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Low protein intake may accelerate age-related loss of lean mass and physical function. We investigated prevalence of low protein intake (<1.0 g/kg/day) and the associations between dietary patterns, key modifiable risk factors and low protein intake in self-reliant community-dwelling adults ≥ 80 years. This cross-sectional study consisted of two home-visits. Data collection consisted of physical measurements (physical function, weight, height, physical activity) and self-report of nutritional intake (4-day food records), appetite, eating symptoms, dysphagia, dental status, medical conditions, pain and living status. Binary analyses were performed to compare participants with low and normal protein intake. Multiple logistic regression analyses were performed to investigate associations between low protein intake, dietary patterns and modifiable risk factors adjusted for age, sex, BMI-categories and diseases. N=126 were included in the study from January 2017 to August 2018. Prevalence of low protein intake was 54%. A greater day-to-day variation in protein intake was associated with low protein intake (adjusted OR 2.5 CI: 1.14-5.48). Participants with low protein intake had a higher prevalence of nausea, diarrhoea and mouth dryness. Reduced appetite, mouth dryness and pain increased odds of low protein intake (adjusted OR 3.06 CI: 1.23-7.63, OR 3.41 CI:1.51-7.7, OR 1.54 CI:1.00-2.36, respectively). There was a high prevalence of low protein intake in community-dwelling adults ≥ 80-years. Day-to-day variability, reduced appetite, mouth dryness and pain may be potentially modifiable risk factors. Targeting dietary patterns and risk factors in primary prevention strategies may be important to improve intake of protein and minimise risk of physical frailty.

Background: The proportion of older citizens is increasing worldwide. A well-known syndrome in old age is physical frailty which is associated with a greater risk of disabilities in activities of daily living, greater reliance on inhome services, hospitalization, institutionalization, and premature mortality. The purpose of this study is to determine the effects of an intervention with high-protein diet alone or in combination with power training in prefrail and frail old adults. Methods: The study is a community-based assessor-blinded parallel randomized controlled trial (RCT), consisting of two phases. Phase 1 is a 1-month stabilization phase, where self-reliant community-dwelling adults + 80 years old will receive individual guidance regarding protein intake, to prevent the risk of negative protein balance prior to phase 2 and to only include participants who have reached the minimum recommended level of protein intake (1.0 g/kg/day) in the randomized controlled trial. Phase 2 is a 4-month RCT where 150 participants will be randomized into the following three arms: protein-only where participants will be provided with dairy products to increase their protein intake to 1.5 g/kg/day, protein + exercise where participants will be provided with the protein intervention in combination with power training two times a week, and recommendation group where participants will continue as in phase 1. Primary outcome is lower leg muscle power. Secondary outcomes include physical function and mobility, frailty status, muscle mechanical function, body composition, nutritional status, and healthrelated quality of life. The statistical analysis will include an intention-to-treat analysis of all randomized participant and per-protocol analysis of all compliant participants. The study hypothesis will be tested with mixed linear models to assess changes in the main outcomes over time and between study arms.

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