• Ilse Reinders, Wijnhoven Hanneke A H HAH Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, , Satu K Jyväkorpi, Merja H Suominen, Riikka Niskanen, Judith E Bosmans, Ingeborg A Brouwer, Kristien S Fluitman, Michel C A Klein, Lothar D Kuijper, Laura M van der Lubbe, Margreet R Olthof, Kaisu H Pitkälä, Rachel Vijlbrief, and Marjolein Visser.
• Department of Health Sciences, Faculty of Science, and the Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ilse.reinders@vu.nl.
• BMJ Open. 2020 Nov 20; 10 (11): e040637.

IntroductionShort-term metabolic and observational studies suggest that protein intake above the recommended dietary allowance of 0.83 g/kg body weight (BW)/day may support preservation of lean body mass and physical function in old age, but evidence from randomised controlled trials is inconclusive.Methods And AnalysisThe PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS) trial examines the effect of personalised dietary advice aiming at increasing protein intake with or without advice regarding timing of protein intake to close proximity of usual physical activity, on change in physical functioning after 6 months among community-dwelling older adults (≥65 years) with a habitual protein intake of <1.0 g/kg adjusted (a)BW/day. Participants (n=264) will be recruited in Finland and the Netherlands, and will be randomised into three groups; two intervention groups and one control group. Intervention group 1 (n=88) receives personalised dietary advice and protein-enriched food products in order to increase their protein intake to at least 1.2 g/kg aBW/day. Intervention group 2 (n=88) receives the same advice as described for intervention group 1, and in addition advice to consume 7.5-10 g protein through protein-(en)rich(ed) foods within half an hour after performing usual physical activity. The control group (n=88) receives no intervention. All participants will be invited to attend lectures not related to health. The primary outcome is a 6-month change in physical functioning measured by change in walk time using a 400 m walk test. Secondary outcomes are: 6-month change in the Short Physical Performance Battery score, muscle strength, body composition, self-reported mobility limitations, quality of life, incidence of frailty, incidence of sarcopenia risk and incidence of malnutrition. We also investigate cost-effectiveness by change in healthcare costs.DiscussionThe PROMISS trial will provide evidence whether increasing protein intake, and additionally optimising the timing of protein intake, has a positive effect on the course of physical functioning after 6 months among community-dwelling older adults with a habitual protein intake of <1.0 g/kg aBW/day.Ethics And DisseminationThe study has been approved by the Ethics Committee of the Helsinki University Central Hospital, Finland (ID of the approval: HUS/1530/2018) and The Medical Ethical Committee of the Amsterdam UMC, location VUmc, Amsterdam, the Netherlands (ID of the approval: 2018.399). All participants provided written informed consent prior to being enrolled onto the study. Results will be submitted for publication in peer-reviewed journals and will be made available to stakeholders (ie, older adults, healthcare professionals and industry).Trial Registration NumberClinicalTrials.gov Registry (NCT03712306).© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

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