The journal of nutrition, health & aging

, Volume 15, Issue 2, pp 147–152 | Cite as

Dietary protein intake and subsequent falls in older men and women: The Framingham study

  • E. S. Zoltick
  • S. Sahni
  • R. R. McLean
  • L. Quach
  • V.A. Casey
  • M.T. HannanEmail author
JNHA: Geriatric Science



Poor nutritional status is often present among older adults who experience a fall. However, dietary intake and weight loss are often overlooked as potential factors. The objective of this study was to test the association between dietary protein intake and risk of subsequent falls in a population-based cohort of elderly men and women.


Dietary intake and clinic data from 807 men and women (ages 67–93 years) from the Framingham Original Cohort Study were analyzed. Protein intake (total, animal and plant) was assessed as a continuous variable and by tertile of intake. Falls were reported by participants using a validated questionnaire at two time points. Weight was ascertained at each examination to examine the effect of weight loss over follow-up.


Higher dietary protein intakes were associated with a reduced odds of falling, although of borderline statistical significance (OR=0.80, 95% CI: 0.60–1.07) and were not associated with the rate of falls over follow-up (RR=0.93, 95%CI: 0.73–1.19). Tertile analyses tended towards a protective association, but most did not achieve statistical significance; there was no dose-response. For those who lost ≥ 5% of their baseline weight, higher intakes of total, animal and plant protein showed a significantly lower rate of subsequent falls.


This work highlights the importance of adequate protein intake as a potentially modifiable risk factor for fall prevention in older adults. Further exploration of the interaction of protein intake and weight loss as related to falls is needed.

Key words

Protein intake falls dietary protein animal protein elderly cohort study 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA. May 12 1989;261(18):2663–2668.PubMedCrossRefGoogle Scholar
  2. 2.
    Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. Jan 2 2003;348(1):42–49.PubMedCrossRefGoogle Scholar
  3. 3.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. Dec 29 1988;319(26):1701–1707.PubMedCrossRefGoogle Scholar
  4. 4.
    Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. In: Kenny RA, O’shea D, eds. Falls and Syncope in Elderly Patients. Clinics in Geriatric Medicine. Philadelphia: W.B. Saunders Co.; 2002.Google Scholar
  5. 5.
    Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc. Nov 1995;43(11):1214–1221.PubMedGoogle Scholar
  6. 6.
    Sattin RW, Lambert Huber DA, DeVito CA, et al. The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol. Jun 1990;131(6):1028–1037.PubMedGoogle Scholar
  7. 7.
    Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol. Sep 1991;46(5):M164–170.PubMedGoogle Scholar
  8. 8.
    Onambele-Pearson GL, Breen L, Stewart CE. Influences of carbohydrate plus amino acid supplementation on differing exercise intensity adaptations in older persons: skeletal muscle and endocrine responses. Age (Dordr). Jun 2010;32(2):125–138.CrossRefGoogle Scholar
  9. 9.
    Parkkari J, Kannus P, Palvanen M, et al. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int. Sep 1999;65(3):183–187.PubMedCrossRefGoogle Scholar
  10. 10.
    Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci. Mar 1998;53(2):M112–119.PubMedGoogle Scholar
  11. 11.
    Kiel DP, O’sullivan P, Teno JM, Mor V. Health care utilization and functional status in the aged following a fall. Med Care. Mar 1991;29(3):221–228.PubMedCrossRefGoogle Scholar
  12. 12.
    Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol. Jul 1989;44(4):M112–117.PubMedGoogle Scholar
  13. 13.
    Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. May 2001;49(5):664–672.CrossRefGoogle Scholar
  14. 14.
    Vivanti AP, McDonald CK, Palmer MA, Sinnott M. Malnutrition associated with increased risk of frail mechanical falls among older people presenting to an emergency department. Emerg Med Australas. Oct 2009;21(5):386–394.PubMedCrossRefGoogle Scholar
  15. 15.
    Bauer JD, Isenring E, Torma J, Horsley P, Martineau J. Nutritional status of patients who have fallen in an acute care setting. J Hum Nutr Diet. Dec 2007;20(6):558–564.PubMedCrossRefGoogle Scholar
  16. 16.
    Meng X, Zhu K, Devine A, Kerr DA, Binns CW, Prince RL. A 5-year cohort study of the effects of high protein intake on lean mass and BMC in elderly postmenopausal women. J Bone Miner Res. Nov 2009;24(11):1827–1834.PubMedCrossRefGoogle Scholar
  17. 17.
    Houston DK, Nicklas BJ, Ding J, et al. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr. Jan 2008;87(1):150–155.PubMedGoogle Scholar
  18. 18.
    Misra D, Berry SD, Broe KE, et al. Does dietary protein reduce hip fracture risk in elders? The Framingham osteoporosis study. Osteoporos Int. May 5 2010.Google Scholar
  19. 19.
    Munger RG, Cerhan JR, Chiu BC. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr. Jan 1999;69(1):147–152.PubMedGoogle Scholar
  20. 20.
    Hannan MT, Tucker KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP. Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res. Dec 2000;15(12):2504–2512.PubMedCrossRefGoogle Scholar
  21. 21.
    Holm L, Olesen JL, Matsumoto K, et al. Protein-containing nutrient supplementation following strength training enhances the effect on muscle mass, strength, and bone formation in postmenopausal women. J Appl Physiol. Jul 2008;105(1):274–281.PubMedCrossRefGoogle Scholar
  22. 22.
    Haub MD, Wells AM, Tarnopolsky MA, Campbell WW. Effect of protein source on resistive-training-induced changes in body composition and muscle size in older men. Am J Clin Nutr. Sep 2002;76(3):511–517.PubMedGoogle Scholar
  23. 23.
    Dawber TR, Meadors GF, Moore FE, Jr. Epidemiological approaches to heart disease: the Framingham Study. Am J Public Health Nations Health. Mar 1951;41(3):279–281.PubMedCrossRefGoogle Scholar
  24. 24.
    Jacques PF, Sulsky SI, Sadowski JA, Phillips JC, Rush D, Willett WC. Comparison of micronutrient intake measured by a dietary questionnaire and biochemical indicators of micronutrient status. Am J Clin Nutr. Feb 1993;57(2):182–189.PubMedGoogle Scholar
  25. 25.
    Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. May 15 1992;135(10):1114–1126; discussion 1127–1136.PubMedGoogle Scholar
  26. 26.
    Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. Jul 1985;122(1):51–65.PubMedGoogle Scholar
  27. 27.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture (2005) Dietary Guidelines for Americans. Washington, DC: U.S. Government Printing Office.Google Scholar
  28. 28.
    Kannel WB, Sorlie P. Some health benefits of physical activity. The Framingham Study. Arch Intern Med. Aug 1979;139(8):857–861.CrossRefGoogle Scholar
  29. 29.
    Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. Apr 1997;65(4 Suppl):1220S–1228S; discussion 1229S–1231S.PubMedGoogle Scholar
  30. 30.
    Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. Jul 1986;124(1):17–27.PubMedGoogle Scholar
  31. 31.
    Glynn RJ, Stukel TA, Sharp SM, Bubolz TA, Freeman JL, Fisher ES. Estimating the variance of standardized rates of recurrent events, with application to hospitalizations among the elderly in New England. Am J Epidemiol. Apr 1 1993;137(7):776–786.PubMedGoogle Scholar
  32. 32.
    Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, D.C.: The National Academies Press; 2005.Google Scholar
  33. 33.
    Larsen ER, Mosekilde L, Foldspang A. Correlates of falling during 24 h among elderly Danish community residents. Prev Med. Aug 2004;39(2):389–398.PubMedCrossRefGoogle Scholar
  34. 34.
    Shahar D, Levi M, Kurtz I, et al. Nutritional status in relation to balance and falls in the elderly: a preliminary look at serum folate. Ann Nutr Metab. 2009;54(1):59–66.PubMedCrossRefGoogle Scholar
  35. 35.
    Bales CW, Ritchie CS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr. 2002;22:309–323.PubMedCrossRefGoogle Scholar
  36. 36.
    Ensrud KE, Cauley J, Lipschutz R, Cummings SR. Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med. Apr 28 1997;157(8):857–863.PubMedCrossRefGoogle Scholar
  37. 37.
    Leidy HJ, Carnell NS, Mattes RD, Campbell WW. Higher protein intake preserves lean mass and satiety with weight loss in pre-obese and obese women. Obesity (Silver Spring). Feb 2007;15(2):421–429.CrossRefGoogle Scholar
  38. 38.
    Layman DK, Evans E, Baum JI, Seyler J, Erickson DJ, Boileau RA. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. J Nutr. Aug 2005;135(8):1903–1910.PubMedGoogle Scholar
  39. 39.
    Layman DK, Boileau RA, Erickson DJ, et al. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr. Feb 2003;133(2):411–417.PubMedGoogle Scholar
  40. 40.
    Bopp MJ, Houston DK, Lenchik L, Easter L, Kritchevsky SB, Nicklas BJ. Lean mass loss is associated with low protein intake during dietary-induced weight loss in postmenopausal women. J Am Diet Assoc. Jul 2008;108(7):1216–1220.PubMedCrossRefGoogle Scholar
  41. 41.
    Gordon MM, Bopp MJ, Easter L, et al. Effects of dietary protein on the composition of weight loss in post-menopausal women. J Nutr Health Aging. Oct 2008;12(8):505–509.PubMedCrossRefGoogle Scholar
  42. 42.
    Campbell WW, Barton ML, Jr., Cyr-Campbell D, et al. Effects of an omnivorous diet compared with a lactoovovegetarian diet on resistance-training-induced changes in body composition and skeletal muscle in older men. Am J Clin Nutr. Dec 1999;70(6):1032–1039.PubMedGoogle Scholar
  43. 43.
    Hannan MT, Gagnon MM, Aneja J, et al. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. Am J Epidemiol. May 1 2010;171(9):1031–1036.PubMedCrossRefGoogle Scholar
  44. 44.
    Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc. Jul 1988;36(7):613–616.Google Scholar

Copyright information

© Serdi and Springer Verlag France 2011

Authors and Affiliations

  • E. S. Zoltick
    • 1
  • S. Sahni
    • 2
    • 3
  • R. R. McLean
    • 2
    • 3
  • L. Quach
    • 2
  • V.A. Casey
    • 2
  • M.T. Hannan
    • 2
    • 3
    • 4
    Email author
  1. 1.Boston University School of Public HealthBostonUSA
  2. 2.Institute for Aging ResearchHebrew SeniorLifeBostonUSA
  3. 3.Department of MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  4. 4.Musculoskeletal Research, Institute for Aging ResearchHebrew SeniorLifeBostonUSA

Personalised recommendations