1. The Importance of Lean Body Mass & Muscle in Healthy Ageing: Latest Evidence
Nicolaas E Deutz, MD, PhD. Professor, Ponder Endowed Chair
Editor-in-Chief Clinical Nutrition and Clinical Nutrition ESPEN
Director Center for Translational Research in Aging & Longevity. 
Department of Health & Kinesiology, Texas A&M University

2. Aging and Body Mass Index
20-49
50-59
60-69
70-79
80-99
Body Mass Index (kg/m2)
Predicted Mortality (%)
Predicted probability of death as a function of body mass index (BMI) calculated from the logistic model for each of 5 age groups.
Potter JF, et al. J Gerontol. 1988;43(3):M59-M63

3. Relation between BMI and Muscle Mass
Correlation between BMI and FFMI in 186,975 healthy white-ethnic individuals. R = , P <0.001.
FFMI = Fat-Free mass/heigth2
FFM = mainly muscle tissue
Franssen et al. J Am Med Dir Assoc. 2014;15(6):448 e1-6

4. How often is Malnutrition present?
Community
5% - 11%
Institutionalized Patients
30% - 60%
Hospitalized Patients
35% - 65%
Nursing Homes
85%
By 2030, nearly 20% of USA population will be 64 years or older
85% of elderly Americans have 1 or more chronic diseases
Wilson, AJM, 1998, Rush, ARN, 1997

5. Sarcopenia (loss of muscle mass)
Adults over the age of 60 have more often loss of muscle mass (sarcopenia) than loss of bone mass (osteoporosis)
Sarcopenia (“poverty of flesh”) is the loss of skeletal muscle mass and strength related to aging
Sarcopenia has large impact in many older adults and leads to a fast loss of quality of life
Sarcopenia
Less Muscle Mass
Sensation of Increased Effort
Fewer Physical Activities
Muscle Loss

6. Consequences of loss of muscle mass
Reduced strength and function in older adults
limit their daily activities
more vulnerable to become severely ill when they have an infection or are treated for another illness
Higher mortality

7. Physical activity and muscle loss
Physical activity of older adults becomes less that leads to
muscle loss
reduced need for calories
Body responds with less desire to eat
Older adults start to eat less during the day and thus reduce their protein intake

8. Protein intake in Older Adults
Deutz et al., Recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):

9. Protein intake in Older Adults
Deutz et al., Recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):

10. Ways to increase muscle mass
At the moment, sarcopenia cannot be treated with any form of medication, unlike osteoporosis.
The main treatment options to increase muscle size are:
Exercise programs with weight-bearing exercises
Increasing protein intake + higher quality of protein
Deutz et al., Clinical Nutrition 2014

11. Recommendations for Older Adults
Deutz et al., Recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):

12. Recommendations for Older Adults
Deutz et al., Recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):

13. Which proteins are optimal?
Which proteins have the higher biological value?
Higher biological value (BV) indicates that less is needed!
Are there specific requirements of certain proteins/amino acids in chronic disease states?
Whey/Casein Dairy Protein: 96
Human milk: 95
Chicken egg: 94
Soybean milk: 91
Cow milk: 90
Cheese: 84
Rice: 83
Defatted soy flour: 81
Fish: 76
Beef: 74.3
Immature bean: 65
Full-fat soy flour: 64
Soybean curd (tofu): 64
Whole wheat: 64
White flour: 41
Wikipedia

14. 24h balance studies in healthy subjects Relation between intake and net balance
Kim et al., AJP 2014

15. Chronic wasting disease
Chronic diseases
Normal
Chronic wasting disease
Characterized by muscle wasting
Cancer
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Heart Failure
Chronic Renal Failure

16. Disturbed nutritional status in chronic diseases and higher mortality
10-30% of patients with a stable chronic disease are underweight or have recent involuntary weight loss.
Muscle loss despite normal body weight (hidden depletion) in 30-60% of patients
Engelen ERJ 1994, 2011
Landbo et al, AJRCCM 1999

17. Excellent relation between intake essential amino acids and net protein Synthesis
Quality of Supplement related to amount of EAA
Leucine does not seems to make the EAA more anabolic
Engelen, Deutz et al. Ann Oncology 2015

18. Muscle wasting in chronic diseases
even in those patients who have normal/over weight!
when (involuntary) body weight changes in time
during disease progression
after treatment
during nutritional intervention
Careful nutritional assessment of muscle mass is crucial in chronic diseases

19. Change in lean mass
Deutz et al, Clinical Nutrition 2013

20. How to improve protein intake and metabolism in chronic diseases?
Increase muscle buildup
&
Reduce muscle breakdown
Protein intake needs to be high
Quality of protein intake needs to be optimal
Exercise
Inflammation needs to be reduced
>> 1.5 g/kg bw
E.g. Fish oil
Milk proteins
Specific (essential) amino acids
HMB
MULTIDISCIPLINARY APPROACH
(Resistance) exercise

21. Optimal protein intake (and exercise) are critical in older adults and chronic diseases There could be a role for specialized nutritional components like HMB