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Optimal Protein Intake & The Recommended Daily Allowance (RDA)

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Medical experts should consider minimal and optimal levels of protein intake for their patients. This presentation discusses the current RDA & how this affects the nutritional balance of a person's …

Medical experts should consider minimal and optimal levels of protein intake for their patients. This presentation discusses the current RDA & how this affects the nutritional balance of a person's well being.

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  • Despite popular perceptions, an analysis of government consumption data indicates most Americans are NOT over consuming proteinIn fact, research indicates people should increase high-quality protein intake to the higher end of the Acceptable Macronutrient Distribution Range (AMDR) to optimize health benefits
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    • 1. Presents
      Seminar Highlights from the Florida Dietetics Association Meeting
      July 13, 2010
      Orlando, FL
      Optimal Protein Intake and the RDA
      A Presentation Provided by The HealthSpan Institute and Continuing Education
      Programming from the Institute’s Medical Affairs Group
    • 2. Optimal Protein Intake and the RDA
      The Scientific Basis for the Benevia ® Product Portfolio and The Need for Superior High Leucine/Essential Amino Acid Protein Blends as Provided in all Benevia Clinical Nutrition Products.
    • 3. Optimal Protein Intake and the RDA
      Robert R. Wolfe, Ph.D.
      Professor, Geriatrics
      University of Arkansas for Medical Sciences
      Jul y 13, 2010. Orlando, Florida
      Florida Dietetics Association Annual Meeting
    • 4. Current Guidelines – Where Do They Come From?
      EAR
      Estimate Average Requirement
      RDA
      Recommended Dietary Allowance
      UL + LL
      Upper and Lower Limits
      AMDR
      Acceptable Macronutrient Distribution Range
      USDA Dietary Guidelines
      Other Factors
      Institute of Medicine
      Food and Nutrition Board
      Dietary Reference Intake (DRIs)
    • 5. N-Balance: The Primary Tool for Determining DRI
      N-balance determines the minimal amount of protein intake needed to avoid a progressive loss of body protein.
    • 6. 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
    • 7. Relation Between Recommended Dietary Allowance (RDA)andAcceptable Nutrient Distribution Range
    • 8. Acceptable Macronutrient Distribution Ranges
    • 9. Average Energy Requirement35 kcal / kg x day
      If protein intake =
      35% = 12.25 Kcal / kg x day
      = 3 gm protein / kg x day
      10% = 3.5 Kcal / kg x day
      = 0.89 gm protein / kg x day
    • 10. The RDA is Below the Minimal AMDR for Protein
    • 11. Implication of AMDRs:
      The optimal level of protein intake is greater than the minimal needed to avoid deficiency.
    • 12. We Should Consider Minimal and Optimal Levels of Protein Intake
    • 13. Protein Intake Greater than Minimal Requirements Primarily Targets Muscle
    • 14. Muscle Protein Plays a Central Role in Whole Body Protein Metabolism
    • 15. Fasted
      Amino
      Acids
      Gut
    • 16. Fasted + Stress
      Amino
      Acids
      Gut
    • 17. Fed
      Amino
      Acids
      Amino acids
      Gut
    • 18. Is Adequate Muscle Mass Important for Health?
    • 19. Midthigh Muscle Cross-Sectional Area Predicts Mortality in Patients with COPDMarquis et al, Am J Respir Care Med, 166: 809, 2002
    • 20. There is a threshold effect of loss of muscle and severity of stress.
    • 21. 21
      Mortality and Strength
      From Ruiz RJ, et al. BMJ 2008; 337(7661):92-95.
    • 22. Older individuals are much closer to the “danger threshold” than young people
    • 23. How Does Ingested Protein Affect Muscle Protein?
    • 24. PROTEINS
      Synthesis
      Breakdown
      AMINO ACIDS
      Oxidation
      CELL
      BLOOD
      Amino Acids
      Muscle Protein is in a Constant State of Turnover
    • 25.
    • 26. Protein intake stimulates growth of muscle protein
    • 27. Response to a Single Serving of Beef
    • 28. Dose Response to Protein Intake
      There is a maximal effective single dose response to protein intake.
    • 29. Does increased protein intake translate to more lean mass and improved health outcomes?
    • 30. 30
      Dietary Protein Intake and Change in LBM over 3 y in Elderly (n= 2066)
      From Houston DK et al. Am J Clin Nutr 2008; 87(1):150-155.
    • 31. Changes in Nutritional Status and Patterns of Morbidity among Free-Living Persons: a 10 year longitudinal studyVellas 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.
    • 32. Protein Intake and Cardiovascular Health
    • 33. Relative Risks (RR) of Ischemic Heart Disease in 80,082 Women
      From: Hu et al. Am J Clin Nutr 1999; 70:21-227.
    • 34. Protein Supplements (20g/day) Reduce Blood Pressure in Hypertension
      From: Townsend et al. Am J Hypertension 2004; 17:1056
    • 35. 35
      Protein Intake and Bone Health
      Protein under nutrition associated with low bone mineral density 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 hip fracture.
      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.
    • 36. Benefits of Protein Intake inWeight Management
      Thermogenesis
      Satiety
      Partitioning of nutrients to muscle
    • 37. How Much Protein Intake is “Optimal”
    • 38. Estimation of Optimal Protein Intake from Muscle Metabolism Studies
    • 39. Optimal Protein Intake from Metabolic Studies
      Maximal stimulation of muscle protein synthesis is achieved with 15 gm EAAs (≈35 gm protein).
      Recommended intake for 70 kg man:
      35 gm protein / meal x 3 meals / day
      = 105 gm protein
      = 1.5 gm protein / kg x day
    • 40. Optimal Intake vs RDA
      RDA = 0.8 gm protein / kg x day
      Recommended from Metabolic Studies
      = 1.5 gm protein / kg x day
    • 41. Dietary Recommendations
      Protein intake by age – NHANES, 2003-2004
      35
      30
      25
      1.5 g/kg/d
      20
      % Calories
      15
      Protein
      10
      5
      0
      2-3
      4-8
      9-13
      14-
      19-
      31-
      51-
      71+
      18
      30
      50
      70
      Years
      Dietary Guidelines
      Lower AMDR
      Upper AMDR
    • 42. Conditions Which May Increase the Optimal Level of Protein Intake
      Aging
      Muscle wasting (eg, cachexia, sarcopenia, etc.
      Acute response to injury, critical illness
      Diabetes
      Obesity
      Osteoporosis
      Exercise training
    • 43. Muscle Protein Synthesisin Cancer
    • 44. There was a significant interaction and group effect for leucine (P<0.001), but not for isoleucine, valine or phenylalanine. For all, a significant time effect was observed (P<0.01).
    • 45. Muscle protein fractional synthetic rate. A significant interaction was found for FSR (P=0.0269.
    • 46. What About the Kidney?
    • 47. “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
    • 48. Lean Body Mass Predicts Relative Risk of Death in ESRD
      Lowrie and Lew, AJKD, 1990
    • 49. From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.
      Effect of Dietary Protein Intake in Kidney Disease (n=585)
    • 50. From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888.
      Effect of Protein Intake on Incidence of Kidney Failure(A) and composite of Kidney Failure and All-Cause Mortality (B)
    • 51. ConclusionA relatively high proportion (20% or more of caloric intake) of protein intake benefits muscle and other health outcomes without significant health risks.

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