Clinical nutrition: Trending platforms for optimal recovery

05 Sep 2018 --- The medical nutrition space, which includes oral nutritional supplements (ONS) and enteral nutrition (tube feeding via the nose or gastrointestinal tract), is enjoying increased growth. Oral nutritional supplements, in particular, are experiencing a boost as consumers and healthcare providers increasingly prioritize health & wellness, focusing more on aging well and disease prevention. Moreover, ongoing research into the benefits of nutrition on the healing process, as well as a growing demand for products that have a chance of encouraging patient compliance, are providing ample opportunities for ongoing R&D.

“The market for ONS and Enteral Nutrition is growing at an increasing rate worldwide – from 6.3 percent in 2016 to 8.4 percent in 2018. Because of this, and the continued advancements in healthcare, we see a rise in the number of medical nutrition solutions in the market to not only improve quality of life but significantly reduce healthcare spending,” says Anna-Maria Stiefel, Global Segment Director, Medical Nutrition at DSM. 

Sensing the opportunity 
Companies are starting to take note. At the end of 2017, NZMP, Fonterra’s B2B ingredients brand, launched a Medical Nutrition and Healthy Aging division, while FrieslandCampina Ingredients recently became an associate member of the Medical Nutrition International Industry Association. 

Floor van der Horst, Marketing Director Medical Nutrition at FrieslandCampina, explains: “Dairy plays an important role in providing high-quality nutrition as a natural, good tasting source of essential nutrients such as proteins, fats, vitamins and minerals.” 

“With Nourishing by Nature as FrieslandCampina’s purpose, it has been a logical step to establish a dedicated B2B team for the medical nutrition segment in 2016; targeting the nutritious nature of milk to enhance the quality of life for patients and frail people,” she says. 

“More companies are starting to realize that the medical nutrition segment is not only growing because of the elderly population, but also because more people around the world want to act more preventatively regarding their health and what they consume,” says Maarten van Beek, Fonterra Director of NZMP Medical Nutrition. 
 
The malnutrition hurdle and overarching trends
One of the significant hurdles medical nutrition needs to address is that of malnutrition among patients as well as the aging. Research by Advocate Health Care and Abbott, published in July 2018, showed that one in three patients are malnourished or at risk of malnutrition when they are admitted to the hospital and many are unaware of it. 

There are three pervasive trends currently influencing NPD within the medical nutrition category: compacting, approximating normal food items and targeted solutions. 

1.    Compacting
Compacting refers to the creation of products with a high nutrient density in a small serving size, which is vital for patients and the elderly who may have a reduced ability to chew, swallow, taste and digest. “Patients often have trouble consuming enough energy and proteins in a normal diet,” says van der Horst. “At the same time, patients are reluctant to consume nutritional support products, such as medical nutrition drinks, because of mental barriers regarding serving size and sensory features.” 

Compacting presents suppliers with significant challenges in functionality aspects, as the products must still be appealing and palatable. 

NZMP’s Medical Nutrition team has developed a 14 percent high-protein ready-to-drink medical beverage, with good viscosity and mouthfeel due to a unique combination of a heat stable whey protein and fast-absorbing milk protein concentrate. Sensory research in collaboration with Wageningen University & Research comparing NZMP’s 14 percent high-protein ready-to-drink medical beverage against two products on the market had as “good if not better consumer appeal than competing 10 percent protein commercial products.” 

“Our fast milk protein is one of our hero ingredients. Athletes know about the benefits of the fast absorption of protein, but if you are a vulnerable aging person, or you have just undergone chemotherapy or surgery, your body experiences muscle wastage. You need quality protein in your body as quickly as possible. Even though it began as a sports ingredient, it has potentially even more benefits for the medical community,” says Stephen Gregory, General Manager Innovation & Technical, NZMP Medical Nutrition at Fonterra. 

The company says that this solution could also appeal due to its good taste. “In the medical nutrition industry, it is said that patients don’t finish drinks because of taste and texture; this product is unique because it tastes good,” van Beek adds. 

This feeds into the second trend within medical nutrition, which focuses on providing patients and those in need of care with nutritional solutions that will allow them to feel a little more “normal,” by focusing on products to approximate “regular” food items as much as possible. 

2.    “Feeling normal”
A major focus in this aspect is providing those in need of medical nutrition with solutions that are convenient and tasty, and that do not highlight the fact they are ill, in a way giving patients a sense of dignity. ONS are usually presented as ready-to-drink liquids or powders that can be prepared as drinks, suitable as a sole source of nutrition or used as a supplement to normal foods. Further innovation could focus on presenting ONS in more traditional food formats, such as muffins or other bakery. 

“A wider choice of flavors, textures and smells and smaller portion sizes, as well as novel delivery formats that make products easier to consume, are all key to better medical nutrition,” says Stiefel of DSM. “They are looking for solutions that are regarded as less artificial, especially for products sold in retail and e-commerce channels. Innovative close to normal food concepts enter the market to provide an alternative to regular medical nutrition products, to increase consumers’ compliance and improve nutritional status,” Sjors Verlaan, Development Director Medical Nutrition at FrieslandCampina, explains.

“FrieslandCampina Ingredients is working on several formats and prototypes to address this need. This ranges from protein enrichment suitable for a wide range of meals such as soup, bakery products or yogurt, to an innovative clear protein drink that covers the protein need and offers differentiation in taste & experience,” he adds. 

3.    Targeted solutions
Medical nutritional solutions are now also being targeted at conditions ranging from Crohn’s disease, Alzheimer’s disease and chronic kidney disease to preand post-surgery recovery and metabolic disorders. 

“Each patient’s nutritional and medical needs are different, which means it can be challenging to create a tailored solution that works on an individual level,” says Stiefel, adding that this points to the need for more research on genetic variability and personalized nutrition. Within this space, targeted mobility solutions that support the aging population’s desire to remain independent and participate actively in society are seeing a particular interest. 

“The inherent loss of muscle mass, strength and physical function during aging can result in delayed recovery from illness. It has a severe impact on mobility when it becomes below a certain threshold, also known as sarcopenia,” says Verlaan. 

“Exercise and high-quality protein play a pivotal role in keeping older adults mobile and can prevent the development of sarcopenia and frailty. With the increasing awareness among elderly and healthcare professionals mobility solutions for active aging are on a rise,” Verlaan adds.

Forward-looking 
Creating medical nutrition requires particular adherence to regulations as well as extensive clinical trials. Considering the growth potential of this category, these regulations are particularly pertinent and will guide companies in creating solutions of the highest standard. 

As for further platforms for medical nutrition innovation, much research is still needed to further understand the mechanisms in the body and subsequent nutritional efficacy during different diseases and conditions. As the medical nutrition market develops, suppliers are likely to also see a growing demand for plant-based offerings, as well as other consumer trends, such as Non-GMO. 

By Lucy Gunn