HDHL_FORTIPHY: Preventing the risk of undernutrition by fostering meal FORTIfication and PHYsical activity in older adult

营养不良在老年人中普遍存在，是面临人口老龄化的社会的一个重大公共卫生挑战。营养不良是一种具有长期后果的险恶疾病，它增加了易受疾病侵害的可能性;随着年龄的增长，它会诱发或加重虚弱、残疾和依赖。毫无疑问，营养不良影响到老年人的福祉和预期寿命，但也增加了成本，加重了我们保健系统的负担，FORTIFY旨在克服营养建议与现行做法之间的差距。保健和营养方案将制定、评估和传播解决方案（营养强化和体育活动方案），以帮助老年人满足其营养需求并维持其功能状态，从而防止营养不良的发生。一个关键的方法是在项目一开始就让最终用户参与以消费者为中心的方法，以确保解决方案在实地的相关性和适用性。食欲不振被认为是蛋白质-能量营养不良的主要决定因素，而与通常的看法相反，营养需求几乎不会随着年龄的增长而减少，有时甚至会增加。强化，即在普通饮料或食物中添加高能量/高蛋白质成分，被认为是食欲减退的老年人的一种灵活和相关的方法。与此同时，一些研究表明，将营养方法与身体活动相结合的干预措施比单独的营养或身体活动干预措施效果更好。在此背景下，项目FORTIPHY将解决生活在家中的老年少食者（70岁及以上）的营养和身体活动需求。具体来说，FORTIFY将开发新的解决方案，让老年人加强他们的日常饮食。此外，FORTIFY将评估体力活动对膳食强化的附加值。为了确保FORTPHY解决方案的高采用率和合规性，最终用户（老年人，护理人员）将通过共同创造和参与性研究在项目的早期就联系起来。第一个工作包将致力于合理设计强化食谱，方法是（i）对现有的高蛋白成分进行公正的审查，（ii）确定技术和消费者使用限制。根据这些投入，第二个工作包将考虑到老年人的偏好，制定强化食谱（家用测试）。将测量强化菜肴中氨基酸的生物利用度以及这些菜肴对饱腹感和食欲生物标志物的潜在影响。第三个工作包将评估膳食强化的效率和身体活动的附加值，以防止生活在家里的老年人出现营养不良的风险（随机对照现场试验）。特别是，FORTIFY将构思一个易于实施的工具（MOOC -大规模开放式在线课程），将食谱和体育锻炼结合起来，以支持老年人的健康，以及一个暑期学校，以促进食品工业中易于使用的强化解决方案的进一步发展。因此，FORTIFHY将有助于提高利益攸关方对这一问题和预防营养不良的解决方案的认识。

Undernutrition is widespread among older people and represents a major public health challenge for societies facing population aging. Undernutrition is a sinister disease with long-term consequences which increases vulnerability to diseases; with aging it induces or worsens frailty, disability and dependence. There is no doubt that undernutrition affects well-being and life expectancy of older people, but also increases costs and burden our health-care system.FORTIPHY aims to overcome the gap between the nutritional recommendations and the current practices. FORTIPHY will develop, assess and disseminate solutions (fortification and physical activity programs) to help older people fulfil their nutritional needs and sustain their functional status in order to prevent the onset of undernutrition. A key-approach is to involve end-users at the very beginning of the project in consumer-centred approach to ensure the relevance and take-up of the solutions in the field. Poor appetite is acknowledged to be a major determinant of protein-energy undernutrition while contrary to common beliefs, nutritional needs decrease little with age and even sometimes increase. Fortification, which consists in adding high-energy/high-protein ingredients to regular drinks or foods is acknowledged to be a flexible and relevant approach for older people with reduced appetite. In parallel, several studies have demonstrated better effect of interventions combining nutritional approaches with physical activity over nutritional or physical activity interventions alone. Given this context, the project FORTIPHY will address the nutritional and physical activity needs of older small eaters (70 years old and over) living at home. Specifically, FORTIPHY will develop new solutions allowing older people to fortify their regular meals. In addition, FORTIPHY will assess the added value of physical activity to meal fortification. In order to ensure high adoption and compliance levels for FORTIPHY solutions, end users (older people, caregivers), will be associated very early in the project through co-creation and participatory research. The first work package will be dedicated to the rational design of fortified recipes through (i) an unbiased review of available high-protein ingredients and (ii) the identification of technological and consumer usage constraints. Based on these inputs, the second work package will develop fortified recipes considering the preferences of older people (home-used tests). The bioavailability of the amino acids in fortified dishes and potential impact of these dishes on satiety and biological markers of appetite will be measured. The third work package will assess the efficiency of meal fortification and the added value of physical activity to prevent the onset of the risk of undernutrition in older small eaters living at home (randomized controlled field trial) A fourth work package will disseminate the results. In particular, FORTIPHY will conceive an easy-to-implement tool (MOOC - massive open on-line course) combining recipes and physical exercises in synergy to support the health of the older population, and a Summer School to promote further development of easy-to-use fortification solutions in the food industry. As such, FORTIPHY will contribute to raise the awareness of stakeholders regarding the issue and the solutions to prevent undernutrition.