Malnutrition is associated with dynamic physical performance

Background Malnutrition and poor physical performance are both conditions that increase in prevalence with age; however, their interrelation in a clinically relevant population has not been thoroughly studied. Aims This study aimed to determine the strength of the association between malnutrition and measures of both static and dynamic physical performance in a cohort of geriatric outpatients. Methods This cross-sectional study included 286 older adults (mean age 81.8, SD 7.2 years, and 40.6% male) who were referred to geriatric outpatient mobility clinics. The presence of malnutrition was determined using the Short Nutritional Assessment Questionnaire (SNAQ, cut-off ≥ 2 points). Measures of dynamic physical performance included timed up and go (TUG), 4-m walk test, and chair stand test (CST). Static performance encompassed balance tests and hand grip strength (HGS). Physical performance was standardized into sex-specific Z-scores. The association between malnutrition and each individual measure of physical performance was assessed using linear regression analysis. Results 19.9% of the cohort was identified as malnourished. Malnutrition was most strongly associated with CST and gait speed; less strong but significant associations were found between malnutrition and TUG. There was no significant association between malnutrition and HGS or balance. Discussion Physical performance was associated with malnutrition, specifically, dynamic rather than static measures. This may reflect muscle power being more impacted by nutritional status than muscle strength; however, this needs to be further addressed. Conclusions Malnutrition is associated with dynamic physical performance in geriatric outpatients, which should inform diagnosis and treatment/prevention strategies

Postprandial muscle protein synthesis is higher after a high whey protein, leucine-enriched supplement than after a dairy-like product in healthy older people: a randomized controlled trial

BACKGROUND: Decreased ability of muscles to respond to anabolic stimuli is part of the underlying mechanism for muscle loss with aging. Previous studies suggest that substantial amounts of essential amino acids (EAA), whey protein and leucine are beneficial for stimulation of acute muscle protein synthesis in older adults. However, these studies supplied only proteins, and no bolus studies have been done with dairy products or supplements that contained also fat and carbohydrates besides proteins. The aim of this study was to evaluate whether a specifically designed nutritional supplement in older adults stimulates muscle protein synthesis acutely to a greater extent than a conventional dairy product. Moreover, the combined effect with resistance exercise was studied by using a unilateral resistance exercise protocol. METHODS: Utilizing a randomized, controlled, double blind study design, healthy older adults received a single bolus of a high whey protein, leucine-enriched supplement (EXP: 20g whey protein, 3g total leucine, 150kcal; n = 9) or an iso-caloric milk protein control (Control: 6g milk protein; n = 10), immediately after unilateral resistance exercise. Postprandial mixed muscle protein fractional synthesis rate (FSR) was measured over 4h using a tracer infusion protocol with L-[ring-(13)C(6)]-phenylalanine and regular blood and muscle sampling. RESULTS: FSR was significantly higher overall after EXP (0.0780 ± 0.0070%/h) vs Control (0.0574 ± 0.0066%/h (EMM ± SE)) (p = 0.049). No interaction between treatment and exercise was observed (p = 0.519). Higher postprandial concentrations of EAA and leucine are possible mediating factors for the FSR response, while plasma insulin increase did not dictate the FSR response. Moreover, when the protein intake from the supplements was expressed per kg leg lean mass (LLM), a significant correlation was observed with resting postprandial FSR (r = 0.48, P = 0.038). CONCLUSIONS: Ingestion of a high whey protein, leucine-enriched supplement resulted in a larger overall postprandial muscle protein synthesis rate in healthy older subjects compared with a conventional dairy product. This acute effect is promising for long-term effects on parameters of muscle mass, strength and function in sarcopenic older people, which requires further study. TRIAL REGISTRATION: This trial is registered in the Dutch Trial Register under number NTR1823

Safety and tolerability of 6-month supplementation with a vitamin D, calcium and leucine-enriched whey protein medical nutrition drink in sarcopenic older adults

Abstract Aims Safety and tolerability of prolonged supplementation with a vitamin D, calcium and leucine-enriched whey protein medical nutrition drink (WP-MND) was evaluated in sarcopenic older adults. Methods A 13-week double-blinded, randomized, isocaloric placebo-controlled trial (PROVIDE study; n = 380) was extended with a voluntary 13-week open-label extension (OLE). OLE participants were randomized to receive daily 1 or 2 servings of WP-MND (21 g protein, 3 g leucine, 10 µg vitD and 500 mg calcium per serving). Gastro-intestinal tolerability, kidney function and serum levels of calcidiol, parathyroid hormone (PTH) and calcium were evaluated at week 0, 13 and 26. Results and discussion In response to the high daily protein intake (median1.5; IQR: 1.3, 1.7 g/kg BW/day), the estimated glomerular filtration rate (eGFR) increased in the test group during the RCT (p = 0.013). The same trend was observed for those participants with moderate chronic kidney disease. During OLE no eGFR change was observed in any of the groups. Serum calcidiol and calcium reached a plateau after 13-week WP-MND supplementation. As expected, PTH significantly changed in the opposite direction, decreasing during RCT in the test group (T vs C: p  2.55 mmol/L (T: n = 3; C: n = 3), without associated adverse events. Conclusion A 6 months intervention with up to 2 servings of WP-MND did neither result in kidney function deterioration nor symptoms of vitamin D or calcium toxicity. The product was overall well tolerated

The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: a systematic review and meta-analysis

Background Engaging in physical activity (PA) and avoiding sedentary behavior (SB) are important for healthy ageing with benefits including the mitigation of disability and mortality. Whether benefits extend to key determinants of disability and mortality, namely muscle strength and muscle power, is unclear. Aims This systematic review aimed to describe the association of objective measures of PA and SB with measures of skeletal muscle strength and muscle power in community-dwelling older adults. Methods Six databases were searched from their inception to June 21st, 2020 for articles reporting associations between objectively measured PA and SB and upper body or lower body muscle strength or muscle power in community dwelling adults aged 60 years and older. An overview of associations was visualized by effect direction heat maps, standardized effect sizes were estimated with albatross plots and summarized in box plots. Articles reporting adjusted standardized regression coefficients (β) were included in meta-analyses. Results A total of 112 articles were included representing 43,796 individuals (range: 21 to 3726 per article) with a mean or median age from 61.0 to 88.0 years (mean 56.4 % female). Higher PA measures and lower SB were associated with better upper body muscle strength (hand grip strength), upper body muscle power (arm curl), lower body muscle strength, and lower body muscle power (chair stand test). Median standardized effect sizes were consistently larger for measures of PA and SB with lower compared to upper body muscle strength and muscle power. The meta-analyses of adjusted β coefficients confirmed the associations between total PA (TPA), moderate-to-vigorous PA (MVPA) and light PA (LPA) with hand grip strength (β = 0.041, β = 0.057, and β = 0.070, respectively, all p ≤ 0.001), and TPA and MVPA with chair stand test (β = 0.199 and β = 0.211, respectively, all p ≤ 0.001). Conclusions Higher PA and lower SB are associated with greater skeletal muscle strength and muscle power, particularly with the chair stand test

Sufficient levels of 25-hydroxyvitamin D and protein intake required to increase muscle mass in sarcopenic older adults - The PROVIDE study

BACKGROUND: Inadequate nutritional intake and altered response of aging muscles to anabolic stimuli from nutrients contribute to the development of sarcopenia. Nutritional interventions show inconsistent results in sarcopenic older adults, which might be influenced by their basal nutritional status. OBJECTIVE: To test if baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations and dietary protein intake influenced changes in muscle mass and function in older adults who received nutritional intervention. METHODS AND DESIGN: Post-hoc analysis was performed in the PROVIDE study that was a randomized controlled, double blind trial among 380 sarcopenic older adults. This study showed that those who received a vitamin D and leucine-enriched whey protein medical nutrition drink for 13 weeks gained more appendicular muscle mass (aMM), and improved lower-extremity function as assessed by the chair stand test compared with controls. To define low and high groups, a baseline serum concentration of 50 nmol/L 25(OH)D and baseline dietary protein intake of 1.0 g/kg/d were used as cut offs. RESULTS: At baseline, participants with lower 25(OH)D concentrations showed lower muscle mass, strength and function compared with participants with a high 25(OH)D, while the group with lower protein intake (g/kg/day) had more muscle mass at baseline compared with the participants with higher protein intake. Participants with higher baseline 25(OH)D concentrations and dietary protein intake had, independent of other determinants, greater gain in appendicular muscle mass, skeletal muscle index (aMM/h2), and relative appendicular muscle mass (aMM/body weight × 100%) in response to the nutritional intervention. There was no effect modification of baseline 25(OH)D status or protein intake on change in chair-stand test. CONCLUSIONS: Sufficient baseline levels of 25(OH)D and protein intake may be required to increase muscle mass as a result of intervention with a vitamin D and protein supplement in sarcopenic older adults. This suggests that current cut-offs in the recommendations for vitamin D and protein intake could be considered the "minimum" for adults with sarcopenia to respond adequately to nutrition strategies aimed at attenuating muscle loss

Protein type and caloric density of protein supplements modulate postprandial amino acid profile through changes in gastrointestinal behaviour: A randomized trial

BACKGROUND & AIMS: The requirement of leucine and essential amino acids (EAA) to stimulate muscle protein synthesis increases with age. To target muscle anabolism it is suggested that higher postprandial blood levels of leucine and EAA are needed in older people. The aim was to evaluate the impact of oral nutritional supplements with distinct protein source and energy density, resembling mixed meals, on serum amino acid profiles and on gastrointestinal behaviour. METHODS: Four iso-nitrogenous protein (21 g) supplements were studied containing leucine-enriched whey protein with 150/320 kcal (W150/W320) or casein protein with 150/320 kcal (C150/C320); all products contained carbohydrates (10 or 32 g) and fat (3 or 12 g). Postprandial serum AA profiles were evaluated in twelve healthy, older subjects who participated in a randomized, controlled, single blind, cross-over study. Gastrointestinal behaviour was studied in vitro by looking at gastric coagulation and cumulative intestinal protein digestion over time. RESULTS: The peak serum leucine concentration was twofold higher for W150 vs. C150 (521 +/- 15 vs. 260 +/- 15 mumol/L, p < 0.001), higher for W320 vs. C320 (406 +/- 15 vs. 228 +/- 15 mumol/L, p < 0.001), and higher for low-caloric vs. high-caloric products (p < 0.001 for pooled analyses; p < 0.001 for interaction protein source*caloric density). Similar effects were observed for the peak concentrations of EAA and total AA (TAA). In vitro gastric coagulation was observed only for the casein protein supplements. Intestinal digestion for 90 min resulted in higher levels of free TAA, EAA, and leucine for W150 vs. C150, for W150 vs. W320, and for C150 vs. C320 (p < 0.0125). CONCLUSIONS: A low caloric leucine-enriched whey protein nutritional supplement provides a higher rise in serum levels of TAA, EAA and leucine compared to casein protein or high caloric products in healthy, elderly subjects. These differences appear to be mediated in part by the gastrointestinal behaviour of these products. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT02013466

Spierbehoud bij ouderen met obesitas tijdens afvallen

Introductie Gewichtsverlies bij obese ouderen is een risicofactor voor spiermassaverlies en sarcopenie. Deze studie evalueert het effect van een hoog wei-eiwitsupplement met toegevoegd leucine en vitamine D op spiermassabehoud tijdens een gewichtsverliesperiode van 13 weken met krachttraining bij ouderen met obesitas. De resultaten van deze studie worden gepresenteerd en in een breder perspectief geplaatst. Methoden In deze gerandomiseerde gecontroleerde trial werden tachtig obese ouderen geïncludeerd. Alle deelnemers kregen gedurende 13 weken een hypocalorisch dieet (-600 kcal) en namen 3x/week deel aan een krachttrainingsprogramma. Deelnemers in de interventiegroep kregen 10x/week een hoog wei-eiwitsupplement met toegevoegd leucine en vitamine D (150 kcal, 21 g eiwit). Deelnemers in de controlegroep kregen een isocalorisch controlesupplement. De primaire uitkomstmaat was verandering in de spiermassa in armen en benen (DXA). Secundaire uitkomstmaten waren lichaamssamenstelling, handknijpkracht en fysiek functioneren. Resultaten Bij baseline was de gemiddelde leeftijd (±SD) 63±6 jaar en de BMI 33±4. Tijdens het gewichtsverliesprogramma was de eiwitinname in de interventiegroep 1,11±0,28 vs. 0,85±0,24 g/kg in de controlegroep. Zowel de interventie- als de controlegroep verloor gewicht (-3,4±3,6 vs. -2,8±2,8 kg) en vetmassa (-3,2±3,1 vs. -2,5±2,4 kg), zonder verschillen tussen de groepen. De verandering in spiermassa in armen en benen was wel verschillend (+0,4±1,2 vs. -0,5±2,1 kg, p=0,03). Spierkracht en spierfunctie verbeterden over de tijd, zonder verschillen tussen de groepen. Conclusie Een hoog wei-eiwitsupplement met toegevoegd leucine en vitamine D zorgt in vergelijking met een controlesupplement voor spiermassabehoud tijdens een gewichtsverliesperiode met krachttraining bij obese ouderen. Op basis van literatuur lijkt er voor deze doelgroep voldoende onderbouwing voor het adviseren van minimaal 1,0-1,2 g/kg hoogwaardige eiwitten en mogelijk zelfs hoger dan 1,2 g/kg in combinatie met een (kracht)trainingsprogramma