Assessment of Dietary Consumption in Independent Community-Dwelling Older Adults with and without Sarcopenia

Comparison of protein intake per eating occasion, food sources of protein and general characteristics between community-dwelling older adults with a low and high protein intake

Evaluation of Dietary Comsumption in Independents Community-Dwelling Older Adults With and Without Sarcopenia

Primary Versus Secondary Prevention of Chronic Kidney Disease: The Case of Dietary Protein

Introduction: Diet and exercise are key prevention strategies for type 2 diabetes (T2DM). Few longitudinal studies have examined separate effects of animal and plant proteins on T2DM risk and results are conflicting. The goal of this study was to evaluate the association between usual intake of dietary protein (total, animal, and plant) and T2DM risk. Methods: Data from middle-aged men and women in the longitudinal Framingham Offspring Study (FOS) with approximately 20 years of follow-up were used. Diet was assessed using three-day diet records (exams 3 and 5); protein intake was adjusted for body weight using the residuals from a linear regression model. Glucose was measured after an overnight fast; impaired fasting glucose (IFG) was defined as a FG >100; diabetes was diagnosed using a standardized and validated FOS protocol. To estimate the hazards ratios) (HR) for IFG or T2DM, Cox proportional hazards models were used to adjust for confounding by age, sex, education level, physical activity, cigarette smoking, height, energy intake, and weight-adjusted carbohydrate intake. Results: Subjects with the highest total protein intakes (≥100 g, men, ≥90 g women) had 34% reduced risks of IFG/T2DM (HR: 0.66; 95% CI: 0.51, 0.85). In this cohort, intakes of animal protein were more than double those of plant protein. The highest intakes of animal protein (≥65 g, men; ≥55 g, women) vs. lower intakes (<55 g, men; <40 g, women) were linked with 33% reduced risks of IFG/T2DM (95% CI: 0.55, 0.82) while intermediate levels of intake were linked with 29% lower risks. In contrast, moderate and higher intakes of plant protein (20-25 g and ≥25 g vs. <20 g) led to non-statistically significant 6-12% risk reductions. Beneficial effects of total protein were stronger for women (HR: 0.53; 95% CI: 0.36, 0.80) than for men (HR: 0.80; 95% CI 0.57, 1.13). In secondary analyses, we evaluated effect modification by other dietary and lifestyle factors. In particular, both men and women with higher intakes of protein and higher levels of physical activity had statistically significant reductions in long-term risk of IFG/T2DM (31%, 39%, and 22% risk reductions among active adults with higher intakes of total, animal, and plant protein, respectively) compared with more sedentary adults who had lower intakes of protein. In contrast, higher physical activity levels alone (among those with lower protein intakes) were associated with non-statistically significant 13-14% lower risks of IFG/T2DM. Conclusions: This prospective study of middle-aged men and women provides important evidence to suggest that dietary protein when combined with an active lifestyle, may be a strategy for lowering long-term risk of diabetes. In this study, animal protein had stronger beneficial effects, but future studies are needed in population groups with higher intakes of plant protein to determine whether these effects would be comparable.

BackgroundConcerns regarding the impact of screen-based sedentary behavior on health have been increasing. Therefore, the present study investigated the longitudinal relationship between multiple screen time and nutrient intake in children and adolescents.MethodsThe present study was conducted utilizing 3 years longitudinal data. Study subjects were 740 Japanese children aged between 6 and 12 years at baseline and between 9 and 15 years in the follow-up. Screen-based sedentary behavior was assessed using screen time, including television (TV) viewing, personal computer (PC) use, and mobile phone (MP) use. The main outcomes were the intakes of nutrients. Mixed effect multivariate linear regression analyses were used to examine the longitudinal relationship between screen-based sedentary time and nutrient intake. Covariates included in the multivariable analysis consisted of sex, age, solitary eating, skipping breakfast, staying up late, and body weight status, as confounders, and physical inactivity, as mediator.ResultsIn boys, a longer total screen time longitudinally correlated with higher intake of energy and lower intakes of protein, dietary fiber, minerals, and vitamins. In girls, longer total screen time longitudinally associated with higher intake of sucrose and lower intakes of protein, minerals, and vitamins. In boys, a longer TV viewing time was associated with higher intake of sucrose and lower intakes of protein, minerals, and vitamins. In girls, a longer TV viewing time was associated with higher intake of carbohydrates and lower intakes of protein, fat, minerals, and vitamins. In boys, relationships were observed between a longer PC use time and higher intakes of energy as well as lower intakes of protein, minerals, and vitamins. Relationship was observed between longer PC use time and lower intakes of minerals in girls. An increased MP use time was associated with higher intakes of energy, and lower intakes of protein, sucrose, dietary fiber, minerals, and vitamins in boys. A longer MP use time was associated with higher intakes of fat, and salt as well as lower intakes of carbohydrates, protein, minerals, and vitamins in girls.ConclusionsThe present results revealed that longer screen-based sedentary behaviors were longitudinally associated with nutrient intake in children and adolescents. Future study is needed to elucidate these relationships.Supplementary informationThe online version contains supplementary material available at https://doi.org/10.1265/ehpm.23-00307.

Plant and Animal Protein Intake and Risk of Incident Kidney Stones: Results from the Shanghai Men's and Women's Health Studies.

Chronic inflammation is linked to cardiovascular disease, cancer, and other non-communicable diseases. Dietary factors like fibre and protein may affect inflammation, but limited evidence exists exploring how they interact. This study investigated associations between dietary fibre, protein sources, and the inflammatory marker C-reactive protein (CRP) in older adults. This cross-sectional analysis included 128,612 UK Biobank participants aged 60+ years with CRP measurements and dietary data from multiple 24 h recalls. Fibre intake was reported as total fibre (g/day). Protein intake included total, animal, and vegetable protein (g/day). Robust regression analysis examined associations between quintiles of fibre, protein, and CRP, adjusted for demographics, lifestyle factors, and multimorbidity. Analyses were stratified by health status (with and without multimorbidity). Higher fibre and vegetable protein intakes were inversely associated with CRP, while higher animal and total protein were positively associated with CRP in people with no multimorbidity. Specifically, participants in the highest quartile of dietary fibre had CRP levels that were 0.42 mg/L lower compared with the lowest quartiles. In contrast, those with the highest total protein and animal protein intakes had CRP levels that were 0.24 mg/L and 0.40 mg/L higher, respectively. In people with multimorbidity, fibre exhibited an inverted U-shaped association with the strongest association in participants in the highest quintile of intake. Vegetable protein had an inverse association with CRP. Animal and total protein had strong positive linear associations with CRP. Notably, high animal protein coupled with low dietary fibre intake resulted in CRP levels that were 0.65 mg/L higher compared with low animal protein and high dietary fibre intake. Higher fibre and vegetable protein intakes were associated with lower inflammation in older adults. In promoting protein intake to maintain muscle mass and function, future studies should investigate replacing animal with vegetable protein to concomitantly reduce age-related inflammation.

BACKGROUND/OBJECTIVESWe investigated the association of plant and animal protein intake with grip strength in Koreans aged ≥ 50 yrs.SUBJECTS/METHODSThe data was collected from 3,610 men and 4,691 women (≥ 50 yrs) from the 2016–2018 Korea National Health and Nutrition Examination Survey. We calculated the total energy intake, and the intake of animal and plant protein and collected dietary data using 1-day 24-h dietary recalls. Low grip strength (LGS) was defined as the lowest quintile (men: up to 26.8 kg, women: up to 15.7 kg). The association of protein intake with grip strength was examined using Pearson’s correlation and multiple linear regression analysis.RESULTSThe results proved that participants with LGS had lower daily energy, protein and fat intake, and percent energy from protein than those with normal or high grip strength (P < 0.0001). Total energy intake, animal protein, and plant protein were positively associated with grip strength. A higher intake of total plant protein (P for trend = 0.004 for men, 0.05 for women) and legumes, nuts, and seeds (LNS) protein (P for trend = 0.01 for men, 0.02 for women) was significantly associated with a lower prevalence of LGS. However, non-LNS plant protein intake was not associated with LGS (P for trend = 0.10 for men, 0.15 for women). In women, a higher total animal protein intake was significantly associated with decreased LGS (P for trend = 0.03).CONCLUSIONSHigher total plant protein and LNS protein intake are negatively associated with LGS.

To determine the association between protein intake and risk of higher-level functional decline in older community-dwelling adults. Prospective. Ohasama Town, Japan. Residents (N = 1,007; mean age 67.4 ± 5.5) free of functional decline at baseline; follow-up was conducted for 7 years. Nutrient and food intakes were determined using a validated 141-item food frequency questionnaire. Participants were divided into quartiles according to intake levels of total, animal, and plant protein. Subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence subscales were used to assess higher-level functional decline. Logistic regression analysis was used to examine the future risk of higher-level functional decline in relation to protein intake, with lowest protein intake as reference. During the study period, 24.4% of eligible participants reported declines in higher-level functional capacity. After adjustment for putative confounding factors, men in the highest quartile of animal protein intake had significantly lower risk of higher-level functional decline than those in the lowest quartile (odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.20-0.83; P for trend .01). These associations were not seen in women (OR = 0.76, 95% CI = 0.41-1.34; P for trend .37). No consistent association was observed between plant protein intake and future higher-level functional decline in either sex. Higher protein, particularly animal protein, was associated with lower risk of decline in higher-level functional capacity in older men. Animal protein intake may be a modifiable indicator for early detection and prevention of higher-level functional decline in elderly adults.

Malnutrition is a concern among older adults, leading to physical health issues and psychological challenges, including depression. Moreover, poor nutritional habits can adversely impact mood, while depression can, in turn, deteriorate nutritional status. This study examined food group intake and malnutrition of older adults in Birjand, Iran, to determine their association with depression. In this cross-sectional study, 1,344 adults aged 60 years and older from the Birjand Longitudinal Aging Study (BLAS) were included. Participants were categorized based on nutritional status into two distinct groups: a well-nourished group and a combined group comprising individuals who were malnourished or at risk of malnutrition. Depression and nutritional status were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Mini Nutritional Assessment (MNA), respectively. The intake of major food groups was also evaluated. Out of 1,344 participants, 268 (20%) were diagnosed with depression. The sample included 648 men and 696 women, with a mean age of 69.7 years. Logistic regression showed that malnourished participants had higher odds of depression than well-nourished individuals (fully adjusted OR = 2.47, 95% CI: 1.95-3.14). In binary analyses, depression was significantly associated with lower intake of animal protein and milk products (p < 0.01). Ordinal logistic regression indicated that higher intake of animal protein, milk/dairy, and fruits and vegetables, and cereals was related to lower odds of more severe depression (animal protein: OR = 0.59, 95% CI: 0.44-0.78; milk/dairy: OR = 0.54, 95% CI: 0.41-0.69; fruits and vegetables: OR = 0.61, 95% CI: 0.46-0.81; and cereals: OR = 0.72, 95% CI:0.56-0.94), whereas beans were not significantly associated. Malnutrition was significantly associated with depression in community-dwelling older individuals. Higher intake of fruits, vegetables, cereals, dairy, and animal protein was associated with improved depressive symptoms; however, no such association was observed for beans intake.

Investigate protein intake patterns over the day and their association with total protein intake in older adults. Cross-sectional study utilising the dietary data collected through two non-consecutive, dietary record-assisted 24-h recalls. Days with low protein intake (n 290) were defined using the RDA (<0·8 g protein/kg adjusted BW/d). For each day, the amount and proportion of protein ingested at every hour of the day and during morning, mid-day and evening hours was calculated. Amounts and proportions were compared between low and high protein intake days and related to total protein intake and risk of low protein intake. Community. 739 Dutch community-dwelling adults ≥70 years. The mean protein intake was 76·3 (sd 0·7) g/d. At each hour of the day, the amount of protein ingested was higher on days with a high protein intake than on days with a low protein intake and associated with a higher total protein intake. The proportion of protein ingested during morning hours was higher (22 v. 17 %, P < 0·0001) on days with a low protein intake, and a higher proportion of protein ingested during morning hours was associated with a lower total protein intake (P < 0·0001) and a higher odds of low protein intake (OR 1·04, 95 % CI 1·03, 1·06). For the proportion of protein intake during mid-day or evening hours, opposite but weaker associations were found. In this sample, timing of protein intake was associated with total protein intake. Additional studies need to clarify the importance of these findings to optimise protein intake.

Low protein intake can lead to declined lean mass (LM) in elderly. We examined the associations of total protein (TP), animal protein (AP) and plant protein (PP) intakes with LM. The association of TP intake with LM change was further evaluated according to weight change status. This cross-sectional and prospective cohort study included 554 women aged 68 (sd 1·9) years from the Osteoporosis Risk Factor and Prevention - Fracture Prevention Study (OSTPRE-FPS). The intervention group (n 270) received daily cholecalciferol (800IU; 20 μg) and Ca (1000mg) for 3 years while the control group received neither supplementation nor placebo (n 282). Participants filled out a questionnaire on lifestyle factors and a 3-d food record in 2002 and underwent dual-energy X-ray absorptiometry for body composition measurements at baseline and 3 years. Multiple linear regressions evaluated the association between protein intake and LM, adjusting for relevant covariates. At the baseline TP and AP intakes were positively associated with LM and trunk LM, TP was associated also with appendicular LM (aLM). Follow-up results showed that in the total population and the intervention group, higher TP and AP were associated with increased LM and aLM (P≤0·050). No such associations were observed in the control group. PP intake was also associated with aLM change in the total population. Overall, the associations were independent of fat mass. Further, among weight maintainers, TP intake was positively associated with LM, aLM and trunk LM changes (P≤0·020). In conclusion, dietary TP, especially AP, intake may be a modifiable risk factor for sarcopenia by preserving LM in the elderly.

which are rich in animal proteins and base-inducing foods. Thus increased fruit and vegetable consumption associate with a lower protein intake appear to be an alternative to alkali therapy for patients with metabolic acidosis and without hyperkalemia. However, definitive evidence is lacking for optimal evidence-based practice guidelines. We investigated the association between dietary acid load and serum bicarbonate in pre-dialysis CKD patients. METHODS: One-hundred patients with CKD stage 3 and 4 were enrolled in this cross-sectional study. Dietary acid load (DAL) was determined by 3-day food records using an algorithm including dietary protein, phosphorus, magnesium, and potassium described as potential renal acid load (PRAL) by Remer and Manz. As a sensitivity analysis, we estimated net endogenous acid production (NEAP), which is the ratio of protein to potassium intake and another means of evaluating dietary acid load: NEAP = 54.5 * (protein/potassium) -10.2. Estimated daily animal and plant protein intakes were determined for each participant and expressed as a percentage of total daily protein intake. The serum bicarbonate (HCO3) was determined as well as the urine pH. Spearman's correlation was applied to investigate association between the variables DAL, bicarbonate, urine pH and dietary protein, considering p <0.05. RESULTS: In the overall study population, the mean age was 57 years (range 28 to 69 years), 53% were female, the median eGFR was 30 mL/min/1.73 m 2 , 39% had diabetes and 80% had hypertension. There were fifty percent of participants in each CKD stage 3 and 4. The median level (25th, 75th percentiles) of PRAL and NEAP were 8.3 (1.6, 15.6) mEq/day and 55.1 (41.8, 75.7) mEq/day, respectively. Median total protein intake was 56.8 (42.7, 75.3) g/day with median of 0.8 (0.6, 1.0) g/kg/day after scaling to body weight. Median intake of protein from animal sources was 41.3 (28.4, 59.5) g/day and from plant sources was 13.9 (10.1, 19.4) g/day resulting in a median percentage of total protein from plant sources (percent plant protein) of 25 (17, 37) %. The median HCO3 and urine pH was 25.4 (23.2, 27.6) mEq/L and 5.5 (5.3, 6.2), respectively. No associations were observed between PRAL or NEAP and bicarbonate. We found significant positive correlation between PRAL and % animal protein intake (r = 0.36) and negative correlation with % plant protein intake (r = -0.36). PRAL was also correlated with the total daily protein intake (r = 0.64, p<0.001). NEAP became progressively more positive as the dietary plant-to-animal ratio declined (r = -0.43 , p<0.001). Positive correlation was also found between eGFR with PRAL (r = 0.21) and with NEAP (r = 0.22). We didnt find a significant association between HCO 3 and eGFR. HCO 3 was correlated with urine pH (r = 0.45). CONCLUSIONS: There was no correlation between dietary acid load and bicarbonate in the pre-dialysis patients. However, it has been shown that acid retention can precede an overt fall in HCO3 concentration in patients with CKD and some of those patients maintain a normal serum bicarbonate even in the presence of severe kidney failure. The replacement of animal protein for plant protein sources reduces the DAL suggesting further study to prove if it can improve parameters of metabolic acidosis. Ongoing trials testing the benefits and harms of lowering DAL will hopefully facilitate more evidence-based treatment of metabolic acidosis in the future.

Diagnosed prevalence of malnutrition and dietary intake are currently unknown in patients with severe aortic stenosis planned to undergo Transcatheter Aortic Valve Implantation (TAVI). This study describes the preprocedural nutritional status, protein intake and diet quality. Consecutive preprocedural TAVI patients were asked to participate in this explorative study. Nutritional status was diagnosed with the global leadership initiative on malnutrition (GLIM) criteria. Preprocedural protein intake and diet quality were assessed with a three-day dietary record. To increase the record's validity, a researcher visited the participants at their homes to confirm the record. Protein intake was reported as an average intake of three days and diet quality was assessed using the Dutch dietary guidelines (score range 0-14, 1 point for adherence to each guideline). Of the included patients (n=50, median age 80±5, 56% male) 32% (n=16) were diagnosed with malnutrition. Patients diagnosed with malnutrition had a lower protein intake (1.02±0.28g/kg/day vs 0.87±0.21g/kg/day, p=0.04). The difference in protein intake mainly took place during lunch (20±13g/kg vs 13±7g/kg, p=0.03). Patients adhered to 6.4±2.2 out of 14 dietary guidelines. Adherence to the guideline of whole grains and ratio of whole grains was lower in the group of patients with malnutrition than in patients with normal nutritional status (both 62% vs 19%, p=0.01). In a multivariate analysis diabetes mellitus was found as an independent predictor of malnutrition. Prevalence of malnutrition among TAVI patients is very high up to 32%. Patients with malnutrition had lower protein and whole grain intake than patients with normal nutritional status. Furthermore, we found diabetes mellitus as independent predictor of malnutrition. Nutrition interventions in this older patient group are highly warranted.

The contrasting relationships of plant and animal protein intake with blood pressure (BP) may be partially attributed to the differential non-protein (e.g., saturated fat and fibre) and amino acid (AA) compositions. This study determined whether animal and plant protein intake were related to differential metabolomic profiles associated with BP. This study included 1008 adults from the African-PREDICT study (aged 20–30 years). Protein intake was determined using 24-h dietary recalls. Twenty-four-hour ambulatory BP was measured. Amino acids and acylcarnitines were analysed in spot urine samples using liquid chromatography-tandem mass spectrometry-based metabolomics. Participants with a low plant, high animal protein intake had higher SBP (by 3 mmHg, p = 0.011) than those with high plant, low animal protein intake (low-risk group). We found that the relationships of plant and animal protein intake with 24-h SBP were partially mediated by BMI and saturated fat intake, which were independently associated with SBP. Protein intake was therefore not related to SBP in multiple regression analysis after adjusting for confounders. In the low-risk group, methionine (Std. β = −0.217; p = 0.034), glutamic acid (Std. β = −0.220; p = 0.031), glycine (Std. β = −0.234; p = 0.025), and proline (Std. β = −0.266; p = 0.010) were inversely related to SBP, and beta-alanine (Std. β = −0.277; p = 0.020) to DBP. Ultimately a diet high in animal and low in plant protein intake may contribute to higher BP by means of increased BMI and saturated fat intake. Conversely, higher levels of urinary AAs observed in adults consuming a plant rich diet may contribute to lower BP.