Dietary Protein Intake Is Positively Associated with Appendicular Lean Mass and Handgrip Strength among Middle-Aged US Adults

Abstract

Background: Sarcopenia, a progressive loss of skeletal muscle mass and strength, can begin in the 4th decade of life. Protein intake predicts skeletal muscle mass and strength among older adults, but knowledge of similar associations among middle-aged adults is lacking.

Objectives: We aimed to assess associations between protein intake and skeletal muscle mass, characterized by appendicular lean mass adjusted for BMI [in kg/m2 (ALMBMI)], and muscle strength, represented by handgrip strength adjusted for BMI (GSMAXBMI), among middle-aged adults.

Methods: We analyzed cross-sectional data from 1209 men and 1208 women aged 40-59 y in the 2011-2014 NHANES. Protein intake per kilogram actual body weight (BW), assessed by two 24-h recalls, was examined as continuous and categorical parameters [low (<RDA, 0.8 g/kg BW), moderate (≥RDA, <1.2 g/kg BW), and high (≥1.2 g/kg BW)]. ALM was measured using DXA, and GSMAX was measured using handgrip dynamometer. "Low lean mass" and "weakness" were defined using NIH criteria for ALMBMI and GSMAXBMI, respectively. Linear and logistic regression models were performed.

Results: Among middle-aged adults, 15.6% of men and 13.4% of women had low lean mass and 3.5% of men and 2.3% of women exhibited weakness. Protein intakes per kilogram BW were positively associated with ALMBMI and GSMAXBMI among men and women after adjustment for age, race/Hispanic origin, physical activity, and self-rated health. Compared with the moderate protein group, the high protein group had a higher GSMAXBMI and the low protein group had a lower GSMAXBMI among men and women. The low protein group had a lower ALMBMI (women) and had a higher OR for low lean mass (men) compared with the moderate protein group.

Conclusions: Higher protein intakes were associated with greater ALMBMI and GSMAXBMI in this representative sample of US middle-aged adults. Our findings highlight the need for further research on dietary protein as a potential modifying factor of sarcopenia risk in middle age.

Keywords: NHANES; appendicular lean mass; handgrip strength; middle age; protein; sarcopenia.

FIGURE 1

The prevalence of low lean mass and weakness, determined by the Foundation for the National Institutes of Health Sarcopenia Project criteria for appendicular lean mass and grip strength adjusted for BMI, respectively, among men and women aged 40–59 y, NHANES 2011–2014. Values are percentages ± SEs. Low lean mass was defined as appendicular lean mass adjusted for BMI <0.789 for men and <0.512 for women, and weakness was defined as grip strength adjusted for BMI <1.0 for men and <0.56 for women.