Poor oral health conditions represent an aggravating factor significantly linked to the risk of undernutrition.

In practice, doctors from the institutions for dependants elderly people prescribe enriched food (spontaneous oral feeding), "enriched" food elements (common food) and/or nutritional supplements for undernourished people.

The choice of food takes into account the poor oral health conditions of the target populations: normal, mixed or soft texture (8).

When a malnourished person needs enriched food, dishes can be enriched in proteins and in energy with eggs, some cream, some grated cheese, some powdered milk or some milk proteins (a nutritional supplement) (9). But certain persons do not appreciate the taste of milk given to food, and these home-made enriched dishes generally have a soft texture (soups, quiches, cheese-topped dishes, sweets, etc.). It is true also for the oral nutritional supplements (ONSs), which are often dairy creams or drinks (10,11). But the elderly often complain about an exclusively soft or mixed food, which constitutes an additional source of anorexia and malnutrition (12-15).

According to a clinical trial (16):

• 50% of the elderly patients who have a normal diet do not eat the recommended dietary allowance.
  100 % of patients who have to have a soft or mixed diet do not eat the recommended dietary allowance.
• 40% of the elderly patients who have a normal diet do not eat the recommended protein intake
  93% of patients who have to have a soft or mixed diet do not eat the recommended protein intake.

Another study carried out on 51 patients hospitalized in the geriatricward in Nice University Hospital showed that (17):

• 23 % of the patients refused to consume high protein ONSs in the form of drinks or of creams,
• 8 % did not take them systematically and
• 24 % did not finish them. The main causes of refusal were the milky or too much sweetened taste, the liquid texture or the effect of ballast which got away the appetite from the following meal (17).

As the preservation of the nutritional state is directly bound to the masticatory ability (18,19), Protibis cookies constitute a solid nutritional supplement conceived for the persons having a bad oral state (20-23).

Protibis cookies have an innovative a three-level texture (crunched, dipped or soften). They can be even crunched by the persons having a bad oral state: they break easily between the toothless jaws. In case of fatigue of masticatory muscles or oral dryness, Protibis cookies can be dipped into a warm or cold drink without splitting too quickly. For the persons having swallowing disorders, they can be crumbled and softened in a drink.

Conclusion

Several clinical studies have been realized with Protibis cookies at the hospital and in nursing homes. These studies showed that Protibis cookies pleased most of the malnourished elderly, including those who had a poor dental state.

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