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，对面临人口老龄化的社会来说是一个重大的公共卫生挑战。营养不良是一种具有长期后果的险恶疾病，它增加了疾病的脆弱性；随着年龄的增长，它会导致或恶化虚弱、残疾和依赖。毫无疑问，营养不良影响老年人的福祉和预期寿命，但也增加了我们的医疗保健系统的成本和负担。FORTIPHY的目标是克服营养建议和当前做法之间的差距。FORTIPHY将制定、评估和传播解决方案(强化和体力活动方案)，以帮助老年人满足他们的营养需求并维持他们的机能状态，以防止出现营养不良。一个关键办法是在项目一开始就让最终用户参与以消费者为中心的办法，以确保实地解决办法的相关性和接受度。食欲不足被认为是蛋白质-能量营养不足的主要决定因素，而与人们普遍的看法相反，营养需求随着年龄的增长几乎没有减少，有时甚至会增加。强化，包括在常规饮料或食物中添加高能/高蛋白成分，被认为是一种灵活和相关的方法，适用于食欲减退的老年人。同时，几项研究表明，将营养方法与体力活动相结合的干预措施比单独进行营养或体力活动干预效果更好。在这种情况下，FORTIPHY项目将解决居住在家里的老年小食者(70岁及以上)的营养和体力活动需求。具体来说，FORTIPHY将开发新的解决方案，使老年人能够加强他们的日常饮食。此外，FORTIPHY将评估体力活动对膳食强化的附加值。为了确保FORTIPHY解决方案的高采用率和合规性，最终用户(老年人、照顾者)将通过共同创建和参与性研究在项目的早期就建立联系。第一个工作包将致力于通过(I)对可用的高蛋白成分进行公正的审查和(Ii)确定技术和消费者使用限制来合理设计强化食谱。基于这些输入，第二个工作包将开发考虑到老年人的偏好的强化食谱(家庭使用的测试)。将测量强化菜肴中氨基酸的生物利用率，以及这些菜肴对饱腹感和食欲生物标记物的潜在影响。第三个工作包将评估膳食强化的效率和体力活动的附加值，以防止居家中的老年小食者出现营养不良的风险(随机对照现场试验)第四个工作包将传播结果。特别是，FORTIPHY将设想一个易于实施的工具(MOOC-大规模在线开放课程)，将食谱和体育锻炼结合在一起，以支持老年人的健康，并设立暑期学校，以促进食品行业进一步开发易于使用的强化解决方案。因此，FORTIPHY将有助于提高利益攸关方对防止营养不良的问题和解决方案的认识。

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.