ReviewWhey protein ingestion in elderly diet and the association with physical, performance and clinical outcomes
Introduction
Aging is a process in which there is a decline of the body structure and functions in general, which can lead to chronic diseases (Gonçalves et al., 2013; Malta et al., 2013). The elderly population growth is a global milestone since the number of elderly people has been increasing significantly in recent years in developing countries, such as Brazil (Brasil, 2013). It is estimated that in Brazil there will be about 32 million elderly in 2025, thus the country will occupy the sixth position among the longest-lived countries worldwide (Garcez-Leme and Leme, 2014), and that the number of elderly will equal or exceed the number of children and teenagers between zero and 15 years old in 2050 (Brasil, 2013).
This is due to better quality of life and health care, which contributes to a greater longevity (Oliveira et al., 2015). The World Health Organization considers as elderly people who are 60 years-old or older in developing countries and 65 or older in developed countries.
Because of the large number of elderly, it is important to find ways to supply the nutritional amount of this population. Nutrition science is a great ally, since a balanced diet can bring many benefits to this group either as prevention or as diet therapy for diseases (Abreu et al., 2013; Deon et al., 2015). In addition, physiologically with aging, there are changes in nutrient intake, absorption and digestion (Malta et al., 2013).
Protein is indicated as the key nutrient for the health of the elderly, aiding in a better performance of the organism and in a better quality of life (Wolfe et al., 2008). However, many studies indicate that the elderly population has an insufficient intake of proteins of high biological value (Deon et al., 2015).
The whey protein fraction is obtained from the whey resulting from cheese making process through caseification. Whey proteins have around 15% to 20% of the total milk proteins (Patel, 2015; Camargo et al., 2018). They also have β-lactoglobulin (35% to 65%), and α-lactalbumin (12% to 25%). In smaller amounts, it has immunoglobulins (8%), albumin (5%), and lactoferrin (1%) as their main components. It is rich in branched chain amino acids, such as leucine, isoleucine, and valine; as well as cysteine (Patel, 2015). Whey protein is easily digestible, which rapidly increases the concentration of amino acids in plasma, promoting protein synthesis in tissues (Pacheco et al., 2005). It can be found for commercialization as: concentrated (containing lipids and lactose along with proteins – 29% to 89%), isolate (90% of protein), or hydrolyzed (partially digested, facilitating metabolism, besides being hypoallergenic) (Patel, 2015; Camargo et al., 2018). There are several functionalities attributed to whey protein in research: increasing of the technological quality of bakery products (Camargo et al., 2018), oxidative stress reduction, appetite reduction, hypoglycemia, attenuation of cardiovascular risks and increasing in muscle mass (Patel, 2015).
The main changes in body composition during the aging process are progressive loss of muscle mass and increase in fat mass (Chung et al., 2013; Verreijen et al., 2015). The loss of muscular mass and functionality (sarcopenia) contributes to the aggravation of many health outcomes, such as metabolic disorders, especially diabetes mellitus 2, as well as greater fragility, related to sarcopenia. Studies have shown that whey protein, along with resistance training, can improve muscle performance by stimulating protein synthesis, a protective factor against sarcopenia (Niitsu et al., 2015; Bell et al., 2017). It can also contribute to significant reductions in the risk of cardiovascular disease, improved metabolic health and cardiorespiratory capacity (Bell et al., 2017).
Considering the characteristics of the elderly population, as well as the nutritional properties of whey protein, this study reviews the literature and analyzes the use of whey protein in the elderly. It also investigates if whey protein supplementation generates some benefit in the process of aging because of its functionality when compared to the control population.
Section snippets
Methods
A systematic review was conducted in order to find papers that shed some light in the correlation between whey protein and elderly.
The search for data was carried out by two researchers from April 2016 to September 2018. The identification of the studies was carried out using a list of references of the papers published in the last five years in Portuguese, English, and Spanish, selected for full reading.
Inclusion criteria were type of study: clinical trial, controlled clinical trial,
Results
The results of the search strategy are shown in Fig. 1. After reading the papers, considering the inclusion and exclusion criteria, 35 studies were included in the present review. In the papers selected, the age group considered as elderly was ≥65 years old in 27 papers and ≥60 years old in the other 8 papers. The studies were divided by outcome of physical performance (Table 1) and clinical outcome (Table 2).
Discussion
According to the countries where the studies were carried out, two distinct age groups were considered to be elderly in the papers surveyed, which corroborates with WHO (2002), which considers the elderly people who are 60 or older in developing countries, and 65 or older in developed countries. However, developed countries such as the Netherlands (Gorissen et al., 2017), Denmark (Dideriksen et al., 2016a; Dideriksen et al., 2016b), Japan (Niitsu et al., 2015), and United States of America (
Conclusion
In general, the data found in this review suggest that whey protein supplementation was promising for the health of the elderly population, since several authors found positive results in groups of elderly people who received supplementation when compared to the control groups.
However, there are still outcomes whose results of supplementation are not well understood, as well as some studies that found no difference between the respective groups supplemented with whey protein and the control
Declaration of competing interest
The authors declare that they do not have any conflicts of interest.
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2022, Journal of Nutritional BiochemistryCitation Excerpt :Whey protein supplementation has been demonstrated to be the most impactful nutritional intervention to alleviate muscle aging by now [7,8]. Previous studies demonstrated whey protein could promote post-prandial muscle protein synthesis, maintain muscle strength, increase lean mass as well as improve muscle function in aged animal models and human [7,9,10]. So far, phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway has been widely accepted as a major pathway to regulate muscle health after whey protein supplementation [11], which focused on post-translational regulation mainly by phosphorylation.
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2022, Journal of Dairy ScienceCitation Excerpt :It has high nutritional value, and its essential AA structure is more reasonable and perfect than that of plant-derived proteins (Zhao et al., 2021a). In addition, whey protein is helpful for improving human immunity (Legrand, 2016), protecting the heart (van der Ven et al., 2002), preventing cancer (Baena Ruiz and Salinas Hernández, 2014), providing antiaging effects (Camargo et al., 2020), and promoting health and controlling weight (Pal et al., 2010). Pectin is a polysaccharide composed of a linear chain of galacturonic acid units joined by α-1–4 links, interspersed by rhamnose units linked by α-1–2, in which the carboxylic groups of galacturonic acid may be esterified by methyl groups (Thakur et al., 1997).
Protein intake is not associated with functional biomarkers of physical frailty: A cross-sectional analysis of community-dwelling older adults with type 2 diabetes mellitus
2021, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Despite all questionnaires being administered by a member of the research team, recall bias may still exist, leading to potential misreporting of dietary data and an overestimation of energy expenditure, both of which may impact the reported prevalence of physical frailty within the cohort. Lastly, the present study did not investigate the relationship between the meal distribution of protein intake, or the source of dietary protein (e.g. whey), both of which have been associated with improved physical performance and attenuation of functional decline in the elderly [50,51]. In conclusion, our results are clinically meaningful as we further confirmed that older adults with T2DM are vulnerable to physical frailty.