Prevalence of protein intake below recommended in community-dwelling older adults: a meta-analysis across cohorts from the PROMISS consortium

Linda M Hengeveld, Jolanda M A Boer, Pierrette Gaudreau, Martijn W Heymans, Carol Jagger, Nuno Mendonça, Marga C Ocké, Nancy Presse, Stefania Sette, Eleanor M Simonsick, Heli Tapanainen, Aida Turrini, Suvi M Virtanen, Hanneke A H Wijnhoven, Marjolein Visser, Linda M Hengeveld, Jolanda M A Boer, Pierrette Gaudreau, Martijn W Heymans, Carol Jagger, Nuno Mendonça, Marga C Ocké, Nancy Presse, Stefania Sette, Eleanor M Simonsick, Heli Tapanainen, Aida Turrini, Suvi M Virtanen, Hanneke A H Wijnhoven, Marjolein Visser

Abstract

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 cut-off 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. Cut-off 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 cut-off 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 cut-off 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.

Keywords: Diet; Multi-cohort; Old age; Prevalence; Protein; Recommendations.

Conflict of interest statement

None declared.

© 2020 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Figures

FIGURE 1
FIGURE 1
Flow chart representing the participants included in the analysis. Studies included the Health, Aging and Body Composition Study (Health ABC), Longitudinal Aging Study Amsterdam (LASA), the Newcastle 85+ Study (Newcastle 85+), Quebec Longitudinal Study on Nutrition and Aging (NuAge), Dutch National Food Consumption Survey‐Older adults (DNFCS), National FINDIET Survey 2007 and 2012 (FINDIET 2007 and 2012), and the Third Italian National Food Consumption Survey (INRAN‐SCAI).
FIGURE 2
FIGURE 2
Forest plot representing both the study‐specific prevalences and the overall pooled prevalence of protein intake below the recommended dietary allowance of 0.8 g/kg aBW/d among community‐dwelling older adults. The pooled proportion with 95% confidence interval was obtained from a meta‐analysis using a random‐effects model. Studies included the Health, Aging and Body Composition Study (Health ABC), Longitudinal Aging Study Amsterdam (LASA), the Newcastle 85+ Study (Newcastle 85+), Quebec Longitudinal Study on Nutrition and Aging (NuAge), Dutch National Food Consumption Survey‐Older adults (DNFCS), National FINDIET Survey 2007 and 2012 (FINDIET 2007 and 2012), and the Third Italian National Food Consumption Survey (INRAN‐SCAI).
FIGURE 3
FIGURE 3
Pooled prevalence of protein intake below recommended among community‐dwelling older adults according to the cut‐off values of 2), and appetite (C; ♦ poor, ▲ good). Pooled proportions with 95% confidence intervals were obtained from meta‐analyses using a random‐effects model. Studies included the Health, Aging and Body Composition Study (Health ABC), Longitudinal Aging Study Amsterdam (LASA), the Newcastle 85+ Study (Newcastle 85+), Quebec Longitudinal Study on Nutrition and Aging (NuAge), Dutch National Food Consumption Survey‐Older adults (DNFCS), National FINDIET Survey 2007 and 2012 (FINDIET 2007 and 2012), and the Third Italian National Food Consumption Survey (INRAN‐SCAI).

References

    1. (EFSA) EFSA, Dietary reference values for nutrients: Summary report. 2017.
    1. WHO, Protein and amino acid requirements in human nutrition, in WHO Technical Report Series, Organization WH, Editor . 2007, WHO Press: Geneva, Switzerland: p 1‐265.
    1. Wolfe RR. The role of dietary protein in optimizing muscle mass, function and health outcomes in older individuals. Br J Nutr 2012;108:S88–S93.
    1. Deer RR, Volpi E. Protein intake and muscle function in older adults. Curr Opin Clin Nutr Metab Care 2015;18:248–253.
    1. Paddon‐Jones D, Campbell WW, Jacques PF, Kritchevsky SB, Moore LL, Rodriguez NR, et al. Protein and healthy aging. Am J Clin Nutr 2015;101:1339S–1345S.
    1. Mendonca N, Granic A, Hill TR, Siervo M, Mathers JC, Kingston A, et al. Protein intake and disability trajectories in very old adults: the Newcastle 85+ study. J Am Geriatr Soc 2019;67:50–56.
    1. Mijnarends DM, Meijers JM, Halfens RJ, ter Borg S, Luiking YC, Verlaan S, et al. Validity and reliability of tools to measure muscle mass, strength, and physical performance in community‐dwelling older people: a systematic review. J Am Med Dir Assoc 2013;14:170–178.
    1. Hardy SE, Kang Y, Studenski SA, Degenholtz HB. Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs. J Gen Intern Med 2011;26:130–135.
    1. Ruiz JR, Sui X, Lobelo F, Morrow JR, Jackson AW, Sjostrom M, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ 2008;337:a439.
    1. Bauer J, Biolo G, Cederholm T, Cesari M, Cruz‐Jentoft AJ, Morley JE, et al. Evidence‐based recommendations for optimal dietary protein intake in older people: a position paper from the PROT‐AGE Study Group. J Am Med Dir Assoc 2013;14:542–559.
    1. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy‐Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 2014;33:929–936.
    1. Fulgoni VL. Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003‐2004. Am J Clin Nutr 2008;87:1554S–1557S.
    1. Houston DK, Tooze JA, Garcia K, Visser M, Rubin S, Harris TB, et al. Protein intake and mobility limitation in community‐dwelling older adults: the Health ABC study. J Am Geriatr Soc 2017;65:1705–1711.
    1. Isanejad M, Mursu J, Sirola J, Kroger H, Rikkonen T, Tuppurainen M, et al. Dietary protein intake is associated with better physical function and muscle strength among elderly women. Br J Nutr 2016;115:1281–1291.
    1. Mendonca N, Granic A, Mathers JC, Hill TR, Siervo M, Adamson AJ, et al. Prevalence and determinants of low protein intake in very old adults: insights from the Newcastle 85+ Study. Eur J Nutr 2018;57:2713–2722.
    1. Hengeveld LM, Pelgrom ADA, Visser M, Boer JMA, Haveman‐Nies A, Wijnhoven HAH. Comparison of protein intake per eating occasion, food sources of protein and general characteristics between community‐dwelling older adults with a low and high protein intake. Clin Nutr ESPEN 2019;29:165–174.
    1. Berner LA, Becker G, Wise M, Doi J. Characterization of dietary protein among older adults in the United States: amount, animal sources, and meal patterns. J Acad Nutr Diet 2013;113:809–815.
    1. Granic A, Mendonca N, Sayer AA, Hill TR, Davies K, Adamson A, et al. Low protein intake, muscle strength and physical performance in the very old: the Newcastle 85+ study. Clin Nutr 2018;37:2260–2270.
    1. Beasley JM, LaCroix AZ, Neuhouser ML, Huang Y, Tinker L, Woods N, et al. Protein intake and incident frailty in the Women's Health Initiative observational study. J Am Geriatr Soc 2010;58:1063–1071.
    1. Hengeveld LM, Wijnhoven HAH, Olthof MR, Brouwer IA, Harris TB, Kritchevsky SB, et al. Prospective associations of poor diet quality with long‐term incidence of protein‐energy malnutrition in community‐dwelling older adults: the Health, Aging, and Body Composition (Health ABC) study. Am J Clin Nutr 2018;107:155–164.
    1. Lemieux FC, Filion ME, Barbat‐Artigas S, Karelis AD, Aubertin‐Leheudre M. Relationship between different protein intake recommendations with muscle mass and muscle strength. Climacteric 2014;17:294–300.
    1. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997;65:1220S–1228S, discussion 1229S–1231S.
    1. Block G, Hartman AM, Dresser CM, Carroll MD, Gannon J, Gardner L. A data‐based approach to diet questionnaire design and testing. Am J Epidemiol 1986;124:453–469.
    1. Elstgeest LEM, Visser M. Nutrition and Food‐related Behaviour study 2014–2015 (side study). 2017; Available from:
    1. Mendonca N, Hill TR, Granic A, Davies K, Collerton J, Mathers JC, et al. Macronutrient intake and food sources in the very old: analysis of the Newcastle 85+ study. Br J Nutr 2016;115:2170–2180.
    1. Farsijani S, Payette H, Morais JA, Shatenstein B, Gaudreau P, Chevalier S. Even mealtime distribution of protein intake is associated with greater muscle strength, but not with 3‐y physical function decline, in free‐living older adults: the Quebec longitudinal study on Nutrition as a Determinant of Successful Aging (NuAge study). Am J Clin Nutr 2017;106:113–124.
    1. Ocké MC, Buurma‐Rethans EJM, de Boer EJ, Wilson‐van den Hooven C, Etemad‐Ghameslou Z, Drijvers JJMM, et al. Diet of community‐dwelling older adults. Dutch National Food Consumption Survey Older Adults 2010–2012. Bilthoven: National Institute for Public Health and the Environment; 2013.
    1. Pietinen P, Paturi M, Reinivuo H, Tapanainen H, Valsta LM. FINDIET 2007 Survey: energy and nutrient intakes. Public Health Nutr 2010;13:920–924.
    1. Leclercq C, Arcella D, Piccinelli R, Sette S, Le Donne C, Turrini A, et al. The Italian National Food Consumption Survey INRAN‐SCAI 2005‐06: main results in terms of food consumption. Public Health Nutr 2009;12:2504–2532.
    1. R Core Team . A language and environment for statistical computing R Foundation for Statistical Computing. Vienna, Austria; 2018. Available online at .
    1. Schwarzer G, meta: an R package for meta‐analysis, in R News. 2007. p. 40–45.
    1. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta‐analysis of prevalence. J Epidemiol Community Health 2013;67:974–978.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557–560.
    1. Tieland M, Borgonjen‐Van den Berg KJ, van Loon LJ, de Groot LC. Dietary protein intake in community‐dwelling, frail, and institutionalized elderly people: scope for improvement. Eur J Nutr 2012;51:173–179.
    1. Balder HF, Virtanen M, Brants HA, Krogh V, Dixon LB, Tan F, et al. Common and country‐specific dietary patterns in four European cohort studies. J Nutr 2003;133:4246–4251.
    1. Huseinovic E, Winkvist A, Slimani N, Park MK, Freisling H, Boeing H, et al. Meal patterns across ten European countries ‐ results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. Public Health Nutr 2016;19:2769–2780.
    1. Chan R, Leung J, Woo J, Kwok T. Associations of dietary protein intake on subsequent decline in muscle mass and physical functions over four years in ambulant older Chinese people. J Nutr Health Aging 2014;18:171–177.
    1. Hannan MT, Tucker KL, Dawson‐Hughes B, Cupples LA, Felson DT, Kiel DP. Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis study. J Bone Miner Res 2000;15:2504–2512.
    1. Briefel RR, Sempos CT, McDowell MA, Chien S, Alaimo K. Dietary methods research in the third National Health and Nutrition Examination Survey: underreporting of energy intake. Am J Clin Nutr 1997;65:1203S–1209S.
    1. Johnson RK, Goran MI, Poehlman ET. Correlates of over‐ and underreporting of energy intake in healthy older men and women. Am J Clin Nutr 1994;59:1286–1290.
    1. Olsen KM, Dahl SA. Health differences between European countries. Soc Sci Med 2007;64:1665–1678.
    1. Oksuzyan A, Juel K, Vaupel JW, Christensen K. Men: good health and high mortality. Sex differences in health and aging. Aging Clin Exp Res 2008;20:91–102.
    1. Gregorio L, Brindisi J, Kleppinger A, Sullivan R, Mangano KM, Bihuniak JD, et al. Adequate dietary protein is associated with better physical performance among post‐menopausal women 60‐90 years. J Nutr Health Aging 2014;18:155–160.
    1. Freedman LS, Commins JM, Moler JE, Arab L, Baer DJ, Kipnis V, et al. Pooled results from 5 validation studies of dietary self‐report instruments using recovery biomarkers for energy and protein intake. Am J Epidemiol 2014;180:172–188.
    1. Freisling H, van Bakel MM, Biessy C, May AM, Byrnes G, Norat T, et al. Dietary reporting errors on 24 h recalls and dietary questionnaires are associated with BMI across six European countries as evaluated with recovery biomarkers for protein and potassium intake. Br J Nutr 2012;107:910–920.
    1. Chen CC, Schilling LS, Lyder CH. A concept analysis of malnutrition in the elderly. J Adv Nurs 2001;36:131–142.
    1. Landi F, Calvani R, Tosato M, Martone AM, Ortolani E, Savera G, et al. Anorexia of aging: risk factors, consequences, and potential treatments. Nutrients 2016;8:69.
    1. Shim JS, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiol Health 2014;36:e2014009.
    1. Hoffmann K, Boeing H, Dufour A, Volatier JL, Telman J, Virtanen M, et al. Estimating the distribution of usual dietary intake by short‐term measurements. Eur J Clin Nutr 2002;56:S53–S62.
    1. Ma Y, Olendzki BC, Pagoto SL, Hurley TG, Magner RP, Ockene IS, et al. Number of 24‐hour diet recalls needed to estimate energy intake. Ann Epidemiol 2009;19:553–559.
    1. Dodd KW, Guenther PM, Freedman LS, Subar AF, Kipnis V, Midthune D, et al. Statistical methods for estimating usual intake of nutrients and foods: a review of the theory. J Am Diet Assoc 2006;106:1640–1650.
    1. Freedman LS, Midthune D, Carroll RJ, Krebs‐Smith S, Subar AF, Troiano RP, et al. Adjustments to improve the estimation of usual dietary intake distributions in the population. J Nutr 2004;134:1836–1843.
    1. Murphy SP, Poos MI. Dietary reference intakes: summary of applications in dietary assessment. Public Health Nutr 2002;5:843–849.
    1. Beasley JM, Wertheim BC, LaCroix AZ, Prentice RL, Neuhouser ML, Tinker LF, et al. Biomarker‐calibrated protein intake and physical function in the Women's Health Initiative. J Am Geriatr Soc 2013;61:1863–1871.
    1. Holen T, Norheim F, Gundersen TE, Mitry P, Linseisen J, Iversen PO, et al. Biomarkers for nutrient intake with focus on alternative sampling techniques. Genes Nutr 2016;11:12.
    1. in DRI dietary reference intakes: applications in dietary assessment. 2000: Washington (DC).
    1. Volpi E, Campbell WW, Dwyer JT, Johnson MA, Jensen GL, Morley JE, et al. Is the optimal level of protein intake for older adults greater than the recommended dietary allowance? J Gerontol A Biol Sci Med Sci 2013;68:677–681.
    1. Bilancio G, Cavallo P, Ciacci C, Cirillo M. Dietary protein, kidney function and mortality: review of the evidence from epidemiological studies. Nutrients 2019;11.
    1. Devries MC, Sithamparapillai A, Brimble KS, Banfield L, Morton RW, Phillips SM. Changes in kidney function do not differ between healthy adults consuming higher‐ compared with lower‐ or normal‐protein diets: a systematic review and meta‐analysis. J Nutr 2018;148:1760–1775.
    1. von Haehling S, Morley JE, Coats AJS, Anker SD. Ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2019. J Cachexia Sarcopenia Muscle 2019;10:1143–1145.

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