How Your Patient's Protein Needs Change As They Age

Dietary protein intake is required for maintaining strength and muscle mass. Protein is also imperative for many physiologic functions, including metabolic processes, neurotransmitter signaling, hormone synthesis, and tissue regeneration and repair. 

Protein requirements evolve with age, as well as other factors like body weight, activity level, illness or injury, and health goals. 

With increasing age, muscle wasting (sarcopenia) is common. Maintaining sufficient protein intake and having adequate physical activity can help mitigate age-related functional decline.

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The Role of Protein in the Body

Protein is an essential macronutrient that is necessary for the growth and repair of tissues in the body. It is used to rebuild muscles and other vital structures, either during everyday activity or in events requiring significant healing. As protein builds and maintains lean muscle mass, it helps promote optimal metabolism.

Protein has a number of vital physiologic roles: 

• Tissue structure and strength
• Required cofactors for chemical reactions
• DNA replication
• Hormone synthesis
• Chemical transport
• Cell-to-cell signaling

Importance for Aging Populations: 

Age-related muscle and functional decline, termed sarcopenia, is common in aging populations. With increasing age come a number of factors that predispose to sarcopenia: decreased hormone levels, increased inflammation, other health problems, reduced physical activity, and declining nutrition. Protein intake is important to help preserve muscle mass and to prevent or delay sarcopenia. Adequate protein intake supports muscle repair and strength, allowing older patients to preserve mobility, reduce the risk of falls, and maintain functional status. 

Protein Needs Across the Lifespan

Protein Needs of Children

Protein intake is required for children's growth and development, including muscle formation, tissue repair, and immune function. Protein needs vary by age, activity level, other health conditions, and additional factors. 

However, children generally need about 0.5 to 1 gram of protein per day per kilogram of body weight to ensure optimal growth and health. Inadequate protein intake can lead to stunted growth, weakened immune function, and delayed development. 

Protein Needs of Young Adults: 

Young adults need sufficient protein intake to maintain muscle mass and continue engaging in an active lifestyle. 

The recommended daily intake is typically a minimum of 1 gram of protein per kilogram of body weight per day, with needs of as much as 2 grams per kilogram for athletes or those involved in regular strength training. Ensuring adequate protein intake allows for muscle recovery and improves performance, helping maintain strength and vitality.

Protein Needs During Middle Age: 

As metabolic rate slows and lifestyle changes occur, protein needs may shift in the middle age. However, in some patients, decreased physical activity can lead to the beginning of muscle wasting. 

In addition, recovery from illnesses and injuries may be more difficult. It is necessary to carefully plan protein intake to optimize functional status, maintain health, and preserve lean body mass as metabolism declines.

Protein Needs for Seniors: 

Older adults are at increased risk of sarcopenia, age-related muscle loss, and a decline in functional status that threatens overall health and well-being. Adequate protein intake in these patients can help preserve muscle mass and bone integrity, allowing older patients to preserve mobility, reduce the risk of falls, and maintain functional status. 

A higher protein intake of at least 1.2 grams per kilogram of body weight per day helps with muscle maintenance and repair, supports bone health, and improves wound healing. 

Factors Influencing Protein Needs in Older Adults

Physiologic Changes

Physiologic changes associated with aging can significantly impact protein needs in older adults. Changes in protein metabolism and slowing of kidney function can decrease protein breakdown and excretion, changing overall protein needs. 

Focusing on higher-quality protein sources and personalized protein recommendations can help counterbalance these physiologic changes while maintaining muscle mass, immunity, and overall functional status. 

Health Conditions

Age-related health conditions (like osteoporosis and type 2 diabetes) and catabolic medical conditions (like chronic obstructive pulmonary disease or cancers) can affect protein needs in various ways. 

Osteoporosis includes decreased bone density and increased fracture risk. Protein is necessary for bone formation and remodeling, increasing calcium absorption and collagen synthesis. 

As a result, patients with osteoporosis may need higher protein intakes to support the best possible bone health, including reducing further bone loss. 

In contrast, patients with type 2 diabetes mellitus must prioritize blood glucose levels and should balance macronutrients accordingly. Patients with COPD or cancer often burn more energy for regular breathing, necessitating higher energy and, specifically, higher protein intake. 

Discussing personalized recommendations for optimal protein intake with your healthcare provider can help optimize nutrition status and overall well-being in patients as they age.

Activity Levels

Changes in physical activity can substantially impact protein requirements. Higher activity levels, like regular moderate to vigorous exercise or strenuous physical work, require more protein to help support muscle repair, growth, recovery, and performance. 

On the other hand, more sedentary lifestyles or decreased activity levels require less dietary protein, and dietary intakes should be adjusted to prevent excess calorie consumption for healthy weight maintenance.

Assessing Protein Intake in Older Adults

Accurately assessing protein intake in older adults can be difficult, often relying on dietary recalls or food diaries, which are notoriously inaccurate. Not only is it easy to omit certain foods or drinks consumed, but it is also difficult for some patients to accurately assess portion sizes. 

Certain biomarkers, like prealbumin, can provide insight into protein status in the body. Combining subjective assessments, examination of muscle mass, and biomarker results can help clinicians assess protein status, pinpoint possible deficiencies, and offer personalized dietary recommendations to optimize nutrition status.

Signs of Inadequate Protein Intake: 

The following findings can herald inadequate protein intake:

• Muscle wasting or reduced muscle mass
• Delayed wound healing
• Poor skin barrier function
• Low serum prealbumin
• Poor immunity with frequent infections

Strategies to Enhance Protein Intake in Aging Populations

Dietary Recommendations

Incorporating protein-rich foods into meals and snacks requires concerted effort. Furthermore, individual preferences and dietary restrictions must be considered to provide personalized nutrition recommendations that meet protein goals. 

The following are examples of protein-rich foods in aging patients:

• Lean meats like chicken and turkey
• Fish and seafood
• Eggs and dairy
• Legumes (beans and lentils)
• Nuts and seeds
• Tofu and tempeh

Supplementation

Protein supplements can be a good solution for older adults when meeting protein needs through whole foods is difficult. Powders of whey protein, plant-based protein, and collagen protein are all readily available and can be consumed in a variety of ways. 

From adding to smoothies, drinking as a shake, and adding to baked products, protein powders can be an effective way to increase protein intake in cases of poor appetite, swallowing difficulties, or intolerances. When possible, protein should come from real, whole food sources, but supplements can be a helpful addition.

Meal Planning

Meal planning is necessary to incorporate a variety of protein-rich foods. Distributing protein intake evenly across the day has several purposes. It optimizes muscle protein synthesis and the metabolic advantages of protein intake. 

Consuming protein throughout the day also helps maintain an adequate supply of amino acids in the bloodstream for muscle repair and growth, neurotransmitter signaling, hormone synthesis, and hunger control. Planning meals with appropriate macronutrient content helps individuals to consume a well-rounded and satisfying diet, thereby promoting overall health and well-being.

Challenges and Considerations

Chewing and Swallowing Difficulties

Chewing and swallowing difficulties are increasingly common with age, making it harder to eat solid protein sources. Introduce softer, easy-to-swallow protein sources like yogurt, cottage cheese, smoothies, and protein shakes. 

Consulting with a speech therapist or dietitian can determine personalized strategies to ensure adequate protein intake while managing swallowing limitations.

Dietary Restrictions

Dietary restrictions like reduced sodium or renal diets can pose limitations on protein-rich foods. For those following a low-sodium diet, consider these protein sources and be mindful of the added salt during their preparation:

• Lean red meats (on occasion)
• Turkey and poultry 
• Fresh fish and seafood
• Eggs
• Lower-sodium dairy products

Renal diets require special attention to protein intake and blood levels of phosphorus and potassium. Adhering to individualized dietary recommendations in the midst of other chronic medical problems helps patients consider various sources of protein intake.

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Key Takeaways

• Adequate protein intake is important at all ages, and many factors impact protein needs in addition to age, such as overall health status, activity level, body weight, illness or injury, and other medical problems.
• Especially in older adults, adequate protein intake is essential to mitigate sarcopenia and overall age-related decline.
• Maintaining muscle strength and functional status helps promote optimal physical and mental health.
• Healthcare providers should proactively address their patient’s nutritional status, including an assessment for proper energy and protein intake.
• Developing a personalized nutrition plan (including protein goals) helps ensure optimal health outcomes.