Thanks to technological advances as well as increased access to health services, the elderly population has grown considerably in Brazil. With this, it is the duty of health professionals to emphasize that, over time, the elderly’s organism undergoes physiological and anthropometric changes, such as the loss of lean mass, which can lead the individual to a state of sarcopenia and impaired mobility as well as inapetency to perform basic daily activities, submitting this group to a vulnerability. Creatine: Are there benefits for the elderly?
In addition, another very common impairment, caused by the reduction of nutrient bioavailability, is the reduction of bone mass of the elderly and increased fragility of bones, making them prone to loss of balance with a higher risk of falls, injuries and fractures.
Mechanism of Action
The biochemical mechanism of creatine is established by means of the reaction catalyzed by the enzyme creatine kinase (CK) which forms a bioenergetic supply for tissues with high demand, such as muscle, which enshrines greater tissue functionality and enables, for example, the use of resistance training in older populations. It is worth noting that creatine also has participation in the cellular translocation of GLUT4 (glucose transporter type 4), which allows its therapeutic applicability in insulin resistance and type 2 diabetes mellitus, which is an incident in the elderly.
That said, the creatine molecule also has a cellular osotic effect, which promotes the expression of growth factors, such as insulin-like growth factor type 1 (IGF-1), and phosphorylation of anabolic signaling proteins that, together, facilitate muscle anabolism. These mechanisms are considered myogenic regulation factors that act by mediating the activation, proliferation and differentiation of muscle satellite cells, responsible for the growth of muscle fiber. Promoting, by this mechanism, a promising role to this substance in the case of increased muscle functionality in the elderly individual mediated by increased myofibrillar protein synthesis.
Applicability of creatine in the Elderly
From its mechanism of action, it is evident that creatine supplementation is extremely welcome in the elderly population because it presents a wide range of benefits, especially when associated with regular physical activity.
Thus, the physiology of aging favors a decrease in functional reserves, which directly affects the immune system in a process called immunosenescence. In this there is a decline in the innate and adaptive immune response, represented by a fall in the function of immune cells and a dysfunction in the system of activation and regulation of the cytokine-mediated cellular response. Thus, the process of senility associated with the immune system promotes a greater predisposition to neurodegenerative, cardiovascular and immune diseases, as well as neoplastic diseases, which contribute to the morbidity and mortality of this age group.
In addition to the literature, it already describes its action under the bone remodeling process, since it promotes the increase of osteoblastic metabolic activity, which enables the synthesis of osteoprotegerin (OPG) and this binds to the RANKL (receptor activating receptor of the nuclear factor kappa B), preventing the connection with the RANK (receptor activating the nuclear factor κB) responsible for the differentiation of osteoclasts, which results in decreased bone resorption. This is a possible way in which creatine should be considered in the clinic for patients presenting with osteopenia or osteoporosis.
Furthermore, studies show that creatine has an antioxidant effect that acts on inflammatory indices and the production of reactive oxygen species by neutrophils, enabling, from this, a reduction in oxidative stress responsible for catabolism represented, for example, by the decrease in muscle protein synthesis.
Clinical Practice on creatine in the elderly
It is certain, therefore, that nutritionists should use creatine supplementation as a resource for the management of elderly patients, especially when it comes to sarcopenia, osteopenia, osteoporosis, osteosarcopenia, chronic inflammation, type 2 diabetes mellitus, insulin resistance and dysbiosis, since it plays an anabolic and anti-inflammatory role that enables a therapeutic in the face of physiological changes observed in this portion of the population.
Bibliographic references
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Forbes SC, Candow DG, Ostojic SM, Roberts MD, Chilibeck PD. Meta-Analysis Examining the Importance of Creatine Ingestion Strategies on Lean Tissue Mass and Strength in Older Adults. Nutrients. 2021 Jun 2;13(6):1912. doi: 10.3390/nu13061912. PMID: 34199420; PMCID: PMC8229907.
