Exercise and Nutrition: Partners in the fight against muscle - - PowerPoint PPT Presentation

Exercise and Nutrition: Partners in the fight against muscle weakness

Dr Theocharis Ispoglou

Reader in Skeletal Muscle Health ​Active Ageing in Health and Disease (SARCA) theme coordinator

@Theo_Ispoglou

Topics

 Background  Sarcopenia  Potential causes and consequences  Exercise and Nutrition Modifiable Risk Factors  Sharing some of our research findings

Background

Sepulveda et al. (2015)

Key issues driving our research

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Sarcopenia Frailty and decreased physical activity Inadequate energy and protein intake

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René Koopman, and Luc J. C. van Loon (2009)

SARCOPENIA

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Functional decline and link with non-communicable diseases

Kuh et al (2014)

“The total public expenditure on malnutrition in health and social care was estimated to be £19.6 billion, with older adults accounting for 52% of the total. (2011-12) Elia (2015)

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Sarcopenia Dementia ~13 million people over the age of 65 in UK ~5-13% for those 60-70 years of age and up to 50% in over 80s ~850,000 people with dementia in the UK, with numbers set to rise to

• ver 1 million by 2025.

~ 40,000 people under 65 with dementia in the UK Sources: Office for National Statistics, Alzheimer’s Society ~70% of patients with dementia had sarcopenia

http://www.jarcp.com/629-prevalence-of-sarcopenia-in-elderly-with- dementia-institutionalized-a-multicenter-study.html

Exercise and Nutrition Modifiable Risk Factors

 Key points  Good Evidence for the role of Resistance exercise (RE) and Protein Supplementation as a means to promote muscle mass, bone health, and functional capacity.  Supporting evidence for improvement of ADL and reduction in the risk of falls in people with dementia who partake in exercise interventions  Nutritional deficiencies in older people

Effect of resistance training on functional capacity in chronic diseases.

Pasanen et al. (2017)

Effect of combined endurance and RE on functional capacity in chronic diseases. Pasanen et al. (2017)

Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis (Burton et al. 2014)

Cermak et al. (2012): Outcome-Fat Free Mass Resistance Exercise Plus Protein Supplementati

• n

Cermak et al. (2012): Outcome-1RM Strength Resistance Exercise Plus Protein Supplementation

Protein Intake in Older Individuals

Daily recommendations of 0.8 g.kg-

1.Bm.d-1 inadequate is too low to avoid

sarcopenia Need for higher protein per meal-at least 30g or 0.4 g.kg-1.BM.d-1 per meal

Challenge: age-related anorexia and satiating effects of protein

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This is what 30g

protein looks like……

Protein is the most satiating macronutrient

10 20 30 40 50 60 30 90 Hunger (0-100) Time (min)

Protein Carbohydrate Fat Preload

Poppitt et al., 1998. Physiol Behav 64: 279-85.

Total protein intake, protein intake per meal, or leucine intake

18 PS PB

Older individuals have a higher leucine threshold and they would benefit from larger amounts of leucine either within a meal or as a protein/EAAs supplement (Katsanos et al., 2006, Bauer et al., 2015, Ispoglou et al., 2016, Phillips et al., 2016, Komar et al., 2015, Yang et al., 2012, Pennings et al., 2011, Verreijen et al., 2015).

Tieland et al (2015)

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5 10 15 20 25 30 35 40 Breakfast Lunch Dinner

Protein Intake (g) Meal

Per Meal Protein Intake

Older people do eat enough protein per meal- especially at breakfast and lunch. Green line indicates recommendations (unpublished PhD data, Matt Butterworth)

Our Research

21  One of our key objectives to address protein and energy deficiencies

Pilot study (Ispoglou et al. 2016)

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Follow-up study (Ispoglou et al. 2017)

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When considering the satiating effects of EAAs-based nutritional supplements enriched with leucine, no studies have examined the impact on appetite and concurrent mealtime intake nor the practical aspects of palatability

Development of prototypes (Bar and gel)

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Nutritional information per 100 g:

• BAR: energy 1511 kJ, fat 8.2 g,

carbohydrate 47.5 g, protein 25.4 g of which 15 g was EAAs, fibre 2.8 g, salt 0.2 g.

• GEL: energy 967 kJ, fat 0.0 g,

carbohydrate 47.5 g, protein 15 g which was entirely due to the EAAs content, fibre 0.5 g, salt 0.2 g.

Our nutritional prototypes (GEL and BAR) are effective means to facilitate an increase in protein and energy intake when taken

• ne hour before an ad lib

breakfast meal. (Ispoglou et al. 2017)

Our nutritional prototypes (GEL and BAR) are effective means to facilitate an increase in protein and energy intake when taken alongside an ad lib breakfast meal. Ispoglou et al (2017)

Follow-up project

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30 Our GEL is effective means to facilitate an increase in protein and energy intake when taken

• ne hour before an ad lib

breakfast meal. PhD Project (Manuscript under review, PhD student Matt Butterworth)

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Composite appetite ratings for CON (▼), WP (●) and GEL (○).Values are mean (SEM), n=10.

32 Whey protein enhances satiety and as a result people eat less

 Hunger perceptions and energy intake was lower in older adults when compared to younger adults.  Ageing increased concentrations of; CCK, leptin, insulin and PYY  These hormones all promote feelings of fullness whilst attenuating feelings of hunger which could provide explanations towards the anorexia of ageing (Abstract, NutSoc2018)

PhD Project (Manuscript under preparation, PhD student Kelsie Johnson)

Present and Future

Our current and future research is primarily focused on strengthening evidence base of exercise and nutrition/nutritional supplementation: Health and wellbeing: Prevention of sarcopenia in healthy older individuals contributing to retention of lean tissue mass, prevention of

• steoporosis and enhanced functional capacity.

Clinical settings: Treatment of sarcopenia in frail older individuals in chronic disease conditions such as respiratory, rheumatoid arthritis, diabetes, CHD and CF, liver and gastro-intestinal disease, where increased protein requirements may be a result of enhanced requirements or malabsorption.

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Thank you

Any questions?

Staff Webpage: http://www.leedsbeckett.ac.uk/staff/dr- theocharis-ispoglou/ LinkedIn: https://www.linkedin.com/in/theochari s-ispoglou-b7b71a2a/ Twitter: @Theo_Ispoglou