Hanneke A.H. Wijnhoven, Liset E.M. Elstgeest, Henrica C.W de Vet, Mary Nicolaou, Marieke B. Snijder, Marjolein Visser, May 2018
In order to preserve muscle mass and physical function, it is important to consume a sufficient amount of protein with food. However, research shows that around 50% of adults aged 65 years and older consume less than 1.0 gram/kg body weight of protein per day.
The practical question is how to calculate if you fall in this case?
PROMISS researchers set up a short food questionnaire, named the Protein Screener 55+ or Pro55+ to provide you with the probability for low protein intake in community-dwelling older people.
The Pro55+ finally consists of questions on weight and height, and the consumption (amount on average day or frequency in 4 weeks) of: slices of bread (number); glasses of milk (number); meat with warm meal (portion size); cheese (amount and frequency); dairy products (like yoghurt) (frequency); egg(s) (frequency); pasta/noodles (frequency); fish (frequency); and nuts/peanuts (frequency).
Validation tests proved that the Pro55+performs well in discrimination persons with a low and high protein intake.
Our conclusion is that the Pro55+ can be used to validly screen for protein intake below 1.0 gram/kg body weight of protein per day in community-dwelling older adults.
Available in English, its online version can be found at www.proteinscreener.nl.
PROMISS encourages such tool to be up-taken and used in other countries, and in other languages as well.
Publication in: PLOS ONE, May 23, 2018, https://doi.org/10.1371/journal.pone.0196406
The EFAD conference will be on stage on September 28th and 29th in Rotterdam, the Netherlands.
The meeting place with dietitians from all over Europe is the World Trade Centre in Rotterdam.
Researchers are warmly encouraged to the inform and disseminate about their projects and results, by submitting abstract and present at the Conference.
Where are you on the 28th and 29th of September 2018? At the EFAD Conference in ! Now is your chance to meet dietitians from all over Europe!
The deadline for submitting abstracts of original research is 1 June 2018.
More information at the EFAD website.
The world is facing a situation without precedent: we will soon have more older people than children, and more people at very
old age than ever before. When looking at nutrition in old age, it strikes that more than 90 % of older people in Europe are living at home, and a very poor appetite is reported by 10–15 % of them, which, consequentially, causes malnutrition, and a ‘cascade’ of deteriorated body functions and illnesses; muscle loss, cognitive decline, weak immune systems and slowed wound healing.
The PROMISS project intends to tackle malnutrition, and Professor Marjolein Visser from Vrije Universiteit Amsterdam explains that, in order to design concrete and tailored solutions, optimal protein intake combined with physical activity at certain time points release extra positive effects on ageing. We should however not be left alone in improving our nutrition: the support by healthcare professionals is key.
Discover more in the extensive article, appeared in the BIOECONOMY INNOVATION – COMMBEBIZ MAGAZINE 2017-2018
Across Europe, one out of five older adults living at home is malnourished, or at risk of protein-energy malnutrition. Improving protein intake might prevent malnutrition.
Many older persons today do not meet the current Recommended Dietary Allowance (RDA) of protein intake, which may lead to mobility limitations, loss of muscle strength, and increases the risks of chronic protein-energy malnutrition. There is increasing evidence that adequate protein intake is crucial in old age, which makes recognition of low protein intake key, and interventions to prevent malnutrition essential.
These are the issues at the core of the PROMISS research, and you can read about this in our first press release.
PROMISS and the Health ABC Study
The Health, Aging and Body Composition (Health ABC) Study is one of the longitudinal studies contributing to work package 1 of PROMISS. The Health ABC cohort consists of 3,075 black and white US older adults aged 70 years and over, who were generally well-functioning at baseline. The main focus of the Health ABC study is to determine risk factors for functional decline and loss of independence in healthier older people.
Since the start of PROMISS in April 2016, several researchers have used the Health ABC data to investigate associations of dietary intake with appetite, malnutrition and mobility limitation in US older adults. In the first paper, entitled “Protein intake and mobility limitation in community-dwelling older adults: the Health ABC Study”, it was hypothesized that older adults with low protein intake would have a greater risk of developing mobility limitations than those with higher protein intake. The results confirmed the hypothesis: it was shown that older adults with a lower protein intake (<0.7 and 0.7-<1.0 kg/kg body weight/d) had a higher risk of developing mobility limitations in the following 6 years compared to older adults with the highest protein intake (≥1.0 g/kg body weight/d).
The second paper, entitled “Poor appetite and dietary intake in community-dwelling older adults”, focused on differences in food intake in community-dwelling older adults with different appetite levels. This study showed that 21.8% of the participants had a poor appetite. Those participants consumed less protein, dietary fiber, whole grains, fruits and vegetables, but consumed more dairy foods, fats, sweets and sodas compared to the participants with a very good appetite.
The association between diet quality and protein-energy malnutrition was investigated in the third paper, entitled “Prospective associations of poor diet quality with long-term incidence of protein-energy malnutrition in community-dwelling older adults: the Health, Aging and Body Composition Study.” This study showed that the majority of the participants consumed a diet of insufficient quality and that 40% of the participants had a protein intake below the recommended daily intake. Furthermore, in 4 years almost 25% of the participants developed protein-energy malnutrition. It was observed that a higher protein intake may reduce the risk of developing persistent protein-energy malnutrition.
Researchers of work package 1 of PROMISS are currently working on a two other studies by using data from the Health ABC Study. In the first one, those data will be used in a multi-cohort paper on determining the prevalence of low protein intake in community-dwelling older adults. In a second paper, the association between poor diet quality and the risk of developing frailty in (initially non-frail) community-dwelling older adults will be investigated.
Combining physical activity and functional tasks in older age
Part of the work carried out in the PROMISS project is based on the HANC study. HANC is an ongoing large-scale European project between 8 Danish and German entities. Currently, 560 older adults (average 82.7 years old) with mobility impairment have a baseline assessment from 12 different domains (e.g. physical activity and sedentariness, sleep, muscle function, environmental characteristics). Assessment involve 7-day measurement by wrist-worn accelerometers, which contributes especially to PROMISS WP2 on reporting physical activity, sedentary behavior in older adults and can be compared with other cohorts in the PROMISS consortium.
Li-Tang Tsai and Paolo Caserotti, from the University of Southern Denmark, have reported preliminary results of accelerometer data from 2 cohorts: data from HANC suggested that older people with a combination of low activity count and low variability of activity throughout the week (meaning their activity level is stable throughout the weak) performed worst in functional tasks (SPPB: walking speed, chair stand, balance test) while those with high activity count and high variability of activity throughout the week performed best in the same tasks.
The team is currently working on a manuscript which will describe and compare accelerometer data from 5 cohorts within PROMISS consortium. This work will be an input to the symposium on “The impact of appetite, low protein, and physical activity on function: the PROMISS study” in the 24th Nordic Congress of Gerontology on 2-4 May in Oslo, reporting on “Associations between accelerometer-assessed physical activity, sedentary behavior, and handgrip strength among older adults across Europe and USA”.
Kristina S. Fluitman, Madelief Wijdeveld, Max Nieuwdorp, Richard G IJzerman Gut.
2018 Jan 30. pii: gutjnl-2017-315543. doi: 10.1136/gutjnl-2017-315543. [Epub ahead of print]
Various issues influence our appetite and metabolism, and gut bacteria have a role to play in there. A previous research project focused on one of the substances made by gut bacteria, namely butyrate, which is thought to improve body weight, appetite, and glucose- and fat-metabolism.
The project demonstrated in mice that most effects of butyrate on body weight and metabolism were actually not caused by butyrate directly. Rather, butyrate caused a decrease in appetite and food intake, which in turn caused the improvements in body weight and metabolism. Because of its effects on appetite, the researchers concluded that butyrate might potentially be used as weight-losing drug.
PROMISS would like more research to be carried out. The fact that that project was performed in mice, not in human beings, cannot make us jump to the conclusions that their results would be similar in human beings. The PROMISS experience is that effects in mice (promising as they might be) are often not as remarkable in humans. Furthermore, even if butyrate would work as effective in humans as it does in mice, we think that it might only work in specific individuals.
Read the whole scientific paper here: “Potential of butyrate to influence food intake in mice and men”.
Malnutrition is a critical issue, with a direct impact on older people’s quality of life. In Europe alone, about one out of 5 older people living at home is malnourished or at risk of malnutrition.
Preventing malnutrition is urgent for the whole society, for older generations of today as well as those of tomorrow.
- A sneak peek of PROMISS research (pages 2-5):
- The power of microbiota
- The work on the accelerometer
- Findings of the most prominent longitudinal ageing studies in the field of nutrition
- Nutrition and appetite in older people (page 6):
- Preliminary research results show what is relevant for seniors
- What comes next? (page 7)
- Read about what keeps our team busy in the coming months
Join the Council for Responsible Nutrition-International (CRN-I) in Berlin for its 8th annual Scientific Symposium—convenient to the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) meeting taking place 4–8 December in Berlin.
Healthy Aging, the Natural Consequences of Good Nutrition
Saturday, 2 December, 0800 – 1700
Sunday, 3 December, 1830 – 2100
H4 Hotel Berlin Alexanderplatz (the CCNFSDU host hotel)
See the CRN-I website for agenda and registration details.
During the 19th and 20th of September 2017, a PROMISS Consortium Meeting has been hosted at the premises of the Hôtel Novotel Nice Centre Vieux in Nice, France. All project partners where represented by experts in the fields of epidemiology, clinical trials, geriatrics, nutrition, physical activity, microbiomics, and behaviour, consumer, sensory and computer sciences, as well as industry, SMEs, European stakeholder organisations and representatives of older adults themselves.
The meeting consisted of a set of plenary sessions with topics ranging from reports from the project work packages and the second General Assembly, as well as a set of parallel breakout group sessions, which results where shared in a plenary session. All in one, the result was a very fruitful Consortium Meeting.
In addition to the working sessions, the group also had the opportunity to participate in a social program, including a visit to Saint Paul de Vence and a dinner in a restaurant of this beautiful village which medieval walls encircle pitoresque narrow streets.
At the very well attended PROMISS symposium, which took place during the 39th ESPEN congress, our researchers presented their work on potential dietary risk factors for the development of malnutrition and on nutritional interventions to prevent malnutrition in community-dwelling older adults.
The PROMISS leaflet is meant to introduce the audience to PROMISS activities and ambition, and let it become familiar with its content and visual identity. It is distributed during every relevant event organised by PROMISS partners, such as the EUGMS Congress, the EFAD conference, the ESPEN Conference, the AGE Platform Europe’s Annual Conference, and during external events where PROMISS is represented.
You can find it here.
Do not hesitate to share it as well!
Last 6 and 7 June 2016, PROMISS partners gathered in Amsterdam, the Netherlands, to officially kick-off the project.
It was the occasion for partners to meet, exchange their views on PROMISS activities and officially start the work towards the first PROMISS deliverables.
We look forward to seeing PROMISS reach tangible results on how to prevent malnutrition among community-dwelling older adults. Keep an eye on the website and PROMISS social media accounts to learn about the project’s developments, and subscribe to the newsletters to directly receive regular updates.
Last February 2016, the European Innovation Partnership on Active and Healthy Ageing (EIP AHA) opened new calls inviting organisations to get involved in developing, promoting or deploying innovative solutions and ecosystems for active and healthy ageing. The Call for Commitments targeted innovative solutions for active and healthy ageing.
The call received a strong support. The European Commission has recorded over 850 commitments from 28 Member States (and beyond) while 78 Reference Site applications (from 22 Member States) were submitted, representing regional and national alliances of stakeholders invested in the scaling up of innovation for active and healthy ageing.
We are very happy that the commitment submitted by PROMISS has been accepted, letting us become one of the official members of the EIP AHA, and more precisely of the A3 action group on Functional decline and frailty.