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. Check out more information at http://www.GoBeneVia.com/blog

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

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.