Abstract
Recommendations concerning protein quantity, source, and leucine intake for older adults are difficult to reach by regular dietary intake. This randomized clinical trial assesses in sarcopenic community-dwelling older adults (i) the regular (non-supplemented) daily protein and leucine intake; and (ii) the effect of personalized protein supplementation (aiming for an evenly distributed total protein intake of 1.5 g·kg−1·d−1 of body mass, accounting for energy intake) on regular and total (dietary and supplemental) intake. A preliminary feasibility study in participants of the ongoing Exercise and Nutrition for Healthy AgeiNg (ENHANce) study was performed with the objective to assess the intake and distribution of regular dietary protein and leucine, protein source and energy intake in (pre)sarcopenic community-dwelling older adults. Moreover, this study aimed to assess if personalized protein supplementation was feasible without negatively affecting regular dietary intake. ENHANce (NCT03649698) is a 5-armed RCT that assesses the effect of anabolic interventions on physical performance in (pre)sarcopenic older adults. In August 2019, n = 51 participants were included in ENHANce with complete available data on dietary intake at screening and thus eligible for inclusion in present analysis. Of these, n = 35 participants completed the intervention period of ENHANce at the moment of analysis, allowing an exploration of the effect of supplementation on regular dietary intake. The regular dietary protein intake of 51 (pre)sarcopenic adults (73.6 ± 6.5 years) was 1.06 ± 0.3 g·kg−1·d−1 of body mass. Protein supplementation (n = 20) improved total protein intake to 1.55 ± 0.3 g·kg−1·d−1 of body mass (P < 0.001) without affecting regular dietary protein (P = 0.176) or energy intake (P = 0.167). Placebo supplementation (n = 15) did not affect regular dietary protein intake (P = 0.910) but decreased regular dietary energy intake (P = 0.047). Regular leucine intake was unevenly distributed over the day, but increased by supplementation at breakfast (P < 0.001) and dinner (P = 0.010) to at least 2.46 g leucine·meal−1, without reducing regular dietary leucine intake (P = 0.103). Animal-based protein intake—the main protein source—was not affected by supplementation (P = 0.358). Personalized protein supplementation ensured an adequate quantity and even distribution of protein and leucine over the day, without affecting regular dietary protein or energy intake.
Highlights
Sarcopenia is the loss of skeletal muscle function and mass through aging [1, 2]
The present study showed that the quantity, quality and distribution of regular dietary protein or leucine intake of community-dwellingsarcopenic older adults do not reach the recommended levels [16]
We showed that the addition of a personalized protein supplement resulted in an adequate quantity and quality total protein intake, and a more even distribution over the day, without affecting the protein or energy intake through the diet
Summary
Sarcopenia is the loss of skeletal muscle function and mass through aging [1, 2]. Exercise is the primary treatment component and improves older adults’ muscle strength, muscle mass and physical functioning [2]. The combination of exercise with protein supplementation results in even greater gains in lean mass and leg strength compared to exercise alone [3, 4]. Leucine plays a dual role as regulator of intracellular signaling pathways leading to protein synthesis and as substrate for protein synthesis [5, 6]. Sarcopenia has been associated with low protein intake and specific dietary patterns (butter, red meat, gravy and potato) [7, 8]. An umbrella review recommends supplementation of leucine for older adults with sarcopenia to improve muscle mass [4]
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