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NUTRITION
Nutrition and older people
AMBER BEAUMONT
Optimising nutrition
and muscle strength for
healthy ageing.
References
1. Australian Bureau of Statistics. Reflecting a nation:
Stories from the 2011 Census, 2011–2013.
Available at www.abs.gov.au/ausstats/[email protected]/Loo
kup/2071.0main+features752012-2013 [Accessed
11 February 2016].
2. Tiedemann A, Sherrington C, Close JC, Lord SR,
Exercise and Sports Science Australia position
statement on exercise and falls prevention in older
people. J Sci Med Sport 2011;14:489–95.
3. Phillips SM. Nutritional supplements in support
of resistance exercise to counter age-related
sarcopenia. Adv Nutr 2015;6:452–60.
4. Cermak NM, Res PT, de Groot LC, Saris WH, van
Loon LJ. Protein supplementation augments the
adaptive response of skeletal muscle to resistance
type exercise training: a meta-analysis. Am J Clin
Nutr 2012;96:1454–64.
5. Bauer J, Biolo G, Cederholm T, et al. Evidence-based
recommendations for optimal dietary protein intake in
older people: a position paper from the PROT-AGE
study group. J Am Med Dir Assoc 2013;14:542–59.
6. Mamerow MM, Mettler JA, English KL, et al.
Dietary protein distribution positively influences 24-h
muscle protein synthesis in healthy adults. J Nutr
2014;144(6):876–80.
7. National Health and Medical Research Council.
Nutrient Reference Values for Australia and New
Zealand 2006. Canberra: Commonwealth of
Australia, 2006.
8. Australian Bureau of Statistics. Australian health
survey: Usual nutrient intakes, 2011–2012. Available
at www.abs.gov.au/ausstats/[email protected]/Lookup/
by Subject/4364.0.55.008~2011-12~Main
Features~Macronutrients ~200 [Accessed 11
February 2016].
9. Thomson RL, Brinkworth GD, Noakes M, Buckley
JD. Muscle strength gains during resistance exercise
training are attenuated with soy compared with dairy
or usual protein intake in older adults: A randomized
controlled trial. Clin Nutr 2016;35(1):27–33.
10. Candow D, Forbes S, Little J, Cornish S, Pinkoski
C, Chilibeck P. Effect of nutritional interventions
and resistance exercise on aging muscle mass and
strength. Biogerontology 2012;13:345–58.
11. Hartman JW, Tang JE, Wilkinson SB, et al.
Consumption of fat-free fluid milk after resistance
exercise promotes greater lean mass accretion than
does consumption of soy or carbohydrate in young,
novice, male weightlifters. Am J Clin Nutr 2007;
86(2):373–81.
12. Koopman R, Walrand S, Beelen M, et al. Dietary
protein digestion and absorption rates and the
subsequent postprandial muscle protein synthetic
response do not differ between young and elderly
men. J Nutr 2009;139(9):1707–13.
13. Department of Health. Eating when you’re older.
Available at www.eatforhealth.gov.au/eating-well/
healthy-eating-throughout-all-life/healthy-eatingwhen-you%E2%80%99re-older [Accessed 11
February 2016].
People aged 65 and older represent
approximately 15% of the Australian
population.1 How can we support these patients
in staying fit, active and independent as they
age? Research suggests the Holy Grail to
healthy ageing could lie in optimising muscle
mass and dietary protein intake.
Muscle loses size and strength as we age,
which can lead to reduced activity and increased
risk of obesity, type 2 diabetes and cancer.
Age-related muscle loss – sarcopenia – can also
compromise balance and mobility, increasing the
risk of falls and disability. While not completely
defined, sarcopenia appears to be a result of
decreased protein synthesis combined with
increased protein breakdown.
Resistance training (ie strength or weight
training) is recognised as a strategy to increase
muscle strength and maintain bone integrity.
The American College of Sports Medicine
and American Heart Association recommend
older people undertake 8–10 strength-training
exercises, 10–15 repetitions of each, 2–3 times
per week.2 Such exercises include squats, wall
push-ups, bicep curls and step-ups.
Muscle gain from resistance training is
enhanced by optimal dietary protein intake,3
and muscle mass increases up to 35% when
resistance training is combined with 1.2 g
protein/kg body weight/day.4 Older people
with acute or chronic diseases need even more
dietary protein; 1.2–1.5 g/kg body weight/day.5
New research also emphasises the
benefits of consuming adequate protein at
breakfast, lunch and dinner, compared to typical
patterns of protein intake skewed towards
dinner.6 Around 25–30 g of protein at each
meal appears to be the trigger point to turn on
muscle protein synthesis.
These amounts are greater than current
recommendations – around 1 g/kg/day – which
were based on nitrogen balance rather than
functional health outcomes.7 They are also
much higher than current intake among older
people, with approximately one in seven men
and one in 25 women aged 71 and older not
meeting their protein requirements, which
increase from the age of 70.8 This is mostly
explained by a reduction in total food intake.9
Protein quality is another important
consideration. A recent study found significantly
fewer improvements in exercise metrics with a
high soy protein diet, compared to high dairy
and typical protein (meat and dairy) diets.9
This might be because soy protein is lower
in the amino acid leucine, a key trigger for
switching on muscle protein synthesis while
inhibiting muscle protein breakdown.10
The highest concentrations of leucine are
found in dairy protein. Studies using dairy
protein supplements have shown greater
increases in strength and lean body mass
compared to other protein sources.11 Current
evidence indicates the body’s ability to
digest and absorb protein probably does not
significantly change with age.12 Similarly, both
young and older people require the same amino
acids for good health.
The following foods provide 10 g of highquality protein, which can be combined to reach
patient meal targets of 25–30 g. They also
make easy, nutritious snacks between meals
for older people with chronic disease and higher
protein requirements:
• 200 g yoghurt
• two small eggs
• 40 g cheese (two slices)
• 70 g cottage cheese
• 300 ml milk
• 35 g lean beef, lamb, pork or chicken
(cooked weight)
• 50 g can tuna or salmon
• 300 ml custard
With increasing protein requirements and
decreasing energy needs, it can be harder
for older people to meet nutrient needs and
tasty nutrient-rich foods should be a focus.
Limiting fats, added salt and added sugars
can sometimes mean someone at risk of
malnutrition actually eats too few nutrients and
kilojoules, putting themselves at risk.13
With poor appetite and high requirements,
food and drink supplementation or fortification
may be required.
GPs can help older patients optimise
their muscle strength and protein intake
with these tips:
• Recommend resistance training, including
free weights, medicine balls and their
own body weight.
• Encourage a conscious effort to consume
adequate high-quality protein (aiming for
1.2 g/kg/day) spread evenly across the
day, with a focus on breakfast (eg cereal
with milk and yoghurt; eggs on toast; milk
smoothie) and lunch (eg toasted cheese
sandwich; tuna pasta; milk or yoghurt stirred
through soup).
Good Practice Issue 4, April 2016
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