Special Article
Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group

https://doi.org/10.1016/j.jamda.2013.05.021Get rights and content
Under a Creative Commons license
open access

Abstract

New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance- and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, ≥1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2–1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73m2), but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function.

Keywords

Older people
dietary protein
exercise
protein quality
physical function

Cited by (0)

All authors attended the setup meeting, so they all were involved in conception of principal content. Working teams then drafted text, and all authors critically reviewed and edited both the draft manuscript and the final text.

Endorsed by the European Union Geriatric Medicine Society (EUGMS), the International Association of Gerontology and Geriatrics-European Region (IAGG-ER), the International Association of Nutrition and Aging (IANA), and the Australian and New Zealand Society for Geriatric Medicine (ANZSGM).

The EUGMS received a grant from Nestlé Nutrition to fund the Study Group on meeting protein needs of older people (PROT-AGE); this grant was used for operational activities of the EUGMS and for funding the meeting of the Study Group. Members of the group did not receive honoraria or other benefits for their work on this document.

J.B. has received speaker honoraria from Nestlé, Nutricia, Fresenius, Abbott, Pfizer, and Novartis, and received research grants from Nestlé and Nutricia. All proceeds are turned over to an official account of J.B.’s hospital. T.C. has received research funding from Nestlé and Nutricia, and served as a speaker for Nestlé, Abbott, Nutricia, and Fresenius-Kabi. M.C. has been a speaker for Nestlé, received a research grant from Pfizer, and been a consultant to Sanofi-Aventis. A.C.-J. has received speaker honoraria from Abbott Nutrition International, Nestlé, and Nutricia. J.M. has been a consultant to Purina, Nutricia, and Sanofi-Aventis. S.P. has served as both a speaker and consultant for Nestlé. C.S. has been a speaker for Abbott Nutrition International, a consultant for Fresenius, and a speaker and consultant for Nutricia and Nestlé. P.S. declared no conflict of interest. D.T. has served as a consultant and speaker for Abbott Nutrition International, received a research grant from the Baxter ExtraMural Grant Program, and was a speaker for Fresenius Medical Care, Fresenius Kabi, and Shire. R.V. has performed educational projects for and received grants from Nestlé Australia and Nestlé Inc. Y.B. has received speaker honoraria from Nestlé, Nutricia, and Lactalis, and research funding from Nutricia, Lactalis, and Sanofi-Aventis.