The correct nutritional balance can assist and enhance athletic performance. Just as a performance car engine needs the right fuel and oil to run at its best, athletes can optimise their performance with the right nutritional intake.
Athletes need higher protein levels than the average person to maintain energy levels, muscle growth and repair. The amount of extra protein an athlete requires depends on their body composition, weight and the type of sport they practise.
Why do athletes use protein supplements?
Exercise can cause muscle damage and muscles need protein to grow and repair. Athletes often use protein supplements in their diet to promote this repair as this is a convenient way to increase protein intake. It’s easy to consume a protein shake or bar either pre-training or after, especially if the athlete doesn´t have the time to eat a protein-enriched meal at this time.
The amount of protein an athlete needs depends on the type of sport or training they do. For example, a runner (endurance) will need a different amount than someone who performs weight training (resistance).
Another benefit of protein supplements is that they can speed up muscle repair. During exercise muscles can tear, even minutely, and protein helps these tears to repair quickly.
Some athletes also take protein supplements to help injuries heal faster. For professional athletes, this is essential, as long-term muscle injuries can equal a loss of career development.
What is an athletes’ typical nutritional intake?
Athletes take sports nutrition seriously and have to plan their protein and carbohydrate intake and adjust their meals and snacks depending on their activity. This takes discipline, which comes from the desire to succeed in a particular sporting field.
The RDA (recommended daily allowance) of protein is 0.8 grams of protein per kilogram for the average person. According to the British Nutrition Foundation, strength and endurance athletes need around 1.2-2.0 grams of protein per kilogram of bodyweight.
In addition to a high-protein diet that includes red meat, chicken, fish, dairy products, eggs and nuts, milk-based protein supplements deliver a further source of protein. In the form of protein drinks, snacks and powders, these products offer athletes a suitable alternative to consuming more protein through eating extra meals.
Milk is another athletes’ favourite for recovery after a training session or event as it contains a balance of protein and carbohydrates. It also includes whey protein (which the body absorbs quickly) and casein (which absorbs more slowly), the combination of which increase muscle repair and energy levels.
Why is sports nutrition planning essential for athletes?
The timing of protein intake for athletes is crucial – it’s easier on the stomach to consume a protein supplement before an event or training than to eat a large, protein-fuelled meal.
Just as important is post-sports nutrition, and many athletes take protein supplements after activity to replenish energy levels and prevent muscle soreness. Plus, drinking a protein shake or eating an energy bar is easier than eating a big meal directly after training.
Milk-based proteins are particularly useful for this as they prompt the fast growth of muscle mass. A study carried out by the Journal of Nutrition concluded “The results suggest that high protein and dairy intake led to the best results in terms of weight loss and muscle gain.”
Muscle mass is the amount of muscle in the body. Not only does muscle mass contribute to a lean appearance, but it’s also beneficial for a healthy body as it can help boost the immune system, regulate glucose levels and aid illness recovery.
Timing is essential also in sports nutrition during low-intensity periods. To maintain the right balance, athletes adjust the amount of protein (and carbohydrates and fat) they receive daily depending on whether their training is light or high-intensity. This adjustment is essential out of season when athletes are only training and not performing.
What’s the future for sports nutrition?
There is increasing demand for sports nutrition products for athletes that are convenient, taste good and benefit performance. Research carried out by Allied Market Research expects the sports nutrition market to grow to $44,003 million this year.
This is an opportunity for sports nutrition manufacturers to also grow sales by offering quality products to cater for the needs of athletes, fitness enthusiasts and the general sports market.
For any other inquiry, contact us.
Over the past few decades, interest in animal welfare has grown steadily. In August 2020, the IFOP (French Institute of Public Opinion) published a survey conducted for the Brigitte Bardot Foundation (French Foundation dedicated to animal protection) on the opinion of French regarding the animal condition. Out of a sample of 1009 people, more than 4 out of 5 persons are in favor of a prohibition on breeding animals in conditions that do not meet their needs, i.e. in closed buildings without outside access. However, in France, 4 out of 5 animals are bred under these conditions…1
How can we fight against these farming methods?
The best way is to adopt a more responsible consumption pattern: consume products made with respect for the environment and animal welfare is the best choice to encourage this sector to develop better!
In the case of milk and dairy ingredients, it is making the choice of Ingredia and milk cooperative such as Prospérité Fermière!
What are the commitments of milk from Prospérité Fermière cooperative?
The Prospérité fermière commits to product sustainable milk through the Via Lacta approach. It is based on 3 points: Humans, Milk and Environment.
In the introduction of this article, we talked about breeding in closed buildings: with Via Lacta milk, respect for the living conditions of cows is at the heart of concerns. This is the reason why cows spend 170 days a year on pasture with at least 1500m² of grass per animal. We are far away from stables and their 10m² per cow.2 This is made possible by the fact that in the Hauts-de-France region, the cooperative has 1600 member-producers from 1000 family-sized farms: with an average of 50 cows, these farms are perfectly compatible with animal welfare.3
In this idea of sustainable development, the Prospérité Fermière has established a differentiating collection program. So, traditional milk and milk from grass-fed cows are only collected within an 80km radius around the St-Pol-sur-Ternoise creamery located in the region of Hauts-de-France. This allows to:
- Limit the carbon footprint of milk by reducing transport
- Boost local production while preserving grassy landscapes of the Hauts-de-France region
- Correctly remunerate breeders by fixing a minimum price per year as well as a bonus for the grass-fed milk production.3
From a product quality point of view, is milk from grass-fed cows different from conventional milk?
In addition to the eco-responsible dimension (natural and GMO-free) of promoting grass-fed milk, it is important to know that milk is a reflection of the diet of the cow which produced it.
This was studied during a 2019 review: the purpose was to compare the nutritional quality of milk from grass-fed cows and a more conventional milk. The study revealed that the milking cow’s diet had a direct impact on the fat profile of the milk:4
- Milk from Grass-fed cows contains more polyunsaturated fatty acids and less saturated fatty acids, which is positive as it is always better to reduce your saturated fatty acids intake in favor of unsaturated fats.
- Grass-fed milk contains less omega 6 and more omega 3 fatty acids. The nutritional interest of grass-fed milk is therefore superior since our diet is generally too rich in omega 6 and too low in omega 3, whereas it is important to respect a low omega 6/omega 3 ratio.
- Grass-fed milk contains more CLA (conjugated linoleic acid). A 2015 review details the positive health impact of these molecules, such as stimulating the immune system and reducing the risk of cancer and type II diabetes.5 These molecules could also stimulate metabolism, and so on increase energy expenditure. This is the reason why CLA dietary supplements can be found on the market.
A study by the Chamber of Agriculture of Brittany carried out between 2006 and 2008 demonstrates the same results.6 In figure n°1, we can observe that an increase of pasture in forages allows an increase in the proportion of polyunsaturated fatty acids, an increase in the CLA content, as well as a decrease in the omega 6/omega 3 ratio.
Therefore, in addition to more conventional milk, the Prospérité Fermière cooperative offers this eco-friendly grass-fed milk of greater nutritional quality. Moreover, some of the Ingredia’s dairy ingredients come from this special collection milk.
Concerning dairy ingredients, why should we choose Ingredia?
The first important point is the quality of raw materials. Not all products in the dairy ingredients industry come directly from milk. Some come from co-products of other industries. For example, it is possible to use whey from cheese industry. However, proteins of this whey are usually broken down by different thermal or chemical treatments that may be done during the cheese production. Whey proteins from cheese are produced from these whey proteins.
But if a protein is denatured, it can lose some of its bioactive properties.
Concerning Ingredia’s dairy ingredients, this is not the case: the raw material is milk; therefore, ingredients are native and not broken down (native whey proteins, micellar caseins).
But in the case of casein ingredients, the raw material is necessarily milk. So they all use “native” caseins, don’t they?
No, they don’t, as shown in figure n°2 there are 2 types of caseins:
- Micellar caseins: they are obtained by membrane filtration. So, proteins are not denatured and keep their native structure.
- Caseinates: they are obtained by a denaturing chemical process.
In order to preserve all caseins properties, Ingredia promotes membrane filtration, a non-denaturing physical process, and offers different micellar caseins with different functional properties depending on the application.
To summarize, Via Lacta is part of a global approach. All actors of the milk production commit themselves to respect a highly controlled specifications in order to ensure:
- Animal welfare
- An eco-responsible milk of the best possible quality
- The correct remuneration of producers
For more information, do not hesitate to consult the following links:
- The Prospérité Fermière milk (French website): https://www.lait-prosperite.fr/
- Ingredia’s dairy ingredients : https://www.ingredia.com/fields-of-expertise/functional-nutritional-proteins/innovative-proteins/
For any other inquiry, contact us.
Author: Rémi Maleterre.
 IFOP, “Les Français et la condition animale,” IFOP, accessed September 28, 2020, https://www.ifop.com/publication/les-francais-et-la-condition-animale/.
 Jacques Charlery and Yves Sèité, “Bien Être Des Animaux et Des Éleveurs – Les Vaches Ne s’entassent Pas,” Cap Elevage 14 (May 2007): 24–25.
 “Notre coopérative – Coopérative Prospérité Fermière,” accessed October 22, 2020, https://www.lait-prosperite.fr/notre-cooperative/.
 Mohammad Alothman et al., “The ‘Grass-Fed’ Milk Story: Understanding the Impact of Pasture Feeding on the Composition and Quality of Bovine Milk,” Foods 8, no. 8 (August 2019): 350, https://doi.org/10.3390/foods8080350.
 Bo Yang et al., “Review of the Roles of Conjugated Linoleic Acid in Health and Disease,” Journal of Functional Foods 15 (May 1, 2015): 314–25, https://doi.org/10.1016/j.jff.2015.03.050.
 Chambre d’agriculture de Bretagne, “Matière Grasse du lait : l’herbe améliore la qualité nutritionnelle des laits,” May 2009, 2.
 “La Caséine Micellaire,” Prodiet Fluid – la caséine micellaire dédiée aux boissons hyperprotéinées (blog), accessed September 28, 2020, https://www.prodiet-fluid.fr/la-caseine-micellaire/.
According to 2019 INSEE estimations, people over 75 years old represent up to one tenth of the French population.1 Among them, only 10% attend or live in a retirement home for elderly people.2 Therefore the majority of this population remains at home with varying dependencies.
With age, we can see lifestyle changes due to physical capacities decline and psychological state evolution. This may result in a decrease of physical activities and a dietary intake reduction. Weight loss can be important, which is not without risk for elderly people: diseases such as sarcopenia or osteoporosis could appear. 3 4
So, it is essential to provide food products designed for elderly people to ensure that their dietary intake remains adequate. Indeed, these can be important in order to maintain adequate dietary intakes and therefore maintain a healthy lifestyle.
An American statistical study of 2018 revealed that a healthy lifestyle (good and adequate eating habits, moderate alcohol consumption, etc…) could potentially increase life expectancy by 12.2 years for men and 14 years for women.5 For comparison, the average life expectancy in the United Stated is 78.5 years old (2017 data).6
Why do we need products that are “adapted” to elderly people? Are common products not enough?
Common food products should of course not be removed. But a lot of studies demonstrate that dietary intake strongly tends to decrease with age. 3 7 8 9 Between 20 and 80 years old, we estimate that energy intake decreases about 600 and 1 300kcal respectively for women and men. 10 This represents an average energy intake reduction of up to 50%. Such a decrease is not without any consequences for the body: cognitive and physical capacities reduction, fatigue increase, weakening of the immune system, etc… Indeed, a 2018 meta-analysis showed that the quality of life of older adults was directly associated to their eating habits. 11
Consequently, dietary supplements can be necessary in order to better cover energy need of elderly people. Then, three types of products exist:
- Nutritional supplement; they can be useful to provide vitamins, minerals and other essential nutrients such as omega-3. The main disadvantage of these is that they can be difficult to swallow for some elderly people, especially those with dysphagia (swallowing difficulties). Moreover, these products may be seen as drugs by elderly people. This is the reason why some aversion may be observed.
- Functional foods, i.e. foods that appear to be similar to conventional foods, but they contain one or more health benefits nutrients.12 These foods can often contain a concentrate of essential nutrients. For example, they can be presented as dairy beverage, dessert cream or even soup.
- Finger-food products; these are traditional foods but with a shape and a consistency that allowed them to be eaten with fingers. These foods will usually be a concentrate of energy and essential nutrients. The advantage of these products is the fact that they are simple to eat for older adults with difficulties to use fork and knife (such as patients with Parkinson’s disease). Moreover, they can be easily added in a dish or be consumed at any time of the day without necessarily being at the dinner table.
What are the most important nutrients for these products adapted to elderly people?
We have already seen that energy intake of elderly people is often insufficient. Consequently, a product intended for this population could be concentrate in energy. Then it could be richer in fats, because lipid is the most energetic nutrient: carbohydrates and proteins approximately represent 4kcal/g while lipids represent 9kcal/g. Concerning the quality of these lipids, it would be ideal to maximize omega-3 since it is an essential fatty acid that is too little present in the traditional diet. Various epidemiological studies have shown that increased consumption of omega-3 would reduce the risk of stroke as well as cognitive declines. 10 13 14
Proteins are also extremely important for elderly people because they help maintain bone and muscle mass integrity. This allows this population to better preserve their physical capacities. For more information, we talk about this topic in several blog article:
- “What are the protein needs of the elderly?“
- “What is the perfect protein for the elderly people?“
- “How are proteins beneficial to bone health?“
With age, anabolic A resistance can occur. In other words, a small quantity of proteins could not be enough to stimulate muscular synthesis.15 However, it is still possible to counterbalance the phenomenon by providing a biggest quantity of essential amino acids B, especially Leucine, the most important amino acid to enhance anabolism.16 17 Therefore, a dose of between 2 and 3g would represent the minimum amount per food intake to properly stimulate muscular synthesis in the elderly people. 15 18 19
Furthermore, it is important to notice that food alone is not enough: physical activity (even walking) is essential in order to maintain the muscle stimulation. For more information, please see our article on protein needs of elderly people.
The addition of micronutrient can also be important. According to recommendations from the 2016 review “Nutrition recommendations in elderly and aging. Medical Clinics of North America”, the lack of certain nutrients may pose a health risk. Nutrients that are commonly deficient are vitamin D and B12, and Calcium. These are the three micronutrients to be included as a priority in products for elderly people.19
If food products are more energetic, are elderly people likely to eat less?
No, they are not, provided that the dish volume does not change. A study conducted in a hospital on 36 patients aged from 52 to 96 years old found that the food volume ingested between a regular dish and a dish with a higher energy density is negligible. Therefore, it is possible to significantly increase energy intake by providing food products high in energy. 20
What foods should be included in these products adapted to elderly people?
Not all foods are suitable for elderly people. Not for health reasons, but simply for the hedonic side of the product. As we have seen earlier, there is often an appetite decline with age. That is the reason why the product must be as appetizing as possible so that the elderly person wants to consume it.8
A 2008 study of the Journal of Nutrition Health and Aging indicates that the more negative emotion is generated by food (disgust, indifference, worry, doubt, frustration, disappointment, fatigue), the greater the risk of undernutrition may be. So, it appears essential to choose foods that generate positive emotions in this population. 21
What foods can elicit these positive emotions in elderly people?
A 2006 study shows that elderly people’s favorite dishes seem to be foods they are familiar with, with a traditional way of preparation. So, we have to forget overelaborated methods of preparation and exotic foods. It Is important to use what they know well and appreciate. 22
Therefore, flavorings should always remain simple: vanilla, chocolate, caramel, coffee… Furthermore, sensory abilities often decrease with age. As taste and smell may weaken, it seems necessary to raise the flavors of foods more and to propose stronger aromas than those traditionally used.
Do these foods have to meet specific requirements?
In addition to the nutrition and hedonic aspect, these products must have a shape and a texture adapted. Indeed, elderly people can have certain diseases such as dysphagia or xerostomia (oral dryness). That is why product should have a particular texture. 23
It can be a good idea to make products in small portion form so that they can be eaten without cutlery. To this extent, finger-food products can be very interesting.
As a conclusion, to be perfectly adapted to elderly people, a food product must:
- Be energetic and source of essential nutrients, especially vitamins (D and B12), minerals (calcium) and proteins. Moreover, for proteins, it is important to choose a Leucine-rich one. That is the reason why dairy proteins can be very interesting: whey proteins contain 11.7% of Leucine, and micellar caseins 9.2%. *
- Be attractive, it must generate positive emotions. But it should not be too extravagant: older people generally prefer products that are familiar to them.
- Be easy to consume, with a suitable texture and shape (not too hard, not too dry for example)
*A [Anabolism]: Muscular protein synthesis
*B [Essential Amino Acids]: Amino acid that the body cannot synthesize. Therefore, they must be supplied through the diet
*data for Leucine correspond to those measured in Prodiet® 80S for whey proteins and Prodiet® Fluid for micellar caseins. These products are developed by Ingredia.
For more information and any inquiry, contact us.
Authors: Rémi Maleterre & Audrey Boulier.
 “Population Par Âge − Tableaux de l’économie Française | Insee,” accessed April 9, 2020, https://www.insee.fr/fr/statistiques/3676587?sommaire=3696937.
 DREES, “728 000 Résidents En Établissements d’hébergement Pour Personnes Âgées En 2015,” Études & Résultats, 2015, https://drees.solidarites-sante.gouv.fr/IMG/pdf/er1015.pdf.
 Sonya Brownie, “Why Are Elderly Individuals at Risk of Nutritional Deficiency?,” International Journal of Nursing Practice 12, no. 2 (2006): 110–18, https://doi.org/10.1111/j.1440-172X.2006.00557.x.
 Alfonso J. Cruz-Jentoft et al., “Prevalence of and Interventions for Sarcopenia in Ageing Adults: A Systematic Review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS),” Age and Ageing 43, no. 6 (November 1, 2014): 748–59, https://doi.org/10.1093/ageing/afu115.
 Yanping Li et al., “Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population,” Circulation, July 2018, https://doi.org/10.1161/CIRCULATIONAHA.117.032047.
 “Indicateurs de Développement Dans Le Monde – Google Public Data Explorer,” accessed August 30, 2020, https://www.google.com/publicdata/explore?ds=d5bncppjof8f9_&met_y=sp_dyn_le00_in&idim=country:USA:GBR:CAN&hl=fr&dl=fr#!ctype=l&strail=false&bcs=d&nselm=h&met_y=sp_dyn_le00_in&scale_y=lin&ind_y=false&rdim=world&idim=country:USA&ifdim=world&hl=fr&dl=fr&ind=false.
 J. E. Morley, “Decreased Food Intake With Aging,” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56, no. Supplement 2 (October 1, 2001): 81–88, https://doi.org/10.1093/gerona/56.suppl_2.81.
 Anna Pilgrim et al., “An Overview of Appetite Decline in Older People,” Nursing Older People 27, no. 5 (June 2015): 29–35, https://doi.org/10.7748/nop.27.5.29.e697.
 Lorenzo M. Donini, Claudia Savina, and Carlo Cannella, “Eating Habits and Appetite Control in the Elderly: The Anorexia of Aging,” International Psychogeriatrics 15, no. 1 (March 2003): 73–87, https://doi.org/10.1017/S1041610203008779.
 Riccardo Calvani et al., “Current Nutritional Recommendations and Novel Dietary Strategies to Manage Sarcopenia,” The Journal of Frailty & Aging 2, no. 1 (2013): 38–53.
 Thara Govindaraju et al., “Dietary Patterns and Quality of Life in Older Adults: A Systematic Review,” Nutrients 10, no. 8 (July 26, 2018), https://doi.org/10.3390/nu10080971.
 karine Pierre-Lecocq, “Aliment fonctionnel,” CERIN, accessed April 9, 2020, https://www.cerin.org/glossaire/aliment-fonctionnel/.
 Institute of Medicine (US) Food Forum, Nutrition Concerns for Aging Populations, Providing Healthy and Safe Foods As We Age: Workshop Summary (National Academies Press (US), 2010), https://www.ncbi.nlm.nih.gov/books/NBK51837/.
 Natalia Ubeda, María Achón, and Gregorio Varela-Moreiras, “Omega 3 Fatty Acids in the Elderly,” The British Journal of Nutrition 107 Suppl 2 (June 2012): 3, https://doi.org/10.1017/S0007114512001535.
 Benoit Smeuninx et al., “Age-Related Anabolic Resistance of Myofibrillar Protein Synthesis Is Exacerbated in Obese Inactive Individuals,” The Journal of Clinical Endocrinology and Metabolism 102, no. 9 (July 14, 2017): 3535–45, https://doi.org/10.1210/jc.2017-00869.
 Imanipour Vahid et al., “The Effects of Branch-Chain Amino Acids on Fatigue in the Athletes,” Interventional Medicine & Applied Science 10, no. 4 (n.d.): 233–35, https://doi.org/10.1556/1646.10.2018.10.
 Joshua C. Anthony et al., “Orally Administered Leucine Stimulates Protein Synthesis in Skeletal Muscle of Postabsorptive Rats in Association with Increased EIF4F Formation,” The Journal of Nutrition 130, no. 2 (February 1, 2000): 139–45, https://doi.org/10.1093/jn/130.2.139.
 Christos S. Katsanos et al., “A High Proportion of Leucine Is Required for Optimal Stimulation of the Rate of Muscle Protein Synthesis by Essential Amino Acids in the Elderly,” American Journal of Physiology. Endocrinology and Metabolism 291, no. 2 (August 2006): E381-387, https://doi.org/10.1152/ajpendo.00488.2005.
 Hope Barkoukis, “Nutrition Recommendations in Elderly and Aging,” The Medical Clinics of North America 100, no. 6 (November 2016): 1237–50, https://doi.org/10.1016/j.mcna.2016.06.006.
 Ann Ödlund Olin et al., “Energy-Enriched Hospital Food to Improve Energy Intake in Elderly Patients,” Journal of Parenteral and Enteral Nutrition 20, no. 2 (1996): 93–97, https://doi.org/10.1177/014860719602000293.
 Issa Narchi et al., “Emotions Generated by Food in Elderly French People,” The Journal of Nutrition, Health & Aging 12 (February 1, 2008): 626–33, https://doi.org/10.1007/BF03008273.
 M. Laureati et al., “Sensory Acceptability of Traditional Food Preparations by Elderly People,” Food Quality and Preference, The First European Conference on Sensory Science of Food and Beverages: “A Sense of Identity,” 17, no. 1 (January 1, 2006): 43–52, https://doi.org/10.1016/j.foodqual.2005.08.002.
 E. Rothenberg and K. Wendin, “7 – Texture Modification of Food for Elderly People,” in Modifying Food Texture, ed. Jianshe Chen and Andrew Rosenthal (Woodhead Publishing, 2015), 163–85, https://doi.org/10.1016/B978-1-78242-334-8.00007-9.
Elsa Trotier, Product Manager responsible for the range of nutritional proteins and Wenqian Sun, Nutritional Development Specialist at Ingredia, will discuss in a FREE webinar the growth request of protein in healthy ageing market.
Nowadays, population is getting older, in 2050, 2 billion of the global population will be more than 60 years (WHO). To support healthy ageing, many products are launched in senior nutrition. Most of them contain proteins. Seniors do not want to be categorized and want indulgent products as their counterpart.
Faced with these challenges, Ingredia offers solutions to meet targeted nutritional needs and technical support during your product development with our range of nutritional milk proteins PRODIET®.
Learn more and join us on Tuesday, November 24th, 1:45 P.M (French time) Save the date, register now!
Our physical abilities change throughout life. They gradually increase with age until their maximum between 20 and 30 years old.1 After a stagnation period, then there is a decline.2 The beginning of this stage depends on number of factors: genetic, food intake, physical activity, and the global health state.3 With age, complications may arise especially in bones. After the age of 50, it is not uncommon to see a progressive bone weakening: this is osteopenia.
Osteopenia? What is the difference between osteopenia and osteoporosis we hear about fairly regularly?
As shown in figure 1, it is possible to simplify the evolution of bone health degradation in 3 steps. Before the age of 50, mineral density is generally normal and bones are strong. Then the first complications appear: bones start to weaken and the fracture risk increase. This is osteopenia. At this point, the aim is to strengthen bone mass to delay osteoporosis as much as possible, even recover a good bone health. If nothing is done, bones will keep getting worse: this is the typical bone demineralization of osteoporosis (figure 2).4
Figure 2: Bone density evaluation based on bone density score. The more this score is low, the more porous bones are.6
Do these complications concern everyone?
Yes, they do. With age, it is perfectly natural to observe a declining bone health. However, some factors can potentially increase the occurrence of this complications: sex (during their lifetime, more than half of women will on average have an osteoporotic fracture compared to only one third of men)7, exposition to certain harmful substances (alcohol, smoke), diet and physical activity.8
Is it possible to reduce the risk of bone fragility by changing your lifestyle?
Yes, you can, and we will especially focus on food. Indeed, it is well accepted that calcium and vitamin D are absolutely essential to bone health. That’s why recommended daily intake of calcium are about 1200mg/d and 10µg/j for vitamin D from the age of 50.9
However, these are not the only essential nutrients to consider. A study from « Current Osteoporosis Report » show that numbers of nutrients (figure 3) are beneficial to bone health, such as proteins.10
Can proteins be beneficial to bone health? I thought it was the opposite…
This is a common misconception. Before demonstrating their beneficial effects on bone health, it was first observed that dietary proteins cause an increase of urinary calcium. That is the reason why we firstly think that proteins could be harmful to bone health because they may generate bone demineralization.11
But this conclusion was far too hasty: even if an increase of dietary protein consumption generates an increase of urinary calcium, at the same time they enhance intestinal calcium absorption. This has been proven in 2003 study from the « American Journal of Clinical Nutrition ». As shown in figure 4, a high protein diet (2.1g/kg of body weight) allow to reach an intestinal calcium absorption of 26.3% against only 18.4% for a lower protein diet (0.7g/kg of body weight). This represents a significant increase of calcium absorption of 43%.12 13
According to the figure 4, the high-protein diet (2.1g/kg) increase urinary calcium excretion by 2 mmol on 24h (3.4 to 5.4 mmol/d).
Knowing the calcium daily intake in the prescribed diet during the study (20 mmol/d), it is possible to deduce the amount absorbed with the low- (0.7g/kg) and the high- (2.,g/kg) protein diet: 3.7mmol with the first (18.4% of 20 mmol) and 5.3 mmol with the second one (26.3% of 20 mmol). Consequently, the high-protein diet enables to absorb 1.6 mmol more calcium in 24h.12
As a result, most of the increase in calcium excretion is explained by an increase in its intestinal absorption.
But it is not just about the calcium excretion: it is said that proteins are considered as “acidic” for the body, and this promotes bone demineralization. Is that true?
It is true that we commonly consider proteins as “acidic” for the body, in contrast to vegetables considered as “alkaline”. But the question is: does an “acidic” or “alkaline” diet have an impact on bone health? This we the topic of a 2013 review conducted by Hanly & Whiting. They summarize results from different articles and they concluded that evidences supporting the role of proteins in the development of osteoporosis are not consistent. At the same time, the authors found that a more “alkaline” diet does not appear to be particularly more beneficial for bone health.14
To summarize this review, there is no link between bone health and an “acidic” or “alkaline” diet.
Fine, but then how does proteins affect bone health? Bones are not made of protein…
And yet it is false: contrary to a common misconception, bones are not only composed of inert material: they contain proteins such as collagen.15 Like all proteins, they breakdown and regenerate perpetually: this is the protein turn-over. We studied more precisely this subject in our blog article “Why do endurance athletes need more protein?”. Consequently, a dietary protein intake increased can helps to correctly ensure this protein turn-over and maintain bone health.
But that’s not all since a 2011 review suggests that dietary proteins could act on different mechanisms of our body and thus have a positive impact on bone health: 16
- By increasing intestinal calcium absorption as we saw before.12
- By suppressing parathyroid hormone, an osteolysis hormone (bone demineralization) when its concentration is too high. The other hand, this hormone promotes bone remineralization at a low dose. So, its suppression is positive for bone health.17
- By increasing IGF-1 production, a hormone that positively contributes to bone mineralization.18
- By increasing muscular mass, providing a better bone protection and reducing fall and fracture risk. A 5-years cohort study completed in 2009 showed a positive link between muscular mass increase and bone health in elderly people.19
So, what are the best foods to maintain a good bone health?
The answer is simple: you need protein, vitamins (especially vitamin D) and minerals (calcium, magnesium, potassium) source foods. The ideal solution is to choose foods with the most complete protein, i.e. rich in essential amino acids A.
That is the reason why milk and dairy products are excellent foods that maintain bone health. As detailed in our article “How to characterize protein quality?”, dairy proteins are a good source of essential amino acids. Furthermore, minerals from the milk and especially the calcium are very bioavailable B.20 21 Finally, dairy products contain number of vitamins such as D, K, B9 and B12, which are essential for bones.22
Therefore, it is important to provide foods rich in essential nutrients for bone health for most-at-risk populations, including the elderly people. As we have seen in this article or even in precedents such as “What is the perfect protein for the elderly people?”, milk and dairy products can be a great choice to meet this demand.
For more information on our milk proteins and our expertise, contact us.
Authors: Rémi Maleterre & Audrey Boulier.
*A [Essential Amino Acids]: Amino acid that the body cannot synthesize. Therefore, they must be supplied through the diet
*B [Bioavailable]: relating to the absorption and used of a nutrient by the body. The more bioavailable a nutrient is, the more it is absorbed and used by the body.
 David B. Burr, “Muscle Strength, Bone Mass, and Age-Related Bone Loss,” Journal of Bone and Mineral Research 12, no. 10 (1997): 1547–51, https://doi.org/10.1359/jbmr.19188.8.131.527.
 Douglas Paddon-Jones and Blake B. Rasmussen, “Dietary Protein Recommendations and the Prevention of Sarcopenia,” Current Opinion in Clinical Nutrition and Metabolic Care 12, no. 1 (January 2009): 86–90, https://doi.org/10.1097/MCO.0b013e32831cef8b.
 Taylor J. Marcell, “Review Article: Sarcopenia: Causes, Consequences, and Preventions,” The Journals of Gerontology: Series A 58, no. 10 (October 1, 2003): M911–16, https://doi.org/10.1093/gerona/58.10.M911.
 David L. Glaser and Frederick S. Kaplan, “Osteoporosis. Definition and Clinical Presentation,” Spine 22, no. 24 Suppl (December 15, 1997): 12S-16S, https://doi.org/10.1097/00007632-199712151-00003.
 “Osteoporosis vs Osteopenia: Know the Difference,” OrthoAtlanta, accessed February 27, 2020, https://www.orthoatlanta.com/media/osteoporosis-vs-osteopenia-know-the-difference.
 Harvard Health Publishing, “Osteopenia: When You Have Weak Bones, but Not Osteoporosis,” Harvard Health, accessed February 27, 2020, https://www.health.harvard.edu/womens-health/osteopenia-when-you-have-weak-bones-but-not-osteoporosis.
 Philip D. Ross, “Osteoporosis: Frequency, Consequences, and Risk Factors,” Archives of Internal Medicine 156, no. 13 (July 8, 1996): 1399–1411, https://doi.org/10.1001/archinte.1996.00440120051005.
 Farkhondeh Pouresmaeili et al., “A Comprehensive Overview on Osteoporosis and Its Risk Factors,” Therapeutics and Clinical Risk Management 14 (November 6, 2018): 2029–49, https://doi.org/10.2147/TCRM.S138000.
 John A. Sunyecz, “The Use of Calcium and Vitamin D in the Management of Osteoporosis,” Therapeutics and Clinical Risk Management 4, no. 4 (August 2008): 827–36, https://doi.org/10.2147/tcrm.s3552.
 Shivani Sahni et al., “Dietary Approaches for Bone Health: Lessons from the Framingham Osteoporosis Study,” Current Osteoporosis Reports 13, no. 4 (August 2015): 245–55, https://doi.org/10.1007/s11914-015-0272-1.
 Jane E. Kerstetter and Lindsay H. Allen, “Protein Intake and Calcium Homeostasis,” in Nutrition and Osteoporosis, ed. Harold H. Draper, vol. 9, Advances in Nutritional Research (Boston, MA: Springer US, 1994), 167–81, https://doi.org/10.1007/978-1-4757-9092-4_10.
 Jane E. Kerstetter, Kimberly O. O’Brien, and Karl L. Insogna, “Dietary Protein, Calcium Metabolism, and Skeletal Homeostasis Revisited,” The American Journal of Clinical Nutrition 78, no. 3 (September 1, 2003): 584S-592S, https://doi.org/10.1093/ajcn/78.3.584S.
 J. E. Kerstetter, K. O. O’Brien, and K. L. Insogna, “Dietary Protein Affects Intestinal Calcium Absorption,” The American Journal of Clinical Nutrition 68, no. 4 (October 1998): 859–65, https://doi.org/10.1093/ajcn/68.4.859.
 David A. Hanley and Susan J. Whiting, “Does a High Dietary Acid Content Cause Bone Loss, and Can Bone Loss Be Prevented with an Alkaline Diet?,” Journal of Clinical Densitometry: The Official Journal of the International Society for Clinical Densitometry 16, no. 4 (December 2013): 420–25, https://doi.org/10.1016/j.jocd.2013.08.014.
 Bach Quang Le et al., “The Components of Bone and What They Can Teach Us about Regeneration,” Materials 11, no. 1 (December 22, 2017): 14, https://doi.org/10.3390/ma11010014.
 Jane E. Kerstetter, Anne M. Kenny, and Karl L. Insogna, “Dietary Protein and Skeletal Health: A Review of Recent Human Research,” Current Opinion in Lipidology 22, no. 1 (February 2011): 16–20, https://doi.org/10.1097/MOL.0b013e3283419441.
 G. Lombardi et al., “The Roles of Parathyroid Hormone in Bone Remodeling: Prospects for Novel Therapeutics,” Journal of Endocrinological Investigation 34, no. 7 Suppl (July 2011): 18–22.
 J. P. Bonjour et al., “Protein Intake and Bone Growth,” Canadian Journal of Applied Physiology = Revue Canadienne De Physiologie Appliquee 26 Suppl (2001): S153-166, https://doi.org/10.1139/h2001-050.
 Xingqiong Meng et al., “A 5-Year Cohort Study of the Effects of High Protein Intake on Lean Mass and BMC in Elderly Postmenopausal Women,” Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research 24, no. 11 (November 2009): 1827–34, https://doi.org/10.1359/jbmr.090513.
 Elizabeth F. Buzinaro, Renata N. Alves de Almeida, and Gláucia M. F. S. Mazeto, “[Bioavailability of dietary calcium],” Arquivos Brasileiros De Endocrinologia E Metabologia 50, no. 5 (October 2006): 852–61, https://doi.org/10.1590/s0004-27302006000500005.
 Léon Guéguen and Alain Pointillart, “The Bioavailability of Dietary Calcium,” Journal of the American College of Nutrition 19, no. sup2 (April 1, 2000): 119S-136S, https://doi.org/10.1080/07315724.2000.10718083.
 Frédéric Gaucheron, “Milk and Dairy Products: A Unique Micronutrient Combination,” Journal of the American College of Nutrition 30, no. 5 Suppl 1 (October 2011): 400S-9S, https://doi.org/10.1080/07315724.2011.10719983.
Over 2 billion people are currently overweight in the world, and this number keeps growing every year.1 Overweight is defined as a BMI* greater than or equal to 25 whereas obesity is defined as a BMI* greater than or equal to 30.1
Being overweight is commonly known to be a risk factor for cardiovascular diseases, musculoskeletal disorders and cancers.1
Over 80% of teenagers are not physically active enough.1 2 A sedentary lifestyle has an impact on their lifestyle habits, including their health. A study on excess weight risks factors among 13-14 teenagers has shown that depending on social background and gender, overtime spent watching screens, skipping breakfast and not practicing any sport could be correlated to weight gain.3 Overweight and obesity among teenagers is a global public health concern, as this category of the population have high risks to encounter health issues during adulthood.1
What are consumers’ concerns about their weight?
A survey has shown that 48% of the global population is currently concerned about being overweight in the future (Euromonitor International, 2020). Nowadays, the general population is well-aware of the excessive weight gain risks and is concerned about its health, especially its well-being. A biennial survey has shown that higher rates of people attempted to lose weight in 2015-2016 compared to 2007-2008 (almost 50% of American adults).4
Plus, with Summer, many people want to manage their weight. Consumers want to feel emotionally and physically good about their body.
What are the product categories for managing weight?
Two categories of products are positioned on the managing weight products market.
- The first category is the weight management products. It targets people who would like to lose weight without exercising. These products have the following benefits: full or partial meal replacing, designed to create the required calorie deficit to lose weight, often rich in proteins and fibers. The weight management products market growth tends to stay constant and to even decrease (Mintel, 2019).
- The second category is the active nutrition products.
Consumers’ interest shifts to exercising coupled with active nutrition products. This new trend will be detailed in a later part of this article.
What kind of weight management products can we find?
For the past year, meal replacement drinks with slimming claims were the main launched products as sales represent 55% of the weight management market (Figure 1).
The highest meal replacement drinks demands are in Asia Pacific (49% of the sales) (Euromonitor, 2020).
A majority of the drinks with slimming claims contain proteins (74%, which 38% contain more than 10% proteins) (Figure 2).
The rest of the weight management market is represented by 45% of food products (snack bars, breakfast cereals, bakery products…). 88% contain proteins.
It seems that a lot of the slimming products contain proteins. What are consumers’ thoughts about them?
In order to lose weight, many consumers pay more attention to the content of their diet. Some of them tend to increase their protein intake by having high-protein diets (Figure 3).
70% of the general population recognizes the importance of having the right protein intake levels daily (FMCG Gurus, 2018).
Why are proteins a key component in weight management?
Proteins are mainly used for the following abilities:
- Increasing of satiety; this will help people who want to have a better management of their weight.5 6
- Proteins increase our energy expenditures.5
- Muscle gain; proteins are rich in all essential amino acids, including Leucin which function is to synthesize muscles. It also reduces lean body mass loss.5 7
Milk proteins are well adapted for weight management diets as they have an excellent amino-acid profile.
For more detailed information on proteins’ benefits on weight management, please refer to our last articles on weight management “The interest of proteins in weight management” and “The added interest of milk proteins for weight management”.
As mentioned previously, the weight management market growth is very low, due to more and more consumers turning to active nutrition.
Why are consumers shifting from weight management products to active nutrition?
Active nutrition is part of sports nutrition. The sports nutrition sales growth shows that it is a promising market with global sales of 12.7 billion dollar in 2018, and a growth of +8.4% (CAGR 2018-2023) (Euromonitor International, 2020).
Action nutrition can be defined as a “healthy lifestyle choice with the primary objective of optimizing both physical and mental performance”.8
In the past, products were specialized for weight management and were marketed for overweight people. Now, people want to maintain their weight and stay fit, as sport and nutrition are now recognised as pillars of wellness and take part of active people’s life balance. Consumers look for functional nutrients, such as proteins. 32% of adults aged 45-54 consider personal fitness to be an important part of their identity.9
Products that are generally launched in active nutrition are “on-the-go” products: “ready-to-drink” products, high protein bars and shakes.
Is weight loss a key component of sports nutrition?
Weight loss is a key component of sports nutrition marketing with high protein products, specially drinks. A survey of Euromonitor (2019) shows that the reasons for sports nutrition consumption differ for men and women. 36% of women and 26% of men consume nutritional products to lose weight. 37% of women and 45% of men look for strength and muscle tone. Women tend to look more for weight loss than men, to whom muscle tone is more important. Slogans can be observed on packaging, like the catch phrase “strong is the new skinny”.10
I need to gain weight. Are consuming proteins also beneficial for me?
Apart from wanting to lose weight or gain muscles, some people may also need to gain weight, such as seniors or undernourished people. It is recommended to use high protein drinks with high nutritional content to maintain weight and prevent sarcopenia.
To conclude, proteins are a key ingredient to manage weight. They can be used to lose, maintain or gain weight at a healthy level.
Nowadays weight management applies to any type of consumer, with high protein food and drinks as an excellent ally.
For more information and any inquiry, contact us.
Authors: Sandrine Tran & Elsa Trotier.
*BMI: Body Mass Index.
 WHO, 2020. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (consulted on 06.18.2020)
 WHO, 2019. To grow up healthy, children need to sit less and play more. https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more (consulted on 06.18.2020)
 Guignon N., et al., 2019. En 2017, des adolescents plutôt en meilleure santé physique mais plus souvent en surcharge pondérale. Direction de la recherche, des études, de l’évaluation et des statistiques. Volume 1122, August 2019. Pages 1-6. https://drees.solidarites-sante.gouv.fr/IMG/pdf/er1122.pdf (consulted on 06.18.2020)
 Euromonitor, 2018. Passport, New Visions of Weight Management: A 2018 Update on Trends and Innovations.
 Paddon-Jones, E. Westman, R.D. Mattes, R.R. Wolfe, A. Astrup, M. Westerterp-Plantenga, 2008. Protein, weight management, and satiety. The American Journal of Clinical Nutrition, Volume 87, Issue 5, May 2008, Pages 1558S–1561S. Pub May 01, 2008. https://doi.org/10.1093/ajcn/87.5.1558S (consulted on 17.06.2020)
 Soenen S., Westerterp-Plantenga, Margriet S., 2008. Proteins and satiety: implications for weight management. Clinical Nutrition and Metabolic Care. Vol 11:6, 747-751. Pub November 2008. https://doi.org/10.1097/MCO.0b013e328311a8c4 (consulted on 17.06.2020)
 Tappy, 1996. Thermic effect of food and sympathetis nervous system activity in humans. Reprod Nutr Dev. 36(4):391-7. Pub 1996.
 Euromonitor International, 2016. Passport. What is “Active Nutrition” and how can health and wellness players leverage the concept?
 Mintel, 2019. Optimum nutrition launches products geared towards adults 40%.
 Euromonitor, December 2018. Passport, New Visions of Weight Management: A 2018 Update on Trends and Innovations.
Because of environmental reasons, economics, or health, the current food trend is reduction of meat consumption. A lot of diets with little or no meat are very popular for several years. The most commons are flexitarianism (big reduction of meat consumption), vegetarianism (meat exclusion) or veganism (exclusion of all animal-based products). Therefore, according to a 2018 study conducted by the Credoc, consumption of meat products fell by 12% in France in only 10 years.1
However, for a lot of us, meat is or was our main proteins source. So, it is necessary to find different substitutes in order to provide our nutritional requirements. This is how dairy products can be a great substitute for flexitarian and vegetarian people!
Are dairy products good proteins source?
To answer this question, the best way is to look at a nutritional food composition table such the Ciqual, the French table from the ANSES.2 Data in figure 1 are taken from this database.
If we compare data from figure with those of a meat product, for example a ground beef steak of 100g: it contains between 20 and 25g of proteins. A portion of Camembert (6.3g proteins) with a cottage cheese bowl of 200g (16g proteins) provide 22.3g of proteins. It represents as much proteins as the ground beef steak. Therefore, dairy products are a good proteins source to substitute meats.2
Are milk proteins of good quality?
Yes, they are proteins of excellent quality. Like meat proteins, they contain all the amino acids that make up our body’s proteins. As shown in figure 2 from a 2015 Journal of Nutrition article, they contain all essential amino acids A in good proportions: with 52g/100g of proteins, whey proteins are the higher in essential amino acids. Casein are in second position (48g/100g) just before beef or eggs (44g/100g). 3
White bars correspond to plant-based proteins, blue bars are milk proteins, grey bars are the other animal-based proteins (meat, fish, egg) and the black bar correspond to human muscle. The horizontal dashed line represents the highest concentration of essential amino acids found in the study, namely whey protein.
Are all essential amino acids as important?
Yes, they are. An essential amino acid can inherently not be synthesized by the body. The lack of any of them could have adverse effects on the body.
However, among these, an amino acid is particularly important to stimulate muscle protein synthesis: Leucine. This can be very interesting for athletes or elderly people.3 4 5 For more information about the interest of Leucine to stimulate anabolism B, take a look at our article “What is the perfect protein for the elderly people?” .
Figure 3 represents Leucine concentration of different proteins sources. We can see that milk proteins are the best Leucine source (11.7% for whey protein and 9.2% for caseins*). So, these proteins are perfectly adapted to people who want to maintain or strengthen their muscle mass.3
Is the essential amino acids content the only parameter to be taken into account when judging the quality of a protein?
No, it is not. There is an indicator to evaluate the quality of a protein: the DIAAS (Digestible Indispensable Amino Acid Score). For a given protein, it considers the essential amino acids composition and the digestibility C of each of them.6 7 For more information about the DIAAS, do not hesitate to read our article dedicated to the quality of proteins.
According to the figure 4, which comes from a 2017 study conducted by S. Phillips, whole milk has a DIAAS about 1.14. In comparison, chicken breast has a DIAAS of 1.08 and beef meat is around 1.0 (DIAAS depends on digestibility of each essential amino acid of the protein, the cooking method of the meat can influence this data).8 9 The more a food has a high DIAAS, the more digestible the proteins it contains are, and the more it corresponds to the nutritional requirements. Consequently, we can note that milk proteins represent an excellent substitute to meat products.
White bars correspond to plant-based proteins, blue bars are milk proteins, grey bars are the other animal-based proteins (meat, egg).
Furthermore, figure 4 shows the two main drawbacks of plant-based proteins: on one hand they are globally not complete, on the other hand they are less digestible. That is the reason why these proteins never exceed a DIAAS of 1.0. For example, rice proteins are short of Lysine and Threonine, two essential amino acids not very present in cereals (particularly Lysine).10 And the digestibility of these proteins is about 55 to 65%.11 That is why DIAAS of cooked rice is only 0.59.12
Nevertheless, plant-based proteins should not be ignored. They can be better than meats on certain point, as figure 3 shown: maize has an excellent Leucine concentration (12.2%) which is nearly 40% higher than beef protein (8.8%).3 However, the lack of other essential amino acids can limit the previously mentioned beneficial effects of Leucine. It is therefore important to always vary its protein sources to properly cover its nutritional needs.
Compare to other proteins, only the benefits of milk proteins are presented. Are they really any better?
The answer is obviously no, there is no perfect food. Then, red meats retain an undeniable advantage: their high iron content.13 Red meats is one of the best iron sources of the traditional diet since 100g of cooked food cover 18 to 26% of iron daily needs. D On his side, milk only contains a very negligible amount of iron.14
Nevertheless, vegetarians can cover their iron needs with foods such as lentils. By comparison, 100g of cooked greed lentils can satisfy 15 to 22% of daily iron requirements (however, the bioavailability E of iron from plants is less important than iron from meats).2
Nota bene: Anemia, i.e. the lack of hemoglobin whose cause is multiple but often due to a lack of iron (dietary deficiency or malabsorption), concerns nearly a quarter of the world population (1.62 billion people) according to 2008 data from the WHO.15 If we choose to not consume meat anymore, then it is important pay attention to its daily consumption of iron and to focus on foods that provide enough iron (oilseed and legumes) and, if necessary, opt for iron rich food supplements (such as Lactoferrin).
However, concerning vitamins and minerals, milk is also very interesting: as beef meat, it is a good source of Phosphorus, Potassium, and vitamins B2, B5 and B12. Moreover, milk contains even more Calcium and vitamins B1 and B9.2 13 16
But in the end, how do you replace meat when you are used to having it on your plate?
For a lot of us, food traditions are rooted in our culture: a complete dish consists of meat and its sides (vegetables and starchy foods). But today, products imitating the look, the texture and sometimes even the taste of meat have appeared. These are meat analogues, or steak type. The best know are plant-based proteins steak type (soybeans, cereals, chickpeas, etc.) but is not uncommon for milk proteins to complement these meat analogues, particularly by addition of cheese. It is also possible to create meat analogue entirely with milk.
To conclude this article, it is perfectly possible to substitute meat products with a variety of animal-based (eggs and dairy products) and plant-based foods (cereals, legumes, oilseeds) to meet its protein requirements. Varying the sources ensures to cover its intake in all essential nutrients (amino acids, fatty acids, vitamins, minerals, etc.). That is the reason why the PNNS (French National Nutrition Health Plan) recommends a balance of 50% animal-based proteins and 50% plant-based proteins. In this sense, the new meat analogues composed of plant-based proteins and cheese appear to be a very good compromise.
For more information, please contact us
Authors: Rémi Maleterre & Audrey Boulier.
*A [Essential Amino Acids]: Amino acid that the body cannot synthesize. Therefore, they must be supplied through the diet
*B [Anabolism]: Muscular proteins synthesis.
*C [Digestibility]: For a given nutrient, this is the amount actually ingested available to the body after digestion and absorption. It can be expressed as a percentage.
*D [Daily iron requirements]: According to the ANSES, daily iron requirements are 11mg for men and postmenopausal women, and 16mg for premenopausal women
*E [Bioavailable]: relating to the absorption and used of a nutrient by the body. The more bioavailable a nutrient is, the more it is absorbed and used by the body.
*data for Leucine correspond to those measured in Prodiet® 90S for whey proteins and Prodiet® Fluid for micellar caseins. These products are developed by Ingredia.
 Gabriel Tavoularis and Éléna Sauvage, “Les nouvelles générations transforment la consommation de viande,” Crédoc, September 1, 2018, https://www.credoc.fr/publications/les-nouvelles-generations-transforment-la-consommation-de-viande.
 ANSES, “Ciqual French Food Composition Table,” accessed April 7, 2020, https://ciqual.anses.fr/#.
 Stephan van Vliet, Nicholas A. Burd, and Luc J. C. van Loon, “The Skeletal Muscle Anabolic Response to Plant- versus Animal-Based Protein Consumption,” The Journal of Nutrition 145, no. 9 (September 2015): 1981–91, https://doi.org/10.3945/jn.114.204305.
 Imanipour Vahid et al., “The Effects of Branch-Chain Amino Acids on Fatigue in the Athletes,” Interventional Medicine & Applied Science 10, no. 4 (n.d.): 233–35, https://doi.org/10.1556/1646.10.2018.10.
 Chad M. Kerksick et al., “ISSN Exercise & Sports Nutrition Review Update: Research & Recommendations,” Journal of the International Society of Sports Nutrition 15, no. 1 (August 1, 2018): 38, https://doi.org/10.1186/s12970-018-0242-y.
 Food and Agriculture Organization of the United Nations, ed., Dietary Protein Quality Evaluation in Human Nutrition: Report of an FAO Expert Consultation, FAO Food and Nutrition Paper 92 (FAO Expert Consultation on Protein Quality Evaluation in Human Nutrition, FAO, 2011).
 Gertjan Schaafsma, “The Protein Digestibility–Corrected Amino Acid Score,” The Journal of Nutrition 130, no. 7 (July 1, 2000): 1865S-1867S, https://doi.org/10.1093/jn/130.7.1865S.
 Stuart M. Phillips, “Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults,” Frontiers in Nutrition 4 (2017): 13, https://doi.org/10.3389/fnut.2017.00013.
 Suzanne M. Hodgkinson et al., “Cooking Conditions Affect the True Ileal Digestible Amino Acid Content and Digestible Indispensable Amino Acid Score (DIAAS) of Bovine Meat as Determined in Pigs,” The Journal of Nutrition 148, no. 10 (October 1, 2018): 1564–69, https://doi.org/10.1093/jn/nxy153.
 V. R. Young and P. L. Pellett, “Wheat Proteins in Relation to Protein Requirements and Availability of Amino Acids,” The American Journal of Clinical Nutrition 41, no. 5 Suppl (1985): 1077–90, https://doi.org/10.1093/ajcn/41.5.1077.
 Kunlun Liu, Jiabao Zheng, and Fusheng Chen, “Effect of Domestic Cooking on Rice Protein Digestibility,” Food Science & Nutrition 7, no. 2 (January 24, 2019): 608–16, https://doi.org/10.1002/fsn3.884.
 Brigid McKevith, “Nutritional Aspects of Cereals,” Nutrition Bulletin 29, no. 2 (2004): 111–42, https://doi.org/10.1111/j.1467-3010.2004.00418.x.
 ANSES, “Ciqual Table de Composition Nutritionnelle Des Aliments – La Viande Rouge, Cuite (Aliment Moyen),” accessed March 24, 2020, https://ciqual.anses.fr/#/aliments/6585/viande-rouge-cuite-(aliment-moyen).
 “Le Fer | Anses – Agence Nationale de Sécurité Sanitaire de l’alimentation, de l’environnement et Du Travail,” accessed March 24, 2020, https://www.anses.fr/fr/content/le-fer.
 Bruno De Benoist, World Health Organization, and Centers for Disease Control and Prevention (U.S.), Worldwide Prevalence of Anaemia 1993-2005 of: WHO Global Database of Anaemia (Geneva: World Health Organization, 2008), http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf.
 ANSES, “Ciqual Table de Composition Nutritionnelle Des Aliments – Le Lait, Teneur En Matière Grasse Inconnue, UHT (Aliment Moyen),” accessed March 19, 2020, https://ciqual.anses.fr/#/aliments/19039/lait-teneur-en-matiere-grasse-inconnue-uht-(aliment-moyen).
Undernourishment affects more than 50% of patients with cancer or Alzheimer’s disease in France. It may unfortunately worsen with therapeutic management and results in increased morbidity (i.e. amplify disease) and death.
These statistics have remained unchanged for 30 years because the assessment of the patient’s nutritional status is rarely carried out. In order to bridge these nutritional deficiencies in hospitals, it is important to provide adequate nutritional supplements.1 2
What is undernourishment?
Undernourishment corresponds to an imbalance between nutritional intake and the body’s needs. This can have important consequences, such as organs dysfunction or the loss of certain tissues, especially muscles. The first alarming symptom will be an important weight loss.2 3
When undernourishment becomes too important, then we have cachexia: a profound weakening of the body characterized by a significant loss of muscle mass, a deficient immune system, and a decrease in cognitive and physical abilities.4
Why is the number of undernourished patients so high?
There are several possible explanations for this high number of undernourished patients, particularly those with cancer.
First, it is not uncommon for cancer patients not to eat enough. Consequently, energy providings are inferior to the bodily needs. Causes can be multiple. The disease or the treatment may cause hormonal disturbances affecting hunger signals, or have an important psychological impact on the patient who can lose their appetite. 5
Secondly, almost one-third of cancers affects digestive organs (colon and rectum, liver, pancreas,…) and elimination organs (renal system, bladder). This can lead to dysfunctions in the digestive system and then malabsorption or misuse of certain nutrients.3 6
Finally, in the case of cancers, tumor consumes a lot of energy at the expense of the integrity of the body. Therefore, it is essential for the patient to consume a sufficient amount of energy and essential nutrients so as not to increase deficiencies.4 7
What are the most common nutritional deficiencies in these patients?
The first nutritional deficiency that may show visible side effects is the lack of proteins. The protein need is about 0.8g/kg of bodyweight per day.8 9
Protein deficiency exists when the subject does not consume enough proteins to meet his needs (so less than 0.8g/kg/d) or when an essential amino acidA is deficient. That is why hospitalized patients, who consume less food and/or do not assimilate them as well, are much more exposed to a lack of protein.10
The deficiency of one or more essential amino acids is also amplified if the person does not consume enough proteins of good quality and if sources are not suitably varied. For more information on the quality of proteins, see our article “How to characterize the quality of a protein”.
To synthetize muscles, our body needs all essential amino acids. This synthesis will then be proportional to the nutritional intake of the most deficient amino acid called limiting amino acid. In other words, if the requirements for the limiting amino acid are only covered up to 30%, then anabolismB will only reach 30% of its potential. As shown in Figure 1, the deficiency of a single essential amino acid is sufficient to unbalance the protein balance.11
A chronic imbalance in protein intake can lead to a progressive loss of muscle mass accompanied by a decrease in physical strength.1 2 4 But this is not the only risk of muscle mass decrease. It can also lead to a gradual decrease in the proper functions of immune system due to the need of amino acids. This would lead to an increase in morbidity and risk of serious infection, and death (figure 2).12 13
Therefore, an adequate diet and especially a sufficient protein intake is vital for these patients.
Shouldn’t we consume more proteins to make sure we do not run out of amino acids?
Indeed, we often consider the value of 0.8g of proteins per kg of bodyweight per day. However, for a patient affected by a disease such as cancer, it is recommended to consume more proteins. Based on current scientific knowledge, it has been shown that a consumption of at least 1.2 to 1.6g/kg/d of high-quality proteins appears to be the ideal intake for optimal health in diseased adults.2 8 14
Furthermore, a 2009 clinical study has tried to find a link between nutrition and mortality reduction in critically ill patients. It has been shown that an increase in energy intake of an average of 1034kcal with 47g of proteins per day can significantly reduce the risk of death in undernourished patients or in important weight loss situation (figure 3).15
Moreover, other studies have shown a strong correlation between increasing energy consumption (> 1.2 g/kg/d) and the improvement of the health status in sick patients, resulting in a mortality reduction. 7 13 16
What can be the solution to adequately meet the nutritional needs of these patients?
There are two solutions to better cover the nutritional needs of these patients.
The first one is simply to enrich the diet. The aim is then to increase the energy and protein intake without increasing the food volume too much. In order to do this, different products can be used, such as milk powder (whole milk, whey or casein), whole condensed milk, grated cheese, eggs, peanut butter, cream, oil and butter. These foods represent either a high caloric load, especially in the case of fatty foods, or a concentrate of essential nutrients, in the case of eggs and milk products. 17
Unfortunately, enriching the diet is often insufficient to meet nutritional needs of the patient, more particularly in older subjects.18 This is the reason why it is possible to consider an oral nutritional supplement. Then we bring high-calories nutritional supplements and especially rich in proteins and micronutrients (vitamins and minerals) in order to fight against malnutrition. These products are easy and fast to assimilate and can be adapted to the patient tastes: drink, dessert cream, soup, etc… The French National Authority for Health (HAS) recommends the prescription of hyper-energetic and/or hyper-protein products to achieve a dietary supplement of 400kcal/d and/or 30g of proteins per day, most often with 2 products per day.19 20
What kind of proteins is contained in these oral nutritional supplements?
These products often contain micellar caseins because they are complete proteins that can meet the nutritional needs of undernourished people. Moreover, they are ideal for the formulation of drinks or dessert creams because they are resistant to heat treatments and they allow for the conservation of the desired texture of the product.21
For more information, please contact us
Authors: Rémi Maleterre & Audrey Boulier.
*A [Essential Amino Acids]: Amino acids the body cannot synthesize. Therefore they must be supplied through the diet.
*B [Anabolism]: Muscular protein synthesis.
 S. Benoist, A. Brouquet (2015). Dépistage de la dénutriton. Nutritional assessment and screening for malnutrition. Journal de Chirurgie Viscérale, 152(1):3-7. Pub February 2015. https://doi.org/10.1016/S1878-
 SFNEP (Société Francophone Nutrition Clinique et Métabolisme). « Nutrition chez le patient adulte atteint de cancer ». SFNEP professional recommandation [présentation of november 2012]
 P. Shetty (2006). Malnutrition and undernutrition. Medicine, 34(12):524-529. Pub December 2006. https://doi.org/10.1053/j.mpmed.2006.09.014
 J.M. Argilés (2005). Cancer-associated malnutrition. Eur J Oncol Nurs. 9(2):S39-50. https://doi.org/10.1016/j.ejon.2005.09.006
 Cancer Treatment Centers of America. “Malnutrition” [online] https://www.cancercenter.com/integrative-care/malnutrition. Last accessed September 3, 2019.
 American Cancer Society: Cancer Facts and Figures 2019. Atlanta, Ga: American Cancer Society, 2019 [online]. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf Last accessed September 3, 2019.
 H.F.R. da Cunha, E.E.M. da Rocha, M. Hissa (2013). Protein requirements, morbidity and mortality in critically ill patients: fundamentals and applications. Rev Bras Ter Intensiva, 25(1):49-55. Pub January 2013. https://doi.org/10.1590/S0103-507X2013000100010
 Poortmans, J.R., Carpentier, A., Pereira-Lancha, L.O., & Lancha Jr., A. (2012). Protein turnover, amino acid requirements and recommendations for athletes and active populations. Brazilian Journal of Medical and Biological Research, 45(10), 875-890. Epub June 06, 2012. https://dx.doi.org/10.1590/S0100-879X2012007500096
 National agency of food safety, environmend and work (ANSES). (2019) Les protéines : définition, rôle dans l’organisme, sources alimentaires. At: https://www.anses.fr/fr/content/les-prot%C3%A9ines
 D.W. Nixon, S.B. Heymsfield, A.E. Cohen, M.H. Kutner, J. Ansley, D.H. Lawson, D. Rudman (1980). Protein-calorie undernutrition in hospitalized cancer patients. The American Journal of Medicine, 86(5): 683-690. Pub May 1980. https://doi.org/10.1016/0002-9343(80)90254-5
 M.F. Holick (2003). Vitamin D: a millennium perspective. J Cell Biochem. 1;88(2):296-307. Pub February 1, 2003. https://doi.org/10.1002/jcb.10338
 D.W. Chang, L. DeSanti, R.H. Demling (1998). Anticatabolic and anabolic strategies in critical illness: a review of current treatment modalities. Shock, 10(3):155-60. Pub September 1998.
 Frebesenius Kabi. « The Role of Protein in critically ill patients » [online]. https://clinicalnutrition.com.ar/en/the-role-of-protein-in-critically-ill-patients/. Last accessed September 6, 2019.
 S.M. Philips, S. Chevalier, H.J. Leidy (2016). Protein « requirements » beyond the RDA : implications for optimizing health. Adv. Physiol. Nutr. Metab. 41(5): 565-572. Epub February 9, 2016. https://doi.org/10.1139/apnm-2015-0550
 C. Alberda, L. Gramlich, N. Jones, K. Jeejeebhoy, A.G. Day, R. Dhaliwal (2009). The relationship between nutritional intake and clinical outcomes in critically ill patients: results of international multicenter observational study. Intensive Care Medicine, 35(10):1728-1737. Pub July 02, 2009. https://doi.org/10.1007/s00134-009-1567-4
 P.J.M Weijs, S.N. Stapel, S.D.W. de Groot, R.H. Driessen, E. de Jong, A.R.J. Girbes, R.J.M. Strack van Schijndel, A. Beishuizen (2011). Optimal Protein and Energy Nutrition decreases mortality in mechanically ventilated, critically ill patients. Journal of Parenteral and Enteral Nutrition, 36(1):60-68. Pub December 13, 2011. https://doi.org/10.1177/0148607111415109
 B. Dorner (2009). Fortify to enhance nutritional value. Today’s Dietitian, 11(7):20. Pub July 2009. https://www.todaysdietitian.com/newarchives/062909p20.html
 C. Gaillard, E. Alix, Y. Boirie, G. Berrut, P. Ritz (2008). Are elderly hospitalized patients getting enough protein? Journal of the American Geriatrics Society. 56(6):1045-1049. Pub June 02, 2008. https://doi.org/10.1111/j.1532-54152008.01721
 I. Bourdel-Marchasson, M. Barateau, V. Rondeau, L. Dequae-Merchadou, N. Salles-Montaudon, J.P. Emeriau, G. Manciet, J.F. Dartiques (2000). A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. Nutrition, 16(1):1-5. Pub January 2000. https://doi.org/10.1016/s0899-9007(99)00227-0
 HAS (French National Authority for Health). « Synthèse des recommandations professionnelles (2007) ». Stratégie de prise en charge en cas de dénutrition protéino-énergétique chez la personne âgée. [online]. https://www.has-sante.fr/upload/docs/application/pdf/synthese_denutrition_personnes_agees.pdf. Last accessed September 4, 2019.
 Ingredia, Prodiet Fluid. The Innovative Micellar Casein dedicated to high protein beverages. [online] https://www.prodiet-fluid.com/. Last accessed September 4, 2019