Advertisement

The journal of nutrition, health & aging

, Volume 21, Issue 2, pp 173–179 | Cite as

Protein enrichment of familiar foods as an innovative strategy to increase protein intake in institutionalized elderly

  • Janne Beelen
  • N. M. de Roos
  • L. C. P. G. M. de Groot
Article

Abstract

Objective

To increase the protein intake of older adults, protein enrichment of familiar foods and drinks might be an effective and attractive alternative for oral nutritional supplements (ONS). We performed a pilot study to test whether these products could help institutionalized elderly to reach a protein intake of 1.2 gram per kg body weight per day (g/kg/d).

Design

Intervention study with one treatment group (no control group). Dietary assessment was done before and at the end of a 10-day intervention.

Setting

Two care facilities in Gelderland, the Netherlands: a residential care home and a rehabilitation center.

Participants

22 elderly subjects (13 women, 9 men; mean age 83.0±9.4 years).

Intervention

We used a variety of newly developed protein enriched regular foods and drinks, including bread, soups, fruit juices, and instant mashed potatoes.

Measurements

Dietary intake was assessed on two consecutive days before and at the end of the intervention, using food records filled out by research assistants. Energy and macronutrient intake was calculated using the 2013 Dutch food composition database. Changes in protein intake were evaluated using paired t-tests.

Results

Protein intake increased by 11.8 g/d (P=0.003); from 0.96 to 1.14 g/kg/d (P=0.002). This increase is comparable to protein provided by one standard portion of ONS. The intake of energy and other macronutrients did not change significantly. At the end of the intervention more elderly reached a protein intake level of 1.2 g/kg/d than before (9 vs 4). Protein intake significantly increased during breakfast (+3.7 g) and during the evening (+2.2 g).

Conclusion

Including familiar protein enriched foods and drinks in the menu helped to meet protein recommendations in institutionalized elderly.

Key words

Protein enriched products protein intake the elderly rehabilitation 

References

  1. 1.
    Health Council of the Netherlands. Undernutrition in the elderly. The Hague 2011; publication 2011/32. ISBN 978-90-5549-868-0Google Scholar
  2. 2.
    White JV, Guenter P, Jensen G, Malone A, Schofield M, Group AMW, Force ASPENMT, Directors atASPENBo. Consensus statement: Academy of nutrition and dietetics and american society for parenteral and enteral nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). Journal of Parenteral and Enteral Nutrition 2012;36(3):275–283.CrossRefPubMedGoogle Scholar
  3. 3.
    Morley JE. Undernutrition in older adults. Fam Pract 2012;29i89–i93.Google Scholar
  4. 4.
    Soenen S, Chapman IM. Body weight, anorexia, and undernutrition in older people. J Am Med Dir Assoc 2013;14(9):642–648.CrossRefPubMedGoogle Scholar
  5. 5.
    Volpi E, Campbell WW, Dwyer JT, Johnson MA, Jensen GL, Morley JE, Wolfe RR. Is the optimal level of protein intake for older adults greater than the recommended dietary allowance? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2013;68(6):677–681.CrossRefGoogle Scholar
  6. 6.
    Mudge AM, Ross LJ, Young AM, Isenring EA, Banks MD. Helping understand nutritional gaps in the elderly (hunger): A prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients. Clin Nutr 2011;30(3):320–325.CrossRefPubMedGoogle Scholar
  7. 7.
    Mahler M, Sarvimäki A. Appetite and falls: Old age and lived experiences. International Journal of Qualitative Studies on Health and Well-being 2012;710.3402/qhw.v3407i3400.11540.Google Scholar
  8. 8.
    Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, Phillips S, Sieber C, Stehle P, Teta D, Visvanathan R, Volpi E, Boirie Y. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the prot-age study group. J Am Med Dir Assoc 2013;14(8):542–559.CrossRefPubMedGoogle Scholar
  9. 9.
    Gaffney-Stomberg E, Insogna KL, Rodriguez NR, Kerstetter JE. Increasing dietary protein requirements in elderly people for optimal muscle and bone health. J Am Geriatr Soc 2009;57(6):1073–1079.CrossRefPubMedGoogle Scholar
  10. 10.
    Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, Lee JS, Sahyoun NR, Visser M, Kritchevsky SB. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: The health, aging, and body composition (health abc) study. Am J Clin Nutr 2008;87(1):150–155.PubMedGoogle Scholar
  11. 11.
    Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia: Protein, amino acid metabolism and therapy. Curr Opin Clin Nutr Metab Care 2009;12(1):86–90.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wolfe RR, Miller SL, Miller KB. Optimal protein intake in the elderly. Clin Nutr 2008;27(5):675–684.CrossRefPubMedGoogle Scholar
  13. 13.
    Morais J, Chevalier S, Gougeon R. Protein turnover and requirements in the healthy and frail elderly. J Nutr Health Aging 2006;10(4):272.PubMedGoogle Scholar
  14. 14.
    Tieland M, Borgonjen-Van den Berg KJ, van Loon LJC, de Groot LC. Dietary protein intake in community-dwelling, frail, and institutionalized elderly people: Scope for improvement. Eur J Nutr 2012;51(2):173–179.CrossRefPubMedGoogle Scholar
  15. 15.
    Neelemaat F, Lips P, Bosmans JE, Thijs A, Seidell JC, van Bokhorst-de van der Schueren MAE. Short-term oral nutritional intervention with protein and & vitamin d decreases falls in malnourished older adults. J Am Geriatr Soc 2012;60(4):691–699.CrossRefPubMedGoogle Scholar
  16. 16.
    Vikstedt T, Suominen MH, Joki A, Muurinen S, Soini H, Pitkälä KH. Nutritional status, energy, protein, and micronutrient intake of older service house residents. J Am Med Dir Assoc 2011;12(4):302–307.CrossRefPubMedGoogle Scholar
  17. 17.
    Milne AC PJ, Vivanti A, Avenell A.. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database of Systematic Reviews 2009(2).Google Scholar
  18. 18.
    Bruce D, Laurance I, McGuiness M, Ridley M, Goldswain P. Nutritional supplements after hip fracture: Poor compliance limits effectiveness. Clin Nutr 2003;22(5):497–500.CrossRefPubMedGoogle Scholar
  19. 19.
    Lad H, Gott M, Gariballa S. Elderly patients compliance and elderly patients and health professional’s, views, and attitudes towards prescribed sip-feed supplements. J Nutr Health Aging 2005;9(5):310–315.PubMedGoogle Scholar
  20. 20.
    Methven L, Rahelu K, Economou N, Kinneavy L, Ladbrooke-Davis L, Kennedy O, Mottram DS, Gosney M. The effect of consumption volume on profile and liking of oral nutritional supplements of varied sweetness: Sequential profiling and boredom tests. Food Qual Prefer 2010;21(8):948–955.CrossRefGoogle Scholar
  21. 21.
    Bertenshaw EJ, Lluch A, Yeomans MR. Satiating effects of protein but not carbohydrate consumed in a between-meal beverage context. Physiol Behav 2008;93(3):427–436.CrossRefPubMedGoogle Scholar
  22. 22.
    Sienkiewicz-Sizer F, Noss-Whitney, E., Nutrition concepts and controvercies. seventh edition ed: Belmont; 1997.Google Scholar
  23. 23.
    RIVM. Dutch food composition table (nevo-tabel 2013). Bilthoven 2013.Google Scholar
  24. 24.
    Weijs PJM, Sauerwein HP, Kondrup J. Protein recommendations in the icu: G protein/kg body weight–which body weight for underweight and obese patients? Clin Nutr 2012;31(5):774–775.CrossRefPubMedGoogle Scholar
  25. 25.
    Stelten S, Dekker I, Ronday E, Thijs A, Boelsma E, Peppelenbos H, de van der Schueren M. Protein-enriched ‘regular products’ and their effect on protein intake in acute hospitalized older adults; a randomized controlled trial. Clin Nutr 2014.Google Scholar
  26. 26.
    van Til A, Naumann E, Cox-Claessens I, Kremer S, Boelsma E, de van der Schueren MA. Effects of the daily consumption of protein enriched bread and protein enriched drinking yoghurt on the total protein intake in older adults in a rehabilitation centre: A single blind randomised controlled trial. J Nutr Health Aging 2014;19(5):525–530.Google Scholar
  27. 27.
    Iuliano S, Woods J, Robbins J. Consuming two additional serves of dairy food a day significantly improves energy and nutrient intakes in ambulatory aged care residents: A feasibility study. J Nutr Health Aging 2013;17(6):509–513.CrossRefPubMedGoogle Scholar
  28. 28.
    Manders M, de Groot C, Blauw Y, Dhonukshe-Rutten R, van Hoeckel-Prüst L, Bindels J, Siebelink E, van Staveren W. Effect of a nutrient-enriched drink on dietary intake and nutritional status in institutionalised elderly. Eur J Clin Nutr 2009;63(10):1241–1250.CrossRefPubMedGoogle Scholar
  29. 29.
    van der Zanden LDT, van Kleef E, de Wijk RA, van Trijp HCM. Examining heterogeneity in elderly consumers’ acceptance of carriers for protein-enriched food: A segmentation study. Food Qual Prefer 2015;42(0):130–138.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2017

Authors and Affiliations

  • Janne Beelen
    • 1
  • N. M. de Roos
    • 1
  • L. C. P. G. M. de Groot
    • 1
  1. 1.Division of Human NutritionWageningen UniversityWageningenThe Netherlands

Personalised recommendations