Advertisement

European Journal of Nutrition

, Volume 58, Issue 2, pp 807–817 | Cite as

The association of protein and carbohydrate intake with successful aging: a combined analysis of two epidemiological studies

  • Alexandra Foscolou
  • Emmanuela Magriplis
  • Stefanos Tyrovolas
  • Christina Chrysohoou
  • Labros Sidossis
  • Antonia-Leda Matalas
  • Loukianos Rallidis
  • Demosthenes PanagiotakosEmail author
Original Contribution

Abstract

Purpose

Previous studies have reported associations between levels of protein and carbohydrate intake with several health outcomes. Yet, their effect on successful (or healthy) aging remains unknown. The purpose of the present work was to investigate the association of protein and carbohydrate intake levels with successful aging.

Methods

A cross-sectional analysis was carried out on the participants of two epidemiological studies; the ATTICA and the MEDIS studies. Anthropometrical, clinical and socio-demographic characteristics, dietary habits, and lifestyle parameters were derived through standard procedures. Successful aging was evaluated using a validated index (SAI) composed of 10 health-related social, lifestyle and clinical characteristics.

Results

SAI levels were lower in low protein—high carbohydrate diet group (B = − 0.08, p = 0.04), but higher in high protein—high carbohydrate group (B = 0.06, p = 0.04), as compared to low protein and low carbohydrate diet, in participants living in insular areas. Protein—carbohydrate diet was not associated with SAI (all p’s > 0.05) among participants living in urban areas (p for diet—study interaction < 0.001).

Conclusions

A high protein diet seems to be beneficial for older islanders in terms of successful aging; stating a hypothesis for a potential diet–environmental interaction that may be related to the quality of foods consumed and, consequently the sources of nutrients.

Keywords

Successful aging Carbohydrate Protein Lifestyle Nutrition 

Notes

Acknowledgements

Authors are particularly grateful to the men and women from all areas that participated in the ATTICA and MEDIS studies. Also, author would like to acknowledge the contribution of the MEDIS study group: E. Polychronopoulos, M. Tornaritis, A. Polystipioti, M. Economou, (field investigators from Cyprus), A. Zeimbekis, K. Gelastopoulou, I. Vlachou (field investigator from Lesvos), C. Lionis, I. Tsiligianni, M. Antonopoulou, N. Tsakountakis, K. Makri (field investigators from Crete), E. Niforatou, V. Alpentzou, M. Voutsadaki, M. Galiatsatos (field investigators from Cephalonia), K. Voutsa, E. Lioliou, M. Miheli (field investigator from Corfu), S. Tyrovolas, G. Pounis, A. Katsarou, E. Papavenetiou, E. Apostolidou, G. Papavassiliou, P. Stravopodis (field investigators from Zakynthos), E. Tourloukis, V. Bountziouka, A. Aggelopoulou, K. Kaldaridou, E. Qira, (field investigators from Syros and Naxos), D. Tyrovola (field investigator from Kassos), I. Protopappa (field investigator from Ikaria), C. Prekas, O. Blaserou, K.D. Balafouti (field investigators from Salamina), S. Ioakeimidi (field investigators from Rhodes and Karpathos), A. Foscolou (field investigator from Tinos), A. Mariolis, E. Petropoulou, A. Kalogerakou, K. Kalogerakou (field investigators from Mani), A. Foscolou, K. Katsana, P. Drepanidis, S. Iosifidis (field investigators from Spetses), A. Foscolou, K. Gkouvas, K. Katsana, (field investigators from Aegina), A. Foscolou, K. Gkouvas, K. Katsas, P. Kaloudi, E. Papachristou, A. Stamouli (field investigators from Paros) S. Piscopo (field investigators from Malta), J.A. Tur (field investigators from Mallorca and Menorca), G. Valacchi, (B. Nanou (field investigators from Sardinia and Sicily), A. Foscolou, E. Paka, P. Drepanidis (field investigators from Gökçeada) for their substantial assistance in the enrolment of the participants. Authors would like to thank the ATTICA study group investigators: Y. Skoumas, N. Katinioti, L. Papadimitriou, C. Masoura, S. Vellas, Y. Lentzas, M. Kambaxis, K. Paliou, V. Metaxa, N. Skourlis, C. Papanikolaou, A. Kalogeropoulou, E. Pitaraki, A. Laskaris, M. Hatzigeorgiou, A. Grekas, E. Kokkou, E. Georgousopoulou, for either assistance in the initial physical examination, as well as laboratory team: C. Vassiliadou and G. Dedousis (genetic analysis), M. Toutouza-Giotsa, C. Tselika and S. Poulopouloou (biochemical analysis) and M. Toutouza for the database management.

Funding

The ATTICA study is supported by research grants from the Hellenic Cardiology Society (HCS2002) and the Hellenic Atherosclerosis Society (HAS2003). The MEDIS study was funded by Research grants from the Hellenic Heart Foundation, the Graduate Program of the Department of Nutrition & Dietetics, Harokopio University and the Rutgers University, NJ, USA (GA #5884). Stefanos Tyrovolas was supported by the Foundation for Education and European Culture (IPEP), the Sara Borrell postdoctoral program [reference no. CD15/00019 from the Instituto de Salud Carlos III (ISCIII—Spain) and the Fondos Europeo de Desarrollo Regional (FEDER)]. Demosthenes Panagiotakos and Stefano Tyrovolas have been funded for ATHLOS project to study trajectories of healthy aging (European Union’s Horizon 2020 research and innovation program, Grant Agreement no. 635316).

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Antonio J, Ellerbroek A, Silver T, Orris S, Scheiner M, Gonzalez A, Peacock CA (2015) A high protein diet (3.4 g/kg/d) combined with a heavy resistance training program improves body composition in healthy trained men and women–a follow-up investigation. J Int Soc Sports Nutr 12(1):39CrossRefGoogle Scholar
  2. 2.
    Astrup A, Raben A, Geiker N (2015) The role of higher protein diets in weight control and obesity-related comorbidities. Int J Obes (Lond) 39(5):721–726CrossRefGoogle Scholar
  3. 3.
    Bradlee ML, Mustafa J, Singer MR, Moore LL (2017) High-protein foods and physical activity protect against age-related muscle loss and functional decline. J Gerontol A Biol Sci Med Sci.  https://doi.org/10.1093/gerona/glx070 Google Scholar
  4. 4.
    Chiarelli F, Verrotti A, Basciani F, di Ricco L, Sabatino G, Morgese G (1998) Controversies on the prevention of diabetic nephropathy. J Pediatr Endocrinol Metab 11(Suppl 2):365–369Google Scholar
  5. 5.
    Nilsson LM, Winkvist A, Johansson I, Lindahl B, Hallmans G, Lenner P, Van Guelpen B (2013) Low-carbohydrate, high-protein diet score and risk of incident cancer; a prospective cohort study. Nutr J 12:58CrossRefGoogle Scholar
  6. 6.
    Kennedy ET, Bowman SA, Spence JT, Freedman M, King J (2001) Popular diets: correlation to health, nutrition, and obesity. J Am Diet Assoc 101(4):411–420CrossRefGoogle Scholar
  7. 7.
    Seneff S, Wainwright G, Mascitelli L (2011) Nutrition and Alzheimer’s disease: the detrimental role of a high carbohydrate diet. Eur J Intern Med 22(2):134–140CrossRefGoogle Scholar
  8. 8.
    Huang J, Pan G, Jiang H, Li W, Dong J, Zhang H et al (2017) A meta-analysis between dietary carbohydrate intake and colorectal cancer risk: evidence from 17 observational studies. Biosci Rep 37(2):BSR20160553CrossRefGoogle Scholar
  9. 9.
    Namazi N, Larijani B, Azadbakht L (2017) Low-carbohydrate-diet score and its association with the risk of diabetes: a systematic review and meta-analysis of cohort studies. Horm Metab Res 49(8):556–571Google Scholar
  10. 10.
    Jung CH, Choi KM (2017) Impact of high-carbohydrate diet on metabolic parameters in patients with type 2 diabetes. Nutrients.  https://doi.org/10.3390/nu9040322 Google Scholar
  11. 11.
    Shinaberger CS, Kilpatrick RD, Regidor DL, McAllister CJ, Greenland S, Kopple JD, Kalantar-Zadeh K (2006) Longitudinal association between dietary protein intake and survival in hemodialysis patients. Am J Kidney Dis 48(1):37–49CrossRefGoogle Scholar
  12. 12.
    Global Burden of Disease Study 2013 Collaborators (2015) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386(9995):743–800CrossRefGoogle Scholar
  13. 13.
    Sowa A, Tobiasz-Adamczyk B, Topor-Madry R, Poscia A, la Milia DI (2016) Predictors of healthy ageing: public health policy targets. BMC Health Serv Res 16(Suppl 5):289CrossRefGoogle Scholar
  14. 14.
    Cosco TD, Howse K, Brayne C (2017) Healthy ageing, resilience and wellbeing. Epidemiol Psychiatr Sci.  https://doi.org/10.1017/S2045796017000324 Google Scholar
  15. 15.
    Kim Y, Kim K, Boerner K, Han G (2017) Aging together: self-perceptions of aging and family experiences among korean baby boomer couples. Gerontologist.  https://doi.org/10.1093/geront/gnx132 Google Scholar
  16. 16.
    Panagiotakos DB, Georgousopoulou EN, Pitsavos C, Chrysohoou C, Metaxa V, Georgiopoulos GA et al (2015) Ten-year (2002–2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: the ATTICA Study. Int J Cardiol 180:178–184CrossRefGoogle Scholar
  17. 17.
    Tyrovolas S, Haro JM, Mariolis A, Piscopo A, Valacchi G, Tsakountakis N et al (2014) Successful aging, dietary habits and health status of elderly individuals: a k-dimensional approach within the multi-national MEDIS study. Exp Gerontol 60:57–63CrossRefGoogle Scholar
  18. 18.
    Papathanasiou G, Georgoudis G, Papandreou M, Spyropoulos P, Georgakopoulos D, Kalfakakou V, Evangelou A (2009) Reliability measures of the short International Physical Activity Questionnaire (IPAQ) in Greek young adults. Hellenic J Cardiol 50(4):283–294Google Scholar
  19. 19.
    Katsouyanni K, Rimm EB, Gnardellis C, Trichopoulos D, Polychronopoulos E, Trichopoulou A (1997) Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers. Int J Epidemiol 26(Suppl 1):S118–S1127Google Scholar
  20. 20.
    Maneesriwongul W, Dixon JK (2004) Instrument translation process: a methods review. J Adv Nurs 48:175–186CrossRefGoogle Scholar
  21. 21.
    Tyrovolas S, Pounis G, Bountziouka V, Polychronopoulos E, Panagiotakos D (2010) Repeatability and validation of a short, semi-quantitative food frequency questionnaire designed for older adults living in Mediterranean areas: the MEDIS-FFQ. J Nutr Elder 29(3):311–324CrossRefGoogle Scholar
  22. 22.
    Bountziouka V, Bathrellou E, Giotopoulou A, Katsagoni C, Bonou M, Vallianou N et al (2012) Development, repeatability and validity regarding energy and macronutrient intake of a semi-quantitative food frequency questionnaire: methodological considerations. Nutr Metab Cardiovasc Dis 22(8):659–667CrossRefGoogle Scholar
  23. 23.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285(19):2486–2497CrossRefGoogle Scholar
  24. 24.
    Endberg H, Oksuzyan A, Jeune B, Vaupel JW, Christensen K (2009) Centenarians—a useful model for healthy aging? A 29-year follow-up of hospitalizations among 40,000 Danes born in 1905. Aging Cell 8(3):270–276CrossRefGoogle Scholar
  25. 25.
    Franceschi C, Bonafe M (2003) Centenarians as a model for healthy aging. Biochem Soc Trans 31(2):457–461CrossRefGoogle Scholar
  26. 26.
    Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V et al (2017) Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet​​ 390(10107):2050–2062CrossRefGoogle Scholar
  27. 27.
    Vasto S, Rizzo C, Caruso C (2012) Centenarians and diet: what they eat in the Western part of Sicily. Immun Ageing 9(1):10CrossRefGoogle Scholar
  28. 28.
    Dandona P, Ghanim H, Chaudhuri A, Mohanty P (2016) Macronutrient intake, insulin secretion, oxidative stress & inflammation: clinico-pathological implications. Indian J Med Res 144(5):645–649CrossRefGoogle Scholar
  29. 29.
    Rao TS, Asha MR, Ramesh BN, Rao KS (2008) Understanding nutrition, depression and mental illnesses. Indian J Psychiatry 50(2):77–82CrossRefGoogle Scholar
  30. 30.
    Bettelheim FA, Brown WH, Campbell MK, Farrell SO (2010) Introduction to organic and biochemistry, 7th edn. Cengage Learning, United KingdomGoogle Scholar
  31. 31.
    Van Goudoever JB (2015) 1.3.3 Protein. 1.3 Nutritional needs. World Rev Nutr Diet 113:41–45CrossRefGoogle Scholar
  32. 32.
    Mendonca N, Granic A, Mathers JC, Hill TR, Siervo M, Adamson AJ, Jagger C (2017) Prevalence and determinants of low protein intake in very old adults: insights from the Newcastle 85 + Study. Eur J Nutr.  https://doi.org/10.1007/s00394-017-1537-5 Google Scholar
  33. 33.
    Beasley JM, Katz R, Shlipak M, Rifkin DE, Siscovick D, Kaplan R (2014) Dietary protein intake and change in estimated GFR in the Cardiovascular Health Study. Nutrition 30(7–8):794–799CrossRefGoogle Scholar
  34. 34.
    Bahadoran Z, Mirmiran P, Hosseini-Esfahabni F, Sadeghi M, Azizj F (2013) Dietary protein, protein to carbohydrate ratio and subsequent changes in lipid profile after a 3-year follow-up: tehran lipid and glucose study. Iran J Public Health 42(11):1232–1241Google Scholar
  35. 35.
    Liu X, Zhang G, Ye X, Li H, Chen X, Tang L et al (2013) Effects of low-carbohydrate diet on weight loss and cardiometabolic profile in Chinese women: a randomized controlled feeding trial. Br J Nutr 110(8):1444–1453CrossRefGoogle Scholar
  36. 36.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156CrossRefGoogle Scholar
  37. 37.
    Van der Zwaluw NL, van de Rest O, Tieland M, Adam JJ, Hiddink GJ, van Loon LJ, de Groot LC (2014) The impact of protein supplementation on cognitive performance in frail elderly. Eur J Nutr 53(3):803–812CrossRefGoogle Scholar
  38. 38.
    Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, Hu FB (2006) Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med 355(19):1991–2002CrossRefGoogle Scholar
  39. 39.
    Jenkins DJ, Kendall CW, Augustin LS, Vuksan V (2002) High-complex carbohydrate or lente carbohydrate foods? Am J Med 113(Suppl 9B):30S–37SGoogle Scholar
  40. 40.
    De Mello Fontanelli M, Sales CH, Carioca AA, Marchioni DM, Fisberg RM (2017) The relationship between carbohydrate quality and the prevalence of metabolic syndrome: challenges of glycemic index and glycemic load. Eur J Nutr.  https://doi.org/10.1007/s00394-017-1402-6 Google Scholar
  41. 41.
    Dernini S, Berry EM (2015) Mediterranean diet: from a healthy diet to a sustainable dietary pattern. Front Nutr 2:15CrossRefGoogle Scholar
  42. 42.
    Tourlouki E, Matalas AL, Bountziouka V, Tyrovolas S, Zeimbekis A, Gotsis E et al (2013) Are current dietary habits in Mediterranean islands a reflection of the past? Results from the MEDIS study. Ecol Food Nutr 52(5):371–386CrossRefGoogle Scholar
  43. 43.
    Garcia-Closas R, Berenguer A, Gonzalez CA (2006) Changes in food supply in Mediterranean countries from 1961 to 2001. Public Health Nutr 9(1):53–60CrossRefGoogle Scholar
  44. 44.
    Tyrovolas S, Haro JM, Mariolis A, Piscopo S, Valacchi G, Makri K et al (2015) The role of energy balance in successful aging among elderly individuals: the multinational MEDIS study. J Aging Health 27(8):1375–1391CrossRefGoogle Scholar
  45. 45.
    Grosso G, Mistretta A, Frigiola A, Gruttadauria S, Biondi A, Basile F, Vitaglione P, D’ Orazio N, Galvano F (2014) Mediterranean diet and cardiovascular risk factors: a systematic review. Clin Rev Food Sci Nutr 54(5):593–610CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alexandra Foscolou
    • 1
  • Emmanuela Magriplis
    • 1
  • Stefanos Tyrovolas
    • 1
    • 2
  • Christina Chrysohoou
    • 3
  • Labros Sidossis
    • 4
  • Antonia-Leda Matalas
    • 1
  • Loukianos Rallidis
    • 5
  • Demosthenes Panagiotakos
    • 1
    Email author
  1. 1.Department of Nutrition and Dietetics, School of Health Science and EducationHarokopio UniversityAthensGreece
  2. 2.Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAMUniversitat de BarcelonaBarcelonaSpain
  3. 3.First Cardiology Clinic, School of MedicineUniversity of AthensAthensGreece
  4. 4.Department of Kinesiology and Health, School of Arts and SciencesRutgers UniversityNew BrunswickUSA
  5. 5.Second Cardiology Clinic, School of MedicineUniversity of AthensAthensGreece

Personalised recommendations