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Macronutrient intake and frailty

PURPOSE: To investigate the longitudinal association between the macronutrient composition of the diet and frailty.METHODS: Data were obtained from 5205 Dutch middle-aged and older adults participating in the Rotterdam Study. Frailty was measured using a frailty index based on the accumulation of 38 health-related deficits, score between 0 and 100, and a higher score indicating more frailty. Frailty was assessed at baseline and 11 years later (range of 23 years). Macronutrient intake was assessed using food-frequency questionnaires. The association between macronutrients and frailty over time was evaluated using multivariable linear regression, adjusted for the frailty index at baseline, energy intake, and other relevant confounders. All analyses were performed in strata of BMI.RESULTS: Median frailty index score was 13.8 points (IQR 9.6; 19.1) at baseline and increased by a median of 2.3 points (IQR - 2.0; 7.6) after 11 years. Overall, we found no significant associations between intake of carbohydrates or fat and frailty over time. We did observe a significant positive association between an iso-energetic intake of 10 g protein and frailty over time (β 0.31 (95% CI 0.06; 0.55)) which was mainly driven by animal protein (β 0.31 (95% CI 0.07; 0.56)). It did not depend on whether it was substituted fat or carbohydrates.CONCLUSIONS: Our findings suggest that a reduction in the intake of animal protein may improve the overall health status over time in a relatively healthy population. More research is needed on the optimal macronutrient composition of the diet and frailty in more vulnerable populations.

Impact of a surgical ward breakfast buffet on nutritional intake in postoperative patients

BACKGROUND: An early return to normal intake and early mobilization enhances postoperative recovery. However, one out of six surgical patients is undernourished during hospitalization and approximately half of the patients eat 50% or less of the food provided to them. We assessed the use of newly introduced breakfast buffets in two wards for gastrointestinal and oncological surgery and determined the impact on postoperative protein and energy intake.METHODS: A prospective pilot cohort study was conducted to assess the impact of the introduction of breakfast buffets in two surgical wards. Adult patients had the opportunity to choose between an attractive breakfast buffet and regular bedside breakfast service. Primary outcomes were protein and energy intake during breakfast. We asked patients to report the type of breakfast service and breakfast intake in a diary over a seven-day period. Prognostic factors were used during multivariable regression analysis.RESULTS: A total of 77 patients were included. The median percentage of buffet use per patient during the seven-day study period was 50% (IQR 0-83). Mean protein intake was 14.7 g (SD 8.4) and mean energy intake 332.3 kcal (SD 156.9). Predictors for higher protein intake included the use of the breakfast buffet (β = 0.06, p = 0.01) and patient weight (β = 0.13, p = 0.01). Both use of the breakfast buffet (β = 1.00, p = 0.02) and Delirium Observation Scale scores (β = -246.29, p = 0.02) were related to higher energy intake.CONCLUSION: Introduction of a breakfast buffet on a surgical ward was associated with higher protein and energy intake and it could be a promising approach to optimizing such intake in surgical patients. Large, prospective and preferably randomized studies should confirm these findings.

A higher protein intake at breakfast does not compromise total daily protein intake in older adults

Introduction: A protein intake of 25–30 g per meal is suggested to maximally stimulate muscle protein synthesis in older adults in order to prevent sarcopenia. Protein intake at breakfast is often low and therefore breakfast offers the potential for protein suppletion. Since protein is known for its satiating effects, we explored the association between the amount of protein intake at breakfast and total daily protein intake in older adults. Methods: Baseline protein intake was assessed by a 3-day dietary record in 507 community dwelling older adults of 55 years and older participating in lifestyle interventions at the Amsterdam Nutritional Assessment Center. Multiple linear regression analysis was used to examine the association between protein intake at breakfast (in g) and total daily protein intake (in g, and g/kg body weight), adjusted for energy intake (kcal/d), sex, age and BMI. Interactions were tested for sex, age and BMI but were not significant (p>0.80). Results: Mean age was 67.6 ± (SD) 7.3 years, 42% was female, and mean BMI was 30.0 ± 5.6 kg/m2. Total daily protein intake was 81 ± 24 g which equals 0.96 ± 0.3 g/kg and 17.6 ± 3.7 percent of total energy intake. Protein intake at breakfast was 14 ± 7 g. A 10 g higher protein intake at breakfast was associated with a 6.7 g (SE = 1.0; P<0.001) and a 0.06 g/kg (SE = 0.01; P<0.001) higher total daily protein intake after adjustment for confounders. Key conclusions: A higher protein intake at breakfast does not compromise total daily protein intake in community dwelling older adults.

A higher protein intake at breakfast and lunch is associated with a higher total daily protein intake in older adults: a post-hoc cross-sectional analysis of four randomised controlled trials

Background: A protein intake of 30‐40 g per meal is suggested to maximally stimulate muscle protein synthesis in older adults and could therefore contribute to the prevention of sarcopenia. Protein intake at breakfast and lunch is often low and offers a great opportunity to improve daily protein intake. Protein, however, is known for its satiating effects. Therefore, we explored the association between the amount of protein intake at breakfast and lunch and total daily protein intake in older adults.Methods: Protein intake was assessed by a 3‐day food record in 498 community dwelling older adults (≥55 years) participating different lifestyle interventions. Linear mixed model analysis was used to examine the association between protein intake at breakfast or lunch and total daily protein intake, adjusted for sex, age, body mass index, smoking status, study and total energy intake.Results: After adjustment for potential confounders, a 10 g higher protein intake at breakfast was associated with a 3.2 g higher total daily protein intake (P = 0.008) for males and a 4.9 g (P < 0.001) higher total daily protein intake for females. A 10 g higher protein intake at lunch was associated with a 3.7 g higher total daily protein intake (P < 0.001) for males, and a 5.8 g higher total daily protein intake (P < 0.001) for females.Conclusions: A higher protein intake at breakfast and lunch is associated with a higher total daily protein intake in community dwelling older adults. Stimulating a higher protein intake at breakfast and lunch might represent a promising nutritional strategy to optimise the amount of protein per meal without compromising total daily protein intake.

Data Wood

Protein intake during hospital admission; Dutch national data on protein intake in 339,720 malnourished patients from 2009–2019

IntroductionTo stimulate early recognition and treatment of malnutrition, the Dutch Healthcare Inspectorate obliged all hospitals from 2008–2019 to report the number of malnourished patients with an adequate protein intake on the fourth day of hospital admission. In this article we present results over the past 11 years and discuss success factors and barriers for adequate treatment of malnourished patients in hospitals.MethodsThe annual reports of hospitals on the numbers of patients with a screening result ‘malnourished’ and an adequate protein intake on the fourth day of admission were analysed. Hospitals were categorized based on the percentage of malnourished patients with an adequate protein intake on the fourth day of admission as ‘poor’ (<40% of patients in a hospital achieve an adequate protein intake), ‘moderate’ 40–60% of patients in a hospital achieve an adequate protein intake), and ‘good’ (>60% of patients in a hospital achieve an adequate protein intake). To identify success factors and barriers for adequate treatment and registration of malnourished patients in hospitals, three focus groups were held in June and July 2020. Participants were dietitians and quality employees or nurses who were involved in data collection for malnutrition indicators in their hospitals.ResultsBetween 2008–2019, data were reported of 339,720 malnourished patients. The relative number of patients with adequate intake of protein on the fourth day in hospital ranges from 44%-53% between 2011 and 2019. Before 2013, the number of hospitals that reported data was too small to draw conclusions about results of treatment of malnutrition. Data from 2013 to 2019, show a decline in the number of hospitals with a ‘poor’ score. The number of hospitals with a moderate score increased between 2015 and 2019 and the number of hospitals with a good score remained more or less stable, except for 2018 where more hospitals reached a ‘good’ score. Sixteen professionals from ten different hospitals participated in the focus groups and revealed several determinants of adequate treatment of malnourished patients in hospitals such as awareness, feeling responsible and the need of clear instructions and good collaboration.ConclusionThis inventory of the protein intake of 339,720 hospital malnourished patients over 11 years shows that in one out of five Dutch hospitals >60% of malnourished patients had an adequate protein intake on the fourth day of admission. This shows that meeting protein requirements remains a difficult challenge. Early recognition of malnutrition, optimal multidisciplinary treatment and continuous evaluation is necessary to provide optimal nutritional care in the hospital and beyond.