A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: A case-control study. Low nutrient intake is an essential component of frailty in older persons. Protein intake and incident frailty in the Women's Health Initiative observational study. Dietary protein intake is associated with better physical function and muscle strength among elderly women. Associations of dietary protein intake on subsequent decline in muscle mass and physical functions over four years in ambulant older Chinese people Dairy Consumption and Risk of Frailty in Older Adults: A Prospective Cohort Study. The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle. Dietary Protein and Vitamin D Intake and Risk of Falls: A Secondary Analysis of Postmenopausal Women from the Study of Osteoporotic Fractures Phenotypic characteristics associated with slow gait speed in idiopathic pulmonary fibrosis
This study was design ed to evaluate the effects of enriching an essential amino acid ( EAA ) mixture with leucine on muscle protein metabolism in elderly and young individuals . Four ( 2 elderly and 2 young ) groups were studied before and after ingestion of 6.7 g of EAAs . EAAs were based on the composition of whey protein [ 26 % leucine ( 26 % Leu ) ] or were enriched in leucine [ 41 % leucine ( 41 % Leu ) ] . A primed , continuous infusion of L-[ring-2H5]phenylalanine was used together with vastus lateralis muscle biopsies and leg arteriovenous blood sample s for the determinations of fractional synthetic rate ( FSR ) and balance of muscle protein . FSR increased following amino acid ingestion in both the 26 % ( basal : 0.048 + /- 0.005%/h ; post-EAA : 0.063 + /- 0.007%/h ) and the 41 % ( basal : 0.036 + /- 0.004%/h ; post-EAA : 0.051 + /- 0.007%/h ) Leu young groups ( P < 0.05 ) . In contrast , in the elderly , FSR did not increase following ingestion of 26 % Leu EAA ( basal : 0.044 + /- 0.003%/h ; post-EAA : 0.049 + /- 0.006%/h ; P > 0.05 ) but did increase following ingestion of 41 % Leu EAA ( basal : 0.038 + /- 0.007%/h ; post-EAA : 0.056 + /- 0.008%/h ; P < 0.05 ) . Similar to the FSR responses , the mean response of muscle phenylalanine net balance , a reflection of muscle protein balance , was improved ( P < 0.05 ) in all groups , with the exception of the 26 % Leu elderly group . We conclude that increasing the proportion of leucine in a mixture of EAA can reverse an attenuated response of muscle protein synthesis in elderly but does not result in further stimulation of muscle protein synthesis in young subjects BACKGROUND & AIM Sarcopenia , the age-related decrease in muscle mass , strength , and function , is a main cause of reduced mobility , increased falls , fractures and nursing home admissions . Cross-sectional and prospect i ve studies indicate that sarcopenia may be influenced in part by reversible factors like nutritional intake . The aim of this study was to compare functional and nutritional status , body composition , and quality of life of older adults between age and sex-matched older adults with and without sarcopenia . METHODS In a multi-centre setting , non-sarcopenic older adults ( n = 66 , mean ± SD : 71 ± 4 y ) , i.e. Short Physical Performance Battery ( SPPB ) : 11 - 12 and normal skeletal muscle mass index , were recruited to match 1:1 by age and sex to previously recruited adults with sarcopenia : SPPB 4 - 9 and low skeletal muscle mass index . Health-related quality of life , self-reported physical activity levels and dietary intakes were measured using the EQ-5D scale and index , Physical Activity Scale for the Elderly ( PASE ) , and 3-day prospect i ve diet records , respectively . Concentrations of 25-OH-vitamin D , α-tocopherol ( adjusted for cholesterol ) , folate , and vitamin B-12 were assessed in serum sample s. RESULTS In addition to the defined components of sarcopenia , i.e. muscle mass , strength and function , reported physical activity levels and health-related quality of life were lower in the sarcopenic adults ( p < 0.001 ) . For similar energy intakes ( mean ± SD : sarcopenic , 1710 ± 418 ; non-sarcopenic , 1745 ± 513 , p = 0.50 ) , the sarcopenic group consumed less protein/kg ( -6 % ) , vitamin D ( -38 % ) , vitamin B-12 ( -22 % ) , magnesium ( -6 % ) , phosphorus ( -5 % ) , and selenium ( -2 % ) ( all p < 0.05 ) compared to the non-sarcopenic controls . The serum concentration of vitamin B-12 was 15 % lower in the sarcopenic group ( p = 0.015 ) , and all other nutrient concentrations were similar between groups . CONCLUSIONS In non-malnourished older adults with and without sarcopenia , we observed that sarcopenia substantially impacted self-reported quality of life and physical activity levels . Differences in nutrient concentrations and dietary intakes were identified , which might be related to the differences in muscle mass , strength and function between the two groups . This study provides information to help strengthen the characterization of this geriatric syndrome sarcopenia and indicates potential target areas for nutritional interventions BACKGROUND Poor nutrient intake is conceptualized to be a component of frailty , but this hypothesis has been little investigated . We examined the association between low energy and nutrient intake and frailty . METHODS We used data from 802 persons aged 65 years or older participating to the InCHIANTI ( Invecchiare in Chianti , aging in the Chianti area ) study . Frailty was defined by having at least two of the following criteria : low muscle strength , feeling of exhaustion , low walking speed , and reduced physical activity . The European Prospect i ve Investigation into Cancer and nutrition ( EPIC ) question naire was used to estimate the daily intake of energy and nutrients .  Low intake was defined using the value corresponding to the lowest sex-specific intake quintile of energy and specific nutrients . Adjusted logistic regression analyses were used to study the association of frailty and frailty criteria with low intakes of energy and nutrients . RESULTS Daily energy intake < or = 21 kcal/kg was significantly associated with frailty ( odds ratio [ OR ] : 1.24 ; 95 % CI : 1.02 - 1.5 ) . After adjusting for energy intake , a low intake of protein ( OR : 1.98 ; 95 % CI : 1.18 - 3.31 ) ; vitamins D ( OR : 2.35 ; 95 % CI : 1.48 - 3.73 ) , E ( OR : 2.06 ; 95 % CI : 1.28 - 3.33 ) , C ( OR : 2.15 ; 95 % CI : 1.34 - 3.45 ) , and folate ( OR : 1.84 ; 95 % CI : 1.14 - 2.98 ) ; and having a low intake of more than three nutrients ( OR : 2.12 ; 95 % CI : 1.29 - 3.50 ) were significantly and independently related to frailty . CONCLUSIONS This study provides evidence that low intakes of energy and selected nutrients are independently associated with frailty OBJECTIVES To evaluate the association between protein intake and incident frailty . DESIGN Prospect i ve cohort study . SETTING Subset of the Women 's Health Initiative Observational Study conducted at 40 clinical centers . PARTICIPANTS Twenty-four thous and four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self-reported energy intakes ( 600 - 5,000 kcal/day ) according to the Food Frequency Question naire ( FFQ ) . MEASUREMENTS Baseline protein intake was estimated from the FFQ . Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure ( doubly labeled water ) and dietary protein ( 24-hour urinary nitrogen ) . After 3 years of follow-up , frailty was defined as having at least three of the following components : low physical function ( measured using the R and -36 question naire ) , exhaustion , low physical activity , and unintended weight loss . Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake . RESULTS Of the 24,417 eligible women , 3,298 ( 13.5 % ) developed frailty over 3 years . After adjustment for confounders , a 20 % increase in uncalibrated protein intake ( % kcal ) was associated with a 12 % ( 95 % confidence interval (CI)=8 - 16 % ) lower risk of frailty , and a 20 % increase in  calibrated protein intake  was associated with a 32 % ( 95 % CI=23 - 50 % ) lower risk of frailty . CONCLUSION Higher protein consumption , as a fraction of energy , is associated with a strong , independent , dose-responsive lower risk of incident frailty in older women . Using uncalibrated measures underestimated the strength of the association . Incorporating more protein into the diet may be an intervention target for frailty prevention Dietary protein intake might be beneficial to physical function ( PF ) in the elderly . We examined the cross-sectional and prospect i ve associations of protein intake of g/kg body weight ( BW ) , fat mass ( FM ) and lean mass ( LM ) with PF in 554 women aged 65·3 - 71·6 years belonging to the Osteoporosis Risk Factor and Prevention Fracture Prevention Study . Participants filled a question naire on lifestyle factors and 3-d food record in 2002 . Body composition was measured by dual-energy X-ray absorptiometry , and PF measures were performed at baseline and at 3-year follow-up . Sarcopaenia was defined using European Working Group on Sarcopenia in Older People criteria . At the baseline , women with higher protein intake ( ≥ 1·2 g/kg BW ) had better performance in h and -grip strength/body mass ( GS/BM ) ( P=0·001 ) , knee extension/BM ( P=0·003 ) , one-leg stance ( P=0·047 ) , chair rise ( P=0·043 ) , squat ( P=0·019 ) , squat to the ground ( P=0·001 ) , faster walking speed for 10 m ( P=0·005 ) and higher short physical performance battery score ( P=0·004 ) compared with those with moderate and lower intakes ( 0·81 - 1·19 and ≤ 0·8 g/kg BW , respectively ) . In follow-up results , higher protein intake was associated with less decline in GS/BM , one-leg stance and t and em walk for 6 m over 3 years . Overall , results were no longer significant after controlling for FM . Associations were detected between protein intake and PF in non-sarcopaenic women but not in sarcopaenic women , except for change of GS ( P=0·037 ) . Further , FM but not LM was negatively associated with PF measures ( P<0·050 ) . This study suggests that higher protein intake and lower FM might be positively associated with PF in elderly women Objective To examine the association of dietary protein intake with 4-year change in physical performance measures and muscle mass in Chinese community-dwelling older people aged 65 and older in Hong Kong . Design Prospect i ve cohort study design . Setting Hong Kong , People ’s of Republic of China . Participants There were 2,726 ( 1411 male , 1315 female ) community-dwelling older people aged 65 and older . Measurements Baseline total , animal and vegetable protein intakes  were collected using a vali date d food frequency question naire . Relative protein intake expressed as g/kg body weight was calculated and divided into quartiles for data analysis . Baseline and 4-year physical performance measures ( normal and narrow 6-meters walking speed and step length in a 6-meters walk ) were measured and 4-year change in appendicular skeletal muscle mass ( ASM ) from baseline was assessed by dual-energy X-ray absorptiometry . Univariate analysis identified age and sex as significant factors associated with change in physical performance measures or ASM , thus adjustments for these factors were made for subsequent analysis of covariance . Results  Median relative total protein intake  was 1.3 g/kg body weight in men and 1.1 g/kg body weight in women . After adjustment for age and sex , relative total protein intake and animal protein intake were not associated with change in physical performance measures and ASM . In contrast , participants in the highest quartile ( > 0.72 g/kg body weight ) of relative vegetable protein intake lost significantly less ASM over 4-year than those in the lowest quartile of relative vegetable protein intake ( < = 0.40 g/kg body weight ) ( adjusted mean ± SE : 0.270 ± 0.029 vs. 0.349 ± 0.030 kg , ptrend=0.025 ) . There was no association between relative vegetable protein intake and change in physical performance measures .  Conclusions Higher protein intake from vegetable source was associated with reduced muscle loss in Chinese community-dwelling older people in Hong Kong whereas no association between total and animal protein intake and subsequent decline in muscle mass or physical performance measures was observed in this sample OBJECTIVES To examine the association between consumption of dairy products and risk of frailty  in community-dwelling older adults . DESIGN Prospect i ve cohort study . SETTING General population from the older cohort of the Study on Nutrition and Cardiovascular Risk in Spain . PARTICIPANTS Community-dwelling adults aged 60 and older free of frailty at baseline ( N = 1,871 ) . MEASUREMENTS From 2008 to 2010 ,  food consumption was assessed using a vali date d diet history . Participants were examined again in 2012 to assess incident frailty , defined as at least three of the five Fried criteria ( exhaustion , weakness , low physical activity , slow walking speed , unintentional weight loss ) . Adjusted odds ratios ( OR ) for the main confounders were obtained using logistic regression . RESULTS During follow-up , 134 new cases of frailty were identified . Participants consuming seven or more servings per week of low-fat milk and yogurt had lower incidence of frailty ( OR = 0.52 ; 95 % confidence interval ( CI ) = 0.29 - 0.90 ; P for trend = .03 ) than those consuming less than one serving per week . Specifically , consumers of seven or more servings per week of low-fat milk and yogurt had less risk of slow walking speed ( OR = 0.64 , 95 % CI = 0.44 - 0.92 , P trend = .01 ) and of weight loss ( OR = 0.54 , 95 % CI = 0.33 - 0.87 , P trend = .02 ) . Consuming seven or more servings per week of whole milk or yogurt ( OR = 1.53 , 95 % CI = 0.90 - 2.60 , P trend = .10 ) or of cheese ( OR = 0.91 , 95 % CI = 0.52 - 1.61 ; P trend = .61 ) was not associated with incident frailty . CONCLUSION Higher consumption of low-fat milk and yogurt was associated with lower risk of frailty and , specifically , of slow walking speed and weight loss . Current recommendations to prevent frailty include protein supplementation ; thus , although experimental research is needed , increasing the consumption of low-fat yogurt and milk might prevent frailty in older adults BACKGROUND Inadequate dietary protein intake results in loss of skeletal muscle mass . Some shorter-term nitrogen balance studies suggest that the Recommended Dietary Allowance ( RDA ) of protein may not be adequate for older people . The aim of this study was to assess the adequacy of the RDA of protein for older people by examining longer-term responses in urinary nitrogen excretion , whole-body protein metabolism , whole-body composition , and mid-thigh muscle area . METHODS This was a 14-week precisely controlled diet study . Ten healthy , ambulatory men and women , aged 55 to 77 years , were provided eucaloric diets that contained 0.8 g protein.kg(-1).day(-1 ) . The study was conducted at a General Clinical Research Center using an outpatient setting for 11 weeks and an inpatient setting for 3 weeks . The main outcome measures included urinary nitrogen excretion , postabsorptive and postpr and ial whole-body leucine kinetics via infusion of L-[1-(13)C]-leucine , whole-body density via hydrostatic weighing , total body water via deuterium oxide dilution , and mid-thigh muscle area via computed tomography scans . RESULTS Mean urinary nitrogen excretion decreased over time from Weeks 2 to 8 to 14 ( p = .025 ) . At Week 14 , compared with Week 2 , there were no changes in postabsorptive or postpr and ial leucine kinetics ( turnover , oxidation , incorporation into protein via synthesis , release via breakdown , or balance ) . Whole-body composition ( % body fat , fat-free mass , and protein + mineral mass ) did not change over time in these weight-stable subjects . Mid-thigh muscle area was decreased by -1.7 + /- 0.6 cm(2 ) ( p = .019 ) at Week 14 compared with Week 2 . The loss of mid-thigh muscle area was associated with the decrease in urinary nitrogen excretion ( Spearman r = .83 , p = .010 ) . CONCLUSIONS The maintenance of whole-body leucine metabolism and whole-body composition is generally consistent with a successful adaptation to the RDA for protein . However , the decrease in mid-thigh muscle area and the association with decreased urinary nitrogen excretion are consistent with a metabolic accommodation . These results suggest that the RDA for protein may not be adequate to completely meet the metabolic and physiological needs of virtually all older people More than 90 % of hip fractures in older Americans result from a fall . Inadequate intake of dietary protein and vitamin D are common in older adults , and diets in low these could contribute to loss of muscle mass and strength or coordination , in turn increasing the risk of falling . The objective of the study was to evaluate the relationship between protein and vitamin D intake with the occurrence of falls in older women in the Study of Osteoporotic Fracture , a prospect i ve cohort of more than 4000 postmenopausal women participating from January 1997 to September 1998 . Incident falls were ascertained for one year .  Protein and vitamin D intake  was assessed by a food frequency question naire ; associations with a reported fall were estimated with logistic regression , adjusted for fall-related covariates and energy . Protein and vitamin D were modeled separately because of high correlation ( rho = 0.55 , P < 0.001 ) . A total of 1429 women reported a fall within one year . In separate , unadjusted models  dietary protein  ( per 1 g/kg increase ) and  vitamin D  ( per 100 International Unit ( IU ) increase ) significantly increased the odds ratio ( OR ) of falling ( OR 1.35 95 % CI 1.15–1.59 , OR 1.11 95 % CI 1.03–1.19 , respectively ) . Once fall-related covariates were added to each model ,  dietary protein and vitamin D  were noncontributory to falls . While we could find no direct association between vitamin D and protein intake and fall prevention , adequate intake of these two nutrients are critical for musculoskeletal health in older adults BACKGROUND AND OBJECTIVE Usual gait speed over 4 m ( 4MGS ) is an established functional performance measure in older adults that consistently predicts adverse health outcomes , but few data exist in idiopathic pulmonary fibrosis ( IPF ) . We assessed the reliability of 4MGS , its relationship with established outcome measures and its responsiveness to pulmonary rehabilitation . METHODS In four prospect i ve IPF cohorts , 4MGS inter-observer ( n = 46 ) and test-retest ( n = 46 ) reliability , concurrent validity ( n = 65 and n = 62 ) and responsiveness ( n = 60 ) were determined . The phenotypic characteristics of all patients stratified according to slow 4MGS ( < 0.8 m/s ) were compared , including lung function parameters , H RCT of the chest , 6-min walking distance ( 6MWD ) , Medical Respiratory Council ( MRC ) dyspnoea score , King 's Brief Interstitial Lung Disease ( KBILD ) question naire and Gender , Age and lung Physiology ( GAP ) prognostic index . RESULTS Intra-class correlation coefficients for inter-observer and test-retest reliability were 0.996 and 0.983 , respectively . There was a strong association between 4MGS and 6MWD ( r = 0.76 ; P < 0.0001 ) and moderate correlations with MRC ( r = -0.56 ) , KBILD ( r = 0.44 ) and GAP index ( r = -0.41 ) ; all P < 0.005 . 4MGS improved significantly with pulmonary rehabilitation ( mean ( 95 % CI ) change : 0.16 ( 0.12 - 0.20 ) m/s ) , effect size 0.65 . Patients with slow 4MGS had significantly worse exercise performance ( 6MWD : -167 ( -220 to -133 ) m ) , dyspnoea , health status and prognosis index than those with preserved 4MGS , despite similar lung function and H RCT parameters . CONCLUSION 4MGS is a simple , reliable , valid and responsive tool that may detect a patient phenotype with worse exercise performance , dyspnoea , health status and prognosis index in stable IPF
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