HDHL_FORTIPHY: Preventing the risk of undernutrition by fostering meal FORTIfication and PHYsical activity in older adult

Undernutrition is widespread among older people and represents a major public health challenge for societies facing population aging. Undernutrition is a sinister disease with long-term consequences which increases vulnerability to diseases; with aging it induces or worsens frailty, disability and dependence. There is no doubt that undernutrition affects well-being and life expectancy of older people, but also increases costs and burden our health-care system.
FORTIPHY aims to overcome the gap between the nutritional recommendations and the current practices. FORTIPHY will develop, assess and disseminate solutions (fortification and physical activity programs) to help older people fulfil their nutritional needs and sustain their functional status in order to prevent the onset of undernutrition. A key-approach is to involve end-users at the very beginning of the project in consumer-centred approach to ensure the relevance and take-up of the solutions in the field.
Poor appetite is acknowledged to be a major determinant of protein-energy undernutrition while contrary to common beliefs, nutritional needs decrease little with age and even sometimes increase. Fortification, which consists in adding high-energy/high-protein ingredients to regular drinks or foods is acknowledged to be a flexible and relevant approach for older people with reduced appetite. In parallel, several studies have demonstrated better effect of interventions combining nutritional approaches with physical activity over nutritional or physical activity interventions alone.
Given this context, the project FORTIPHY will address the nutritional and physical activity needs of older small eaters (70 years old and over) living at home. Specifically, FORTIPHY will develop new solutions allowing older people to fortify their regular meals. In addition, FORTIPHY will assess the added value of physical activity to meal fortification. In order to ensure high adoption and compliance levels for FORTIPHY solutions, end users (older people, caregivers), will be associated very early in the project through co-creation and participatory research.
The first work package will be dedicated to the rational design of fortified recipes through (i) an unbiased review of available high-protein ingredients and (ii) the identification of technological and consumer usage constraints. Based on these inputs, the second work package will develop fortified recipes considering the preferences of older people (home-used tests). The bioavailability of the amino acids in fortified dishes and potential impact of these dishes on satiety and biological markers of appetite will be measured. The third work package will assess the efficiency of meal fortification and the added value of physical activity to prevent the onset of the risk of undernutrition in older small eaters living at home (randomized controlled field trial) A fourth work package will disseminate the results. In particular, FORTIPHY will conceive an easy-to-implement tool (MOOC - massive open on-line course) combining recipes and physical exercises in synergy to support the health of the older population, and a Summer School to promote further development of easy-to-use fortification solutions in the food industry. As such, FORTIPHY will contribute to raise the awareness of stakeholders regarding the issue and the solutions to prevent undernutrition.

FORTIPHY addresses the nutritional and physical activity needs of older people at risk of undernutrition living at home. The project is part of a Joint Programming Initiative entitled 'A Healthy Diet for a Healthy Life' (JPI HDHL). The FORTIPHY project consortium is led by INRAE (France), collaborating with Nofima (Norway), University of Reading (UK) and University of Brussels (Belgium). There are 4 work packages. WP1 is the rational design of new fortified recipes through (i) an unbiased review of available high-protein ingredients and (ii) the identification of technological and consumer usage constraints (participatory approach). WP2 will consists of (i) developing protein-fortified recipes based on WP1 inputs, (ii) testing acceptability of these dishes, and (iii) assessing the bioavailability of protein in the targeted older population as well as the impact of fortified dishes on satiety and appetite. WP3 will evaluate the prevention of undernutrition using the most efficient recipes evaluated in WP2 and incorporate physical activity in an "at-home" study. WP4 encompasses dissemination. The UK researchers are responsible for WP2, delivering Tasks 2.2/ 2.3, and developing a MOOC (massive open on-line course) in WP4. In T2.2/2.3 seventy participants (70+ years) will be randomly allocated to a liquid or semi-solid food matrix. Of the 35 participants allocated to each matrix, 15 will be recruited to provide blood samples. The 3-way crossover study will compare two fortified recipes with different protein compositions and a control unfortified variant. At each session, volunteers will consume a full portion of the test food. Protein bioavailability will be measured as the postprandial increase in plasma essential amino acid concentration over 4 hours. Appetite will be measured through endocrine markers of appetite (in blood), gastric emptying (labelled sodium acetate), rated perception and intake of an ad libitum meal 4 hours post test meal.