Two dietary advice strategies to increase protein intake among community-dwelling older adults: A feasibility study

Abstract

Background & aims: Expert groups propose that recommendations for protein intake for older adults should be increased to compensate for a blunted anabolic response to protein. As many older adults do not meet the (current and higher) recommendations, we examined the feasibility of two dietary advice strategies to increase protein intake following either an even distribution of protein over the day ('even' strategy) or a peak in protein during one meal moment ('peak' strategy).

Methods: This randomized controlled trial examined the feasibility (effectiveness and appreciation) of an 'even' or 'peak' dietary advise strategy on increasing protein intake after four weeks among community-dwelling older adults aged ≥65 y. Participants (n = 60) were randomized into one of the three groups; two intervention groups ('even' or 'peak' strategy) and one control group. Participants of both intervention groups with a baseline protein intake <0.9 g/kg adjusted body weight (aBW)/day received personalized dietary advice and protein enriched food products to increase their protein intake to at least 1.2 g/kg aBW/day, and those with an intake between 0.9 and 1.2 g/kg aBW/day to increase their protein intake with 0.3 g/kg aBW/day. When current intake was higher than 1.2 g/kg aBW/day they received advice to follow the strategy without increasing protein intake. The 'even' group was advised to consume a maximum of 20 g of protein during each meal or snack moment while the 'peak' group was advised to consume at least one daily meal with 35-45 g of protein. Effectiveness to increase protein intake was assessed by three 24-h recalls after four weeks and appreciation of the dietary strategies by a five point scale questionnaire.

Results: Baseline protein intake was 71.0 ± 12.1 g/day in participants with a protein intake <1.2 g/kg aBW/day. Protein increased significantly more in both intervention groups (+28.9 ± 22.9 g/day for the 'even' group and +21.8 ± 21.4 g/day for the 'peak' group) versus control (+5.7 ± 13.0 g/day), and participants following the 'peak' strategy more often had at least one meal per day very high in protein (≥35 g). Both intervention groups considered the advice to increase protein as (very) clear (100% and 93.6% for the 'even' and 'peak' strategy), and most reported they would (partly) continue following the advice (81% and 88% for the 'even' and 'peak' strategy).

Conclusions: The 'even' and 'peak' dietary advice strategies were effective in increasing protein intake in four weeks and both well appreciated by community-dwelling older adults. The study is registered in The Netherlands National Trial Register (NTR6849).

Keywords: Adjusted body weight; Dietary advice; Malnutrition; Randomized controlled trial.