Aktuelle Ernährungsmedizin 2009; 34(4): 171-177
DOI: 10.1055/s-0029-1220334
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Bedeutung der Proteinzufuhr bei der Entstehung und Behandlung der Sarkopenie

Role of Protein in the Etiology and Treatment of SarcopeniaK.  Norman1 , J.  Bauer2 , C.  Smoliner1 , H.  Lochs1 , M.  Pirlich1
  • 1Medizinische Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin – CCM
  • 2Medizinische Klinik 2 – Klinikum Nürnberg, Lehrstuhl für Innere Medizin – Geriatrie Universität Erlangen – Nürnberg
Further Information

Publication History

Publication Date:
03 July 2009 (online)

Zusammenfassung

Als Sarkopenie wird der Verlust von Muskelmasse und Muskelkraft bei älteren Personen bezeichnet. Protein- und energiereiche Supplemente führen bei älteren und gebrechlichen Personen meistens zu einer Erhöhung der Nahrungsaufnahme und des Körpergewichts, zeigen jedoch wenig Einfluss auf funktionelle Parameter wie die Muskelfunktion. Mehrere Studien deuten darauf hin, dass der Proteinbedarf im Alter wahrscheinlich insgesamt erhöht ist. Neue Ansätze zur Verbesserung der Wirkung von Proteinsupplementen bei älteren Menschen betreffen jedoch vor allem die Zusammensetzung von Proteinen oder Aminosäurenlösungen. Es wurde unter anderem gezeigt, dass in erster Linie essenzielle Aminosäuren für die Stimulation der muskulären Proteinsynthese verantwortlich sind, wobei Leucin, eine verzweigtkettige Aminosäure, eine zentrale Rolle einnimmt. Ein höherer Anteil an Leucin scheint für eine signifikante Erhöhung der Proteinsynthese im Muskel bei älteren Personen ausschlaggebend zu sein. Auch eine Veränderung der Essensgewohnheiten zugunsten einer proteinreichen Mahlzeit zu Mittag stellt eine wertvolle Alternative zur Förderung des Proteinanabolismus im Vergleich zu einer undifferenzierten Steigerung der Proteinaufnahme dar, da gezeigt wurde, dass eine Bolusgabe mit bis zu 80 % der täglichen Proteinaufnahme zu Mittag, gefolgt von einer proteinarmen Mahlzeit am Abend die Proteinretention erhöht. Vieles spricht jedoch dafür, dass auch zukünftig selbst bei Nutzung dieser neuen, zum Teil vielversprechenden ernährungstherapeutischen Optionen der zusätzliche Effekt eines auf das Alter und die individuellen Gegebenheiten angepassten körperlichen Trainings für das Erreichen dieses Zieles unverzichtbar sein wird.

Abstract

Sarcopenia, which describes the loss of muscle mass and muscle strength, is a common phenomenon in the elderly. Although clinical intervention studies with energy and protein supplementation have consistently shown an increase in nutritional intake and body weight, the impact on functional parameters such as muscle function has been minor. Several studies have suggested that protein requirements might be higher in the elderly than in younger adults. New strategies regarding protein supplementation focus on the composition of proteins and amino acid solutions. It has e. g. been shown that essential amino acids are mainly responsible for the stimulation of fractional protein synthesis in the muscle. Here, leucine, a branched chain amino acid, seems to play a central role and a higher intake of leucine has been shown to increase muscle protein synthesis in elderly subjects. Also, pulse feeding pattern, supplying 80 % of protein at lunch followed by a protein reduced meal in the evening, has also been reported to increase protein retention in the elderly and might thus be considered an interesting alternative to high protein diets. Evidence, however, clearly suggests that physical training will remain mandatory in order to reach major improvement of muscle mass and function.

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Dr. Kristina Norman

Medizinische Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin – CCM

Charitéplatz 1

10117 Berlin

Phone: +49 30 450 514 139

Fax: +49 30 450 514 923

Email: kristina.norman@charite.de