of functional limitation and disability (NuAge Study) Hlne Payette, - - PowerPoint PPT Presentation

Dietary Protein Food Clusters and risk

• f functional limitation and disability

(NuAge Study)

Hélène Payette, U Sherbrooke (Qc) CAN

Collaborators: P Gaudreau (U Montreal), JA Morais (McGill U) , B Shatenstein (U Montreal), M Sene (U Sherbrooke)

CONFLICT OF INTEREST DISCLOSURE

I (and collaborators) have no potential conflict of interest to report

Dietary Protein Food Clusters and risk

• f functional limitation and disability

(NuAge Study)

Hélène Payette, U. Sherbrooke (Qc) CAN

Collaborators: P Gaudreau, JA Morais, B Shatenstein, M Sene EUGMS, Nice, France September 2017

Study Design

Random sample

Quebec Medicare database n = 1,793 men/women Montreal/Sherbrooke (Qc, Can)

Eligibility

Good physical & mental health Functional independence

Follow-up

Annual face-to-face interview 6-month telephone interview

95 90 85 80 75 70

2003 2009 2013 4 yrs annual follow-up

Eligibility criteria

Inclusion

• Community-dwelling men and women French or English speaking
• Willing to commit for a 5-year period
• Able to walk without help
• Free of disabilities in activities of daily living
• No cognitive impairment (3MS > 79)
• Able to walk 100 metres and climb 10 stairs without rest
• Able to sign informed consent
• Class II heart failure
• COPD requiring home oxygen therapy or oral steroids
• Inflammatory digestive diseases
• Cancer (radiation therapy, chemotherapy or surgery 5 previous years)

Exclusion

Dietary assessment

T0 : 3 non-consecutive 24 hrs recalls (2 week days + 1 weekend)

modified USDA 5-step Multiple Pass Method

% total protein intake contributed from each food group was calculated for each individual as

[Protein from specific food group (g) / total protein intake (g)]* Dietary protein food clusters**

K-means to classify individuals into mutually exclusive groups Euclidean distances between each person & each cluster center in iterative process

Analysis

** SAS (version 9.4) FASTCLUS procedure * Food groups contribution < 0.5% removed

Food groups % Cakes & cookies Cakes, pies, doughnut, pastries muffins, cookies, granola bars, etc. 3,61 Dairy Milk, cheese, yoghurt, cream 15,22 Dairy desserts Puddings, ice cream, ice milk, frozen yoghurt 0,98 Eggs Eggs, omelettes, quiche 2,95 Fast foods Pizza, hamburger, hot dog, french fries & other meals from fast-food restaurants 2,11 Fish & shellfish products Any fish & seafood fresh, frozen or canned 6,22 Fruits Any fruit 1,78 Fruit juices Any fruit juice no sugar added 0,69 Legumes & legume products Legumes, hummus, beans with pork, tofu, foods with soja or vegetable protein 2,96 Nuts & seeds Any nuts, peanuts, peanut or other nuts butter, sunflower seeds, other seeds 0,90

Mean food groups contribution (%) to total daily protein intake

Food groups % Poultry products Chicken, turkey, duck 10,33 Potatoes Boiled, mashed or baked 1,96 Processed meats Sausages, hot dog, ham, cold cuts… 4,86 Red meat products Beef, lamb, pork, veal, liver, game, etc. 17,47 Refined grain bread & breakfast cereals Refined cold or hot cereals, white breads or rolls, bagels, tortillas, waffle or pancakes unsweetened 5,41 Rice & other grains Rice, rice noodle, couscous, bulgur, quinoa, etc. 1,21 Sauces, gravies, salad dressing Meat sauces, salad dressing, mayonnaise, dips 0,83 Soups Any kind 3,69 Salty snacks Chips, salted crackers, pretzels, popcorn, etc. 0,63 Vegetables Green, yellow, red & other vegetables 3,99 Wholegrain bread & breakfast cereals High fibre, whole wheat, multigrain or rye breads, rolls, bagels, tortillas or cereals 7,11

Mean food groups contribution (%) to total daily protein intake

Dietary protein food clusters

generated with K means method

Food groups 1 2 3 Dairy Milk, cheese, yoghurt, cream ++5

• -7
• -6

Eggs Eggs, omelettes, quiche ++8

• -5

Fast foods Pizza, hamburger, hot dog, french fries, etc. ++12

• Fish & shellfish

fresh, frozen or canned ++3

• -3
• -9

Fruits Any fruit ++10

• -8

+ Pasta Any kind, tomato, creamy sauce or meat ++4

• -6
• -7

Poultry Chicken, turkey, duck

• -2
• -2

++1 Potatoes Boiled, mashed or baked

• -11

++5

• -8

Processed meats Sausages, hot dog, ham, cold cuts… ++6

• -4

Red meat Beef, lamb, pork, veal, liver, game, etc.

• -1‡

++1

• -2

Refined grain Refined cereals, white breads, bagels, etc.

• ++10
• -10

Rice & other grains Rice, rice noodle, couscous, bulgur, quinoa

• -9

++3 Soups Any kind ++9

• Wholegrain

High fibre, whole wheat, multigrain /rye breads ++7

• -4

+

# position in cluster definition and lower consumption in food groups # position in cluster definition and greater consumption in food groups

1 (n = 781) → High fish & pasta + dairy & wholegrain Low red meat, poultry, potatoes 2 (n = 499) → High red meat & potatoes

Low poultry, fish, wholegrain, pasta

3 (n = 498) → High poultry, rice & grains

Low red & processed meat, eggs, dairy Dietary Protein Food Clusters

Stratified Random Sample Strata:

• 1. Sex
• 2. Region (Sherbrooke, Montreal, Laval)
• 3. Age (70 ± 2 yrs, 75 ± 2 yrs, 80 ± 2 yrs)

Analyses

→ SAS “survey” procedures (version 9.3)

results weighed for age, sex and region

Frailty Markers

Nutrition Physical activity Energy Mobility Strength

≥ 5% self-reported weight loss last 12 m OR BMI < 22 PASE score < mean-1SD by age & sex

23.9%

Vitality subscale SF-36 < mean-1SD by age & sex

9.5%

Gait speed < 1m/s

21.7%

Grip strength < mean-1SD by age, sex

13.6%

Sourial et al., J Gerontol 2012

18.1% Prevalence of frailty criteria at baseline

Fish, Pasta & Dairy Red meat & Potatoes Poultry, Rice & Grains P Men, %

39.9% 43.2% 33.9% 0.009

Age, y

74.1 ± 4.0 73.7 ± 3.8 73.9 ± 4.6 N.S.

BMI, Kg/m2

27.5 ± 4.5 28.2 ± 4.4 27.4 ± 4.7 N.S.

Smoking, %

7.5 9.6 5.6 0.062

Married, %

53.3 54.5 44.7 0.002

Education, yrs

13.3 ± 4.7 12.7 ± 4.1 12.8 ± 4.4 0.002

Burden of disease (0-70)

3.6 ± 2.7 3.5 ± 2.4 4.0 ± 3.3 N.S.

Frail, %

5.4 3.0 4.8 0.001

Physical activity PASE (0-793)

93.8 ± 48.0 93.5 ± 43.7 90.8 ± 48.8 N.S.

Baseline Characteristics

• f Participants across Protein Food Clusters

Fish, Pasta & Dairy Red meat & Potatoes Poultry, Rice & Grains P

Total Protein Intake

(g/day)

73.0 ± 21.5 75.8 ± 21.9 73.7 ± 20.1 0.006 Protein

(g/kg/day)

1.10 ± 0.33 1.13 ± 0.28 1.13 ± 0.31 < 0.001 Protein %

(g/kg/day < 0.8)

15.1 13.8 12.0 0.06 Protein %

(g/kg/day ≥ 1.0)

58.9 64.1 66.6 Energy

(Kcal/day)

1784 ± 473 1843 ± 522 1717 ± 494 0.003

Baseline Protein & Energy Intake across Protein Food Clusters

Self-reported functional limitations (Nagi, 1976) Do you have difficulties:

• Reaching or extending your arms above your shoulders?
• Stooping, crouching, or kneeling down?
• Pushing or pulling large objects like a living room chair?
• Lifting 4,5 kg from the floor, like a heavy bag or groceries?
• Handling small objects, like picking up a coin from a table?
• Stand for long period (around 15 min)?

Without or with little or some difficulty = 0 Lot of difficulty or unable to do or don’t do on doctor’s order = 1

Score range (0-6)

(1rst FU) 0,44 ± 0.9 (2nd FU) 0,55 ± 0.93 (3rd FU) 0,69 ± 1.17 P = 0.177

Disability (≥ 1 ADL) (Katz & Akom, 1976) Incidence = 13.6%

4th yr follow-up

Protein % (g/kg/day < 0.8) Protein % (g/kd/day ≥ 1.0)

Fish, Pasta & Dairy

Ref ref

Red meat & Potatoes

OR (95% CI)

1.20 (1.15, 1.25) 0.73 (0.70, 0.76)

Poultry, Rice & Grains

OR (95% CI)

0.91 (0.88, 0.95) 1.33 (1.29, 1.39)

Risk associated with protein intake

• ver 3 yrs across protein food clusters

Generalized Estimating Equations adjusted for age, sex, marital status, education, burden of disease, BMI, PASE, Kcal

% ≥ 1 ADL* OR (95% CI) NAGI score** β ± SE p Fish, Pasta & Dairy ref ref Red meat & Potatoes 1.57 (1.52, 1.63)

• 0.03 ± 0.005

< 0.001 Poultry, Rice & Grains 1.30 (1.26, 1.34) 0.14 ± 0.005 < 0.001

*Generalized Estimating Equations **Linear Mixed Model Adjusted for age, sex, marital status, education, burden of disease, BMI, PASE, Kcal

Risk associated with physical functioning

• ver 4 yrs across protein food clusters

As compared to fish/pasta/dairy protein cluster, Red meat/potatoes ↑ incidence of low pro intake & disability ↓ risk of functional limitation Poultry/rice ↓ incidence of low pro intake ↑ incidence of disability & risk of functional limitation

Summary

Conclusions

Dietary protein food patterns are associated with :  current protein & energy intake  3-yr risk of low protein intake  4-yr risk of functional limitiation & disability In a generally healthy & well nourished elderly population

Conclusions

More research is needed  In larger samples  In different populations  With different food habits  And longer follow-up

This project has received funding from the European Union’s Horizon 2020 research and innovation programme, grant n° 678732.

2986 men & women, aged 19–72 y Framingham 3rd Generation Study

Mangano et al. Am J Clin Nutr 2017

Over a 6-yrs follow-up

NO association with appendicular lean mass, quadriceps strength, or bone mineral density after adjustment for potential confounders

6 protein food clusters : Fast food/full-fat dairy, Fish, Red meat,

Chicken, Low-fat milk, Legumes

Previous study