Carezzo Sparkling at Sixty
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This document summarizes research on addressing undernutrition in elderly patients through improved dietary protein intake. It describes: 1. Current treatment options are often insufficient to meet protein needs, and even patients at low risk of undernutrition have inadequate intake. 2. Research found protein-enriched foods and drinks significantly increased intake for at-risk patients, helping more to meet recommendations. However, intake was still inadequate for many. 3. Interviews revealed elderly are often unaware of undernutrition risks and importance of protein. They are reluctant to change diets. Successful options must fit within current food preferences and habits.
Carezzo Sparkling at Sixty
- 1. 5‐10‐2015 1 KIEZEN WAT JE LEKKER VINDT KRIJGEN WAT JE NODIG HEBT the ‘FOOD SOLUTION’ 1 Carezzo Nutrition bv – Sparkling a sixty – Wageningen 1 oktober 2015 ‐ Fred Bergmans CAREZZO NUTRITION BV Ondervoeding met voeding aanpakken Lekker, variatie Betaalbaar Voeding concept & Netwerk: Wetenschap en R&D Productie en Zorg Nieuwe aanbieder
- 2. 5‐10‐2015 2 Ondervoeding Gevolgen van ondervoeding: • Vertraagde wondgenezing • Langer ziekenhuisverblijf • Verminderde kwaliteit van leven • Verhoogde sterftekans Totale kosten € 1,8 miljard2 • Ziekenhuis: € 1,1 miljard Leeftijdsgroep 60+: €752 miljoen 2 SEO‐rapport nr. 2014‐11, based on numbers of 2011 Ondervoeding: Eiwit tekort voor de spieropbouw Risicogroep: Kwetsbare ouderen • Weinig eetlust: < eiwit aanbeveling • Behoud spieren Ondervoeding bij ziekte • Onbedoeld gewichtsverlies • Stop spierafbraak 1/3 < onacceptabel 1/3 ongewenst 1/3 > gewenst + 30g 60g 90g Prestatie indicator IGZ 1,2 g eiwit/kg + 50% Eiwit inname Prestatie indicator IGZ Screening SNAQ/MUST 4
- 3. 5‐10‐2015 3 Inname op dag 4 versus aanbeveling 1,5 g/kg/d 1,2 g/kg/d 0,8 g/kg/d (n=31) (n=32) MUST ≥1 krijgt energie en eiwit verrijkt dieet Ondervoeding in de zorg: Ongewenst gewichtsverlies 25%‐40% + 30g 08.00 10.00 12.00 15.00 18.00 20.00 WARM BROOD TUSSEN DOOR 2E BROOD TUSSEN DOOR TUSSEN DOOR NIEUW VOEDING CONCEPT • eiwitverrijkte basisvoeding – groenten, fruit en granen • voor broodmaaltijden en tussendoor De VOEDINGs oplossing
- 4. 5‐10‐2015 4 EERSTE REAKTIES VAN DIETISTEN • ‘ik heb niet zo’n goed gevoel bij de huidige aanpak van diëten en drinkvoeding: niks werkt echt om ondervoeding op te lossen’. • ‘we blijven hangen in een JA MAAR discussie en dan gebeurt er niks’ • ‘met zo’n hele range is er altijd wel iets dat men lekker vindt, dit gaat gewoon werken’. • ‘als je kan kiezen kun je het langer volhouden’ • ‘de getallen op de verpakking zijn een leuke hulp om uit te tellen wat je nodig hebt’ • ‘met Carezzo wordt het ons wel heel eenvoudig gemaakt’ WAARDE PROPOSITIE: ‘Kiezen wat je lekker vindt en krijgen wat je nodig hebt’ EIWITVERRIJKT /portie • Brood 6 g • Bollen 6 g • Banket 10 g • Fruitsap 10 g • Groentesoep 10 g • Fruitzuivel 10 g • Fruitijs 10 g 7 Proces innovatie 8
- 5. 5‐10‐2015 5 Wetenschappelijk onderzoek, productontwikkeling en interventie studies in de doelgroep Smaaktesten in de doelgroep • Senioren SenTo panel Wageningen UR Voedingsstudies: meer inname eiwit • Ziekenhuis Vumc • Revalidatie kliniek ZZG Herstelhotel. • Ziekenhuis ZGV & thuiswonenden Effectstudie: voeding & functies • Ziekenhuis: 10 dagen • Thuiswonenden: 12 weken Consortium ‘Cater with Care’ 9 Kiezen wat je lekker vindt, en krijgen wat je nodig hebt. SenTo – smaakpanel Wageningen Universiteit Senioren met volledige geur/smaakvermogen Senioren met verminderde geur/smaakvermogen (geur‐impairment) Volwassenen
- 6. 5‐10‐2015 6 Smaaktest in de doelgroep 0 10 20 30 40 50 60 sento normal sento impaired Young Standard Carezzo Senioren met verminderde geur‐/smaakvermogen vinden Carezzo lekkerder dan het geteste standaardbrood. SenTo panel WUR ‐FBR WAT WERKT WERKT NIET: MEER ETEN Huidige behandelmethoden: ‐ Energie & Eiwitrijk dieet ‐ Suppletie drinkvoeding info@alliantievoeding.nl w w w .alliantievoeding.nl Alliantie Voeding Gelderse Vallei p/ a Ziekenhuis Gelderse Vallei Postbus 9025 6710 HN Ede CATER WITH CARE: INSIGHTS INTO MEETING PROTEIN REQUIREMENTS IN HOSPITALISED ELDERLY PATIENTS Nancy Janssen* 1, Emmelyne Vasse1, Janne Beelen2, Quinta van der Sluijs1, Joyce van Geel2, Nicole M de Roos2, André Janse md3 1department of dietetics, Gelderse Vallei Hospital, Ede, 2Division of Human Nutrition, Wageningen University, Wageningen, 3department of geriatric medicine, Gelderse Vallei Hospital, Ede, Netherlands Rat ionale A considerable part of hospitalized elderly patients are unable to meet protein and energy requirements. The objective of this study was 1. To gain insight into the protein and energy intake of hospitalized elderly patients. 2. To gain insight into their awareness of undernutrition, importance of protein and preferences for foods and drinks of these patients. Results 1. We observed a significant difference in protein intake but not in energy intake between patients receiving an enriched diet versus not enriched (1.13 grams vs. 0.62 grams of protein per kg BW; P<0.05). 2. Interviews showed that elderly are unaware of the risks of being undernourished and the importance of dietary protein. Healthy food is associated with eating vegetables. Elderly are not prone to change dietary habits. Conclusions 1. Current treatment options for undernutrition do not seem sufficient for meeting energy and protein requirements in the majority of elderly patients. 2. Even MUST 0 patients have inadequate protein intake. 3. Increasing awareness about undernutrition among elderly patients and offering enriched foods and drinks that fit in with current dietary choices could increase their protein and energy intake. Method 1. Design: cross-sectional study. Participants: Forty hospitalized patients of 65+ years, at risk of undernutrition (MUST ≥1) and receiving a protein and energy enriched diet, and 40 hospitalized patients of 65+ years not at risk and receiving a standard diet. Measurement: 24h-recall on the fourth day of hospitalisation to calculate protein and energy intake. 2. Ten patients at risk of undernutrition were interviewed using a semi-structured interview guide. Thematic analyses was used for analysing the interviews. What do they mean.. Protein?? Undernourished? Not me, I eat vegetables Figure. Actual protein intake compared to the recommendations for hospitalized elderly in the MUST 0 group (n=31) and the MUST ≥ 1 group (n=32) on the fourth day of hospitalisation. Key m essage Most hospitalized elderly would benefit from protein enriched foods. Since elderly won’t change their habits, we need to adjust the amount of protein within these habits. Departm ent of dietetics Gelderse Vallei Hospital PO box 9025 6710 HN Ede, the Netherlands janssenn@zgv.nl WERKT WEL: MEER EIWIT ‐ Eiwit verrijkt brood & drink yoghurt ‐ Zelfde hoeveelheid gegeten Titel voorbeeld titel Protein-enriched bread and drinking yoghurt and their effect on protein intake in acutely hospitalized older adults: a randomized controlled trial Rationale Earlier studies have shown that protein intake in elderly is often insufficient during hospitalization. The objective of this study was to examine the effect on protein intake of acutely hospitalized elderly of consuming a protein-enriched bread and drinking yoghurt, replacing normal products. Methods This study was performed as a single blind randomized controlled trial in elderly (≥ 55 years), acutely admitted to the hospital. During 3 consecutive days participants received either ad libitum protein-enriched bread (7 g of protein) and drinking yoghurt (20 g of protein) in the intervention group or isocaloric, non-enriched bread (4 g of protein) and drinking yoghurt (8 g of protein) in the control group as part of their daily meals. Food intake of the participants was measured and nutritional values were calculated according to the Dutch Food Composition Table. An independent samples t-test was used to compare protein intake between intervention and control group. Conclusion The use of protein-enriched bread and drinking yoghurt, consumed as part of regular meals, is a promising and feasible solution to increase the protein intake of acutely ill elderly. It needs to be confirmed whether a longer-term use of these products in larger groups of patients will also result in better clinical outcomes. S. Stelten*1 , I.M. Dekker1, A.E. Ronday1, A. Thijs2, E. Boelsma3, H.W. Peppelenbos3, M.A.E. de van der Schueren1,4 1 Nutrition and Dietetics, VU University Medical Center, Amsterdam, 2 Internal Medicine, VU University Medical Center, Amsterdam, 3 Food & Biobased Reaserch, Wageningen UR, Wageningen, 4 Faculty of Health and Social Studies, Department Nutrition, Sports and Health, HAN Univerity of Applies Sciences, Nijmegen Data are presented as mean ± SD, unless stated otherwise a Percentage of patients reaching the minimum protein requirement of 1.2 g/kg/day Correspondence: s.stelten@hotmail.com Control group (n=25) Intervention group (n=22) P -value Protein intake (g) 58 ± 15 75 ± 33 0.039 Protein intake (g/kg/day) 0.9 ± 0.3 1.1 ± 0.5 0.041 Protein requirementa (%) 8% 36% 0.030 Results The use of enriched products resulted in a significantly increased protein intake. Bread and drinking yoghurt contributed almost equally to the increased intake of protein in the intervention group. WERKT BETER: SPREIDING INNAME ‐ broodmaaltijden & tussendoor ‐ optimaal over de dag Effects of the daily consumption of protein enriched bread and protein enriched drinking yoghurt on the total protein intake in elderly in a rehabilitation centre: a single blind randomised controlled trial Rationale A sufficient total protein intake (1.2-1.5 g/kg for acutely and chronically ill older adults) and an optimal protein distribution over the day (25-30 g/meal) are important to counteract sarcopenia. However, patients recovering from disease often have an insufficient protein intake. The purpose of the current study was to investigate the effects of the consumption of protein enriched products on the daily protein intake and the protein distribution over the day in older adults in a rehabilitation centre. Methods Single blind RCT. Patients received either protein enriched bread (Carezzo; 6.9 g protein per slice) and protein enriched drinking yoghurt (Drinking yoghurt enriched with Fonterra Whey Protein Concentrate (WPC 515), 20.0 g protein / 250 mL) or regular products during three weeks (4.0 g and 7.5 g protein, resp.) For each patient, 24h intake of all food products was measured (6 measurement days per patient). Results Thirty-four patients were included in the study. Compared with controls, patients who received the protein enriched products had a significantly higher protein intake (table). AJ van Til1, E Naumann1, IJHM Cox-Claessens2, S Kremer³, E Boelsma³, MAE de van der Schueren1,4 1 HAN University of Applied Sciences, Faculty of Health and Social Studies, Department of Nutrition, Sports and Health, 2 ZZG Rehabilitation centre, Medical director, ³ Wageningen UR, Food and Biobased Research, 4 VU University Medical Centre, Nutrition and Dietetics, Internal Medicine Conclusion The daily consumption of protein enriched bread and protein enriched drinking yoghurt is effective to achieve both a significant higher protein intake and an optimal distribution of the dietary protein over the day in older adults. Control Intervention P-value Protein intake (g/day) 72.5 115.3 <0.001 Protein intake g/kg 1.1 1.6 <0.001 Correspondence: Marian.devanderSchueren@han.nl The intervention group consumed quantities over the recommended level (25-30 g/meal) during each of the three meals, where the control group consumed quantities below the recommended level during breakfast and lunch (figure). 12
- 7. 5‐10‐2015 7 Eiwit eiwitverrijkt brood, sap, soep 1,5 g/kg/d 1,2 g/kg/d 0,8 g/kg/d (n=22) (n=22) EET PILOTSTUDY unpublished 2014 - ZGV 13 Sales Operations Grondstoffen leveranciers & contract research Inkopers Ziekenhuizen, Woon‐ & Thuiszorg, Cateraars, grossiers Universiteiten Ziekenhuizen Patienten& Dietisten Zorginstellingen Fabrikanten, bakkerijen, logistiek providers Marketing Technology Business concept: 4 kernfuncties DOELGROEP VOEDING <- Verkoop & logistiek-> <- Receptuur ontwikkeling-> Verrijkte producten laten produceren Info over voedingstoestand verbetering BUSINESS CONCEPT: 4 KERNFUNCTIES 14
- 8. 5‐10‐2015 8 Carezzo Nutrition – ZorgTotaal beurs maart 2015 Ter kennismaking: 2 assortiments dozen 15 Strategisch investeerder – begin van de groeiMarkt entrée in ziekenhuizen, woonzorg en thuiszorg 16
- 9. 5‐10‐2015 9 Onderzoek & Ontwikkeling 2010‐2011 2012‐2014 2014‐2015 idee & haalbaarheid fase wetenschappelijk onderzoek & productontwikkeling effect studie & markt entrée 17 Kiezen wat je lekker vindt, en krijgen wat je nodig hebt.