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Open Access 01-02-2022 | Original Contribution

The cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake: a randomized controlled trial

Authors: Ilse Reinders, Marjolein Visser, Satu K. Jyväkorpi, Riikka T. Niskanen, Judith E. Bosmans, Ângela Jornada Ben, Ingeborg A. Brouwer, Lothar D. Kuijper, Margreet R. Olthof, Kaisu H. Pitkälä, Rachel Vijlbrief, Merja H. Suominen, Hanneke A. H. Wijnhoven

Published in: European Journal of Nutrition | Issue 1/2022

Abstract

Purpose

To examine the cost effectiveness of dietary advice to increase protein intake on 6-month change in physical functioning among older adults.

Methods

In this multicenter randomized controlled trial, 276 community-dwelling older adults with a habitual protein intake < 1.0 g/kg adjusted body weight (aBW)/d were randomly assigned to either Intervention 1; advice to increase protein intake to ≥ 1.2 g/kg aBW/d (PROT, n = 96), Intervention 2; similar advice and in addition advice to consume protein (en)rich(ed) foods within half an hour after usual physical activity (PROT + TIMING, n = 89), or continue the habitual diet with no advice (CON, n = 91). Primary outcome was 6-month change in 400-m walk time. Secondary outcomes were 6-month change in physical performance, leg extension strength, grip strength, body composition, self-reported mobility limitations and quality of life. We evaluated cost effectiveness from a societal perspective.

Results

Compared to CON, a positive effect on walk time was observed for PROT; – 12.4 s (95%CI, – 21.8 to – 2.9), and for PROT + TIMING; – 4.9 s (95%CI, – 14.5 to 4.7). Leg extension strength significantly increased in PROT (+ 32.6 N (95%CI, 10.6–54.5)) and PROT + TIMING (+ 24.3 N (95%CI, 0.2–48.5)) compared to CON. No significant intervention effects were observed for the other secondary outcomes. From a societal perspective, PROT was cost effective compared to CON.

Conclusion

Dietary advice to increase protein intake to ≥ 1.2 g/kg aBW/d improved 400-m walk time and leg strength among older adults with a lower habitual protein intake. From a societal perspective, PROT was considered cost-effective compared to CON. These findings support the need for re-evaluating the protein RDA of 0.8 g/kg BW/d for older adults.

Trial registration

The trial has been registered at ClinicalTrials.gov (NCT03712306). Date of registration: October 2018. Registry name: The (Cost) Effectiveness of Increasing Protein Intake on Physical Functioning in Older Adults. Trial Identifier: NCT03712306.

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EFSA (2012) Scientific opinion on dietary reference values for protein. EFSA panel on dietetic products, nutrition and allergies (NDA). EFSA J 10(2):2257

Cuthbertson D, Smith K, Babraj J, Leese G, Waddell T, Atherton P, Wackerhage H, Taylor PM, Rennie MJ (2005) Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle. FASEB J 19(3):422–424. https://doi.org/10.1096/fj.04-2640fjeCrossRefPubMed

Moore DR, Churchward-Venne TA, Witard O, Breen L, Burd NA, Tipton KD, Phillips SM (2015) Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A Biol Sci Med Sci 70(1):57–62. https://doi.org/10.1093/gerona/glu103CrossRefPubMed

Wall BT, Gorissen SH, Pennings B, Koopman R, Groen BB, Verdijk LB, van Loon LJ (2015) Aging is accompanied by a blunted muscle protein synthetic response to protein ingestion. PLoS ONE 10(11):e0140903. https://doi.org/10.1371/journal.pone.0140903CrossRefPubMedPubMedCentral

Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB, Moore LL, Rodriguez NR, van Loon LJ (2015) Protein and healthy aging. Am J Clin Nutr 101(6):1339S-1345S. https://doi.org/10.3945/ajcn.114.084061CrossRefPubMed

Deutz NE, Wolfe RR (2013) Is there a maximal anabolic response to protein intake with a meal? Clin Nutr 32(2):309–313. https://doi.org/10.1016/j.clnu.2012.11.018CrossRefPubMed

Burd NA, Gorissen SH, van Loon LJ (2013) Anabolic resistance of muscle protein synthesis with aging. Exerc Sport Sci Rev 41(3):169–173. https://doi.org/10.1097/JES.0b013e318292f3d5CrossRefPubMed

Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, Lee JS, Sahyoun NR, Visser M, Kritchevsky SB, Health ABCS (2008) Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 87(1):150–155CrossRef

Wolfe RR (2012) The role of dietary protein in optimizing muscle mass, function and health outcomes in older individuals. Br J Nutr 108(Suppl 2):S88-93. https://doi.org/10.1017/S0007114512002590CrossRefPubMed

10.

Deer RR, Volpi E (2015) Protein intake and muscle function in older adults. Curr Opin Clin Nutr Metab Care 18(3):248–253. https://doi.org/10.1097/MCO.0000000000000162CrossRefPubMedPubMedCentral

11.

Houston DK, Tooze JA, Garcia K, Visser M, Rubin S, Harris TB, Newman AB, Kritchevsky SB, Health ABCS (2017) Protein intake and mobility limitation in community-dwelling older adults: the health ABC study. J Am Geriatr Soc 65(8):1705–1711. https://doi.org/10.1111/jgs.14856CrossRefPubMedPubMedCentral

12.

Granic A, Mendonca N, Sayer AA, Hill TR, Davies K, Adamson A, Siervo M, Mathers JC, Jagger C (2018) Low protein intake, muscle strength and physical performance in the very old: The Newcastle 85+ Study. Clin Nutr 37(6 Pt A):2260–2270. https://doi.org/10.1016/j.clnu.2017.11.005CrossRefPubMedPubMedCentral

13.

Mustafa J, Ellison RC, Singer MR, Bradlee ML, Kalesan B, Holick MF, Moore LL (2018) Dietary protein and preservation of physical functioning among middle-aged and older adults in the framingham offspring study. Am J Epidemiol 187(7):1411–1419. https://doi.org/10.1093/aje/kwy014CrossRefPubMedPubMedCentral

14.

Hruby A, Sahni S, Bolster D, Jacques PF (2018) Protein intake and functional integrity in aging: the framingham heart study offspring. J Gerontol A Biol Sci Med Sci. https://doi.org/10.1093/gerona/gly201CrossRefPubMedCentral

15.

Mendonca N, Granic A, Hill TR, Siervo M, Mathers JC, Kingston A, Jagger C (2019) Protein intake and disability trajectories in very old adults: the newcastle 85+ study. J Am Geriatr Soc 67(1):50–56. https://doi.org/10.1111/jgs.15592CrossRefPubMed

16.

Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, Phillips S, Sieber C, Stehle P, Teta D, Visvanathan R, Volpi E, Boirie Y (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14(8):542–559. https://doi.org/10.1016/j.jamda.2013.05.021CrossRefPubMed

17.

Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, Cederholm T, Cruz-Jentoft A, Krznaric Z, Nair KS, Singer P, Teta D, Tipton K, Calder PC (2014) Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 33(6):929–936. https://doi.org/10.1016/j.clnu.2014.04.007CrossRefPubMedPubMedCentral

18.

Nutrition reference intake values for the German Speaking Countries D-A-CH ed 2, update 1 (2016) https://www.dge.de/wissenschaft/referenzwerte/protein/

19.

Nordic Council of Ministers. Nordic nutrition recommendations 2012. Integrating nutrition physical activity; 2014. pp. 1e627. Copenhagen

20.

Ten Haaf DSM, Nuijten MAH, Maessen MFH, Horstman AMH, Eijsvogels TMH, Hopman MTE (2018) Effects of protein supplementation on lean body mass, muscle strength, and physical performance in nonfrail community-dwelling older adults: a systematic review and meta-analysis. Am J Clin Nutr 108(5):1043–1059. https://doi.org/10.1093/ajcn/nqy192CrossRefPubMed

21.

Tieland M, Franssen R, Dullemeijer C, van Dronkelaar C, Kyung Kim H, Ispoglou T, Zhu K, Prince RL, van Loon LJC, de Groot L (2017) The impact of dietary protein or amino acid supplementation on muscle mass and strength in elderly people: individual participant data and meta-analysis of RCT’s. J Nutr Health Aging 21(9):994–1001. https://doi.org/10.1007/s12603-017-0896-1CrossRefPubMed

22.

Beelen J, de Roos NM, de Groot L (2017) A 12-week intervention with protein-enriched foods and drinks improved protein intake but not physical performance of older patients during the first 6 months after hospital release: a randomised controlled trial. Br J Nutr 117(11):1541–1549. https://doi.org/10.1017/S0007114517001477CrossRefPubMed

23.

Bhasin S, Apovian CM, Travison TG, Pencina K, Moore LL, Huang G, Campbell WW, Li Z, Howland AS, Chen R, Knapp PE, Singer MR, Shah M, Secinaro K, Eder RV, Hally K, Schram H, Bearup R, Beleva YM, McCarthy AC, Woodbury E, McKinnon J, Fleck G, Storer TW, Basaria S (2018) Effect of protein intake on lean body mass in functionally limited older men: a randomized clinical trial. JAMA Intern Med 178(4):530–541. https://doi.org/10.1001/jamainternmed.2018.0008CrossRefPubMed

24.

Park Y, Choi JE, Hwang HS (2018) Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 108(5):1026–1033. https://doi.org/10.1093/ajcn/nqy214CrossRefPubMed

25.

Ten Haaf DSM, Eijsvogels TMH, Bongers C, Horstman AMH, Timmers S, de Groot L, Hopman MTE (2019) Protein supplementation improves lean body mass in physically active older adults: a randomized placebo-controlled trial. J Cachexia Sarcopenia Muscle. https://doi.org/10.1002/jcsm.12394CrossRefPubMedPubMedCentral

26.

Cribb PJ, Hayes A (2006) Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci Sports Exerc 38(11):1918–1925. https://doi.org/10.1249/01.mss.0000233790.08788.3eCrossRefPubMed

27.

Wijnhoven HAH, Elstgeest LEM, de Vet HCW, Nicolaou M, Snijder MB, Visser M (2018) Development and validation of a short food questionnaire to screen for low protein intake in community-dwelling older adults: The Protein Screener 55+ (Pro55+). PLoS ONE 13(5):e0196406. https://doi.org/10.1371/journal.pone.0196406CrossRefPubMedPubMedCentral

28.

Berner LA, Becker G, Wise M, Doi J (2013) Characterization of dietary protein among older adults in the United States: amount, animal sources, and meal patterns. J Acad Nutr Diet 113(6):809–815. https://doi.org/10.1016/j.jand.2013.01.014CrossRefPubMed

29.

Reinders I, Wijnhoven HAH, Jyväkorpi SK, Suominen MH, Niskanen R, Bosmans JE, Brouwer IA, Fluitman KS, Klein MCA, Kuijper LD, van der Lubbe LM, Olthof MR, Pitkälä KH, Vijlbrief R, Visser M (2020) Effectiveness and cost-effectiveness of personalized dietary advice aiming at increasing protein intake on physical functioning in community-dwelling older adults with lower habitual protein intake: rationale and design of the PROMISS randomized controlled trial. BMJ Open 10:e040637. https://doi.org/10.1136/bmjopen-2020-040637CrossRefPubMedPubMedCentral

30.

English KL, Paddon-Jones D (2010) Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care 13(1):34–39. https://doi.org/10.1097/MCO.0b013e328333aa66CrossRefPubMedPubMedCentral

31.

Paddon-Jones D, Rasmussen BB (2009) Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 12(1):86–90. https://doi.org/10.1097/MCO.0b013e32831cef8bCrossRefPubMedPubMedCentral

32.

Simonsick EM, Montgomery PS, Newman AB, Bauer DC, Harris T (2001) Measuring fitness in healthy older adults: the Health ABC Long Distance Corridor Walk. J Am Geriatr Soc 49(11):1544–1548CrossRef

33.

Simonsick EM, Fan E, Fleg JL (2006) Estimating cardiorespiratory fitness in well-functioning older adults: treadmill validation of the long distance corridor walk. J Am Geriatr Soc 54(1):127–132. https://doi.org/10.1111/j.1532-5415.2005.00530.xCrossRefPubMed

34.

Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85-94CrossRef

35.

EuroQol G (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRef

36.

Versteegh MM, Vermeulen KM, Evers SMAA, de Wit GA, Prenger R, Stolk EA (2016) Dutch tariff for the five-level version of EQ-5D. Value Health 19(4):343–352. https://doi.org/10.1016/j.jval.2016.01.003CrossRef

37.

Whitehead SJ, Ali S (2010) Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull 96:5–21. https://doi.org/10.1093/bmb/ldq033CrossRefPubMed

38.

Kanters TA, Bouwmans CAM, van der Linden N, Tan SS, Hakkaart-van Roijen L (2017) Update of the Dutch manual for costing studies in health care. PLoS ONE 12(11):e0187477. https://doi.org/10.1371/journal.pone.0187477CrossRefPubMedPubMedCentral

39.

Wimo A (1998) Evaluation of the resource utilization and caregiver time in Anti-dementia drug trials-a quantitative battery. The health economics of dementia

40.

Zorginstituut Nederland - Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg. In Ministerie van Volksgezondheid, Welzijn en Sport (2016) https://www.zorginstituutnederland.nl/publicaties/publicatie/2016/02/29/richtlijn-voor-het-uitvoeren-van-economische-evaluaties-in-de-gezondheidszorg

41.

Wilson MM, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, Diebold MR, Morley JE (2005) Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 82(5):1074–1081CrossRef

42.

Skotte J, Korshoj M, Kristiansen J, Hanisch C, Holtermann A (2014) Detection of physical activity types using triaxial accelerometers. J Phys Act Health 11(1):76–84. https://doi.org/10.1123/jpah.2011-0347CrossRefPubMed

43.

Perera S, Studenski S, Newman A, Simonsick E, Harris T, Schwartz A, Visser M, Health ABCS (2014) Are estimates of meaningful decline in mobility performance consistent among clinically important subgroups? (Health ABC study). J Gerontol A Biol Sci Med Sci 69(10):1260–1268. https://doi.org/10.1093/gerona/glu033CrossRefPubMedPubMedCentral

44.

Twisk JWR (2013) Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide. Cambridge University Press, CambridgeCrossRef

45.

Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences. 2nd ed. L. Erlbaum Associates

46.

Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 4:863. https://doi.org/10.3389/fpsyg.2013.00863CrossRefPubMedPubMedCentral

47.

Rubin DB (2004) Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons

48.

Willan AR, Briggs AH, Hoch JS (2004) Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Econ 13(5):461–475. https://doi.org/10.1002/hec.843CrossRefPubMed

49.

White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: Issues and guidance for practice. Stat Med 30(4):377–399. https://doi.org/10.1002/sim.4067CrossRefPubMed

50.

Fenwick E, O’Brien BJ, Briggs A (2004) Cost-effectiveness acceptability curves–facts, fallacies and frequently asked questions. Health Econ 13(5):405–415. https://doi.org/10.1002/hec.903CrossRefPubMed

51.

Hakkaart-van Roijen L, Van der Linden N, Bouwmans CAM, Kanters TA, Tan SS (2015) Costing manual: Methodology of costing research and reference prices for economic evaluations in healthcare [in Dutch: Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg]

52.

Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC, Pahor M, Satterfield S, Brach JS, Studenski SA, Harris TB (2006) Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 295(17):2018–2026. https://doi.org/10.1001/jama.295.17.2018CrossRefPubMed

53.

Pierson LM, Herbert WG, Norton HJ, Kiebzak GM, Griffith P, Fedor JM, Ramp WK, Cook JW (2001) Effects of combined aerobic and resistance training versus aerobic training alone in cardiac rehabilitation. J Cardiopulm Rehabil 21(2):101–110. https://doi.org/10.1097/00008483-200103000-00007CrossRefPubMed

54.

Ferguson-Stegall L, McCleave E, Ding Z, Doerner Iii PG, Liu Y, Wang B, Healy M, Kleinert M, Dessard B, Lassiter DG, Kammer L, Ivy JL (2011) Aerobic exercise training adaptations are increased by postexercise carbohydrate-protein supplementation. J Nutr Metab 2011:623182. https://doi.org/10.1155/2011/623182CrossRefPubMedPubMedCentral

Title: The cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake: a randomized controlled trial
Authors: Ilse Reinders
Marjolein Visser
Satu K. Jyväkorpi
Riikka T. Niskanen
Judith E. Bosmans
Ângela Jornada Ben
Ingeborg A. Brouwer
Lothar D. Kuijper
Margreet R. Olthof
Kaisu H. Pitkälä
Rachel Vijlbrief
Merja H. Suominen
Hanneke A. H. Wijnhoven
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nutrition / Issue 1/2022
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-021-02675-0

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