Protein-rich diet tied to better quality of life for men with BMD

A protein-rich diet was associated with less body fat and better quality of life among adults with Becker muscular dystrophy (BMD), a small study in the U.K. found.

While the study didn’t show that eating more protein would reduce body fat or improve quality of life, the findings “support further investigation into the role of protein intake in adults with BMD,” the researchers wrote. “Prospective and intervention studies are needed to establish the true nature of these relationships to inform nutritional recommendations for the BMD population.”

The study, “Protein intake is associated with adiposity and quality of life in adults with Becker muscular dystrophy,” was published in Clinical Nutrition ESPEN.

A type of muscular dystrophy, BMD is caused by mutations that lead to the production of too little or abnormal dystrophin, a protein that helps protect muscle fibers from damage. This leads to muscle weakness and wasting that can increasingly interfere with walking and everyday activities. Muscle tissue may also gradually be replaced by fat.

“With no current pharmacological cure, practical easy-to implement strategies are needed to improve [quality of life] in BMD,” the researchers wrote.

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Nutrition may be particularly relevant in BMD, where progressive muscle deterioration and fat infiltration can make staying physically active increasingly difficult, potentially limiting the benefits of physical exercise on muscle health and body composition.

Yet, as the researchers noted, “there remains no specific investigation of habitual dietary patterns in adults with BMD and whether dietary components are associated with body composition, muscle size, strength and function, or [quality of life].”

To address this gap, they characterized dietary intake in 20 men with BMD, with a mean age of 46, and 12 similarly aged men without muscular dystrophy who served as controls. Nine men with BMD could walk, and 11 could not.

Participants recorded what they ate and drank over three days on two occasions about six weeks apart. The researchers also assessed body composition, muscle size and strength, physical function, pain, fatigue, and quality of life.

Men with BMD reported consuming 29% fewer calories per day than controls, along with 25% to 30% less carbohydrates and fat.

Protein intake was also lower. Men with BMD consumed an average of 0.86 grams of protein per kilogram of body weight per day (g/kg/day), compared with 1.08 g/kg/day among controls — about 20% less.

There are no protein intake recommendations specifically for BMD. However, guidelines for people with certain acute or chronic illnesses associated with increased risk of muscle loss recommend 1.2-1.7 g/kg/day. Only two men with BMD (10%) reached the lower end of that range.

Despite reporting fewer calories, men with BMD had more body fat. Their fat mass index — the amount of body fat adjusted for height — was 48% higher than that of controls. Overall, 19 of 20 (95%) were classified as overweight or obese.

As expected, men with BMD had less muscle strength and poorer physical function than controls. They also reported more pain and fatigue, greater difficulty with daily activities, and poorer quality of life.

The researchers looked within the BMD group to see whether specific components of their diet were related to body composition, muscle health, physical function, or quality of life.

Higher protein intake relative to body weight was associated with less body fat and better quality of life. Both associations remained significant after accounting for age, calorie intake, and physical activity.

But higher protein intake was not associated with lean body mass or physical function, which the researchers had thought might help explain the link between protein intake and quality of life.

They cautioned that the findings show associations and cannot establish cause and effect, so the study did not show that increasing protein intake would reduce body fat or improve quality of life in people with BMD.

The seemingly contradictory finding that men with BMD reported eating fewer calories despite having more body fat also requires caution. Food diaries can underestimate calorie intake, while previous research suggests people with BMD may burn 20% to 30% less energy at rest. Lower physical activity could further reduce their energy needs.

For that reason, the researchers cautioned that simply increasing overall food intake to increase protein intake could potentially worsen excess body fat.

“Future interventional studies should therefore investigate whether increasing dietary protein intake, to within clinically recommended ranges, can directly affect [body fat and quality of life] in this population,” they said.