Dietary Protein Intake and Transition between Frailty States in Octogenarians Living in New Zealand.

Ruth Teh,Louise Robinson,Marama Muru-Lanning,Ngaire Kerse,Sue Macdonell,Nuno Mendonça

doi:10.3390/nu13082843

Ruth Teh, Louise Robinson + Show 4 more

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https://doi.org/10.3390/nu13082843

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Abstract

Adequate nutritional status may influence progression to frailty. The purpose of this study is to determine the prevalence of frailty and examine the relationship between dietary protein intake and the transition between frailty states and mortality in advanced age. We used data from a longitudinal cohort study of Māori (80–90 years) and non-Māori (85 years). Dietary assessments (24-h multiple pass dietary recalls) were completed at the second year of follow-up (wave 2 and forms the baseline in this study). Frailty was defined using the Fried Frailty criteria. Multi-state modelling examined the association of protein intake and transitions between frailty states and death over four years. Over three quarters of participants were pre-frail or frail at baseline (62% and 16%, respectively). Those who were frail had a higher co-morbidity (p < 0.05), where frailty state changed, 44% showed a worsening of frailty status (robust → pre-frail or pre-frail → frail). Those with higher protein intake (g/kg body weight/day) were less likely to transition from robust to pre-frail [Hazard Ratio (95% Confidence Interval): 0.28 (0.08–0.91)] but also from pre-frail to robust [0.24 (0.06–0.93)]. Increased protein intake was associated with lower risk of transitioning from pre-frailty to death [0.19 (0.04–0.80)], and this association was moderated by energy intake [0.22 (0.03–1.71)]. Higher protein intake in this sample of octogenarians was associated with both better and worse outcomes.

Highlights

Frailty is a multidimensional geriatric syndrome considered to be a state of increased vulnerability to external stressors [1]
There were no statistically significant differences in the likelihood of transition with lower or higher protein intake (≥0.8 g/kg body weight (BW)/day) (Table 3 and Figure S1). Those with higher protein intake (per 1 g/kg of BW/d were less likely to transition from robust to pre-frail (Model 3: g/kg BW/d: hazard ratios (HR): 0.28, 95%confidence intervals (CI): 0.08–0.91)
Pre-frail to dead (Model 2: g/kg BW/d: HR: 0.19, 95%CI: 0.04–0.80). Those with higher protein intake (g/kg BW/d) tended to be less likely to recover from pre-frail to robust (Model 3: g/kg BW/d: HR: 0.24, 95%CI: 0.06–0.93) (Table 3)

Summary

Introduction

Frailty is a multidimensional geriatric syndrome considered to be a state of increased vulnerability to external stressors (acute illness, injury, or stress) [1]. The inability to recover fully from these stressors is linked to adverse health outcomes over time, including an increased risk of falls, cognitive impairment, functional decline, re-admission to hospital and admission to residential age care [2]. Frailty can be defined using either a cumulative deficit approach or a phenotypic approach [3,4]. The frailty phenotype is most commonly determined by the presence of five physical characteristics: weakness, fatigue, slowness, unintentional weight loss and low physical activity [2], whereas cumulative deficit approaches, such as the Frailty Index, consider the accumulation of health conditions and impairments from physical, psychological and social domains [3,4]. Identifying factors that could form the basis of health interventions to reduce frailty onset or progression is, of major public health importance

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