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Optimal Protein Intake for the Elderly: Analyzing the requirements and Challenges

The nutritional needs of the elderly specifically the protein intake is vastly different from the average adult population. Contrary to popular perception the elderly have a higher protein requirement (both minimum protein and optimal). This is primarily due to the loss of muscle mass as we progress with age. In this article we will take a look at the optimal protein intake for the elderly which will enable them to have a better health in their advancing years. Combined with resistance training a proper protein rich diet enables the elderly to regain muscle strength and reduce the chances of injuries from a fall .

How Much Protein is Required?

Let us look at a cross section MRI image of the upper leg in a 24 year old and compare it with a 66 year old (a) one who is inactive (b) one who is active Mc Leod et al [1].

Fig 1: . (a) shows the decline of muscle cross sectional area with age (b) shows the decline of type 2 muscle fibres with age .
MRI images of upper leg (c) adult 24 years old active (d) adult 66 years old inactive (e)adult 66 years old active Mc Leod et al [1]

From Fig 1, we can clearly observe muscle cross sectional area decreases with age. However, the MRI images make a clear distinction in the degradation between an inactive and an active older adult when compared to a 24 year old. The darker areas of the image represent muscle and the white areas surrounding and in between the muscles represent fat. It is quite clear that an active older adult has much lesser fat in between his muscles and lower degradation when compared to an inactive adult. It is clear an active 66 year old would have a greater amount of muscle mass than an inactive 66 year old. The question arises besides exercise what role does diet play in ensuring a good amount of muscle mass.

Humans require protein from their diet, the protein from our diet helps in muscle synthesis. However, there is also muscle breakdown, in order for muscles to grow muscle synthesis should be greater than muscle breakdown. It has been estimated that older adults lose 3-8% of the muscle mass every decade of their life, this loss of muscle mass is termed as sarcopenia. Hence, it is imperative that the diet of older adults should not only meet the recommended daily requirement for protein that a young adult has but exceed it to compensate for the loss of muscle.

Typically an adult requires 0.8-0.9 gm of protein / kg of body weight, for older adults this requirement would be 1.2 gm/kg of body weight. It should be noted this is the recommended daily intake ,taking into account large population sizes and variety of lifestyles , the optimal intake should be a bit higher at 1.5 gm/kg of body weight.

Challenges in Protein Intake

Protein rich diet and exercise sounds fairly a straightforward solution to address sarcopenia in older adults. However, it isn’t that simple due to a number of factors associated with old age. Firstly, older adults face a loss of appetite. If we assume the 1.2 g/kg protein requirement , it would be 97 gms for an older adult weight 75 gms. That would indicate a minimum of 25-30 gm protein per meal is required (assuming three meals a day) which is quite a challenge for older adults. The loss of appetite is also associated with loss of taste and loss of smell with age, food doesn’t appear as appealing as they found it in their younger years.

Secondly, dental health is a major challenge in older adults. Due to poorer dental health such as loss of teeth, weakened gums and frequent infections older adults often shy away from eating especially harder to chew meats. A good strategy in this case would be to go for softer proteins such as eggs and flaky fish. Milk and softer dairy products such as yogurt and cottage are a good idea too as it would also provide calcium and Vitamin D in addition to protein.

The third factor which proves to be a huge barrier in muscle growth strategies for older adults is the fact that they utilize a greater percentage of amino acids present in the protein for digestion and other bodily functions and lesser amino acids are available for muscle growth than that for a younger person. Lastly, a less talked about factor is the higher rates of depression and loneliness than older adults face which directly affects their food consumption , appetite and subsequently the protein intake.

Hence it is imperative for nutritionists and fitness trainers alike to understand the special needs of older populations and advice them a diet and workout regime taking into account the aforementioned factors.

References

McLeod M, Breen L, Hamilton DL, Philp A Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology. 2016 Jun;17(3):497-510. doi: 10.1007/s10522-015-9631-7. Epub 2016 Jan 20.

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