Medical Nutrition—Truly Patient-Led To Support An Ageing Population

Friday, June 21st, 2019

Developing medical nutrition beverages is complex and demands a deep understanding of the nutrition needs and sensory preferences of the medically unwell.


Why Is Medical Nutrition Growing In Asia?

Life expectancy is quickly growing, with the global population of senior people set to double before 2050 (Mintel GNPD; Frost & Sullivan). A natural part of a longer life is experiencing poorer health and increased likelihood of disease.

A study from Vietnam has shown older people experience approximately 2.4 days of illness each month, equating to one month each year spent unwell for our ageing population (Acute Market Reports). In hospital settings, over 80 percent of elderly parents are likely to suffer from malnutrition, and up to 20 percent of those people will lose their independence because of it (Acute Market Reports). The research clearly shows a market opportunity for medical nutrition in reducing the impact of malnutrition in the elderly and the unwell.

In Asia-Pacific, there is high growth in the variety and volume of medical nutrition offerings due to increased investment and evolution of healthcare infrastructure. In China, clinical nutrition offerings targeted toward specific disease states such as post-surgery and cancer have increased by more than 60 percent since 2013 (Yang, Churchward-Venne, Burd et al., 2012).


The Challenge: Formulating High-Protein Beverages For Medical Nutrition

Recovery can be supported through a varied diet focussed on providing extra protein and energy. Illness generally reduces appetite and may impact how well people digest and absorb nutrients from their foods. A good option is supplementation of a ready-to-drink medical beverage that provides all micro- and macronutrients and is especially high in protein content.

It is understood that high protein foods support muscle maintenance, however, the type of protein contributes to the taste, texture, and viscosity of the beverage, and therefore ability of the patient to drink the prescribed amount of the medical beverage. Due to the high protein content, often these beverages have a thick consistency which may be difficult to drink, especially if you’re unwell and suffering with low appetite. The concentrated nutrient density required in a small serving often leads to unpleasant or unfamiliar flavours. Additionally, medications can impact hunger cues, taste experience or the ability to digest and absorb nutrients. These are all issues which challenge the industry to innovate for a better taste, texture, aiming to improve product compliance.

Formulating medical beverages can be challenging; ingredients are not all created equal. A dairy base is most often used for medical beverages due to the high quality and palatability of the protein (Rutherford et al., 2015). In dairy beverages, there are two key proteins—whey protein and casein protein. Both contain a full suite of amino acids which are required for muscle growth and maintenance. Whey protein is high-quality and quick to absorb into the body, which is beneficial for muscle maintenance. However, it is generally not well suited for UHT treatment and creates an unpleasant taste and texture. Casein, on the other hand, is a slower-digesting protein which is heat stable, and therefore commonly used in medical nutrition beverages where UHT treatment is required for the highest level of food safety.

Whey protein, despite providing quick digestion and a full amino acid profile, is typically not heat-stable. However, the innovation of whey protein ingredients with enhanced heat stability characteristics is essential for performance in medical beverage formulations (Gulla et al., 2015). Formulating high protein ready-to-drink beverages using whey protein poses problems of chalkiness, sandiness, lumpiness, high- viscosity, sedimentation or gelation during shelf-life, which are not the type of features that will get you a product with good acceptance levels by patients.


Successful Formulation Of Ready-To-Drink Medical Beverages

Developing medical nutrition beverages is complex and demands a deep understanding of the nutrition needs and sensory preferences of the medically unwell. A healthy, young person assessing a small portion of a medical beverage is not compatible for sensory testing for an elderly, unwell person who must drink 500 ml each day, on top of their regular diet, to reach their increased protein and energy goals. Continuous research and development is important to not only consider new ingredients and formulations, but to innovate process steps and manufacturing to create a product that works best for the end consumer. In this category, developments must be truly consumer-led to ensure preference and realisation of the full benefit to the patient.

The vulnerable end consumer requires world-class food safety systems for sourcing high quality ingredients, as well as safe manufacturing and packaging of the final beverages. Using the right ingredients and developing deep technical expertise for a successful formulation is important, as well as understanding the regulatory requirements and developing the scientific background for health and nutrition claims.

In terms of formulating and manufacturing the beverage, utilising advanced technologies to provide heat stable whey protein is key to ensuring good taste, texture, and therefore better compliance. SureProtein Vital WPC550 is the only heat-stable whey protein and can be used in medical beverages to provide the great taste and texture which will likely contribute to much better recovery.

Fonterra has world class innovative protein ingredients in its SureProtein range and Fonterra’s NZMP Medical Nutrition and Healthy Ageing team has put a lot of formulation and processing expertise into developing its bespoke, unique 14 percent protein medical beverage consisting of 9 percent whey protein, as well as the lowest viscosity and preferred taste. And remaining at the forefront of medical nutrition is an area the business is heavily focused on.

As Ping Gao, Medical Solutions Manager for NZMP, Fonterra states, “A great medical nutrition formulation must consider the most recent nutrition research, combining that with dairy manufacturing expertise, and thinking of the patient first. On top of this, we must keep re-formulating and innovating to ensure we are meeting our patient’s needs in the ageing population.”


*References available upon request


Contributed by By Laura McPike, registered New Zealand Nutritionist, Master of Dietetics and Global Marketing and Communications Manager, NZMP Medical Nutrition.