1. Nutritional Recommendation for Elderly - Protein -
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

2. Quantity of Protein

3. 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
50-69 yrs.
0.90
65.3 60
13-20
80-123g
≧70
1.06
60.0
72-110g
Nitrogen balance (mgN/kgBW/day)
Nitrogen balance 136 mgN/kgBW/day
Y=0.245X-33.4
Nitrogen intake (mgN/kgBW/day)
(Deitary Reference Intake, Japan, 2015)

4. Indicator Amino Acid Oxidation (IAAO) method shows more protein requirement
Break point
(= EAR : estimated average requirement)
70-74 yrs. 1.24g/kg
75-80 yrs. 1.12g/kg
≧80 yrs. 1.20g:kg
(EAR from nitrogen balance study=0.85g/kg)
(Kido Y et al., 2015, research report for Ministry Heath, Labour and Welfare)

5. More than 70g of protein related with low prevalence of frailty
Q1(<62.9g), Q2( g), Q3( g), Q4( g), Q5(>84.3g)
(Kobayashi S et al., Nutr J 2013;12:164)

6. Higher protein intake prevent loss of lean mass （N=2066, men and women aged 70-79 y for 3 years）
Low High
10.9%
12.7%
14.2%
15.9%
18.6%
Protein
(% of energy)
0.8 g
0.7 g
0.8 g
0.9 g
1.2 g
(g/kg/day）
Change in lean mass (kg)
40%
(Houston DK et al.,Am J Clin Nutr 2008;87:150)

7. Aging diminished accretion of muscle protein
(Katsanos CS et al., Am J Clin Nutr 2005;82:1065)

8. Recent Recommendations
To maintain and regain muscle g/kg/day
The pre-meal anabolic threshold is higher (25-30g/meal containing g leucine)
The PROT-AGE Study Group 2013)
For healthy older adults g/kg/day
For older with acute or chronic illness g/kg/day
The ESPEN Expert Group (2014)
g/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)

9. Muscle strength is higher for the women taking 1.2g/kg/day protein
(Lemieux FC et al., Climacteric 2014;17:294)

10. Protein intake among Japanese Elderly
Differences by activity level
Differences by BMI
(Ishikawa-Takata K. et al., 2015, research report for Ministry Heath, Labour and Welfare、
Reanalysis of National health and nutrition survey2012)

11. Taking all Staple food (grain), Main dish (protein source), and Side dish (vegetables) related with protein intake
(g/kg)
■ none
■ once
■ twice
■ 3 times
Male
Female
(Ishikawa-Takata K. et al., 2015, research report for Ministry Heath, Labour and Welfare. Reanalysis of National health and nutrition survey2012)

12. Quality of Protein

13. Whey supports muscle hypertrophy most effectively in young adults
Change in lean mass (kg)
Milk
Whey
Soy
CHO/placebo
Protein supplement
(Phillips et al., Am J Coll Nutr 2009;28:343)

14. Comparison of food intake
(kg/year/capita）
(FAO FOODSTAT　2011)

15. Effect of Leucine
Q1 (<4.78), Q2( ), Q3( ), Q4( ), Q5(>6.45)
(Ishikawa-Takata K. et al., 2015, research report for Ministry Heath, Labour and Welfare、
Reanalysis of National health and nutrition survey2012)
(Kobayashi S et al.,Nutr J 2013; 12:164)

16. Timing of Protein intake

17. Dietary protein distribution and muscle protein synthesis
After breakfast
24hr
Mixed muscle fractional synthesis rate (%/h)
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)

18. Higher protein intake results greater muscle protein synthesis
(Pennings B et al., Am J Physiol Endocrinol Metab 2012;302:E992)

19. Protein intake per meal
■ Breakfast　■ Lunch
■ Dinner　
■ Snacks
Adults (aged≥19y) in the USA（NHANES ）
Male
Female
(Paddon-Jones D et al., Am J Clin Nutr 2015;101:1339S)
(Ishikawa-Takata K. et al., 2015, research report for Ministry Heath, Labour and Welfare、
Reanalysis of National health and nutrition survey2012)

20. Conclusions Are above values same for Japanese?
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, g/meal)
Are above values same for Japanese?