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Sensory Science Centre Department of Food and Nutritional Sciences AGE-RELATED SENSORY PERCEPTION AND FOOD BEHAVIOUR Dr Lisa Methven [email protected] 1 Copyright University of Reading LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT From Baby to Grandparent… what should we … (sensory scientist, product developer, marketeer, consumer) …consider ?? • Changes in perception ? • Changes in exposure / familiarity ? • Changes in needs (physiological / psychological / social) ? • Designing foods to meet the needs of an increasingly older population ? • Designing “healthier foods” to appeal to the sensory preferences different age groups? • Modifying choice behaviour of specific age groups through encouraging exposure? 2 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Changes in Perception with Age 3 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT As Older Person: • Olfaction & Taste diminished • Dentition and muscle strength influencing texture acceptability • Lots of experience or Set experiences ? • Health influencing perception As Adult: • Increasing tolerance of the trigeminal…”maturing” but reducing sensitivity? As Adolescent: • Is “junk” diet influencing perception ?? “High sweet of fatty diets reducing sensitivity ?” As Child: • Teeth !...Exploring texture • Exposure • Neophobia As Baby: • Olfaction Complete & Familiarity already influencing liking. • Sensitive & dislike of Bitter & Sour • Sensitive & like Sweet & Savoury 4 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT How does taste change with age & health ? 5 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT TASTE DETECTION THRESHOLDS: Why They May Increase with Age Morphological changes - decrease in receptor numbers Functional changes of gustatory cells 6 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT What’s this literature evidence? • Meta-analysis of 23 studies Identification thresholds higher for older adults in 17 out of 18 studies. • Consensus was that taste detection thresholds increased with age (p<0.001) across all taste modalities. 16 out of 25 studies reported perception of taste intensity at supra-threshold levels to be significantly lower for older adults, 7 Methven, Allen, Withers & Gosney (2012) Ageing and Taste. Proceeding LIMITLESS of the Nutrition Society, 71 (4):POTENTIAL 556-65 | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Chemosensory loss is connected with Frailty not just Age Orosensory decline correlates with dependency (poor health, medication, cognitive dysfunction): • N=559 France (65-99 yr) • Independent living & Nursing Home • Measured: • Salt taste detection • Olfaction : detection, characterisation & discrimination • Results: • Well preserved abilities : 43% • Moderate Impairment : 21 % • Clear trend between impairment & level of dependence Sulmont-Rossé et al. (2015) Chem Senses, 40, 153-164. 8 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT OUR EVIDENCE • Taste Threshold data collected from three groups : • Younger healthy adults • Older healthy adults • Older hospital patients • Participants presented with a series of triads; and asked to identify the strongest taste • Four basic tastants assessed: Sweet (sucrose), Salty (NaCl), Umami (glutamate), Bitter (quinine) 9 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Taste Thresholds : Age & Health 10 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Taste Thresholds : A call to Act ? Significant increase in all taste thresholds between YV & OV and between OV & OP (p<0.001 to p<0.05) Mean 0.12% in the region of salt level of typical meals 11 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT In the region of salt level of typical meals TASTE DETECTION THRESHOLDS Group n Mean Age(range) Sweet (sucrose) Salt (NaCL) Umami (MSG) Bitter (quinine) Hospital patients (50) (42) (51) (28) Healthy older 38 (35) volunteers 84 (65-98) 16mM (0.5%) 19.4 mM (0.12%) 3.7 mM (0.06%) 0.03 mM (0.002%) 71 (62 – 87) 5.9 mM (0.03%) 1.8 mM (0.03%) 0.006mM (0.0005%) Healthy younger volunteers (25-35) 2.5mM (0.01%) 0.5mM (0.01%) 35 Significant increase in Salt, Umami & Bitter threshold between healthy older volunteers and older patients (p<0.001 to p<0.05) 12 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT WHAT ABOUT AROMA : Ortho & Retronasal? What are the impacts of ageing on odour perception? • Diminished olfaction with age more common than taste decline • Effects > 50% of adults 65-80 yrs; ca. 75% of adults > 80 Doty & Kamath (2014) 13 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT OLFACTORY DETECTION Thresholds with SNIFFIN’ Sticks • SNIFFIN’ Sticks of butanol; 3 AFC Younger group (20 – 40 yrs) Average = 0.03 mg/L 14 x higher Older group range (65+ yrs) Average = 0.35 mg/L 14 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Supra-threshold Aroma Perception • Caramel flavours in sweetened milk at supra-threshold levels • Both ortho-nasal (smell) and retro-nasal (flavour-in mouth) perception were assessed to determine… 15 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT DISCRIMINATION THRESHOLDS FOR CARAM Lots of Older people need more to notice a difference Lots of Younger people noticed small increases 16 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT • Doty Doty & Kamath (2014) Frontiers in Psychology, 5, 20 Doty & Kamath (2014) Applied Olfactory Cognition, 2, 213-232 Devanad (2015) Annals of Neurology, 78(3) 401-411 Köster et al (2014) Frontiers in Psychology, 5, 1-11 Kremer et al (2014) FQP, 38, 30-39 17 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT WHAT ABOUT TEXTURE? Generally accepted increase in preference for foods that are easier to breakdown & swallow with age 18 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Texture Perception with Age Dentition influences mouthfeel perception Muscular strength could also impact on the ability to chew and move food around the mouth 25% OAs have swallowing difficulties (dysphagia) 50% of institutionalised / hospitalised OAs Declines in taste and flavour could put more emphasis on texture attributes 19 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT • Studies report decline of texture sensation with age: • Kremer 2005: soup less creamy • Kremer 2007 : waffles less elastic 20 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Thickness & Mouth-coating Perception • Skimmed milk + starch thickener or Weightwatchers thick cream : 5 thickness & 4 mouth-coating levels • 2-AFC tests Level 4 Standards Level 3 • Staircase approach : Volunteer answers dictated the concentration of the next test to minimise consumption volumes 21 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT FINDINGS 22 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Perceived Mouthdrying • Milk-based Mouth drying – Heat treated rennet whey compared to skimmed milk • Older volunteers found whey significantly more mouthdrying than skimmed milk (p=0.03) • Young volunteers found no significant difference • Suggests mouth drying is more important and easier to detect to older groups Withers, Gosney & Methven(2013), JSS, 28(3) 230-237 23 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT BUT SOME MOUTHFEEL SENSATIONS MAY INCREASE WITH AGE… • Thickness & Mouthcoating in Milk : • No Differences between young (YV) & old (OV) • Milk-based Mouth drying Heat treated rennet whey compared to skimmed milk OV found whey significantly more mouthdrying than skimmed milk (p=0.03) YV found no significant difference Older Adults detected mouthdrying more easily Withers, Gosney & Methven(2013), JSS, 28(3) 230-237 24 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Sensory Perception with Ageing : Key Findings Taste perception declines with ageing, with sweetness most preserved Odour and flavour thresholds are generally affected by ageing, although the extent is stimulus specific Thickness and mouth coating perception is not influenced by ageing Older people can detect milk-based mouth drying to a greater extent than younger people 25 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Changes in Exposure & Familiarity with Age 26 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Food Familiarity • Where Children & Older Adults converge ? • Both tend to have clear preference for familiar foods • With older adults, it’s independent of sensory performance • Poor olfaction in older adults can increase willingness to try novel foods (Pelchat, 2000) • But, decreased sensory acuity & increased dependency, pickiness & rejection can increase (Maitre, 2014) 27 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Food Memory • Food memory can triggered by sensory perception, but also by eating situation or recognition of the dish (Koster & Mojet, 2015) • Disruption caused if perceived flavour deviates from memory of it • Loss of olfactory sensitivity could benefit this ! 28 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Add in something in repeatd exposure & kids And thehn on adults – fllav flavour John My older adults work 29 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT UMAMI TASTE PREVIOUSLY FOUND TO CONDITION LI • Subjects (n=69) rated liking of novel soups • 9 exposures to one novel soup; either consuming with MSG, without MSG, or just tasting with MSG Novel Flavours : (Chickpea & dried flower base or Spinach & dried fungus) Prescott, 2004. Appetite, 42, 143-150 30 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT DOES UMAMI CONDITION WANTING ? • We studied older adults (n=40; age 65=88) • Used “novel” flavoured potato soups • Lemongrass • Cumin • Ran a repeat exposure liking & consumption study Dermiki, M., Prescott, J., Sargent, L. J., Willway, J., Gosney, M. A. and Methven, L. (2015) Novel flavours paired with glutamate condition increased intake in older adults in the absence of changes in liking. Appetite, 90. pp. 108-113. 31 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT DOES UMAMI CONDITION WANTING ? Familiarity increased… …but liking did not! 32 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT DOES UMAMI CONDITION WANTING ? However consumption of soups that had been paired with MSG increased ! 33 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Changes in Needs (Physiological, Psychological, S 34 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT DEVELOPING FOODS FOR OLDER PEO TASTE ENHANCEMENT OF FOOD FOR OLDER HOSPIT PATIENTS USING NATURAL INGREDIENTS 35 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT TASTE ENHANCEMENT OF FOOD FO OLDER HOSPITAL PATIENTS 36 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Enhancement of umami taste of food for older people in order to increase consumption • Schiffman et al. : Flavour and/or monosodium glutamate (MSG) led to increased food consumption among older people, increased salivary flow, improved immunity and muscle strength • Bellisle et al. (1998): older people preferred food with MSG • Essed et.al. (2007): no effect of 16 week flavour /and or MSG addition to animal protein on dietary intake and nutritional status of nursing home elderly & Essed et.al. (2009): no effect on intake and liking of soup enhanced with MSG • Toyama et al. (2008): consumption of food with MSG improved routine function and quality of life of older patients 37 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Enhancement of Other Tastes & Flavour TASTE: • De Jong et al. (1996): OP preferred sweeter orange drinks • Drewnowski et al. (1996): OP preferred LOWER salt soup • Mojet et al. (2004): salt, umami, bitter & sour enhancement NO effect FLAVOUR: • De Graaf et al. (1996): OP preferred higher flavour levels (4 foods) • Kremer et al. (2007): vanilla flavour NO effect in waffles • Koskinen et al. (2003): flavour NO effect in yoghurt-product • Kremer et al. (2014): Celery flavour improved pref for mashed potato • Pouyet et al. (2015)…fqp,44, 119-129 38 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT OUR APPROACH… AIM • Improve the palatability of savoury foods for older hospital patients in order to stimulate appetite and increase consumption. Hypothesis • Taste enhancement will increase liking and consumption. • Taste sensitivity affects their liking and consumption. Natural ingredients Approach • Enhancement of savoury characteristics using naturally occurring tastants in hospital food to levels preferred by older people 39 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT OUR APPROACH… Use of natural ingredients rich in umami taste compounds Maximum levels of “UMAMI” ingredients in a meat dish Keep Sodium levels constant 40 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT THE UMAMI TASTE • Characteristic taste of Glutamate (MSG) and 5’-nucleotides • Multiple Receptors (Chaudhari, 2009, Am J Clin Nutr, 90, 1S-5S) • Specific L- glutamate receptors on the tongue, and in stomach • mGluR1 • mGluR4 • Less specific heterodimer T1R1 + T1R3 • responds to amino acids AND ribonucleotides • Synergy between the umami amino acids & ribonucleotides • Enhancement of savoury volatile flavours : greater activation shown in cortex taste-olfactory convergence regions of the brain by fMRI (McCabe & Rolls, 2007, E J Neuroscience, 25, 1855-1864) 41 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT UMAMI AND OLDER PEOPLE • Dry mouth due to diminished salivation • Umami stimulation increases salivary flow (Hodson and Linden, 2006; Schiffman et al.) • Reduced appetite due to diminished sensory ability • Umami sensitivity strongest correlation with human appetite (Shi et al, 2004) • Preference for umami is affected by nutritional status (Murphy, 1987) • Gastric dysfunction • Stimulating gastric function through gastric L-glutamate receptors (Toyoma et al, 2008) • Chronic atrophic gastritis • MSG supplementation of meals was reported to increase basal and maximal acid output to normal amounts and improved appetite (Kochet et al) • Delayed gastric emptying • MSG in combination with protein rich foods increased gastric emptying rate (Zai et al, 2009) 42 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT UMAMI AMINO ACIDS & RIBONUCLEOTIDES Glutamic acid Inosine monophosphate Aspartic acid Adenosine monophosphate Guanosine monophosphate 43 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Methodology Sensory profiling Trained sensory panel Recipe development chemical analysis (n=10, mean age 46 ) Consumer study 1 Younger (n=31, age 2132, mean 25) Older (n=32, age 62-83, mean 73) Hospital study Older hospital patients Consumer study 2 Older (n=35, age 62-87, mean 71) (n=31, age 65-92, mean 84) 44 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT OPTIMISATION OF RECIPE NHS Basic minced meat Maximum possible levels of ingredients recipe Minced meat (42%) Sodium levels kept constant for all recipes (0.2%) + Sunflower oil (1%) + Onion puree(8.6%) Additional Ingredients : + Garlic puree (0.7%) MSG + Cornflour (1.7%) Yeast extracts (maxarome, gistex) + Water (beef stock) (43%) Mycoscent (mycoprotein) + Tomato puree (30%TS) Soy sauce (Kikkoman Low Salt) (SS) (2.8%) + Tomato puree Salt (0.2) Instructions Honzokuri miso paste (Low Salt) 1. Heat oil 2. Brown beef Shiitake (70oC extract) 3. Cook onion Concentrated Tomato Extract 4. Add garlic tomato puree 5. Add salt 6. Add beef stock and 45 simmer LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT 7. Add cornflour HOSPITAL STUDY: METHODS • Which samples? Control vs Enhanced cottage pies • Enhanced pie: Soy Sauce and Concentrated Tomato Extract (SS+CTE) • Enhanced gravy : soy sauce (SS) • Where? Elderly Care Wards in one NHS Trust Fund • Volunteers? 31 older (age>65) patients (11 Male and 20 Female) • Protocol • • • • Consent Screening Liking and preference test on minced meat Measurement of consumption of the two cottage pies during lunch time 46 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT HOSPITAL STUDY: RESULTS Control Liking minced meat (9-point) Preference minced meat (number of people ) Consumption (g) Enhanced significance 6.1 6.7 p=0.045 7 24 p=0.02 117.5 137.1 n.s. There was a trend for consumption to be affected by liking scores (p=0.125) There was a trend for total consumption to be higher where depression scores (HADS) were lower (p=0.06) 47 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT CHALLENGES/LIMITATIONS • Consenting & bias to the “least frail” • Two plates confusing / difficult to handle / overwhelming • Lunch time too early, volunteers were not hungry • Some people stated that preferred one sample but decided to eat more of the other one ?! • Older people score liking high to please the researcher • Repeat exposure may affect consumption of enhanced meals – not taken into account here 48 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Conclusions • Thresholds increase with age & illness/medication. Salt thresholds increased more than glutamate. → Logical approach to enhance umami taste of food for older people • Natural ingredients successfully used to enhance the taste of food • Majority of patients preferred enhanced minced meat • No significant differences in consumption of the different samples • Consumption can be affected by mood • More factors need to be taken into account apart from taste in order to increase consumption for older hospital patients 49 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT SENSORY AND CONSUMER RESULTS : Sensory analysis Consumer Liking by OV OV Sample SS & mycoscent SS & Shiitake SS & CTE CTE Control Min Max Mean 4 9 6.9a 3 9 6.9 a 4 3 3 9 9 9 7.0 a 6.8 a 6.8 a No discrimination : tendency to give high scores to please researcher !! SS+CTE most positive comments Dermiki et al (2013) JSFA, 93(13): 3312-3321 50 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Department of Food and Nutritional Sciences Hospital Study: Methods Samples: Location: Control vs Enhanced cottage pies Enhanced pie: Soy Sauce and Concentrated Tomato Extract Enhanced gravy : Soy Sauce Volunteers: 31 Older Patients (aged 65+) 11 male, 20 female Elderly Care Wards in RBH NHS Trust Protocol: Consent , Screening Liking and preference test on minced meat Measurement of consumption of the two cottage pies © University of Reading 2008 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES |www.reading.ac.uk LIMITLESS IMPACT HOSPITAL STUDY: RESULTS Preference minced meat (number of people) Consumption (g) Control Enhanced significance 6 24 p=0.001 119 137 n.s. Enhanced significantly preferred A trend but no sig. difference in consumption Dermiki et al. (2013) Nutrition and Aging, 2,69-75 52 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Texture Enhancement • Abstract • Texture-modified meals are provided to people with chewing and swallowing difficulties, such as those with dysphagia. Foods may be pureed, chopped, mashed, minced or made soft to reduce the likelihood of choking. The texture modification process can deplete the nutrient density of these diets, inadvertently increasing potential for malnutrition. At its core, patients with dysphagia require food that is moist and cohesive to promote safe and efficient swallowing. This chapter details the eating hazards and risks of dysphagia patients along with their needs from a texture-modified diet. It outlines the specific criteria of texture-modified food, addressing issues relating to ‘institutional food’. The chapter concludes with descriptions of texture-modified food classifications and the variations in this terminology seen on an international scale. Rothenberg & Wendin (2015) Sensory Analysis, Consumer Requirements and Preferences, 2, 163-185. 53 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT So, Is Enhancement effective? • Although difficult to demonstrate increased intake, we can demonstrate increases liking ….so Yes • Recent Reviews conflict to some extent: Song & Bredie (2016): • “Flavor and texture modifications usually enhance food liking of most dependent elderly.” • “Multisensory compensatory strategies are highly advised in future study and practice.” Doets & Kremer (2016): • “Most flavour enhancement/enrichment strategies do not increase liking in independent living seniors” • Concluded a need for holistic interventions • Combined visual / textural modifications with flavour enhancement / enrichment did increase liking (Kremer, 2014) Song, Giacalone, Johansen, Frøst, Bredie (2016). Trends in Food Sci & Tech, 53, 49-59 Doets & Kremer (2016) FQP, 48, 316-332 54 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Most studies show an increase in Liking / Pref / Acceptance. BUT only for dependent elderly 55 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Why does flavour enrichment / enhancement not often work in independent older adults ? • The MISFIT Theory (Koster et al., 2014): odour / flavour only leads to spontaneous perception if it doesn’t fit expectations • Enhancement may cause the misfit – or at least not be noticed • Neural pathways of perception & liking are independent (Rolls, 2015) • The extent of impairment may not be sufficient to warrant flavour modification 56 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Design of Texture Modified Foods • Texture needs to: • improve safety and ease of swallowing • reduce risks of choking and aspiration Hall & Wendin (2008) : • Meat & Carrot TMF varying particle size, fat, starch, egg. • Resulted in varied coarseness, juiciness, softness, creaminess • Conclusion : Firmness important for ease of swallow; Final TMF needs to Look & Taste Good Currently Investigating protein fortification of TMF : effects on appetite as well as acceptability. Hall & Wendin (2008) : Annals of Nutrition & Metabolism. 52(S1) 25-28. 57 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Department of Food and Nutritional Sciences Malnutrition in older patients: re-designing the food and nutrition service through a multidisciplinary and participative process Lisa left this first slide in just so I don’t lose the formatting ! © University of Reading 2008 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES |www.reading.ac.uk LIMITLESS IMPACT Re-thinking foods for older people in hospital Lisa Methven Food Scientist University of Reading LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Hospital food in the UK • • • • the preparation: in-house or bought in the plating: central kitchen, at ward, or at manufacturer cooking or regeneration: trolleys or microwaves the timing: generally 3 time points per day overall points raised: • some textural issues (drying & condensation) • all systems have good & bad points • patients rate their liking of meals high (>7/10), but their hunger low • measured waste at main meals ca. 40 % (of patients well enough to consent to study) LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Hospital food today bigger issues raised : • portion sizes too large • choice not always appropriate • choosing and receiving too separated • do not want to eat & cannot eat enough • the importance of texture modified foods ….smaller portions of standard meals will not supply sufficient nutrients ….foods provided “between” meals are limited LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT DEVELOPING FOODS TARGETED AT NUTRITIONAL NEEDS OF OLDER PEOPLE 62 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT RECOMMENDED INTAKES FOR OLDER ADULTS (24H) Micronutrient Energy (kcal) Protein (g) Fat (g) Saturated fat(g) Potassium (mg) Magnesium (mg) Iron (mg) Zinc (mg) Vit D ( µg) Riboflavin (B2) (mg) Vit B6 (mg) Folate (B9) (µg) Vit C (mg) Government daily guidelines a 1955 50 <74.5 <23.5 > 3500 > 300 >9 > 9.5 > 10 > 1.3 nr (1.3) c > 200 nr (40) c mappmal recommendation per PORTION minimeal b >300 8 nr Current Hospital Typical <4 day : up to 1175 Maximum Supplied 2100 kcal up to 150 If 60 % consumed: 3 - 4.5 Maximum 1260 kcal 3.2 -Intake 4.8 3.3 - 5 0.4 - 0.6 0.43 - 0.65 67-100 13.3 – 20 References : aFSA (2006) guidelines for nutrients for food provided to older people in residential care bMicronutrients : range of 1/3rd to 1/2 of daily RNI per supplemented minimeal. bMacronutrients : 1/6th of DRV per minimeal. cnr = no recommendation specified; but highlighted as low intake and/or deficient in older adults in two studies: (Bates et al 1999, Br J Nutr 82(1), 7-15; Russell & Suter POTENTIAL 1993, Am J Clin Nutr 58(1), 4-14) LIMITLESS | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT THE MICRONUTRIENT OPTIONS : TWO 1 fortification of nutrients required by older people at up to 1/3rd RNI (daily recommendation) into minimeal portions 2 fortification of nutrients to match nutritional supplements beverages (ONS) typically given to undernourished older adults Government Guidelines Iron, potassium, magnesium, zinc and 5 vitamins (folic acid, B2, B6, C and D) 11 minerals & 13 vitamins LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT ICE CREAM: AN EXAMPLE OF AN “ONS” key benefits • alternative oral nutritional supplement (ONS) • higher in calories than standard ice cream • vitamin, mineral and protein enriched • “hard” rather than ”soft” ice cream • aiming for not too fast to melt!! LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT ICE CREAM: AN “ONS” ALTERNATIVE why did we developed this? • ice cream often preferred to ONS beverage • standard IC too low in calories to match an ONS • mineral and vitamins in ice cream have less taste impact due to lower temperature • older volunteers liked enhanced formulation as much as standard standard mappmal IC nutritional information IC (100ml) (100ml) Energy (kcal) 128 215 Protein (g) 3 5 Carbohydrates (g) 14 14 Fat (g) 7 15 No Yes (as for ONS beverage) Addition of Minerals / Vitamins LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT COOKIES: MORE FROM A TRADITIONAL SNACK key benefits • • • • • • alternative oral nutritional supplement (ONS) high in calories and adequate protein vitamin, mineral and protein enriched not too hard to bite not to leave too many dry particles in mouth (avoid choking) portion size : 40 g (2 biscuits) LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT COOKIES: MORE FROM A TRADITIONAL SNACK We had two micronutrient options: 1.meeting known needs: iron, potassium, magnesium, zinc and 5 vitamins 2.matching an ONS beverage: 11 minerals, 13 vitamins 3.no difference in liking between the control and the two vitamin / mineral enriched options (older volunteers) standard digestive biscuit (100g) mappmal cookie (100g) 470 517 Protein (g) 7 12 Fat (g) 22 32 No Yes nutritional information Energy (kcal) Addition of Minerals / Vitamins LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT SO, SHOULD WE RECRUIT OLDER AS AS YOUNGER SENSORY PANELS? Raija-Liisa Heiniö runs a trained seniors panel at VTT 69 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT ACKNOWLEDGEMENTS Our Volunteers Dr Maria Dermiki Dr Orla Kennedy Prof Margot Gosney Project Students RBH NHS Trust Catering RBH NHS Clinical MMR Sensory panel 70 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Thank you for listening Any questions are welcome LIMITLESS 71 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES | LIMITLESS IMPACT Department of Food and Nutritional Sciences FOOD DESIGN TO MEET THE NEEDS OF THE INCREASING OLDER POPULATION : SO HOW DOES AGEING INFLUENCE OUR SENSORY PERCEPTION? Dr Lisa Methven [email protected] 3 July 2014 © University of Reading 2008 LIMITLESS POTENTIAL | LIMITLESS OPPORTUNITIES |www.reading.ac.uk LIMITLESS IMPACT