August 31, 2009 Written by JP    [Font too small?]

Physical strength isn’t just a characteristic of athleticism and youth. Rather, it’s something we rely on in order to live the type of lifestyle we choose. It’s not imperative that we look like bodybuilders on Muscle Beach or bikini models in a sports magazine. But, we all hope to have enough power in our muscles to take walks in the park, shop at a sprawling super market and to play catch with our grandchildren. Unfortunately, maintaining lean body mass as we age is not a given. For many, it requires actively railing against the course that nature has plotted.

Sarcopenia is a term used to describe age related muscle loss. This process by which the body loses strength is a major contributor to disability and mobility issues that affect seniors throughout the world. The fact is that if you don’t have the ability to move around, illness, in one form or another, is rarely far behind. That is, unless you take every possible step to counter the expected changes that often accompany this “golden age”. (1)

There are three practical steps that may help to protect against the development and progression of sarcopenia. All three of these strategies address at least one aspect of this muscular dysfunction and loss of lean body mass.

Step # 1 – Adequate Protein and Amino Acids

In the September 2009 edition of the Journal of the American Dietetic Association, a group of researchers from the University of Kentucky attempted to establish the optimal amount of protein per meal. As a test, they enrolled 17 younger volunteers (with an average age of 34) and 17 elderly participants (68 years old on average). Each group was fed two separate meals on different occasions: Meal #1 consisted of 113 g of lean beef containing 30 g of protein. Meal #2 was comprised of 340 g of lean beef containing 90 g of protein. The scientists used blood tests and muscle biopsies to determine protein absorption and utilization.

  • There was a 50% increase in muscle protein production in both the younger and older volunteers.
  • The 30 gram protein meal was as effective as the 90 gram meal in promoting muscle growth in both groups.

These results are very hopeful because they indicate that older individuals are still capable of deriving significant benefits from good sources of dietary protein. It’s also helpful to note that excessive amounts of protein are not required to achieve the desired muscle supportive effects in those at risk for sarcopenia. Two other studies from 2009 also recommend similar amounts of protein intake. One medical journal advises “25-30 grams of high quality protein per meal” and the other suggests a minimum of 1.0-1.2 grams of protein per kilogram of body weight. Currently the RDA (Recommended Daily Allowance) for adult protein intake is set at .8 g/kg. (2,3,4)

When the body digests protein, it liberates amino acids from the food source. In short, amino acids are the isolated building blocks of protein. Several recent trials have determined that supplementing with purified amino acids can help increase lean body mass and improve insulin sensitivity in those with sarcopenia. One study even found that amino acids provided superior results when compared to a whey protein supplement. The researchers chose whey protein as a comparison because it’s previously been shown to support muscle growth and is generally easily digested and utilized. (5,6,7)

Step # 2 – Exercise Therapy

Use it or lose it. That’s how the saying goes and it’s so very true in the case of sarcopenia. An Italian study from 2008 examined the effects of a “specific resistance training program” consisting of chest press, leg press and vertical row in a group of 20 seniors. Over the course of 18 weeks, they all performed a supervised set of these exercises 3 times per week. Improvements in muscle strength were registered and a particular benefit was found in the lower limbs. This is very important because increased muscular ability in the legs can help reduce falls and fractures that often accompany advancing age. Resistance and strength training not only help to improve muscle mass and performance, but they also appear to restore energy production on a cellular level (in the mitochondria). Mitochondrial dysfunction is believed to be a hallmark of this form of muscle incapacity. (8,9,10)

Source: J Nutr Health Aging. 2008 Aug-Sep (link)

Step # 3 – Inflammation and Vitamin D

Elevated levels of inflammatory substances have consistently been detected in those with sarcopenia. Vitamin D is documented as having potent anti-inflammatory activity in a variety of conditions. In addition, this nutrient is frequently found to be deficient in those with poor musculature. Because of these established connections, some researchers have advised raising the “target value” for vitamin D in those at risk for or suffering from sarcopenia. At present, a vitamin D blood level of 40 ng/mL is considered adequate. Certain experts believe that shooting for a goal of 75 ng/mL may be advisable and advantageous as a means of ensuring optimal vitamin D levels. This is yet another inexpensive and safe strategy worth considering. (11,12,13,14,15,16,17,18,19,20)

Other contributing factors such as hormone deficiencies, insulin resistance and inadequate oxygen saturation also seem to exert some influence on sarcopenia. Currently, there are a number of medications under investigation as viable treatments for this growing problem. But the truth is that proper nutrition, specialized exercises and vitamin supplementation can go a long way in influencing just about every known factor relating to this condition. That’s not to say that these natural approaches will always be enough to provide full resolution of symptoms. But what I’m suggesting is that doctors and patients alike at least consider these natural approaches before resigning themselves to potentially dangerous prescriptive options or just allowing nature to take its course. (21,22,23)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Men's Health, Nutrition, Women's Health

28 Comments & Updates to “Sarcopenia”

  1. JP Says:

    Update 05/24/15:

    Am J Clin Nutr. 2015 May 20. pii: ajcn105833.

    Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults.

    BACKGROUND: Age-associated declines in muscle mass and function are major risk factors for an impaired ability to carry out activities of daily living, falls, prolonged recovery time after hospitalization, and mortality in older adults. New strategies that can slow the age-related loss of muscle mass and function are needed to help older adults maintain adequate performance status to reduce these risks and maintain independence.

    OBJECTIVE: We evaluated the efficacy of fish oil-derived n-3 (ω-3) PUFA therapy to slow the age-associated loss of muscle mass and function.

    DESIGN: Sixty healthy 60-85-y-old men and women were randomly assigned to receive n-3 PUFA (n = 40) or corn oil (n = 20) therapy for 6 mo. Thigh muscle volume, handgrip strength, one-repetition maximum (1-RM) lower- and upper-body strength, and average power during isokinetic leg exercises were evaluated before and after treatment.

    RESULTS: Forty-four subjects completed the study [29 subjects (73%) in the n-3 PUFA group; 15 subjects (75%) in the control group]. Compared with the control group, 6 mo of n-3 PUFA therapy increased thigh muscle volume (3.6%; 95% CI: 0.2%, 7.0%), handgrip strength (2.3 kg; 95% CI: 0.8, 3.7 kg), 1-RM muscle strength (4.0%; 95% CI: 0.8%, 7.3%) (all P < 0.05), and tended to increase average isokinetic power (5.6%; 95% CI: -0.6%, 11.7%; P = 0.075). CONCLUSION: Fish oil-derived n-3 PUFA therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults. Be well! JP

  2. JP Says:

    Update 06/16/15:

    J Am Coll Nutr. 2015;34(2):91-9.

    The addition of beta-hydroxy-beta-methylbutyrate and isomaltulose to whey protein improves recovery from highly demanding resistance exercise.

    OBJECTIVE: This study evaluated whether a combination of whey protein (WP), calcium beta-hydroxy-beta-methylbutyrate (HMB), and carbohydrate exert additive effects on recovery from highly demanding resistance exercise.

    METHODS: Thirteen resistance-trained men (age: 22.6 ± 3.9 years; height: 175.3 ± 12.2 cm; weight: 86.2 ± 9.8 kg) completed a double-blinded, counterbalanced, within-group study. Subjects ingested EAS Recovery Protein (RP; EAS Sports Nutrition/Abbott Laboratories, Columbus, OH) or WP twice daily for 2 weeks prior to, during, and for 2 days following 3 consecutive days of intense resistance exercise. The workout sequence included heavy resistance exercise (day 1) and metabolic resistance exercise (days 2 and 3). The subjects performed no physical activity during day 4 (+24 hours) and day 5 (+48 hours), where recovery testing was performed. Before, during, and following the 3 workouts, treatment outcomes were evaluated using blood-based muscle damage markers and hormones, perceptual measures of muscle soreness, and countermovement jump performance.

    RESULTS: Creatine kinase was lower for the RP treatment on day 2 (RP: 166.9 ± 56.4 vs WP: 307.1 ± 125.2 IU · L(-1), p ≤ 0.05), day 4 (RP: 232.5 ± 67.4 vs WP: 432.6 ± 223.3 IU · L(-1), p ≤ 0.05), and day 5 (RP: 176.1 ± 38.7 vs 264.5 ± 120.9 IU · L(-1), p ≤ 0.05). Interleukin-6 was lower for the RP treatment on day 4 (RP: 1.2 ± 0.2 vs WP: 1.6 ± 0.6 pg · ml(-1), p ≤ 0.05) and day 5 (RP: 1.1 ± 0.2 vs WP: 1.6 ± 0.4 pg · ml(-1), p ≤ 0.05). Muscle soreness was lower for RP treatment on day 4 (RP: 2.0 ± 0.7 vs WP: 2.8 ± 1.1 cm, p ≤ 0.05). Vertical jump power was higher for the RP treatment on day 4 (RP: 5983.2 ± 624 vs WP 5303.9 ± 641.7 W, p ≤ 0.05) and day 5 (RP: 5792.5 ± 595.4 vs WP: 5200.4 ± 501 W, p ≤ 0.05).

    CONCLUSIONS: Our findings suggest that during times of intense conditioning, the recovery benefits of WP are enhanced with the addition of HMB and a slow-release carbohydrate. We observed reductions in markers of muscle damage and improved athletic performance.

    Be well!


  3. JP Says:

    Update 07/09/15:

    An example of how not to supplement with vitamins C & E …

    Scand J Med Sci Sports. 2015 Jul 1. doi: 10.1111/sms.12506.

    Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training.

    The aim of this study was to investigate the effects of vitamin C and E supplementation on changes in muscle mass (lean mass and muscle thickness) and strength during 12 weeks of strength training in elderly men. Thirty-four elderly males (60-81 years) were randomized to either an antioxidant group (500 mg of vitamin C and 117.5 mg vitamin E before and after training) or a placebo group following the same strength training program (three sessions per week). Body composition was assessed with dual-energy X-ray absorptiometry and muscle thickness by ultrasound imaging. Muscle strength was measured as one-repetition maximum (1RM). Total lean mass increased by 3.9% (95% confidence intervals: 3.0, 5.2) and 1.4% (0, 5.4) in the placebo and antioxidant groups, respectively, revealing larger gains in the placebo group (P = 0.04). Similarly, the thickness of m. rectus femoris increased more in the placebo group [16.2% (12.8, 24.1)] than in the antioxidant group [10.9% (9.8, 13.5); P = 0.01]. Increases of lean mass in trunk and arms, and muscle thickness of elbow flexors, did not differ significantly between groups. With no group differences, 1RM improved in the range of 15-21% (P < 0.001). In conclusion, high-dosage vitamin C and E supplementation blunted certain muscular adaptations to strength training in elderly men. Be well! JP

  4. JP Says:

    Updated 07/15/15:

    J Am Med Dir Assoc. 2015 Jul 10. pii: S1525-8610(15)00388-6.

    Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial.

    BACKGROUND: Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could positively influence aspects of sarcopenia and thereby prevent mobility disability.

    OBJECTIVE: To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia.

    DESIGN: A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention.

    RESULTS: Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): -1.01 seconds (-1.77 to -0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004-0.338), P = .045.

    CONCLUSIONS: This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.

    Be well!


  5. JP Says:

    Updated 08/21/15:

    J Bone Miner Res. 2015 Aug 19.

    Dietary Magnesium Is Positively Associated with Skeletal Muscle Power and Indices of Muscle Mass and May Attenuate the Association Between Circulating C-Reactive Protein and Muscle Mass in Women.

    Age-related loss of skeletal muscle mass and strength are risk factors for sarcopenia, osteoporosis, falls, fractures, frailty and mortality. Dietary magnesium (Mg) could play a role in prevention of age-related loss of skeletal muscle mass, power and strength directly through physiological mechanisms or indirectly through an impact on chronic low-grade inflammation, itself a risk factor for loss of skeletal muscle mass and strength. In a cross-sectional study of 2570 women aged 18-79 years we examined associations between intakes of Mg, estimated using an FFQ, DXA-derived measures of muscle mass (fat free mass as a percentage of body weight (FFM%), fat free mass index (FFMI, kg/m2 )), leg explosive power (LEP) and grip-strength (n = 949 only). We also examined associations between circulating hs-CRP (C-reactive protein) and muscle mass and LEP, and explored the potential attenuation of these relationships by Mg. We compared our findings with those of age and protein intake. Endpoints were calculated by quintile of Mg and adjusted for relevant confounders. Significant positive associations were found between a higher Mg and indices of skeletal muscle mass and LEP, and also with hs-CRP, after adjustment for covariates. Contrasting extreme quintiles of Mg intake showed differences of 2.6% for FFM% (P trend <0.001), 0.4 kg/m2 for FFMI (P trend = 0.005), and 19.6 watts/kg for LEP (P trend < 0.001). Compared to protein these positive associations were 7 times greater for FFM% and 2.5 times greater for LEP. We also found that higher hs-CRP was negatively associated with skeletal muscle mass and, in statistical modelling, that a higher dietary Mg attenuated this negative relationship by 6.5%, with greater attenuation in women aged over 50 years. No association was found between Mg and grip strength. Our results suggest that dietary magnesium may aid conservation of age-related loss of skeletal muscle mass and power in women of all ages. Be well! JP

  6. JP Says:

    Updated 09/06/15:

    J Clin Endocrinol Metab. 2015 Aug 26:jc20152352.

    Impact of the macronutrient composition of a nutritional supplement on muscle protein synthesis rates in older men: a randomized, double blind, controlled trial.

    CONTEXT: An impaired muscle protein synthetic response to feeding likely contributes to muscle loss with aging. There are few data available on the effect of the macronutrient composition of clinical supplements on the postprandial muscle protein synthetic response in older subjects.

    OBJECTIVE: To determine the impact of the macronutrient composition of a nutritional supplement on the postprandial muscle protein synthetic response in older men.

    METHODS: A total of 45 non-sarcopenic older men (age: 69±1 y; BMI: 25.7±0.3 kg/m2) were randomly assigned to ingest 21 g of leucine-enriched whey protein with carbohydrate (9 g) and fat (3 g) (Pro-En), an isonitrogenous amount of 21 g of leucine-enriched whey protein without carbohydrate and fat (Pro), or an isocaloric mixture (628 kJ) containing carbohydrate and fat only (En). Stable isotope tracer methodology was applied to assess basal as well as postprandial muscle protein synthesis rates in the three groups.

    RESULTS: Ingestion of protein in the Pro-En and Pro groups significantly increased muscle protein synthesis rates when compared with basal rates (from 0.032±0.003 to 0.053±0.004 and 0.040±0.003 to 0.049±0.003 %/h, respectively; P<0.05), whereas ingestion of carbohydrate and fat did not increase muscle protein synthesis rates in the En group (from 0.039±0.004 to 0.040±0.003 %/h; P=0.60). Despite the greater postprandial rise in circulating insulin concentration in the Pro-En group, no significant differences were observed in postprandial muscle protein synthesis rates between the Pro-En and Pro groups (P=0.32). Postprandial muscle protein synthesis rates were higher in the Pro-En vs En group (P=0.01).

    CONCLUSION: The ingestion of a nutritional supplement containing 21 g of leucine-enriched whey protein significantly raises muscle protein synthesis rates in non-sarcopenic older men, but co-ingestion of carbohydrate and fat does not modulate the postprandial muscle protein synthetic response to protein ingestion in older men.

    Be well!


  7. JP Says:

    Updated 09/16/15:

    Br J Nutr. 2015 Sep 10:1-9.

    Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomised controlled trial.

    Protein supplementation in combination with resistance training may increase muscle mass and muscle strength in elderly subjects. The objective of this study was to assess the influence of post-exercise protein supplementation with collagen peptides v. placebo on muscle mass and muscle function following resistance training in elderly subjects with sarcopenia. A total of fifty-three male subjects (72·2 (sd 4·68) years) with sarcopenia (class I or II) completed this randomised double-blind placebo-controlled study. All the participants underwent a 12-week guided resistance training programme (three sessions per week) and were supplemented with either collagen peptides (treatment group (TG)) (15 g/d) or silica as placebo (placebo group (PG)). Fat-free mass (FFM), fat mass (FM) and bone mass (BM) were measured before and after the intervention using dual-energy X-ray absorptiometry. Isokinetic quadriceps strength (IQS) of the right leg was determined and sensory motor control (SMC) was investigated by a standardised one-leg stabilisation test. Following the training programme, all the subjects showed significantly higher (P<0·01) levels for FFM, BM, IQS and SMC with significantly lower (P<0·01) levels for FM. The effect was significantly more pronounced in subjects receiving collagen peptides: FFM (TG +4·2 (sd 2·31) kg/PG +2·9 (sd 1·84) kg; P<0·05); IQS (TG +16·5 (sd 12·9) Nm/PG +7·3 (sd 13·2) Nm; P<0·05); and FM (TG -5·4 (sd 3·17) kg/PG -3·5 (sd 2·16) kg; P<0·05). Our data demonstrate that compared with placebo, collagen peptide supplementation in combination with resistance training further improved body composition by increasing FFM, muscle strength and the loss in FM.

    Be well!


  8. JP Says:

    Updated 03/09/16:

    J Gerontol A Biol Sci Med Sci. 2016 Mar 4.

    Macronutrients Intake and Incident Frailty in Older Adults: A Prospective Cohort Study.

    BACKGROUND: Only a few studies have assessed the association between protein intake and frailty incidence and have obtained inconsistent results. This study examined the association of protein and other macronutrient intake with the risk of frailty in older adults.

    METHODS: A prospective cohort of 1,822 community-dwelling individuals aged 60 and older was recruited in 2008-2010 and followed-up through 2012. At baseline, food consumption was assessed with a validated, computerized face-to-face diet history. In 2012, individuals were contacted again to ascertain incident frailty, defined as the presence of at least three of the five Fried criteria: low physical activity, slowness, unintentional weight loss, muscle weakness, and exhaustion. Analyses were performed using logistic regression and adjusted for the main confounders, including total energy intake.

    RESULTS: During a mean follow-up of 3.5 years, 132 persons with incident frailty were identified. The odds ratios (95% confidence interval) of frailty across increasing quartiles of total protein were 1.00, 0.55 (0.32-0.93), 0.45 (0.26-0.78), and 0.41 (0.23-0.72); p trend: .001. The corresponding figures for animal protein intake were 1.00, 0.68 (0.40-1.17), 0.56 (0.32-0.97), and 0.48 (0.26-0.87), p trend: .011. And for intake of monounsaturated fatty acids (MUFAs), the results were 1.00, 0.66 (0.37-1.20), 0.54 (0.28-1.02), and 0.50 (0.26-0.96); p trend: .038. No association was found between intake of vegetable protein, saturated fats, long-chain ω-3 fatty acids, α-linolenic acid, linoleic acid, simple sugars, or polysaccharides and the risk of frailty.

    CONCLUSION: Intake of total protein, animal protein, and MUFAs was inversely associated with incident frailty. Promoting the intake of these nutrients might reduce frailty.

    Be well!


  9. JP Says:

    Updated 04/18/16:

    Clin Nutr. 2016 Apr 7.

    Per meal dose and frequency of protein consumption is associated with lean mass and muscle performance.

    BACKGROUND: It has been hypothesized that for older adults evenly distributing consumption of protein at 30-40 g per meal throughout the day may result in more favorable retention of lean mass and muscular strength. Such a thesis has not, to our knowledge, been tested outside of short-term studies or acute measures of muscle protein synthesis.

    AIMS: To examine whether the number of times an individual consumed a minimum of 30 g of protein at a meal is associated with leg lean mass and knee extensor strength.

    METHODS: Data from the 1999-2002 NHANES were used, with 1081 adults (50-85 y) constituting the analytic sample. A “multiple pass” 24-h dietary interview format was used to collect detailed information about the participants’ dietary intake. Knee extensor strength was assessed objectively using the Kin Com MP dynamometer. Leg lean mass was estimated from whole-body dual-energy X-ray absorptiometry (DXA) scans.

    RESULTS: Participants with 1 vs. 0 (βadjusted = 23.6, p = 0.002) and 2 vs. 0 (βadjusted = 51.1, p = 0.001) meals of ≥30 g protein/meal had greater strength and leg lean mass (1 vs. 0, βadjusted = 1160, p < 0.05 and 2 vs. 0, βadjusted = 2389, p < 0.05). The association of protein frequency with leg lean mass and strength plateaued at ∼45 g protein/meal for those consuming 2 vs. 0 meals above the evaluated protein/meal threshold. However, for those with only 1 meal at or above the evaluated threshold, the response plateaued at 30 g/meal. Leg lean mass mediated the relationship between protein frequency and strength, with the proportion of the total effect mediated being 64%. CONCLUSIONS: We found that more frequent consumption of meals containing between 30 and 45 g protein/meal produced the greatest association with leg lean mass and strength. Thus, the consumption of 1-2 daily meals with protein content from 30 to 45 g may be an important strategy for increasing and/or maintaining lean body mass and muscle strength with aging. Be well! JP

  10. JP Says:

    Updated 05/19/16:

    Consult Pharm. 2016;31(5):267-70.

    Zinc and Taste Disturbances in Older Adults: A Review of the Literature.

    According to the National Health and Nutrition Examination Survey III, 35% to 45% of adults 60 years of age or older had zinc intakes below the estimated average requirement of 6.8 mg/day for elderly females and 9.4 mg/day for elderly males. Zinc deficiency may lead to loss of appetite, impaired immune function, weight loss, delayed healing of wounds, eye and skin lesions, and smell and taste disturbances. Older adults are especially affected by changes in taste sensations because of age-related gustatory dysfunction, use of multiple medications, increased frailty, and zinc deficiency. This article reviews the finding of clinical studies investigating the use of zinc supplementation for improvement with taste disturbances in older adults.

    Be well!


  11. JP Says:

    Updated 05/23/16:

    Clin Nutr. 2016 Apr 30.

    Enriching a protein drink with leucine augments muscle protein synthesis after resistance exercise in young and older men.

    Maximizing anabolic responses to feeding and exercise is crucial for muscle maintenance and adaptation to exercise training. We hypothesized that enriching a protein drink with leucine would improve anabolic responses to resistance exercise (RE: 6 × 8 knee-extension repetitions at 75% of 1-RM) in both young and older adults. Groups (n = 9) of young (24 ± 6 y, BMI 23 ± 2 kg m-2) and older men (70 ± 5 y, BMI 25 ± 2 kg m-2) were randomized to either: (i) RE followed by Slim-Fast Optima (SFO 10 g PRO; 24 g CHO) with 4.2 g of leucine (LEU) or, (ii) RE + SFO with 4.2 g of alanine (ALA; isonitrogenous control). Muscle biopsies were taken before, immediately after, and 1, 2 and 4 h after RE and feeding. Muscle protein synthesis (MPS) was measured by incorporation of [1, 2-13C2] leucine into myofibrillar proteins and the phosphorylation of p70S6K1 by immunoblotting. In young men, both area under the curve (AUC; FSR 0-4 h P < 0.05) and peak FSR (0.11 vs. 0.08%.h.-1; P < 0.05) were greater in the SFO + LEU than in the SFO + ALA group, after RE. Similarly, in older men, AUC analysis revealed that post-exercise anabolic responses were greater in the SFO + LEU than SFO + ALA group, after RE (AUC; FSR 0-4 h P < 0.05). Irrespective of age, increases in p70S6K1 phosphorylation were evident in response to both SFO + LEU and SFO + ALA, although greater with leucine supplementation than alanine (fold-change 2.2 vs. 3.2; P < 0.05), specifically in the older men. We conclude that addition of Leucine to a sub-maximal PRO bolus improves anabolic responses to RE in young and older men. Be well! JP

  12. JP Says:

    Updated 06/29/16:

    Eur Rev Med Pharmacol Sci. 2016 Feb;20(4):762-6.

    A novel phospholipid delivery system of curcumin (Meriva®) preserves muscular mass in healthy aging subjects.

    OBJECTIVE: Curcumin is known to interrupt pro-inflammatory signalling and increases anti-oxidant protection, thus inhibiting the expression of inflammatory cytokines and the expression and function of inducible inflammatory enzymes. Together, these effects contribute to limit the onset and the progression of sarcopenia, due to the major role played by inflammation in the pathophysiology of this disease. This registry study evaluates the effects of Meriva® supplementation in otherwise healthy elderly subjects.

    PATIENTS AND METHODS: This was a registry, supplement study, conducted in healthy subjects > 65 years with apparent loss of strength and tiredness who freely decided to start one of the following interventions: (1) standard management (exercise, balanced diet including proteins) (n = 33); (2) standard management + Meriva® one tablet/day (n = 31); (3) standard management + Meriva® one tablet/day + other supplementation (n = 22). A number of functional and biochemical parameters were evaluated at baseline and after three months (hand grip, weight lifting, time/distance before feeling tired after cycling, walking and climbing stairs; general fitness, proteinuria, oxidative stress, Karnofsky scale; left ventricular ejection fraction).

    RESULTS: Significant improvements in all parameters, with respect to baseline values, were observed in the two supplementation groups (p < 0.05 for all comparisons). On the other hand, no improvement was observed in the standard management-only group. At three months, inter-group comparison revealed a statistical advantage in all parameters for both supplementation groups compared with the standard management-only group (p < 0.05 for all comparisons). CONCLUSIONS: Our registry study shows that the addition of Meriva® – either or not combined with other nutritional supplements – to standardized diet and exercise plan contributes to improve strenght and physical performance in elderly subjects, potentially preventing the onset of sarcopenia. Be well! JP

  13. JP Says:

    Updated 06/30/16:

    Int J Mol Sci. 2016 Jun 14;17(6).

    Effect of a Prebiotic Formulation on Frailty Syndrome: A Randomized, Double-Blind Clinical Trial.

    Aging can result in major changes in the composition and metabolic activities of bacterial populations in the gastrointestinal system and result in impaired function of the immune system. We assessed the efficacy of prebiotic Darmocare Pre(®) (Bonusan Besloten Vennootschap (BV), Numansdorp, The Netherlands) to evaluate whether the regular intake of this product can improve frailty criteria, functional status and response of the immune system in elderly people affected by the frailty syndrome. The study was a placebo-controlled, randomized, double blind design in sixty older participants aged 65 and over. The prebiotic product was composed of a mixture of inulin plus fructooligosaccharides and was compared with placebo (maltodextrin). Participants were randomized to a parallel group intervention of 13 weeks’ duration with a daily intake of Darmocare Pre(®) or placebo. Either prebiotic or placebo were administered after breakfast (between 9-10 a.m.) dissolved in a glass of water carefully stirred just before drinking. The primary outcome was to study the effect on frailty syndrome. The secondary outcomes were effect on functional and cognitive behavior and sleep quality. Moreover, we evaluated whether prebiotic administration alters blood parameters (haemogram and biochemical analysis). The overall rate of frailty was not significantly modified by Darmocare Pre(®) administration. Nevertheless, prebiotic administration compared with placebo significantly improved two frailty criteria, e.g., exhaustion and handgrip strength (p < 0.01 and p < 0.05, respectively). No significant effects were observed in functional and cognitive behavior or sleep quality. The use of novel therapeutic approaches influencing the gut microbiota-muscle-brain axis could be considered for treatment of the frailty syndrome. Be well! JP

  14. JP Says:

    Updated 07/12/16:

    Br J Community Nurs. 2016 Jun;21(6):305-9.

    Considering the benefits of egg consumption for older people at risk of sarcopenia.

    Sarcopenia is an important health issue for older people. It is closely linked with frailty and malnutrition and can significantly reduce both health and quality of life for those affected. Sarcopenic decline in muscle mass can start as early as the fourth and fifth decade of life, so the maintenance of muscle mass throughout adulthood, through regular physical activity and a balanced diet, should be an important consideration in reducing the risk of sarcopenia in older age. Maintaining regular exercise throughout older age remains key to the treatment of sarcopenia, as does an adequate intake of nutrients, including high-quality protein and vitamin D. A significant proportion of older people fail to meet the recommended requirements for protein; it has also been suggested that the requirements in existing recommendations could be higher. Evidence is emerging that an adequate intake of protein at each meal may be required to optimise muscle synthesis in older people. Eggs are an inexpensive, widely available and easily digestible source of high-quality protein and contain a significant proportion of leucine, an amino acid that is important for muscle synthesis, as well as many other nutrients of significance for older people, including vitamin D and omega-3 fatty acids. For many older people, eggs are a familiar and acceptable protein food at breakfast and other meals. Encouraging both those approaching older age and older people to include eggs more frequently, as part of a healthy, balanced diet and in addition to physical activity, could help them maintain their muscle strength and function, thereby preserving their functional capacity and reducing morbidity, mortality and healthcare costs associated with sarcopenia.

    Be well!


  15. JP Says:

    Updated 09/27/16:

    J Sci Food Agric. 2016 Sep 19.

    The Effects of Licorice Flavonoid Oil on Increasing Muscle Mass: A Randomized, Double-Blind, Placebo-Controlled Trial.

    BACKGROUND: The current study evaluated the effects of licorice flavonoid oil (LFO) on increasing the muscle mass of elderly populations using a randomized, double-blind, placebo-controlled study. Fifty participants aged 54-90 (male 7, female 43), who underwent rehabilitation treatment for osteoarthritis of the knee, were examined and assigned to either the LFO group (n = 26) or the placebo group (n = 24). The LFO group consumed 300 mg of LFO per day, while the placebo group consumed one placebo capsule per day for 16 weeks. We measured muscle mass, body fat percentage, and the score of the Japanese Knee Osteoarthritis Measure (JKOM) at baseline and every 4 weeks thereafter.

    RESULTS: In the LFO group, muscle mass in the body trunk increased significantly after 16 weeks of LFO intake (+0.38 kg, P = 0.02). The trunk muscle mass weight of the LFO group increased significantly compared with that of the placebo group (p < 0.01). Further, the body fat percentage and body trunk fat percentage of the LFO group were significantly suppressed compared to that of the placebo group (P = 0.03, P < 0.01, respectively). CONCLUSIONS: This trial indicates that LFO supplementation has effects on increasing muscle mass and on suppressing the body fat percentage of elderly populations, especially in the body trunk. Be well! JP

  16. JP Says:

    Updated 09/30/16:

    Minerva Ortopedica e Traumatologica 2016 September;67(3):124-30

    Preservation of muscular mass and strength in aged subjects with Pycnogenol® supplementation

    Gianni BELCARO 1, 2, Mark DUGALL 1, 2

    1 Irvine3 Labs, Chieti, Italy; 2 Department of Clinical and Experimental Sciences, D’Annunzio University, Pescara, Italy

    BACKGROUND: The aim of this study is an evaluation of the effects of Pycnogenol® supplementation in a registry study in healthy aged subjects with sarcopenia, not using drugs and without any other clinical condition and risk condition.

    METHODS: The registry study included 64 healthy aged subjects (age range 70-78) with symptoms of fatigue. Two resulting groups included a control group (using an exercise plan and lifestyle changes) and a second group using the same plan and Pycnogenol® (150 mg/day).

    RESULTS: At start the groups were comparable. Subjects with loss of strength and apparent loss of muscular mass were included; no clinical disease was present; no other treatment was used. Significant improvements (P<0.0.5) in hand grip, weight lifts, walking distance without pain, number of stairs, in the time for feeling tired were observed in both groups due to the training. The supplementation group showed a more significant progress (P<0.05) in comparison with controls at 2 months. Proteinuria and general fitness were significantly better than values in controls at 2 months (P<0.05) with the supplementation. In the supplementation group a significant decrease in plasma oxidative stress was observed (P<0.05) in comparison with controls. Subjects using the supplement also improved their Karnofsky score (P<0.05) more than controls (who showed a minimal variation). The left ventricular ejection fraction (ultrasound) also had a significant improvement from 53.2±1.2% to 55.4±1.1% (P<0.05) with the supplement; this observations was superior (P<0.05) to the values observed in controls. Ejection fraction could be a very important parameter to evaluate, in a specific study, in more affected patients with more significant muscle loss and cardiac deterioration. There were no changes at 8 weeks in blood tests and physiological parameters.

    CONCLUSIONS: Supplementation with Pycnogenol® improved muscular strength and the general fitness level (also decreasing oxidative stress) in otherwise healthy, older subjects with symptoms of fatigue and signs of muscle mass loss.

    Be well!


  17. JP Says:

    Updated 11/19/16

    Exp Gerontol. 2016 Nov 11.

    A combination of Korean mistletoe extract and resistance exercise retarded the decline in muscle mass and strength in the elderly: A randomized controlled trial.

    Given the increased concerns about the degenerative decline in the physical performance of the elderly, there is a need for developing effective strategies to suppress the age-related loss of skeletal muscle mass and functional capacity through a lifestyle intervention. This randomized controlled trial examined whether a combination of Korean mistletoe extract (KME) supplement and exercise affected muscle mass, muscle function, and targeted molecular expressions. Sixty-seven subjects aged 55-75years were assigned to placebo, low-dose (1g/d), or high-dose (2g/d) of KME for 12weeks. The body composition was significantly changed in the high-dose group during the intervention period as determined by skeletal muscle mass (P=0.040), fat free mass (P=0.042), soft lean mass (P=0.023), skeletal muscle index (P=0.041), fat-free mass index (P=0.030), percent body fat (P=0.044), and fat mass to lean mass ratio (P=0.030). Knee strength was measured by Cybex, demonstrating a significant effect in the KME groups compared to the placebo group (P=0.026 for peak torque and P=0.057 for set total work), which was more pronounced after adjusting for age, gender, protein, and energy intake (P=0.009 for peak torque and P=0.033 for set total work). The dynamic balance ability was remarkably improved in the high-dose group over a 12-week period as determined by Timed “Up and Go” (P=0.005 for fast walk test and P=0.024 for ordinary walk test). Consistent with these results, RT-PCR, multiplex analyses, and immunocytofluorescence staining revealed that a high-dose KME supplementation was effective for suppressing intracellular pathways related to muscle protein degradation, but stimulating those related to myogenesis. In particular, significant differences were found in atrogin-1 mRNA (P=0.002 at a single administration and P=0.001 at a 12-week administration), myogenin mRNA (P<0.0001 at a single administration and P=0.040 at a 12-week administration), and insulin growth factor 1 receptor phosphorylation (P=0.002 at a 12-week administration). These results suggest that KME supplementation together with resistance exercise may be useful in suppressing the age-related loss of muscle mass and strength in the elderly.

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  18. JP Says:

    Updated 12/10/16:

    Am J Clin Nutr. 2016 Dec;104(6):1594-1606.

    Leucine supplementation enhances integrative myofibrillar protein synthesis in free-living older men consuming lower- and higher-protein diets: a parallel-group crossover study.

    BACKGROUND: Leucine co-ingestion with lower-protein (LP)-containing meals may overcome the blunted muscle protein synthetic response to food intake in the elderly but may be effective only in individuals who consume LP diets.

    OBJECTIVE: We examined the impact of leucine co-ingestion with mixed macronutrient meals on integrated 3-d rates of myofibrillar protein synthesis (MyoPS) in free-living older men who consumed higher protein (HP) (1.2 g · kg-1 · d-1) or LP (0.8 g · kg-1 · d-1) in rested and resistance exercise (REX) conditions.

    DESIGN: In a crossover design, 20 healthy older men [aged 65-85 y] were randomly assigned to receive LP or HP diets while ingesting a placebo (days 0-2) and Leu supplement (5 g leucine/meal; days 3-5) with their 3 main daily meals. A bout of unilateral REX was performed during the placebo and Leu treatments. Ingested 2H2O and skeletal muscle biopsies were used to measure the 3-d integrated rate of MyoPS during the placebo and Leu treatments in the rested and REX legs.

    RESULTS: Leucinemia was higher with Leu treatment than with placebo treatment (P < 0.001). MyoPS was similar in LP and HP during both treatments (P = 0.39) but was higher with Leu treatment than with placebo treatment in the rested (pooled mean ± SD: Leu, 1.57% ± 0.11%/d; placebo, 1.48% ± 0.08%/d; main effect of treatment: P < 0.001) and REX (pooled mean: Leu, 1.87% ± 0.09%/d; placebo, 1.71 ± 0.10%/d; main effect of treatment: P < 0.001) legs. CONCLUSIONS: Leu co-ingestion with daily meals enhances integrated MyoPS in free-living older men in rested and REX conditions and is equally effective in older men who consume daily protein intakes greater than or equal to the RDA. Be well! JP

  19. JP Says:

    Updated 01/19/17:

    Clinical Nutrition – Published online: January 17, 2017

    Sufficient levels of 25-hydroxyvitamin D and protein intake required to increase muscle mass in sarcopenic older adults – The PROVIDE study

    Background: Inadequate nutritional intake and altered response of aging muscles to anabolic stimuli from nutrients contribute to the development of sarcopenia. Nutritional interventions show inconsistent results in sarcopenic older adults, which might be influenced by their basal nutritional status.

    Objective: To test if baseline serum 25-hydroxyvitamin D (25(OH)D) concentrations and dietary protein intake influenced changes in muscle mass and function in older adults who received nutritional intervention.

    Methods and design: Post-hoc analysis was performed in the PROVIDE study that was a randomized controlled, double blind trial among 380 sarcopenic older adults. This study showed that those who received a vitamin D and leucine-enriched whey protein medical nutrition drink for 13 weeks gained more appendicular muscle mass (aMM), and improved lower-extremity function as assessed by the chair stand test compared with controls. To define low and high groups, a baseline serum concentration of 50 nmol/L 25(OH)D and baseline dietary protein intake of 1.0 g/kg/d were used as cut offs.

    Results: At baseline, participants with lower 25(OH)D concentrations showed lower muscle mass, strength and function compared with participants with a high 25(OH)D, while the group with lower protein intake (g/kg/day) had more muscle mass at baseline compared with the participants with higher protein intake. Participants with higher baseline 25(OH)D concentrations and dietary protein intake had, independent of other determinants, greater gain in appendicular muscle mass, skeletal muscle index (aMM/h2), and relative appendicular muscle mass (aMM/body weight*100%) in response to the nutritional intervention. There was no effect modification of baseline 25(OH)D status or protein intake on change in chair-stand test.

    Conclusions: Sufficient baseline levels of 25(OH)D and protein intake may be required to increase muscle mass as a result of intervention with a vitamin D and protein supplement in sarcopenic older adults. This suggests that current cut-offs in the recommendations for vitamin D and protein intake could be considered the “minimum” for adults with sarcopenia to respond adequately to nutrition strategies aimed at attenuating muscle loss.

    Be well!


  20. JP Says:

    Updated 01/23/17:

    Nutrition & Metabolism201714:7

    Efficacy of a novel formulation of L-Carnitine, creatine, and leucine on lean body mass and functional muscle strength in healthy older adults: a randomized, double-blind placebo-controlled study

    Background: Progressive decline in skeletal muscle mass and function are growing concerns in an aging population. Diet and physical activity are important for muscle maintenance but these requirements are not always met. This highlights the potential for nutritional supplementation. As a primary objective, we sought to assess the effect of a novel combination of L-Carnitine, creatine and leucine on muscle mass and performance in older subjects.

    Method: Forty-two healthy older adults aged 55–70 years were randomized to receive either a novel L-Carnitine (1500 mg), L-leucine (2000 mg), creatine (3000 mg), Vitamin D3 (10 μg) (L-Carnitine-combination) product (n = 14), L-Carnitine (1500 mg) (n = 14), or a placebo (n = 14) for eight weeks. We evaluated body mass by DXA, upper and lower strength by dynamometry, and walking distance by a 6-min walk test at baseline and after eight weeks of intervention. These measures, reflecting muscle mass, functional strength and mobility have been combined to generate a primary composite score. Quality of life, blood safety markers, and muscle biopsies for protein biomarker analysis were also conducted at baseline and the end of the study.

    Results: The primary composite outcome improved by 63.5 percentage points in the L-Carnitine-combination group vs. placebo (P = 0.013). However, this composite score did not change significantly in the L-Carnitine group (P = 0.232), and decreased slightly in the placebo group (P = 0.534). Participants supplemented with the L-Carnitine-combination showed a 1.0 kg increase in total lean muscle mass (P = 0.013), leg lean muscle mass (0.35 kg, P = 0.005), and a 1.0 kg increase in lower leg strength (P = 0.029) at week 8. In addition, these increases were significant when compared to the placebo group (P = 0.034, P = 0.026, and P = 0.002, respectively). Total mTOR protein expression was increased in participants in the L-Carnitine-combination group at the end of the study compared to the baseline (P = 0.017). This increase was also significant when compared to the placebo (P = 0.039), suggesting that the increase in muscle mass and strength was due to new protein synthesis and mTOR pathway activation.

    Conclusions: The trial did reach its primary objective. L-Carnitine combined with creatine and L-leucine significantly improved the composite score which reflects muscle mass and strength, at the end of the study compared to placebo. The combination showed an increase in mTOR protein level, a driver for increased muscle mass which translated to an improvement in muscle strength. This new combination may provide a potential nutritional intervention to promote muscle growth and improved physical functioning in older adults.

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  21. JP Says:

    Updated 05/28/17:

    J Gerontol A Biol Sci Med Sci. 2017 May 25.

    High-Protein Foods and Physical Activity Protect Against Age-Related Muscle Loss and Functional Decline.

    Background: Some clinical trials suggest that protein supplementation enhances the effects of resistance exercise on skeletal muscle mass (SMM); fewer studies examine the effects of diets rich in protein-source foods on SMM and functional status among community-dwelling adults.

    Methods: Data from the Framingham Offspring study including diet (three-day records, exams 3 and 5), physical activity (exams 2 and 4), percent SMM (%SMM) (exams 6 and 7), and functional performance (exams 5 through 8) were used to evaluate independent and combined effects of physical activity and high-protein foods on adjusted mean %SMM (using analysis of covariance) and risk of functional decline (using Cox proportional hazard’s models). Analyses were adjusted for such factors as age, education, height, smoking, and fruit and grain consumption).

    Results: Higher intakes of protein-source foods (red meat, poultry, fish, dairy, and soy, nuts, seeds and legumes) were associated with higher %SMM over 9 years, particularly among women. Men and women with higher intakes of foods from animal sources had a higher % SMM regardless of activity; beneficial effects of plant-based protein foods were only evident in physically active adults. Active subjects with higher intakes of animal or plant protein-source foods had 35% lowest risks of functional decline. Among less active individuals, only those consuming more animal protein-source foods had reduced risks of functional decline (HR: 0.7l; 95% CI: 0.50-1.01).

    Conclusion: Higher intake of animal-protein foods, alone and especially in combination with a physically active lifestyle, was associated with preservation of muscle mass and functional performance in older adults.

    Be well!


  22. JP Says:

    Updated 06/11/17:

    Menopause. 2017 Jun 5.

    Associations between high-risk alcohol consumption and sarcopenia among postmenopausal women.

    OBJECTIVE: Sarcopenia is an age-related process, leading to cardio-metabolic diseases and disabilities. High-risk drinking is also closely related to diabetes, hypertension, and dyslipidemia, which are modifiable risk factors for sarcopenia. In the present study, we aimed to investigate the association between alcohol-drinking patterns and sarcopenia in Korean postmenopausal women.

    METHODS: Data from 2,373 postmenopausal women were analyzed from the 2008 to 2011 Korean National Health and Nutrition Examination Survey. We defined sarcopenia as two standard deviations below the sex-specific means of the appendicular skeletal muscle/weight (percentage) values of a young reference group. Participants were categorized into three groups according to alcohol-drinking patterns, as assessed by the Alcohol Use Disorders Identification Test questionnaire. The odds ratios and 95% confidence intervals for sarcopenia were calculated using multiple logistic regression analyses.

    RESULTS: In total, 8.2% of Korean postmenopausal women met criteria for sarcopenia. The prevalence of sarcopenia increased from low-risk to high-risk alcohol-drinking groups as follows: 7.6, 11.0, and 22.7%, respectively. Compared with the low-risk group, the odds ratio (95% confidence interval) for the high-risk group was 4.29 (1.87-9.82) after adjusting for age, body mass index, systolic blood pressure, total cholesterol, fasting blood glucose, household income, education level, daily calorie intake, current smoking and regular exercise, and household food security status.

    CONCLUSIONS: High-risk alcohol drinking was associated with a higher risk of sarcopenia in postmenopausal Korean women.

    Be well!


  23. JP Says:

    Updated 1/5/18:

    J Nutr Health Aging. 2018;22(1):59-67.

    Effects of Low-Dose Dairy Protein Plus Micronutrient Supplementation during Resistance Exercise on Muscle Mass and Physical Performance in Older Adults: A Randomized, Controlled Trial.

    OBJECTIVES: To investigate whether supplementation with low-dose dairy protein plus micronutrients augments the effects of resistance exercise (RE) on muscle mass and physical performance compared with RE alone among older adults.

    DESIGN: Randomized controlled trial.

    SETTING: Tokyo, Japan.

    PARTICIPANTS: Eighty-two community-dwelling older adults (mean age, 73.5 years) were randomly allocated to an RE plus dairy protein and micronutrient supplementation group or an RE only group (n = 41 each).

    INTERVENTION: The RE plus supplementation group participants ingested supplements with dairy protein (10.5 g/day) and micronutrients (8.0 mg zinc, 12 μg vitamin B12, 200 μg folic acid, 200 IU vitamin D, and others/day). Both groups performed the same twice-weekly RE program for 12 weeks.

    MEASUREMENTS: Whole-body, appendicular, and leg lean soft-tissue mass (WBLM, ALM, and LLM, respectively) with dual-energy X-ray absorptiometry, physical performance, biochemical characteristics, nutritional intake, and physical activity were measured before and after the intervention. Data were analyzed by using linear mixed-effects models.

    RESULTS: The groups exhibited similar significant improvements in maximum gait speed, Timed Up-and-Go, and 5-repetition and 30-s chair stand tests. As compared with RE only, RE plus supplementation significantly increased WBLM (0.63 kg, 95% confidence interval [CI]: 0.31-0.95), ALM (0.37 kg, 95% CI: 0.16-0.58), LLM (0.27 kg, 95% CI: 0.10-0.46), and serum concentrations of 25-hydroxyvitamin D (4.7 ng/mL, 95% CI: 1.6-7.9), vitamin B12 (72.4 pg/mL, 95% CI: 12.9-131.9), and folic acid (12.9 ng/mL, 95% CI: 10.3-15.5) (all P < 0.05 for group-by-time interactions). Changes over time in physical activity and nutritional intake excluding the supplemented nutrients were similar between groups. CONCLUSION: Low-dose dairy protein plus micronutrient supplementation during RE significantly increased muscle mass in older adults but did not further improve physical performance. Be well! JP

  24. JP Says:

    Updated 2/6/18:

    Clin Nutr. 2018 Jan 9. pii: S0261-5614(18)30007-4.

    A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: A double-blind randomized controlled trial.

    OBJECTIVE: Sarcopenia, an age-related decline of muscle mass, strength, and physical function, was associated with falls, frailty, and poor quality of life. The aim of the current study is to examine the effect of nutritional supplement containing whey protein, vitamin D and E on measures of sarcopenia.

    METHODS: A total of 60 sarcopenic older adult subjects participated in the current randomized, double-blind, placebo-controlled (iso-caloric control product) trial for 6 months. Muscle mass [Relative skeletal mass index (RSMI) measured by bioimpedance analysis (BIA)], muscle strength (handgrip strength), physical function (6-m gait speed, chair stand test, and timed-up-and-go test, TUG), quality of life (measured by Short-Form 36-Item Health Survey, SF-36), and blood biochemical indexes were measured before and after the 6-month intervention.

    RESULTS: Compared to placebo group, nutritional supplementation improves RSMI (mean difference: 0.18 kg/m2, 95%CI: 0.01-0.35, P = 0.040), handgrip strength (mean difference: 2.68 kg, 95%CI: 0.71-4.65, P = 0.009), SF-36 mental component summary (SF-36 MCS) (mean difference: 11.26, 95%CI: 3.86-18.65, P = 0.004), SF-36 physical component summary (SF-36 PCS) (mean difference: 20.21, 95%CI: 11.30-29.12, P < 0.001), serum IGF-1 (mean difference: 14.34 ng/mL, 95%CI: 2.06-26.73), IL-2 (mean difference: -575.32 pg/mL, 95%CI: -1116.94 ∼ -33.70, P = 0.038), serum vitamin D3 (mean difference: 11.01 ng/mL, 95%CI: 6.44-15,58, P < 0.001), and serum vitamin E (mean difference: 4.17 ng/L, 95%CI: 1.89-6.45, P = 0.001). CONCLUSION: The current study demonstrated that the combined supplementation of whey protein, vitamin D and E can significantly improve RSMI, muscle strength, and anabolic markers such as IGF-I and IL-2 in older adults with sarcopenia. Further larger well-designed studies are warranted to evaluate whether long-term whey protein supplementation can blunt the declines of muscle function and mass in older adults with sarcopenia. Be well! JP

  25. JP Says:

    Updated 10/02/18:

    J Cachexia Sarcopenia Muscle. 2018 Sep 26.

    Building strength, endurance, and mobility using an astaxanthin formulation with functional training in elderly.

    BACKGROUND: Building both strength and endurance has been a challenge in exercise training in the elderly, but dietary supplements hold promise as agents for improving muscle adaptation. Here, we test a formulation of natural products (AX: astaxanthin, 12 mg and tocotrienol, 10 mg and zinc, 6 mg) with both anti-inflammatory and antioxidant properties in combination with exercise. We conducted a randomized, double-blind, placebo-controlled study of elderly subjects (65-82 years) on a daily oral dose with interval walking exercise on an incline treadmill.

    METHODS: Forty-two subjects were fed AX or placebo for 4 months and trained 3 months (3×/week for 40-60 min) with increasing intervals of incline walking. Strength was measured as maximal voluntary force (MVC) in ankle dorsiflexion exercise, and tibialis anterior muscle size (cross-sectional area, CSA) was determined from magnetic resonance imaging.

    RESULTS: Greater endurance (exercise time in incline walking, >50%) and distance in 6 min walk (>8%) accompanied training in both treatments. Increases in MVC by 14.4% (±6.2%, mean ± SEM, P < 0.02, paired t-test), CSA by 2.7% (±1.0%, P < 0.01), and specific force by 11.6% (MVC/CSA, ±6.0%, P = 0.05) were found with AX treatment, but no change was evident in these properties with placebo treatment (MVC, 2.9% ± 5.6%; CSA, 0.6% ± 1.2%; MVC/CSA, 2.4 ± 5.7%; P > 0.6 for all).

    CONCLUSIONS: The AX formulation improved muscle strength and CSA in healthy elderly in addition to the elevation in endurance and walking distance found with exercise training alone. Thus, the AX formulation in combination with a functional training programme uniquely improved muscle strength, endurance, and mobility in the elderly.

    Be well!


  26. JP Says:

    Updated 12/02/18:

    J Nutr Health Aging. 2018;22(10):1266-1274.

    Pre Frail 80: Multifactorial Intervention to Prevent Progression of Pre-Frailty to Frailty in the Elderly.

    OBJECTIVES: Preventing or delaying frailty has important benefits in the elderly, and in health and social services. Studies have demonstrated the effectiveness of multifactorial interventions in the frail elderly, but there are fewer studies on community-dwelling pre-frail individuals. Identifying pre-frail individuals susceptible to intervention could prevent or delay frailty and its consequences and associated disability and might reverse the state from pre-frail to robust. To evaluate a multifactorial, interdisciplinary primary care intervention in community-dwelling pre-frail elderly patients aged ≥ 80 years.

    DESIGN: Randomized clinical trial in a Barcelona primary healthcare centre.

    SETTING: We included 200 community-dwelling subjects aged ≥ 80 years meeting the Fried pre-frailty criteria. Participants were randomized to intervention and control groups.

    INTERVENTION: The intervention group received a 6-month interdisciplinary intervention based on physical exercise, Mediterranean diet advice, assessment of inadequate prescribing in polypharmacy patients and social assessment, while the control group received standard primary healthcare treatment.

    RESULTS: 173 pre-frail participants (86.5%) completed the study; mean age 84.5 years, 64.5% female. At twelve months, frailty was lower in the intervention group (RR 2.90; 95%CI 1.45 to 8.69). Reversion to robustness was greater in the intervention group (14.1% vs.1.1%, p <0.001). Functional and nutritional status, adherence to Mediterranean diet, quality of life, and functional mobility were improved in the intervention group (p ≤0.001).

    CONCLUSION: A multifactorial, interdisciplinary primary healthcare intervention focused on physical exercise, nutrition, review of polypharmacy and social assessment prevented frailty in pre-frail elderly patients, and improved functional capacity, quality of life and adherence to the Mediterranean diet.

    Be well!


  27. JP Says:

    Updated 12/14/18:

    J Clin Med. 2018 Nov 26;7(12).

    The Effects of Group and Home-Based Exercise Programs in Elderly with Sarcopenia: A Randomized Controlled Trial.

    Physical exercise is effective for sarcopenic elderly but evidence for the most effective mode of exercise is conflicting. The objective of this study was to investigate the effects of a three-month group-based versus home-based exercise program on muscular, functional/physical performance and quality of life (QoL) across elderly with sarcopenia. 54 elderly (47 women, 7 men aged 72.87 ± 7 years) were randomly assigned to one of three interventions: supervised group (n = 18), individualized home-based exercise (n = 18) and control group (n = 18). Body composition was determined by bioelectrical impedance analysis, calf measurement with inelastic tape and strength assessments (grip and knee muscle strength) via hand-held and isokinetic dynamometers. Functional assessments included four-meter (4 m), Τimed-Up and Go (TUG) and chair stand (CS) tests. QoL was assessed with Greek Sarcopenia Quality of Life (SarQol_GR) questionnaire. Outcomes were assessed at baseline, immediately post-intervention (week 12), and 3 months post-intervention (week 24). Significant group x time interactions (p < 0.001) were observed in QoL, calf circumference, TUG, CS, and 4 m tests, grip and knee muscle strength. Group-based compared to home-based exercise yielded significant improvements (p < 0.05) in muscle mass index, CS and 4 m tests, calf circumference, muscle strength at 12 weeks. Most improvements at 24 weeks were reported with grouped exercise. No changes were found across the control group. Results suggest group-based exercise was more effective than home-based for improving functional performance. Be well! JP

  28. JP Says:

    Updated 03/15/19:

    Int J Mol Sci. 2019 Mar 7;20(5).

    Effects of Prolonged Dietary Curcumin Exposure on Skeletal Muscle Biochemical and Functional Responses of Aged Male Rats.

    Oxidative stress resulting from decreased antioxidant protection and increased reactive oxygen and nitrogen species (RONS) production may contribute to muscle mass loss and dysfunction during aging. Curcumin is a phenolic compound shown to upregulate antioxidant defenses and directly quench RONS in vivo. This study determined the impact of prolonged dietary curcumin exposure on muscle mass and function of aged rats. Thirty-two-month-old male F344xBN rats were provided a diet with or without 0.2% curcumin for 4 months. The groups included: ad libitum control (CON; n = 18); 0.2% curcumin (CUR; n = 18); and pair-fed (PAIR; n = 18) rats. CUR rats showed lower food intake compared to CON, making PAIR a suitable comparison group. CUR rats displayed larger plantaris mass and force production (vs. PAIR). Nuclear fraction levels of nuclear factor erythroid-2 related-factor-2 were greater, and oxidative macromolecule damage was lower in CUR (vs. PAIR). There were no significant differences in measures of antioxidant status between any of the groups. No difference in any measure was observed between CUR and CON rats. Thus, consumption of curcumin coupled with reduced food intake imparted beneficial effects on aged skeletal muscle. The benefit of curcumin on aging skeletal muscle should be explored further.

    Be well!


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