Low protein intake, muscle strength and physical performance in the - - PowerPoint PPT Presentation

Low protein intake, muscle strength and physical performance in the very old

September 21st, 2017

Granic A, Mendonca N, Sayer AA, Hill TR, Davies K, Adamson A, Siervo M, Mathers JC, Jagger C

Newcastle University

Causes of non-optimal protein intake and utilisation in older adults

Muscle strength & Physical performance

Bauer et al 2013: PROT-AGE study group position paper, EUGMS

Protein requirements

• RDA 0.8 g/kg BW/d does not take into account

multimorbidity, physiological changes, reduced physical activity and appetite in the very old 1-3

• 1-1.5 g/kg BW/d

– 25-30g/meal (~10g EAA) – adjusted (ideal) body weight 4

• 1. Paddon-Jones D, Leidy H. Curr Opin Clin Nutr Metab Care 2014;17:5-11. 2. Bauer J et al. J Am Med Dir Assoc 2013;14:542-
• 559. 3. Deutz NE et al Clin Nutr 2014;33:929-936. 4. Berner LA et al. J Acad Nutr Diet 2013;113:809-815.

Aims

• Association low protein intake (<1 g/ kg aBW/d),

and muscle strength (grip strength, GS) and physical performance (Timed Up-and-Go, TUG) in the very old over 5 years.

• Explore if physical activity (PA) and protein

intake distribution across the day influence these relationships.

The Newcastle 85+ Study

845

with health assessments and GP records data

805 consented to dietary

assessment

Excluded 12 with a single-day diet recall

791

with complete baseline data

188

GP records data only

793 (98.5%)

complete 2x24-MPR

Excluded 2 without health assessment

+

722

lived in community

Analytic sample

Methods

• Protein intake
• 2x24hr MPR to estimate protein intake
• <1 g/kg aBW/d (Low protein intake) *
• ≥1 g/kg aBW/d (Good protein intake).
• Outcomes
• Decline in GS and TUG (baseline, 1.5, 3 and 5y follow-up)
• Mixed linear models (stratified by sex and protein intake group)
• Confounders
• Anthropometry, health-related, diet-related, life style, attrition

* Adjusted body weight to reflect a healthy BMI in those ≥71, Berner LA et al J Acad Nutr Diet 2013;113:809-15

2 4 6 8 10 12 14 16 1 2 3 4 5 6

β estimates for GS (kg) Time (years)

GS decline by protein intake in men

Lineare (Low protein) Lineare (Good protein)

Low protein: <1 g/kg aBW/d Good protein: ≥ 1g/kg aBW/d n=289

• no association between low protein intake and GS in men.
• Protein distribution was not associated with GS in men.

1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6

β estimates for GS (kg) Time (years)

GS decline by protein intake in women

Lineare (Low protein) Lineare (Good protein)

• association between low protein intake and GS at baseline
• not with GS decline over time
• protein distribution was not a significant predictor of GS
• 0.83 (0.41), p=0.046

Low protein: <1 g/kg aBW/d Good protein: ≥1 g/kg aBW/d n=433

2 4 6 8 10 12 14 1 2 3 4 5 6

β estimates for GS (kg) Time (years)

Lineare (Low protein - High PA) Lineare (Low protein - Moderate PA) Lineare (Low protein - Low PA) Lineare (Good protein - High PA) Lineare (Good protein - Moderate PA) Lineare (Good protein - Low PA)

GS decline in low and good protein intake group by levels of PA

• ↑PA predicted the rate of GS decline in the good protein intake group (grey lines),

but not the rate in low protein (black lines).

• good protein intake group with low PA had the worst GS trajectory.

High PA: β(SE)= 4.44 (0.98) Moderate PA: β(SE)= 4.1 (0.92), P<0.001 (both)

High P*time β(SE)= 0.83 (0.27), p=0.002 Moderate PA*time β(SE)= 0.77 (0.27), p=0.005

1,3 1,35 1,4 1,45 1,5 1,55 1,6 1 2 3 4 5 6

β estimates for TUG (log10 s) Time (years)

Decline in TUG by protein intake in men

• Poli. (Low protein)
• Poli. (Good protein)
• low protein intake was not associated with TUG in men.
• no significant interactions (PA*time)

1,4 1,42 1,44 1,46 1,48 1,5 1,52 1,54 1 2 3 4 5 6

β estimate for TUG (log10 s) Time (year)

Decline in TUG by protein intake in women

• Poli. (Low protein)
• Poli. (Good protein)

β(SE)=0.04(0.02), p=0.03

• low protein intake was associated with worse TUG at baseline only in women
• no interactions (PA*time) were found
• protein distribution was not associated with TUG

Conclusion

• Protein intake <1g/ kg aBW/d was associated with -0.83 kg GS

and worse TUG in women at baseline only after adjustment for a range of confounders

• Confirms previous reports that a higher protein intake above

the current RDA is needed

• Suggests that higher PA may be ineffective in the very old if

protein intake is not adequate

Acknowledgement

Funding for this research is provided by the European Horizon 2020 PROMISS Project ‘Prevention Of Malnutrition In Senior Subjects in the EU’, Grant agreement

• no. 678732 (AG, CJ). The content only reflects the author’s view and the Commission

is not responsible for any use that may be made of the information it contains.

Thank you