An Even Distribution of Protein Intake Daily Promotes Protein Adequacy but Does Not Influence Nutritional Status in Institutionalized Elderly

Objective: Although it has been established that sufficient protein is required to maintain good nutritional status and support healthy aging, it is not clear if the pattern of protein consumption may also influence nutritional status, especially in institutionalized elderly who are at risk of malnutrition. Therefore, we aim to determine the association between protein intake distribution and nutritional status in institutionalized elderly people. Design: Cross-sectional study among 481 institutionalized older adults. Methods: Dietary data from 481 ambulant elderly people (68.8% female, mean age 87.5 +/- 6.3 years) residing in 52 aged-care facilities in Victoria, Australia, were assessed over 2 days using plate waste analysis. Nutritional status was determined using the Mini-Nutritional Assessment tool and serum (n = 208) analyzed for albumin, hemoglobin, and IGF-1. Protein intake distribution was classified as: spread (even distribution across 3 meals, n = 65), pulse (most protein consumed in one meal, n = 72) or intermediate (n = 344). Regression analysis was used to investigate associations. Results: Mean protein intakes were higher in the spread (60.5 +/- 2.0 g/d) than intermediate group (56.0 +/- 0.8 g/d, P = .037), and tended to be higher than those in the pulse group (55.9 +/- 1.9 g/d, P = .097). Residents with an even distribution of protein intake achieved a higher level of the recommended daily intake for protein (96.2 +/- 30.0%) than the intermediate (86.3 +/- 26.2%, P = .008) and pulse (87.4 +/- 30.5%, P = .06) groups, and also achieved a greater level of their estimated energy requirements (intermediate; P = .039, pulse; P = .001). Nutritional status (Mini-Nutritional Assessment score) did not differ between groups (pulse; 20.5 +/- 4.5, intermediate; 21.0 +/- 2.5, spread; 20.5 +/- 3.5), nor did any other indices of nutritional status. Conclusions: Meeting protein requirements is required before protein distribution may influence nutritional status in institutionalized elderly. Achieving adequate protein and energy intakes is more likely when protein is distributed evenly throughout the day. Provision of high protein foods especially at breakfast, and in the evening, may support protein adequacy and healthy aging, especially for institutionalized elderly. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.