HDHL MICA:Innovative plant protein fibre and physical activity solutions to address poor appetite and prevent undernutrition in older adults, APPETITE

Background: Poor appetite is commonly reported by older adults, and is known to predict poorer health outcomes, such as frailty, disability and mortality. It impacts both on the amount of food eaten and on the diversity of the diet so that older adults with a poor appetite can have lower consumption of some nutrient-rich types of foods (eg meat, fish, whole grains, vegetables) and reduced intakes of a range of nutrients, that include protein and dietary fibre. At the same time, consumption of foods low in micronutrients (eg fats, oils, sweets, and sodas) may be higher. Older adults with poor appetite are therefore at a higher risk of undernutrition.

Objectives: APPETITE is a transdisciplinary consortium of experienced researchers from eight institutions in six European countries. The key objective of the consortium is to develop approaches to promote protein and fibre consumption in community-dwelling older adults who have poor appetite, to overcome undernutrition through targeted nutrition and physical activity. This collaborative research will involve the development of innovative food products, in cooperation with older consumers, testing these products and evaluation of their application.

Workplan: The planned research is based on a series of linked work packages. Firstly, we will work with a group of older adults who have poor appetite to find out what influences their appetite and the approaches and strategies they may use to make sure they eat enough food. We will also analyse data from the Longitudinal Aging Study Amsterdam in which appetite and diet have been assessed in a large group of older adults to develop better understanding of the determinants of poor appetite, how it changes over time, and the impact of these changes on diet. Building on these insights, the second part of the research is to design new and affordable food products for older adults who have poor appetite, with different plant protein fibre combinations. The focus will be on foods that combine different plant protein sources (eg corn, grain, legumes), to achieve a balanced profile of amino acids (the building blocks of protein), that have attractive sensory properties. The third part of the planned research will be to evaluate these new foods, for example, to examine effects on digestibility, amino acid bioavailability and whole body protein metabolism. Two of these new food products will then be tested in the fourth part of the research in a multi-country randomized controlled intervention trial in a group of older adults with poor appetite, as part of a personalised optimized diet, a physical activity program, and their combination. Effects on appetite, dietary intake, nutritional status, metabolic and physiological function will be determined. The project findings will be disseminated widely through a range of different activities, to provide information and raise awareness, to share knowledge and promote dialogue between older consumers, scientists, the food industry and policy makers.

Impact: APPETITE will improve our understanding of plant-based protein and fibre products and their metabolic and clinical effects. It will create new knowledge about these products, and how a whole-diet approach, together with physical activity and regular social contacts, may contribute to overcome poor appetite and undernutrition. The findings will inform policy and dietary recommendations and guidelines, strengthen European agri-food industry, contributing to a better quality of life for older Europeans.

Older adults with poor appetite are at high risk of undernutrition due to the role of appetite as a key driver of food intake. Dietary protein and fibre are critical nutrients in this population and enhancing their intake is vital to preventing undernutrition and maintaining organ function and health. APPETITE is a transdisciplinary consortium of researchers from eight institutions in six European countries that will collaborate to design approaches to enhance protein and fibre consumption of community-dwelling older adults with poor appetite, and overcome undernutrition through targeted nutrition and physical activity. This translational research will include development of innovative food products, testing these products, and their application in clinical studies.

In a series of linked work packages, older adults with poor appetite will be carefully characterized, and their nutritional and behavioural preferences evaluated; working with them, innovative and affordable food products combining several domestic plant proteins and dietary fibres will be developed. Mechanistic insights will be gained by examining the impact of selected products, physical activity and probiotic interventions on digestibility, amino acid bioavailability and whole-body protein metabolism. In a multi-country randomized controlled intervention trial, the impact of two new food products, as part of a personalised optimized diet, a physical activity program, and their combination will be determined regarding appetite, dietary intake, nutritional status, anabolic response, metabolic parameters and physiological function.

A wide range of dissemination activities will raise awareness, share knowledge, and improve dialogue between consumers, scientists, healthcare professionals and the food industry. The findings will inform dietary recommendations and policy, strengthen European agri-food industry, and contribute to a better quality of life for older Europeans.