Key Players
Competitive Landscape
Competition in this category is decided by the point in the care pathway where a product enters. A compact ready-made supplement competes for the dietitian’s first choice, a powder competes on cost where someone can prepare it, and a tube feed competes on eligibility for the route. Derbyshire’s guidance includes compact 125 mL ready-made formats beside several brand alternatives,[8] and the Bedfordshire formulary lists Ensure, Fortisip, Resource, Fresubin, Altraplen and Aymes together, with Fresubin Pro Compact limited to dietitian-initiated use.[9] A change of supplier at that level is a substitution between qualifying products, which moves share without changing category revenue.
In Japan, the ENORAS regulatory record links EN Otsuka, Otsuka Pharmaceutical and Otsuka Pharmaceutical Factory to an enteral liquid.[16] Separately, Nestle Japan funded the 2025 postoperative ONS trial.[7] Supplier selection involves the product's format, preparation requirements, initiation protocol, tolerance monitoring and stopping point.
Developments mapped to drivers, trends and opportunities (2025 to 2026)
Table 10: Company and Policy Developments Mapped to Drivers, Trends and Opportunities (2025 to 2026)
| Development | Driver | Trend | Opportunity |
|---|---|---|---|
| Annals of Surgery, 7 August 2025: simple ONS versus usual care in 124 patients after gastric cancer surgery at 19 Japanese institutions.[7] | Limit weight loss after surgery, 4.8% with ONS against 6.4% at eight weeks. | Symptom scores for appetite loss, diarrhea and insomnia rose during supplementation. | Study longer courses with tolerance support. The open-label, eight-week design does not establish long-term outcome. |
| ESPEN surgical guideline update, accepted 22 August 2025.[1] | Early oral feeding and intervention once nutritional risk is identified. | Immunonutrition recommended before or around major tumor surgery. | Integrate nutrition assessment and immunonutrition into surgical protocols. |
| AWMF clinical nutrition in oncology guideline, 19 February 2026.[15] | Coordination across hospital and community care. | Multidisciplinary practice with quality indicators. | Connect hospital nutrition plans with community follow-up. |
Source: FMI, Gastric Cancer Nutrition Market; the public references identified in Research Sources and Bibliography.
Repeat use depends on supporting intake with a tolerated product that fits the local prescribing pathway.
How do the profiled companies differ in documented positioning?
Otsuka-linked entities supply an enteral liquid recorded by PMDA in Japan.[16] In UK oral supplements, NHS prescribing advice links Fresubin, Ensure, Fortisip and Resource products to Fresenius, Abbott, Nutricia and Nestle.[20] Bedfordshire's formulary includes these brands among its ready-made options and requires dietitian initiation for Fresubin Pro Compact.[9]
What qualification questions should buyers ask before selecting a supplier?
Purchasers should ask who can prepare the product at home, whether a dietitian must initiate it, how tolerance is monitored, when supplementation stops and which benefit covers it. Derbyshire and Bedfordshire entries show the first two conditions in UK practice,[8][9] NICE describes the stopping point,[2] and the CMS policy shows how coverage differs for tube feeding.[13]
How should clinical evidence inform product selection?
The postoperative Japanese trial found less weight loss with one ONS regimen over eight weeks, alongside higher symptom scores.[7] Clinicians need to weigh that balance when reviewing tolerance and course length. ESPEN's immunonutrition recommendation applies to major tumor surgery,[1] with feeding decisions tailored to the individual patient's needs.
Where do purchasing routes differ across the profiled countries?
In Japan, specialist surgical centers and a completed trial shape the route.[7][11] In the UK, a food-first sequence and dietitian initiation set the terms.[8][9] In the USA, stage-specific treatment and benefit categories divide hospital and post-discharge purchasing.[10][13] Germany has a new coordination guideline for hospital and community care,[15] and South Korea has a screening pathway into diagnosis.[5]
Representative Company Overview
Table 11: Representative Company Overview for the Gastric Cancer Nutrition Market (qualitative), 2025 to 2026
| Company | Documented role | Dated reference |
|---|---|---|
| Otsuka Pharmaceutical | Commercial partner on a regulated Japanese enteral liquid. | PMDA package insert dated 23 May 2023: EN Otsuka is the listed manufacturer, with Otsuka Pharmaceutical and Otsuka Pharmaceutical Factory as commercial partners.[16] |
| Nestle Health Science | Resource is a ready-made ONS alternative in a UK formulary.[9] NHS prescribing advice lists Resource Energy under Nestle.[20] | Bedfordshire formulary entries reviewed in 2025; Dudley NHS oral nutritional supplement prescribing advice.[9][20] |
| Fresenius Kabi | Fresubin Pro Compact is a ready-made compact ONS requiring dietitian initiation. | Bedfordshire NHS formulary entries reviewed in July and September 2025.[9] |
Research Methodology
The analysis combines FMI estimates with clinical guidelines, national cancer statistics, regulator records and NHS prescribing documents. Product definitions determine the revenue boundary, while country discussions examine treatment pathways, prescribing and coverage. Clinical outcomes retain their study population and follow-up period.
