Design and assessment of protein-fortified recipes for community-dwelling older adults to prevent the onset of undernutrition

Introduction: Public health guidelines recommend food fortification (adding ingredients of nutritional importance into commonly consumed foods) to help older adults achieve sufficient protein intake. Despite the nutritional benefits of food fortification, there is a significant gap between nutritional research and sensory acceptance, which can limit older adults' compliance to fortified foods. The present study aimed at developing and testing the feasibility and liking of using "Do it yourself" protein-fortified recipes that could be easily prepared at home in France, Norway and the UK. Materials and methods: A market review was conducted to identify available high-protein ingredients (n = 140). After screening for sensory, nutritional, food technology, and regulatory characteristics, two high-protein ingredients were selected: milk protein powder (isolate) and organic soya mince (extruded). In parallel, common food matrices that could serve as relevant candidates for fortification were identified through 4-day food diaries collected with 65 respondents in France, Norway, and the UK. Eight dishes were selected for recipe fortification and paired with high-protein ingredients (+ 6 to 11 g of protein per portion, mean = 8.1, SD = 2.3). Then, these fortified recipes were assessed for ease-of-use and acceptability in a home-use trial with healthy older adults in the three countries (> 70 years; n = 158). Participants made the recipes themselves at home using their own cooking equipment. Results: Feedback from participants indicated that they found the recipes easy to follow and to prepare themselves. The fortified recipes were liked (mean liking from 5.3 to 5.9 on a 7-point scale) and perceived as being easy to chew, moisten (humidify in mouth) and swallow. More than 50% of the participants were willing to make the recipes again in the future and liked the fortified version equally or more to their usual recipes. Discussion: Making the recipes by themselves at home removed participants' barriers to using high-protein ingredients. Furthermore, participants modified dishes to their liking by adjusting seasoning and texture to their preference underling the flexibility of the fortification strategy.