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Physical frailty may compromise physical function and reduce self-reliance in community-dwelling older adults. We investigated if nutritional risk factors and protein intake were associated with physical frailty in community-dwelling adults.This cross-sectional study combined data from two studies in community-dwelling adults ≥65 years. Variables included physical frailty (SHARE-FI75+), nutritional risk factors (dysphagia, poor dental status, illness, unintentional weight loss, low and high BMI), chronic diseases, physical function, and protein intake (4-day food records). Logistic regression analyses were performed to investigate the association between physical frailty, number of nutritional risk factors and specific nutritional risk factors, and between physical frailty and protein intake.A total of 1430 participants were included in the study of these n = 860 were ≥80 years. Having one, two or more nutritional risk factors increased odds of physical pre-frail/frail condition (adjusted OR 1.39 95% CI 1.07-1.80; OR 2.67 1.76-4.04, respectively). Unintentional weight loss, poor dental status, dysphagia, and high BMI independently increased odds of physical pre-frail/frail condition. In participants ≥80 years two or more nutritional risk factors were associated with physical pre-frail/frail condition (adjusted OR 2.56 95%CI 1.45-4.52) and high BMI increased odds of physical pre-frail/frail condition independently. Higher intakes of protein did not significantly reduce odds of physical pre-frail/frail condition (adjusted OR 0.23 95% CI 0.05-1.09) in this sample of community-dwelling adults ≥80 years.Nutritional risk factors were independently associated with physical pre-frail/frail condition in community-dwelling older adults. Tackling nutritional risk factors offers an opportunity in primary prevention of malnutrition and physical frailty.

Background The proportion of older citizens is increasing worldwide. A well-known syndrome in old age is physical frailty which is associated with a greater risk of disabilities in activities of daily living, greater reliance on in-home services, hospitalization, institutionalization, and premature mortality. The purpose of this study is to determine the effects of an intervention with high-protein diet alone or in combination with power training in pre-frail and frail old adults. Methods The study is a community-based assessor-blinded parallel randomized controlled trial (RCT), consisting of two phases. Phase 1 is a 1-month stabilization phase, where self-reliant community-dwelling adults + 80 years old will receive individual guidance regarding protein intake, to prevent the risk of negative protein balance prior to phase 2 and to only include participants who have reached the minimum recommended level of protein intake (1.0 g/kg/day) in the randomized controlled trial. Phase 2 is a 4-month RCT where 150 participants will be randomized into the following three arms: protein-only where participants will be provided with dairy products to increase their protein intake to 1.5 g/kg/day, protein + exercise where participants will be provided with the protein intervention in combination with power training two times a week, and recommendation group where participants will continue as in phase 1. Primary outcome is lower leg muscle power. Secondary outcomes include physical function and mobility, frailty status, muscle mechanical function, body composition, nutritional status, and health-related quality of life. The statistical analysis will include an intention-to-treat analysis of all randomized participant and per-protocol analysis of all compliant participants. The study hypothesis will be tested with mixed linear models to assess changes in the main outcomes over time and between study arms. Discussion The finding of this study may add to the knowledge about the beneficial effects of high-protein diet from dairy products combined with power training to counteract frailty in community-dwelling older adults. This may ultimately have an impact on the ability to live well and independent for longer. Trial registration ClinicalTrials.gov NCT03842579. Registered on 15 February 2019, version 1