Download FRI Session 3 Jones

Dietary protein, muscle and health:
beyond the guidelines
Douglas Paddon-Jones, Ph.D., FACSM
Department of Nutrition and Metabolism
The University of Texas Medical Branch
Conceptual Model…..
Inactivity
Disease
Inadequate
Nutrition
Aging
Blood Flow
Drug therapies
Mitochondrial
Dysfunction
Activity
Inflammation
Stable Isotope Methodology (ring - 13C6
- Phenylalanine)
Artery
Synthesis
Breakdown
Vein
How much protein – need, want or desire… ?
Interpreting Protein Recommendations
RDA: “estimate of the minimum daily average dietary intake level that meets
the nutrient requirements of 97-98% of healthy individuals”
High
Risk
RDA for protein: 0.8 g of good quality protein / kg body weight / day
Low
Risk
Low
EAR
RDA
Moderate
High
Protein Consumption
Excessive
Dietary protein and bone
• Moderate protein diet (1- 1.5 g/kg/day)
 normal calcium metabolism
• Low protein intakes ( 0.8 g/kg/day):
- reduced intestinal calcium absorption
- increased parathyroid hormone
- release of calcium from bone
Feskanich D, et al. Am J Epidemiol 1996;143:472-9. Cooper C, et al. Calcif Tissue Int 1996;58:320-25
Protein and renal function
Institute of Medicine:
“protein content of diet is not
related to progressive decline
in kidney function with age."
Complete vs. incomplete protein
and biological value
Protein digestibility and biological value
DIAAS vs. PDCAAS
(2013)
(1989)
 Paul Moughan – Massey
 Hans Stein - Illinois
Key concept: limiting amino acids
Limiting amino acids:
- methionine &
cysteine
- lysine
(soy)
- methionine /
tryptophan
(
* quantity?)
- lysine
+ methionine
+
+ lysine
- methionine
=
Reality Check / Reminder:
Low protein quality ≠ Poor nutritional quality
(…...not all the time anyway)
Single source protein supplements:
Clinical / Practical Relevance ?





Whey
Casein
Soy
Blends
Milk protein
 Collagen ( - tryptophan)
 Rice
( - lysine)
 Pea
( - methionine + cysteine)
Anabolic response to “whole-food” protein
4 oz Beef
Protein Synthesis (%/h)
0.14
*
0.12
12 oz Beef
*
*
*
0.1
0.08
0.06
0.04
Young
Old
0.02
0
Fasting
30 g protein
Fasting
90 g protein
References: Symons et. al. AJCN, 2007
Symons et. al. JADA. 2009
Synergistic Effect of Protein and Exercise
0.18
*
*
0.16
Protein Synthesis (%/h)
0.14
100% increase
0.12
0.1
*
*
50% increase
Young
Elderly
0.08
0.06
0.04
0.02
0
Fasting
Protein meal
Protein + Exercise
Reference: Symons et. al. JNHA, 2010
Reality: Age-related dose-response
Net Muscle Protein Synthesis
(mg Phe/leg)
60
6g
50
Young
40
Elderly
5g
30
20
8g
10
0
More than ~25 g protein
Less than ~15 g protein
6g
Reference: Katsanos et. al. AJCN, 2005
Protein timing and distribution
Typical US protein consumption pattern
45
Protein consumed per meal (g)
40
average: 60-100 g protein/day (~1.0 g /kg/day)
35
30
25
20
15
10
5
0
Breakfast
Lunch
Dinner
National Health and Nutrition Examination Survey (NHANES)
Snacks
Fulgoni AJCN 2008
Katsanos et. al. AJCN, 2005
Symons et. al. AJCN, 2007
Symons et. al. JADA. 2009
We can’t store excess protein for later anabolism
Catabolism
Anabolism
maximum rate of protein synthesis
Total Protein
90 g
10 g
15 g
X
65 g
30 g
Usable Protein
55 g ?
~ 0.7 g/kg/day ?
Reference: Paddon-Jones and Rasmussen 2009
Concept: Optimizing protein at each meal ?
Catabolism Anabolism
maximum rate of protein synthesis
30 g
30 g
30 g
Total
Total Protein
Protein
90 gg ?
~ 120
Usable Protein
90 g ?
~ 1.3 g/kg/day
 greater 24 h protein synthesis response ?
Reference: Paddon-Jones and Rasmussen 2009
Protein distribution impacts muscle protein synthesis
25%
*
*
30 - 30 - 30 g
10 - 15 - 65 g
Older (?)
Reference: Mamerow, et.al. J. Nutr. 2014
Building and Losing Muscle
 protein & amino acids
If you are hospitalized - you are put in bed
100
90
80
%
Time 70
60
50
40
30
20
10
0
Inactive
(0 steps/min)
Low Activity
(< 15 steps/min)
Inactivity and Muscle Loss
Loss of lean leg mass (g)
- Bed Rest -
Young
Middle-aged
Older
Older
Patients
28 Days
14 Days
10 Days
4 Days
0
-250
-500
-750
-1000
-1500
|-------------------- best case situation----------------------|
-2000
Paddon-Jones et. al. 2004
English et al., 2014
Kortebein et al. 2007
Paddon-Jones , Pilot Data
What do older inpatients eat ?
Presented
grams
100
Consumed
80
60
40
20
0
Protein
Carbohydrate
per meal
Paddon-Jones, pilot data
Fat
Protecting Muscle with Nutrition
Leucine has a key
regulatory role on
muscle protein
synthesis
…are the benefits
overstated ?
Leucine: partially protects muscle function
Knee extension
endurance
Aerobic capacity
(VO2max)
Knee extension
strength/torque
Percentage change %
0
-5
-10
-15
-20
Control
Leucine
English, et al. 2015 AJCN
Leucine: partially / temporarily protects muscle mass
Day 7
(mid-point)
Day 14
(end bed rest)
Whole body lean mass (g)
0
-250
-500
-750
-1000
-1250
Control
Leucine
English, et al. 2015 AJCN
Smaller protein meal + leucine
Clinical relevance ?
Young
Net Muscle Protein Synthesis
(mg Phe/leg)
60
Elderly
50
40
30
10 g
20
3g
10
0
More than ~25 g protein
Less than ~15 g protein
protein
+
leucine
Leucine content of food
Protein source
Leucine
whey protein isolate
13 %
milk protein
10 %
egg protein
8.5 %
muscle protein
8%
soy protein isolate
8%
wheat protein
7%
collagen
2%
Amino Acid Composition of Whey Protein
25
g / 100 g
20
15
10
5
0
His
Lys
Me Phe
t
Iso
Leu
Val Th
Whey
Asp
Ser
Gln
Pro
Human muscle
Gly
Ala
Ty
Arg
Summary and recommendations
Summary
 Protein quality – don’t over complicate it
 Combinations, quantities and common sense
 Mechanism-focused studies provide direction and highlight potential
 Current dietary practices: obstacles and opportunities
 Protein/leucine: meal distribution, dose response, ceiling effects?
Recommendations
For all adults….
Establish a dietary framework that includes a moderate amount of high
quality protein (or combination) at each meal.
Modify as necessary to accommodate individual needs:
- energy requirements
- physical activity
- health status
- body composition goals
- dentition, satiety
Recommendations
React aggressively with
targeted protein / nutrition
interventions to preserve
normal protein turnover and
reduce negative metabolic
consequences of short-term
physical inactivity, illness or
injury
Paddon-Jones Lab
• Emily Arentson-Lantz
• Jennifer Ellison
• Elfego Galvan
Colleagues
• ITS-CRC Nursing & Bionutrition Staff
• Blake Rasmussen
• Wayne Campbell
• Don Layman
• Thomas Lang
• Aaron Russell / Severine Lamon
Funding
• RO1 NR012973
• R21 AR062479
• NSBRI (NNJ08ZSA002N)
• National Dairy Council
• Texas Space Grant Consortium
• UTMB Claude D. Pepper Older
Americans Independence Center (NIH)
Medical Team
• Adam Wacher
• Elena Volpi
• James Pattarini
• Charles Mathers