Low protein intake, muscle strength and physical performance in the very old

Transcription

1 Low protein intake, muscle strength and physical performance in the very old September 21 st, 2017 Granic A, Mendonca N, Sayer AA, Hill TR, Davies K, Adamson A, Siervo M, Mathers JC, Jagger C Newcastle University

2 Causes of non-optimal protein intake and utilisation in older adults Muscle strength & Physical performance Bauer et al 2013: PROT-AGE study group position paper, EUGMS

3 Protein requirements RDA 0.8 g/kg BW/d does not take into account multimorbidity, physiological changes, reduced physical activity and appetite in the very old g/kg BW/d 25-30g/meal (~10g EAA) adjusted (ideal) body weight 4 1. Paddon-Jones D, Leidy H. Curr Opin Clin Nutr Metab Care 2014;17: Bauer J et al. J Am Med Dir Assoc 2013;14: Deutz NE et al Clin Nutr 2014;33: Berner LA et al. J Acad Nutr Diet 2013;113:

4 Aims Association low protein intake (<1 g/ kg abw/d), and muscle strength (grip strength, GS) and physical performance (Timed Up-and-Go, TUG) in the very old over 5 years. Explore if physical activity (PA) and protein intake distribution across the day influence these relationships.

5 The Newcastle 85+ Study 845 with health assessments and GP records data GP records data only 805 consented to dietary assessment Excluded 12 with a single-day diet recall 793 (98.5%) complete 2x24-MPR Analytic sample 722 lived in community 791 with complete baseline data Excluded 2 without health assessment

6 Methods Protein intake 2x24hr MPR to estimate protein intake <1 g/kg abw/d (Low protein intake) * 1 g/kg abw/d (Good protein intake). Outcomes Decline in GS and TUG (baseline, 1.5, 3 and 5y follow-up) Mixed linear models (stratified by sex and protein intake group) Confounders Anthropometry, health-related, diet-related, life style, attrition * Adjusted body weight to reflect a healthy BMI in those 71, Berner LA et al J Acad Nutr Diet 2013;113:809-15

7 β estimates for GS (kg) 16 GS decline by protein intake in men Low protein: <1 g/kg abw/d Good protein: 1g/kg abw/d 8 n= Lineare (Low protein) Lineare (Good protein) Time (years) no association between low protein intake and GS in men. Protein distribution was not associated with GS in men.

8 β estimates for GS (kg) 10 GS decline by protein intake in women (0.41), p=0.046 Low protein: <1 g/kg abw/d Good protein: 1 g/kg abw/d n= Lineare (Low protein) Lineare (Good protein) Time (years) association between low protein intake and GS at baseline not with GS decline over time protein distribution was not a significant predictor of GS

9 β estimates for GS (kg) 14 GS decline in low and good protein intake group by levels of PA High P*time β(se)= 0.83 (0.27), p= Moderate PA*time β(se)= 0.77 (0.27), p= High PA: 4 β(se)= 4.44 (0.98) Moderate PA: β(se)= 4.1 (0.92), 2 P<0.001 (both) Time (years) Lineare (Low protein - High PA) Lineare (Low protein - Moderate PA) Lineare (Low protein - Low PA) Lineare (Good protein - High PA) Lineare (Good protein - Moderate PA) Lineare (Good protein - Low PA) PA predicted the rate of GS decline in the good protein intake group (grey lines), but not the rate in low protein (black lines). good protein intake group with low PA had the worst GS trajectory.

10 β estimates for TUG (log10 s) 1,6 Decline in TUG by protein intake in men 1,55 1,5 1,45 1,4 1,35 Poli. (Low protein) Poli. (Good protein) 1, Time (years) low protein intake was not associated with TUG in men. no significant interactions (PA*time)

11 β estimate for TUG (log10 s) 1,54 Decline in TUG by protein intake in women 1,52 1,5 1,48 1,46 β(se)=0.04(0.02), p=0.03 1,44 1,42 Poli. (Low protein) Poli. (Good protein) 1, Time (year) low protein intake was associated with worse TUG at baseline only in women no interactions (PA*time) were found protein distribution was not associated with TUG

12 Conclusion Protein intake <1g/ kg abw/d was associated with kg GS and worse TUG in women at baseline only after adjustment for a range of confounders Confirms previous reports that a higher protein intake above the current RDA is needed Suggests that higher PA may be ineffective in the very old if protein intake is not adequate

13 Acknowledgement Funding for this research is provided by the European Horizon 2020 PROMISS Project Prevention Of Malnutrition In Senior Subjects in the EU, Grant agreement no (AG, CJ). The content only reflects the author s view and the Commission is not responsible for any use that may be made of the information it contains. Thank you