Bedeutung der Proteinzufuhr bei der Entstehung und Behandlung der Sarkopenie

Zusammenfassung

Als Sarkopenie wird der Verlust von Muskelmasse und Muskelkraft bei älteren Personen bezeichnet. Protein- und energiereiche Supplemente führen bei älteren und gebrechlichen Personen meistens zu einer Erhöhung der Nahrungsaufnahme und des Körpergewichts, zeigen jedoch wenig Einfluss auf funktionelle Parameter wie die Muskelfunktion. Mehrere Studien deuten darauf hin, dass der Proteinbedarf im Alter wahrscheinlich insgesamt erhöht ist. Neue Ansätze zur Verbesserung der Wirkung von Proteinsupplementen bei älteren Menschen betreffen jedoch vor allem die Zusammensetzung von Proteinen oder Aminosäurenlösungen. Es wurde unter anderem gezeigt, dass in erster Linie essenzielle Aminosäuren für die Stimulation der muskulären Proteinsynthese verantwortlich sind, wobei Leucin, eine verzweigtkettige Aminosäure, eine zentrale Rolle einnimmt. Ein höherer Anteil an Leucin scheint für eine signifikante Erhöhung der Proteinsynthese im Muskel bei älteren Personen ausschlaggebend zu sein. Auch eine Veränderung der Essensgewohnheiten zugunsten einer proteinreichen Mahlzeit zu Mittag stellt eine wertvolle Alternative zur Förderung des Proteinanabolismus im Vergleich zu einer undifferenzierten Steigerung der Proteinaufnahme dar, da gezeigt wurde, dass eine Bolusgabe mit bis zu 80 % der täglichen Proteinaufnahme zu Mittag, gefolgt von einer proteinarmen Mahlzeit am Abend die Proteinretention erhöht. Vieles spricht jedoch dafür, dass auch zukünftig selbst bei Nutzung dieser neuen, zum Teil vielversprechenden ernährungstherapeutischen Optionen der zusätzliche Effekt eines auf das Alter und die individuellen Gegebenheiten angepassten körperlichen Trainings für das Erreichen dieses Zieles unverzichtbar sein wird.

Abstract

Sarcopenia, which describes the loss of muscle mass and muscle strength, is a common phenomenon in the elderly. Although clinical intervention studies with energy and protein supplementation have consistently shown an increase in nutritional intake and body weight, the impact on functional parameters such as muscle function has been minor. Several studies have suggested that protein requirements might be higher in the elderly than in younger adults. New strategies regarding protein supplementation focus on the composition of proteins and amino acid solutions. It has e. g. been shown that essential amino acids are mainly responsible for the stimulation of fractional protein synthesis in the muscle. Here, leucine, a branched chain amino acid, seems to play a central role and a higher intake of leucine has been shown to increase muscle protein synthesis in elderly subjects. Also, pulse feeding pattern, supplying 80 % of protein at lunch followed by a protein reduced meal in the evening, has also been reported to increase protein retention in the elderly and might thus be considered an interesting alternative to high protein diets. Evidence, however, clearly suggests that physical training will remain mandatory in order to reach major improvement of muscle mass and function.

Schlüsselwörter

Sarkopenie - Proteinsynthese - essenzielle Aminosäuren - Muskelmasse - ältere Menschen

Keywords

sarcopenia - protein synthesis - essential amino acids - muscle mass - elderly

Literatur

• 1 Thomas D R. Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia.  Clin Nutr. 2007;  26 (4) 389-399
• 2 Bauer J M, Volkert D, Wirth R. et al . Diagnosing malnutrition in the elderly.  Dtsch Med Wochenschr. 2006;  131 (5) 223-227
• 3 Norman K, Smoliner C, Valentini L. et al . Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality?.  Nutrition. 2007;  23 (7–8) 564-569
• 4 Biolo G, Ciocchi B, Lebenstedt M. et al . Sensitivity of whole body protein synthesis to amino acid administration during short-term bed rest.  J Gravit Physiol. 2002;  9 (1) 197-198
• 5 Biolo G, Ciocchi B, Lebenstedt M. et al . Short-term bed rest impairs amino acid-induced protein anabolism in humans.  J Physiol. 2004;  558 (Pt 2) 381-388
• 6 Biolo G, Ciocchi B, Stulle M. et al . Calorie restriction accelerates the catabolism of lean body mass during 2 wk of bed rest.  Am J Clin Nutr. 2007;  86 (2) 366-372
• 7 Paddon-Jones D, Sheffield-Moore M, Cree M G. et al . Atrophy and impaired muscle protein synthesis during prolonged inactivity and stress.  J Clin Endocrinol Metab. 2006;  91 (12) 4836-4841
• 8 Moriguti J C, Das S K, Saltzman E. et al . Effects of a 6-week hypocaloric diet on changes in body composition, hunger, and subsequent weight regain in healthy young and older adults.  J Gerontol A Biol Sci Med Sci. 2000;  55 (12) B580-B587
• 9 Mosoni L, Malmezat T, Valluy M C. et al . Lower recovery of muscle protein lost during starvation in old rats despite a stimulation of protein synthesis.  Am J Physiol. 1999;  277 (4 Pt 1) E608-E616
• 10 Newman A B, Lee J S, Visser M. et al . Weight change and the conservation of lean mass in old age: the Health, Aging and Body Composition Study.  Am J Clin Nutr. 2005;  82 (4) 872-878
• 11 Houston D K, Nicklas B J, Ding J. et al . Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study.  Am J Clin Nutr. 2008;  87 (1) 150-155
• 12 Volpi E, Sheffield-Moore M, Rasmussen B B. et al . Basal muscle amino acid kinetics and protein synthesis in healthy young and older men.  JAMA. 2001;  286 (10) 1206-1212
• 13 Cuthbertson D, Smith K, Babraj J. et al . Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle.  FASEB J. 2005;  19 (3) 422-424
• 14 Guillet C, Prod'homme M, Balage M. et al . Impaired anabolic response of muscle protein synthesis is associated with S6K1 dysregulation in elderly humans.  FASEB J. 2004;  18 (13) 1586-1587
• 15 Mosoni L, Valluy M C, Serrurier B. et al . Altered response of protein synthesis to nutritional state and endurance training in old rats.  Am J Physiol. 1995;  268 (2 Pt 1) E328-E335
• 16 Rasmussen B B, Fujita S, Wolfe R R. et al . Insulin resistance of muscle protein metabolism in aging.  FASEB J. 2006;  20 (6) 768-769
• 17 Fujita S, Rasmussen B B, Cadenas J G. et al . Effect of insulin on human skeletal muscle protein synthesis is modulated by insulin-induced changes in muscle blood flow and amino acid availability.  Am J Physiol Endocrinol Metab. 2006;  291 (4) E745-E754
• 18 Boirie Y, Gachon P, Beaufrere B. Splanchnic and whole-body leucine kinetics in young and elderly men.  Am J Clin Nutr. 1997;  65 (2) 489-495
• 19 Kobayashi H, Borsheim E, Anthony T G. et al . Reduced amino acid availability inhibits muscle protein synthesis and decreases activity of initiation factor eIF2B.  Am J Physiol Endocrinol Metab. 2003;  284 (3) E488-E498
• 20 Lange K H, Andersen J L, Beyer N. et al . GH administration changes myosin heavy chain isoforms in skeletal muscle but does not augment muscle strength or hypertrophy, either alone or combined with resistance exercise training in healthy elderly men.  J Clin Endocrinol Metab. 2002;  87 (2) 513-523
• 21 Yeh S S, Wu S Y, Lee T P. et al . Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double-blind, placebo-controlled study.  J Am Geriatr Soc. 2000;  48 (5) 485-492
• 22 Ryall J G, Schertzer J D, Lynch G S. Attenuation of age-related muscle wasting and weakness in rats after formoterol treatment: therapeutic implications for sarcopenia.  J Gerontol A Biol Sci Med Sci. 2007;  62 (8) 813-823
• 23 Milne A C, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition.  Cochrane Database Syst Rev. 2005;  (2) , CD003288
• 24 Price R, Daly F, Pennington C R. et al . Nutritional supplementation of very old people at hospital discharge increases muscle strength: a randomised controlled trial.  Gerontology. 2005;  51 (3) 179-185
• 25 Edington J, Barnes R, Bryan F. et al . A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes.  Clin Nutr. 2004;  23 (2) 195-204
• 26 Smoliner C, Norman K, Scheufele R. et al . Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition.  Nutrition. 2008;  24 (11–12) 1139-1144
• 27 Fiatarone M A, O'Neill E F, Ryan N D. et al . Exercise training and nutritional supplementation for physical frailty in very elderly people.  N Engl J Med. 1994;  330 (25) 1769-1775
• 28 Candow D G, Chilibeck P D, Facci M. et al . Protein supplementation before and after resistance training in older men.  Eur J Appl Physiol. 2006;  97 (5) 548-556
• 29 Campbell W W. Synergistic use of higher-protein diets or nutritional supplements with resistance training to counter sarcopenia.  Nutr Rev. 2007;  65 (9) 416-422
• 30 Bross R, Javanbakht M, Bhasin S. Anabolic interventions for aging-associated sarcopenia.  J Clin Endocrinol Metab. 1999;  84 (10) 3420-3430
• 31 Volpi E, Ferrando A A, Yeckel C W. et al . Exogenous amino acids stimulate net muscle protein synthesis in the elderly.  J Clin Invest. 1998;  101 (9) 2000-2007
• 32 Volpi E, Mittendorfer B, Wolf S E. et al . Oral amino acids stimulate muscle protein anabolism in the elderly despite higher first-pass splanchnic extraction.  Am J Physiol. 1999;  277 (3 Pt 1) E513-E520
• 33 Rasmussen B B, Wolfe R R, Volpi E. Oral and intravenously administered amino acids produce similar effects on muscle protein synthesis in the elderly.  J Nutr Health Aging. 2002;  6 (6) 358-362
• 34 Volpi E, Mittendorfer B, Rasmussen B B. et al . The response of muscle protein anabolism to combined hyperaminoacidemia and glucose-induced hyperinsulinemia is impaired in the elderly.  J Clin Endocrinol Metab. 2000;  85 (12) 4481-4490
• 35 Volpi E, Kobayashi H, Sheffield-Moore M. et al . Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults.  Am J Clin Nutr. 2003;  78 (2) 250-258
• 36 Paddon-Jones D, Sheffield-Moore M, Zhang X J. et al . Amino acid ingestion improves muscle protein synthesis in the young and elderly.  Am J Physiol Endocrinol Metab. 2004;  286 (3) E321-E328
• 37 Biolo G, clan Fleming R Y, Wolfe R R. Physiologic hyperinsulinemia stimulates protein synthesis and enhances transport of selected amino acids in human skeletal muscle.  J Clin Invest. 1995;  95 (2) 811-819
• 38 Ferrando A A, Tipton K D, Doyle D. et al . Testosterone injection stimulates net protein synthesis but not tissue amino acid transport.  Am J Physiol. 1998;  275 (5 Pt 1) E864-E871
• 39 Yarasheski K E, Zachwieja J J, Campbell J A. et al . Effect of growth hormone and resistance exercise on muscle growth and strength in older men.  Am J Physiol. 1995;  268 (2 Pt 1) E268-E276
• 40 Katsanos C S, Kobayashi H, Sheffield-Moore M. et al . Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids.  Am J Clin Nutr. 2005;  82 (5) 1065-1073
• 41 Borsheim E, Bui Q U, Tissier S. et al . Effect of amino acid supplementation on muscle mass, strength and physical function in elderly.  Clin Nutr. 2008;  27 (2) 189-195
• 42 Paddon-Jones D, Sheffield-Moore M, Katsanos C S. et al . Differential stimulation of muscle protein synthesis in elderly humans following isocaloric ingestion of amino acids or whey protein.  Exp Gerontol. 2006;  41 (2) 215-219
• 43 Anthony J C, Anthony T G, Kimball S R. et al . Orally administered leucine stimulates protein synthesis in skeletal muscle of postabsorptive rats in association with increased eIF4F formation.  J Nutr. 2000;  130 (2) 139-145
• 44 Anthony J C, Yoshizawa F, Anthony T G. et al . Leucine stimulates translation initiation in skeletal muscle of postabsorptive rats via a rapamycin-sensitive pathway.  J Nutr. 2000;  130 (10) 2413-2419
• 45 Crozier S J, Kimball S R, Emmert S W. et al . Oral leucine administration stimulates protein synthesis in rat skeletal muscle.  J Nutr. 2005;  135 (3) 376-382
• 46 Rieu I, Sornet C, Bayle G. et al . Leucine-supplemented meal feeding for ten days beneficially affects postprandial muscle protein synthesis in old rats.  J Nutr. 2003;  133 (4) 1198-1205
• 47 Katsanos C S, Kobayashi H, Sheffield-Moore M. et al . A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly.  Am J Physiol Endocrinol Metab. 2006;  291 (2) E381-E387
• 48 Rieu I, Balage M, Sornet C. et al . Leucine supplementation improves muscle protein synthesis in elderly men independently of hyperaminoacidaemia.  J Physiol. 2006;  575 (Pt 1) 305-315
• 49 Symons T B, Schutzler S E, Cocke T L. et al . Aging does not impair the anabolic response to a protein-rich meal.  Am J Clin Nutr. 2007;  86 (2) 451-456
• 50 Dangin M, Boirie Y, Garcia-Rodenas C. et al . The digestion rate of protein is an independent regulating factor of postprandial protein retention.  Am J Physiol Endocrinol Metab. 2001;  280 (2) E340-E348
• 51 Remond D, Machebeuf M, Yven C. et al . Postprandial whole-body protein metabolism after a meat meal is influenced by chewing efficiency in elderly subjects.  Am J Clin Nutr. 2007;  85 (5) 1286-1292
• 52 Beaufrere B, Dangin M, Boirie Y. The ‚fast‘ and ‚slow‘ protein concept.  Nestle Nutr Workshop Ser Clin Perform Programme . 2000;  3 121-131
• 53 Boirie Y, Dangin M, Gachon P. et al . Slow and fast dietary proteins differently modulate postprandial protein accretion.  Proc Natl Acad Sci U.S.A.. 1997;  94 (26) 14 930-14 935
• 54 Dangin M, Guillet C, Garcia-Rodenas C. et al . The rate of protein digestion affects protein gain differently during aging in humans.  J Physiol. 2003;  549 (Pt 2) 635-644
• 55 Pannemans D L, Wagenmakers A J, Westerterp K R. et al . Effect of protein source and quantity on protein metabolism in elderly women.  Am J Clin Nutr. 1998;  68 (6) 1228-1235
• 56 Gersovitz M, Motil K, Munro H N. et al . Human protein requirements: assessment of the adequacy of the current Recommended Dietary Allowance for dietary protein in elderly men and women.  Am J Clin Nutr. 1982;  35 (1) 6-14
• 57 Morse M H, Haub M D, Evans W J. et al . Protein requirement of elderly women: nitrogen balance responses to three levels of protein intake.  J Gerontol A Biol Sci Med Sci. 2001;  56 (11) M724-M730
• 58 Pannemans D L, Wagenmakers A J, Westerterp K R. et al . The effect of an increase of protein intake on whole-body protein turnover in elderly women is tracer dependent.  J Nutr. 1997;  127 (9) 1788-1794
• 59 Campbell W W, Trappe T A, Wolfe R R. et al . The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle.  J Gerontol A Biol Sci Med Sci. 2001;  56 (6) M373-M380
• 60 Vellas B J, Hunt W C, Romero L J. et al . Changes in nutritional status and patterns of morbidity among free-living elderly persons: a 10-year longitudinal study.  Nutrition. 1997;  13 (6) 515-519
• 61 Wolfe R R, Miller S L, Miller K B. Optimal protein intake in the elderly.  Clin Nutr. 2008;  27 (5) 675-684
• 62 Humayun M A, Elango R, Ball R O. et al . Reevaluation of the protein requirement in young men with the indicator amino acid oxidation technique.  Am J Clin Nutr. 2007;  86 (4) 995-1002
• 63 Arnal M A, Mosoni L, Boirie Y. et al . Protein pulse feeding improves protein retention in elderly women.  Am J Clin Nutr. 1999;  69 (6) 1202-1208
• 64 Arnal M A, Mosoni L, Boirie Y. et al . Protein turnover modifications induced by the protein feeding pattern still persist after the end of the diets.  Am J Physiol Endocrinol Metab. 2000;  278 (5) E902-E909
• 65 Pacy P J, Price G M, Halliday D. et al . Nitrogen homeostasis in man: the diurnal responses of protein synthesis and degradation and amino acid oxidation to diets with increasing protein intakes.  Clin Sci (Lond). 1994;  86 (1) 103-116
• 66 Arnal M A, Mosoni L, Dardevet D. et al . Pulse protein feeding pattern restores stimulation of muscle protein synthesis during the feeding period in old rats.  J Nutr. 2002;  132 (5) 1002-1008
• 67 Morley J E, Perry III H M, Kaiser F E. et al . Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study.  J Am Geriatr Soc. 1993;  41 (2) 149-152
• 68 Tenover J S. Effects of testosterone supplementation in the aging male.  J Clin Endocrinol Metab. 1992;  75 (4) 1092-1098
• 69 Papadakis M A, Grady D, Black D. et al . Growth hormone replacement in healthy older men improves body composition but not functional ability.  Ann Intern Med. 1996;  124 (8) 708-716
• 70 Yeh S S, Wu S Y, Levine D M. et al . The correlation of cytokine levels with body weight after megestrol acetate treatment in geriatric patients.  J Gerontol A Biol Sci Med Sci. 2001;  56 (1) M48-M54
• 71 Siriett V, Salerno M S, Berry C. et al . Antagonism of myostatin enhances muscle regeneration during sarcopenia.  Mol Ther. 2007;  15 (8) 1463-1470