The (Cost)Effectiveness of Increasing Protein Intake on Physical Funtioning in Older Adults
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|ClinicalTrials.gov Identifier: NCT03712306|
Recruitment Status : Completed
First Posted : October 19, 2018
Last Update Posted : September 18, 2020
|Condition or disease||Intervention/treatment||Phase|
|Protein-Energy Malnutrition Physical Disability||Other: Dietary advice Other: Dietary advice and advice on timing||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||276 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||
Participants will be randomized intro one of the three study groups.
Stratification by gender and habitual protein intake (low protein (>=0.9 g/kg aBW/day - <1.0 g/kg aBW/day), very low protein (<0.9 g/kg aBW/day)), since we expect a different intervention effect for participants with a very low baseline habitual protein intake (< 0.9 g/kg aBW/d) compared to participants with a low baseline habitual protein intake (≥ 0.9 g/kg aBW/d), and because of potential differences in how women and men respond to the intervention.
In case couples participate, we will make sure they will be allocated to the same intervention group. This will ensure no interference between intervention groups. We will randomly select whether the randomization for the intervention group is based on the men or the women.
|Masking:||None (Open Label)|
|Official Title:||The (Cost) Effectiveness of Increasing Daily Protein Intake to 1.2 Gram Per Kilo Body Weight on Physical Functioning in Community-dwelling Older Adults With a Habitual Daily Protein Intake < 1.0 Gram Per Kilo Body Weight|
|Actual Study Start Date :||October 11, 2018|
|Actual Primary Completion Date :||July 31, 2020|
|Actual Study Completion Date :||August 14, 2020|
No Intervention: Control group
No intervention. Participants will only receive a brochure on general healthy eating habits.
Experimental: Dietary advice
Personalized nutritional advice from a registered dietician or nutritionist aimed at increasing protein intake to at least 1.2 g/kg adjusted body weight/d, through intake of regular protein rich food products and provided protein-enriched food products.
Other: Dietary advice
Dietary advice to increase protein intake to at least 1.2 g/kg adjusted body weight/d
Experimental: Dietary advice and advice on timing
Personalized nutritional advice from a registered dietician or nutritionist aimed at increasing protein intake to at least 1.2 g/kg adjusted body weight/d, through intake of regular protein rich food products and provided protein-enriched food products, as well as advice regarding the consumption of protein rich food products in close proximity of usual physical activity.
Other: Dietary advice and advice on timing
Dietary advice to increase protein intake to at least 1.2 g/kg adjusted body weight/d plus advice on consuming protein in close proximity of usual physical activity
- 6-month change in walk time on a 400 meter walk test [ Time Frame: 6 months ]Change in walk time on a 400 meter walk test
- 6-months change in Physical performance assessed by the Short Physical Performance Battery (SPPB) [ Time Frame: 6 months ]SPPB consists of three tests: repeated chair stands test, 4 meter walk test, and tandem stand test. The total score ranges from 0-12. A higher score indicates better physical functioning.
- 6-month change in hand grip strength [ Time Frame: 6 months ]Hand grip strength measured by a hand held dynamometer
- 6-month change in leg strength [ Time Frame: 6 months ]Upper leg strength measured by a measurement chair
- 6-month change in body composition [ Time Frame: 6 months ]Body composition (fat-free mass, skeletal muscle mass and fat mass) will be assessed from bioelectrical impedance using body resistance, reactance, impedance and phase angle. In the Dutch sample only, fat-free mass and fat mass will be directly measured by using densitometry (BODPOD).
- 3, and 6-moths self-reported mobility limitations (questionnaire) [ Time Frame: 3 and 6 months ]Mobility limitations will be assessed by means of a questionnaire; "Because of your health, how much difficulty do you have walking 400 meter?" and "Because of your health, how much difficulty do you have climbing one flight of stairs?" Participants responded using a five level Likert scale: 'No difficulty', 'a little difficulty', 'some difficulty', 'a lot of difficulty', and 'unable to do the activity'.
- 3, and 6-moths self perceived quality of life [ Time Frame: 3 and 6 months ]Quality of life measured using the EuroQol-5D instrument. The EuroQol 5D consists of five questions on a Likert scale (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Answer categories range from (1) 'no problems' to (5) 'unable to'. An additional thermometer for experienced health is scored on a Visual Analogue scale (VAS), ranging from 0-100. The exact point where the line crosses the VAS is the VAS score. The scores are converted to an index value, which facilitates the calculation of quality-adjusted life years (QALYs) that is used to calculate the cost-effectiveness of the study.
- Incident frailty assessed by the Fried Frailty Index [ Time Frame: 6 months ]
Frailty will be determined using the 5 criteria of the Fried Frailty Index:
- Self-reported unintentional weight loss: >4 kg in past 6 months.
- Self-reported exhaustion. Based on two self-reported questions from the Center for Epidemiologic Studies Depression scale on exhaustion in the past week at baseline and follow-up: "I felt that everything I did was an effort" and "I could not get going". Scores ranges from 1 'not at all' to 4 'most of the time'. A score of 3 or 4 on either question indicates exhaustion.
- Weakness: grip strength in the lowest 20% of the study population, adjusted for gender and BMI.
- Slow walking speed: walk time on the 400 meter walk test in the slowest 20% of the study population, adjusted for gender and height.
- Low physical activity: Kilocalories expended/wk based on accelerometer data in the lowest quintile of physical activity for each gender.
1 or 2 components:intermediate/prefrail 3 or more components:frail
- Incidence of sarcopenia risk [ Time Frame: 3 and 6 months ]Incidence of sarcopenia risk will be assessed with the SARC-F questionnaire; how much effort do you experience when 1) lifting and carrying a bag of 4.5 kilo, 2) walking across a room, 3) transferring from a chair or bed, 4) climbing a flight of 10 stairs, and 5) how many times have you fallen in the past year. Answering option include no effort (0 points), a bit of effort (1 point) and a lot of effort (2 points), where a score equal to or greater than 4 is predictive of sarcopenia and poor outcomes.
- Incident malnutrition [ Time Frame: 6 months ]BMI<22 kg/m2 and unintentional weight loss >5% over 6 months
- 3, and 6-moths health care costs assessed by questionnaire [ Time Frame: 3 and 6 months ]To measure health care costs the investigators will use a modified version of the Resource Utilization in Dementia Questionnaire WIMO. This questionnaire contains questions on hospital admissions, prescribed medicine use, care from health professionals, and use of other health care services in the past three months. These are the domains that the investigators might expect changes in due to the intervention.
- 3, and 6-month change in body weight [ Time Frame: 3 and 6 months ]Body weight (kg) will be measured to the nearest 0,1 kg using a calibrated scale.
- Body height [ Time Frame: baseline ]Body height (cm) will be measured to the nearest 0.1 cm using a stadiometer.
- 3, and 6-month change in body mass index (BMI) [ Time Frame: 3 and 6 months ]Based on measured weight (measured at baseline and after 6 months) and height (measured at baseline) BMI will be calculated as body weight (kg) divided by height (m) squared.
- Dietary intake assesed by three 24-hour recalls [ Time Frame: 3 and 6 months ]A 24-hour recall is a structured interview intended to capture detailed information about all foods and beverages consumed by the participant in the past 24 hours. Changes in dietary intake (based on data of the 24-hour recalls) enables to investigate compliance; i.e. higher protein intake indicates higher compliance.
- Physical activity [ Time Frame: 3 and 6 months ]Physical activity will be objectively assessed by means of an accelerometer (Axivity, AX3) during 7 subsequent days after each clinic visit.
- Effectiveness of persuasive technology sub-study on protein intake [ Time Frame: 6 months ]Examine the effect of persuasive technology on adherence to increasing protein intake. A subsample of the Dutch participants will receive a food storage box that can measure which protein rich food products are taken out and a small-size screen (tablet) that provides reminders and nudges. The investigators will test if there are differences in adherence to the interventions between participants who took part in this sub-study and participants who did not.
- Microbiota sub-study [ Time Frame: 6 months ]The effect of increasing protein intake to at least 1.2 g/kg body weight/d on faecal and oral microbiota composition
- Effect of protein intake on satiety and reward responses measured by functional magnetic resonance imaging [ Time Frame: 6 months ]
To examine the effects of increasing protein intake on food-stimuli related central nervous system satiety and reward responses involved in the regulation of food intake, measured by functional magnetic resonance imaging.
BOLD fMRI will be used to measure neuronal activity in CNS satiety and reward circuits (including striatum, amygdala, orbitofrontal cortex, insula) in response to visual food stimuli (pictures of food items) and to the actual consumption of food (chocolate milk).
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03712306
|University of Helsinki|
|Vrije Universiteit Amsterdam|
|Amsterdam, Noord Holland, Netherlands, 1081 HV|
|Study Chair:||Marjolein Visser, Prof., PhD||VU University of Amsterdam|