Diet modeling in older Americans: The impact of increasing plant-based foods or dairy products on protein intake



To determine the effects of increasing plant-based foods or dairy products on protein intake in older Americans by performing diet modeling.


Data from What We Eat in America (WWEIA), the dietary component of the National Health and Nutrition Examination Survey (NHANES), 2007-2010 for Americans aged 51 years and older (n=5,389), divided as 51-70 years (n=3,513) and 71 years and older (n=1,876) were used.


Usual protein intake was compared among three dietary models that increased intakes by 100%: (1) plant-based foods; (2) higher protein plant-based foods (i.e., legumes, nuts, seeds, soy); and (3) dairy products (milk, cheese, and yogurt). Models (1) and (2) had commensurate reductions in animal-based protein intake.


Doubling intake of plant-based foods (as currently consumed) resulted in a drop of protein intake by approximately 22% for males and females aged 51+ years. For older males and females, aged 71+ years, doubling intake of plant-based foods (as currently consumed) resulted in an estimated usual intake of 0.83±0.02 g/kg ideal body weight (iBW))/day and 0.78±0.01 g/kg iBW/day, respectively. In this model, 33% of females aged 71+ years did not meet the estimated average requirement for protein. Doubling dairy product consumption achieved current protein intake recommendations.


These data illustrate that increasing plant-based foods and reducing animal-based products could have unintended consequences on protein intake of older Americans. Doubling dairy product intake can help older adults get to an intake level of approximately 1.2 g/kg iBW/day, consistent with the growing consensus that older adults need to consume higher levels of protein for health.

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United States


Recommended Dietary Allowance


National Health and Nutrition Examination Survey


Estimated Average Requirement


What We Eat in America


National Cancer Institute


Dietary Reference Intake


United States Department of Agriculture


body weight


ideal body weight


actual body weight


Acceptable Macronutrient Distribution Range


Dietary Guidelines for Americans


  1. 1.

    United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2015–Highlights (ST/ESA/SER.A/368). http://www. Highlights.pdf. Accessed 11 January 2016

  2. 2.

    Vincent GK and Velkoff VA, 2010. The Next Four Decades, The Older Population in the United States: 2010 to 2050, Current Population Reports, U.S. Census Bureau, Washington, D.C. Accessed 10 May 2016

    Google Scholar 

  3. 3.

    Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, Cederholm T, Cruz-Jentoft A, Krznariç Z, Nair KS, Singer P, Teta D, Tipton K, Calder PC. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33: 929–936

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Goldspink G (2012). Age-related loss of muscle mass and strength. J Aging Re, 2012. doi: 10.1155/2012/158279

    Google Scholar 

  5. 5.

    Faulkner JA, Larkin LM, Claflin DR, Brooks SV. Age-related changes in the structure and function of skeletal muscles. Clin Exp Pharmacol Physiol. 2007;34: 1091–1096

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol. 2000;89(1): 81–88. Erratum in: J Appl Physiol. 2014; 116:1342

    CAS  PubMed  Google Scholar 

  7. 7.

    Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84: 475–482

    CAS  PubMed  Google Scholar 

  8. 8.

    Anderson G, 2010. Chronic Care: Making the Case for Ongoing Care. Robert Wood Johnson Foundation. Accessed 11 January 2016

    Google Scholar 

  9. 9.

    Ward BW, Schiller JS, 2013. Prevalence of Multiple Chronic Conditions Among US Adults: Estimates From the National Health Interview Survey, 2010. Prev Chronic Dis. doi: Accessed 11 January 2016

  10. 10.

    Institute of Medicine of the National Academies, 2005. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. National Academies Press, Washington DC.

  11. 11.

    Campbell WW, Crim MC, Dallal GE, Young VR, Evans WJ. Increased protein requirements in elderly people: new data and retrospective reassessments. Am J Clin Nutr. 1994;60: 501–509

    CAS  PubMed  Google Scholar 

  12. 12.

    Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, Phillips S, Sieber C, Stehle P, Teta D, Visvanathan R, Volpi E, Boirie Y. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14: 542–559

    Article  PubMed  Google Scholar 

  13. 13.

    Volpi E, Campbell WW, Dwyer JT, Johnson MA, Jensen GL, Morley JE, Wolfe RR. Is the optimal level of protein intake for older adults greater than the recommended dietary allowance? J Gerontol A Biol Sci Med Sci. 2013;68: 677–681

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Wolfe RR, Miller SL, Miller KB. Optimal protein intake in the elderly. Clin Nutr. 2008;7: 675–84.

    Article  Google Scholar 

  15. 15.

    Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB, Moore LL, Rodriguez NR, van Loon LJ. Protein and healthy aging. Am J Clin Nutr. 2015;101(Suppl1):1339S–1345S

    CAS  Article  Google Scholar 

  16. 16.

    Pedersen AN, Cederholm T. Health effects of protein intake in healthy elderly populations: a systematic literature review. Food Nutr Res, 2014. doi: 10.3402/fnr. v58.23364

    Google Scholar 

  17. 17.

    Paddon-Jones D, Leidy H. Dietary protein and muscle in older persons. Cur Opin Clin Nutr Metab Care. 2014;17: 5–11

    CAS  Article  Google Scholar 

  18. 18.

    Boirie Y, Morio B, Caumon E, Cano NJ. Nutrition and protein energy homeostasis in elderly. Mech Ageing Dev. 2014;136-137:76–84

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, Lee JS, Sahyoun NR, Visser M, Kritchevsky SB. 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. 2008;87: 150–155

    CAS  PubMed  Google Scholar 

  20. 20.

    Pannemans DL, Wagenmakers AJ, Westerterp KR, Schaafsma G, Halliday D. Effect of protein source and quantity on protein metabolism in elderly women. Am J Clin Nutr. 1998;68: 1228–35

    CAS  PubMed  Google Scholar 

  21. 21.

    Campbell WW, Barton ML, Cyr-Campbell D, Davey SL, Beard JL, Parise G, Evans WJ. 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. 1999;70: 1032–9

    CAS  PubMed  Google 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. 2002;76: 511–517

    CAS  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Institute of Medicine, 2014; Sustainable diets: Food for healthy people and a healthy planet. Workshop summary. National Academies Press, Washington DC.

  24. 24.

    Department of Agriculture and U.S. Department of Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. 8 February 2016

  25. 25.

    Auestad N, Fulgoni VL. What Current Literature Tells Us About Sustainable Diets: Emerging Research Linking Dietary Patterns, Environmental Sustainability, and Economics. Adv Nutr. 2015;6: 19–36

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Eshel G, Martin PA. Diet, Energy, and Global Warming. Earth Interactions. 2006;10: 1–17.

    Article  Google Scholar 

  27. 27.

    Centers for Disease Control and Prevention. About the National Health and Nutrition Examination Survey. Accessed 8 May 2015

  28. 28.

    Tooze JA, Kipnis V, Buckman DW, Carroll RJ, Freedman LS, Guenther PM, Krebs-Smith SM, Subar AF, Dodd KW. A mixed-effects model approach for estimating the distribution of usual intake on nutrients: The NCI method. Stat Med., 2010; doi:10.1002/sim.4063

    Google Scholar 

  29. 29.

    Quann EE, Fulgoni VL, Auestad N. Consuming the daily recommended amounts of dairy products would reduce the prevalence of inadequate micronutrient intakes in the United States: diet modeling study based on NHANES 2007-2010. Nutr J. 2015;14:90. Doi: 10.1186/s12937-015-0057-5

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Canada Food Guide, 2011. Accessed May 10, 2016.

  31. 31.

    Australian Dietary Guidelines, 2015; Accessed 14 January 2016

  32. 32.

    U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at Accessed 4 March 2016

  33. 33.

    Food Agricultural Organization (FAO). Sustainable Diets and Biodiversity: Directions and Solutions for Policy, Research and Action. Proceedings of the International Scientific Symposium: Biodiversity and Sustainable Diets United Against Hunger. FAO Headquarters, Rome; 3-5 November 2010. Accessed 9 April 2015

  34. 34.

    Bowman SA, Clemens JC, Friday JE, Thoerig RC, Shimizu M, Barrows BR, and Moshfegh AJ, 2013; Food Patterns Equivalents Database 2007-08: Methodology and User Guide [Online]. Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland. Available at: Accessed January 2015

    Google Scholar 

  35. 35.

    Bowman SA, Clemens JC, Thoerig RC, Friday JE, Shimizu M, and Moshfegh AJ; 2013; Food Patterns Equivalents Database 2009-10: Methodology and User Guide [Online]. Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland. Accessed January 2015

    Google Scholar 

  36. 36.

    U.S. Department of Agriculture, Agricultural Research Service, 2015; What We Eat in America Food Categories 2011-2012. Accessed 12 January 2015

  37. 37.

    Usual Dietary Intakes: SAS Macros for Analysis of a Single Dietary Component, 2012; Accessed 12 January 12 2015

  38. 38.

    Berner LA, Becker G, Wise M, Doi J. Characterization of dietary protein among older adults in the United States: amount, animal sources, and meal patterns. J Acad Nutr Diet 2013;113: 809–15

    Article  PubMed  Google Scholar 

  39. 39.

    Devries MC, Phillips SM. Supplemental Protein in Support of Muscle Mass and Health: Advantage Whey. J Food Science 2015;80(S1):A8–14

    CAS  Article  Google Scholar 

  40. 40.

    FAO/WHO Expert Consultation, 1991; Protein quality evaluation report of the Joint FAO/WHO Expert Consultation held in Bethesda, Md., USA, in 1989. FAO Food and Nutrition Paper 51, Rome.

  41. 41.

    Miller GD, Jarvis JK, McBean LD, 2007; The Importance of Milk and Milk Products in the Diet In Handbook of Dairy Foods and Nutrition, 3rd edition, CRC Press, Boca Raton, FL.

    Google Scholar 

  42. 42.

    Mitchell CJ, McGregor RA, D’Souza RF, Thorstensen EB, Markworth JF, Fanning AC, Poppitt, SD, Cameron-Smith D. Consumption of Milk Protein or Whey Protein Results in a Similar Increase in Muscle Protein Synthesis in Middle Aged Men. Nutrients 2015;7: 8685–8699

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Gryson C, Ratel S, Rance M, Penando S, Bonhomme C, Le Ruyet P, Duclos M, Boirie Y, Walrand S. Four-month course of soluble milk proteins interacts with exercise to improve muscle strength and delay fatigue in elderly participants. J Am Med Dir Assoc 2014;15:958.e1-9

    Article  PubMed  Google Scholar 

  44. 44.

    Pennings B, Boirie Y, Senden JMG, Gijsen AP, Kuipers H, van Loon LJC. Whey protein stimulates postprandial muscle protein accretion more effectively than do casein and casein hydrolysate in older men. Am J Clin Nutr 2011;93: 997–1005

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Burd NA, Yang Y, Moore DR, Tang JE, Tarnopolsky MA, Phillips SM. Greater stimulation of myofibrillar protein synthesis with ingestion of whey protein isolate v. micellar casein at rest and after resistance exercise in elderly men. Br J Nut. 2012;108: 958–562

    CAS  Google Scholar 

  46. 46.

    Yang Y, Churchward-Venne TA, Burd NA, Breen L, Tarnopolsky MA, Phillips SM. Myofibrillar protein synthesis following ingestion of soy protein isolate at rest and after resistance exercise in elderly men. Nutr Metab 2012;9:57. doi: 10.1186/1743-7075-9-57

    CAS  Article  Google Scholar 

  47. 47.

    Boirie Y, Dangin M, Gachon P, Vasson M-P, Maubois J-L, Beufrère B. Slow and fast dietary proteins differently modulate postprandial protein accretion. Proc Natl Acad Sci 1997;94: 14930–14935.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Murphy CH, Oikawa SY, Phillips SM. Dietary protein to maintain muscle mass in aging: a case for per-meal protein recommendations. J Frailty Aging 2015;5: 49–58

    Google Scholar 

  49. 49.

    Kim I-Y, Schutzler S, Schrader A, Spencer H, Kortebein P, Deutz NEP, Wolfe RR, Ferrando AA. Quantity of dietary protein intake, but not pattern of intake, affects net protein balance primarily through differences in protein synthesis in older adults. Am J Physiol Endocrinol Metab 2015;308:E21–28

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Xu ZR, Ran ZJ, Zhang Q, Gui QF, Yang YM. The effectiveness of leucine on muscle protein synthesis, lean body mass and leg lean mass accretion in older people: a systematic review and meta-analysis. Br J Nutr 2014;19: 1–10

    CAS  Google Scholar 

  51. 51.

    Fakhouri TH, Ogden CL, Carroll MD, Kit BK, Flegal KM, 2012; Prevalence of Obesity Among Older Adults in the United States, 2007-2010. NCHS data brief, no 106. Hyattsville, MD: National Center for Health Statistics. Accessed 10 May 2016

    Google Scholar 

  52. 52.

    Abargouei AS, Janhorbani M, Salehi-Marzijarani M, Esmaillzadeh A. Effect of dairy consumption on weight and body composition in adults: a systematic review and meta-analsysis or randomized controlled clinical trials. Int J Obes (Lond) 2012;36: 1485–1493

    CAS  Article  Google Scholar 

  53. 53.

    Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in Diet and Lifestyle and Long-Term Weigth Gain in Women and Men. N Engl J Med 2011;364: 2392–2404

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Chen M, Pan A, Malik VS, Hu FB. Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2012;96: 735–747

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Rice BH, Quann EE, Miller GD. Meeting and exceeding dairy recommendations: effects of dairy consumption on nutrient intakes and risk of chronic disease. Nut Rev 2013;71: 209–223

    Article  Google Scholar 

  56. 56.

    Huth PJ, Park KM. Influence of Dairy Product and Milk Fat Consumption on Cardiovascular Disease Risk: A Review of the Evidence. Ad Nutr 2012;3: 266–285

    CAS  Article  Google Scholar 

  57. 57.

    German JB, Gibson RA, Krauss RM, Nestel P, Lamarch B, van Staveren WA, Steijns JM, de Groot LCPGM, Lock AL, Destaillats F. A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk. Eur J Nutr 2009;48: 191–203

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Astrup A. Yogurt and dairy product consumption to prevent cardiometabolic diseases: epidemiologic and experimental studies. Am J Clin Nutr 2014;99(suppl):1235S–1242S

    CAS  Article  PubMed  Google Scholar 

  59. 59.

    U.S. Department of Health and Human Services and National Institutes of Health, 2010;National Institutes of Health Consensus Development Conference Statement. NIH Consensus Development Conference: Lactose Intolerance and Health. February 22-24, 2010. Statement.pdf Accessed 8 February 2016

  60. 60.

    Bailey RK, Fileti CP, Keith J, Tropez-Sims S, Price W, Allison-Ottey SD. Lactose Intolerance and Health Disparities Among African Americans and Hispanic Americans: An Updated Consensus Statement. J Natl Med Assoc 2013;105: 112–127

    Article  PubMed  Google Scholar 

  61. 61.

    Kesse-Guyot E, Assmann KE, Andreeva VA, Ferry M, Hercberg S, Galan P, The SU.VI. MAX 2 Research Group. Consumption of dairy products and cognitive functioning: findings from the SU.VI.MAX 2 study. J Nutr Health Aging 2016;20: 128–137

    CAS  PubMed  Google Scholar 

  62. 62.

    Otsuka R, Kato Y, Nishita Y, Tange C, Nakamoto M, Tomida M, Imai T, Ando F, Shimokata H. Cereal Intake Increases and Dairy Products Decrease Risk of Cognitive Decline among Elderly Female Japanese. J Prev Alzheimers Di. 2014;1: 160–167

    Google Scholar 

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Correspondence to Jenny A. Houchins.

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Houchins, J.A., Cifelli, C.J., Demmer, E. et al. Diet modeling in older Americans: The impact of increasing plant-based foods or dairy products on protein intake. J Nutr Health Aging 21, 673–680 (2017).

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Key words

  • Aging
  • muscle
  • protein
  • plant
  • dairy