Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study.

Antoneta Granic,Andrew Kingston,Carol Jagger,Nuno Mendonça

doi:10.1093/ageing/afz142

Abstract

ObjectivesTo examine the association of protein intake with frailty progression in very old adults.DesignThe Newcastle 85+ study, a prospective longitudinal study of people aged 85 years old in Northeast England and followed over 5 years.Setting and Participants668 community-dwelling older adults (59% women) at baseline, with complete dietary assessment and Fried frailty status (FFS).MeasuresDietary intake was estimated with 2 × 24-h multiple pass recalls at baseline. FFS was based on five criteria: shrinking, physical endurance/energy, low physical activity, weakness and slow walking speed and was available at baseline and 1.5, 3 and 5 years. The contribution of protein intake (g/kg adjusted body weight/day [g/kg aBW/d]) to transitions to and from FFS (robust, pre-frail and frail) and to death over 5 years was examined by multi-state models.ResultsIncrease in one unit of protein intake (g/kg aBW/d) decreased the likelihood of transitioning from pre-frail to frail after adjusting for age, sex, education and multimorbidity (hazard ratios [HR]: 0.44, 95% confidence interval [CI]: 0.25–0.77) but not for the other transitions. Reductions in incident frailty were equally present in individuals with protein intake ≥0.8 (HR: 0.60, 95% CI: 0.43–0.84) and ≥1 g/kg aBW/d (HR: 0.63, 95% CI: 0.44–0.90) from 85 to 90 years. This relationship was attenuated after adjustment for energy intake, but the direction of the association remained the same (e.g. g/kg aBW/d model: HR: 0.71, 95% CI: 0.36–1.41).ConclusionHigh protein intake, partly mediated by energy intake, may delay incident frailty in very old adults. Frailty prevention strategies in this age group should consider adequate provision of protein and energy.

Highlights

Frailty is a clinical syndrome defined as an increased vulnerability or failure to return to homeostatic equilibrium after a stressor event that increases the risk of dependency, hospitalisation and death [1]
We have previously shown that low protein intake was associated with lower muscle strength and physical performance [7], worse disability trajectories [8] and incident disability [9] in very old adults
We tested for interactions between protein intake and energy but none were significant apart from the transition from pre-frail to dead

Summary

Introduction

Frailty is a clinical syndrome defined as an increased vulnerability or failure to return to homeostatic equilibrium after a stressor event that increases the risk of dependency, hospitalisation and death [1]. Frail older adults are at increased risk of disability, hospitalisation, care home admission and death [1]. Two popular frailty models include the cumulative deficits model [3] and the frailty phenotype [4], the latter using five criteria: muscle weakness, slow walking speed, low physical activity, exhaustion and unintentional weight loss [4]. We aimed to determine whether transitions between frailty states (robust, pre-frail and frail) and to death varied by protein intake in very old adults as they aged further. Our hypothesis was that higher protein intake was protective against frailty incidence between the age of 85 and 90 years but not impactful enough to promote recovery to either a pre-frail or robust state at this age

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