scholarly journals Prevalence and Correlates of Sarcopenia among Elderly CKD Outpatients on Tertiary Care

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1951 ◽  
Author(s):  
Claudia D’Alessandro ◽  
Giorgina Piccoli ◽  
Massimiliano Barsotti ◽  
Serena Tassi ◽  
Domenico Giannese ◽  
...  
Keyword(s):  
Muscle Mass ◽  
Energy Intake ◽  
Protein Intake ◽  
Tertiary Care ◽  
Physical Capacity ◽  
Activity Levels ◽  
Dietary Intakes ◽  
Elderly Male ◽  
Ckd Stage ◽  
Male Patients

Background: Sarcopenia is a widespread concern in chronic kidney disease (CKD) as well in elderly patients and is one of the main reasons why low-protein diets for this population are controversial. The aim of this study was to assess the prevalence and correlates of sarcopenia among elderly male patients affected by CKD followed up in an outpatient nephrology clinic, where moderate protein restriction (0.6–0.8 g/Kg/day) is routinely recommended to patients in CKD stage 3b-5 not on dialysis. Methods: This observational study included 80 clinically-stable male out-patients aged >60, affected by stage 3b-4 CKD. Forty patients aged ≥75 (older seniors) were compared to the other forty patients aged 60–74 (younger seniors). All patients underwent a comprehensive nutritional and functional assessment. Results: Older seniors showed lower serum albumin, hand-grip strength, body mass index (BMI), skeletal muscle mass, and resting energy expenditure. Protein intake was significantly lower in older seniors whereas energy intake was similar. Average daily physical activity was lower in the older seniors than in the younger ones. Sarcopenia was more prevalent in older than in younger seniors. Among older seniors, sarcopenic and non-sarcopenic ones differed in age and performance on the Six-Minute Walk test, whereas the estimated glomerular filtration rate (eGFR), biochemistry, dietary protein, and energy intakes were similar. Conclusions: Older senior CKD male patients have lower muscle mass, muscle strength, and physical capacity and activity levels, with a higher prevalence of sarcopenia than younger patients. This occurs at the same residual renal function and metabolic profile and protein intake. Energy intake was at the target in both subgroups. In this CKD cohort, sarcopenia was associated with age and physical capacity, but not with eGFR or dietary intakes.

scholarly journals Optimal Protein Intake in Pre-Dialysis Chronic Kidney Disease Patients with Sarcopenia: An Overview

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1205
Author(s):  
Yoshitaka Isaka
Keyword(s):  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Exercise Therapy ◽  
Protein Intake ◽  
Renin Angiotensin System ◽  
Protein Restriction ◽  
Ckd Stage ◽  
End Stage

Multi-factors, such as anorexia, activation of renin-angiotensin system, inflammation, and metabolic acidosis, contribute to malnutrition in chronic kidney disease (CKD) patients. Most of these factors, contributing to the progression of malnutrition, worsen as CKD progresses. Protein restriction, used as a treatment for CKD, can reduce the risk of CKD progression, but may worsen the sarcopenia, a syndrome characterized by a progressive and systemic loss of muscle mass and strength. The concomitant rate of sarcopenia is higher in CKD patients than in the general population. Sarcopenia is also associated with mortality risk in CKD patients. Thus, it is important to determine whether protein restriction should be continued or loosened in CKD patients with sarcopenia. We may prioritize protein restriction in CKD patients with a high risk of end-stage kidney disease (ESKD), classified to stage G4 to G5, but may loosen protein restriction in ESKD-low risk CKD stage G3 patients with proteinuria <0.5 g/day, and rate of eGFR decline <3.0 mL/min/1.73 m2/year. However, the effect of increasing protein intake alone without exercise therapy may be limited in CKD patients with sarcopenia. The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia. In the case of loosening protein restriction, it is safe to avoid protein intake of more than 1.5 g/kgBW/day. In CKD patients with high risk in ESKD, 0.8 g/kgBW/day may be a critical point of protein intake.

scholarly journals Impact of daily protein and energy intake and distribution on muscle mass and strength in Danish older individuals-The CALM study

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Yusuke Nishimura ◽  
Grith Hojfeldt ◽  
Simon Rønnow Schacht ◽  
Kenneth Mertz ◽  
Morten Hjulmand ◽  
...  
Keyword(s):  
Total Energy ◽  
Grip Strength ◽  
Muscle Mass ◽  
Energy Intake ◽  
Protein Intake ◽  
Knee Extension ◽  
Hand Grip Strength ◽  
Energy Ratio ◽  
Older Individuals ◽  
Hand Grip

AbstractThe importance of dietary protein for the maintenance of muscle mass and strength is heavily discussed. However, adequate energy intake is an underlying assumption but often not considered. In this study, we investigated the impact of daily intake and meal distribution of both protein and energy on muscle mass and strength. In a cross-sectional study, a total of 184 older individuals (gender: 86F/98M, age: 70.2 ± 3.9 yrs, BMI: 25.4 ± 3.7 kg/m2; means ± SD) were recruited. Participants underwent a 3-day weighed dietary record, Dual-energy X-ray Absorptiometry (DXA) scan, hand-grip strength, and Maximal Voluntary Isometric knee-extension Contraction (MVIC). Participants were divided into two categories: lower (LOW; < 0.83 g/adjusted(a)BW/day) or higher (HIGH; ≥ 1.1 g/aBW/day) protein intake levels analysed by gender to characterize a daily protein and energy intake pattern. Main meal protein and energy intake distributions were calculated, and correlations were made. Further, energy intake at breakfast and lunch divided by total energy intake (energy ratio) was correlated with appendicular skeletal muscle index (ASMI), hand-grip strength, and MVIC were determined using the LOW/HIGH-protein-intake categorization. Further, gender-specific ASMI, hand-grip strength and knee extension were compared based on the following four distinct daily protein intake ranges: < 0.66; ≥ 0.66- < 0.83; ≥ 0.83- < 1.1; ≥ 1.1 g/aBW/day. A positive correlation appeared between protein and energy intake in all main meals (r ≥ 0.57, p < 0.0001). In the LOW category, positive correlations were found between energy ratio and ASMI (r = 0.16, p = 0.048), hand-grip strength (r = 0.40, p = 0.0009), and MVIC (r = 0.36, p = 0.0019), whereas no associations were found in the HIGH category. ASMI, hand grip, and MVIC were similar regardless of the protein intake ranges, though with women being lower than men (p < 0.05) in all outcomes. These results show that total daily protein intake did not affect muscle mass and strength in our cohort. However, our data demonstrate that greater energy intake in breakfast and lunch relative to total energy intake is associated with higher muscle mass and strength, particularly when protein intake is lower than 0.83 g/aBW/day, indicating the potential importance of meal energy content at lower intakes of protein.

scholarly journals Short-Term Protein Supplementation Does Not Alter Energy Intake, Macronutrient Intake and Appetite in 50–75 Year Old Adults

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1711
Author(s):  
Esme R. Tuttiett ◽  
Dan J. Green ◽  
Emma J. Stevenson ◽  
Thomas R. Hill ◽  
Bernard M. Corfe ◽  
...  
Keyword(s):  
Muscle Mass ◽  
Protein Intake ◽  
Nutrient Intake ◽  
Phase 1 ◽  
Protein Supplementation ◽  
Older Age ◽  
Protein Supplement ◽  
Dietary Intakes ◽  
Short Term ◽  
Energy And Nutrient Intake

Ageing is associated with a reduction in muscle mass and strength, termed sarcopenia. Dietary protein is important for the maintenance of muscle mass through the promotion of muscle protein synthesis. However, protein is also reported to be a highly satiating nutrient. This raises concerns that protein intake for musculoskeletal health reasons in older adults may exacerbate age-related decreased appetite and may result in reduced energy and nutrient intake. This study aimed to investigate the effect of short-term protein supplementation and its timing (morning vs. evening), on energy and nutrient intake and appetite measures in middle-older age adults. Twenty-four 50–75 year olds were recruited to a randomised cross-over trial. In phase 1 (pre-supplementation) participants completed a food diary and reported hunger and appetite on three alternate days. During the second and third phases, participants consumed a 20 g whey protein gel (78 mL/368 kJ), for four days, either in the morning (after breakfast) or the evening (before bed), whilst completing the same assessments as phase 1. No differences in dietary intakes of energy, macronutrients and micronutrients were recorded when comparing the pre-supplementation phase to the protein supplementation phases, irrespective of timing (excluding the contribution of the protein supplement itself). Similarly, no differences were observed in self-reported feelings of hunger and appetite. In conclusion, a 20 g/day whey protein supplement given outside of meal-times did not alter habitual dietary intakes, hunger or appetite in this middle-older age adult population in the short-term. This approach may be a useful strategy to increasing habitual protein intake in the middle-older age population.

scholarly journals Daily Protein and Energy Intake Are Not Associated with Muscle Mass and Physical Function in Healthy Older Individuals—A Cross-Sectional Study

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2794
Author(s):  
Grith Højfeldt ◽  
Yusuke Nishimura ◽  
Kenneth Mertz ◽  
Simon R. Schacht ◽  
Jonas Lindberg ◽  
...  
Keyword(s):  
Physical Function ◽  
Muscle Mass ◽  
Energy Intake ◽  
Dietary Protein ◽  
Protein Intake ◽  
Cross Sectional Study ◽  
Dietary Protein Intake ◽  
Older Individuals ◽  
Sectional Study ◽  
Cross Sectional

Dietary protein has a pivotal role in muscle mass maintenance with advancing age. However, an optimal dose and distribution of protein intake across the day as well as the interaction with energy intake for the maintenance of muscle mass and physical function in healthy older adults remain to be fully elucidated. The purpose of this study was to examine the association between muscle mass, strength, and physical function, and the total amount and distribution of protein and energy intake across the day in healthy older individuals. The research question was addressed in a cross-sectional study including 184 Danish men and woman (age: 70.2 ± 3.9 years, body mass: 74.9 ± 12.1 kg, Body Mass Index (BMI): 25.4 ± 3.7 kg/m2) where a 3-day dietary registration, muscle mass, strength, and functional measurements were collected. We found that neither daily total protein intake nor distribution throughout the day were associated with muscle mass, strength, or physical function. Consequently, we do not provide an incentive for healthy older Danish individuals who already adhere to the current internationally accepted recommended dietary protein intake (0.83 g/kg/day) to change dietary protein intake or its distribution pattern throughout the day.

scholarly journals Nutritional Aspects in Diabetic CKD Patients on Tertiary Care

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 427
Author(s):  
D’Alessandro ◽  
Barsotti ◽  
Cianchi ◽  
Mannucci ◽  
Morganti ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Albumin ◽  
Muscle Mass ◽  
Energy Intake ◽  
Phase Angle ◽  
Tertiary Care ◽  
Residual Renal Function ◽  
Diabetic Patients ◽  
Dietary Energy ◽  
Dietary Energy Intake

Background and objectives: Diabetes is largely prevalent in the chronic kidney disease (CKD) population. Both conditions have metabolic and nutritional abnormalities that affect body composition and the presence of diabetes makes the dietary management of CKD patients more difficult. The aim of this study was to assess peculiar nutritional and functional aspects of diabetic patients in an adult/elderly CKD population, and their predictive significance. Materials and methods: This prospective cohort study included 144 out-patients aged >55 years, affected by stage 3b-4 CKD, on tertiary care clinic; 48 (40 males) were type 2 diabetics and 96 (80 males) were nondiabetics. The two groups have similar age, gender, and residual renal function (30 ± 9 vs. 31 ± 11 mL/min×1.73). All patients underwent a comprehensive nutritional and functional assessment and were followed for 31 ± 14 months. Results: Diabetic CKD patients showed higher waist circumference and fat body mass, lower muscle mass, and lower number of steps per day and average daily METs. Meanwhile, resting energy expenditure (REE), as assessed by indirect calorimetry, and dietary energy intake were similar as well as hand-grip and 6 min walking test. Diabetic patients did not show a greater risk for all-cause mortality and renal death with respect to nondiabetics. Middle arm muscle circumference, phase angle, serum cholesterol, and serum albumin were negatively related to the risk of mortality and renal death after adjustment for eGFR. Conclusions: CKD diabetic patients differed from nondiabetics for a greater fat mass, lower muscle mass, and lower physical activity levels. This occurred at the same REE and dietary energy intake. The outcome of diabetic or nondiabetic CKD patients on tertiary care management was similar in terms of risk for mortality or renal death. Given the same residual renal function, low levels of muscle mass, phase angle, serum albumin, and cholesterol were predictive of poor outcome. Overall, a malnutrition phenotype represents a major predictor of poor outcome in diabetic and nondiabetic CKD patients.

scholarly journals Meeting Minimum ESPEN Energy Recommendations Is Not Enough to Maintain Muscle Mass in Head and Neck Cancer Patients

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2743 ◽  
Author(s):  
Benjamin McCurdy ◽  
Sara Nejatinamini ◽  
Brock J. Debenham ◽  
Mirey Álvarez-Camacho ◽  
Catherine Kubrak ◽  
...  
Keyword(s):  
Body Composition ◽  
Head And Neck Cancer ◽  
Dietary Intake ◽  
Head And Neck ◽  
Muscle Mass ◽  
Neck Cancer ◽  
Protein Intake ◽  
Post Treatment ◽  
Muscle Loss ◽  
Dietary Intakes

The relationship between dietary intake and body composition changes during cancer treatment has not been well characterized. The aim of this study was to compare dietary intake at diagnosis and end of treatment in relation to changes in muscle mass and adiposity in head and neck cancer (HNC) patients. Dietary intakes (three-day food record) and body composition using computed tomography (CT) were assessed at diagnosis (baseline) and after treatment completion (post-treatment). Skeletal muscle (SM) loss was explored as a consequence of energy and protein intake in relation to the minimum and maximum European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines. Higher energy intakes (kcal/kg/day) and increases in energy intake (%) from baseline to post-treatment were correlated with attenuated muscle loss (r = 0.62, p < 0.01; r = 0.47, p = 0.04, respectively). Post-treatment protein intake demonstrated a weak positive correlation (r = 0.44, p = 0.05) with muscle loss, which did not persist when controlling for covariates. Meeting minimum ESPEN energy guidelines (25 kcal/kg/day) did not attenuate SM loss, whereas intakes >30 kcal/kg/day resulted in fewer participants losing muscle. Greater baseline adiposity correlated with greater SM loss (p < 0.001). Energy intakes of 30 kcal/kg/day may be required to protect against SM loss during treatment in HNC patients. The influence of adiposity on SM loss requires further exploration.

scholarly journals 333 Practical applications of whey protein in promoting skeletal muscle maintenance, recovery, and reconditioning

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 67-68
Author(s):  
Emily Arentson-Lantz
Keyword(s):  
Whey Protein ◽  
Muscle Mass ◽  
Energy Intake ◽  
Protein Intake ◽  
Protein Quality ◽  
Muscle Protein ◽  
Muscle Protein Synthesis ◽  
Primary Objective ◽  
Negative Effects ◽  
Practical Applications

Abstract Protein is an essential component of a healthy diet at all stages of life for growth and maintenance of muscle mass. Adequate protein intake is especially critical during periods of catabolic crises, such as periods of disuse due to illness or injury, that accelerate the loss of muscle mass and function. Therefore, the primary objective of this talk will be discussing the implementation of whey protein to optimize nutritional practices and protein intake to mitigate the consequences of disuse and aging. Increased protein and/or energy intake can be a well-intentioned but often impractical strategy to protect muscle due to limitations such as a cost or issues with satiety. Whey protein offers a practical, palatable source of protein rich in leucine, the amino acid thought to initiate muscle protein synthesis. In a recent study, we sought to determine whether increase in dietary protein quality through use of whey protein could reduce the negative effects of physical inactivity in older human adults. Findings from this study showed that whey protein protected against muscle loss. Additionally, whey appeared to offer some protection against gaining fat mass during disuse and promoted recovery of strength during recovery. These findings suggest that improving protein quality (e.g. the addition of whey protein) without increasing total energy intake may partially protect against some of the negative effects of bed rest in older adults.

771-P: Protein Intake at Breakfast Contributes to Maintenance of Skeletal Muscle Mass in Japanese Elderly Patients with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 771-P
Author(s):  
SODAI KUBOTA ◽  
HITOSHI KUWATA ◽  
SAKI OKAMOTO ◽  
DAISUKE YABE ◽  
KENTA MUROTANI ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Skeletal Muscle ◽  
Elderly Patients ◽  
Muscle Mass ◽  
Protein Intake ◽  
Skeletal Muscle Mass ◽  
P Protein ◽  
Japanese Elderly
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