Malnutrition affects more than 925 million people globally. In developing economies initiatives address micronutrient malnutrition through supplementation and food fortification, whilst in developed countries it is under diagnosed and undertreated.

This report outlines the various strategies and products that food companies have developed to combat the issue of malnutrition. It includes approaches to treating micronutrient deficiencies (e.g. fortified and genetically modified foods), and assesses malnutrition associated with eating disorders and the aging population. The report also identifies market opportunities for the food industry.

Scope of this research

• Analyze different strategies that have been developed by companies to meet specific needs for both micronutrient and disease-related malnutrition. • Identify companies involved in global initiatives in the developing world and assess their business models for targeting emerging consumers. • Assess malnutrition in the elderly and its long term impact on health and disease, and the import of the elderly in future functional food development. • Understand how increased knowledge of the pathophysiology of eating disorders may lead to more effective nutritional therapy. • Evaluate how new technologies are being applied and to which foods in order to address malnutrition.

Research and analysis highlights

Globally 14% of people undernourished and 1 in 3 people in developing countries are affected by vitamin and mineral deficiencies. Food supplementation and fortification is a cost-effective way to address this issue and may provide the food industry with a new opportunity to address the nutritional needs of over 1 billion new and emerging consumers.

Eating disorders such as anorexia and bulimia are prevalent in adolescents affecting up to 3% of females. Recent research indicates that the incidence of eating disorders is on the increase particularly in boys (representing up to 10% of all cases in children and adolescents). Eating disorders may be affected by genetic and environmental factors.

Malnutrition is common in the elderly and is a major cause for concern. By 2020 it is estimated that almost 2 billion people will be aged over 60 and by 2050 nearly a 25% of the world population will be 60 or over. Companies are increasingly focusing on the development of disease-related nutrition to promote healthy aging.

Key reasons to purchase this research

• What global initiatives are underway to address malnutrition in developed and emerging countries, and who are the major players? • Who is working in the field of biofortification and genetic engineering and when will new products emerge and how will they be received? • What impact does malnutrition have on the older generation, and hospitalized patients, and what disease-related products are under development? • What strategies are companies adopting to target malnutrition in the younger and older generation in the industrialized and developing world? • What role does nutrition education play in healthy eating and how can it be used to target malnutrition and eating disorders in today’s society?

About the author 2
Disclaimer 2
Executive summary 11
Introduction 11
Malnutrition in the developing world 12
Malnutrition and eating disorders 13
Malnutrition in older people 14
Challenges, opportunities, and leading players 15

Chapter 1 Introduction 16
Summary 16
Introduction 17
Malnutrition in the developing world 18
Malnutrition in children and adolescents 21
Malnutrition in older people 22
Eating attitudes 24
The role of nutrition in eating disorders and malnutrition 24
Industry strategies for malnutrition and undernutrition 26
Report outline 27

Chapter 2 Malnutrition in the developing world 28
Introduction 29
Malnutrition trends and characteristics in the developing world 32
The role of diet and food provision in malnutrition in the developing world 35
Recommended nutritional intake and nutritional education 35
Global initiatives targeting malnutrition 40
Strategies for reducing the prevalence of malnutrition 44
Supplementation 45
Vitamin A 45
Innovative approaches to vitamin A supplementation 47
Fortification of foods 47
Multinutrient powders 48
Ready-to-use therapeutic foods (RUTF) 53
Fortification of staple ingredients 55
Flour fortification 56
Case study: Fortified flour (Interflour) 59
Other flour fortification initiatives 60
Rice fortification 61
Case study: NutriRice (DSM/Bühler) 63
Salt and seasonings 65
Fortified milk and milk powders 67
Oil fortification 69
Biofortification 71
Case study: Orange-fleshed sweet potato (HarvestPlus) 72
Case study: The golden rice project 74
Conclusions 75

Chapter 3 Malnutrition and eating disorders 77
Summary 77
Introduction 78
Prevalence, characteristics, and trends 80
Diagnosing eating disorders 81
Medical nutrition therapy in eating disorders 85
Good nutrition and how it can impact eating disorders 87
Strategies to target malnutrition associated with eating disorders 89
Abbott Nutrition 91
Nestlé Health Science 92
Fresenius Kabi 94
Conclusions 95

Chapter 4 Malnutrition in older people 97
Summary 97
Introduction 98
Malnutrition trends and characteristics 100
Malnutrition in the elderly 102
Malnutrition in hospitalized and institutionalized patients 104
Malnutrition in patients with chronic conditions 106
Designing foods for malnutrition in older people 107
Health issues associated with age- and disease-related malnutrition 109
The role of good nutrition and the establishment of guidelines to target malnutrition 110
Strategies that target malnutrition in older people 111
Meal fortification 112
Oral nutritional supplements 112
Enteral nutrition 115
Parenteral nutrition 116
Company strategies 117
Abbott Nutrition 117
Fresenius Kabi 119
Nestlé Health Science 120
Nutricia Advanced Medical Nutrition 123
Conclusions 127

Chapter 5 Challenges, opportunities, and leading players 128
Summary 128
Introduction 129
Challenges 132
Nutritional education 132
Regulation 135
Applying food sciences and technology 136
Biotechnology in new food products 136
Nutrigenomics 138
Opportunities 139
Emerging consumers 139
Soft drink fortification 141
Expanding healthcare nutrition for older people 143
Leading companies 143
Abbott Nutrition 145
Ajinomoto Group 147
BASF 148
Groupe Danone 149
DSM Nutritional Products 151
Fresenius Kabi 152
Nestlé Health Science 153
Unilever 155
Outlook 156
Appendix 158
Research methodology 158
Acknowledgements 158
Bibliography 159
References 164

Chapter 1 164

Chapter 2 164

Chapter 3 167

Chapter 4 169

Chapter 5 171
Abbreviations 173

Table of figures

Figure 1: Global breakdown of undernourished people (%), 2010 17
Figure 2: Impact of vitamin A, iron, and iodine deficiencies 19
Figure 3: GDP growth: emerging vs developed economies (%), 2005–10 20
Figure 4: Common eating disorders 22
Figure 5: Impact of malnutrition in the elderly 23
Figure 6: Global number of hungry people (m), 1969–2010 30
Figure 7: Purchasing power of consumers 31
Figure 8: Split of types of disease in low- and high-resource countries (m), 2010 33
Figure 9: Timelines on initiatives to target malnutrition 42
Figure 10: Sight and Life Initiative 43
Figure 11: Phasing of micronutrient intervention 45
Figure 12: Vitalita Sprinkles 49
Figure 13: Chispitas sprinkles 51
Figure 14: MixMe Premix 52
Figure 15: Nutriset range for malnutrition 54
Figure 16: Compact for Life range for malnutrition 55
Figure 17: World Bank ranking of cost-effective interventions 56
Figure 18: Regional penetration (%) of industrial-scale fortification 57
Figure 19: GAIN premix facility – addressing premix procurement challenges 61
Figure 20: Vitamin and mineral content (%) of raw and milled rice 62
Figure 21: Manufacturing process of NutriRice 64
Figure 22: Micronutrient profile of NutriRice 65
Figure 23: Nestlé’s Maggi product range 66
Figure 24: Nestlé – affordable fortified milk products 68
Figure 25: DSM – affordable powdered milk 69
Figure 26: BASF – food fortification with vitamin A 70
Figure 27: Key advantages of biofortification 72
Figure 28: HarvestPlus biofortified orange-fleshed sweet potato 73
Figure 29: Long-term health impact of malnutrition from eating disorders 78
Figure 30: Long-term health impact of overnutrition from obesity 79
Figure 31: Multidisciplinary approach to eating disorders 86
Figure 32: Fresenius – Fresubin and Diben range 95
Figure 33: Individuals at risk of age and disease-related malnutrition 99
Figure 34: Screening tools to identify individuals at risk of malnutrition 101
Figure 35: Global population aged over 60 (%), 1950–2050 103
Figure 36: Healthy aging – maintaining functional capacity over lifetime 104
Figure 37: Malnutrition in hospital patients (%) by category 105
Figure 38: Malnutrition in patients with chronic conditions (%) 106
Figure 39: Impact of malnutrition on the elderly 110
Figure 40: Nutritional management strategies for malnutrition 112
Figure 41: Impact of ONS on age and disease-related malnutrition 114
Figure 42: Fresenius Kabi ONS range 119
Figure 43: Fresenius disease-specific enteral products 120
Figure 44: Nestlé Resource SeniorActiv, a FSMP 122
Figure 45: MNA–SF Assessment 123
Figure 46: Nutricia ONS range 124
Figure 47: Nutricia range for dysphagia patients 125
Figure 48: Medical Nutrition USA product range 126
Figure 49: Drivers, challenges and opportunities in malnutrition 130
Figure 50: Population (%) meeting recommended daily intake of dairy 132
Figure 51: Population (%) meeting recommended daily intake of fruit and vegetable 133
Figure 52: BIO survey on the top 10 national issues in the US, 2007 134
Figure 53: Emerging consumer population (m), 2000–20 139
Figure 54: Emerging consumer segmentation 140
Figure 55: Vitingo 142

Table of tables
Table 1: Definitions of key terms 18
Table 2: Composition of micronutrient supplements providing 1 RNI for pregnant women & children36
Table 3: Community gardening projects in developing countries 38
Table 4: School gardening projects in developing countries 39
Table 5: Vitalita Sprinkles composition 50
Table 6: Guidelines for flour fortification 58
Table 7: Crops currently undergoing biofortification 71
Table 8: Eating disorders – statistics 81
Table 9: Anorexia nervosa – incidence, characterization, and symptoms 82
Table 10: Bulimia nervosa – incidence, characterization, and symptoms 83
Table 11: Binge eating disorder (BED)* – incidence, characterization and, symptoms 83
Table 12: Nutrition-related clinical signs of eating disorders 88
Table 13: Nutrient-dense and energy-dense foods and drinks 90
Table 14: Nestlé Health Science – key brands 92
Table 15: Nestlé Health Science – key brands (contd) 93
Table 16: Factors contributing to disease-related malnutrition 100
Table 17: Consequences of age- and disease-related malnutrition 109
Table 18: Leading enteral nutrition products 116
Table 19: Leading parenteral nutrition products 117
Table 20: Companies and product strategies in malnutrition 145