Vitaal naar de eindstreep

Hoe worden we gezond oud? Trainen en extra eiwitten werken, blijkt uit onderzoek van de afdeling Humane voeding. Over het effect van vitamines en omega-3 vetzuren is het laatste woord nog niet gezegd

Dietary strategies to augment muscle mass in the elderly

Background: The world population is aging rapidly. This growth of the aging population is accompanied by an increased number of frail elderly people who are at risk of adverse health outcomes such as disability, co-morbidity and mortality. A dominant feature of frailty is the age related loss of muscle mass, strength and performance, also called sarcopenia. Resistance-type exercise training and dietary protein supplementation are considered promising strategies to reverse sarcopenia and subsequent frailty. However, strong evidence for the impact of protein supplementation with or without resistance exercise in frail elderly people is scarce. Well-designed intervention studies in frail elderly people are needed to define new leads for the development of nutritional and exercise interventions to effectively prevent or treat the progressive loss of muscle mass, strength and physical performance with aging. Therefore, the aims of this thesis are to study 1) the impact of protein supplementation and 2) the impact of protein supplementation during prolonged resistance-type exercise training on muscle mass, strength and physical performance in frail elderly people. Methods: First, we studied various characteristics of dietary protein intake, including the distribution of dietary protein intake throughout the day, and the use of protein-containing food sources in various elderly populations. With this knowledge, we designed two large intervention trials to study the impact of dietary protein supplementation with or without prolonged resistance-type exercise training on muscle mass, strength and physical performance in frail elderly people. In addition, we assessed the usefulness of handgrip strength as a measure of post exercise strength differences and studied the association of vitamin D status and vitamin D intake on muscle mass, strength and physical performance in a frail elderly population. Results: Dietary protein intake in frail and institutionalized elderly people were especially low at breakfast and lunch. Supplementing protein at breakfast and lunch did not increase muscle mass but improved physical performance in frail elderly people. Resistance-type exercise training improved muscle leg strength and physical performance, but not handgrip strength. Supplementing protein at breakfast and lunch was required to significantly increase muscle mass during prolonged resistance-type exercise training in frail elderly people. Furthermore, low vitamin D status and vitamin D intake were associated with impaired physical performance. Conclusions: Although dietary protein supplementation does not increase muscle mass, it represents a promising strategy to improve physical performance in frail elderly people. Prolonged resistance-type exercise training represents an effective strategy to improve strength and physical performance, but dietary protein supplementation is required to allow muscle mass gain during exercise training in frail elderly people. </p

Bio-impedance analysis for appendicular skeletal muscle mass assessment in (pre-) frail elderly people

Background & aims Screening populations for skeletal muscle mass (SMM) is important for early detection of sarcopenia. Our aim was to develop an age specific bio-impedance (BI) prediction equation for the assessment of appendicular skeletal muscle mass (ASMM) in (pre-) frail elderly people aged 65 and older. Methods Anthropometric, BI and dual-energy X-ray absorptiometry (DEXA) measurements from 106 (pre-) frail elderly subjects (61 females and 45 males, aged 65–96 years) were used to derive three ASMM prediction equations using multiple regression analysis: one for single frequency BI measurements at 50 kHz (ASMM50kHz), one for measurements at the characteristic frequency (ASMMFc) and one for bioelectrical impedance spectroscopy (ASMMBIS). The same data was used to evaluate an existing prediction equation. Results ASMM50kHz had the best fitting model (r2adj = 0.923, SEE = 1.19 and a PRESS value = 163.4), followed by ASMMFc (r2adj = 0.915, SEE = 1.25 and a PRESS value = 175.9) and ASMMBIS (r2adj = 0.915, SEE = 1.26 and a PRESS value = 177.1). Average ASMM measured by DEXA and both ASMM50kHz and ASMMFc were comparable. ASMMBIS tended to underestimate ASMM slightly. An existing prediction equation had a tendency to underestimate ASMM in people with a lower amount of ASMM and overestimate ASMM in people with a higher amount of ASMM. Conclusions ASMM50kHz was able to measure average ASMM within our population of (pre-) frail elderly in a valid way. However, its predictive power on both individual and population level needs to be confirmed in an independent and larger (pre-) frail elderly population and across multiple institutions and ethnic groups

Dietary protein intake in Dutch elderly people: a focus on protein sources

Introduction: Sufficient high quality dietary protein intake is required to prevent or treat sarcopenia in elderly people. Therefore, the intake of specific protein sources as well as their timing of intake are important to improve dietary protein intake in elderly people. Objectives: to assess the consumption of protein sources as well as the distribution of protein sources over the day in community-dwelling, frail and institutionalized elderly people. Methods: Habitual dietary intake was evaluated using 2- and 3-day food records collected from various studies involving 739 community-dwelling, 321 frail and 219 institutionalized elderly people. Results: Daily protein intake averaged 71 ± 18 g/day in community-dwelling, 71 ± 20 g/day in frail and 58 ± 16 g/day in institutionalized elderly people and accounted for 16% ± 3%, 16% ± 3% and 17% ± 3% of their energy intake, respectively. Dietary protein intake ranged from 10 to 12 g at breakfast, 15 to 23 g at lunch and 24 to 31 g at dinner contributing together over 80% of daily protein intake. The majority of dietary protein consumed originated from animal sources (≥60%) with meat and dairy as dominant sources. Thus, 40% of the protein intake in community-dwelling, 37% in frail and 29% in institutionalized elderly originated from plant based protein sources with bread as the principle source. Plant based proteins contributed for >50% of protein intake at breakfast and between 34% and 37% at lunch, with bread as the main source. During dinner, >70% of the protein intake originated from animal protein, with meat as the dominant source. Conclusion: Daily protein intake in these older populations is mainly (>80%) provided by the three main meals, with most protein consumed during dinner. More than 60% of daily protein intake consumed is of animal origin, with plant based protein sources representing nearly 40% of total protein consumed. During dinner, >70% of the protein intake originated from animal protein, while during breakfast and lunch a large proportion of protein is derived from plant based protein sources

Handgrip strength does not represent an appropriate measure to evaluate changes in muscle strength during an exercise intervention program in frail elderly people

Although handgrip strength is considered a strong predictor of negative health outcomes, it is unclear whether handgrip strength represents a useful measure to evaluate changes in muscle strength following resistance-type exercise training in elderly people. We assessed whether measuring handgrip strength provides proper insight in the efficacy of resistance-type exercise training to increase muscle mass, strength and physical performance in frail elderly. Methods: Pre-frail and frail elderly (=65 y) were either conducting a 24 wk resistance-type exercise training or no exercise training. Before, during, and after the intervention, handgrip strength (JAMAR), lean body mass (DXA), leg strength (1-RM), and physical performance (SPPB) were assessed. Results: Handgrip strength correlated with appendicular lean mass (¿ =0.68;

Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people

Background/Objectives: Serum 25-hydroxyvitamin D (25(OH)D) status has been associated with muscle mass, strength and physical performance in healthy elderly people. Yet, in pre-frail and frail elderly people this association has not been studied. The objective of this study was to explore the association between vitamin D intake and serum 25(OH)D status with muscle mass, strength and physical performance in a pre-frail and frail elderly population. Subjects/Methods: This cross-sectional study included 127 pre-frail and frail elderly people in The Netherlands. Whole body and appendicular lean mass (ALM) (dual energy X-ray absorptiometry), leg strength (one repetition maximum), handgrip strength and physical performance (short physical performance battery) were measured, and blood samples were collected for the assessment of serum 25(OH)D status (liquid chromatography-tandem mass spectrometry). In addition, habitual dietary intake (3-day food records) and physical activity data (accelerometers) were collected. Results: In total, 53% of the participants had a serum 25(OH)D level below 50¿nmol/l. After adjustment for confounding factors, 25(OH)D status was associated with ALM (ß=0.012, P=0.05) and with physical performance (ß=0.020, P0.05). Conclusion: In this frail elderly population, 25(OH)D status is low and suggests a modest association with reduced ALM and impaired physical performance. In addition, vitamin D intake tended to be associated with impaired physical performance. Our findings highlight the need for well-designed intervention trials to assess the impact of vitamin D supplementation on 25(OH)D status, muscle mass and physical performance in pre-frail and frail elderly peopl

Dietary protein intake in community-dwelling, frail, and institutionalized elderly people: scope for improvement

Adequate dietary protein intake is required to postpone and treat sarcopenia in elderly people. Insight into dietary protein intake in this heterogeneous population segment is needed to locate dietary inadequacies and to identify target populations and feeding strategies for dietary interventions. Therefore, we assessed dietary protein intake, distribution of protein intake throughout the day, and the use of protein-containing food sources in community- dwelling, frail, and institutionalized elderly people in the Netherlands. Methods Secondary analyses were carried out using dietary data collected from studies among community-dwelling, frail, and institutionalized elderly people to evaluate protein intake characteristics. Results Dietary protein intake averaged 1.1 ± 0.3 g/kgbw/ day in community-dwelling, 1.0 ± 0.3 g/kg-bw/day in frail, and 0.8 ± 0.3 g/kg-bw/day in institutionalized elderly men. Similar protein intakes were found in women. Ten percent of the community-dwelling and frail elderly and 35% of the institutionalized elderly people showed a protein intake below the estimated average requirement (0.7 g/kg-bw/day). Protein intake was particularly low at breakfast in community-dwelling (10 ± 10 g), frail (8 ± 5 g), and institutionalized elderly people (12 ± 6 g) with bread and dairy products as predominant protein sources. Conclusions Whereas daily protein intake is generally well above the recommended dietary allowance in community- dwelling and frail elderly people, a significant proportion of institutionalized elderly showed an intake below the current protein requirement, making them an important target population for dietary interventions. Particularly at breakfast, there is scope for improving protein intake