The Association of Protein Intake and Bone Outcomes in Midwestern Post-menopausal Women

Abstract Objectives Determine the extent to which baseline protein and amino acid intake is independently associated with measures of baseline bone outcomes in a cohort of post-menopausal women. Methods This study was a secondary analysis of participants in the Heartland Osteoporosis Prevention Study (HOPS) randomized controlled trial evaluating the effect of different osteoporosis interventions on post-menopausal women in the Midwest. Diets were evaluated via a Harvard Willett Semi-quantitative Food Frequency Questionnaire (FFQ) at baseline. Dual energy x-ray absorptiometry (DXA) scans were used to collect bone mineral density (BMD) and trabecular bone score (TBS) measurements. Single and multivariate linear regression of total protein intake (g/d and g/kg/d), proline (g), and lysine (g) with BMD and TBS locations were conducted. Student T-tests were used to compare the bone outcome differences between groups with protein intake above and below 1.2g/kg. Results There were 249 participants available for analysis. Mean total protein intake was 82.7 g with 62% consuming < 1.2/kg/d. After adjustment, for every additional gram intake of protein, lysine and proline, Hip BMD increased (Protein: β = 0.0005, P = 0.047; Lysine: β = 0.006, P = 0.04; Proline: β = 0.008, P = 0.04). Whole body BMD and TBS-1 were significantly associated with proline intake (Whole body BMD: β = 0.008, P = 0.04; TBS-1: β = −0.007, P = 0.02). After adjustment, women who consumed protein above 1.2 g/kg, had a Hip BMD 0.03 g/cm2 higher than those who consume protein below 1.2 g/kg (β = 0.03, P = 0.046). Lumbar BMD, Total L1-L4 BMD, TBS-2, TBS-3, TBS-4, and Total TBS were not significantly associated with protein or amino acid intakes after adjustment of covariates. Conclusions Higher protein intakes were associated with higher Hip BMD. Proline may play a controversial role in bone outcomes. Future research should investigate the role of dietary factors on BMD vs TBS. Funding Sources The original research was funded by the National Institute of Nursing Research of the National Institutes of Health under award number R01NR015029. No additional funding was used for the secondary analysis.

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Impact on Isoleucine and Valine Supplementation When Decreasing Use of Medical Food in the Nutritional Management of Methylmalonic Acidemia

Nutrients ◽

10.3390/nu12020473 ◽

2020 ◽

Vol 12 (2) ◽

pp. 473

Author(s):

Laurie E. Bernstein ◽

Casey Burns ◽

Morgan Drumm ◽

Sommer Gaughan ◽

Melissa Sailer ◽

...

Keyword(s):

Amino Acid ◽

Total Protein ◽

Protein Intake ◽

Chart Review ◽

Methylmalonic Acidemia ◽

Plasma Amino Acid ◽

Medical Food ◽

Natural Protein ◽

Total Protein Intake ◽

Amino Acid Concentrations

Background: Methylmalonic acidemia (MMA) is an autosomal recessive disorder treated with precursor-free medical food while limiting natural protein. This retrospective chart review was to determine if there was a relationship between medical food, valine (VAL) and/or isoleucine (ILE) supplementation, total protein intake, and plasma amino acid profiles. Methods: A chart review, of patients aged 31 days or older with MMA treated with dietary intervention and supplementation of VAL and/or ILE and followed at the Children’s Hospital Colorado Inherited Metabolic Diseases Clinic. Dietary prescriptions and plasma amino acid concentrations were obtained at multiple time points. Results: Baseline mean total protein intake for five patients was 198% of Recommended Dietary Allowance (RDA) with 107% natural protein and 91% medical food. Following intervention, total protein intake (p = 0.0357), protein from medical food (p = 0.0142), and leucine (LEU) from medical food (p = 0.0276) were lower, with no significant change in natural protein intake (p = 0.2036). At baseline, 80% of patients received VAL supplementation and 100% received ILE supplementation. After intervention, only one of the cohort remained on supplementation. There was no statistically significant difference in plasma propiogenic amino acid concentrations. Conclusions: Decreased intake of LEU from medical food allowed for discontinuation of amino acid supplementation, while meeting the RDA for protein.

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Protein intake and the incidence of pre-diabetes and diabetes in 4 population-based studies: the PREVIEW project

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy388 ◽

2019 ◽

Vol 109 (5) ◽

pp. 1310-1318 ◽

Cited By ~ 10

Author(s):

Diewertje Sluik ◽

Elske M Brouwer-Brolsma ◽

Agnes A M Berendsen ◽

Vera Mikkilä ◽

Sally D Poppitt ◽

...

Keyword(s):

Waist Circumference ◽

Total Protein ◽

Protein Intake ◽

Meta Analysis ◽

Population Based ◽

Dietary Factors ◽

Total Protein Intake ◽

Use Of Data ◽

Dietary Records ◽

Total Plant

ABSTRACT Background Data on the relationship between protein intake and the risk of type 2 diabetes are conflicting. Objective We studied prospective associations between the intake of total, plant-based, and animal protein and the risk of pre-diabetes and diabetes in 4 population-based studies included in the PREVIEW project. Methods Analyses were conducted with the use of data from 3 European cohorts and 1 Canadian cohort, including 78,851 participants. Protein intake was assessed through the use of harmonized data from food-frequency questionnaires or 3-d dietary records. Cohort-specific incidence ratios (IRs) were estimated for pre-diabetes and diabetes, adjusting for general characteristics, lifestyle and dietary factors, disease history, and body mass index (BMI) and waist circumference; results were pooled based on a random-effects meta-analysis. Results Higher total protein intake (g · kg–1 · d–1) was associated with lower incidences of pre-diabetes and diabetes (pooled IRs: 0.84; 95% CI: 0.82, 0.87 and 0.49; 95% CI: 0.28, 0.83, respectively); plant-based protein intake was the main determinant (pooled IRs: 0.83; 95% CI: 0.81, 0.86 and 0.53; 95% CI: 0.36, 0.76, respectively). Substituting 2 energy percentage (E%) protein at the expense of carbohydrates revealed increased risks of pre-diabetes and diabetes (pooled IRs: 1.04; 95% CI: 1.01, 1.07 and 1.09; 95% CI: 1.01, 1.18, respectively). Except for the associations between intakes of total protein and plant-based protein (g · kg–1 · d–1) and diabetes, all other associations became nonsignificant after adjustment for BMI and waist circumference. Conclusions Higher protein intake (g · kg–1 · d–1) was associated with a lower risk of pre-diabetes and diabetes. Associations were substantially attenuated after adjustments for BMI and waist circumference, which demonstrates a crucial role for adiposity and may account for previous conflicting findings. This study was registered at ISRCTN as ISRCTN31174892.

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Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to < 10 Years: Findings of the EsNuPI Study

Nutrients ◽

10.3390/nu13041062 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1062

Author(s):

Casandra Madrigal ◽

María José Soto-Méndez ◽

Ángela Hernández-Ruiz ◽

Teresa Valero ◽

Federico Lara Villoslada ◽

...

Keyword(s):

Dietary Protein ◽

Total Protein ◽

Dairy Products ◽

Protein Intake ◽

Meat Products ◽

Food Sources ◽

Animal Origin ◽

Total Protein Intake ◽

Fish And Shellfish ◽

Milk And Dairy Products

Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to < 10 years old (n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler’s milk, and enriched and fortified milks) (n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to < 10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.

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Physical Activity, Diet, and Incident Urinary Incontinence in Postmenopausal Women: Women’s Health Initiative Observational Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab118 ◽

2021 ◽

Author(s):

Scott R Bauer ◽

Stacey A Kenfield ◽

Mathew Sorensen ◽

Leslee L Subak ◽

Suzanne Phelan ◽

...

Keyword(s):

Physical Activity ◽

Urinary Incontinence ◽

Observational Study ◽

Weight Change ◽

Protein Intake ◽

Macronutrient Intake ◽

Health Initiative ◽

Menopausal Women ◽

Baseline Weight ◽

Post Menopausal

Abstract Background Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI). Methods We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food-frequency questionnaire, with incident UI subtypes after 3 years among 19,741 post-menopausal women in the Women’s Health Initiative Observational Study. Odds ratios (OR) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression. Results Women who reported total physical activity (MET-hours/week) ≥30 vs <0.1 were 16% less likely to develop urgency UI (OR=0.84; 95% CI 0.70, 1.00) and 34% less likely for mixed UI (OR=0.66; 0.46, 0.95), although linear trends were no longer statistically significant after adjusting for baseline weight and weight change (P-trend=0.15 and 0.16, respectively). The association between physical activity and incident stress UI was less consistent. Higher uncalibrated protein intake was associated with increased odds of incident urgency UI (≥19.4% versus <14.1% of energy intake OR=1.14; 95% CI 0.99, 1.30; P-trend=0.02), while confidence intervals were wide and included 1.0 for calibrated protein intake. Other macronutrients were not associated with urgency UI and macronutrient intake was not associated with incident stress or mixed UI (P-trend>0.05 for all). Conclusions Among post-menopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increase urgency UI, but no associations were observed between other macronutrient and UI subtypes.

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The Relationships between Total Protein Intake, Protein Sources, Physical Activity, and Lean Mass in a Representative Sample of the US Adults

Nutrients ◽

10.3390/nu12103151 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3151

Author(s):

Furong Xu ◽

Jacob E. Earp ◽

Maya Vadiveloo ◽

Alessandra Adami ◽

Matthew J. Delmonico ◽

...

Keyword(s):

Physical Activity ◽

Lean Mass ◽

Total Protein ◽

Representative Sample ◽

Protein Intake ◽

Large Scale ◽

Weight Status ◽

Protein Sources ◽

Total Protein Intake ◽

Study Results

Background: Although dietary protein and physical activity play essential roles in developing and preserving lean mass, studies exploring these relationships are inconsistent, and large-scale studies on sources of protein and lean mass are lacking. Accordingly, the present study examined the relationship between total protein intake, protein sources, physical activity, and lean mass in a representative sample of US adults. Methods: This cross-sectional study analyzed data from 2011–2016 US National Health and Nutrition Examination Survey and corresponding Food Patterns Equivalents Database (n = 7547). Multiple linear regression models were performed to examine the sex-specific associations between total protein intake, protein sources (Dairy, Total Protein Foods, Seafood, and Plant Proteins), physical activity, and lean mass adjusting for demographics, weight status, and total daily energy intake. Results: Total protein intake was inversely related to lean mass in females only (Lean mass index: β= −0.84, 95%CI: −1.06–−0.62; Appendicular lean mass index: β= −0.35, 95%CI: −0.48–−0.22). However, protein sources and physical activity was positively associated with lean mass in males and/or females (p < 0.05). Conclusion. Study results suggest that consuming more protein daily had a detrimental influence on lean mass in females whereas eating high-quality sources of proteins and being physically active are important for lean mass for men and women. However, the importance of specific protein sources appears to differ by sex and warrants further investigation.

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Effect of 12 Weeks of Whole-Body Vibration Versus Multi-Component Training in Post-Menopausal Women

Rejuvenation Research ◽

10.1089/rej.2015.1681 ◽

2015 ◽

Vol 18 (6) ◽

pp. 508-516 ◽

Cited By ~ 12

Author(s):

Elena Marín-Cascales ◽

Jacobo A. Rubio-Arias ◽

Salvador Romero-Arenas ◽

Pedro E. Alcaraz

Keyword(s):

Whole Body Vibration ◽

Whole Body ◽

Body Vibration ◽

Menopausal Women ◽

Post Menopausal ◽

Component Training

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Whole-body leucine and lysine metabolism: response to dietary protein intake in young men

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1981.240.6.e712 ◽

1981 ◽

Vol 240 (6) ◽

pp. E712-E721 ◽

Cited By ~ 17

Author(s):

K. J. Motil ◽

D. E. Matthews ◽

D. M. Bier ◽

J. F. Burke ◽

H. N. Munro ◽

...

Keyword(s):

Amino Acid ◽

Dietary Protein ◽

Protein Intake ◽

Whole Body ◽

Dietary Protein Intake ◽

Body Protein ◽

Fed State ◽

Amino Acid Requirements ◽

Maintenance Requirements ◽

Lysine Metabolism

Whole-body leucine and lysine metabolism was explored in young adult men by a primed constant intravenous infusion of a mixture of L-[1–13C]leucine and L-[alpha-15N]lysine over a 4-h period. Subjects were studied after an overnight fast (postabsorptive state) or while consuming hourly meals (fed state) after adaptation to diets providing either a surfeit level of protein (1.5 g.kg body-1.day-1), a level approximating maintenance requirements (marginal intake) (0.6 g.kg body wt-1.day-1), or a grossly inadequate level (0.1 g.kg-1.day-1). The change in protein intake from a marginal to a surfeit level was associated with an increased leucine flux and incorporation of leucine into body protein. In the fed state, oxidation of leucine increased sharply and release of leucine from tissue protein diminished. When dietary protein intake was reduced from the requirement to inadequate level, leucine flux and body protein synthesis and protein breakdown were reduced, together with a smaller reduction in leucine oxidation. The response of the metabolism of [15N]lysine was responsible for maintenance of leucine and other essential amino acid economy, and they appear to be related to the nitrogen and amino acid requirements of the subject. These findings also demonstrate an effect of meals, modulated by their protein content, on the dynamics of whole-body amino acid metabolism.

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The Relationship Between Healthy Eating Motivation and Protein Intake in Community-Dwelling Older Adults With Varying Functional Status

Nutrients ◽

10.3390/nu12030662 ◽

2020 ◽

Vol 12 (3) ◽

pp. 662

Author(s):

Hanna M. Rempe ◽

Gudrun Sproesser ◽

Anne Hannink ◽

Thomas Skurk ◽

Beate Brandl ◽

...

Keyword(s):

Older Adults ◽

Functional Status ◽

Healthy Eating ◽

Total Protein ◽

Protein Intake ◽

Community Dwelling ◽

Cross Sectional ◽

Protein Sources ◽

Total Protein Intake ◽

The Relationship

In older adults, the relationship between healthy eating motivation (HEM) and protein intake as key component of a healthy diet is poorly understood. Therefore, we investigate the association of HEM with (1) total protein intake and (2) intake of different protein sources in older adults with varying functional status. In this cross-sectional study including 250 adults (≥70 years), we assessed HEM with “The Eating Motivation Survey” and protein intake by 7-day food records. In addition, gender, age, Body Mass Index (BMI), energy intake and functional status were considered. Regression analyses revealed that HEM was neither related to total (β = −0.02; p = 0.723) nor to relative protein intake (β = 0.04; p = 0.370). Notwithstanding this, participants with stronger HEM showed lower intake of protein from meat and meat products (β = −0.14; p = 0.018), higher intake of overall plant-based protein (β = 0.11; p = 0.032), protein from fruit and vegetables (β = 0.20; p = 0.002) and from pulses, nuts an seeds (β = 0.16; p = 0.016). Our findings suggest HEM as a valuable indicator for intake of distinct protein sources. However, since HEM is not related to total protein intake, the importance of sufficient protein consumption should be emphasized by promoting healthy eating, regardless of self-perceived HEM.

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Acute effects of calcium supplements on blood pressure and blood coagulation: secondary analysis of a randomised controlled trial in post-menopausal women

British Journal Of Nutrition ◽

10.1017/s0007114515003694 ◽

2015 ◽

Vol 114 (11) ◽

pp. 1868-1874 ◽

Cited By ~ 18

Author(s):

Sarah M. Bristow ◽

Greg D. Gamble ◽

Angela Stewart ◽

Anne M. Horne ◽

Ian R. Reid

Keyword(s):

Blood Pressure ◽

Blood Coagulation ◽

Controlled Trial ◽

Secondary Analysis ◽

Control Group ◽

Calcium Citrate ◽

Acute Effects ◽

Menopausal Women ◽

Post Menopausal ◽

Randomised Controlled

AbstractRecent evidence suggests that Ca supplements increase the risk of cardiovascular events, but the mechanism(s) by which this occurs is uncertain. In a study primarily assessing the effects of various Ca supplements on blood Ca levels, we also investigated the effects of Ca supplements on blood pressure and their acute effects on blood coagulation. We randomised 100 post-menopausal women to 1 g/d of Ca or a placebo containing no Ca. Blood pressure was measured at baseline and every 2 h up to 8 h after their first dose and after 3 months of supplementation. Blood coagulation was measured by thromboelastography (TEG) in a subgroup of participants (n 40) up to 8 h only. Blood pressure declined over 8 h in both the groups, consistent with its normal diurnal rhythm. The reduction in systolic blood pressure was smaller in the Ca group compared with the control group by >5 mmHg between 2 and 6 h (P≤0·02), and the reduction in diastolic blood pressure was smaller at 2 h (between-groups difference 4·5 mmHg, P=0·004). Blood coagulability, assessed by TEG, increased from baseline over 8 h in the calcium citrate and control groups. At 4 h, the increase in the coagulation index was greater in the calcium citrate group compared with the control group (P=0·03), which appeared to be due to a greater reduction in the time to clot initiation. These data suggest that Ca supplements may acutely influence blood pressure and blood coagulation. Further investigation of this possibility is required.

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Impact of habituated dietary protein intake on fasting and postprandial whole-body protein turnover and splanchnic amino acid metabolism in elderly men: a randomized, controlled, crossover trial

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa201 ◽

2020 ◽

Vol 112 (6) ◽

pp. 1468-1484 ◽

Cited By ~ 2

Author(s):

Grith Højfeldt ◽

Jacob Bülow ◽

Jakob Agergaard ◽

Ali Asmar ◽

Peter Schjerling ◽

...

Keyword(s):

Amino Acid ◽

Protein Turnover ◽

Protein Intake ◽

Amino Acid Metabolism ◽

Acid Metabolism ◽

High Protein ◽

Whole Body ◽

Body Protein ◽

Protein Absorption ◽

Fasted State

ABSTRACT Background Efficacy of protein absorption and subsequent amino acid utilization may be reduced in the elderly. Higher protein intakes have been suggested to counteract this. Objectives We aimed to elucidate how habituated amounts of protein intake affect the fasted state of, and the stimulatory effect of a protein-rich meal on, protein absorption, whole-body protein turnover, and splanchnic amino acid metabolism. Methods Twelve men (65–70 y) were included in a double-blinded crossover intervention study, consisting of a 20-d habituation period to a protein intake at the RDA or a high amount [1.1 g · kg lean body mass (LBM)−1 · d−1 or >2.1 g · kg LBM−1 · d−1, respectively], each followed by an experimental trial with a primed, constant infusion of D8-phenylalanine and D2-tyrosine. Arterial and hepatic venous blood samples were obtained after an overnight fast and repeatedly 4 h after a standardized meal including intrinsically labeled whey protein concentrate and calcium-caseinate proteins. Blood was analyzed for amino acid concentrations and phenylalanine and tyrosine tracer enrichments from which whole-body and splanchnic amino acid and protein kinetics were calculated. Results High (compared with the recommended amount of) protein intake resulted in a higher fasting whole-body protein turnover with a resultant mean ± SEM 0.03 ± 0.01 μmol · kg LBM−1 · min−1 lower net balance (P < 0.05), which was not rescued by the intake of a protein-dense meal. The mean ± SEM plasma protein fractional synthesis rate was 0.13 ± 0.06%/h lower (P < 0.05) after habituation to high protein. Furthermore, higher fasting and postprandial amino acid removal were observed after habituation to high protein, yielding higher urea excretion and increased phenylalanine oxidation rates (P < 0.01). Conclusions Three weeks of habituation to high protein intake (>2.1 g protein · kg LBM−1 · d−1) led to a significantly higher net protein loss in the fasted state. This was not compensated for in the 4-h postprandial period after intake of a meal high in protein. This trial was registered at clinicaltrials.gov as NCT02587156.

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