Senior protein deficiency: Multiple personalized strategies needed to motivate “difficult-to-reach category”

16 Apr 2019 --- Dietary strategies to boost protein intake among elderly people should better take into account sensory properties, familiarity, affordability, accessibility and convenience. This is according to novel research by the “Prevention of Malnutrition In Senior Subjects in the EU” (PROMISS) consortium. Christine Yung Hung, PROMISS researcher, tells NutritionInsight that there are many untapped areas for food innovation targeting protein malnutrition in the elderly, and industry should focus on producing high-quality and sustainable protein, with products that are appealing to consumers.

Most importantly, the products should be effective in increasing muscle protein synthesis, without compromising on taste, she explains.

Christine Yung Hung, PROMISS researcher. “Food fussiness plays an important role in older adults’ acceptance towards food innovation and the resulting new food products. Older consumer preferences and behavior have yet to be investigated extensively, which should be a priority, to identify and optimize ways to motivate this ‘difficult-to-reach’ consumer group to adopt a healthier and more sustainable diet,” Yung Hung notes. 

The study aimed to profile older adults in the EU according to their appetite and protein intake levels and to identify dietary and physical activity behaviors. The researchers conducted a survey, including 1,825 older adults – aged 65 years or above – in the Netherlands, UK, Finland, Spain and Poland. 

The goal was to create a holistic approach that covered the following parameters: 

• Socioeconomic and demographic background. 
• Health characteristics.
• Presence of health problems. 
• Knowledge and attitude related to protein. 
• Food and diet. 
• Attitude towards physical activity.
• Habitual behaviors.

“Older adults with different appetite and protein intake profiles have different nutritional needs and dietary intake patterns, they should be taken into account as different subgroups to cater for their specific needs,” Yung Hung says.

Study findings
The researchers discovered that older adults ought to become more aware of the importance of protein consumption, precisely the amount of protein needed. Moreover, they should be educated on the concrete actions to take to reach recommended protein intake levels, such as more frequent consumption of specific protein-rich food products. 

“Several common misconceptions might have become a hurdle for older adults when it comes to having sufficient protein intake. Among elderly people, the vast majority believe that one meal per day with a good protein source is sufficient, especially in the subgroup who had a lower protein intake and poor appetite,” she says.

Yung Hung explains that food and beverage offerings or any dietary strategies to increase protein intake in older adults should pay attention to:

• Sensory properties to combat poor appetite. 
• Familiarity to cope with food fussiness. 
• Affordability to match with lower expenditure on foods. 
• Accessibility to overcome the challenge of low mobility.
• Convenience that fits older adults’ ability for meal preparation and ingestion.

The findings showed that the consumption of certain foods at a certain moment of the day and physical activity level or pattern were associated with a lower risk of having low protein intake. Low levels of physical activity emerged as a risk factor for a lower protein intake in older adults with poor appetite, while vigorous physical activities between meals were associated with a lower risk in older adults with a good appetite. 

The researchers concluded that increasing older adults’ confidence in their ability to engage in physical activities in more difficult situations could be a potentially effective strategy to increase physical activity level and thereby increase protein intake. Dietary and physical activity strategies to increase protein intake should be tailored according to older adults’ appetite profiles. 

“These findings shed light on possible key messages in communication strategies, in which not only the awareness about the importance of protein consumption should be increased, but the messages should also be specific in relation to the amount of protein needed and concrete actions on how recommended levels could be achieved,” Yung Hung says.

Next in research 
Going forward, the researchers will incorporate more sustainability elements in their research and further take into account ethnic differences. 

“For example, we will investigate older consumers’ readiness to accept more sustainable protein sources, implications for new food product development to overcome protein malnutrition in older adults, etc.,” Yung Hung says.

At the moment, the team is running a long term prevention trial within the PROMISS consortium that seeks to examine the cost-effectiveness of increasing the consumption of dietary protein above 1.2 g/kg adjusted for body weight per day on physical functioning after six months in older adults, aged 65 years and over, with low habitual protein intake. The study is expected to be published at the beginning of 2021, she says.