Protein Intake and Incident Frailty in the Women's Health Initiative Observational Study
Open accessAbstract
OBJECTIVES: To evaluate the association between protein intake and incident frailty. DESIGN: Prospective cohort study. SETTING: Subset of the Women's Health Initiative Observational Study conducted at 40 clinical centers. PARTICIPANTS: Twenty‐four thousand four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self‐reported energy intakes (600–5,000 kcal/day) according to the Food Frequency Questionnaire (FFQ). MEASUREMENTS: Baseline protein intake was estimated from the FFQ. Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure (doubly labeled water) and dietary protein (24‐hour urinary nitrogen). After 3 years of follow‐up, frailty was defined as having at least three of the following components: low physical function (measured using the Rand‐36 questionnaire), exhaustion, low physical activity, and unintended weight loss. Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake. RESULTS: Of the 24,417 eligible women, 3,298 (13.5%) developed frailty over 3 years. After adjustment for confounders, a 20% increase in uncalibrated protein intake (%kcal) was associated with a 12% (95% confidence interval (CI)=8–16%) lower risk of frailty, and a 20% increase in calibrated protein intake was associated with a 32% (95% CI=23–50%) lower risk of frailty. CONCLUSION: Higher protein consumption, as a fraction of energy, is associated with a strong, independent, dose‐responsive lower risk of incident frailty in older women. Using uncalibrated measures underestimated the strength of the association. Incorporating more protein into the diet may be an intervention target for frailty prevention.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Generally, 25.0-30.0 g of protein containing 2.5-2.8 g of leucine can slow frailty.
“Generally, 25.0–30.0 g of protein containing 2.5–2.8 g of leucine can slow frailty261,262.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [261]
The Results and Discussion report that higher protein intake was associated with lower incidence of frailty in older women. Our copy gives no 25.0–30.0 g protein or 2.5–2.8 g leucine recommendation (searched those amounts and leucine), and this observational association does not establish that such an intake slows frailty. (LLM, conf=0.89)
Experimental — accuracy not yet measuredHigher protein consumption has been associated with a dose-responsive lower risk of incident frailty in older women.
“Higher protein consumption has been associated with a dose-responsive lower risk of incident frailty in older women.82”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [82]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(1992) · PubMed · Cited by 33,716 · see citing works
The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection
Ware, J. E., & Sherbourne, C. D. (1992) · Medical Care · doi:10.1097/00005650-199206000-00002 · Cited by 30,033 · see citing works
Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907 · see citing works
MCHORNEY, C. A., JOHNE, W., & ANASTASIAE, R. (1993) · Medical Care · doi:10.1097/00005650-199303000-00006 · Cited by 6,681 · see citing works
2011 Compendium of Physical Activities: A Second Update of Codes and MET Values
AINSWORTH, B. E., HASKELL, W. L., HERRMANN, S. D., MECKES, N., BASSETT, D. R., TUDOR-LOCKE, C., GREER, J. L., VEZINA, J., WHITT-GLOVER, M. C., & LEON, A. S. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31821ece12 · Cited by 6,317 · see citing works
McHorney, C. A., Ware, J. E., Rachel Lu, J. F., & Sherbourne, C. D. (1994) · Medical Care · doi:10.1097/00005650-199401000-00004 · Cited by 4,458 · see citing works
Compendium of Physical Activities: Classification of energy costs of human physical activities
AINSWORTH, B. E., HASKELL, W. L., LEON, A. S., JACOBS, D. R., MONTOYE, H. J., SALLIS, J. F., & PAFFENBARGER, R. S. (1993) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199301000-00011 · Cited by 4,102 · see citing works
Design of the Women’s Health Initiative Clinical Trial and Observational Study
The Women’s Health Initiative Study Group (1998) · Controlled Clinical Trials · doi:10.1016/s0197-2456(97)00078-0 · Cited by 2,580 · see citing works
Protein and amino acid requirements in human nutrition.
(2007) · PubMed · Cited by 2,227 · see citing works
Houston, D. K., Nicklas, B. J., Ding, J., Harris, T. B., Tylavsky, F. A., Newman, A. B., Lee, J. S., Sahyoun, N. R., Visser, M., & Kritchevsky, S. B. (2008) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.1.150 · Cited by 1,214 · see citing works
Subar, A. F. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwg092 · Cited by 1,070 · see citing works
Fugate Woods, N., LaCroix, A. Z., Gray, S. L., Aragaki, A., Cochrane, B. B., Brunner, R. L., Masaki, K., Murray, A., & Newman, A. B. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53405.x · Cited by 1,040 · see citing works
Self-citationMeasurement Characteristics of the Women’s Health Initiative Food Frequency Questionnaire
Patterson, R. E., Kristal, A. R., Tinker, L. F., Carter, R. A., Bolton, M. P., & Agurs‐Collins, T. (1999) · Annals of Epidemiology · doi:10.1016/s1047-2797(98)00055-6 · Cited by 1,021 · see citing works
Self-citationEnsrud, K. E. (2008) · Archives of Internal Medicine · doi:10.1001/archinternmed.2007.113 · Cited by 975 · see citing works
Structure of Dietary Measurement Error: Results of the OPEN Biomarker Study
Kipnis, V. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwg091 · Cited by 868 · see citing works
Volpi, E., Kobayashi, H., Sheffield-Moore, M., Mittendorfer, B., & Wolfe, R. R. (2003) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/78.2.250 · Cited by 846 · see citing works
Ensrud, K. E., Ewing, S. K., Taylor, B. C., Fink, H. A., Stone, K. L., Cauley, J. A., Tracy, J. K., Hochberg, M. C., Rodondi, N., & Cawthon, P. M. (2007) · The Journals of Gerontology Series A · doi:10.1093/gerona/62.7.744 · Cited by 764 · see citing works
Implementation of the women's health initiative study design
Anderson, G. L., Manson, J. E., Wallace, R. B., Lund, B., Hall, D., Davis, S., Shumaker, S. A., Wang, C., Stein, E. A., & Prentice, R. L. (2003) · Annals of Epidemiology · doi:10.1016/s1047-2797(03)00043-7 · Cited by 757 · see citing works
Self-citationOptimal protein intake in the elderly
Wolfe, R. R., Miller, S. L., & Miller, K. B. (2008) · Clinical Nutrition · doi:10.1016/j.clnu.2008.06.008 · Cited by 456 · see citing works
Role of dietary protein in the sarcopenia of aging.
Paddon-Jones, D., Short, K., Campbell, W., Volpi, E., & Wolfe, R. (2008) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.5.1562s · Cited by 403 · see citing works
Campbell, W. W., Trappe, T. A., Wolfe, R. R., & Evans, W. J. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.6.m373 · Cited by 397 · see citing works
Frailty in older adults: insights and interventions.
Espinoza, S. E., & Walston, J. D. (2005) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.72.12.1105 · Cited by 362 · see citing works
Neuhouser, M. L., Tinker, L. F., Shaw, P. A., Schoeller, D. A., Bingham, S. A., Horn, L. V., Beresford, S. A. A., Caan, B. J., Thomson, C. A., Satterfield, S., et al. (2008) · American Journal of Epidemiology · doi:10.1093/aje/kwn026 · Cited by 355 · see citing works
Self-citationMeta-Analysis: Protein and Energy Supplementation in Older People
Milne, A. C., Avenell, A., & Potter, J. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-1-200601030-00008 · Cited by 346 · see citing works
Amount and type of protein influences bone health
Heaney, R. P., & Layman, D. K. (2008) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.5.1567s · Cited by 259 · see citing works
Menon, V., Kopple, J. D., Wang, X., Beck, G. J., Collins, A. J., Kusek, J. W., Greene, T., Levey, A. S., & Sarnak, M. J. (2008) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2008.08.009 · Cited by 256 · see citing works
Atrophy and Impaired Muscle Protein Synthesis during Prolonged Inactivity and Stress
Paddon-Jones, D., Sheffield-Moore, M., Cree, M. G., Hewlings, S. J., Aarsland, A., Wolfe, R. R., & Ferrando, A. A. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0651 · Cited by 254 · see citing works
Smoliner, C., Norman, K., Scheufele, R., Hartig, W., Pirlich, M., & Lochs, H. H. (2008) · Nutrition · doi:10.1016/j.nut.2008.06.024 · Cited by 144 · see citing works
Optimizing protein intake in aging
Walrand, S., & Boirie, Y. (2004) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/00075197-200501000-00014 · Cited by 99 · see citing works
Tuunainen, A., Langer, R. D., Klauber, M. R., & Kripke, D. F. (2001) · Psychiatry Research · doi:10.1016/s0165-1781(01)00278-5 · Cited by 99 · see citing works
Prentice, R. L., Shaw, P. A., Bingham, S. A., et al. (2009) · American Journal of Epidemiology · doi:10.1093/aje/kwp008 · Cited by 96 · see citing works
Self-citationLaCroix, A. Z., Gray, S. L., Aragaki, A., Cochrane, B. B., Newman, A. B., Kooperberg, C. L., Black, H., Curb, J. D., Greenland, P., & Woods, N. F. (2008) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/63.4.369 · Cited by 84 · see citing works
Self-citationDietary animal protein intake: association with muscle mass index in older women.
Lord, C., Chaput, J., Aubertin‐Leheudre, M., Labonté, M., & Dionne, I. J. (2007) · PubMed · Cited by 82 · see citing works
Evaluation of a simplified vitamin supplement inventory developed for the Women's Health Initiative
Patterson, R. E., Levy, L., Tinker, L. F., & Kristal, A. R. (1999) · Public Health Nutrition · doi:10.1017/s1368980099000361 · Cited by 61 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [8]A Report of the Panel on Macronutrients SoURLoN, Interpretation, Uses of Dietary Reference I, et al Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) 2005 589 National Academies Press Washington, D.C.
Cited by
Sorted by citations
Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., Phillips, S., Sieber, C., Stehle, P., Teta, D., et al. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.05.021 · Cited by 2,553 · see citing works
Deutz, N. E. P., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., Cederholm, T., Cruz-Jentoft, A., Krznariç, Z., Nair, K. S., et al. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.04.007 · Cited by 1,738 · see citing works
Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies
Batsis, J. A., & Villareal, D. T. (2018) · Nature Reviews Endocrinology · doi:10.1038/s41574-018-0062-9 · Cited by 1,382 · see citing works
Nutrition, frailty, and sarcopenia
Cruz-Jentoft, A. J., Kiesswetter, E., Drey, M., & Sieber, C. C. (2017) · Aging Clinical and Experimental Research · doi:10.1007/s40520-016-0709-0 · Cited by 488 · see citing works
Nutritional considerations for healthy aging and reduction in age-related chronic disease
Shlisky, J., Bloom, D. E., Beaudreault, A. R., Tucker, K. L., Keller, H. H., Freund-Levi, Y., Fielding, R. A., Cheng, F. W., Jensen, G. L., Wu, D., et al. (2017) · Advances in Nutrition · doi:10.3945/an.116.013474 · Cited by 462 · see citing works
Protein "requirements" beyond the RDA: implications for optimizing health
Phillips, S. M., Chevalier, S., & Leidy, H. J. (2016) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2015-0550 · Cited by 396 · see citing works
Talegawkar, S. A., Bandinelli, S., Bandeen-Roche, K., Chen, P., Milaneschi, Y., Tanaka, T., Semba, R. D., Guralnik, J. M., & Ferrucci, L. (2012) · The Journal of Nutrition · doi:10.3945/jn.112.165498 · Cited by 265 · see citing works
Protein Requirements and Recommendations for Older People: A Review
Nowson, C., & O'Connell, S. (2015) · Nutrients · doi:10.3390/nu7085311 · Cited by 243 · see citing works
Protein intake and muscle function in older adults
Deer, R. R., & Volpi, E. (2015) · Current Opinion in Clinical Nutrition and Metabolic Care · doi:10.1097/mco.0000000000000162 · Cited by 206 · see citing works
Health effects of protein intake in healthy adults: a systematic literature review
Pedersen, A. N., Kondrup, J., & Børsheim, E. (2013) · Food & Nutrition Research · doi:10.3402/fnr.v57i0.21245 · Cited by 167 · see citing works
Adherence to Mediterranean Diet and Frailty
Ntanasi, E., Yannakoulia, M., Kosmidis, M.-H., Anastasiou, C. A., Dardiotis, E., Hadjigeorgiou, G., Sakka, P., & Scarmeas, N. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.11.005 · Cited by 94 · see citing works
Nutrition and protein energy homeostasis in elderly
Boirie, Y., Morio, B., Caumon, E., & Cano, N. J. (2014) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2014.01.008 · Cited by 94 · see citing works
Veronese, N., Stubbs, B., Noale, M., Solmi, M., Rizzoli, R., Vaona, A., Demurtas, J., Crepaldi, G., & Maggi, S. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.08.028 · Cited by 80 · see citing works
Prospective views for whey protein and/or resistance training against age-related sarcopenia
Liao, Y., Peng, Z., Chen, L., Zhang, Y., Cheng, Q., Nüssler, A. K., Bao, W., Liu, L., & Yang, W. (2019) · Aging and Disease · doi:10.14336/ad.2018.0325 · Cited by 68 · see citing works
Zhu, K., Wactawski-Wende, J., Ochs-Balcom, H. M., LaMonte, M. J., Hovey, K. M., Evans, W., Shankaran, M., Troen, B. R., & Banack, H. R. (2021) · The Journals of Gerontology: Series A · doi:10.1093/gerona/glab020 · Cited by 37 · see citing works
Dietary Protein and Muscle in Aging People: The Potential Role of the Gut Microbiome
Ni Lochlainn, M., Bowyer, R. C. E., & Steves, C. J. (2018) · doi:10.20944/preprints201806.0152.v1 · Cited by 138 · see citing works
Ispoglou, T., Deighton, K., King, R. F., White, H., & Lees, M. (2017) · Nutrition Journal · doi:10.1186/s12937-017-0298-6 · Cited by 21 · see citing works
Of sound mind and body: Exploring the diet-strength interaction in healthy aging
Askow, A. T., McKenna, C. F., Box, A. G., Khan, N. A., Petruzzello, S. J., De Lisio, M., Phillips, S. M., & Burd, N. A. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.00145 · Cited by 10 · see citing works
- Authors
- Beasley, J. M., LaCroix, A. Z., Neuhouser, M. L., Huang, Y., Tinker, L., Woods, N., Michael, Y., Curb, J. D., & Prentice, R. L.
- Affiliations
- Fred Hutch Cancer Center (US)
- Columbia University (US)
- University of Washington (US)
- Drexel University (US)
- University of Hawaiʻi at Mānoa (US)
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2010-06
- Volume
- 58
- Issue
- 6
- Pages
- 1063-1071
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC2924946
- OpenAlex
- W1497284321
- Cited by
- 337
- References
- 34
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 10 · 2023: 18 · 2022: 22 · 2021: 25 · 2020: 26 · 2019: 24 · 2018: 37 · 2017: 31 · 2016: 23 · 2015: 20 · 2014: 23 · 2013: 27 · 2012: 16
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (N01-WH-4-2130, n01wh22110-38-0-0, N01 WH022110)
- U.S. Public Health Service (44221, 32122, 24152, 42107-26, 42129-32, 32118-32119, 32100-2, 32105-6, 32108-9, 32111-13, 32115)
- National Institute on Aging (K99AG035002, R01AG025441, T32AG027677)
- National Cancer Institute (P01CA53996, CA53996, P01CA053996, R01CA119171)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- protein intake, frailty, incident frailty, older women, measurement error correction, regression calibration, energy expenditure, urinary nitrogen, physical function, exhaustion, weight loss, frailty prevention, Women's Health Initiative Observational Study
- MeSH terms
- Aged, Energy Intake, Dietary Proteins, Female, Humans, Prospective Studies, Surveys and Questionnaires, Risk Factors, United States, Geriatric Assessment, Diet Records, Confounding Factors, Epidemiologic, Logistic Models, Frail Elderly
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
