Rationale: The goal of the PROVE (Protein enriched vegan products to fight malnutrition) project is to innovate the assortment of plant-based energy and protein enriched products for dietary treatment of (risk of) malnutrition. We aimed to explore preferences of dietitians for plant-based products in the treatment of malnutrition.Methods: In this design-based research project, the Double Diamond model was applied. Contextual interviews were performed with 9 dietitians experienced in treating clients using a vegan diet (1 omnivore, 3 flexi-vegetarian, 1 vegetarian, 1 pescetarian, 3 flexi-vegan). Interviews focused on preferences regarding product type, size, nutrients, taste, packaging, price. Affinity mapping was used to code and analyze the transcripted interviews. The results were summarized into concept products.Results: Four product concepts were developed that represent preferences of dietitians for a plant-based energy and protein enriched product for clients with (risk of) malnutrition. Overall, pea or soy were preferred as a protein source and addition of vitamins and minerals was not preferred.Conclusion: Preferences of dietitians for plant-based protein and energy rich products for patients with risk of malnutrition largely vary. Within PROVE, we will enrich these results with patient perspectives, as basis to develop and deliver plant-based energy and protein enriched products for treatment of (risk of) malnutrition.
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Introduction: The kinetics of protein oxidation, monitored in breath, and its contribution to the whole body protein status is not well established. Objectives: To analyze protein oxidation in various metabolic conditions we developed/validated a 13C-protein oxidation breath test using low enriched milk proteins. Method/Design: 30 g of naturally labeled 13C-milk proteins were consumed by young healthy volunteers. Breath samples were taken every 10 min and 13CO2 was measured by Isotope Ratio Mass Spectrometry. To calculate the amount of oxidized substrate we used: substrate dose, molecular weight and 13C enrichment of the substrate, number of carbon atoms in a substrate molecule, and estimated CO2-production of the subject based on body surface area. Results: We demonstrated that in 255 min 20% ± 3% (mean ± SD) of the milk protein was oxidized compared to 18% ± 1% of 30 g glucose. Postprandial kinetics of oxidation of whey (rapidly digestible protein) and casein (slowly digestible protein) derived from our breath test were comparable to literature data regarding the kinetics of appearance of amino acids in blood. Oxidation of milk proteins was faster than that of milk lipids (peak oxidation 120 and 290 minutes, respectively). After a 3-day protein restricted diet (~10 g of protein/day) a decrease of 31% ± 18% in milk protein oxidation was observed compared to a normal diet. Conclusions: Protein oxidation, which can be easily monitored in breath, is a significant factor in protein metabolism. With our technique we are able to characterize changes in overall protein oxidation under various meta-bolic conditions such as a protein restricted diet, which could be relevant for defining optimal protein intake under various conditions. Measuring protein oxidation in new-born might be relevant to establish its contribution to the protein status and its age-dependent development.
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Background: A chronic low-grade infammatory profle (CLIP) is associated with sarcopenia in older adults. Protein and Vitamin (Vit)D have immune-modulatory potential, but evidence for efects of nutritional supplementation on CLIP is limited. Aim To investigate whether 13 weeks of nutritional supplementation of VitD and leucine-enriched whey protein afected CLIP in subjects enrolled in the PROVIDE-study, as a secondary analysis. Methods: Sarcopenic adults (low skeletal muscle mass) aged ≥ 65 years with mobility limitations (Short Physical Performance Battery 4–9) and a body mass index of 20–30 kg/m2 were randomly allocated to two daily servings of active (n=137, including 20 g of whey protein, 3 g of leucine and 800 IU VitD) or isocaloric control product (n=151) for a double-blind period of 13 weeks. At baseline and after 13 weeks, circulating interleukin (IL)-8, IL-1 receptor antagonist (RA), soluble tumor-necrosis-factor receptor (sTNFR)1, IL-6, high-sensitivity C-reactive protein, pre-albumin and 25-hydroxyvitamin(OH) D were measured. Data-analysis included repeated measures analysis of covariance (corrected for dietary VitD intake) and linear regression. Results: IL-6 and IL-1Ra serum levels showed overall increases after 13 weeks (p=0.006 and p<0.001, respectively). For IL-6 a signifcant time × treatment interaction (p=0.046) was observed, with no signifcant change over time in the active group (p=0.155) compared to control (signifcant increase p=0.012). IL-8 showed an overall signifcant decrease (p=0.03). The change in pre-albumin was a signifcant predictor for changes in IL-6 after 13 weeks. Conclusions: We conclude that 13 weeks of nutritional supplementation with VitD and leucine-enriched whey protein may attenuate the progression of CLIP in older sarcopenic persons with mobility limitations
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Aanleiding Ondervoeding komt nog veel voor in Nederland, vooral bij zieken en ouderen. Dieetbehandeling bij ondervoeding bestaat uit eiwit- en energierijke voeding. Omdat de meeste verrijkte producten op dierlijke basis zijn, zijn verrijkte producten op plantaardige basis zeer beperkt. Hierdoor wordt de kans op effectieve dieetbehandeling van ondervoeding bij mensen die een plantaardige (plantbased) voeding willen gebruiken beperkt. Doel PROVE beoogt het plantbased assortiment eiwit- en energieverrijkte voeding te innoveren, vanuit samenwerking tussen leveranciers van plantaardige grondstoffen (Avebe), producenten van medische voeding (Nutricia), producenten/distributeurs van maaltijden (Van Smaak), zorginstellingen (Zorggroep Groningen, Martini ziekenhuis) en een hogeschool (Hanzehogeschool Groningen). Binnen PROVE wordt een pakket van wensen samengesteld rondom o.a. sensorische eigenschappen, productsamenstelling, houdbaarheid, milieugerelateerde eigenschappen en kosten door patiënten en diëtisten, voor een productconcept geschikt voor patiënten met (risico op) ondervoeding die plantbased willen eten. Hiermee willen we bijdragen aan de noodzakelijke verschuiving naar een meer plantbased en minder dierlijk voedingspatroon (eiwittransitie). Praktijkopbrengst Op basis van het pakket van eisen kan een plantbased productconcept worden ontwikkeld, dat bijdraagt aan een volwaardig voedingspatroon dat voorziet in de verhoogde voedingsbehoefte bij ondervoeding. Met de ruimere keuze in verrijkte producten kunnen patiënten die een plantbased voeding gebruiken hun voedingsinname en voedingstoestand beter behouden danwel verbeteren. Diëtisten zullen door een ruimere keuze aan verrijkte plantbased producten minder handelingsverlegen zijn in de dieetbehandeling van ondervoeding bij deze doelgroep. Innovatie Binnen PROVE brengen we alle schakels in de keten bijeen, van grondstof tot patiënt, waarmee we krachten bundelen en slagingskansen optimaliseren om als eerste consortium het plantbased assortiment voor patiënten met ondervoeding(srisico) uit te breiden. Vervolgonderzoek In vervolgonderzoek wordt op basis van het pakket van eisen dat voortvloeit uit het voorgestelde KIEM project een prototype van het productconcept ontworpen, waarna deze wordt geëvalueerd bij patiënten.
