Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group

The group recommends at least 1.0 to 1.2 g of protein per kg of body weight daily for people over 65, and more than 1.2 g/kg/day for those who exercise, to help maintain and regain lean mass and physical function.
Summary

An international expert group appointed by the European Union Geriatric Medicine Society reviewed the evidence on how much dietary protein older adults need. They accounted for age-related changes in protein metabolism and for the effect of illness and inactivity. The group recommends 1.0 to 1.2 g of protein per kg of body weight per day for most people over 65, higher amounts for those who are active or unwell, alongside endurance and resistance exercise.

Context Note
Recommendations apply to adults over 65.

Study breakdown

Why this study was done

Protein guidelines have long given every adult the same number regardless of age: 0.8 grams per kilogram of body weight per day. That figure takes no account of what changes with age. Older people extract more of an ingested protein load in the gut and liver before it reaches muscle, and their muscle responds less to what does arrive. Illness adds further demand. A group convened by the European Union Geriatric Medicine Society reviewed the evidence and produced updated recommendations for people over 65.

How it was run

This is a position paper from an appointed expert panel, not a trial. The EUGMS appointed an international study group of 13 members led by Jurgen Bauer and Yves Boirie, covering geriatric medicine, endocrinology, nutrition, exercise physiology, gastroenterology and renal medicine. The group first met in July 2012 and then worked by email, following a Delphi-like consensus process of structured discussion, evidence-based reasoning and iterative steps toward agreement. It reviewed protein needs in healthy older people and in disease, exercise alongside protein, protein source and timing, and functional outcomes.

What they found

The key recommendations are:

  • Healthy older people should consume at least 1.0 to 1.2 g of protein per kg of body weight per day, up from 0.8 g/kg.
  • The per-meal threshold for stimulating muscle building is higher in older people: about 25 to 30 g of protein per meal, containing roughly 2.5 to 2.8 g of leucine.
  • Most older adults with an acute or chronic disease need 1.2 to 1.5 g/kg/day. Those with severe illness, injury or marked malnutrition may need as much as 2.0 g/kg/day.
  • Older people with severe kidney disease who are not on dialysis, meaning an estimated glomerular filtration rate below 30 mL/min/1.73 square meters, are the exception and need to limit protein intake.
  • Endurance exercise is recommended at 30 minutes a day or at individually safe and tolerated levels, with progressive resistance training 2 to 3 times a week for 10 to 15 minutes or more per session where possible.
  • People who exercise should reach at least 1.2 g/kg/day, and the group suggests considering a 20 g protein supplement after exercise sessions.

The group says protein quality, timing and amino acid supplementation may be worth considering, but evidence is not yet sufficient for specific recommendations.

Limitations

The funding and conflict declarations should be read carefully. The EUGMS received a grant from Nestle Nutrition to fund this study group, which paid for its operational activities and its meeting. However, most named authors declare payments from nutrition companies: speaker honoraria, consultancies or research grants from Nestle, Nutricia, Abbott, Fresenius, Lactalis, Sanofi-Aventis, Pfizer, Novartis, Purina, Baxter and Shire appear across the author list. One author, P.S., declared no conflict of interest. Beyond funding, this is consensus expert opinion rather than a systematic review, with no pooled effect estimates and no formal evidence grading. The authors note that longer-term studies are needed and that relatively few studies of protein in older people have used physical function as an outcome.

What it means in practice

These recommendations are written for and about people over 65, including frail, hospitalized and chronically ill older adults. The figures do not automatically extend to healthy or younger people, whose metabolism the paper explicitly contrasts with the older group's. It names a clear exception where more protein is the wrong answer: severe kidney disease without dialysis. It reports no trial result, so it is not evidence that any particular product changes outcomes. It is a panel's reading of the literature, produced with industry funding.

Study Type
Position Stand
Published
2013
Journal of the American Medical Directors Association
Participants
Not applicable, position paper
Dose Studied
1.0 to 1.2 g protein per kg body weight daily, higher for active or unwell older adults
Health Focus
Strength & Power
Recovery
Ingredients
Protein

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