Protein Intake among Community-Dwelling Older Adults: The Influence of (Pre-) Motivational Determinants.

An adequate protein intake is important for healthy ageing, yet nearly 50% of Dutch community-dwelling older adults do not meet protein recommendations. This study explores protein intake in relation to eight behavioral determinants (I-Change model) among Dutch community-dwelling older adults. Data were collected through an online questionnaire from October 2019-October 2020. Protein intake was assessed by the Protein Screener 55+, indicating a high/low chance of a low protein intake (<1.0 g/kg body weight/day). The behavioral determinants of cognizance, knowledge, risk perception, perceived cues, attitude, social support, self-efficacy and intention were assessed by evaluating statements on a 7-point Likert scale. A total of 824 Dutch community-dwelling older adults were included, recruited via online newsletters, newspapers and by personal approach. Poisson regression was performed to calculate quartile-based prevalence ratios (PRs). Almost 40% of 824 respondents had a high chance of a low protein intake. Univariate analyses indicated that lower scores for all different behavioral determinants were associated with a higher chance of a low protein intake. Independent associations were observed for knowledge (Q4 OR = 0.71) and social support (Q4 OR = 0.71). Results of this study can be used in future interventions aiming to increase protein intake in which focus should lie on increasing knowledge and social support.

The protein gap-increasing protein intake in the diet of community-dwelling older adults: a simulation study.

OBJECTIVE: Approximately 50 % of Dutch community-dwelling older adults does not meet protein recommendations. This study assesses the effect of replacing low protein foods with protein-rich alternatives on the protein intake of Dutch community-dwelling older adults. DESIGN: The Dutch National Food Consumption Survey-Older Adults 2010-2012 (DNFCS-OA) was used for scenario modelling. Dietary intake was estimated based on two 24-h recalls. Commonly consumed products were replaced by comparable products rich in protein (scenario 1), foods enriched in protein (scenario 2) and a combination of both (scenario 3). Replacement scenarios were confined to participants whose dietary protein intake was < 1·0 g/kg BW/d (n 391). Habitual protein intake of all older adults was estimated, adjusting for effects of within-person variation in the 2-d intake data. SETTING: A simulation study based on the DNFCS-OA. PARTICIPANTS: 727 Dutch community-dwelling older adults aged 70+. RESULTS: Mean protein intake of the total population increased from 1·0 to 1·2 g/kg BW/d (scenarios 1 and 2) and to 1·3 g/kg BW/d (scenario 3). The percentage of participants with intakes of ≥ 1·0 g/kg BW/d increased from 47·1 % to 91·4 %, 90·2 % and 94·6 %, respectively, in scenarios 1, 2 and 3. The largest increases in protein intake were due to replacements in food groups: yoghurt, cream desserts and pudding, potatoes, vegetables and legumes and non-alcoholic beverages and milk in scenario 1 and bread; yoghurt, cream desserts and pudding and soups in scenario 2. CONCLUSIONS: This simulation model shows that replacing low protein foods with comparable alternatives rich in protein can increase the protein intake of Dutch community-dwelling older adults considerably. Results can be used as a basis for nutritional counselling.

What Is on the Menu?-A Quantitative Analysis on Label Format among (Potential) Restaurant Guests and Restaurant Owners.

About 20% of energy intake in the Netherlands is consumed out-of-home. Eating out-of-home is associated with higher energy intake and poorer nutrition. Menu labeling can be considered a promising instrument to improve dietary choices in the out-of-home sector. Effectiveness depends on the presentation format of the label and its attractiveness and usability to restaurant guests and restaurant owners. This exploratory study investigated which menu labeling format would be mostly appreciated by (a) (potential) restaurant guests (n386) and (b) the uninvestigated group of restaurant owners (n41) if menu labeling would be implemented in Dutch full-service restaurants. A cross-sectional survey design was used to investigate three distinct menu labeling formats: a simple health logo; (star) ranking and calorie information. Questionnaires were used as study tool. Ranking has been shown to be the most appreciated menu labeling format by both (potential) restaurant guests and owners. Statistical analysis showed that label preference of potential restaurant guests was significantly associated with age, possibly associated with level of education, and not associated with health consciousness. In summary, we found that ranking is the most appreciated menu label format according to both (potential) restaurant guests and restaurant owners, suggesting it to be a promising way to improve healthy eating out-of-home.

Low awareness of community-dwelling older adults on the importance of dietary protein: new insights from four qualitative studies.

Meeting the recommended daily protein intake can be a challenge for community-dwelling older adults (CDOA). In order to understand why, we studied attitudes towards protein-rich products and healthy eating in general; identified needs and preferences, barriers and promotors and knowledge regarding dietary behaviour and implementation of high protein products. Attitudes towards protein-rich products and healthy eating were evaluated in focus groups (study 1, n 17). To gain insights in the needs and preferences of older adults with regard to meals and meal products (study 2, n 30), visual information on eating behaviour was assessed using photovoicing and verified in post-photovoice interviews. In studies 3 and 4, semi-structured interviews were conducted to identify protein consumption-related barriers, opportunities (n 20) and knowledge and communication channels (n 40), respectively. Risk of low protein intake was assessed using ProteinScreener55+ (Pro55+) in studies 2-4 (n 90). Focus groups showed that participants were unaware of potential inadequate dietary protein. Photovoicing showed that sixteen of thirty participants mainly consumed traditional Dutch products. In post-photovoice interviews, participants indicated that they were satisfied with their current eating behaviour. Barriers for adequate use of protein-rich products were 'lack of knowledge', 'resistance to change habits' and 'no urge to receive dietary advice'. Promotors were 'trust in professionals' and 'product offers'. Sixty-two percent had a low risk of low protein intake. CDOA feel low urgency to increase protein intake, possibly linked to low knowledge levels. A challenge for professionals would be to motivate older adults to change their eating pattern, to optimise protein intake.

What do screening tools measure? Lessons learned from SCREEN II and SNAQ65.

BACKGROUND: Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice. METHODS: Dutch community-dwelling older adults (n = 200, 78.2 ± 6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQ65+ (low risk vs moderate/high risk) was used to assess risk of protein energy malnutrition and SCREEN II was used to assess nutrition risk (score <54 out of 64). Chi-square tests were used to test associations between demographic, health, physical and social factors and outcome of SNAQ65+ and SCREEN II. RESULTS: Of all participants 69.0% were at nutrition risk (SCREEN II), while 13.5% were at risk of protein energy malnutrition (SNAQ65+). Agreement between the two tools was poor (kappa < 0.20). Gender, BMI, living status, income, activity level and protein/energy intake were associated with SCREEN II; age, BMI, comorbidities, medication use, help at home, activity level and low basic mobility were associated with SNAQ65+. CONCLUSION: SCREEN II and SNAQ65+ measure different concepts of malnutrition and therefore identify different persons at risk. SCREEN II is more inclusive and comprises both undernutrition and overnutrition as well as different determinants that can impact on food intake, while SNAQ65+ is solely focused on protein-energy malnutrition.

The ConsuMEER study: a randomised trial towards the effectiveness of protein-rich ready-made meals and protein-rich dairy products in increasing protein intake of community-dwelling older adults after switching from self-prepared meals towards ready-made meals.

The risk of undernutrition in older community-dwelling adults increases when they are no longer able to shop or cook themselves. Home-delivered products could then possibly prevent them from becoming undernourished. This single-blind randomised trial tested the effectiveness of home-delivered protein-rich ready-made meals and dairy products in reaching the recommended intake of 1·2 g protein/kg body weight (BW) per d and ≥25 g of protein per meal. Community-dwelling older adults (n 98; mean age 80·4 (sd 6·8) years) switched from self-prepared to home-delivered hot meals and dairy products for 28 d. The intervention group received ready-made meals and dairy products high in protein; the control group received products lower in protein. Dietary intake was measured at baseline, after 2 weeks (T1), and after 4 weeks (T2). Multilevel analyses (providing one combined outcome for T1 and T2) and logistic regressions were performed. Average baseline protein intake was 1·09 (se 0·05) g protein/kg BW per d in the intervention group and 0·99 (se 0·05) g protein/kg BW per d in the control group. During the trial, protein intake of the intervention group was 1·12 (se 0·05) g protein/kg BW per d compared with 0·87 (se 0·03) g protein/kg BW per d in the control group (between-group differences P < 0·05). More participants of the intervention group reached the threshold of ≥25 g protein at dinner compared with the control group (intervention T1: 84·8 %, T2: 88·4 % v. control T1: 42·9 %, T2: 40·5 %; P < 0·05), but not at breakfast and lunch. Our findings suggest that switching from self-prepared meals to ready-made meals carries the risk of a decreasing protein intake, unless extra attention is given to protein-rich choices.

Paternal lifestyle as a potential source of germline mutations transmitted to offspring.

Paternal exposure to high levels of radioactivity causes heritable germline minisatellite mutations. However, the effect of more general paternal exposures, such as cigarette smoking, on germline mutations remains unexplored. We analyzed two of the most commonly used minisatellite loci (CEB1 and B6.7) to identify germline mutations in blood samples of complete mother-father-child triads from the Norwegian Mother and Child Cohort Study (MoBa). The presence of mutations was subsequently related to general lifestyle factors, including paternal smoking before the partner became pregnant. Paternally derived mutations at the B6.7 locus (mutation frequency 0.07) were not affected by lifestyle. In contrast, high gross yearly income as a general measure of a healthy lifestyle coincided with low-mutation frequencies at the CEB1 locus (P=0.047). Income was inversely related to smoking behavior, and paternally derived CEB1 mutations were dose dependently increased when the father smoked in the 6 mo before pregnancy, 0.21 vs. 0.05 in smoking and nonsmoking fathers, respectively (P=0.061). These results suggest that paternal lifestyle can affect the chance of heritable mutations in unstable repetitive DNA sequences. To our knowledge, this is the first study reporting an effect of lifestyle on germline minisatellite mutation frequencies in a human population with moderate paternal exposures.

Incomplete protection of genetic integrity of mature spermatozoa against oxidative stress.

Although DNA damage in human spermatozoa is associated with adverse health effects, its origin is not fully understood. Therefore, we assessed biomarkers in ejaculates that retrospectively reflect processes that occurred in the epididymis or testis. Smoking increased the amount of DNA strand breaks (P<0.01), and enhanced the presence of vitamin C radicals in seminal plasma. In vitro, vitamin C protected mature spermatozoa against DNA damage, but this protection appeared to be insufficient in vivo. CAT and DDIT4 expression in spermatozoa were higher in smokers than in nonsmokers, but were not related to DNA damage. CAT and DDIT4 expression were inversely related with sperm count (P=0.039 and 0.024 resp.), but no effect was observed for SOD2 expression. These data indicate that spermatozoa of smokers encounter higher levels of oxidative stress. Expression of antioxidant enzymes and seminal vitamin C were insufficient to provide full protection of spermatozoa against DNA damage.

Use of spermatozoal mRNA profiles to study gene-environment interactions in human germ cells.

Paternal exposure to genotoxic compounds is thought to contribute to diseases in their offspring. Therefore, it is of importance to develop biomarkers of male germ cell exposure to genotoxins. Unfortunately, the testis cannot be reached for routine biomonitoring, but mRNA-profiles in spermatozoa may reflect the processes that have occurred in the testis after exposures to genotoxins, since spermatozoa are largely transcriptionally inactive. Therefore, mRNA profiles from sperm in ejaculates of cigarette smokers (N=4) were compared with non-smokers (N= 4). Smoking behaviour was verified by assessing cotinine levels in seminal plasma. High expression of the germ cell specific gene protamine 2 (PRM2) was observed in spermatozoal mRNA isolates by Q-PCR, which was absent in reference mRNA isolates obtained from a pool of other organs. Gene-expression analysis was subsequently performed using microarray technology and a total of 781 genes were found to be differentially expressed in spermatozoa of smokers compared to non-smokers (fold change >40%; p < 0.05). To further limit the number of false positive results, genes were additionally selected on basis of the correlation between their expression levels with cotinine concentrations in seminal plasma (r > 0.80 as arbitrary cut-off value, p < 0.05), and a total of 200 transcripts remained, of which the germ cell specific transcription factor SALF was the highest up-regulated gene (5.4-fold) and the zinc finger encoding gene TRIM26 most down regulated (7.4-fold). Although no altered pathways could be identified for the differentially expressed genes, an enrichment was observed for NF-kappaB regulated genes (46% vs. 27%, p = 0.004) playing a central role in stress response. Accordingly, subsequent analysis of transcription factor networks suggests that apoptosis was inhibited in smokers. These data show the feasibility of using gene-expression profiles in mature sperm to elucidate gene-environment interactions in male testis.

New methods for assessing male germ line mutations in humans and genetic risks in their offspring.

Germ line mutations resulting from chemical or radiation exposure are a particular problem in toxicology as they affect not only the exposed generation but also an infinite number of generations thereafter. Established methods to show that these mutations occur in an F1 or subsequent population require the use of a large number of progeny for statistical significance. Consequently, many thousands of animals have been used in the past. Such a use is no longer considered desirable and is also very expensive. Several new molecular techniques (including analysis of tandem repeats and randomly amplified polymorphic DNA) now provide alternative methods of assessment, which also allow the quantification of individual mutations in individual sperm cells. These can also be applied to human offspring, making extrapolation obsolete. The downside of these methods is that they effectively determine the mutation rate in certain regions of DNA and the relevance of these to diseases, particularly cancer, is not always apparent. Therefore, it must be assumed that an increase in mutation rates in these selected regions correlates with altered phenotype. However, disease types linked to changes in tandem repeat length indicate that these may act as relevant markers for the development of phenotypes. Further research and evaluation are required to more closely link changes in DNA with altered phenotype and validate the use of tandem repeats and randomly amplified polymorphic DNA in transgenerational genotoxicity testing. This paper introduces and compares recently developed methods to assess mutations in sperm due to stem cell damage.