Effects of soy milk ingestion immediately after resistance training on muscular-related biomarkers in older men: a randomized controlled trial.

We evaluated the effects of soy milk ingestion on changes in body composition, strength, power, and muscular-related biomarkers following 12 weeks of resistance training in older men. Thirty healthy older men (age = 65.63 ± 3.16 years; body mass = 62.63 ± 3.86 kg) were randomly assigned to one of two groups: soy milk + resistance training (SR) or placebo + resistance training (PR). Participants in the SR group received 240 ml of vanilla-flavoured non-dairy soy milk immediately after every training session and at the same time on non-training days. Differences in muscle mass, upper limb body strength (UBS), lower limb aerobic power (LAP), activin A, and GDF15 were significantly greater in the SR group vs. the PR group (P < 0.05). Both intervention groups experienced a significant (p < 0.05) reduction in body mass (PR = -3.9 kg; SR = -3.2 kg), body fat % (PR = -0.8%; SR = -1.2%), activin A (PR = -5.1 pg/ml; SR = -12.8 pg/ml), GDF15 (PR = -8.1 pg/ml; SR = -14.7 pg/ml), TGFß1 (PR = -0.43 pg/ml; SR = -0.41 pg/ml), and increase in muscle mass (PR = 0.81 kg; SR = 2.5 kg), UBS (PR = 3.4 kg; SR = 6.7 kg), lower limb body strength (PR = 2.8 kg; SR = 5.2 kg), upper limb aerobic power (PR = 34.3 W; SR = 38.6 W), LAP (PR = 23.2 W; SR = 45.2 W), BDNF (PR = 8.3 ng/ml; SR = 12.7 ng/ml), and irisin (PR = 1.5 ng/ml; SR = 2.9 ng/ml) compared to baseline. The ingestion of soy milk during 12 weeks of resistance training augmented lean mass, strength, and power, and altered serum concentrations of skeletal muscle regulatory markers in older men.

Improvement of inflammatory status following saffron (Crocus sativus L.) and resistance training in elderly hypertensive men: A randomized controlled trial.

OBJECTIVE: We sought to determine the independent and combined effects of saffron and resistance training on markers of inflammation and cardiovascular risk factors in elderly hypertensive patients. METHODS: Hypertensive older men were randomly assigned to a control group (C) or one of three experimental groups [saffron consumption (S), resistance training (R), and resistance training + saffron (RS)] for 12 weeks. Inflammatory markers and lipid profiles were measured at baseline and following the 12-week intervention period. Patients in S and RS received one tablet containing 200 mg of saffron daily. Primary outcomes were analyzed using univariate analysis of covariance (ANCOVA). RESULTS: The RS group had significantly greater reductions in leptin, resistin, MCP-1, and IL-6 as compared with the C, S, and R groups (ps < 0.05). In addition, the RS, S, and R groups had significantly greater reductions in TC and greater increases in HDL-c as compared with the C group (ps < 0.05), but there were no differences between the RS, S, and R groups. Finally, there were no differences between groups for TNF-α, homocysteine, and hs-CRP (ps > 0.05). CONCLUSION: Combining Saffron and resistance training can reduce inflammation and cardiovascular disease risk factors associated with increased risk for hypertension in older men with hypertension.

The effects of saffron (Crocus sativus L.) in conjunction with concurrent training on body composition, glycaemic status, and inflammatory markers in obese men with type 2 diabetes mellitus: A randomized double-blind clinical trial.

AIMS: Chronic inflammation is one of the major challenges in the management of obesity and type 2 diabetes mellitus (T2DM). Our primary aim was to assess the anti-inflammatory effects of Saffron (Crocus sativus L.) supplementation and concurrent training in obese men with T2DM. METHODS: Sixty obese men with T2DM (age = 39 ± 5 years; body mass = 93.9 ± 6 kg) were randomly assigned to four groups; concurrent training + placebo (CT; n = 15), saffron supplementation (S; n = 15), concurrent training + saffron supplementation (CTS; n = 15), or control (CON; n = 15). The participants in the CT group performed concurrent training (resistance + aerobic) three times per week for 12 weeks and received daily one pill of placebo (maltodextrin); the participants in the S group supplemented with one pill of 100 mg of saffron daily, and the participants in the CTS group participated in both saffron and training intervention while CON group continued regular lifestyle (no training and no supplementation). Inflammatory markers, body composition (evaluated by a multi-frequency bioelectrical impedance device; Jawon X-Contact 356), and metabolic profile were evaluated before and after interventions. RESULTS: All three interventions significantly (P < .05) decreased TNF-α (CT = -4.22, S = -1.91, CTS = -9.69 pg/mL), hs-CRP (CT = -0.13, S = -0.1, CTS = -0.32 ng/mL), IL-6 (CT = -6.84, S = -6.36, CTS = -13.55 pg/mL), IL-1ß (CT = -8.85, S = -6.46, CTS = -19.8 pg/mL), FBG (CT = -6.97, S = -2.45, CTS = -13.86 mg/dL), insulin (CT = -0.13, S = -0.03, CTS = -0.21 mU/L), HOMA-IR (CT = -0.12, S = -0.04, CTS = -0.21), HbA1c (CT = -0.17, S = -0.11, CTS = -0.26%), and increased IL-10 (CT = 1.09, S = 0.53, CTS = 2.27 pg/mL) concentrations. There was a positive correlation between changes in BFP with hs-CRP, IL-6, IL-1ß and TNF-α, and IL-10 concentrations across the intervention groups. Additionally, significant differences were observed between the changes for all variables in the CTS group compared to CT, S and CON groups (P < .05). CONCLUSION: It seems that an interaction of saffron supplementation and concurrent training has more efficient effects on anti-inflammatory status compared to saffron supplementation or concurrent training alone.

Effects of Icelandic yogurt consumption and resistance training in healthy untrained older males.

Due to the important roles of resistance training and protein consumption in the prevention and treatment of sarcopenia, we assessed the efficacy of post-exercise Icelandic yogurt consumption on lean mass, strength and skeletal muscle regulatory factors in healthy untrained older males. Thirty healthy untrained older males (age = 68 ± 4 years) were randomly assigned to Icelandic yogurt (IR; n 15, 18 g of protein) or an iso-energetic placebo (PR; n 15, 0 g protein) immediately following resistance training (3×/week) for 8 weeks. Before and after training, lean mass, strength and skeletal muscle regulatory factors (insulin-like growth factor-1 (IGF-1), transforming growth factor-beta 1 (TGF-ß1), growth differentiation factor 15 (GDF15), Activin A, myostatin (MST) and follistatin (FST)) were assessed. There were group × time interactions (P < 0·05) for body mass (IR: Δ 1, PR: Δ 0·7 kg), BMI (IR: Δ 0·3, PR: Δ 0·2 kg/m2), lean mass (IR: Δ 1·3, PR: Δ 0·6 kg), bench press (IR: Δ 4, PR: 2·3 kg), leg press (IR: Δ 4·2, PR: Δ 2·5 kg), IGF-1 (IR: Δ 0·5, Δ PR: 0·1 ng/ml), TGF-ß (IR: Δ - 0·2, PR: Δ - 0·1 ng/ml), GDF15 (IR: Δ - 10·3, PR: Δ - 4·8 pg/ml), Activin A (IR: Δ - 9·8, PR: Δ - 2·9 pg/ml), MST (IR: Δ - 0·1, PR: Δ - 0·04 ng/ml) and FST (IR: Δ 0·09, PR: Δ 0·03 ng/ml), with Icelandic yogurt consumption resulting in greater changes compared with placebo. The addition of Icelandic yogurt consumption to a resistance training programme improved lean mass, strength and altered skeletal muscle regulatory factors in healthy untrained older males compared with placebo. Therefore, Icelandic yogurt as a nutrient-dense source and cost-effective supplement enhances muscular gains mediated by resistance training and consequently may be used as a strategy for the prevention of sarcopenia.

The Combined Effects of 6 Weeks of Jump Rope Interval Exercise and Dark Chocolate Consumption on Antioxidant Markers in Obese Adolescent Boys.

Research has shown that both dark chocolate and exercise training may have favorable effects on antioxidant function in obese cohorts. However, their combined effect has not been established. We assessed the influences of six weeks of dark chocolate consumption combined with jump rope exercise on antioxidant markers in adolescent boys with obesity. Fifty adolescent boys with obesity (age = 15 ± 1 years) were randomly assigned into one of four groups; jump rope exercise + white chocolate consumption (JW; n = 13), jump rope exercise + dark chocolate consumption (JD; n = 13), dark chocolate consumption (DC; n = 12), or control (C; n = 12). Two participants dropped out of the study. Participants in JW and JD groups performed jump rope exercise three times per week for six weeks. Participants in the DC and JD groups consumed 30 g of dark chocolate containing 83% of cocoa during the same period. Serum concentrations of superoxide dismutase (SOD), total antioxidant capacity (TAC), glutathione peroxidase (GPx), and thiobarbituric acid reactive substances (TBARS) were evaluated prior to and after the interventions. All 3 intervention groups noted significant (p < 0.01) increases in serum concentrations of TAC, SOD, and GPx from baseline to post-test. In contrast, all intervention groups showed significantly reduced serum concentrations of TBARS from pre- to post-test (p ≤ 0.01). Bonferroni post hoc analysis revealed that post-test serum concentrations of TAC in the JD group were significantly greater than C (p < 0.001), DC (p = 0.010), and JW (p < 0.001) groups. In addition, post-test serum concentrations of SOD in the JD group were significantly greater than C group (p = 0.001). Post-test serum concentrations of GPx in the JD group were significantly greater than C (p < 0.001), DC (p = 0.021), and JW (p = 0.032) groups. The post-test serum concentrations of TBARS in the JD group was significantly lower than C (p < 0.001). No other significant between-group differences were observed. The current study provides evidence that dark chocolate consumption in combination with jump rope exercise is more efficient in improving antioxidant capacity than dark chocolate consumption or jump rope exercise alone among obese adolescent boys.

The Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Inflammatory Markers, Body Composition, and Physical Fitness in Overweight/Obese Survivors of Breast Cancer: A Randomized Controlled Clinical Trial.

Background: Chronic inflammation associated with breast cancer (BC) poses a major challenge in care management and may be ameliorated by physical activity. This randomized controlled trial assessed the effects of a 12-week high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on inflammatory markers, body composition, and physical fitness in BC survivors (BCS). Methods: Forty BCS (age = 57 ± 1 years; body mass [BM] = 74.8 ± 1.5 kg; VO2peak = 20.8 ± 2.1 mL·kg-1·min-1) were randomly assigned to three groups: HIIT (n = 15), MICT (n = 15), or control (CON; n = 15). The intervention groups (HIIT and MICT) performed their respective exercise protocols on a cycle ergometer 3 days/week for 12 weeks while the CON group maintained their current lifestyle. Baseline and post-intervention assessments included body composition (BM, fat mass (FM), lean mass (LM)), physical fitness (VO2peak, lower body strength (LBS), upper body strength (UBS)), and serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), leptin, and adiponectin. Results: Both intervention groups significantly (p < 0.05) decreased BM (HIIT = -1.8 kg, MICT = -0.91 kg), FM (HIIT = -0.81 kg, MICT = -0.18 kg), TNF-α (HIIT = -1.84 pg/mL, MICT = -0.99 pg/mL), IL-6 (HIIT = -0.71 pg/mL, MICT = -0.36 pg/mL), leptin (HIIT = -0.35 pg/mL, MICT = -0.16 pg/mL) and increased VO2peak (HIIT = 0.95 mL·kg-1·min-1, MICT = 0.67 mL·kg-1·min-1), LBS (HIIT = 2.84 kg, MICT = 1.53 kg), UBS (HIIT = 0.53 kg, MICT = 0.53 kg), IL-10 (HIIT = 0.63 pg/mL, MICT = 0.38 pg/mL), and adiponectin (HIIT = 0.23 ng/mL, MICT = 0.1 ng/mL) compared to baseline. The changes in BM, FM, TNF-α, leptin, and LBS were significantly greater in HIIT compared to all other groups. Conclusions: Our findings indicate that compared to the often-recommended MICT, HIIT may be a more beneficial exercise therapy for the improvement of inflammation, body composition and LBS in BCS; and consequently, merits long-term study.

Strategic Ingestion of High-Protein Dairy Milk during a Resistance Training Program Increases Lean Mass, Strength, and Power in Trained Young Males.

BACKGROUND: We evaluated the effects of high-protein dairy milk ingestion on changes in body composition, strength, power, and skeletal muscle regulatory markers following 6 weeks of resistance training in trained young males. METHODS: Thirty resistance-trained young males (age: 27 ± 3 years; training experience: 15 ± 2 months) were randomly assigned to one of two groups: high-protein dairy milk (both whey and casein) + resistance training (MR; n = 15) or isoenergetic carbohydrate (maltodextrin 9%) + resistance training (PR; n = 15). Milk and placebo were ingested immediately post-exercise (250 mL; 30 g protein) and 30 min before sleep (250 mL; 30 g protein). Before and after 6 weeks of linear periodized resistance training (4 times/week), body composition (bioelectrical impedance), strength, power, and serum levels of skeletal muscle regulatory markers (insulin-like growth factor 1 (IGF-1), growth hormone, testosterone, cortisol, follistatin, myostatin, and follistatin-myostatin ratio) were assessed. RESULTS: The MR group experienced a significantly higher (p < 0.05) increase in lean mass, strength, and power (upper- and lower-body) than the PR group. Further, IGF-1, growth hormone, testosterone, follistatin, and follistatin-myostatin ratio were significantly increased, while cortisol and myostatin significantly decreased in the MR group than the PR group (p < 0.05). CONCLUSIONS: The strategic ingestion of high-protein dairy milk (post-exercise and pre-sleep) during 6 weeks of resistance training augmented lean mass, strength, power, and altered serum concentrations of skeletal muscle regulatory markers in trained young males compared to placebo.

Saffron (Crocus sativus L.) in combination with resistance training reduced blood pressure in the elderly hypertensive men: A randomized controlled trial.

AIMS: We aimed to determine the independent and combined effects of saffron and resistance training on blood pressure (BP) and some chemical biomarkers in the elderly with hypertension. METHODS: The present study was a randomized clinical trial on hypertensive men aged 60-70 years who were assigned to a control group (CO) and 3 experimental groups; resistance training (RT); saffron (S); and resistance training + saffron (RTS) for 12 weeks. Dynamic resistance training was applied with moderate intensity. Patients in S and RTS received 1 tablet containing 200 mg of saffron daily. BP variables, chemical biomarkers and anthropometric indicators were measured at weeks 0, 6, 12 and 18. Data were analysed by repeated measurements ANOVA with 95% confidence interval (CI). RESULTS: In comparison to the CO (153.3 ± 1.18, CI = 10.9-20.2, P < .001) and S (143.3 ± 1.18, CI = 0.97-10.2, P = .01), RTS (137.7 ± 1.18) reduced systolic BP with the effect size partial η2 of 0.68. Nitric oxide increased in the RTS compared to the CO group (CI = 0.13-0.62, P = .001). There was a significant increase and decrease in adiponectin and endothelin-1 in the S (CI = 0.03-1.20, P = .012; CI = 4.30-17.3, P < .001) and RT (CI = 0.36-1.60, P < .001; CI = 2.26-15.3, P = .003) compared to the CO, respectively. The partial η2 for nitric oxide, adiponectin and ET-1 were 0.35, 0.35 and 0.38, respectively. There was no significant difference between the groups for atrial natriuretic peptide. CONCLUSIONS: Resistance training and consumption of saffron can improve BP in the elderly with hypertension by affecting the factors involved in altering vascular endothelial resistance. The present study was approved by the Ethics Committee of Iran's sports science research institution (IR.SSRC.REC.1398.020) and registered at the Iranian Registry of Clinical Trials (IRCT20190731044398N1).

Whole Egg Vs. Egg White Ingestion During 12 weeks of Resistance Training in Trained Young Males: A Randomized Controlled Trial.

ABSTRACT: Bagheri, R, Moghadam, BH, Ashtary-Larky, D, Forbes, SC, Candow, DG, Galpin, AJ, Eskandari, M, Kreider, RB, and Wong, A. Whole egg vs. egg white ingestion during 12 weeks of resistance training in trained young males: a randomized controlled trial. J Strength Cond Res 35(2): 411-419, 2021-The primary purpose was to compare the effects of whole egg ingestion and egg white ingestion during 12 weeks of resistance training (RT) on muscle cross-sectional area, body composition, muscular strength, and anaerobic power in resistance-trained young males. A secondary purpose was to examine systemic hormonal responses. Thirty resistance-trained young males were randomly assigned to one of 2 groups: Whole eggs + RT (WER; n = 15) or egg whites + RT (ERT; n = 15). Whole eggs + RT ingested 3 whole eggs immediately following RT, whereas ERT ingested an isonitrogenous quantity consisting of 6 egg whites immediately following RT. Before and after 12 weeks of whole-body undulating periodized RT (3 sessions per week), knee extensor muscle mass and cross-sectional area (computed tomography), lean body mass and body fat percentage (bioelectrical impedance), muscular strength (knee extension, handgrip strength), Wingate (cycle ergometer), and serum concentrations of hormones were assessed. There was a significant group × time interaction for body fat percentage, serum testosterone, knee extension, and handgrip strength with greater improvements observed in WER. There was a significant main effect of time (p < 0.05) for knee extensor muscle mass, cross-sectional area, lean body mass, anaerobic power, and all other blood hormones. There was a trend (p = 0.06) in the WER group for having a greater change in lean body mass compared with that of ERT. Postexercise whole egg ingestion increases knee extension and handgrip strength, testosterone, and reduces body fat percentage compared with postexercise egg white ingestion, despite no group differences in muscle mass, in resistance-trained young males. Whole eggs consumption may be preferable during RT programs geared toward the improvement of muscular strength and body fat percentage.

Effects of Interval Jump Rope Exercise Combined with Dark Chocolate Supplementation on Inflammatory Adipokine, Cytokine Concentrations, and Body Composition in Obese Adolescent Boys.

We examined the effects of six weeks of dark chocolate supplementation combined with interval jump rope exercise (JRE) on inflammatory cytokines, adipokines, and body composition in obese adolescent boys. Forty-eight obese adolescent boys (age = 15.4 ± 1.1 years and body mass index = 32.2 ± 2.4 kg/m2) were randomly assigned into one of four groups: JRE + white chocolate (JW; n = 13), JRE + dark chocolate supplementation (JD; n = 13), dark chocolate supplementation (DS; n = 12), or control (C; n = 12). Participants in JW and JD groups performed JRE for three times per week for six weeks. Participants in the DS and JD groups consumed 30 g of dark chocolate containing 83% of cocoa. Body composition, pro-inflammatory cytokines ((hs-CRP, TNF-α, IL-6), adipokines (leptin, resistin, RBP-4, chemerin, MCP-1), and anti-inflammatory adipokines (irisin, adiponectin)) were evaluated prior to and after the intervention trials. All three intervention trials significantly (p < 0.05) decreased body mass, waist-hip ratio, fat mass, hs-CRP, TNF-α, IL-6, leptin, resistin, RBP-4, and MCP-1, and increased irisin and adiponectin concentrations. The improvements in these parameters were greater in the JD group, and additionally, chemerin concentrations decreased only in the JD group. JD enhanced adiponectin concentrations and decreased IL-6 concentrations compared to C. Moreover, JD significantly reduced chemerin concentrations, an effect not observed in any of the other interventions. We demonstrated that dark chocolate supplementation potentiated JRE-induced decreases in body mass, WHR, FM, hs-CRP, TNF-α, IL-6, leptin, resistin, RBP-4, and MCP-1, chemerin as well as increases irisin and adiponectin concentrations in obese adolescent boys. Therefore, JRE combined with dark chocolate supplementation could be a beneficial in reducing obesity-induced inflammation in adolescent boys.

The effect of 12-week resistance exercise training on serum levels of cellular aging process parameters in elderly men.

BACKGROUND: Regular physical activity has a positive effect on the prevention of cellular aging. The present study investigated the effect of 12-week resistance training (RT) on serum levels of Sirtuin-1 (SIRT1), Sirtuin-3 (SIRT3), Sirtuin-6 (SIRT6), Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1-α), and telomerase enzyme in elderly men. METHODS: For this purpose, 30 elderly men (age 66.23 ± 0.57 years) were randomly divided into two groups: resistance training group (RET, n = 15) and control group (CTR, n = 15). Participants in RET performed RT protocols with intensity of 60% one-repetition maximum (3×/week, 4 sets of the six exercise circuits). Body composition, physical functioning and, blood samples were assessed before (pre-test) and after (post-test) a 12-week intervention. RESULTS: The results showed that there was a significant increase in serum levels of SIRT1 (P = 0.001), SIRT3 (P = 0.001), SIRT6 (P = 0.02), PGC1-α (P = 0.001), and telomerase enzyme (P = 0.001) in RET. Also, we found a significant difference between the RET and CTR in serum levels of SIRT1 (P = 0.001), SIRT3 (P = 0.001), SIRT6 (P = 0.037), PGC1-α (P = 0.007), and telomerase enzyme (P = 0.001). CONCLUSIONS: 12-Week RT increased the levels of proteins associated with the biological aging process in elderly men. It seems that the RT may have beneficial effects on cellular senescence and also improved impaired mitochondrial protein and enzymatic functional induced aging.

Comparing High-Intensity Interval Training (HIIT) and Continuous Training on Apelin, APJ, NO, and Cardiotrophin-1 in Cardiac Tissue of Diabetic Rats.

BACKGROUND AND AIMS: Exercise activity is an important method for managing type 2 diabetes. This investigation examined the HIIT and continuous training on apelin, APJ receptor, NO, and cardiotrophin-1 in the cardiac tissue of diabetic rats. METHODS: The animals were categorized into 3 groups of HIIT, continuous (CO), and control (C) (all animals were sacrificed immediately and 2 days after exercise training period). Rats underwent the treadmill exercise program either HIIT (12 bouts at 90-95% of VO2 max with 60 s rest at 50% of VO2 max) or CO (60-65% VO2 max for 40 min). Protocols performed 5 days per week for 8 weeks. Apelin, APJ receptor, NO, and cardiotrophin-1 protein expressions were measured using the Western blotting method in the left ventricle. RESULTS: Immediately after HIIT and CO exercise protocols, apelin and CT-1 protein showed a significant difference in contrast by the C-0 group (p < 0.01). However, NO values were substantially higher in HIIT-0 compared to C-0 and CO-0 groups rats (p < 0.01). After two days of exercise protocols, apelin and NO protein showed a significant increase in HIIT and CO groups in contrast to the C animals (p < 0.01). Moreover, APJ and CT-1 protein significantly upregulated in CO-2 and HIIT-2 compared to the other groups (p < 0.01). CONCLUSIONS: This study indicates that exercise training, despite the type, is an efficient method to modify apelin, APJ receptor, NO, and cardiotrophin-1 values in animals with type 2 diabetes.

Comparison of whole egg v. egg white ingestion during 12 weeks of resistance training on skeletal muscle regulatory markers in resistance-trained men.

Eggs are considered a high-quality protein source for their complete amino acid profile and digestibility. Therefore, this study aimed to compare the effects of whole egg (WE) v. egg white (EW) ingestion during 12 weeks of resistance training (RT) on the skeletal muscle regulatory markers and body composition in resistance-trained men. Thirty resistance-trained men (mean age 24·6 (sd 2·7) years) were randomly assigned into the WE + RT (WER, n 15) or EW + RT (EWR, n 15) group. The WER group ingested three WE, while the EWR group ingested an isonitrogenous quantity of six EW per d immediately after the RT session. Serum concentrations of regulatory markers and body composition were measured at baseline and after 12 weeks. Significant main effects of time were observed for body weight (WER 1·7, EWR 1·8 kg), skeletal muscle mass (WER 2·9, EWR 2·7 kg), fibroblast growth factor-2 (WER 116·1, EWR 83·2 pg/ml) and follistatin (WER 0·05, EWR 0·04 ng/ml), which significantly increased (P < 0·05), and for fat mass (WER -1·9, EWR -1·1 kg), transforming growth factor-ß1 (WER -0·5, EWR -0·1 ng/ml), activin A (WER -6·2, EWR -4·5 pg/ml) and myostatin (WER -0·1, EWR -0·06 ng/ml), which significantly decreased (P < 0·05) in both WER and EWR groups. The consumption of eggs absent of yolk during chronic RT resulted in similar body composition and functional outcomes as WE of equal protein value. EW or WE may be used interchangeably for the dietary support of RT-induced muscular hypertrophy when protein intake is maintained.