Balanced fat compositions and their application in liquid nutritional compositions for enteral feeding
SUBSTANCE: invention relates to a balanced fat composition, suitable for probe feeding. The fat composition, suitable for the probe feeding, contains from 8 to 15 wt % of linoleic acid (LA); from 3.0 to 6.0 wt % of a mixture, consisting of ω-3 polyunsaturated fatty acids, alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), where the quantity of ALA>2.5 wt % and the mixed quantity of DHA and EPA≤2.5 wt %l from 10 to 20 wt % of at least one medium-chain fatty acid (MCFA); and from 35 to 79 wt % of one monounsaturated fatty acid (MUFA). Claimed is a liquid nutritional composition, containing the said fat composition. Claimed is a method of supplying enteral feeding to patients, which includes the introduction of an effective quantity of the said liquid nutritional composition, containing the balanced fat composition by the invention.
EFFECT: invention makes it possible to obtain the balanced nutritional composition for long enteral feeding.
27 cl, 1 dwg, 5 tbl
Area of technology
The invention relates to a balanced fat composition and use thereof in a liquid nutritional compositions, particularly suitable for enteral feeding. This invention also relates to said liquid composition for providing enteral nutrition to patients in need in itself, in particular to provide full enteral nutrition, in particular for providing long-term enteral nutrition. More specifically balanced fat composition and liquid nutritional composition comprising said balanced fat composition includes specific amounts of linoleic acid (LA), alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), at least one medium chain fatty acid (MCFA) and at least one monounsaturated fatty acid (MUFA). The invention further relates to a method of providing enteral nutrition to a person when necessary in itself, comprising administering to the specified person an effective amount of a specified liquid nutritional composition containing a balanced fat composition according to the invention.
Patients who need enteral nutrition as the only�Ennom the power source (probe or food additives), are vulnerable to malnutrition, but also more likely to benefit from a healthy and well balanced nutritional product, since it replaces their regular (probably less healthy) food. When the application period is stretched (for example, in situations of home care or hospice care), the need for optimal and improved composition becomes even more important. Detailed standards and requirements for minerals, vitamins and amino acids are common to medical power; the standards for fat composition for a full medical power are rare. On the contrary, the recommendation is for healthy and balanced intake of fats and fatty acids calculated on society and widely disseminated. Provided for specific food composition justify not contradict each other (for example, in particular in the issue of metabolic needs), so there is no reason to deny patients the best possible nutrition in accordance with the latest data.
For various reasons, such as illness, medical condition, low nutrition, medical disability, postoperative period, etc., patients may be unable to obtain adequate nutrition by oral administration, e.g.�R through the mouth, with the help of food and drink. Therefore, it is known medical enteral feeding using nutritional supplements or nutrition through a tube. Feeding through a tube is provided mainly through the use of such device, such as a nasogastric feeding tube or nationally supply probe, or by means of percutaneous endoscopic gastrostomy (PEG) or PEG feeding system-jejunum. In the context of this application, in a state where the power gain in the form of oral nutritional supplements or nutritional probe, called enteral nutrition, which includes all the above mentioned methods, and the nutrition in these types of feeding is called enteral nutrition. The use of such enteral feeding may be temporary in the treatment of acute conditions or lifelong in the case of chronic disability. In the latter case it is based on the fact that enteral nutrition is designed for long-term use of all the necessary components. Thanks to advances in medicine leading to the increase in projected life expectancy, and better treatment of diseases, a large number of patients will benefit from such nutritional compositions, developed for long-term enteral nutrition.
The aim of the invention is the provision of balanced fats�th compositions which will be suitable for use as an enteral nutritional composition in accordance with the General recommendations for a healthy and balanced diet. Also balanced fat composition included in enteral nutritional composition belongs. Moreover, enteral nutritional composition comprising a specified balanced fat composition according to the invention, should easily be introduced through the probe, i.e., it must have low viscosity and low density, its pH should be neutral, it should have good storage stability, does not decompose, not to agglomerate or not sediment. It should be suitable for thermal processing (such as sterilization and pasteurization) without significant changes in the structure, have a pleasant taste (especially for oral nutritional compositions), viscosity, etc. Balanced fat composition should easily be mixed with other components such as the fraction of proteins, the fraction of carbohydrates, digestible fraction of fiber, and with other components, for example, to provide a complete nutritional composition.
For obtaining of the invention the inventors first confirmed the absence of the recommendations for a balanced fat composition for requiring enteral medical nutrition n�patients. To overcome this problem, the inventors have collected a sufficient number of recommendations and/or standards for healthy and balanced fat intake in the range defined by the lowest maximum and the highest minimum of the recommendations. Further recommendations (in En%) were converted to percentages by weight, was carried out search of a suitable source of fat, however, no one source could not meet the recommendations. Therefore, to obtain the desired balanced fat composition was the composition of sources of fat.
After careful consideration, the inventors found that this balanced fat composition must include at least the specific amount of linoleic acid (LA, 18:2n-6), alpha-linolenic acid (ALA, 18:3n-3), docosahexaenoic acid (DHA, 22:6n-3), eicosapentaenoic acid (EPA, 20:5n-3), at least one medium chain fatty acid (MCFA, for example, 8:0 and/or 10:0) and at least one monounsaturated fatty acid (MUFA, for example, 16:1, 18:1, 20:1, 22:1 and/or 24:1). In particular, the balanced fat composition contains a lower amount of LA than found in the prior art, in particular in commercial products are available, for example, Abbott, Fresenius, Nestlé and Nutricia.
Surprisingly, indicated a balanced fat composition can be developed on about�the basis of common sources of fats, you can produce and use for the production of liquid nutritional compositions.
The level of prior art
EP 1964554 A1 (Katry Inversiones) discloses a balanced fat composition suitable for enteral nutritional composition with a specific lipid profile for use in enteral nutritional products. Fatty composition of the invention differs from the proposal in that it comprises from about 17.2 to 22.8 wt.% (reference value at $ 19.95 wt.%) LA and from 1.7 to 2.4 wt.% ALA (reference value of 2.28 wt.%).
WO 2008/046871 A2 (Nestec SA) discloses a long period of gavage feeding for specific groups of patients such as the elderly. Fatty composition disclosed in the examples of the invention differs from the authors of the application on several points (both lower and higher content of LA, the lack of EPA and DHA or a higher content of EPA and DHA, and lower content of ALA in comparison with the composition according to the present invention).
Summary of the invention
In one embodiment of the present invention relates to fat compositions, in particular for the application of a composition suitable for the feeding tube that contains
from 8 to 15 wt.%, preferably from 12.5 to 14.5 wt.%, most preferably from 13.5 to 13.9 wt.% linoleic acid (LA, 18:2n-6);
from 3 up to 6.0 wt.%, preferably from 4.0 to ,0 wt.%, most preferably from 4.3 to 4.7 wt.% the combination consisting of the ω-3 polyunsaturated fatty acids: alpha-linolenic acid (ALA, 18:3n-3), docosahexaenoic acid (DHA, 22:6n-3) and eicosapentaenoic acid (EPA, 20:5n-3), where the amount of ALA > 2.5 wt.%, more preferably >2.7 percent by weight or preferably varies between 2.5 and 4.0 wt.%; and the combined amount of DHA and EPA is ≤2.5 wt.%, preferably ≤1.0 wt.%;
from 10 to 20 wt.%, preferably from 14 to 18 wt.%, most preferably from 15.7 to 16.2 wt.% at least one medium chain fatty acid (MCFA, for example, 8:0 and/or 10:0); and
from 35 to 79 wt.%, preferably from 40 to 70 wt.%, most preferably 50 to 60 wt.% at least one monounsaturated fatty acid (MUFA, for example, 16:1, 18:1, 20:1, 22:1 and/or 24:1),
where are all relative values are calculated based on the total fatty acids in the fat composition. The relative values do not need to add up to 100 wt.%, since the balanced fat composition according to the invention may also include other types of fats. However, the balanced fat composition according to the invention should not substantially contain other components, which, according to experts, can not be classified as fat.
In another embodiment of the present invention relative�tsya to the liquid nutritional composition, in particular a complete nutritional composition containing a balanced fat composition according to the invention. Specified liquid nutritional composition is in particular suitable for enteral feeding, particularly for a long period.
On the other hand, the present invention relates to a liquid nutritional composition, in which the fat composition comprises between 30 and 50 En%, preferably between 30 and 40 En% of the total energy of the composition. Specified liquid nutritional composition is in particular suitable for enteral feeding, particularly for a long period.
In the context of this request % of total energy is also denoted as En% En%, thus, is short for energy percentage and represents the relative amount of constituent contributes to the caloric value of the composition.
In the context of this application the term "at least" also includes the initial value of the open range. For example, the number of "at least 95 wt.%" means any amount equal to 95 wt.% or higher.
The invention will not be further covered in the description of the explanatory notes to invented the balanced fat composition according to the invention.
Detailed description of the invention
The metabolism of fatty acids
Strictly speaking, polyunsaturated fatty acids (PUFA) linoleic acid, (18:2n-6, denoted as LA, omega-6 fatty acid) and α-linolenic acid (18:3n-3, abbreviated as ALA, omega-3 fatty acid) are the only natural fatty acids for humans; all other physiologically and structureagency important fatty acids can be derived from these two fatty acids. However, conversion of LA into a more long-chain fatty acid, arachidonic acid (20:4n-6, ARA), and docosahexaenoic acid (22:6n-3, DHA) using enzymes of elongase and desaturase in humans is not very effective. The possible values of the conversion of LA to ARA and ALA into EPA vary, but rarely exceed 10%. Moreover, the conversion of ALA to DHA is considered to be even lower, possible values range from 4 to only 0.2% (Gerster 1998; Burdge et al. 2002; Goyens et al. 2006). These fatty acids (ARA, EPA, DHA) not only play an important structural role, but also transformed into eicosanoids and resolvin with a variety of physiological and immunological functions (Tapiero et al. 2002; Calder 2006; Serhan 2006). ARA, EPA and DHA are the so-called long-chain PUFA (LCPUFA, PUFA with a carbon chain length of more than 18 atoms) or LCP, with ARA belonging to omega-6 LCPUFA, EPA and DHA belong to the omega-3 LCPUFA.
Composition of food largely determines the embedding of these fatty acids in different cells and tissues complicated way. The most important is that fatty sour�s, as obtained through the diet and is synthesized from precursors that are competing at different levels for the same enzymes, which determine the embedding in tissue and/or transformation into biologically active metabolites: enzymes, which determine (1) incorporation into phospholipids and tissue, (2) the release from membranes and other stores, (3) conversion to other fatty acids, and (4) transformation into various metabolites (eicosanoids, resolvin). These eicosanoids and resolvin involved in a large number of physiological and immunological processes that they regulate the release of a number of hormones that have influence on the functioning of the nervous system. Because of the competition of fatty acids for converting enzymes relative overspending LA will provide education ARA at the expense of EPA and DHA. Similarly, the relative abundance of ALA will result in higher than ARA, the formulation of EPA and DHA. Consequently, this will lead to both a shift towards ARA-metabolites or EPA and DHA metabolites. In this case, both the absolute values and the ratios between the different fatty acids in the diet will affect the structural and regulatory role of fatty acids and their metabolites.
Table 1 gives a schematic representation of the metabolism of fatty acids in people which begins with two natural fatty acids - Lino�eve and α-linolenic - of food (plant-based) sources. Of these fatty acids (theoretically) possible to get all the other important fatty acids through enzymatic conversion: enzymes of desaturation (Δ5, Δ6) insert a new double bond between carbon atoms, and the enzyme elongase adds carbon atoms to the carbon chain.
Review the most recent recommendations
Some organizations have published standards for compositions for enteral nutrition that meets the dietary standards of specific groups of patients. For example, standards ESPEN published for certain groups of patients (i.e. in cardiology and pulmonology; gastroenterology; geriatrics; Hepatology; in cachexia in HIV; intensive care; when neoperiruemaya Oncology; renal insufficiency; in surgery and transplantation). However, none of these standards did not cover any optimal nutrient composition for total enteral nutrition, no detailed recommendations for on fat composition. On the other hand, recommendations for a healthy and balanced diet for the General public are becoming more detailed result information on the role of nutrition for health and, in particular, to prevent progression of the disease.
The availability and accessibility combined with the awareness of ZD�global nutrition underlines the suitability of these nutrition recommendations as a starting point for consideration of a fatty composition improved medical nutritional products. Therefore, it is very important that patients who receive total medical nutrition, won from the same nutrient composition, which are considered superior to the rest of the population. To determine the optimal level of specific (groups) of fatty acids was carried out a detailed comparison of the recommendations for healthy and balanced intake of fats from national and international organizations, among others, include the organizations listed below. The specified list is not complete, but it reflects the diversity of recommendations, which are powered by "Western type":
Health Council of the Netherlands (Netherlands)
British Nutrition Foundation (United Kingdom)
Scientific Advisory Committee on Nutrition (United Kingdom)
Deutsche Gesellschaft für Ernährung (Germany)
Superior Health Council of Belgium (Belgium)
Agence Française de Sécurité Sanitaire des Aliments (AFSSA) & Centre National d'etudes et des Recommandations sur la Nutririon Alimentation et l (CNERNA) - Centre National de la Recherche Scientifique (CNRS) (France)
Società Italiana di Nutrizione Umana (Italy)
American Heart Association Nutrition Committee (U. S. A.)
Food and Agriculture Organization &World Health Organization (FAO/WHO)
International Society for the Study of Fatty Acids and Lipids (ISSFAL).
A look at healthy intake of fats has changed in the past few decades to reduce total fat intake to give emphasis to the distinction of different types of fats and the recognition of the so-called "Zdor�o fats". Scientific information that should be considered optimal levels, different in different countries, which leads to a variety of recommendations. However, there are several universal recommendations:
Reducing the total energy absorbed (in part) by reducing the intake of fats.
Reduced intake of TRANS fats (mainly from semi-finished products);
Reduced intake of saturated fat;
Reduce consumption of omega-6 fatty acids, particularly linoleic acid (LA, 18:3n-6);
Increased consumption of long chain omega-3 fatty acids EPA (20:5n-3) and DHA (22:6n-3), for example, by increasing the consumption of (fatty) fish at least 1-2 times a week.
In Table 2, the inventors have collected recommendations, in the range which is healthy and balanced fatty acids: while none of the organizations does not provide recommendations/standards forallaspects of optimal fat intake, as shown in Table 2, the combination of all the recommendations/standards led to the emergence ofthe most balancedcompositions which will meet all the aforementioned recommendations/regulations.
These recommendations are aimed at a broad (healthy) population with the main aim to prevent disease and reduce mortality associated with power, for example, cardiovascular Soboleva�th. Although fat compositions of the latter prior art for nutritional supplements and tube fed meet most of the recommendations for healthy and balanced fat intake, you can determine a few differences, which are generally associated with the inclusion of DHA and EPA, which are usually lacking in the products of the prior art for enteral nutrition, and LA-component that is systematically present in the products of the prior art for enteral feeding in too high quantities.
The implementation of the recommendations
The inventors now found that the balanced fat composition may be created in conjunction with the recommendations for healthy and balanced intake of fats, suitable for enteral feeding. After careful consideration of the following lipid compositions, which will be discussed in more detail in the following sections and which take into account:
The inclusion of a source of EPA and/or DHA:almost all organizations recommend a minimum intake (fatty) fish 1-2 times per week, which met the minimum intake of approximately 500 mg of EPA+DHA.
The selection of the suitable sources of fat with a low content of LA: several organizations have recommended reducing the intake of LA to the minimum reception from 1 to 4 En% for adults.
The inclusion of medium chain fatty �of Islam (MCFA): adding source of MCFA provides an easy and relatively inexpensive way to reduce the content of LA (see item 2 above). In order to reduce the content of LA 4 En% may require an equivalent amount of 4 En% MCFA (10-20% fat composition).
The inclusion of source, rich in monounsaturated fatty acids (MUFA) like oleic acid (18:1n-9); several organizations have recommended a minimum or adequate intake of MUFA between 10 and 30 En%. The inclusion of sufficient amounts of MUFA is a great way to limit the total amount of saturated fatty acids, as well as the replacement of omega-6 PUFA mentioned above.
Table 2.Combined national and international guidelines from 13 national and international organizations to receive various types of fats. Recommended values are expressed in percentage energy intake from absorbed food; daily intake is calculated for 2 caloric diets, when these products are consumed as whole food substituents (full power).
|The highest minimum and the lowest maximum||Daily intake (g) in the diet of 1500 kcal/day||Daily intake (g) in the diet of 2000 kcal/day|
|Total sod�neigh fats||15-35 En%||25,0-58,3||33,3-78,8|
|Saturated fats||A maximum of 10 En%||A maximum of 16.7 g||Most 22, 2 g|
|Unsaturated fats||15,3-33 En%||25,5-55 g||34,0-73,3 g|
|- MUFA||10-30 En%||from 16.7 50.0 g||22,2-66,7 g|
|- PUFA||the 5.3-12 En%||the 8.8-20.0 g||11,8-26,7 g|
Minimally 0,27 En%|
Minimum 500 mg/day
|Minimum of 450 mg/day|
Minimum 500 mg/day
|Minimum 600 mg/day|
Minimum 500 mg/day
|The total content of ω-6||4-8 En%||of 6.7 and 13.3 g||the 8.9 to 17.8 g|
|The total content of ω-3||1,3-2 En%||the 2.2-3.3 g||2.9 to 4.4 g|
The basis of this application, the words "balanced", "balanced" and the like are used to denote the fact that the fat composition according to the invention is the best solution on the recommendations for healthy and balanced fat intake than the existing commercially available fat compositions.
The inclusion of a source of EPA and/or DHA
Increase consumption of fish oil rich in omega-3 fatty acids EPA and DHA, affects a number of physiological and immunological processes, including the fluidity of the membrane function and signal transduction pathways. Most importantly, increased consumption of EPA and DHA reduces the production of the wire�sporitelny mediators such as cytokines, interleukins and tumor necrosis factor (TNF). This is achieved by (1) competition with omega-6 arachidonic acid (20:4n-6, ARA) for incorporation into the phospholipids of the membranes, which reduces the content of ARA in cell membranes and, thus, its availability for the synthesis of eicosanoids, and (2) competition for the same enzymes that convert ARA to proinflammatory eicosanoids (Calderm 2006; Sijben et al. 2007).
Numerous studies (mechanism) confirmed that the intake of sufficient quantities of fish has the following beneficial effects:
The reduction of inflammatory serum markers (e.g., Zampelas et al. 2005).
The decrease in overall heart rate (e.g., Mozaffarian et al. 2005).
The decrease in blood pressure (e.g., Theobald et al. 2005).
The decrease in fasting postprandial plasma triglycerides (for example, Schwellenbach et al. 2006).
Protection from cardiac arrhythmia, most likely due to modulation of sodium and calcium ion channels in the myocardium (e.g., Chrysohoou et al. 2007).
It was published a large number of interventions with a high intake of n-3 PUFA to reduce symptoms (and sometimes treatment) of diseases associated with chronic inflammation, including rheumatoid arthritis, asthma, cancer cachexia and inflammatory bowel disease. Other diseases, for co�which determined the effects of consumption of fatty acids fish oil are, among all, cardiovascular disease (CVD), macular degeneration, osteoporosis, depression, schizophrenia, attention deficit disorder with hyperactivity (ADHD), eating disorders, cancer, burns and skin diseases (Calder, 2006).
The composition and purity of the available fish oil vary considerably. These fats not only differ in the total content of EPA and DHA, but also the ratio of EPA to DHA is also variable (see Table 3). EPA and DHA provide various functions in the human body; positive effects of EPA fundamentally is aimed at competitive inhibition of the synthesis of eicosanoids from ARA, DHA properties are always associated with the functioning of membranes. Despite the difference in the functioning of many studies in the inventions provide very little information about the exact intake of fatty acids, in any degree, since these levels can be difficult to detect in food.
Table 3.The approximate composition of fatty acids (grams per 100 grams) grams) in several commonly used fish oils. Source: "The Lipid Handbook", third edition, 2007. F. D. Gunstone, J. L. Hardwood, A. J. Dijkstra (Eds.). CRC Press, USA.
The most common fish species, i.e. anchovies and sardines, characterized by a relative excess of EPA relative to DHA, while, on the contrary, the fat tuna is relatively rich in DHA (Tab�Itza 2). Thus, the ratio of EPA to DHA depends on the types that apply, and the production process largely determines the quality of these fatty acids. With the exception of fish oil, which contains most of EPA and DHA in the form of triglycerides, EPA and DHA can also be provided purified ethyl esters. For example, research has shown that moderate consumption of DHA (0.7 g DHA/day from the source is purified algae) reduces diastolic blood pressure within 3 months, and this effect is more pronounced compared with those obtained by use of higher doses of EPA and DHA combined in other studies (Theobald et al. 2007). Similarly, the addition of 1 g/day of DHA was as effective as 1.25 g EPA+DHA, to concentration decrease in plasma triglycerides in elderly men after 8 weeks (Davidson et al. 1997). Omega-3 LCPUFA from ethyl ester and triglyceride equally well embedded in the lipids of the plasma, despite possible differences in the initial time of absorption (Luley et al. 1990; Hansen et al. 1993).
Nutritional LCPUFA may also be administered in the form of phospholipids, for example, obtained from eggs. While some studies report a high intestinal absorption of omega-3 LCPUFA from phospholipids compared to triglycerides (Carnielli et al. 1998), others report similar LCPUFA status in lipid fractions of plasma and actually� parity embedding of ARA and DHA in red blood cells from the phospholipids, and triglycerides in children under 1 year (Sala-Vila et al. 2004; Sala-Vila et al. 2006).
As explained above, nutrient α-linolenic acid (ALA) can be converted into long-chain omega-3 fatty acids ALA and DHA using enzymatic transformations. The opportunity arises because due to the increased consumption of ALA may increase the levels of EPA and DHA in the tissues. Rich sources of ALA are vegetable oils, such as linseed oil (approximately 60% ALA), Perilla oil (approximately 50% ALA) and canola oil (approximately 10%). However, the conversion of ALA to EPA (less than 10% of nutrient ALA) and DHA (less than 4% nutrient ALA) in adults is not sufficient and even further reduced by 40-50% at basic diet rich in omega-6 PUFA (Gerster 1998; Williams et al. 2006). This suggests that a high intake of ALA is required to achieve the equivalent of the recommended intake of EPA+DHA. Thus, the addition of prepared EPA+DHA seems important.
In conclusion, increasing the nutrient intake of omega-3 LCPUFA reduces the risk of certain diseases, including cardiovascular disease. Moreover, improvements in overall health can be expected due to the reduction of Pro-inflammatory markers, reduce serum triglycerides and/or lower blood pressure. The recommended intake of EPA+DHA varies from 0.15 to 0.5 En%. To meet the minimum R�cementoenamel many organizations to receive a daily intake of EPA+DHA should be at least 500 mg/day (based on the minimum daily food intake is 1500 kcal/day).
Balanced fat composition according to the invention includes between 3.0 and 6 wt.% the combination consisting of the ω-3 polyunsaturated fatty acids, alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), where the amount of ALA > 2.5 wt.%, more preferably >2.7 wt.% or preferably is in the range between 2.5 and 4.0% by weight, and a mixed amount of DHA and EPA ≤2.5 wt.%, preferably ≤1.0 wt.%.
ω-3 Polyunsaturated fatty acids can be represented by triglycerides, ethyl esters, phospholipids, sphingolipids, glycolipids, and other food forms.
The choice of a suitable source of fat with a low content of LA
Almost all commercially available products contain natural fatty acids, linoleic acid (LA) and α-linolenic acid (ALA), to match theminimumthe requirements for fatty acids. However, these two fatty acids are precursors to long-chain polyunsaturated fatty acids (LC PUFA), which are required for normal physiological functioning of all tissues. Omega-6 population has increased in the last decades, and, reputedly, the Western diet now contains too many omega-6 fatty acids and not enough omega-3 fatty acids (Ailhaud et al. (2006). This affects a number of physiology�environmental and immunological functions.
Recommendations for a minimum intake of LA varies from 1 to 4% of the total daily intake of calories: AFSSA French organization and CNERNA-CNRS give recommendations 4 En% for adults. None of the national committees or of the health boards do not include the safe upper limit for consumption LA. However, the level of LA in the fat compositions that are currently used in several commercially available products, is several times the reception, which is considered sufficient to prevent deficiency. The reasons for limiting the content of LA to number close to the highest recommended (sufficient) intake, are discussed in the next section.
The conversion of fatty acids LA and ALA to their respective LCPUFA is controlled by a combination of metabolic factors and nutrient composition (fatty acids). Among other things, increase the nutrient intake of LCPUFA reduces the conversion of ALA and ALA, probably due to the negative regulation by the product of desaturation and elongation enzyme pathways that are responsible for conversion of LA and ALA (Brenna 2002). Moreover, Emken et al. (1994) also demonstrated that the conversion of LA and ALA to their respective LCPUFA (ARA, EPA, DHA) is reduced by 40-54% when the intake of LA increased from 15 to 50 g/day in volunteers (Emken et al. 1994). These techniques LA corresponded to 4.7 and 9.3 En% resp�governmental (diet 2800 kcal/day), what is the normal range of dietary intake and nutrient supplements and probe power on the market currently. To compensate for the reduced endogenous production of long-chain omega-3 fatty acids, EPA and DHA must be supported by a diet that is another subject of controversy for the inclusion of fish oil in the composition according to the invention.
High intake of LA not only reduces the conversion of LA and ALA to long chain fatty acids, but LA also competes with ALA, EPA, and DHA for incorporation into phospholipids of tissues: correlation between nutritional omega-6 and omega-3 fatty acids have a great effect on the final composition of the tissues. Accordingly, high levels of LA have a marked impact on the effectiveness of adding fish oil. Although the reception ARA (the degradation product of LA) also plays a role, LA is the precursor PUFA in normal (Western) diet. Hibbeln et al. (2006) compared the diversity of the world omega-6 and omega-3 fatty acids with risk of cardiovascular and mental diseases and has set the target tissue for omega-3 LCPUFA: 60% omega-3 fatty acids LCPUFA (and 40% n-6 fatty acids LCPUFA) will be sufficient to protect 98% of the population from mortality due to cardiovascular diseases. As this level is reached only in populations with high fish consumption (�pony, Greenland) proposed a more plausible and realistic the target tissue 50% omega-3 tissue LCPUFA. 50% omega-3 is aimed at the tissue LCPUFA, which in particular is responsible for approximately 60% reduction in the relative risk of sudden death, as reported by Albert et al. (2002). By using a formula that takes into account the competition between fatty acids for embedding (Lands et al. 1992), the required intake of EPA+DHA when the count reaches 50% omega 3 targets with respect to the base receiving LA (Figure 1). This graph illustrates the fact that the effectiveness of adding fish oil is increased as the intake of LA is reduced or, in other words, the effectiveness of adding fish oil significantly reduced, when the increased intake of LA. For example, more than 3 times higher dose of EPA+DHA required to achieve the same tissue level when receiving 8,9 En% LA than in the diet containing a 3.2 En% LA. Knowing that LA competes with EPA and DHA for incorporation into tissue, can be defined as the content of LA in this invention relates to the guidelines for the use of fish that are in the range of 0.2 to 0.5 En% EPA+DHA.
In conclusion, to make sure that the LA level can be considered adequate in accordance with all recommendations require a minimum number of 4 En% LA (French recommendations for adults). Because higher levels reduce LA �efficiency of adding fish oil and affect the level of omega-6/omega-3 in tissues, this level 4 En% should preferably be regarded as a maximum level for full nutritional products. By modifying the oils currently in production (see also next section) it is possible to reduce the content to LA 4 En%, although it should be concerned about maintaining the content above 1 ALA En% ALA (the most high recommended minimum intake of ALA). Then the ratio of omega-6/omega-3 formula can be reduced to approximately 3:1. Preferably, the ratio of ω-6:ω-3 in the fatty composition according to the invention is approximately 2.5:1-3,5:1, preferably 3:1, where the term "approximately" means the relative deviation equal to 10%.
Balanced fat composition according to the invention includes between 10 and 15 wt.% linoleic acid (LA).
Acid may be present in the form of triglycerides, phospholipids, sphingolipids, glycolipids, and other food forms.
The inclusion of medium chain fatty acids (MCFA)
Most of the currently available vegetable oils contains LA, which makes the decrease in the content of LA in adipose composition to the recommended level of 4 En%. Without compromise on the part of the total fat content possible solution is to increase the content of other fatty acids, for example, MUFA (e.g., oleic acid). Unfortunately, the available oils rich in MUFA (olive �aslo, rich in oleic acid sunflower oil), also, as a rule, contain LA. Instead, you can increase the content of saturated fatty acids: currently, the saturated fatty acid in most commercially available products is below the highest recommended doses (see Table 2). However, the increase in the content of saturated fatty acids cannot directly be considered advantageous, as it also increases the levels of cholesterol in the serum. One group of saturated fatty acids, which can be considered a healthier alternative, are medium chain fatty acids (MCFA), which are usually in the form of medium chain triglycerides (MCT). MCT are esters of glycerin medium chain fatty acids consisting of 3 medium chain saturated fatty acids (MCFA), each of which contains from 6 to 12 carbon atoms.
Natural sources of MCFA are coconut oil and palm oil seeds. After hydrolysis of these oils provide a concentrated source of MCFA long chains initially in 8 atoms (Caprylic or octanoic acid) and 10 (capric or cekanova acid) carbon atoms. Thus, with the introduction of MCT or MCF, there is a limit to fatty acids with 8 - and 10-carbon chains (theoretically). MCFA also includes carbon� chain of 6 and 12 carbon atoms.
Therefore, the MCFA according to the invention is preferably selected from MCT derived from coconut oil and/or oil from palm kernels. Chain length MCFA according to the invention is 6, 7, 8, 9, 10, 11 or 12, preferably 8, 9 or 10, most preferably 8 or 10 carbon atoms, or any mixture of the above substances.
MCFA are not considered natural and thus not considered a necessary part of proper nutrition. Although MCFA belong to the category of saturated fats, they have completely different biochemical and physiological properties compared with long-chain saturated fatty acids, which will be explained below.
Digestion and absorption MCFA happens easier and faster than long-chain fatty acids (LCFA). MCFA are absorbed in the small intestine (unchanged or with subsequent hydrolysis) and first carried in the portal vein to the liver. On the contrary, nutritious long-chain triglycerides are first hydrolyzed in the small intestine to LCFA and re-aeriferous in the cells of the mucosa of the small intestine to long-chain triglycerides. Then they are embedded in chylomicrons and reach the bloodstream via the lymphatic system (Bach et al. 1996; Snook et al. 1996). Moreover, the digestion and absorption MCFA is not dependent on pancreatic enzymes or bile salts acidic�you. In particular, patients with malabsorption syndromes and/or pancreatic insufficiency will benefit from a diet rich in MCT/MCFA, and therefore MCFA are often used as the preferred source of fat for these patients (Marten et al. 2006).
MCFA can easily pass through the mitochondrial membrane and are rapidly oxidized (beta-oxidation). This occurs (partly) due to the fact that fatty acids containing from 6 to 12 carbon atoms, do not require carnitine for transport across the mitochondrial membrane in liver tissue of a healthy, well-nourished adults, the opposite occurs in fatty acids with 14 or more carbon atoms with camicissima beta-oxidation (Calabrese et al. 1999). Beta-oxidation of fatty acids results in the production of acetyl-COA, which is embedded in the Krebs cycle for energy production, but acetyl-COA can also turn into acetoacetate, beta-hydroxybutyrate and acetone, which are collectively referred to as ketone bodies. A quick intake of MCFA in the mitochondria can lead to excessive production of acetyl-COA and develop high ketone bodies (ketogenic effect), which can be further metabolized in the liver, but also the system can be transported by the bloodstream to other tissues and serve as direct available energy source (Marten et al. 2006).
Preferred β-oxidation MFA in mitochondria can protect PUFA from oxidation which will increase the availability of EPA and DHA for incorporation into phospholipids of tissues. A small number of studies actually suggested the presence of this effect. For example, in one study, premature infants received enteral nutrition and received his formula with 40% MCFA (MCT) or without MCFA within 7 days (Rodriguez et al. 2003). After this period, the standard oxidation of the labeled dose LA significantly decreased in the treated group MCFA. Similarly injecting the emulsion with MCFA in combination with long-chain triglycerides (ratio 1:1) within 8 days only slightly increased the levels of LCPUFA in plasma phospholipids and triacylglycerides compared to the emulsion containing only PUFA, in another study with premature infants (Lehner et al. 2006). However, evidence of the protection of PUFA by providing MCT/MCFA in adults is limited.
The advantage of β-oxidation of MCFA into the mitochondria for energy production is higher compared with LCFA, which (theoretically) means that fewer fatty acids stored in adipose tissue when provided by MCFA, and more is used for generating energy (Metges et al. 1991).
The amount of MCFA or MCT required to reduce the content of LA is relatively small: for example, for a commercial product Nutrison Standard (NV Nutricia) enough about 4En% MCFA (C8-C10) - together with modification of springs or so, you'll�oil - for reducing the content of LA from 8.3 to 4 En%. This corresponds to approximately 10 to 15% fat compositions as MCFA or 6-8 g MCFA (C8+C10) per day (1500 kcal/day). At these levels, you should not experience discomfort in the gastro-intestinal tract because the higher levels are considered well portable. For example, a diet with 40 En% fat, of which 50% consists of MCT, generally well tolerated, although during the first days of consumption showed a slight stomach discomfort and periodic nausea (Bourque et al. 2003). Similarly, a diet with as many as 67% fat in the form of MCT (40 En% fat) is well-tolerated by volunteers (St-Onge et al. 2003).
In conclusion, to facilitate the reduction of the content of LA in adipose composition, the total amount of PUFA can be reduced by increasing the amount of saturated fat: total saturated fatty acids of these commodity products is low (<5 En%) and may be increased within the recommended high levels (10-12 En%). Although MCFA belong to the category of saturated fats, these fatty acids are easily digested and rapidly oxidized with the release of energy unlike long-chain fatty acids stored in adipose tissue. The inclusion of MCT/MCFA can be used as a healthy way to reduce the content of LA in the products (within boundaries). Only a small �of kolichestvo MCT/MCFA (10-15% fat composition) are required to reduce the content of LA to the desired level in 4 En% in the case what other vegetable oils modified.
Balanced fat composition according to the invention includes between 10 and 20 wt.%, preferably from 14 to 18 wt.%, most preferably from 15.7 to 16.2 wt.% medium chain fatty acids (MCFA).
Medium chain fatty acids can be in the form of triglycerides, phospholipids, sphingolipids or in other food forms.
The inclusion of source, rich in monounsaturated fatty acids (MUFA)
Unsaturated fatty acids are prone to oxidation, which leads to the formation of traumatic oxygen radicals and oxidative damage to surrounding molecules and cells. As the sensitivity of fatty acid oxidation depends on the number of double bonds in the carbon chain of fatty acid, monounsaturated fatty acids (MUFA) are less sensitive to oxidation than polyunsaturated fatty acids.
The development of atherosclerosis, a chronic inflammatory response in the artery walls, is triggered by the deposition of lipoproteins (plasma proteins that carry cholesterol and triglycerides) in the walls of the arteries. Oxidized low density lipoproteins (LDL) are considered to be more traumatic to the arterial wall than natural LDL, and LDL oxidation leads to the development of atherosclerosis. Elevated concentrations of oxidized LDL has �good relationship with severity of acute coronary conditions and is a precursor to coronary heart disease in patients with coronary artery disease, and in the population as a whole (Covas et al. 2007).
The substitution of saturated fatty acids oleic acid reduces the risk of developing coronary heart disease, among other things, by embedding oleic acid and consumption of linoleic acid (C18:2n-6), which reduces the sensitivity of LDL to oxidation (Reaven et al., 1993; Covas, 2007). Moreover, the total concentration of LDL in the blood, as well as factor VII coagulation, decreases when the food is rich in saturated fats, is replaced by food with high content of oleic acid sunflower oil in men and women of middle age in a matter of weeks (Allman-Farinelli et al., 2005).
Monounsaturated fatty acid is preferably selected from the group of palmitoleic acid (16:1), oleic acid (18:1), eicosenoic acid (20:1), erucic acid (22:1), Neronova acid (24:1) or a mixture of the above substances. Most preferably, at least 80 wt.% monounsaturated fatty acids consisted of oleic acid.
Balanced fat composition according to the invention includes between 35 and 79 wt.%, preferably from 50 to 70 wt.%, most preferably 50 to 60 wt.% at least one monounsaturated fatty acid.
Suitable sources to increase the content of MUFA are, for example, is rich in oleic acid sunflower oil, rich in oleic to�slotow safflower oil and olive oil.
Monounsaturated fatty acids can be in the form of triglycerides, phospholipids, sphingolipids or in other food forms.
Balanced fat composition
When people talk about a balanced fat composition according to the invention, the fatty composition may be available in the form of a mixture, it can be available in the form of a set of components at a certain concentration in the nutrient composition, it may be so or it may be made by adding the various components, LA, ALA, DHA, EPA, MCFA and MUFA, or sources, incorporating the components together with other ingredients to produce a nutritional composition containing fat composition according to the invention. It may also be available in the form of complex components, including various components, LA, ALA, DHA, EPA, MCFA and MUFA, or sources, incorporating the components of the combination and in certain quantities, possibly accompanied by instructions on how to do it.
Fatty composition according to the invention may optionally include additional fatty acid, preferably a fatty acid selected from the group of saturated fatty acids than MCFA, and polyunsaturated fatty acid different from ALA, DHA and EPA.
Fatty composition according to the invention may be performed by a specialist by combining suitable�value fats from their sources in the right quantities. In accordance with one variant of implementation can be combined from the following sources: canola oil, rich in oleic acid sunflower oil, fish oil and MCT oil. More specifically combine: about 37 wt.% canola oil, approximately 42 wt.% rich in oleic acid sunflower oil, about 2 wt.% fish oil and about 17 wt.% MCT oil. Specialists will be clear that these quantities can vary to some extent depending on the specific composition of the fat source.
Unexpectedly balanced fat composition according to the invention made possible the production of liquid enteral nutritional composition with a long shelf life and low viscosity. Consequently, the invention also relates to a balanced fat composition according to the invention for use in the manufacture of a liquid nutritional composition, in particular for use as a probe power, in particular for long-term feeding through a tube.
In one specific embodiment of the present invention relates to a liquid nutritional composition containing fat composition, which includes:
from 8 to 15 wt.%, preferably from 12.5 to 14.5 wt.%, most preferably from 13.5 to 13.9 wt.% linoleic acid (LA);
�t 3 up to 6.0 wt.%, preferably from 4.0 to 5.0 wt.%, most preferably from 4.3 to 4.7 wt.% the combination consisting of the ω-3 polyunsaturated fatty acids, alpha-linolenic acid (ALA, 18:3n-3), docosahexaenoic acid (DHA, 22:6n-3) and eicosapentaenoic acid (EPA, 20:5n-3), where the amount of ALA > 2.5 wt.%, more preferably >2.7 wt.% or preferably varies between 2.5 and 4.0 wt.%; and the combined amount of DHA and EPA ≤2.5 wt.%, preferably ≤1.0 wt.%; and
from 10 to 20 wt.%, preferably from 14 to 18 wt.%, most preferably from 15.7 to 16.2 wt.% at least one medium chain fatty acid (MCFA, for example, 8:0 and/or 10:0) ; and
from 35 to 79 wt.%, preferably from 40 to 70 wt.%, most preferably 50 to 60 wt.% at least one monounsaturated fatty acid (MUFA, for example, 16:1, 18:1, 20:1, 22:1 and/or 24:1).
where are all relative values are calculated based on the total fatty acids in the fat composition. The relative values do not need to add up to 100 wt.%, since the balanced fat composition according to the invention may also include other types of fats. However, the balanced fat composition according to the invention should not substantially contain other components, which according to experts could not be classified as fat.
Preferably, the liquid nutritional components�police according to the invention contains a balanced fat composition according to the invention, and balanced fat composition comprises at least between 30 and 50 En%, preferably between 30 and 40 En% of the total energy of the composition.
Preferably, the liquid nutritional composition according to the invention includes at least 0.4 kcal/ml, preferably of 0.7 kcal/ml, more preferably at least 0.9 kcal/ml of the composition.
A composition according to the invention is created as a support for the nutrition of the patient and to provide nutrition. Thus, the composition according to the invention may further include at least proteins and/or carbohydrates and/or source of vitamins and minerals, and/or source of prebiotics. Preferably the composition according to the invention is a complete nutritional composition.
In one embodiment of the present invention, the viscosity of the liquid enteral composition is lower than 500 mPas, measured at 20°C (e.g. at room temperature) at a shear rate of 100 s-1, preferably between 10 and 200 mPas, more preferably between 10 and 100 mPas, most preferably below 50 mPas. The viscosity can be determined appropriately by using a rotating viscometer with cone/flat shape. This viscosity is perfect for oral administration liquid enteral nutritional composition according to the invention, since�the man can easily swallow served with low viscosity, as shown in the present invention. The viscosity is also ideal for single dosages for insertion through the probe.
In one embodiment of the present invention, the density of the composition varies between 1.00 g/ml and 1.20 g/ml, particularly between 1.05 g/ml and 1.15 g/ml.
Liquid enteral nutritional composition according to the invention is preferably in the form of proper nutrition, for example, it can meet all nutritional needs of the user. Thus, the liquid enteral nutritional composition according to the invention preferably contains from 1000 to 2500 kcal per daily use. Depending on the condition of the patient, the daily dose is from about 25 to 35 kcal/kg body weight/day. Thus, a typical daily dose for a 70 kg man has approximately 2000 kcal. Good nutrition can be in the form of a plurality of dosage units, i.e. 8 (250 ml/unit) to 2 units (1 l/unit) per day to maintain the energy in a 2000 kcal/day using a liquid enteral nutritional composition according to the invention 1 kcal/ml. Preferably the nutritional composition is adapted for the feeding tube.
Liquid enteral nutritional composition can also be oral nutrition, for example, can be used in addition to it�medical diet or normal diet. Preferably as support oral liquid enteral nutritional support contains a daily dose of less than 1500 kcal, in particular in support of the liquid enteral nutritional composition comprises from 500 to 1000 kcal per daily dose. Support the power may be in the form of a plurality of dosage units, i.e. from 2 (250 ml/unit) to 10 units (50 ml/unit) per day to maintain energy 500 kcal/day when using a liquid enteral nutritional composition according to the invention 1 kcal/ml.
Preferably the nutritional composition is packaged, stored and provided in a container, such as a plastic bag or package, etc. a Variety of such containers are widely known, for example in the art known to a 500 ml, 1000 ml and 1500 ml containers. It should be noted that it is possible to apply any suitable container for packaging, storage and distribution of nutritional compositions according to the invention.
In one embodiment of the present invention the composition is provided in a ready to use liquid form and does not require conversion or mixing prior to use. The composition according to the invention can be entered via tube or orally. For example, a composition according to the invention may be provided in the Bank on spike and hand bag. However, the composition may provide�I person in need thereof, in powder form, suitable for transformation with the use of an aqueous solution or water to get the composition according to the invention.
Thus, in one embodiment of the present invention, the present composition is in powder form, accompanied by instructions for dissolution or conversion to an aqueous composition or water to obtain a liquid enteral nutritional composition according to the present invention. In one embodiment of the present invention, the present liquid nutritional enteral composition can be obtained by dissolving or conversion of the powder, preferably in an aqueous composition, in particular in water.
In one embodiment of the present invention, the composition according to the invention is Packed. Packaging may have a suitable shape, for example in the form of a square box shape, for example to be empty with straw inside; carton or plastic vessel with a removable cover; the small size of the bottle, for example, for the range of 80-200 ml, and small cups, for example, range from 19 to 30 ml. Other suitable packaging option is the inclusion of small volumes of liquid (e.g., from 10 ml to 20 ml) in edible casings or capsules, for example, gelatinous coating, and the like. Another suitable option of packaging is powder in con�anere, for example a sachet, preferably with instructions on dissolution or conversion in an aqueous composition or water.
The present invention also relates to a method of providing nutrition to people who need such, includes introduction to the specified person an effective amount of a nutritional composition in accordance with the present invention, containing a balanced fat composition according to the invention. The specified person may be an elderly person in a state of disease, person, recovering from illness, or a person with poor nutrition.
The present invention also relates to providing power for a long period of feeding a patient through a tube, if necessary, in such. Used above, the term "long period" means a period greater than one month (30 days). It is obvious that the power, which is suitable for long-term supply, also suitable for any other shorter period supply, such as srednei (10 to 30 days) and korotkoe periods of power (between 1 and 10 days). However, tube feeding designed to support patients. As used above, "maintaining patients" refers to patients, to people of any age, in particular children, adults and elderly who are unable to get nutrition through �armaline nutrition, but who have a normal metabolism, i.e. not suffering from metabolic disorders. As used above, the term "normal food" means getting at least almost full power by absorption of food, i.e., for example, orally, by eating or drinking. Because of the composition for long-term enteral nutrition according to the invention are provided to maintain, they are not directed to the treatment of any specific disorder, such as cancer, HIV, diabetes etc. the Patients are usually stable, have a normal metabolism, healthy except for the fact that they need enteral nutrition to meet the necessary nutritional requirements. Thus, these patients may suffer from various disorders, including disorders of swallowing various etiologies, particularly after surgery for cancer of the ear/nose/throat, and patients suffering from cerebral vascular disorders.
The invention will be further illuminated by some examples, not limited to.
The drawing shows the influence of basic consumption of omega-6 linoleic acid (LA) on the effectiveness of supportive nutrition omega-3 LCPUFA to achieve the goal of 50% tissue LCPUFA consisting of omega-3 fatty acids. At this level it is expected a significant reduction in the risk of death�spine from cardiovascular disease. The high intake of LA refers to the total consumption in the United States, whereas the lowest level of LA corresponds to the reception in the Philippines, established from data on home maintenance food for human consumption. The requested omega-3 LCPUFA is calculated by an empirically derived formula that takes into account the competition of different PUFA for incorporation into tissue. Graph is based on data Hibbein et al. 2006.
Following a balanced fat composition can suitably be used as enteral composition according to the invention (Tables 4 and 5).
Fatty composition according to the invention
|Fatty composition (g per 100 g fatty acids)|
|All fatty acids||100 g|
|Saturated fatty acids||25,7 g|
|Unsaturated fatty acids||74,3 g|
|-EPA + DHA||0.9 g|
|ALA + EPA + DHA||4.5 g|
|Total ω-6||13,8 g|
|Total ω-3||4.7 g|
|ω-6/ω-3||2,9 : 1|
Enteral composition according to the invention
Tube feeding adults
Tube feeding adults
Tube feeding adults
|Fat (g/100 ml)|
|*In these examples, 3.9 g of fat corresponds to 3.7 g of fatty acids; 5.8 g fat corresponding to 5.5 g of fatty acids; 9.3 g fat corresponds to 8.7 g of fatty acids.|
It should be understood thatvarious changes and modifications presented in these variants of implementation, described here � above, will be obvious to experts in this field of technology. Such changes and modifications may be made without straying from the essence and subject of the invention and without diminishing its advantages. Thus, it is believed that changes and modifications covered by the attached claims.
1. Fatty composition, suitable for the feeding tube that contains
- from 8 to 15 wt.% linoleic acid (LA);
- from 3.0 to 6.0 wt.% a mixture consisting of ω-3 polyunsaturated fatty acids, alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), where the amount of ALA > 2.5 wt.% and a mixed amount of DHA and EPA≤2.5 wt.%;
- from 10 to 2 0 wt.% at least one medium chain fatty acid (MCFA); and
from 35 to 79 wt.% one monounsaturated fatty acid (MUFA).
2. Fatty composition according to claim 1, containing from 12.5 to 14.5 wt.%, most preferably from 13.5 to 13.9 wt.% linoleic acid (LA).
3. Fatty composition according to claim 1, containing from 4.0 to 5.0 wt.%, most preferably from 4.3 to 4.7 wt.% a mixture consisting of ω-3 polyunsaturated fatty acids, alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapen�enoeou acid (EPA).
4. Fat composition according to any one of claims. 1-3, in which the number of ALA>2.7 wt.%, preferably varies in the range of up to 4.0 wt.%.
5. Fat composition according to any one of claims. 1-3, in which the mixed amount of DHA and EPA≤1.0 wt.%.
6. Fat composition according to any one of claims. 1 to 3, containing from 14 to 18 wt.%, most preferably from 15.7 to 16.2 wt.% at least one medium chain fatty acid (MCFA).
7. Fat composition according to any one of claims. 1 to 3, containing from 40 to 70 wt.%, most preferably 50 to 60 wt.% at least one monounsaturated fatty acid (MUFA).
8. Fat composition according to any one of claims. 1-3, in which monounsaturated fatty acid includes oleic acid (18:1).
9. Fat composition according to any one of claims. 1-3, in which the ratio of ω-6:ω-3 is approximately 3:1.
10. Fat composition according to any one of claims. 1-3, is made of mixed in suitable quantities canola oil, rich in oleic acid sunflower oil, fish oil and MCT oil.
11. Fat composition according to any one of claims. 1-3, is made by mixing approximately 37 wt.% canola oil, approximately 42 wt.% rich in oleic acid sunflower oil, about 2 wt.% fish oil and about 17 wt.% MCT oil.
12. Fatty composition, suitable for the feeding tube that contains
- from 12.5 d� of 14.5 wt.% linoleic acid (LA);
- from 4.0 to 5.0 wt.% a mixture consisting of ω-3 polyunsaturated fatty acids, alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), where the number of ALA>2.7 wt.% or varies in the range between 2.5 and 4.0 wt.%, and a mixed amount of DHA and EPA≤1.0 wt.%;
- from 14 to 18 wt.% at least one medium chain fatty acid (MCFA); and
- from 40 to 70 wt.% one monounsaturated fatty acid (MUFA).
13. Fatty composition according to claim 12, in which monounsaturated fatty acid includes oleic acid (18:1).
14. Fatty composition according to claim 12, in which the ratio of ω-6:ω-3 is approximately 3:1.
15. Fatty composition according to claim 12, made of mixed in suitable quantities canola oil, rich in oleic acid sunflower oil, fish oil and MCT oil.
16. Fatty composition according to claim 15, made by mixing approximately 37 wt.% canola oil, approximately 42 wt.% rich in oleic acid sunflower oil, about 2 wt.% fish oil and about 17 wt.% MCT oil.
17. Fatty composition, suitable for the feeding tube that contains
- from 13.5 to 13.9 wt.% linoleic acid (LA);
- from 4.3 to 4.7 wt.% a mixture consisting of ω-3 polyunsaturated fatty acids, alpha-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapen�type acid (EPA), where the number of ALA>2.7 wt.% or varies in the range between 2.5 and 4.0 wt.%, and a mixed amount of DHA and EPA≤1.0 wt.%;
- from 15.7 to 16.2 wt.% at least one medium chain fatty acid (MCFA); and
from 50 to 60 wt.% one monounsaturated fatty acid (MUFA).
18. Fatty composition according to claim 17, in which monounsaturated fatty acid includes oleic acid (18:1).
19. Fatty composition according to claim 17, in which the ratio of ω-6:ω-3 is approximately 3:1.
20. Fatty composition according to claim 17, made of mixed in suitable quantities canola oil, rich in oleic acid sunflower oil, fish oil and MCT oil.
21. Fatty composition according to claim 20, made by mixing approximately 37 wt.% canola oil, approximately 42 wt.% rich in oleic acid sunflower oil, about 2 wt.% fish oil and about 17 wt.% MCT oil.
22. Liquid nutrient composition for the feeding tube containing fat composition according to any preceding item.
23. Liquid nutritional composition according to claim 22, in which a specified fatty composition comprises between 30 and 50 En%, preferably between 30 and 40 En% of the total amount of energy of the liquid nutritional composition.
24. Liquid nutritional composition according to claim 22 or 23, having an energy content of at least 0.4 kcal/ml, pre�respectfully at least 0.7 kcal/ml, more preferably at least 0.9 kcal/ml of the composition.
25. The use of liquid nutritional composition according to any one of claims. 22-24 for feeding through a tube, in particular for long-term feeding through a tube.
26. The use of a fat composition according to any one of claims. 1-21 for the manufacture of a liquid nutritional composition suitable for enteral feeding.
27. Method of providing enteral nutrition to a person when necessary in itself, comprising administering to a specified person using the probe of an effective amount of a liquid nutritional composition containing fat composition according to any one of claims. 1-21.
SUBSTANCE: invention can be used for the local treatment of trophic ulcers, infected and persistent septic wounds, degrees I-II-IIIA burns, traumatic skin injuries, pyoinflammatory skin diseases, bed sores, etc. The invention refers to a preparation, which contains a streptocide powder 1-2.5 g, Ichthyol ointment 7-10 g and castol oil 87.5-92 ml.
EFFECT: reducing the length of treatment up to 14 days with no side effects.
SUBSTANCE: method includes milling glauconite with the content of rock from 20 to 95%, selection of a fraction of 1.0-10 mcm, preparation of a 40-80% suspension of glauconite in water. The obtained suspension is processed by ultrasound with a frequency of 15-25 kHz for 2-5 minutes. As a result obtained is a glauconite-based enterosorbent, which represents a 40-80% suspension of the glauconite 1.0-10 mcm fraction in water.
EFFECT: obtaining the glauconite-based enetrosorbent, which has the increased sorption ability in the form of a stable water suspension of glauconite.
2 cl, 2 tbl, 2 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to the pharmaceutical industry and represents a therapeutic agent used for treating or preventing palmar-plantar erythrodysesthesia syndrome (PPES) induced by a multifunction kinase inhibitor (MKI) therapy and containing a therapeutically effective amount of allopurinol or its pharmaceutically acceptable salt.
EFFECT: invention provides extending the range of products for treating or preventing palmar-plantar erythrodysesthesia syndrome (PPES) induced by the multifunction kinase inhibitor (MKI) therapy.
21 cl, 5 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to pharmaceutics and represents a vaccine composition for inducing an immune response in animals. The composition contains an antigen and a 40% oil-in-water emulsion diluted to 2.5%, wherein the above 40% oil-in-water emulsion contains 30 vl/vl % of light hydrocarbon non-metabolic oil, 10 vl/vl % of lecithin, 0.6 vl/vl % of sorbitan monooleate, 1.4 vl/vl % of polyoxyethylene sorbitan monooleate; the oil component is dispersed in an aqueous component by emulsification, while the vaccine composition is prepared by a microfluidiser. An average drop size in the composition makes less than 0.3 mcm.
EFFECT: composition possesses improved physical characteristics, enhanced immunising action, as well as high safety.
10 cl, 20 ex, 17 tbl, 11 dwg
SUBSTANCE: as an active substance, the composition contains butoconazol, a base that is a combination of a hydrophobic ingredient, a hydrophilic ingredient and an emulsifier, and also a gel-forming polymer. Hydroxypropylstarch phosphate is preferentially used as the gel-forming polymer. A method for preparing the declared composition consists in the fact that a mixture of butoconazol with a portion of the hydrophilic ingredient, the hydrophobic ingredient and emulsifier is added with a dispersion of the gel-forming polymer in the rest of the hydrophilic ingredient; the produced mixture is agitated homogenously with a preserving agent added where it might be necessary.
EFFECT: new pharmaceutical composition is characterised by a high level of antifungal activity, stability both at a storage temperature, and at a use temperature, and good pack extrusion.
14 cl, 2 tbl, 10 ex
SUBSTANCE: claimed is application of fat emulsion for parenteral feeding as solvent for compounds which are poorly soluble in water. Fat emulsion contains in 1 l of solution: 30 g of refined soybean oil, 30 g of triglycerides with the average chain length, 25 g of olive refined oil, 15 g of purified fish oil.
EFFECT: obtaining solvent for compounds, poorly soluble in water, which makes it possible to determine parameters and spectrum of biological activity of novel compounds of chemical nature at the stages of pre-clinical and clinical tests, which does not change basic biological constants and possesses biological inertness.
2 tbl, 2 ex
SUBSTANCE: invention represents a producing method of cream containing fusidic acid, which involves a stage of application of sodium fusidate as an initial active ingredient and conversion of the above sodium fusidate in situ to fusidic acid in an oxygen-free medium by immediate addition of the acid to a cream base containing a preservative, an acid, a cosolvent, an emulsifier, a wax-like product and water.
EFFECT: obtaining cream having high stability at storage and smaller particles of an active ingredient.
9 cl, 11 tbl
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention relates to pharmaceutical industry and represents dermatological cream, intended for local treatment of bacterial skin infections and for healing wounds associated with them, which contains framycetin sulfate and biopolymer, included into cream base, which contains at least one substance from each of the following groups: preservative, primary and secondary emulsifier, selected from the group which contains ketostearyl alcohol, ketomacrogol 1000, polysorbate-80 and Span-80; paraffin as wax-like product, cosolvent, selected from the group, including propylene glycol, hexylene glycol and polyethylene glycol-400; nitric acid or lactic acid and water, with said biopolymer preferably being chitosan.
EFFECT: invention provides higher therapeutic effect.
8 cl, 10 tbl, 2 dwg
FIELD: medicine, pharmaceutics.
SUBSTANCE: present invention refers to pharmaceutics and represents a pharmaceutical composition for parenteral administration containing sub-micron particles of dosocahexaenoic acid ester dispersed in a water phase with the use of mixture of at least two surfactants specified in a) at least one fatty acid polyoxyethylene ester and b) at least one phospholipide derivative, as well as a method for preparing the above pharmaceutical composition.
EFFECT: invention provides higher pharmacological activity.
14 cl, 3 dwg, 3 tbl, 2 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention relates to the pharmaceutical and cosmetic industry, in particular to nanoemulsions of a water-in-oil type for transdermal application with biologically active compounds.A nanoemulsion of the water-in-oil type contains 35-80% of a hydrophobic phase, 1-15% of a hydrophilic phase, and a surface-active substance.
EFFECT: nanoemulsion of the water-in-oil type for transdermal application with biologically active compounds possesses good storage stability.
8 cl, 1 dwg, 1 tbl
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to pharmaceutics, namely represents pharmaceutical formulations containing 9-cis-retinyl esters in a lipid excipient. The pharmaceutical formulations containing 9-cis-retinyl esters are described to be applicable in a retinoid replacement therapy for treating retinal degenerations in individuals.
EFFECT: using the formulations for the retinoid replacement therapy for treating retinal degenerations in individuals.
73 cl, 14 dwg, 2 tbl, 6 ex
SUBSTANCE: composition includes glutaryl histamine in an amount of 18.0-75.0 wt % as an active substance, and as auxiliary substances: microcrystalline cellulose in an amount of 18.0-71.0 wt %, sodium croscarmellose in an amount of 0.25-1.0 wt %, colloidal silicon dioxide in an amount of 0.5-2.0 wt %, calcium stearate in an amount of 0.5-2.0 wt % and lactose monohydrate. The invention also relates to a method of obtaining the said composition.
EFFECT: invention is characterised by the high bioavailability of the active component and high pharmacological activity.
4 cl, 6 tbl, 3 ex
SUBSTANCE: method for preparing a gel for wound and burn healing involving diluting chitosan in an organic acid, combining it with a biologically active substance and water; chitosan is diluted in citric or lactic acid; mussel hydrolysate is used as the biologically active substance; the hydrolysate is added to the chitosan solution before PEG 600 and calcium alhylose are added in the certain environment.
EFFECT: method enables preparing the new effective wound-healing agent.
2 dwg, 1 tbl, 2 ex
SUBSTANCE: invention refers to medicine. There are described implanted devices with various versions of biologically active ingredient loading with the version selectable and applicable for creating a prolonged-release profile or a release profile having a low initial ejection of the biologically active ingredient from the implanted device.
EFFECT: there are described the implanted devices with various versions of biologically active ingredient loading.
11 cl, 2 dwg
SUBSTANCE: what is described is a mesh bioactive wound coating with its base containing disintegrated bacterial cellulose comprising antimicrobial and antioxidant ingredients: silver-modified montmorillonite and fellerenol aiming at optimising the course of the wound process, preventing the development and suppression of a wound infection. The mesh bioactive wound coating is used for treating gunshot wounds, severe mechanical injuries, uninfected and infected wounds, including septic and persistent wounds, granulating wounds following deep thermal, chemical and radiation burns, for conducting the integrated treatment of trophic ulcers and bedsores in hospital, out-patient and field settings.
EFFECT: mesh bioactive wound coating is non-toxic; it causes no local irritant and skin re-absorption action, possesses elasticity, a high degree of wound modelling; it is not fragmented that facilitates a wound care.
5 dwg, 2 tbl, 3 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention relates to compositions for local application for the prevention and treatment of local eye pathologies, in particular inflammatory keratites and conjunctivitis and the dry eye syndrome, which contain as active ingredients polyunsaturated fatty acids of the omega-3 and omega-6 type, namely, EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid) and GLA (γ-linolenic acid), mixed with vitamin E acetate and combined into a stable composition in a hydrogel, that is in the disperse form in a water solution, containing one or more gel-forming polymers. The claimed compositions are especially recommended for application as artificial tears.
EFFECT: invention provides an increased efficiency of the prevention and treatment of eye pathologies.
15 cl, 15 tbl, 3 dwg, 7 ex
SUBSTANCE: what is described is a medical semisynthetic biological adhesive based on biopolymer nanocomposites as a semisynthetic polymer matrix containing a substrate presented by low-molecular polyisobutylene, collapan as an excipient, human immunoglobulin, castor aerosol lubricant as a binding agent; faster setting of the microporous sandwich adhesive is ensured by performing an operation by means of a repetitively pulsed laser (CO2 laser) scalpel in a combination with a semiconductor laser. A polyacrylamide hydrogel placed into a polymer bath is used as a setting agent of an upper layer that is a polymer plaster tape.
EFFECT: medical semisynthetic biological adhesive has high adhesion characteristics.
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to a pharmaceutical composition for treating bladder cancer. The above composition contains an effective amount of valrubicin and dimethyl sulphoxide, as well as polyethoxylated castor oil or one or more substances specified in trimethyl chitosan, mono-N-carboxymethyl chitosan, N-diethylmethyl chitosan, sodium caprylate, cytochalasin B, IL-1, polycarbophil, Carbopol 934P, N-sulphate-N,O-carboxymethyl chitosan, Zonula occludens toxin, 1-palmitoyl-2-glutaroyl-sn-glycero-3-phosphocholine, and represents a dosage form for intra-bladder administration by instillation. The invention also refers to liposomal pharmaceutical compositions containing valrubicin, and methods of treating bladder cancer involving administering the above compositions.
EFFECT: invention reduces bladder irritation and increases the clinical effectiveness in bladder cancer.
12 cl, 3 dwg, 3 tbl, 1 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: present invention refers to a pharmaceutical composition for preventing and treating a skin inflammation and photopathy containing a water-soluble herbal extract of Solarium.
EFFECT: composition possesses the photoprotective action and can be used as a cosmetic composition.
6 cl, 2 tbl
SUBSTANCE: what is described is a gel containing structured nanovesicles - niosomes prepared from silicone compounds with enclosed albendazole, anthelmintic preparation.
EFFECT: invention enables extending the range of application of the anthelmintic preparations by reducing dyspeptic reactions that makes them applicable in both adults, and children suffering gastrointestinal diseases.
FIELD: food industry.
SUBSTANCE: method envisages disperse protein system production of soya seeds, protein substances coagulation in such system with organic acid solution and coagulate separation from whey. The disperse protein system is prepared by way of combined disintegration of soya seeds and red pepper of weak or medium pungency in water medium at a ratio of 1:1:7. Coagulation is performed with 5% water solution of ascorbic acid. The coagulate separated from whey is moulded and conditioned till moisture content is equal to 10-55%; whey is mixed with tomato paste at a weight ratio of 2:1 to produce adjika sauce.
EFFECT: method allows to manufacture increased biological value food products with high organoleptic indices.
1 dwg, 1 ex