Novel Insights on Nutrient Management of Sarcopenia in Elderly
Identifieur interne : 005872 ( Ncbi/Merge ); précédent : 005871; suivant : 005873Novel Insights on Nutrient Management of Sarcopenia in Elderly
Auteurs : Mariangela Rondanelli [Italie] ; Milena Faliva [Italie] ; Francesca Monteferrario [Italie] ; Gabriella Peroni [Italie] ; Erica Repaci [Italie] ; Francesca Allieri [Italie] ; Simone Perna [Italie]Source :
- BioMed Research International [ 2314-6133 ] ; 2015.
Abstract
Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of muscle mass and strength. The more rationale approach to delay the progression of sarcopenia is based on the combination of proper nutrition, possibly associated with the use of dietary supplements and a regular exercise program. We performed a narrative literature review to evaluate the till-now evidence regarding (1) the metabolic and nutritional correlates of sarcopenia; (2) the optimum diet therapy for the treatment of these abnormalities. This review included 67 eligible studies. In addition to the well recognized link between adequate intake of proteins/amino acids and sarcopenia, the recent literature underlines that in sarcopenic elderly subjects there is an unbalance in vitamin D synthesis and in omega-6/omega-3 PUFA ratio. Given the detrimental effect of these metabolic abnormalities, a change in the lifestyle must be the cornerstone in the treatment of sarcopenia. The optimum diet therapy for the sarcopenia treatment must aim at achieving specific metabolic goals, which must be reached through accession of the elderly to specific personalized dietary program aimed at achieving and/or maintaining muscle mass; increasing their intake of fish (4 times/week) or taking omega-3 PUFA supplements; taking vitamin D supplementation, if there are low serum levels.
Url:
DOI: 10.1155/2015/524948
PubMed: 25705670
PubMed Central: 4326274
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<front><div type="abstract" xml:lang="en"><p>Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of muscle mass and strength. The more rationale approach to delay the progression of sarcopenia is based on the combination of proper nutrition, possibly associated with the use of dietary supplements and a regular exercise program. We performed a narrative literature review to evaluate the till-now evidence regarding (1) the metabolic and nutritional correlates of sarcopenia; (2) the optimum diet therapy for the treatment of these abnormalities. This review included 67 eligible studies. In addition to the well recognized link between adequate intake of proteins/amino acids and sarcopenia, the recent literature underlines that in sarcopenic elderly subjects there is an unbalance in vitamin D synthesis and in omega-6/omega-3 PUFA ratio. Given the detrimental effect of these metabolic abnormalities, a change in the lifestyle must be the cornerstone in the treatment of sarcopenia. The optimum diet therapy for the sarcopenia treatment must aim at achieving specific metabolic goals, which must be reached through accession of the elderly to specific personalized dietary program aimed at achieving and/or maintaining muscle mass; increasing their intake of fish (4 times/week) or taking omega-3 PUFA supplements; taking vitamin D supplementation, if there are low serum levels.</p>
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<author><name sortKey="Trocki, O" uniqKey="Trocki O">O. Trocki</name>
</author>
<author><name sortKey="Ogle, C K" uniqKey="Ogle C">C. K. Ogle</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Fetterman, J W" uniqKey="Fetterman J">J. W. Fetterman</name>
</author>
<author><name sortKey="Zdanowicz, M M" uniqKey="Zdanowicz M">M. M. Zdanowicz</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Smith, G I" uniqKey="Smith G">G. I. Smith</name>
</author>
<author><name sortKey="Atherton, P" uniqKey="Atherton P">P. Atherton</name>
</author>
<author><name sortKey="Reeds, D N" uniqKey="Reeds D">D. N. Reeds</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Biomed Res Int</journal-id>
<journal-id journal-id-type="iso-abbrev">Biomed Res Int</journal-id>
<journal-id journal-id-type="publisher-id">BMRI</journal-id>
<journal-title-group><journal-title>BioMed Research International</journal-title>
</journal-title-group>
<issn pub-type="ppub">2314-6133</issn>
<issn pub-type="epub">2314-6141</issn>
<publisher><publisher-name>Hindawi Publishing Corporation</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25705670</article-id>
<article-id pub-id-type="pmc">4326274</article-id>
<article-id pub-id-type="doi">10.1155/2015/524948</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Novel Insights on Nutrient Management of Sarcopenia in Elderly</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Rondanelli</surname>
<given-names>Mariangela</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Faliva</surname>
<given-names>Milena</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Monteferrario</surname>
<given-names>Francesca</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Peroni</surname>
<given-names>Gabriella</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Repaci</surname>
<given-names>Erica</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-1596-506X</contrib-id>
<name><surname>Allieri</surname>
<given-names>Francesca</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2720-1473</contrib-id>
<name><surname>Perna</surname>
<given-names>Simone</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
</contrib-group>
<aff id="I1">Department of Public Health, Experimental and Forensic Medicine, School of Medicine, University of Pavia and Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona di Pavia, Via Emilia 12, 27100 Pavia, Italy</aff>
<author-notes><corresp id="cor1">*Mariangela Rondanelli: <email>mariangela.rondanelli@unipv.it</email>
</corresp>
<fn fn-type="other"><p>Academic Editor: Giuseppe D'Antona</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><year>2015</year>
</pub-date>
<pub-date pub-type="epub"><day>29</day>
<month>1</month>
<year>2015</year>
</pub-date>
<volume>2015</volume>
<elocation-id>524948</elocation-id>
<history><date date-type="received"><day>18</day>
<month>8</month>
<year>2014</year>
</date>
<date date-type="rev-recd"><day>16</day>
<month>10</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>19</day>
<month>10</month>
<year>2014</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2015 Mariangela Rondanelli et al.</copyright-statement>
<copyright-year>2015</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of muscle mass and strength. The more rationale approach to delay the progression of sarcopenia is based on the combination of proper nutrition, possibly associated with the use of dietary supplements and a regular exercise program. We performed a narrative literature review to evaluate the till-now evidence regarding (1) the metabolic and nutritional correlates of sarcopenia; (2) the optimum diet therapy for the treatment of these abnormalities. This review included 67 eligible studies. In addition to the well recognized link between adequate intake of proteins/amino acids and sarcopenia, the recent literature underlines that in sarcopenic elderly subjects there is an unbalance in vitamin D synthesis and in omega-6/omega-3 PUFA ratio. Given the detrimental effect of these metabolic abnormalities, a change in the lifestyle must be the cornerstone in the treatment of sarcopenia. The optimum diet therapy for the sarcopenia treatment must aim at achieving specific metabolic goals, which must be reached through accession of the elderly to specific personalized dietary program aimed at achieving and/or maintaining muscle mass; increasing their intake of fish (4 times/week) or taking omega-3 PUFA supplements; taking vitamin D supplementation, if there are low serum levels.</p>
</abstract>
</article-meta>
</front>
<floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Flow diagram of narrative review of literature.</p>
</caption>
<graphic xlink:href="BMRI2015-524948.001"></graphic>
</fig>
<table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label>
<caption><p>Nutrients and drugs that have been shown to present an activity of stimulation in increasing the mass and/or muscle strength in humans or in the animal model.</p>
</caption>
<table frame="hsides" rules="groups"><tbody><tr><td align="left" rowspan="4" colspan="1">Nutrients</td>
<td align="left" rowspan="1" colspan="1">Proteins and amino acids (BCAAs) and creatine.</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Antioxidants (vitamin E, vitamin C, carotenoids, and resveratrol)</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Vitamins: vitamin D</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Long-chain omega-3 fatty acids</td>
</tr>
<tr><td align="center" colspan="2" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="2" colspan="1">Drugs</td>
<td align="left" rowspan="1" colspan="1">Antagonists of mineral corticoids (Spironolactone)</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">ACE inhibitors</td>
</tr>
<tr><td align="center" colspan="2" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="5" colspan="1">Hormone replacement therapy</td>
<td align="left" rowspan="1" colspan="1">Testosterone (T)</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Growth hormone (GH)</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Combination therapy: T and GH</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Estrogen</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">DHEA-S</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label>
<caption><p>Studies (prospective cohort study or randomized controlled trial) performed in elderly subjects to investigate the optimum dietary supplementation, other than proteins, for the treatment of sarcopenia.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Nutrients</th>
<th align="center" rowspan="1" colspan="1">Author</th>
<th align="center" rowspan="1" colspan="1">Type of study</th>
<th align="left" rowspan="1" colspan="1">Results </th>
<th align="left" rowspan="1" colspan="1">Recommended treatment</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="3" colspan="1">Vitamin D</td>
<td align="center" rowspan="1" colspan="1">Snijder et al., 2006 [<xref rid="B114" ref-type="bibr">114</xref>
]</td>
<td align="center" rowspan="1" colspan="1">Prospective cohort study</td>
<td align="left" rowspan="1" colspan="1">Poor vitamin D status is independently associated with an increased risk of falling in the elderly, particularly in those aged 65–75 yr.</td>
<td align="left" rowspan="1" colspan="1"> </td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Verhaar et al., 2000 [<xref rid="B110" ref-type="bibr">109</xref>
]</td>
<td align="center" rowspan="1" colspan="1">Randomized controlled trial</td>
<td align="left" rowspan="1" colspan="1">Six months of alphacalcidol treatment led to a significant increase in the walking distance over 2 minutes.</td>
<td align="left" rowspan="1" colspan="1">Six months of vitamin D treatment (0.5 microg alphacalcidol)</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Gloth et al., 1995 [<xref rid="B109" ref-type="bibr">110</xref>
]</td>
<td align="center" rowspan="1" colspan="1">Randomized controlled trial</td>
<td align="left" rowspan="1" colspan="1">In this cohort of homebound older people, improvement in vitamin D status was associated with functional improvement as measured by the Frail Elderly Functional Assessment questionnaire.</td>
<td align="left" rowspan="1" colspan="1">One month of therapy with either placebo or vitamin D (ergo-calciferol)</td>
</tr>
<tr><td align="center" colspan="5" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Beta-hydroxy-beta-methylbutyrate (HMB) </td>
<td align="center" rowspan="1" colspan="1">Flakoll et al., 2004 [<xref rid="B50" ref-type="bibr">50</xref>
]</td>
<td align="center" rowspan="1" colspan="1">Randomized controlled trial</td>
<td align="left" rowspan="1" colspan="1">Daily supplementation of HMB, arginine, and lysine for 12 wk </td>
<td align="left" rowspan="1" colspan="1">Daily supplementation of HMB, arginine, and lysine for 12 wk positively altered measurements of functionality, strength, fat-free<break></break>
mass, and protein synthesis, suggesting that the strategy of targeted nutrition has the ability to affect muscle health in elderly women.</td>
</tr>
<tr><td align="center" colspan="5" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Long-chain omega-3 fatty acids</td>
<td align="center" rowspan="1" colspan="1">Smith et al., 2011 [<xref rid="B131" ref-type="bibr">131</xref>
]</td>
<td align="center" rowspan="1" colspan="1">Randomized controlled trial</td>
<td align="left" rowspan="1" colspan="1">Omega-3 fatty acid supplementation had no effect on the basal rate of muscle protein synthesis but enhanced the hyperaminoacidemia-hyperinsulinemia-induced increase in the rate of muscle protein synthesis, which was accompanied by greater increases in muscle mTORSer2448 phosphorylation</td>
<td align="left" rowspan="1" colspan="1">1.86 g eicosapentaenoic acid (EPA, 20:5n23) and 1.50 g docosahexaenoic acid (DHA, 22:6n23), both as ethyl esters</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label>
<caption><p>Summary of methodology.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Step</th>
<th align="left" rowspan="1" colspan="1">General activities</th>
<th align="left" rowspan="1" colspan="1">Specific activities</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Step 1</td>
<td align="left" rowspan="1" colspan="1">Configuration of a working group </td>
<td align="left" rowspan="1" colspan="1">Three operators skilled in clinical nutrition:<break></break>
(i) one operator acting as a methodological operator <break></break>
(ii) two operators participating as clinical operators</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Step 2</td>
<td align="left" rowspan="1" colspan="1">Formulation of the revision question</td>
<td align="left" rowspan="1" colspan="1">Evaluation of the state of the art on metabolic and nutritional correlates of sarcopenia and their nutritional treatment</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Step 3</td>
<td align="left" rowspan="1" colspan="1">Identification of relevant studies on PUBMED</td>
<td align="left" rowspan="1" colspan="1">(a) Definition of the key words (sarcopenia, nutrients, and dietary supplement), allowing the definition of the interest field of the documents to be searched, grouped in inverted commas (“…”), and used separately or in combination;<break></break>
(b) use of the Boolean (a data type with only two possible values: true or false) AND operator that allows the establishments of logical relations among concepts; <break></break>
(c) research modalities: advanced search; <break></break>
(d) limits: time limits: papers published in the last 20 years; humans; languages: English; <break></break>
(e) manual search performed by the senior researchers experienced in clinical nutrition through the revision of reviews and individual articles on sarcopenia in elderly published in journals qualified in the Index Medicus</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Step 4</td>
<td align="left" rowspan="1" colspan="1">Analysis and presentation of the outcomes</td>
<td align="left" rowspan="1" colspan="1">The data extrapolated from the revised studies were carried out in the form of a narrative review of the reports and were collocated in tables.</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab4" orientation="portrait" position="float"><label>Table 4</label>
<caption><p>Effect of nutrients or dietary supplementations on metabolic correlates of sarcopenia.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Nutrients or dietary supplementations</th>
<th align="left" rowspan="1" colspan="1">Recommendations</th>
<th align="left" rowspan="1" colspan="1">Specific effect</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Proteins: average daily intake</td>
<td align="left" rowspan="1" colspan="1">It is recommended that the total protein intake should be 1–1.2 g/kg/day [<xref rid="B16" ref-type="bibr">16</xref>
] </td>
<td align="left" rowspan="1" colspan="1"> </td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Proteins: timing of intake</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have 30 grams of protein of high biological value for each meal [<xref rid="B25" ref-type="bibr">25</xref>
]</td>
<td align="left" rowspan="1" colspan="1">The elderly, compared with younger subjects, would require a larger amount of protein to obtain the same maximization of protein synthesis</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Proteins: fast and slow</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have whey protein ingestion because whey protein ingestion results in greater postprandial protein retention than does casein ingestion [<xref rid="B32" ref-type="bibr">31</xref>
]</td>
<td align="left" rowspan="1" colspan="1">The greater anabolic properties of whey than of casein are mainly attributed to the faster digestion and absorption kinetics of whey, which results in a greater increase in postprandial plasma amino acid availability and thereby further stimulates muscle protein synthesis. Moreover, whey has a considerably higher leucine content</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Proteins: animal and vegetal sources</td>
<td align="left" rowspan="1" colspan="1">When the total protein intake is adequate, the source of protein consumed (vegetal or animal) does not influence muscle strength and size [<xref rid="B36" ref-type="bibr">36</xref>
]</td>
<td align="left" rowspan="1" colspan="1">Increases in muscle strength and size were not influenced by the predominant source of protein consumed by older men with adequate total protein intake</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Branched chain amino acids (BCAAs),</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have an adequate daily leucine supplementation (3 g/day)</td>
<td align="left" rowspan="1" colspan="1">A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Beta-hydroxy-methylbutyrate (HMB)</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have a daily intake of beta-hydroxy butyrate (HMB-b, 2 g/day) because it can attenuate the loss of muscle mass and increase muscle mass and strength [<xref rid="B50" ref-type="bibr">50</xref>
]</td>
<td align="left" rowspan="1" colspan="1">Beta-hydroxy-beta-methylbutyrate is a product of leucine metabolism that has been shown to slow protein breakdown in muscle tissue</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Creatine</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have an adequate creatine supplementation because it could represent an intriguing intervention to counteract sarcopenia and in particular fatigue associated with sarcopenia; the timing of creatine ingestion (i.e., 0.03–0.5 g/kg before and after the sessions of resistance training) can be more relevant than the amount of creatine [<xref rid="B74" ref-type="bibr">73</xref>
, <xref rid="B76" ref-type="bibr">76</xref>
]</td>
<td align="left" rowspan="1" colspan="1">The ingestion of an adequate creatine supplementation determines the increase in muscle phosphocreatine (PCr) and the energy provided for the phosphorylation of adenosine diphosphate (ADP) to adenosine triphosphate (ATP) during and after intense exercise largely depends on the amount of PCr stored in the muscle</td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Vitamin D</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have a dietary vitamin D supplementation (800–1000 UI ergo-calciferol/day) in vitamin D deficient sarcopenic subjects [<xref rid="B127" ref-type="bibr">127</xref>
]</td>
<td align="left" rowspan="1" colspan="1">Dietary vitamin D supplementation determines an increase of the expression of the receptors VDR (vitamin D receptor) in skeletal muscle </td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Antioxidants. vitamin E, vitamin C, carotenoids, and resveratrol</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have a diet with high intake of fruits, vegetables whole grains, which is rich in antioxidant, and lower consumption of red meat and saturated fats, because it is associated with a reduced risk of inflammation correlated to oxidative damage [<xref rid="B83" ref-type="bibr">83</xref>
]</td>
<td align="left" rowspan="1" colspan="1">Adherence to the diet rich in antioxidants is associated with lower circulating IL-6 </td>
</tr>
<tr><td align="center" colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Long-chain omega-3 polyunsaturated fatty acids (LC<italic>n</italic>
-3PUFA)</td>
<td align="left" rowspan="1" colspan="1">It is recommended to have dietary long-chain omega-3 polyunsaturated fatty acids (1.86 g eicosapentaenoic acid and 1.50 g docosahexaenoic acid/day) supplementation [<xref rid="B131" ref-type="bibr">131</xref>
]</td>
<td align="left" rowspan="1" colspan="1">Long-chain omega-3 polyunsaturated fatty acids (LC<italic>n</italic>
-3PUFA) supplementation improves insulin-mediated glucose metabolism in insulin-resistant states and increases the activation (phosphorylation) of anabolic signaling proteins in muscle during administration of insulin and amino acids and increases the nonoxidative whole-body disposal of amino acids, an index of increased whole-body protein synthesis</td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Italie</li>
</country>
</list>
<tree><country name="Italie"><noRegion><name sortKey="Rondanelli, Mariangela" sort="Rondanelli, Mariangela" uniqKey="Rondanelli M" first="Mariangela" last="Rondanelli">Mariangela Rondanelli</name>
</noRegion>
<name sortKey="Allieri, Francesca" sort="Allieri, Francesca" uniqKey="Allieri F" first="Francesca" last="Allieri">Francesca Allieri</name>
<name sortKey="Faliva, Milena" sort="Faliva, Milena" uniqKey="Faliva M" first="Milena" last="Faliva">Milena Faliva</name>
<name sortKey="Monteferrario, Francesca" sort="Monteferrario, Francesca" uniqKey="Monteferrario F" first="Francesca" last="Monteferrario">Francesca Monteferrario</name>
<name sortKey="Perna, Simone" sort="Perna, Simone" uniqKey="Perna S" first="Simone" last="Perna">Simone Perna</name>
<name sortKey="Peroni, Gabriella" sort="Peroni, Gabriella" uniqKey="Peroni G" first="Gabriella" last="Peroni">Gabriella Peroni</name>
<name sortKey="Repaci, Erica" sort="Repaci, Erica" uniqKey="Repaci E" first="Erica" last="Repaci">Erica Repaci</name>
</country>
</tree>
</affiliations>
</record>
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