Community Research and Development Information Service - CORDIS

Periodic Report Summary 2 - OPTIFEL (Optimised food products for elderly populations)

Project Context and Objectives:
The European population has been ageing since the 50s and prospects show that this trend will be increasing in the next decades with a peak in 2040. Facing this problem in a decent while economically-efficient way is a challenge posed to almost all European countries (EIP Active and Healthy Ageing). Malnutrition, which particularly affects older people, costs European healthcare systems similar amounts as obesity and overweight, and is a major determinant in accelerated loss of autonomy and adverse health outcomes. However up until now, elderly denutrition is fought at the quantitative level by elderly food pyramid-based prescriptions or food supplements.

The aim of Optifel is to fight the onset of elderly malnutrition by achieving a paradigm shift: rather than remedying elderly nutritional deficiencies, the project will contribute to fight appetite loss with attractive and nutrient-dense food products designed to meet the nutritional needs, sensory expectations and physical constraints at the level of end-products as well as preparation and delivery. To design the products Optifel will map all the relevant information on elderly’s needs, expectations, capabilities of handling and manipulating product and packaging, and acquire data on the evolution of taste sensitivity (for attractiveness) as well as physical capacities (ease of chewing, ease of opening) with ageing. This will provide data to guide further product development and contribute to design a new generation of varied and tasty food products for elderly and thus help improve life quality and pushback hospitalisation. Optifel will test the developed concepts using fruit and vegetable as a base.

The specific objectives of OPTIFEL are:

• To bring new knowledge on elderly’s sensory expectations and physical constraints, and in particular on food preference, integrating sensory, physical, cultural and personal factors. Concerning physical constraints, we plan to better understand the food properties that impact on mastication and swallowing, in relation with evolution of physical capacities, and to design packaging taking into account ease-of-opening and legibility. A specific item concerns the environment and costs assessments of the existing solutions for meal delivery.

• To provide tools for categorization of elderly according to their eating capability and/or sensorial discrimination, enabling food manufacturers to produce foods tailored to particular segment of elderly population. Furthermore, the observed relationship between hand and oro-facial muscle strengths might offer caregivers a safe and reliable method to assess and eating capability of elderly using non-invasive hand gripping force measurement for assessment.

• To synthetize existing and new knowledge on nutritional requirements, texture, packaging and environmental costs in guidelines adapted for the food industry, and use these guidelines to design adapted products, delivery and preparation solutions.

• To elaborate adapted products, using fruit and vegetable base, with enrichment in proteins and in vitamins and minerals. This will also allow to better understand the impact of food processes, including innovative processes such as high pressure and ohmic heating, on texture and nutritional qualities of fruit and vegetable foods.

• To validate these products from production to the individual plate, taking into account the sensory qualities, nutritional content and digestibility, microbial safety and environmental and cost performance.

• To test selected products with seniors, either able to come at the lab for a preference assessment, or with decreased autonomy, using meals-on-wheels or in retirement homes.

The results of the project will be disseminated at three levels: to the general public, through a dedicated website and communication, to scientific community through articles, and to the food science and catering communities through design of courses and presentations at professional fairs.

Project Results:
WP1 – User specifications
WP1 was mostly active in the first reporting period (M1-M18), as planned in the Description of Work. M19-M30 was devoted to completing some of the studies and valorisation of the work so far. A major achievement was a survey of preferences concerning fruit and vegetables, and food products from fruit and vegetables, allowing to assess common aspects and cultural differences. This survey included 400+ elderly and 45 care-caterers and was carried out in France, Finland, United Kingdom, Poland, Span and Turkey, involving 8 of the project’s partners and a common (translated) questionnaire. During M19-M30, in Turkey, survey was completed with personal interview of 42 elderly participants. Fruit and vegetable foods got good scores from elderly. Sauces, spices and seasonings did not seem to be well liked. Differences between countries in terms of preferred products were large, however overall least disliked fruits were peach, plum, apple, pear and strawberry, and least disliked vegetables were green peas, lettuce, green cabbage, raw tomato and cooked carrot. Different levels of food neophobia (the fear of eating new or unfamiliar foods) among elderly were observed in different countries. Turkish interviewees seemed to be the most and French least neophobic. When analysing pleasure concerning food, meals and eating, it was found that UK subjects felt more enjoyment than subjects from other countries.

For packaging, a focus group approach was used to identify with elderly persons, the optimal packaging type and maximal acceptable force or torque needs for its opening. These focus groups were also used to study factors that impact legibility of information on packaging and coordinated with the survey on preferences.

Characterization of eating capacity in relation with hand grip strength and finger force was carried out with 203 subjects in UK and Spain, its rationale being that hand grip or finger force are easy to measure and non-invasive, and can become predictors of eating capacity. Elderly subjects were grouped into 4 groups based on their eating capability scores. Elderly of the first three groups perceived food products with more hardness and/or fibrous structure as difficult to process orally. The objective measurements of various physiological factors enabled quantitative characterisation of the eating capabilities of elderly people and their difficulty perceived. The observed relationship between hand and oro-facial muscle strengths provided a possibility of using non-invasive hand gripping force measurement for eating capability assessment. A second study with 61 young and elderly subjects in UK and Spain was successfully completed to establish the relationship between bolus swallowing, food physics and eating capability using a set of non-invasive objective techniques (hand gripping force, tongue pressure, biting force, and hand dexterity) in conjunction with frame-by-frame video recording analysis of chewing and swallowing of real food products, hydrocolloid gels (with different matrix inhomogeneity) and their self-reported difficulty perception on the same products. Interestingly, the weakest group needed more time for chewing and swallowing, however it was not statistically significant. The eating capability (EC) parameters did not correspond to oral residence time, or the difficulty perceived. Bite force differed by EC group, and was significantly different by dental status and influenced both liking and number of chews. The food hardness was significantly correlated with the number of chews. Gel heterogeneity influenced food oral processing behaviour. Oral residence time was significantly correlated with number of chews, liking and difficulty perceived.

Discrimination capacities for sweet and acid tastes in an apple purée based-product were measured in young adults and autonomous elderly (300 subjects). Liking for products with varying sugar / acid ratios was also tested as a tool for formulation. Discrimination performances were different between age groups. Discrimination capacities of young adult and autonomous elderlies were comparable, however, discrimination performances decrease in the older dependent elderly group, who are living in nursing homes. Sweet apple purées were preferred over sour ones, whichever the level of dependency. However the sweetest apple purée (sugar level: 280 g/kg) was differently appreciated: it was the preferred product for the dependant elderlies while it split the population of autonomous elderlies in two, being cited by them equally as the most liked and the most disliked product. A baseline environmental and cost assessment of existing meal delivery systems was carried out, taking into account the cold-chain and transportation aspects. A review on nutritional needs and existing solutions was carried out including the recent published advances.

WP2 – Functional requirement specifications
In WP2, the existing recommendations for daily allowances across Europe were synthetized and used to give aims in amounts per portion. Averages for recommended nutrient concentrations have been calculated. Due to nutritional risks, fortification is recommended for several nutrients. This has been summarized in the Guidelines that have been elaborated with for dissemination within WP6. A food calculator calculating personal nutrient needs based on these recommendations was elaborated and is available Information was sought throughout the scientific literature for texture parameters and sensory modification for adapted foods. No universal texture requirements were found, except in the case of dysphagia patients, and even then described in broad categories not textural parameters. In general the elderlies like fruit and vegetables but cultural and individual differences are great, thus no universal taste requirement can be recommended. Existing products were benchmarked with two options: one was the existing products for seniors world-wide, the other was for products related to Optifel ideas for all ages. Plenty of products exist already on the market, but many of them need further development of taste and texture. From interactions and creativity sessions during the meetings involving all partners, a number of product ideas were generated and the most promising ones were further developed to propose product concepts. The meta-analysis highlighted a limited impact of processing on the nutritional composition of fruit and vegetable products, notably ascorbic acid, carotenoids and polyphenols.

WP3 – Design and processing of novel food products
WP3 has been the most active workpackage in this second period, in conjunction with WP5 for validation of interest of the products and WP4 for their analysis. The proposed product ideas were tested in terms of feasibility, stabilisation and packaging. Supplementation levels and the processing conditions were optimised. Two meetings were organised in spring 2015 to fine-tune the choice of products and the precise conditions to be tested. Results from WP4 and from particular sensory testing were used to choose the final products to be produced on a larger scale (choice during the 3rd project meeting). Most of the products were based on apple (fruit) or carrot (vegetable) as they are among the well-accepted fruits and vegetables, and are available throughout the year for trials. The SME participants further developped the concept using different raw materials. The products were sent to WP4 for assessment of safety, nutritional quality and sensory characterization, and to WP5 for establishment of preferences.

On carrots and apples (Golden delicious) raw materials, different formulation, texture, packaging and processing have been tested. Rough sensory and microbiological analyses have been carried out to select food prototypes and their stabilisation process. According to the results obtained in WP3 some products have been sent to partners in WP4 for further testing. Results from WP4 have been used to select the products to be produced for WP5. Industrial production and logistic distribution have been checked with WP5 partners.

A series of 9 product concepts have been designed and tested. Five product concepts are based on apple raw materials (enriched apple purée, healthy confectionary, apple pieces with watermelon texture, apple dessert and smoothie) and three product concepts (carrot purée, culinary aids, concentrated soup) are based on vegetables. The products were enriched either in proteins (apple purée, carrot purée, culinary aids, and concentrated soups) or in vitamin and mineral supplement (healthy confectionary, apple pieces, apple dessert and smoothie). Innovative processes (high pressure and ohmic heating, new tubular pasteurization concept) were tested for the stabilization. For each concept, various formulations have been proposed to be tested in WP4 and 19 selected products (4 concentrated soups, 5 culinary aids, 3 carrot purees, 3 apple dessert and 4 apple based smoothies) have been produced and sent to Task 5.2 partners for testing of preferences by autonomous elderlies, in order to choose the final products for M31-M42 assessment in meals-on-wheels and retirement homes.

WP4 – Impact of food storage and preparation of food product properties
The objective of WP4 is to measure the sensory properties, the nutritional value, the microbial safety and the environmental and cost performance, of the products developed in WP3, considering the impact of food storage and food preparation. During the first project period work began for nutritional value and microbiological risk on solutions mimicking the conditions in the real foods. The stability of vitamin C in the conditions of reheating (45-85°C) was studied in buffer solutions and in the serum of apple purée. Oxygen concentrations at equilibrium were also measured. Microbial safety was assessed using the sore-forming pathogen B. cereus, in presence and absence of oxygen, in conditions of storage (8-10°C) and reheating. During the present period WP4 made a first selection of prototype foods from WP3 and analysed their characterisation (after processing and during shelf-live) with a specific objective to select the range of prototype foods for WP5. Impact of temperatures (cold and warm) and pH relevant to the food composition, food storage and food re-heating conditions, on nutritional value and microbial safety were studied in model solution and in real foods.

Environmental and cost performance of different scenarios representing different usages of foods for elderlies, was assessed. Environmental and cost performance of the foods will be mostly affected by the conditions of food supply in nursing homes, or at elderlies’ home, and by the mode of storage. Environmental and cost performance assessment of the prototype foods was limited to the definition of the data needed, and will be done during the next period, on the very final version of the prototype foods, integrating the last improvements brought by the first results of WP5.

Six prototype foods were selected through a tiered approach, integrating results of bench marking, shelf-life, microbial and vitamin stability, first sensory tests. Sensory evaluation by an expert panel measured the impact of fortification of the foods with proteins and the impact of processing methods. Addition of proteins in the prototype foods had a major impact on sensory properties and was accepted only in some recipes. In contrast, food processing method had little impact. Among the proteins added, pea protein was the most digestible, in both carrot and apple purée. Processing methods and re-heating increased digestibility. A model was build that predict vitamin C degradation during re-heating as a function of oxygen concentration. This model fits well with experimental results obtained in the foods tested. Folate degradation depends on the vitamers and in real food, the most heat sensitive vitamer could be protected by vitamin C. Foodborne pathogens that could grow during storage of foods are very heat sensitive and easy to kill during food re-heating. However, some strains produce a very heat-resistant toxin (cereulide) of which the production during cold storage is under investigation.

The list of selected prototype foods is: smoothies, concentrated soup, culinary aids, carrot purée, and apple purée. Each food will be tested by elderlies in WP5 with a fortified version and a plain version. The prototype foods provide elements for the main meal (soup as a starter, purée and culinary aid cooked with chicken as the main course, and apple purée as dessert). Smoothies will be proposed for breakfast or mid-afternoon break, depending on countries. The detailed composition and information (processing, packaging, storage, usage) on these prototype foods was made available to project partners.

WP5 – Product acceptance at homes and nursing homes
The first prototypes were produced by partners of WP3 and WP4. Different recipes for soups, carrots purées, culinary aids, apple purée and smoothies with and without enrichment (proteins or minerals plus vitamins) were identified to be tested in the task 5.2.

In task 5.2, the evaluations of prototypes (preference tests) by autonomous population are in progress. Subjects were recruited. Sessions started in all participating countries. A list of critical points was dealt with concerning the supply and logistics: transports companies, quantities of products to produce and to deliver in the different labs and the organisation. Written procedures of tests were sent to each country. In parallel, the quantities for each product were estimated, according to the number of places where they will be tested, and the number of subjects. We included a margin to cover the extra number of subjects we need to recruit as there are always some resignation (15%), and another margin to prevent the possible loss of products during transport (breakage) or use. The final planning takes in account constraints from production, transport, delivery and tests. For the distribution of products, the transport company (STEF) was able to deliver the pallets on time. Dataloggers travelled with the products to post-verify the temperature during transport.

Concerning the ethical issue to allow the realization of the studies (5.3 and 5.4), the protocols were written in English and sent to each partner to translate into local language in order to get approval from local ethical committee. Some partners, in Finland, in Poland, in Turkey, in France and in Spain have already identified nursing homes and meal on wheels structures for Task 5.3 and 5.4. In UK, the companies of meal on wheels deliver a hot service and it is not consistent with the Optifel studies; for this reason, the costumers of one committee centre will be chosen to participate to the study. In Germany, only one nursing home can participate.

The main results archived so far are the following. Four different recipes of each product were defined to be tested in task 5.2 and microbiological analyses of products were done.
• For soup: 7 vegetable soups (carrot, tomato, potato, etc.) with 5% or 7.5% of proteins, leeks and potatoes soup with 5% of proteins, and tomato soup with 7.5% of proteins.
• For culinary aids: Basquaise (tomato, sweet pepper, etc.) with 7.8% of proteins, mushrooms with 4.1% of proteins, sunny vegetables (tomato, sweet pepper, aubergine/eggplant, etc.) with 8.2% of proteins, onion and white wine with 6.01% of proteins.
• For carrot purées: carrot purée with extract of cooked carrot with 5% or 7.5% of proteins, carrot purée with extract of fresh/raw carrot and 7.5% of proteins, and base carrot purée without added proteins.
• Four apple purées: apple-based desserts with pineapple aroma or black carrots juice with fibres and/or minerals and vitamins enrichment and fibre enrichment with Psyllium husk and/or apple fibre.
• Four smoothies: apple-based smoothies with minerals and vitamins enrichments and blueberry or rose.
The sensory profiles have been done with one expert panel in Angers (France) with sensory characterization. Hedonic evaluation and hedonic test by one consumer panel per country were just finished.
The number of subjects involved in each test and in each country (France, Finland, Poland, Spain) in task 5.2 was at least 80 (a total of 320 subjects); there were 92 inclusions in France; 75 in Finland, 96 in Poland and 85 in Spain (a total of 348 participants).

Protocols for 5.3 and 5.4 were deposited in local Ethical committees and a positive approval was obtained for Spain and Poland, approval is in progress in UK, Finland and Turkey, it is not needed for Germany; in France, it is not needed, but submitted to the local Ethical Committee. The use of MMSE questionnaire to know the cognitive status was not authorized by Finnish and England Ethical Committee.

In WP6 – Dissemination and technology transfer,
An action plan explaining the main dissemination actions to perform during the project was developed with all partners.
The first action was the development of the project website,, with the implementation of two ways for visiting the website: for the general public (more than 150 different posts/recipes/news, in French and English) and for the scientific community (English only). A continuous update of the information of the website is done, with in average 2-3 pages/news added per month.

The second action was the development of the newsletter to send to the contact database. Since the beginning of the project, 4 newsletters and 2 press releases (on October 2014 and 2015 - International day of older persons) have been sent to more than 500 contacts and stakeholders, and to 200 professional journals or local media.

The third action was to communicate to the scientific community through the classical dissemination channels (poster, scientific communications, articles...) which was successful during the 2 first periods.

The last action was to develop guidelines describing characteristics of Fruit and Vegetable products adapted to the senior population.

The website with its numerous contents, posts and news is an excellent channel for propagating information, not only on the project itself but also on the general topic of food and nutrition for the elderly.

Other ways of communication used (twitter, newsletters, press releases, communication at specialised congresses...) yielded also excellent results.

Guidelines for food industry are available in 6 different languages.

All the partners are involved in dissemination activities.

Potential Impact:
The OPTIFEL strategy is to develop a specification-based approach for food products targeted at the senior and elderly market. The specifications will be elaborated within the project, from pre-existing knowledge and from the project’s results, and tested using fruit and vegetable based products.

New knowledge is expected in the following fields:

• Elderly preferences and physical requirements (texture, ease-of-opening, packaging design): OPTIFEL will have gathered a database on the preferences of elderly Europeans of various fruit and vegetable-based products across countries, gender and frailty. Better understanding of the evolution with age of taste perception and preference will be available. New knowledge is expected on the textural specification for foods that are easy-to-chew and safe to swallow, while avoiding the “baby-food” effect, as well as on the relation between physical capacities and eating capacities of elderly.

• Food science and food processing: The impact of innovative and conventional technologies on fruit and vegetable-based products will be better understood, allowing manipulation of texture and improved preservation of nutrient content. The basis for texture variation in puréed fruit and vegetables, including the evolution of pectin and the impact of particles, will be better understood. The impact on sensory characteristics of supplementation will be assessed. Knowledge-based recommendations for better preservation of vitamin contents and protein digestibility while maintain food safety during re-heating of plant-based foods will be proposed.

OPTIFEL will also provide guidelines to design future food products that reach the same specifications in terms of eating pleasure and nutritional contributions, as well as guidelines on distribution. These guidelines will synthetize published data on nutritional requirements, and will be based on Optifel results for texture, packaging and impact of processing. These will be disseminated to the food processing industries to facilitate further elaboration of senior product lines. Advice on the life-cycle costing of the various distribution strategies will be available for care-caterers and public authorities. Optifel will also address cook-serve stage, with a simulator of vitamin loss and proposed solutions to mitigate the effects of cooking and reheating on food quality and safety.

OPTIFEL will provide attractive and nutrient-dense, fruit and vegetable-based, food solutions for the elderly. These food solutions will be validated qua attractiveness, packaging, nutrition, microbial safety, texture and means of delivery. Detailed product concepts will be described within the consortium for further use by participants for new products and product lines. Options for personalisation and preparation will be conceived. These products will allow nutritional status to be better maintained while providing pleasure, and to help prevent malnutrition. Specifically enriched foods will be available with sensory and use characteristics such that they can be used as part of a meal. Equipment for food preparation with adapted ergonomics that meet the technical specifications, elaborate for nutrition preservation and microbial safety will be designed.

Expected impact is thus three-folds:

• New knowledge will be obtained on elderly themselves, their preferences and capabilities, as well as in food science, specifically on processing of fruit and vegetable.

• Tools will be available to the stakeholders for conception of products adapted for elderly and their distribution. Adoption of these guidelines is expected to contribute to competitiveness of the European food industry by facilitating their product development, and to a decrease in malnutrition in the European population.

• Actual products can be proposed to seniors for increased food pleasure and better nutrition. This will have a direct economic impact on participating businesses and a long-term effect on reduction of malnutrition.

Work packages WP1 and WP2 are now completed and some first conclusions can be drawn from their results.

From WP1. We can conclude that:
- Elderlies generally appreciate fruit and vegetables, but there are marked differences in preference between the different countries.
- Ease of opening was associated with larger screw-caps, stand-up pouches with perforations, aluminium foil for peelable packaging as it allows good grip. Further, labelling needs sufficient font size (> 1.5 mm), familiar and sans serif characters, clear contrasts and a structured layout.
- Sensory discrimination was not impaired in autonomous elderlies, but was lower in dependant elderlies, which was associated with a preference for sweet products. Food products aimed at autonomous elderlies therefore should not require specific taste formulation, while those for dependant elderlies must be adapted.
- Beside hardness and viscosity, food structural complexity can be also used to increase the swallowing time in elderlies and this insight might be used to design future food offered to the elderly population, which are at risk of swallowing disorder. Furthermore, dental status and bite force of elderly subjects are determining EC parameters to design optimized food-texture.

WP2 The meta-analysis, soft-ware tool and report on nutritional composition requirements will be useful for food industry. Their main results have been summarized in guidelines. The research need of instrumental methods for food texture definition should be notified within funding organizations.

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