Yung Hung, Hanneke A. H. Wijnhoven, Marjolein Visser and Wim Verbeke
Nutrients 2019, 11(4), 777; https://doi.org/10.3390/nu11040777
European older adults have been studied according to their appetite and protein intake profiles, and the relevant dietary and physical activity behavioural determinants were identified. A survey with 1,825 older adults aged 65 years or above in five European countries (Netherlands, United Kingdom, Finland, Spain and Poland) was conducted in June 2017.
Older adults with a poor appetite and lower level of protein intake is characterized by a larger share of people aged 70 years or above, living in the UK or Finland, having an education below tertiary level, who reported some or severe financial difficulties, having less knowledge about dietary protein and being fussier about food. This group also tends to have a higher risk of malnutrition in general, oral-health related problems, experience more difficulties in mobility and meal preparation, lower confidence in their ability to engage in physical activities in difficult situations, and a lower readiness to follow dietary advice. Therefore, effective dietary strategies to increase protein intake should take into account sensory properties, familiarity, affordability, accessibility and convenience.
Consumption of certain foods at a certain moment of the day and physical activity level or pattern were associated with a lower risk of having lower protein intake. Low level of physical activity emerged as a risk factor for having a lower protein intake in older adults with poor appetite, and vigorous physical activities between lunch and dinner were associated with a lower risk in older adults with good appetite.
This study provides an overview and highlights the similarities and differences in older adults’ profiles, as well as the challenges in promoting healthy ageing regarding protein intake. Recommendations for optimal dietary and physical activity strategies to prevent protein malnutrition were derived, discussed and tailored according to older adults’ profiles.
Antoneta Granic, Nuno Mendonça, Avan A. Sayer, Tom R. Hill, Karen Davies, Mario Siervo, John C. Mathers, Carol Jagger
Clinical Nutrition 2019 Jan 10. doi.org/10.1016/j.clnu.2019.01.009 [Epub ahead of print].
Sarcopenia is a progressive loss of muscle mass and muscle strength that may lead to disability, falls, and hospitalisation. The very old, those aged 85 years and older, are the fastest growing age group in most western societies and are at especially high risk of sarcopenia. Onset of sarcopenia may be partly explained by diet. Therefore, we aimed to explore the role of dietary patterns and protein intake in the risk of sarcopenia over 3 years. Our study, the Newcastle 85+, was based in North East England, and involved more than 750 people aged 85 years old. These participants had their diet estimated by a 24 hour multiple pass recall (people are asked what foods and drinks they consumed in the past 24 hours) on two different days of the week and from this, dietary patterns were derived. Sarcopenia was measured over 3 years according to a muscle mass index, gait speed and grip strength. We identified three dietary patterns: ‘Low Red Meat’, ‘Traditional British’ and ‘Low Butter’ that varied by unsaturated fat spreads/oils, butter, red meat, gravy and potato consumption. We found that very old adults who had a dietary pattern high in foods characteristic of a traditional British diet (high butter, red meat, gravy and potato consumption, and high fat and energy intake), especially compared to a low butter dietary pattern (high in unsaturated fat spreads/oils, fibre, percentage of energy from protein and starch) had an increased risk of sarcopenia even when overall protein intake was good. These results add to the limited literature on the role of the whole diet in sarcopenia in very old adults.
Daily sedentary time and physical activity among Dutch older adults
Higher physical activity is associated with lower chronic disease risk among older adults. However, less is known about the optimal balance between daily physical activity and sedentary time and their correlates among older adults. In this study van Ballegooijen et al from the VU University in Amsterdam objectively measured physical activity patterns and assessed its correlates in a large sample of older Dutch adults. In addition, they examined different combined profiles of sedentary time and physical activity across strata of sex, age, education and BMI groups.
They made use of cross-sectional data from 1,201 participants of the 2015-2016 examination of the Longitudinal Aging Study Amsterdam, a population-based cohort of older Dutch adults. The mean age was 71 year and 51% were women Participants were instructed to wear an Actigraph accelerometer for 7 consecutive days at the right hip. Time spent in sedentary (<100 counts per minute [cpm]), light (100-2020 cpm), and moderate and vigorous activity (MVPA) ≥2020 cpm) were calculated and compared across age, sex, education and BMI groups.
The authors conclude that the majority of wake time was spent sedentary 65% followed by light (33%), and moderate to vigorous physical activity (2%). Higher age and higher BMI were related to more time spent sedentary, while female sex and lower education were related to less time spent sedentary. The combination of high sedentary time and low physical activity was significantly associated with higher age, higher BMI, and slower walking speed compared to the combination of low sedentary time and high physical activity. This suggests that increasing light activity might be an effective and feasible strategy in older persons to reduce sedentary time.
In a nutshell, these are the key findings of the study:
- Dutch older adults spend on average 65% of their waking time sedentary.
- Older adults’ sedentary time differs by age, sex, education and BMI groups.
- The combination of high sedentary time and low physical was associated with higher age, higher BMI, and slower walking speed compared to the combination of low sedentary time and high moderate to physical activity.
Comparison of protein intake per eating occasion, food sources of protein and general characteristics between community-dwelling older adults with a low and high protein intake
Linda M. Hengeveld, Anouk D.A. Pelgröm, Marjolein Visser, Jolanda M.A. Boer, Annemien Haveman-Nies, Hanneke A.H. Wijnhoven
Clinical Nutrition ESPEN, https://doi.org/10.1016/j.clnesp.2018.10.013
Adequate protein intake is required to maintain muscle health, which is of great importance for prevention or delay of disability and mortality. However, a substantial part of older adults has a protein intake below the recommended 0.8 gram per kg body weight per day. In this study we explored the timing of the day, the origin (animal or vegetable) and food sources of protein intake of older adults (70 years and older) from The Netherlands. We also examined if we could characterize older adults with a low protein intake. For example, are they lower educated, do they have difficulties with walking or are they living alone? This knowledge will help us to develop strategies to improve the diet of older adults with a low protein intake.
We found that 15% of these older adults had a protein intake below the recommended 0.8 gram per kg body weight per day. Compared to older adults with a high protein intake, older adults with a low protein intake consequently ate less protein at all meal moments (breakfast, lunch, dinner, snack moments) Furthermore, older adults with a low protein intake ate less protein from animal origin than older adults with a high protein intake. The biggest food sources of protein were similar among those with a low and a high protein intake: dairy, meat and cereals. Out of a long list of characteristics, we only found that older adults who follow a diet, who are obese an who don’t drink alcohol are more likely to have a low protein intake. However, in general we did not find that there is a specific group of characteristics that defines older adults with a low protein intake, which means that this can occur in every older person.
This study shows that the timing and animal versus vegetable origin of protein intake differs between older adults with a low and with a high protein intake. Because food sources and characteristics appear largely similar between those with a high and low protein intake, strategies to improve the diet of older adults with a low protein intake should target a broad population and multiple food sources.
The whole scientific paper can be found here:
Hanneke A.H. Wijnhoven, Liset E.M. Elstgeest, Henrica C.W de Vet, Mary Nicolaou, Marieke B. Snijder, Marjolein Visser, May 2018
In order to preserve muscle mass and physical function, it is important to consume a sufficient amount of protein with food. However, research shows that around 50% of adults aged 65 years and older consume less than 1.0 gram/kg body weight of protein per day.
The practical question is how to calculate if you fall in this case?
PROMISS researchers set up a short food questionnaire, named the Protein Screener 55+ or Pro55+ to provide you with the probability for low protein intake in community-dwelling older people.
The Pro55+ finally consists of questions on weight and height, and the consumption (amount on average day or frequency in 4 weeks) of: slices of bread (number); glasses of milk (number); meat with warm meal (portion size); cheese (amount and frequency); dairy products (like yoghurt) (frequency); egg(s) (frequency); pasta/noodles (frequency); fish (frequency); and nuts/peanuts (frequency).
Validation tests proved that the Pro55+performs well in discrimination persons with a low and high protein intake.
Our conclusion is that the Pro55+ can be used to validly screen for protein intake below 1.0 gram/kg body weight of protein per day in community-dwelling older adults.
Available in English, its online version can be found at www.proteinscreener.nl.
PROMISS encourages such tool to be up-taken and used in other countries, and in other languages as well.
Publication in: PLOS ONE, May 23, 2018, https://doi.org/10.1371/journal.pone.0196406
Kristina S. Fluitman, Madelief Wijdeveld, Max Nieuwdorp, Richard G IJzerman Gut.
2018 Jan 30. pii: gutjnl-2017-315543. doi: 10.1136/gutjnl-2017-315543. [Epub ahead of print]
Various issues influence our appetite and metabolism, and gut bacteria have a role to play in there. A previous research project focused on one of the substances made by gut bacteria, namely butyrate, which is thought to improve body weight, appetite, and glucose- and fat-metabolism.
The project demonstrated in mice that most effects of butyrate on body weight and metabolism were actually not caused by butyrate directly. Rather, butyrate caused a decrease in appetite and food intake, which in turn caused the improvements in body weight and metabolism. Because of its effects on appetite, the researchers concluded that butyrate might potentially be used as weight-losing drug.
PROMISS would like more research to be carried out. The fact that that project was performed in mice, not in human beings, cannot make us jump to the conclusions that their results would be similar in human beings. The PROMISS experience is that effects in mice (promising as they might be) are often not as remarkable in humans. Furthermore, even if butyrate would work as effective in humans as it does in mice, we think that it might only work in specific individuals.
Read the whole scientific paper here: “Potential of butyrate to influence food intake in mice and men”.
Am J Clin Nutr. 2018 Feb 1;107(2):155-164. doi: 10.1093/ajcn/nqx020.
Protein-energy malnutrition is a major problem in older adults. Even in industrialized countries, a high percentage of the older population suffers from protein-energy malnutrition. It is also known that dietary intake may be altered or reduced while one gets older. In addition, previous studies have shown that the overall diet of a large number of community-dwelling older adults is of insufficient quality.
The analysis carried out in PROMISS involved community-dwelling older adults aged 70 years and over, who live in the areas of Memphis, Tennessee, and Pittsburgh, Pennsylvania (USA).
We investigated whether poor diet quality would increase the risk of developing protein-energy malnutrition in the future. We found that the majority of these older adults had a diet that was of insufficient quality (~80%). Furthermore, 40% of the older adults had a low intake of protein.
Our study did not show that older adults whose diet is of poor quality had a higher risk of developing protein-energy malnutrition. However, we observed that the diet of the majority of the older adults can be improved, and that a higher protein intake may lower the risk of chronic protein-energy malnutrition in community-dwelling older adults.
The whole scientific paper can be found here: https://academic.oup.com/ajcn/article/107/2/155/4911431.
Antoneta Granic, Nuno Mendonca, Avan Aihie Sayer, Tom R Hill, Karen Davies, Ashley Adamson, Mario Siervo, John C Mathers, Carol Jagger
Clinical Nutrition 2017 Nov 9 (Article in Press).
As they age adults experience a progressive decline in muscle mass and strength which puts them at increased risk of falls, frailty, disability and death. Physical inactivity and a poor diet can accelerate this loss of muscle mass and strength. We aimed to investigate the relationship between an important part of the diet for muscle, protein intake, and muscle strength and physical performance in very old adults (aged 85 years) as they aged further. Our study, the Newcastle 85+ Study, was based in North East England, and involved 722 people aged 85 years old, with diet assessed by 24h recalls on two non-consecutive days. Low protein intake was defined as less than 1 g per kg of adjusted body weight per day (or around 65 g per day for an average weight individual). Muscle strength was measured by grip strength (squeezing a dynamometer for 5s) and physical performance was measured by the Timed Up-and-Go test (getting up, walking 3 m, walking back, and sitting again). Both grip strength and Timed-Up-and-Go were measured at age 85, 87.5, 88 and 90 years of age.
We found that very old women who had low protein intake had lower grip strength and Timed-Up-and-Go at baseline, but grip strength and Timed-Up-and-Go declined at the same rate as in women with adequate protein intake (1 g per kg of adjusted body weight or more). For men, there was no difference in the baseline measures or decline in grip strength and Timed-Up-and-Go between those with low or adequate protein intake. We found an added benefit of combining adequate protein intake (above 1 g per kg of adjusted body weight per day) with medium/high physical activity on muscle strength. This positive effect was not observed if medium/high physical activity was combined with low protein intake. We conclude that (a) low protein intake may negatively affect muscle strength and physical performance in late life, especially in older women and before age 85, independently of other important factors; and (b) a combination of adequate protein intake and physical activity may be necessary to reduce the loss of muscle strength in the very old.
Read the whole scientific paper here.
Nuno Mendonça, Antoneta Granic, John C. Mathers, Tom R. Hill, Mario Siervo, Ashley J. Adamson, Carol Jagger
European Journal of Nutrition 2017 Sep 25. doi: 10.1007/s00394-017-1537-5. [Epub ahead of print]
The very old, those aged 85 years and older, are the fastest growing age group in most western societies and are at especially high risk of malnutrition, as well as loss of muscle mass and strength. The amount of protein that the very old get from their diet, which foods provide the best source of protein and the time of day that such foods are eaten, are all factors that may play important roles in delaying or even preventing malnutrition and such information is essential to develop new food products and public health policies to better tackle the problem of malnutrition. Our study, the Newcastle 85+ Study, was based in North East England, and involved 722 people aged 85 years old, whose diet was estimated by a 24 hour multiple pass recall (people are asked what foods and drinks were consumed in the past 24 hours) on two non-consecutive days. We found that 28% of our population were below the commonly used protein intake target (0.8g of protein per kg of adjusted bodyweight per day) and that this group ate less meat, more cereals and had more non-alcoholic beverages than those who had adequate protein intake. After accounting for other factors, people in the low protein group were more likely to be men, had lower energy intake and fewer teeth. People with low protein also took more of their protein during the morning than those in the adequate protein intake group. This study provides new evidence of the magnitude of low protein intake in the very old, the sources of protein and the diurnal patterning of protein intake.
Read the whole scientific paper here.
S. van der Meij , H. A.H. Wijnhoven , J. S. Lee, D. K. Houston, T. Hue, T. B. Harris, S. B. Kritchevsky , B. Newman , M. Visser
Journal of the American Geriatrics Society, accepted for publication on 31-5-2017
Poor appetite is a problem in many older adults and is associated with unintentional weight loss and lower quality of life. Insight in food preferences of these older adults could be used to improve dietary intake and develop meals, drinks and snacks that are specifically adapted to these preferences. It can also be used to identify the risk of nutrient deficiencies.
In this study we investigated differences in food intake by appetite level among 2.597 older adults (70-79 years) who are living in the United States and who participated in the second year of the Health, Aging and Body Composition Study. The dietary intake of the older adults was measured with a “food frequency questionnaire” that consisted of 108 items on frequency and amount of different foods.
In total, 22% of the older adults reported that they had a poor appetite, 38% reported a good appetite and 40% a very good appetite. The older adults with a poor appetite were more often female, black, lower educated, and reported a poorer general health status, more biting/chewing problems, unintentional weight loss, and a lower Healthy Eating Index score.
The older adults with a poor appetite consumed less protein and dietary fiber, less solid foods, smaller portion sizes, less wholegrains, and less fruits and vegetables than older adults with a very good appetite. They consumed more dairy foods, fats, oils, sweets and soda’s.
This study shows that older adults with a poor appetite report a different dietary intake pattern compared to those with very good appetite. The study results can be used for nutrition interventions to enhance food intake, diet variety and diet quality in older adults with a poor appetite.
Read the whole scientific paper here.
Houston DK, Tooze JA, Garcia K, Visser M, Rubin S, Harris TB, Newman AB, Kritchevsky SB; Health ABC Study.
J Am Geriatr Soc. 2017 Mar 17. doi: 10.1111/jgs.14856
In this study we investigated the protein intake of 1.998 older adults (70-79 years) who are living in the United States and who participate in the Health, Aging and Body Composition Study. On average, the older adults consumed 66.2 gram of protein per day. Of the men, 27.3% consumed less protein than the current Recommended Dietary Allowance, which indicates a consumption of at least 0.8 gram protein per kilogram of body weight. For women this was 26.5%.
All adults were well-functioning at baseline. The older adults were followed over 6 years, during which 45.5% developed a new mobility limitation, indicating they reported to experience difficulties walking one-quarter of a mile or climbing 10 steps without resting.
Older adults who consumed less than 0.70 grams of protein per kilogram of body weight at baseline, and those who consumed between 0.70 and 1.0 grams of protein per kilogram of body weight at baseline, were more likely to developed mobility limitation during the 6 years compared to older adults who consumed 1.0 or more grams of protein per kilogram body weight. These findings were similar when the animal protein consumption or the vegetable protein consumption were investigated separately.
The results of this research suggest that older adults with a lower protein intake are at greater risk of developing mobility limitations. They also suggest that consuming 1.0 or more grams of protein per kilogram body weight might be optimal for older persons to maintain physical function.
Read the whole scientific paper here.
Fluitman, K. S., De Clercq, N. C., Keijser, B. J. F., Visser, M., Nieuwdorp, M., & Ijzerman, R. G. (2017). The intestinal microbiota, energy balance, and malnutrition: emphasis on the role of short-chain fatty acids. Expert Review of Endocrinology & Metabolism, 12(3), 215-226. doi: 10.1080/17446651.2017.1318060
Over the last decades, increasing attention is being directed toward the vast amount of bacteria inhabiting the human gut: the intestinal microbiota.
These microbiota have been demonstrated to actively influence human energy balance.
Thus, a disruption of the normal microbiota can contribute to the development of malnutrition.
Accordingly, it was demonstrated that microbial composition differs between subjects with and without malnutrition.
This review of the literature summarizes the pathways through which the intestinal microbiota might contribute to malnutrition, how the microbiota differs in over- and undernutrion, and how the microbiota could be manipulated in a way to promote a healthy nutritional state.
Read the whole scientific paper here.