Protein malnutrition and nutritional risk factors in old and very old self-reliant community-dwelling adults: association with physical frailty and reversibility with protein supplementation and power training: The I’m still standing study

Background


The burden on the healthcare sector that may arise from the occurrent ageing population largely depend on the health status of the older adults. Overall malnutrition, protein malnutrition, and physical frailty are related age-associated conditions that may compromise health status of the older adults. Nutritional risk factors may precede or co-exist with malnutrition risk and malnutrition, and early screening during the preventive home-visits followed by targeted interventions is an opportunity to
prevent malnutrition and physical frailty. Protein supplementation in combination with training has been suggested in the management of physical frailty. However, more evidence is needed on the effect of an individually targeted nutritional intervention (alone or in combination with power training) in the population of physical pre-frail community-dwelling adults ≥80 years on indicators of physical frailty.

Objectives

This thesis aimed to investigate the prevalence of protein malnutrition, the association of daily protein intake with physical pre-frail/frail condition and the association of selected nutritional risk factors with protein malnutrition and physical pre-frail/frail condition in populations of old (≥65 years) and very old (≥80 years) community-dwelling. In addition, the effect of protein supplementation alone or in combination with power training in very old physical pre-frail/frail self-reliant community-dwelling adults on indicator of physical frailty was investigated.

Methods

The aims were investigated in two cross-sectional studies with home-visits to old and very old community-dwelling adults, the I’m still standing study 1 and the Welfare Innovation in Primary Prevention project conducted in the municipalities of Odense, Esbjerg and Slagelse. In addition, a two phased three-armed randomized controlled trial I’m still standing study 2 was initiated to investigate the effect of 4-months of protein supplementation with dairy products alone or in combination with two weekly sessions of power training compared to general recommendations on indicators of physical frailty in very old pre-frail/frail community-dwelling adults.

Results 

Prevalence of protein malnutrition was 54% in very old adults and the nutritional risk factors mouth dryness, reduced appetite, and pain was associated with odds of protein malnutrition (Paper I). A higher daily protein intake was not associated with physical pre-frail/frail condition. However, high BMI was associated with physical pre-frail/frail condition in very old adults and unintentional weight loss, dysphagia, poor dental status, and high BMI was associated with odds of physical pre-frail/frail condition in old adults (Paper II). Preliminary results from the ISS2 study (n=35) showed that protein supplementation in combination with two weekly sessions of power training increased within group muscle power whereas protein supplementation alone increased within group whole-body lean mass, with no between group differences (Paper III, study protocol).

Conclusion 

Protein malnutrition is a concern in very old self-reliant community-dwelling adults. Nutritional risk factors associated with protein malnutrition (mouth dryness, reduced appetite, and pain) and physical frailty (high BMI, unintentional weight loss, dysphagia, and poor dental status) could be used in early screening in primary preventive strategies. Lastly, protein supplementation alone or in combination with power training may improve indicators of physical frailty, in very old pre-frail/frail communitydwelling adults.