Cheese products and eating comfort for the elderly

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In some cases, elderly people have difficulty eating due to problems chewing, swallowing and salivating frequently leading to malnutrition and associated pathologies. Providing enriched products for the elderly is an effective way to improve their nutritional intake and prevent health problems. Easy to supplement, dairy products can be an important source of easily digestible protein. Recent research has also shed light on the fact that  these products provide few difficulties for consumption by the elderly, in spite of different textures, from soft to hard.

Certain characteristics must be taken into account when considering food for the elderly. Nutritional requirements change, particularly for protein, going from 0.8g/kg per day to 1 or even 1.2g/kg/day. The body changes too: teeth deteriorate, swallowing is more difficult, saliva production goes diminishes and chewing is less effective. As a result, the simple act of eating can become complicated and painful. These changes often go hand in hand with diseases such as osteoporosis, sarcopenia and undernutrition.

Innovation in Silver Food, another term for food for the elderly, is increasing. The aim is to design foods adapted to the nutritional and sensory needs of the elderly to keep them healthy and to help them continue to enjoy eating. As a result, food in general can benefit from being rethought, and particularly dairy products.

Dairy products are high sources of protein and calcium. According to scientific literature, these are respectively required for muscle synthesis and to reduce the risk of osteoporosis. Customers can choose from a wide range of classic cheese products on the market, depending on their preferences for taste and texture. What about enriched dairy products? What do the elderly like in cheese? Which parameters should be taken into account when making enriched cheese?

Research by Lucie Lorieau, PhD student at the Milk and Egg Science and Technology joint research unit (STLO) sheds light on the importance of the formation of the food bolus on oral comfort when developing enriched cheese products. These results were obtained during her thesis as part of the AlimaSSenS project, accredited by Vitagora.

Surprising results

Hard cheese is not necessarily a source of discomfort

During Lucie’s doctoral studies, model cheeses made with whey protein were developed with different textures ranging from soft to hard. Cheese products were made with neutral flavour to study the perception of oral comfort on a panel of independent-living elderly people, with and without oral problems.

Contrary to what one might expect, the model cheese with a hard texture did not cause oral discomfort. It took longer to chew, but it did not affect oral comfort. "The elderly were perfectly able to eat this type of product," adds Lorieau. "We now need to confirm that it is the case for cheese available on the market".

Oral problems do not affect oral comfort

Chewing, dental and salivatory problems do not reduce oral comfort. "An unexpected result! We presumed that elderly people with dental and oral problems might have more difficulty eating or suffer from more pain if the product sticks, because it will be uncomfortable for their dental prosthesis. But the contrary was observed which is quite positive,” says Lucie. "Apparently, as oral health deteriorates with age, elderly people become accustomed to it and gradually adapt.” With the issue of oral health excluded by this result, it will be easier to develop new enriched dairy products for the elderly.

The food bolus: the real comfort indicator

Chewing food and adding saliva form the food bolus, the first stage of digestion. Food is perceived as comfortable when the food bolus is easy to form. What’s more, hard food is not necessarily difficult to consume if the food bolus is easy to form. "Oral comfort is partly related to organoleptic properties, but the characteristics of the food bolus are more important.” 

Oral condition does not directly affect the comfort of the mouth, but it does affect food bolus formation. "The process is less effective when teeth have deteriorated and saliva is reduced," explains Lucie. If chewing capacity is reduced, the food bolus is less homogeneous, making it more difficult to swallow and digest, causing uncomfortable digestion.

Whey protein

More effective for muscle synthesis than casein

"Classic dairy products are made with casein, the protein from milk. Coagulation of casein is the first phase of cheese making,” explains Lucie Lorieau. As part of her thesis, she replaced casein with whey protein, usually a cheese byproduct, to develop cheese products that are rich in protein and easy to digest. "Studies of liquid products have shown that whey protein is twice as effective in the stimulation of muscle as casein. The use of whey protein could improve the nutritional intake for the elderly without increasing the amounts consumed," she continues.

An opening onto additional analyses

"Differences have been observed in the digestion of model cheeses rich in whey protein compared with casein-based cheese. The impact on muscle synthesis in the elderly must now be observed. If the nutritional advantages of solid cheese products are confirmed, we will have a range of products with different textures. A real win! Though currently satisfactory, there is also room for improvement in the taste and appearance of these cheese products," she concludes. The ultimate goal is to offer food that is good to eat, that provides real pleasure to prevent monotony, and also meets protein requirements in the elderly.

Keywords

Health, senior, elderly, diet, aging, whey protein, dairy products, comfort, dentition, salivating, chewing

Further reading

• Assad-Bustillos, M., Tournier, C., Septier, C., Della Valle, G., and Feron, G. (2017). Relationships of oral comfort perception and bolus properties in the elderly with salivary flow rate and oral health status for two soft cereal foods. Food Res. Int.
• Lorieau, L., Le Roux, L., Gaucheron, F., Ligneul, A., Hazart, E., Dupont, D., and Floury, J. (2018). Bioaccessibility of four calcium sources in different whey-based dairy matrices assessed by in vitro digestion. Food Chem. 245, 454–462.
• Lorieau, L., Halabi, A., Ligneul, A., Hazart, E., Dupont, D., and Floury, J., (2018). Impact of the dairy product structure and protein nature on the proteolysis and amino acid bioaccessiblity during in vitro digestion. Food Hydro
• Vandenberghe-Descamps, M., Labouré, H., Septier, C., Feron, G., and Sulmont-Rossé, C. (2017). Oral comfort: A new concept to understand elderly people’s expectations in terms of food sensory characteristics. Food Qual. Prefer.
• Senior et Sens : https://www2.dijon.inra.fr/senior-et-sens/index.php