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Clinical Nutrition Products: World Markets, 3rd Edition
February 1, 2009
This Kalorama Information report - Clinical Nutrition - focuses on three primary
segments of essential medical nutrition:
• Infant Nutrition: (Milk-based, Soy-based, Special Needs such as Chronic Reflux
or Gastrointestinal Discomfort)
• Enteral Nutrition (Standard and Fiber-containing Elemental and Semi-elemental,
Specialized for Chronically Ill Patients)
• Parenteral Nutrition
For each category, the report provides revenue data and forecasts for the most
important segmentations. The report includes incidence of conditions which often
require enteral or parenteral feeding, birth rates, over 65 population, and overall global
population. Information is presented as a worldwide overview, with special emphasis on
the U.S., Europe, and other key markets. The market segments provide an overview,
description of products on the market, new developments, market estimates and
forecasts, and competitive analysis of leading providers. The report also includes
current issues and trends affecting the industry.
Coverage of Issues and Trends in Clinical Nutrition
There are several issues and trends that are impacting the clinical nutrition market,
including:
• Wound Care Applications
• Reimbursement of Nutrition Products
• Food Programs
• Nutrition and Education
• DHA and ANA Additives
• Counterfeit Infant Formulas
• Recalled Infant Formulas
• Acquisition, Mergers and Alliances
• Technology Applications

2. A Growing Market with Thriving Competition
Competition in the clinical nutrition market is dominated by a handful of companies,
ranging from global nutritional manufacturers to leading pharmaceutical companies. The
majority of competitive participation is in developed regions such as the United States,
Western Europe, and Japan. However, many companies are expanding into less
developed regions, intensifying competition in less tapped markets. China, for example,
is among the expanding competitive regions as companies continue to break into the
growing demand for clinical nutrition in new world markets. Companies highlighted in
this study include:
• Abbott Laboratories
• Baxter International
• B. Braun
• Danone
• Fresenius Kabi
• Mead Johnson
• Nestle
• PBM Products
• Wyeth
The information for this report was gathered using both primary and secondary research
including comprehensive research of secondary sources such as company literature,
databases, investment reports, and medical and business journals. Telephone
interviews and email correspondence were the primary method of gathering information.
For the purpose of this study, Kalorama Information conducted interviews with more
than 80 key industry officials, consultants, health care providers, and government
personnel. These sources were the primary basis in gathering information specifically
relating to revenue and market share data presented in this report. Specific interviews
with nutrition company representatives included marketing directors, division managers,
and product representatives. All market data pertains to the world market at the
manufacturers’ level.
The base year for data was 2008. Historical data was provided for the years 2006 and
2007, with forecast data provided for 2009 through 2013. Compound annual growth
rates (CAGRs) are provided for the 2006-2008, 2008-2013 and 2006-2013 periods for
each industry segment covered. Competitive analysis is provided for the year 2008. The
forecasted market analysis for 2009-2013 was based on demographic trends, new
developments, and global expansion.
Table of Contents
CHAPTER ONE: EXECUTIVE SUMMARY

3. • Introduction
• Infant Nutrition
• Enteral Nutrition
• Parenteral Nutrition
• Scope and Methodology
• Size and Growth of the Market
• Issues and Trends Affecting Market
• Leading Competitors
CHAPTER TWO: INTRODUCTION TO THE CLINICAL NUTRITION INDUSTRY
• Introduction and History of Nutrition in the Clinical Setting
• Defining Clinical Nutrition
• Infant Nutrition
• Enteral Nutrition
• Parenteral Nutrition
• Regulatory Environment
• Environments for Clinical Nutrition
• Hospital Settings
• Skilled Nursing Settings
• Home Care Settings
• Essential Nutrients
• Carbohydrates
• Proteins
• Fats
• Vitamins
• Minerals
• Demographics and Statistics
• Worldwide Demographics
• Aging Population
• Cancer and Nutrition
• Cardiovascular Disease and Nutrition
• Diabetes and Nutrition
• HIV/AIDS and Nutrition
• Summary of Diseases
CHAPTER THREE: INFANT NUTRITION
• Overview
• Product Categories
• Milk-based Formulas
• Soy-based Formulas
• Elemental Formulas
• Premature Formulas
• Lactose-free Formulas
• Follow-Up Formulas

4. • Other Specialized Formulas
• New Developments
• Organic Infant Formula
• Probiotic/Prebiotic Infant Formula
• Algae-derived Omega-3 Fatty Acid DHA Infant Formula
• Allergy Management and
• Hydrolysated Protein Infant Formulas
• Market Size and Growth
• Global Market Introduction
• Sales by Product Type
• Global Markets
• Competitive Analysis
CHAPTER FOUR: ENTERAL NUTRITION
• Overview
• Product Categories
• New Developments
• Market Size and Growth
• Global Market Introduction
• Sales by Product Type
• Global Markets
• Competitive Analysis
CHAPTER FIVE: PARENTERAL NUTRITION
• Overview
• Product Categories
• Amino Acids
• Dextrose
• Fats
• Nutritional Additives
• New Developments
• Market Size and Growth
• Global Market Introduction
• Sales by Product Type
• Global Markets
• Competitive Analysis
CHAPTER SIX: TOTAL MARKET SIZE AND FORECAST
• Total Market Size and Forecast
• Global Market Overview
• Sales by Broad Market Segment
• Markets by Geographic Region
• Competitor Analysis

5. CHAPTER SEVEN: ISSUES AND TRENDS AFFECTING THE NUTRITION MARKET
• Introduction
• Wound Care applications
• Reimbursement of Nutrition Products
• Food Programs
• WIC
• WHO
• Nutrition and Education
• Dietician Statistics in the United States
• DHA and ARA Additives
• Counterfeit Infant Formulas
• Recalls for Infant Formulas
• Acquisitions, Mergers and Alliances
• Technology Applications
CHAPTER EIGHT: CORPORATE PROFILES
• Introduction
• Abbott
• Baxter
• B Braun
• Danone-Royal Numico
• Fresenius Kabi
• Mead Johnson
• Nestlé
• Wyeth
TABLE OF EXHIBITS
CHAPTER ONE: EXECUTIVE SUMMARY
• Table 1-:1 The Global Market for Clinical Nutrition 2006-2008
• Table 1-2: The Global Market for Clinical Nutrition 2009-2013
• Figure 1-3: The Global Market for Clinical Nutrition 2006-2013
CHAPTER TWO: INTRODUCTION TO THE CLINICAL NUTRITION INDUSTRY
• Table 2-1: Nutrient Requirements for Infant Formulas as Required by the FDA
Infant Formula Act
• Table 2-2: U.S. Registered Hospitals by Type, 2007
• Figure 2-1: Number of Hospitals in the US, 1975-2007
• Table 2-3: Statistics for U.S. Hospitals, 2007
• Table 2-4: U.S. Hospital Length of Stays, 2006-2008 Average by Broad Age
Group
• Figure 2-2: Number of Nursing Homes in the U.S., 2000-2005
• Figure 2-3: Number of Home Care Agencies in the U.S., 2007/2008

6. • Table 2-5: Essential Nutrients for Human Health
• Table 2-6: World Population by Selected Geographical Region, 2007 - 2050
• Figure 2-4: World Population by Selected Geographical Region, 2007-2050
• Table 2-7: Estimated World Population by Age and Geographical Region, 2007
• Figure 2-5: Estimated World Population by Age and Geographical Region, 2007
• Table 2-8: Percent Population Over 65 by Year and Region
• Figure 2-6: Estimated World Population by Age, 2007 and 2050
• Table 2-9: Estimated and Projected World Cancer Incidence by Selected Types
of Cancer, 2007 and 2020
• Figure 2-7: Estimated and Projected World Cancer Incidence by Selected Types
of Cancer, 2007 and 2020
• Table 2-10: Total Cancer Incidence by Sex and Country, 2007 Estimates
• Figure 2-8: Total Cancer Incidence by Sex and Country
• Table 2-11: Summary of Strength of Evidence on Lifestyle Factors and Risk of
Developing Cancer
• Table 2-12: Summary of Strength of Evidence on Lifestyle Factors and Risk of
Developing Cardiovascular Diseases
• Table 2-13: Summary of Strength of Evidence on Lifestyle Factors and Risk of
Developing Type 2 Diabetes
• Table 2-14: Total Number of People Living with HIV/AIDS, Newly Infected
Population and Deaths, 2004 and 2006 by Region
• Figure 2-9 The Role of Nutrition Education as HIV Infection Develops
• Table 2-15: Hospital Utilization Measures for HIV Patients in the United States,
1990-2006
• Table 2-16: Percentage of the Adult Population Considered to be Obese Average
Rates by Country
• Table 2-17: Summary of Strength of Evidence on Factors that Might Promote or
Protect Against Weight Gain and Obesity
• Table 2-18: Classification of Overweight in Adults According to BMI
• Table 2-19: Prevalence/Incidence of Diseases by Type, 2006 51
• Table 2-10: Prevalence/Incidence of Disease by Type, 2006
• Table 2-11: Prevalence/Incidence of Disease by Type, 2006
• Table 2-20: Disease Mortality by Type, 2006 (Cardiovascular, Cancer, HIV/AIDS)
• Table 2-12: Disease Mortality by Type, 2006 (Cardiovascular, Cancer, HIV/AIDS)
• Table 2-13: Disease Mortality by Type, 2006 (Cardiovascular, Cancer, HIV/AIDS)
CHAPTER THREE: INFANT NUTRITION
• Table 3-1: Composition of Breast Milk (early and mature range) and Select Infant
Formulas
• Table 3-2: Live Births and Birth Rates by Country*
• Table 3-1: Live Births by Country*
• Table 3-2: Births Rates by Country*
• Table 3-3: Marketed Infant Formulas (Manufacturer, Product Types, and Product
Lines)
• Table 3-4: The Market for Infant Nutrition 2006-2008

7. • Table 3-5: The Market for Infant Nutrition 2009-2013
• Figure 3-4: The Global Market for Infant Nutrition 2006-2013
• Table 3-6: The Global Market for Infant Nutrition by Product Type 2006-2008
• Table 3-7: The Global Market for Infant Nutrition by Product Type (Milk-based,
Soy-based, Specialized, Total) 2009-2013
• Figure 3-5: The Global Market for Infant Nutrition by Product Type(Milk-based,
Soy-based, Specialized, Total) 2006-2013
• Figure 3-6: The Global Market for Infant Nutrition by Product Type(Milk-based,
Soy-based, Specialized, Total) 2008
• Figure 3-7: The Global Market for Infant Nutrition by Product Type(Milk-based,
Soy-based, Specialized, Total) 2013
• Table 3-8: The Global Market for Infant Nutrition Estimated Products Sales by
Select Geographic Region, 2008 (US, Europe, Germany, United Kingdom,
France, China, Japan, Indonesia, Pakistan, Rest of World)
• Figure 3-8: The Global Market for Infant Nutrition Market Share by Select
Geographic Region, 2008
• Table 3-9: The Global Market for Infant Nutrition Estimated Revenues and
Market Share of Leading Suppliers 2008
• Figure 3-9: The Global Market for Infant Nutrition Estimated Market Share by
Leading Suppliers 2008
• Table 3-10: The Global Market for Infant Nutrition Estimated Market Shares by
Region for Leading Suppliers 2008
• Figure 3-10: The Global Market for Infant Nutrition Estimated U.S. Market Shares
for Leading Suppliers 2008
• Figure 3-11: The Global Market for Infant Nutrition Estimated Market Shares
Outside the U.S. for Leading Suppliers 2008
CHAPTER FOUR: ENTERAL NUTRITION
• Table 4-1: Aging Population, Percent of Total Population, and Annual Growth by
Country*, 2008
• Figure 4-1: Over 65 Population by Countr
• Figure 4-2: Marketed Pediatric and Adult Enteral Formulas (Manufacturer,
Product Types, and Product Lines)
• Figure 4-3: The Market for Enteral Nutrition 2006-2008
• Table 4-4: The Market for Enteral Nutrition 2009-2013
• Figure 4-4: The Global Market for Enteral Nutrition 2006-2013
• Table 4-5: The Global Market for Enteral Nutrition by Product Type 2006-2008
• Table 4-6: The Global Market for Enteral Nutrition by Product Type (Standard
and Fiber-Containing, Elemental and Semi-element Specialized) 2009-2013
• Figure 4-5: The Global Market for Enteral Nutrition by Product Type (Standard
and Fiber-Containing, Elemental and Semi-elemental, Specialized) 2006-2013
• Figure 4-6: The Global Market for Enteral Nutrition by Product Type (Standard
and Fiber-Containing, Elemental and Semi-elemental, Specialized) 2008

8. • Figure 4-7: The Global Market for Enteral Nutrition by Product Type
2013(Standard and Fiber-Containing, Elemental and Semi-elemental,
Specialized)
• Table 4-6: The Global Market for Enteral Nutrition Estimated Products Sales by
Select Geographic Region, 2008
• Figure 4-8: The Global Market for Enteral Nutrition Market Share by Geographic
Region, 2008
• Table 4-7: The Global Market for Enteral Nutrition Estimated Revenues and
Market Share of Leading Suppliers 2008
• Figure 4-9: The Global Market for Enteral Nutrition Estimated Market Share by
Leading Suppliers 2008
• Table 4-8: The Global Market for Enteral Nutrition Estimated Market Shares by
Region for Leading Suppliers 2008
• Figure 4-10: The Global Market for Enteral Nutrition Estimated U.S. Market
Shares for Leading Suppliers 2008
• Figure 4-11: The Global Market for Enteral Nutrition Estimated Market Shares
Outside the U.S. for Leading Suppliers 2008
CHAPTER FIVE:PARENTERAL NUTRITION
• Table 5-1: Aging Population, Percent of Total Population, and Annual Growth by
Country*, 2008
• Table 5-1: Over 65 Population by Country
• Table 5-2: Over 65 Population as a Percent of Total Population by Country, 2008
• Table 5-3: Over 65 Annual Population Growth by Country, 2007-2008
• Table 5-2: Standard Electrolyte Requirements
• Table 5-3: Standard Parenteral Multivitamin Package* Vitamin
• Table 5-4: Standard Parenteral Trace Elements Package
• Table 5-5: Single Parenteral Trace Element Formulations
• Table 5-6: Major Marketed Parenteral Formulas (Manufacturer, Product Types,
and Product Lines)
• Table 5-7: The Market for Parenteral Nutrition 2006-2008
• Table 5-8: The Market for Parenteral Nutrition 2009-2013
• Figure 5-4: The Global Market for Parenteral Nutrition 2006-2013
• Table 5-9: The Global Market for Parenteral Nutrition by Product Type* 2006-
2008
• Table 5-10: The Global Market for Parenteral Nutrition by Product Type*(Amino
Acids, Dextrose, Fats, Additives, Total), 2009-2013
• Figure 5-5: The Global Market for Parenteral Nutrition by Product Type*(Amino
Acids, Dextrose, Fats, Additives, Total), 2006-2013
• Figure 5-6: The Global Market for Parenteral Nutrition by Product Type*(Amino
Acids, Dextrose, Fats, Additives, Total), 2008
• Figure 5-7: The Global Market for Parenteral Nutrition by Product Type*(Amino
Acids, Dextrose, Fats, Additives, Total), 2013

9. • Table 5-11: The Global Market for Parenteral Nutrition Estimated Products Sales
by Select Geographic Region, 2008(United States Europe, Germany, United
Kingdom, Rest of World, Japan, China)
• Figure 5-8: The Global Market for Parenteral Nutrition Market Share by Select
Geographic Region, 2008 (United States Europe, Germany, United Kingdom,
Rest of World, Japan, China)
• Table 5-12: The Global Market for Parenteral Nutrition Estimated Revenues and
Market Share of Leading Suppliers 2008
• Figure 5-9: The Global Market for Parenteral Nutrition Estimated Market Share
by Leading Suppliers 2008
• Table 5-13: The Global Market for Parenteral Nutrition Estimated Market Shares
by Region for Leading Suppliers 2008
• Figure 5-10: The Global Market for Parenteral Nutrition Estimated U.S. Market
Shares for Leading Suppliers 2008
• Figure 5-11: The Global Market for Parenteral Nutrition Estimated Market Shares
Outside the U.S. for Leading Suppliers 2008
CHAPTER SIX: TOTAL MARKET SIZE AND FORECAST
• Table 6-1: The Global Market for Clinical Nutrition 2006-2008
• Table 6-2: The Global Market for Clinical Nutrition 2009-2013
• Figure 6-1: The Global Market for Clinical Nutrition 2006-2013
• Table 6-3: The Global Market for Clinical Nutrition by Product Type 2006-2008
• Table 6-4: The Global Market for Clinical Nutrition by Product Type 2009-2013
• Figure 6-2: The Global Market for Clinical Nutrition by Type 2006-2013
• Figure 6-3: The Global Market for Clinical Nutrition by Type 2008
• Figure 6-4: The Global Market for Clinical Nutrition by Type 2013
• Table 6-5: The Global Market for Clinical Nutrition by Country 2006 and 2008
• Figure 6-5: The Global Market for Clinical Nutrition by Country 2006 and 2008
• Table 6-6: Leading Suppliers Clinical Nutrition Revenues and Significant
Segments of Participation, 2008
• Figure 6-6: Leading Suppliers Clinical Nutrition Estimated Market Shares, 2008
CHAPTER SEVEN: ISSUES AND TRENDS AFFECTING THE NUTRITION MARKET
• Table 7-1: Examples of ICD-9 Codes for Home Parenteral Nutrition
• Table 7-2: Examples of ICD-9 Codes for Home Enteral Nutrition
• Table 7-3: Medicare Reimbursement for Home Parenteral and Enteral Nutrition;
DME MAC
• Table 7-4: Enteral Product Classification
• Table 7-5: Example of DMEPOS Fee Schedule for Common Enteral Items
• Table 7-6: Example of DMEPOS Fee Schedule for Common Parenteral Items
• Table 7-7: WIC Participants by Participant Category in 2004 and 2006
• Figure 7-1: Distribution of WIC Participants by Type, 2006
• Table 7-8: WIC Agencies and Distribution of Participants by State, 2006

10. • Table 7-8 (continued): WIC Agencies and Distribution of Participants by State,
2006
• Table 7-9: Dieticians and Nutritionists by Facility Type, 2007
• Table 7-10: Highest Concentration of Dieticians and Nutritionists by State, 2007
• Table 7-11: 5-year Recalls of Infant Feeding Products, 2001-2006
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