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NEWS AND VIEWS DOI: 10.1111/nbu.12063

The 2013 FAO report on dietary protein

quality evaluation in human nutrition:
Recommendations and implications
S. Leser
Volac Human Nutrition, Hertfordshire, UK

Summary In January 2013, the Food and Agriculture Organization (FAO) of the United
Nations released a new report on dietary protein quality, the result from an
Expert Consultation that followed the International Symposium on Dietary
Protein for Human Health, held in New Zealand during March 2011. The report,
‘Dietary protein quality evaluation in human nutrition’, is part of the call from
the United Nations to promote sustainable diets and health, and was motivated
mainly by advances in methods available to measure the quality of nutritional
proteins with more accuracy. The main recommendation from the report concerns
a new, advanced method of assessing nutritional protein quality. The FAO report
recommends that the new method, known as Digestible Indispensable Amino
Acid Score (DIAAS), replaces Protein Digestibility Corrected Amino Acid Score as
the preferred method to describe protein quality and that it is adopted in Codex
food labelling and claims guidelines. In addition, the report recommends that
future research determines protein and amino acid needs that may be above the
minimum requirements in certain circumstances. This article provides a summary
of the report’s findings, discusses its recommendations and implications, and out-
lines the next steps before the new protein quality method DIAAS can be fully
adopted.

Keywords: Codex, legislation, nutritional requirements, protein quality, sustainable diets

Protein quality evaluation evaluation measures bioavailability, i.e. the proportion

Proteins are not nutritionally equal and vary according
to origin, individual amino acid composition and
bioactivity. Proteins play many important roles in
human health and wellbeing, and the methods to assess
their nutritional quality, impact of processing and
appropriate levels of intake need to be reviewed as new
research emerges (Boye et al. 2012). Protein quality
Correspondence: Ms Suzane Leser, Head of Nutrition, Volac
Human Nutrition, Volac House, Orwell, Royston, Hertfordshire
SG8 5QX, UK.
E-mail: suzane.leser@volac.com
of amino acids that can be absorbed from the diet and
utilised in the body. It is a relative measure that aims to
predict the capacity of food protein sources and diets to
satisfy the body’s demand for amino acids and nitrogen
(WHO 2007). It accounts for additional specific needs,
such as for growth, pregnancy, lactation, illness and
recovery, and the match between dietary supply and
human protein needs is vital to support health and well-
being. In the future, protein quality evaluation is
expected to also consider the needs for the less under-
stood demands from ageing, maintenance of optimal
health, physical activity and management of weight loss
(Millward et al. 2008; FAO 2013).

© 2013 British Nutrition Foundation Nutrition Bulletin, 38, 421–428 421

422 S. Leser
Methods to evaluate protein quality have been dis-
cussed by the FAO since the 1950s to enable compari-
sons of the adequacy of different staple protein sources
to meet overall human protein requirements. Protein
sources with a higher protein quality score are better
able to supply amino acids for use by the body. Not
without their limitations, a number of methods exist to
evaluate protein quality, and these generally consider
the amino acid composition, the digestibility of the
protein and the bioavailability of individual amino acids
(Boye et al. 2012).
The Protein Digestibility Corrected Amino Acid Score
(PDCAAS) was the method chosen by the Codex Com-
mittee on Vegetable Proteins in the late 1980s. It was
adopted by the 1991 Joint FAO/WHO Expert Consul-
tation on Protein Quality as the best method available at
that time to describe dietary protein quality (FAO/WHO
1991). In use for over 20 years, the PDCAAS has been
widely accepted but also criticised for important tech-
nical limitations, as discussed below.
Limitations of the Protein Digestibility
Corrected Amino Acid Score (PDCAAS)
There are three critical limitations in the PDCAAS
method: (1) overestimation: PDCAAS is based on an
estimate of crude protein digestibility determined over
the total digestive tract, yet protein in faeces is mainly
microbial in origin. The values derived from using this
method generally overestimate the amount of amino
acids absorbed, which contributes to narrowing the dif-
ference between high- and low-quality protein sources,
and highly and poorly digestible proteins; (2) trunca-
tion: PDCAAS has been applied in conjunction with
‘truncation’, which rounds down protein digestibility
scores to a maximum of 1.00 when scores exceed 100%
of the body’s indispensable amino acid requirements.
This underestimates the higher nutritional value of
animal proteins, in particular; (3) bioavailability:
PDCAAS overvalues the quality of proteins containing
anti-nutritional factors and does not account for
reduced bioavailability of some amino acids that are
susceptible to damage during food processing, such as
lysine, which can become biologically unavailable.
The 2011 FAO Expert Consultation
The Expert Consultation forms part of the call from the
United Nations (UN) to promote sustainable diets, bio-
diversity and human wellbeing (Burlingame & Dernini
2012). Finding a method that describes dietary protein
quality as accurately as possible has been driven by the
importance of optimally matching food supply and
human protein needs against the backdrop of a rapidly
growing world population and limited land, water and
food resources (FAO 2013). A previous 2007 FAO report
on ‘Protein and amino acid requirements in human nutri-
tion’ highlighted a number of areas of concern relating to
protein quality evaluation, both conceptual and techni-
cal, that had not been fully resolved, and identified likely
circumstances where poor protein quality might compro-
mise nutritional status (FAO/WHO/UNU 2007). In
2010, the International Dairy Federation (IDF) expressed
to the FAO their concerns regarding the PDCAAS
method and explained its limitations (IDF 2013). The
latest Expert Consultation subsequently took place after
the International Symposium on Dietary Protein for
Human Health, held in New Zealand during March
2011. The work received funding from the UN as well as
private funding from New Zealand’s Riddet Institute and
sections of the dairy industry. A total of 33 scientific
papers that informed the FAO report are published in the
British Journal of Nutrition (v. 108, Suppl. 2, Aug 2012).
The final report, ‘Dietary protein quality evaluation in
human nutrition’ (FAO 2013), was released in January
2013, containing two additional post-consultation sub-
committee reports (Gilani et al. 2012; Uauy et al. 2012).
The new FAO report builds on and extends the knowl-
edge from previous FAO/WHO reports on this topic.
Recommendations of the report
To validate a more accurate method for assessing
protein quality: Digestible Indispensable Amino Acid
Score (DIAAS)
The report proposes a new method for assessing the
quality of dietary proteins, the DIAAS. The method
attempts to use the best scientific information currently
available to describe how each dietary protein source
can meet human protein and amino acid requirements,
with more accuracy. This is the most important change
in protein quality evaluation since the PDCAAS was
introduced 20 years ago.
DIAAS is expected to overcome the limitations of
PDCAAS: (1) overestimation: DIAAS will focus on indi-
vidual amino acid digestibility, as opposed to crude
protein, and will determine amino acid digestibility at the
end of the small intestine (terminal ileum), which pro-
vides a more accurate measure of the amounts of amino
acids absorbed by the body and the protein’s contribu-
tion to a human’s amino acid and nitrogen requirements;
(2) truncation: DIAAS will remove the PDCAAS ‘trun-
cation’, which will better separate proteins at the top end
of the scoring system and recognise the nutritional value
© 2013 British Nutrition Foundation Nutrition Bulletin, 38, 421–428

of higher quality proteins as supplements to low-quality
proteins; (3) bioavailability: DIAAS methodology is
expected to determine bioavailable lysine more accu-
rately, removing this additional difference in nutritional
quality. The amino acid lysine is essential for healthy
growth in children, for calcium absorption and to form
collagen for healthy connective tissues. As the report
debates, indispensable amino acids such as lysine can be
significantly destroyed during food processing, mainly
cereal processing. Current analytical methods to deter-
mine lysine in foods do not distinguish well between
destroyed and bioavailable lysine, but new testing is
expected to do so.
To include a measure of protein quality in nutrition
claims made in foods
The report provides the FAO with tools to address
practical questions such as the standards to be applied
in Codex claims and labelling guidelines. The report
endorses adoption of a measure of protein quality,
determined by DIAAS, in Codex nutrition claims
related to protein. This would mean that to qualify for
the nutrition claim ‘source of’ protein, a food would
have to meet not only the well-established criteria for
protein quantity, but also a cut-off score for quality that
would distinguish between ‘high’ (100 or more),
‘source’ (75–99) and potentially no claim if the quality
score does not meet the minimum requirement (less
than 75). Any claim will have to reflect the amino acids
that are available, absorbed and able to be used by the
body. For adults, preliminary DIAAS data suggest that
milk and soy proteins would be eligible for a claim
based on quantity and quality, whereas wheat and peas
would be judged as low-quality protein and not eligible
to make a claim. DIAAS data for other important
dietary protein sources, such as meat, fish and egg, need
to be developed.
The many limitations of the old PDCAAS method
have contributed to preventing protein quality from
being established in regulation, but DIAAS can enable
this to happen. This is important for food products
carrying nutrition claims about their protein content, as
significant differences (up to 50%) in the protein digest-
ibility of various foods arise from inherent variances in
the nature of food protein (e.g. protein configuration
and amino acid bonding), the presence of non-protein
constituents that modify digestion such as dietary fibre,
and the presence of anti-nutritional factors (occurring
naturally or formed during processing) that may alter
the bioavailability of amino acids and do not provide
the same contribution to a human’s nutritional require-
© 2013 British Nutrition Foundation Nutrition Bulletin, 38, 421–428
FAO dietary protein report 423
ments (Gilani et al. 2005). In summary, the regulatory
recommendations from the report, if adopted by Codex,
could provide the foundation for health and nutrition
claims being based on protein quality in food legislation
(Gander 2013; Moughan 2013).
To determine specific amino acid requirements for
healthy populations
In light of the increased scientific activity investigating
the value and role of specific amino acids, the Expert
Consultation goes further, recommending the need for
future research to determine specific amino acid require-
ments in different circumstances, such as ageing and
physical activity, as well as gender effects. It also sug-
gests that ongoing research may prove that there are
circumstances in which benefits accrue from intakes
above the minimum protein requirements, not only to
prevent deficiency but also to support good health, well-
being and reduced risk of chronic disease at various
stages of life.
The consequences of inadequate protein intake are
well known, but less well known is the optimal protein
and amino acids intake. The report reveals a new mean
basic requirement of 0.91 g protein/kg/day and a popu-
lation estimate of 0.99 g protein/kg/day, as opposed to
the current 0.83 g protein/kg/day, which suggests that
the protein requirements recommended by the WHO
are low by around 70% (Pencharz 2013). The report
also gives examples of studies in which it has been
suggested that benefits may accrue from protein intakes
greater than the minimum requirements to optimise
certain health outcomes in people of different ages and
physiological states, in contrast to the previous focus on
determining protein and amino acid requirements to
meet basic body nitrogen balance. These examples
include weight loss, resistance physical activity and
chronic inflammation. It also discusses situations in
which it is desirable to increase the intake of specific
amino acids, such as in the elderly. Research in this
direction is encouraged by the Expert Consultation and,
recently, the PROT-AGE Study Group (formed by the
European Union Geriatric Medicine Society, the Inter-
national Association of Gerontology and Geriatrics, and
other scientific organisations) developed and updated
the evidence-based recommendations for optimal
dietary protein intake that come with ageing, and rec-
ommended that older people should consume an
average daily intake of 1.0 to 1.2 g protein/kg/day, pro-
viding 25 to 30 g protein per meal and about 2.5 to
2.8 g of the essential amino acid leucine, with the caveat
that more studies, with better methodologies, are
424 S. Leser
desired to refine the protein recommendations for older
adults (Bauer et al. 2013).
Implications of the report
The recommendations from the report are expected to
impact on the food industry, food assistance pro-
grammes and current standards in nutrition, particu-
larly those for vulnerable populations. It provides
health professionals, regulators, policy makers and
world bodies with the best available information on
what constitutes a high-quality protein and with a
more accurate representation on which foods should
be part of a diet that can improve nutrition within our
growing population.
Food industry
The dairy industry was the first to welcome the recom-
mendations of the FAO Expert Consultation, noting that
the recommendations from the report have taken the IDF
concerns with PDCAAS into account (IDF 2013) and
that the new method DIAAS provides important infor-
mation on how foods contribute to a sustainable diet
(GDP 2013). DIAAS confirms the higher bioavailability
of milk and soy proteins when compared with other
plant-based protein sources, and milk proteins’ ability to
complement the lower quality sources for efficient use of
available foods. Data in the FAO report shows whole
milk powder to have a DIAAS score of 1.22, compared
with 0.64 for peas and 0.40 for wheat. When compared
with soy isolates, DIAAS scores for milk proteins were
10% to 30% higher (Moughan 2013).
The European Natural Soy Foods Association (ENSA)
was the next to issue a position statement on the revised
protein quality method. Although confident that the high
quality of soy proteins will be confirmed by both
PDCAAS and DIAAS methods, ENSA noted that the new
method still needs to be developed, as animal studies are
not representative of the situation in humans and human
data will be very difficult to obtain. Furthermore, ENSA
expressed the opinion that the DIAAS method is only
relevant in developing countries, where protein/energy
malnutrition is common and where it is important to
identify the protein sources that could help limit short-
ages of important amino acids. ENSA believes that in
Western countries, there is no shortage of specific amino
acids owing to the varied diet consumed, and therefore,
the proposed new method is not relevant in such settings
(ENSA 2013; Starling 2013). Some dairy businesses
refuted ENSA’s suggestions, stating that protein defi-
ciency is still an issue in developed societies, especially as
the elderly population grows (Astley 2013b). In Europe,
5% of the population is at risk of undernutrition
(Ljungqvist 2010). In the European population aged
above 65, this figure rises to 10% and for those aged
75–80 years and living at home, as many as 20% are at
risk of undernutrition (Ljungqvist 2010). Calculations
extrapolated from the European Society for Clinical
Nutrition and Metabolism (ESPEN) sister society, the
British Association for Parenteral and Enteral Nutrition
(BAPEN) (UK) to the European Union situation indicates
that as many as 20 million individuals are at risk of
undernutrition and that the cost for society of
undernutrition is around 120 billion Euros annually
(Ljungqvist 2010). In the developed world, DIAAS may
be directly relevant to anyone whose food or protein
intake may be compromised, including the immune-
compromised and sports people, especially female ath-
letes, where adequate protein consumption is not always
the case (Phillips 2012).
The relative ranking of protein sources in terms of
quality will change with DIAAS, and protein efficiency
directly impacts on the commercial value of a protein
product. The current PDCAAS method has been widely
used to market the nutritional value of both plant and
animal proteins in foods. However, in changing the
method, the differences in protein quality will become
more apparent, mainly at the competitive top end of the
scoring system. If this goes ahead, manufacturers and
suppliers of low-quality protein sources and mixtures,
which are not able to carry a health or a nutrition claim,
may be pushed to improve the nutritional profile by
blending with proteins of higher value.
In Europe, the regulation of nutrition and health
claims on foods does not define or include protein quality
in protein-related nutrition claims and does not consider
protein quality as part of the criteria to make authorised
protein-related health claims. Although the scientific
opinions on health claims applications issued by the
European Food Safety Authority (EFSA) acknowledge
that differences in quality between proteins exist, their
recommendations do not, at this time, adopt a definition
for protein quality that would complement protein quan-
tity (NDA 2010). This is based on the fact that the varied
European diets generally meet basic protein and amino
acid needs because intake of high-quality proteins domi-
nates over low-quality proteins (NDA 2012). Therefore,
the current regulatory environment has established that
all proteins are considered nutritionally equal, by defini-
tion. This has compromised the industry’s ability to give
consumers accurate information about the nutritional
quality of the protein in their foods within marketing
communications (Astley 2013a).
© 2013 British Nutrition Foundation Nutrition Bulletin, 38, 421–428

Sustainable diets
According to the Chair of the Expert Consultation,
over the next 40 years, accurate information to evalu-
ate a food’s profile and its ability to deliver nutrition is
essential to create sustainable diets that can meet the
nutritional needs of a 9 billion global population
(Moughan 2013). In the developed world, high-protein
diets (diets providing more than 0.83 g protein/kg/day
and/or where protein contributes 20% or more of total
energy intake) have been increasingly identified as
important for improving health markers, managing
bodyweight and maintaining lean body mass (Clifton
2012; Westerterp-Plantenga et al. 2012; Wolfe 2012).
Thus, the role of dietary protein quality will be
central, especially when viewed against an expanding
world population and a finite food supply (Moughan
2013). As access to high-quality dietary protein varies
according to social, economic and other geopolitical
factors, the future holds challenges around the nutri-
tion paradox of undernutrition and obesity, and con-
sequent disease burdens that will need to be given
greater attention (Boye et al. 2012). While there is still
the need to define a ‘sustainable diet’, recommenda-
tions exist for regimens that are less dependent on
meat proteins, without going beyond the limits set by
nutrition and health, by using alternative protein
sources (Boer et al. 2006). The new DIAAS method is
a tool that is expected to inform the efficient distribu-
tion of protein resources to supply the higher world
demand for protein and ensure adequacy of protein
intakes in developing countries (Gander 2013;
Moughan 2013).
Public health
In general, the current approach to establishing amino
acid and protein requirements for human adults is that
the total protein intake should be in equilibrium with
protein losses. The current definition of protein require-
ment is the lowest level of dietary protein intake that
will balance body nitrogen losses, and thus maintain the
body’s protein status, in persons at energy balance with
modest levels of physical activity (FAO/WHO/UNU
2007). It is acknowledged that this definition addresses
the lowest level of dietary protein intake that will
balance body losses, however does not necessarily iden-
tify the optimal intake for health, which is less quanti-
fiable (Uauy 2013). Other issues under consideration
are: (1) whether the recommended protein intakes are
based on the assumption that the protein obtained from
varied diets are of high quality; and (2) whether current
© 2013 British Nutrition Foundation Nutrition Bulletin, 38, 421–428
FAO dietary protein report 425
requirements, specifically intended to meet the needs of
healthy populations, change in the case of at-risk popu-
lations (e.g. the elderly, illness and infection) and are
accurately represented by nitrogen balance (Uauy
2013). Recent changes in lifestyle, dietary habits, energy
expenditure and new challenges in populations with
significant non-communicable disease burdens require
that protein and amino acid recommendations, guide-
lines and relevant legislation are reviewed and, if neces-
sary, revised to maintain their relevance (Boye et al.
2012). In addition, consumers in the developed world
have become increasingly concerned and aware of the
relationship between diet, food intake and health, and
the increased interest in nutrition and healthy eating has
led consumers to expect more detailed and accurate
information about their diets and the particular foods
they eat (Hoefkens et al. 2011).
The report suggests that daily protein requirements
for optimal health may be above the established recom-
mended intakes. One argument supporting higher
intakes, especially of indispensable amino acids, is that
their role extends beyond that of supporting growth or
nitrogen balance. Indispensable amino acids have been
related to lean body mass retention, cell signalling, bone
health, glucose homeostasis and satiety induction. The
report depicts potential short- and long-term health out-
comes related to protein quality and indicates the need
to look beyond physiological and metabolic responses in
assessing health effects. New research is required to
demonstrate the functional role of some amino acids
and determine the specific needs for optimal health, to
support policy and to inform expert recommendations
at the global level (Boye et al. 2012).
Of major public health relevance, an adequate
protein intake contributes to the benefits of physical
activity in maintaining muscle and skeletal mass (NDA
2010). Muscles are the powerhouses of the body,
playing an important role in energy metabolism and in
moderating blood sugar levels. The importance of
maintaining muscle mass and strength has been increas-
ingly recognised in relation to prevention of obesity,
cardiovascular disease, diabetes and sarcopenia
(Stephen & Janssen 2009; Pedersen 2012). As popula-
tions age, sarcopenia – the progressive age-related loss
of muscle mass – may compromise mobility, indepen-
dence and eventually quality of life. Around half of
age-related loss of muscle is attributed to environmental
factors such as inactivity and poor-quality diets
(Wilkes & Rennie 2009).
The FAO report lays groundwork for acknowledge-
ment of the importance of protein quality in public
health and sustainable diets worldwide. In the UK, as
426 S. Leser
government authorities, in their public health role,
focus on addressing dietary excesses and low fruit and
vegetable intake, protein and amino acids have, under-
standably, not been at the top of the public health
agenda (Jones 2013). Current recommendations for
daily protein intakes were published over 20 years ago
and are arguably in need of review in light of new
scientific evidence that suggests potential for high-
quality proteins to improve public health (Chiuve et al.
2011).
Next steps
The FAO report notes that there is currently insufficient
data to allow DIAAS to be applied immediately. As with
any new methodology, today there is not enough vali-
dated data on ileal digestibility to support a swift move
to DIAAS. The key areas of future research outlined in
the report include animal studies in order to calculate
true ileal digestibility, and human studies to prove the
correlation between findings in animals and humans.
Preliminary data for DIAAS is mostly based on studies
using rats and pigs, and the preferred animal model for
human digestion of proteins needs to be validated.
There is also a requirement to develop a robust DIAAS
dataset, for a wide range of foods, before the method
can be adopted. The agri-food industry, FAO and gov-
ernments have been urged by members of the Expert
Consultation Committee to support the future work
required, such that DIAAS can be used to its fullest
extent. Funding for research is currently being sought,
with the hope that the work will begin in the latter half
of 2013 and will take 1–2 years to complete (Moughan
2013). Others suggest a longer process, taking 5–7 years
to collect the evidence and extrapolate it to humans, and
even longer to progress towards adoption within Codex,
as this FAO Expert Consultation, different from other
most recent FAO/WHO expert consultations related to
human nutrition and health, was not requested by
Codex. Having now published the report, FAO will
continue the process of informing Codex. Discussions
around the global recommendations, with specific coun-
tries and jurisdictions, are already underway (Gander
2013).
Conclusion
The new FAO report from the 2011 Expert Consulta-
tion on dietary protein quality evaluation addresses
protein nutritional value and utilisation, important
elements of sustainable diets and health that underpin
food security. As food systems change to become more
stressed and complex, the report contributes to address-
ing issues such as meeting higher global demand for
sufficient safe and nutritious food that results from
population growth, changes in dietary preferences and
higher demand for particular food items, to lead healthy
and active lives.
The report mainly covers the proposal for a new
method, DIAAS, which better reflects current scientific
understanding, to be used as an alternative to the
PDCAAS method in the evaluation of protein quality.
However, any change to current practice will depend
upon sufficient research data being produced to support
DIAAS, and FAO’s determination to see through the
report’s recommendations (Gander 2013). Implementa-
tion of the DIAAS method is expected to bring a more
accurate, although more complex, measure of the
amounts of amino acids absorbed by the body and a
protein’s contribution to human amino acid and nitro-
gen needs. Adoption of the method would enable those
in nutrition to better identify and use high- and low-
quality protein foods in sustainable diets.
In the interim, the report recommends immediate use
of DIAAS values, calculated from faecal crude protein
digestibility data, while awaiting ileal data, and that
‘truncation’ (rounding down) of protein quality scores
should be abandoned for individual ingredients, but
maintained when assessing overall dietary efficiency.
This will give health professionals, regulators, policy
makers and world bodies a more accurate representa-
tion of the protein quality profile of foods.
Conflict of interest
At the time of writing, the author is employed by Volac.
Volac is a UK-based dairy nutrition business, manufac-
turing and supplying performance nutrition products to
the global market – in both the animal and human
nutrition industry. The author is also a member of the
International Dairy Federation (IDF) Action Team on
Proteins.
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