How to ensure meals contain enough protein and fibre

A nutritious diet is important throughout our lives but as we age, some nutrients become particularly important, such as protein.

As you heard in Week 1, protein is important for the cell growth and function of our muscles. Protein, alongside physical activity, is required to prevent sarcopenia. Sarcopenia is the medical term for loss of muscle mass and function and can lead to greater risk of falls and fractures. Protein is also important for improving bone strength and recovery from illnesses so it’s vital for maintaining independence and quality of life. However, a review of protein intake in older adults in the UK¹ shows that it falls below the EU recommendations and below the UK recommendations for nutritionally vulnerable people. About a quarter of older women consume less than 45g protein a day.

Why can eating enough protein get more difficult with age?

Protein intake of older adults tends to reduce for a number of reasons, including decreasing appetites, poor saliva flow, poor dentition and swallowing issues. As well as these, there is ‘anabolic resistance’ to protein, meaning that the body stops processing it as effectively which is part of the reason why higher levels of protein are required than younger people. There is no simple solution but we know that eating sufficient protein at regular intervals along with physical activity, are all important factors; the more the muscles are working the more protein they can use.

How much protein and fibre should we consume?

The official recommendations for protein intake vary slightly across Europe but whichever recommendations you look at, we should not be eating less protein as we age!

The current UK protein recommendation is 0.75g/kg body weight per day which translates to an average of:

• 56g/day for men
• 45g/day for women².

However, the European Society for Clinical Nutrition and Metabolism (ESPEN)³ and the PROT-AGE Study Group have advised that a healthy older adult’s daily protein intake should be increased to 1-1.2g/kg body weight per day, approximately:

• 83g/day for men
• 66g/day for women.

In the UK, nutritionally vulnerable adults in health and care settings are recommended the higher intake of 1.2g/kg body weight⁴.

As well as protein, it’s important to eat fibre to avoid digestion issues (such as constipation) and to keep the right balance of bacteria in your gut (British Nutrition Foundation: The Science of Fibre). Fibre intake in Western diets is typically too low. The UK recommendation is 30g⁵ but the average intake is approximately 20g/day⁶.

The simplest ways to increase fibre intake are to choose wholegrain versions of everyday foods (wholemeal bread, brown rice and brown pasta), keep the skin on potatoes, and eat foods such as oats, beans, lentils and plenty of fruits and vegetables.

IMPORTANT NOTE: excessive protein intake should be avoided by people with pre-existing kidney (renal) disease⁷, although high protein intake has not been found to impair kidney function in healthy adults⁸.

What’s the best way to eat enough protein each day?

Protein provides the most benefits when it’s spread out across the day rather than eating all of the recommended amount in one meal. For example, to have the best chance of building muscles mass, research suggests we should consume at least 25g of protein three times a day¹.

It’s easy to see how this might be more difficult to achieve at some mealtimes than others, but it is possible if you get into the habit of using high protein foods at each mealtime. Protein fortification of regular food or drinks can provide a flexible and relevant approach for older adults, particularly those with a small appetite. This can be achieved by:

• adding dairy ingredients like milk, yoghurt (look for the high protein ones), quark (soft cheese), milk powders, eggs and cheese into meals – even into simple foods like mashed potato.
• Nuts are a great source too, try adding ground almonds to savoury or sweet meals (beware of nut allergies).
• Soy protein can be a convenient and cost effective option, either for vegetarians or to further fortify minced-meat meals.
• Look in the sports section of supermarkets to find whey protein powders – these are marketed to gym enthusiasts, but actually whey is one of the best proteins to stimulate muscle growth⁹.

Examples of 25g+ protein meals

Breakfast

• one boiled egg (7g protein)
• one slice of wholemeal toast (5g)
• one glass (200ml) of milk (7g)
• a 115g tub of yogurt (5g protein).

Whilst fruit doesn’t contribute much to the protein, it’s also a good idea to start the day with a piece of fruit, such as an orange or banana.

Lunch or tea

• one sandwich (2 slices bread) combining two protein sources such as ham, cheese or tuna. As a guide, you’d need 2 slices of ham and 30g cheddar in 2 slices of bread to reach 25g protein.

Main meal

• one chicken breast would typically weigh 150g and provide 36g protein which would be enough. Combine this with high fibre foods such as vegetables and wholegrains.

OR

• half a 400g can of chick peas would provide 9g protein so it would need topping up with another source of protein.

Task

Have a go at calculating the recommended amount of daily protein for the person you care for. Simply multiply their weight in kilograms by the protein recommendation relevant to their state of health in your region. This will give you the number of grams of protein they should be eating each day.

Divide this amount by 3 to work out how much protein needs to be incorporated into each meal. Share ideas for menu choices that would achieve this in the Comments area below.

In the next few Steps you’ll discover lots of ways you might add protein to every day meals and we’ll share recipe cards, tips and advice on protein-rich dishes for you to adapt for use in your own situation.

References

1. Review of protein intake and suitability of foods for protein-fortification in older adults in the UK by Rachel Smith et al. Critical Reviews in Food Science and Nutrition. 2022.
2. Scientific Advisory Committee on Nutrition. UK Gov 2023.
3. Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group by Jürgen Bauer et al. JAMDA 14 (8), 542-559. 2013.
4. Updated nutrition standards and guidance for healthcare food service BDA The Association of British Dieticians 2023.
5. SACN Carbohydrates and Health Report. Public Health England 2015.
6. NDNS: time trend and income analyses for Years 1 to 9. Public Health England 2019.
7. Dietary protein intake and renal function by Martin, W.F. et al. Nutr Metab (Lond) 2, 25. 2005.
8. Changes in Kidney Function Do Not Differ between Healthy Adults Consuming Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis by Devries Michaela C. et al. Jnl of Nutrition 148 (11), 1760-1775. 2018.
9. Postprandial muscle protein synthesis is higher after a high whey protein, leucine-enriched supplement than after a dairy-like product in healthy older people: a randomized controlled trial by Yvette C Luiking et al. Nutr J 13, 9. 2014.