How to reconcile eating pleasure and nutrition in cases of undernutrition

The French clinical nutrition market saw its turnover reach €369 million in 2021. In the same year, 2 million people were identified as suffering from undernutrition in France^1,2. Though chiefly restricted to hospitalized patients or the elderly, cases of undernutrition are alarmingly on the increase. Furthermore, France’s Ministry of Health estimates that the proportion of people over 75 suffering from undernutrition will reach 1 in 5 by 2050³. More generally, in Europe, it is estimated that undernutrition affects between 5 and 10% of the population. 

The treatment of undernourished patients is therefore an important public health issue that must be dealt with in a holistic manner. Combining eating pleasure and nutrition is thus one of the key points for guaranteeing compliance with medical prescriptions and also helping to limit the risk of relapse.

Laïta Nutrition – the nutrition division of the Laïta dairy cooperative – has extensive know-how in the development of complex nutritional products combining eating pleasure and nutrition.

Diagnosis of undernutrition⁴

Undernutrition is a chronic form of malnutrition that is defined as a state of negative nutritional imbalance resulting from insufficient energy intake and nutrients. The individual’s energy and/or protein balance is negative because they ingest less energy than they consume.

A state of undernutrition is diagnosed if the individual combines at least one phenotypic criterion and one etiological criterion from the list of established criteria.

Phenotypic criteria include the following:

• weight loss ≥ 5% in 1 month, ≥ 10% in 6 months or ≥ 10% compared to the usual weight before the onset of the disease.
• BMI less than 18.5 kg/m² in children and adults or < 21 kg/m² in people over 70 years of age.
• a reduction in muscle mass and/or function (in children and adults).

The etiological criteria are less obvious to detect and often require a medical diagnosis. In cases of undernutrition, such criteria include:

• a reduction in food intake ≥ 50% for more than one week, or any reduction in intake for more than two weeks compared to the usual quantified food intake, or compared to the estimated protein-energy requirements.
• reduced absorption (malabsorption or maldigestion).
• a situation of aggression (protein hypercatabolism with or without inflammatory syndrome).

Once undernutrition has been diagnosed, it is important to determine the cause(s) in order to set up an appropriate treatment combining eating pleasure and nutrition.

Causes of undernutrition⁵

Old age is one of the main factors leading to undernutrition. It is often accompanied by a loss of pleasure in eating and a loss of appetite, due to poor oral condition, problems with chewing and/or swallowing, a reduction in sensory perceptions (taste and smell) and a reduction in feelings of hunger and satiety.

The existence of a chronic pathology should also be taken into consideration, as they increase the individual’s nutritional needs by increasing energy expenditure, catabolism and protein synthesis. At the same time, they increase losses through mobilization of reserves (particularly protein reserves), digestive malabsorption, diarrhea or excessive protein loss. The chronic pain that accompanies these pathologies can also encourage loss of appetite, while many drugs affect taste perception or induce digestive disorders (e.g., diarrhea, cramps, burns, etc.).

Other psychosocial and behavioral factors contribute to instances of undernutrition e.g., depression, isolation, precariousness, a sedentary lifestyle or, conversely, hyperactivity, an unbalanced diet or, more acutely, the existence of an eating disorder (anorexia nervosa, bulimia, orthorexia, etc.).

In all cases, there is a demand for nutrients that the patient cannot meet through food consumption alone. It is therefore necessary to develop solutions to increase their intake in a healthy and sustainable way.

Combining eating pleasure and nutrition to respond to undernutrition

The main objectives of a prescription in case of undernutrition are to rebalance the patient’s diet and increase their energy levels and/or protein intake.

To achieve this, corrective measures implemented include:

• a split diet,
• an enriched diet,
• the integration of texture-modified foods in the event of swallowing or chewing problems,
•  food supplements to make up for deficiencies,
• and Food for Special Medical Purposes (FSMP) to provide the macro- and micro-nutrients that the patient needs.

In all cases, eating pleasure must be central to the renutrition process. Without this motivation, the patient will find it difficult to adhere to their treatment objectives until the end (i.e., poor compliance) and the risk of recidivism into undernutrition will be high.

However, during hospital treatment, the risk of food consumption is reduced: 73% of adults do not consume the quantity of calories their body theoretically needs and 85% have insufficient protein intake⁶. The prescription of a special medical diet (salt-free, fiber-free, low-protein, low-calorie, etc.) can also alter the quality of the patient’s diet and desire to eat.

It is therefore important to develop nutritional solutions with a variety of shapes, tastes, smells, colors and textures, which are as close as possible to everyday products so that the patient can enjoy following their prescribed treatment. Attractive packaging with a less medical appearance is also an important attribute to ensure patient affinity.

Laïta Nutrition supports you in the development of clinical nutrition products adapted to undernutrition

Our expertise in developing FSMPs

Our ability to develop nutritionally complex and effective FSMPs is reflected firstly in our expertise in complex nutritional formulation. At Laïta Nutrition, we have created a unique customized development methodology, managed by a cutting-edge R&D team. With 30 years of experience, we have developed expertise in both liquid and powder formats. This enables us to formulate FSMPs in different formats according to your requirements.

Our strong technological expertise allows us to produce precise product models and prototypes, as well as to ensure constant and demanding monitoring throughout the development phases.

Finally, our mastery of very specific processes allows us to develop high quality FSMPs that comply with international food safety standards. The FSSC 22000 and ISO 9001 certifications obtained by our factories guarantee the traceability and food safety of the FSMPs manufactured.

All this expertise is combined in the development of our own FSMPs. Laïta Nutrition is fully confident of its ability to provide valuable and personalized assistance to your project to develop nutritionally complex and effective FSMPs.

Clinical nutrition at Laïta Nutrition: a historical expertise

Specializing in the formulation and manufacture of complex nutritional products, Laïta Nutrition has been providing its know-how on the clinical nutrition market since its creation.

Over the years, Laïta Nutrition has been able to meet the nutritional needs of specific populations thanks to its specialized R&D team. Today, Laïta Nutrition offers a wide range of solutions to meet the specific problems of dysphagia and certain metabolic diseases such as diabetes. Laïta Nutrition also specializes in infant and sports nutrition.

To respond to our partners’ specific needs, we have developed an FSMP in powder format in order to meet these expectations.

Intended for adult patients with or at risk of malnutrition, rich in calcium and gluten-free, our product provides a high amount of energy, high quality proteins (easily absorbed by the body, which help maintain and synthesize muscles), as well as omega 3 & 6 to support heart health.

Finally, per 100g, this FSMP provides 130 kcal, 4.8g protein, 4g fat and 18.6g good quality carbohydrates.

The product also completes the patient’s intake of micronutrients with its 28 vitamins and minerals, including:

• vitamin D and calcium for bone strength,
• vitamin B for energy metabolism,
• vitamin A to reduce fatigue,
• vitamins C and E to protect the body against oxidation.

Laïta Nutrition has taken potential intolerances or allergies in the patient into account and thus offers FSMPs in both lactose-free and lactose-rich versions.

Behind the formulation of this product, a significant amount of work has been carried out on developing taste and texture in order to combine both eating pleasure and nutrition. It has a milky taste and smell that is close to a real dairy product, with a smooth and fluid texture. Our product can be easily integrated into an enriched diet or as an oral nutritional supplement.

Our multiple areas of expertise enable us to develop effective, qualitative and safe solutions to tackle undernutrition. We also work on the organoleptic qualities of our products (texture, taste, smell, etc.) with the aim of offering appetizing solutions that combine both eating pleasure and nutrition.

Whether you want to develop technically and legally controlled clinical nutrition products, or your main objective is to give restore the pleasure of eating to patients , Laïta Nutrition can help you. Our expertise and our high standards are at your service to develop your clinical nutrition projects in a personalized manner and on demand.

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Sources:

_{1. L’Alliance 7, Nutrition Clinique, Des produits au service de la lutte contre la dénutrition, mai 2021}

_{2. Syndicat Français de la Nutrition Spécialisée, Les chiffres 20213}

_{3. Ministère de la Santé, Dénutrition, une pathologie méconnue en société d’abondance}

_{4. HAS, Recommandation de bonne pratique, Diagnostic de la dénutrition de l’enfant et de l’adulte, novembre 2019}

_{5. PNNS, Dénutrition, une pathologie méconnue en société d’abondance, 2010}

_{6. AP-HP, Etude énergie 4+}