**1. Introduction**

The relationship between health and nutrition has come to the forefront of scientific research due to global health trends and lifestyle changes. According to WHO data, chronic non-communicable diseases (CNDs) are the leading cause of death worldwide [1]. In 2016, they were responsible for 71% (41 million) of the 57 million deaths which occurred globally, and 94% of the number of deaths in Hungary. Major CNDs are cardiovascular diseases (44% of all CND deaths), cancers (22%), chronic respiratory diseases (9%), and diabetes (4%), all of which are strongly connected to dietary factors, among others [2]. Therefore, WHO formed a guideline for healthy diet to prevent chronic diseases worldwide, and national level health prevention programs also emerged [3–5]. Demographic statistics related to ageing shows that life expectancy (LE) and proportion of older adults in the population are increasingly growing both at global and EU level. Between 2000 and 2016, global LE at birth increased by 5.5 years, from 66.5 to 72.0 years [6]. In the EU, almost one fifth of the population (19.7%) was over the age of 65 in 2018, and the relative share of the population is projected to reach 28.5% until 2050 [7]. According to the latest country reports of the European Health & Life Expectancy Information System (EHLEIS) based on 2015 data, Hungarian LE was 18.2 years (21.2 for women and 17.9 for men) at the age 65 [8]. This index, compared to LE at birth, give better estimation to older adults, but do not give information about the quality of those years. The same report presents another indicator: the healthy life years (HLY, also called healthy life expectancy or disability-free life expectancy), which was 5.9 years in Hungary at the age 65, so 68% of elderly years (approximately 12 years) are usually spent with disabilities. LE at birth in Hungary was 75.7 years in 2015, which was nearly 5 years below the EU average, mainly due to higher death rates from cardiovascular diseases and cancer [9]. The same study highlights that only slightly more than half (56%) of Hungarians consider themselves to be in good health, which is one of the lowest rates in the EU. Besides new ways in the investigation of health-related issues [10–12], sustainability of food consumption (including food security) is also becoming an increasingly prominent topic for the scientific community [13–16]. Furthermore, the harmonization of a balanced and sustainable diet opened a new research regime [17].

Nowadays, a rising number of consumers follow a special or consciously composed diet because of health issues or lifestyle decisions, which have opened new opportunities for food business operators. During the last decades, a special focus was given to the health-related functionality of foodstu ffs [18]. Functional foods with high added value have become the fastest growing area of the food industry, although the market share varies greatly from country to country, and there is not one generally accepted definition of functional foods in the industry, so di fferent market data are available due to di fferent interpretations of the category [18,19]. A study reviewed over one hundred di fferent definitions to determine the boundaries of functional food better [20]. One even argued that functional foods might not be handled as a well-definable separate product category [21]. Although the definitions help scientific and professional dialogues, they do not have a particularly significant role from the perspective of consumers. Instead of legal definitions, consumers receive information about the functional properties of food through advertisements and labels. Regarding labels, nutrition and health claims in the EU may appear on products by following the indications of Regulation (EC) No. 1924/2006 [22] and Regulation (EU) 432/2012 [23] based on the scientific advice of the European Food Safety Authority (EFSA) [24,25].

The increasing importance of the functionality of foodstu ffs was recognized even before the turn of the millennium by the food industry, which has accelerated the development of new products. However, new products had a high failure rate on the market in the 1990s, because most of them were not preceded by a deeper exploration of consumer needs [19,26]. Developing functional food is often a far more complex issue than introducing a new variation of generalized food products, which was realized by researchers and company experts in the 2000s. Many consumer-related studies emerged about functional foods from that time. The first consumer studies related to functional foods tried to explore the e ffect of socio-demographics factors [27–29], attitudinal profiles and motivations [21,30–34], and reactions connected to health and nutrition claims [35–38]. Based on the results of the studies that focused on the concept of functional foods in general, later studies targeted more specific product categories and novel concepts [39–44]. It also means that the focus shifted to market-related surveys and product development aspects.

The relatively few consumer-related articles, which focus on older European consumers, also follow a marketing approach, and they are connected to protein-enriched functional foods majorly [45–47]. In Eastern Europe, a Polish study, based on a nationwide representative consumer survey in 2009, found significant di fferences between age groups in functional food consumption, awareness, and perceived barriers to health improvement. Qualitative consumer studies that support the food product development for older adults have also been published [48,49]. In Hungary, however, a few consumer studies have recently emerged on the relationship between health and food consumption [50–52], and the perspective of older adults on functional foods have not been analyzed yet.

Based on the previous findings, physical and psychological wellbeing of the older population has become a globally significant social challenge. The aim of this study is to give an overall picture about the impact of age on consumer expectations about the functionality of foods, which covers attitude, health-related lifestyle factors, nutrition claims, carriers, health problems, and known diseases as well. It was also an important goal of our study to investigate the most common sustainability markers used on food products.


**8. Termination of pregnancy**

Termination of pregnancy with severe fetal anomalies is a controversal issue with many moral and ethical controversies. Indication for termination of such pregnancy is a medical decision but as well moral choice of mother or parents. This moral choice is affected by religion beliefs, legislation, cultural values and socioeconomical status [42]. Around 40% of mothers decide to continue with pregnancy after diagnose of severe open spinal dysraphism [23].


*4.2. Cases Competing Based on a Single Quadrant*

Our analysis indicates that some firms occupy and compete based on a single quadrant of the typology. This is more readily observable for Future Emergent and Niche. Future Emergent production, as characterized from practice anecdotally and our single Future Emergent case (see Figure 4), is conducted by start-up organizations, some of which claim to be on the verge of commercialization. The phenomenon of competing within a single quadrant is also observed in Niche production when firms prioritize some form or combination of domestic conventions as a basis of competition. Seven of our 23 cases occupy a single quadrant.

Case D, for example is a producer that operates all levels of the supply chain, encompassing production through retail. Cultivation and animal husbandry techniques are more labor intensive than industrial farming and meat production methods, but are beneficial in terms of minimizing off-farm inputs such as pesticide and fertilizer as well as promoting carbon sequestration, soil quality, and animal welfare. In addition, the producer conducts their own slaughter, packaging, and distribution of products in a direct-to-consumer model, limiting distribution to a several hour drive from the farm. Our analysis of this case suggests two particularly interesting findings. First, products are characterized and marketed as *local* food. Second, this producer strongly asserts that scaling operations would destroy core capabilities and quality conventions.

When asked to define *local* food, the consensus of Case D responses indicated that in this context the term denotes more than geographical proximity between producer and consumer. Two main themes emerged related to their conceptualization of local food. First, local food offers the opportunity to develop a connection between the producer and the customer. Second, the term indicates a type of proximity that allows transparency regarding production methods and quality attributes [61]. In addition to limiting how far products travel, their distribution and retailing model maximizes direct contact between the producer and the customer. In addition to their production methods, this connection was reported to be an important, order-winning attribute for their products. Customers are encouraged to visit the farm and facilities, the producer regularly holds open on-site events, operates

an on-site store, and maintains an extensive website explaining their values, production methods, and quality attributes. The producer charges a substantial premium as compared to similar products available in specialty grocery stores or farmers' markets. Domestic and ecological quality conventions are intrinsic in product marketing, and justify the price premium (e.g., public and market). Because of relatively high prices and the method of distribution, these products are largely unavailable to socio-economically disadvantaged consumers. As a result, there is a tradeoff for this producer with respect to achieving market, ecological and public conventions versus the civic convention.

Conventional business logic suggests that where a premium can be earned, expansion and greater production scale are desirable. However, our interviews at Case D reflected strong resistance to the idea of scaling production up to higher volumes. Interviewees expressed serious doubt regarding the potential for achieving economies of scale with these practices. The producer firmly rejected the idea that a large firm could successfully undertake similar agricultural practices. The rationale behind this assertion was twofold: (1) Loss of the relational aspect of small volume production with direct-to-consumer sales would erode consumer trust in quality attributes; and (2) Perception that larger firms, because they rely heavily on external investment, would be unable to balance potential tradeoffs between sustainable practices and seeking higher efficiency.

Cases concentrating on Niche tend to be smaller firms with highly specific target markets. Cases D, G, H, I, and N serve relatively small geographic areas, reinforcing their branding as local food. The domestic convention as evidenced by these firms does not necessarily rely on external validation by certifying bodies or other institutions. Instead, Niche producers may develop and rely on their own definitions of practices that fulfill the domestic conventions. In this sense, this type of producer is particularly vulnerable to encroachment by Growth products, which may have more obvious and externally validated quality attributes and are more competitively priced than their Niche counterparts. To defend their competitive advantage, producers concentrating solely on Niche must therefore consistently deliver products that are perceived by customers as fulfilling domestic conventions with attributes that justify price premiums (public, market). We observed multiple instances of Niche producers implementing practices to defend their domestic convention, including direction connection to consumers (Cases D, G, and H) and high levels of transparency regarding production methods (Cases D, E, G, N, and U). In each case, demonstrating authenticity to customers appears to be central to domestic convention, conveying producer trustworthiness and maintaining socially embedded attributes of transactions [45,61–63].

Firms that compete in one quadrant face potential tradeoffs. Niche firms, for example exploit existing capabilities and accept lower productivity to earn a price premium. By forgoing entry into Growth, for example, such firms are trading off access to volume demand with avoiding investment in industrial conventions. For some Niche producers, this choice is philosophical (Case D, G, I), however, multiple producers indicated that they were more interested in, and believed their skills and resources were more suited for, incremental growth, including expansion of scope, within Niche. Firms may not have the resources to compete in multiple quadrants, or may decide that focusing on single set of quality conventions is more efficient. Finally, as explained by multiple respondents at Case D, there may be a perceived quality risk associated with expanding to different supply or demand characteristics.