BackgroundProtein-energy malnutrition (PEM) is a major problem in older adults. Whether poor diet quality is an indicator for the long-term development of PEM is unknown.ObjectiveThe aim was to determine whether poor diet quality is associated with the incidence of PEM in community-dwelling older adults.DesignWe used data on 2234 US community-dwelling older adults aged 70–79 y of the Health, Aging, and Body Composition (Health ABC) Study. In 1998–1999, dietary intake over the preceding year was measured by using a Block food-frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (HEI), energy intake, and protein intake. Outcomes were determined annually by using measured weight and height and included the following: 1) incident PEM [body mass index (in kg/m2) <20, involuntary weight loss of ≥5% in the preceding year at any follow-up examination, or both] and 2) incident persistent PEM (having PEM at 2 consecutive follow-up examinations). Associations of indicators of diet quality with 4-y and 3-y incidence of PEM and persistent PEM, respectively, were examined by multivariable Cox regression analyses.ResultsThe quality of the diet, as assessed with the HEI, was rated as “poor” for 6.4% and as “needs improvement” for 73.0% of the participants. During follow-up, 24.9% of the participants developed PEM and 8.5% developed persistent PEM. A poor HEI score was not associated with incident PEM or persistent PEM. Lower baseline energy intake was associated with a lower incidence of PEM (HR per 100-kcal/d lower intake: 0.98; 95% CI: 0.97, 0.99) and persistent PEM (HR: 0.97; 95% CI: 0.95, 0.99), although lower baseline protein intake was observed to be associated with a higher incidence of persistent PEM (HR per 10-g/d lower intake: 1.15; 95% CI: 1.03, 1.29).ConclusionsThese findings do not indicate that a poor diet quality is a risk factor for the long-term development of PEM in community-dwelling older adults, although there is an indication that lower protein intake is associated with higher PEM risk.
Background Lower protein intake in older adults is associated with loss of muscle mass and strength. The present study aimed to provide a pooled estimate of the overall prevalence of protein intake below recommended (according to different cutoff values) among community-dwelling older adults, both within the general older population and within specific subgroups. Methods As part of the PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS) project, a meta-analysis was performed using data from four cohorts (from the Netherlands, UK, Canada, and USA) and four national surveys [from the Netherlands, Finland (two), and Italy]. Within those studies, data on protein and energy intake of community-dwelling men and women aged ≥55 years were obtained by either a food frequency questionnaire, 24 h recalls administered on 2 or 3 days, or food diaries administered on 3 days. Protein intake below recommended was based on the recommended dietary allowance of 0.8 g/kg body weight (BW)/d, by using adjusted BW (aBW) instead of actual BW. Cutoff values of 1.0 and 1.2 were applied in additional analyses. Prevalences were also examined for subgroups according to sex, age, body mass index (BMI), education level, appetite, living status, and recent weight loss. Results The study sample comprised 8107 older persons. Mean ± standard deviation protein intake ranged from 64.3 ± 22.3 (UK) to 80.6 ± 23.7 g/d [the Netherlands (cohort)] or from 0.94 ± 0.38 (USA) to 1.17z ± 0.30 g/kg aBW/d (Italy) when related to BW. The overall pooled prevalence of protein intake below recommended was 21.5% (95% confidence interval: 14.0-30.1), 46.7% (38.3-55.3), and 70.8% (65.1-76.3) using the 0.8, 1.0, and 1.2 cutoff value, respectively. A higher prevalence was observed among women, individuals with higher BMI, and individuals with poor appetite. The prevalence differed only marginally by age, education level, living status, and recent weight loss. Conclusions In community-dwelling older adults, the prevalence of protein intake below the current recommendation of 0.8 g/kg aBW/d is substantial (14-30%) and increases to 65-76% according to a cutoff value of 1.2 g/kg aBW/d. To what extent the protein intakes are below the requirements of these older people warrants further investigation.
Background & aims: Adequate protein intake is required to maintain muscle health in old age, but a low protein intake is very common in older adults. There is little insight in the general and dietary profile of older adults with a low protein intake. Therefore, this study aimed to compare community-dwelling older adults with a low and a high protein intake with regard to protein intake per eating occasion, food sources of protein and general participant characteristics. Methods: Data were used from 727 Dutch community-dwelling older adults aged 70 years. Protein intake at meal and snack moments was measured with two non-consecutive dietary record assisted 24-h recalls. Low protein intake was defined as below the Recommended Dietary Allowance of 0.8 g protein per kg adjusted body weight per day (g/kg aBW/d). Differences in protein and food intakes between those with a low and a high protein intake were assessed with the ManneWhitney U test and Chi-square test. Eating occasions were compared with regard to differences between the low and high protein intake group by using MANOVA. Characteristics of older adults with low protein intake were selected by using a multiple logistic backward elimination procedure. Results: Low protein intake was present in 15% of the participants. At all eating occasions, median protein intake was lower in the low compared to the high protein intake group (breakfast, 7.8 vs. 10.8 g; lunch, 12.6 vs. 24.3 g; dinner, 21.8 vs. 31.1 g; snack moments, 6.7 vs. 9.7 g; P < 0.001), and was also consistently lower relative to energy intake. The contribution of animal protein to total protein intake was lower among the low protein intake group. Both groups obtained most protein from dairy, meat and cereals, but meat contributed less (21.5 vs. 28.2%) and cereals more (21.9 vs. 19.6%) among the low than the high protein intake group (all P < 0.01). Differences in protein intake, percentage of energy from protein and contribution of animal to total protein intake between the groups were largest at lunch compared to the other eating occasions. Out of a long list of variables, low protein intake was only associated with following a diet, being obese vs. normal-weight and drinking alcohol on none vs. some but <5 days/week (P < 0.05). Conclusions: At all eating occasions, Dutch community-dwelling older adults with a protein intake <0.8 g/kg aBW/d ate less protein (also relative to their energy intake) and a lower proportion of animal protein compared to those with a high protein intake. These differences were largest at lunch. Major food sources of protein e in both groups e were dairy, meat and cereals. We could only identify following a diet, being obese and not drinking alcohol as general characteristics of older adults with a low protein intake.
OBJECTIVE To examine associations of diet quality indicators with 4‐year incidence of frailty in community‐dwelling older adults. DESIGN Prospective cohort study. SETTING Health, Aging, and Body Composition Study, United States. PARTICIPANTS Community‐dwelling men and women, aged 70 to 81 years in 1998 to 1999 (first follow‐up, present study's baseline; n = 2154). MEASUREMENTS At first follow‐up, dietary intake over the preceding year was assessed with a food frequency questionnaire. Indicators of diet quality include the Healthy Eating Index (categorized as poor, medium, and good), energy intake, and protein intake (a priori adjusted for energy intake using the nutrient residual model). Frailty status was determined using Fried's five‐component frailty phenotype and categorized into “robust” (0 components present), “pre‐frailty” (1 ‐ 2 components present), or “frail” (3‐5 components present). Cox proportional hazards analysis was used to examine associations of the diet quality indicators with 4‐year incidence of (1) frailty and (2) pre‐frailty or frailty. Competing risk analysis was used to examine associations with frailty by accounting for competing risks of death. RESULTS During the 4‐year follow‐up, 277 of the 2154 participants, robust or pre‐frail at baseline, developed frailty, and 629 of the 1020 participants, robust at baseline, developed pre‐frailty or frailty. Among the robust and pre‐frail, after adjustment for confounders including energy intake, those consuming poor‐ and medium‐quality diets had a higher frailty incidence than those consuming good‐quality diets (hazard ratio [HR] = 1.92 [95% confidence interval {CI} = 1.17‐3.17] and HR = 1.40 [95% CI = 0.99‐1.98], respectively). No associations for energy or protein intake were observed. Competing risk analyses yielded similar results. Among the robust, those with lower vegetable protein intake had a higher “pre‐frailty or frailty” incidence (per −10 g/d: HR = 1.20; 95% CI = 1.04‐1.39). No other associations were observed. CONCLUSION Poorer overall diet quality and lower vegetable protein intake may increase the risk of becoming frail in old age. We found no association for intakes of energy, total protein, or animal protein. J Am Geriatr Soc 67:1835–1842, 2019
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