Focus op Ondervoeding 24-05-2016

1. KIEZEN WAT JE LEKKER VINDT
KRIJGEN WAT JE NODIG HEBT
the ‘FOOD SOLUTION’
1
Carezzo Nutrition bv – 24 Mei 2016 – Fred Bergmans

2. Onderzoek & Ontwikkeling
2010-2011 2012-2014 2014-2015
idee & haalbaarheid
fase
wetenschappelijk onderzoek &
productontwikkeling
effect studie & markt
entrée
2

3. 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
3

4. 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

5. 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
5

6. Wat is het probleem
0
2
4
6
8
10
12
14
16
18
18 t/m 29 30 /tm 49 50 t/m 70 >70
Energie(MJ/dag)
Energie behoefte van volwassenen (MJ/dag)
Gezondheidsraad 2002
0
0.2
0.4
0.6
0.8
1
1.2
18 t/m 29 30 /tm 49 50 t/m 70 >70
Eiwitbehoefte(g/kgLW/dag)

7. Ondervoeding in de zorg:
Ongewenst gewichtsverlies 25%-40%
+ 30g
08.00 10.00 12.00 15.00 18.00 20.00
WARMBROOD
TUSSEN
DOOR
2E BROOD
TUSSEN
DOOR
TUSSEN
DOOR
NIEUW VOEDING CONCEPT
• eiwitverrijkte basisvoeding – groenten, fruit en granen
• voor broodmaaltijden en tussendoor
De VOEDINGs oplossing

8. 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
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9. Proces innovatie
9

10. 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’
10

11. WAT WERKT
WERKT NIET: MEER ETEN
Huidige behandelmethoden:
- Energie & Eiwitrijk dieet
- Suppletie drinkvoeding
info@alliantievoeding.nl
www.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
Rationale
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 message
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.
Department 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).
11

12. 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

13. 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

14. 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 - verpleeghuis
14

17. Ondervoeding: Eiwit tekort OPLOSSEN zonder meer te eten
Resultaten:
doelgroep haalt de eiwit
NORM,
79% met het
eiwitverrijkte menu
(Cater with Care)
versus
50% in de controle groep

18. Resultaten Eiwitinname
Cntrl CwC
Eiwitinname
(g/kg/d)
1.05 1.51*
1.2 g/kg/d
bereikt
31% 72%
*P = 0.001
Beelen et al. to be published
Controle
CwC

19. Voornaamste eiwitbronnen (≥3%) in
controle- en interventiegroep
drinkvoeding
banket
soepen
Met name de verrijkte broodsoorten,
sappen en fruitzuivel verhoogden de
eiwitinname

20. Nieuwe categorie
€ per gram eiwit
Nieuwe categorie
tussen reguliere voeding en medische drinkvoeding
Drink-
voeding
> € 0,17
Per gram
eiwit
Reguliere voeding
(brood & melk)
€ 0,03 per gram eiwit
Carezzo
€ 0,03 -
€ 0,15
Als meer eiwit nodig is, en reguliere voeding onvoldoende is?
Carezzo voedingsconcept: range in kosten per gram eiwit
Meeste keuze en meest betaalbaar

21. Customer Journey
Transmurale zorg (thuis) – pre/post operatieve fase
22
Pre – operatief chirurgie Post operatief
Poliklinische
screening
op ondervoeding.
Behandeling Herstel
Behandeling van ondervoeding is Kosten effectief:
Webshop &
Maaltijd
verstrekking
Webshop & Maaltijd
verstrekking

23. Communicatie gericht op diëtisten en zorgprofessionals
• Ziekenhuizen
– Presentatie en proeverij
– Dietetiek en facilitair
• Diëtisten/zorg professionals
bijeenkomsten (sponsor)
– Geriatrie dagen - 18 & 19 februari
• 1000 Klinisch geriaters
– Welkom in de Zorg - 6 & 7 April
• 1700 facilitaire managers
– Diëtisten dagen NVD – 8 & 9 April
• 1000 diëtisten van de Ned Vereniging
van Diëtisten
• In de Media: zie www.Carezzo.nl
24
Geriatrie Dagen 2016
Donderdag 18 en Vrijdag 19 februari
1931 Congrescentrum ‘s-Hertogenbosch

24. Launching customers
25
• 32 afdeling
• Pilot oncologie
• Pre – operatief
• Vrije keuze

25. Kiezen wat je lekker vindt,
en krijgen wat je nodig hebt.