Open Access Open Badges Research

Distribution but not amount of protein intake is associated with frailty: a cross-sectional investigation in the region of Nürnberg

Julia Bollwein14*, Rebecca Diekmann1, Matthias J Kaiser1, Jürgen M Bauer2, Wolfgang Uter3, Cornel C Sieber1 and Dorothee Volkert1

Author Affiliations

1 Institute for Biomedicine of Aging (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg, Kobergerstr. 60 90408 Nürnberg, Germany

2 Geriatric Center Oldenburg, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany

3 Institute for Medical Informatics, Biometrics and Epidemiology (IMBE), Friedrich-Alexander Universität Erlangen-Nürnberg, Waldstraße 6, 91054 Erlangen, Germany

4 Korbinianplatz 4d, 80807 Munich, Germany

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Nutrition Journal 2013, 12:109  doi:10.1186/1475-2891-12-109

Published: 5 August 2013



To preserve muscle mass and therefore limit the risk of disability in older adults protein intake is seen as important factor. Besides the amount of protein, its distribution over the day is thought to affect protein anabolism. This cross-sectional study investigates the association between the amount and distribution of protein intake and frailty in older adults.


In 194 community-dwelling seniors (≥75 years) amount of protein intake and its distribution over the day (morning, noon, evening) were assessed using a food frequency questionnaire. Unevenness of protein distribution was calculated as coefficient of variation (CV). Frailty was defined as the presence of at least three, pre-frailty as the presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed.


15.4% of the participants were frail, 40.5% were pre-frail. Median (min.-max.) daily protein intake was 77.5 (38.5–131.5) g, 1.07 (0.58–2.27) g/kg body weight (BW) and 15.9 (11.2–21.8) % of energy intake without significant differences between the frailty groups. The risk of frailty did not differ significantly between participants in the higher compared to the lowest quartile of protein intake. Frail participants consumed significantly less protein in the morning (11.9 vs. 14.9 vs. 17.4%, p = 0,007), but more at noon (61.4 vs. 60.8 vs. 55.3%, p = 0.024) than pre-frail and non-frail. The median (min.-max.) CV of protein distribution was highest in frail (0.76 (0.18–1.33)) compared to pre-frail (0.74 (0.07–1.29)) and non-frail (0.68 (0.15–1.24)) subjects (p = 0.024).


In this sample of healthy older persons, amount of protein intake was not associated with frailty, but distribution of protein intake was significantly different between frail, pre-frail and non-frail participants. More clinical studies are needed to further clarify the relation between protein intake and frailty.

Frailty; Community living older adults; Protein intake; Protein distribution