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Dietary protein and exercise for preservation of lean mass and perspectives on type 2 diabetes prevention.
de Sousa, MV, da Silva Soares, DB, Caraça, ER, Cardoso, R
Experimental biology and medicine (Maywood, N.J.). 2019;(12):992-1004
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Abstract
UNLABELLED Sedentary lifestyle and aging favor the increasing prevalence of obesity and type 2 diabetes and their comorbidities. The loss of lean body mass reduces muscle strength, resulting in impaired functional capacity and leading to increased risks of chronic diseases with advancing age. Besides aging, conditions such as inappetence, social isolation, and inadequate dietary intake cause the loss of lean body mass and increased abdominal fatty mass, resulting in sarcopenic obesity and predisposition to type 2 diabetes. Compared to younger people, this condition is more common in the elderly owing to natural changes in body composition associated with aging. Lifestyle changes such as increased physical activity and improved dietary behaviors are effective for preventing the occurrence of comorbidities. Regarding muscle nutrition, besides caloric adequacy, meeting the requirements for the consumption of dietary amino acids and proteins is important for treating sarcopenia and sarcopenic obesity because muscle tissue mainly consists of proteins and is, therefore, the largest reservoir of amino acids in the body. Thus, this review discusses the effects of dietary protein on the preservation of lean body mass, improvements in the functional capacity of muscle tissue, and prevention of chronic diseases such as type 2 diabetes. In addition, we address the effects of regular physical training associated with dietary protein strategies on lean body mass, body fat loss, and muscle strength in the elderly at a risk for type 2 diabetes development. IMPACT STATEMENT Diabetes mellitus is a worldwide health problem associated with obesity and sedentary lifestyle, which predisposes affected individuals to mortality and morbidity. Additionally, aging and unhealthy lifestyle behaviors increase inflammation and insulin resistance, contributing to the reduction of cytokines related to muscle nutrition and the suppression of lipogenesis, resulting in the development of sarcopenic obesity. One strategy for the prevention of T2D is the avoidance of secondary aging by participating in healthy action programs, including exercise and nutritional interventions. This minireview of several studies demonstrates the impact of physical activity and nutritional interventions on gaining or preserving muscle mass and on the functional aspects of muscles with aging. It provides information on the effect of protein, leucine, β-hydroxy-β-methylbutyrate (HMB), and creatine supplementation on muscle mass, strength, and volume gain and on the prevention of the progressive decrease in muscle mass with aging in combination with maintaining regular physical activity.
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Revised Reference Values for the Intake of Protein.
Richter, M, Baerlocher, K, Bauer, JM, Elmadfa, I, Heseker, H, Leschik-Bonnet, E, Stangl, G, Volkert, D, Stehle, P, ,
Annals of nutrition & metabolism. 2019;(3):242-250
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Abstract
BACKGROUND Following a timely update process, the nutrition societies of Germany, Austria, and Switzerland (D-A-CH) revised the reference values for the intake of protein in 2017. The Working Group conducted a structured literature search in PubMed considering newly published papers (2000- 2017). SUMMARY For infants < 4 months, the estimated values were set based on the protein intake via breast milk. Reference values for infants > 4 months, children, adolescents, pregnant, and lactating women were calculated using the factorial method considering both requirement for growth and maintenance. For adults, reference values were derived from nitrogen balance studies; for seniors (> 65 years), reports on metabolic and functional parameters under various protein intakes were additionally considered. Reference -values (g protein/kg body weight per day) were set as follows: infants < 4 months: 2.5-1.4, children: 1.3-0.8, adults < 65 years: 0.8, adults > 65 years: 1.0. Key Messages: The reference values for infants, children, adolescents, and adults < 65 years are essentially unchanged compared to recently published values. Scientifically reliable data published between 2000 and 2017 guided the D-A-CH Working Group to set a higher estimated value for adults > 65 years. Since the energy consumption continuously decreases with age, this new estimated protein intake value might be a challenge for the introduction of food-based nutrition concepts for older people.
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High-protein diets in trained individuals.
Antonio, J
Research in sports medicine (Print). 2019;(2):195-203
Abstract
The United States (US) recommended dietary allowance (RDA) for protein is 0.8 grams per kilogram body weight per day (g/kg/d). The International Society of Sports Nutrition (ISSN) recently recommended an intake of 1.4-2.0 g/kg/d whereas the United States and Canadian Dietetic Association typically recommend a lower range of 1.2 to 1.7 g/kg/d. It is clear that the US RDA for protein is grossly inadequate for exercising individuals; thus, athletes are typically advised to consume twice the RDA. This falls within the range commonly recommended by academic societies. The effect of protein consumption that exceeds these aforementioned guidelines is not entirely known. This review examines the current literature as it pertains to the influence of very high protein intakes in trained individuals (i.e., humans). It is the scientific opinion of the author that athletes should consume at least 2.2 g/kg/d of protein.
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The Muscle Protein Synthetic Response to Meal Ingestion Following Resistance-Type Exercise.
Trommelen, J, Betz, MW, van Loon, LJC
Sports medicine (Auckland, N.Z.). 2019;(2):185-197
Abstract
Protein ingestion following resistance-type exercise stimulates muscle protein synthesis rates and consequently enhances the skeletal muscle adaptive response to prolonged training. Ingestion of ~ 20 g of quickly digestible protein isolate optimizes muscle protein synthesis rates during the first few hours of post-exercise recovery. However, the majority of daily protein intake is consumed as slower digestible, nutrient-rich, whole-food protein sources as part of mixed meals. Therefore, the muscle protein synthetic response to the ingestion of protein supplements and typical foods or mixed meals may differ substantially. In addition, the muscle protein synthetic response to feeding is not only determined by acute nutrient intake but is also likely modulated by habitual energy and nutrient intake and nondietary factors such as habitual physical activity, body composition, age, and/or sex. Therefore, nutritional recommendations to maximize the muscle protein synthetic response to exercise depend on the type of meal (e.g., protein supplements vs. mixed meals) and the time until the next feeding opportunity (e.g., feeding before overnight sleep) and, therefore, need to be personalized to the individual athlete.
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Dietary Protein for Training Adaptation and Body Composition Manipulation in Track and Field Athletes.
Witard, OC, Garthe, I, Phillips, SM
International journal of sport nutrition and exercise metabolism. 2019;(2):165-174
Abstract
Track and field athletes engage in vigorous training that places stress on physiological systems requiring nutritional support for optimal recovery. Of paramount importance when optimizing recovery nutrition are rehydration and refueling which are covered in other papers in this volume. Here, we highlight the benefits for dietary protein intake over and above requirements set out in various countries at ∼0.8-1.0 g·kg body mass (BM)-1·day-1 for training adaptation, manipulating body composition, and optimizing performance in track and field athletes. To facilitate the remodeling of protein-containing structures, which are turning over rapidly due to their training volumes, track and field athletes with the goal of weight maintenance or weight gain should aim for protein intakes of ∼1.6 g·kg BM-1·day-1. Protein intakes at this level would not necessarily require an overemphasis on protein-containing foods and, beyond convenience, does not suggest a need to use protein or amino acid-based supplements. This review also highlights that optimal protein intakes may exceed 1.6 g·kg BM-1·day-1 for athletes who are restricting energy intake and attempting to minimize loss of lean BM. We discuss the underpinning rationale for weight loss in track and field athletes, explaining changes in metabolic pathways that occur in response to energy restriction when manipulating protein intake and training. Finally, this review offers practical advice on protein intakes that warrant consideration in allowing an optimal adaptive response for track and field athletes seeking to train effectively and to lose fat mass while energy restricted with minimal (or no) loss of lean BM.
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Controversies in Allergy: Food Testing and Dietary Avoidance in Atopic Dermatitis.
Robison, RG, Singh, AM
The journal of allergy and clinical immunology. In practice. 2019;(1):35-39
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James Lind Alliance research priorities: what role do carbohydrates, fats and proteins have in the management of Type 2 diabetes, and are there risks and benefits associated with particular approaches?
Dyson, P, McArdle, P, Mellor, D, Guess, N
Diabetic medicine : a journal of the British Diabetic Association. 2019;(3):287-296
Abstract
AIMS: To assess the role played by carbohydrates, fat and proteins in the management of Type 2 diabetes. BACKGROUND Diabetes research tends to reflect the interests of academics or the pharmaceutical industry, rather than those of people living with Type 2 diabetes. The James Lind Alliance and Diabetes UK addressed this issue by defining the research priorities of people living with Type 2 diabetes. Three of the top 10 research priority questions focused on lifestyle. METHODS A narrative review was undertaken with a structured search strategy using three databases. Search terms included the three macronutrients and Type 2 diabetes. No restrictions were placed on macronutrient quantity or length of study follow-up. Outcomes included changes in HbA1c , body weight, insulin sensitivity and cardiovascular risk. RESULTS There is no strong evidence that there is an optimal ratio of macronutrients for improving glycaemic control or reducing cardiovascular risk. Challenges included defining the independent effect of macronutrient manipulation and identifying the effects of macronutrients, independent of foods and dietary patterns. Extreme intakes of macronutrients may be associated with health risks. CONCLUSIONS It is challenging to formulate food-based guidelines from studies based on macronutrient manipulation. Structured education should be offered to support individuals in discovering their optimal, individual dietary approach. Recommendations for dietary guidelines should be expressed in terms of foods and not macronutrients.
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Dietary Protein and Amino Acid Intake: Links to the Maintenance of Cognitive Health.
Glenn, JM, Madero, EN, Bott, NT
Nutrients. 2019;(6)
Abstract
With the rapid growth in the aging population, there has been a subsequent increase in the rates of Alzheimer's disease and related dementias (ADRD). To combat these increases in ADRD, scientists and clinicians have begun to place an increased emphasis on preventative methods to ameliorate disease rates, with a primary focus area on dietary intake. Protein/amino acid intake is a burgeoning area of research as it relates to the prevention of ADRD, and consumption is directly related to a number of disease-related risk factors as such low-muscle mass, sleep, stress, depression, and anxiety. As a result, the role that protein/amino acid intake plays in affecting modifiable risk factors for cognitive decline has provided a robust area for scientific exploration; however, this research is still speculative and specific mechanisms have to be proven. The purpose of this review is to describe the current understanding of protein and amino acids and the preventative roles they play with regard to ADRD, while providing future recommendations for this body of research. Additionally, we will discuss the current recommendations for protein intake and how much protein older adults should consume in order to properly manage their long-term risk for cognitive decline.
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The importance of protein intake and strength exercises for older adults.
Paproski, JJ, Finello, GC, Murillo, A, Mandel, E
JAAPA : official journal of the American Academy of Physician Assistants. 2019;(11):32-36
Abstract
Sarcopenia, the progressive deterioration of muscle mass, quality, and strength, is prevalent among older adults. Since the first Baby Boomers reached age 65 years in 2010, primary care providers have faced a challenge to address sarcopenia in this growing older population. Preventing sarcopenia is essential for reducing falls, preventing chronic disease, and improving longevity. This article reviews new dietary and exercise guidelines for sarcopenia prevention in older adults.
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Optimal Protein Intake during Weight Loss Interventions in Older Adults with Obesity.
Al-Nimr, RI
Journal of nutrition in gerontology and geriatrics. 2019;(1):50-68
Abstract
Obesity rates in people 60 years and older are increasing. While obesity is linked with detrimental health risks, weight loss in this population has previously been considered controversial due to potential worsening of age-related sarcopenia. Protein intake during energy restriction has been linked to lean body mass preservation. No formal guidelines for optimal protein intake during structured weight loss interventions exist for this population, but it appears that the current Recommended Dietary Allowance of 0.8 grams per kilogram of body weight per day may be inadequate. The purpose of this review is to discuss optimal protein intake during structured weight loss interventions in persons 60 years and older with obesity and to present a framework for guidelines to be used by health professionals focusing on weight loss interventions in older adults. Goals for the amount, source, and timing of protein intake, from both food and supplements, are presented and discussed.