Physical Disability Clinical Trial
Official title:
The (Cost) Effectiveness of Increasing Daily Protein Intake to 1.2 Gram Per Kilo Body Weight on Physical Functioning in Community-dwelling Older Adults With a Habitual Daily Protein Intake < 1.0 Gram Per Kilo Body Weight
In this RCT with the duration of 6 months among 264 community-dwelling older adults (65+ years) with habitual low protein intake, the investigators will examine the long term (cost) effectiveness of increasing daily protein intake to at least 1.2 gram/kg of adjusted body weight on physical functioning in older adults with low protein intake.
In this RCT with the duration of 6 months the investigators will examine the long term (cost)
effectiveness of increasing protein intake to at least 1.2 g/kg adjusted body weight/d on
physical functioning in older adults with habitual low protein intake. Additionally, the
investigators will examine the combined effect of increasing protein intake to at least 1.2
g/kg adjusted body weight/d and consuming protein in close proximity with regular physical
activity on physical functioning in older adults with habitual low protein intake.
Three sub-studies will be conducted, of which the main objectives are to:
1. Examine the effect of persuasive technology on adherence to consumption of protein rich
food products in order to increase protein intake to at least 1.2 g/kg adjusted body
weight/d, and to the combination of increasing protein intake to at least 1.2 g/kg
adjusted body weight/d and consuming protein in close proximity with regular physical
activity.
2. Examine the effect of increasing protein intake to at least 1.2 g/kg adjusted body
weight/d on faecal and oral microbiota composition in older adults with a habitual low
protein intake.
3. Examine the effects of increasing protein intake to at least 1.2 g/kg adjusted body
weight/d on food-stimuli related central nervous system satiety and reward responses
involved in the regulation of food intake, measured by functional magnetic resonance
imaging in older adults with a habitual low protein intake.
Study design: Randomized controlled trial with the duration of 6 months in two study
sites: Amsterdam, the Netherlands and Helsinki, Finland. Stratification by gender and
habitual protein intake (low protein (>=0.9 g/kg BW/day - <1.0 g/kg BW/day), very low
protein (<0.9 g/kg BW/day)).
Study population: A total of 264 community-dwelling older adults aged ≥ 65 years with an
habitual low protein intake (n=132 at each study site).
Intervention: This RCT consists of three groups; two intervention groups and one control
group. Intervention group 1 (N=44 at each study site) will receive personalized dietary
advice aimed at increasing protein intake to at least 1.2 g/kg adjusted body weight/d
without changing daily energy intake, by regular foods and by provided protein-enriched
food products. Intervention group 2 (N=44 at each study site) receives personalized
dietary advice similar to group 1 and also receives personalized advice to consume
protein rich foods in close proximity of usual physical activity. All groups receive a
standard brochure of the Netherlands or Finnish Nutrition Centre with general
information about healthy eating habits. The control group (N=44 at each at each study
site) receives no further intervention.
Main study parameters/endpoints: The primary outcome of this study is change in walk
time on the 400 meter walk test. Secondary outcomes are change in dietary intake
(including macro- and micronutrients), malnutrition prevalence, physical performance,
mobility limitations, muscle strength, body weight and body composition, frailty status,
quality of life, and health care costs.
Statistical analyses:
The collected data at the two study sites will be pooled together.
As a result of randomization at study baseline, we assume that groups are equal
regarding demographical and socio-economic variables. If this is not the case, we will
adjust for differences between groups at baseline. We will adjust for study site (the
Netherlands, Finland) and baseline outcome values. We will present unadjusted and
adjusted results.
The main analyses will be based on intention-to-treat principles, but per-protocol
analyses will also be conducted as a sensitivity analysis.
Multiple Imputation (MI) using multivariate Imputation by Chained Equations (MICE) will
be used to impute missing cost and effect data. For this, the missing values need to be
missing at random.
The (cost) effectiveness of two intervention groups will be examined against the control
group on the primary outcome walk time on the 400 meter walk test. We will compare
outcomes between the respective intervention groups and control group separately to
determine whether the two interventions are effective (group 1 versus control group;
group 2 versus control group).
We will perform mixed model regression analyses adjusting for confounding variables at
baseline and study site as cluster variable. We will not correct for multiple testing
but look at the clinical relevance of the outcome.
In addition, we will perform sensitivity analyses leaving out the participants who took
part in the persuasive technology sub-study.
**** Update June 2020 ****
Deviation of the protocol
Due to the worldwide spread of Covid-19, the original protocol of the PROMISS prevention
trial has been changed for those participants who were still active in the study during
the spread (March 16th - June 1st). In consultation with both Medical Ethical boards
from Finland and the Netherlands, and PROMISS' ethical advisor, the following changes
were applied:
March 2020 * Starting from March 16 2020, the final follow-up measurement of 80
participants (out of 276) was postponed until further notice.
* Participants were informed that they would be invited for the final follow-up
measurement when the country-specific governmental regulations allowed it.
* Participants were requested to stick to their habitual diet (control group) or their
intervention diet (both intervention groups).
April 2020 * Final measurements were resumed (through interview by phone) except for the
physical measurements.
* Dietary intake was assessed in the week prior to the phone call measurement.
* Self-reported body weight was added to the questionnaire.
* The physical follow-up measurement was still postponed until further notice.
May 2020
* Data collection was continued by means of questionnaires during the phone call
measurement in both Finland and the Netherlands.
June 2020
- Starting from the beginning of June, the physical measurements at the clinic site
were also resumed in both Finland and the Netherlands. Those with no health
complaints potentially caused by the coronavirus were allowed to visit the clinic
site.
- The data collection will finish by July 31, 2020.
We will perform sensitivity analyses excluding those participants who were still active
in the study during the spread and thus had their physical follow-up measurement +/- 8
months after the baseline assessment (instead of 6 months).
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