Protein Recommendations for Healthy Aging: Considerations for Quantity

Protein Recommendations for Healthy Aging: Considerations for Quantity

Protein Recommendations for Healthy Aging: Considerations for Quantity and Quality Nancy R. Rodriguez, PhD, RDN, CSSD, FACSM MINNESOTA ACADEMY OF NUTRITION AN DIETETICS 2019 ANNUAL MEETING APRIL 24 - 26, 2019 Disclosures Research Support Beef Checkoff National Dairy Council American Egg Board USDA, NIH, American Heart Association Speakers Bureau and Advisory Boards National Dairy Council National Cattlemans Beef Association Whey Protein Advisory Panel Objectives

Consider protein requirements with specific regard for healthy, active aging, essential amino acid intake, and the flexibility provided by current DRIs for respective dietary protein prescriptions; Translate the latest scientific findings on the role of protein quantity, quality and timing/meal distribution into practical meal plans designed for healthy aging; and Extend concept of amino acid density to the design of healthy eating patterns that incorporate high-quality protein sources to meet dietary protein recommendations. Protein is Fundamental to Life Protein is made up of building blocks and provides structural components for various proteins required for numerous physiological functions and optimal health Proteins Roles in

Health Build, maintain, and repair muscle Deliver oxygen to tissues Boost immunity Build better brains Assist with metabolism of other nutrients Build stronger bones Aid satiety/fullness Manage weight Provide energy Protein Recommendations: Minimum vs Optimal Intakes RDA: 0.8 g/kg BW/d for adults estimate of the minimum daily average dietary intake level that meets the nutrient requirements of nearly all (97 to 98%) healthy individuals Acceptable Macronutrient Distribution Range (AMDR): 10-35% total calories a range of intakes for a particular energy source that is associated with reduced risk of chronic

diseases while providing adequate intakes of essential nutrients Research supports some may benefit from protein intakes greater than the RDA Athletes / highly active adults Older adults Rodriguez NR & Miller SL, Am J Clin Nutr 2015; Wolfe RR & Miller SL, JAMA 2008 Changes in Body Composition with Age Lean Body Mass 60 55 30 25 (kg)

50 (kg) Fat Mass 35 45 20 40 15 35 10 30

5 30 40 50 60 Age (years) 70 80 20 30 40

50 60 70 Age (years) Hollozy, Mayo Clin Proc 75:2000 80 Decreases in Muscle Strength with Age Men Women Isokinetic Force (Nm) 250

200 150 100 10 20 30 40 50 60 70 80

Age (yr) Borges et al., J Rehab Med Scand 21:43, 1989 Considering Protein Quantity Recommended Protein Intakes Athletes AND Routinely Active Adults: 1.2 2.0 g/kg1 Healthy Older Adults: 1.0 1.2 g/kg2,3 Older Adults with Acute or Chronic Disease: 1.2 1.5 g/kg2 Older Adults with Severe Illness/Marked Malnutrition: Up to 2 g/kg2 Middle-Aged Men and Women 1.0-1.5 g/kg3 J Acad Nutr Diet. 2016: 116:501-528. Bauer J et al., JAMDA 2013; Deutz NEP et al., Clinical Nutrition, 2014 3 English, K.L. and D. Paddon-Jones, Curr Opin Clin Nutr Metab Care, 2010. 13(1): p. 34-9. 1 2 Healthy Aging: Recommendations from

International Expert Groups Call for 125 Higher Additional Protein Intakes in Older Adults Recommendations Up to 2.0g/kg 84 Protein Levels 68 1.0-1.2g/kg 0.8g/kg RDA (19-70+yrs)1 Current1 minimum

protein intake for healthy people2,3 severe illness or injury, or marked malnutrition2 1.2-1.5g/kg acute or chronic disease2,3 2 25-30 g of protein per meal 2.5-2.8g of leucine per meal

New Recommendations >65 years2,3 *increase above current Protein RDA1 Older people with severe kidney disease not on dialysis may need to limit protein intake. 1 U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2015. 8th Edition, Washington, DC: U.S Government Printing Office, January 2015. 2 Bauer J et al., JAMDA 2013 3 Deutz NEP et al., Clinical Nutrition, 2014 Slide adapted from Stu Phillips, PhD, SCAN Annual Meeting 2015 Protein Diets: Defined - Relative Lower Protein Diet 10-15% of calories from protein Moderate/Higher Protein Diet 20-35% of calories from protein Protein Diets: Defined - Absolute Lower Protein Diet

~1 g/kg body weight (RDA - 0.8 g/kg) Moderate/Higher Protein Diet 1.2 -1.5 g/kg 1.5 -1.8 g/kg Protein Consumption Across the Lifespan 35 30 Women 15 16 16 16 16 16 16 14 14 15 16 15 15 16 16

14 14 14 15 10 5 1219 y 2029 y 3039 y 4049 y 5059 y 6069 y 70+ y 1y 6-1 2-5 y

1219 y 2029 y 3039 y 4049 y 5059 y 6069 y 70+ y 1y 6-1 y 0 2-5 % kcal 20

AMDR Men 25 Age NHANES 2011-2012 Evidence Documents Elevated protein intake Protein intake higher than the enhances meal satiety and RDA may provides a variety of is an effective and practical metabolic benefits including Higher Protein Intakes Do Notweight-loss/weight Harm Kidney Function regulation of blood glucose and

reduced Berryman, blood CE, et pressure al. Diets higher in animal management and plant protein strategy. are associated with lower adiposity and do not impair kidney function in US adults. Am J Clin Nutr 2016. a moderate serving of highIncluding quality protein with each meal Adequate protein and Devries, MC, et al. Changes in kidney function do not differ between health contributes to increasing skeletal muscle calcium intake adults consuming higher compared with lower or normal-protein diets: A protein and reducing muscle losses systematic review and meta-analysis.

J Nutrfor 2018. interact to positively the majority of older adults. Higher affect bone health. protein intake combined with routine exercise promotes healthy aging. Am J Clin Nutr, 2015;101 (Suppl) Calorie Needs Decrease with Age. Protein Needs Do Not 3000 500 450 2500 400 350

2000 300 Calorie needs 1500 250 200 1000 150 100 500 50 0

1 2 3 4 5 6 7 8 9 0 10 11 12 85

Optimal Protein Intake(g) Protein Intake Declines with Age 120 Protein (g) Women 100 Men 80 60 40 20 0 19

31 51 71 Age Fulgoni VL 3rd. Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003-2004. Am J Clin Nutr. 2008 May;87(5):1554S-1557S. Protein Quality Complete high quality proteins provides sufficient amounts of all 9 essential amino acids* and support growth and maintenance of body tissues *Must be provided by the diet; cannot be made by the body

Considerations for Protein Quality: Translating to Practice Review of Protein Turnover Body Protein/ Muscle A A Food Protein Sources Muscle Protein Balance Protein Balance = Protein Synthesis (PS) Protein Breakdown (PB) Positive Net Balance +

PS > PB = lean body mass gain + PB > PS = lean body mass loss Negative Net Balance - - Review of Protein Turnover: Effects of Exercise Body/Muscle Protein A A

Food Protein Sources Routine exercise increases protein turnover Review of Protein Turnover: Effects of Nutrition Body/Muscle Protein A A Food Protein Sources Consuming protein reduces protein breakdown

NET Protein Balance Response to Nutrition and Exercise Exercise is essentially catabolic; energy is required for work Recovery is essentially anabolic; energy and rest is required to repair, rebuild, and maintain muscle and body protein Nutrients primarily protein need to be consumed to achieve an anabolic state, a positive NET balance Phillips et al., J Am Coll Nutr, 2005 Critical Role of Essential Amino Acids in Context of Protein Requirements and Recommendations has been Lost in Translation Only Essential Amino Acids Needed

to Achieve a Positive NET Balance MAA = 6g mixed amino acids EAA = 6g essential amino acids MAA + CHO = 6g mixed amino acids + 35g carbohydrate EAA+CHO = 6g essential amino acids + 35g carbohydrate Borsheim E et al., Am J Physiol Endocrinol Metab. 2002 Leucine is Key Essential Amino Acid Phillips et al., Sports Med. 2014 Translating Evidence Regarding Protein Quantity

and Quality into Healthy Eating Patterns Essential Amino Acid Density: Innovative and Practical Concept Caloric Density Nutrient Density Essential Amino Acid Density The Dietary Guidelines Considering an ounce-equivalent in the protein foods group In general, 1 ounce of meat, poultry or fish, 1 egg, cup cooked beans, 1 tablespoon peanut butter.. can be considered as 1 ounce-equivalent from the Protein Food Group*.

* http://www.choosemyplate.gov/protein-foods Considering Essential Amino Acid Density But: 1 oz beef 20% of all EAA requirements 1 egg 20% of all EAA requirements cup cooked beans 1.4% of all EAA requirements 1 Tbs peanut butter 0.5% of all EAA requirements Protein Sources and Meeting Minimal Requirements for All Essential Amino Acids Soy Milk Soy Milk Soy Milk Soy Milk

5 oz 85% Lean Ground Beef >4 cups Soy Milk >5 Hard Boiled Eggs >18 cups Chickpeas >25 slices Wheat Bread

50 Tbsp. Peanut Butter Considering Protein Quality: Essential Amino Acid Density 200 cal/day x 5 day/wk x 52 wks = 52,000 calories 52,000 calories/3500 calories/lb = ~ 15 lbs/yr Totals 800 cal 1000 cal ______ 600 cal 800 cal Nutrition Reviews, Volume 77, Issue 4, 06 February 2019, Pages 197215, https://doi.org/10.1093/nutrit/nuy073 The content of this slide may be subject to copyright: please see the slide notes for details. Room for Improvement:

Breakfast and Snacks Men Women 45.0 Percent of daily protein 40.3 40.0 Protein: g/day 35.0 30.0 27.3

26.2 25.0 18.6 20.0 15.0 14.1 13.1 11.3 9.3 10.0 5.0 0.0 Breakfast

Lunch Dinner Snacks Daily total: 93.7 g Breakfast Lunch Dinner Daily total: 66.5 g NHANES 2011-2012 Snacks Breakfast: Lunch:

Dinner: Snacks: 16% 28% 42% 14% Protein Distribution Protein-centric meals for optimal protein utilization: Can it be that simple? Rodriguez, NR. J Nutr 2014 Dietary protein distribution positively influences 24 h muscle protein synthesis in healthy adults Mamerow MM et al., J Nutr 2014 Considering Protein Quality in Meal Planning Breakfast Option 1

Breakfast Option 2 Breakfast Option 3 1 cup Cabot greek yogurt 1 cup strawberries cup granola 1 English muffin 2 large scrambled eggs with slice (1 oz) of cheese 1 cup Kashi cereal 1 cup 1% milk 1 large hard boiled egg 1 medium banana 499 calories 24 g protein 400 calories

26 g protein 500 calories 21 g protein Considering Protein Quality in Meal Planning Meal Option 1 3 oz grilled chicken cup brown rice 2 cups mixed greens + 2 tbsp vinaigrette avocado 530 calories 32 g protein 2.6 g leucine 14.0 g EAAs Meal Option 2 1 cup sliced, grilled portobello mushrooms

cup quinoa, cooked Spinach salad (2 cups spinach + cup feta cheese + 6 cherry tomatoes + 2 tbsp toasted soynuts + cup chickpeas + 1 tbsp ranch dressing) 500 calories 26 g protein 1.9 g leucine 9.6 g EAAs Meal Option 3 3 oz baked tofu 2 oz brown rice noodles cup steamed broccoli 1 oz unsalted peanuts cup shelled edamame 1 tbsp low-sodium soy sauce

580 calories 33 g protein 2.3 g leucine 11.0 g EAAs Summary and Practice Applications 1. The RDA sets the minimal amount of dietary protein for most healthy adults to prevent deficiency and is based on nitrogen balance, not functional outcomes 2. Current evidence suggests that dietary protein intake 1.0 g/kg/d is recommended to maintain muscle mass, benefit musculoskeletal health, and support active aging 3. High quality protein sources are critical to the design of healthy, nutrient-rich, calorie-conscious eating patterns. Prioritize protein in breakfast and snacks Protein quantity does not necessarily equate to protein quality. Thank You!

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