Whey Protein Supplementation as a Strategy to Preserve Muscle Mass and Increase Protein Synthesis in the Elderly: A Review of Literature

Celine de Carvalho Furtado1; Império Lombardi2

Whey Protein Supplementation as a Strategy to Preserve Muscle Mass and Increase Protein Synthesis in the Elderly: A Review of Literature

Celine de Carvalho Furtado^1*, Império Lombardi²

¹Department of Health Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, Brazil

²Department of Human Movement Science, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, Brazil

^*Corresponding author: Celine de Carvalho Furtado, Department of Health Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, Brazil. Tel: +55-1332024100; Email: celine_carvalho@yahoo.com.br

Received Date:14 August, 2018; Accepted Date: 08 October, 2018; Published Date:15 October, 2018

Citation: Furtado CC, Lombardi I (2018) Whey Protein Supplementation as a Strategy to Preserve Muscle Mass and Increase Protein Synthesis in the Elderly: A Review of Literature. J Aging Neuro Psychol: JANP-114. DOI: 10.29011/JANP-114.100014

1. Abstract

1.1. Introduction: Aging often coincides with loss of muscle mass, strength and function, known as sarcopenia. Sarcopenia, a geriatric syndrome closely linked to physical frailty, has a substantial impact on the quality of life. Inadequate dietary intake, especially protein intake, has been associated with decreased lean body mass. Dietary protein affects muscle mass by the stimulation of muscle protein synthesis after absorption of amino acids into muscle cells

1.2. Aims: Verify the effectiveness of whey protein supplementation in increasing protein synthesis and muscle mass in elderly.

1.3. Methods: This is a systematic review conduced in the pub med database, which sought clinical trials published between 2012 and 2016, with the combination of descriptors: Whey protein, muscle mass, protein synthesis, sarcopenia.

1.4. Results: We found 30 articles and after exclusion of non-relevant issues and duplicate articles were included 11 articles in this study. Of the selected material, 3 studies did not find positive effects with supplementation, this null response could have occurred because of dose and/or timing of supplementation, 1 study found the same effect with leucine supplementation and 7 studies found positive effects with whey proteinsupplementationfor the protein synthesis and the increase of lean body mass in the elderly.

1.5. Conclusions: Therefore, we can conclude that supplementation of whey protein shows positive results for increased protein synthesis and muscle mass in the elderly. However, the results differ between the sexes, quantity and timing of consumption, which after the need of new studies for the best understanding of the subject. It seems that the elderly respond best to higher amounts of supplement and the periods more distant from the practice of resistive exercise. In addition, after reviewing the articles it appears that men present better results than women do. The results give us another option to maintain the independence and quality of the elderly.

2. Keywords: Muscle Mass; Protein Synthesis; Sarcopenia; Whey Protein

1. Introduction

Based on demographic extrapolations, the number of elderly citizens above the age of 65 years will increase in the next three decades by 50-200 %, with the specific proportion being dependent on country [1].

Aging often coincides with loss of muscle mass, strength and function, known as sarcopenia. Sarcopenia, a geriatric syndrome closely linked to physical frailty, has a substantial impact on the quality of life of the individual and increases the risk of disability and hospitalization [2]. Sarcopenia takes place at an annual rate of up to 1-2 % starting in the sixth decade of life [3]. The impact of sarcopenia progression may become detrimental to an individual’s personal life and autonomy, and the societal implications are vast when one considers future healthcare and nursing expenditures [4].

Because of the aging muscle becoming less sensitive to daily anabolic stimuli due to protein intake and muscular activity, it is suggested that exactly these two factors possess a high potential to antagonize sarcopenia [5]. Inadequate dietary intake, especially protein intake, has been associated with decreased lean body mass [6]. Dietary protein affects muscle mass by the stimulation of Muscle Protein Synthesis (MPS) after absorption of amino acids into muscle cells [7].This brief increase in MPS above post absorptive rates serves the purpose of replenishing protein stores lost during fasting, ensuring preservation of muscle protein mass [8].With regard to protein intake, cohort studies strongly suggest an association between high protein intake and decreased rates of age-dependent decline in physical performance and reduced risk of frailty [9].

Whey protein, a fast-acting protein that is quickly digested and becomes fast-absorbing peptides and amino acids, can potentially be the most effective in maintaining adequate anabolic/catabolic balance in the musculature of elderly individuals [10]. Research has shown a superiority of whey protein in enhancing muscle protein synthesis compared with other protein sources in older adults [11]. The purpose of study was verifying the effectiveness of whey protein supplementation in increasing protein synthesis and muscle mass in elderly.

2. Methods

This is a review conduced in the pub med database, which sought clinical trials published between 2012 and 2016, with the combination of descriptors: Whey protein, muscle mass, protein synthesis, sarcopenia.

2.1. Inclusion criteria

Be published in English with humans Age more than 65 years

2.2. Exclusion criteria

Not full text Disabling Diseases Chronic obstructive pulmonary disease.

3. Results

We found 30 articles, after exclusion of non-relevant issues and duplicate articles were included 11 articles in this study which are described in (Table 1).

4. Discussion

As demonstrated in results, we can verify that only 4 researches [8,12,14,19] did not find positive effects for the gain of muscular mass in the elderly with the supplementation of whey protein. Some of these results can be explained for the low dose used in some of them (20g.), or the timing for supplementation (immediately of exercise).

According Paddon-Jones D., Rasmussen B. B, [21] to counteract protein catabolism, the elderly must increase the anabolic stimulus, consuming 30 g protein/meal. With advancing age, an impaired and/or delayed response to the anabolic effects of hyperaminoacidemia and resistance exercise has been seen (Kumar V., et al 2009) [22].

Although some authors mentioned positive effects of whey protein supplementation in the elderly without the presence of physical exercises [18], other studies investigating protein supplementation in combination with exercise have been mixed [23].

In the 7 positive results we can verify that whey protein was responsible for a greater loss of body fat and improved preservation of muscle mass, in an obese elderly group [13]. A recently meta-analysis demonstrates favorites results for reduction of fat mass, comparing groups controls and groups with whey protein supplementation [24], protein source is an important factor in the success of these weight-loss interventions. For example, ingestion of whey protein throughout the day, along with an ad libitum diet independent of caloric restriction, may mediate the increased satiety and enhanced body weight loss and composition changes compared with isoenergetic soy or Carbohydrate (CHO) [25], additionally, recent findings provide compelling, new data in support of beginning and ending the day with a 20- to 30-g protein feeding to reduce abdominal fat and favorably alter adipokines [26,27], concludes the whey protein supplementation can reduce fat free mass loss due to low-calorie diets and prevent sarcopenia in obese adults.

Whey protein supplementation also increased muscle mass, functionality, strength besides reducing inflammatory markers and catabolic mediators [17,18] a growing body of evidence supports an enhanced rate of protein synthesis (muscle and whole body) from protein ingestion at rest and during exercise [28,29], Kirsten E. Bell, et al. [30] also reported that consumption of a whey protein-based, multi-ingredient supplement resulted in significant gains in muscle strength and lean mass.

Pal S, Ellis V, also demonstrated it, [31] a reduction of pro-inflammatory cytokines may be associated with reduction of body weight gain after consumption of whey protein and it amino acids.

Finally, when was compared whey protein with E.A.A, in regards to improved muscle strength and functionality, whey protein was more effective [15,20].Cruz-Jentoft, A.J, Morley J.E, Ebrary, I., 2012 and Makanae Y, Fujita S., 2015 [32,33]reported that leucine alsocan activate the mTORC1 signaling pathway to increase the rate of MPS and hypertrophy.

5. Conclusions

Therefore, we can conclude that supplementation of whey protein shows positive results for increased protein synthesis and muscle mass in the elderly. However, the results differ between the sexes, quantity and timing of consumption, which after the need of new studies for the best understanding of the subject. It seems that the elderly respond best to higher amounts of supplement and the periods more distant from the practice of resistive exercise, whichis attributed to the process of anabolic resistance present in individuals of this age. In addition, after reviewing the articles it appears that men present better results than women do.

The results give us another option to maintain the independence and quality of the elderly.Further studies should be done in this specific population so that we can have all the answers about this effect and the safety of the product.

6. Acknowledgments: capes for funding the research; UNIFESP for opportunity of Phd; UNILUS for professional opportunity.

7. Conflate of Interest: not disclose.

Authors/ year	Design of study	Characteristics of participants	Interventions	Variables of interesting	Conclusions
Authors/ year	Design of study	Characteristics of participants	Interventions	Variables of interesting	Conclusions
BURD NA, et al. 2012 [12]	Clinical trial	14 elderly men	1 session of Resistance exercise, supplementation of 20g of micellar casein or isolated whey protein	Myofibrillar protein synthesis	The ingestion of isolated whey proteinsupports greater rates of myofibrillar protein synthesis than micellar casein.
CHALÉ A, et al. 2013[8]	Clinical trial, double blind, controlled	80 older adults with mobility-limited	6 months of progressive resistance training, 3 times a week, 40g of whey protein concentrated or an isocaloric drink, in 2 times a day (morning and evening)	Lean mass, mid-thigh muscle cross-sectional area, muscle strength and stair-climbing performance	They suggest the whey protein concentrated supplementation at this dose not offer additional benefit to the effects of resistance training.
COKER RH, et al. 2012 [13]	Clinical trial, randomized	12 Males and females, 65-80 years, obese	Caloric-restriction (7% weight loss), Whey protein + essential amino acid supplementation or competitive meal replacement, 5 times/day for 8 weeks	Biopsies of the vastuslateralis, Skeletal muscle protein synthesis	Whey protein + essential amino acids during a caloric restriction-induced weight loss promotes the preferential reduction of adipose tissue and modest loss of lean tissue.
ARNARSON A, et al. 2013 [14]	Clinical trial, randomized, controlled, double-blind	161 men and women, 65-91 years	12 weeks of resistance exercise program, 3 times a week and supplementation of 20g of whey protein or isocaloric carbohydrate	Body composition (DEXA), physical function, Strength, dietary intake	The ingestion of 20g of whey protein immediately resistanceexercise, not lead to greater gains in lean body mass, strength and physical function in elderly with sufficient energy and protein intake.
LUIKING YC, et al. 2014 [15]	Clinical trial, randomized, controlled, double-blind	20 older adults, > 60 years	1 session of unilateral leg resistance exercise protocol, supplementation of 1 single dose of 200 ml of a high whey protein, leucine-enriched or a isocaloric drink (milk)	Body composition (DEXA), muscle biopsies, muscle protein synthesis	Ingestion of a high whey protein, leucine-enriched supplement resulted in a larger overall postprandialmuscle protein synthesis rates.
BUKHARI SS I, et al. 2015 [16]	Clinical trial	16 postmenopausal women, > 65 years	1 session of resistance exercise at 75% of their predetermined 1-RM using the dominant leg	Body composition (DEXA), Appendicular muscle mass, Skeletal muscle index, biopsies	The findings show that low dose Intriguingly though, bolus of whey protein offers no trophic advantage over Leucineessential amino acid. LE.A.Asupplementation have potential as strategies for older women to enhance muscle maintenance.
KIRN DR, et al. 2015 [17]	Multi-center, clinical trial, randomized, double blind	Males and Females, >70 years, BMI > 35 kg/M²⁰	6 month exercise program 3 times a week and supplementation of once daily 20g whey protein drink with 800 UI of Vitamin D or Low calorie placebo drink	400 meter walk time in mobility-limited older adults	better average gait speed during the 400m walk
BAUER JM, et al. 2015 [18]	Multi-center, clinical trial, randomized, double blind, placebo- controlled	380 sarcopenic primarily, with mobility limitations, > 65 years, men and women	supplementation 20g whey protein with 3g leucine and 800 UI vitamin D or isocaloric drink control with only carbohydrates, to consumed in 2 doses a day (before breakfast and lunch) for 13 weeks	handgrip strength, physical function, skeletal muscle mass index,	the group with whey protein supplementation obtained improvements in muscle mass and lower-extremity function among sarcopenic older adults.
ZHU K, et al. 2015 [19]	Clinical trial, randomized, double-blind, placebo-controlled	219 postmenopausal women, 70-80 years	supplementation with high whey protein drink (30g) or placebo drink low in protein, 1 dose a day for 2 years	Body composition (DEXA), handgrip strength, lower limb muscle strength, time up and go, 24h urinary nitrogen	extra 30g/day did not improve the maintenance of muscle mass or physical function in healthy older postmenopausal women.
KRAMER IF, et al. 2015[20]	Clinical trial, randomized, double-blind	45 nonsarcopenic older men,	supplementation with 21g leucine-enriched whey protein with carbohydrate or leucine-enriched whey protein without carbohydrate or a isocaloric with no protein or a.a.	gait speed, handgrip-strength, body-composition (DEXA), BMI	the leucine-enriched whey protein with no carbohydrate significantly raises muscle synthesis rate in nonsarcopenic older men.
RONDANELLI, M., et al. 2016	Clinical trial, randomized, double-blind, placelo-controlled	130 sarcopenic, men and women, > 65 years	12 weeks of a comprehensive physical fitness and muscle mass enhancement training program and supplementation with 32g amino-acid, whey protein and vitamin d mixture or an isocaloric placebo (maltodextrin)	body-composition (DEXA), muscle strength, blood biochemical index of nutrition, physical function, global nutrition status an quality of life	Supplementation with whey protein, amino-acids and vitamin D, in conjunction with age-appropriate exercise, not only boosts fat-free mas and strength but also enhances like physical function and quality of life, contributing to well-being in sarcopenic elderly.
Source: Authors

Table 1: Articles included in study.

1. NATIONAL INSTITUTE ON AGING, NATIONAL INSTITUTES OF HEALTH (NIH), WORLD HEALTH ORGANIZATION. Global health and aging. NIH Publication 11-7737. Washington, DC: NIH 2011.

2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, et al. (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. European Working Group on Sarcopenia in Older People. Age Ageing 39: 412-23.

3. Janssen I, Heymsfield SB, Wang ZM, Ross R (2000) Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol 89: 81-88.

4. Bechshøft RL, Reitelseder S, Hojfeldt G, Castro-Mejia JL, Khakimov B, et al. (2016) Counteracting Age-related Loss of Skeletal Muscle Mass: a clinical and ethnological trial on the role of protein supplementation and training load (CALM Intervention Study): study protocol for a randomized controlled trial. Trials 17:397.

5. Moore DR, Churchward-Venne TA, Witard O, Breen L,Burd NA, et al. (2015) Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A BiolSci Med Sci 70: 57-62.

6. Wolfe RR, Miller SL, Miller KB (2008) Optimal protein intake in the elderly. Clin Nutr 27: 675-684.

7. Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, et al. (2008) Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 87: 150-155.

8. Chale A, Cloutier GJ, Hau C, Phillips EM, Dallal GE, et al. (2013) Efficacy of whey protein supplementationon resistance exercise-induced changes in lean mass, muscle strength, and physical function in mobility-limitedolder adults. J Gerontol A BiolSci Med Sci 68: 682-690.

9. Beasley JM, Shikany JM, Thomson CA (2013) The role of dietary protein intake in the prevention of sarcopenia of aging. Nutr Clin Pract 28: 684-90.

10. Molnár A,Sztruhar JI, Csontos AA, Ferencz C, VarbiroS, et al. (2016) Special nutrition intervention is required for muscle protective efficacy of physical exercise in elderly people at highest risk of sarcopenia. Physiology International, Volume 103: 368-376.

11. Devries MC, Breen L, Allmen MV, Mac Donald MJ, Moore DR, et al. (2015) Low-load resistance training during step-reduction attenuates declines in muscle mass and strength and enhances anabolic sensitivity in older men. Physiol Rep 3: 12493.

12. Burd NA, Yang Y, Moore DR, Tang JE, Tarnopolsky MA, et al.(2012) Greater stimulation of myofibrillar protein synthesis with ingestion of whey protein isolate v. micellar casein at rest and after resistance exercise in elderly men. Br. J. Nutr. 108: 958-962.

13. Coker RH, Miller S, Schutzler S, Deutz N, Wolfe RR (2012) Whey protein and essential amino acids promotethe reduction of adipose tissue and increasedmuscle protein synthesis during caloricrestriction-induced weight loss in elderly, obeseindividuals. Nutrition Journal 11: 105.

14. Arnarson A, Gudny Geirsdottir O, Ramel A, Briem K, Jonsson PV, et al. (2013) Effects of whey proteins on the results of resistance training in elderly people: double blind, randomized controlled trial. European Journal of Clinical Nutrition 2013: 1-6.

15. Luiking YC, Deutz NE, Memelink RG, Verlaan S, Wolfe RR (2014) Postprandial muscle protein synthesis is higher after a high whey protein, leucine-enriched supplementthan after a dairy-like product in healthy older people: arandomized controlled trial. Nutr J. 13: 1475-2891.

16. Bukhari SS, Phillips BE, Wilkinson DJ, Limb MC, Rankin D, et al. (2015) Intake of low-dose leucine-rich essential amino acids stimulates muscle anabolismequivalently to bolus whey protein in older women at rest and after exercise.Am J Physiol Endocrinol Metab 308: 1056-1065.

17. Kirn DR, Koochek A, Reid KF, Berens Av, Travison TG, et al. (2015) The Vitality, Independence, and Vigor in the Elderly 2 Study (VIVE2): Design and methods. Contemporary Clinical Trials 43: 164-171.

18. Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, et al. (2015) Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional supplement on Measures of Sarcopenia in Older Adults, the provide Study: A Randomized, Double-Blind, Placebo-Controlled Trial. JAMDA 16: 740-747.

19. Zhu K, Kerr DA, Meng X, Devine A, Solah V, et al. (2015) Two-Year Whey Protein Supplementation Did Not Enhance Muscle Mass and Physical Function in Well-Nourished Healthy Older Postmenopausal Women. J Nutr 145: 2520-6.

20. Kramer IF, Verdijk LB, Hamer HM, Verlaan S, Luking Y, et al. (2015) Impact of the Macronutrient Composition of a Nutritional Supplement on Muscle Protein Synthesis Rates in Older Men: A Randomized, Double Blind, Controlled Trial. J Clin Endocrinol Metab100: 4124-4132.

21. Paddon-Jones D, Rasmussen BB (2009) Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care12: 86-90.

22. Kumar V, Selby A, Rankin D, Patel R, Atherton, et al. (2009) Age-related differences in the dose-response relationship of muscle protein synthesis to resistance exercise in young and old men J Physiol 587: 211-217.

23. Kukuljan S, Nowson CA, Sanders K, Daly RM(2009) Effects of resistance exercise and fortified milk on skeletal muscle mass, muscle size, and functional performance in middle-aged and older men: an 18-months randomized controlled trial, J. Appl. Physiol. 107 : 1864-1873.

24. Wirunsawanya, K. Upala S, Jaruvongvanich V, Sanguankeo A (2018) Whey Protein Supplementation Improves Body Composition and Cardiovascular Risk Factors in Overweight and Obese Patients: A Systematic Review and Meta-Analysis. J Am Coll Nutr. 37:60-70.

25. BAER DJ, Stote KS, Paul DR, Harris GK, Rumple WV, et al. (2011) Whey protein but not soy protein supplementation alters body weight and composition in free-living overweight and obese adults. J Nutr 141: 1489-1494.

26. Arciero PJ, Ormsbee MJ, Gentile CL, Nindl BC, Brestoff JR, et al. (2013) Increased protein intake and meal frequency reduces abdominal fat during energy balance and energy deficit. Obesity (Silver Spring) 21: 1357-1366.