Dietary protein intake, protein sources & distribution patterns in community-dwelling older adults: A harmonized analysis of eight studies.

Sufficient protein intake is important for older adults to prevent sarcopenia. Better insight into dietary characteristics may be helpful to improve daily protein intake. Therefore, this study aimed to compare characteristics of community-dwelling older adults with distinct amounts of daily protein intake. Baseline data of older adults (age >55 years) from eight intervention studies were pooled. Protein intake was measured using 24-h recalls or 3-day food records. Participants were stratified into one of four different groups based on their habitual protein intake (<0.8 g per kilogram bodyweight per day (g/kg/d), 0.8-0.99 g/kg/d, 1.0-1.2 g/kg/d and >1.2 g/kg/d). Protein intake per meal, animal-versus plant-based protein intake, daily protein distribution patterns (e.g. spread or pulse) and the protein intake from distinct protein-rich food categories (meat, fish, dairy, grains and others) were assessed. Among 814 participants (69 ± 9 years, 54 % male), mean protein intake was 0.98 ± 0.30 g/kg/d. 28 % (n = 227) of the population had a protein intake <0.8 g/kg/d, 29 % (n = 240) 0.8-0.99 g/kg/d, 22 % (n = 179) 1.0-1.2 g/kg/d and 21 % (n = 168) >1.2 g/kg/d. Higher protein intake groups had a lower body weight and BMI and a higher energy intake per day. Although protein intake distribution patterns did not differ across groups, meals with >20 g or >0.4 g protein per kilogram bodyweight per meal more often occurred in the higher protein intake groups. Protein intake was the lowest at breakfast followed by lunch and dinner, in all groups. Higher protein intake groups consumed a higher proportion of animal-based protein sources. Distinct protein intake groups showed comparable intake distribution patterns, with lowest protein consumption at breakfast and highest at dinner. Nevertheless, the highest protein intake group more often consumed >20 gr of protein per meal, indicating that a focus on the absolute amount of protein per meal, particularly at breakfast, could further optimize daily protein intake in older adults.

Koopmans L ，van Oppenraaij S ，Heijmans MWF ，Verlaan S ，Schoufour JD ，Ten Haaf DSM ，van der Avoort CMT ，van den Helder J ，Memelink R ，Verreijen A ，Weijs PJM ，Eijsvogels TMH ，Hopman MTE ... -  《-》

Provision of a daily high protein and high energy meal: Effects on the physical and psychological wellbeing of community-dwelling, malnourished older adults; a randomised crossover trial.

To determine whether daily provision of a high protein, high energy meal for 12-weeks to under-nourished older adults living independently in the community can improve physical, physiological, and psychological outcomes. A randomised crossover trial. Participant homes within a 15-mile radius to meal supplier; Dartmoor Community Kitchen Hub. Fifty-six community dwelling older adults (82 ± 7 years, 70% female) were randomised (stratified for baseline mini nutritional assessment (MNA) score and cohabiting or living alone) to receive 12-weeks of meal provision followed by 12-weeks no intervention (meals first group, n = 28), or, 12-weeks without intervention followed by 12-weeks of meal provision intervention (meals second group, n = 28). A daily high protein and high energy home-delivered meal for 12-weeks. Each meal contained >50% daily protein requirements (0.6 g kg-1 of the recommended 1.2 g kg-1.day-1, ∼42 g protein per meal) and >40% daily energy requirements (∼715 kcal). Physical, physiological and psychological health (including MNA score, body composition, hand grip strength, self-esteem, and depression) were evaluated in participants' homes before and after each 12-week period (baseline, 12-weeks, and 24-weeks). The effect of meal provision was assessed by t-test then effects were combined using meta-analysis. Retention of any meal provision effect after cessation of meal delivery was quantified as change from the end of the meal intervention versus 12-weeks follow-up via paired t-test. The meal intervention significantly increased MNA score with a medium effect size (MNA: pooled Cohen's D = 0.74, p < 0.001). Energy and protein intake increased significantly during the control period where participants were asked to maintain their habitual diet in the meals second group (energy intake: increase = 252 kcal [95% CI 36-487 kcal], t(22) = 2.408, p = 0.025, protein intake: increase = 0.20 g kg-1 [95% CI 0.04-0.357 g kg-1], t(22) = 2.629, p = 0.015), which confounded the principle of a randomised crossover design analysis. When the control effect in those in the meals second group was removed from the analysis, the effect of the meal provision was much greater (meal provision significantly improved energy and protein intakes (311 kcal D = 0.52 (95% CI 0.22 to 0.82), p < 0.001; 0.24 g kg-1D = 0.52 (0.19-0.81), p < 0.001, respectively), MNA score (2.6 points D = 1.14 (0.78-1.50), p < 0.001), and handgrip strength (1.5 kg D = 0.36 (0.06-0.66), p = 0.02), but did not change levels of depression or self-esteem). Twelve weeks after meal removal, the following % of the meal effect was retained: 68% for MNA score, 27% for negative mood score, 15% for daily energy intake, 6% for daily protein intake and 0% for handgrip strength. Provision of high protein, high energy meals to community dwelling older adults for 12-weeks improved nutritional status and handgrip strength, indicative of reduced frailty risk. Benefits were not retained upon withdrawal of the intervention, suggesting a need for sustained interventions in this cohort to meet nutritional needs. Home-delivered meals offer a popular, and scalable intervention for community dwelling older adults to prevent malnutrition, promote health and sustain high quality independent living thus reducing the burden of ageing and frailty on health and social care systems.

Struszczak L ，Hickson M ，McClelland I ，Metcalf B ，Barreto M ，Torquati L ，Fulford J ，Allen R ，Hulme C ，O'Leary MF ，Bowtell JL ... -  《-》

Protein Intake and Its Association With Meal Patterns and Dietary Patterns in a Swedish Population of Older Adults.

Meeting protein intake recommendations is relevant for maintaining muscle mass. This study aimed to describe protein intake and its association with meal patterns and dietary patterns. An in-house designed, web-based 4-day record was used in the national dietary survey (in 2010/2011). Participants 60 years and older were included in the analysis (n = 533). Protein intake was described by hour of consumption, self-indicated meals and food source. Eating and drinking occasion (EDO) and food groups were defined, from which meal patterns and three a posteriori dietary patterns (using principal component analysis) were assessed. We observed a mean protein intake of just over 1 g/kg body weight (bw) in both men and women. Over 50% of the protein intake was sourced from the food groups meat, fish and milk/yoghurt. A bolus intake of 30 g protein per meal was observed in a small proportion of participants at breakfast and lunch, but was most common at dinner (41% women and 56% men). No strong correlations were observed between protein intake and neither dietary patterns nor the number of EDOs. A 5 g higher protein intake at any meal, but not higher EDO frequency, was associated with higher odds of meeting a protein intake over 1.1 g/kg bw. Protein intake over 1.1 g/kg bw was met by 44% of the participants. Lunch and dinner were the highest contributors to protein intake. Dietary and meal patterns were weakly associated with protein intake. Only total daily protein intake was associated with reaching > 1.1 g/kg bw.

Engelheart S ，Karlsson M ，Lentjes MAH 《-》

Falls prevention interventions for community-dwelling older adults: systematic review and meta-analysis of benefits, harms, and patient values and preferences.

About 20-30% of older adults (≥ 65 years old) experience one or more falls each year, and falls are associated with substantial burden to the health care system, individuals, and families from resulting injuries, fractures, and reduced functioning and quality of life. Many interventions for preventing falls have been studied, and their effectiveness, factors relevant to their implementation, and patient preferences may determine which interventions to use in primary care. The aim of this set of reviews was to inform recommendations by the Canadian Task Force on Preventive Health Care (task force) on fall prevention interventions. We undertook three systematic reviews to address questions about the following: (i) the benefits and harms of interventions, (ii) how patients weigh the potential outcomes (outcome valuation), and (iii) patient preferences for different types of interventions, and their attributes, shown to offer benefit (intervention preferences). We searched four databases for benefits and harms (MEDLINE, Embase, AgeLine, CENTRAL, to August 25, 2023) and three for outcome valuation and intervention preferences (MEDLINE, PsycINFO, CINAHL, to June 9, 2023). For benefits and harms, we relied heavily on a previous review for studies published until 2016. We also searched trial registries, references of included studies, and recent reviews. Two reviewers independently screened studies. The population of interest was community-dwelling adults ≥ 65 years old. We did not limit eligibility by participant fall history. The task force rated several outcomes, decided on their eligibility, and provided input on the effect thresholds to apply for each outcome (fallers, falls, injurious fallers, fractures, hip fractures, functional status, health-related quality of life, long-term care admissions, adverse effects, serious adverse effects). For benefits and harms, we included a broad range of non-pharmacological interventions relevant to primary care. Although usual care was the main comparator of interest, we included studies comparing interventions head-to-head and conducted a network meta-analysis (NMAs) for each outcome, enabling analysis of interventions lacking direct comparisons to usual care. For benefits and harms, we included randomized controlled trials with a minimum 3-month follow-up and reporting on one of our fall outcomes (fallers, falls, injurious fallers); for the other questions, we preferred quantitative data but considered qualitative findings to fill gaps in evidence. No date limits were applied for benefits and harms, whereas for outcome valuation and intervention preferences we included studies published in 2000 or later. All data were extracted by one trained reviewer and verified for accuracy and completeness. For benefits and harms, we relied on the previous review team's risk-of-bias assessments for benefit outcomes, but otherwise, two reviewers independently assessed the risk of bias (within and across study). For the other questions, one reviewer verified another's assessments. Consensus was used, with adjudication by a lead author when necessary. A coding framework, modified from the ProFANE taxonomy, classified interventions and their attributes (e.g., supervision, delivery format, duration/intensity). For benefit outcomes, we employed random-effects NMA using a frequentist approach and a consistency model. Transitivity and coherence were assessed using meta-regressions and global and local coherence tests, as well as through graphical display and descriptive data on the composition of the nodes with respect to major pre-planned effect modifiers. We assessed heterogeneity using prediction intervals. For intervention-related adverse effects, we pooled proportions except for vitamin D for which we considered data in the control groups and undertook random-effects pairwise meta-analysis using a relative risk (any adverse effects) or risk difference (serious adverse effects). For outcome valuation, we pooled disutilities (representing the impact of a negative event, e.g. fall, on one's usual quality of life, with 0 = no impact and 1 = death and ~ 0.05 indicating important disutility) from the EQ-5D utility measurement using the inverse variance method and a random-effects model and explored heterogeneity. When studies only reported other data, we compared the findings with our main analysis. For intervention preferences, we used a coding schema identifying whether there were strong, clear, no, or variable preferences within, and then across, studies. We assessed the certainty of evidence for each outcome using CINeMA for benefit outcomes and GRADE for all other outcomes. A total of 290 studies were included across the reviews, with two studies included in multiple questions. For benefits and harms, we included 219 trials reporting on 167,864 participants and created 59 interventions (nodes). Transitivity and coherence were assessed as adequate. Across eight NMAs, the number of contributing trials ranged between 19 and 173, and the number of interventions ranged from 19 to 57. Approximately, half of the interventions in each network had at least low certainty for benefit. The fallers outcome had the highest number of interventions with moderate certainty for benefit (18/57). For the non-fall outcomes (fractures, hip fracture, long-term care [LTC] admission, functional status, health-related quality of life), many interventions had very low certainty evidence, often from lack of data. We prioritized findings from 21 interventions where there was moderate certainty for at least some benefit. Fourteen of these had a focus on exercise, the majority being supervised (for > 2 sessions) and of long duration (> 3 months), and with balance/resistance and group Tai Chi interventions generally having the most outcomes with at least low certainty for benefit. None of the interventions having moderate certainty evidence focused on walking. Whole-body vibration or home-hazard assessment (HHA) plus exercise provided to everyone showed moderate certainty for some benefit. No multifactorial intervention alone showed moderate certainty for any benefit. Six interventions only had very-low certainty evidence for the benefit outcomes. Two interventions had moderate certainty of harmful effects for at least one benefit outcome, though the populations across studies were at high risk for falls. Vitamin D and most single-component exercise interventions are probably associated with minimal adverse effects. Some uncertainty exists about possible adverse effects from other interventions. For outcome valuation, we included 44 studies of which 34 reported EQ-5D disutilities. Admission to long-term care had the highest disutility (1.0), but the evidence was rated as low certainty. Both fall-related hip (moderate certainty) and non-hip (low certainty) fracture may result in substantial disutility (0.53 and 0.57) in the first 3 months after injury. Disutility for both hip and non-hip fractures is probably lower 12 months after injury (0.16 and 0.19, with high and moderate certainty, respectively) compared to within the first 3 months. No study measured the disutility of an injurious fall. Fractures are probably more important than either falls (0.09 over 12 months) or functional status (0.12). Functional status may be somewhat more important than falls. For intervention preferences, 29 studies (9 qualitative) reported on 17 comparisons among single-component interventions showing benefit. Exercise interventions focusing on balance and/or resistance training appear to be clearly preferred over Tai Chi and other forms of exercise (e.g., yoga, aerobic). For exercise programs in general, there is probably variability among people in whether they prefer group or individual delivery, though there was high certainty that individual was preferred over group delivery of balance/resistance programs. Balance/resistance exercise may be preferred over education, though the evidence was low certainty. There was low certainty for a slight preference for education over cognitive-behavioral therapy, and group education may be preferred over individual education. To prevent falls among community-dwelling older adults, evidence is most certain for benefit, at least over 1-2 years, from supervised, long-duration balance/resistance and group Tai Chi interventions, whole-body vibration, high-intensity/dose education or cognitive-behavioral therapy, and interventions of comprehensive multifactorial assessment with targeted treatment plus HHA, HHA plus exercise, or education provided to everyone. Adding other interventions to exercise does not appear to substantially increase benefits. Overall, effects appear most applicable to those with elevated fall risk. Choice among effective interventions that are available may best depend on individual patient preferences, though when implementing new balance/resistance programs delivering individual over group sessions when feasible may be most acceptable. Data on more patient-important outcomes including fall-related fractures and adverse effects would be beneficial, as would studies focusing on equity-deserving populations and on programs delivered virtually. Not registered.

Pillay J ，Gaudet LA ，Saba S ，Vandermeer B ，Ashiq AR ，Wingert A ，Hartling L ... -  《Systematic Reviews》

Role of Medical Nutrition Therapy as Treatment of Sarcopenia in Older People with Type 2 Diabetes.

Gaglio A ，Grancini V ，Giacchetti F ，Mirani M ，Orsi E ，Resi V ... -  《-》