Prevalence of protein intake below recommended in community-dwelling older adults: a meta-analysis across cohorts from the PROMISS consortium.
社区老年人蛋白质摄入量低于推荐的患病率: 来自 PROMISS 联盟的队列荟萃分析。
- 作者列表："Hengeveld LM","Boer JMA","Gaudreau P","Heymans MW","Jagger C","Mendonça N","Ocké MC","Presse N","Sette S","Simonsick EM","Tapanainen H","Turrini A","Virtanen SM","Wijnhoven HAH","Visser M
BACKGROUND:Lower protein intake in older adults is associated with loss of muscle mass and strength. The present study aimed to provide a pooled estimate of the overall prevalence of protein intake below recommended (according to different cut-off values) among community-dwelling older adults, both within the general older population and within specific subgroups. METHODS:As part of the PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS) project, a meta-analysis was performed using data from four cohorts (from the Netherlands, UK, Canada, and USA) and four national surveys [from the Netherlands, Finland (two), and Italy]. Within those studies, data on protein and energy intake of community-dwelling men and women aged ≥55 years were obtained by either a food frequency questionnaire, 24 h recalls administered on 2 or 3 days, or food diaries administered on 3 days. Protein intake below recommended was based on the recommended dietary allowance of 0.8 g/kg body weight (BW)/d, by using adjusted BW (aBW) instead of actual BW. Cut-off values of 1.0 and 1.2 were applied in additional analyses. Prevalences were also examined for subgroups according to sex, age, body mass index (BMI), education level, appetite, living status, and recent weight loss. RESULTS:The study sample comprised 8107 older persons. Mean ± standard deviation protein intake ranged from 64.3 ± 22.3 (UK) to 80.6 ± 23.7 g/d [the Netherlands (cohort)] or from 0.94 ± 0.38 (USA) to 1.17z ± 0.30 g/kg aBW/d (Italy) when related to BW. The overall pooled prevalence of protein intake below recommended was 21.5% (95% confidence interval: 14.0-30.1), 46.7% (38.3-55.3), and 70.8% (65.1-76.3) using the 0.8, 1.0, and 1.2 cut-off value, respectively. A higher prevalence was observed among women, individuals with higher BMI, and individuals with poor appetite. The prevalence differed only marginally by age, education level, living status, and recent weight loss. CONCLUSIONS:In community-dwelling older adults, the prevalence of protein intake below the current recommendation of 0.8 g/kg aBW/d is substantial (14-30%) and increases to 65-76% according to a cut-off value of 1.2 g/kg aBW/d. To what extent the protein intakes are below the requirements of these older people warrants further investigation.
背景: 老年人较低的蛋白质摄入与肌肉质量和力量的丧失有关。本研究旨在提供社区居住的老年人蛋白质摄入量低于推荐值 (根据不同的临界值) 的总体患病率的汇总估计,在一般老年人群和特定亚组内。 方法: 作为欧盟 (PROMISS) 项目中预防老年受试者营养不良的一部分，使用来自四个队列 (来自荷兰、英国、加拿大、和美国) 和四项国家调查 [来自荷兰、芬兰 (两项) 和意大利]。在这些研究中，年龄 ≥ 55 岁的社区居住男性和女性的蛋白质和能量摄入数据通过食物频率问卷获得，24 h 召回在 2 或 3 天进行,或 3 天管理的食物日记。建议的蛋白质摄入量低于 0.8g/kg 体重 (BW)/d 的建议膳食供给量，使用调整 BW (aBW) 而不是实际 BW。在附加分析中应用 1.0 和 1.2 的临界值。根据性别、年龄、体重指数 (BMI) 、教育程度、食欲、生活状况和近期体重减轻情况，对患病率进行亚组检查。 结果: 研究样本包括 8107 名老年人。平均 ± 标准差蛋白质摄入量从 64.3 ± 22.3 (英国) 到 80.6 ± 23.7g/d [荷兰 (队列)] 或从 0.94 ± 0.38 (美国) 至 1.17z ± 0.30g/kg aBW/d (意大利)，当与 BW 有关时。推荐蛋白质摄入量低于 21.5% 的总体汇总患病率为 95% (14.0 置信区间: 30.1-46.7%) 、 38.3 (55.3-70.8%) 和 65.1 (76.3-0.8),分别为 1.0 和 1.2 的临界值。在女性、 BMI 较高的个体和食欲不佳的个体中观察到较高的患病率。患病率仅在年龄、教育水平、生活状况和近期体重减轻方面略有不同。 结论: 在社区居住的老年人中，蛋白摄入量低于目前推荐的 0.8g/kg aBW/d 的患病率相当高 (14-30%) 并根据 76% g/kg aBW/d 的临界值增加到 65-1.2。蛋白质摄入量在多大程度上低于这些老年人的要求值得进一步研究。
METHODS:BACKGROUND:Given the importance of habitual dietary protein intake, distribution patterns and dietary sources in the aetiology of age-related declines of muscle mass and function, the present study examined these factors as a function of sex and age in Irish adults aged 18-90 years comprising The National Adult Nutrition Survey (NANS). METHODS:In total, 1051 (males, n = 523; females, n = 528) undertook a 4-day semi-weighed food diary. Total, body mass relative intake and percentage contribution to total energy intake of dietary protein were determined in addition to protein distribution scores (PDS), as well as the contribution of food groups, animal- and plant-based foods to total protein intake. RESULTS:Total and relative protein intake [mean (SD)] were highest in those aged 18-35 years [96 (3) g day , 1.32 (0.40) g kg day ], with lower protein intakes with increasing age (i.e. in adults aged ≥65 years [82 (22) g, 1.15 (0.34) g kg day , P < 0.001 for both]. Differences in protein intake between age groups were more pronounced in males compared to females. Protein distribution followed a skewed pattern for all age groups [breakfast, 15 (10) g; lunch, 30 (15) g; dinner, 44 (17) g]. Animal-based foods were the dominant protein source within the diet [63% (11%) versus 37% (11%) plant protein, P < 0.001]. CONCLUSIONS:Protein intake and the number of meals reaching the purported threshold for maximising post-prandial anabolism were highest in young adults, and lower with increasing age. For main meals, breakfast provided the lowest quantity of protein across all age categories and may represent an opportunity for improving protein distribution, whereas, in older adults, increasing the number of meals reaching the anabolic threshold regardless of distribution pattern may be more appropriate.
METHODS:BACKGROUND:Low cardiorespiratory fitness (CRF) increases risk of all-cause mortality and cardiovascular events. Periodic CRF assessment can have an important preventive function. OBJECTIVE:To develop a protocol-free method to estimate CRF in daily life based on heart rate (HR) and body acceleration measurements. METHODS:Acceleration and HR data were collected from 37 subjects (M=49%) while performing a standardized laboratory activity protocol (sitting, walking, running, cycling) and during a 5-days free-living monitoring period. CRF was determined by oxygen uptake (VO2max) during maximal exercise testing. A doubly-labeled water validated equation was used to predict total energy expenditure (TEE) from acceleration data. A fitness index was defined as the ratio between TEE and HR (TEE-pulse). Activity recognition techniques were used to process acceleration features and classify sedentary, ambulatory and other activity types. Regression equations based on TEE-pulse data from each activity type were developed to predict VO2max. RESULTS:TEE-pulse measured within each activity type of the laboratory protocol was highly correlated to VO2max (r from 0.74 to 0.91). Averaging the outcome of each activity-type specific equation based on TEE-pulse from the laboratory data led to accurate estimates of VO2max (RMSE: 300.0 mlO2/min or 10%). The difference between laboratory and free-living determined TEE-pulse was 3.7 ± 11% (r =0.85). The prediction method preserved the prediction accuracy when applied to free-living data (RMSE: 367 mlO2/min or 12%). CONCLUSIONS:Measurements of body acceleration and HR can be used to predict VO2max in daily life. Activity-specific prediction equations are needed to achieve highly accurate estimates of CRF.
METHODS:OBJECTIVE:Postprandial dyslipidemia is a common feature of insulin resistant states and contributes to increased cardiovascular disease risk. Recently, bile acids have been recognized beyond their emulsification properties as important signaling molecules that promote energy expenditure, improve insulin sensitivity, and lower fasting lipemia. While bile acid receptors have become novel pharmaceutical targets, their effects on postprandial lipid metabolism remain unclear. Here we investigated the potential role of bile acids in regulation of postprandial chylomicron production and triglyceride excursion. Approach and Results: Healthy C57BL/6 mice were given an intraduodenal infusion of taurocholic acid (TA) under fat-loaded conditions and circulating lipids were measured. Targeting of bile acid receptors was achieved with GW4064, a synthetic agonist to the farnesoid X receptor (FXR), and with deoxycholic acid (DCA), an activator of the Takeda G-protein-coupled receptor 5. TA, GW4064, and DCA treatments all lowered postprandial lipemia. FXR agonism also reduced intestinal triglyceride content and activity of microsomal triglyceride transfer protein, involved in chylomicron assembly. Importantly, TA effects (but not DCA) were largely lost in FXR knockout mice. These bile acid effects are reminiscent of the anti-diabetic hormone glucagon-like peptide-1 (GLP-1). While the GLP-1 receptor agonist exendin-4 retained its ability to acutely lower postprandial lipemia during bile acid sequestration and FXR deficiency, it did raise hepatic expression of the rate limiting enzyme for bile acid synthesis. CONCLUSIONS:Bile acid signaling may be an important mechanism of controlling dietary lipid absorption and bile acid receptors may constitute novel targets for the treatment of postprandial dyslipidemia.