Protein for Life: Towards a Focused Dietary Framework for Healthy Ageing

Western society is living a lot longer, and 'ageing well' is now becoming a very important priority for public health. Ageing goes hand in hand with a loss of muscle size and strength (known as sarcopenia). This loss of muscle affects people's balance, ability to walk, and overall ability to complete daily living tasks. This can lead to a loss of independence and mobility, which can impact on quality of life, well-being and increase health-care costs. Physical inactivity and poor nutrition are known to speed up the loss of muscle size and strength, however, we are all able to change these aspects of our lifestyle and become more active and consume a healthier diet.

A diet low in protein is one of the main causes of sarcopenia, and it has been recommended that older individuals eat more protein than is currently advised. However, a key dietary deficiency for the ageing population is the widespread failure to achieve recommended intakes for protein consumption. Food intakes, including protein-rich foods, are known to decline with age and this is attributable to a range of factors including loss of appetite, changes in perceptions and taste, living conditions and financial reasons. Being aware of factors that may prevent older adults from increasing their total daily protein intake, we should focus on strategies to increase protein intake across the day rather than at just one meal.

There is a severe lack of mainstream food products that can help meet the protein needs of an ageing population that are functional, taste good and are affordable. The purpose of this research is therefore to identify and develop guidelines for protein products for healthy ageing that are sustainable, cost effective and enjoyable. This information will then inform the food industry for new product development and reformulation of existing products that are appropriate for this population.

Our study will take a number of different approaches to ultimately develop and disseminate guidelines to the food industry for the formulation of palatable higher-protein foods. First, we will take different sources of existing data to develop a profile of the type, quantity, quality and timing of protein intake in the . Alongside this, we will undertake a series of focus groups with members of the public (aged 40-54 years, 55-69 years and 70+ years) to further understand the barriers to and the facilitators of the consumption of protein rich foods in mid-life and later life. We will also run a series of experiments to further understand drivers of food choice and decision making in different age groups with a focus on the role of protein. A further objective is to collate information available in the academic literature and from the food industry on the optimal sources of protein that could be used in new products. This will include consideration of the composition of the proteins, palatability, sustainability, cost and public acceptance.

All of this information will then be used to provide the food industry with a set of 'design rules' for new products. Working with our industry partners, we will then develop and trial some exemplar products based on the design rules. The products will then be tested for palatability and acceptability in groups of mid-life and older adults and then refined accordingly.

Importantly, we will ensure that the findings of the study are then disseminated to key stakeholders including the public, policy makers and the food industry. We hope that this research will also provide a more general roadmap to inform future product development.

The UK is transitioning to an ageing population. By 2039 it is estimated that 43% of the UK population will be aged over 60 (ONS 2015). Ageing well across the life course is a major public health priority.

Ageing is associated with sarcopenia (a decline of muscle mass and strength), which can affect physical functioning as well as being a key determinant of quality of life and premature mortality. Sarcopenia is a complex, multi-factorial syndrome caused by a number of contributing processes. One key factor associated with sarcopenia is protein deficiency. Increasing protein intake throughout the life course may help to reduce the rate of muscle decline and the onset of associated health conditions. Furthermore, the benefits of increased protein intake for older adults for promoting muscle mass have led to recommendations that protein intake should be greater than the recommended daily allowance for older adults.

While there has been some investigation of the levels of protein intake by age group, there is a lack of understanding of the social, demographic and psychological drivers of food choices surrounding protein intake. This is despite a wide range of evidence demonstrating the importance of these factors in determining broader nutrition behaviours. Examining how the influence of these factors vary by age will also be important for tailoring interventions to encourage healthy ageing at different points of the life course. As such, it is necessary to develop a strong multidisciplinary evidence base to gain a deeper understanding of the drivers of and the barriers to increased protein intake. Only through such an ambitious approach can an effective set of guidelines be developed to inform useful products to promote healthy ageing.

The overall aim of the proposed work is to develop and disseminate a set of design rules for formulation of palatable higher-protein foods suitable for an ageing population. This research will have far-reaching impact across the following sectors:

Food and Drink Industry: This proposal has been developed with food industry stakeholders who have identified a significant market gap for high protein products to support healthy ageing. The stakeholders understand the need for multidisciplinary empirical information to inform new product development and reformulation with the ultimate aim to increase sales in this market area. The pre-competitive nature of this research means that the findings will be relevant across the food and drink industry and may also provide a roadmap for approaches to new product development and reformulation using other foods and ingredients. This research will lead to further collaborative funding opportunities for industry with academics and help to develop a network of academics and industry partners committed to developing effective nutrition for healthy ageing. Through our knowledge launch we will disseminate our main findings to key industry partners who are members of Campden BRI helping to maximise our impact.

The National Health Service (NHS): It is anticipated that the development of convenient new food products that are high in protein, palatable and cost effective will improve the protein status of older individuals. Increasing protein intake will help to support the maintenance of muscle size and strength and reduce the incidence of sarcopenia. Prevention of sarcopenia, particularly earlier in the ageing process would reduce the risk of falls, illness and injury. This would result in significant reductions in patient admissions and hospital care in the elderly and also result in less dependency on in-home carers. The reduction of falls alone would have important financial implications for NHS. It is estimated that falls cost the NHS over £2billion every year therefore significant cost reductions could be made through initiatives such as this that can help to support fall prevention in an ageing population.

The ageing population: Improving the choice of palatable, cost-effective protein-rich food will support individuals in achieving their daily recommended protein intakes which will help to maintain good health across the life-course. Improvements in quality of life through improved functional activity, prolonged independence, ability to maintain social interactions and enjoyment of food are all important outcomes of maintaining good health throughout the ageing process.

Training of Postdoctoral Research Associates: This work takes a novel multidisciplinary approach towards addressing an overarching scientific challenge of relevance to the food and drink industry. This project will therefore offer experience and training across a range of techniques and discipline areas therefore building the skills and capacity of the next generation of healthy ageing researchers. The opportunities to engage with the food industry stakeholders involved in this project will also support future collaborations, knowledge transfer with industry and raise awareness of potential career opportunities in the food and drink industry.