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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

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Dietary patterns for healthier cognitive ageing
Berendsen, Agnes A.M. - \ 2017
Wageningen University. Promotor(en): Lisette de Groot; Edith Feskens, co-promotor(en): Ondine van de Rest. - Wageningen : Wageningen University - ISBN 9789463436014 - 190
meal patterns - feeding habits - aging - cognition - health - food supplements - dementia - nutritional intervention - elderly - elderly nutrition - nutrition and health - maaltijdpatronen - voedingsgewoonten - verouderen - kenvermogen - gezondheid - voedselsupplementen - dementie - maatregel op voedingsgebied - ouderen - ouderenvoeding - voeding en gezondheid

With ageing of our population and the accompanying increase in the number of people living with dementia, it is important to find modifiable risk factors to postpone the onset of cognitive decline. Diet has been proposed such a modifiable risk factor. To date, numerous studies have been conducted demonstrating a possible role of specific nutrients and foods in cognitive functioning. However, as people do not consume single nutrients, the research field has shifted towards studying dietary patterns in which synergistic effects of single nutrients and/or foods can be studied. The main aim of this thesis was to study the association of healthful dietary patterns with cognitive functioning. In addition, nutrient intake inadequacies were assessed and the potential to change dietary intake in older adults aged 65 years and older was studied.

Chapter 2 describes nutrient intake of 245 Dutch adults aged 65-80 years. We identified the contribution of nutrient dense foods, fortified foods and dietary supplements to the total intake of micronutrients. Nutrient density of foods was evaluated using the Nutrient Rich Food score 9.3. Nutrient intake inadequacies were observed for vitamin D, vitamin B6 and selenium. Conventional foods were the main source of vitamin D, vitamin B6 and selenium intake. Foods with the highest nutrient density contributed most to total vitamin B6 intake. In order to optimize nutrient intakes of elderly, combinations of natural food sources, fortified foods and dietary supplements should be considered.

Chapter 3 provides a systematic review of the literature on human studies up to May 2014 that examined the role of dietary patterns in relation to cognitive decline or dementia. The results demonstrate that better adherence to a Mediterranean diet was associated with less cognitive decline, dementia or Alzheimer’s Disease (AD) in four out of six cross-sectional studies, six out of 12 longitudinal studies, one trial and three meta-analyses. Other healthy dietary patterns, among which the Healthy Diet Indicator, have shown to be associated with reduced cognitive decline and/or a reduced risk of dementia in all six cross-sectional studies and six out of eight longitudinal studies. The conclusion of this literature review was that more conclusive evidence is needed to come to more targeted and detailed dietary guidelines to prevent or postpone cognitive decline.

In chapter 4 the association between the Healthy Diet Indicator (HDI) and cognitive functioning in older adults from three different cohort studies was investigated. The cohorts included in total 21,837 subjects from Europe (SENECA and the Rotterdam Study [RS]) and the Unites States (Nurses’ Health Study [NHS]). Cognitive functioning was measured using the Mini-Mental State Examination (MMSE) in SENECA and RS, and the Telephone Interview for Cognitive Status (TICS) in NHS. In all three cohorts, the HDI was not significantly associated with cognitive decline, nor with cognitive function.

In chapter 5 the association of long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women was examined. A total of 16,144 women from the Nurses’ Health Study, aged ≥70 years, who underwent cognitive testing a total of 4 times by telephone from 1995-2001 (baseline), with multiple dietary assessments between 1984 and the first cognitive exam were studied. Greater adherence to long-term DASH score was significantly associated with better average global cognition, verbal memory and TICS score at older ages, but not with cognitive decline.

In chapter 6, the same cohort as in chapter 5 was studied to examine the association between long-term adherence to a recently developed Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function and decline. Higher MIND diet scores were associated with better verbal memory at older ages, but not with cognitive decline over 6 years in global cognition, verbal memory or TICS.

Chapter 7 provides an overview of the NU-AGE (NUtrients and AGEing) dietary intervention study. The NU-AGE study is a randomized one-year intervention in 1,250 apparently healthy, independently living European subjects aged 65 to 80 years. Subjects were randomised into either the intervention group or the control group. Participants in the intervention group received dietary advice aimed at meeting the dietary recommendations of the ageing population. At the start of this thesis, the NU-AGE study was the first dietary intervention investigating the effect of a whole diet and providing targeted dietary recommendations for optimal health and quality of life in apparently healthy European elderly.

In chapter 8, we evaluated if the NU-AGE intervention could be effective to shift the dietary intake of apparently healthy older adults aged 65-80 years living in Italy, the UK, the Netherlands, Poland, and France towards a more healthful diet. The NU-AGE index was created to assess adherence to the NU-AGE diet. At baseline and after one-year follow-up dietary intake was assessed by means of 7-day food records. In total, 1,296 participants were randomized and 1,145 participants completed the intervention (571 in intervention group, 570 in control group). After one-year follow-up, the intervention group improved mean intake of 13 out of 16 dietary recommendations of the NU-AGE diet (p<0.05) with a significant increase of the total NU-AGE index, compared to the control group (mean change in NU-AGE index 21.3±15.9, p<0.01). The NU-AGE dietary intervention, based on dietary recommendations for older adults, may be a feasible strategy to improve dietary intake in an ageing European population.

Chapter 9 shows the results of the NU-AGE parallel randomized dietary intervention study on cognitive functioning in the Dutch NU-AGE subpopulation, including 252 older adults aged 65-80 years (123 intervention, 129 control). The primary outcome was one-year change in global cognition and in four cognitive domains as measured through a comprehensive neuropsychological test battery. Comparing the intervention with the control group, there was no effect of the intervention on cognitive functioning.

In chapter 10 the main findings of this thesis were summarized and a reflection on methodological aspects was given. When grading the reported associations in previous studies and studies in this thesis, it was concluded that there is probable evidence for a role of the Mediterranean diet on cognitive functioning. For the DASH and MIND diet there is a possible link with cognitive functioning; for the HDI and the NU-AGE diet there is no sufficient evidence yet to conclude that there is a relation with cognitive functioning. Not only is there a need for well-designed intervention and prospective studies, we also call for communication strategies to the general public about the consumption of healthier diets to not only impact cardiovascular but also potentially impact brain health as many individuals will face progressive cognitive decline in the near future.

Understanding heterogeneity in decision-making among elderly consumers: the case of functional foods
Zanden, Lotte D.T. van der - \ 2017
Wageningen University. Promotor(en): Hans van Trijp, co-promotor(en): Ellen van Kleef; Rene de Wijk. - Wageningen : Wageningen University - ISBN 9789463431439 - 161
voedselopname - ouderen - voedselsamenstellingtabellen - voedselverrijking - ouderenvoeding - leeftijdsgroepen - marketing - marketing van voedingsmiddelen - ziekenhuisdiëten - besluitvorming - consumenten - voedselconsumptie - food intake - elderly - food composition tables - food enrichment - elderly nutrition - age groups - food marketing - hospital diets - decision making - consumers - food consumption

The population of elderly has grown considerably over the past few decades, due to reduced birth rates and increased life expectancy. Old age is, however, still associated with a higher incidence of various health conditions that pose a threat to quality of life and result in high healthcare costs. Various products and services could help elderly to stay active and healthy for longer if they were adopted, such as mobility aids, home modifications and functional foods. A key challenge is to position products and services like these on the market in such a way that elderly can see their value and will start using them. In doing this, it is crucial to know what elderly need and to understand how they make decisions. This thesis therefore aims to provide a deeper understanding of decision-making among elderly consumers. It does so using functional foods as an example, and concentrates on answering the following research questions: 1) Which types of wants, inferences and intentions characterize the elderly consumer population? 2) What are relevant ways to distinguish between elderly consumers? and 3) How can elderly consumers be motivated to form consumption intentions for products and services aimed at promoting their wellbeing?

An experience-sampling paradigm shows that there are age-related differences in both desires (i.e. wants), such as the desire for food, and goals, such as the goal to work (i.e. intentions), but not in the way these wants and intentions interact with each other (Chapter 2). Young and old consumers experience the same types of conflict between their wants and intentions. The extent of conflict does change with age however, such that older adults experience conflict less often and less strongly than younger adults. This age-related difference can be partly explained by the way in which consumers perceive the time they have left in their lives. Those who perceive time as limited, experience more conflict. Zooming in on product-specific decision-making, a series of focus groups indicates that elderly consumers overall want to use healthy products that they use frequently as a basis for enrichment with protein (Chapter 3). Most elderly do not display intentions to purchase and use such products, however, either because they do not feel the need to use functional foods or because they hold various negative inferences regarding functional foods, such as a high price or bad taste. Importantly, elderly consumers differ strongly in their wants, inferences and intentions, suggesting that segmentation of this population is warranted.

A narrative review reveals that there are various ways to segment the elderly consumer population, for example based on age, future time perspective or purchase behaviour, and every approach has its strengths and weaknesses (Chapter 4). Based on the objectives of a segmentation approach one can, however, make an informed decision regarding which segmentation base to use. In the functional food market, elderly consumers may best be segmented using a segmentation base on the food or product level (i.e. rather than the person level) that results in segments in which consumers have similar needs and wants, for example the attributes benefits that consumers seek. A segmentation study shows that using such a segmentation base results in segments that provide concrete instructions for the development of functional foods (Chapter 5). The resulting segments of elderly have unique preferences that do not necessarily reflect those of the average elderly consumer and thereby provide useful insights that can help increase our understanding of elderly consumers.

Segmentation also provides a basis for tailoring products to the needs and wants of elderly consumers. A segmentation study illustrates that such tailoring can increase elderly consumers’ willingness to try protein-enriched foods for the first time (i.e. trial purchase), as well as their willingness to use such products on a more regular basis (i.e. repeat purchase) (Chapter 5). For a small group of elderly, tailoring proves to be ineffective, however, as they categorically reject all types of protein-enriched foods presented to them. These elderly are relatively uninterested in the concept of functional foods, which may be due to negative inferences surrounding such products. Overcoming the activation of such negative inferences may be useful in motivating elderly consumers to use protein-enriched foods. A field study in a hospital setting shows that the implementation of a verbal prompt intervention that motivates consumers to make decisions without much can increase the consumption of protein (Chapter 6). By understanding and capitalizing on cognitive biases in human decision-making, interventions like these can motivate consumers to form consumption intentions even when they hold negative inferences about products or services.

Overall, this thesis shows that although elderly consumers share an age bracket they are strongly heterogeneous in their wants, inferences and intentions. This heterogeneity is robust, as it can even be observed when zooming in on decision-making regarding a specific product category (i.e. protein-enriched foods). Our understanding of the elderly consumer population increases by studying this heterogeneity, as it provides insights beyond those that apply to the group of elderly that reflect the average. In studying heterogeneity, it pays off to focus on bases that are predictive of behaviour while demographic characteristics like age provide only few insights. Industry and health institutions can also benefit from an increased understanding of the composition of the elderly population and how they make decisions. Such understanding may provide them with concrete instructions for the development and commercialization of products and services for this growing group of consumers.

Undernutrition management and the role of protein-enriched meals for older adults
Ziylan, Canan - \ 2016
Wageningen University. Promotor(en): Lisette de Groot; Stefanie Kremer; Annemien Haveman-Nies. - Wageningen : Wageningen University - ISBN 9789462579323 - 148
elderly - elderly nutrition - undernutrition - enrichment - protein - eating patterns - feeding behaviour - meals - nursing homes - ouderen - ouderenvoeding - ondervoeding - verrijking - eiwit - eetpatronen - voedingsgedrag - maaltijden - verpleeghuizen

Undernutrition is a major health problem in the growing elderly population. It is estimated that one in ten Dutch community-dwelling older adults is suffering from undernutrition, and one in three Dutch older adults who receive home care. Undernutrition may lead to many negative consequences, ranging from fatigue and falls to impaired immune function and death. This makes undernutrition an obvious target for preventive measures.

Undernutrition can be defined as “a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function, and clinical outcome”. In addition, it is often described as protein energy malnutrition. Adequate protein intake may to some extent prevent and reverse this process. However, throughout ageing, it becomes increasingly difficult to reach adequate protein intake due to higher protein needs and lower protein intakes. Finding solutions to assist older adults in reaching their optimal protein intake is necessary.

In our overall research project, we considered 1.2g protein per kg weight per day (g/kg/d) as adequate protein intake. In Dutch community-dwelling older adults, protein intake is around 1.0 g/kg/d, implying room for improvement. However, it is possible that many of these older adults deal with physiological changes, medical conditions, and physical and mental limitations that impair their appetite and food provision. For these older adults with higher protein needs, merely recommending that they eat more would not be realistic. It would be more realistic to explore strategies that increase protein intake without having to increase food intake. This calls for the exploration of instruments that match the needs and preferences of older adults: protein-enriched regular products.

One particular group that can be identified as a target group for such products, are older adults who receive home care. Undernutrition prevalence is high in this group, which may be explained by their health problems that led to this dependence on home care. Likewise, many of these older adults also depend on meals-on-wheels. These meals-on-wheels recipients, regardless of whether they receive home care or not, often risk undernutrition too. In both these (overlapping) care-dependent groups, difficulties in adhering to energy and protein recommendations can be discerned. For this reason, enriching the readymade meals that these older adults receive may contribute to the prevention of protein undernutrition by increasing protein intake while keeping food intake the same. Here, protein enrichment instruments can be used to prevent undernutrition, but only when implemented in a timely manner. Adequate undernutrition management systems are therefore necessary to facilitate timely intervention, ensuring that the developed protein-enriched meals are actually offered and effective. For this reason, the overall aim of our research project was to gain insight into the current state of undernutrition management in community-dwelling older adults in the Netherlands and explore the role of protein-enriched regular products as a supportive instrument in protein undernutrition management.

In Study 1 (chapter 2) we explored the experiences of 22 Dutch nutrition and care professionals and researchers with undernutrition awareness, monitoring, and treatment among community-dwelling older adults. This qualitative study among, for example, dietitians, general practitioners, nurse practitioners, and home care nurses provided insight into the current bottlenecks within the existing undernutrition management guidelines. In these telephone interviews, these experts also discussed the current dietary behaviour problems of older adults and their impact on undernutrition risk. The experts’ experiences implied that undernutrition awareness is limited, among both older adults and care professionals. In addition, the interviewees were unclear about which professionals are responsible for monitoring and which monitoring procedures are preferred. The dietitians feel that they become involved too late, leading to decreased treatment effectiveness. In general, the interviewees desired more collaboration and a coherent and feasible allocation of responsibilities regarding undernutrition monitoring and treatment. This implied that the available guidelines on undernutrition management require more attention and facilitation.

In the following mixed-methods study (chapter 3), with interviews, we qualitatively explored the dietary behaviour and undernutrition risk of 12 Dutch elderly meals-on-wheels clients, one of the largest at-risk groups. We followed up on this information by quantifying the topics that emerged from the qualitative exploration of experienced bottlenecks in performing adequate dietary behaviour. For this, we used a survey among 333 meals-on-wheels clients. The interviews with elderly meals-on-wheels clients made clear that they have fixed and habitual eating patterns, while at the same time their appetite had decreased throughout the years. This was confirmed by the survey finding that regular portion size meals were perceived as too large by the oldest group aged over 75y. In addition, as the professionals suggested earlier, the interviewed elderly clients indeed showed limited awareness of undernutrition risk. Simultaneously, the survey showed that almost one in four elderly meals-on-wheels clients was undernourished. These findings led to the conclusion that staying close to the identified dietary habits may facilitate small yet effective modifications within these habits to prevent inadequate nutritional intake. Still, the limited awareness of undernutrition risk was expected to play a limiting role in whether clients believe they need dietary modifications. Consequently, informing them about this need could facilitate their motivation to implement modifications.

After learning about the general dietary behaviour of these older adults, we used this information for Study 3 (chapter 4). We developed two kinds of protein-enriched readymade meals that are in line with the needs and preferences of older adults: one of regular size (450g) and one of reduced size (400g). We tested these meals in a lab setting in 120 community-dwelling older adults in a single-blind randomised crossover trial. One day a week at lunchtime, for four weeks, participants had to consume and evaluate a readymade meal. Overall, regardless of portion size, the protein-enriched meals led to higher protein intakes in vital older adults in a lab setting during lunch. In this crossover study, the participants liked the protein-enriched meals and the regular meals equally. However, we did not find the expected lower ratings of satiety after the reduced-size meals, while one reduced-size enriched meal and another regular-size enriched meal led to higher ratings of subsequent satiety. This higher satiety in the enriched meals could lead to compensational behaviour on the remainder of the day.

After establishing that the protein-enriched meals were effective and acceptable in the lab setting, we moved to the homes of older adults to test the meals in a longer-term study in Study 4 (chapter 5). In this double-blind randomised controlled trial of two weeks, we also included protein-enriched bread to assess whether both this bread and the meals could increase daily protein intake to 1.2g/kg/d in 42 community-dwelling older adults to reach optimal protein intake. We found that the enriched products again led to higher protein intakes and a high liking. The mean protein intake per day was 14.6g higher in the intervention group, which amounted to a protein intake of 1.25g/kg/d, compared with 0.99g/kg/d in the control group. In addition, the meals scored 7.7 out of 10, while the bread scored 7.8 out of 10, which both were comparable with their regular counterparts. Lastly, we found no negative effect of compensational behaviour throughout the day. These promising findings indicated that we achieved a good match between older adults’ needs and preferences regarding protein intake.

In the general discussion of this thesis (chapter 6), we combined our learnings from the four studies to reflect on protein undernutrition management in community-dwelling older adults and the possible role of protein-enriched regular products. We have discussed a conceptual framework consisting of three wheels of protein undernutrition management. In the first wheel regarding awareness, we proposed that limited awareness of adequate nutrition and body composition forms the largest bottleneck in undernutrition management. When this awareness is generated among both older adults and professionals, it will benefit the second wheel of monitoring. Here, we argued that a policy and the actual facilitation of that policy are required for this monitoring to succeed. When the monitoring is performed adequately, in the third wheel, the appropriate treatment can be carried out. We discussed that personalisation and evaluation of this treatment are important conditions. All in all, the public health implications that we have discussed on the basis of our findings can be summarised by the three key messages that could help us ace in adequate protein undernutrition management: address awareness in both older adults and professionals, facilitate continuous collaboration between professionals, and offer protein-enriched products expediently.

Older adults, mealtime-related emotions, and functionalities : tailoring protein-enriched meals
Uijl, Louise C. den - \ 2016
Wageningen University. Promotor(en): Kees de Graaf, co-promotor(en): Stefanie Kremer; Gerry Jager. - Wageningen : Wageningen University - ISBN 9789462578920 - 178
meals - emotions - elderly nutrition - elderly - smell - food preferences - protein - proteins - questionnaires - young adults - chocolate - maaltijden - emoties - ouderenvoeding - ouderen - reuk - voedselvoorkeuren - eiwit - eiwitten - vragenlijsten - jongvolwassenen - chocolade

Background and aim

Dietary proteins are of special interest for the heterogeneous group of older adults, since these people do not always have an adequate protein intake. When protein-rich products are better aligned with the requirements of older persons, an adequate nutrient intake is more likely. In this thesis we therefore explored two approaches for tailoring protein-enriched meals to older consumer subgroups; emotion-based and functionality-based. We expected a better ‘product-cluster fit’ (i.e. a more positive meal experience) when the clusters’ meal associations are congruent to their mealtime expectations.


We conducted an online survey in which vital community-dwelling older adults (n=392) reported their mealtime-related emotions and mealtime functionality. Using a hierarchical clustering analysis we described clusters within our population. Subsequently, we explored the extent to which the expectations of these clusters can be applied for the development of tailored protein-enriched meals. For the emotion-based approach, we conducted two central location tests (CLTs, n=461) to explore older adults’ food-evoked emotions. For the functionality-based approach we conducted in-depth interviews in order to get further insights regarding functional mealtime expectations and attitudes towards proteins and protein-enrichment. Based on the latter insights we tailored PE meal concepts to two functionality-based segments. In a final home-use test, the members of the functionality-based segments (n=91) prepared and evaluated the tailored PE meal concepts.


The emotion-based approach resulted in four clusters; pleasurable averages, adventurous arousals, convivial indulgers, and indifferent restrictives. These emotions that these segments associated with their mealtimes varied along the two dimensions valence and arousal. However, from both CLTs we learned that the variation in valence-arousal as observed for mealtime-related emotions was not observed for emotions related to actual foods. The latter makes it challenging to identify products that evoke emotions congruent to the mealtime expectations of the emotion-based clusters.

With regard to the functionality-based approach, we encountered three clusters; physical nutritioners, cosy socialisers, and thoughtless averages. The cosy socialisers value the social interactions and cosiness during their mealtimes, whereas the physical nutritioners focus more on the health and nutrient aspects of meals. Thoughtless averages have the least distinctive mealtime expectations. We translated these functional mealtime expectations into two PE meal concepts; one tailored to cosy socialisers and one tailored to physical nutritioners. These meal concepts were well-accepted by the participants. However, congruency between mealtime expectations and functional meal associations did not result in a better ‘product-cluster fit’.


Given the challenge to identify congruency between the meal associations and the mealtime expectations of the emotion-based clusters, we consider the emotion-based approach to be not yet actionable enough as a basis for tailoring PE products to older consumers. In contrast, the functionality-based approach appeared to be more promising, since the functional meal expectations could be translated to well-accepted tailored PE meal concepts. However, the effectivity of our functionality-based approach was not yet confirmed in this thesis, since congruency between functional meal associations and functional meal expectations did not necessarily result in a better ‘product-cluster fit’. Future studies, focussing on e.g. other meal types, are recommended to further explore mealtime functionality as a basis for tailoring PE meals to older consumer subgroups.

Alleen sterkere smaak verhoogt eetlust niet
Doets, E.L. ; Kremer, S. - \ 2015
Resource: weekblad voor Wageningen UR 10 (2015)6. - ISSN 1874-3625 - p. 8 - 8.
ondervoeding - eiwitdepletie - ouderen - voedselvoorkeuren - voedselkwaliteit - productontwikkeling - smaak - voedselverpakking - voeding - voedingsonderzoek - ouderenvoeding - undernutrition - protein depletion - elderly - food preferences - food quality - product development - taste - food packaging - nutrition - nutrition research - elderly nutrition
Vijf tot tien procent zelfstandige ouderen is ondervoed. Ouderen waarderen voeding waarschijnlijk beter als verschillende aspecten zoals textuur, smaak en uiterlijk tegelijkertijd worden verbeterd. Dit schrijven Esmée Doets en Stefanie Kramer, onderzoekers bij Food & Biobased Research, in een overzichtsstudie in het tijdschrift Food Quality and Preference.
Langer fit met beter eten
Smit, A. ; Groot, C.P.G.M. de; Kremer, S. ; Ziylan, C. ; Peppelenbos, H.W. - \ 2015
WageningenWorld (2015)1. - ISSN 2210-7908 - p. 10 - 15.
ouderen - ouderenvoeding - voeding en gezondheid - ondervoeding - voedingstoestand - eiwitrijke voedingsmiddelen - voedselverrijking - voedselconsumptie - gezondheidsbevordering - elderly - elderly nutrition - nutrition and health - undernutrition - nutritional state - protein foods - food enrichment - food consumption - health promotion
Ouderen die zelfstandig thuis wonen, lopen het risico ondervoed te raken. Wageningen UR onderzoekt hoe dat is te voorkomen met producten en maaltijden die verrijkt zijn met extra eiwit. Maar hoe breng je die op de markt? De meeste ouderen voelen zich niet oud en zijn zich totaal niet bewust van hun voedingsstatus.
Healthy aging through a healthy diet : never too old to eat healthy?!
Jankovic, N. - \ 2015
Wageningen University. Promotor(en): Ellen Kampman; Edith Feskens; Lisette de Groot, co-promotor(en): Anouk Geelen. - Wageningen : Wageningen University - ISBN 9789462572508 - 159
voeding en gezondheid - gezondheidsvoedsel - ouderen - dieetrichtlijnen - eetpatronen - analytische methoden - ziektepreventie - ouderenvoeding - nutrition and health - health foods - elderly - dietary guidelines - eating patterns - analytical methods - disease prevention - elderly nutrition


Background: The world’s population is aging and with it the prevalence of chronic diseases, especially cardiovascular diseases and cancer, increases. A long lasting life is envisaged without the burden of disease. Therefore, current research focuses on risk factors, such as a healthy diet, which may decrease the occurrence of chronic diseases even at advanced age. Earlier studies, examining the role of a healthy diet in the elderly, applied different analysis strategies. In consequence, comparability across studies is limited and prevent an overall conclusion on the role of a healthy diet in elderly.

Methods and subjects: Eleven prospective cohort studies among elderly people (N=396,391) from Europe and the United States, collaborating in the CHANCES consortium, were analysed. Most cohorts eligible for our analysis, assessed diet once at baseline. Therefore, we first assessed the stability of dietary patterns, derived with reduced rank regression (RRR), in the Zutphen Elderly Study. In the remainder of this thesis, healthy diets were defined based on the 2003 World Health Organization (WHO) “nutrient intake goals” and the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) food group recommendations. The recommendations were operationalized, using the Healthy Diet Indicator (HDI) and the WCRF/AICR diet score. The association between a healthy diet and risk of all-cause mortality and CVD mortality, was studied using the WHO recommendations, which aim at the prevention of chronic diseases in general. The cancer specific WCRF/AICR recommendations were applied to study the association between a healthy diet and cancer risk. Diet disease associations were assessed in each cohort separately, using Cox-proportional hazards regression. Cohort specific hazard ratios (HR) were pooled by random effects meta-analysis.

Results: The results of the Zutphen Elderly Study showed that dietary patterns, derived by RRR, remained stable over a period of five years. In the CHANCES project a total of 84,978 person years were accumulated, during a median follow-up time ranging between 7 and 15 years across cohorts. An increase of 10 HDI points (range total score 0 to 70 points) was significantly associated with a decreased risk of all-cause mortality (HR: 0.90 and 95% confidence interval (CI): 0.87-0.93). The HR estimate was equivalent to a two year increase in life expectancy. We found a significant inverse association between an increase of 10 HDI points and CVD mortality for Southern European countries and the US (HR: 0.85, 95 % CI: 0.83-0.87), whereas no significant association was found for Northern and Central and Eastern Europe. An increase of 1 point for the WCRF/AICR diet score (range 0-4) was associated with a significantly 6% decreased risk in developing any type of cancer. Greatest risk reduction was found between a 1 point increase in WCRF/AICR diet score and colorectal cancer (HR: 0.84, 95% CI:0.80-0.89).

Conclusion: Dietary indices based on globally defined dietary recommendations by WHO and WCRF/AICR were found to be associated with all-cause and CVD mortality and cancer risk in old age. Public health interventions targeted on the elderly should not focus on one definition of a “healthy diet” but rather a smart combination of available evidence, to optimally account for CVD as well as cancer specific outcomes.

Nutrition and cognition in older adults : studies on the role of glucose, sucrose, protein, vitamin B12 and folic acid
Zwaluw, N.L. van der - \ 2014
Wageningen University. Promotor(en): Lisette de Groot, co-promotor(en): Ondine van de Rest; Rosalie Dhonukshe-Rutten. - Wageningen : Wageningen University - ISBN 9789462571075 - 184
ouderenvoeding - voeding - ouderen - kenvermogen - glucose - sucrose - eiwittoevoegingen - vitamine b12 - dementie - elderly nutrition - nutrition - elderly - cognition - protein supplements - vitamin b12 - dementia

The age-related cognitive decline and the increase in dementia patients are large problems in societies with growing ageing populations. No cure is present for dementia, while the available medication only focuses on alleviating symptoms. It is therefore of major importance to find risk factors that can modify the development of cognitive decline and dementia. Pre-clinical and observational studies suggest a role for nutrients. Evidence derived from randomized controlled trials (RCTs) is, however, limited and equivocal with most studies showing no effect and only a few studies showing a beneficial effect of a nutritional intervention. In the current thesis, we investigated the acute and longer-term effects of different nutrients, i.e. glucose and sucrose, protein, resistance-type exercise training with or without protein, and vitamin B12 and folic acid in order to optimize and preserve cognitive functions in non-demented elderly people.

A comprehensive literature review was performed on the acute effects of glucose and sucrose on cognitive performance (Chapter 2). Glucose is the most important fuel for the brain, and as such, manipulation of the supply of glucose may affect cognitive functions. The main conclusion of our review was that a glucose load may have a short-term beneficial effect on episodic memory. Enhancing effects on other cognitive domains were less clear, partly due to the small number of studies examining these effects. Limited research was also done on the possible effects of sucrose on cognitive functions. Therefore, we investigated the acute effects of 50 g of glucose and 100 g of sucrose on a broad spectrum of cognitive functions reflecting performance on episodic memory, working memory, attention and information processing speed, and executive functions (Chapter 3). This was done by a cross-over study in 43 elderly participants who had self-reported memory complaints. In contrast to the conclusion of our review, we did not observe an effect of glucose or sucrose on episodic memory, though we showed a beneficial effect of sucrose on attention and information processing speed.

Protein supplementation was the next nutritional intervention that was investigated. Several amino acids are precursors for neurotransmitters, and their supply may affect the synthesis and release of these neurotransmitters, and may consequently affect cognitive performance. A 24-week randomized placebo-controlled trial was carried out in 65 frail and pre-frail elderly people (Chapter 4). The protein supplementation included twice a day 15 grams of protein in the form of a drink. Reaction time improved more in the protein group compared to the placebo group, but the scores on the cognitive domains, i.e. episodic memory, attention and working memory, information processing speed, and executive functions, or the other single test scores, did not differ between treatment groups. In addition, we investigated the effects of 24 weeks resistance-type exercise training with and without protein supplementation in pre-frail and frail elderly people (Chapter 5). Exercise training without extra protein (n=62) improved performance on the domain attention and working memory. Exercise training together with protein supplementation (n=65) improved performance on information processing speed.

Last, the role of vitamin B12 and folate on cognitive health was investigated. Low levels of these nutrients can increase homocysteine levels, which is a suggested risk factor for cognitive decline. The effect of daily supplementation with 500 µg vitamin B12 and 400 µg folic acid was investigated in 2,919 participants for two years (Chapter 6). Global cognitive function and episodic memory were assessed in the total study population, whereas extensive neuropsychological testing was done in a subpopulation (n=856). B-vitamin supplementation did not improve cognitive domain scores. Only a small, though significant, effect was observed on global cognitive performance, measured by the Mini-Mental State Examination, but this was suggested to be due to chance. Brain MRI scans were made in a subgroup (n=218) after two years of intervention to obtain volumetric measures of grey and white matter, and total brain volume (Chapter 7). We investigated the cross-sectional associations between follow-up levels of folate, homocysteine and three vitamin B12 status biomarkers, e.g. methylmalonic acid, holotranscobalamin and serum vitamin B12, and brain volumes. Fully adjusted regression models showed a borderline significant association between plasma homocysteine and total brain volume, with a stronger association in the group that received B-vitamin supplementation. Serum B12 and holotranscobalamin were not associated with brain volumes, whereas high methylmalonic acid levels were associated with lower brain volumes in the group that received B-vitamins. In contrast, higher folate levels were associated with lower total brain volumes. In addition, when comparing the group that received two years of B-vitamin supplementation and those who did not, we observed lower brain volumes in the B-vitamin group, which might be a result of a difference in age between the two groups.

To conclude, the nutritional intervention studies showed little evidence for a beneficial effect on cognitive performance in relatively healthy older adults. Given the large problem of dementia, research on modifiable risk factors, including nutrition, should continue, with well thought out research methods, including large and long-term observational and intervention studies with high-sensitive study populations and early biomarkers (e.g. imaging techniques) for cognitive decline in combination with neuropsychological tests. In this way, nutrition can be added to the list of lifestyle factors that can fight dementia.

Ouderen eten beter dankzij eiwitrijke yoghurt
Boelsma, Esther - \ 2014
elderly - elderly nutrition - protein foods - appetite - yoghurt - bread - nutrition and health
Rapportage onderzoeksproject Genieten aan tafel : een toegepast onderzoek naar maaltijdbeleving in verpleeghuizen
Zeinstra, G.G. ; Atten, M.N. van; Ziylan, C. ; Boelsma, E. ; Peppelenbos, H.W. ; Brok, P. den - \ 2014
Wageningen : Wageningen UR - Food & Biobased Research (Rapport / Wageningen UR Food &amp; Biobased Research 1483) - ISBN 9789462570535 - 86
verpleeghuizen - ouderenvoeding - ouderen - perceptie - volksgezondheid - ziektepreventie - maaltijden - nederland - ondervoeding - voedselconsumptie - nursing homes - elderly nutrition - elderly - perception - public health - disease prevention - meals - netherlands - undernutrition - food consumption
Er komen steeds meer ouderen in Nederland. Zij doen over het algemeen een groter beroep op de gezondheidszorg, wat tot stijgende zorgkosten leidt en een lagere kwaliteit van leven. Eten en drinken speelt een belangrijke rol bij de preventie van ziekte. Hoewel er steeds meer aandacht is voor de voedingsstatus van ouderen en screeningsprocedures steeds meer toegepast worden, laten de laatste metingen in Nederland zien dat 17% van de cliënten in instellingen ondervoed is en dat 28% risico loopt op ondervoeding. Om ziekte en daarmee verhoogde zorgkosten te voorkomen, en om de kwaliteit van leven te optimaliseren, is preventie van ondervoeding bij ouderen noodzakelijk. Het onderzoek ‘Genieten aan tafel’ beoogde de maaltijdbeleving van verpleeghuiscliënten te optimaliseren, met als doel om eetlust, voedingsstatus, functionele status en kwaliteit van leven te verbeteren en zo zorgkosten te verminderen.
Voeding en beweging ter preventie van cognitieve achteruitgang
Severs, A. ; Rest, O. van de; Groot, C.P.G.M. de; Loon, L.J.C. van - \ 2014
VoedingsMagazine 27 (2014)1. - ISSN 0922-8012 - p. 18 - 20.
ouderen - ouderenvoeding - eiwittoevoegingen - dementie - kenvermogen - lichaamsbeweging - voeding en gezondheid - voedingsstoffen - elderly - elderly nutrition - protein supplements - dementia - cognition - exercise - nutrition and health - nutrients
Dementie wordt een steeds groter en kostbaarder probleem door de vergrijzing. Wetenschappers zijn naarstig op zoek naar mogelijkheden om het tij te keren. Zo ook Ondine van de Rest, onderzoeker aan Wageningen University. Haar onderzoek is gericht op de rol van voeding bij leeftijdsgerelateerde cognitieve achteruitgang. Samen met prof. dr.Lisette de Groot, hoogleraar voeding voor de oudere mens aan Wageningen Universiteit, en Prof. Dr. Luc van Loon, hoogleraar fysiologie van inspanning aan Maastricht Universiteit, voerde ze binnen het Top Instituut Food and Nutrition (TIFN) een interventiestudie uit bij ouderen naar het effect van eiwitsuppletie en beweging op de cognitie.
Hoe voeden we de oudere mens?
Staveren, W.A. van; Groot, C.P.G.M. de - \ 2014
VoedingsMagazine 27 (2014)1. - ISSN 0922-8012 - p. 21 - 23.
ouderenvoeding - voeding en gezondheid - voedselconsumptie - eetpatronen - voedingsstoffen - ouderen - elderly nutrition - nutrition and health - food consumption - eating patterns - nutrients - elderly
Wat zijn de effecten van voedingspatronen en nutriënten op de gezondheid, het functioneren, en de kwaliteit van leven van ouderen? Het onderzoeksteam van prof. Wija van Staveren en prof. Lisette de Groot in Wageningen heeft de afgelopen kwart eeuw observationele en interventiestudies uitgevoerd om die vragen te beantwoorden. Een symposium in Wageningen inventariseerde wat met dit en ander onderzoek is bereikt op het gebied van voeding voor ouderen.
Fragiele ouderen sterker en scherper door eiwit
Koningsbruggen, W. van; Groot, C.P.G.M. de; Zwaluw, N.L. van der - \ 2014
VoedingsMagazine 27 (2014)1. - ISSN 0922-8012 - p. 8 - 10.
melkproducten - eiwitbronnen - ouderenvoeding - voedingsstoffen - voeding en gezondheid - eiwitrijke voedingsmiddelen - milk products - protein sources - elderly nutrition - nutrients - nutrition and health - protein foods
Fragiele ouderen die extra eiwit krijgen, vertonen fysieke en ook enige mentale vooruitgang. Dit is aangetoond door een onderzoeksgroep van de afdeling Humane Voeding van Wageningen Universiteit. Promovendus Nikita van der Zwaluw en prof. dr. ir Lisette de Groot vertellen over het cognitieve deel van de studie.
Voeding voor wie lang fit wil blijven
Groot, C.P.G.M. de - \ 2012
In: Voeding voor vitale 50-plussers Wageningen : Food Valley - ISBN 9789081609371 - p. 9 - 9.
ouderenvoeding - voeding en gezondheid - ouderen - productontwikkeling - gezondheidsbevordering - voedingsstoffenbehoeften - elderly nutrition - nutrition and health - elderly - product development - health promotion - nutrient requirements
Goede voeding kan helpen ouderdomskwalen te voorkomen, ook voor wie al 50-plus is. En tot die categorie behoren steeds meer mensen, in Nederland en daarbuiten. Ook gaat met de jaren de behoefte aan sommige voedingsstoffen omhoog. Volop kansen voor productontwikkeling dus.
Het stimuleren van gezonde voedselkeuzes : onderzoek gericht op schoolkantines en zorginstellingen
Reinders, M.J. ; Onwezen, M.C. ; Veggel, R.J.F.M. van; Ruissen, A. ; Voordouw, J. ; Dhonukshe-Rutten, R.A.M. - \ 2012
Den Haag : LEI, onderdeel van Wageningen UR (LEI-rapport : Onderzoeksveld Consument &amp; gedrag ) - ISBN 9789086156085 - 78
voedselvoorkeuren - voedingsgedrag - voeding en gezondheid - gezondheidsvoedsel - schoolmaaltijden - maaltijden - verpleeghuizen - ouderenvoeding - eetlust - food preferences - feeding behaviour - nutrition and health - health foods - school meals - meals - nursing homes - elderly nutrition - appetite
In dit rapport is onderzocht op welke manier scholen en zorginstellingen voedsel aanbieden en hoe dit aanbod het voedselkeuzegedrag van leerlingen en de eetlust van ouderen beïnvloedt.
Beweging wordt efficiënter met juiste voeding
Tieland, Michael - \ 2012
elderly - nutrition and health - exercise - physical activity - proteins - dietary protein - elderly nutrition
Aanbevolen hoeveelheden gebasseerd op schattingen (interview met C.P.G.M. de Groot)
Geerts, A. ; Groot, C.P.G.M. de - \ 2010
VoedingsMagazine 23 (2010)2. - ISSN 0922-8012 - p. 24 - 26.
voedingsnormen - ouderen - ouderenvoeding - aanbevolen dagelijkse hoeveelheden - voedselconsumptie - voeding en gezondheid - feeding standards - elderly - elderly nutrition - recommended dietary allowances - food consumption - nutrition and health
Eind 2009 werden de 'Vraag het de Expert'-bijeenkomsten over senioren gehouden. 'Besef dat de aanbevolen hoeveelheden voedingsmiddelen gebaseerd zijn op schattingen. Een kritische reflectie op de getallen die je hanteert is belangrijk', zei prof. dr. Lisette de Groot tegen de diëtisten in de zaal. De gebruikte voedingsnormen zijn niet zonder meer geschikt voor de beoordeling van voedselconsumptiegegevens van individuen.
De Genietende Groene Tafel : een pilotonderzoek naar wat goed eten en drinken binnen de zorgsector kan opleveren
Brok, P. ; Gorselink, M. - \ 2010
Wageningen : Wageningen UR - Food & Biobased Research - 28
ouderenvoeding - voedselopname - eetlust - gezondheidszorginstellingen - catering in instellingen - verpleeghuizen - kwaliteit van het leven - gezondheidsvoedsel - duurzaamheid (sustainability) - kosten van de gezondheidszorg - welzijn - voeding en gezondheid - elderly nutrition - food intake - appetite - health maintenance organizations - institutional catering - nursing homes - quality of life - health foods - sustainability - health care costs - well-being - nutrition and health
Het hier gepresenteerde pilot onderzoek heeft als doel het management in zorginstellingen te ondersteunen in wat goed eten en drinken kan opleveren voor de organisatie. Dit betekent dat resultaten in het pilot onderzoek enerzijds gericht zijn op verbetering van de kwaliteit van leven van de cliënt, diens gezondheid en welbevinden (vertaalt in absolute voedselconsumptie en belevingsmetingen), maar dat deze resultaten tevens in toekomst nadrukkelijk financieel vertaald moeten worden, ondermeer in het gebruik van dieetproducten, mate van hulpvraag en de consequenties op het gebied van medicijngebruik. Het onderzoek vond plaats op twee verpleeghuislocaties.
Aanwijzingen voor effecten op functionele eindpunten : vitaminesuppletie voeding van ondervoede ouderen
Groot, C.P.G.M. de - \ 2009
VoedingsMagazine 2009 (2009)6. - ISSN 0922-8012 - p. 16 - 18.
vitaminetoevoegingen - ondervoeding - ouderen - voedingstoestand - ouderenvoeding - voeding en gezondheid - vitamin supplements - undernutrition - elderly - nutritional state - elderly nutrition - nutrition and health
Protein or energy supplementation of the diet of malnourished older people leads to body weight gain and an improved nutritional status. There are no indications for an effect on functional endpoints. In contrast, according to Prof. Lisette de Groot (Wageningen University), vitamin supplementation reportedly leads to functional improvements
Flavor enhancement of food as a stimulant for food intake in elderly people
Essed, N.H. - \ 2009
Wageningen University. Promotor(en): Kees de Graaf; Wija van Staveren. - [S.l. : S.n. - ISBN 9789085854913 - 160
voedselopname - eetlust - smaakversterkers - voedselconsumptie - eten - ouderen - ouderenvoeding - sensorische evaluatie - food intake - appetite - flavour enhancers - food consumption - eating - elderly - elderly nutrition - sensory evaluation

It is often speculated that the age related decline in taste and smell performance can add to the decreased food intake among elderly by causing a change in liking of food. Flavor enhancement (by adding a taste and/or an odor to enhance or intensify the flavor of the food) has been suggested to counteract for the diminished taste and smell performance in order to increase liking and subsequently intake among elderly people. However, there is no clear relationship between an impaired taste and smell functioning and flavor enhancement. In addition, the results of studies on the effect of flavor enhancement on intake are inconsistent. In this thesis we investigated the effect of flavor enhancement on liking and/or food intake in elderly people and the relationship between an altered taste and/or smell performance and liking of flavor-enhanced foods.

When flavor enhancement is used as an approach to stimulate intake, it is important to know how elderly respond to a daily repeated exposure of a food. We first examined the effect of repeated exposure to fruit drinks with different sweet intensities on intake, pleasantness and boredom in young and non-institutionalized elderly adults. Second, the relationship between an impaired taste and smell performance and the liking and intake of tomato soup enhanced with MSG (0.12%) and celery powder (3 g) was studied. Third, the effect of flavor enhancement on liking and intake has been examined in nursing home elderly people that received MSG (0.3%) and/or flavors (700 mg) sprinkled over the protein component of their hot meal during 16 weeks. As last, to study the effect of a determined optimal preferred amount of MSG on food intake, we added 0.5% MSG (optimal amount) to mashed potatoes and 2% MSG to spinach and ground beef and measured the intake of these foods among institutionalized elderly.

The results showed that the elderly experienced no increase in boredom and pleasantness after daily repeated exposure to fruit juices. Elderly with an impaired taste and/or smell functioning did not show an increase in liking and intake of the flavor-enhanced soup. Thus, no relationship was established between an impaired chemosensory performance and flavor enhancement. Flavor enhancement also did not increase liking and energy intake of the hot meal after 16 weeks nor did an optimal preferred amount of MSG increase intake of mashed potatoes, spinach and ground beef.

A standardized flavor enhancement of foods did not prove an effective approach to increase food intake in frail elderly people. Therefore we reviewed the literature to obtain a recent picture on the causes of taste and smell loss in the elderly and to examine if the available methods to measure these losses are adequate. Results of the review showed that elderly are a heterogeneous group with various degrees of taste and smell loss and that the applied methods can distinguish the variations. This result implies a more individual, tailored taste and/or flavor enhancement of foods when it is part of a treatment or used in the prevention of undernutrition. We proposed a future strategy for flavor enhancement of foods in which we embedded the results of this review.

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