Presents

Seminar Highlights from the Florida Dietetics

Association Meeting
July 13, 2010
Optimal Protein Intake Orlando, FL

and the RDA

A Presentation Provided by The HealthSpan Institute and
Continuing Education
Optimal Protein Intake
and the RDA

The Scientific Basis for the Benevia ® Product

Portfolio and The Need for Superior High
Leucine/Essential Amino Acid Protein Blends as
Provided in all Benevia Clinical Nutrition
Products.
Optimal Protein Intake
and the RDA
Robert R. Wolfe, Ph.D.
Professor, Geriatrics
University of Arkansas for Medical Sciences
Jul y 13, 2010. Orlando, Florida
Florida Dietetics Association Annual Meeting
 Current Guidelines –
Where Do They Come From?
Institute of Medicine
Food and Nutrition Board
Dietary Reference Intake (DRIs)

EAR RDA UL + LL AMDR

Estimate Recommend Upper and Acceptable
Average ed Dietary Lower Macronutrie
Requirement Allowance Limits nt
Distribution
Range

Other USDA Dietary Guidelines

N-Balance: The Primary
Tool for Determining DRI

N-balance determines the minimal

amount of protein intake needed to
avoid a progressive loss of body
protein.
 Current Recommendations

EAR - 0.66 gm protein / kg x day

RDA- 0.80 gm protein / kg x day
UL + LL - No Recommendations
AMDR - 10-35% of Energy of Intake

Taken from DRIs

 Relation Between
Recommended Dietary
Allowance (RDA)
and
Acceptable Nutrient
Distribution Range
 Acceptable Macronutrient
Distribution Ranges

Range (% of energy)
Macronutrient Children, 1-3 y Children, 4-18 y Adults
Fat 30-40 25-35 20-35
n-6 polyunsaturated fats 5-10 5-10 5-10
(linoleic acid)
n-3 polyunsaturated fats* 0.6-1.2 0.6-1.2 0.6-1.2
(α-linolenic acid)
Carbohydrate 45-65 45-65 45-65
Protein 5-20 10-30 10-35

SOURCE: IOM (2002a).

 Average Energy Requirement

35 kcal / kg x day
If protein intake =

35% = 12.25 Kcal / kg x day

= 3 gm protein / kg x day

10% = 3.5 Kcal / kg x day

= 0.89 gm protein / kg x day
 The RDA is Below the
Minimal AMDR for Protein
 Implication of AMDRs:

The optimal level of protein intake

is greater than the minimal needed
to avoid deficiency.
 We Should Consider
Minimal and Optimal Levels
of Protein Intake
Protein Intake Greater than
Minimal Requirements
Primarily Targets Muscle
 Muscle Protein Plays a
Central Role in Whole Body
Protein Metabolism
Fasted

Amino
Acids

Gut
Fasted + Stress

Amino
Acids

Gut
Fed

Amino
Acids

o a ci d s
Gut Amin
Is Adequate Muscle Mass
Important for Health?
Midthigh Muscle Cross-Sectional Area Predicts
Mortality in Patients with COPD
Marquis et al, Am J Respir Care Med, 166: 809, 2002

Click to edit Master text styles

Second level
● Third level

● Fourth level

● Fifth level
 There is a threshold effect of
loss of muscle and severity of
stress.
 Mortality and Strength

21

From Ruiz RJ, et al. BMJ 2008; 337(7661):92-95.

 Older individuals are much
closer to the “danger
threshold” than young people
How Does Ingested Protein
Affect Muscle Protein?
Muscle Protein is in a Constant
State of Turnover
PROTEINS

Breakdo Synthesi
wn s
AMINO ACIDS

CELL Oxidation

BLOOD
Amino
Acids
Protein intake stimulates
growth of muscle protein
Response to a Single Serving of Beef

0.2
Muscle Protein Synthesis %/h

0.18

0.16

0.14

0.12

0.1

0.08

0.06

0.04

0.02

0
Basal 4 oz Basal 12 oz
Dose Response to Protein Intake

There is a maximal effective single

dose response to protein intake.
Does increased protein intake
translate to more lean mass
and improved health
outcomes?
 Dietary Protein Intake and Change in
LBM over 3 y in Elderly (n= 2066)

30

From Houston DK et al. Am J Clin Nutr 2008; 87(1):150-155.

Changes in Nutritional Status and Patterns
of Morbidity among Free-Living Persons: a
10 year longitudinal study
Vellas BJ, et al. Nutrition 1997; 13:505-519.

304 subjects, age 72 at start

Results:
Subjects with protein intakes greater than 1.2 g / kg
● day had fewer health problems over 10 years than
those with protein intakes less than 0.8 g / kg ● day.
 Protein Intake and
Cardiovascular Health
 Relative Risks (RR) of Ischemic
Heart Disease in 80,082 Women

1 2 3 4 5
Total Protein Intake 14.7 17.1 18.8 20.6 24.0
Multivariable RR 1.0 0.86 0.84 0.91 0.72

From: Hu et al. Am J Clin Nutr 1999; 70:21-227.

 Protein Supplements (20g/day) Reduce
Blood Pressure in Hypertension

0
-2
-4
-6

-8
-10
-12
-14
Systolic Pressure Diastolic Pressure

From: Townsend et al. Am J Hypertension 2004; 17:1056

 Protein Intake and Bone Health

• Protein under nutrition associated with low bone mineral

density and greater fracture risk.
Geinoz G, et al. Osteoporos Int 1993; 3:242-248.
Heany RP. Am J Clin Nutr 2002; 75:509

• Protein supplementation improves outcome after hip

fracture.
Bonjou JP, et al. Bone 1996; 18:139S.
Tkatch L, et al. J Am Coll Nur 1992; 11:519.
Frost HM. J Bone Min Res 1997; 12:1-9.

35
 Benefits of Protein Intake in
Weight Management

Thermogenesis
Satiety
Partitioning of nutrients to muscle
How Much Protein Intake is
“Optimal”
 Estimation of Optimal
Protein Intake from Muscle
Metabolism Studies
 Optimal Protein Intake from
Metabolic Studies
Maximal stimulation of muscle protein synthesis is
achieved with 15 gm EAAs (≈35 gm protein).
Recommended intake for 70 kg man:
35 gm protein / meal x 3 meals / day

= 105 gm protein

= 1.5 gm protein / kg x day

Optimal Intake vs RDA

RDA = 0.8 gm protein / kg x day

Recommended from Metabolic Studies

= 1.5 gm protein / kg x day
 Dietary Recommendations
Protein intake by age – NHANES, 2003-2004

35
30
25
% Calories

20 1.5 g/kg/d
15
10 Protein

5
0
2-3 4-8 9-13 14- 19- 31- 51- 71+
18 30 50 70
Years
Lower AMDR Dietary Guidelines Upper AMDR
 Conditions Which May Increase the
Optimal Level of Protein Intake

Aging
Muscle wasting (eg, cachexia, sarcopenia, etc.
Acute response to injury, critical illness
Diabetes
Obesity
Osteoporosis
Exercise training
Muscle Protein Synthesis
in Cancer
 pLeu pIle
500 200
EXP EXP
400 Control Control
150
µM 300

µM
100
200
50
100

0 0
0
30
60
90

0
0

0
30
60
90

0
0
0
0
0
0
0

0
0
0

0
0
12
15
18
21
24
27
30

12
15
18
21
24
27
30
Time (min) Time (min)

pVal pPhe
400 150
EXP EXP
Control Control
300
100
µM

µM
200

50
100

0 0
0

0
0

0
0
30
60
90

0
0
0
0
0

30
60
90

0
0
0

0
0
12
15
18
21
24
27
30

12
15
18
21
24
27
30
Time (min) Time (min)

There was a significant interaction and group effect for leucine (P<0.001), but not for isoleucine, valine or
phenylalanine. For all, a significant time effect was observed (P<0.01).
 meanFSR%
0.15
Control
EXP
0.10
%hour

0.05

0.00

-0.05

ta
d
e
tiv

Fe

el
D
orp
bs
a
st
Po

Muscle protein fractional synthetic rate. A significant interaction was found for FSR (P=0.0269.
What About the Kidney?
 “There is no evidence that higher
protein intakes cause renal failure
in healthy individuals”
Institute of Medicine. Dietary Reference Intakes
for Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids.
Washington, D.C.: National Academy Press; 2005
 Lean Body Mass
Predicts Relative Risk of Death in ESRD

Lowrie and Lew, AJKD, 1990

 Effect of Dietary Protein Intake in
Kidney Disease (n=585)

From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.

 Effect of Protein
Intake on Incidence
of Kidney Failure
(A) and composite
of Kidney Failure
and All-Cause
Mortality (B)

From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.

Conclusion

A relatively high proportion (20% or

more of caloric intake) of protein intake
benefits muscle and other health
outcomes without significant health
risks.