A.M. Verreijen

A high whey protein–, leucine-, and vitamin D–enriched supplement preserves muscle mass during intentional weight loss in obese older adults: a double-blind randomized controlled trial

BACKGROUND Intentional weight loss in obese older adults is a risk factor for muscle loss and sarcopenia. OBJECTIVE The objective was to examine the effect of a high whey protein-, leucine-, and vitamin D-enriched supplement on muscle mass preservation during intentional weight loss in obese older adults. DESIGN We included 80 obese older adults in a double-blind randomized controlled trial. During a 13-wk weight loss program, all subjects followed a hypocaloric diet (-600 kcal/d) and performed resistance training 3×/wk. Subjects were randomly allocated to a high whey protein-, leucine-, and vitamin D-enriched supplement including a mix of other macro- and micronutrients (150 kcal, 21 g protein; 10×/wk, intervention group) or an isocaloric control. The primary outcome was change in appendicular muscle mass. The secondary outcomes were body composition, handgrip strength, and physical performance. Data were analyzed by using ANCOVA and mixed linear models with sex and baseline value as covariates. RESULTS At baseline, mean ± SD age was 63 ± 5.6 y, and body mass index (in kg/m(2)) was 33 ± 4.4. During the trial, protein intake was 1.11 ± 0.28 g · kg body weight(-1) · d(-1) in the intervention group compared with 0.85 ± 0.24 g · kg body weight(-1) · d(-1) in the control group (P < 0.001). Both intervention and control groups decreased in body weight (-3.4 ± 3.6 kg and -2.8 ± 2.8 kg; both P < 0.001) and fat mass (-3.2 ± 3.1 kg and -2.5 ± 2.4 kg; both P < 0.001), with no differences between groups. The 13-wk change in appendicular muscle mass, however, was different in the intervention and control groups [+0.4 ± 1.2 kg and -0.5 ± 2.1 kg, respectively; β = 0.95 kg (95% CI: 0.09, 1.81); P = 0.03]. Muscle strength and function improved over time without significant differences between groups. CONCLUSION A high whey protein-, leucine-, and vitamin D-enriched supplement compared with isocaloric control preserves appendicular muscle mass in obese older adults during a hypocaloric diet and resistance exercise program and might therefore reduce the risk of sarcopenia. This trial was registered at the Dutch Trial Register (http://www.trialregister.nl) as NTR2751.

OP019 EXPLORATION OF WHAT LEVEL OF PROTEIN IS NEEDED FOR MUSCLE MASS ACCRETION DURING WEIGHT LOSS WITH RESISTANCE TRAINING IN OBESE ELDERLY

Rationale: Recent studies from our laboratory have indicated that glycine represents an effective anti-inflammatory agent that attenuates muscle loss in tumour-bearing mice. However, it remains to be established whether glycine affects skeletal muscle directly. The aim was to investigate how muscle cell health, metabolism and inflammation are affected by glycine. Methods: After differentiation, C2C12 myotubes were incubated with either 2.5mM glycine or 2.5mM alanine and exposed to 1) lipopolysaccharide (LPS, 1mg/mL) for 24 h to induce an inflammatory response and wasting; or 2) serum free media (SFM) for 48 h to induce wasting. Myotube diameter was assessed and changes in intracellular [Ca2+] were monitored by loading cells with Fluo-4/AM and imaging using confocal microscopy Protein synthesis was determined using SunSET methodology. Insulin-mediated glucose uptake was determined using fluorescent deoxyglucose and anabolic signalling was assessed using routine western blot analyses. One way ANOVA was used to identify differences between groups. Results: Serum withdrawal reduced protein synthesis in myotubes by 25% (P < 0.05). Interestingly, glycine treatment completely prevented this decrease. LPS-treated myotubes were 25% smaller, had an 80% higher intracellular [Ca2+], and a 40% reduction in insulin-mediated glucose uptake compared with control cells (P < 0.05). Glycine treatment reduced the loss of myotube diameter by 50% and improved insulinmediated glucose uptake and Akt phosphorylation by 40% and 10%, respectively (P < 0.05). Conclusion: Glycine protects muscle cells from various catabolic stimuli in vitro, thereby maintaining protein synthesis, anabolic signalling and insulin-mediated glucose transport. These findings suggest a direct protective effect of glycine on skeletal muscle.

Exercise and Nutrition Strategies to Counteract Sarcopenic Obesity

As the population is aging rapidly, there is a strong increase in the number of individuals with chronic disease and physical limitations. The decrease in skeletal muscle mass and function (sarcopenia) and the increase in fat mass (obesity) are important contributors to the development of physical limitations, which aggravates the chronic diseases prognosis. The combination of the two conditions, which is referred to as sarcopenic obesity, amplifies the risk for these negative health outcomes, which demonstrates the importance of preventing or counteracting sarcopenic obesity. One of the main challenges is the preservation of the skeletal muscle mass and function, while simultaneously reducing the fat mass in this population. Exercise and nutrition are two key components in the development, as well as the prevention and treatment of sarcopenic obesity. The main aim of this narrative review is to summarize the different, both separate and combined, exercise and nutrition strategies so as to prevent and/or counteract sarcopenic obesity. This review therefore provides a current update of the various exercise and nutritional strategies to improve the contrasting body composition changes and physical functioning in sarcopenic obese individuals.

Oral Communication III: Nutritional Assessment, Epidemiology and FormulationsOR25: Validity of Predictive Equations for Resting Energy Expenditure for Overweight Older Adults with and without Diabetes

Rationale: Predictive equations for resting energy expenditure (REE) are used in the treatment of overweight and obesity, but the validity of these equations in overweight older adults is unknown. This study evaluates which predictive REE equation is the best alternative to indirect calorimetry in overweight older adults with and without diabetes. Methods: In total 273 adults aged ≥55 years with a BMI of ≥25 kg/m2 were included. REE (by indirect calorimetry), body weight, body height, age, gender, and fat-free and fat mass (from air-displacement plethysmography) were measured. The measured REE was used as a reference and compared with 28 existing REE equations. The accuracy of the equations was evaluated by the percentage accurate predictions (within 10% of REE measured), the root mean squared error (RMSE), and the mean percentage difference (bias) between predicted and measured REE. Subgroup analyses were performed for type 2 diabetics (T2D) and non-T2D. Results: Mean age was 64 ± (SD 6) years, 42% had T2D (n = 116), and mean BMI was 32.8 ± (SD 4.5) with range 25–54 kg/m2. The adjusted Harris & Benedict (1984) provided the highest percentage accurate predictions in all adults (70%) and in T2D (74%), and second best in non-T2D (67%). RMSE was 184, 175 and 191 kcal/day, and bias −1.2%, −1.5% and −1.0% for all adults, T2D and non-T2D, respectively. Conclusion: For Dutch overweight older adults with and without diabetes the adjusted Harris–Benedict (1984) predictive equation for REE seems to be the best alternative to indirect calorimetry.

MON-P144: Energy Intake and Expenditure in Obese Older Adults with and Without Type 2 Diabetes

Rationale: Obesity is a risk factor for type 2 diabetes (DM2), however not all obese people develop DM2. We explored differences in energy intake and expenditure between obese older adults with and without DM2. Methods: Baseline data from 2 lifestyle interventions with a total of 202 obese older adults were included in the analyses. Obesity was defined as BMI > 30.0, or >27.0 with waist circumference >88 (women) or >102 cm (men). DM2 was confirmed by use of diabetes medication. Subjects were between 55 and 85 years old and 45% was female. Energy intake (EI) was measured by 3-day food diary and physical activity level (PAL) by 3-day movement diary. Resting energy expenditure (REE) was measured using indirect calorimetry and total energy expenditure (TEE) was calculated as REE x PAL. Between group differences were analysed with independent samples T-tests. Results: The obese group with DM2 (n = 117) had more males (67.5% vs 37.6% p < 0.001) and similar BMI (33.3 vs 33.0 kg/m2) compared to the group without DM2 (n = 85). Analyses of males and females separately showed lower PAL in males with DM2 (vs without DM2; 1.37 vs 1.45, p = 0.015), without differences in EI (2055 vs 1953 kcal/d), REE (1970 vs 1929 kcal/d), and TEE (2699 vs 2830 kcal/d). In females with DM2, both PAL (1.38 vs 1.47, p = 0.014) and EI (1543 vs 1839 kcal/d, p = 0.008) were significantly lower, whereas REE (1592 vs 1598 kcal/d) and TEE (2220 vs 2318 kcal/d) did not differ significantly from obese females without DM2. Conclusion: In both males and females, obese older adults with type 2 diabetes showed similar resting and total energy expenditure but lower physical activity level compared to those without DM2. Females with DM2 showed lower energy intake. On average, subjects seem to have a negative energy balance, which is probably due to a combination of underreporting of intake and over-reporting of activity.

MON-PP209: Effect of a High Protein Diet and/or Resistance Exercise on Preservation of Fat Free Mass During Weight Loss in Overweight Older Adults: a Randomized Controlled Trial

Correspondence a.verreijen@hva.nl, Amely Verreijen, MSc., School of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, 1067 AM, Amsterdam, Netherlands Conclusion Although the targeted high protein diet was not completely achieved, the contrast of 23 gram protein per day had no effect on changes in FFM and FM during weight loss in older overweight subjects. Supervised resistance exercise increased the loss of relative FM but had no effect on FFM. However, in the group receiving the protein and exercise combination a significant increase in FFM was observed. Results At baseline, mean±SD BMI was 32±4 kg/m2. During intervention, protein intake was 1.15±0.27 g/kg in the protein groups vs. 0.93±0.19 g/kg in the non-protein groups, corresponding to a 23±5 g/day (p<0.001) higher protein intake. Mean adherence to the exercise program was 2.8±0.3 times/week. No interaction was observed between protein*exercise for all outcomes. Overall, subjects lost weight (-3.1±2.8 kg, p<0.01) without significant between-group effects, and had no significant change in FFM (+0.4±1.9 kg, p=0.12). Effects of protein and effects of exercise on body composition are displayed in the Table and Figure. Table: Outcome measures for protein vs. non-protein groups and for exercise vs. non-exercise groups in means ± SD. Protein (n=40) Non-protein (n=32) Protein effect