By- Fred Bergmans
Adequate protein intake among elderly is a growing concern in healthcare. At the beginning of this century, scientific studies signaled malnutrition in affluent countries up to 25% with hospital patients. Disease-related protein deficiency due to acute or chronic diseases or decreased appetite and frailty were identified as the main causes for malnutrition.
General dietary advice focused on adding high-protein snacks and oral nutritional supplements to the daily menu. The disappointing result was that still, less than 50% of hospital patients would not meet the recommended protein intake.
A consortium, led by Wageningen University and Research, started in 2012 to develop a new nutritional strategy and products to solve malnutrition. Scientific studies revealed that standardized care focused both on the supplementation of energy and protein. As satiation was the barrier for higher protein intake the current practice of both energy and protein supplementation did not work.
To solve this problem, new products were developed, focusing on protein enrichment instead of energy density.
These products were familiar basic foods, like bread and pastry, fruit juice and soups, and ice-cream and small meals. All these products were tested in the food hospital Gelderse Valley, in residential care and among patients at home. RCT studies concluded that 79% of patients reached the recommended protein intake.
This study shows that the new nutritional strategy works: substitution instead of supplementation. Substitute regular basic nutrition with protein-enriched basic nutrition. The essence of the substitution strategy is the range of familiar products people like to eat, replaced by the same products containing 2 to 4 times the amount of protein, tasting equally as good as their reference products.
The range of protein-enriched products fits in all eating moments of the day. Spreading the intake in 3 main meals and 3 in-between moments results in an optimal protein intake per moment and the highest intake per day. This was all confirmed by RCT studies.
In 2015 Carezzo Nutrition, a start-up partner of the consortium introduced this range of products in the Dutch market. The success of the strategy was confirmed by winning the Accenture Innovation Award for Fair Food, and scientific proof of the effectiveness of the new nutritional strategy of substitution was presented.
We first entered the Dutch hospital market, which welcomed the good taste of these familiar products and the high protein density versus regular protein-rich food. It also adds to the quality of life as these products fit in regular eating habits and do not look like medicine.
Since hospital length of stay gets shorter, ‘better in is better out’ gets more important. Improving patients’ nutritional condition before hospitalization and after discharge, called prehabilitation and rehabilitation, is seen as a direct contribution to the efficacy of medical treatment. Less complications, shorter length of stay and successful recovery potentially leads to increased benefits at decreased costs. An RCT study on pre-operative nutritional support on senior patients scheduled for heart surgery was conducted by Nina Zipfel PhD in collaboration with Carezzo. Participants received Carezzo products at home during 2 weeks. Their protein intake increased by 50-100%, due to the protein-enriched products and the high motivation to self-manage nutritional condition improvement.
The group of people with a protein deficiency is much larger than discussed so far. Frail elderly people with low appetite tend to eat less. Since they are less physically active their portions get smaller and so does the energy intake. However, their protein intake recommendation is not related to their activity, but to their body composition. Knowing that their protein recommendation is 25% higher than that of young adults, there is a high risk of protein malnutrition. In practice we see that it is hard to finish a full hot meal, and that 10-20% is left behind on the plate, or worse one meal is consumed in two days, shared with a partner or thrown in the trash. Protein intake then drops under 20 g, as regular meals (500 g) contain 20-25 g protein. Carezzo developed small meals of 350 g, containing 30 g of protein.
Protein-enriched products fit in maintaining the dietary habits. Just change products to address the different protein recommendations due to different circumstances.
To serve patients at home the Carezzo web shop was opened which facilitates the substitution strategy in the home setting and patients could continue the use of the products they received in the hospital during the total period of medical treatment; pre and post included. The webshop also serves people with chronic diseases, such as age-related malnutrition, sarcopenia and COPD, which already used Carezzo products for multiple years.
The combination of global trends ‘better for the environment = better for your health’ boosts the shift towards plant-based products, reducing meat and dairy consumption. The protein quality for golden-aged people is, however, a major concern. The advice for them is to not go Vegan. Protein quality, defined by the amount and completeness of essential amino-acid profile, from plant-proteins, is lower than the quality of animal-based proteins.
There is a challenging goal, also for Carezzo, to improve the protein quality of plant-based products also for the older aged groups. We will develop new products combining fruit, vegetables and hybrid proteins.
We now have 80% of all Dutch hospitals as clients, which is a fast-track record in institutional healthcare. It shows that the new nutritional strategy is well accepted. Unfortunately, due to healthcare insurance and governmental regulations, there is no level playing field with oral nutritional supplements. There is no reimbursement on Carezzo products by health care insurance, so people do not have an equal choice.
The ‘Food as Medicine’ theme acknowledges the importance of the functionality of food in the prevention and treatment of lifestyle-related diseases. There is a huge opportunity to change towards ‘the food solution’ and reduce healthcare costs while improving the quality of life.
As a society, we should embrace innovation to improve healthcare:
- The technological innovation for better food products
- The social innovation for faster implementation
- The governance innovation to reduce barriers in finance and regulation
We are committed to transferring academic insights into good-tasting functional food products, that is our practice.
We are deeply touched by the gratitude of patients that finally reach their desired protein intake because that is our purpose.
About Fred Bergmans, Co-founder, Carezzo Nutrition
Fred Bergmans is Co-founder of Carezzo Nutrition, a Dutch for protein-enriched food & drinks for malnutrition. Fred started his marketing career in food companies, like Heineken, Mars, Kraft Foods and Perfetti/van Melle. He founded an innovation strategy consultancy, where he first met the problem of malnutrition in healthcare. Passionately he founded Carezzo Nutrition.