Erfolgreiche Ernährungsmassnahmen bei Sarkopenie Prof. Dr. med. Reto W. Kressig

Transkript

1 Erfolgreiche Ernährungsmassnahmen bei Sarkopenie Prof. Dr. med. Reto W. Kressig Klinische Professur für Geriatrie Ärztlicher Direktor

2 Gründe für Sarkopenie: Therapeutische Optionen? Inflammation increased IL-6 Vitamin D deficiency Senescence reduced sex hormones, satellite cell dysfunction, motor neuron loss, mitochondria Disuse immobility, sedentarism SARCOPENIA Endocrine GH and IGF-1 deficiency Insulin resistance Starvation anorexia, malabsorption, splanchnic extraction of AA Cederholm et al. Clin Geriatr Med 2011

3 Potentielle therapeutische Strategien Overview of potential pathways whereby resistance exercise and nutritional interventions may influence cellular events implicated in the regulation of muscle mass. Muscle Cell Barillaro C et al. Aging Clin Exp Res 2013

4 Kreatin Fontana P. AGUK Seminar 2017, Universität Basel

5 Recommendations for maintaining healthy muscle with aging Deutz NEP, et al., Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group, Clinical Nutrition (2014),

6 Sport Körperliche Aktivität

7 Sport Körperliche Aktivität Ist Sport eine validierte Aktivität zur Sarkopeniebehandlung? Ja, insbesondere Krafttraining! Evidenzgrad: sehr gut!

8 Sturzprävention Konventionelles Krafttraining? Nein! Cochrane Review 2009: 120 Studien, 6700 ältere Studienteilnehmer Zunahme der Muskelmasse und -kraft, doch lediglich leichte Verbesserung von einigen einfachen u. auch komplexeren täglichen Alltagsfunktionen (keine Sturzreduktion!) Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009

9 Kombination von Protein mit Training

10 Protein enriched diet lean red meat Supply of 220g to be eaten 6 d/wk for 4 mo + (4 months) Carbohydrate-rich diet pasta, rice, potato 1 serving (0.5 cups or 250 ml)/d Progressive resistance and balance training + Vit D Daly RM et al. Protein-enriched diet, with the use of lean red meat, combined with progressive resistance training enhances lean tissue mass and muscle strength and reduces circulating IL-6 concentrations in elderly women: a cluster randomized controlled trial. Am J Clin Nutr 2014;99:

11 Changes by groups aly RM et al. Protein-enriched diet, with the use of lean red meat, combined with progressive resistance training enhances lean tissue mass and muscle strength and reduces circulating IL-6 concentrations in elderly women: a cluster randomized controlled trial. Am J Clin Nutr 2014;99:

12 Benefits linked to protein-enriched diet: Daly RM et al. Protein-enriched diet, with the use of lean red meat, combined with progressive resistance training enhances lean tissue mass and muscle strength and reduces circulating IL-6 concentrations in elderly women: a cluster randomized controlled trial. Am J Clin Nutr 2014;99:

13 Kraftzunahme in Pflegeheimbewohnern mit Krafttraining und Ernährungssupplementen Training + Protein-Drinks (Soja) Training n = 100 Pflegeheimbewohner Durchschnittsalter: 87.1 ± 0.6 Jahre Progressives Krafttraining Ernährungssupplement 10 Wochen Protein-Drinks (Soja) Fiatarone MA et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994;

14 Schnelle u. langsame Proteine Molkenproteine: Verstärkter positiver Effekt auf Muskelmasse u. Muskelkraft in Kombination mit Krafttraining! (kurz vor oder nach Training) Grüntee-Kiwi Molke Hayes A, Cribb PJ. Effect of whey protein isolate on strength, body composition and muscle hypertrophy during resistance training. Curr Opin Clin Nutr Metab Care 2008;11:40-4

15 Proteinanreicherung im Muskel nach: Molke 2. Essentielle AS (Molke) 3. nicht-essentielle AS Katsanos CS et al. Nutr Res Oct;28(10):651-8.

16 2x3g/d powdered amino acid supplements: (42.0% leucine, 14.0% lysine, 10.5% valine, 10.5% isoleucine, 10.5% threonine, 7.0% phenylalanine, and 5.5% other) for 3 months. Comprehensive physical fitness and muscle mass enhancement program of moderate intensity 2x/week for 3 months.

17 Proteine - Ernährungssupplemente

18 Biologische Wertigkeit ausgedrückt als Protein Digestibility-Corrected Amino Acid Score (PDCAAS) WHO technical report series ; no. 935, 2007 Schaafsma J. Journal of Nutrition. 2000;130:1865S-1867S (70)

19 Protein Synthesis (%/h) Inaktivität reduziert Muskelproteinsynthese Day 1 Day 10 * 30% 24 h muscle protein synthesis during 10 day of inactivity in elders (stable isotope methodology) Kortebein et al. 2007

20 Proteingabe bekämpft inaktivitätsbedingten Muskelverlust Protein Synthesis (%/h) Normal Diet Normal Diet + Amino Acids - older adults - Day 1 Day 10 * Normal Diet # Normal Diet + Amino Acids 30% Ferrando et al. Clin Nutr 2010 ;29:18-23

21 Net Muscle Protein Synthesis (mg Phe/leg) Muskelsynthese mit schlechterer Antwort auf Proteineinnahme im Alter Young Elderly 0 More than ~25 g protein Less than ~15 g protein Katsanos et. al. AJCN, 2005

22 Optimale tägliche Proteinverteilung im Alter Bsp: 75kg schwerer Senior maximale Proteinsyntheserate Katabol Anabol 30 g 30g 30 g Total Protein 90 g Tagesbedarf: 1.2g pro kg KG/d Wiederholte maximale Proteinsynthesestimulation Zunahme/Erhalt der Muskelmasse Nach Paddon-Jones, 2012

23 Plasma Leucin Konzentration und Muskelproteinsyntheserate Rieu I et al. Nutrition 2007

24 Role of Leucine / Branch chain AA on muscle function Barillaro C et al. THE NEW METABOLIC TREATMENTS FOR SARCOPENIA Aging Clin Exp Res 2013

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26 Kritische Leucinschwelle, die bei älteren Menschen zu einer robusten Steigerung der Muskelneusynthese führt. Leucine threshold (elderly) Um die Leucin-spezifische Schwelle für Muskelneusynthese im Alter zu erreichen braucht es entweder 42 g Molke Protein oder 6.25 g Molke Protein mit 5 g Leucin (Devries et al. 2015) 42 g whey Devries MC, Phillips SM. J Food Sci 2015;80 Suppl 1:A8-A15.

27 Conclusion This 13-week intervention of a vitamin D and Leucine-enriched whey protein oral nutritional supplement (alone, without exercise) resulted in improvements in muscle mass and lower extremity function. Bauer J et al. JAMDA 2015;16:740-7.

28 Vitamin D and muscle function Institutionalized elderly Vitamin D : 150,000 IU per month for 2 months, then 90,000 IU per month for 4 months Moreira-Pfrimer et al. Ann Nutr Metab 2009

29 Mechanism of action Vitamin D Role of Vitamin D on muscle function : Barillaro C et al. THE NEW METABOLIC TREATMENTS FOR SARCOPENIA Aging Clin Exp Res 2013

30 Empfohlene Monatsdosis Vitamin D3: IU (800 IU/Tag)

31 Danke!