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Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study.

ABSTRACT: OBJECTIVES:To examine the association of protein intake with frailty progression in very old adults. DESIGN:The Newcastle 85+ study, a prospective longitudinal study of people aged 85 years old in Northeast England and followed over 5 years. SETTING AND PARTICIPANTS:668 community-dwelling older adults (59% women) at baseline, with complete dietary assessment and Fried frailty status (FFS). MEASURES:Dietary intake was estimated with 2?×?24-h multiple pass recalls at baseline. FFS was based on five criteria: shrinking, physical endurance/energy, low physical activity, weakness and slow walking speed and was available at baseline and 1.5, 3 and 5 years. The contribution of protein intake (g/kg adjusted body weight/day [g/kg aBW/d]) to transitions to and from FFS (robust, pre-frail and frail) and to death over 5 years was examined by multi-state models. RESULTS:Increase in one unit of protein intake (g/kg aBW/d) decreased the likelihood of transitioning from pre-frail to frail after adjusting for age, sex, education and multimorbidity (hazard ratios [HR]: 0.44, 95% confidence interval [CI]: 0.25-0.77) but not for the other transitions. Reductions in incident frailty were equally present in individuals with protein intake ?0.8 (HR: 0.60, 95% CI: 0.43-0.84) and ?1 g/kg aBW/d (HR: 0.63, 95% CI: 0.44-0.90) from 85 to 90 years. This relationship was attenuated after adjustment for energy intake, but the direction of the association remained the same (e.g. g/kg aBW/d model: HR: 0.71, 95% CI: 0.36-1.41). CONCLUSION:High protein intake, partly mediated by energy intake, may delay incident frailty in very old adults. Frailty prevention strategies in this age group should consider adequate provision of protein and energy.

SUBMITTER: Mendonca N

PROVIDER: S-EPMC6939283 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study.

Mendonça Nuno N Kingston Andrew A Granic Antoneta A Jagger Carol C

Age and ageing 20191201 1

<h4>Objectives</h4>To examine the association of protein intake with frailty progression in very old adults.<h4>Design</h4>The Newcastle 85+ study, a prospective longitudinal study of people aged 85 years old in Northeast England and followed over 5 years.<h4>Setting and participants</h4>668 community-dwelling older adults (59% women) at baseline, with complete dietary assessment and Fried frailty status (FFS).<h4>Measures</h4>Dietary intake was estimated with 2 × 24-h multiple pass recalls at b ...[more]

PMID: 31711099

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Project description:BACKGROUND:Low protein intake has been linked to reduced muscle strength and physical performance in older adults but little is known about how it may affect muscle health and subsequent functional decline in the very old (aged 85+), who are at enhanced risk of malnutrition and loss of muscle mass and strength. AIMS:To investigate the associations between low protein intake, defined as the intake of <1 g protein/kg adjusted body weight/day (<1 g/kg aBW/d) and decline in muscle strength and physical performance in the very old. METHODS:The analytic sample consisted of 722 community-dwelling participants (60% women) from the Newcastle 85+ Study who had protein intake at baseline. Participants were followed-up for change in grip strength (GS) and Timed Up-and-Go (TUG) test over 5 years (baseline, 18, 36, and 60 months). We used mixed models to determine the effects of low protein intake on muscle strength and physical performance in all participants, and also stratified by sex. RESULTS:At baseline, 390 (54%) participants (261 women, p < 0.001) reported low protein intake, and these differed from participants with good intake (≥1 g/kg aBW/d) on several measures of health and function. In the model adjusted for protein intake, consuming <1 g/kg aBW/d of protein was associated with a 1.62 kg lower GS (p = 0.008) in all participants, and especially in women (β (SE) = -0.83 (0.41), p = 0.05) after adjusting for key baseline covariates (anthropometry, multimorbidity, arthritis in hands, cognitive status and physical activity). The rate of decline in GS over 5 years was not associated with protein intake. Women, but not men, with low protein intake had worse baseline TUG (β (SE) = 0.04 (0.02), p = 0.03) compared with those with good protein intake in the fully adjusted model, but the rate of decline in TUG was not affected by daily protein status. CONCLUSIONS:Intake of <1 g protein/kg aBW/d may negatively affect muscle strength and physical performance in late life, especially in older women, independently of important covariates. More research is needed in the very old to define the optimal protein intake for maintenance of muscle health and function.

Project description:BACKGROUND:Sarcopenia, a progressive age-related loss of skeletal muscle mass and strength, leads to disability, falls, and hospitalisation. Individual variation in sarcopenia onset may be partly explained by lifestyle factors such as physical activity and diet. Healthy dietary patterns (DPs) have been linked to better physical functioning in older adults, but their role in sarcopenia in the very old (aged ?85) is unknown. AIMS:To investigate the association between DPs and the risk of sarcopenia over 3 years, and to determine whether protein intake influences this relationship in community-dwelling older adults from the Newcastle 85 + Study. METHODS:The analytic sample consisted of 757 participants (61.2% women) who had dietary assessment at baseline. After two-step clustering with 30 food groups to derive DPs, we used logistic regression to determine the risk of prevalent and incident sarcopenia across DPs in all participants, and in those with low (<1 g/kg adjusted body weight/day [g/kg aBW/d]) and good protein intake (?1 g/kg aBW/d). RESULTS:We identified three DPs (DP1: 'Low Red Meat', DP2: 'Traditional British' and DP3: 'Low Butter') that varied by unsaturated fat spreads/oils, butter, red meat, gravy and potato consumption. Compared with participants in DP3, those in DP2 had an increased risk of prevalent (OR = 2.42, 95% CI: 1.15-5.09, p = 0.02) but not 3-year incident sarcopenia (OR = 1.67, 0.59-4.67, p = 0.33) adjusted for socio-demographic, anthropometry, health and lifestyle factors. Furthermore, DP2 was associated with an increased risk of prevalent sarcopenia at baseline (OR = 2.14, 1.01-4.53, p = 0.05) and 3-year follow-up (OR = 5.45, 1.81-16.39, p = 0.003) after adjustment for key covariates in participants with good protein intake. CONCLUSION:A DP high in foods characteristic of a traditional British diet (butter, red meat, gravy and potato) was associated with an increased risk of sarcopenia even when overall protein intake was good. The results need to be replicated in other cohorts of the very old to understand the role of DPs in sarcopenia onset and management.

Dataset Information

Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study.

Publications

Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study.

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