Even mealtime distribution of protein intake is associated with greater muscle strength, but not with 3-y physical function decline, in free-living older adults: the Quebec longitudinal study on Nutrition as a Determinant of Successful Aging (NuAge study)

Am J Clin Nutr. 2017 Jul;106(1):113-124. doi: 10.3945/ajcn.116.146555. Epub 2017 May 17.


Background: Functional status declines with aging, thus impeding autonomy. Recently, a more even mealtime distribution of dietary protein was positively associated with muscle mass, but the relation of this distribution to physical performance remains unknown.Objective: We examined the relation between mealtime protein-intake distribution and physical performance and its 3-y decline in community-dwelling older adults.Design: Three-year follow-up data from 827 men and 914 women (67-84 y) in the longitudinal study on nutrition and aging [Quebec longitudinal study on Nutrition as a Determinant of Successful Aging (NuAge study); Quebec, Canada] were analyzed. Physical performance, which was measured yearly, was grouped into the following 2 functional composite scores: muscle strength (handgrip, arm, and leg) and mobility (timed-up-and-go, chair stand, and walking speed). Dietary data were collected in 2 sets of three 24-h food recalls at baseline and year 2. The individual mealtime protein distribution was calculated as the CV (i.e., SD divided by the mean) of grams of protein per meal. A mixed model analysis was used to examine trajectories of muscle strength and mobility across time by sex as conditioned by the protein distribution and adjusted for potential covariates.Results: Physical performance deteriorated over 3 y with muscle strength declining more than the mobility score in men (-1.51 ± 1.68 compared with -0.66 ± 2.81) and women (-1.35 ± 1.77 compared with -0.78 ± 2.63) (means ± SD, P < 0.001). More-evenly distributed protein intake, independent of the total quantity, was associated with a higher muscle-strength score in both sexes throughout follow-up. It was also associated with a greater mobility score, but only in men and only before adjustment for covariates. Strength and mobility rates of decline were not affected by protein-intake distribution in either sex.Conclusions: In addition to the previously observed association with lean mass, an even distribution of daily protein intake across meals is independently associated with greater muscle strength, but not with the mobility score, in older adults. A longer-term investigation of the role of protein intake and its distribution on physical performance is warranted, as are intervention studies, to support future recommendations.

Keywords: aging; diet; dietary protein; dynapenia; functional capacity; mobility; nutrition; physical performance; skewed protein intake.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Aging*
  • Diet*
  • Dietary Proteins / administration & dosage
  • Dietary Proteins / pharmacology*
  • Feeding Behavior*
  • Female
  • Follow-Up Studies
  • Gait
  • Geriatric Assessment
  • Hand Strength
  • Humans
  • Longitudinal Studies
  • Male
  • Meals*
  • Movement
  • Muscle Strength / drug effects*
  • Physical Fitness*
  • Quebec


  • Dietary Proteins