PROMISS: Low protein intake in community-dwelling older adults

Speaking at the European Federation of the Associations of Dietitians (EFAD) conference held in Rotterdam, the Netherlands on 28 and 29 September 2018, Marjolein Visser from the Department of Health Sciences, Vrije Universiteit Amsterdam, presented the unpublished findings of the on-going PROMISS (PRevention Of Malnutrition In Senior Subjects) trial. The PROMISS trial focuses on understanding and managing protein-energy malnutrition in community-dwelling older adults.

Summary | Prelimary findings of the PROMISS trial show gaps in the understanding of protein and protein-energy malnutrition among community-dwelling older adults. Also, a higher recommended daily protein intake of 0.8 g/kg adjusted body weight/day may be necessary.

Protein-energy malnutrition is defined as the progressive loss of lean body mass and adipose tissue due to insufficient consumption of protein and energy (1). Older adults have an increased risk of developing protein-energy malnutrition. The prevalence of protein-energy malnutrition was 12% in Dutch community-dwelling older adults (≥65 years old) with home care, 7% in those without home care and 18% for those staying in nursing homes (2). As the majority (90-97%) of older adults live at home, protein-energy malnutrition is a sizeable problem.

All the participants (n=8107) of the PROMISS trial were ≥55 years old, said Visser. Using the cut-off point of <0.8 g/kg adjusted body weight/day, the prevalence of low protein intake was 21.5%. Additionally, the prevalence of low protein intake was associated with gender—women tend to have a low protein intake than men, BMI— those with a higher BMI (overweight and obese) tend to have a low protein intake and appetite—poor appetite is linked to low protein intake, she noted. Low protein intake was not associated with various factors such as age, education level, living status and weight status.

In general, the knowledge level on protein among community-dwelling older adults is low, said Visser. Majority (64.7%) of older adults do not know what dietary protein is. Among those who do know, the 3 most common misconceptions were:

  • One meal a day with a good protein source is sufficient;
  • Health experts recommend people of my age to consume less protein;
  • The human body is good at storing protein to use later, it is thus not necessary to consume a steady amount of protein every day.

The preliminary findings of the PROMISS trial is in line with the findings of other reports: a higher protein intake above the current RDA (recommended daily allowance) of 0.8 g/kg adjusted body weight/day may be necessary to prevent protein-energy malnutrition in community-dwelling older adults, Visser concluded.


  1. Hengeveld LM, Wijnhoven HAH, Olthof MR, Brouwer IA, Harris TB, Kritchevsky SB, Newman AB, Visser M; Health ABC Study. (2018) Prospective associations of poor diet quality with long-term incidence of protein-energy malnutrition in community-dwelling older adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr2018; 107(2): 155-164.
  2. Undernutrition in community-dwelling older individuals. Recognition and Treatment. 2013. Available at: