Takehome:
- In China, a country with over 200 million elderly people aged 60+, prepackaged foods intended for the elderly is still an under-developed segment. The national standard for elderly food and nutrition was opened to public feedback in 2018 and is awaiting finalization.
- The National Nutrition Plan (2017-2030)[1] aims to improve the nutritional status of older persons. Part of the plan calls for production of healthier foods that meet the demands of the elderly, especially fortified foods, low-salt and low-fat foods.
High Prevalence of Chronic Illness Amongst China’s Senescent Population
According to the 6th China census, the number of Chinese residents aged over 60 was 178 million, accounting for 13.3% of the Chinese population. There was 119 million aged over 65 accounting for 8.9% of the population. At the end of 2014, the population of older persons aged over 60 reached 210 million, accounting for a whopping 22% of the world’s population of elderly people.
Despite the improved living quality and access to more diversified diets, malnutrition is a big problem for older persons. The so called “tea and toast” diet of the elderly is a major contributor to numerous dietary deficiency diseases including anemia, dementia, osteomalacia etc. According to Nutrition and Health Report of the Elderly in China, 48.4% of older persons suffered from malnutrition[2]; Looking more closely, you’ll find up to 80%~90% older persons did not consume enough micronutrients such as calcium, zinc, vitamins and more than half of those surveyed consumed inadequate dietary protein. Zhang Jian, a researcher at National Institute for Nutrition and Health affiliated to Chinese Center for Disease Control and Prevention, noted that among patients suffering from dysphagia in China, 40.3% also suffer have comorbid conditions related to malnutrition and 38.6% have a high risk of malnutrition.
Proper diet and a healthy life go hand in hand, especially for older adults over the age of 65. According to reports by World Health Organization (WHO), a majority of the diseases that older people suffer are due dietary inadequacy.[3] In China, 12.6% of older persons aged above 60 suffered from anemia (both microcytic due to iron deficiency anemia and macrocytic due to b12 deficiency). Amongst those over 75 years of age the prevalence of anemia jumps to 17%.
According to Zhang “Chinese older persons consume a great deal of functional health foods due to their health anxiety and to alleviate illness”. Nearly half of residents aged above 60 suffer from high blood pressure and 20%~30% of them live with diabetes. Yet quite often they prefer consuming health food instead of listening to the dietary advice of their doctors.Status Quo of Foods for the Elderly
Food for the elderly is not meant to have health functions, instead it provides dietary nutrition for older persons and for elderly people who have odynophagia or dysphagia and who are vulnerable to malnutrition. China National Center for Food Safety Risk Assessment (CFSA) and School of Public Health of Qingdao University carried out a research on prepackaged foods for the elderly sold on the online and offline market from January 2018 to May 2018. The results suggested that there are limited categories of foods for the elderly on the market, and although some are labeled as “consumable for elderly person”, their sugar, salt, fat contents and nutrients are unsuitable.Market segmentation
Researchers collected samples of 220 prepackaged foods for the elderly on the market. Those products are divided based on their forms. Pastry food took up 40%, followed by 31% modified milk powder. The rest are sesame paste, lotus root powder etc. and liquid drinks.
| Form | Amount |
| Modified milk powder | 69 |
| Drink | 27 |
| Pastry | 87 |
| Sesame paste, lotus root powder and the likes | 36 |
According to GB 28050-2011 General Rules for Nutrition Labeling of Prepackaged Foods, mandatory content of nutrition labeling includes energy, core nutrients (protein, fat, carbohydrate and sodium), their concentration and proportion to Nutrient Reference Value(NRV%). Other nutrients, if involved in nutrition or health claims, shall be labeled in this way too.[4] Therefore researchers made analysis based on the energy and nutrition claims on their packages.
Modified milk powder
The recommended daily intake (RDI) of modified milk powder is generally 50 gram per day. According to Chinese National Dietary Reference Daily Intake (RDI) of Nutrients (2013)[5], a daily serving of modified milk powder intended for the elderly should provide 1/10 of daily energy requirements, 1/3 protein, 1/10 fat, 1/10 carbohydrate and 1/10 sodium.
| Components/100g | Minimum | Maximum | ||
| Concentration | NRV% | Concentration | NRV% | |
| Energy (kJ) | 465 | 5 | 2115 | 25 |
| Protein (g) | 7 | 12 | 37 | 62 |
| Fat (g) | 1 | 2 | 28 | 47 |
| Carbohydrate (g) | 12 | 4 | 64 | 21 |
| Sodium (mg) | 145 | 7 | 600 | 30 |
Apart from core nutrients, many products additionally provide older persons more nutrients. In terms of vitamins, over three quarters of all products contain additional Vitamin A, Vitamin D, Vitamin E, and Vitamin C. In terms of minerals, nearly all of them contains Calcium. Iron and zinc are also frequently used nutrients.
| nutrients | Application rate | |
| Vitamins | VA | 78% |
| VD | 78% | |
| VE | 78% | |
| VC | 78% | |
| B2 | 25% | |
| B6 | 26% | |
| B9 | 7% | |
| B1 | 4% | |
| B12 | 3% | |
| Choline | 1% | |
| Minerals | Ca | 97% |
| Fe | 75% | |
| Zn | 70% | |
| Mg | 33% | |
| Se | 20% | |
| P | 23% | |
| K | 9% | |
| Mn | 1% |
42% of protein products for the elderly claim to have fiber and a few products contain taurine and probiotics. Micronutrients such as Vitamin K, biotin, niacin, copper, fluorine, iodine, chromium are not found in these products.
Liquid drink
Among the 27 types of liquid foods for the elderly circulating on the market, 25.9% are milk, 26% are goat milk, 11.1% are soymilk. Their nutrition claims feature “low/zero fat”, “cholesterol free”, “low/zero lactose”.
| Components/100ml | Minimum | Maximum | ||
| Concentration | NRV% | Concentration | NRV% | |
| Energy (kJ) | 182 | 2 | 309 | 4 |
| Protein (g) | 72 | 4 | 4 | 6 |
| Fat (g) | 1 | 2 | 4 | 6 |
| Carbohydrate (g) | 2 | 1 | 5 | 2 |
| Sodium (mg) | 45 | 2 | 80 | 4 |
Major micronutrients are Vitamin D, Calcium, Vitamin A, Vitamin D and Vitamin E.
| % of all liquid drinks | |
| Ca | 55.5% |
| Vitamin A/D/E | 7.4% |
Pastry food
Of the 87 pastry foods for the elderly circulating on the market, 73.5% (64 products) are biscuits and 26.5% (23 products) are cakes. Product differentiation often hinges on labeling claims which include claims relating to “low/zero sugar”, “xylitol/maltitol”, “dietary fiber” and “soft”. Fat, sugar and salt concentration usually surpass other types of foods for the elderly.
| Components/100ml | Minimum | Maximum | ||
| Concentration | NRV% | Concentration | NRV% | |
| Energy (kJ) | 904 | 11 | 2069 | 30 |
| Protein (g) | 1 | 1 | 25 | 42 |
| Fat (g) | 1 | 2 | 55 | 93 |
| Carbohydrate (g) | 36 | 12 | 94 | 31 |
| Sodium (mg) | 3 | 0 | 1400 | 70 |
As stipulated in the GB 28050 Appendix C Requirements of Concentration Claims, for solid food, “low fat” claim means a fat concentration of less than 3g/100g. There are only 7 products that are low-fat.
| Fat concentration (per 100g) | Proportion |
| ≤3g | 8.0% |
| 3~15g | 25.3% |
| 15~30g | 62.1% |
| ＞30 g | 4.6% |
Sesame paste and similar products
This category refers to lotus root powder, sesame paste, walnut powder etc. Of the 36 products in this category, sesame paste is the most common type, accounting for nearly 60% of all products. Walnut and sesame powder also serve as a good source of unsaturated fatty acids (omega 3 and 6). Lotus root powder provides abundant energy as carbohydrates.
| Components/100g | Minimum | Maximum | ||
| Concentration | NRV% | Concentration | NRV% | |
| Energy (kJ) | 465 | 6 | 2510 | 30 |
| Protein (g) | 1 | 1 | 25 | 41 |
| Fat (g) | 1 | 2 | 45 | 76 |
| Carbohydrate (g) | 18 | 19 | 93 | 31 |
| Sodium (mg) | 6 | 1 | 312 | 16 |
The Sector Needs Standardization: New National Standards Required
Food for the elderly is playing an increasingly important role in the realization of “healthy aging”. In September 2018, China consulted on national standard titled General Standard of Food for Older Person (draft). The standard is still under development after already undergoing the public consultation period.
The consultation draft clarified the definition of food for older person and set requirements for physical property, energy, nutrients (both mandatory & optional), upper level of contaminants and microorganism etc. In this draft, food for the elderly falls into three types:
| Easily consumed food | A kind of special dietary food whose physical property is changed to meet dietary demand of older people who suffer from dysphagia or odynophagia. From liquid to solid form, it has five sub-categories. |
| Nutrition formula food | A kind of special dietary food whose main ingredients are dairy products, dairy protein products, soybean protein products, grain and its products, and contains extra vitamins, minerals and/or other ingredients. Its target consumers are older groups suffering from malnutrition. It can meet all their daily nutrition demands. |
| Nutrition supplementary food | A kind of special dietary food whose basic material is dairy product, dairy protein product and/or soybean protein product with vitamins, minerals etc. to supplement nutrition needs of the older group. |
