Abstract
As living standards change with the development of modern industry and social encounters, people tend to change their lifestyle and environment exposure along with their psychophysiological factors, leading to an imbalance of homeostasis and increasing the risk for chronic diseases. In addition to ingredients, methods, and food conditions storage and processing, the use of additives and certain new foods have facilitated the increased occurrence of chronic diseases in children or adults. The interaction of some components of the food system with enzymes that metabolize different types of drugs can affect the body's clearance and therapeutic index.The objective of this chapter was to present the general principles of food development for special nutritional conditions, also the adjuvants used for chronic disease status improvement, under the condition of nutritional nutrivigilence and food safety standards, and specific to introduce an adjuvant food for atopic dermatitis management.
TopIntroduction
As living standards change along with the development of modern industry and social encounters, people are tending to change their lifestyle and psycho-physiological factors exposure, leading to an imbalance of homeostasis and increasing the chronic diseases frequency. In addition, as people's living standards have improved and people are increasingly busy and interested by modern industrial lifestyles, this has led to a shift in the food industry following the requirements to create safe, nutritious and functional foods (for example, ready-to-eat or processed foods with stronger sensory properties and long shelf life), at competitive prices. Today's foods do not succed only sensory aspects but the trend of food supplements with nutritional and functional values is constantly evolving. However, not all companies in the food market sector have a team of multidisciplinary research and development specialists, which is a combination of nutritionists, physicians, pharmacists, economists, and food production professionals. Many companies in the food industry are limited in terms of information, measurable objectives, or qualitative verification for the nutritional composition of manufactured products. Due to these shortcomings, but also to the existing legislative regulations in each country, the food market for special nutritional conditions, preclinically or clinically verified, is very small.
In addition to ingredients, food processing methods and storage conditions, the use of additives have facilitated the chronic diseases high frequency. The interaction of some components of the food system with enzymes that metabolize different types of drugs, can affect the body clearance and therapeutic index (e.g. in vitro it has been shown that aloe vera juice and many other plant sources inhibit the enzyme CYP3A4 and may affect the metabolism of dermatological drugs metabolized by it – like terbinafinum or itraconazole). Also, the interaction between certain foods consumed at the same time can cause important side affects (like grapefruit juice which increases the effect of citritin and can induce various side effects of different severity depending on individual sensitivity).
In the production of food products for special medical purposes, the quality control (from physical, chemical, microbiological and toxicological point of view) it is necessary in order to prevent the use of fraudulent ingredients or toxic contaminants, and brings a proper quality of life to consumers with chronic diseases.
According to the WHO classification, the most frequent chronic diseases are the following: cardiovascular diseases, diabetes, mental and behavioral disorders, obesity and other disorders due to excessive food consumption, neoplasms and chronic digestive disorders. Other chronic diseases are: respiratory diseases, diseases of the osteoarticular system, muscles and connective tissue. We can add chronic kidney disease, chronic hematological disorders, unspecified nutritional anemia (simple chronic anemia), or dermatological diseases such as dermatitis (atopic, contact), eczema and psoriasis (inflammatory diseases with an increasing prevalence).
According to the Regulation of the European Union no. 128 of 2016, the formula of foods intended for special medical purposes must start from the correct medical and nutritional principles. Foods evaluated and developed for any chronic disease, for research – development, production or marketing, must be undertaken by an interdisciplinary team. This team must have reached the level of knowledge required for medicine and pharmacology (pathogenicity, complications, treatment, food-drug interaction), also for food production and protection of industrial property (prescription patenting). After establishing the new food product formulation and validating the technological data in terms of food safety and hygiene, in accordance with HACCP and nutrivigilence standards, the next important step is to verify in vivo efficacy by establishing the design of the preclinical or clinical study and statistical methods to verify the accuracy of the claimed results.
Because the number of chronic diseases is large, to understand the summary of the presentation of the principles of research - development and manufacture of organic food for special nutritional conditions, wie took atopic dermatitis as an example in our chapter.
Key Terms in this Chapter
Food for Special Nutritional States: Processed or specially designed foods intended for the diet of patients, including infants, to be used under medical supervision; they are intended for the exclusive or partial feeding of patients with limited, weakened or impaired ability to take, digest, absorb, metabolise or excrete ordinary foods or nutrients they contain or their metabolites, or patients with other nutritional requirements identified on medical basis, whose diet can not be achieved only by changing the normal diet.
Nutrivigilance: A nutrivigilance system is quality system used by the marketing responsible company to fulfil the tasks and responsibilities as required by the Competent Authorities and designed to monitor the safety of authorised food supplements and detect any change to their risk-benefit balance.
Atopic Dermatitis (AD): Also known as atopic eczema, is a long-term type of inflammation of the skin (dermatitis).
Interleukin: Interleukins (ILs) are a group of cytokines (secreted proteins and signal molecules).
Critical Control Point: A critical control point is defined as a step at which control can be applied and is essential to prevent or eliminate a food safety hazard or reduce it to an acceptable level.
Patent: A patent is a type of intellectual property that gives its owner the legal right to exclude others from making, using, or selling an invention for a limited period of years, in exchange for publishing an enabling public disclosure of the invention.
OCDI OCD-10-AM: The International Classification of Diseases (ICD) is the international standard diagnostic classification for all recognised diseases and related health problems. ICD codes are alphanumeric designations given to every diagnosis and description of symptoms on medical records. These classifications are developed and monitored by the World Health Organization (WHO) for the incidence and prevalence of diseases and other health problems. The ICD is revised periodically and is currently in its tenth edition, the ICD-10.
Chronic Disease: A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time.