Effects of Alpha-lactalbumin Intake on Metabolic and Cognitive Functions in Elderly

Study Overview
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Brief Summary
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Aging modifies the metabolic pathway of the neurotransmitter serotonin by reducing the synthesis rate and increasing the breakdown rate of serotonin, possibly related to the observed enhanced sensitivity of the serotonergic pathway. Since serotonin plays a prominent role in neuropsychological functions such as anxiety, mood and memory, the enhanced sensitivity of the serotonergic pathway in aging can probably explain the fact that elderly are more vulnerable to develop cognitive deficits and depressive symptoms. Serotonin synthesis in brain is regulated by its precursor tryptophan (TRP). Because tryptophan is an essential amino acid, modifying the availability of tryptophan through dietary intake, can directly influence central serotonin metabolism and consequently affective and cognitive processes. The aim of this study is to test the hypothesis that an acute intake of whey protein with high levels of TRP such as alpha-lactalbumin can stabilize the metabolism of serotonin and subsequently enhance metabolic and cognitive functions in healthy older adults. The acute effects of this dietary protein will be investigated in subjects with mild cognitive impairment (MCI), or dementia, compared to control subjects in order to examine whether healthy older subject with MCI benefit more from the intake of alpha-lactalbumin and/or whey. The investigators will investigate if this meal can optimize serotonin metabolism by elevating plasma TRP levels and plasma TRP appearance and enhance splanchnic TRP extraction. In addition, the effects on mood and cognitive functions will be examined.

Detailed Description
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The study involves for all subjects 3 test days (approximately 8 hours each). On this test day the investigators will examine the acute effects of a protein meal. Subjects will receive a mixture of alpha-lactalbumin and/or whey and/or casein, carbohydrates and amino acid stable isotopes to investigate protein and amino acid kinetics (assigned to alpha-lactalbumin or whey or casein group on test day 1, then switch on test day 2 and 3). The subjects will receive these stable isotopes by infusion in their blood and by oral intake (e.g. simultaneously with protein meal). For study purposes, blood will be drawn approx. 25 times during 8 hours on the test day, altogether about 100-120 ml of blood will be drawn on the test day.

Official Title
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Effects of Alpha-lactalbumin on Metabolic and Cognitive Functions in Healthy Older Adults

Conditions
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Mild Cognitive Impairment

Intervention / Treatment
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* Dietary Supplement: Alpha-lactalbumin
* Dietary Supplement: Whey
* Dietary Supplement: Casein


Participation Criteria
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Eligibility Criteria
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Inclusion criteria subjects with dementia: Dementia diagnosis Ability to walk, sit down and stand up independently Age 55 years or older Ability to lie in supine or elevated position for 8 hours Willingness and ability to comply with the protocol, including: Adhering to fasting state from 10 pm ± 2h onwards the day prior to each study visit Inclusion criteria healthy subjects: Healthy male or female according to the investigator's or appointed staff's judgment Ability to walk, sit down and stand up independently Age 55 years or older Ability to lie in supine or elevated position for 8 hours Willingness and ability to comply with the protocol, including: Adhering to fasting state from 10 pm ± 2h onwards the day prior to each study visit Exclusion Criteria: Any condition that may interfere with the definition 'healthy subject' according to the investigator's judgment (for healthy control group only) Failure to give informed consent or Investigator's uncertainty about the willingness or ability of the subject to comply with the protocol requirements Indication of severe cognitive impairment (MOCA score < 17) Established diagnosis of Insulin Dependent Diabetes Mellitus History of untreated metabolic disease(s) including hepatic or renal disorder Presence of acute illness or metabolically unstable chronic illness Presence of fever within the last 3 days Preplanned surgery of procedures that would interfere with the conduct of the study Any other condition according to the PI or study physician that would interfere with proper conduct of the study / safety of the patient Current alcohol or drug abuse Known allergy to milk or milk products Use of long-term oral corticosteroids or short course of oral corticosteroids 4 weeks preceding first test day Use of protein or amino acid containing nutritional supplements within 5 days of test day (Possible) pregnancy BMI of < 18.5 or ≥ 40 kg/m2 Dietary or lifestyle characteristics: When during the period from enrollment to completion of the study (end of test day) any condition is developed, whether causing the subject to not meet inclusion criteria or to meet exclusion criteria, the subject will be excluded from the study

Ages Eligible for Study
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Minimum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Healthy<br>healthy control subjects | Dietary Supplement: Alpha-lactalbumin<br>* Subjects will ingest the liquid meal containing alpha-lactalbumin and carbohydrates (0.6 g/kg FFM protein + 0.3 g/kg FFM carbohydrates).<br>Dietary Supplement: Whey<br>* commercially available whey protein<br>Dietary Supplement: Casein<br>* commercially available casein protein<br>|
| Experimental: MCI<br>mild cognitive impariments | Dietary Supplement: Alpha-lactalbumin<br>* Subjects will ingest the liquid meal containing alpha-lactalbumin and carbohydrates (0.6 g/kg FFM protein + 0.3 g/kg FFM carbohydrates).<br>Dietary Supplement: Whey<br>* commercially available whey protein<br>Dietary Supplement: Casein<br>* commercially available casein protein<br>|
| Experimental: Dementia<br>established diagnosis of dementia | Dietary Supplement: Alpha-lactalbumin<br>* Subjects will ingest the liquid meal containing alpha-lactalbumin and carbohydrates (0.6 g/kg FFM protein + 0.3 g/kg FFM carbohydrates).<br>Dietary Supplement: Whey<br>* commercially available whey protein<br>Dietary Supplement: Casein<br>* commercially available casein protein<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Net whole-body protein synthesis | Change in whole-body protein synthesis rate after intake of meal | 0, 15, 30, 45, 60, 75, 90, 105, 120, 150, 180, 210 min post-meal | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Citrulline rate of appearance | Plasma enrichment of citrulline | Postabsorptive state during 2 hours | 
| Skeletal and respiratory muscle strength | Difference in leg strength and fatigue, handgrip strength and fatigue, and inspiratory and expiratory pressure between older adults with and without MCI. | 1 day | 
| Cognitive function and mood | Outcome of neuro-psychological tests in healthy older adults with and without MCI in relation to the tryptophan metabolism | Postabsorptive state during 3 hours and change after feeding | 
| Protein digestion after feeding | Ratio enrichment free phenylalanine versus phenylalanine from protein spirulina | 0, 15, 30, 45, 60, 75, 90, 105, 120, 150, 180, 210 min post-meal | 
| Arginine turnover rate | Arginine enrichment in plasma | Postabsorptive state during 3 hours | 
| Whole body collagen breakdown rate | Hydroxyproline enrichment in plasma | Postabsorptive state during 3 hours | 
| Tryptophan turnover rate | Tryptophan enrichment in plasma in postabsorptive state and after intake of meal | Postabsorptive state during 3 hours and change after feeding | 
| Insulin response to feeding | Acute change from postabsorptive state after intake of meal | During 3 hours after feeding | 
| Fat-free mass | Characteristics of study subjects | Postabsorptive state during 15 min | 
| Myofibrillar protein breakdown rate | 3methylhistidine enrichment in plasma | 0, 15, 30, 45, 60, 75, 90, 105, 120, 150, 180, 210 min post-meal | 
| Glycine rate of appearance | Glycine enrichment in plasma | Postabsorptive state during 3 hours | 
| Taurine turnover rate | Enrichment of taurine in plasma | Postabsorptive state during 3 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mild cognitive impairment, Protein digestion, Tryptophan digestion, Cognitive function, Mood, Muscle function, Alpha-lactalbumin