In the United Kingdom (UK), the population of the very old (TVO) aged 85 and over has increased by 186% between 1981 and 2021(1). As life expectancy rises, ensuring optimal nutrition in TVO becomes essential to reduce the prevalence of chronic diseases(2).

The Newcastle 85+ study is a cohort of 793 participants which aimed to assess the spectrum of health in TVO(3). Dietary intake data were collected using two non-consecutive 24-hour dietary recalls. The study presented here aimed to characterise the dietary intake of TVO using the NOVA food classification system. Foods were classified into four NOVA categories: 1) unprocessed/minimally processed foods, 2) processed culinary ingredients, 3) processed foods, and 4) ultra-processed foods (UPF) and were categorised into tertiles based on percentage energy consumed as UPF. Macronutrient intakes between tertiles of UPF consumption were examined using Analysis of Variance.

The average daily total energy intake (TE) was 1681.8 kcal (SD = 512.8) and 26.3% of TE came from NOVA 1, 6.86% from NOVA 2, 15.2% from NOVA 3 and 51.7% from NOVA 4 (UPF). Among macronutrient contributions from UPF of TE, carbohydrates contributed 57.3% (SD = 10.2), protein contributed 12.5% (SD = 3.4), and fat contributed to 32.0% (SD = 8.9). The average fibre intake from UPF was 48.6% of the mean total fibre intake (SD = 3.5).

Significant differences in macronutrient intake were shown across tertiles of UPF intake of TE. Energy intake declined across tertiles but did not reach statistical significance (p = 0.081), with means of 1730.1 kcal, 1684.2 kcal, and 1630.9 kcal in the 1st, 2nd, and 3rd tertiles, respectively. Carbohydrate intake as percentage of TE was significantly higher in the highest UPF tertile (50.2%) compared to the lowest (45.6%, p < 0.001). Conversely, protein contribution to TE showed the greatest decline across tertiles (14.8%, p < 0.001). Similarly, fat intake decreased significantly across tertiles (36%, p < 0.05). Fibre intake was significantly lower in the highest tertile when expressed as grams per day (p < 0.05).

Foods from the UPF group which contributed the highest amount of percentage TE from carbohydrates, was white bread (17.4%), wholemeal bread (11.5%), and breakfast cereals (9.7%). Protein sources included white bread (13.3%), bacon and ham (11.3%), and wholemeal bread (10.7%), while fat intake was dominated by fat spreads (10.3%), sweet biscuits (7.6%), and pies and pastries (7.2%).

These findings show the potential reliance on UPF as sources of dietary energy and fibre to the diet of 85 year olds. These outcomes reflect a distinct dietary profile compared to cohorts of adults aged 18 and over.

With the global population set to reach 9.8 billion by 2050, including a doubling of adults aged ≥60 years old(1,2), sustainable dietary transitions are increasingly urgent. One postulated solution is controlled environment agriculture (CEA) vertical farming (VF), defined as plant factories in which environmental conditions are intricately controllable(3).

VF affords opportunities to reduce climate impact, such as reductions in water and land use(4). Further, it allows for tailoring the nutritional profiles of food through methods such as light manipulation and agronomic biofortification(5,6). This is especially relevant to older adults, with their inherent specific nutritional needs and the role of diet in healthy ageing(7). However, older adults have high rates of food neophobia(8) that may hinder acceptance of novel VF produce. This study assessed the acceptability of VF in UK older adults.

An online survey within a UK older adult cohort (≥60 years old) (n=680) assessed knowledge, sentiment scores (SS), and attitudes (Likert scales) towards VF. Willingness to pay (WTP) and purchasing likelihood for VF products were also assessed. Sentiment scores were generated using text highlighting(9). Data were analysed across genders and the index of multiple deprivation (IMD). Mann-Whitney and Kruskal-Wallis were used for non-normally distributed data. Two-way repeated measures ANOVA and two-factor MANOVA were used where applicable. Purchasing likelihood was evaluated using ordinal regression.

Knowledge of VF was low (44%), with fewer participants (23.6%) understanding CEA VF. Total SS were ambivalent (8.8), with no significant gender or IMD differences. However, sentences concerning sustainable benefits, e.g. yield, land and water use, were positive (range; 14-23). Females showed more positive SS for tailoring VF to support older adults’ nutritional needs (p=0.012). Attitudes (from Likert scale) were mostly neutral, with females slightly more favourable towards environmental concerns (p=0.008) and food fortification (p=0.03). WTP for VF produce was slightly higher (£0.016) than for conventionally produced foods (p < 0.001), with no significant differences between genders and IMD. 43% of participants were more likely to purchase VF produce, while 10% were less likely. Lower-income households (0.59 OR; 0.40–0.88, p=0.008); lack of knowledge of food fortification (0.62 OR; 0.42–0.89, p=0.011) and those with the more negative SS, SS Q1 (0.45 OR; 0.29 – 0.71, p=0.046) and SS Q2 (0.65 OR; 0.43 – 0.99, p<0.001) where significantly less likely to purchase VF produce.

Low knowledge and negative sentiment towards VF, coupled with low WTP, pose significant barriers to adopting VF food products in older adults. Socio-economic factors like income also affect purchasing likelihood, potentially exacerbating current health gaps. Increasing VF awareness and improving attitudes whilst reducing VF production costs could help promote its adoption in this demographic.

Prolonged food oral processing and slower eating rates are linked to reduced food intake in both younger and older adults(1). Oral processing behaviours are influenced by food texture(2) and in younger adults it has been shown that harder textures are consumed with smaller bites, longer chewing duration and slower eating rates than softer textures(3). Older adults often experience ageing-related changes which affect their eating abilities, and yet the influence of food texture on their oral processing behaviour is under-researched.

This study compared oral processing characteristics, perception of sensory and functional properties, and expected satiation (viewing a 100g portion) in response to different food texture samples across three age groups(4): 18-35 years, (N=19), 70-74 years (N=21) and 75+ years (N=29). Specifically, participants consumed 40 g of a “softer/easier” and a “harder/more challenging” to eat version of two foods: potato and beef. The food samples were mashed potatoes (MP), roast potatoes (RP), minced beef (MB) and roast beef (RB). Consumption was video recorded for behavioural annotation, and analysed for oral processing characteristics (bites, chews, swallows, eating rate, chewing duration). Participants rated each sample for liking, sensory and functional properties and expected satiation. One-way Analysis of Variance was used to compare the three age groups, with post hoc tests identifying group differences.

The results showed that within all age groups, the “softer/easier” foods (MP, MB) required less oral processing than the “harder/more challenging” foods (RP, RB) respectively, and scored lower on sensory attributes, such as dryness and hardness, and higher on the functional attribute of easiness to eat (all p<0.05). When compared to young adults (18-35 years), the 75+ years’ group consumed RB with a slower eating rate [Δ Mean (SD): 5.7 (1.9) g/min, p=0.01), more chews [99 (32), p=0.008) and a longer chewing duration [63.1 (21.8) s, p=0.014). The older adults’ groups (70-74 and 75+ years) consumed RP with more bites and rated expected satiation for RP and MB significantly higher than the young adults (p<0.05). Sensory and liking ratings did not differ across age groups.

These findings demonstrate significant variability in oral processing behaviours across different food textures and age groups. Further research is needed to confirm that these age-related differences in oral processing remain when consuming a meal, and to understand whether these differences influence food intake and satiety. As current research in older adults’ eating abilities and behaviours is limited, these results can provide useful ground for designing appropriate dietary interventions and food products that could improve older adults’ food and nutrient intakes.

Parkinson’s disease (PD) is an age-related neurodegenerative disorder characterized by motor symptoms, such as tremor, slowness (bradykinesia) and postural instability. Global prevalence has doubled in the past 25 years, with 8.5 million people affected worldwide in 2019(1). PD is also associated with other 'non motor’ symptoms, including constipation and orthostatic hypotension early in the disease(2). Overt dysphagia is common later in the disease, and associated with reduced fluid intake of approximately 300 mLs per day(3). This study investigates whether fluid intake is also reduced in individuals newly diagnosed with PD.

Participants with newly diagnosed PD (within six months of diagnosis or longer if untreated) were recruited alongside household controls. Assessments included a 24-hour dietary recall, a video-recorded swallowing evaluation, and stool consistency grading using the Bristol Stool Chart.

The study enrolled 30 participants: 19 with newly diagnosed PD and 11 household controls. Fluid intake from beverages was significantly lower in the PD group compared to controls (median intake: 1124 mL vs. 1799 mL, p=0.005). Dietary fluid sources did not offset this reduction. While the PD group exhibited slightly slower drinking speeds (6.0 mL/second vs. 7.5 mL/second for controls), this difference was not statistically significant. Participants with PD also had significantly harder stools, with a mean Bristol Stool Chart score of 3.2 compared to 4.6 in controls (p=0.01).

Newly diagnosed PD is associated with reduced fluid intake from beverages, which may exacerbate constipation and orthostatic hypotension.

Older adult hip fracture patients are at high risk of malnutrition(1), but research exploring postoperative dietary intake remains limited. Previous studies have relied on visual estimation methods, which may lack precision(2). Resting Energy Expenditure (REE) can be used to calculate the nutritional intake of adults in an acute illness state(3). The aim of this study was to observe if postoperative dietary intake of older adult hip fracture patients met individual REE needs. Secondary aims were to examine associations between dietary intake, length of hospital stay (LOS), comorbidities, and postoperative complications.

This was a prospective cohort study of older adult hip fracture patients (> 60yrs) requiring surgical repair recruited over four weeks. Data were collected on patient characteristics and food diary data was collected using a digital weighing scale for all hospital meals from the day of surgery to postoperative day (POD) three inclusive. Descriptive data were analysed in Microsoft Excel, and we used a statistical package for regression analysis to explore variables of interest(4). REE was calculated according to current guidance(3) and adjusted according to acute factors regarding hip fracture surgery as appropriate. The study was registered with ClinicalTrials.gov (NCT06451679).

Twenty-one patients were consecutively recruited (80.5 ± 8.9 years) and fourteen patients completed the food diary. The REE intake for completed food diaries ranged from 645.6 kcal (2701.2 kJ) to 6419.8 kcal (26860.4 kJ). In relation to the primary aim, one participant (male) met their REE needs for the food diary inclusive. Regarding secondary aims, linear regression analysis of the percentage of REE met and LOS demonstrated that dietary intake on POD one was linked with a longer LOS (95% CI, –0.11 to –0.02, p=0.01). An increased ASA (American Society of Anaesthesiologists) grade was associated with reduced dietary intake, but this was not statistically significant. In relation to postoperative complications, a reduced appetite was the most reported complication across all participants regardless of completing the food diary (n = 13) and higher in females (57.1%) than males (4.8%).

Only one patient achieved their REE over the course of the food diary which may indicate that current nutritional strategies require further development to meet the needs of this patient group. The observed association between dietary intake on POD one and a longer LOS indicates targeted support for older adult hip fracture patients would be beneficial.

Diet quality indices are essential tools for assessing diet in epidemiological studies. However, established indices may not adequately capture features of current dietary patterns that impact health. Dietary diversity is widely recognised as an important indicator of diet quality(1). This study aimed to 1) develop a diet quality index that reflects modern dietary habits, and 2) evaluate its association with dietary diversity, compared to the Healthy Eating Index (HEI).

The ZOE diet score evaluates diet quality based on six components: macronutrient distribution (% total energy of protein, carbohydrates and fats), fibre intake (g/d), intake of poor quality fats (% total energy), plant diversity (counts/d), intake of ultra-processed foods (% total energy), and a personalised food score(2) (daily mean; range 0–100). Components were combined into a composite score ranging from 0 to 100 (higher scores indicating better quality). Dietary diversity was analysed from habitual diet (PREDICT food frequency questionnaire), calculated using Shannon’s Index. Longitudinal data (baseline and 4-months) from the ZOE PREDICT 3 study(2), in which participants took part in a personalised dietary program (PDP; n = 10,411; NCT04735835), were used to explore associations between the ZOE diet score, HEI, and dietary diversity using Pearson’s correlation. Strength of correlation was interpreted as weak (r < 0.3), moderate (0.3 ≥ r < 0.5) or strong (0.5 ≥ r ≤ 1.0).

Participants were 79.0% female (n = 8,224), had a mean age of 57.7 y (SD 11.1) and Body Mass Index of 26.3 kg/m2 (SD 5.5). At baseline, the mean ZOE diet score was 62.8 (SD, 9.4; range 21.1-87.7), and HEI was 77.9 (SD, 7.7; range 37.1-98.2). There was a stronger positive correlation between the ZOE diet score and dietary diversity (Pearson’s r = 0.39, p < 0.001), compared to the HEI and dietary diversity (Pearson’s r = 0.21, p < 0.001). After 4 months on a PDP, the mean ZOE diet score was 72.7 (change, 9.9; SD, 9.2; range 9.2-91.5), and HEI was 81.0 (change, 3.1; SD, 6.31; range 53.0–98.3). The PDP resulted in an increase in dietary diversity (mean change in Shannon’s index, 0.07; SD 0.25). There was a moderate positive correlation between the change in ZOE diet score and change in dietary diversity (Pearson’s r = 0.30, p < 0.001), while the HEI showed a weaker positive correlation with dietary diversity (Pearson’s r = 0.23, p < 0.001).

The ZOE diet score, incorporating dietary components relevant to current dietary habits and health, is positively associated with dietary diversity. The ZOE diet score is a valuable tool for capturing changes in diet diversity, as a component of overall diet quality, over time. Further research is needed to explore its potential in predicting long-term health outcomes.

Child undernutrition is a major global health concern, with children in low- and middle-income countries (LMIC) at the highest risk(1-2). Several LMICs have implemented various interventions, policies, or programmes on a local, regional, or national level to address this issue. Systematic reviews have synthesised the effectiveness of those initiatives, with some focusing on a single specific outcome, such as child growth, while others examine multiple factors and outcomes in multiple settings(3). However, very little is known about the effectiveness of community-focussed interventions, policies, or programmes, on child growth and anaemia together (key indicators of child undernutrition) in LMICs. This systematic review of systematic reviews explored available evidence on the impact of community-focused interventions, policies and programmes on child growth and /or anaemia in LMIC.

Six electronic databases (MEDLINE, Embase, CINAHL, Scopus, Cochrane, and Web of Science) were searched from 2000 to 2024 April using the standard search strategy based on the PICO (population, intervention, comparison, outcome) method. The study protocol was registered in Prospero (ID CRD42024523666) before commencing the study. Included articles were reviewed by four authors. The methodological quality of identified reviews was assessed using the AMSTAR-2 tool.

In total, 63 systematic reviews of variable quality (critically low-high) assessing the impact of the interventions, policies, and programmes on child growth and/or anaemia in under-5 children were identified. Of the 20 studies reporting on both child growth and anaemia, community-focussed interventions with positive effects were micronutrient supplementation, lipid-based nutrient supplements, and cash transfer programme (n=3). Among 60 studies reporting on stunting, wasting, underweight, and growth outcome, a combination of nutrition-specific (n = 1) and nutrition-sensitive interventions (n =5) such as biofortification, home food production, training in home gardening, fisheries, and plantation (n =2), cash transfers, lipid-based nutrient supplementation, nutrition education, and improving defecation practices proved highly effective. The food transfer intervention (n=1) when combined with cash, had a positive effect on stunting. Interventions that contributed to reduction of anaemia (n=13) were cooking in an iron pot, fortification of food with iron, and multi-micronutrient supplementation. Programmes such as Mexico Oportunidades and Progresa effectively improved stunting and/or anaemia status. Furthermore, multisectoral policies focusing on scaling up community-based nutrition programmes were effective in improving child growth.

This study identified several community-focussed interventions that effectively improved child growth and/or reduced anaemia. Among these, two interventions and one programme had the greatest positive impact on both outcomes. These findings can guide the design of interventions, policies, and programmes to address multiple forms of child undernutrition in low- and middle-income countries.

Food and Nutrition Security is heavily threatened by the onset of COVID-19 pandemic, and Pakistan is no exception. The most vulnerable segments including women and low wage workers are mainly relying on free or subsidized meals served by public and private sector managed food distribution networks (FDNs). These FDNs are mainly relying on wheat flour, which could be used as a fortification vehicle to provide essential nutrients after fortification for Zn, Fe, Folic acid and B12, during post COVID period. The aim of this project was to ensure that wheat flour, procured by selected FDNs, was replaced with high quality fortified wheat flour in daily distribution meals, so that more nutritious foods would reach the most vulnerable segments in Pakistan.

This pilot project executed through different private sector managed food distribution networks (FDNs), industrial distribution networks (IDNs), and ration distribution networks (RDNs), and their regular wheat flour was replaced with quality fortified wheat flour. After selection and agreement with flour mills and FDNs, their employees were capacitated to produce and serve quality fortified flour. Alongside the provision and monitoring of quality fortified wheat flour, supplied to FDNs, the fortification quality was also assessed for fortification compliance, through analysis of added iron content.

The agreements were signed with 11 flour mills, 11 FDNs, 6 RDNs, and 6 IDNs in 4 cities of Punjab i.e. Faisalabad, Lahore, Multan and Gujranwala; and 1 city of Sindh i.e. Karachi. Likewise, in total 858 people from these flour mills, FDNs and provincial regulatory authorities were capacitated to provide quality fortified flour. During the project period June to December 2021 around 1,722 tons of quality fortified flour was produced by selected flour mills and 8.6 million fortified meals were served to the vulnerable consumers (61.50% males and 38.50% females). Furthermore, the analysis revealed that the average content of added iron in case of all flour mills complied with the recommended fortification standards of Punjab Food Authority i.e. ≥15 mg/kg.

Micronutrient fortified wheat flour provision to vulnerable populations through these FDNs is one of the best strategy to be adopted both by government as well as private sector to compliment the basic nutrition of vulnerable segments.

High intakes of ultra-processed foods (UPFs) have been associated with adverse health outcomes including weight gain, cardiometabolic disease and cancer(1,2). However, the limitations of NOVA highlight the need for a novel classification which captures food properties and features of processing that drive these health outcomes. Proposed mechanisms underlying the associations between UPF and health include energy density and hyperpalatability(3,4). Within the US food system, the prevalence of both energy dense and hyperpalatable foods is increasing, and there is moderate overlap between foods identified by each definition(5). The aim of this study was to characterise the energy density and hyperpalatability of foods and habitual diets consumed by UK adults.

Logged dietary data, baseline characteristics and body composition were analysed from ZOE PREDICT 1 UK participants (n= 1001; NCT03479866)(6). Weighted logged dietary data, including more than 12,000 foods (beverages excluded), from participants with ≥2 free-living days (n=891) were included. Energy density (kcal/g) for all foods and participant diets was calculated. Hyperpalatable foods (HPF) were classified using a data-defined definition(7) and percentage energy intake (%EI) from HPFs were calculated. Differences in energy density and hyperpalatability were examined across top and bottom tertiles of energy intake.

In the PREDICT 1 cohort (n=891, 73% females, (mean±SD) age 46±12 years and BMI 26±4.9 kg/m2) 55% of foods were high in energy density (>2 kcal/g), 49% were defined as HPFs and 35% were both energy dense and hyperpalatable. Across participants’ habitual diets (beverages excluded), the average energy density was 2.1±1.0 kcal/g and proportion of energy consumed from HPFs was 48±16 %EI. There was a significant difference across tertiles of energy intake (low versus high) in the energy density of diets (kcal/g) and contribution of energy from HPFs (%EI) (P<0.05 for all).

This analysis provides valuable insights into the energy density and hyperpalatability of habitual diets in the PREDICT 1 cohort, demonstrating overlap between these features. Further work is required to understand the independent and combined role of these factors, and additional proposed mechanisms underlying the negative health effects associated with processing, such as food texture, energy-intake-rate, and additives and non-culinary ingredients. A novel classification should build on NOVA by encompassing the food properties and features of processing that drive adverse health outcomes. Policy makers must consider the role of these factors to ensure nutritionally beneficial and affordable foods are not penalised without appropriate scientific justification.

In the past five years the UK food system has been severely impacted by a combination of events including the pandemic, geopolitical conflicts, and the cost-of-living crisis. The resulting escalation of food prices has increased levels of food insecurity however much research has focused on families. Food aid providers have reported increasing numbers of older adults seeking support to access food(1). Food insecurity in older adults is affected by an accumulation of factors that can amplify the impact of financial threats to exacerbating their susceptibility to food poverty, including decline in functional ability and reduced social networks(2). Traditionally, services like Meals on Wheels or lunch clubs safeguarded the food security of older adults; however, austerity policies have led to their decline, further compromising older people’s ability to access nutritious food. Prolonged food insecurity increases risk of malnutrition/undernutrition. A scoping review aimed to map current academic knowledge of pensioner age experience of using food aid in the UK and other OECD member countries.

Four databases: Scopus, PubMed, Cochrane Library, and CINAHL were searched using predefined search terms identifying 4762 papers. Screening of abstracts and full text papers resulted in 30 academic articles that met the inclusion/exclusion criteria and were included in the review.

Most of the studies (16 studies) were undertaken in the USA, 8 in the UK, in Australia and 1 in the Netherlands. Most of the studies used qualitative methods (n=22), two were quantitative, and six used mixed methods. Included identified the following 4 themes: (1) Social and Emotional Benefits (12 Studies): Many individuals use food aid services not just for accessing food but also for social support and interaction; (2) Stigma (16 Studies): Stigma and shame were barriers for older people using food aid. Lack of knowledge about available services are significant barriers to accessing support; (3) Quality and Suitability of Food (8 Studies) : There are concerns about the quality and suitability of food provided, particularly for those with dietary restrictions or cultural preferences; and (4) Challenges Accessing Food Support (13 Studies): Challenges to accessing food aid include transport especially in rural areas, mobility affects ability to carry food home. Language barriers affected ability to engage with infrastructure.

The scoping review highlights the challenges PAH face when accessing food aid services. In the short term, in order to better meet the nutritional needs of the Increasing numbers of PAH needing support to address food insecurity requires food aid services to respond to their specific needs. Longer term, policy makers need to address the issues driving PAH to food aid. Further research is needed to explore the wider cost of food insecurity across the food, health and social care system.

Parkinson’s disease (PD) is an age-related neurological disorder characterized by bradykinesia, tremor, and postural instability. Early weight loss following diagnosis is linked to a poorer prognosis. In older adults, loss of skeletal muscle increases the risk of falls and related injuries, making body composition measurements, such as muscle and fat mass, critical in PD, where the risk of falls is high. Traditional body composition analysis equipment is bulky, expensive, and primarily limited to research settings(1). This study evaluated the reliability of the portable SECA mBCA 525 device, which has not been validated in PD populations.

Nineteen participants with PD and 11 household controls were recruited from Movement Disorder Clinics. Participants underwent body composition analysis using the SECA mBCA 525 device. A mild electrical current is passed between adhesive electrodes applied to hands and feet, and the impedance is measured. Proprietary algorithms use the impedance data and manually entered data, such as age, weight, height, waist circumference and reported activity level, to estimate the fat, lean, and water mass (in kilograms). Measurements were repeated at two visits one month apart to assess test-retest reliability.

Data were collected from 30 participants: 19 with PD and 11 controls. Five PD participants experienced data collection failures, all exhibiting rest tremor. However, tremor amplitude was similar to the group average (mean 1.6, standard deviation 1.9 vs. mean 1.6, standard deviation 1.2).

Two sets of complete data were collected for 14 participants with PD and 10 controls. No significant differences in lean- or fat mass estimates were observed between trials 1 and 2 (Bland-Altman plot and linear regression, p>0.05).

The SECA mBCA 525 portable bio-impedance analysis device demonstrated good test-retest reliability for assessing lean and fat mass in individuals with and without PD. However, data collection failures, potentially caused by limb tremor, limit its applicability in PD studies.

Expert groups have recommended that adults over 65 years should aim for 1.0-1.2 grams (g) of protein per kilogram of body weight per day (g/kg/d) to support health and functionality(1). However, data from the National Diet and Nutrition Survey (2016-2019) showed 50.2% of over 65-year-olds consumed below 1.0 g/kg of adjusted body weight per day(2). Identifying barriers and facilitators to optimising protein intake in older adults is crucial for dietary intervention. This systematic review thus aimed to evaluate modifiable determinants of protein intake amongst community dwelling adults aged over 65 years.

The protocol was registered on the PROSPERO database (CRD42023399243). Eligible studies included community dwelling older adults within Organisation for Economic Co-operation and Development countries. Comprehensive searches were conducted in CINAHL, AMED, MEDLINE, PsycINFO and EMBASE, followed by backward and forward citation chasing and a search for grey literature. The latest search date was July 2024. Searches identified 2316 publications for screening once duplicates were removed. These were screened by two independent reviewers and quality assessed using the Mixed Methods Appraisal tool (version 2018). A meta-analysis was not possible due to substantial heterogeneity in the reporting of both protein consumption and the measurement of determinants.

Sixty publications were included in the final analysis, reporting 54 quantitative studies. The majority of studies were cross-sectional and presented a lesser quality of evidence. Age range of participants was 65-103 years. Protein intake was reported as amount consumed per day, or a criterion applied to determine low intake which varied from 0.75 g–1.1g/kg/d. There was evidence from multiple lesser-quality cross-sectional studies that lower financial income (n=4), increased physical limitations (including an increased number of limitations in activities of daily living, reduced mobility or being housebound, n=5), dental problems (n=8) and poor appetite (n=7) are associated with suboptimal or lower protein intake. For men only, living alone appeared to determine lower protein consumption (n=2). In contrast, higher self-perceived health-status (n=3), increased physical activity (n=7), lunch club attendance (n=3) and increased dietary knowledge (n=3) were associated with a higher protein intake. Poor appetite in older adults may be expected to reduce protein intake as food consumption decreases, however evidence suggested that the diet also became less protein dense.

In conclusion, determinants of protein consumption in community dwelling older adults are multifactorial, ranging across influences from socioeconomic, physical health, lifestyle and knowledge domains. These areas are likely to interact with one another, and all should be considered for future research, clinical practice and public health. There is a need for practical dietary interventions that consider affordability and accessibility for optimal uptake, additionally these need to be underpinned by increased dietary knowledge specific to older adults.

Flavour enhancement has been identified as a potential strategy to counteract the loss of taste in pureed foods(1,2), making them more palatable and recognisable for older people(3). However, it is unclear whether flavour enhancement with protein fortification of pureed diets can influence appetite and dietary intake. Thus, the aim of this study was to explore the influence of flavour-enhanced and protein-enriched pureed meals on perceived appetite, palatability, and intake in older people.

Forty-one healthy older people were recruited in Reading, UK to partake in a randomised, crossover study involving three study days. Participants consumed a standard breakfast, followed by one of three ad-libitum pureed lunches (high protein (HP), high-protein-with-aroma (HP-Aro) or low-protein (LP)) and three hours later an ad-libitum pureed buffet-style meal. Intake of the ad-libitum meals were measured by weighing food leftovers, perceived appetite and palatability were rated using a visual analogue scale and remaining intakes for the day assessed using food diaries.

SPSS was used to carry out all statistical analysis. Differences in energy and macronutrient intake between the three ad-libitum pureed lunch meals were examined using repeated measures analysis of variances (RM-ANOVA) with pair-wise comparisons (Bonferroni corrected). This test was also applied to assess the effects of these meals on subsequent intake at the ad-libitum buffet meal and total day intake. Post-lunch appetite sensations were analysed using Friedman’s test with Wilcoxon signed-rank test. Changes in self-reported palatability ratings between the three pureed lunch meals were evaluated using RM-ANOVA with pair-wise comparisons (Bonferroni corrected). Statistical significance was accepted at p<0.05 in all analysis.

Participants’ intake of ad-libitum pureed lunch was significantly higher when they consumed the HP+Aro pureed meal compared to the HP and LP pureed meals (p<0.001). Protein fortification with or without flavour enhancement significantly reduced energy intake (EI) and macronutrient intake at subsequent ad-libitum meal (p<0.001). Even though protein fortification did not affect EI for the rest of the day, it led to greater total protein intake (p<0.001). However, participants had higher total EI, carbohydrate and fat intake across the study day when they had LP pureed lunch compared to when they had HP pureed lunch (p<0.001) but no difference occurred between the LP and HP + Aro conditions (p=0.72).

Protein fortification led to significantly greater satiety (p<0.001) and fullness (p=0.04) post lunch. Palatability ratings were significantly improved with flavour enhancement (p<0.05).

The study suggested that intakes and liking of pureed meals are greater through the combination of flavour enhancement and protein fortification among older people. Also, although protein fortification could suppress appetite which might lead to reduced EI across the whole day, this may be mitigated by the combined addition of the flavour enhancer.