The protein gap: increasing protein intake in the diet of community-dwelling older adults – A simulation study

Abstract Objective: Approximately 50% of Dutch community-dwelling older adults does not meet protein recommendations. This study assesses the effect of replacing low protein foods with protein-rich alternatives on protein intake of Dutch community-dwelling older adults. Design: The Dutch National Food Consumption Survey – Older Adults 2010-2012 was used for scenario modelling. Dietary intake was estimated for 727 adults aged 70+ based on two 24-h recalls. Commonly consumed products were replaced by comparable products rich in protein (scenario 1), foods enriched in protein (scenario 2), and a combination of both (scenario 3). Replacement scenarios were confined to participants whose dietary protein intake was <1.0g/kg BW/day (n=391). Habitual protein intake of all older adults was estimated, adjusting for effects of within-person variation in the 2-days intake data. Results: Mean protein intake of the total population increased from 1.0 to 1.2 g/kg BW/day (scenarios 1 and 2) and to 1.3 g/kg BW/day (scenario 3). The percentage of participants with intakes of ≥1.0 g/kg BW/day increased from 47.1% to 91.4%, 90.2%, and 94.6% respectively in scenarios 1, 2 and 3. The largest increases in protein intake were due to replacements in food groups Yoghurt, cream desserts and pudding, Potatoes, vegetables and legumes and Non-alcoholic beverages and milk in scenario 1 and Bread; Yoghurt, cream desserts and pudding and Soups in scenario 2. Conclusions: This simulation model shows that replacing low protein foods with comparable alternatives rich in protein can increase the protein intake of Dutch community-dwelling older adults considerably. Results can be used as a basis for nutritional counseling.

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Low awareness of community-dwelling older adults on the importance of dietary protein: new insights from four qualitative studies

Journal of Nutritional Science ◽

10.1017/jns.2021.92 ◽

2021 ◽

Vol 10 ◽

Author(s):

Joost O. Linschooten ◽

Marije H. Verwijs ◽

Janne Beelen ◽

Marian A. E. de van der Schueren ◽

Annet J. C. Roodenburg

Keyword(s):

Older Adults ◽

Focus Groups ◽

Healthy Eating ◽

Dietary Protein ◽

Protein Intake ◽

Eating Behaviour ◽

Community Dwelling ◽

Low Protein ◽

Protein Rich ◽

Community Dwelling Older Adults

Abstract Meeting the recommended daily protein intake can be a challenge for community-dwelling older adults (CDOA). In order to understand why, we studied attitudes towards protein-rich products and healthy eating in general; identified needs and preferences, barriers and promotors and knowledge regarding dietary behaviour and implementation of high protein products. Attitudes towards protein-rich products and healthy eating were evaluated in focus groups (study 1, n 17). To gain insights in the needs and preferences of older adults with regard to meals and meal products (study 2, n 30), visual information on eating behaviour was assessed using photovoicing and verified in post-photovoice interviews. In studies 3 and 4, semi-structured interviews were conducted to identify protein consumption-related barriers, opportunities (n 20) and knowledge and communication channels (n 40), respectively. Risk of low protein intake was assessed using ProteinScreener55+ (Pro55+) in studies 2–4 (n 90). Focus groups showed that participants were unaware of potential inadequate dietary protein. Photovoicing showed that sixteen of thirty participants mainly consumed traditional Dutch products. In post-photovoice interviews, participants indicated that they were satisfied with their current eating behaviour. Barriers for adequate use of protein-rich products were ‘lack of knowledge’, ‘resistance to change habits’ and ‘no urge to receive dietary advice’. Promotors were ‘trust in professionals’ and ‘product offers’. Sixty-two percent had a low risk of low protein intake. CDOA feel low urgency to increase protein intake, possibly linked to low knowledge levels. A challenge for professionals would be to motivate older adults to change their eating pattern, to optimise protein intake.

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Effectiveness and cost-effectiveness of personalised dietary advice aiming at increasing protein intake on physical functioning in community-dwelling older adults with lower habitual protein intake: rationale and design of the PROMISS randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-040637 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040637

Author(s):

Ilse Reinders ◽

Hanneke A H Wijnhoven ◽

Satu K Jyväkorpi ◽

Merja H Suominen ◽

Riikka Niskanen ◽

...

Keyword(s):

Older Adults ◽

Physical Functioning ◽

Protein Intake ◽

Intervention Group ◽

Community Dwelling ◽

Dietary Advice ◽

Control Group ◽

Randomised Controlled ◽

Community Dwelling Older Adults ◽

Habitual Protein Intake

IntroductionShort-term metabolic and observational studies suggest that protein intake above the recommended dietary allowance of 0.83 g/kg body weight (BW)/day may support preservation of lean body mass and physical function in old age, but evidence from randomised controlled trials is inconclusive.Methods and analysisThe PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS) trial examines the effect of personalised dietary advice aiming at increasing protein intake with or without advice regarding timing of protein intake to close proximity of usual physical activity, on change in physical functioning after 6 months among community-dwelling older adults (≥65 years) with a habitual protein intake of <1.0 g/kg adjusted (a)BW/day. Participants (n=264) will be recruited in Finland and the Netherlands, and will be randomised into three groups; two intervention groups and one control group. Intervention group 1 (n=88) receives personalised dietary advice and protein-enriched food products in order to increase their protein intake to at least 1.2 g/kg aBW/day. Intervention group 2 (n=88) receives the same advice as described for intervention group 1, and in addition advice to consume 7.5–10 g protein through protein-(en)rich(ed) foods within half an hour after performing usual physical activity. The control group (n=88) receives no intervention. All participants will be invited to attend lectures not related to health. The primary outcome is a 6-month change in physical functioning measured by change in walk time using a 400 m walk test. Secondary outcomes are: 6-month change in the Short Physical Performance Battery score, muscle strength, body composition, self-reported mobility limitations, quality of life, incidence of frailty, incidence of sarcopenia risk and incidence of malnutrition. We also investigate cost-effectiveness by change in healthcare costs.DiscussionThe PROMISS trial will provide evidence whether increasing protein intake, and additionally optimising the timing of protein intake, has a positive effect on the course of physical functioning after 6 months among community-dwelling older adults with a habitual protein intake of <1.0 g/kg aBW/day.Ethics and disseminationThe study has been approved by the Ethics Committee of the Helsinki University Central Hospital, Finland (ID of the approval: HUS/1530/2018) and The Medical Ethical Committee of the Amsterdam UMC, location VUmc, Amsterdam, the Netherlands (ID of the approval: 2018.399). All participants provided written informed consent prior to being enrolled onto the study. Results will be submitted for publication in peer-reviewed journals and will be made available to stakeholders (ie, older adults, healthcare professionals and industry).Trial registration numberClinicalTrials.gov Registry (NCT03712306).

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Protein Intake among Community-Dwelling Older Adults: The Influence of (Pre-) Motivational Determinants

Nutrients ◽

10.3390/nu14020293 ◽

2022 ◽

Vol 14 (2) ◽

pp. 293

Author(s):

Marije H. Verwijs ◽

Annemien Haveman-Nies ◽

Jos W. Borkent ◽

Joost O. Linschooten ◽

Annet J. C. Roodenburg ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Protein Intake ◽

Community Dwelling ◽

Online Questionnaire ◽

Behavioral Determinants ◽

Low Protein ◽

Personal Approach ◽

Increase Protein Intake ◽

Community Dwelling Older Adults

An adequate protein intake is important for healthy ageing, yet nearly 50% of Dutch community-dwelling older adults do not meet protein recommendations. This study explores protein intake in relation to eight behavioral determinants (I-Change model) among Dutch community-dwelling older adults. Data were collected through an online questionnaire from October 2019–October 2020. Protein intake was assessed by the Protein Screener 55+, indicating a high/low chance of a low protein intake (<1.0 g/kg body weight/day). The behavioral determinants of cognizance, knowledge, risk perception, perceived cues, attitude, social support, self-efficacy and intention were assessed by evaluating statements on a 7-point Likert scale. A total of 824 Dutch community-dwelling older adults were included, recruited via online newsletters, newspapers and by personal approach. Poisson regression was performed to calculate quartile-based prevalence ratios (PRs). Almost 40% of 824 respondents had a high chance of a low protein intake. Univariate analyses indicated that lower scores for all different behavioral determinants were associated with a higher chance of a low protein intake. Independent associations were observed for knowledge (Q4 OR = 0.71) and social support (Q4 OR = 0.71). Results of this study can be used in future interventions aiming to increase protein intake in which focus should lie on increasing knowledge and social support.

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The effectiveness of protein-rich ready-made meals and dairy products in increasing protein intake of community-dwelling older adults after switching from self-prepared to ready-made meals

Clinical Nutrition ◽

10.1016/j.clnu.2018.06.1087 ◽

2018 ◽

Vol 37 ◽

pp. S5

Author(s):

J.W. Borkent ◽

J. Beelen ◽

J.O. Linschooten ◽

A.J.C. Roodenburg ◽

M.A.E. de van der Schueren

Keyword(s):

Older Adults ◽

Dairy Products ◽

Protein Intake ◽

Community Dwelling ◽

Protein Rich ◽

Community Dwelling Older Adults

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The ConsuMEER study: a randomised trial towards the effectiveness of protein-rich ready-made meals and protein-rich dairy products in increasing protein intake of community-dwelling older adults after switching from self-prepared meals towards ready-made meals

Journal of Nutritional Science ◽

10.1017/jns.2019.27 ◽

2019 ◽

Vol 8 ◽

Cited By ~ 2

Author(s):

Jos W. Borkent ◽

Janne Beelen ◽

Joost O. Linschooten ◽

Annet J. C. Roodenburg ◽

Marian A. E. de van der Schueren

Keyword(s):

Older Adults ◽

G Protein ◽

Dairy Products ◽

Protein Intake ◽

Randomised Trial ◽

Intervention Group ◽

Community Dwelling ◽

Control Group ◽

Protein Rich ◽

Community Dwelling Older Adults

AbstractThe risk of undernutrition in older community-dwelling adults increases when they are no longer able to shop or cook themselves. Home-delivered products could then possibly prevent them from becoming undernourished. This single-blind randomised trial tested the effectiveness of home-delivered protein-rich ready-made meals and dairy products in reaching the recommended intake of 1·2 g protein/kg body weight (BW) per d and ≥25 g of protein per meal. Community-dwelling older adults (n 98; mean age 80·4 (sd 6·8) years) switched from self-prepared to home-delivered hot meals and dairy products for 28 d. The intervention group received ready-made meals and dairy products high in protein; the control group received products lower in protein. Dietary intake was measured at baseline, after 2 weeks (T1), and after 4 weeks (T2). Multilevel analyses (providing one combined outcome for T1 and T2) and logistic regressions were performed. Average baseline protein intake was 1·09 (se 0·05) g protein/kg BW per d in the intervention group and 0·99 (se 0·05) g protein/kg BW per d in the control group. During the trial, protein intake of the intervention group was 1·12 (se 0·05) g protein/kg BW per d compared with 0·87 (se 0·03) g protein/kg BW per d in the control group (between-group differences P < 0·05). More participants of the intervention group reached the threshold of ≥25 g protein at dinner compared with the control group (intervention T1: 84·8 %, T2: 88·4 % v. control T1: 42·9 %, T2: 40·5 %; P < 0·05), but not at breakfast and lunch. Our findings suggest that switching from self-prepared meals to ready-made meals carries the risk of a decreasing protein intake, unless extra attention is given to protein-rich choices.

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