Challenges and Opportunities of Feeding an Expanding, Aging Population

By Catherine

Written by Catherine Bolgar

Food has its fashions, with form and function battling for dominance. Convenience, low-calorie, locavores, organic, functional food, indulgent excesses…what’s next?

Personalized nutrition, nutrition density, immediacy and alternative proteins are some of the key words for the future.

Personalized nutrition

Salad

We’re going to see even more diversity of choices, as well as products aimed at specific population groups, says Gerhard Rechkemmer, president of the Max Rubner Institut, a food and nutrition research organization in Karlsruhe, Germany.

In the future, that will go into what we call personalized nutrition,” he says. “You will have the genetic or metabolic design of a person and provide food for their needs.”

The microbiome—the bacteria in the gut—is even more genetically diverse than the genes in our own bodies. These bacteria “have a metabolism as we do, but it’s something we don’t much understand yet,” says Peter Weber, a medical doctor and nutritionist in Kaiseraugst, Switzerland. “In the future, we will understand better how the different systems in the body interact.”

While the outlines of a prudent diet are known, new research results in adjustments to details like recommended daily requirements for various nutrients. That’s likely to go further, with adjustments based on individuals’ genetic makeup.

Nutrition density

Two rapid changes are affecting our relationship with food that will make nutrition density a key trend in the future. First, our lifestyle has become much more sedentary, even within the past few decades. Second, we are living much longer.

In both cases, we are eating more calories than we need. The result is the explosion in obesity—a 28% increase in adults and 47% increase in children in the past 33 years, with the number of overweight and obese people hitting 2.1 billion in 2013, according to the Global Burden of Disease Study 2013, published in The Lancet.

Yet even though we’re eating too much, we aren’t getting the nutrition we need. “When we talk about nutritional challenges, we typically start off with developing countries because that’s so obvious,” Dr. Weber says. “But in affluent societies we also have micronutrient inadequacies.”

On a global level, about 37% of people have insufficient vitamin D serum levels and only 12% are within the desired range, Dr. Weber says, adding that about 90% of Americans aren’t getting enough vitamin E. The World Health Organization estimates 250 million preschool children lack enough vitamin A, which puts them at risk of blindness.

As people age, their bodies absorb less of the micronutrients in food. The challenge in the future is “how we can make appropriate food which is micronutrient dense, with not too much energy and which tastes good,” Dr. Weber says.

Immediacy

Snacking in the U.S. represents half of all “eating occasions.” While people say they are looking for something healthy for more than half of those snacks, “planning is hard. People are time-stressed. Their lives are hectic,” says Laurie Demeritt, chief executive of The Hartman Group, a food research and consulting firm in Bellevue, Washington.

People prefer to make decisions about food close to the eating occasion, to choose based on their mood at the moment. “They don’t like to plan. They eat on a whim. It changes how we view food,” she says.

As a result, retail formats are adapting to serve people who want to buy something to eat at the last minute, by serving freshly prepared offerings. Food-service operators also are making it possible for people to call in an order that they can run in to pick up. It’s a trend that’s likely to grow.

Twenty or 30 years ago, there were certain places where you could buy food,” Ms. Demeritt says. “Now there are more options for food procurement, and not so much pressure for planning.”

Even though 60% of millennials say they enjoy cooking, they aren’t talking about cooking from scratch, she says. “They want to get a sauce that’s prepared, but they’ll choose the vegetables, for example. They’re looking for the manufacturer to be the sous-chef and still let them have choice and creativity.”

Alternative proteins

As the world population climbs toward an expected peak of nine billion, there’s a question of how people will get enough to eat, especially as people who enter the middle class in developing countries tend to adopt the same kind of meat-heavy, processed diets common to affluent societies.

When the Chinese began to drink more milk, it had an impact on the global milk supply,” Dr. Weber says. “If we have three billion more people to feed in the future, from where should we provide protein? From even better farming? From plants? From artificial proteins that you grow in a lab? These are opportunities and challenges.”

Protein ties into the aging of society as well, because older people need to consume more protein to deal with muscle wasting.

senior woman cutting vegetables on chopping board in kitchen

However, in Europe and the U.S., vegetarian and vegan diets are becoming more popular, says Dr. Rechkemmer of the Max Rubner Institut. India shows that “a vegetarian diet supplies sufficient protein if you have products available. It remains to be seen whether that trend will continue.”

However, in Europe and the U.S., vegetarian and vegan diets are becoming more popular, says Dr. Rechkemmer of the Max Rubner Institut. India shows that “a vegetarian diet supplies sufficient protein if you have products available. It remains to be seen whether that trend will continue.”

For more from Catherine, contributors from the Economist Intelligence Unit along with industry experts, join The Future Realities discussion.

Research Heralds 3D-Printed Organs and even Hearts

By Catherine

3D printing human organs

Written by Catherine Bolgar

Few would have guessed the trajectory from 1970s inkjet printers to 3D printed organs consisting of human cells, yet, that’s where we’re headed.

3D printers apply layers of melted plastic to create complex objects, from the silly to the serious, including personalized prostheses such as eyes, ears or knees. A patient at the University Medical Center Utrecht, the Netherlands, recently was the first to receive a custom 3D printed plastic skull.

A step beyond plastic parts is a biological-synthetic combination. A personalized 3D printed scaffolding is made of synthetic material, on which living cells are placed that will grow around the structure. This technique, which prints the structure but not the cells, is being examined for bone and for skin.

Cells we isolate from fat will stimulate bone formation and blood vessel formation in these structures,” says Stuart K. Williams, director of the bioficial organs program at the University of Louisville, Kentucky. “That is on the cusp of becoming utilized in a more widespread manner.”

The next goal: to use 3D printing techniques with live cells. Tissue made artificially with real human cells is called “bioficial.”

A patch of bone tissue may one day help patients whose vertebrae are damaged by an injury or cancer. Cartilage, which doesn’t regenerate on its own, could be repaired with bioficial tissue created from patients’ own cells. And perhaps, someday, entire organs could be replaced.

3d printed head

Cells are trickier to work with than plastic. The printer itself has to be adjusted—rather than melting at high temperatures, it has to use low temperatures that won’t kill the cells. It has to be sterile. A robot-controlled syringe squeezes out the cells, which are suspended in a gel that can solidify and maintain the desired shape, similar to gelatin desserts. But those desserts melt when they get warm; for the 3D printed tissue not to melt in the heat of the body requires other chemical processes to ensure they retain the desired shape, says Jos Malda, deputy head of orthopedic research at University Medical Center Utrecht.

Not just that, but each cell needs nutrition. When a body part or organ loses its blood supply, it dies. “If you create a larger construct in the lab, keeping that piece alive is a big challenge,” Dr. Malda says.

Finally, “having cells in the right place doesn’t mean an organ will function,” Dr. Malda says. “But never say never.”

These challenges are why Dr. Williams decided to focus on a bioficial heart. “It doesn’t have complex metabolic activities like the liver or kidneys do. A heart is simply a pump. It pushes blood out and allows blood to come back in,” Dr. Williams says.

The artificial heart was one of the first implanted devices made of synthetic materials. Dr. Williams’s team is working to make a bioficial heart, starting by printing individual parts: the valves, the cardiomyocytes (heart muscle cells), the electrical conduction system, the large blood vessels and the small blood vessels.

We have made dramatic steps forward printing the individual parts of the heart,” he says. “We haven’t assembled it yet, but it’s likely to happen in the not too distant future. It won’t be ready for implantation, but we will be able to understand how the heart works in assembled form.”

The first step is to assemble blood vessels to ensure the blood supply. That would allow for building tissue two to four centimeters thick that has its own blood supply.

Back in 1988, Dr. Williams used fat-derived cells to build a blood vessel and put it into the body of a patient. “Fat has the capability of forming all the different cells found in the heart,” he says.

Some day, doctors might be able to take a patient’s own cells to build a replacement organ, thereby getting around the problems of rejection of a donor organ.

Perhaps we’ll find out it isn’t necessary for a bioficial heart to look exactly like a real heart, or a bioficial kidney to look exactly like a real kidney for them to work well. “Maybe we can make it more simplistic, using a slightly different blueprint,” Dr. Williams says.

Will the first use in a patient be the complete heart or parts of a heart?” he asks. “I think it will be parts: a patch of large and small blood vessels.”

Such a patch, which researchers are trying to make in the lab, could be used in a patient whose blood isn’t reaching part of the heart. Another possibility is pediatric applications, for children whose hearts haven’t formed properly because of a genetic defect.

We’re hoping that one day we’ll be able to treat the patient by repairing parts long before they are in such a condition that we have to replace the entire organ,” Dr. Williams says.

For more from Catherine, contributors from the Economist Intelligence Unit along with industry experts, join The Future Realities discussion.

Open-source Thinking is Revolutionizing Medical Device Development

By Catherine

Written by Catherine Bolgar

medical deviceWhen we think about medical care in the future, we tend to think about the progress technology will bring us, with cutting-edge machines that let us see what’s happening inside our bodies in ever-greater detail.

That’s true, but there’s another aspect to technological progress. As Moore’s Law brings down the cost of computing, and as consumer electronics become more sophisticated and yet cheaper, there are opportunities to use those advances to make medical devices that can serve the bottom of the pyramid.

The global middle class is estimated at 1.8 billion people in 2009, a number expected to rise to 3.2 billion by 2020 and 4.9 billion by 2030. Years ago, many people in developing countries viewed medical care as out of reach as jetting off on vacation. Today, the new middle class in these countries is going on vacation, and it expects decent health care too.

A new breed of bioengineers sees opportunity in emerging markets for devices that deliver results without costly bells and whistles.

There are still very challenging design and engineering problems,” says Josh Kornfeld, president of Tactile Inc., a Seattle product and interaction design firm. “But until five or 10 years ago, nobody even had an interest in designing for markets like this unless it was an NGO [nongovernmental organization]. Now, they’re not just giving a gift to these countries; they’re companies that are building long-term business models around servicing the needs of these countries.”

Mr. Kornfeld’s company helped Intellectual Ventures Lab and the Gates Foundation engineer a cooler whose proprietary materials make it so efficient it can keep vaccines cold for 30 days using just ice. That’s crucial in places where electricity is at best irregular and at worst non-existent—factors that have left many people unable to get vaccinated.

In the U.S. and Europe, we relish complexity,” he says. “We see technological devices as better the more training they require. We can afford to train people and make sure things get cleaned the right way and police all that stuff. In Africa, they’re highly trained people—the WHO [World Health Organization] does a great job of that—but the facilities they have access to, clean water, the resources for cleaning equipment the right way, aren’t as good. So it requires different design for use in those areas.”

In other words, the future of medical devices will involve, to a large extent, streamlining and simplifying.

Evolving Technologies, or Evotech, of San Francisco came up with a simplified endoscope—an instrument with a camera for looking inside the body. Evotech’s endoscope, called EvoCam, is being used in Uganda and India in keyhole surgery, hysterectomy surgery, ear and nose care such as sinus operations, and complicated cases of vaginal fistulas.

The EvoCam costs about $500, versus $50,000 to $100,000 for the high-tech systems usually used in modern hospitals. These modern systems weigh about 100 pounds, and consist of several devices—an image-processing unit, a light source and other modules, which sit on a big cart. Evotech turned it into a tablet- or laptop-based system.

When modern endoscopes were developed in the mid-1970s, consumer electronics were no match—videocassette recorders were rare and camcorders were huge. Today, a person can add a high-definition camera to a mobile phone for $2.

Evotech put the EvoCam under a Creative Commons license and published a shopping list of off-the-shelf parts, along with assembly instructions, so doctors anywhere can make their own. By not using proprietary parts, repairs are cheap and easy. For example, the EvoCam uses a regular USB cable to connect the device to a laptop; modern systems have special cords that cost about $1,000 to replace and that aren’t easily available, says Moshe Zilversmit, co-founder of Evotech.

Now we want to open-source it so anybody can build it,” Mr. Zilversmit says. “We’re trying to create a community where physicians come back with different ideas about how to improve it. We can gather information on what kinds of surgeries they’re doing. A lot of them are macgyvering it,” referring to the TV character who uses resources at hand to solve difficult problems.

Open-source innovation for medical devices is a new frontier. Even in the information technology industry, open-source hardware is a new, but growing, trend.

When you think of medical devices, it’s about high margins and low-volume sales,” says Avi Latner, Evotech’s other co-founder. “When you do affordable devices, you have to go beyond product design and rethink the business model as well. We decided we wanted to make it open source. Like software—open source revolutionized software. On the common basis of free tools, why not do the same for hardware in medicine?”

The trend is likely to lead to better-designed and better-engineered products adapted to emerging markets. And as fiscally strapped developed countries re-examine health-care spending, medical devices that are cheap, solid and simple are likely to gain favor in certain cases where the benefits of fancier systems is marginal.

For more from Catherine, contributors from the Economist Intelligence Unit along with industry experts, join The Future Realities discussion.



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