高齢者の最適な蛋白質摂取量

エビデンスに基づいた高齢者の最適な蛋白質摂取量に関する方針論文Position Paper を紹介します。

Jürgen Bauer, et al: Evidence-based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. JAMDA, in press

下記のHPで全文読めると思います。

http://www.jamda.com/article/S1525-8610(13)00326-5/fulltext

高齢者では少なくとも1-1.2g/kg/日の蛋白質摂取が推奨されます。持久性トレーニングとレジスタンストレーニングの実施も推奨され、これらを実施している場合には1.2-1.5g/kg/日の蛋白質摂取が推奨されます。

ただし、重度の腎疾患（例：eGFRが30未満）で透析を行っていない場合には、このルールは当てはまりません。蛋白質の質、摂取のタイミング、他の栄養素摂取に関するエビデンスはまだ不十分です。

運動をしている場合に1.2-1.5g/kg/日の蛋白質摂取が推奨されることは、リハ栄養的にも重要です。また、CKDのStage3（eGFRが30以上）であれば、蛋白質摂取の制限を必要としない（特に運動を行う場合）かもしれません。これも重要ですね。

Abstract
New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (65 years and older) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance- and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, ≥1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2–1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR less than 30) but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function.