title: Protein-enriched 'regular products' and their effect on protein intake in acute hospitalized older adults; a randomized controlled trial.
abstract: OBJECTIVE
  Especially in older adults, maintaining muscle mass is essential to perform activities of daily living. This requires a sufficient protein intake. However, protein intake in hospitalized older adults is often insufficient. Thus far different nutrition intervention strategies have failed to show success in reaching sufficient protein intake in hospitalized older adults. The effect of recently developed protein-enriched bread and drinking yoghurt on protein intake is still unknown. Therefore, the objective of this study was to examine the effect of protein-enriched bread and drinking yoghurt on the protein intake of acute hospitalized older adults (≥55 years).
  
  
  METHODS
  This study was performed as a single blind randomized controlled trial in 47 hospitalized elderly acutely admitted to a university hospital. During three consecutive days participants received either ad libitum protein-enriched bread and drinking yoghurt or normal, non-enriched products as part of their daily meals. The protein-enriched bread contained 6.9 g of protein per serving and the normal bread 3.8 g of protein. For drinking yoghurt this was 20.0 g and 7.5 g of protein per serving respectively. The products were almost isocaloric. Food intake of participants was measured and nutritional values were calculated according to the Dutch Food Composition Table. An independent sample t-test was used to compare protein intake between the intervention and control group.
  
  
  RESULTS
  Analyses illustrate a protein intake in the intervention group of 75.0 ± 33.2 g per day versus 58.4 ± 14.5 g in the control group (p = 0.039). Intervention patients had a mean protein intake of 1.1 g/kg/day, with 36% of the patients reaching the minimum requirement of 1.2 g/kg/day; in control patients this was 0.9 g/kg/day (p = 0.041) and 8% (p = 0.030). Bread and drinking yoghurt contributed almost equally to the increased intake of protein in the intervention group.
  
  
  CONCLUSIONS
  The use of protein-enriched bread and drinking yoghurt, consumed as part of regular meals, is a promising and feasible solution to increase the protein intake of acutely ill patients. It needs to be confirmed whether the use of these products will also result in a better clinical outcome. ClinicalTrials.gov ID number: NCT01907152.
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Stelten
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Dekker
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Ronday
authors.affiliation: Department of Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Thijs
authors.affiliation: Wageningen UR Food & Biobased Research, PO Box 17, 6700 AA Wageningen, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Boelsma
authors.affiliation: Wageningen UR Food & Biobased Research, PO Box 17, 6700 AA Wageningen, The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: Peppelenbos
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Department Nutrition, Sports and Health, PO Box 6960, 6503 GL Nijmegen, The Netherlands. Electronic address: m.devanderschueren@vumc.nl.
authors.forename: M A E
authors.initials: MA
authors.lastname: de van der Schueren
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001939:Bread / Q000032:analysis*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005527:Food, Fortified; D006760:Hospitalization; D006801:Humans; D008297:Male; D062407:Meals; D016037:Single-Blind Method; D015014:Yogurt / Q000032:analysis*
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D004044:Dietary Proteins
keywords: Dietary protein intake; Malnutrition; Older adults; Protein-enriched bread; Protein-enriched drinking yoghurt; Randomized controlled trial