Low Protein Intake Irrespective of Source is Associated with Higher Mortality Among Older Community-Dwelling Men



Our aim was to determine the association between protein intake (overall and by source) and all-cause and cause-specific mortality among older men.


Prospective cohort study.


5790 ambulatory community-dwelling older men from multicenter Osteoporotic Fractures in Men (MrOS) study.


Total energy and protein intake, and protein intake by source (dairy, non-dairy animal, plant) were assessed using a 69-item food frequency questionnaire. We included up to 10-year follow-up with adjudicated cardiovascular, cancer and other mortality outcomes. We used time-to-event analysis with protein exposures, mortality outcome, and adjusted for possible confounders including age, center, education, race, smoking, alcohol use, physical activity, weight, total energy intake (TEI), and comorbidities. Hazard ratios were expressed per each unit=2.9% TEI decrement for all protein intake variables.


The mean (SD) baseline age of 5790 men was 73.6 (5.8) y. There were 1611 deaths and 211 drop-outs prior to 10 years, and 3868 men who were alive at the 10-year follow-up. The mean (SD) total protein intake was 64.7 (25.8) g/d, while the mean (SD) intake expressed as percent of total energy intake (%TEI) was 16.1 (2.9) %TEI. Lower protein intake was associated with an increased risk of death, with unadjusted HR=1.11 (95% CI: 1.06, 1.17) and adjusted HR=1.09 (95% CI: 1.04, 1.14) and the associations for protein intake by source were similar. The adjusted HR for cancer mortality was HR=1.13 (95% CI: 1.03, 1.25) while the association for CVD mortality was HR=1.08 (95% CI: 0.99, 1.18).


Low protein intake, irrespective of source, was associated with a modest increase in risk of all-cause and cause-specific mortality among older men. Special consideration should be given to level of protein intake among older adults.

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  1. 1.

    Houston, D. K. 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. 2008;87, 150–155.

    CAS  Article  Google Scholar 

  2. 2.

    McLean, R. R., Mangano, K. M., Hannan, M. T., Kiel, D. P. & Sahni, S. Dietary Protein Intake Is Protective Against Loss of Grip Strength Among Older Adults in the Framingham Offspring Cohort. J. Gerontol. A. Biol. Sci. Med. Sci. 2016;71, 356–361.

    CAS  Article  Google Scholar 

  3. 3.

    Hirsch, C. H., Buzková, P., Robbins, J. A., Patel, K. V. & Newman, A. B. Predicting late-life disability and death by the rate of decline in physical performance measures. Age Ageing 2012;41, 155–161.

    Article  Google Scholar 

  4. 4.

    Granic, A. et al. Grip Strength Decline and Its Determinants in the Very Old: Longitudinal Findings from the Newcastle 85+ Study. PloS One 11, e0163183.

  5. 5.

    Hruby, A., Sahni, S., Bolster, D. & Jacques, P. F. Protein Intake and Functional Integrity in Aging: The Framingham Heart Study Offspring. J GerontolA BiolSciMedSci, 2018 doi: https://doi.org/10.1093/gerona/gly201.

  6. 6.

    Zoltick, E. S. et al. Dietary protein intake and subsequent falls in older men and women: the Framingham Study. J. Nutr. Health Aging 2011;15, 147–152.

    CAS  Article  Google Scholar 

  7. 7.

    Houston, D. K. et al. Protein Intake and Mobility Limitation in Community-Dwelling Older Adults: the Health ABC Study. J. Am. Geriatr. Soc. 2017;65, 1705–1711.

    Article  Google Scholar 

  8. 8.

    Langsetmo, L. et al. High dairy protein intake is associated with greater bone strength parameters at the distal radius and tibia in older men: a cross-sectional study. Osteoporos. Int. J. Establ. Result Coop. Eur. Found. Osteoporos. Natl. Osteoporos. Found. USA 2018;29, 69–77.

    CAS  Article  Google Scholar 

  9. 9.

    Shikany, J. M. et al. Macronutrients, diet quality, and frailty in older men. J. Gerontol. A. Biol. Sci. Med. Sci 2014; 69, 695–701.

    CAS  Article  Google Scholar 

  10. 10.

    Langsetmo, L. et al. The Association Between Protein Intake by Source and Osteoporotic Fracture in Older Men: A Prospective Cohort Study. J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res. 2017;32, 592–600.

    CAS  Article  Google Scholar 

  11. 11.

    Fried, L. P. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A. Biol. Sci. Med. Sci. 2001;56, M146–156.

    CAS  Article  Google Scholar 

  12. 12.

    Ensrud, K. E. et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J. Am. Geriatr. Soc. 2009;57, 492–498.

    Article  Google Scholar 

  13. 13.

    Song, M. et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern. Med. 2016; 176, 1453–1463.

    Article  Google Scholar 

  14. 14.

    Seidelmann, S. B. et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018;3, e419–e428.

    Article  Google Scholar 

  15. 15.

    Levine, M. E. et al. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014; 19, 407–417.

    CAS  Article  Google Scholar 

  16. 16.

    Blank, J. B. et al. Overview of recruitment for the osteoporotic fractures in men study (MrOS). Contemp. Clin. Trials 2005;26, 557–568.

    Article  Google Scholar 

  17. 17.

    Orwoll, E. et al. Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp. Clin. Trials 2005;26, 569–585.

    Article  Google Scholar 

  18. 18.

    Block, G., Hartman, A. M. & Naughton, D. A reduced dietary questionnaire: development and validation. Epidemiol. Camb. Mass 1990;1, 58–64.

    CAS  Article  Google Scholar 

  19. 19.

    Washburn, R. A., Smith, K. W., Jette, A. M. & Janney, C. A. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J. Clin. Epidemiol. 1993;46, 153–162).

    CAS  Article  Google Scholar 

  20. 20.

    Deutz, N. E. P. et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin. Nutr. Edinb. Scotl. 2014;33, 929–936.

    CAS  Article  Google Scholar 

  21. 21.

    Bauer, J. et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J AmMedDirAssoc 2013; 14, 542–559.

    Google Scholar 

  22. 22.

    Virtanen, H. E. K. et al. Dietary proteins and protein sources and risk of death: the Kuopio Ischaemic Heart Disease Risk Factor Study. AmJ.Clin.Nutr. 2019; 109, 1462–1471.

    Article  Google Scholar 

  23. 23.

    Hernandez-Alonso, P. et al. High dietary protein intake is associated with an increased body weight and total death risk. Clin.Nutr. 2016;35, 496–506.

    CAS  Article  Google Scholar 

  24. 24.

    Etemadi, A. et al. Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study. BMJ 2017;357, J1957.

    Article  Google Scholar 

  25. 25.

    Farvid, M. S. et al. Dietary Protein Sources and All-Cause and Cause-Specific Mortality: The Golestan Cohort Study in Iran. Am. J. Prev. Med. 2017;52, 237–248.

    Article  Google Scholar 

  26. 26.

    Schwingshackl, L. et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am. J. Clin. Nutr. 2017; 105, 1462–1473.

    CAS  PubMed  Google Scholar 

  27. 27.

    Zeraatkar, D. et al. Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann. Intern. Med. 2019 doi: https://doi.org/10.7326/M19-0655.

  28. 28.

    Vernooij, R. W. M. et al. Patterns of Red and Processed Meat Consumption and Risk for Cardiometabolic and Cancer Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann. Intern. Med. 2019 doi: https://doi.org/10.7326/M19-1583.

  29. 29.

    Dickinson, J. M. et al. Leucine-enriched amino acid ingestion after resistance exercise prolongs myofibrillar protein synthesis and amino acid transporter expression in older men. J.Nutr. 2014; 144, 1694–1702.

    CAS  Article  Google Scholar 

  30. 30.

    Wilkinson, D. J. et al. Effects of leucine-enriched essential amino acid and whey protein bolus dosing upon skeletal muscle protein synthesis at rest and after exercise in older women. Clin. Nutr. Edinb. Scotl. 2018;37, 2011–2021.

    CAS  Article  Google Scholar 

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Corresponding author

Correspondence to Lisa Langsetmo.

Additional information


The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NLA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NTH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG04214S, U01 AG042168, U01 AR066160, and UL1 TR000128. Additional funding for this study was provided by Abbott Nutrition. This manuscript is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System. Analysis funded by Abbott through an institutional research grant supporting L.L., P.M.C. and S.H. L.L. and P.M.C. designed the study: S.H. analyzed the data; all authors interpreted the findings: L.L. drafted the manuscript; and L.L. and P.M.C. have primary responsibility for the final content. All authors read and approved the final manuscript.


Analysis funded by Abbott Nutrition through an institutional research grant supporting L.L., P.M.C. and S.H. S.J. and S.L.P are employed by Abbott Nutrition. In addition L.L. has an institutional research grant from Merck and P.M.C has institutional research grants from Nestle and is a consultant to BioAge. The other authors have no disclosures.

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The institutional review board at each participating institution approved the study protocol and written informed consent was obtained from all study participants.

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Langsetmo, L., Harrison, S., Jonnalagadda, S. et al. Low Protein Intake Irrespective of Source is Associated with Higher Mortality Among Older Community-Dwelling Men. J Nutr Health Aging 24, 900–905 (2020). https://doi.org/10.1007/s12603-020-1422-4

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Key words

  • Protein intake
  • older men
  • all-cause mortality
  • cause-specific mortality