The Relationship between Excess Dietary Protein and Bone Loss or Fractures in Elderly People - Research Proposal Example

An Examination of the Relationship between Excess Dietary Protein and Bone Loss or Fractures in Elderly People The effect of protein consumption on bone density is uncertain. However, an increased consumption of protein causes excretion of calcium from the body. Thus, inadequate dietary intake of calcium could adversely affect the risk of bone loss or fracture from dietary protein. There is no clear evidence of the type of protein; animal or vegetable and its effect on bone density. The study examines the relationship between dietary protein and bone loss or fractures in people aged 55-95 years old. Also, the effect of dietary supplements, type of protein and lifestyle would be examined. The strength of the study would be to contribute to ongoing studies on dietary protein and risk for bone loss or fractures. The weakness of the study would be the inability to capture or examine other factors in greater detail. An understanding of the relationship between dietary protein and risk of bone loss or fracture could help prevent fractures, especially in elderly people. Aims and Objectives The study aims to study the relationship between protein consumption and loss of bone mass or bone fractures in elderly people aged 55-95 years. More specifically, the study objectives are to test the following hypotheses. 1. Excess dietary protein causes bone loss or fracture in elderly people. 2. Animal protein causes greater bone loss or fracture in elderly people than vegetable protein. 3. Regular exercise reduces bone loss or fracture in elderly people. Background Review of relevant literature on effects of dietary protein and bone density, type of protein, dietary supplements and exercise have been illustrated in table 1. Table 1. Review of Relevant Literature Source Study Conclusion Avenell et al (2003) A systematic review of protein and energy supplementation for hip fracture aftercare in older people Protein and energy supplements could influence recovery after hip fracture by reducing undesirable outcome. Barzel et al (1998) Excess Dietary Protein Can Adversely Affect Bone Excess protein with high renal acid load potential can adversely affect bone health. Barker et al (2005) Serum Retinoids and Carotene as Predictors of Hip and Other Fractures in Elderly Women Excessive vitamin A exposure does not increase risk of fracture. Bachrach et al (2001) Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture The use of biochemical markers in the acute postoperative period in the assessment of nutritional status may not be effective. Butler Role of milk consumption in osteoporotic fractures There is no protective effect of milk consumption on osteoporotic fractures. Moderate consumption of animal food may have protective effect against hip fracture. Dawson et al (2002) Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women Increase in protein intake along with calcium citrate malate and vitamin D has a favourable effect on BMD in elderly people. Evans et al (1997) Nutrition, exercise, and healthy aging Regular exercise is beneficial for good bone health and improves the functional capacity in elderly people. Freudenheim et al (2000) Relationships between usual nutrient intake and bone-mineral content of women 35-65 years of age: longitudinal and cross-sectional analysis High intake of energy, protein, calcium, phosphorus, zinc, and folate were associated with slower bone loss. Feskanich et al (1996) Protein Consumption and Bone Fractures in Women Women who consumed more protein and five or more servings of red meat per week had an increased risk of forearm fracture. Hannan et al (2000) Risk Factors for Longitudinal Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study Estrogen use may maintain bone health in women, while smoking may cause bone loss in men. Hannan et al (2000) Effect of Dietary Protein on Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study Protein intake helped minimizing bone loss in elderly people. Higher intake of animal protein may not affect bone health in the elderly. Heaney (1998) Excess Dietary Protein May Not Adversely Affect Bone Excess dietary protein does not cause any harm to bone health. Ilich et al (2003) Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density There may be an association between nutrients, such as magnesium, vitamin C, zinc, protein, energy, and calcium and bone mineral density (BMD). Massey (2003) Dietary Animal and Plant Protein and Human Bone Health: A Whole Foods Approach Excess protein with high renal acid load potential can adversely affect bone health. Massey (1998) Does Excess Dietary Protein Adversely Affect Bone? Overall diet determines the effect on bone. Calcium form milk, fruits and vegetables could counter adverse effects of protein. Munger et al (1999) Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women Protein intake might be associated with a reduced incidence of hip fractures. Promislow et al (2002) Protein Consumption and Bone Mineral Density in the Elderly Animal protein consumption may cause an increase in BMD, especially in women. Vegetable protein consumption does not cause an increase in BMD. Rapuri et al (2001) Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes High intake of caffeine could increase spinal bone loss in elderly postmenopausal women. Rapuri et al (2003) Protein intake: effects on bone mineral density and the rate of bone loss in elderly women Higher intake of protein caused higher BMD, especially in women with calcium intakes. Protein intake and the rate of bone loss were not correlated. Rizzoli et al (2001) Protein intake and bone disorders in the elderly Protein supplements along with vitamin D and calcium improves clinical outcomes after hip fracture, and prevents BMD loss. Riggs et al (1998) A Unitary Model for Involutional Osteoporosis: Estrogen Deficiency Causes Both Type I and Type II Osteoporosis in Postmenopausal Women and Contributes to Bone Loss in Aging Men Estrogen deficiency increases bone resorption and negatively impacts increase in bone formation. Sellmeyer et al (2001) A High Ratio of Dietary Animal to Vegetable Protein Increases the Rate of Bone Loss and the Risk of Fracture in Postmenopausal Women Increase in vegetable protein and reduced intake of animal protein reduces the risk of hip fracture in the elderly. Spencer et al (1998) Do Protein and Phosphorus Cause Calcium Loss? Normal protein intake along with normal or high phosphorus and calcium intake could be protective. Tucker et al (2002) Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study High fruit and vegetable intake had a protective role, especially in men, while high candy intake was associated with low BMD. Welteh et al (2005) A Meta-Analysis of the Effect of Calcium Intake on Bone Mass in Young and Middle Aged Females and Males Calcium intake higher than 800 mg/d could optimize bone mass before the onset of menopause. Weaver et al (1999) Choices for achieving adequate dietary calcium with a vegetarian diet Calcium in vegetarian diets may not be sufficient, and fortified foods or supplements are required. Yano et al (1995) The relationship between diet and bone mineral content of multiple skeletal sites in elderly Japanese-American men and women living in Hawaii There may be an association between intake of milk, calcium, and vitamin D and bone mineral content in elderly people. Design and Methodology Men and women aged between 55-95 years would be enrolled in the study. Sufficient number of samples would be collected for statistically significant results. Data would be collected by the use questionnaires. A detailed questionnaire with several sections would be prepared. A section would capture their dietary protein consumption habits, such as quantity and the type of protein. Another section would capture their lifestyle habits, such as hours or activity, work, sleep, exercise and type of exercise. Finally, a section on medical history would be designed to capture their medical history and diseases. This would enable to determine the existence of correlation between protein intake and bone loss for subjects with hip fractures or rest fractures. A comprehensive statistical analysis would be conducted to test the hypotheses by the use of tools, such as SPSS. Schedule It is estimated that the study, would extend over 180 days. This includes the design of questionnaire, approval of study by the ethical advisory committee, subject enrolment, data collection, data analysis, and preparation of the report. Ethical Approval All considerations for ethical issues would be made and necessary approval from ethical advisory committees and boards would be obtained. Since, elderly people would be enrolled in the study special considerations would be made to make them comfortable with the study. Also, considerations would be made for cultural values of the subjects. Resources Resources required for this study are subjects, questionnaire for data gathering, and data analysis tools, such as SPSS. References Avenell, A, Handoll, HHG, 2003. A systematic review of protein and energy supplementation for hip fracture aftercare in older people. European Journal of Clinical Nutrition. 57, 895–903. Barzel, US, Massey, LK, 1998. Excess Dietary Protein Can Adversely Affect Bone. J. Nutr. 128: 1051–1053. Barker, ME, McCloskey, E, Saha, S, Gossiel, F, Charlesworth, D, Powers, HJ, Blumsohn, A, 2005. Serum Retinoids and Carotene as Predictors of Hip and Other Fractures in Elderly Women. J Bone Miner Res. 20:913–920. Bachrach-Lindstrum, M, Unosson, M, Anna-Christinaek, Jarnqvist, H, 2001. Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture. Clinical Nutrition. 20(3): 217-223. Butler, J, Boning up on Calcium! VVF Dawson-Hughes, B, Harris, SS, 2002. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr. 75:773–9. Evans, WJ, Cyr-Campbell, D, 1997. Nutrition, exercise, and healthy aging. J Am Diet Assoc. 97: 632-638. Freudenheim, JL, Johnson, NE, Smith, EL, 2000. Relationships between usual nutrient intake and bone-mineral content of women 35-65 years of age: longitudinal and cross-sectional analysis. Am J Clin Nutr. 44: 863-76. Feskanich, D, Willett, WC, Stampfer, MJ, Colditz, GA, 1996. Protein Consumption and Bone Fractures in Women. Am J Epidemiol. 143:472-9. Hannan, MT, Felson, DT, Dawson-Hughes, B, Tucker, KL, Cupples, LA, Wilson, PWF, Kiel, DP, 2000. Risk Factors for Longitudinal Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study. J Bone Miner Res; 15:710 –720. Hannan, MT, Tucker, KL, Dawson-Hughes, B, Cupples, LA, Felson, DT, Kiel, DP, 2000. Effect of Dietary Protein on Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study. J Bone Miner Res. 15:2504 –2512. Heaney, RP, 1998. Excess Dietary Protein May Not Adversely Affect Bone. J. Nutr. 128: 1054–1057. Ilich, JZ, Brownbill, RA, Tamborini, L, 2003. Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density. European Journal of Clinical Nutrition. 57, 554–565. Massey, LK, 2003. Dietary Animal and Plant Protein and Human Bone Health: A Whole Foods Approach. J. Nutr. 133: 862S–865S. Massey, LK, 1998. Does Excess Dietary Protein Adversely Affect Bone? Symposium Overview. American Society for Nutritional Sciences. Munger, RG, Cerhan, JR, Chiu, BCH, 1999. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr. 69:147–52. Promislow, JHE, Goodman-Gruen, D, Slymen, DJ, Barrett-Connor, E, 2002. Protein Consumption and Bone Mineral Density in the Elderly. Am J Epidemiol. 155(7). Rapuri, PB, Gallagher, JC, Kinyamu, HK, Ryschon, KL, 2001. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr. 74:694–700. Rapuri, PB, Gallagher, JC, Haynatzka, V, 2003. Protein intake: effects on bone mineral density and the rate of bone loss in elderly women. Am J Clin Nutr. 77:1517–25. Rizzoli, R, Ammann, P, Chevalley, T, Bonjour, J, 2001. Protein intake and bone disorders in the elderly. Joint Bone Spine. 68: 383-92. Riggs, BL, Khosla, S, Melton, LJ, 1998. A Unitary Model for Involutional Osteoporosis: Estrogen Deficiency Causes Both Type I and Type II Osteoporosis in Postmenopausal Women and Contributes to Bone Loss in Aging Men. Journal of Bone and Mineral Research. 13 (5). Sellmeyer DE, Stone KL, Sebastian A, Cummings SR, 2001. A High Ratio of Dietary Animal to Vegetable Protein Increases the Rate of Bone Loss and the Risk of Fracture in postmenopausal Women. Am J Clin Nutr 73:118-122. Spencer, H, Kramer, L, Osis, D, 1998. Do Protein and Phosphorus Cause Calcium Loss? J. Nutr. 118:657-660. Tucker, KL, Chen, H, Hannan, MT, Cupples, LA, Wilson, PWF, Felson, D, Kiel, DP, 2002. Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study. Am J Clin Nutr: 76:245–52. Welteh, DC, Kemper, HCG, Post, GB, Staveren, WAV, 1995. A Meta-Analysis of the Effect of Calcium Intake on Bone Mass in Young and Middle Aged Females and Males. J. Nutr. 125: 2802-2813. Weaver, CM, Proulx, WR, Heaney, R, 1999. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 70(suppl):543S–8S. Yano, K, Heilbrun, LK, Wasnich, RD, Hankin, JH, Vogel, JM, 1985. The relationship between diet and bone mineral content of multiple skeletal sites in elderly Japanese-American men and women living in Hawaii. Am J Clin Nutr. 877-888. Read More