Background
Protein intake of older adults often fails to meet recommendations and may contribute to reductions in muscle strength and function increasing the risk of developing sarcopenia.
Objectives
This 10-week intervention study evaluated the effects of a per-meal protein prescription, tele-diet coaching, and nutrition education on dietary protein intake and muscle strength and function among a group of older adults.
Methods
Twenty older adults (75% females, age 73 + 10 years, body mass index 25.2 ± 4.2 kg/m2), recruited from congregate meal and low-incoming housing sites and a hospital-affiliated wellness center, participated in the study. All participants received individualized per-meal protein prescriptions, in-person nutrition education and were called weekly for diet coaching tailored to food preferences and constraints. Dietary intake was assessed using 24-hour dietary recalls at baseline, week 5 and 10. Grip strength, timed up-and-go (TUG), 3m walk, chair rise tests, and the short physical performance battery (SPPB) were conducted at baseline and 10 weeks. Data were analyzed using repeated measures analysis of variance.
Results
Nineteen of the 20 participants attended at least 70% of the tele-coaching sessions. At baseline, 23% of meals met the per-meal protein prescription, while 51% of the meals met the prescription at week 10. Protein intake at week 10 was significantly higher than at baseline for breakfast, increasing from 11 g at baseline to 21 g, lunch increasing from 17 g at baseline to 27 g, and dinner increasing from 23 g at baseline to 31 g. Protein intake per kg body weight also significantly (p<0.0001) increased from 0.8 g at baseline to 1.2 g/kg body weight at week 10. Weight did not change significantly. Participants improved protein intake at breakfast primarily with the addition of dairy products, nuts and/or nut butters. Lunch and dinner improvements were made mostly by increasing portion sizes of typically-selected protein-rich foods. The majority of the participants began reading food labels for protein content and 100% of participants stated they had a better awareness of the importance that protein plays in their diet at the end of the study. Significant improvements were also observed in grip strength (23 vs 22 kg, p=0.005) and in times for TUG (10 vs. 8s, p=0.010), 3m walk (4 vs. 3s, p=0.001) and completion of 5 chair-rises (13 vs. 11s, p=0.010). SPPB scores did not change significantly. Obstacles to meeting the prescription that were indicated by participants included early satiety, lack of appetite in the morning, fear of gaining weight sometimes coupled with an overwhelming desire to lose weight, and bouts of injury/illness.
Conclusions
The use of an individualized per-meal protein prescription, nutrition education, and tele-diet coaching improved dietary protein intake, walking and chair-rise times, and grip strength of older adults. Given that a fairly large number of adults, especially older adults, fail to consume enough protein and its ramifications on muscle, practitioners should include discussions about dietary protein intake with their patients.
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