Establishing a dietary framework to maintain muscle in health and - PowerPoint PPT Presentation

Establishing a dietary framework to maintain muscle in health and disease Douglas Paddon-Jones , Ph.D. Professor, Nutrition and Metabolism The University of Texas Medical Branch

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.

Overview 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

Maintaining Muscle Mass and Function Hormones Musc scle le growth owth Synthesis Exercise Protein Nutrition Balanc lance Malnutrition Musc scle le Inactivity loss ss Breakdown Illness/Injury

1. Building muscle in response to protein

Stable Isotope Methodology ( ring - 13 C 6 - Phenylalanine) Artery Synthesis Breakdown Vein

Stimulating Muscle Growth with Protein Protein Synthesis (%/h) 0.14 * * 0.12 0.1 50% increase 0.08 Young Elderly 0.06 0.04 0.02 0 30 g protein Fasting Symons et. al. AJCN, 2007

2. How much protein do we need – and when ?

How much protein do we need ? - a message of moderation - 30 g protein 90 g protein 0.14 * * * * Protein Synthesis (%/h) 0.12 0.1 0.08 0.06 0.04 Young 0.02 Old 0 Fasting 30 g protein Fasting 90 g protein ~1.2 g/kg/day for 75kg individual Symons et. al. AJCN, 2007 Symons et. al. JADA. 2009

Key points No No age ge-rela elated ted impairmen impair ment t 0.18 Protein Synthesis (%/h) 0.16 0.14 * * 0.12 0.1 0.08 0.06 0.04 0.02 0 Moderate te protein meal Fasting Symons et. al. AJCN, 2007

Age-related dose-response 60 6 g is 50 Young ung hesis nthe Elderly derly ein Synt 40 g) e/leg) 5 g g Phe/le otein 30 le Prot (mg 20 uscle Net Mus 8 g 10 0 Les ess than an ~15 5 g prot otein in More re than han ~25 5 g prot otein ein 6 g Katsanos et. al. AJCN, 2005

Protein + Exercise +

Additive Effect of Protein and Exercise * * 0.18 0.16 0.14 * * 100% increase Protein Synthesis (%/h) 0.12 0.1 50% increase Young 0.08 Elderly 0.06 0.04 0.02 0 Fasting Protein meal Protein + Exercise Symons et. al. JNHA, 2010

Timing of Protein and Exercise Meal Appearance in plasma Peak anabolic window Whey Protein 10-20 minutes Consume 0-60 minutes post exercise Amino Acids Intact Proteins Consume approx.. 60-90 minutes before 90 + minutes (beef, fish etc.) exercise

3. Protein distribution and recommendations

How Much Protein Do We Eat? HIGH PROTEIN DIETS Protein consumed in Australia (grams per day) 5 th % 50 th % 95 th % Males 19-30y 77 115 186 31-49y 79 107 155 50-69y 63 96 144 70+y …good thing I moved 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)

Daily protein distribution - typical ? - maximum rate of protein synthesis Catabolism Anabolism Total Protein 90 g 65 g 65 15 g 15 10 g 10 ~ 1.3 g/kg/day A skewed daily protein distribution fails to maximize potential for muscle growth Paddon-Jones and Rasmussen 2009

Daily protein distribution - typical ? - maximum rate of protein synthesis Catabolism Anabolism Total Protein 90 g 65 g 65 X 15 15 g 10 g 10  30 30 g in Usable le Prote tein 55 55 g ~ 0.7 g/kg/day A skewed daily protein distribution fails to maximize potential for muscle growth Paddon-Jones and Rasmussen 2009

Daily protein distribution - Optimal - maximum rate of protein synthesis Catabolism Anabolism Total Protein 30 30 g 30 30 g 30 30 g 90 g in Usable le Prote tein 90 90 g ~ 1.3 g/kg/day Repeated maximal stimulation of protein synthesis  increase / maintenance of muscle mass Paddon-Jones and Rasmussen 2009

Metabolic Study

24 hr protein distribution impacts the potential for muscle growth and repair Breakfast Response 24-hour Response * ** Skewed Protein Even Protein 30 g Protein 10 g Protein Mamerow, et.al. 2012

Protein Distribution: Glucose Response Protein: Protein: Protein: 10 g vs. 30 g 15 g vs. 30 g 65 g vs. 30 g Mamerow, et.al. 2012

Self-reported hunger : 30 g/meal may be enough Hungry 30 g vs. 10 g protein * 30 g vs. 65 g protein Stuffed Mamerow, et.al. 2012

Exercise and protein distribution Effective exercise? maximum rate of protein synthesis Catabolism Anabolism Total Protein 90 g 65 65 g 15 15 g 10 10 g

Exercise and protein distribution Effective exercise maximum rate of protein synthesis Catabolism Anabolism Total Protein 30 30 g 30 30 g 30 30 g 90 g

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

4. priority areas : dealing with injury or illness

Bed rest is a defacto treatment modality - if you’re hospitalized you become inactive - 100 90 % of 80 Time 70 60 50 40 30 20 10 0 Inactive Low Activity (0 steps/min) (< 15 steps/min)

Inactivity and Aging Muscle 250 Loss of lean leg mass (g) Healthy Young Healthy Elders 28 Days Inactivity 10 Days Inactivity 0 3 times more -250 muscle loss 1/3 the time -500 2% -750 total lean leg mass All volunteers consumed the -1000 RDA for protein -1500 10% total lean leg mass -2000 Paddon-Jones et. al. 2004 Kortebein et al. 2007

Inactivity reduces muscle protein synthesis 0.1 0.09 Protein Synthesis (%/h) 0.08 0.07 * 30% 0.06 0.05 0.04 0.03 0.02 0.01 0 Day y 1 Day y 10 24 h muscle protein synthesis during 10 day of inactivity in elders (stable isotope methodology ) Kortebein et al. 2007

Protein combats muscle loss during inactivity Day y 1 Day y 10 0.1 - older adults - 0.09 09 thesis (%/h) # 0.08 08 0.07 07 n Synthes * 0.06 06 30% 0.05 05 0.04 04 ein Protei 0.03 03 0.02 02 0.01 01 0 Norm rmal al Diet Norm rmal al Diet et + Norm rmal al Diet Norm rmal al Diet et + Amino no Acids ds Amino no Acids ds Ferrando & Paddon-Jones et. al. 2009

Muscle Loss in Hospitalized Older Adults 250 Healthy Young Healthy Elders Elderly Inpatients 28 Days Inactivity 10 Days Inactivity 3 days hospitalization Loss of lean leg mass (g) 0 -250 -500 -750 -1000 -1500 2% 10% 10+ % total lean leg mass total lean leg mass total lean leg mass -2000 Paddon-Jones , Pilot Data

Are our older inpatients eating enough ? Presented Presented 100 100 Consumed Consumed 80 80 grams grams 60 60 40 40 20 20 0 0 Protein Protein Carbohydrate Carbohydrate Fat Fat per meal Paddon-Jones, pilot data

High simple sugar desserts accounted for 50% of the protein consumed by inpatients Delicious ? …maybe…. Healthy ?.... not so much

5. Sarcopenia and a new approach to interventions

SA SARCO COPE PENIA IA o Decline in basal energy expenditure o Reduced insulin sensitivity o Reduced muscle strength o Reduced physical performance o Increased risk for falls o Increased health-related expenses o Increased morbidity o Increased mortality Adapted from: Dr. OMAR JALUUL Fried LP, Hadley EC, Walston JD, et al. 2005.

Sarcopenia: - definitions - Fat Mass Lean Body Mass 35 55 30 50 (kg) 25 45 (kg) 20 40 15 35 10 30 5 20 30 40 50 60 70 80 20 30 40 50 60 70 80 Age (years) Age (years) Holloszy, Mayo Clin Proc. 2000

Alternate model of muscle loss - developing tactical nutrition interventions - 31 Lean muscle mass (kg) 29 27 25 23 21 19 17 15 40 44 48 52 56 60 64 68 72 76 80 84 88 Age (yrs)

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

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

Barbara Doucet, OT., Ph.D Madonna Mamerow, Ph.D. Kirk English Assistant Professor Fellow Doctoral Student Joni Mettler, Ph.D. Christopher Danesi Emily Arentson-Lantz, Ph.D. Assistant Professor, TSU Coordinator Fellow