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More than 90% of hip fractures in older Americans result from a fall. Inadequate intake of dietary protein and vitamin D are common in older adults, and diets in low these could contribute to loss of muscle mass and strength or coordination, in turn increasing the risk of falling. The objective of the study was to evaluate the relationship between protein and vitamin D intake with the occurrence of falls in older women in the Study of Osteoporotic Fracture, a prospective cohort of more than 4000 postmenopausal women participating from January 1997 to September 1998. Incident falls were ascertained for one year.

Protein and vitamin D intake was assessed by a food frequency questionnaire; associations with a reported fall were estimated with logistic regression, adjusted for fall-related covariates and energy. Protein and vitamin D were modeled separately because of high correlation (rho=0.55, P. INTRODUCTION Falls are frequent among older adults; one out of three individuals aged 65 years and older fall each year (). Older women are at increased risk, and two-thirds of those who fall once will do so again within six months (). Falls are also highly linked with serious injury; they are the leading cause of fractures. Indeed, nine out of ten hip fractures in older Americans result directly from a fall ().

Fractures, especially hip fractures, are associated with significant morbidity and mortality; one of four will die within a year of experiencing a hip fracture (). Besides age and gender, factors that are known to increase the risk of falling include prior history of falls, reduced muscle strength, balance impairment, visual impairment, multiple medication use, depression, functional limitations, cognitive impairment, physical activity, and low body mass index (BMI) (, –).

Hence, falls are a major concern for older adults, and effective preventative measures are central to health and longevity. In general, nutrition has not been widely studied in relation to falls. Few studies have linked poor nutritional status with falls (–). The possible association between dietary protein and falls has been overlooked.

To date, only one known prospective cohort study looked at the association of protein intake and fall risk (). Dietary protein may affect fall incidence through its ability to affect muscle mass and function. Since adequate protein intake is needed to optimize muscle health (), it may favorably impact muscle strength, which is a major risk factor of falls ().

Insufficient consumption of dietary protein is common in older individuals; between 32% and 41% of women aged 50 years and older consume less than the Recommended Dietary Allowance (RDA) (). Therefore, a diet low in protein could contribute to the loss of muscle mass and strength, and partly explain the high incidence of falls in older adults. Recently, dietary vitamin D intake is an area of investigative interest in fall pathogenesis and prevention. Despite this vitamin's importance, deficiency and insufficiency are prevalent in older Americans as a consequence of inadequate dietary intake, minimal sunlight exposure, impaired intestinal absorption, medication use, and enterohepatic recirculation (). All this notwithstanding, it remains unclear if supplementation with vitamin D significantly reduces the risk of falling.

Some studies have reported an inverse relationship between vitamin D status and intake and fall risk (–), while others have shown no relationship (). The primary purpose of our analysis was to evaluate the association between dietary protein and subsequent falls in a sample of postmenopausal women from the Study of Osteoporotic Fractures (SOF). Second, we wanted to examine both serum vitamin D status and dietary vitamin D intake with falls.

We hypothesized that increased dietary protein and vitamin D would be independently associated with decreased risk of falling over a one-year period in both unadjusted models and models adjusted for potential confounders. Subjects Participants are from SOF, an observational study of postmenopausal women that includes prospective data on bone health and aging (). Enrollment began in 1986 in four U.S. Clinical centers, and clinical visits occurred approximately every two years. A total of 9704 Caucasian women older than 65 years were enrolled when the study began.

For the purpose of our study, data from visit 6 (V6, years 1997–1998) were utilized because 4886 participants completed the Block Food Frequency Questionnaire (FFQ) (); V6 data are considered “baseline.” The Block FFQ consisted of 109 food items and included questions on alcohol intake and vitamin and mineral supplementation including calcium. A slightly modified version of this FFQ was found to have moderate to high reliability and validity (). Predictor Variables Protein intake from any source was analyzed by the FFQ as grams per day (g/day), which we converted to grams per kilograms body weight (g/kg) to compare subjects' intakes with the RDA for protein, 0.8 g per kg.

Kunguma Poovum Konjum Puravum Film Mp3 Songs Free Download on this page. Daily intake (IU/day) through diet and average supplemental vitamin D and calcium (mg) were estimated from the FFQ. The unadjusted associations with falls were analyzed separately for total daily intake, dietary and supplementary vitamin D to determine which would have the strongest association with falling. In addition, a subset of women (N=1,171) were randomly chosen to have their visit 6 serum 25-hydroxyvitamin D [25 (OH) D] measured as nano-grams per milliliters (ng/ ml). Complete details of the methodology of serum 25 (OH) D measurement and collection are shown elsewhere ().

Primary Outcome Variable Falls, the primary outcome variable, was examined prospectively one year post-V6 and treated as a dichotomous variable. Fall incidence was captured by postcard and telephone calls every four months. Subjects were asked, “During the past four months, have you fallen and landed on the floor or ground, or fallen and hit an object like a table or stair (or chair)?” and, if so, how many times (, ). Falls were defined as “landing on the floor or ground, or falling and hitting an object like a table or a chair.” For fall data, only incidences of falls were examined and they were not distinguished as injurious or noninjurious. Statistics For descriptive purposes women were divided into below RDA for dietary protein (. Participant Characteristics Baseline characteristics of the participants were compared between those whose dietary protein is below the RDA versus those who meet the RDA ().

Sixty-two percent of participants consumed the RDA for protein or higher. Individuals with protein intakes that met the RDA also consumed more total calories, vitamin D, and calcium; were older; and had lower BMIs and lower average grip strength compared to persons with protein intakes below the RDA ( P. Results of the Unadjusted Regression Models Of the 4369 women included in the regression model, 1429 (33%) reported at least one fall within 12 months following V6.

Higher dietary protein, per 1 g/kg increase was found to be significantly associated with an increased risk of falling in unadjusted regression ( P. Dietary Protein, Vitamin D, and Falls in Adjusted Models When all significant fall-related covariates were added to the final forward stepwise regression models, protein and dietary vitamin D were no longer associated with falls (). Code Alarm Catx4 Manual more. Of note, calcium was not selected possibly due to its low correlation with falling ( P=0.04). When dietary protein and vitamin D were adjusted for energy intake, they continued to be nonsignificant (). In quartile analyses, neither protein nor vitamin D remained significant in the final step. DISCUSSION In this prospective analysis of more than 4000 women using unadjusted logistic regression, dietary protein and vitamin D were positively associated with increased risk of falling.

With the addition of covariates known to be associated with falls, and in separate models, protein and vitamin D no longer contributed to the odds of falling. To our knowledge, there is only one study directly examined protein intake and fall incidence.

In a prospective study with 807 male and female participants (mean age 75 years) in the Framingham Study, Zoltick and colleagues () studied how dietary protein adjusted for total energy intake dietary calcium, calcium supplement use, dietary vitamin D, and weight loss affected risk of falling. Occurrence of falls (yes/no) was assessed at baseline and one-year follow-up. Similar to our study, falls were recorded regardless of an injury. Two main differences between our study and Zoltick and colleagues' study are they stratified their analyses by weight loss versus no weight change and 37% of their cohort were men. The authors theorized that a weight loss of ≥ 5% body weight at follow-up would be a potential effect modifier since unintentional weight loss is associated with increased risk of falling (). They found some benefit of moderate protein intake on falls over a one-year period. The rate ratios for falls indicated protective effects of each type of protein intake (total, animal, vegetable), although they were not statistically significant ( P>0.05).

Total and animal protein intakes were significantly protective of falling in subjects who lost weight versus those who did not lose ≥5% of their weight, although there was no mention if the authors performed a test for interaction to observe this difference between the subgroups. There also was no association between protein intake and falls with weight maintenance ().

Their lack of significant findings outside weight changes is consistent with our observations that dietary protein does not affect falls. The inverse link between protein intake and risk of falling with weight loss indicates further research is needed. Our results are surprising as higher protein intake is associated with increased lean body mass, thus one might predict less susceptibility to falling. Diets higher in protein in older adults may be protective against sarcopenia ().

Close to one-third of adults 60 years or older have sarcopenia and the incidence increases to more than 50% for adults older than 80 years (). These individuals with lower muscle mass are at risk of being frail and in combination with a slow, unsteady gait, and loss of strength, the risk of falling greatly increases (). Houston and colleagues () examined the association of protein intake with lean body mass over a three-year period in 2066 older men and women (mean age 74.5 years) participating in the Health, Aging, and Body Composition Study. Those with the highest protein intake (divided into quintiles) lost 43% less lean mass than those who consumed the lowest amount ( P. Publisher's Disclaimer: Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content.

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