The Effect of Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults



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Aging is the time-related deterioration of the physiological functions necessary for survival and fertility. In the 2019 US population, life expectancy at birth was 77.8 years, with males at 75.1 years and females at 80.5 years. Therefore, most adults could live well into their senior years. However, as adults age, several age-related diseases can occur, the most common being cardiovascular disease, cancer, Alzheimer’s disease, Parkinson’s disease, and sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. In research, the worldwide sarcopenia prevalence ranges from 0.2-86.5%, with women from 0.3-91.2% and men from 0.4-87.7%. Severe worldwide sarcopenia varied from 0.2-45% in women and 0.2-17.1% in men. In the US, 15.51% of older adults have been diagnosed with sarcopenia. Early identification and intervention are the keys to improved sarcopenia outcomes. A sarcopenia diagnosis requires the measurements of muscle mass, strength, and function. Although many factors lead to sarcopenia, the two crucial factors in older adults that can be controlled are inadequate nutrient intake and physical inactivity. The Society for Sarcopenia, Cachexia, and Wasting Disease provided protein recommendations for treating and preventing sarcopenia of at least 1.0–1.5 g/kg BW/day with exercise. The per-meal anabolic threshold recommendation is 25-30 g protein to initiate muscle protein synthesis. Additionally, physical activity directly impacts muscle quality and quantity. For example, inactivity in older adults can promote sarcopenia, while physical activity prevents it. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking. CM helps people access and eat nutrient-dense meals to prevent and treat potential chronic diseases. Unfortunately, older adults need to be aware of their macro- and micronutrient needs and need more proper skills to prepare nutrition-dense foods. Thus, the CM program can be an innovative strategy to improve protein intake in independent older adults through at-home cooking. This program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality. A single-center, parallel-group, randomized study was conducted, comparing an online culinary medicine intervention (CMG) teaching about enhancing protein intake to a control group (CNG) while monitoring each group’s muscle strength, muscle mass, and physical activity for muscle quality. The study comprised a 16-week intervention. Participant recruitment started in June 2022 and was completed in late August 2022. The final participant total for the data analysis was 24 in the CMG and 23 in the CNG. No between-group difference in muscle mass change from the pre-study was detected (p = 0.881). There was no between-group difference in the muscle strength change from the pre-study (dominant: p = 0.920 and non-dominant: p = 0.715). A borderline non-significant time-by-intervention interaction was observed for daily protein intake (p = 0.08). There was also no statistically significant difference in protein intake between the groups (p = 0.498). However, a statistically significant time effect was observed (p = <0.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 2-16 vs. week 1 (p < 0.05) in the cohort. At week 16, protein intake was 16.9 g (95% CI, 5.77 to 27.97), higher than at baseline. When evaluating behavioral changes toward cooking during the post-study appointment, most of the intervention group reported that the cooking demonstrations helped them prepare recipes at home, providing more confidence in the kitchen, and its learning was feasible for them. Similar age, majority female and Caucasian, and overall healthy state could have affected the diversity of the study’s population. In this cohort of healthy older adults, a CM program that aimed to enhance protein intake and muscle quality did not affect protein intake, muscle mass, muscle strength, and physical activity. Insufficient consistent protein intake, low physical activity, adherence to the intervention, and accuracy of the questionnaires could explain the results. In the future, it would be valuable to investigate further the factors that could have affected this study. Future directions could include in-person intervention; staff of registered dietitians, chefs, health coaches, and psychologists; recruitment meeting the general population and certain cooking skill levels; how recipes and education are done; and considering muscle biopsy and serum biomarkers for alternative ways to measure muscle quality.



Culinary Medicine, Older Adults, Protein, Muscle Quality, Nutrition Intervention