Increasing total protein intake and a spread protein intake distribution are potential strategies to attenuate sarcopenia related loss of physical function and quality of life. The aim of this cross-sectional study was to investigate whether protein intake and protein intake distribution are associated with muscle strength, physical function and quality of life in community-dwelling elderly people with a wide range of physical activity. Dietary and physical activity data were obtained from two studies (N = 140, age 81 ± 6, 64% male), with the following outcome measures: physical functioning (Short Physical Performance Battery (SPPB), comprising balance, gait speed and chair rise tests), handgrip strength and quality of life (EQ-5D-5L). Protein intake distribution was calculated for each participant as a coefficient of variance (CV = SD of grams of protein intake per main meal divided by the average total amount of proteins (grams) of the main meals). Based on the CV, participants were divided into tertiles and classified as spread, intermediate or pulse. The average total protein intake was 1.08 ± 0.29 g/kg/day. Total protein intake was not associated with outcome measures using multivariate regression analyses. Individuals with a spread protein diet during the main meals (CV < 0.43) had higher gait speed compared to those with an intermediate diet (CV 0.43–0.62) (β = −0.42, p = 0.035), whereas a spread and pulse protein diet were not associated with SPPB total score, chair rise, grip strength and Quality-Adjusted Life Year (QALY). The interaction of higher physical activity and higher total protein intake was significantly associated with higher quality of life (β = 0.71, p = 0.049). While this interaction was not associated with SPPB or grip strength, the association with quality of life emphasizes the need for a higher total protein intake together with an active lifestyle in the elderly.

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Background: Undernutrition can negatively affect community-dwelling older adults' health and quality of life. Undernutrition management guidelines have been developed in the Netherlands for the primary care setting, however, the application of these guidelines remain unsatisfactory. The current study therefore aims to explore qualitatively the experiences of Dutch nutrition and care professionals and researchers with undernutrition awareness, monitoring, and treatment among community-dwelling older adults. Methods: We telephonically interviewed 22 Dutch nutrition and care professionals and researchers. Our semi-structured interview guide elicited answers that we audiotaped and transcribed verbatim. The interviews were coded using grounded theory and content analysis with the qualitative analysis software MAXQDA, after which the codes were categorized into themes. Results: The interviews resulted in six themes relevant to the topics of interest: undernutrition awareness, monitoring, and treatment. These were: (1) adverse changes in nutrition behaviour; (2) limited undernutrition awareness; (3) unclear monitoring responsibilities and procedures; (4) lack of awareness, time, and priority as monitoring barriers; (5) lack of treatment personalization and justification; (6) lack of timely treatment implementation and evaluation. Conclusions: The experts' experiences imply that undernutrition awareness is limited, among both older adults and care professionals. In addition, the interviewees are unclear about which professionals are responsible for monitoring and which monitoring procedures are preferred. The dietitians feel that they become involved too late, leading to decreased treatment effectiveness. In general, the interviewees desire a coherent and feasible allocation of responsibilities regarding undernutrition monitoring and treatment. This implies that the available guidelines on undernutrition management require more attention and facilitation.

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Background and Objectives The ProMuscle in Practice intervention combines resistance exercise training and dietary protein intake for community-dwelling older adults, implemented by health care professionals (HCPs). This study aimed to evaluate implementation and context of this intervention in Dutch health care practice. Research Design and Methods We conducted a randomized controlled multicenter intervention study in 5 Dutch municipalities. Eighty-two older adults received the 12-week intensive support intervention (resistance exercise training and individual dietary counseling) and the optional 12-week moderate support intervention (resistance exercise training and a nutrition course). Mixed method data were collected from both participants and HCPs (n = 37) on process indicators recruitment, dose received, acceptability, fidelity, applicability, and context. Results Overall, the intervention was feasible to implement and accepted by participants and HCPs. About two thirds of participants continued with the moderate support intervention after the first 12 weeks. The mean dose received for the training sessions was 83.6% in the intensive intervention, 63.6% in the moderate intervention, &gt;90% for individual dietitian consultations, and 76.8% for the nutrition course. The intensive support intervention was implemented with high fidelity, whereas for the moderate support intervention resistance exercise trainings varied in implementation between exercise providers. Discussion and Implications A combined resistance exercise training and dietary protein intervention for community-dwelling older adults can be successfully implemented in practice. Well-tailored interventions, intensive supervision by skilled HCPs, social aspects, fidelity, and fit within real-world settings appeared essential for successful implementation. These elements are important for continuous intervention optimization to accomplish broader and successful implementation.