Protibis

Study 3 : Frequent meals and snacks

4 to 8 Protibis cookies : Intake of protein concentrated under a small volume easy to split during the day.

Most of malnourished elderly like to eat 4 to 8 small Protibis cookies daily, at breakfast or as a snack.

 

Abstract

 

This clinical study aimed to verify that the recommended posology of 8 Protibis cookies a day was suited to the elderly, with a daily contribution of 10.7 g of protein and 225 kcal. It was also necessary to verify that 8 cookies could be eaten at breakfast and at tea-time without decreasing appetite for the following meal.

 

This study conducted on 11 patients was planned for 3 weeks in a nursing home and at the hospital.

This study of acceptability shows that it is possible to provide a supplement of 10 g of protein a day with 8 high-protein, high-energy Protibis cookies, to a large part of institutionalized elderly.

A majority of malnourished patients enjoyed eating 8 cookies a day at breakfast or at tea-time, even after 3 weeks of daily consumption. 
This solid and crisp food increases the appetite of anorexic patients who often have a bad dental state and need a soft diet (mixed and mashed food).

 

It is generally not necessary to encourage these patients to eat Protibis cookies. The nursing staff appreciated the simplicity of use and the absence of unnecessary waste.

 

 
 

Test in a geriatric ward: the majority of malnourished elderly enjoyed eating 8 small Protibis cookies every day, at breakfast and at tea-time

This study had for objective to verify that the recommended posology, 8 Protibis cookies a day was suited to the elderly. This posology gives a daily contribution of 10.7 g of protein and 225 kcal. It was also necessary to verify that 8 cookies could be easily at breakfast or at tea-time, without decreasing appetite in the following meal.

People who have reduced appetite (anorexia) have difficulties in increasing their intake of protein and energy by increasing their daily food ration.  An anorexic elderly person will not eat larger portions and will not requests seconds.  In addition, a voluminous meal will "bloat the stomach" and the person will eat less at the following meal.

 To fight against malnutrition, it is necessary to give food which in a similar volume or weight contains more protein and energy. As a comparison:
- a Protibis cookie weighs 6 g; 
- a “Petit Beurre Lu” cookie weighs 8.3 g (Kraft Food, Vélizy Villacoublay, 78); 
- a high-protein, high-energy oral nutritional supplement (ONS), Nutra' Cake cookie, weighs 35 g (Lactalis, Torcé, France).

For 100 g:
- Protibis cookies contain 22.2 g of protein, 468 kcal and 19 % of the metabolizable energy intake (MEI) in protein; 
- “Petit Beurre Lu” cookies contain three times less protein with 7.2 g of protein, 434 kcal and 6.7 % of the MEI in protein; 
- Nutra' Cake cookies contain some palm oil and less protein, with 16.9 g of protein, 386 kcal and 18 % of the MEI in protein (prune-flavored cookie).

The recommended daily dose is 8 Protibis cookies; it weighs 48 g and this dose provides 10.7 g of protein. Eight cookies are easily distributed during the day, without waste. Other ONS in the form of drinks or creams bring generally between 10 g and 20 g of protein, under a volume of 100-200 ml or approximately 100-200 g. It is necessary to serve them fresh, because of microbial proliferation. In addition,it should be noted that the elderly have a slowed-down gastric draining of liquids (1-4).

This clinical test included 11 patients for a period of 3 weeks. It was realized in a nursing home and at the hospital in a geriatric long-stay ward. The investigators chose patients who needed an enriched food supply and the taking of other ONSs was not a criterion of exclusion. The study consisted of observing the conditions of use of Protibis. A single 6 g-cookie brings 1.3 g of protein and 28 kcal, with 22 % of the weight in protein and 19 % of the MEI in protein. In order to bring 10 g of protein to the patient, the recommended posology is 8 cookies per day.

Eleven patients were included in the study, with a mean age of 86 (M/F ratio 1/10). This study showed that these very aged and malnourished patients took without any trouble 8 Protibis cookies every day during 3 weeks. At the end of 3 weeks of cookies distribution, the level of consumption remained at approximately 8 cookies a day (average > 7.6 cookies a day). Only one patient grew tired of eating 8 cookies a day after 3 weeks of daily consumption.

Certain patients asked for more cookies and 8 patients needed no encouragement to eat cookies. The patients who had swallowing disorders (8/11 patients) were able to eat cookies dipped or crumbled into a drink.

The 10 staff members filled satisfaction surveys: they were globally satisfied with this new product. They found that Protibis cookies were very much appreciated by the residents, that this protidic supplement was practical, economic and allowed to limit waste. The charts results are detailed below.

Conclusion

This study of acceptability shows that it is possible to provide a supplement of 10 g of protein a day with 8 high-protein, high-energy Protibis cookies to most of the elderly residents in care facilities. A large majority of malnourished and elderly patients eat 8 cookies a day easily and with pleasure at breakfast or at tea-time, even after 3 weeks of daily consumption. This solid and crispy food increases the appetite of anorexic patients, who often have a poor dental state and therefore need a soft-mixed diet. It is generally not necessary to encourage them to eat Protibis cookies. The nursing staff appreciate the simplicity of use and the absence of waste.

Detail of the results

Eleven anorexic elderly were selected for the test. The mean weight remained stable during the 3 weeks of the study:
- Before cookies 52.6 kg + 9.7 kg
- After 3 weeks of cookies daily consumption: 52.7 kg + 9.9 kg.

The mean appetite increased from 4.6 to 7.2 on a scale of 10.
Notation ranged from 0 (I’m absolutely not hungry) to 10 (I am ravenous):
- Before cookies the mean appetite was noted 4.6 + 4.2 on 10
- After three weeks of cookies distribution the appetite was noted 7.2 + 1.8 on 10.

Acceptability: most of the patients ate 8 cookies a day during 3 weeks.
The average consumption of cookies was:
- The 7th day: 7.6 cookies + 1.2 on 8,
- The 14th: 7.7 cookies + 0.6 on 8,
- The 21th day: 7.6 cookies + 12 on 8.

The majority of the patients did not need encouragement to eat the cookies.
Average mark: 2.5 + 0.8 on 3. Notation:
- 1: it is necessary to encourage the patient a lot (1 patient)
- 2: it is a little bit necessary to encourage the patient (2 patients)
- 3: no need to encourage the patient (8 patients).

Cookies were generally entirely eaten.
Average mark: 3.8 +0.4 on 4. Notation: 
- 1: no, the patient does like the cookies
- 2: no, the patient chews but does not really eat cookies
- 3: yes, the patient nibbles
- 4: yes, the patient eats the whole cookie.

Eight patients had swallowing disorders.
Average mark: 1.7 + 0.9 on 3. Notation:
- 1: yes, swallowing disorder (6 patients)
- 2: yes, small swallowing disorder present (2 patients)
- 3: no, no swallowing disorder (3 patients).

The nursing staff members are globally satisfied by Protibis cookies.
Notation from 1 (absolutely not satisfied) in 4 (very satisfied): 
- Were the cookies appreciated by the residents? Yes: average mark 3.9 + 0.3 on 4.
- Is this protein supplement practical? Yes: average mark 3.6 + 0.5 on 4.
- Is this new product economic by limiting the wasting? Yes: average mark 3.4 + 0.8 on 4.
- Are you globally satisfied by this new product? Yes : average mark 3.4 + 0.8 on 4.

 References

1. Milne AC, Potter J, Avenell A. Cochrane collaboration. Protein and energy supplementation in elderly people at risk from malnutrition (Review). The Cochrane Library Issue 1 2008.

2. Arvanitakis M, Beck A, Coppends P et al. Nutrition in care homes and home care: How to implement adequate strategies (report of the Brussels Forum (22-23 November 2007)). Clin Nutr 2008, 27:481-488.

3. Paddon-Jones D, Short KR, Campbell WW et al. Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr 87(suppl): 2008, 1562S– 6S.

4. Volkert D, Bernenr YN, Cederholm T et al. ESPEN guidelines on enteral nutrition: geriatrics. Clin Nutr 2006, 25:330-360.