SLIDE 1
Douglas Paddon-Jones, Ph.D.
Professor, Nutrition and Metabolism The University of Texas Medical Branch
Establishing a dietary framework to maintain muscle in health and disease
SLIDE 2 Disclosures
- Dr. Paddon-Jones is a Research Investigator with funding
from the National Institute of Health (NIH), Dairy Research Institute and the National Space Biomedical Research Institute (NSBRI).
- Dr. Paddon-Jones is a member of the Scientific Advisory
Board or Speaker’s Bureau for the National Dairy Council, US Dairy Export Council, American Egg Board, Texas Beef Council and Abbott Nutrition.
SLIDE 3
- 1. building muscle in response to protein
- 2. how much protein do we need – and when ?
- 3. protein distribution and daily recommendations
- 4. priority areas: what happens if you are injured or sick?
- 5. sarcopenia and a new approach to interventions
Overview
SLIDE 4 Inactivity Malnutrition
Balanc lance
Synthesis Breakdown
Musc scle le growth
Musc scle le loss ss
Nutrition Exercise Hormones
Maintaining Muscle Mass and Function
Protein
Illness/Injury
SLIDE 5
- 1. Building muscle in response to protein
SLIDE 6 Artery Vein Synthesis Breakdown
Stable Isotope Methodology (ring - 13C6 - Phenylalanine)
SLIDE 7 Stimulating Muscle Growth with Protein
Symons et. al. AJCN, 2007
* *
0.02 0.04 0.06 0.08 0.1 0.12 0.14 Fasting
Protein Synthesis (%/h)
Young Elderly
50% increase
30 g protein
SLIDE 8
- 2. How much protein do we need – and when ?
SLIDE 9 How much protein do we need ?
- a message of moderation -
* *
0.02 0.04 0.06 0.08 0.1 0.12 0.14
Fasting 30 g protein Protein Synthesis (%/h) * * Fasting 90 g protein Young Old
~1.2 g/kg/day for 75kg individual
90 g protein 30 g protein
Symons et. al. AJCN, 2007 Symons et. al. JADA. 2009
SLIDE 10 * *
0.02 0.04 0.06 0.08 0.1 0.12 0.14 Fasting
Protein Synthesis (%/h)
0.16 0.18 No No age ge-rela elated ted impair impairmen ment t
Key points
Moderate te protein meal
Symons et. al. AJCN, 2007
SLIDE 11 Net Mus uscle le Prot
ein Synt nthe hesis is (mg g Phe/le e/leg) g) More re than han ~25 5 g prot
ein
Age-related dose-response
10 20 30 40 50 60
Young ung Elderly derly Les ess than an ~15 5 g prot
in
Katsanos et. al. AJCN, 2005
5 g 8 g 6 g 6 g
SLIDE 12
Protein + Exercise
+
SLIDE 13 * *
0.02 0.04 0.06 0.08 0.1 0.12 0.14 Fasting Protein meal Protein Synthesis (%/h) 0.16 0.18 Young Elderly
* *
Protein + Exercise
50% increase 100% increase
Additive Effect of Protein and Exercise
Symons et. al. JNHA, 2010
SLIDE 14 Timing of Protein and Exercise
Meal Appearance in plasma Peak anabolic window Whey Protein Amino Acids 10-20 minutes Consume 0-60 minutes post exercise Intact Proteins (beef, fish etc.) 90 + minutes Consume approx.. 60-90 minutes before exercise
SLIDE 15
- 3. Protein distribution and recommendations
SLIDE 16 How Much Protein Do We Eat?
Males 5th % 50th % 95th % 19-30y 77 115 186 31-49y 79 107 155 50-69y 63 96 144 70+y Females 19-30y 47 74 120 31-49y 50 73 107 50-69y 47 70 101 70+y 38 61 95
Source : NNS 95 (M. Noakes) Protein consumed in Australia (grams per day)
HIGH PROTEIN DIETS
…good thing I moved
SLIDE 17 Daily protein distribution
Total Protein
90 g
Catabolism Anabolism
10 10 g
maximum rate of protein synthesis
15 15 g 65 65 g
A skewed daily protein distribution fails to maximize potential for muscle growth
~ 1.3 g/kg/day
Paddon-Jones and Rasmussen 2009
SLIDE 18 Daily protein distribution
Total Protein
90 g
Catabolism Anabolism
10 10 g
maximum rate of protein synthesis
15 15 g 65 65 g
A skewed daily protein distribution fails to maximize potential for muscle growth
~ 0.7 g/kg/day
Paddon-Jones and Rasmussen 2009
Usable le Prote tein in
55 55 g
30 30 g
X
SLIDE 19 Daily protein distribution
Catabolism Anabolism
maximum rate of protein synthesis
30 30 g 30 30g 30 30 g
Total Protein
90 g
Repeated maximal stimulation of protein synthesis
increase / maintenance of muscle mass
~ 1.3 g/kg/day
Paddon-Jones and Rasmussen 2009
Usable le Prote tein in
90 90 g
SLIDE 20
Metabolic Study
SLIDE 21 24 hr protein distribution impacts the potential for muscle growth and repair
Breakfast Response 24-hour Response
Mamerow, et.al. 2012
** *
Even Protein Skewed Protein 30 g Protein 10 g Protein
SLIDE 22 Protein Distribution: Glucose Response
Mamerow, et.al. 2012 Protein: 10 g vs. 30 g Protein: 15 g vs. 30 g Protein: 65 g vs. 30 g
SLIDE 23 Self-reported hunger: 30 g/meal may be enough
Mamerow, et.al. 2012
30 g vs. 10 g protein 30 g vs. 65 g protein
*
Hungry Stuffed
SLIDE 24 Exercise and protein distribution
Total Protein
90 g
Catabolism Anabolism
10 10 g
maximum rate of protein synthesis
15 15 g 65 65 g
Effective exercise?
SLIDE 25 Catabolism Anabolism
maximum rate of protein synthesis
30 30 g 30 30g 30 30 g
Total Protein
90 g
Exercise and protein distribution
Effective exercise
SLIDE 26
30-gram protein breakfast ideas
Breakfast #1: Smoothie with 1 scoop vanilla whey protein powder + 1 cup milk + ½ cup strawberries + 1 English muffin Breakfast #2: 2 scrambled eggs + 1 slice toast + 1 cup coffee (1/2 milk) + ½ cup yogurt/melon Breakfast #3: ½ cup cottage cheese with ½ cup peaches + 1 cup coffee (1/2 milk) + 1 slice toast with peanut butter Breakfast #4: ½ cup high-protein oatmeal with 1 T. walnuts + ½ cup Greek yogurt with 1 cup coffee (1/2 milk) + 1 ham slice Breakfast #5: 1 egg, Canadian bacon, and cheese muffin sandwich + 1 cup milk or chocolate milk
SLIDE 27
- 4. priority areas: dealing with injury or illness
SLIDE 28 Bed rest is a defacto treatment modality
- if you’re hospitalized you become inactive -
Inactive (0 steps/min) Low Activity (< 15 steps/min) 10 20 30 40 50 60 70 80 90 100
% of Time
SLIDE 29 Inactivity and Aging Muscle
250
Loss of lean leg mass (g)
Healthy Young 28 Days Inactivity
2% total lean leg mass
Healthy Elders 10 Days Inactivity
10% total lean leg mass
Paddon-Jones et. al. 2004 Kortebein et al. 2007
3 times more muscle loss 1/3 the time All volunteers consumed the RDA for protein
SLIDE 30 Inactivity reduces muscle protein synthesis
0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09 0.1
Day y 1 Day y 10
Protein Synthesis (%/h)
* 30%
Kortebein et al. 2007
24 h muscle protein synthesis during 10 day of inactivity in elders (stable isotope methodology)
SLIDE 31 Protein combats muscle loss during inactivity
0.01 01 0.02 02 0.03 03 0.04 04 0.05 05 0.06 06 0.07 07 0.08 08 0.09 09 0.1
Day y 1 Day y 10
Protei ein n Synthes thesis (%/h)
*
Norm rmal al Diet Norm rmal al Diet Norm rmal al Diet et + Amino no Acids ds
#
Norm rmal al Diet et + Amino no Acids ds
30%
Ferrando & Paddon-Jones et. al. 2009
SLIDE 32 Muscle Loss in Hospitalized Older Adults
250
Loss of lean leg mass (g)
Healthy Young 28 Days Inactivity
2% total lean leg mass
Healthy Elders 10 Days Inactivity
10% total lean leg mass 10+ % total lean leg mass
Elderly Inpatients 3 days hospitalization
Paddon-Jones , Pilot Data
SLIDE 33 Are our older inpatients eating enough ?
20 40 60 80 100 Protein Carbohydrate Fat Presented Consumed
grams
20 40 60 80 100 Protein Carbohydrate Fat Presented Consumed
grams
per meal
Paddon-Jones, pilot data
SLIDE 34
Delicious ? …maybe…. Healthy ?.... not so much
High simple sugar desserts accounted for 50% of the protein consumed by inpatients
SLIDE 35
- 5. Sarcopenia and a new approach to interventions
SLIDE 36 SA
SARCO COPE PENIA IA
- Decline in basal energy expenditure
- Reduced insulin sensitivity
- Reduced muscle strength
- Reduced physical performance
- Increased risk for falls
- Increased health-related expenses
- Increased morbidity
- Increased mortality
Adapted from: Dr. OMAR JALUUL
Fried LP, Hadley EC, Walston JD, et al. 2005.
SLIDE 37 Sarcopenia: - definitions -
20 30 40 50 60 70 80 5 10 15 20 25 30 35
Fat Mass
Age (years) (kg) 20 30 40 50 60 70 80 30 35 40 45 50 55
Lean Body Mass
Age (years) (kg)
Holloszy, Mayo Clin Proc. 2000
SLIDE 38 Alternate model of muscle loss
- developing tactical nutrition interventions -
15 17 19 21 23 25 27 29 31 40 44 48 52 56 60 64 68 72 76 80 84 88
Age (yrs)
Lean muscle mass (kg)
SLIDE 39
Prevention and treatment strategies
PREVENTION:
Adopt a meal-based approach to protein consumption Consume a moderate amount of high-quality protein, 3-times per day Consume protein in close proximity to exercise
SLIDE 40
Prevention and treatment strategies
TREATMENT:
React aggressively with nutritional support to reduce the rapid loss of muscle and strength associated with physical inactivity, illness or injury
SLIDE 41 Madonna Mamerow, Ph.D. Fellow Joni Mettler, Ph.D. Assistant Professor, TSU Kirk English Doctoral Student Christopher Danesi Coordinator Emily Arentson-Lantz, Ph.D. Fellow Barbara Doucet, OT., Ph.D Assistant Professor
