Abstract
PurposeTo examine the cost effectiveness of dietary advice to increase protein intake on 6-month change in physical functioning among older adults.MethodsIn this multicenter randomized controlled trial, 276 community-dwelling older adults with a habitual protein intake < 1.0 g/kg adjusted body weight (aBW)/d were randomly assigned to either Intervention 1; advice to increase protein intake to ≥ 1.2 g/kg aBW/d (PROT, n = 96), Intervention 2; similar advice and in addition advice to consume protein (en)rich(ed) foods within half an hour after usual physical activity (PROT + TIMING, n = 89), or continue the habitual diet with no advice (CON, n = 91). Primary outcome was 6-month change in 400-m walk time. Secondary outcomes were 6-month change in physical performance, leg extension strength, grip strength, body composition, self-reported mobility limitations and quality of life. We evaluated cost effectiveness from a societal perspective.ResultsCompared to CON, a positive effect on walk time was observed for PROT; – 12.4 s (95%CI, – 21.8 to – 2.9), and for PROT + TIMING; – 4.9 s (95%CI, – 14.5 to 4.7). Leg extension strength significantly increased in PROT (+ 32.6 N (95%CI, 10.6–54.5)) and PROT + TIMING (+ 24.3 N (95%CI, 0.2–48.5)) compared to CON. No significant intervention effects were observed for the other secondary outcomes. From a societal perspective, PROT was cost effective compared to CON.ConclusionDietary advice to increase protein intake to ≥ 1.2 g/kg aBW/d improved 400-m walk time and leg strength among older adults with a lower habitual protein intake. From a societal perspective, PROT was considered cost-effective compared to CON. These findings support the need for re-evaluating the protein RDA of 0.8 g/kg BW/d for older adults.Trial registrationThe trial has been registered at ClinicalTrials.gov (NCT03712306). Date of registration: October 2018. Registry name: The (Cost) Effectiveness of Increasing Protein Intake on Physical Functioning in Older Adults. Trial Identifier: NCT03712306.
Highlights
The current EFSA recommended daily allowance (RDA) for protein intake is 0.83 g/kg body weight (BW)/day) (d) for all European adults [1]
The majority of randomized controlled trials (RCTs) on effects of increasing protein intake in older adults showed no benefit on muscle mass, strength or function, but no study targeted those with a lower habitual protein intake [20,21,22]
The first participant was randomized on November 4, 2018 and the last participant completed the study on July 31, 2020
Summary
The current EFSA recommended daily allowance (RDA) for protein intake is 0.83 g/kg body weight (BW)/day) (d) for all European adults [1]. The majority of randomized controlled trials (RCTs) on effects of increasing protein intake in older adults showed no benefit on muscle mass, strength or function, but no study targeted those with a lower habitual protein intake [20,21,22]. Three recent RCTs have investigated the effect of increasing protein intake to ≥ 1.2 g/kg BW/d in healthy older adults with a habitual protein intake below 1.0 g/kg BW/d on lean body mass, strength or physical performance, with inconclusive results [23,24,25]. No previous trial investigated the cost effectiveness of dietary advice to increase protein intake
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