Abstract
The amount of breakfast protein intake is important for maintaining muscle strength. However, the effect of breakfast protein quality (ie, bioavailability) remains unclear. We investigated the association between breakfast protein quality and the incidence of muscle weakness. Longitudinal study. Healthy older adults age 60-83years without stroke, arthritis, Parkinson disease, or muscle weakness at baseline (maximum follow-up period and participations were 9.2years and 5 times, respectively). Weakness was defined by the Asian Working Group for Sarcopenia 2019 criteria, using grip strength. Breakfast protein quality was evaluated using the protein digestibility-corrected amino acid score (PDCAAS), where higher scores represent higher quality, calculated from 3-day dietary records. Participants were classified according to sex-stratified tertiles of breakfast PDCAAS (ie, low to high groups). The association between PDCAAS and incident weakness was analyzed using the generalized estimating equation, after adjusting for sex, age, follow-up time, grip strength, body mass index, physical activity, cognition, education, smoking, economics, medical history, lunch and dinner PDCAASs, and energy and protein intake during 3 regular meals at baseline. Overall, 14.4% of the initial sample was excluded owing to a diagnosis of weakness-related diseases, and 58.3% (n= 701) had at least 1 follow-up measurement for inclusion in the analysis. The mean ± SD follow-up period was 6.9 ± 2.1years; the cumulative number of participants was 3019, and 282 developed weakness. Using the low PDCAAS group as the reference, the adjusted odds ratios (95% CIs) for incident weakness in the middle and high PDCAAS groups were 0.71 (0.43-1.18) and 0.50 (0.29-0.86), respectively. Higher breakfast protein quality was associated with a reduction in incident weakness in older adults, independent of protein intake. These findings may highlight the role of protein quality for muscle health in older adults.
Highlights
Regarding nutritional intake at breakfast, the protein/energy and fat/energy ratios significantly increased from the low to the high protein digestibilityecorrected amino acid score (PDCAAS) groups, the carbohydrate/energy ratio decreased significantly (P < .001, for both, group differences and trends)
The consumption of cereal grains, sugars and sweeteners, and fats and oils was significantly higher in the low PDCAAS group; the consumption of beans and legumes, fish and seafood, eggs, and milk and dairy products was significantly lower in this group
The contribution of this study is that it demonstrates the importance of protein intake in muscle health; protein appears to be a key element of the contribution of breakfast toward muscular health and function, which is increasingly being recognized as an important component of healthy aging
Summary
The amount of breakfast protein intake is important for maintaining muscle strength. the effect of breakfast protein quality (ie, bioavailability) remains unclear. We investigated the association between breakfast protein quality and the incidence of muscle weakness. The association between PDCAAS and incident weakness was analyzed using the generalized estimating equation, after adjusting for sex, age, follow-up time, grip strength, body mass index, physical activity, cognition, education, smoking, economics, medical history, lunch and dinner PDCAASs, and energy and protein intake during 3 regular meals at baseline. Conclusions and Implications: Higher breakfast protein quality was associated with a reduction in incident weakness in older adults, independent of protein intake. These findings may highlight the role of protein quality for muscle health in older adults
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