Dietary Protein Distribution Across Meals as a Predictor of Muscle Strength and Functional Decline in Older Hospitalized Adults: A Prospective Cohort Study

Dietary Protein Distribution and Muscle Strength

Abstract

Background: Hospitalized older adults are often at risk for insufficient protein, acute catabolism, sedentary lifestyle and rapid muscle loss. When you consume protein throughout the day may be as important as how much protein you eat during the day.

Objective: To determine whether dietary protein distribution across meals predicts discharge muscle strength and 30-day functional decline in older hospitalized adults.

Methods: This was a prospective cohort study of 170 adults aged 65 years and above admitted to the medical wards of The University of Lahore Teaching Hospital. Three days of dietary intake were recorded. Protein distribution at breakfast, lunch, and dinner was calculated using the coefficient of variance and categorized as even or skewed distribution. Handgrip strength was measured after stabilization and before discharge, while physical performance was assessed using the Short Physical Performance Battery at baseline, discharge, and 30 days. Multivariable regression adjusted for demographic, nutritional, inflammatory, and clinical factors.

Results: Seventy-two participants had an even protein distribution, and 98 had a skewed pattern. Mean protein intake was 0.80 ± 0.23 g/kg/day. Participants with even distribution had greater discharge handgrip strength than those with skewed distribution (20.6 ± 6.2 vs 18.0 ± 6.0 kg; p = 0.007) and lower 30-day functional decline (20.8% vs 38.8%; p = 0.013). Even distribution independently predicted higher discharge strength and lower odds of functional decline.

Conclusion: A balanced distribution of dietary protein across meals was associated with better preservation of muscle strength and reduced short-term functional decline in older hospitalized adults across both sexes independently.