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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 well being.

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Optimal Protein Intake & The Recommended Daily Allowance (RDA)

  1. 1. Presents<br />Seminar Highlights from the Florida Dietetics Association Meeting<br /> July 13, 2010<br /> Orlando, FL<br />Optimal Protein Intake and the RDA<br />A Presentation Provided by The HealthSpan Institute and Continuing Education <br /> Programming from the Institute’s Medical Affairs Group<br />
  2. 2. Optimal Protein Intake and the RDA<br />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.<br />
  3. 3. Optimal Protein Intake and the RDA<br />Robert R. Wolfe, Ph.D.<br />Professor, Geriatrics<br />University of Arkansas for Medical Sciences<br />Jul y 13, 2010. Orlando, Florida<br />Florida Dietetics Association Annual Meeting<br />
  4. 4. Current Guidelines – Where Do They Come From?<br />EAR<br />Estimate Average Requirement<br />RDA<br />Recommended Dietary Allowance<br />UL + LL<br />Upper and Lower Limits<br />AMDR<br />Acceptable Macronutrient Distribution Range<br />USDA Dietary Guidelines<br />Other Factors<br />Institute of Medicine<br />Food and Nutrition Board<br />Dietary Reference Intake (DRIs)<br />
  5. 5. N-Balance: The Primary Tool for Determining DRI<br />N-balance determines the minimal amount of protein intake needed to avoid a progressive loss of body protein.<br />
  6. 6. Current Recommendations<br />EAR - 0.66 gm protein / kg x day<br />RDA - 0.80 gm protein / kg x day<br />UL + LL - No Recommendations<br />AMDR - 10-35% of Energy of Intake<br />Taken from DRIs<br />
  7. 7. Relation Between Recommended Dietary Allowance (RDA)andAcceptable Nutrient Distribution Range<br />
  8. 8. Acceptable Macronutrient Distribution Ranges<br />
  9. 9. Average Energy Requirement35 kcal / kg x day<br />If protein intake =<br /> 35% = 12.25 Kcal / kg x day<br /> = 3 gm protein / kg x day<br /> 10% = 3.5 Kcal / kg x day<br /> = 0.89 gm protein / kg x day<br />
  10. 10. The RDA is Below the Minimal AMDR for Protein<br />
  11. 11. Implication of AMDRs:<br />The optimal level of protein intake is greater than the minimal needed to avoid deficiency.<br />
  12. 12. We Should Consider Minimal and Optimal Levels of Protein Intake<br />
  13. 13. Protein Intake Greater than Minimal Requirements Primarily Targets Muscle<br />
  14. 14. Muscle Protein Plays a Central Role in Whole Body Protein Metabolism<br />
  15. 15. Fasted<br />Amino <br />Acids<br />Gut<br />
  16. 16. Fasted + Stress<br />Amino <br />Acids<br />Gut<br />
  17. 17. Fed<br />Amino <br />Acids<br />Amino acids<br />Gut<br />
  18. 18. Is Adequate Muscle Mass Important for Health?<br />
  19. 19. Midthigh Muscle Cross-Sectional Area Predicts Mortality in Patients with COPDMarquis et al, Am J Respir Care Med, 166: 809, 2002<br />
  20. 20. There is a threshold effect of loss of muscle and severity of stress.<br />
  21. 21. 21<br /> Mortality and Strength<br />From Ruiz RJ, et al. BMJ 2008; 337(7661):92-95.<br />
  22. 22. Older individuals are much closer to the “danger threshold” than young people<br />
  23. 23. How Does Ingested Protein Affect Muscle Protein?<br />
  24. 24. PROTEINS<br />Synthesis<br />Breakdown<br /> AMINO ACIDS<br />Oxidation<br />CELL<br />BLOOD<br />Amino Acids<br />Muscle Protein is in a Constant State of Turnover<br />
  25. 25.
  26. 26. Protein intake stimulates growth of muscle protein<br />
  27. 27. Response to a Single Serving of Beef<br />
  28. 28. Dose Response to Protein Intake<br />There is a maximal effective single dose response to protein intake.<br />
  29. 29. Does increased protein intake translate to more lean mass and improved health outcomes?<br />
  30. 30. 30<br />Dietary Protein Intake and Change in LBM over 3 y in Elderly (n= 2066)<br />From Houston DK et al. Am J Clin Nutr 2008; 87(1):150-155.<br />
  31. 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.<br />304 subjects, age 72 at start<br />Results: <br />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.<br />
  32. 32. Protein Intake and Cardiovascular Health<br />
  33. 33. Relative Risks (RR) of Ischemic Heart Disease in 80,082 Women<br />From: Hu et al. Am J Clin Nutr 1999; 70:21-227.<br />
  34. 34. Protein Supplements (20g/day) Reduce Blood Pressure in Hypertension<br />From: Townsend et al. Am J Hypertension 2004; 17:1056<br />
  35. 35. 35<br />Protein Intake and Bone Health<br />Protein under nutrition associated with low bone mineral density and greater fracture risk.<br /> Geinoz G, et al. Osteoporos Int 1993; 3:242-248.<br /> Heany RP. Am J Clin Nutr 2002; 75:509<br />Protein supplementation improves outcome after hip fracture.<br /> Bonjou JP, et al. Bone 1996; 18:139S.<br /> Tkatch L, et al. J Am Coll Nur 1992; 11:519.<br /> Frost HM. J Bone Min Res 1997; 12:1-9.<br />
  36. 36. Benefits of Protein Intake inWeight Management<br />Thermogenesis<br />Satiety<br />Partitioning of nutrients to muscle<br />
  37. 37. How Much Protein Intake is “Optimal”<br />
  38. 38. Estimation of Optimal Protein Intake from Muscle Metabolism Studies<br />
  39. 39. Optimal Protein Intake from Metabolic Studies<br />Maximal stimulation of muscle protein synthesis is achieved with 15 gm EAAs (≈35 gm protein).<br />Recommended intake for 70 kg man:<br /> 35 gm protein / meal x 3 meals / day<br /> = 105 gm protein<br /> = 1.5 gm protein / kg x day<br />
  40. 40. Optimal Intake vs RDA<br />RDA = 0.8 gm protein / kg x day<br />Recommended from Metabolic Studies<br /> = 1.5 gm protein / kg x day<br />
  41. 41. Dietary Recommendations<br />Protein intake by age – NHANES, 2003-2004<br />35<br />30<br />25<br />1.5 g/kg/d <br />20<br />% Calories<br />15<br />Protein<br />10<br />5<br />0<br />2-3<br />4-8<br />9-13<br />14-<br />19-<br />31-<br />51-<br />71+<br />18<br />30<br />50<br />70<br />Years<br />Dietary Guidelines<br />Lower AMDR<br />Upper AMDR<br />
  42. 42. Conditions Which May Increase the Optimal Level of Protein Intake<br />Aging<br />Muscle wasting (eg, cachexia, sarcopenia, etc.<br />Acute response to injury, critical illness<br />Diabetes<br />Obesity<br />Osteoporosis<br />Exercise training<br />
  43. 43. Muscle Protein Synthesisin Cancer<br />
  44. 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).<br />
  45. 45. Muscle protein fractional synthetic rate. A significant interaction was found for FSR (P=0.0269.<br />
  46. 46. What About the Kidney?<br />
  47. 47. “There is no evidence that higher protein intakes cause renal failurein healthy individuals”<br />Institute of Medicine. Dietary Reference Intakes for Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C.: National Academy Press; 2005<br />
  48. 48. Lean Body Mass Predicts Relative Risk of Death in ESRD<br />Lowrie and Lew, AJKD, 1990<br />
  49. 49. From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888. <br />Effect of Dietary Protein Intake in Kidney Disease (n=585)<br />
  50. 50. From Levey AS, et al. Am J Kid Disease 2006; 48(6):878-888. <br />Effect of Protein Intake on Incidence of Kidney Failure(A) and composite of Kidney Failure and All-Cause Mortality (B)<br />
  51. 51. ConclusionA relatively high proportion (20% or more of caloric intake) of protein intake benefits muscle and other health outcomes without significant health risks.<br />

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