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Distribution of daily protein intake across meals and lower extremity functioning in community-dwelling Spanish older adults: a prospective cohort study

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Abstract

Purpose

Total dietary protein intake has been associated with better physical function in older adults. However, it is unclear whether an even mealtime distribution of protein intake also has an impact on physical functioning. The aim of this study was to examine the prospective association between distribution of daily protein intake across meals and the risk of impaired lower extremity function (ILEF).

Methods

We used information of 2975 individuals ≥ 60 years from the Seniors-ENRICA cohort. Habitual dietary protein intake was assessed in 2008–2010 with a validated diet history. For each participant, dietary protein intake across meals was determined using the coefficient of variation (CV) of the distribution. Study participants were followed up until 2017 to identify incident ILEF, assessed with the short physical performance battery (SPPB).

Results

Over a median follow-up of 6.3 years, we identified 521 participants with ILEF (SPPB ≤ 6). After adjusting for potential confounders including total protein intake/kg/day, a higher CV (less even distribution) of protein intake did not show an association with the risk of ILEF [hazard ratios (HR) and 95% confidence intervals (CI) for second and third vs. the first tertile: 1.08 (0.87–1.34), and 1.06 (0.85–1.32), respectively; p trend = 0.60]. When assessing each component of the SPPB, a higher CV of protein intake was associated with higher risk of impaired standing balance (HR for tertile 3 vs. tertile 1: 1.26 (1.03–1.54); p trend = 0.02).

Conclusion

The mealtime distribution of protein intake was not associated with ILEF. The possibility of a detrimental effect of uneven distribution of protein on standing balance needs to be further investigated.

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Acknowledgements

This work was supported by Consejo Nacional de Ciencia y Tecnología de México (CONACyT 493867), FIS Grants 16/609 and 16/1512 (Instituto de Salud Carlos III, State Secretary of R+D+I, and FEDER/FSE), the ATHLOS project (EU H2020- Project ID: 635316) and the JPI HDHL (SALAMANDER project). The funding agencies had no role in the study design, data analysis, interpretation of results, writing of the report, and in the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain

    Daniela B. Estrada-DeLeón, Ellen A. Struijk, Félix Caballero, Fernando Rodríguez-Artalejo & Esther Lopez-Garcia

  2. IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain

    Fernando Rodríguez-Artalejo & Esther Lopez-Garcia

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  1. Daniela B. Estrada-DeLeón
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  3. Félix Caballero
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Contributions

The authors’ responsibilities were as follows: DBE-D, EAS, and EL-G created the study concept and design; DBE-D and FC analyzed data; DBE-D and EL-G drafted the manuscript; FR-A and EL-G obtained funding; EL-G supervised the manuscript. All authors have read and approved the manuscript as submitted and are prepared to take public responsibility for the work.

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Correspondence to Ellen A. Struijk or Esther Lopez-Garcia.

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Study participants gave their informed written consent. The Clinical Research Ethics Committee of ‘La Paz’ University Hospital in Madrid approved the study protocol.

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Estrada-DeLeón, D.B., Struijk, E.A., Caballero, F. et al. Distribution of daily protein intake across meals and lower extremity functioning in community-dwelling Spanish older adults: a prospective cohort study. Eur J Nutr 60, 665–675 (2021). https://doi.org/10.1007/s00394-020-02273-6

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