Self-rated health among older adults: Longitudinal analyses examining sex differences across different birth cohorts and educational levels.

Background Given the known female disadvantage in physical and mental health, this study aims to investigate sex differences in self-rated health (SRH) among older adults, considering the longitudinal course by age, birth cohort and educational level. Methods Data from birth cohort 1911-1937 with baseline age 55-81 years (n=3107) and birth cohort 1938-1947 with baseline age 55-65 years (n=1002) from the Longitudinal Ageing Study Amsterdam (LASA) were used. Mixed models analyses were used to examine sex differences in SRH (RAND General Health Perception Questionnaire (RAND-GHPQ, range 0-16) over the age course, testing for effect modification by birth cohort and educational level (low, middle, high). Results For both sexes, a decline in SRH was seen with increasing age. Over the age course, there was no significant sex difference in SRH within the older (1911-1937) birth cohort (0.13 lower score on SRH for women compared to men, 95% CI -0.35 - 0.09) and only a small sex difference in the more recent (1938-1947) birth cohort (0.35 lower score on SRH for women compared to men (95% CI -0.69 - - 0.02), p=0.04). There was no significant cohort difference in the size of the sex difference (p=0.279). Those with a higher level of education reported a higher SRH, but between educational levels there was no significant difference in the size of the sex difference in SRH. Discussion In this study, no relevant sex difference in SRH over the age course was observed among older adults. Future research on SRH trajectories by sex during ageing should take health-related, cognitive, psychosocial and behavioral factors into account.

The feasibility of a 6-month dietary intervention aiming to increase protein intake among community-dwelling older adults with low habitual protein intake: A secondary analysis of the PROMISS randomised controlled trial.

BACKGROUND: The PROMISS randomised controlled trial showed that personalised dietary advice increased protein intake and improved 400-m walk time and leg strength among community-dwelling older adults with a low habitual protein intake. This secondary analysis describes and further evaluates the methods and feasibility of the model used to carry out dietary intervention in the PROMISS randomised controlled trial. METHODS: In total, 185 participants (≥65 years, 54% women) with a habitual low protein intake (<1.0 g/kg adjusted body weight/day) in Finland and the Netherlands received personalised dietary advice and complimentary protein-enriched food products for 6 months with two main objectives: (1) to increase protein intake to ≥1.2 g/kg adjusted body weight/day (energy-neutral) and (2) to include each day a 'high-protein meal' containing ≥ 30-35 g of protein. The feasibility of the model was evaluated by the adoption of the advice, feedback from the participants, and practical experiences by the nutritionists. RESULTS: In all, 174 participants (93.5%) completed the intervention. At the 6-month follow-up, 41.8% reached both main objectives of the advice. The participants' general rating for the dietary advice was 8.6 (SD 1.0) (on a scale of 1-10; 10 indicating very good). Sticking to the advice was (very) easy for 79.2% of the participants. The nutritionists perceived the model feasible for the participants except for those with low food intake. CONCLUSIONS: The methods used in this model are mainly feasible, well-received and effective in increasing protein intake among community-dwelling older adults with low habitual protein intake.

Effect of personalized dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults: results from the PROMISS trial.

PURPOSE: Diet modelling studies suggest that increasing protein intake with no consideration for sustainability results in a higher environmental impact on the diet. To better understand the impact in real life, the aim of this study was to assess the effect of dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults. METHODS: Food consumption and environmental impact were analyzed among 124 Dutch older adults with lower habitual protein intake (< 1.0 g/kg adjusted body weight/day) participating in the six-month PROMISS trial. Dietary intake data from three 24-h dietary recalls, aided by food diaries, and results from life cycle assessments were used to examine the differences in changes in food consumption and environmental impact between those who received dietary advice to isocalorically increase protein intake to ≥ 1.2 g/kg aBW/d (Protein + ; n = 84) and those who did not receive dietary advice (Control; n = 40). RESULTS: Compared to the Control, Protein + increased protein intake from animal-based food products (11.0 g protein/d, 95% CI 6.6-15.4, p < 0.001), plant-based food products (2.1 g protein/d, 95% CI 0.2-4.0, p = 0.031) and protein-enriched food products provided during the trial (18 g protein/d, 95% CI 14.5-21.6, p < 0.001) at the 6-month follow-up. Diet-associated greenhouse gas emissions increased by 16% (p < 0.001), land use by 19% (p < 0.001), terrestrial acidification by 20% (p = 0.01), and marine eutrophication by 16% (p = 0.035) in Protein + compared to the Control. CONCLUSION: This study found that dietary advice increased protein intake, favoring animal-based protein, and increased the environmental impact of the diet in older adults. TRIAL REGISTRATION: ClinicalTrials.gov. NCT03712306. October 2018.

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

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.

Sex Differences in Cognitive Functioning with Aging in the Netherlands.

INTRODUCTION: Dementia prevalence in older women is higher than that in men. The purpose of the present study was to investigate whether there is a female disadvantage in cognitive functioning at adult age and/or whether a female disadvantage develops with age. METHODS: Data of 5,135 women and 4,756 men from the Longitudinal Aging Study Amsterdam (LASA) and the Doetinchem Cohort Study (DCS) were used. In the LASA, memory, processing speed, fluid intelligence, and global cognitive function were measured every 3-4 years since 1992 in persons aged 55+ years for up to 23 years. In the DCS, memory, processing speed, cognitive flexibility, and global cognitive function were measured every 5 years since 1995 in persons aged 45+ years for up to 20 years. Sex differences in cognitive aging were analyzed using linear mixed models and also examined by the 10-year birth cohort or level of education. RESULTS: Women had a better memory, processing speed, flexibility, and, in the DCS only, global cognitive function than men (p's < 0.01). However, women showed up to 10% faster decline in these cognitive domains, except for flexibility, where women showed 9% slower decline. In the LASA, women scored poorer on fluid intelligence (p < 0.01), but their decline was 10% slower than that in men. Female advantage was larger in later born cohorts; adjustment for the educational level increased the female advantage. CONCLUSION: Women have better memory and processing speed than men at middle age. This female advantage becomes smaller with aging and has increased in more recent birth cohorts.

Exploring the difference between men and women in physical functioning: How do sociodemographic, lifestyle- and health-related determinants contribute?

BACKGROUND: To explore whether differences between men and women in the sensitivity to (strength of the association) and/or in the exposure to determinants (prevalence) contribute to the difference in physical functioning, with women reporting more limitations. METHODS: Data of the Doetinchem Cohort Study was used (n = 5856, initial ages 26-70 years), with follow-up measurements every 5 years (up to 20). Physical functioning (subscale SF-36, range:0-100), sex (men or women) and a number of socio-demographic, lifestyle- and health-related determinants were assessed. Mixed-model multivariable analysis was used to investigate differences between men and women in sensitivity (interaction term with sex) and in exposure (change of the sex difference when adjusting) to determinants of physical functioning. RESULTS: The physical functioning score among women was 6.55 (95%CI:5.48,7.61) points lower than among men. In general, men and women had similar determinants, but pain was more strongly associated with physical functioning (higher sensitivity), and also more prevalent among women (higher exposure). The higher exposure to low educational level and not having a paid job also contributed to the lower physical functioning score among women. In contrast, current smoking, mental health problems and a low educational level were more strongly associated with a lower physical functioning score among men and lower physical activity and higher BMI were more prevalent among men. CONCLUSIONS: Although important for physical functioning among both men and women, our findings provide no indications for reducing the difference in physical functioning by promoting a healthy lifestyle but stress the importance of differences in pain, work and education.

The sex difference in gait speed among older adults: how do sociodemographic, lifestyle, social and health determinants contribute?

BACKGROUND: This study explores whether a sex difference in sensitivity to (strength of the association) and/or in exposure to (prevalence) determinants of gait speed contributes to the observed lower gait speed among older women compared to men. METHODS: Data from the Longitudinal Aging Study Amsterdam (LASA) were used. In total 2407 men and women aged 55-81 years were included, with baseline measurements in 1992/2002 and follow-up measurements every 3-4 years for 15/25 years. Multivariable mixed model analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure to (change of the sex difference when adjusted) socio-demographic, lifestyle, social and health determinants of gait speed. RESULTS: Women had a 0.054 m/s (95 % CI: 0.076 - 0.033, adjusted for height and age) lower mean gait speed compared to men. In general, men and women had similar determinants of gait speed. However, higher BMI and lower physical activity were more strongly associated with lower gait speed in women compared to men (i.e. higher sensitivity). More often having a lower educational level, living alone and having more chronic diseases, pain and depressive symptoms among women compared to men also contributed to observed lower gait speed in women (i.e. higher exposure). In contrast, men more often being a smoker, having a lower physical activity and a smaller personal network size compared to women contributed to a lower gait speed among men (i.e. higher exposure). CONCLUSIONS: Both a higher sensitivity and higher exposure to determinants of gait speed among women compared to men contributes to the observed lower gait speed among older women. The identified (modifiable) contributing factors should be taken into account when developing prevention and/or treatment strategies aimed to enhance healthy physical aging. This might require a sex-specific approach in both research and clinical practice, which is currently often lacking.

Sex differences in mental health among older adults: investigating time trends and possible risk groups with regard to age, educational level and ethnicity.

OBJECTIVES: Older women report lower mental health compared to men, yet little is known about the nature of this sex difference. Therefore, this study investigates time trends and possible risk groups. METHOD: Data from the Doetinchem Cohort Study (DCS) and the Longitudinal Aging Study Amsterdam (LASA) were used. General mental health was assessed every 5 years, from 1995 to 1998 onwards (DCS, n = 1412, 20-year follow-up, baseline age 55-64 years). Depressive and anxiety symptoms were assessed for two birth cohorts, from 1992/1993 onwards (LASA cohort 1, n = 967, 24-year follow-up, age 55-65 years,) and 2002/2003 onwards (LASA cohort 2, n = 1002, 12-year follow-up, age 55-65 years) with follow-up measurements every 3-4 years. RESULTS: Mixed model analyses showed that older women had a worse general mental health (-6.95; -8.36 to 5.53; range 0-100, ∼10% lower), more depressive symptoms (2.09; 1.53-2.63; range 0-60, ∼30% more) and more anxiety symptoms (0.86; 0.54-1.18; range 0-11, ∼30% more) compared to men. These sex differences remained stable until the age of 75 years, where after they decreased due to an accelerated decline in mental health for men compared to women. Sex differences and their course by age were consistent over successive birth cohorts, educational levels and ethnic groups (Caucasian vs. Turkish/Moroccan). CONCLUSION: There is a consistent female disadvantage in mental health across different sociodemographic groups and over decennia (1992 vs. 2002) with no specific risk groups.

Seven-year time trends in energy balance-related behaviours according to educational level and ethnic background among 14-year-old adolescents.

OBJECTIVE: To assess seven-year time trends in energy balance-related behaviours in 14-year-old adolescents living in an urban area and to examine the influence of educational level and ethnicity on these time trends. DESIGN: Second grade students (mean age 13·6 years) filled in questionnaires about the energy balance-related behaviours of breakfast consumption, fruit and vegetable consumption, physical activity and screen-time behaviour from school years 2006-2007 to 2012-2013. Energy balance-related behaviours were dichotomized and logistic regression analyses were used to examine time trends in healthy energy balance-related behaviours, including interaction terms for educational level and ethnicity. SETTING: Secondary schools in Amsterdam, the Netherlands. SUBJECTS: Per school year, 2185-3331 children participated. The total sample included 19 244 students of Dutch, Surinamese, Turkish and Moroccan ethnic background. RESULTS: A significant linear increase was found for positive screen-time behaviour (<2 h/d; OR per year=1·04; 95 % CI 1·03, 1·06). For daily vegetable consumption a non-linear negative trend was observed (school year 2012-2013 v. 2006-2007: OR=0·90; 95 % CI 0·80, 1·00). Time trends in screen time were significantly different across educational levels (P-interaction=0·002) and ethnic backgrounds (P<0·001), as were time trends in daily fruit consumption (P=0·017 and P=0·018, respectively) and, for ethnicity, trends in daily vegetable consumption (P<0·001). CONCLUSIONS: The increase in positive screen-time behaviour is a positive finding. However, discouraging screen time and promoting other healthy behaviours, more specifically daily fruit and vegetable consumption, remain important particularly among adolescents enrolled in pre-vocational education and of non-Dutch ethnic background.

Specific food preferences of older adults with a poor appetite. A forced-choice test conducted in various care settings.

A poor appetite in older adults is an important determinant of reduced food intake and undernutrition. Food preferences may influence food intake. The aim of this study was to investigate food preferences of older adults with a poor appetite and compare these with preferences of older adults with a good appetite. Older adults (n = 349, aged 65-101 years) in nursing/residential care homes, hospitals or at home receiving home care participated in a computer-based forced-choice food preference assessment. Self-reported appetite in the past week was classified as 'good' or 'poor' using a validated instrument. Food preferences were determined by counting the relative frequency of choices for food images according to 11 dichotomous categories: high/low 1) protein; 2) fat; 3) carbohydrates; 4) fiber; 5) variation; and 6) animal/vegetarian proteins; 7) sweet/savory taste; 8) solid/liquid texture; 9) dairy/non-dairy; with/without 10) sauce or 11) color variation. Specific food preferences in participants with a poor appetite were identified by one-sample t-tests comparing frequencies to the expected value of 48. Preference differences between those with a good and a poor appetite were analyzed using GLM adjusting for confounders. The results showed that older adults with a poor appetite (n = 113; 32.4%) preferred variation (51.6 vs. 48, P < 0.001), color variation (55.9 vs. 48, P < 0.01), non-dairy (53.0 vs. 48, P < 0.001), high-fiber (51.8 vs. 48, P < 0.05), and solid texture (53.5 vs. 48, P < 0.05). Participants with a poor appetite had a higher frequency score for variation than participants with a good appetite (51.6 vs. 48.5, P < 0.001). In conclusion, older adults with a poor appetite may have specific food preferences. Their preference for variation differs from those with a good appetite. These results may be used to develop meals that are preferred by older adults with poor appetite in order to increase food intake and prevent undernutrition.

The associations between sleep quality, mood, pain and appetite in community dwelling older adults: a daily experience study.

OBJECTIVES: To investigate the daily life experiences of sleep, mood, and pain in relation to appetite in community-dwelling older adults aged 75 years and older, stratified by sex. DESIGN: Existing data from a daily experience study embedded in the Longitudinal Aging Study Amsterdam (LASA) among the oldest-old (≥75 years). SETTING: LASA is an ongoing cohort study of a nationally representative sample of older adults aged ≥55 years from three culturally distinct regions in the Netherlands. PARTICIPANTS: 434 community-dwelling older adults aged ≥75 years. MEASUREMENTS: Participants filled-out a one-week diary on daily experience of pain, mood, last night sleep (10-point Likert scale), and appetite (5-point Likert scale) on five measurement occasions between 2016 and 2021. (Hybrid) linear mixed models were used to investigate overall, within-subject and between-subject association between mood, sleep, and pain (independent variables) and appetite (dependent variable), while correcting between-subject associations for season, age, educational level, partner status, body mass index, alcohol consumption, physical activity level, smoking status, chronic diseases and use of nervous system medication, stratified by sex. RESULTS: Averaged over all days, males reported a poor appetite on 12% of the days and females on 19% of the days. Statistically significant between-subject associations with a poorer appetite were found for lower mood (unstandardized b = 0.084 [95% CI 0.043-0.126] (males), (b = 0.126 [95% CI 0.082-0.170] (females)), poorer sleep (b = 0.045 [95% CI 0.007-0.083] (males), (b = 0.51 [95% CI 0.017-0.085] (females)) and more severe pain in males only (b = 0.026 [95% CI 0.002-0.051]). Except for pain, within-subject associations were somewhat weaker: mood: b = 0.038 [95% CI 0.016-0.060] (males), (b = 0.082 [95% CI 0.061-0.104] (females)); sleep: b = 0.029 [95% CI 0.008-0.050] (males), (b = 0.15 [95% CI 0.005-0.025] (females)); and pain (b = 0.032 [95% CI 0.004-0.059] (males)). CONCLUSIONS: This study found that poor sleep, low mood (more strongly in females) and more severe pain (males only) are associated with poor appetite in older adults on a daily level both within and between persons. Sex differences in factors related to poor appetite should be considered in future research.

Effects of a dietetic treatment in older, undernourished, community-dwelling individuals in primary care: a randomized controlled trial.

PURPOSE: Undernutrition is a prevalent problem in older, community-dwelling individuals. Aim of this study was to determine the effects of a dietetic treatment in older, undernourished, community-dwelling individuals. METHODS: A parallel randomized controlled trial was performed in 146 non-institutionalized, undernourished individuals aged ≥65 years in primary care. Participants were randomly assigned to the intervention (referral to and treatment by a trained dietitian) or control group (no referral). Body weight, physical performance, handgrip strength, energy intake, protein intake and fat-free mass were assessed at baseline, after 3 months and after 6 months. RESULTS: All randomized participants (n = 146) were included in the intention-to-treat generalized estimating equations analysis (72 in intervention and 74 in control group). No treatment effect was found on the primary outcomes body weight (ß = 0.49 kg, 95% CI: -0.15-1.12), physical performance (ß = 0.15 points, 95% CI: -0.33-0.64) and handgrip strength (ß = 0.49 kg, 95% CI: -0.62-1.60). Furthermore, no treatment effect was found for the secondary outcomes. Predefined subgroup analyses showed a treatment effect on body weight in physically active participants (ß = 1.25 kg, 95% CI: 0.70-2.11) and not in inactive participants (ß = -0.20 kg, 95% CI: -1.16-0.75). CONCLUSIONS: After 6 months, a dietetic treatment by trained dietitians does not lead to increases in body weight and physical functioning in older, undernourished, community-dwelling individuals.

The Association between Caffeine Consumption from Coffee and Tea and Sleep Health in Male and Female Older Adults: A Cross-Sectional Study.

Poor sleep health is common in older adults and is associated with negative health outcomes. However, the relationship between caffeine consumption and sleep health at an older age is poorly understood. This study investigated the association between caffeine consumption and sleep health in community-dwelling older males and females in The Netherlands. Cross-sectional analyses were performed using data from 1256 participants aged 61-101 years from the Longitudinal Ageing Study Amsterdam. Self-reported questions assessed sleep disturbances (including sleep latency, continuity, and early awakening), sleep duration, and perceived sleep quality. Caffeine consumption was determined with questions about frequency, quantity, and type of coffee and tea consumption. Logistic and linear regression models were used, controlling for potential confounders, and interaction by sex and age was tested. Caffeine consumption showed significant interactions with sex (p < 0.005) in association with sleep health outcomes. Older females who abstained from caffeine consumption reported more sleep disturbances (ß = 0.64 [95%CI 0.13; 1.15]) and had greater odds of short sleep duration (<7 h/day) (OR = 2.26 [95% CI 1.22; 4.20]) compared to those who consumed caffeine. No associations were observed for long sleep duration (>8 h/day) and perceived sleep quality. No associations were observed in older males. Caffeine abstinence was associated with more sleep disturbances and short sleep duration in older females, but not in males. The observed association in older females may reflect reverse causation, suggesting that females may have different motivations for discontinuing caffeine consumption than males.

Validation of the German version of the Protein Screener 55.

BACKGROUND/OBJECTIVES: The Protein Screener 55 + (Pro55 + ) is a brief food questionnaire to screen older community-dwelling adults for low protein intake. The result is the predicted probability of protein intake <1.0 g/kg adjusted body weight (aBW)/d ranging from 0-1. For purposes of cross-cultural validation, we translated the Pro55+ into German and tested its discriminative accuracy in detecting low protein intake of older community-dwelling people in Germany. SUBJECTS/METHODS: After translation and pilot-testing, the Pro55+ and the reference standard (3-day dietary record) were completed by 144 participants (81.6 ± 3.9 years, 61.8% female). Discriminative properties were tested by receiver operating characteristic curves and by calculating sensitivity and specificity for different cut-offs of predicted probability (>0.3/>0.5/>0.7) using <1.0 or <0.8 g/kg aBW/d to define low protein intake. RESULTS: Protein intake was <1.0 g/kg aBW/d in 39.6% of the sample and <0.8 g/kg aBW/d in 17.4%. Area under the curve was 62.0% (95%CI 52.6-71.5) and 68.8% (58.1-79.4), respectively. Specificity was 82-90% using probability cut-offs of 0.5 and 0.7 for both protein thresholds. Sensitivity was poor for protein threshold of 1.0 g/kg aBW/d regardless of the used probability cut-offs. For protein threshold of <0.8 g/kg aBW/d, sensitivity was 88.0% (71.8-96.9) using a probability cut-off of 0.09. CONCLUSION: The overall discriminative accuracy of the German Pro55+ to identify older community-dwelling people with low protein intake was poor. However, applying different probability cut-offs allows increasing specificity and sensitivity for 0.8 g/kg aBW/d to levels justifying the use for certain purposes e.g. excluding individuals with adequate protein intake. Further validation is needed.

The Effect of Dietary Advice Aimed at Increasing Protein Intake on Oral Health and Oral Microbiota in Older Adults: A Randomized Controlled Trial.

Nutrition and oral health are closely related, especially in older adults in whom poor nutrition may lead to oral microbial perturbations, exacerbating poor oral health. In a 6-month randomized controlled trial, we evaluated the effects on oral microbiota and on oral health of dietary advice aimed at increasing protein intake to ≥1.2 g/kg adjusted body weight/day (g/kg aBW/d) in community-dwelling older adults with low habitual protein intake (<1.0 g/kg aBW/d). Food intake was measured via 24 h dietary recalls, oral health was measured via questionnaires, and oral microbial composition was assessed via the 16S rRNA sequencing of tongue swabs. Mean baseline protein intake was 0.8 g/kg aBW/day in both groups. In the high protein group (n = 47), participants increased their protein intake to mean 1.2 g/kg aBW/day at the 6-month follow-up. Protein intake in the control group (n = 43) remained at 0.9 g/kg a BW/day. The intervention did not affect self-reported oral health. While it caused moderate shifts in oral microbiota alpha- and beta-diversity measures, abundances of individual bacterial taxa were not affected. In conclusion, our intervention did not affect self-reported oral health within a period of 6 months, nor did it substantially affect the tongue microbiota composition.

Personalized Dietary Advice to Increase Protein Intake in Older Adults Does Not Affect the Gut Microbiota, Appetite or Central Processing of Food Stimuli in Community-Dwelling Older Adults: A Six-Month Randomized Controlled Trial.

Expert groups argue to raise the recommended daily allowance for protein in older adults from 0.8 to 1.2 g/kg/day to prevent undernutrition. However, protein is thought to increase satiety, possibly through effects on gut microbiota and central appetite regulation. If true, raising daily protein intake may work counterproductively. In a randomized controlled trial, we evaluated the effects of dietary advice aimed at increasing protein intake to 1.2 g/kg adjusted body weight/day (g/kg aBW/day) on appetite and gut microbiota in 90 community-dwelling older adults with habitual protein intake <1.0 g/kg aBW/day (Nintervention = 47, Ncontrol = 43). Food intake was determined by 24-h dietary recalls and gut microbiota by 16S rRNA sequencing. Functional magnetic resonance imaging (fMRI) scans were performed in a subgroup of 48 participants to evaluate central nervous system responses to food-related stimuli. Both groups had mean baseline protein intake of 0.8 ± 0.2 g/kg aBW/day. At 6 months' follow-up this increased to 1.2 ± 0.2 g/kg aBW/day for the intervention group and 0.9 ± 0.2 g/kg aBW/day for the control group. Microbiota composition was not affected, nor were appetite or brain activity in response to food-related stimuli. Increasing protein intake in older adults to 1.2 g/kg aBW/day does not negatively impact the gut microbiota or suppress appetite.

Effects of Nutritional Interventions in Older Adults with Malnutrition or at Risk of Malnutrition on Muscle Strength and Mortality: Results of Pooled Analyses of Individual Participant Data from Nine RCTs.

Nutritional intervention studies in older adults with malnutrition aim to improve nutritional status. Although these studies show a significant gain in body weight, there is inconsistent evidence of clinical effectiveness on muscle strength and mortality. This study aimed to examine the effects of nutritional interventions on muscle strength and risk of mortality in older adults (malnourished or at risk) and explore whether these effects are influenced by participant characteristics. Individual participant data were used from nine RCTs (community setting, hospital and long-term care; duration 12-24 weeks and included oral nutritional supplements, dietary counseling, or both). Handgrip strength (HGS) was measured in seven RCTs and six RCTs obtained mortality data. A ≥3 kg increase in HGS was considered clinically relevant. Logistic generalized estimating equations analyses (GEE) were used to test intervention effectiveness. GEE showed no overall treatment effect (OR 1.11, 95% CI 0.78-1.59) on HGS. A greater, but not statistically significant, effect on HGS was observed for older (>80 years) versus younger participants. No significant treatment effect was observed for mortality (OR 0.78, 95% CI 0.42-1.46). The treatment effect on mortality was greater but remained non-significant for women and those with higher baseline energy or protein intake. In conclusion, no effects of nutritional interventions were observed on HGS and mortality in older adults (malnourished or at risk). While the treatment effect was modified by some baseline participant characteristics, the treatment also lacked an effect in most subgroups.

Region-specific fat mass and muscle mass and mortality in community-dwelling older men and women.

BACKGROUND: Increased mortality risk at low body mass index values is well established for older persons. It is, however, unclear how the underlying body mass components (fat and muscle mass - FM and MM, respectively) are associated with mortality in old age. OBJECTIVE: This study aimed to examine the mortality risk of four body composition measures (appendicular skeletal MM, leg, arm and trunk FM) with 12-year mortality in community-dwelling older men and women. As a secondary objective, the influence of cancer, obstructive lung disease, smoking and previous weight loss on these associations was examined. METHODS: Data were used from the Longitudinal Aging Study Amsterdam, a random population-based cohort study (55-85 years) in the Netherlands. Body composition was determined in 1995-1996 by dual energy X-ray absorptiometry. The present study included 477 community-dwelling persons aged ≥65 years who were followed until 2007 for their vital status. RESULTS: Twelve-year mortality rates were 133/242 (55%) in men and 92/235 (39%) in women. Since most associations were U- or J-shaped, only observations below the sample mean were included to calculate hazard ratios (HRs) per one SD lower value. Adjusted for height, age and each other, lower appendicular skeletal MM [HR 1.59 (95% CI: 1.04-2.42)] and lower leg FM [1.68 (1.04-2.72)] in men and lower trunk FM [1.61 (1.02-2.53)] in women were associated with an increased mortality risk. Associations attenuated and became statistically nonsignificant in men after adjustment for cancer, obstructive pulmonary disease and smoking and in women after additional adjustment for previous 3-year weight change. CONCLUSIONS: In older men, lower MM and lower leg FM are associated with an increased mortality risk, while in older women only lower trunk FM is associated with an increased risk. The causality of these associations is debated. Suggested sex differences deserve further study.

Adaptation and validation of a protein intake screening tool for a UK adult population.

Adequate dietary protein intake is important in human subjects for maintaining muscle turnover, determining the protein content of tissues and thus the preservation of muscle mass and function as we age. A screening tool to assess if an older individual is likely to have a lower dietary protein intake (predicted probability of protein intake ≤1⋅0 g/kg per d), has been developed for a Netherlands dietary profile, but this has not been validated in a UK population. This study aimed to adapt and then validate the protein screening tool for use in a UK population. Amendment of the tool was undertaken using data from UK BioBank and the UK National Diet and Nutrition Survey to reflect protein sources in the UK diet. Validation of the amended version of the protein screener screening tool was conducted using protein intake derived from a food frequency questionnaire (FFQ) in a sample of UK adults (n = 184) (age range 18-91 years) as the reference standard. Using the FFQ, 40 % of respondents (n = 74) reported a protein intake of ≤1⋅0 g per kg body mass. The discriminative accuracy of the amended screener was tested using receiver operating characteristic (ROC) curves. The area under the curve for the ROC was 0⋅731 (95 % CI 0⋅657, 0⋅805), indicating that the amended screener may be a valid tool to screen for individuals consuming ≤1⋅0 g/kg adjusted BM/d in an adult UK population. This protein screener tool is a potential method to screen individuals with a likelihood of habitually consuming protein intakes of ≤1⋅0 g/kg per d. Further validation is needed using a more robust dietary intake methodology and for specific groups, such as older adults. The screener may be applicable across healthcare, clinical and research applications.