The cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake : a randomized controlled trial

Purpose To examine the cost effectiveness of dietary advice to increase protein intake on 6-month change in physical functioning among older adults. Methods In this multicenter randomized controlled trial, 276 community-dwelling older adults with a habitual protein intake = 1.2 g/kg aBW/d (PROT, n = 96), Intervention 2; similar advice and in addition advice to consume protein (en)rich(ed) foods within half an hour after usual physical activity (PROT + TIMING, n = 89), or continue the habitual diet with no advice (CON, n = 91). Primary outcome was 6-month change in 400-m walk time. Secondary outcomes were 6-month change in physical performance, leg extension strength, grip strength, body composition, self-reported mobility limitations and quality of life. We evaluated cost effectiveness from a societal perspective. Results Compared to CON, a positive effect on walk time was observed for PROT; - 12.4 s (95%CI, - 21.8 to - 2.9), and for PROT + TIMING; - 4.9 s (95%CI, - 14.5 to 4.7). Leg extension strength significantly increased in PROT (+ 32.6 N (95%CI, 10.6-54.5)) and PROT + TIMING (+ 24.3 N (95%CI, 0.2-48.5)) compared to CON. No significant intervention effects were observed for the other secondary outcomes. From a societal perspective, PROT was cost effective compared to CON. Conclusion Dietary advice to increase protein intake to >= 1.2 g/kg aBW/d improved 400-m walk time and leg strength among older adults with a lower habitual protein intake. From a societal perspective, PROT was considered cost-effective compared to CON. These findings support the need for re-evaluating the protein RDA of 0.8 g/kg BW/d for older adults.Peer reviewe

Body weight and body composition in old age and their relationship with frailty

Purpose of review Aging is associated with various changes in body composition, including changes in weight, loss of muscle mass, and increase in fat mass. This article describes the role of body weight and body composition, and their changes, in the risk of frailty in old age. Recent findings Based on current literature, observational studies on obesity and high waist circumference show most convincing results for an association with frailty. The independent role of muscle mass and muscle fat infiltration remains unclear, mainly due to a lack of studies and a lack of accurate measurement of body composition by computed tomography or MRI. Weight loss and exercise training intervention studies can be of benefit to frail older adults. Summary Obesity and high waist circumference may be important determinants of frailty in old age, whereas the role of muscle mass and muscle fat infiltration is still unclear. More prospective studies that will specifically focus on frailty as an outcome measure are needed to identify specific body composition components as potential targets for the prevention of frailty in old age

Trends in lifestyle among three cohorts of adults aged 55-64 years in 1992/1993, 2002/2003 and 2012/2013

Background: Unhealthy lifestyle factors, such as obesity, smoking, excessive alcohol consumption and physical inactivity, are associated with increased morbidity and mortality risk, even in older age. We investigated trends in lifestyle among three cohorts of adults aged 55-64 years from the Netherlands. Methods: Data from the Longitudinal Aging Study Amsterdam were used. This study consisted of three randomly selected samples of men and women. Lifestyle data were collected in 1992/1993 (cohort 1, n = 988), in 2002/2003 (cohort 2, n = 1002) and in 2012/2013 (cohort 3, n = 1023). Trends in lifestyle across cohorts were tested using multivariable regression analyses. Results: Complete lifestyle data were available for 834 participants from cohort 1, 861 from cohort 2 and 845 from cohort 3. Among men, but not in women, mean BMI and prevalence of obesity increased over time. The mean minutes per day spent being physically active decreased among both men and women, from 130 ± 107 and 230 ± 122 (1992/1993) to 114 ± 100 and 192 ± 109 (2002/2003), and 126 ± 98 and 187 ± 112 (2012/2013), respectively. The percentage of men and women defined as excessive drinkers (>7 alcoholic consumptions per week) increased from 54.9%, 62.3% to 65.4% (men) and 22.7%, 36.1% to 37.4% (women), in 1992/1993, 2002/2003 and 2012/2013, respectively. The percentage of non-smoking men and women increased over time. Conclusion: The lifestyle of Dutch adults aged 55-64 years was less healthy in 2012/2013 compared with 2002/2003 and 1992/1993. Political attention regarding healthy ageing should target the prevention of overweight, physical inactivity and excessive alcohol consumption in middle-aged persons

Experiences with using persuasive technology in a diet trial for older adults

The PROMISS trial studies the effect of dietary advice to increasing protein intake on physical function in older adults with a relatively low protein intake, to promote healthy ageing. Part of this 6-months trial is the persuasive technology sub study, in which a tablet application using persuasive communication techniques and a specifically designed foodbox, both used for diet tracking, are provided to 48 participants. In this paper we present the results of our sub study for technology adherence, protein intake, experience of dietary advice and technology, and the effect of gamification on protein knowledge. Our results show that participants positively evaluate the tablet, but negatively evaluate the foodbox. The adherence of tablet users within the trial is high (on average 83% or 133 days), but there are no significant differences in the change of protein intake for our participants, compared to the 41 other participants in the intervention conditions of the trial. Based on these results we conclude that a diet tracking application designed for older adults is a feasible and appreciated tool to use within a dietary intervention study in older persons

Experiences with using persuasive technology in a diet trial for older adults

The PROMISS trial studies the effect of dietary advice to increasing protein intake on physical function in older adults with a relatively low protein intake, to promote healthy ageing. Part of this 6-months trial is the persuasive technology sub study, in which a tablet application using persuasive communication techniques and a specifically designed foodbox, both used for diet tracking, are provided to 48 participants. In this paper we present the results of our sub study for technology adherence, protein intake, experience of dietary advice and technology, and the effect of gamification on protein knowledge. Our results show that participants positively evaluate the tablet, but negatively evaluate the foodbox. The adherence of tablet users within the trial is high (on average 83% or 133 days), but there are no significant differences in the change of protein intake for our participants, compared to the 41 other participants in the intervention conditions of the trial. Based on these results we conclude that a diet tracking application designed for older adults is a feasible and appreciated tool to use within a dietary intervention study in older persons

Insights on the effect and experience of a diet-tracking application for older adults in a diet trial

With an ageing population, healthy ageing becomes more important. Healthy nutrition is part of this process and can be supported in many ways. The PROMISS trial studies the effect of increasing protein intake in older adults on their physical functioning. Within this trial, a sub-study was performed, researching the added effect of using a diet-tracking app enhanced with persuasive and (optional) gamification techniques. The goal was to see how older adult participants received such technology within their diet program. There were 48 participants included in this sub-study, of which 36 completed the study period of 6 months. Our results on adherence and user evaluation show that a dedicated app used within the PROMISS trial is a feasible way to engage older adults in diet tracking. On average, participants used the app 83% of the days, during a period of on average 133 days. User-friendliness was evaluated with an average score of 4.86 (out of 7), and experienced effectiveness was evaluated with an average score of 4.57 (out of 7). However, no effect of the technology on protein intake was found. The added gamification elements did not have a different effect compared with the version without those elements. However, some participants did like the added gamification elements, and it can thus be nice to add them as additional features for participants that like them. This article also studies whether personal characteristics correlate with any of the other results. Although some significant results were found, this does not give a clear view on which types of participants like or benefit from this technology

Effect of personalized dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults: results from the PROMISS trial

Purpose: Diet modelling studies suggest that increasing protein intake with no consideration for sustainability results in a higher environmental impact on the diet. To better understand the impact in real life, the aim of this study was to assess the effect of dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults. Methods: Food consumption and environmental impact were analyzed among 124 Dutch older adults with lower habitual protein intake (< 1.0 g/kg adjusted body weight/day) participating in the six-month PROMISS trial. Dietary intake data from three 24-h dietary recalls, aided by food diaries, and results from life cycle assessments were used to examine the differences in changes in food consumption and environmental impact between those who received dietary advice to isocalorically increase protein intake to ≥ 1.2 g/kg aBW/d (Protein + ; n = 84) and those who did not receive dietary advice (Control; n = 40). Results: Compared to the Control, Protein + increased protein intake from animal-based food products (11.0 g protein/d, 95% CI 6.6–15.4, p < 0.001), plant-based food products (2.1 g protein/d, 95% CI 0.2–4.0, p = 0.031) and protein-enriched food products provided during the trial (18 g protein/d, 95% CI 14.5–21.6, p < 0.001) at the 6-month follow-up. Diet-associated greenhouse gas emissions increased by 16% (p < 0.001), land use by 19% (p < 0.001), terrestrial acidification by 20% (p = 0.01), and marine eutrophication by 16% (p = 0.035) in Protein + compared to the Control. Conclusion: This study found that dietary advice increased protein intake, favoring animal-based protein, and increased the environmental impact of the diet in older adults. Trial registration: ClinicalTrials.gov. NCT03712306. October 2018

Perceived athletic competence and physical activity in children with developmental coordination disorder who are clinically referred, and control children

The relationship between perceived athletic competence (PAC) and physical activity (PA) in children with developmental coordination disorder (DCD) is still unclear. This study investigated differences in PAC and PA between, and within, a group of children with DCD that were clinically referred (n = 31) and a group of control children (n = 38), aged 7-12 years. All children were categorized in four groups: (1) children with DCD/low PAC, (2) children with DCD/normal to high PAC, (3) control children/low PAC, and (4) control children/normal to high PAC. PAC was assessed with the Self-Perception Profile for Children, and PA was assessed with the Modifiable Activity Questionnaire. Children with DCD participated less in unorganized PA, but not in organized PA, compared with control children. Normal to high PAC was found in more than half of the children (64.5%) with DCD. Children with DCD/low PAC and children with DCD/normal to high PAC participated significantly less in unorganized physical activity compared with control children/normal to high PAC, but not compared with control children/low PAC. The results indicate that there are large individual differences in PAC in children with DCD. (C) 2014 Elsevier Ltd. All rights reserved