Protein Requirements for Older People

The average life expectancy has increased over the past century and now averages about 71 years globally. Along with significant medical advances, exercise, nutrition and lifestyle behaviors have all played a role in modulating longevity. Despite enhanced longevity, aging is associated with reduced muscle and bone mass, strength, metabolism and disease fighting capacity. Protein is a key nutrient in helping to modify the rate of progression of age-related affects. Over the past couple decades greater attention has focused on whether protein requirements are higher for older individuals versus their younger-aged counterparts. Today, it is clear that the evidence points to a higher base protein requirement for older individuals and that dietary guidance around the world relevant to this population and protein should be re-evaluated.

2018 iPB Consensus Statement on Protein Requirement for Older People

Based on the most up-to-date research and understanding on dietary protein for older individuals the International Protein Board presents its 2018 Consensus Statement:

"In general, advanced aging is associated with an increase in base protein requirements. Lower protein requirement guidance levels such as 0.8g/kg body weight should be increased. Moreover, education and practical solutions are important to ensure adequate protein intake for older individuals in conjunction to lifestyle behaviors such as resistance or weight-bearing exercise."

iPB Survey 2018

Protein Requirements for Older People

iPB survey question: “The current dietary requirements for protein (e.g. ≈0.8 g/kg body weight or ≈46g women/56g men) stated by several countries is an adequate diet planning level for daily intake for people who are getting older (e.g. 50+ years of age)."

iPB average score:  The iPB survey score is 4.82 with answers range from 1 = Strongly Agree to 5 = Strongly Disagree. 

2018 iPB Brief

Protein Requirements for Older People

In 2015, the average projected life expectancy globally for those born that year was 71.4 years. Moreover, about 30 countries recorded average life expectancy at 80 years or above including Japan, Singapore and Switzerland all above 83 years.1 Without question, medical advances were a principal driver of extended longevity throughout the 20th and into the 21st century.  Moreover, nutrition, exercise and lifestyle improvements also played a role. While its easy to celebrate greater longevity, it is important to recognize that extended quantity of life isn’t always associated with an extended quality of life.

The last few decades of the human lifespan are associated with reduced muscle and bone mass, strength, metabolism and often decreased capacity to fight disease.2-4 Thus, there is still much to learn about the additive and synergistic relationships of all the influential factors; not least, the role of the most significant macronutrients associated with the quality of aging: protein. Over the past couple of decades more attention has focused on whether the requirements are actually higher for older people relative to their younger-aged adult counterparts.

Anatomically, protein is the basis of physical movement and stability in skeletal muscle and bone. Muscle is nearly 90% protein on a dry weight and bone is close to 40% protein. Reduction in muscle mass and function during aging is referred to as sarcopenia.4-7 Some estimate loss of muscle mass is 3-8% per decade beginning as early as in the 30s to 40s.6,7 Sarcopenia is partly attributed to reduced physical and mechanical stress via less daily activity and weight bearing exercise, as well as more time in seated or supine positions. Moreover, protein serves as the basis of immunity, organ function and general tissue integrity. This points to potential relationships between sarcopenia and general bodily functions.

Looking more closely at skeletal muscle, aging can be associated with a reduction in sensitivity to the stimulatory effect of protein on the activation of muscle protein synthesis, as well as processing steps yielding the actual protein.8-12 This is reflected in the need for higher levels of dietary protein to increase protein synthesis to levels comparable to younger adults during inactivity as well as in response to exercise.8,9 Some of the age-related difference in muscle protein synthesis response to dietary protein may be related to reduction in regular physical stress on the tissue, especially resistance/weight bearing exercise. Moreover, because the essential amino acids (EAA) and one in particular, leucine, are critical to maximize protein synthesis, these remain target amino acids for investigation.9,10

Despite the importance of protein to wellness during the moderate to advanced aging process, emphasis on dietary levels is not always elevated to higher priority. In addition to physiological differences which can compromise protein nourishment for older individuals, often certain higher protein foods are limited in the diet based on reduced caloric need, cost, issues related to chewing and decreased appetite. In addition, higher protein foods are often targeted for reduction in the diet based on heart disease concerns, whether valid or not.

The requirement levels stated by several regions, such as the US, Canada and across Europe, have not identified a consistent and higher requirement for advanced aging. Meanwhile, increased attention has been apparent at scientific conferences and specific international work groups over the past decade or so. For instance, the information presented at the 2015 Canadian Nutrition Society conference, Advances in Protein Nutrition across the Lifespan, presented the evidence at that time indicating that intakes in the range of at least 1.2 to 1.6 g/(kg BW/day) of high-quality protein is a more ideal target for achieving optimal health outcomes in adults.12 In support of an increased base requirement, researchers estimated the protein requirement in young adults and in both elderly men and women to be 0.9 and 1.2 g/kg/day as the Estimated Average Requirements (EAR) and RDA in the US and Canada, respectively.13

Meanwhile, the PROT-AGE group representing 13 researchers from 9 countries and 3 continents studying protein and aging, recommended higher dietary protein intake in the range of 1.0 to 1.2 g/kg BW/d for healthy older adults (65 and older) to maintain and regain muscle.15 In addition, 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. Furthermore, they recommended that the per-meal anabolic threshold of dietary protein/amino acid intake is higher in older individuals (ie, 25 to 30 g protein per meal, containing about 2.5 to 2.8 g leucine) in comparison with young adults. These recommendations are endorsed by the European Union Geriatric Medicine Society (EUGMS), the International Association of Gerontology and Geriatrics-European Region (IAGGER), the International Association of Nutrition and Aging (IANA), and the Australian and New Zealand Society for Geriatric Medicine (ANZSGM).

By and large, current information indicates that protein is a critical macronutrient for older individuals because of its role as a structural and functional macronutrient. Furthermore, evidence suggests that during the aging process, the efficiency of protein and/or specific amino acids may decrease, thereby augmenting the need for higher amounts to 1) prevent deficiency and 2) promote more desirable health and quality of life.

Citations

  1. World Health Organization Life Expectancy: http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/
  2. Rousset S, Droit-Volet S, Boirie Y. Change in protein intake in elderly French people living at home after a nutritional information program targeting protein consumption. J Am Diet Assoc. 2006 Feb;106(2):253-61.
  3. Vanleerberghe P, De Witte N, Claes C, Schalock RL, Verté D. The quality of life of older people aging in place: a literature review. Qual Life Res. 2017 Nov;26(11):2899-2907.
  4. Carvalho do Nascimento PR, Poitras S, Bilodeau M. How do we define and measure sarcopenia? Protocol for a systematic review. Syst Rev. 2018 Mar 27;7(1):51.
  5. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010 Jul;39(4):412-23. (Open Access)
  6. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998 Apr 15;147(8):755-63.
  7. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia: Protein, amino acid metabolism and therapy. Curr Opin Clin Nutr Metab Care. 2009 Jan: 12(1):86-90. (Open Access)
  8. Rafii M, Chapman K, Owens J, Elango R, Campbell WW, Ball RO, Pencharz PB, Courtney-Martin G. Dietary Protein Requirement of Female Adults >65 Years Determined by the Indicator Amino Acid Oxidation Technique Is Higher Than Current Recommendations. J Nutrition. 2015 Jan 145(1): 18–24.
  9. Katsanos, C.S.; Kobayashi, H.; Sheffield-Moore, M.; Aarsland, A.; Wolfe, R.R. A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Am. J. Physiol. Endocrinol. Metab. 2006, 291, 381–387. (Open Access)
  10. Garlick PJ. The role of leucine in the regulation of protein metabolism. J Nutr. 2005, 135: 1553S–1556.
  11. Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB, Moore LL, Rodriguez NR, van Loon LJ. Protein and healthy aging. Am J Clin Nutr. 2015 (101) (suppl):1339S-45S. (Open Access)
  12. Phillips SM, Chevalier S, Leidy HJ. Protein “requirements” beyond the RDA: implications for optimizing health. Appl. Physiol. Nutr. Metab. 41: 565–572 (2016). (Open Access Article)
  13. Courtney-Martin G, Ball RO, Pencharz PB, Elango R. Protein Requirements during Aging. Nutrients. 2016 Aug 11;8(8). (Open Access Free Article)
  14. Baum JI, Kim IY, Wolfe RR. Protein Consumption and the Elderly: What Is the Optimal Level of Intake? Nutrients. 2016 Jun 8;8(6).
  15. Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, Phillips SM, Sieber C, Stehle P, Teta D, Visvanathan R, Volpi E, Boirie Y. Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. JAMDA 14 (2013) 542e559. (Open Access)

iPB Approved PodCasts

SOUND BITES (Jun 14, 2016) : Podcast Episode 039: Protein & Exercise: Partners in Successful Aging – Dr Stuart Phillips, McMasters University - Covers the importance of high-quality protein and exercise in healthy aging – preventing the loss of muscle associated with aging and therefore health-related adverse events.

iPB Approved Videos

Protein Builds (Feb 17, 2016): Protein Builds - For adults approaching or over the age of 50, Dr. Stuart Phillips recommends protein consumption at every meal. In combination with regular exercise, this will prevent the loss of muscle tissue as we age and help adults continue an active and healthy lifestyle.

IRAKI Nutrition Video (Feb 3, 2017): Sarcopenia: Impact of Exercise and Nutrition – Dr Stuart Phillips overviews sarcopenia and key factors in development and what are some of the most important factors in prevention.

iPB Approved Research/Citations

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010 Jul;39(4):412-23. (Open Access)

Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia: Protein, amino acid metabolism and therapy. Curr Opin Clin Nutr Metab Care. 2009 Jan: 12(1):86-90. (Open Access)

Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB, Moore LL, Rodriguez NR, van Loon LJ. Protein and healthy aging. Am J Clin Nutr. 2015 (101) (suppl):1339S-45S. (Open Access)

Videos

Dr Stu Phillips presents a short overview (2 min) on the Importance of Protein as People Get Older and daily distribution and food sources. 

Dr Stu Phillips presents on the Importance of Protein as People Get Older and how requirements are higher versus their younger counterparts. Protein and weight bearing exercise are keys to better retention of strength, muscle and bone health.  

Dr Stu Phillips is interviewed on Sarcopenia and Role of Protein and Increasing RDA. Sarcopenia is a loss of muscle and functional capacity associated with aging and role of exercise, especially weight bearing exercise and ensuring more protein than the RDA as part of prevention measure. 

Dr Douglas Paddon-Jones presents on Muscle and Inactivity: Projecting Muscle Health During Aging. The negative impact of inactivity on muscle maintenance and functional capacity during aging and that protein is the keystone nutrient in prevention.