PROMISS (PRevention Of Malnutrition In Senior Subjects in the EU) 

The challenge of malnutrition

With the European population growing older, the challenge is to keep an increasing number of seniors across all European countries healthy and active.

In Europe, between 13.5 % and 29.7 % of older adults living at home are malnourished or at risk of protein energy malnutrition.

PROMISS aims to better understand and ultimately prevent protein energy malnutrition in seniors. Thereby, PROMISS will contribute to improve active and healthy ageing

PROMISS activities

Within PROMISS, malnutrition is tackled with a specific focus on the prevention of protein-energy malnutrition.

To do so, PROMISS makes use of large scale databases to understand the relationships between food intake, food characteristics, physical activity, the oral and gut microbiota, and poor appetite, malnutrition and poor health among older adults. Preferences and attitudes of older persons with regard to food intake and physical activity are also identified.

Based on the outcomes of this research, PROMISS has developed optimised, sustainable and evidence-based dietary and physical activity strategies, which are now being tested for effectiveness and cost-effectiveness in a long-term intervention study.

The project will show whether these strategies together with new food concepts and products will prevent malnutrition and support active and healthy ageing.

Next steps

The feasibility of increasing protein intake in older persons with a low protein intake, and the potential beneficial effect on relevant clinical outcomes are currently under study in our project.

To disseminate on the final outcomes, PROMISS will also produce:

•             a roadmap that outlines the steps, goals, milestones and deliverables for product development.

•             a masterclass training course that translates scientific results of PROMISS for the food industry and small and medium enterprises.

A list of continuously updated research highlights can be found here:

PROMISS (PRevention Of Malnutrition In Senior Subjects in the EU) is a multi-country project aiming to turn the challenge of tackling malnutrition in community-dwelling older persons into an opportunity for healthy ageing for the future.

The PROMISS consortium contains worldwide expertise in epidemiology, clinical trials, geriatrics, nutrition, physical activity, microbiomics, as well as in behaviour, consumer, sensory  and computer sciences. It builds on strong collaborations with food industry and SMEs to strengthen innovation of the European agri-food sector and their market position. Existing data from scientifically well-established prospective aging cohorts and national nutritional surveys from Europe and ‘third countries’ will be combined with new data from short- and long-term intervention studies in older persons at risk. Its holistic approach will provide insight in the causality of the links between diet, physical activity, appetite and malnutrition and underlying pathways, thereby providing the necessary evidence to develop optimal, sustainable and evidence-based dietary and physical activity strategies to prevent malnutrition and enhance active and healthy aging. PROMISS will also deliver food concepts and products as well as persuasive technology to support adherence to these strategies. The dietary and physical activity strategies and food products will be specifically developed with older user involvement to meet the needs and fit the preferences of older consumers. In close collaboration with stakeholders, PROMISS will translate these strategies into practical recommendations to guide policy and health professionals at EU- and Member States level. Dissemination and implementation takes place through strong dissemination partners operating on an European level and linked to national networks across Member States. PROMISS promises prevention of malnutrition, additional healthy life years and a strengthening of EU’s food industry.

Work packages:

PERT diagram showing the overall relationship of work packages of the PROMISS project

First results:

  • Older adults with a poor appetite consumed less protein and dietary fiber, less solid foods, smaller portion sizes, less wholegrains, and less fruits and vegetables than older adults with a very good appetite. They consumed more dairy foods, fats, oils, sweets and soda’s. (van der Meij et al. 2017)
  • Of those aged 85 years and older, 28% were below the commonly used protein intake target (0.8g of protein per kg of adjusted bodyweight per day). This group ate less meat, more cereals and drank more non-alcoholic beverages than those who had adequate protein intake. (Menonҫa et al. 2017)
  • Older adults with a lower protein intake seem to be at greater risk of developing mobility limitations over 6 years. (Houston et al. 2017)
  • Low protein intake may negatively affect muscle strength and physical performance in late life, and a combination of adequate protein intake and physical activity may be necessary to reduce the loss of muscle strength in the very old. (Granic et al. 2017)
  • Higher protein intake may lower the risk of developing chronic protein-energy malnutrition in community-dwelling older adults. (Hengeveld et al. 2018)
  • The Protein Screener 55+ (Pro55+) was developed and validated to screen for low protein intake in community-dwelling older people. An online version is available for researchers and can be found at (Wijnhoven et al. 2018)
  • Four different disability trajectories were identified between the ages of 85 and 90: 1) a constant very low disability trajectory (difficulty with none or 1 ADL)  over the 5 years; 2) a low disability trajectory (difficulty with 2 ADLs) that steadily progressed to mild disability (5 ADLs); 3) a mild disability score (4 ADLs) at 85 that increased to moderate disability (10 ADLs) by age 90; and 4) a moderate disability score (9 ADLs) that progressed to severe disability (14 ADLs) after 5 years. Those with higher protein intake, especially those at or above 1 g per kg of body weight per day (70g of protein per day for a 70 kg person), were less likely to develop disabilities. (Menonҫa et al. 2018)

25 Partners:

VrijeUniversiteit Amsterdam, Haskoli Islands University Iceland, University of Newcastle Upon Tyne United Kingdom, National Institute for public health and the environment The Netherlands, SyddanskUniversitet Denmark, GoeteborgsUniversitet Sweden, Netherlands Organization for Applied Scientific Research the Netherlands, VIVES University College Belgium, Ghent University Belgium, HAS University of Applied Sciences the Netherlands, Kellogg Management Services United Kingdom, Laboratoires Grand Fontaine Spain, Fonterra the Netherlands, Blonk Consultants the Netherlands, Frigilunch Belgium, Henri BV Belgium, University of Helsinki Finland, The European Federation of the Association of Dieticians the Netherlands, European Society for Clinical Nutrition and Metabolism Luxemburg, European Geriatric Medicine Society Belgium, Friedrich-Alexander-Universitaet Erlangen Nuernberg Germany, AGE platform Europe AISBL Belgium, Université de Sherbrooke Canada, Amsterdam AMC – location VU University Medical Center, HAN University of Applied Sciences the Netherlands.

Contact & information:

Please visit our website:

Twitter: @PROMISS_VU