News · Nutrition & Diet
Protein-rich Mediterranean eating improved nutrition and thinking scores in 105 at-risk older adults
Undernutrition in later life often goes unnoticed and is tied to cognitive decline. Six months of personalized advice on a protein-rich Mediterranean diet improved nutrition and thinking scores; exercise added little.
- A randomized trial in 105 older adults, average age 68, at risk of undernutrition and cognitive decline.
- Groups got personalized diet counseling, counseling plus home exercise, or a healthy eating leaflet, for six months.
- Both counseling groups improved on a 30-point nutrition score by about 3 points more than the leaflet group.
- Thinking test scores also improved slightly more with counseling.
- Few people kept up the exercise, and the cognitive gains were small and need confirming.
Most talk about diet and aging is about eating less: less sugar, less salt, fewer calories. For a sizable group of older people the problem runs the other way. They are not getting enough, particularly enough protein, and the shortfall often goes unnoticed because they may not look thin. Undernutrition in later life is tied to frailty, falls and cognitive decline.
A randomized trial in the American Journal of Clinical Nutrition tested whether six months of tailored advice on a protein-rich Mediterranean diet could help 105 older adults at risk. Nutrition improved clearly, thinking test scores improved a little, and adding exercise made little extra difference.
Why nutrition matters so much for older adults
The authors state the link plainly: undernutrition in older adults is associated with adverse health outcomes including cognitive decline, yet evidence for effective preventive strategies is limited. Appetite tends to shrink with age, and illness, dental problems and living alone can all make eating well harder.
Muscle is part of the picture. MedlinePlus notes that strength exercises make your muscles stronger, and muscles also need enough protein to maintain themselves. A diet short on protein and a life short on activity together speed the loss of strength that makes older people frail.
How the older adults trial was run
A total of 105 participants at risk of undernutrition and cognitive decline were randomized to 1 of 3 groups. One group received personalized dietary counseling on a protein-enriched Mediterranean diet; a second got the same counseling plus a home exercise program; the third received a healthy eating leaflet.
The average participant was about 68 and most were women. The main measure was a 30-point nutrition screening score widely used for older adults, alongside a battery of thinking tests, a diet quality score, physical performance and quality of life.
What happened to nutrition and thinking scores
Nutrition moved clearly. After six months, nutritional status improved significantly in both intervention groups compared with CON, the leaflet group, by roughly 3 points on the 30-point scale. Diet quality scores rose by about 4 points in both counseling groups.
Thinking tests moved too, but less. Cognitive function also improved in both counseling groups compared with the leaflet group, by small amounts on a combined score. The exercise program added some benefit for physical performance and quality of life, despite low adherence to exercise.
Why a diet-first result matters
The simplest part of the program did most of the work. Personalized advice on eating more protein within a Mediterranean pattern improved nutrition as much with exercise as without it, which suggests that for older people at risk, diet counseling alone is worth offering.
The link to thinking is the more interesting and more tentative result. The authors suggest correcting undernutrition could help to slow cognitive decline, but six months of slightly better test scores is a long way from showing that. It is a reason for larger and longer trials, not a claim about preventing dementia.
What a 105-person, six-month trial cannot settle
This is a small trial over six months. Small differences in cognitive scores can arise by chance, and whether they would last, grow, or translate into everyday function is unknown.
Diet counseling is hard to hide from the people receiving it, and knowing which group you are in can influence how you answer questionnaires about diet and quality of life. Few kept up the exercise program, so the trial says little about whether diet plus regular exercise would do better. And everyone was already at risk, so the findings do not apply to well-nourished older adults.
What this changes for eating well after 65
For older adults and their families, the message is that undernutrition is worth watching for, even in people who do not look underweight, and that practical advice on eating more protein and a varied Mediterranean-style diet can improve nutrition within months.
For health services, it supports screening older adults for nutritional risk and offering tailored diet counseling to those who need it. Whether that protects thinking in the long run is the question a larger trial should now answer.
People also ask
What did the study find?
After 6 months, nutritional status improved in both intervention groups compared with the leaflet group: mean differences on the Mini Nutritional Assessment were 2.7 points for diet counseling and 2.9 for diet counseling plus exercise. Cognitive test z-scores improved by 0.3 and 0.2 respectively, and diet quality scores rose by about 4 points.
What is undernutrition?
Not getting enough energy, protein or nutrients to stay healthy. In older adults it can come from smaller appetites, dental problems, illness or living alone, and it often goes unnoticed because the person may not look underweight.
What is the Mini Nutritional Assessment?
A standard 30-point questionnaire and measurement check used to screen older adults for malnutrition. Lower scores mean higher risk.
What made the diet protein-enriched?
A Mediterranean pattern of vegetables, fruit, legumes, whole grains, fish and olive oil, with extra emphasis on protein foods, tailored to each person through counseling sessions.
Why did exercise not add more?
Adherence to the home exercise program was low, which limits what can be concluded. The authors still saw some extra benefit for physical performance and quality of life.
What should older adults take from this?
Eating well, with enough protein, matters in later life, especially for people with small appetites. A dietitian or doctor can check nutritional risk. This is general information rather than medical advice.
References
- Effect of a PROtein-enriched MEDiterranean diet and EXercise (PROMED-EX) on nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline: the PROMED-EX randomized controlled trial. American Journal of Clinical Nutrition, 2026.
- MedlinePlus. Exercise for Older Adults. US National Library of Medicine.