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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 2 - PROMISS (PRevention Of Malnutrition In Senior Subjects in the EU)

Teaser

Summary

PROMISS (PRevention Of Malnutrition In Senior Subjects in the EU) is a multi-country project aiming to turn the challenge of tackling protein-energy malnutrition in community-dwelling older persons into an opportunity for healthy ageing for the future. The PROMISS consortium contains worldwide expertise in epidemiology, clinical trials, geriatrics, nutrition, physical activity, microbiomics, as well as in behaviour, consumer, sensory and computer sciences. It builds on strong collaborations with food industry and SMEs to strengthen innovation of the European agri-food sector and their market position. Existing data from scientifically well-established international prospective aging cohorts and national nutritional surveys from Europe and â€˜third countriesâ€™ will be combined with new data from short- and long-term intervention studies in older persons at risk. Its holistic approach will provide insight in the causality of the links between diet, physical activity, appetite and protein-energy malnutrition and underlying pathways, thereby providing the necessary evidence to develop optimal, sustainable and evidence-based dietary and physical activity strategies to prevent protein-energy malnutrition and enhance active and healthy aging. PROMISS will also deliver food concepts and products as well as persuasive technology to support adherence to these strategies. The dietary and physical activity strategies and food products will be specifically developed with older consumers involvement to meet the needs and fit the preferences of older persons/adults. In close collaboration with stakeholders, PROMISS will translate these strategies into practical recommendations to guide policy and health professionals at EU- and Member States level. Dissemination and implementation takes place through strong dissemination partners operating on a European level and linked to national networks across Member States. PROMISS promises prevention of protein-energy malnutrition, additional healthy life years and a strengthening of EUâ€™s food industry.

Work performed

Within the PROMISS consortium, low protein intake is considered a relevant marker of being at higher risk of developing protein-energy malnutrition. Results using meta-analysis of results from five international aging cohorts and three national surveys showed that the prevalence of low protein intake in older Europeans is substantial. Predictors of higher protein intake that were identified were: being female, having higher energy intake and higher tooth count, whilst significant predictors of lower protein intake included drinking alcohol and having swallowing problems. Importantly, PROMISS showed in multiple prospective studies that a lower protein intake in older persons is associated with increased risk of developing persistent protein-energy malnutrition and mobility limitations, poorer disability trajectories, lower grip strength and poorer physical performance compared to those with a higher protein intake, although no differences in change in muscle mass were observed. PROMISS also showed a high prevalence of poor appetite in older persons, and a different intake of food groups (including a lower overall protein intake) in persons with a poor appetite as compared to those with a good appetite - independent of their overall lower energy intake. The PRO55+ screening tool was developed as a research tool to efficiently identify older adults with a high risk for low protein intake (http://proteinscreener.nl).
A web-based survey among 1825 older adults from five European countries shows that the stratum of older adults with a poor appetite and lower level of protein intake (12.2%) is characterized by a larger share of people aged 70 years or above, living in the UK or Finland, having an education below tertiary level, who reported some or severe financial difficulties, having less knowledge about dietary protein and being fussier about food. This stratum also tends to have a higher risk of malnutrition in general, oral-health related problems, experience more difficulties in mobility and meal preparation, lower confidence in their ability to engage in physical activities in difficult situations, and a lower readiness to follow dietary advice.
We are currently analyzing the oral and gut microbiome of a large sample of older adults well-characterized according to (long-term) weight change history, appetite, diet, taste and smell, in order to explore underlying pathways towards malnutrition.
A database was developed including the environmental impact of 93 food products on carbon footprint, land occupation and fossil depletion and is currently being used to optimize potential dietary strategies for increasing protein intake in older adults with regard to environmental burden and meeting other dietary requirements and guidelines.
The industry/SME partners of PROMISS in collaboration with applied sciences universities have developed novel food concepts and food products for older adults, of which some are currently tested in a two-center, randomized controlled trial with a 6-month duration investigating the effect of different dietary strategies on the prevention of malnutrition and enhance active and healthy aging. Different variants of persuasive technology helping the older person to optimally adhere to the dietary strategies are also tested in this trial.

Final results

PROMISS will develop evidence-based and sustainable dietary strategies and physical activity strategies to improve the protein intake of older persons with a low protein intake, and to subsequent lower the risk of protein-energy malnutrition as well as relevant clinical outcomes such as functional decline and quality of life. Furthermore, PROMISS will deliver new food concepts and new protein rich food products, as well as persuasive technology, to make it easier for older adults at risk to adhere to these strategies. PROMISS will ultimately develop practical tools, clear guidelines and training materials for different stakeholders to disseminate and implement its results, with the goal to actively contribute to the prevention of protein-energy malnutrition and stimulate active and healthy aging for older EU citizens. PROMISS will also disseminate a roadmap for industry for new food product development according to the needs and preferences of older persons to strengthen EUâ€™s food industry.