High protein intake has been linked to increased type 2 diabetes (T2D) risk. However, if this association differs by protein from specific food sources, and if a habitual high protein intake affects ...insulin resistance and prediabetes risk are largely unknown. We aimed to investigate associations between protein intake from different food sources with longitudinal insulin resistance, and risk of prediabetes and T2D.
Our analyses included 6822 participants aged ≥45 years without diabetes at baseline in three sub-cohorts of the prospective population-based Rotterdam Study. We measured protein intake at baseline using food-frequency questionnaires. Data on longitudinal homeostatic model assessment of insulin resistance (HOMA-IR), and incidence of prediabetes and T2D were available from 1993 to 2014.
During follow-up, we documented 931 prediabetes cases and 643 T2D cases. After adjusting for sociodemographic, lifestyle, and dietary factors, higher total protein intake was associated with higher longitudinal HOMA-IR and with higher risk of prediabetes and T2D (per 5% increment in energy from protein at the expense of carbohydrate, for HOMA-IR: β = 0.10, (95%CI 0.07, 0.12); for prediabetes: HR = 1.34 (1.24 1.44); for T2D: HR = 1.37 (1.26, 1.49)). These associations were mainly driven by total animal protein (for HOMA-IR: 0.10 (0.07, 0.12); for prediabetes: 1.35 (1.24, 1.45); for T2D: 1.37 (1.26; 1.49)). The harmful associations of total animal protein were contributed to by protein from meat, fish, and dairy (e.g. for HOMA-IR: protein from meat, 0.13 (0.10, 0.17); from fish, 0.08 (0.03, 0.13); from dairy, 0.04 (0.0003, 0.08)). After additional adjustment for longitudinal waist circumference, associations of total protein and total animal protein with longitudinal HOMA-IR and prediabetes risk were attenuated, but remained statistically significant. Total plant protein, as well as protein from legumes and nuts, from grains, from potatoes, or from fruits and vegetables, was not associated with any of the outcomes.
Higher intake of animal protein, from meat, dairy and fish food sources, is associated with higher longitudinal insulin resistance and risk of prediabetes and T2D, which may be partly mediated by obesity over time. Furthermore, plant protein from different sources is not related to insulin resistance, and risk of prediabetes and T2D. Our findings highlight the importance of specific protein food sources and that habitual high animal protein intake may already in early stages be harmful in the development of T2D.
Abstract The anabolic response to dietary protein can be defined as the difference between protein synthesis and breakdown, or the net protein balance, in response to ingestion of protein alone or a ...mixed meal containing protein. Others have concluded that a maximal anabolic response can be achieved with ingestion of 20-35 g of a high quality protein, leading to the formulation of a popular concept that the maximal anabolic response can be achieved by distributing the total protein intake evenly throughout the day, rather than eating a majority of dietary protein with dinner. However, this concept was based entirely on the measurement of muscle protein synthesis and thus ignored the potential contributions of suppression of protein breakdown to the anabolic response, as well as the possibility that tissues and organs other than muscle may also play a role in the anabolic response. In this review we discuss the factors comprising the total anabolic response, discuss relevant methodological issues, derive a theoretical maximal anabolic response based on current literature values, and interpret recent papers addressing the issue of maximal anabolic response as well as meal distribution of dietary protein. We conclude that it is not likely that there is a practical limit to the maximal anabolic response to a single meal, and the most efficient way in which to maximize the total anabolic response over a 24-h period is to increase dietary protein at breakfast and lunch without reducing protein intake with dinner.
Purpose
During the last decade more researchers have argued in favor of an increased protein intake for older adults. However, there is a lack of knowledge on the long-term effects of conforming to ...such a high protein intake with regards to the basal and postprandial muscle protein turnover. The purpose of this study was to compare the postprandial synthesis response in muscle proteins, and the abundance of directly incorporated food-derived amino acids following habituation to high vs. recommended level of protein intake.
Methods
In a double blinded crossover intervention 11 older male participants (66.6 ± 1.7 years of age) were habituated for 20 days to a recommended protein (RP) intake (1.1 g protein/kg lean body mass (LBM)/day) and a high protein (HP) intake (> 2.1 g protein/kg LBM/day). Following each habituation period, intrinsically labelled proteins were ingested as part of a mixed meal to determine the incorporation of meal protein-derived amino acids into myofibrillar proteins. Furthermore, the myofibrillar fractional synthesis rate (FSR) and amino acid kinetics across the leg were determined using gold standard stable isotope tracer methodologies. RT qPCR was used to assess the expression of markers related to muscle proteinsynthesis and breakdown.
Results
No impact of habituation was observed on skeletal muscle amino acid or protein kinetics. However, the shunting of amino acids directly from artery to vein was on average 2.9
μ
mol/min higher following habituation to HP compared to RP
.
Conclusions
In older males, habituation to a higher than the currently recommended protein intake did not demonstrate any adaptions in the muscle protein turnover or markers hereof when subjected to an intake of an identical mixed meal.
Clinical Trial Registry
Journal number NCT02587156, Clinicaltrials.org. Date of registration: October 27th, 2015.
To stimulate early recognition and treatment of malnutrition, the Dutch Healthcare Inspectorate obliged all hospitals from 2008–2019 to report the number of malnourished patients with an adequate ...protein intake on the fourth day of hospital admission. In this article we present results over the past 11 years and discuss success factors and barriers for adequate treatment of malnourished patients in hospitals.
The annual reports of hospitals on the numbers of patients with a screening result ‘malnourished’ and an adequate protein intake on the fourth day of admission were analysed. Hospitals were categorized based on the percentage of malnourished patients with an adequate protein intake on the fourth day of admission as ‘poor’ (<40% of patients in a hospital achieve an adequate protein intake), ‘moderate’ 40–60% of patients in a hospital achieve an adequate protein intake), and ‘good’ (>60% of patients in a hospital achieve an adequate protein intake). To identify success factors and barriers for adequate treatment and registration of malnourished patients in hospitals, three focus groups were held in June and July 2020. Participants were dietitians and quality employees or nurses who were involved in data collection for malnutrition indicators in their hospitals.
Between 2008–2019, data were reported of 339,720 malnourished patients. The relative number of patients with adequate intake of protein on the fourth day in hospital ranges from 44%-53% between 2011 and 2019. Before 2013, the number of hospitals that reported data was too small to draw conclusions about results of treatment of malnutrition. Data from 2013 to 2019, show a decline in the number of hospitals with a ‘poor’ score. The number of hospitals with a moderate score increased between 2015 and 2019 and the number of hospitals with a good score remained more or less stable, except for 2018 where more hospitals reached a ‘good’ score. Sixteen professionals from ten different hospitals participated in the focus groups and revealed several determinants of adequate treatment of malnourished patients in hospitals such as awareness, feeling responsible and the need of clear instructions and good collaboration.
This inventory of the protein intake of 339,720 hospital malnourished patients over 11 years shows that in one out of five Dutch hospitals >60% of malnourished patients had an adequate protein intake on the fourth day of admission. This shows that meeting protein requirements remains a difficult challenge. Early recognition of malnutrition, optimal multidisciplinary treatment and continuous evaluation is necessary to provide optimal nutritional care in the hospital and beyond.
Food taboos can increase the risk of nutritional deficiencies, especially protein, fat, vitamin A, vitamin E and iron in pregnant women. The purpose of this study was to determine the relationship ...between food taboo culture and protein intake in pregnant women. This research is an analytic observational study with a cross sectional approach. The sample in this study were all pregnant women in the Pojoksari Village selected by the total sampling method. The results of the study show that most pregnant women practice a food taboo culture. Based on the results of statistical tests with chie square obtained p value = 0.683, which means there is no relationship between food taboo culture and protein intake in pregnant women. Although there is no relationship, it is known that pregnant women who practice food taboo culture have less protein intake to a deficit. Providing education about the food taboo to pregnant women is important to keep their nutritional intake during pregnancy well fulfilled.
BACKGROUND
The prospective association between protein intake and falls has been little studied. We assessed this association in a Spanish community‐dwelling cohort.
METHODS
We performed a ...prospective cohort study of 2464 men and women 60 years or older who were recruited in 2008‐2010 and followed up through 2012. At baseline, the habitual protein intake was determined with a validated dietary history. At the end of follow‐up, participants reported the number of falls experienced in the preceding year. Participants were stratified by an unintentional weight loss of 4.5 kg or more. Logistic regression was used after adjustment for the main confounders.
RESULTS
A total of 522 participants (21.2%) experienced at least one fall. The odds ratios (ORs) and 95% confidence intervals (CIs) of falling for the three increasing tertiles of total protein intake were 1.00, 0.86 (0.66‐1.11), and 0.93 (0.70‐1.24) (p for trend = 0.14). However, a statistically significant interaction with unintentional weight loss was observed for the association between protein intake and fall risk (p for interaction = 0.004). Among 163 participants (6.6%) who experienced unintentional weight loss, the ORs (95% CI) of falling for the three increasing tertiles of total protein intake were 1.00, 0.68 (0.21‐2.23), and 0.23 (0.05‐1.08) (p for trend = 0.01).
CONCLUSION
No protective association between protein intake and fall risk in older adults was found. However, high total protein intake tended to confer substantial benefits to participants who experienced an unintentional weight loss of 4.5 kg or more in the preceding year. J Am Geriatr Soc 67:329–335, 2019.
The Asian Working Group for Sarcopenia 2019 consensus emphasized nutritional assessment and intervention for community-dwelling older people with sarcopenia status. This study aimed to examine the ...association of serum albumin and dietary protein intake (DPI) with all-cause mortality among older adults at risk of sarcopenia.
We enrolled 1763 older adults at risk of sarcopenia in the Chinese Longitudinal Healthy Longevity Survey (2012–2018) using calf circumference and handgrip strength. Serum albumin concentrations were measured using bromocresol green methods, and DPI frequency was evaluated using a semi-quantitative questionnaire at baseline. Cox proportional hazards models were used to explore the association of serum albumin and DPI with all-cause mortality.
During 5606.3 person-years of follow-up (median: 3.28 years), 802 older people died. After adjusting for socio-demographics, health behaviors, and clinical characteristics, we observed an inverse linear association between serum albumin and all-cause mortality (Pnon-linear = 0.429). Participants with low albumin levels (<40.0 g/L) had a 43 % higher risk of mortality than their counterparts (hazard ratio (HR) = 1.43, 95 % confidence interval (CI) = 1.22–1.66). There was no significant association between DPI and mortality (Ps > 0.05). Moreover, the association between low albumin and all-cause mortality remained significant in the lower DPI subgroup (HR = 1.47, 95 % CI = 1.18–1.85), but was not significant in the high DPI subgroup (HR = 1.15, 95 % CI = 0.92–1.39).
Serum albumin levels are inversely associated with all-cause mortality in community-based older adults at risk of sarcopenia. Sufficient dietary protein consumption may attenuate the effect of low serum albumin on increased mortality and potential mechanisms for the interaction warrant further exploration.
AbstractObjectiveTo evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD).DesignProspective cohort study.Setting21 low, middle, and high income ...countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China).Participants116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years.Main outcome measuresThe main outcome was development of IBD, including Crohn’s disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals.ResultsParticipants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn’s disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn’s disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD.ConclusionsHigher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods.Study registrationClinicalTrials.gov NCT03225586.
The serum natural abundance carbon isotope ratio (CIR) was recently identified as a candidate biomarker of animal protein intake in postmenopausal women. Such a biomarker would help clarify the ...relation between dietary protein source (plant or animal) and chronic disease risk.
We aimed to evaluate the performance of the serum CIR as a biomarker of dietary protein source in a controlled feeding study of men and women of diverse age and BMI.
We conducted a 15-d feeding study of 100 adults (age: 18–70 y, 55% women) in Phoenix, AZ. Participants were provided individualized diets that approximated habitual food intakes. Serum was collected at the end of the feeding period for biomarker measurements.
Median IQR animal protein intake was 67 g/d 55–88 g/d, which was 64% of total protein. The serum CIR was positively correlated with animal protein and inversely correlated with plant protein intake, leading to a strong correlation (r2 = 0.76) with the dietary animal protein ratio (APR; animal/total protein). Regressing serum CIR on the APR, serum nitrogen isotope ratio (NIR), gender, age, and body weight generated an R2 of 0.78. Following the measurement error model for predictive biomarkers, the resulting regression equation was then inverted to develop a calibrated biomarker equation for APR. Added sugars ratio (added/total sugars intake) and corn intakes also influenced the serum CIR but to a much lesser degree than the APR; variations in these intakes had only small effects on biomarker-estimated APR.
Based on our findings in this US cohort of mixed sex and age, we propose the serum CIR alongside NIR as a predictive dietary biomarker of the APR. We anticipate using this biomarker to generate calibrated estimates based on self-reported intake and ultimately to obtain more precise disease risk estimates according to dietary protein source.
▪
PDF
