Protein Intake and Disability Trajectories in Very Old Adults: The Newcastle 85+ Study

Abstract

ObjectivesTo determine whether protein intake is associated with better disability trajectories in the oldest adults (≥85) and whether muscle mass and muscle strength would partially mediate this.DesignProspective cohort study.SettingNewcastle‐upon‐Tyne and North Tyneside, United Kingdom.ParticipantsCommunity‐dwelling older adults aged 85 at baseline (N=722).MethodsProtein intake was estimated using two 24‐hour multiple‐pass recalls at baseline. Disability was measured as difficulty performing 17 activities of daily living at baseline and 18, 36, and 60 months. Trajectories were derived using mortality‐adjusted group‐based trajectory modelling. The effect of protein intake (g/kg of adjusted body weight (aBW)/d) on disability trajectories was examined using multinomial logistic regression.ResultsParticipants had 4 distinct disability trajectories (between the ages of 85 and 90: constant very low (AT1), mild (AT2), moderate (AT3), and severe (AT4). Each unit increase in protein (g) per kg of aBW/d was associated with greater odds of AT1 (odds ratio (OR=7.97, 95% confidence interval (CI)=1.96–32.43, p = .004) and AT2 (OR=3.28, 95% CI=1.09–9.87, p = .03) than of AT4 over 5 years in models adjusted for selected covariates. Participants with protein intake of 1.0 g/kg aBW/d or more were more likely to belong to AT1 (OR=3.65, 95% CI=1.59–8.38, p = .009) and AT2 (OR=2.12, 95% CI=1.16–3.90, p = .01) than to AT4.ConclusionHigher protein intake, especially 1.0 g/kg aBW/d or more, was associated with better disability trajectories in the oldest adults. These findings will inform new dietary strategies to support active, healthy ageing. J Am Geriatr Soc 67:50–56, 2019.

Nutritional status and functionality in geriatric rehabilitation patients: a systematic review and meta-analysis

“…Our findings emphasize that in addition to malnutrition screening, screening for sarcopenia would benefit this population as a structured approach to manage malnutrition and muscle loss could improve muscle mass and functional outcomes [93]. It is also known that a higher protein intake (1.0-1.2 g/kg bw/day) and an adequate energy intake can prevent disability in higher age [3].…”

“…Good nutritional status allows for faster recovery from illness, shorter hospital stays and reduced rates of readmission [2]. Malnutrition and weight loss, body mass index (BMI) values lower than 20 kg/m 2 , reduced food intake in general and reduced protein intake specifically are established independent factors which negatively influence functional parameters in older people [3,4]. While nutritional status and its association with functionality has been well examined in community-dwelling older individuals [5][6][7], in older hospital patients [2,8] and in nursing home residents [9,10], only scarce information is available in geriatric rehabilitation.…”

Effects of dietary patterns and low protein intake on sarcopenia risk in the very old: The Newcastle 85+ study

“…Low protein intake at baseline was defined as intake of <1 g protein/adjusted (ideal) BW/day (<1 g/kg aBW/d) as described previously [31,33]. This cut-off was based on previous findings from our group showing that protein intake <1 g/kg aBW/d was associated with lower grip strength (GS) and slower performance on Timed Up-and-Go (TUG) test [31] at baseline, whilst intake of !1 g/ kg aBW/d was associated with better disability trajectories from 85 to 90 years in this cohort [32]. For g/kg aBW/d calculations, measured body weight was adjusted to a desirable body weight if a participant was outside a healthy body mass index (BMI) range of 22e27 for an older adult aged !71 years (described in [50]).…”

“…meats, fruits and vegetables, dairy) [29,30] to reduced risk of sarcopenia and better muscle function in older adults. However, only a few studies have been conducted in the very old (aged !85) [31,32], who have higher prevalence of sarcopenia [4], and are at increased risk of malnutrition [33], poor diet [34e36] and inactivity [37]dthe main modifiable risk factors for loss of muscle mass/strength.…”

Associations of poor oral health with frailty and physical functioning in the oldest old: results from two studies in England and Japan

“…Dental diseases such as periodontal (gum) disease can be both a cause and manifestation of chronic in ammatory processes which also underlie disability and frailty (8). Moreover, deterioration of oral health, such as di culties swallowing, dry mouth (xerostomia) and excessive tooth loss, have profound implications for how well people eat and what they choose to eat (9), potentially affecting diet quality, (e.g low protein intake) (10) and in turn muscle mass, muscle strength and physical performance (11).…”