5‐10‐2015

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KIEZEN WAT JE LEKKER VINDTKRIJGEN WAT JE NODIG HEBT

the ‘FOOD SOLUTION’ 

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Carezzo Nutrition bv – Sparkling a sixty – Wageningen 1 oktober  2015 ‐ Fred Bergmans

CAREZZO NUTRITION BV

Ondervoeding met voeding aanpakkenLekker, variatieBetaalbaar

Voeding concept & Netwerk:Wetenschap en R&DProductie en Zorg

Nieuwe aanbieder

5‐10‐2015

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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

1/3ongewenst

1/3 >gewenst

+ 30g

60g 90g

Prestatie indicator IGZ  1,2 g eiwit/kg

+ 50% Eiwit inname 

Prestatie indicator IGZ   Screening SNAQ/MUST

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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 BROODTUSSEN DOOR 

2E BROODTUSSEN DOOR 

TUSSEN DOOR 

NIEUW VOEDING CONCEPT• eiwitverrijkte basisvoeding – groenten, fruit en granen• voor broodmaaltijden en tussendoor

De VOEDINGs oplossing

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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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Proces innovatie

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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’ 

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

SenTo – smaakpanel Wageningen Universiteit

Senioren met volledigegeur/smaakvermogen

Senioren met verminderdegeur/smaakvermogen     

(geur‐impairment)

Volwassenen 

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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 panelWUR ‐FBR

WAT WERKT 

WERKT NIET: MEER ETEN

Huidige behandelmethoden:

‐ Energie & Eiwitrijk dieet 

‐ Suppletie drinkvoeding

info@alliant ievoeding.nl w w w .alliant ievoeding.nl

Alliant ie 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.

Depar tm ent of dietet ics Gelderse Vallei Hospital PO box 9025 6710 HN Ede, the Netherlands j anssenn@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

RationaleA sufficient total protein intake (1.2-1.5 g/kg foracutely and chronically ill older adults) and anoptimal protein distribution over the day (25-30g/meal) are important to counteract sarcopenia.However, patients recovering from disease oftenhave an insufficient protein intake.

The purpose of the current study was to investigatethe effects of the consumption of protein enrichedproducts on the daily protein intake and the proteindistribution over the day in older adults in arehabilitation centre.

MethodsSingle blind RCT. Patients received either proteinenriched bread (Carezzo; 6.9 g protein per slice)and protein enriched drinking yoghurt (Drinkingyoghurt enriched with Fonterra Whey ProteinConcentrate (WPC 515), 20.0 g protein / 250 mL) orregular products during three weeks (4.0 g and 7.5 gprotein, resp.) For each patient, 24h intake of allfood products was measured (6 measurement daysper patient).

ResultsThirty-four patients were included in the study.Compared with controls, patients who receivedthe protein enriched products had asignificantly 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

ConclusionThe daily consumption of protein enriched bread and protein enriched drinking yoghurt is effectiveto achieve both a significant higher protein intake and an optimal distribution of the dietary proteinover the day in older adults.

Control Intervention P-value

Protein intake (g/day)

72.5 115.3 <0.001

Protein intakeg/kg

1.1 1.6 <0.001

Correspondence: Marian.devanderSchueren@han.nl

The intervention group consumed quantitiesover the recommended level (25-30 g/meal)during each of the three meals, where thecontrol group consumed quantities below therecommended level during breakfast and lunch(figure).

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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

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Sales Operations

Grondstoffenleveranciers & 

contract research

InkopersZiekenhuizen, Woon‐

& Thuiszorg, Cateraars, grossiers

UniversiteitenZiekenhuizen

Patienten& DietistenZorginstellingen

Fabrikanten, bakkerijen, 

logistiek providers

Marketing Technology

Business concept: 4 kernfuncties

DOELGROEP VOEDING

<- Verkoop & logistiek->

<- Receptuur ontwikkeling->

Verrijkteproducten laten

produceren

Info over voedingstoestand

verbetering

BUSINESS CONCEPT: 4 KERNFUNCTIES 

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5‐10‐2015

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Carezzo Nutrition – ZorgTotaal beurs maart 2015

Ter kennismaking: 2 assortiments dozen

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Strategisch investeerder – begin van de groeiMarkt entrée in ziekenhuizen,  woonzorg en thuiszorg

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5‐10‐2015

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Onderzoek & Ontwikkeling

2010‐2011 2012‐2014 2014‐2015

idee & haalbaarheidfase

wetenschappelijk onderzoek & productontwikkeling

effect studie & marktentrée

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