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Nutritional supplementation improves bone health in sarcopenic older adults

As described in a 2018 United Nations report, we are witnessing an ageing population and the group 60 years and older is growing faster than all younger age groups.1 Aging is characterized by a progressive decline in physiological reserves and functions contributing to sarcopenia as well as loss of bone mineral density (BMD) and bone strength. Bone health is influenced by lifestyle factors like nutrition and exercise. Among the modifiable nutritional factors the most well-known nutrients are protein, vitamin D, and calcium.

Nutritional supplementation

Recent studies show that enriched nutritional supplementation in sarcopenic older adults would hypothetically improve markers of musculoskeletal health.2,3,4,5,6,7

Calcified Tissue International published A vitamin D, calcium and leucine-enriched whey protein nutritional supplement improves measures of bone health in sarcopenic non-malnourished older adults – the PROVIDE study ”. This sub-study is part of the PROVIDE study exploring whether providing a targeted nutritional supplement containing whey protein enriched with leucine, vitamin D and calcium improves markers of bone health. The sub-study consisted of measurements of bone mineral density (BMD) and biochemical bone turnover markers (osteocalcin (OC) and procollagen type 1 amino-terminal propeptide (P1NP) for bone formation and carboxy-terminal collagen crosslinks (CTX) for bone resorption) in 380 sarcopenic older adults enrolled in the PROVIDE study.

Conclusion

The study results demonstrated significant positive effects of a vitamin D, calcium and leucine-enriched whey protein supplement on BMD and CTX in sarcopenic, non-malnourished older adults. This study could be the basis of future research investigating how specific nutritional supplements improve bone health in geriatric patients and older adults at risk for disability.

The PROVIDE study

The PROVIDE study is a multicenter, randomized, controlled, double-blind, trial including 380 sarcopenic older adults. Participants were randomly allocated to 2 daily-serving of the active product including vitamin D, calcium and leucine-enriched whey protein drink or an iso-caloric control for a period of 13 weeks. The aim of the PROVIDE study was to investigate if a specific oral nutritional supplement can result in improvements in measures of sarcopenia. Although this study showed no effect of the supplement on the primary outcomes hand grip strength and Short Physical Performance Battery (SPPB), a significant treatment effect was shown on chair-stand-time (a proxy for lower extremity muscle strength) and muscle mass. The study showed proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise.

1.
United Nations (2018). Ageing. Retrieved on February 15th 2019 from: http://www.un.org/en/sections/issues-depth/ageing/.
2.
Gaffney-Stomberg E, Insogna KL, Rodriguez NR, Kerstetter JE (2009) Increasing dietary protein requirements in elderly people for optimal muscle and bone health. Journal of the American Geriatrics Society 57(6):1073-9.
3.
Shams-White MM, Chung M, Du M et al (2017) Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation. Am J Clin Nutr 105(6):1528-4.
4.
Jennings A, MacGregor A, Spector T, Cassidy A (2016) Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins. J Bone Min Res 31(2):326-35.
5.
Ammann P, Laib A, Bonjour JP et al (2002) Dietary essential amino acid supplements increase bone strength by influencing bone mass and bone microarchitecture in ovariectomized adult rats fed an isocaloric low-protein diet. J Bone Min Res 17(7):1264-72.
6.
Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al (2013) Evidence-based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. Journal of the American Medical Directors Association.
7.
Ross C, Abrams S, Aloia JF et al. (2010) Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, USA.