Medical nutrition companies
Adding a format to an existing range, or taking a product from powder into a ready-to-consume pack.
Therapeutic application
Recovery, convalescence and post-operative nutrition
Recovery nutrition is a guideline-driven category, and the guidelines have moved. Building a product here means knowing which recommendations are strong, which were recently downgraded, and which populations the evidence actually covers — because that decides both the formulation and what the pack is allowed to say.
The nutritional brief
What the guidelines actually ask for
Current perioperative guidance separates cleanly into recommendations that are strong and cost nothing, and recommendations that are weak and involve buying something. An honest product page should say which is which.
- Nutritional screening, strongly recommendedRoutine screening with a validated tool. GLIM provides the diagnostic criteria, with Asian-specific BMI thresholds that matter for products developed in and for this region.
- Shortened fasting, strongly recommendedClear liquids to two hours and solids to six hours before anaesthesia, rather than fasting overnight.
- Early oral intake after surgery, strongly recommendedIntake resumed within hours rather than days, where the surgery allows it.
- Preoperative nutrition support in malnourished patientsProtein above roughly 1.2 g per kg per day, oral route preferred, for seven to ten days before surgery.
- Preoperative carbohydrate loading — now rated weakThe 2025 ERAS colorectal guideline states it may improve insulin sensitivity but offers no advantage in comfort or clinical outcomes over a standard short fast. ESPEN still recommends it. The two disagree, and that disagreement is current.
- Postoperative oral nutritional supplementsAround 500 kcal alongside normal food for the first three to five days, rated on low-certainty evidence.
What we develop
Formats we build for this need
Each one is developed as its own product with its own specification — formulation, process and the analysis that proves the finished pack meets the profile it declares.
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Preoperative Carbohydrate Drinks
Clear, low-osmolality maltodextrin drinks built to empty from the stomach inside the fasting window.
Develop a pre-op drink -
High-Protein Oral Nutritional Supplements
Post-operative and convalescent supplements delivering protein and energy in a small serve.
Develop an ONS -
Immunonutrition Formats
Arginine, omega-3 and nucleotide formats for the perioperative populations the evidence covers.
Develop an immunonutrition format -
Convalescent and Recovery Meals
Ready-to-eat meals carrying the protein and energy density a catabolic state needs.
Develop a recovery meal -
Soft and Easy-to-Eat Recovery Formats
Gentle textures for the early days after surgery, when appetite and tolerance are both low.
Develop a soft format -
Hospital and Discharge Nutrition
Portion-standardised formats for inpatient use and for the weeks after discharge.
Develop a hospital format
What we change
What we change to make it work
Formulating for this category is about choosing a system that arrives at the specification after processing and storage, rather than one that meets it in the kitchen.
- Osmolality and gastric emptyingA preoperative drink is near-isotonic and free of protein and fat, because both delay emptying. The formulation envelope is narrow and it is narrow for a reason.
- Protein system for a catabolic stateHigh protein in a small volume, built so the protein survives sterilization without gelling or sedimenting.
- Omega-3 stabilityEPA and DHA oxidise. Encapsulation, antioxidant system and pack barrier are chosen together, and the result is confirmed by peroxide value across shelf life rather than assumed.
- Energy density without a broken emulsionRaising calories means raising fat, which makes the emulsion rather than the protein the limiting factor.
- Palatability under low appetiteA supplement that is not finished delivers nothing. Sensory work is part of the development, not an afterthought.
- Format matched to the settingA hospital pack, a pre-surgery drink and a discharge supplement have different volumes, different closures and different handling. The format follows the setting.
Straight answers
What the evidence supports, and what it does not
We would rather you launched a product that holds up under scrutiny than one carrying a claim that does not. These are the places where the evidence is weaker than the category implies.
- Preoperative carbohydrate loading was downgraded in 2025
- The ERAS Society's 2025 colorectal guideline rates it weak and states it offers no advantage in comfort or clinical outcomes over a standard short fast. ESPEN still recommends it. Marketing built on the older, stronger framing is out of date.
- Immunonutrition is Grade B, not Grade A
- Current ESPEN surgical guidance recommends perioperative arginine, omega-3 and nucleotide formulas for major tumour surgery at Grade B. The signal is strongest in malnourished patients having major gastrointestinal surgery, and recent independent trials have not reproduced some earlier positive findings.
- Arginine formulas carry a real contraindication
- Arginine-supplemented diets are not recommended in severe sepsis and critical illness, and high-dose glutamine has been associated with worse outcomes where there is renal or hepatic impairment. This belongs on the label, not in a footnote.
- The wound-healing micronutrient trio is over-marketed
- The current Cochrane review finds the benefits of most supplements for pressure ulcer prevention and treatment unclear, with insufficient evidence for zinc and vitamin C specifically. Correcting a documented deficiency is justified; supplementing a replete patient is not evidence-based. Adequate protein and energy is the defensible element.
Who we develop for
Manufacturers, institutions and programme buyers
Products in this category are developed here for the organisations that have to put them in front of a clinician, a procurement team or a regulator.
Nutraceutical and functional food brands
Moving from general wellness into a defined clinical need, where the profile becomes the specification.
Hospitals, care homes and caterers
Producing to a standardised portion and profile, centrally, and shipping ambient.
Public health and institutional programmes
Supplementary and therapeutic feeding where composition, shelf life and cost per serve are fixed by tender.
Private label and OEM buyers
Sourcing under your own brand, needing the formulation and process proven before a co-packer is committed.
NPD, R&D and regulatory teams
Inside an established manufacturer, needing formulation, process and regulatory work in one place.
The technical side
The terms your file will use
If you are briefing an R&D, regulatory or quality team, or answering a tender or an importer’s questionnaire, these are the concepts the work is built on.
Terms in this category
- ERAS
- Enhanced Recovery After Surgery — the perioperative care protocols that set most of this category's specifications.
- GLIM criteria
- The global diagnostic framework for malnutrition: one phenotypic and one etiologic criterion, with Asian-specific BMI thresholds.
- MUST, NRS-2002, MNA-SF
- The validated screening tools that sit in front of a GLIM diagnosis.
- Catabolic state
- The post-surgical or post-illness state in which the body breaks down its own tissue, raising protein and energy requirements above normal.
- Immunonutrition
- Formulas supplemented with arginine, omega-3 fatty acids and nucleotides, used perioperatively in defined populations.
- Osmolality
- Solute concentration, which governs how fast a drink leaves the stomach and therefore whether it is safe inside a fasting window.
- Peroxide value
- The measure of primary oxidation in an omega-3 bearing product, tracked across shelf life rather than at release only.
- Prehabilitation
- Nutritional and physical preparation before surgery rather than after it.
Where this sits in what we do
- Formulation and developmentConcept, formulation design and lab-scale trials against your target profile
- Pilot manufacturingTrial batches in the pack the product will ship in, including our pilot retort for shelf-stable formats
- Process validationThermal process validation and the scheduled process that a manufacturer runs from
- Stability and shelf lifeAccelerated and real-time studies establishing what the declared life actually is
- Clinical validationTrial design and management where an intended use or a claim has to be substantiated
- Regulatory and commercialisationClassification, labelling and the documentation each destination market asks for
Related work: clinical nutrition, therapeutic nutrition, retort clinical and medical nutrition and clinical trial management.
Questions
Recovery, specifically
Is a preoperative carbohydrate drink still worth developing?
It is still a real category with a live specification, but the claim has to be current. The 2025 ERAS colorectal guideline rates it weak and says it offers no advantage in comfort or clinical outcomes over a standard short fast, while ESPEN still recommends it. We will help you build the product and we will tell you what the label can defensibly say, which is narrower than it was five years ago.
Why can a pre-op drink not contain protein?
Because it has to be clear and empty from the stomach inside the fasting window. Protein and fat both delay gastric emptying, so they are excluded. Near-isotonic, carbohydrate only, no fat, no fibre — the formulation looks simple because the envelope is that tight.
Can we claim Grade A evidence for an immunonutrition product?
No. The highest grade we can verify in current guidance is Grade B, for perioperative arginine, omega-3 and nucleotide formulas in major tumour surgery. Some recent independent trials have failed to reproduce earlier positive findings. We would rather you had a product that holds up than a claim that does not.
Does an arginine formula need a warning?
It needs one in practice. Arginine-supplemented diets are not recommended in severe sepsis or critical illness, and the intended population has to be stated on the pack. This is one of the places where a precaution belongs on the front of the file rather than the back.
Should we add zinc and vitamin C for wound healing?
Only if the position is repletion. The current Cochrane review finds insufficient evidence for zinc and vitamin C in pressure ulcer prevention and treatment, and mixed evidence for the arginine combination. The mechanisms are textbook; the trial evidence is not there. Adequate protein and energy is the part you can stand behind.
What can the label actually say?
It depends on the market and on the classification. In the European Union a food for special medical purposes cannot carry nutrition or health claims at all — it communicates through its intended-use statement. In India, the condition statement on a food for special medical purpose is subject to approval by the Authority on scientific and clinical evidence. We scope that with you before the formulation is fixed, not after.
See the wider applications index
Next step
Tell us what the product has to do
Send the target profile, the format you have in mind and the market you are selling into. We will tell you what is achievable, what the evidence will and will not support on the label, and what the development work would need to cover.
- 1Send the briefA target profile and a format is enough to start.
- 2We come back within two working daysWith what is achievable and where the risk sits.
- 3You get a scoped quotePriced on the work the product actually needs.
