A food-based approach to increase egg and protein intake in community dwelling British older adults aged over 55 years old.

Dietary protein has an important impact on health, physical functioning, and muscle mass, and the prevalence of protein specific under-nutrition is high among older adults. Eggs are a nutrient dense, high quality source of protein. Compared to other protein rich foods, eggs are easy to cook, of low cost, long shelf life, soft texture, and they are familiar to most people. Therefore this PhD project aimed to explore the barriers and facilitators specific to egg intake in older adults, and use these in a food-based approach to increase egg and dietary protein intake in community dwelling older adults aged over 55 years old. Focus groups were used to identify reasons for eating or not eating eggs in adults aged 55 years and older. The 69 different reasons found were then used to design a structured questionnaire. The questionnaire results reveal that the questionnaire statements (based on the reasons) can significantly predict egg consumption in a population wide sample of British older adults. The reasons significantly related to egg consumption reveal several topics to focus on when designing strategies to increase egg consumption in older adults. One of the outcomes showed that older adults who eat more eggs report thinking eggs taste good and add variety to the diet. Adding flavour and more variety may encourage intakes in those who consume fewer eggs. A randomized controlled intervention study was designed to increase egg and protein intake, by providing recipes of protein-rich egg-based meals and herb/spice packets to encourage the addition of flavour and variety to the diet. The results showed that being in the intervention group was significantly related to higher egg intake at a follow up session at the end of the study, but not directly after the intervention. Protein intake was not different between the groups at either of the time points. The current research has showed that exposing older adults to recipes and herb/spice packets can change their egg consumption, and may therefore be helpful in an easy to implement and cost effective strategy to change eating behaviour in older adults

Towards a Food-Based Intervention to Increase Protein Intakes in Older Adults: Challenges to and Facilitators of Egg Consumption

Abstract: Background: Dietary protein intake is important for health. Eggs, as a protein-rich food with characteristics that appeal to older adults, may provide opportunities for increasing protein intake. Interventions that focus on the challenges or facilitators that affect a large proportion of the population will be of increased impact on a population-wide scale. This work aimed to investigate the relative importance of a number of challenges to and facilitators of egg consumption in a UK population-wide sample of older adults. METHODS: A cross-sectional postal questionnaire, measuring habitual egg intake, reasons for eating/not eating eggs and a range of demographic and lifestyle characteristics, was administered by post to 1082 older adults. RESULTS: 230 questionnaires suitable for analysis were returned (110 females, ages 55⁻80+ years). Habitual egg intake ranged from 1⁻89 eggs/month, mean (standard deviation) = 18 (13) eggs/month. Reasons for eating/not eating eggs were reduced using Principal Components Analysis to 23 challenges and facilitators of egg consumption. Regression analyses revealed habitual egg intake to be associated with 10 challenges and facilitators (smallest β = 0.14, p = 0.04), and with protein consumption, age and Body Mass Index (smallest β = 0.14, p = 0.03). DISCUSSION: Many possibilities for future intervention based on existing challenges or facilitators were found. Our results suggest that strategies to increase egg consumption in older adults should focus on: improving liking, tastiness and adding variety; promoting eggs as an everyday type of food; reducing stereotypes about who does and who does not consume eggs; and promoting eggs for people who have noticed the effects of ageing on their food intake. Strategies that highlight value-for-money may be counterproductive. Future work evaluating the value of these strategies for improving protein intake in this age group would be of value

The provision of recipes and single-use herb/spice packets to increase egg and protein intake in community-dwelling older adults: a randomised controlled trial.

OBJECTIVE: This study investigated the impact of recipe and single-use herb/spice packet provision on egg intake and protein intake in community-dwelling individuals aged over 55 years. DESIGN: Using a randomised-controlled intervention design, 100 older adults were randomised to receive (n 53) or not receive (n 47) high-protein egg-based recipes and herb/spice packets through the post for 12 weeks, from June to December 2016. Egg intake, protein intake, adverse events, lean body mass and functional measures of lean body mass were measured at baseline, after the 12 weeks and after a further 12 weeks. SETTING: Bournemouth, UK. PARTICIPANTS: Community-dwelling older adults. RESULTS: Intention-to-treat data were analysed using regression, controlling for various demographic and lifestyle characteristics. Ninety-three individuals (intervention, n 50; control, n 43) completed assessments at all three time points. Egg intakes increased by end of intervention in both groups (mean: 4-5 eggs/month). After a further 12 weeks, higher egg intakes were sustained in the intervention group, while egg intakes in the control group returned to baseline levels (between-group difference: β = -0·124, P = 0·047). No differences were found in other measures (largest β = -0·106, P = 0·12). CONCLUSIONS: The provision of high-protein egg-based recipes and single-use herb/spice packets over 12 weeks increased egg intakes up to 12 weeks after end of intervention. Other factors may explain increased egg intakes during the intervention, but the sustained effects most plausibly result directly from recipe provision. Limited effects in other measures suggest that the recipes may have replaced as opposed to added to existing protein intakes

Increasing dietary protein intake in community dwelling older adults: protocol for a randomised controlled trial and baseline data

Dietary protein has an important impact on health, physical functioning, and muscle mass, and it has been suggested that older adults need more dietary protein than younger adults(1) . Compared to other protein rich foods, eggs are easy to cook, of long shelf life, and low cost; so they may be of help in increasing protein intake in older adults. Reasons for eating or not eating eggs in adults aged 55 years and older were identified in a focus group study(2) and then used to design a structured questionnaire which was sent out to a National sample(3) . Our questionnaire results showed that older adults who eat more eggs report that they think eggs taste good and add variety to the diet. Adding flavour and more variety may encourage intakes in those who consume fewer eggs. A randomized controlled intervention study was designed to increase egg and protein intake, by providing recipes of protein-rich egg-based meals and herbs/spice packets, to encourage the addition of flavour and variety to the diet. Community dwelling adults aged 55 years and over were randomized to receive dietary information followed by either 6 recipes and relevant herbs/spices every fortnight for 3 months, or northing further. Dietary intake (Food Frequency Questionnaire(4) ), body composition (Bioelectrical Impedance Analysis), handgrip strength, and physical performance (Short Physical Performance Battery (SPPB)(5) ) were assessed at baseline, and will be assessed again after the 3-month intervention period and at a 6-month follow up. The study is registered at ClinicalTrials.gov (NCT02777918). All participants have so far completed baseline sessions. A total of 100 participants are taking part - 54 females and 46 males; mean age at baseline was 70 ± 7 years, range 55–97 years. Egg intake was 22 ± 16 eggs per month, which is higher than the National Diet and Nutrition Survey data indicating that British older adults (65yrs+) consume 33 g of eggs and egg dishes per month (equivalent to up to 16–17 eggs). Reported protein intake was 1·24 ± 0·42 g/kg/day. In this sample, 10 % did not meet the Reference Nutrient Intake for all adults of 0·75 g/kg/day, and 50 % did not meet the 1·2 g/kg/day which has been suggested as the protein requirement for older adults(1) . Mean BMI was 27 ± 4 kg/m2 ; lean mass (LM) percentage was 61 ± 6 % for females, and 74 ± 5 % for males; handgrip strength was 25 ± 4 kg for females, and 40 ± 9 kg for males; and SPPB score (0–12) was 9 ± 2. In our sample, 11 % of the females and 9 % of the males could be classified as sarcopenic based on handgrip strength(6) , which is within the estimated range of sarcopenia in community dwelling populations (1–29 % prevalence)(7) . Providing recipes could be a straightforward to implement strategy to encourage older adults to consume more eggs and more protein, which could support good health

The Psychology of Nutrition with Advancing Age: Focus on Food Neophobia.

Many factors impact on eating behaviour and nutritional status in older adults. Strategies can be suggested to combat the impact of these factors, including the development of novel food products, but food neophobia ("the reluctance to eat and/or avoidance of novel foods") may be a barrier to the acceptance of these foods/products. This work aimed to investigate associations between food neophobia, physical disadvantage, and demographic characteristics in adults over 55 years old. Cross-sectional data from 377 older adults was analysed for relationships between food neophobia scores and physical disadvantage (denture wearing, help with food shopping and/or preparing, and risk of sarcopenia), controlling for age group, gender, living status, education, and employment level. Initial analyses demonstrated higher food neophobia scores in association with denture wearing (Beta = 0.186, p = 0.001). However, when demographic characteristics were also considered, food neophobia scores were no longer related to denture wearing (Beta = 0.069, p = 0.226) but instead were related to a higher age, living alone, and a shorter education (smallest Beta = -0.104, p = 0.048). Food neophobia may thus act as a barrier to the consumption of novel foods/products in those who are of higher age, are living alone, and have a shorter education

The impact of changes in taste, smell, and eating behavior in children with cancer undergoing chemotherapy:A qualitative study

Background and aims: Taste changes are the third most common bothersome symptom during treatment in children with cancer. However, it is still unclear what the essence of these taste changes are, to what degree concomitant changes in sense of smell qualify this bothersome treatment symptom and how much of an impact these changes have on the life of children with cancer. The aim of this study was to explore characteristics of both taste and smell changes and to gain insight into the impact of these changes in children with cancer receiving chemotherapy. Methods: Semi-structured interviews were performed until data saturation was achieved in each age group (6–12, 13–17 years). This resulted in an in-depth description of taste and smell changes, including its impact on the life of 27 children with various cancer types receiving chemotherapy. Thematic analysis of interview data was performed. Results: Interview data could be grouped into three main themes, namely changes in (1) taste, (2) smell, and (3) eating behavior. As expected, most children reported experiencing taste and smell changes just after start of treatment, but changes varied greatly between children; that is, some reported changes in intensity (increased or decreased), whereas others reported different perceptions or preferences (from sweet to savory). Taste and smell changes (regardless of direction) negatively impacted quality of life, with these changes commonly described as “disappointing” or “frustrating.” Interestingly, particular chemotherapeutic agents were frequently mentioned regarding taste and smell changes, prompting sensory-specific coping strategies. Children's eating behavior changed in terms of alterations in food liking and appetite, sometimes due to chemosensory changes, but children also mentioned specific medication or hospital food being responsible for their altered eating behavior. Conclusions: Both taste and smell changes are common in children with cancer. The essence of these changes varies widely, but taste and smell changes are generally considered bothersome treatment symptoms. Ways to cope with taste or smell changes specifically were described by the children warranting further research and offering the opportunity for enhancing patient-centered care

Adding Flavours: Use of and Attitudes towards Sauces and Seasonings in a Sample of Community-Dwelling UK Older Adults.

Adding flavours can encourage food intake in older adults for health benefits. The use and attitudes of 22 community-dwelling UK older adults (15 females, aged 65-83 years) towards foods and products that add flavour, e.g., sauces and seasonings, were investigated. Participants used foods/products to add flavour when cooking and eating from 0 to 17 times/day. Taste and flavour were important, and foods/products could add flavour, make foods more pleasant and did not cause discomfort. There were concerns, however, over the healthiness of some foods/products, while consuming a healthy diet and one's health were important. Reasons for adding flavours largely centred around 'meal enhancement', reasons for not adding flavours focused on 'the product itself' and 'characteristics of the meal', but there was 'variation' and many 'individual differences'. Our findings highlight the benefits of adding flavours for food intakes, particularly the use of naturally flavoursome foods, such as herbs, spices, onion and garlic