Opportunities and Key Players in Clinical Nutrition - Business Insights

F o r a c l e a r e r m a r k e t p e r s p e c t i v e
Opportunities and Key
Players in Clinical Nutrition
The market for enteral,
parenteral and infant nutrition
in the US and the EU
Report Price
Publication date
£2495/3610/$4795
June 2009
T H E C O N S U M E R N U T R I T I O N S E R I E S

Opportunities and Key Players in Clinical Nutrition
The market for enteral, parenteral and infant nutrition in the US and the EU
About us...
Business Insights has launched an exciting new set of strategic reports
that provide unique analysis of the clinical nutrition market. Drawing on
the depth of our in-house research on the food, drinks and pharmaceutical
markets and our network of industry experts, our analysis is the leading
source of insight on the future of consumer nutrition.
The consumer nutrition series looks beyond lifestyle-oriented
nutraceuticals to proactive health and clinical applications of food and
drinks products. As pharma, ingredients and FMCG companies
increasingly converge on added value nutritional products, this immature
market is becoming highly dynamic and presents a real opportunity for growth.
Against this backdrop the role of R&D in the food and drinks market will continue to grow as clinically proven
efficacy becomes a key point of differentiation. Our research examines the key trends, analyzes the impact of
innovation and assesses emerging opportunities and the key players operating in the market to give our clients
the full picture on the future of consumer nutrition..
Report Overview
In both the US and EU, the clinical nutrition industry is undergoing a
significant shift as major players re-align their businesses. While some are
divesting clinical nutrition operations to focus on prescription medicines,
others are building their capabilities to expand their presence in clinical
nutrition. This is resulting in some players, such as Novartis, exiting the
market while others, like Nestlé, are growing. Demand for clinical nutrition
products continues to rise with aging populations that are using more
health care products and services, as well as a rising rate of premature
births that is fueling increases in infant clinical nutrition. Rising demand,
coupled with the introduction of sophisticated new clinical nutrition
products, will support market growth over the next five years.
‘Opportunities and Key Players in Clinical Nutrition: The market
for enteral, parenteral and infant nutrition in the US and the EU’
is a new nutrition report published by Business Insights report that
provides an in-depth analysis of the clinical nutrition industry within
the US and EU, including sales forecasts from 2008 to 2013. It offers
a detailed breakdown of the products, positions and market shares of the
leading manufacturers of clinical nutrition products, as well as a discussion of
Pages 124
Figures 19
Tables 24
“Develop strategies
to capitalize on the
rapidly expanding
clinical nutrition market
with this new nutrition
report...”
other important players such as ingredient suppliers and service providers. This report defines clinical
nutrition as nutritional products used under the supervision (but not necessarily prescription) of a physician
in accordance with the US Orphan Drug Act; therefore, forecasts may differ from some other nutrition
product estimates.
T H E C O N S U M E R N U T R I T I O N S E R I E S

Opportunities and Key Players in Clinical Nutrition
The market for enteral, parenteral and infant nutrition in the US and the EU
Key Findings
Parenteral nutrition will demonstrate the
strongest growth, at 11.3% per year, on average,
followed by enteral nutrition with 7.4% annual
growth and infant nutrition with 7.0%.
In the United States, approximately 465,000
persons relied upon clinical nutrition in 2008.
Over the next 5 years, this group will expand by
8.7% per year, with the greatest growth in the
parenteral segment (11.3% annually) followed by
enteral tube feeding (8.9% per year).
In the EU, more than 650,000 individuals utilized
clinical nutrition in 2008. Through 2013, the total
number of European clinical nutrition patients will
expand by 7.7% per year.
Clinical nutrition forecast market growth by
region ($m), 2008-2013
“From 2008 to 2013, the total market will expand by
8.2% per year, on average, to reach $8.0bn. The US
market will expand most rapidly, at 9.2% per year while
the European market will grow by 7.5% annually as
reimbursement and other cost containment issues slow
growth...”
No single company represents more than about 20% of the market, as few have expertise in
both the US and EU regions for all three clinical nutrition segments.
Use this report to...
• Understand the latest trends and
developments in clinical nutrition patient
populations and identify the products and
ingredients associated with each term of
treatment.
• Identify the drivers and key issues that
are shaping the clinical nutrition segment
across the EU and the US and how they will
impact product formulation and marketing in
2009 and beyond.
• Quantify future growth areas in the clinical
nutrition market based on this report’s
analysis and forecasts of the clinical nutrition
market by region (US, EU) and segment
(enteral, parenteral, infant) from 2008-2013.
• Benchmark your competitive position
aganist other players in the clinical
nutrition market using this report’s analysis
of the performance of key players including
Abbott Clinical Nutrition, B. Braun Medical,
Baxter, Danone Baby and Medical Nutrition,
Fresenius Kabi, Hospira, Mead Johnson,
Nestlé HealthCare Nutrition & Wyeth.
T H E C O N S U M E R N U T R I T I O N S E R I E S

Opportunities and Key Players in Clinical Nutrition
The market for enteral, parenteral and infant nutrition in the US and the EU
Key issues...
Consolidation. The clinical nutrition industry is
undergoing consolidation as major players either
divest or acquire operations. This will result in
heightened competition as the market whittles down
to those companies most determined to carve out
leading positions.
New Product Development. The makers of
parenteral therapies are introducing sophisticated
new clinical nutrition products that will replace many
of the older, less cutting edge products.
Market share of leading US infant nutrition
players (%), 2008
“In 2008, Abbott Nutrition led the market with 48.3%
Aging Population. Demand for products is rising
strongly with aging populations in the US and EU as
well as rising rates of premature birth in both regions.
share. It was followed by Mead Johnson with 23.8%.
Other companies, including Danone Baby and Medical
Nutrition as well as manufacturers of products not
specifically labeled for infants, accounted for the
Homecare. Increasing utilization of home care is
expanding the usage of clinical nutrition in the home,
driving demand for products that are simple to use.
remainder. While Abbott reported sales of more than
$1.2bn for pediatric nutritionals, only a small portion of
these meet the definition of clinical nutrition used by
this report...“
Your questions answered...
• Why is the clinical nutrition market growing so
quickly?
• Which diseases account for the greatest
proportion of clinical nutrition patients?
• Which segment of the clinical nutrition market
will experience the strongest growth?
• What characteristic do the most successful
clinical nutrition companies share?
• What patient population will drive the greatest
market growth?
• Which type of companies will gain market
share over the next 5 years?
T H E C O N S U M E R N U T R I T I O N S E R I E S

Opportunities and Key Players in Clinical Nutrition
The market for enteral, parenteral and infant nutrition in the US and the EU
Sample Information
Chapter 1: Introduction
Parenteral nutrition
Parenteral nutrition is a form of intravenous
feeding that provides required nutrients in a
Table 1.6: Advantages and disadvantages
solution that directly enters the bloodstream
of parenteral nutrition
through a special catheter and tubing. Parenteral
feeding is indicated for patients whose daily
nutritional needs cannot be met through the
normal digestive pathway, particularly those who
are unable to eat, digest, or absorb nutrients.
Parenteral nutrition is needed when nutrition
supplies are limited and body function may be
impaired, as well as for patients in whom the
enteral route will be unavailable over two weeks
or longer. However, complications and infection
can occur because parenteral nutrition bypasses
the gastrointestinal system. Parenteral nutrition is
also expensive, often costing more than $100,000
per year. It is therefore generally reserved for patients who require immediate, concentrated feedings.
These advantages and disadvantages are summarized in Table 1.6.
Business Insights
In addition, the American Medical Association (AMA) has issued the following recommendations related
to parenteral nutrition:
• Usage is suggested for patients unable to eat or drink for one to three days be provided with 100 to
150 grams of carbohydrate intravenously each day to minimize protein breakdown (catabolism) and
possible ketosis;
• Patients receiving protein or amino acid solutions should, at the same time, receive large amounts of
carbohydrates, vitamins, and minerals to prevent negative nitrogen balance, and to reduce weight
loss;
• Parenteral nutrition necessitates considerable clinical and pharmaceutical expertise and laboratory
support to minimize biochemical, bacteriological, and surgical complications. Infusates must be
prepared aseptically. Experienced nursing care must be available to resolve problems related to the
catheter, and the patient must be monitored closely;
• Fats supplied as lipid emulsions are a concentrated source of energy that prevent or correct fatty
deficiencies. They are available in concentrations of 10% or 20% and provide 40% to 60% of a
patient's daily calories;
• Metabolic disturbances and/or dehydration must be corrected before parenteral nutrition is begun.
- 42 -
T H E C O N S U M E R N U T R I T I O N S E R I E S

Opportunities and Key Players in Clinical Nutrition
The market for enteral, parenteral and infant nutrition in the US and the EU
Table of Contents
CHAPTER 1: INTRODUCTION
• Background
• Patient populations
- Cancer patients
- Clinical nutrition for cancer patients
- Gastrointestinal disease patients
- Clinical nutrition for GI disease patients
- Other clinical nutrition patients
- AIDS patients
- Anorexia nervosa patients
- Burn patients
- Environments for clinical nutrition
- Inpatient environments
- Outpatient environments
• Major types of clinical nutrition
- Enteral nutrition
- Products and ingredients
- Parenteral nutrition
- Products and ingredients
- Infant nutrition
- Products and ingredients
- Ingredients
- Related products
• Market summary
CHAPTER 2: CLINICAL NUTRITION IN THE US
• Introduction
- Regulation
- Insurance reimbursement
- User populations
• Enteral nutrition
- Key products and players
- Sales and market share
- Sales structure and channels
- New product development
- Issues and trends
• Parenteral nutrition
- Key products and players
- Sales and market share
- Sales structure and channels
- New product development
- Issues and trends
• Infant nutrition
- Key products and players
- Sales and market share
- Sales structure and channels
- New product development
- Issues and trends
• Conclusions
CHAPTER 3: NUTRITION IN EUROPE
• Introduction
- Regulation
- Insurance reimbursement
- User populations
- Market heterogeneity
• Enteral nutrition
- Key products and players
- Sales and market share
- Sales structure and channels
- New product development
- Issues and trends
• Parenteral nutrition
- Key products and players
- Sales and market share
- Sales structure and channels
- New product development
- Issues and trends
• Infant nutrition
- Key products and players
- Sales and market share
- Sales structure and channels
- New product development
- Issues and trends
CHAPTER 4: MAJOR PLAYERS IN CLINICAL
NUTRITION
• Introduction
• Leading suppliers of clinical nutrition
- Current market share
- Company profiles
- Abbott Clinical Nutrition
- B. Braun Medical
- Baxter
- Danone Baby and Medical Nutrition
- Fresenius Kabi
- Hospira
- Mead Johnson
- Nestlé HealthCare Nutrition
- Wyeth
T H E C O N S U M E R N U T R I T I O N S E R I E S

Opportunities and Key Players in Clinical Nutrition
The market for enteral, parenteral and infant nutrition in the US and the EU
Table of Contents
CHAPTER 4: MAJOR PLAYERS IN CLINICAL
NUTRITION (CONT’D)
• Other important market participants
- Company profiles
- Ajinomoto
- Alaris Medical Systems/Cardinal Health
- American HomePatient
- Apria Healthcare
- Arrow International/Teleflex
- DSM
- Gentiva Health Services
- Kyowa Hakko
- Lonza
- Martek
• Index
FIGURES
• Total US & EU markets for clinical nutrition ($m), 2008
• Clinical nutrition forecast market growth by region &
segment ($m), 2008-13
• Forecast number of US & EU clinical nutrition patients
($m), enteral nutrition market ($) & infant nutrition
market ($m), 2008-13
• Forecast EU parenteral nutrition market ($m), 2008-13
• Market share of leading players in the
- US enteral nutrition market (%), 2008
- US parenteral nutrition market (%), 2008-13
- US infant nutrition market (%), 2008
- EU enteral nutrition market (%), 2008
- EU infant nutrition market (%), 2008
• Market share of leading clinical nutrition manufacturers
(%), 2008
• Sales of leading US & EU parenteral nutrition players
($m), 2008
• Projected market shares of leading clinical nutrition
manufacturers (%), 2013
TABLES
• Nutritive needs by condition
• Patients using medical nutrition by condition & type of
supplementation, 2009
• Inpatient care facilities in the US & EU, 2009
• Indications & contraindications for enteral feeding &
TPN
• Disease specific enteral nutrition products
• Advantages & disadvantages of parenteral nutrition
• Composition of neonatal venous nutrient solutions
(per liter)
• Medicare reimbursement for enteral nutrition products,
2009
• Leading US
- Enteral nutrition products, 2009
- Infant nutrition products, 2009
• Leading EU
- Enteral nutrition products, 2009
- Parenteral nutrition products, 2009
- Infant nutrition products, 2009
• US parenteral nutrition products, 2009
• Demographic & healthcare data for EU member
countries, 2006
• ESPEN guidelines for parenteral nutrition in ICU
patients, 2008
• Estimated sales of leading clinical nutrition players
• Market position, 2008
- Abbott Nutrition
- B. Braun
- Baxter
- Danone Baby and Medical Nutrition
- Fresenius Kabi
- Mead Johnson
- Nestlé
T H E C O N S U M E R N U T R I T I O N S E R I E S

Opportunities and Key Players in Clinical Nutrition
The market for enteral, parenteral and infant nutrition in the US and the EU
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