4. Discussion
pneumonia, urinary tract infections, chronic kidney disease, cancer, cancer, infectious diseases, fractures, primary disease
CANCER, PNEUMONIA, DISEASES, URINARY TRACT INFECTIONS
The present study is the first multicenter, randomized, comparative clinical trial to examine the efficacy and safety of increased dietary protein intake for improving physical activity in older adults with diseases such as cancer, pneumonia, fractures, and urinary tract infections and at nutritional risk.Although intervention studies with supplements such as leucine and whey protein have been shown to be effective in improving ADL in older adults [In the present study, we found that grip strength was increased significantly, and that SMI and leg strength tended to be improved by 6-month nutritional intervention of increased dietary protein intake, while there was no change in the ADL-related indices. According to IPAQ quantification, the physical activity recommended to both groups was light-intensity activity such as walking 3 to 5 times per week; since physical activity of the two groups was similar, exercise should not be a factor in the increase of muscle strength and mass observed in the IC group. It has been reported that grip strength decreases by 0.4 kg (0.5 kg for men, 0.3 kg for women) per year with aging [A meta-analysis suggested that increasing protein intake to 1.3 g/kgw/day can increase lean body mass dose-dependently in participants without cancer, infectious diseases, or chronic kidney disease and a mean age of 47.2 years [The present study found no significant changes in the ADL-related indices (Barthel index and Lawton score) in either group. Most participants showed favorable ADL by these indexes at baseline, so it was difficult to demonstrate improvement. However, RFD8.75/w, a force development parameter reflecting fundamental motor competence in daily living that is correlated with Timed Up and Go results and routine physical activity and is used to evaluate leg function in older adults with physical frailty [This study has several limitations: (1) The nutrient intake at baseline differed between the two groups. Participants were randomly allocated to the groups based on the primary disease for hospitalization, gender, and SMI without regard for dietary energy and macronutrient intake, suggesting the possibility that differences in nutrient intake at baseline may have influenced the end points. (2) A considerable number of participants were excluded from the analysis because they requested a transfer to a general practitioner near their home, but dropout rates were comparable in both groups.