Cited by 297Nutrition and Health in AgingMuscle metabolism and nutritionNutritional Studies and Diet

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Dietary protein intake in community-dwelling, frail, and institutionalized elderly people: scope for improvement

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Tieland, Michael, Borgonjen-Van den Berg, Karin J., van Loon, Luc J. C., de Groot, Lisette C. P. G. M.·2012·European Journal of Nutrition

DOI 10.1007/s00394-011-0203-6

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Abstract

Purpose Adequate dietary protein intake is required to postpone and treat sarcopenia in elderly people. Insight into dietary protein intake in this heterogeneous population segment is needed to locate dietary inadequacies and to identify target populations and feeding strategies for dietary interventions. Therefore, we assessed dietary protein intake, distribution of protein intake throughout the day, and the use of protein-containing food sources in community-dwelling, frail, and institutionalized elderly people in the Netherlands.Methods Secondary analyses were carried out using dietary data collected from studies among community-dwelling, frail, and institutionalized elderly people to evaluate protein intake characteristics.Results Dietary protein intake averaged 1.1 ± 0.3 g/kg-bw/day in community-dwelling, 1.0 ± 0.3 g/kg-bw/day in frail, and 0.8 ± 0.3 g/kg-bw/day in institutionalized elderly men. Similar protein intakes were found in women. Ten percent of the community-dwelling and frail elderly and 35% of the institutionalized elderly people showed a protein intake below the estimated average requirement (0.7 g/kg-bw/day). Protein intake was particularly low at breakfast in community-dwelling (10 ± 10 g), frail (8 ± 5 g), and institutionalized elderly people (12 ± 6 g) with bread and dairy products as predominant protein sources.Conclusions Whereas daily protein intake is generally well above the recommended dietary allowance in community-dwelling and frail elderly people, a significant proportion of institutionalized elderly showed an intake below the current protein requirement, making them an important target population for dietary interventions. Particularly at breakfast, there is scope for improving protein intake.

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van de Rest, O., van der Zwaluw, N. L., Tieland, M., Adam, J. J., Hiddink, G. J., van Loon, L. J. C., & de Groot, C. P. G. M. (2014) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2013.12.005 · Cited by 109
Self-citation
Perspective: Vegan Diets for Older Adults? A Perspective On the Potential Impact On Muscle Mass and Strength
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Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults
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Keeping Older Muscle “Young” through Dietary Protein and Physical Activity
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Dairy Consumption and Risk of Frailty in Older Adults: A Prospective Cohort Study
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Background
Growing older with health and vitality: a nexus of physical activity, exercise and nutrition
Witard, O. C., McGlory, C., Hamilton, D. L., & Phillips, S. M. (2016) · Biogerontology · doi:10.1007/s10522-016-9637-9 · Cited by 91
“5–4 h apart versus a conventional (Tieland et al. 2012; Valenzuela et al. 2013) skewed meal pattern that biased daily protein intake (*63/90 g) towards the evening meal.”
Influential
The muscle protein synthetic response to food ingestion
Gorissen, S. H. M., Rémond, D., & van Loon, L. J. C. (2015) · Meat Science · doi:10.1016/j.meatsci.2015.05.009 · Cited by 92
Dose-Dependent Increases in Whole-Body Net Protein Balance and Dietary Protein-Derived Amino Acid Incorporation into Myofibrillar Protein During Recovery from Resistance Exercise in Older Men
Holwerda, A. M., Paulussen, K. J. M., Overkamp, M., Goessens, J. P. B., Kramer, I. F., Wodzig, W. K. W. H., Verdijk, L. B., & van Loon, L. J. C. (2019) · Journal of Nutrition · doi:10.1093/jn/nxy263 · Cited by 96
“55 g/kg) protein in a single mixed meal may be practically challenging for the older population (44, 45).”
Background
Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGG
Volkert, D., Bauer, J. M., Frühwald, T., Gehrke, I., Lechleitner, M., Lenzen-Großimlinghaus, R., Wirth, R., Sieber, C. C., & Arends, J. (2013) · Aktuelle Ernährungsmedizin · doi:10.1055/s-0033-1343169 · Cited by 97
Effectiveness of nutritional and exercise interventions to improve body composition and muscle strength or function in sarcopenic obese older adults: a systematic review
Theodorakopoulos, C., Jones, J., Bannerman, E., & Greig, C. A. (2017) · Nutrition Research · doi:10.1016/j.nutres.2017.05.002 · Cited by 86
“Namely, Tieland et al. [53] provided an oral supplement delivering 15 g of protein twice daily (with breakfast and lunch) to older frail adults.”
Influential
The role of nutrition and physical activity in frailty: A review
O’Connell, M., Coppinger, T. C., & McCarthy, A. L. (2019) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.11.003 · Cited by 89
Interactions between exercise and nutrition to prevent muscle waste during ageing
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No differences in muscle protein synthesis rates following ingestion of wheat protein, milk protein, and their protein blend in healthy, young males
Pinckaers, P. J. M., Kouw, I. W. K., Hendriks, F. K., van Kranenburg, J. M. X., de Groot, L. C. P. G. M., Verdijk, L. B., Snijders, T., & van Loon, L. J. C. (2021) · British Journal Of Nutrition · doi:10.1017/s0007114521000635 · Cited by 76
“These populations suffer from anabolic resistance and typically consume less protein per meal (33,40 – 42) .”
A randomized controlled trial of the impact of protein supplementation on leg lean mass and integrated muscle protein synthesis during inactivity and energy restriction in older persons
Oikawa, S. Y., McGlory, C., D'Souza, L. K., Morgan, A. K., Saddler, N. I., Baker, S. K., Parise, G., & Phillips, S. M. (2018) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqy193 · Cited by 76
“In addition to reduced ambulation, hospitalization or illness can be accompanied by a decrease in appetite and food intake, which can lead to an energy deficit and muscle loss (5).”
Background
Reduced plasma concentration of branched-chain amino acids in sarcopenic older subjects: a cross-sectional study
Ottestad, I. O., Ulven, S. M., Øyri, L. K. L., Sandvei, K. S., Gjevestad, G. O., Bye, A., Sheikh, N. A., Biong, A. S., Andersen, L. F., & Holven, K. B. (2018) · British Journal Of Nutrition · doi:10.1017/s0007114518001307 · Cited by 80
“results corroborate with previous findings in sarcopenic and frail older adults, showing significantly lower absolute intake of protein when compared with non-sarcopenic and non-frail older adults((4,9,27,46)).”
Discriminating sarcopenia in community-dwelling older women with high frequency of overweight/obesity: the São Paulo Ageing & Health Study (SPAH)
Domiciano, D. S., Figueiredo, C. P., Lopes, J., Caparbo, V. F., Takayama, L., Menezes, P. R., Bonfá, E., & Pereira, R. M. R. (2012) · Osteoporosis International · doi:10.1007/s00198-012-2002-1 · Cited by 75
Systematic review and meta-analysis of the effect of protein and amino acid supplements in older adults with acute or chronic conditions
Cheng, H., Kong, J., Underwood, C., Petocz, P., Hirani, V., Dawson, B., & O’Leary, F. (2018) · British Journal of Nutrition · doi:10.1017/s0007114517003816 · Cited by 72
“…0.52 0.873 3.38 Schurch et al., 1998 0.40 0.25 –0.09 0.90 0.112 3.70 Smoliner et al., 2008 0.13 0.28 –0.42 0.69 0.631 3.45 Sugawara et al., 2012 0.42 0.36 –0.29 1.14 0.245 2.74 Tieland et al., 2012 0.00 0.25 –0.49 0.49 1.000 3.76 Zak et al., 2009 0.03 0.32 –0.59 0.65 0.916 3.13 0.27 0.09 0.10 0.44…”
Influential
Dietary Protein in Older Adults: Adequate Daily Intake but Potential for Improved Distribution
Thomas, D. K., Riviere, T., Tieges, Z., & Greig, C. A. (2017) · Nutrients · doi:10.3390/nu9030184 · Cited by 71
“Distribution of protein intake was skewed across the day with particularly small amounts at breakfast, which was consistent with previously reported patterns [20,21].”
Result
Insufficient amounts and inadequate distribution of dietary protein intake in apparently healthy older adults in a developing country: implications for dietary strategies to prevent sarcopenia
Alemán-Mateo, H., Valenzuela, R. E. R., Ponce, Figueroa, G. G. M., Muro, A., & Carreón, R. (2013) · Clinical Interventions in Aging · doi:10.2147/cia.s49810 · Cited by 70
Amount, Source and Pattern of Dietary Protein Intake Across the Adult Lifespan: A Cross-Sectional Study
Smeuninx, B., Greig, C. A., & Breen, L. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.00025 · Cited by 69
Protein intake and lean body mass preservation during energy intake restriction in overweight older adults
Backx, E. M. P., Tieland, M., Borgonjen-van den Berg, K. J., Claessen, P. R., van Loon, L. J. C., & de Groot, L. C. P. G. M. (2016) · International Journal of Obesity · doi:10.1038/ijo.2015.182 · Cited by 66
Self-citation
A focus on leucine in the nutritional regulation of human skeletal muscle metabolism in ageing, exercise and unloading states
Ely, I. A., Phillips, B. E., Smith, K., Wilkinson, D. J., Piasecki, M., Breen, L., Larsen, M. S., & Atherton, P. J. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.08.010 · Cited by 64
Prevalence and determinants of low protein intake in very old adults: insights from the Newcastle 85+ Study
Mendonça, N., Granic, A., Mathers, J., Hill, T., Siervo, M., Adamson, A., & Jagger, C. (2017) · European Journal of Nutrition · doi:10.1007/s00394-017-1537-5 · Cited by 63
“7 g of protein per kg of body weight per day (g/kg BW/day) [5] and close to 10% of women > 71 years had protein intakes below the EAR in the National Health and Nutrition Examination Survey (NHANES) 2003–2004 [6].”
Improved skeletal muscle mass and strength after heavy strength training in very old individuals
Bechshøft, R. L., Malmgaard‐Clausen, N. M., Gliese, B., Beyer, N., Mackey, A. L., Andersen, J. L., Kjær, M., & Holm, L. (2017) · Experimental Gerontology · doi:10.1016/j.exger.2017.03.014 · Cited by 66
Effects of Dairy Products Consumption on Body Weight and Body Composition Among Adults: An Updated Meta‐Analysis of 37 Randomized Control Trials
Geng, T., Qi, L., & Huang, T. (2017) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.201700410 · Cited by 65
Therapeutic approaches to osteosarcopenia: insights for the clinician
Fatima, M., Brennan-Olsen, S. L., & Duque, G. (2019) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x19867009 · Cited by 84
Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions
Mathewson, S. L., Azevedo, P. S., Gordon, A. L., Phillips, B. E., & Greig, C. A. (2021) · Ageing Research Reviews · doi:10.1016/j.arr.2021.101401 · Cited by 60
“…and Silver, 1988), however evidence shows no difference between older men and women in appetite nor protein consumption (Gaspareto et al., 2017; Tieland et al., 2015, 2012; Volkert et al., 2004), with these results suggestive that other factors are present, such as comorbidities and…”
Macronutrient Intake and Inadequacies of Community-Dwelling Older Adults, a Systematic Review
ter Borg, S., Verlaan, S., Mijnarends, D. M., Schols, J. M. G. A., de Groot, C. P. G. M., & Luiking, Y. C. (2015) · Annals of Nutrition and Metabolism · doi:10.1159/000435862 · Cited by 60
Risk of Malnutrition Evaluated by Mini Nutritional Assessment and Sarcopenia in Noninstitutionalized Elderly People
Liguori, I., Curcio, F., Russo, G., Cellurale, M., Aran, L., Bulli, G., Della‐Morte, D., Gargiulo, G., Testa, G., Cacciatore, F., et al. (2018) · Nutrition in Clinical Practice · doi:10.1002/ncp.10022 · Cited by 60
Nutrient-rich, high-quality, protein-containing dairy foods in combination with exercise in aging persons to mitigate sarcopenia
Phillips, S. M., & Martinson, W. (2018) · Nutrition Reviews · doi:10.1093/nutrit/nuy062 · Cited by 63
Frailty, Exercise and Nutrition
Michel, J., Cruz-Jentoft, A. J., & Cederholm, T. (2015) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2015.04.006 · Cited by 61
Dietary protein considerations to support active aging
Wall, B. T., Cermak, N. M., & van Loon, L. J. C. (2014) · Sports Medicine · doi:10.1007/s40279-014-0258-7 · Cited by 56
“little to no additional benefit and result in a ‘waste’ of daily protein intake) and avoiding the typically low protein breakfast often reported in older populations [104].”
Background
Protein Supplementation Augments Muscle Fiber Hypertrophy but Does Not Modulate Satellite Cell Content During Prolonged Resistance-Type Exercise Training in Frail Elderly
Dirks, M. L., Tieland, M., Verdijk, L. B., Losen, M., Nilwik, R., Mensink, M., de Groot, L. C. P. G. M., & van Loon, L. J. C. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.02.006 · Cited by 56
Dietary Protein Sources and Muscle Mass over the Life Course: The Lifelines Cohort Study
Alexandrov, N. V., Eelderink, C., Singh-Povel, C. M., Navis, G. J., Bakker, S. J. L., & Corpeleijn, E. (2018) · Nutrients · doi:10.3390/nu10101471 · Cited by 56
“Many older adults may not be consuming adequate amounts of dietary protein, particularly institutionalized elderly [15].”
BackgroundInfluential
Protein Distribution and Muscle-Related Outcomes: Does the Evidence Support the Concept?
Hudson, J., Bergia, R. E., & Campbell, W. W. (2020) · Nutrients · doi:10.3390/nu12051441 · Cited by 64
Prevalence of sarcopenia and associated risk factors by two diagnostic criteria in community-dwelling older men: the São Paulo Ageing & Health Study (SPAH)
Figueiredo, C. P., Domiciano, D. S., Lopes, J., Caparbo, V. F., Scazufca, M., Bonfá, E., & Pereira, R. M. R. (2013) · Osteoporosis International · doi:10.1007/s00198-013-2455-x · Cited by 55
“healthy individuals' analysis minimizes confounding variables, particularly those observed in institutionalized individuals [32, 33].”
Protein enrichment of familiar foods as an innovative strategy to increase protein intake in institutionalized elderly
Beelen, J., de Roos, N. M., & de Groot, C. P. G. M. (2016) · The journal of nutrition health & aging · doi:10.1007/s12603-016-0733-y · Cited by 56
“Recent studies suggest that most elderly do not reach this high intake with their current diet (14-16).”
The Association of Handgrip Strength and Mortality: What Does It Tell Us and What Can We Do With It?
Buckner, S. L., Dankel, S. J., Bell, Z. W., Abe, T., & Loenneke, J. P. (2018) · Rejuvenation Research · doi:10.1089/rej.2018.2111 · Cited by 55
Effects of resistance exercise and whey protein supplementation on skeletal muscle strength, mass, physical function, and hormonal and inflammatory biomarkers in healthy active older men: a randomised, double-blind, placebo-controlled trial
Griffen, C., Duncan, M. J., Hattersley, J. G., Weickert, M. O., Dallaway, A., & Renshaw, D. W. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111651 · Cited by 60
Prolonged Collagen Peptide Supplementation and Resistance Exercise Training Affects Body Composition in Recreationally Active Men
Kirmse, M., Oertzen-Hagemann, V., de Marées, M., Bloch, W., & Platen, P. (2019) · Nutrients · doi:10.3390/nu11051154 · Cited by 53
“It is often assumed that daily protein intake in elderly populations is even less than the recommended dietary allowance (RDA) or that even more protein per day is needed to ensure age-appropriate muscular system function [46].”
Background
Barriers to and Facilitators of the Consumption of Animal-Based Protein-Rich Foods in Older Adults
Appleton, K. M. (2016) · Nutrients · doi:10.3390/nu8040187 · Cited by 57
“Animal-based protein-rich foods typically contribute a high proportion of protein to an older adults’ diet [27,30,37], can provide a higher quality of protein [5,30,37], and associations between a higher consumption of animal-based protein in older individuals and various positive health outcomes, as above, have been…”
Background
Healthy ageing: Evidence that improvement is possible at every age
Michel, J., DREUX, C., & Vacheron, A. (2016) · European Geriatric Medicine · doi:10.1016/j.eurger.2016.04.014 · Cited by 54
“Published data testify to the fact that protein-energy supplementation alone [88–90] is less effective than physical exercise alone [91–93], and each of these measures individually is less effective than the combination of the two together [94].”
Background
Effects of milk proteins supplementation in older adults undergoing resistance training: A meta-analysis of randomized control trials
Hidayat, K., Chen, G.-C., Wang, Y., Zhang, Z., Dai, X., Szeto, I. M. Y., & Qin, L.-Q. (2018) · The Journal of nutrition, health and aging · doi:10.1007/s12603-017-0899-y · Cited by 52
“…of milk proteins on fat-free mass during resistance training in participants with aged-related medical conditions is reasonable, since these individuals generally consume dietary protein below the average protein requirement, and tend to have lower fat-free mass than healthy participants (41).”
Lean Body Mass Associated with Upper Body Strength in Healthy Older Adults While Higher Body Fat Limits Lower Extremity Performance and Endurance
Charlton, K. E., Batterham, M. J., Langford, K. J., Lateo, J., Brock, E., Walton, K. L., Lyons‐Wall, P., Eisenhauer, K., Green, N., & McLean, C. (2015) · Nutrients · doi:10.3390/nu7095327 · Cited by 52
“Ageing is characterised by changes in body composition, including decreased muscle mass, or sarcopenia, and an accompanying increase in fat mass [1–6].”
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Prevalence of sarcopenia and its association with socioeconomic status among the elderly in Tehran
Motlagh, A. D., Arero, G., Chamar, M., & Tavakoli, S. (2016) · Ethiopian Journal of Health Sciences · doi:10.4314/ejhs.v26i4.11 · Cited by 53
“Many studies have investigated the association between nutritient intake such as protein (19-26), vitamins (27,28), minerals (29) and antioxidants (30) and sarcopenia.”
Background
Interventional strategies to combat muscle disuse atrophy in humans: focus on neuromuscular electrical stimulation and dietary protein
Dirks, M. L., Wall, B. T., & van Loon, L. J. C. (2017) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00985.2016 · Cited by 55
“Protein supplementation can be timed together with a relatively low-protein meal such as breakfast or lunch (151) to maximize the postprandial muscle protein synthetic response to meal ingestion.”
Background
Effectiveness of a Supervised Group-Based Otago Exercise Program on Functional Performance in Frail Institutionalized Older Adults: A Multicenter Randomized Controlled Trial
García-Gollarte, F., Mora-Concepción, A., Hernandis, S. P., Segura‐Ortí, E., Amer-Cuenca, J. J., Arguisuelas, M. D., Lisón, J. F., & Benavent-Caballer, V. (2021) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0000000000000326 · Cited by 50

Authors: Tieland, M., Borgonjen-Van den Berg, K. J., van Loon, L. J. C., & de Groot, L. C. P. G. M.
Affiliations: TiFN (NL)
Corresponding author: Tieland, Michael
ORCID: Tieland, Michael
Venue: European Journal of Nutrition
Publisher: Springer Science and Business Media LLC
Published: 2011-05-12
Volume: 51
Issue: 2
Pages: 173-179
ISSN: 1436-6207 (ISSN-L)
1436-6215
DOI: 10.1007/s00394-011-0203-6
OpenAlex: W2020203688
Cited by: 297
References: 47
Citations by year: 2026: 6 · 2025: 7 · 2024: 17 · 2023: 14 · 2022: 16 · 2021: 28 · 2020: 22 · 2019: 29 · 2018: 40 · 2017: 31 · 2016: 25 · 2015: 18 · 2014: 22 · 2013: 12 · 2012: 9
FWCI: 9.56
Type: journal article
Language: en
Open access: green
research.wur.nl
Licence: www.springer.com/tdm (tdm)
Locations: European Journal of Nutrition (publishedVersion)
PubMed (publishedVersion)
Socio-Environmental Systems Modeling (acceptedVersion)
Research Bank (Australian Catholic University) (submittedVersion)
Research Publications (Maastricht University) (submittedVersion)
Figshare (submittedVersion, cc-by)
Data Archiving and Networked Services (DANS) (submittedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords: protein intake, older adults, sarcopenia, frail elderly, institutionalized elderly, community-dwelling older adults, protein sources, dietary intervention, protein requirements
MeSH terms: Aged, Aged, 80 and over, Bread, Energy Intake, Dairy Products, Diet, Dietary Proteins, Feeding Behavior, Female, Humans, Male, Netherlands, Residence Characteristics, Frail Elderly, Nutrition Policy

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Dietary protein intake in community-dwelling, frail, and institutionalized elderly people: scope for improvement

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