarcopenia, Cachexia, and Wasting DiseaseNutritional recommendations for the management of sarcopenia.J Am Med Dir Assoc. 2010; 11: 391-396Abstract Full Text Full Text PDF PubMed Scopus (432) Google Scholar, 9Paddon-Jones D. Short K.R. Campbell W.W. et al.Role of dietary protein in the sarcopenia of aging.Am J Clin Nutr. 2008; 87: 1562S-1566SPubMed Google Scholar In this respect, it is important to highlight that in the studies by Tieland and colleagues,2Tieland M. van de Rest O. Dirks M.L. et al.Protein supplementation improves physical performance in frail elderly people: A randomized, double-blind, placebo-controlled trial.J Am Med Dir Assoc. 2012; 13: 720-726Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar, 3Tieland M. Dirks M.L. van der Zwaluw N. et al.Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: A randomized, double-blind, placebo-controlled trial.J Am Med Dir Assoc. 2012; 13: 713-719Abstract Full Text Full Text PDF PubMed Scopus (382) Google Scholar with the addition of the 15-g protein supplement at breakfast and 15 g protein at lunch, the daily protein intake was equally distributed during the main meals (27 g at breakfast, 32 g at lunch, and 29 g at dinner). Protein ingestion after physical activity has positive effects on the balance between protein synthesis and breakdown, resulting in net muscle protein anabolism.9Paddon-Jones D. Short K.R. Campbell W.W. et al.Role of dietary protein in the sarcopenia of aging.Am J Clin Nutr. 2008; 87: 1562S-1566SPubMed Google Scholar The maximal muscle protein synthesis is observed approximately 60 minutes after the end of physical exercise. Therefore, increasing the availability of amino acids during this period could provide the best anabolic benefit.9Paddon-Jones D. Short K.R. Campbell W.W. et al.Role of dietary protein in the sarcopenia of aging.Am J Clin Nutr. 2008; 87: 1562S-1566SPubMed Google Scholar Nevertheless, no definitive evidence is yet available regarding protein ingestion. Larger clinical randomized trials are needed to establish whether the intake of moderate amounts of high-quality proteins at each meal (25–30 g) and/or immediately after exercise (eg, 1 hour) could indeed represent an effective strategy to prevent and eventually treat the muscle loss associated with aging." @default.
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• W2169043145 title "Perspective: Protein: What Kind, How Much, When?" @default.
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