Context and Perspectives for Establishing a Novel Database for Protein Quality of Human Foods, as Proposed by a Joint Food and Agriculture Organization of the United Nations/International Atomic Energy Agency Expert Technical Meeting in October 2022.

United Nations agencies have a long history of leading work on establishing global human nutrient requirements. Dietary protein contributes to metabolism and homeostasis and plays an essential role in human health for growth, maintenance, reproduction, and immune function (or immunity). Accurately defining the quantity and quality of protein provided by foods and diets required to meet human nutritional needs is essential to achieving global environmental and nutrition goals. There have been many scientific developments related to protein quality over the past decades, with the preferred method being the scoring approach that relates the capacity of protein sources to provide an adequate amount and proportion of nitrogen and indispensable amino acids (IAAs) in a bioavailable form (often referred to as digestibility). Questions surrounding the scoring approach and IAA metabolic availability have been discussed during past and recent expert consultations. Recently, an Food and Agriculture Organization of the United Nations/International Atomic Energy Agency technical meeting, held in Vienna, 10-13 October, 2022, reviewed and updated evidence and related methods on protein requirements and protein quality assessment and designed a framework for the development of a Protein Digestibility Database to aid dialog on the evaluation of protein quality and protein sufficiency in different populations. The database should be a living document and align with national food compositional databases.

Protein quality, nutrition and health.

Dietary proteins are energy macronutrients providing nitrogen, amino acids (AA), and energy. AAs are the main nitrogen-containing compounds in the body and are the precursors for the synthesis of body proteins and of several other AA-derived molecules. Among the 20 AAs included in protein sequence, 9 are classified as "nutritionally essential" or "indispensable" AA (IAA) because they cannot be synthesized in the body and must be provided by the diet. IAAs are limiting components for protein synthesis. An adequate intake of protein is required to support growth, maintenance, body functions, health and survival. Official definition of protein requirement is based on nitrogen balance. Protein quality is related to the capacity of protein to provide an adequate quantity of nitrogen and of each of the 9 IAAs for the different physiological situations in humans. Protein source is considered high quality for humans when the protein is readily digested, simultaneously providing an adequate quantity of nitrogen and of each of the 9 IAAs to maintain an adequate metabolic AA pool. The most accurate assessment of protein quality of foods for humans is through metabolic studies that measure nitrogen balance. The protein quality score is the ratio of the content of each IAA in the food and in a reference profile. This score corresponds to the calculated composition of a protein which, when meeting protein requirements, simultaneously meets the requirements of each of the 9 IAAs. AA scores as predictors of protein quality must be adjusted for protein and AA availability.

Local Sources of Protein in Low- and Middle-Income Countries: How to Improve the Protein Quality?

Protein inadequacy is a major contributor to nutritional deficiencies and adverse health outcomes of populations in low- and middle-income countries (LMICs). People in LMICs often consume a diet predominantly based on staple crops, such as cereals or starches, and derive most of their daily protein intakes from these sources. However, plant-based sources of protein often contain low levels of indispensable amino acids (IAAs). Inadequate intake of IAA in comparison with daily requirements is a limiting factor that results in protein deficiency, consequently in the long-term stunting and wasting. In addition, plant-based sources contain factors such as antinutrients that can diminish protein digestion and absorption. This review describes factors that affect protein quality, reviews dietary patterns of populations in LMICs and discusses traditional and novel small- and large-scale techniques that can improve the quality of plant protein sources for enhanced protein bioavailability and digestibility as an approach to tackle malnutrition in LMICs. The more accessible small-scale food-processing techniques that can be implemented at home in LMICs include soaking, cooking, and germination, whereas many large-scale techniques must be implemented on an industrial level such as autoclaving and extrusion. Limitations and considerations to implement those techniques locally in LMICs are discussed. For instance, at-home processing techniques can cause loss of nutrients and contamination, whereas limitations with larger scale techniques include high energy requirements, costs, and safety considerations. This review suggests that combining these small- and large-scale approaches could improve the quality of local sources of proteins, and thereby address adverse health outcomes, particularly in vulnerable population groups such as children, adolescents, elderly, and pregnant and lactating women.