Therapeutic food  — a growing market

At an estimated value of $15 billion per year, the global therapeutic/medical foods market is moving into the first world.

The concept of therapeutic foods grew out of the need to care for severely malnourished children across the globe. But this is broadening rapidly as canny marketers in the Western world develop foods and meals for those with special nutrition requirements, such as the elderly, athletes, allergy sufferers and the chronically unwell.

Severely malnourished children have a risk of death nine times greater than that of their well-nourished peers, and much effort has been put in by aid organisations to return these children to health.

Traditionally, once identified, severely malnourished children (usually in the third world) were fed a specialised, therapeutic milk in in-patient facilities. This posed many difficulties, as parents often lived a long way from the health facilities and could neither afford transport to the facility nor the five or six weeks away from their other children and jobs to stay with the child being treated. So many children were simply not helped.

It was recognised that community-based treatment would be much better for both the children and the parents. However, the therapeutic milks were not readily adaptable to home environments. Time, access to potable water, hygiene constraints and access to refrigeration for any excess milk were all limiting factors.

To overcome these hurdles, food processing engineer Michel Lescanne and paediatric nutritionist André Briend invented Plumpy’Nut in 1996. Nutriset’s Plumpy’Nut is a peanut paste-based product that includes vegetable oil, milk powder, sugar, vitamins and dietary minerals. Plumpy’Nut includes all of the macro- and micro-nutrients needed to restore a child to a healthy weight. The only additional item needed is water.

©Michaël Zumstein/Agence Vu’.

Plumpy’Nut meets the needs of its target patients — severely malnourished children. It has a soft texture and young children like the taste. It is ready to eat as it is — no cooking is required, it has a long shelf life, it is microorganism contamination-resistant and it does not require expensive packaging. The paste does not need refrigeration and can be consumed directly from the packet. As it does not need to be mixed with water, the risk of accidental bacterial contamination is eliminated. The single-serve sachets can be stored in ambient conditions for three to four months, even at tropical temperatures.

Ready-to-use therapeutic foods

Most therapeutic foods are made of a ground-up mixture of protein, carbohydrate, lipid, vitamins and minerals. Therapeutic foods are usually produced by grinding all ingredients together and mixing them.

Ready-to-use therapeutic foods (RUTFs) are energy-dense, micronutrient-enriched pastes. The lipids used in formulating RUTFs are in a viscous liquid form and the other ingredients are usually small particles that are mixed through the lipid. The mixture needs to be homogeneous for it to be effectively consumed. The most common RUTFs are made of four ingredients: sugar, dried skimmed milk, oil, and vitamin and mineral supplements.

UNICEF is the primary global procurer of RUTF, therapeutic milk and other essential products for treating severe acute malnutrition, and also provides technical support to governments and non-governmental organisations on their application and use. Another notable procurer is Médecins Sans Frontières.

Properly used, RUTF is safe, cost-effective and has saved hundreds of thousands of children’s lives in recent years. Severe acute malnutrition is a major killer of children under five, accounting for approximately 1 million deaths annually. Around 20 million children worldwide are estimated to be suffering from this condition, of which only approximately 10–15% currently receive treatment using RUTF.

Although most RUTFs are currently manufactured in and imported from advanced economies, the technology to produce them has been introduced in developing countries with minimal industrial infrastructure. By 2012, African-produced RUTF represented 45% of the total purchased by UNICEF.

The $15 billion medical foods sector

Globally, the medical foods market is estimated to be worth about $15 billion and the major food companies are muscling in to secure their share of this growing sector. Medical foods include prescription-based powders and drinks intended to meet specific nutritional requirements to treat diseases.

Medical foods are intended for people with chronic diseases, rather than for healthy people. They must be used under medical supervision because they are intended to manage serious illnesses, like Alzheimer’s disease and inflammatory bowel disease (IBS). The products have active ingredients derived from food products or dietary ingredients that are generally recognised as safe (GRAS) by FDA.

For Nestlé, the medical foods market has huge potential amid an ageing global population as the company navigates tougher times in its traditional packaged food market. Sales of frozen pizza and ice-cream have struggled. It has missed its sales growth target of 5–6% percent three years running.

“For a long time, nutrition has been seen as a sort of pseudoscience,” said Ed Baetge, head of Nestlé’s Institute of Health Sciences (NIHS). “For many conditions like age-related dementia, for example, there is a major clinical need for new approaches and where food can make a big difference."

Currently, scientists at NIHS in Lausanne, Switzerland, are analysing human DNA to develop personalised programs for conditions like epilepsy and intestinal disorders that are tailored to specific genetic profiles. Armed with this knowledge, the scientists will develop medical foods containing natural compounds extracted from foodstuffs like tomatoes, coffee and grapes.

NIHS was established five years ago and has spent half of its US$500 million budget, which runs to 2021, although it has projects that extend beyond then. Nestlé has also been on a US-focused acquisition spree. Earlier this year, the company signed a deal to help US biotech company Seres Therapeutics develop products aimed at restoring bacteriological balance in the digestive system. It also bought a stake in Pronutria Biosciences, a US start-up developing amino acid-based products to treat muscle loss.

“We want to have a significant impact on the company’s overall profitability over the long term,” said Greg Behar, who heads Nestlé’s Health Science business, which markets products developed from findings at the institute’s labs.

Analysts are generally upbeat about the potential of Nestlé’s health business, which also includes nutritional supplements and foods for people after surgery, saying it grew faster than the rest of the company’s operations in 2015 to post sales of about US$2.1 billion. Nestlé aims to increase that amount to US$10.3 billion in the next few years.

Although medical foods don’t need premarket review and approvals like drugs, they must be based on what Nestlé calls “sound medical and nutritional principles”, and the FDA subjects them to monitoring.

Nestlé said that before market introduction, studies must be conducted showing that its products are safe, beneficial and effective in meeting the nutritional requirements of patients.

In addition, some of its products, like one being developed to help remission of inflammatory bowel disease, are being developed through the conventional trials process.

Foods for cancer patients

In the US, Hormel Food is launching a new medical foods line, Hormel Vital Cuisine, which includes ready-to-eat meals, nutrition shakes and whey protein powders specially designed to serve the needs of cancer patients. The company partnered with the Cancer Nutrition Consortium (CNC) to develop the line, which it says are the first products certified by the CNC organisation.

Working closely with professional chefs, including those from the Culinary Institute of America, Hormel says Vital Cuisine provides flavour and great taste as well as functionality, as product developers also ensure the essential nutrients and protein to help patients combat the loss of energy and muscle mass they endure during cancer treatments.

A portion of the proceeds from the line will go to fund CNC’s research and outreach initiatives. The CNC comprises nutritionists, dieticians, oncologists and physicians from leading cancer research institutions. The RTE meals include three high-protein varieties — chicken and dumpling, vegetarian stew and beef and mushroom gravy. The meals are convenient and the company has made an effort to eliminate unnecessary ingredients known to affect consumers’ taste and smell sensitivities.

“During product development, we brought together researchers in both the health and culinary fields to ensure a thorough understanding of a patient’s needs during various phases of treatment,” said Chet S Rao, PhD, strategy and business manager for the specialty foods group at Hormel Foods. “The line was thoughtfully crafted, since many product attributes such as flavour, texture and ingredients are known to affect patients differently during their cancer journey, during which eating and drinking can be challenging.”

“Most cancer patients are too tired to make a meal, or even shop for it. Yet the importance of good, consistent nutrition can’t be overstated,” said Dr Bruce Moskowitz, physician and chairman of the CNC. “We saw an opportunity to address these issues. So in 2014, we embarked on this endeavour with Hormel Health Labs (HHL) to improve cancer patients’ quality of life.”

Top image credit: ©Michaël Zumstein/Agence Vu’.

Typical RUTF composition

Moisture content	2.5% maximum
Energy	520–550 kcal/100 g
Proteins	10–12% total energy
Lipids	45–60% total energy
Sodium	290 mg/100 g maximum
Potassium	1100–1400 mg/100 g
Calcium	300–600 mg/100 g
Phosphorus (excluding phytate)	300–600 mg/100 g
Magnesium	80–140 mg/100 g
Iron	10–14 mg/100 g
Zinc	11–14 mg/100 g
Copper	1.4–1.8 mg/100g
Selenium	20–40 µg
Iodine	70–140 µg/100g
Vitamin A	0.8–1.1 mg/100g
Vitamin D	15–20 µg/100g
Vitamin E	20 mg/100 g minimum
Vitamin K	15–30 µg/100 g
Vitamin B1	0.5 mg/100 g minimum
Vitamin B2	1.6 mg/100 g minimum
Vitamin C	50 mg/100 g minimum
Vitamin B6	0.6 mg/100 g minimum
Vitamin B12	1.6 µg/100 g minimum
Folic acid	200 µg/100 g minimum
Niacin	5 mg/100 g minimum
Pantothenic acid	3 mg/100 g minimum
Biotin	60 µg/100 g minimum
n-6 fatty acids	3–10% of total energy
n-3 fatty acids	0.3–2.5% of total energy