g/kg

Asian Nutrition Society for Sports and Health
University of Taipei
24-25 Oct, 2015
Nutritional Recommendation
for Elderly
- Protein Kazuko Ishikawa-Takata, PhD
Head, Section of Nutritional Care & Management,
Division of Nutritional Education
National Institutes of Biomedical Innovation, Health and
Nutrition, Japan
Quantity of Protein
Protein requirement in the Dietary
Reference Intake 2015 in Japan
RDA
(g/kg/day)
Reference
BW (men,
kg)
RDA
(g/day)
Dietary
Goal (DG)
(%energy)
DG
0.90
65.3
60
13-20
80-123g
≧70
1.06
60.0
60
13-20
72-110g
Nitrogen balance (mgN/kgBW/day)
50-69 yrs.
Nitrogen balance 136 mgN/kgBW/day
Y=0.245X-33.4
Nitrogen intake (mgN/kgBW/day)
(Deitary Reference Intake, Japan, 2015)
Indicator Amino Acid Oxidation (IAAO)
method shows more protein requirement
0.7
Δ13CO2（‰/kgBW）
0.6
0.5
A
Break point
(= EAR : estimated
average requirement)
B
0.4
C
D
E
0.3
F
G
0.2
H
70-74 yrs. 1.24g/kg
75-80 yrs. 1.12g/kg
≧80 yrs. 1.20g:kg
I
0.1
J
0
0
0.5
1
1.5
(EAR from nitrogen
balance study=0.85g/kg)
ProteinIntake（g/kgBW）
(Kido Y et al., 2015, research report for Ministry Heath, Labour and Welfare)
Multivaliate adjusted OR
More than 70g of protein related with low
prevalence of frailty
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Q1
Q2
Q3
Q4
Q5
Total protein intake
Q1(<62.9g), Q2(63.0-69.8g), Q3(69.8-76.1g), Q4(76.1-84.3g), Q5(>84.3g)
(Kobayashi S et al., Nutr J 2013;12:164)
Higher protein intake prevent loss of
lean mass （N=2066, men and women aged 70-79 y for 3
years）
Change in lean mass (kg)
Low
Protein intake
High
10.9%
12.7%
14.2%
15.9%
18.6%
0.8 g
0.7 g
0.8 g
0.9 g
1.2 g
Protein
(% of energy)
(g/kg/day）
40%
(Houston DK et al.,Am J Clin Nutr 2008;87:150)
Aging diminished accretion of muscle
protein
(Katsanos CS et al., Am J Clin Nutr 2005;82:1065)
Recent Recommendations
 To maintain and regain muscle 1.0-1.2g/kg/day
 The pre-meal anabolic threshold is higher (25-30g/meal
containing 2.5-2.8g leucine)
– The PROT-AGE Study Group 2013)
 For healthy older adults 1.0-1.2g/kg/day
 For older with acute or chronic illness 1.2-1.5g/kg/day
– The ESPEN Expert Group (2014)
 1.0-1.2g/kg/day with at least 20-25g of high-quality
protein in each meal
– The European Society for Clinical and Economic Aspects of
Osteoporosis and Osteoartheritic (ESCEO) (2014)/day
 1-1.5g/kg/day of protein
 A leucine –enriched balanced essential amino acid mix
may be added to the diet
– The Society for Sarcopenia, Cachexia, and Wasting Disease (2010)
Muscle strength is higher for the
women taking 1.2g/kg/day protein
(Lemieux FC et al., Climacteric 2014;17:294)
Protein intake among Japanese Elderly
Protein intake (g/kg/day)
Differences by BMI
2
2
1.5
1.5
1
1
0.5
0.5
0
0
Men
Women
Differences by
activity level
Men
Wome
■<18.5 ■18.5-25 ■>25
Active
Less active
(Ishikawa-Takata K. et al., 2015, research report for Ministry Heath, Labour and Welfare、
Reanalysis of National health and nutrition survey2012)
Taking all Staple food (grain), Main dish (protein
source), and Side dish (vegetables) related with
protein intake
(g/kg)
1.6
1.4
■ none
■ once
■ twice
■ 3 times
1.2
1
0.8
0.6
0.4
0.2
0
50～59 60～69
Male
≧70
50～59 60～69
Female
(Ishikawa-Takata K. et al., 2015, research report for Ministry Heath,
Labour and Welfare. Reanalysis of National health and nutrition
survey2012)
≧70
Quality of Protein
Change in lean mass (kg)
Whey supports muscle hypertrophy
most effectively in young adults
Milk
Whey
Soy
CHO/placebo
Protein supplement
(Phillips et al., Am J Coll Nutr 2009;28:343)
Comparison of food intake
(kg/year/capita）
(kg/year/capita）
300
20
18
250
16
14
200
12
150
10
8
100
6
4
50
2
0
0
Rice
Japan
Meat
Milk
USA
France
Fish
China
Beans
Soyabean
Japan
USA
France
(FAO FOODSTAT 2011)
Egg
China
Effect of Leucine
Leucine intake (g/day)
1.6
5
Multivaliate adjusted OR
1.4
1.2
4
1
3
0.8
2
0.6
0.4
1
0.2
0
0
Q1
Q2
Q3
Q4
Leucine intake
Q5
Q1 (<4.78), Q2(4.78-5.31), Q3(5.31-5.82),
Q4(5.82-6.44), Q5(>6.45)
(Kobayashi S et al.,Nutr J
2013; 12:164)
Men
Active
Wome
Less active
(Ishikawa-Takata K. et al., 2015, research
report for Ministry Heath, Labour and Welfare、
Reanalysis of National health and nutrition
survey2012)
Timing of Protein intake
Mixed muscle fractional
synthesis rate (%/h)
Dietary protein distribution and
muscle protein synthesis
After breakfast
24hr
EVEN: Breakfast 31.5±1.3, Lunch 29.9±1.6, Dinner 2.7±1.6g
SKEW: Breakfast 10.7±0.8, Lunch 16.0±0.5, Dinner 63.4±3.7g
(Mamerow MM et al., J Nutr 2014;144:876)
Higher protein intake results greater
muscle protein synthesis
(Pennings B et al., Am J Physiol Endocrinol
Metab 2012;302:E992)
Protein intake per meal
■ Breakfast
■ Lunch
■ Dinner
■ Snacks
5
5
0
0
(Ishikawa-Takata K. et al., 2015, research report for
Ministry Heath, Labour and Welfare、
Reanalysis of National health and nutrition survey2012)
≧70
10
60～69
10
50～59
15
40～49
15
30～39
20
15～19
20
7～14
25
≧70
25
60～69
30
50～59
30
40～49
35
30～39
35
20～29
40
15～19
40
7～14
(Paddon-Jones D et al., Am J Clin Nutr
2015;101:1339S)
Female
Male
20～29
Adults (aged≥19y) in
the USA
（NHANES2001-2008）
Conclusions
 Setting of Dietary goal
– to prevent non-communicable disease ⇒ to prevent
frailty, sarcopenia, functional decline…
 Need for increase protein requirement?
– Total protein 1-1.5g/kg ?
– 25-30g of high quality protein per meal ?
– Leucine ? (42mg/kg/d on DRI in USA, 2.5-2.8g/meal)
Are above values same for Japanese?

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