Effectiveness of a Per-Meal Protein Prescription and Nutrition Education with versus without Diet Coaching on Dietary Protein Intake and Muscle Health in Middle-Aged Women

Sufficient dietary protein intake is vital to maintaining muscle health with aging. Yet protein intake among adults is often inadequate. This study’s main objective was to examine the impact of nutrition education (NE) and a per-meal protein prescription (PRx) with versus without diet coaching on protein intake. A secondary objective examined its effects on muscle health. Participants included 53 women, age 45–64 years. All participants received NE and PRx; those randomized to coached-group received 10-weeks of diet coaching. Assessments included: protein intake at baseline, weeks 4 and 12 and muscle health (muscle mass, grip strength, five-chair rise test, 4 mgait speed test). The Chi-square test examined percentages of participants meeting PRx between groups. Repeated measures analysis of variance assessed within group and intervention effects on protein intake and muscle health parameters. Protein intake (g/kg body weight) increased (p < 0.001): not-coached (n = 28) 0.8 ± 0.2 to 1.2 ± 0.3 and coached (n = 25) 1.0 ± 0.2 to 1.4 ± 0.3 with no significant difference between groups. A greater percentage of coached-group participants met (p = 0.04) breakfast (72%) and met (p < 0.001) three-meal (76%) PRx versus not-coached participants (25% and 53%, respectively). Participants in both groups exhibited significantly (p < 0.001) improved times for the five-chair rise test and 4 mgait speed test. Diet coaching in conjunction with a PRx and NE should be considered to assist individuals in improving protein intake through self-selection of protein-rich foods.

Does Fish Farming Improve Household Nutritional Status? Evidence from Bangladesh

In the present study, nutritional status was assessed using dietary diversity of fish and non-fish farming households in Mymensingh district of Bangladesh. It has determined the incidence of poverty in fish and non-fish farm households through a comparative analysis of family profile, food consumption, calories, and protein intake. A total of 420 farms were selected for data collection using structured questionnaires with 210 fish and 210 non-fish farm families. The study using both descriptive and functional analysis revealed that the respondent age of both farms was 45.10 years, family size was 5.70, average education was 4.64 schooling years, and average farm size was 0.514 hectares. As a result, due to the increase in household income, fish farm families improved their food consumption, calories, and protein intake in comparison with non-fish farms. On a direct calorie intake (DCI) basis, the overall absolute and hardcore poverty levels of fish farm households were 32 percent and 18 percent, respectively, while those of non-fish farm households were 22 percent and 10 percent, respectively. Therefore, the incidence of poverty was higher in non-fish farming families than in fish farming families. In principle, provision of various forms of government assistance through the Department of Fisheries (DOF) will further intensify and strengthen fish farming, which will easily bring fallow and uncultivated lands of the area under fish farming. Moreover, it is possible to inspire the younger generation through this research that will help them to become a fish farm-based entrepreneur. The main conclusion of the present study is that fish farming is more positively related to household income, family food intake, and nutritional status than any other type of farming.

Dietary protein intake and health-related outcomes: a methodological protocol for the evidence evaluation and the outline of an evidence to decision framework underlying the evidence-based guideline of the German Nutrition Society

Purpose The present work aimed to delineate (i) a revised protocol according to recent methodological developments in evidence generation, to (ii) describe its interpretation, the assessment of the overall certainty of evidence and to (iii) outline an Evidence to Decision framework for deriving an evidence-based guideline on quantitative and qualitative aspects of dietary protein intake. Methods A methodological protocol to systematically investigate the association between dietary protein intake and several health outcomes and for deriving dietary protein intake recommendations for the primary prevention of various non-communicable diseases in the general adult population was developed. Results The developed methodological protocol relies on umbrella reviews including systematic reviews with or without meta-analyses. Systematic literature searches in three databases will be performed for each health-related outcome. The methodological quality of all selected systematic reviews will be evaluated using a modified version of AMSTAR 2, and the outcome-specific certainty of evidence for systematic reviews with or without meta-analysis will be assessed with NutriGrade. The general outline of the Evidence to Decision framework foresees that recommendations in the derived guideline will be given based on the overall certainty of evidence as well as on additional criteria such as sustainability. Conclusion The methodological protocol permits a systematic evaluation of published systematic reviews on dietary protein intake and its association with selected health-related outcomes. An Evidence to Decision framework will be the basis for the overall conclusions and the resulting recommendations for dietary protein intake.

Expressed Breast Milk Analysis: Role of Individualized Protein Fortification to Avoid Protein Deficit After Preterm Birth and Improve Infant Outcomes

Background: Expressed breast milk (EBM) protein content is highly variable between mothers and often below published values that are still used for EBM protein fortification strategies. This approach may result in significant protein deficit and suboptimal protein energy (P/E) ratio. The study aim was to determine whether individualized EBM protein analysis and fortification will reduce preterm infant protein deficits and improve growth and neurodevelopmental outcome.Study Methods: In a single-center randomized, blinded study of infants born at 24 0/7–29 6/7 weeks, mother-specific protein values measured by a milk analyzer were used to individualize infant-specific protein intake (interventional group, IG), and compared this to a standardized protein fortification scheme based on published values of EBM protein content of 1.4 g/dL (control group, CG). For IG, milk analyzer protein values of mother's EBM were used to adjust protein content of the EBM. The CG EBM protein content was adjusted using the standard published value of 1.4 g/dL and not based on milk analyzer values. EBM protein content, protein intake, protein/energy (P/E) ratio, weight (WT), head circumference (HC), length (L), growth velocity (GV) from 2 to 6 weeks of age, WT, HC and L Z-Scores at 32- and 35-weeks PMA, and lean body mass (35 weeks PMA skin fold thickness) were measured. Neurodevelopment was assessed by Bayley III at average 24 months corrected gestational age (CGA).Results: EBM protein content before fortification was significantly below published values of 1.4 g/dL at all time points in both CG and IG. CG protein deficit was significantly decreased and progressively worsened throughout the study. Individualized protein fortification in IG avoided protein deficit and optimized P/E ratio. Although no significant change in short-term GV (at 6 weeks of age) was seen between groups, IG infants born at &lt;27 weeks had significant improvements in WT and L z-scores, and leaner body mass at 32 and 35 weeks PMA. IG exhibited significantly improved cognitive scores at 24 months CGA.Conclusions: Infant-specific protein supplementation of mother's EBM optimized P/E ratio by eliminating protein deficit and improved growth z scores at 32- and 35-weeks PMA and neurocognitive testing at 24 months.

Intake of Animal Protein and Dietary Sources in the Colombian Population: Results of the National Nutrition Survey (ENSIN-2015)

Background. There is a lack of knowledge in Colombia about dietary intake and sources of animal protein. Design. Cross-sectional, nationally representative surveys. Setting. Colombia. Participants. n = 32,457 participants aged from 1 to 64 years. The sample analyzed included 21,036 boys and nonpregnant girls, 10,099 adults, and 1,322 pregnant women, 118 of whom were below 18 years of age. Results. Protein intake was 32.9 g/d (95% CI: 32.4, 33.4) per 1,000 kilocalories. The relative contribution (%) of total protein to the total energy intake/day (acceptable macronutrient distribution) was 13.2% (95% CI: 13.0, 13.3). The acceptable macronutrient distribution (AMDR) for animal protein for those aged 1 to 64 years was 7.8% (95% CI: 7.6, 8.0), with a minimum of 7.1% (95% CI: 6.7, 7.5), which was for children aged from 13 to 17 years, and a maximum of 8.3% (95% CI: 8.1, 8.5), for children aged from 1 to 4 years ( P = 0.018 ). For all groups, animal protein made up the majority of total proteins, with 62.6% (95% CI: 61.7, 63.6) for preschoolers, 55.8% (95% CI: 53.2, 58.4) for school-aged children, 54.6% (95% CI: 53.0, 56.1) for adolescents, 58.1% (95% CI: 57.5, 58.7) for adults, and 57.5% (95% CI: 55.2, 59.7) for pregnant women ( P = 0.027 ). The three main dietary sources of animal protein were red meat (17.8%), chicken (16.3%), and eggs (10.5%). The sources of vegetal protein were bread-arepa-pasta (20.0%), cereals (19.8%), and legumes (8.2%). Conclusions. Protein intake is excessive according to the Recommended Dietary Allowance (RDA), while it is not excessive from the perspective of the AMDR.

Using Secondary Fish Raw Materials to Produce Gerodietic Food Products

Elderly people frequently experience a decrease in body weight, associated primarily with a decrease in protein intake, for a variety of reasons, including social factors. In this regard, the consumption of liquid food rations enriched with watersoluble protein hydrolysates is the simplest solution to the problem of providing people with sufficient protein intake. Development of methods for the manufacture of fish and cereal-based products is promising due to the possibility to simulate the composition of a certain nutritional compound for functional consumption by various population groups. Our task was to substantiate the parameters and components for creating a product for gerodietic use. The development of the technology included the following stages: preparation of ingredients, such as cereal filler, by-products from herring cutting, natural food coloring, vegetable oil, table salt and water; their mixing; heat treatment; cooling and packaging. The finished product has a light orange color, characteristic of natural pollock roe, and a pleasant fishy smell; the ”fish eggs” are easily separated from each other. New types of gerodietic products make it possible to increase the nutritional and biological value of the diet of the elderly, as well as to inhibit the development of age-related pathological changes. Keywords: Secondary Raw Materials, Functional Foods, Gerodietic Food Products

Trends of central obesity and associations with nutrients intake and daily behaviors among women of childbearing age in China

Background Obesity among women of childbearing age has becoming an important public health concern. We aimed to describe the trends of central obesity among Chinese women of childbearing age from 2004 to 2011 and to examine its associations with nutrients intake and daily behaviors. Methods Longitudinal data were derived from the China Health and Nutrition Survey. Participants consisted of 2481 women aged 15–44 years old. WC (Waist circumference) and WHtR (Waist to height ratio) were adopted as indicators of central obesity. Generalized linear mixed model was performed to analyze the associations of nutrients intake and daily behaviors with central obesity. Results From 2004 to 2011, the prevalence of central obesity among Chinese women of childbearing age increased from 21.6 to 30.7% (WC as indice) or from 22.8 to 32.6% (WHtR as indice) (both p < 0.001). Protein intake above the AMDR (Acceptable macronutrient distribution range) (OR = 1.21, 95% CI 1.05–1.39, p < 0.01) and non-participation in LTPA (Leisure time physical activity) (OR = 1.45, 95% CI 1.17–1.80, p < 0.001) were risk factors for high WC, and the latter was also associated with high WHtR (OR = 1.36, 95% CI 1.10–1.67, p < 0.01). For those women who had high WC & high WHtR, the impacts of protein intake and LTPA became stronger, especial LTPA (OR = 1.53, 95% CI 1.21–1.94, p < 0.001). Age-stratified analyses found that non-participation in LTPA was key factor for central obesity in 15–34 age group, while protein intake above the AMDR was pronounced in the 35–44 age group. Conclusions Non-participation in LTPA and protein intake above the AMDR were significant contributors of central obesity, which could be intervention targets to deal with the growing trend of central obesity among women of childbearing age.

Protein intake and outcome of critically ill patients: analysis of a large international database using piece-wise exponential additive mixed models

Background Proteins are an essential part of medical nutrition therapy in critically ill patients. Guidelines almost universally recommend a high protein intake without robust evidence supporting its use. Methods Using a large international database, we modelled associations between the hazard rate of in-hospital death and live hospital discharge (competing risks) and three categories of protein intake (low: < 0.8 g/kg per day, standard: 0.8–1.2 g/kg per day, high: > 1.2 g/kg per day) during the first 11 days after ICU admission (acute phase). Time-varying cause-specific hazard ratios (HR) were calculated from piece-wise exponential additive mixed models. We used the estimated model to compare five different hypothetical protein diets (an exclusively low protein diet, a standard protein diet administered early (day 1 to 4) or late (day 5 to 11) after ICU admission, and an early or late high protein diet). Results Of 21,100 critically ill patients in the database, 16,489 fulfilled inclusion criteria for the analysis. By day 60, 11,360 (68.9%) patients had been discharged from hospital, 4,192 patients (25.4%) had died in hospital, and 937 patients (5.7%) were still hospitalized. Median daily low protein intake was 0.49 g/kg [IQR 0.27–0.66], standard intake 0.99 g/kg [IQR 0.89– 1.09], and high intake 1.41 g/kg [IQR 1.29–1.60]. In comparison with an exclusively low protein diet, a late standard protein diet was associated with a lower hazard of in-hospital death: minimum 0.75 (95% CI 0.64, 0.87), and a higher hazard of live hospital discharge: maximum HR 1.98 (95% CI 1.72, 2.28). Results on hospital discharge, however, were qualitatively changed by a sensitivity analysis. There was no evidence that an early standard or a high protein intake during the acute phase was associated with a further improvement of outcome. Conclusions Provision of a standard protein intake during the late acute phase may improve outcome compared to an exclusively low protein diet. In unselected critically ill patients, clinical outcome may not be improved by a high protein intake during the acute phase. Study registration ID number ISRCTN17829198

Protein Intake among Community-Dwelling Older Adults: The Influence of (Pre-) Motivational Determinants

An adequate protein intake is important for healthy ageing, yet nearly 50% of Dutch community-dwelling older adults do not meet protein recommendations. This study explores protein intake in relation to eight behavioral determinants (I-Change model) among Dutch community-dwelling older adults. Data were collected through an online questionnaire from October 2019–October 2020. Protein intake was assessed by the Protein Screener 55+, indicating a high/low chance of a low protein intake (<1.0 g/kg body weight/day). The behavioral determinants of cognizance, knowledge, risk perception, perceived cues, attitude, social support, self-efficacy and intention were assessed by evaluating statements on a 7-point Likert scale. A total of 824 Dutch community-dwelling older adults were included, recruited via online newsletters, newspapers and by personal approach. Poisson regression was performed to calculate quartile-based prevalence ratios (PRs). Almost 40% of 824 respondents had a high chance of a low protein intake. Univariate analyses indicated that lower scores for all different behavioral determinants were associated with a higher chance of a low protein intake. Independent associations were observed for knowledge (Q4 OR = 0.71) and social support (Q4 OR = 0.71). Results of this study can be used in future interventions aiming to increase protein intake in which focus should lie on increasing knowledge and social support.