Health Effects of Increasing Protein Intake Above the Current Population Reference Intake in Older Adults: A Systematic Review of the Health Council of the Netherlands.

Maria T E Hopman, Marjolein Visser, Emely de Vet, Janneke Verkaik-Kloosterman, Coen D A Stehouwer, Nicole M de Roos, Ronald P Mensink, Stef P J Kremers, Jolein A Iestra, Linda M Hengeveld, Johannes Hans B van Goudoever, Johanna M Geleijnse, Eric Boersma, Ellen E Blaak, Joline W J Beulens, Stephan J L Bakker, Lydia A Afman, Janette de Goede

Journal: Advances in nutrition (Bethesda, Md.) 2022;13(4):1083-1117

PMID: 35016214

Free Full Text on Elsevier Science View on PubMed

Abstract

Whether older adults need more protein than younger adults is debated. The population reference intake for adults set by the European Food Safety Authority is 0.83 g/kg body weight (BW)/d based primarily on nitrogen balance studies, but the underlying data on health outcomes are outdated. An expert committee of the Health Council of the Netherlands conducted a systematic review (SR) of randomized controlled trials (RCTs) examining the effect of increased protein intake on health outcomes in older adults from the general population with an average habitual protein intake ≥0.8 g/(kg BW · d). Exposures were the following: 1) extra protein compared with no protein and 2) extra protein and physical exercise compared with physical exercise. Outcomes included lean body mass, muscle strength, physical performance, bone health, blood pressure, serum glucose and insulin, serum lipids, kidney function, and cognition. Data of >1300 subjects from 18 RCTs were used. Risk of bias was judged as high (n = 9) or "some concerns" (n = 9). In 7 of 18 RCTs, increased protein intake beneficially affected ≥1 of the tested outcome measures of lean body mass. For muscle strength, this applied to 3 of 8 RCTs in the context of physical exercise and in 1 of 7 RCTs without physical exercise. For the other outcomes, <30% (0-29%) of RCTs showed a statistically significant effect. The committee concluded that increased protein intake has a possible beneficial effect on lean body mass and, when combined with physical exercise, muscle strength; likely no effect on muscle strength when not combined with physical exercise, or on physical performance and bone health; an ambiguous effect on serum lipids; and that too few RCTs were available to allow for conclusions on the other outcomes. This SR provides insufficiently convincing data that increasing protein in older adults with a protein intake ≥0.8 g/(kg BW · d) elicits health benefits.

Address: Health Council of the Netherlands, The Hague, The Netherlands.; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.; Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.; Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands.; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.; Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.; Erasmus MC, University Medical Center, Department of Cardiology, Rotterdam, The Netherlands.; Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Department of Pediatrics, Amsterdam, The Netherlands.; Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.; Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; National Institute of Public Health and the Environment, Bilthoven, The Netherlands.; Department of Social Sciences, Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, The Netherlands.; Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

DOI: 10.1093/advances/nmab140

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MeSH Terms: Aged, Body Composition, Dietary Proteins, Humans, Lipids, Muscle Strength, Netherlands