Dietary protein intake and body composition, sarcopenia and sarcopenic obesity: A prospective population-based study

Yahong Wu; Tosca O.E. de Crom; Zhangling Chen; Elizabeth Benz; Niels van der Schaft; Alexandre Pinel; Yves Boirie; Doris Eglseer; Eva Topinkova; Josje D.  Schoufour; Peter J.M. Weijs; Fernando Rivadeneira; Cindy G.  Boer; Joyce B.J.  van Meurs; Trudy Voortman

doi:10.1016/j.clnu.2025.07.033

Dietary protein intake and body composition, sarcopenia and sarcopenic obesity: A prospective population-based study

Yahong Wu
, Tosca O.E. de Crom
, Zhangling Chen
, Elizabeth Benz
, Niels van der Schaft
, Alexandre Pinel
, Yves Boirie
, Doris Eglseer
, Eva Topinkova
, Josje D. Schoufour
, Peter J.M. Weijs
, Fernando Rivadeneira
, Cindy G. Boer
, Joyce B.J. van Meurs
, Trudy Voortman

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background&aims

Obesity and sarcopenia are major health concerns, particularly among older populations. Dietary protein may help preserve muscle mass and function, but high-protein diets, especially from animal sources, may also increase adipose mass. We investigated associations of total, animal, and plant protein intake with body composition trajectories, sarcopenia, and sarcopenic obesity.

Methods

We included 4576 participants (mean age 65.1 years, 56 % women) from the population-based Rotterdam Study. Dietary protein was measured using food-frequency questionnaires at baseline (2004–2009). Body composition was measured every 4–5 years using dual X-ray-absorptiometry. Handgrip strength (HGS) was assessed starting 2006 using a hydraulic dynamometer. Sarcopenia was determined based on low appendicular skeletal muscle and HGS; and sarcopenic obesity risk based on measures of lean mass, HGS and body fat. Analyses used linear mixed models and generalized estimate equation models.

Results

Higher total protein intake was associated with increased BMI over time (mean difference [95 %-confidence interval (CI)]: 0.86 kg/m2 [0.01,1.71] per 5E% increase), and increased fat-mass index (1.33 [0.67,1.99]), body-fat-percentage (4.54[2.76,6.31]), and both gynoid and android fat percentage. Higher protein intake was also associated with a higher sarcopenic obesity risk (−0.85[-1.5,-0.2]), but with a lower sarcopenia risk (odds ratio: 0.62 [0.43,0.90]). These associations were mainly driven by animal protein.

Conclusion

Higher protein intake, particularly from animal food sources, is protective against sarcopenia but also linked to a higher obesity risk. A balanced protein intake advice for older persons should be formulated based on individual needs and health status to prevent sarcopenia, obesity, and sarcopenic obesity.

Original language	English
Pages (from-to)	26-34
Journal	Clinical Nutrition
Volume	53
DOIs	https://doi.org/10.1016/j.clnu.2025.07.033
Publication status	Published - Oct 2025

Funding

The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, the Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture, and Science of the Netherlands, the Ministry for Health, Welfare and Sports of the Netherlands, the European Commission (DG XII) and the Municipality of Rotterdam. This project is part of the SO-NUTS project, funded by JPI-HDHL. The funding agencies supporting this consortium are the Netherlands Organisation for Health Research and Development (ZonMw), French National Research Agency (ANR), Federal Ministry of Education, Science and Research represented by the Austrian Research Promotion Agency (BMBWF represented by FFG), Spanish State Research Agency (AEI: PCI2020-120683-2), the Ministry of Education, Youth and Sports Department of Research and Development (MSMT) of the Czech Republic. SO-NUTS has received funding from the European Union's Horizon 2020 research and innovation program under the ERA-NET Cofund action N° 727565. Yahong Wu is supported by the China Scholarship Council (CSC) Ph.D. fellowship for his Ph.D. study at Erasmus University Medical Center, Rotterdam, the Netherlands. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Wu, Y., de Crom, T. O. E., Chen, Z., Benz, E., van der Schaft, N., Pinel, A., Boirie, Y., Eglseer, D., Topinkova, E., Schoufour, J. D., Weijs, P. J. M., Rivadeneira, F., Boer, C. G., van Meurs, J. B. J., & Voortman, T. (2025). Dietary protein intake and body composition, sarcopenia and sarcopenic obesity: A prospective population-based study. Clinical Nutrition, 53, 26-34. https://doi.org/10.1016/j.clnu.2025.07.033

@article{caaae57c60ec4cfa9936b454bec0d0a9,

title = "Dietary protein intake and body composition, sarcopenia and sarcopenic obesity: A prospective population-based study",

abstract = "Background\&aims Obesity and sarcopenia are major health concerns, particularly among older populations. Dietary protein may help preserve muscle mass and function, but high-protein diets, especially from animal sources, may also increase adipose mass. We investigated associations of total, animal, and plant protein intake with body composition trajectories, sarcopenia, and sarcopenic obesity. Methods We included 4576 participants (mean age 65.1 years, 56 \% women) from the population-based Rotterdam Study. Dietary protein was measured using food-frequency questionnaires at baseline (2004–2009). Body composition was measured every 4–5 years using dual X-ray-absorptiometry. Handgrip strength (HGS) was assessed starting 2006 using a hydraulic dynamometer. Sarcopenia was determined based on low appendicular skeletal muscle and HGS; and sarcopenic obesity risk based on measures of lean mass, HGS and body fat. Analyses used linear mixed models and generalized estimate equation models. Results Higher total protein intake was associated with increased BMI over time (mean difference [95 \%-confidence interval (CI)]: 0.86 kg/m2 [0.01,1.71] per 5E\% increase), and increased fat-mass index (1.33 [0.67,1.99]), body-fat-percentage (4.54[2.76,6.31]), and both gynoid and android fat percentage. Higher protein intake was also associated with a higher sarcopenic obesity risk (−0.85[-1.5,-0.2]), but with a lower sarcopenia risk (odds ratio: 0.62 [0.43,0.90]). These associations were mainly driven by animal protein. Conclusion Higher protein intake, particularly from animal food sources, is protective against sarcopenia but also linked to a higher obesity risk. A balanced protein intake advice for older persons should be formulated based on individual needs and health status to prevent sarcopenia, obesity, and sarcopenic obesity.",

keywords = "Body compositions, Sarcopenia, Sarcopenic obesity, Dietary protein intake, Longitudinal cohort study",

author = "Yahong Wu and \{de Crom\}, \{Tosca O.E.\} and Zhangling Chen and Elizabeth Benz and \{van der Schaft\}, Niels and Alexandre Pinel and Yves Boirie and Doris Eglseer and Eva Topinkova and Schoufour, \{Josje D.\} and Weijs, \{Peter J.M.\} and Fernando Rivadeneira and Boer, \{Cindy G.\} and \{van Meurs\}, \{Joyce B.J.\} and Trudy Voortman",

note = "With supplementary file. ",

year = "2025",

month = oct,

doi = "10.1016/j.clnu.2025.07.033",

language = "English",

volume = "53",

pages = "26--34",

journal = "Clinical Nutrition",

issn = "0261-5614",

publisher = "Elsevier Inc.",

}

Wu, Y, de Crom, TOE, Chen, Z, Benz, E, van der Schaft, N, Pinel, A, Boirie, Y, Eglseer, D, Topinkova, E, Schoufour, JD , Weijs, PJM, Rivadeneira, F, Boer, CG, van Meurs, JBJ & Voortman, T 2025, 'Dietary protein intake and body composition, sarcopenia and sarcopenic obesity: A prospective population-based study', Clinical Nutrition, vol. 53, pp. 26-34. https://doi.org/10.1016/j.clnu.2025.07.033

TY - JOUR

T1 - Dietary protein intake and body composition, sarcopenia and sarcopenic obesity

T2 - A prospective population-based study

AU - Wu, Yahong

AU - de Crom, Tosca O.E.

AU - Chen, Zhangling

AU - Benz, Elizabeth

AU - van der Schaft, Niels

AU - Pinel, Alexandre

AU - Boirie, Yves

AU - Eglseer, Doris

AU - Topinkova, Eva

AU - Schoufour, Josje D.

AU - Weijs, Peter J.M.

AU - Rivadeneira, Fernando

AU - Boer, Cindy G.

AU - van Meurs, Joyce B.J.

AU - Voortman, Trudy

N1 - With supplementary file.

PY - 2025/10

Y1 - 2025/10

N2 - Background&aims Obesity and sarcopenia are major health concerns, particularly among older populations. Dietary protein may help preserve muscle mass and function, but high-protein diets, especially from animal sources, may also increase adipose mass. We investigated associations of total, animal, and plant protein intake with body composition trajectories, sarcopenia, and sarcopenic obesity. Methods We included 4576 participants (mean age 65.1 years, 56 % women) from the population-based Rotterdam Study. Dietary protein was measured using food-frequency questionnaires at baseline (2004–2009). Body composition was measured every 4–5 years using dual X-ray-absorptiometry. Handgrip strength (HGS) was assessed starting 2006 using a hydraulic dynamometer. Sarcopenia was determined based on low appendicular skeletal muscle and HGS; and sarcopenic obesity risk based on measures of lean mass, HGS and body fat. Analyses used linear mixed models and generalized estimate equation models. Results Higher total protein intake was associated with increased BMI over time (mean difference [95 %-confidence interval (CI)]: 0.86 kg/m2 [0.01,1.71] per 5E% increase), and increased fat-mass index (1.33 [0.67,1.99]), body-fat-percentage (4.54[2.76,6.31]), and both gynoid and android fat percentage. Higher protein intake was also associated with a higher sarcopenic obesity risk (−0.85[-1.5,-0.2]), but with a lower sarcopenia risk (odds ratio: 0.62 [0.43,0.90]). These associations were mainly driven by animal protein. Conclusion Higher protein intake, particularly from animal food sources, is protective against sarcopenia but also linked to a higher obesity risk. A balanced protein intake advice for older persons should be formulated based on individual needs and health status to prevent sarcopenia, obesity, and sarcopenic obesity.

AB - Background&aims Obesity and sarcopenia are major health concerns, particularly among older populations. Dietary protein may help preserve muscle mass and function, but high-protein diets, especially from animal sources, may also increase adipose mass. We investigated associations of total, animal, and plant protein intake with body composition trajectories, sarcopenia, and sarcopenic obesity. Methods We included 4576 participants (mean age 65.1 years, 56 % women) from the population-based Rotterdam Study. Dietary protein was measured using food-frequency questionnaires at baseline (2004–2009). Body composition was measured every 4–5 years using dual X-ray-absorptiometry. Handgrip strength (HGS) was assessed starting 2006 using a hydraulic dynamometer. Sarcopenia was determined based on low appendicular skeletal muscle and HGS; and sarcopenic obesity risk based on measures of lean mass, HGS and body fat. Analyses used linear mixed models and generalized estimate equation models. Results Higher total protein intake was associated with increased BMI over time (mean difference [95 %-confidence interval (CI)]: 0.86 kg/m2 [0.01,1.71] per 5E% increase), and increased fat-mass index (1.33 [0.67,1.99]), body-fat-percentage (4.54[2.76,6.31]), and both gynoid and android fat percentage. Higher protein intake was also associated with a higher sarcopenic obesity risk (−0.85[-1.5,-0.2]), but with a lower sarcopenia risk (odds ratio: 0.62 [0.43,0.90]). These associations were mainly driven by animal protein. Conclusion Higher protein intake, particularly from animal food sources, is protective against sarcopenia but also linked to a higher obesity risk. A balanced protein intake advice for older persons should be formulated based on individual needs and health status to prevent sarcopenia, obesity, and sarcopenic obesity.

KW - Body compositions

KW - Sarcopenia

KW - Sarcopenic obesity

KW - Dietary protein intake

KW - Longitudinal cohort study

U2 - 10.1016/j.clnu.2025.07.033

DO - 10.1016/j.clnu.2025.07.033

M3 - Article

C2 - 40845421

SN - 0261-5614

VL - 53

SP - 26

EP - 34

JO - Clinical Nutrition

JF - Clinical Nutrition

ER -

Dietary protein intake and body composition, sarcopenia and sarcopenic obesity: A prospective population-based study

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