{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T19:23:10Z","timestamp":1783106590790,"version":"3.54.6"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T00:00:00Z","timestamp":1537747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"North American Branch of the International Life Sciences Institute"},{"DOI":"10.13039\/100000199","name":"U.S. Department of Agriculture","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000199","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007917","name":"Agricultural Research Service","doi-asserted-by":"publisher","award":["58-1950-4-003"],"award-info":[{"award-number":["58-1950-4-003"]}],"id":[{"id":"10.13039\/100007917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Higher protein intake is linked to maintenance of muscle mass and strength, but few studies have related protein to physical function and disability in aging.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In participants of the Framingham Heart Study Offspring, we examined associations between protein intake (g\/d), estimated from food frequency questionnaires, and maintenance of functional integrity, as a functional integrity score based on responses to 17 questions from Katz Activities of Daily Living, Nagi, and Rosow-Breslau questionnaires, repeated up to five times (1991\/1995\u20132011\/2014) over 23 years of follow-up. Cox proportional hazard models were used to estimate risk of incident loss of functional integrity (functional integrity score \u2264 15th percentile).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2,917 participants (age 54.5 [9.8] years), baseline protein intake was 77.2 (15.6) g\/d. The functional integrity score (baseline, mean 98.9, range 82.4\u2013100.0) was associated with objective performance (gait speed, grip strength) and lower odds of falls, fractures, and frailty. Across follow-up, there were 731 incident cases of loss of functional integrity. In fully adjusted models, participants in the highest category of protein intake (median 92.2 g\/d) had 30% lower risk of loss of functional integrity (hazard ratio [95% confidence interval] 0.70 [0.52, 0.95], p trend = .03), versus those with the lowest intake (median 64.4 g\/d). However, sex-stratified analyses indicated the association was driven by the association in women alone (hazard ratio [95% confidence interval] 0.49 [0.32, 0.74], p trend = .002) and was nonsignificant in men (hazard ratio [95% confidence interval] 1.14 [0.70, 1.86], p trend = .59).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Higher protein intake was beneficially associated with maintenance of physical function in middle-aged, high-functioning U.S. adults over the span of two decades. This association was particularly evident in women.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/gerona\/gly201","type":"journal-article","created":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T00:02:02Z","timestamp":1537747322000},"page":"123-130","source":"Crossref","is-referenced-by-count":44,"title":["Protein Intake and Functional Integrity in Aging: The Framingham Heart Study Offspring"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6549-4625","authenticated-orcid":false,"given":"Adela","family":"Hruby","sequence":"first","affiliation":[{"name":"Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts"},{"name":"The Friedman School of Nutrition Science and Policy, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani","family":"Sahni","sequence":"additional","affiliation":[{"name":"Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts"},{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Bolster","sequence":"additional","affiliation":[{"name":"Research and Innovation, Danone North America, Louisville, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F","family":"Jacques","sequence":"additional","affiliation":[{"name":"Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts"},{"name":"The Friedman School of Nutrition Science and Policy, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,9,24]]},"reference":[{"key":"2019121307581262800_CIT0001","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1093\/ajcn\/87.1.150","article-title":"Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study","volume":"87","author":"Houston","year":"2008","journal-title":"Am J Clin Nutr"},{"key":"2019121307581262800_CIT0002","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.3945\/jn.114.204925","article-title":"Higher protein intake is associated with higher lean mass and quadriceps muscle strength in adult men and women","volume":"145","author":"Sahni","year":"2015","journal-title":"J Nutr"},{"key":"2019121307581262800_CIT0003","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1097\/MCO.0000000000000011","article-title":"Dietary protein and muscle in older persons","volume":"17","author":"Paddon-Jones","year":"2014","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"2019121307581262800_CIT0004","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.clnu.2017.08.016","article-title":"Does nutrition play a role in the prevention and management of sarcopenia","volume":"37","author":"Robinson","year":"2018","journal-title":"Clin Nutr"},{"key":"2019121307581262800_CIT0005","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1093\/gerona\/glv184","article-title":"Dietary protein intake is protective against loss of grip strength among older adults in the Framingham Offspring cohort","volume":"71","author":"McLean","year":"2016","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0006","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.3945\/ajcn.117.160325","article-title":"The effects of dietary protein intake on appendicular lean mass and muscle function in elderly men: a 10-wk randomized controlled trial","volume":"106","author":"Mitchell","year":"2017","journal-title":"Am J Clin Nutr"},{"key":"2019121307581262800_CIT0007","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1017\/S0007114514002220","article-title":"Protein intake and lumbar bone density: the Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"112","author":"Hu","year":"2014","journal-title":"Br J Nutr"},{"key":"2019121307581262800_CIT0008","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1080\/07315724.2017.1322924","article-title":"Dietary protein intake above the current RDA and bone health: a systematic review and meta-analysis","volume":"36","author":"Wallace","year":"2017","journal-title":"J Am Coll Nutr"},{"key":"2019121307581262800_CIT0009","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1007\/s00198-010-1179-4","article-title":"Does dietary protein reduce hip fracture risk in elders? The Framingham Osteoporosis Study","volume":"22","author":"Misra","year":"2011","journal-title":"Osteoporos Int"},{"key":"2019121307581262800_CIT0010","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1007\/s12603-015-0544-6","article-title":"Associations of protein intake and protein source with bone mineral density and fracture risk: a population-based cohort study","volume":"19","author":"Langsetmo","year":"2015","journal-title":"J Nutr Health Aging"},{"key":"2019121307581262800_CIT0011","doi-asserted-by":"publisher","first-page":"672.e7","DOI":"10.1016\/j.jamda.2016.05.005","article-title":"Higher protein but not energy intake is associated with a lower prevalence of frailty among community-dwelling older adults in the French three-city cohort","volume":"17","author":"Rahi","year":"2016","journal-title":"J Am Med Dir Assoc"},{"key":"2019121307581262800_CIT0012","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/gerona\/61.6.589","article-title":"Low nutrient intake is an essential component of frailty in older persons","volume":"61","author":"Bartali","year":"2006","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0013","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/1475-2891-12-164","article-title":"High protein intake is associated with low prevalence of frailty among old Japanese women: a multicenter cross-sectional study","volume":"12","author":"Kobayashi","year":"2013","journal-title":"Nutr J"},{"key":"2019121307581262800_CIT0014","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/1475-2891-12-109","article-title":"Distribution but not amount of protein intake is associated with frailty: a cross-sectional investigation in the region of N\u00fcrnberg","volume":"12","author":"Bollwein","year":"2013","journal-title":"Nutr J"},{"key":"2019121307581262800_CIT0015","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s12603-013-0391-2","article-title":"Adequate dietary protein is associated with better physical performance among post-menopausal women 60\u201390 years","volume":"18","author":"Gregorio","year":"2014","journal-title":"J Nutr Health Aging"},{"key":"2019121307581262800_CIT0016","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.1017\/S0007114517001507","article-title":"Effects of progressive resistance training combined with a protein-enriched lean red meat diet on health-related quality of life in elderly women: secondary analysis of a 4-month cluster randomised controlled trial","volume":"117","author":"Torres","year":"2017","journal-title":"Br J Nutr"},{"key":"2019121307581262800_CIT0017","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1111\/j.1532-5415.2010.02866.x","article-title":"Protein intake and incident frailty in the Women\u2019s Health Initiative observational study","volume":"58","author":"Beasley","year":"2010","journal-title":"J Am Geriatr Soc"},{"key":"2019121307581262800_CIT0018","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1093\/gerona\/glw033","article-title":"Macronutrients intake and incident frailty in older adults: a prospective cohort study","volume":"71","author":"Sandoval-Insausti","year":"2016","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0019","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1093\/gerona\/glt196","article-title":"Macronutrients, diet quality, and frailty in older men","volume":"69","author":"Shikany","year":"2014","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0020","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1111\/jgs.12503","article-title":"Biomarker-calibrated protein intake and physical function in the Women\u2019s Health Initiative","volume":"61","author":"Beasley","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"2019121307581262800_CIT0021","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s12603-013-0379-y","article-title":"Associations of dietary protein intake on subsequent decline in muscle mass and physical functions over four years in ambulant older Chinese people","volume":"18","author":"Chan","year":"2014","journal-title":"J Nutr Health Aging"},{"key":"2019121307581262800_CIT0022","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1017\/S000711451600012X","article-title":"Dietary protein intake is associated with better physical function and muscle strength among elderly women","volume":"115","author":"Isanejad","year":"2016","journal-title":"Br J Nutr"},{"key":"2019121307581262800_CIT0023","doi-asserted-by":"publisher","first-page":"1705","DOI":"10.1111\/jgs.14856","article-title":"Protein intake and mobility limitation in community-dwelling older adults: the Health ABC Study","volume":"65","author":"Houston","year":"2017","journal-title":"J Am Geriatr Soc"},{"key":"2019121307581262800_CIT0024","doi-asserted-by":"publisher","first-page":"113","DOI":"10.3945\/ajcn.116.146555","article-title":"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)","volume":"106","author":"Farsijani","year":"2017","journal-title":"Am J Clin Nutr"},{"key":"2019121307581262800_CIT0025","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1093\/gerona\/glx070","article-title":"High-protein foods and physical activity protect against age-related muscle loss and functional decline","volume":"73","author":"Bradlee","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0026","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.1093\/aje\/kwy014","article-title":"Dietary protein and preservation of physical functioning among middle-aged and older adults in the Framingham Offspring Study","volume":"187","author":"Mustafa","year":"2018","journal-title":"Am J Epidemiol"},{"key":"2019121307581262800_CIT0027","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1016\/0091-7435(75)90037-7","article-title":"The Framingham Offspring Study: design and preliminary data","volume":"4","author":"Feinleib","year":"1975","journal-title":"Prev Med"},{"key":"2019121307581262800_CIT0028","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1093\/oxfordjournals.aje.a116211","article-title":"Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals","volume":"135","author":"Rimm","year":"1992","journal-title":"Am J Epidemiol"},{"key":"2019121307581262800_CIT0029","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780195122978.001.0001","volume-title":"Nutritional Epidemiology","author":"Willett","year":"1998"},{"key":"2019121307581262800_CIT0030","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1093\/ije\/18.4.858","article-title":"Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption","volume":"18","author":"Salvini","year":"1989","journal-title":"Int J Epidemiol"},{"key":"2019121307581262800_CIT0031","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.2105\/AJPH.2016.303348","article-title":"Diet assessment methods in the nurses\u2019 health studies and contribution to evidence-based nutritional policies and guidelines","volume":"106","author":"Hu","year":"2016","journal-title":"Am J Public Health"},{"key":"2019121307581262800_CIT0032","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1093\/aje\/kww104","article-title":"Validity of a dietary questionnaire assessed by comparison with multiple weighed dietary records or 24-hour recalls","volume":"185","author":"Yuan","year":"2017","journal-title":"Am J Epidemiol"},{"key":"2019121307581262800_CIT0033","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1093\/oxfordjournals.aje.a114366","article-title":"Total energy intake: implications for epidemiologic analyses","volume":"124","author":"Willett","year":"1986","journal-title":"Am J Epidemiol"},{"key":"2019121307581262800_CIT0034","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1093\/ajcn\/34.3.362","article-title":"Glycemic index of foods: a physiological basis for carbohydrate exchange","volume":"34","author":"Jenkins","year":"1981","journal-title":"Am J Clin Nutr"},{"key":"2019121307581262800_CIT0035","author":"The University of Sydney"},{"key":"2019121307581262800_CIT0036","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0037","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11357-015-9864-z","article-title":"Biomarkers of oxidative stress are associated with frailty: the Framingham Offspring Study","volume":"38","author":"Liu","year":"2016","journal-title":"Age (Dordr)"},{"key":"2019121307581262800_CIT0038","volume-title":"Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients)","author":"Institute of Medicine","year":"2005"},{"key":"2019121307581262800_CIT0039","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1093\/gerona\/glx064","article-title":"Estimation of skeletal muscle mass relative to adiposity improves prediction of physical performance and incident disability","volume":"73","author":"Baker","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0040","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1093\/gerona\/glx194","article-title":"Age, race, and gender factors in incident disability","volume":"73","author":"Jacob","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019121307581262800_CIT0041","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1001\/jamainternmed.2018.0008","article-title":"Effect of protein intake on lean body mass in functionally limited older men: a randomized clinical trial","volume":"178","author":"Bhasin","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2019121307581262800_CIT0042","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12877-017-0496-2","article-title":"Nutritional determinants of frailty in older adults: a systematic review","volume":"17","author":"Lorenzo-L\u00f3pez","year":"2017","journal-title":"BMC Geriatr"},{"key":"2019121307581262800_CIT0043","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1111\/jgs.15273","article-title":"36-Item short form survey (SF-36) versus gait speed as predictor of preclinical mobility disability in older women: the women\u2019s health initiative","volume":"66","author":"Laddu","year":"2018","journal-title":"J Am Geriatr Soc"},{"key":"2019121307581262800_CIT0044","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3389\/fnut.2017.00013","article-title":"Current concepts and unresolved questions in dietary protein requirements and supplements in adults","volume":"4","author":"Phillips","year":"2017","journal-title":"Front Nutr"},{"key":"2019121307581262800_CIT0045","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/S0895-4356(01)00357-2","article-title":"Self-reported preclinical disability identifies older women with early declines in performance and early disease","volume":"54","author":"Fried","year":"2001","journal-title":"J Clin Epidemiol"}],"container-title":["The Journals of Gerontology: Series A"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/biomedgerontology\/article-pdf\/75\/1\/123\/31509345\/gly201.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/biomedgerontology\/article-pdf\/75\/1\/123\/31509345\/gly201.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T07:58:34Z","timestamp":1576223914000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/article\/75\/1\/123\/5106141"}},"subtitle":[],"editor":[{"given":"Anne","family":"Newman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2018,9,24]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,9,24]]},"published-print":{"date-parts":[[2020,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/gerona\/gly201","relation":{},"ISSN":["1079-5006","1758-535X"],"issn-type":[{"value":"1079-5006","type":"print"},{"value":"1758-535X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,1]]},"published":{"date-parts":[[2018,9,24]]}}}