Optimal Protein Intake and the Recommended Daily Allowance (RDA)

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    Optimal Protein Intakeand the RDA

    Presents

    Seminar Highlights from the Florida DieteticsAssociation Meeting

    July 13, 2010

    Orlando, FL

    A Presentation Provided by The HealthSpan Institute andContinuing Education

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    Optimal Protein Intakeand the RDA

    The Scientific Basis for the Benevia ProductPortfolio and The Need for Superior HighLeucine/Essential Amino Acid Protein Blends asProvided in all Benevia Clinical NutritionProducts.

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    Optimal Protein Intake

    and the RDA

    Robert R. Wolfe, Ph.D.

    Professor, GeriatricsUniversity of Arkansas for Medical Sciences

    Jul y 13, 2010. Orlando, Florida

    Florida Dietetics Association Annual Meeting

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    Current Guidelines Where Do They Come From?

    Institute of Medicine

    Food and Nutrition Board

    Dietary Reference Intake (DRIs)

    EAR

    Estimate

    AverageRequirement

    RDA

    Recommend

    ed DietaryAllowance

    UL + LL

    Upper and

    LowerLimits

    AMDR

    Acceptable

    MacronutrientDistribution

    Range

    USDA Dietary GuidelinesOther

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    N-Balance: The Primary

    Tool for Determining DRI

    N-balance determines the minimalamount of protein intake needed toavoid a progressive loss of body

    protein.

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    Current Recommendations

    EAR- 0.66 gm protein / kg x day

    RDA- 0.80 gm protein / kg x day

    UL + LL - No Recommendations

    AMDR - 10-35% of Energy of Intake

    Taken from DRIs

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    Relation Between

    Recommended DietaryAllowance (RDA)and

    Acceptable NutrientDistribution Range

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    Acceptable MacronutrientDistribution Ranges

    Range (% of energy)

    Macronutrient Children, 1-3 y Children, 4-18 y Adults

    Fat 30-40 25-35 20-35n-6 polyunsaturated fats

    (linoleic acid)5-10 5-10 5-10

    n-3 polyunsaturated fats*(-linolenic acid)

    0.6-1.2 0.6-1.2 0.6-1.2

    Carbohydrate 45-65 45-65 45-65Protein 5-20 10-30 10-35

    SOURCE: IOM (2002a).

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    Average Energy Requirement

    35 kcal / kg x dayIf protein intake =

    35% = 12.25 Kcal / kg x day

    = 3gm protein / kg x day

    10% = 3.5 Kcal / kg x day

    = 0.89 gm protein / kg x day

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    The RDA is Below the

    Minimal AMDR for Protein

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    Implication of AMDRs:

    The optimal level of protein intakeis greater than the minimal needed

    to avoid deficiency.

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    We Should ConsiderMinimal and Optimal Levels

    of Protein Intake

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    Protein Intake Greater thanMinimal Requirements

    Primarily Targets Muscle

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    Muscle Protein Plays aCentral Role in Whole Body

    Protein Metabolism

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    Fasted

    AminoAcids

    Gut

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    AminoAcids

    Gut

    Fasted + Stress

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    AminoAcids

    Fed

    Aminoacid

    s

    Gut

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    Is Adequate Muscle Mass

    Important for Health?

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    Midthigh Muscle Cross-Sectional Area PredictsMortality in Patients with COPD

    Marquis et al, Am J Respir Care Med, 166: 809, 2002

    Click to edit Master text stylesSecond level

    Third level Fourth level

    Fifth level

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    There is a threshold effect of

    loss of muscle and severity ofstress.

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    21

    Mortality and Strength

    From Ruiz RJ, et al. BMJ 2008; 337(7661):92-95.

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    Older individuals are much

    closer to the dangerthreshold than young people

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    How Does Ingested ProteinAffect Muscle Protein?

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    Muscle Protein is in a ConstantState of Turnover

    AMINO ACIDS

    CELL

    BLOOD

    AminoAcids

    PROTEINS

    Oxidation

    SynthesisBreakdown

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    Protein intake stimulates

    growth of muscle protein

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    Response to a Single Serving of Beef

    0

    0.02

    0.04

    0.06

    0.08

    0.1

    0.12

    0.14

    0.16

    0.18

    0.2

    Basal 4 oz Basal 12 oz

    MuscleProteinS

    ynthesis%/h

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    Dose Response to Protein Intake

    There is a maximal effective singledose response to protein intake.

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    Does increased protein intake

    translate to more lean massand improved healthoutcomes?

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    Dietary Protein Intake and Change inLBM over 3 y in Elderly (n= 2066)

    From Houston DK et al. Am J Clin Nutr 2008; 87(1):150-155.

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    Changes in Nutritional Status and Patternsof Morbidity among Free-Living Persons: a

    10 year longitudinal study

    Vellas BJ, et al. Nutrition 1997; 13:505-519.

    304 subjects, age 72 at start

    Results:Subjects with protein intakes greater than 1.2 g / kg day had fewer health problems over 10 years than

    those with protein intakes less than 0.8 g / kg day.

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    Protein Intake and

    Cardiovascular Health

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    Relative Risks (RR) of IschemicHeart Disease in 80,082 Women

    1 2 3 4 5

    Total Protein Intake 14.7 17.1 18.8 20.6 24.0

    Multivariable RR 1.0 0.86 0.84 0.91 0.72

    From: Hu et al. Am J Clin Nutr 1999; 70:21-227.

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    Protein Supplements (20g/day) ReduceBlood Pressure in Hypertension

    -14

    -12

    -10

    -8

    -6

    -4

    -2

    0

    Systolic Pressure Diastolic Pressure

    From: Townsend et al. Am J Hypertension 2004; 17:1056

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    Protein Intake and Bone Health

    Protein under nutrition associated with low bone mineraldensity and greater fracture risk.

    Geinoz G, et al. Osteoporos Int 1993; 3:242-248.

    Heany RP. Am J Clin Nutr 2002; 75:509

    Protein supplementation improves outcome after hipfracture.

    Bonjou JP, et al. Bone 1996; 18:139S.

    Tkatch L, et al. J Am Coll Nur 1992; 11:519.

    Frost HM. J Bone Min Res 1997; 12:1-9.

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    Benefits of Protein Intake inWeight Management

    Thermogenesis

    Satiety

    Partitioning of nutrients to muscle

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    How Much Protein Intake is

    Optimal

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    Estimation of Optimal

    Protein Intake from MuscleMetabolism Studies

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    Optimal Protein Intake fromMetabolic Studies

    Maximal stimulation of muscle protein synthesis isachieved with 15 gm EAAs (35 gm protein).

    Recommended intake for 70 kg man:

    35 gm protein / meal x 3 meals / day

    = 105 gm protein

    = 1.5gm protein / kg x day

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    Optimal Intake vs RDA

    RDA = 0.8 gm protein / kg x day

    Recommended from Metabolic Studies

    = 1.5 gm protein / kg x day

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    Dietary Recommendations

    Protein intake by age NHANES, 2003-2004

    Dietary GuidelinesLower AMDR Upper AMDR

    1.5 g/kg/d

    0

    5

    10

    15

    20

    25

    30

    35

    %

    Calories

    2-3 4-8 9-13 14-18

    19-30

    31-50

    51-70

    71+

    Years

    Protein

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    Conditions Which May Increase the

    Optimal Level of Protein Intake

    Aging

    Muscle wasting (eg, cachexia, sarcopenia, etc.Acute response to injury, critical illness

    Diabetes

    ObesityOsteoporosis

    Exercise training

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    Muscle Protein Synthesis

    in Cancer

    pLeu

    500

    pIle

    200

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    0 30 60 90

    120

    150

    180

    210

    240

    270

    300

    0

    100

    200

    300

    400

    500EXP

    Control

    Time (min)

    M

    0 30 60 90

    120

    150

    180

    210

    240

    270

    300

    0

    50

    100

    150

    200EXP

    Control

    Time (min)

    M

    pVal

    0 30 60 90 120

    150

    180

    210

    240

    270

    300

    0

    100

    200

    300

    400EXP

    Control

    Time (min)

    M

    pPhe

    0 30 60 90 120

    150

    180

    210

    240

    270

    300

    0

    50

    100

    150EXP

    Control

    Time (min)

    M

    There was a significant interaction and group effect for leucine (P

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    meanFSR%

    Postab

    sorptiv

    eFe

    d

    Delta

    -0.05

    0.00

    0.05

    0.10

    0.15Control

    EXP

    %hour

    Muscle protein fractional synthetic rate. A significant interaction was found for FSR (P=0.0269.

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    What About the Kidney?

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    There is no evidence that higher

    protein intakes cause renal failurein healthy individuals

    Institute of Medicine. Dietary Reference Intakes

    for Carbohydrate, Fiber, Fat, Fatty Acids,

    Cholesterol, Protein, and Amino Acids.

    Washington, D.C.: National Academy Press; 2005

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    Lean Body Mass

    Predicts Relative Risk of Death in ESRD

    Lowrie and Lew, AJKD, 1990

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    Effect of Dietary Protein Intake inKidney Disease (n=585)

    From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.

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    Effect of ProteinIntake on Incidence

    of Kidney Failure(A) and compositeof Kidney Failure

    and All-CauseMortality (B)

    From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.

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    Conclusion

    A relatively high proportion (20% ormore of caloric intake) of protein intakebenefits muscle and other health

    outcomes without significant healthrisks.