Sarcopenia and Nutrition New Kids on the Block? - St. Galler Geriatrieforum, Trends in der Geriatrie, 11.06.2015
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Sarcopenia and Nutrition New Kids on the Block? 20. St. Galler Geriatrieforum, Trends in der Geriatrie, 11.06.2015 Eva Kiesswetter, PhD eva.kiesswetter@fau.de
Sarcopenia – Definition
Muscle Mass Strength Function
Different operational definitions and cut off points (e.g. EWGSOP, FNIH, IWG)
Cruz-Jentoft et al. Age and Ageing 2010; Dam et al. J Gerontol A Biol
Sci Med Sci 2014; Fielding et al. J Am Med Dir Assoc 2011
Sarcopenia – Prevalence
[%] 50
40
n=122
30
n=198
Sarcopenia
20
n=538
10
0
Community Hospital Nursing Home
Volpato et al. J Gerontol A Biol Sci Med Sci 2013; Smoliner et al. JAMDA 2014;
Landi et al. J Gerontol A Biol Sci Med Sci 2011
Sarcopenia – Mechanisms
Cruz-Jentoft et al. Age and Ageing 2010
Energy Protein, EAA, Leucine, HMB Creatine
Muscle protein synthesis ↑
Muscle phosphocreatine ↑
Muscle protein breakdown ↓
Prevention and therapy of sarcopenia
Oxidative damage ↓ Inflammation ↓
Vitamin D
receptors ↑ Proteolysis ↓ Insulin resistance ↓
Anabolic resistance ↓ Anabolic signaling
proteins ↑
Vitamin D Antioxidants ω-3-Fatty Acids
Body composition and severity of malnutrition
a) Young patients b) Geriatric patients
81% 84% 85% 70% 67% 61%
Fat-free mass Fat mass
Hébuterne et al. Curr Opin Clin Nutr Metab Care 2010
Functional limitations stratified by nutritional status (MNA)
Handgrip strength***
Short Physical Performance TUG***
Battery (SPPB)***
100%
Functional limitations:
(Ø age 81 y)
80% no/slight
/ moderate/severe
60%
physically unable
40% ***Chi²-Test; pSarcopenia – Protein
Exogenous Endogenous
• Protein amount • Protein requirement
• Protein quality • Protein utilization
Muscle mass
and function
• Protein distribution • Protein synthesis
• Timing of • Protein degradation
protein intakeProtein intake – body composition
3-year follow up study (ø age 74.5 y, n=2066)
Groups with increasing protein intake
Loss of lean mass (kg)
p for trend pAnabolic resistance and aging
Postprandial muscle protein synthesis (MPS)
Breen and Phillips Nutr Metab (Lond) 2011Protein intake – recommendations
For older adults:
DACH (DGE 2015)
• 0.8 g/kg BW/day
PROT-AGE (Bauer et al. JAMDA 2013)
• 1.0 – 1.2 g/kg BW/day
ESPEN (Deutz et al. Clin Nutr 2014)
• 1.0 – 1.2 g/kg BW/dayRCT – Protein supplementation without exercise
Intervention: 15 g dairy protein twice daily over 24 weeks
Participants: frail older adults (n=65; ~ 80 years)
Outcome: Total lean mass Outcome: SPPB
treatment x time interaction p>.05 treatment x time interaction pRCT – Protein supplementation plus exercise
Intervention: 15 g dairy protein twice daily or placebo in addition to
progressive resistance exercise training twice per week over 24 weeks
Participants: Frail older adults (n=62; ø age 78 years)
Outcome: Lean body mass
treatment x time interaction p =.006
Tieland et al. JAMDA 2012RCT – Protein supplementation plus exercise
Outcome: Functional tests
No additional effect of protein supplementation on strength and physical performance
was found.
Tieland et al. JAMDA 2012Protein and resistance training – effect on fat-free mass?
Random effects model; point estimates of intervention effects with CI 95%; pooled mean difference with
CI 95%
Cermark et al. Am J Clin Nutr 2012Protein and resistance training – effect on muscle strength
(leg press)?
Random effects model; point estimates of intervention effects with CI 95%; pooled mean difference with
CI 95%
Cermark et al. AM J Clin Nutr 2012Protein intake – distribution
Maximal Protein Synthesis
Protein intake
Paddon-Jones & Rasmussen Curr Opin Clin Nutr Metabol Care 2009Protein intake – timing
Mixed-muscle protein fractional synthetic rate
Intake of 20 g protein at rest and after 30 min
n=12, n=12, exercise (endurance + strength)
75 y 73 y
Postprandial muscle protein synthesis increases
after exercise compared to rest (pβ-hydroxy-β-methylbutyrate (HMB)
a) RCT: 10 days bed rest (60-76 y), b) RCT: 12 weeks (n=50, ~72 y),
Intervention: 3 g HMB/d vs. Placebo Intervention: 2 g/d HMB, 5g/d ARG,
1,5 g/d Lys vs. Placebo
Deutz et al. Clin Nutr 2013 Flakoll et al. Nutrition 2004Vitamin D
a) NHANES III (n=4100; 71±8 y) b) LASA (3 y follow up; n=1008; ~74 y)
>40%
>3%
Bischoff-Ferrari et al Am J Clin Nutr 2004 Visser et al. J Clin Endocrinol Metab 2003
Study results of observational and intervention studies are inconclusive regarding the
association between vitamin D and function.
(Annweiler et al. J Nutr Health Aging 2009)ω-3-Fatty Acids
pAntioxidants
InCHIANTI study 6-year follow up (~75 y)
Hip flexion, n=441 Knee extension, n=444 Grip strength, n=474
p=.0007* p=.0006* p=.04*
Total Plasma Carotenoids Quartiles (µmol/l)
*adjusted for age, sex, baseline muscle strength
Lauretani et al., J Gerontol A Biol Sci Med Sci, 2008Creatine and resistance training – effect on fat-free mass?
Random effects model; point estimates of intervention effects with CI 95%; pooled mean
difference with CI 95%
Weighted mean difference: 1.33; 95%CI 0.79-1.86 kg
Devries and Phillips Med Sci Sports Exerc. 2014Creatine and resistance training – effect on muscle strength
(leg press)?
Random effects model; point estimates of intervention effects with CI 95%; pooled mean
difference with CI 95%
Weighted mean difference: 3.25; 95%CI 0.47-6.03 kg
Devries and Phillips Med Sci Sports Exerc. 2014Sarcopenia and Nutrition New Kids on the Block?
Research:
The evidence of randomized controlled nutrition intervention trails is still low
regarding sarcopenia
Future studies:
• Multicenter, longitudinal design with larger samples
• Consideration of baseline nutritional and functional status
• Studies with four arms (exercise, nutrition, both, none)
• Consideration of the timing of the supplementation
• Assessment of the adherence to nutritional interventions
• Supplementation in context o the subject’s and group’s present intake
Cruz-Jentoft et al. Age Ageing 2014; Hickson M. Proc Nut Soc 2015Sarcopenia and Nutrition New Kids on the Block?
Practice:
The nutrients discussed regarding sarcopenia are the “usual suspects”
Energy:
• sufficient intake to satisfy daily requirements (24 – 36 kcal/kg BW/d)
Protein:
• Intake: 1 – 1.2 g/kg BW/d
• Distribution: 25 – 30 g high quality protein per meal (whey protein)
• Leucine: 2.5 – 3 g per meal
Other nutrients:
• Antioxidants: High intake of fruits and vegetables
• ω-3-Fatty Acids: Fish intake, intake of vegetable oil
Supplements:
• Vitamin D: 800 IU/d
• HMB: 2 g/d?
• Creatine: 5g/d?
Combined interventions of exercise training and nutritionThank You for Your
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