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Clinical Rationale for Oral Nutritional Supplements – Research and Development Perspective. Fionna O’Broin BSc (Hons) SRD Clinical Nutrition Manager Nutricia Clinical Care. Topics. Oral nutritional supplements Considerations for development The physiology of taste

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Clinical rationale for oral nutritional supplements research and development perspective l.jpg

Clinical Rationale for Oral Nutritional Supplements – Research and Development Perspective

Fionna O’Broin BSc (Hons) SRD

Clinical Nutrition Manager

Nutricia Clinical Care


Topics l.jpg
Topics Research and Development Perspective

  • Oral nutritional supplements

    • Considerations for development

  • The physiology of taste

  • Improving taste in ONS – research perspective

  • Innovations in packaging – development perspective

  • Conclusion


Oral nutritional supplements ons l.jpg
Oral Nutritional Supplements (ONS) Research and Development Perspective

  • ONS is one of the main strategies for increasing nutritional intake in patients who are unwilling or unable to consume sufficient foods to meet their nutritional requirements

  • ONS can1:

    • Improve energy and nutrient intake

    • Improve body weight or attenuate weight loss

    • Improve functional outcomes

    • Improve clinical outcomes especially in the hospital setting

  • Compliance is critical to the efficacy of ONS

  • Factors affecting patients’ ability to consume ONS over a long period of time include:

    • Taste of the product

    • Variety of flavours and presentations

      1. Stratton et al 2003


Ons development l.jpg
ONS Development Research and Development Perspective

Nutritional

properties

Consumer

preference

Legislation

Product

Sensory

properties

Ingredients

Packaging

Processing

Chemical/physical

properties

Patient

condition


Ons development5 l.jpg
ONS Development Research and Development Perspective

Development of an ONS is a complex process involving many factors:

  • Target patient group

  • Nutritional composition

  • Overall formulation

  • Packaging


Target patient group l.jpg
Target Patient Group Research and Development Perspective

  • Consider patient needs:

    • Age

    • Condition

    • Specific nutritional restrictions/requirements

    • Taste preferences

    • Length of time taking ONS – choice of flavours


Nutritional composition l.jpg
Nutritional Composition Research and Development Perspective


Directive 1999 21 ec foods for special medical purposes l.jpg
Directive 1999/21/EC Research and Development PerspectiveFoods for Special Medical Purposes

  • Defines the products covered

  • Categorises products according to nutritional content

    • Nutritionally complete, standard formulation, sole source of nutrition

    • Nutritionally complete, nutrient-adapted formulation specific for a disease, sole source of nutrition

    • Nutritionally incomplete, standard or nutrient-adapted, not suitable as a sole source of nutrition

  • Includes compositional guidelines:

    • Apply to products for infants, children and adults

    • Cover all vitamins, minerals and trace elements

    • Includes minimum and maximum levels

  • Sets out specific labelling requirements


Overall formulation l.jpg
Overall Formulation Research and Development Perspective

  • Selecting ingredients

    • Nutritional value

    • Technological properties

    • Taste

  • Balancing tastes

    • Camouflaging less pleasant tastes

    • Enhancing flavour

  • Ensuring stability

    • Behaviour of each component

    • Combination of components

  • Selecting flavours

    • Patient preference

    • Rate and degree of release from the food


The physiology of taste l.jpg
The Physiology of Taste Research and Development Perspective

  • All the senses are involved but those contributing to flavour are the most important

  • Flavour stimuli are classified into:

    • Tastes = basic notes

    • Odours = variety and interest

    • Trigeminal stimuli = excitement

  • It is important to remember that the interaction of the senses contributes to overall preference of a food or drink

  • Flavour release is related to the structure and textural characteristics of a food or drink

  • Senses decline on ageing (or with treatment or medication) and compensation is necessary to maintain enjoyment


The senses l.jpg

Hearing Research and Development Perspective

Olfaction

Vision

Touch

Touch

Taste

The Senses

 Vision  Appearance

 Gustation  Taste

 Olfaction  Odour

 Chemical  Irritant

 Touch  Texture

 Hearing  Texture


Flavour release l.jpg
Flavour release Research and Development Perspective

  • The release of aroma compounds can be affected by ingredients or by structural factors e.g. viscosity


Increase in taste thresholds for elderly people on medication 2 l.jpg
Increase in Taste Thresholds Research and Development Perspectivefor Elderly People on Medication2

Sodium salts

Acids

Bitterness

Amino acids

Glutamate

Sweeteners

2. Brown et al 1986


Slide14 l.jpg
Taste testing Research and Development PerspectiveDavid Kilcast BSc, PhD, FIFST, CSciBusiness Development ManagerLeatherhead Food International


Improved taste research perspective l.jpg
Improved Taste – Research and Development PerspectiveResearch Perspective

Evaluation of the product with the end user is one of the most important

steps in product development

  • Factors to consider:

    • Ability of the patient to respond and concentrate

    • Number and type of questions

    • Rating scales used

    • Taste fatigue

  • Key questions:

    • Overall liking or preference of the new product

    • Evaluation of specific product attributes


Improved taste research perspective16 l.jpg
Improved Taste – Research and Development PerspectiveResearch Perspective

Aim:

  • To evaluate the new flavour of Fortisip Bottle against original Fortisip and other comparable sip feeds

    Method:

  • Single blind sensory evaluation

  • One to one interviews

  • Using pre-poured sip-feed products in cups

  • The order of presentation of sip feeds was randomized

  • Respondents ranked the products

    • in order of taste preference

    • evaluated two product characteristics


Improved taste research perspective17 l.jpg
Improved Taste Research and Development Perspective– Research Perspective

Study population:

  • Elderly patients (>60 years)

  • Recent sip feed users

  • A range of care settings

  • Subjects had to be able:

    • to understand the test procedure

    • Independently form an opinion

    • Communicate their scores

      Study products:

  • New Fortisip

  • Current Fortisip

  • Three comparable sip feed products


Preference ranking of flavour l.jpg
Preference Ranking of Flavour Research and Development Perspective†

most

3.0

preferred

*

Significant against

Old Fortisip

Abbott 1.5kcal/ml sip feed

Fresenius 1.5kcal/ml sip feed

2.5

*

mean ranking

2.0

1.5

N=109

N=204

N=95

N=109

N=95

least

1.0

preferred

Old

New Fortisip

Bottle

Nestle

1.5kcal/ml

Sip feed

Abbott

1.5kcal/ml

Sip feed

Fresenius

1.5kcal/ml

Sip feed

Fortisip

†Strawberry


Innovations in packaging development perspective l.jpg
Innovations in packaging Research and Development PerspectiveDevelopment Perspective

Packaging is important to consumers

Illustration


Patient and carer perspective l.jpg
Patient and carer perspective Research and Development Perspective

Flavour

clear

Easily

stored

Easily

decanted

Ideal

packaging

Bright and

inviting

Bendy

straw

Easy to hold

or grip

Resealable

Does not look like

A medicine

Low centre

of gravity


Manufacturing perspective l.jpg

Consumer preference Research and Development Perspective

Volume of product

Market size

Plant capabilities

Cost and maintenance of machinery

Compliance with safety requirements

Environmental issues

Processing e.g. sterilisation

Effect of packaging material on product

Composition

Sensory qualities

Market trends

Shelf-life

Storage

Distribution

Wholesalers

Outer packaging

Labelling requirements

Need for additional items e.g. straws or scoops

Cost effectiveness

Communication

Consumer preference

Manufacturing perspective


Labelling l.jpg
Labelling Research and Development Perspective

  • Name and legal descriptor

  • Flavour

  • Volume

  • Best before date

  • Nutrition information

  • Ingredients

  • Indication of allergens

  • Important Notice

  • Instructions for storage and use

  • Manufacturer details

  • Place of origin

  • Barcode

  • Special communication e.g. New

  • Position of straw

  • Languages


Development to launch l.jpg
Development to Launch Research and Development Perspective

Product development process

Product trials and market research

ACBS approval

Foods Standards Agency notification

Sales force training

Launch and communication programme


Conclusion l.jpg
Conclusion Research and Development Perspective

Compliance is critical to the efficacy of ONS


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