Age-related decline in muscle strength is an important public health issue for older adults. Dietary protein has been associated with maintenance of muscle mass, yet its relation to muscle strength ...remains unclear.
We determined the association of dietary protein (total, animal, and plant) intake, measured by food frequency questionnaire, with change in grip strength over 6 years in 1,746 men and women from the Framingham Offspring cohort.
Mean age at baseline was 58.7 years (range: 29-85), and mean total, animal, and plant protein intakes were 79, 57, and 22 g/d, respectively. Adjusted baseline mean grip strength did not differ across quartiles of energy-adjusted total, animal or protein intake. Greater protein intake, regardless of source, was associated with less decrease in grip strength (all p for trend ≤.05): participants in the lowest quartiles lost 0.17% to 0.27% per year while those in the highest quartiles gained 0.52% to 0.60% per year. In analyses stratified by age, participants aged 60 years or older (n = 646) had similar linear trends on loss of grip strength for total and animal (all p for trend <.03) but not plant protein, while the trends in participants younger than 60 years (n = 896) were not statistically significant.
Higher dietary intakes of total and animal protein were protective against loss of grip strength in community-dwelling adults aged 60 years and older. Increasing intake of protein from these sources may help maintain muscle strength and support prevention of mobility impairment in older adults.
Abstract
Background
Higher protein intake is linked to maintenance of muscle mass and strength, but few studies have related protein to physical function and disability in aging.
Methods
In ...participants of the Framingham Heart Study Offspring, we examined associations between protein intake (g/d), estimated from food frequency questionnaires, and maintenance of functional integrity, as a functional integrity score based on responses to 17 questions from Katz Activities of Daily Living, Nagi, and Rosow-Breslau questionnaires, repeated up to five times (1991/1995–2011/2014) over 23 years of follow-up. Cox proportional hazard models were used to estimate risk of incident loss of functional integrity (functional integrity score ≤ 15th percentile).
Results
In 2,917 participants (age 54.5 9.8 years), baseline protein intake was 77.2 (15.6) g/d. The functional integrity score (baseline, mean 98.9, range 82.4–100.0) was associated with objective performance (gait speed, grip strength) and lower odds of falls, fractures, and frailty. Across follow-up, there were 731 incident cases of loss of functional integrity. In fully adjusted models, participants in the highest category of protein intake (median 92.2 g/d) had 30% lower risk of loss of functional integrity (hazard ratio 95% confidence interval 0.70 0.52, 0.95, p trend = .03), versus those with the lowest intake (median 64.4 g/d). However, sex-stratified analyses indicated the association was driven by the association in women alone (hazard ratio 95% confidence interval 0.49 0.32, 0.74, p trend = .002) and was nonsignificant in men (hazard ratio 95% confidence interval 1.14 0.70, 1.86, p trend = .59).
Conclusions
Higher protein intake was beneficially associated with maintenance of physical function in middle-aged, high-functioning U.S. adults over the span of two decades. This association was particularly evident in women.
Abstract
BACKGROUND
In the United States, current guidelines recommend a total sodium intake <2,300 mg/day, a guideline which does not consider kilocalorie intake. However, kilocalorie intake varies ...substantially by age and sex. We hypothesized that compared with sodium density, total sodium intake overestimates adherence to sodium recommendations, especially in adults consuming fewer kilocalories.
METHODS
In the National Health and Nutrition Examination Survey (NHANES), we estimated the prevalence of adherence to sodium intake recommendations (<2,300 mg/day) and corresponding sodium density intake (<1.1 mg/kcal = 2,300 mg at 2,100 kcal) by sex, age, race/ethnicity, and kilocalorie level. Adherence estimates were compared between the 2005–2006 (n = 5,060) and 2015–2016 (n = 5,266) survey periods.
RESULTS
In 2005–2006, 23.1% (95% confidence interval CI: 21.5, 24.9) of the US population consumed <2,300 mg of sodium/day, but only 8.5% (CI: 7.6, 9.4) consumed <1.1 mg/kcal in sodium density. In 2015–2016, these figures were 20.9% (CI: 18.8, 23.2) and 5.1% (CI: 4.4, 6.0), respectively. In 2015–2016, compared with 2005–2006, adherence by sodium density decreased more substantially (odds ratio = 0.59; CI: 0.48, 0.72; P < 0.001) than adherence by total sodium consumption (odds ratio = 0.85; CI: 0.73, 0.98; P = 0.03). The difference in adherence between total sodium and sodium density goals was greater among those with lower kilocalorie intake, namely, older adults, women, and Hispanic adults.
CONCLUSIONS
Adherence estimated by sodium density is substantially less than adherence estimated by total sodium intake, especially among persons with lower kilocalorie intake. Further efforts to achieve population-wide reduction in sodium density intake are urgently needed.
Previous studies reported that dairy foods are associated with higher areal bone mineral density (BMD) in older adults. However, data on bone texture are lacking. We determined the association of ...dairy food intake (milk, yogurt, cheese, milk + yogurt and milk + yogurt + cheese) with spinal trabecular bone score (TBS).
In this cross-sectional study, a validated semi-quantitative food frequency questionnaire was used to assess dairy food intake (servings/wk). TBS, an analysis of bone texture, was calculated from dual energy X-ray absorptiometry (DXA) scans. Sex-specific multivariable linear regression was used to estimate the association of dairy food intake (energy adjusted via residual methods) with each bone measure adjusting for covariates.
Mean age of 4,740 participants was 49 (SD: 13) years and mean milk + yogurt + cheese intake was 10.1 (SD: 8.4) servings/week in men and 10.9 (SD: 8.0) servings/week in women. There were no associations between dairy food intake and spinal TBS in adjusted models.
In this cohort of primarily healthy adults, dairy intake was not associated with bone texture.
To examine the association between sleep patterns (sleep duration and insomnia symptoms) and total and regional bone mineral density (BMD) among older Boston Puerto Rican adults.
We conducted a ...cross-sectional study including 750 Puerto Rican adults, aged 47-79 y living in Massachusetts. BMD at 3 hip sites and the lumbar spine were measured using dual-energy X-ray absorptiometry. Sleep duration (≤5 h, 6 h, 7 h, 8 h, or ≥9 h/d) and insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awaking, and non-restorative sleep) were assessed by a questionnaire. Multivariable regression was used to examine sex-specific associations between sleep duration, insomnia symptoms and BMD adjusting for standard confounders and covariates.
Men who slept ≥9h/d had significantly lower femoral neck BMD, relative to those reporting 8 h/d sleep, after adjusting for age, education level, smoking, physical activity, depressive symptomatology, comorbidity and serum vitamin D concentration. This association was attenuated and lost significance after further adjustment for urinary cortisol and serum inflammation biomarkers. In contrast, the association between sleep duration and BMD was not significant in women. Further, we did not find any significant associations between insomnia symptoms and BMD in men or women.
Our study does not support the hypothesis that shorter sleep duration and insomnia symptoms are associated with lower BMD levels in older adults. However, our results should be interpreted with caution. Future studies with larger sample size, objective assessment of sleep pattern, and prospective design are needed before a conclusion regarding sleep and BMD can be reached.
In vitro and in vivo studies suggest that carotenoids may inhibit bone resorption, yet no previous study has examined individual carotenoid intake (other than β‐carotene) and the risk of fracture. We ...evaluated associations of total and individual carotenoid intake (α‐carotene, β‐carotene, β‐cryptoxanthin, lycopene, lutein + zeaxanthin) with incident hip fracture and nonvertebral osteoporotic fracture. Three hundred seventy men and 576 women (mean age, 75 ± 5 yr) from the Framingham Osteoporosis Study completed a food frequency questionnaire (FFQ) in 1988–1989 and were followed for hip fracture until 2005 and nonvertebral fracture until 2003. Tertiles of carotenoid intake were created from estimates obtained using the Willett FFQ adjusting for total energy (residual method). HRs were estimated using Cox‐proportional hazards regression, adjusting for sex, age, body mass index, height, total energy, calcium and vitamin D intake, physical activity, alcohol, smoking, multivitamin use, and current estrogen use. A total of 100 hip fractures occurred over 17 yr of follow‐up. Subjects in the highest tertile of total carotenoid intake had lower risk of hip fracture (p = 0.02). Subjects with higher lycopene intake had lower risk of hip fracture (p = 0.01) and nonvertebral fracture (p = 0.02). A weak protective trend was observed for total β‐carotene for hip fracture alone, but associations did not reach statistical significance (p = 0.10). No significant associations were observed with α‐carotene, β‐cryptoxanthin, or lutein + zeaxanthin. These results suggest a protective role of several carotenoids for bone health in older adults.
Previous studies reported that dairy foods are associated with higher areal bone mineral density (BMD) in older adults. However, data on bone strength and bone microarchitecture are lacking. We ...determined the association of dairy food intake (milk, yogurt, cheese, milk + yogurt, and milk + yogurt + cheese, servings/week) with high resolution peripheral quantitative computed tomography (HR-pQCT) measures of bone (failure load, cortical BMD, cortical thickness, trabecular BMD, and trabecular number). This cross-sectional study included participants with diet from a food frequency questionnaire (in 2005–2008 and/or 1998–2001) and measurements of cortical and trabecular BMD and microarchitecture at the distal tibia and radius (from HR-pQCT in 2012–2015). Sex-specific multivariable linear regression estimated the association of dairy food intake (energy adjusted) with each bone measure adjusting for covariates. Mean age was 64 (SD 8) years and total milk + yogurt + cheese intake was 10.0 (SD 6.6) and 10.6 (6.4) servings/week in men and women, respectively. No significant associations were observed for any of the dairy foods and bone microarchitecture measures except for cheese intake, which was inversely associated with cortical BMD at the radius (p = 0.001) and tibia (p = 0.002) in women alone. In this cohort of primarily healthy older men and women, dairy intake was not associated with bone microarchitecture. The findings related to cheese intake and bone microarchitecture in women warrant further investigation.
Abstract Background Dietary protein is beneficial to bone health; however, dietary patterns of protein intake and their relationship with bone mineral density (BMD) have not been evaluated. Objective ...To examine the relationship of dietary protein food clusters with BMD at the femoral neck, trochanter, total femur, and lumbar spine among middle-aged and older men and women. Design Cross-sectional study. Participants and setting Two thousand seven hundred fifty-eight community-dwelling individuals from the Framingham Offspring Study. Methods BMD was measured by Lunar DPX-L (Lunar Radiation Corporation) in 1996-2001. Dietary intakes were estimated using the Willett food frequency questionnaire in either 1995-1998 or 1998-2001, and the exam closest to a participant’s BMD measurement was used. Cluster analysis (FASTCLUS procedure, k-means method) was used to classify participants into groups, determined by major sources of protein. Generalized linear regression was used to compare adjusted least-squares mean BMD across protein food clusters for all pairwise comparisons. Results From 2,758 participants (44% men; mean age 61±9 years, range=29 to 86 years), five protein food clusters were identified (chicken, fish, processed foods, red meat, and low-fat milk). Three of these food clusters showed associations with BMD. The red meat protein food cluster presented with significantly lower femoral neck BMD compared with the low-fat milk cluster (red meat 0.898±0.005 g/cm2 vs low-fat milk 0.919±0.007 g/cm2 ; P =0.04). Further, the processed foods protein cluster presented with significantly lower femoral neck BMD compared with the low-fat milk cluster (processed foods 0.897±0.004 g/cm2 vs low-fat milk 0.919±0.007 g/cm2 ; P =0.02). A similar, yet nonsignificant, trend was observed for other BMD sites examined. Conclusions Diets with the greatest proportion of protein intake from red meat and processed foods may not be as beneficial to the skeleton compared with dietary patterns where the highest proportion of protein is derived from low-fat milk.
The gut microbiome affects the inflammatory environment through effects on T-cells, which influence the production of immune mediators and inflammatory cytokines that stimulate osteoclastogenesis and ...bone loss in mice. However, there are few large human studies of the gut microbiome and skeletal health. We investigated the association between the human gut microbiome and high resolution peripheral quantitative computed tomography (HR-pQCT) scans of the radius and tibia in two large cohorts; Framingham Heart Study (FHS n=1227, age range: 32 - 89), and the Osteoporosis in Men Study (MrOS n=836, age range: 78 - 98). Stool samples from study participants underwent amplification and sequencing of the V4 hypervariable region of the 16S rRNA gene. The resulting 16S rRNA sequencing data were processed separately for each cohort, with the DADA2 pipeline incorporated in the16S bioBakery workflow. Resulting amplicon sequence variants were assigned taxonomies using the SILVA reference database. Controlling for multiple covariates, we tested for associations between microbial taxa abundances and HR-pQCT measures using general linear models as implemented in microbiome multivariable association with linear model (MaAslin2). Abundance of 37 microbial genera in FHS, and 4 genera in MrOS, were associated with various skeletal measures (false discovery rate FDR ≤ 0.1) including the association of
with bone measures, which was independently replicated in the two cohorts. A meta-analysis of the taxa-bone associations further revealed (FDR ≤ 0.25) that greater abundances of the genera;
and
, were associated with lower radius total vBMD, and tibia cortical vBMD respectively. Conversely, higher abundances of the genera;
, and
were associated with greater tibia cortical vBMD. We also investigated functional capabilities of microbial taxa by testing for associations between predicted (based on 16S rRNA amplicon sequence data) metabolic pathways abundance and bone phenotypes in each cohort. While there were no concordant functional associations observed in both cohorts, a meta-analysis revealed 8 pathways including the super-pathway of histidine, purine, and pyrimidine biosynthesis, associated with bone measures of the tibia cortical compartment. In conclusion, our findings suggest that there is a link between the gut microbiome and skeletal metabolism.
We evaluated the feasibility of using Computrition to design and implement a low vs. typical sodium meal plan intervention for older adults. Dietitians used Computrition to design a 7-day meal plan ...with three caloric levels (≤1750, 2000, ≥2250 kcals/day) and two sodium densities (low = 0.9 mg/kcal;
= 11 or typical = 2 mg/kcal;
= 9). Feasibility was determined by
definitions of effectiveness, sodium compliance, palatability of diet, sustainability, and safety. Given the low number of participants in one of the three calorie groups, the higher calorie groups were combined. Thus, comparisons are between low vs. typical meal plans at two calorie levels (≤1750 or ≥2000 kcals/day). Overall, regardless of the calorie group, the meal plans created with Computrition were effective in reaching the targeted sodium density and were safe for participants. Furthermore, individuals appeared to be equally compliant and reported similar palatability across meal plans. However, one of the three criteria for the sustainability definition was not met. In conclusion, we successfully used Computrition to design low and typical sodium meal plans that were effective, compliable, and safe. Future studies of older adults in similar settings should focus on improving the palatability of the meal plans and scaling this protocol to larger studies in older adults.
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