Dietary Protein: Timing is Key for Preserving Lean Body Mass Protection Status
Blog Category: 
lean body mass

By Mary Ellen Posthauer RDN, CD, LD, FAND

Recently, I attended a webinar that focused on dietary protein and preserving lean muscle mass. There is a wealth of research on this topic, in particular, as it relates to older adults and protecting muscle health during inactivity. Dr. Robert Demling noted the effect of lean body mass (LBM) loss on wound healing. Healing a wound requires increased calories to prevent the body from breaking down protein (LBM) for energy, thus depleting protein stores required for protein synthesis and healing. Lean body mass is metabolically active, transports protein throughout the body and is essential for survival as it contains all of the skeletal and smooth muscles and immune cells. Healthy adults lose between 3-8% of LBM per decade and after age 70 muscle loss increases to 15% per decade. This loss of LBM or sarcopenia is an age-related, insidious loss of lean muscle mass accelerated by physical inactivity and poor nutrition.

Bed Rest Accelerates LBM Loss

Adults experiencing an acute event (such as pneumonia or hip fractures) that are placed on bed rest lose muscles mass rapidly and without nutrition intervention, they are at risk for pressure ulcers. Studies indicate that even healthy adults placed on bed rest for 28 days lost 2% of lean leg mass compared to healthy older adults who had 10% loss in just 10 days. However, older hospitalized adults had a 15% loss of LBM in just four days, which is a dramatic difference. Extended bed rest and inactivity promotes loss of LBM regardless of age. The body’s stress response to wounds releases inflammatory mediators that accelerates LBM loss and escalates the body’s metabolic rate, increasing the requirement for adequate protein to meet the demand.

Protein Timing is Key in Healing Wounds

Since dietary protein impacts muscle protein synthesis, the key is understanding what amount is beneficial and how it should be distributed. Research on the ability of protein rich foods to stimulate protein anabolism indicated a 4oz serving of meat (30 grams) increased protein synthesis by 50% in both young and older adults. Consuming 90 grams of protein evenly over three meals provided a greater protein anabolic response then the typical pattern of eating 10 grams at breakfast, 15 grams at lunch and 65 grams in the evening. Based on a 75kg adult, this equals 1.2 grams/kg/day, which is the guideline recommendation for pressure ulcer healing. Individuals with estimated protein needs higher than 90 grams/day may need a high protein snack or bedtime nourishment to achieve the even protein distribution. Since we cannot store excess protein for later anabolism, the key is even distribution over 24 hours for maximum protein synthesis.

About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Advisory Panel and the American Dietetic Association's Unintentional Weight Loss work group.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Recommended for You

  • August 5th, 2020

    By Heidi Cross, MSN, RN, FNP-BC, CWON

    Pressure injury risk and development are multifactorial, individualized processes. Each patient presents with a unique set of circumstances and needs. In looking at charts for attorneys to determine whether standards of care related to...

  • January 21st, 2021

    By Lauren Lazarevski, RN, BSN, CWOCN

    Could metallic micronutrients be the missing link for your patient with a chronic wound? When we consider the nutrition required to optimize wound healing, protein supplementation is usually the star of the show. However, there are...

  • July 1st, 2021

    By Catherine D’Andrea, RDN, LDN, and Marcia Nusgart, RPh

    Malnutrition is a leading cause of morbidity and mortality, especially among older hospitalized adults, yet it often goes undiagnosed and therefore untreated. It has been established that malnourished hospitalized patients...

Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The content is not intended to substitute manufacturer instructions. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Refer to the Legal Notice for express terms of use.