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The Meat of the Matter

"How much protein does an older person need?"
By: Marc Evans Abat, MD, FPCP, FPCGMThe Meat of the Matter

Current recommended dietary allowance for protein intake of adults regardless of age and sex is 0.8 grams per kilogram of body weight per day.  For an average 50-kilogram older person, this translates to 40 grams of protein per day.  What is 40 grams of protein equivalent to in actual food items?

  • 4.8 ounces cooked chicken breast or pork (just bigger than an iPhone 4) or
  • 13 pieces of shrimp or
  • 6½ eggs or
  • 5 cups of milk or
  • 95 peanuts or
  • 3-4 scoops of protein powder

One may want to consult a dietitian to help you translate your protein requirements to actual food items.

Personally, it really looks like you’ll go hungry with this. And apparently, this is already being challenged:

  1. Whether this is enough to maintain a positive nitrogen balance in older patients (in other words, it’s enough to prevent the body from breaking itself down)
  2. Whether this is enough to sustain other biological functions in an older patient (like immunity)
  3. Whether this is appropriate for older patients with chronic diseases or those who are frail (e.g. if you already have kidney disease or liver failure)
  4. Whether a higher protein intake results in better outcomes

In a fairly recent systematic review, the following findings were noted:

  1. A probable recommended dietary allowance (RDA) of 0.83 grams of protein per kilogram body weight per day, as the minimum need of virtually all healthy elderly persons
  2. There are suggestive to inconclusive evidence that the optimal protein level for functional outcomes like bone mass, muscle mass, and strength, morbidity and mortality, is about 1.2–1.5 grams of protein/kg body weight/day
  3. There are also suggestive to inconclusive evidence regarding an optimal protein intake higher than the estimated RDA, with the possible adverse outcomes to be investigated

As a side note, it is also important to include resistance exercise training, to drive all of the protein into the muscles.  The need for increased protein intake seems to persist even 24 hours after exercise.  Studies are still ongoing to further determine how the timing of protein intake should happen in older patients.

The type of protein source may have a significant effect.  Some studies show that whey protein increased muscle build-up more than casein (both proteins are found in milk), although both are somewhat equivalent regarding muscle synthesis after exercise.  There is also a concept of how to distribute your protein intake throughout the day. Other studies suggest distributing the proteins equally over 4 meals (at least 20 grams per meal).  There were also contradiction results shown in other studies, suggesting having a meal with the bulk of the proteins in it to stimulate muscle synthesis.  Animal and plant-based proteins, in general, are equivalent in meeting general health needs.  Animal proteins may have a higher level of leucine which may help in stimulating muscle build-up more.

Intake of particular amino acids (the building blocks of proteins) in your daily protein requirements may also affect how muscle is built up.  Branched chain amino acids, particularly leucine, are may improve signaling of pathways for muscle synthesis.  Studies among older patients have shown that those who had received leucine supplementation had increased muscle synthesis, whether they received exercise or not.  However, other studies do not appear to support these findings and hence further research is actually needed.  Beta-hydroxy beta-methyl butyrate (β-HMB), a metabolite of leucine, have also shown possible benefits in promoting muscle build-up. 

Another particular concern for older patients is the subset of sarcopenia called sarcopenic obesity, wherein there is a relative decrease in skeletal muscle mass relative to fat.  The management of this condition is two-fold: to promote weight loss, in particular, fat loss, but at the same time to preserve, or improve muscle mass.  Increased protein intake while decreasing total calories plus exercise is the mainstay of management.

As was mentioned earlier, there are also concerns with increasing protein intake in older patients, particularly regarding kidney function.  Generally, heathy older patients with no or very minimal kidney insufficiency can continue with standard protein intake. 

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