My elderly neighbor has been a role model for “successful aging,” evidenced by her good health, active lifestyle, and ability to live alone independently. However, I recently noticed that she seemed to be frail and she commented that fear of falling was limiting her regular walks. Knowing that I’m a Registered Dietitian, she expressed concern about her diet. Other than being aware that her favorite afternoon snack is a cup of clear tea and a cookie, I knew little about what she usually eats. So, I suggested that she keep a food record for a few days. It soon became apparent, based on her low food intake and food choices, that she was not consuming enough high-quality protein. An adequate intake of protein, along with physical activity, helps older adults maintain or increase muscle mass and strength and promote balance to reduce risk of falls.
According to a recent review, older adults need higher intakes of high-quality protein than younger adults to support good health, promote recovery from illness, and maintain muscle strength and function. Older adults’ low protein intake can result in loss of lean body mass, particularly muscle mass, which can contribute to increased risk of sarcopenia and osteoporosis.
Sarcopenia refers to the age-related loss of skeletal muscle mass and function, which can lead to older adults’ loss of independence, increased frailty, disability, and decreased quality of life. Loss of muscle can begin as early as age 40, but more commonly starts after age 55. If measures are not taken to slow or stop this loss of muscle, it can lead to sarcopenia. Depending on how sarcopenia is defined, it has been estimated to affect as many as 50% of adults over age 80. Although the cause of sarcopenia is considered to be complex, current attention is focused on low protein intake and physical inactivity as important contributing factors.
Older adults are at risk of bone loss, which can lead to osteoporosis (porous bones) and increased risk of fractures. Research indicates that higher protein intake has a beneficial effect on bone health when calcium and vitamin D are adequate. Protein’s beneficial effect on bones may be partly mediated by its effect on skeletal muscles, which support bones. The National Osteoporosis Foundation reports that one in two women aged 50 years and older will experience an osteoporosis-related fracture in their lifetime if preventive measures are not taken. Dairy foods are not only an important source of high-quality protein, but also contain calcium, vitamin D, and other nutrients supporting bone health. Unfortunately, my neighbor failed to consume three servings of low-fat or fat-free dairy foods (milk, cheese, yogurt) a day, as recommended by the 2010 Dietary Guidelines for Americans.
Older Adults Need More Protein
The current Recommended Dietary Allowance for protein – the minimum amount to prevent a deficiency – is 0.8 grams/kilogram body weight a day for adults. This amounts to 45 grams/day for women (125 pounds) and 55 grams/day for men (154 pounds). New research indicates that an average daily protein intake of at least 1.0 to 1.2 grams/kilogram body weight may be optimal for healthy older adults.
The Source and Distribution of Protein Are Key
Foods such as dairy, lean meats, poultry, fish, eggs, and soy are sources of high-quality protein. High-quality proteins not only contain all of the essential amino acids or building blocks of protein that the body can’t make on its own, but also are easily digested. Milk, flavored milk, cheese, cottage cheese, yogurt, and Greek yogurt are naturally good to excellent sources of high-quality protein. Milk-based proteins, including casein (80% of milk protein) and whey protein (20% of milk protein), have been shown to increase muscle protein synthesis. In particular, whey protein from dairy products may be beneficial in protecting against sarcopenia. This may be largely due to whey protein’s high content of leucine, an essential amino acid which stimulates muscle protein synthesis.
Evenly distributing protein intake throughout the day is important to provide benefits such as maximizing muscle growth. Some experts recommend that older adults (and others) consume 20 to 30 grams of high-quality protein at each meal (breakfast, lunch, dinner) throughout the day, rather than the typical practice of “end-loading” their protein intake at dinner.
Tips to Help Increase Older Adults’ Protein Intake
Working with my elderly neighbor, we came up with the following strategies to help increase her intake of high-quality protein:
- Incorporate more protein into daily meals and snacks. For example, instead of clear tea and a cookie for a snack, tea with milk and cheese and crackers, or flavored milk, or yogurt contribute more protein. My neighbor especially liked the idea of making smoothies such as the Banana-Nut Breakfast Smoothie recipe. A serving of this smoothie is an excellent source of protein and calcium. Other suggestions to increase protein intake at breakfast – a meal typically low in protein – are to consume milk with cereal, eggs, yogurt, or lean meat. Some suggestions to boost protein intake at lunch – another meal often low in protein – are to add cheese to sandwiches, or add cheese and a chopped, hard-boiled egg to salads, and drink white or flavored milk. For recipes that include protein, visit http://www.udim.org, http://www.wheyprotein.nationaldairycouncil.org, and http://www.nationaldairycouncil.org.
- Look for the protein content of foods and beverages on the Nutrition Facts panel. One cup of cow’s milk or yogurt contains 8 to 10 grams of protein and an equivalent serving (1-1/2 ounces) of Cheddar cheese has 9 to 11 grams of protein, the amount depending on the specific product. The protein content is higher for a serving of Greek yogurt than regular yogurt and for cottage cheese than Cheddar cheese. My neighbor was surprised to learn that not all “milks” contain the same amount of protein. For example, almond “milk” contains only 1 gram of protein for an 8-ounce (1 cup) serving compared to cow’s milk, which contains 8 to 10 grams of protein for a similar size serving.
- Enjoy foods and beverages containing whey protein, such as protein bars or shakes, which can be found at grocery and health food stores.
In addition to talking about increasing intake of foods containing high-quality protein, we discussed ways to increase physical activity, especially resistance exercise (e.g., using elastic exercise bands). The National Institute on Aging has a guide to help older adults fit exercise and physical activity into their daily lives.
It’s been a month since my initial discussion with my neighbor about her diet. She’s very excited about her “protein project,” as she calls it, and has added many protein-rich foods to her meals and snacks. She’s also now reading Nutrition Facts labels on foods to help her make more protein-rich food choices.