Older adults' acceptability of and preferences for food-based protein fortification in the UK, France and Norway.

Research suggests that as we age, protein intake, recognised as vital for combating negative health outcomes, consistently falls below recommendations in older adults. Decreased food intake, combined with age-related eating complications is a major determinant of this protein undernutrition. If nutritional interventions are to be effective and sustainable, they must enable eating pleasure, cater for personal preferences and be adaptable to different eating patterns. As such, we aimed to identify successful strategies for at-home protein-fortification to empower older adults to take a personalised approach to their nutrition, without requiring a large behavioural change. To explore healthy older adults' (age 70+) acceptability and preferences for at-home protein fortification, European project Fortiphy led discussions with older adults (n = 37) and caregivers of older adults (n = 15) to develop high-protein recipes, which were then utilised in a home-use trial with healthy older adults (n = 158). Each fortified recipe was paired with a questionnaire to rate the ease of preparation and liking, and an end-of-study questionnaire was provided to capture overall opinions and preferences. The uniqueness of this study is that the protein fortified recipes were prepared and tested by older adults themselves, in their own homes. Findings showed that older adults were unaware of the importance of protein in ageing and did not have a desire to fortify their foods at present. Yet, they were positive regarding the concept and highlighted the importance of taste, familiar ingredients, and preferred preparation methods. Cultural preferences across countries were identified as having the most influence on the liking of fortified meals. This study also indicated a need for increased awareness of protein requirements to influence the motivation to use fortification.

Prevalence of Undernutrition and Risk of Undernutrition in Overweight and Obese Older People.

Older people with excess body weight are not spared from undernutrition. They may face appetite decline which may lead to insufficient nutrient intake. They also have a higher risk of developing chronic diseases which may have a negative impact on protein-anabolic pathways. The present study aimed to determine the prevalence of undernutrition in overweight and obese older people from a secondary analysis on data collected through two French surveys among people aged 65 or over (n = 782; 31% men; 65-103 years old). Undernutrition was assessed using the MNA screening tool (Mini-Nutritional Assessment). Results showed that 2% of the respondents with a BMI over 25 were undernourished (MNA score below 17/30) and 23% were at risk of undernutrition (MNA score of 17-23.5). Specifically, 18% of overweight and 29% of obese respondents were at risk of undernutrition. Taking into account the most recent French census data, it can be estimated that in France, around 1,7 million people aged over 65 with a BMI over 25 are undernourished or at risk of undernutrition. Given the worldwide increase in the number of overweight/obese individuals in the last few decades, further research will be needed to develop strategies to tackle nutritional risk in overweight/obese older adults.

Kitchen layouts and consumers' food hygiene practices: Ergonomics versus safety.

Our paper emphasizes the importance of the kitchen layout in facilitating consumers' food hygiene practices. A significant correlation was found between the sink placement (inside or outside the kitchen) and hygienic practices during food handling based on a survey performed on consumers from ten European countries, indicating that those who had the sink in the kitchen were more likely to perform proper hygiene practices than those who have not. The self-reported practices were supported by observed practices in 64 households from five European countries. The observational study combined with the examination of kitchen layouts revealed that the kitchen work triangle with its apexes represented by the kitchen sink, cooking stove and refrigerator, which is recommended for ergonomic reasons by architects and designers, did not necessarily support food hygiene practices in kitchens. Cross-contamination events were associated with the sink - countertop distances longer than 1 m. Based on this, a new kitchen triangle with its apexes represented by the kitchen sink, working place (usually countertop) and cooking stove, with the distance between the sink and the working place less than 1 m is proposed to be used as norm in kitchen designs for combining ergonomics with safety. This triangle is proposedly named the food safety triangle and is aimed to mitigate the risks of foodborne illnesses by creating an arrangement that facilitates hygiene practices. This study is the first to highlight the importance of implementing the concept of food safety in the kitchen design based on significant correlations between kitchen equipment placement and consumers' food safety practices.

Prevalence of malnutrition risk among older French adults with culinary dependence.

OBJECTIVE: The term 'culinary dependence' denotes a situation in which someone delegates all or part of their daily meal-related activities to a third party. The present study aimed to explore nutritional risk among older people (≥65 years) with culinary dependence. METHOD: The first survey included 559 people either living at home without help, with help unrelated to food activities, with help related to food activities or living in nursing home. The second survey included 319 people with food help provided by a caregiver, by meals-on-wheels or by a nursing home. Nutritional status was assessed with the Mini-Nutritional Assessment. Sociological background and wellness variables (health, cognitive and mental status) were collected. RESULTS: The first survey found a strong association between culinary dependence and nutritional risk. About half of the people who delegated their food-related activities were malnourished or at risk of malnutrition compared with only 4% for people with no help and 12% for people with help unrelated to food activity. According to the second survey, this prevalence varied slightly depending on who the tasks were delegated to (46% for those who had the support of a caregiver; 60% for those who used a meals-on-wheels service; 69% for those living in nursing home). According to multivariate analyses, dependence categories, depressive symptoms and cognitive status were identified as independent determinants of malnutrition. CONCLUSION: Without inferring a causal relationship between dependence and malnutrition, there is a strong need for care structures to take into account the issue of malnutrition when developing services targeting older people.

Data on European kitchen layouts belonging to vulnerable consumers (elderly people and young families with children or pregnant women) and risk-takers (young single men).

The data presented here capture the structure of kitchen layouts belonging to consumers vulnerable to foodborne diseases and food risk-takers. Data were collected in the frame of the SafeConsume project by multidisciplinary research teams that visited consumers during preparing a meal and had the possibility to examine their cooking routines. Distances between sink and stove, sink and refrigerator, stove and refrigerator, sink and working place (countertop or table), stove and working place were analyzed to correlate food safety practices applied during cooking with kitchen arrangements. The results arising from analyzing the ergonomics of kitchens versus potential cross-contamination events are presented in Mihalache et al., [1]. These data contribute to a better understanding of real kitchen layouts and can be used as a starting point for future research regarding food safety-oriented arrangements instead of ergonomics-focused designs, for food safety risk assessments, as study cases for explaining specific measures that can be established to improve food handling and hygiene practices in homes and for sociological research pointing consumers' behavior during cooking.

Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries.

Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants' health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70-97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.

Food perception, lifestyle, nutritional and health status in the older people: Typologies and factors associated with aging well.

The aging process is associated with physiological, sensory, psychological, and sociological changes likely to have an impact on food intake and the nutritional status. The present study aimed to explore the heterogeneity of the French older population (>65 years old) using a multidisciplinary approach. More specifically, the study aimed to highlight different typologies (i.e. clusters of individuals with similar characteristics) within the older population. We conducted face-to-face interviews and tests with 559 French older people, recruited from different categories of dependency (at home without help, at home with help, in nursing homes). Clustering analysis highlighted seven clusters. Clusters 1-3 contained 'young' older people (<80) with a good nutritional status; these clusters differed according to food preferences, the desire to have a healthy diet, or interest in food. Clusters 4-7 mainly contained 'old' older people (80+), with an increase in the nutritional risk from cluster 4 to cluster 7. Two of these clusters grouped healthy and active people with a good level of appetite, while the two other clusters were associated with a clear decline in nutritional status, with people suffering from eating difficulties or depression. The results raise the need to develop targeted interventions to tackle malnutrition and implement health promotion strategies among the seniors.

Food-related oral discomfort: A cross-sectional survey assessing the sensory dimension of oral discomfort in French independently living adults.

BACKGROUND: Discomfort encountered during oral processing may cause food avoidance and increase the risk of malnutrition in older adults. The aim of the present survey was to explore the relationships between oral health and the oral discomfort experienced while eating in senior people. MATERIALS AND METHODS: In a cross-sectional study, oral discomfort was assessed in a sample of 119 independently living participants aged between 35 and 81 years. Statistical analyses were used to identify categorical variables associated with food-related oral discomfort, including age, oral health-related quality of life (OHQoL), saliva secretion, occluding support, oral diseases and denture use. RESULTS: Food-related oral discomfort concerned 28.5% of the participants. Within the sample study, the risk of experiencing food-related oral discomfort was increased for participants perceiving average (OR = 7.968, CI 95% = 2.603-24.381, p = .000) or poor OHQoL (OR = 17.109, CI 95% = 4.398-66.552, p = .000) and presenting strictly fewer than 7 occlusal functional units (OFUs) (OR = 3.396, CI 95% = 1.206-9.561, p = .020). Textured foods including fibrous (66.6%), heterogenous (60.6%) and grainy foods (42.4%) were mostly cited as food-related oral discomfort trigger factors. Within the 66-80 years group, participants having 0-6 OFUs were four times more likely to experience oral discomfort related to fibrous foods than participants having more than 7 OFUs (OR = 4.812, CI 95% = 1.192-19.415, p = .024). Within this group, participants having their teeth replaced by denture were also four times more likely to develop oral discomfort related to foods with heterogeneous textures (OR = 4.714, CI 95% = 1.030-21.562, p = .045) and grainy foods (OR = 7.285, CI 95% = 1.308-40.568, p = .023) than non-denture wearers. CONCLUSION: Poor oral health conditions may generate oral discomfort with foods in the elderly especially with fibrous, heterogenous and grainy textures, and thus affect mealtime experience.

Consumer practices and prevalence of Campylobacter, Salmonella and norovirus in kitchens from six European countries.

About 40% of foodborne infections are acquired in the home. The aim of the present study was to track contamination of pathogens during domestic food preparation and link the contamination to preparation practices. Research participants from 87 households in six European countries were observed and interviewed during shopping and preparation of a chicken and vegetable meal. The presence of Salmonella spp., Campylobacter spp. and norovirus on raw chicken, kitchen surfaces, cloths and sponges was determined. The prevalence of Campylobacter on raw chicken varied from 8.3% in Norway (NO) to 80% in France (FR) and Portugal (PT), with a mean prevalence of 57%. Campylobacter was found on half of the products that had been frozen and appeared to be less prevalent on chicken from supermarkets than other sources. Salmonella was found in 8.6% of raw chicken samples, exclusively from Hungary (HU). A relationship between observed practices and spread of pathogens to kitchen surfaces was found only for the use of cutting boards for chicken and/or vegetables. After food preparation, Campylobacter and Salmonella were isolated from 23% (samples derived from HU, RO, UK) and 8.7% (HU), respectively of cutting boards. Research participants in France and Portugal were more likely to buy products that fitted their recipe, with less need for using cutting boards. Using the same board and knife for vegetables after using it for chicken and without washing with detergent was common in Portugal and Romania, but not in the other countries. Contamination with Campylobacter to other kitchen surfaces or washing utensils were found in five households (UK, RO, PT). Rinsing chicken in sinks was common in three countries (PT, HU, RO), and washing vegetables in the same sink was also usual. Prevalence of Norovirus was low, with detection in one out of 451 samples. The participants' awareness of the risk posed by pathogens from raw chicken differed among the six countries, with higher awareness in Norway and the UK than the other countries studied. In conclusion, practices intended to avoid cross-contamination from chicken to kitchen surfaces and washing utensils are not established among consumers in all European countries. Nevertheless, cross-contamination events that disseminate infectious doses of pathogens seems to be rare, probably due to the relatively low levels of pathogens in food combined with food preferences. Food safety interventions must consider the national food culture, preferences, practices and the prevalence and levels of pathogens in food. Emphasis should be on providing and promoting chicken products with lower risk (prevalence of pathogens, ready-to-cook) and safe use of cutting boards.

Optimizing sensory quality and variety: An effective strategy for increasing meal enjoyment and food intake in older nursing home residents.

A decline in appetite and consequently in food intake is often observed with ageing, particularly in older adults living in nursing homes. Several strategies have been tested in nursing homes to counter this phenomenon. However, the approaches have rarely focused on food improvement, and most studies have assessed the impact of flavor enhancement on eating behavior. The present experiment aimed to assess the impact of improving sensory quality versus increasing sensory variety on food intake and meal enjoyment in elderly individuals living in a nursing home. Four conditions were compared: control condition, a Quality+ condition (recipes were improved according to sensory preference of the target population), a Variety+ condition (participants were offered a variety of main dishes and several condiments throughout the meal) and a Quality&Variety+ condition combining the two previous conditions. Eighty-two residents (age range: 71-101 years) participated in eight lunchtime sessions (2 replicates × 4 conditions). Compared to control condition, our results showed that improving the sensory quality of the dishes and/or providing variety led to increased meal enjoyment and food intake (energy intake: +5% for Quality+; +7% for Variety+). No additional effect was observed when the two factors were combined (+7% for Quality&Variety+). These results suggest that meal improvement strategies can be used to increase food intake in order to prevent and treat malnutrition in dependent older adults.

Oral health-related food selectivity among French independently living elders.

Impaired oral conditions are described as influencing food intake behaviour and contributing to poor nutritional status in elderly persons. In order to evaluate the influence of age and oral factors on food choice among independently living elderly, we investigated food selectivity and oral health status in elders (aged over 65 years) and in younger people (aged between 35 and 64 years). Food selective behaviour was appraised by using a food selectivity questionnaire based on traditional French dishes. A stepwise binary logistic regression analysis was done to sequentially identify age and oral conditions associated with oral discomfort-related food avoidance. Occlusal status and oral health-related quality of life contributed to food choice. Risk of oral discomfort-related food avoidance was significantly increased in people with fewer than seven occlusal functional units (OFUs) and with Geriatric Oral Health Assessment Index summary scores (GOHAI-ADD) indicating poor and average oral health-related quality of life (P < .05). Age was never a significant factor of food selective behaviour. The present data support the impact of occlusal status and oral health-related quality of life on food behaviour. Specific attention should be given in maintaining or restoring good oral conditions throughout the lifespan, especially occluding teeth.

How oral health and food sensory properties impact oral comfort during consumption of apples: A comparative approach in seniors and young adults.

Difficulties encountered during oral processing may cause food avoidance and increase the risk of malnutrition in older adults. The present survey aimed at comparing oral comfort experienced during consumption of apples in elderly and younger people. To do this, 122 participants divided into a senior group (65-83 years) and a control group (35-64 years) rated three varieties of apples (Gala, Granny Smith, Honey Crunch) using a "food comfortability" questionnaire related to general comfort, bolus formation, pain, texture, and taste sensations, and were assessed for their oral conditions. Each score of the "food comfortability" questionnaire was then submitted to a global principal component analysis and an analysis of variance. Apple variety was a significant factor for all items of the questionnaire. Age significantly affected dental pain, crunchiness, and melting sensation, with increased scores for pain and melting perception, and decreased scores for crunchiness when aging. Global comfort experienced while eating apple was also impacted by dental status and resting saliva flow rate. Bolus moistening was related to stimulated saliva flow rate, and its fragmentation was dependant on denture use. Painful sensations depended on self-reported oral quality of life and sweet taste perception was influenced by the presence of oral mucosal disease. Apple variety is a good predictor of oral comfort experienced while eating. Altough age has a little effect on pain and texture perception, oral conditions such as missing teeth or denture use also contribute to oral comfort when consuming apples.

Prevalence of malnutrition using harmonized definitions in older adults from different settings - A MaNuEL study.

BACKGROUND & AIMS: Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. METHODS: Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m2; age-specific BMI <20 if age 65-<70 and <22 kg/m2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and combined BMI <20 kg/m2 and/or WL in participants aged ≥65 years. RESULTS: Fifteen samples with in total 5956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m2, 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cut-offs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. CONCLUSIONS: Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.

Relationships between nutritional status, depression and pleasure of eating in aging men and women.

Nutritional health is an essential component of quality of life among older adults. The aim of this study was to identify the predictors of nutritional status in order to identify both common and sex specific predictive pathways in an aging population. A questionnaire was administered to 464 people living at home aged 65 years and above. Part of the questionnaire contained questions about nutritional status (MNA), depression (GDS), pleasure of eating and demographic characteristics. Structural equation modeling was used to examine relationships between the variables. For both sexes, results indicate that depression and pleasure of eating are related to nutritional status. In addition, different pathways were found between men and women. In particular, while pleasure of eating is affected by depression among aging women this is not the case for men. The implications of the findings for nutrition communication are discussed.

Evidence for different patterns of chemosensory alterations in the elderly population: impact of age versus dependency.

The present experiment aimed to explore the interindividual variability in chemosensory abilities among the elderly population. The chemosensory abilities of 559 subjects, aged from 65 to 99 years, were evaluated. Various categories of the elderly, including people who were living at home either without or with assistance, and people who were living in a nursing home, were interviewed. The results revealed that 43% of the sample presented well-preserved chemosensory abilities, whereas 21% of the participants presented a moderate impairment. Of the sample, 33% presented well-preserved olfactory abilities but strong impairment in gustatory abilities and 3% were nearly anosmic but remained able to perceive the salty taste, demonstrating that gustation and olfaction were not systematically damaged simultaneously. The results showed a link between the level of dependence (free living vs. living at home with help vs. nursing home) and chemosensory abilities, independently of the age effect. These results strengthen the hypothesis that the impairment of chemosensory abilities is not only an effect of age per se; rather, it is related to events that are associated with aging. Factors that lead to increased dependence (such as poor health) also lead to an impairment in chemosensory performance.

The Dutch Eating Behaviour Questionnaire (DEBQ). Assessment of eating behaviour in an aging French population.

The aim of the study was to develop a French version of the Dutch Eating Behaviour Questionnaire (DEBQ) in order to provide a self-report measure for French people in the field of gerontology. A short version of the DEBQ was administered to 262 participants aged 65years and older. Single and multigroup confirmatory analyses were carried out. The fit measures for the three-factor model and the factorial invariance models with respect to age, sex and BMI status were satisfactory. Three subscales of DEBQ had satisfactory internal consistency. Regarding age, the results showed significant differences in emotional eating and restrained eating. Concerning sex, women had higher mean scores for emotional eating and restrained eating than men. Finally, the overweight older people had higher scores for emotional eating than the normal-weight participants. The short version of DEBQ should provide a useful measure for researchers and clinicians who are interested in exploring eating behaviours among the elderly.

WITHDRAWN: The Dutch Eating Behaviour Questionnaire (DEBQ): Assessment of eating behaviour in an aging French population.

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