JP5315996B2 - Total enteral nutrition composition - Google Patents
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Abstract
Description
本発明は新規な栄養組成物、より詳しくは、高齢者、入院患者などの栄養補給を必要とし、消化管に器質的変化や障害がなく、たんぱく質の形態の窒素源を栄養素として利用しうるヒトに対する総合経腸栄養組成物に関する。すなわち消化管に炎症、壊死、切除、運動麻痺、イレウス等の症状がなく、加齢や低栄養状態に陥ったこと等により消化吸収が減弱した状態の時に、たんぱく質、脂肪、ビタミン、ミネラル等を効率よく吸収、補給させ、栄養状態を回復しうる総合経腸栄養組成物に関する。 The present invention is a novel nutritional composition, more specifically, a human who needs nutritional supplementation for the elderly, hospitalized patients, etc., has no organic changes or disorders in the digestive tract, and can use a nitrogen source in the form of protein as a nutrient. The present invention relates to a general enteral nutrition composition for That is, when there are no symptoms such as inflammation, necrosis, excision, motor paralysis, ileus in the digestive tract, and digestion absorption is attenuated due to aging or undernutrition, etc., protein, fat, vitamins, minerals, etc. The present invention relates to a comprehensive enteral nutrition composition that can be efficiently absorbed and replenished to restore nutritional status.
近年、高齢入院患者、高齢の在宅療養者で栄養状態の悪化が懸念されている。低栄養のなかでも特にたんぱく質、エネルギーの欠乏が複合して生じる栄養失調は、たんぱく質・エネルギー低栄養（Protein Energy Malnutrition；PEM）と呼ばれ、この状態に対しては効率のよい栄養補給の方法の重要性が認識されている。平成７〜１０年の「高齢者の栄養管理サービスに関する研究」(主任研究者：松田朗ほか99年厚生省報告)では、栄養指標である血清アルブミン値が３.５ｇ／dL以下のＰＥＭリスク者は、高齢入院患者の約４割、在宅訪問患者の約３割で観察された。食事摂取量の低下などから適切なたんぱく質やエネルギーの供給不足が、重篤な低栄養状態を招き、この結果、免疫低下による感染症、筋力の低下、寝たきりの状態がおこり、最終的に在院日数の延長、医療費の増大の原因につながっている。寝たきりの場合には褥瘡を発症することが多いが、褥瘡発生に関する因子として、エネルギー摂取不足、たんぱく量摂取不足、体内におけるたんぱく合成の障害、脂肪摂取不良、亜鉛など微量元素の欠乏などが原因としてあげられている。また、高齢者の褥瘡発生に関与する特徴的な因子として、血管障害など複数の合併症、食欲不振、低栄養からの免疫能低下があるといわれている(臨床栄養103巻、4号、424〜431頁、2003年)。 In recent years, there is concern about deterioration of nutritional status among elderly inpatients and elderly home caregivers. Among malnutrition, malnutrition caused by a combination of protein and energy deficiency is called protein energy malnutrition (PEM). The importance is recognized. According to the “Research on Nutritional Management Services for the Elderly” between 1995 and 1995 (Principal Investigator: Akira Matsuda et al., 1999 Ministry of Health and Welfare report), those with PEM risk who have serum albumin levels of 3.5 g / dL or less It was observed in about 40% of elderly inpatients and about 30% of home visiting patients. Insufficient protein and energy supply due to a decrease in food intake leads to severe malnutrition, resulting in infections due to decreased immunity, muscle weakness, and bedridden conditions. This has led to an increase in the number of days and medical expenses. Bedriddens often develop pressure ulcers, but factors related to the development of pressure ulcers include insufficient energy intake, insufficient protein intake, impaired protein synthesis in the body, poor fat intake, and lack of trace elements such as zinc. It is given. In addition, it is said that there are multiple complications such as vascular disorders, loss of appetite, and reduced immune capacity from undernutrition as characteristic factors involved in the development of pressure ulcers in the elderly (Clinical Nutrition 103, 4, 424) ~ 431 pages, 2003).
栄養補給を必要とする対象者のための、たんぱく質、脂質、糖質、ビタミン、ミネラルを総合的に含む経腸栄養組成物が知られている(特許文献１)。これは、これのみで栄養管理を可能とする栄養組成物であって、その配合組成中のたんぱく質原料に乳たんぱく質および大豆たんぱく質を特定の割合で含むことと、脂質中のω３系脂肪酸とω６系脂肪酸を特定の比率で含むことを特徴としている。また、たんぱく質、脂質、糖質、乳化剤および水からなり、浸透圧およびアミノ酸スコアを特定した総合経腸栄養剤が知られている(特許文献２)。 An enteral nutrition composition that comprehensively contains proteins, lipids, carbohydrates, vitamins, and minerals for subjects who need nutritional supplementation is known (Patent Document 1). This is a nutritional composition that enables nutritional management by itself, and includes a specific proportion of milk protein and soy protein in the protein raw material in the composition, and ω3 fatty acids and ω6 in lipids. It is characterized by containing fatty acids in a specific ratio. Further, a general enteral nutritional agent comprising a protein, a lipid, a sugar, an emulsifier and water and specifying an osmotic pressure and an amino acid score is known (Patent Document 2).
特に高齢者や高度な低栄養のヒトでは胃の容量も大きくなく、摂取できる食物量が限られる。したがって、摂取量当たりのカロリーが高く、しかも各栄養成分をバランスよく含み、かつビタミン、ミネラルなどの成分が高濃度に入っている経腸栄養組成物は重要である。このため、経腸栄養組成物１００mLで１００kcal摂取できるものが市販されており、その需要は今後も増大すると予測される。 In particular, elderly people and highly malnourished humans have a small stomach capacity, and the amount of food they can consume is limited. Therefore, an enteral nutrition composition having a high calorie per intake, containing each nutritional component in a well-balanced manner, and containing a high concentration of components such as vitamins and minerals is important. For this reason, what can be ingested 100 kcal with 100 mL of enteral nutrition composition is marketed, and the demand is expected to increase in the future.
しかし現状においては、栄養指標である血清アルブミン値を改善し、血中の銅、亜鉛、ナトリウム等の濃度を適性に保ち、かつ褥瘡の改善において効果のある経腸栄養剤は未だ知られていない。また、精製された純度の高いたんぱく質、脂質を多く配合し、それらの生体内でのエネルギー産生を円滑にするためのビタミン類を適正に含ませるという総合的な観点で、必要成分を適切に配合した総合経腸栄養組成物はこれまで供給されていない。特に、たんぱく質を多く含む栄養組成物に対してナトリウム含量を増やすことは、これまでたんぱく質沈殿(塩析)が生じることから限界があった。しかし、高齢者の場合には低ナトリウム血症を起こす場合があるので、高エネルギー総合経腸栄養組成物において、たんぱく質含量と同時にナトリウム含量を高めることは極めて重要である。 However, at present, enteral nutrients that improve serum albumin levels, which are nutritional indicators, maintain appropriate concentrations of copper, zinc, sodium, etc. in the blood and are effective in improving pressure ulcers are not yet known. . In addition, a lot of purified high-purity proteins and lipids are blended, and the necessary ingredients are blended appropriately from the comprehensive viewpoint of properly containing vitamins to facilitate energy production in vivo. No comprehensive enteral nutritional composition has been provided. In particular, there has been a limit to increasing the sodium content of a nutritional composition containing a large amount of protein because protein precipitation (salting out) has occurred so far. However, since hyponatremia may occur in the elderly, it is extremely important to increase the sodium content simultaneously with the protein content in the high energy total enteral nutrition composition.
一方、経腸栄養法で栄養管理をする場合には、消化吸収低下により十分な経腸栄養が実施できず、患者の栄養状態の低下が深刻な問題となっている。 On the other hand, when nutritional management is performed using the enteral nutrition method, sufficient enteral nutrition cannot be performed due to a decrease in digestion and absorption, and the patient's nutritional state is a serious problem.
グルタミン酸は以前からうま味成分として食物に調味料として使用されている。最近の研究により、グルタミン酸は食物の胃からの排出を促進し、消化管に好影響を与えることが明らかとなってきた（非特許文献１）。グルタミン酸や５’−ヌクレオチドが、大きな手術後のような消化管に器質的な障害がある場合において、下痢を軽減する効果のあることが報告されている（特許文献３）。また、グルタミン酸や５’−ヌクレオチドは、器質的障害が見られない患者の腹部痛、胃もたれ、胸やけ等の機能性胃腸症、胃食道逆流の上部消化管の機能性胃腸症、胃食道逆流症に有効であることが開示されている（特許文献４）。 Glutamic acid has long been used as a seasoning in foods as an umami component. Recent studies have revealed that glutamic acid promotes excretion of food from the stomach and has a positive effect on the gastrointestinal tract (Non-patent Document 1). It has been reported that glutamic acid and 5'-nucleotide have an effect of reducing diarrhea when there is an organic disorder in the digestive tract such as after a large operation (Patent Document 3). In addition, glutamic acid and 5′-nucleotide are functional gastroenteropathy such as abdominal pain, stomach sag, heartburn, etc. in patients with no organic disorder, functional gastroenteropathy of the upper gastrointestinal tract of gastroesophageal reflux, gastroesophageal reflux It is disclosed that it is effective for symptom (patent document 4).
一方、消化吸収の低下のうちでも単なる加齢や低栄養状態に陥ったこと等により、消化吸収が減弱した状態が存在する。このときの栄養補給の窒素源としては、消化吸収に優れる動物や植物由来のたんぱく質が使用される。しかしながらこのときに栄養状態を回復できる有効な栄養組成物はいまだ発見されていない。
本発明の課題は、高齢者、入院患者のように、食事によって十分な栄養摂取ができないヒトに対して、それのみで必要とされる栄養を全て供給できる改善された総合経腸栄養組成物を供給することである。詳しくは、栄養指標である血清アルブミン値の改善および褥瘡の改善、さらには血中ミネラルバランスの改善に効果があり、かつ低栄養状態の回復に顕著な効果を奏する、たんぱく質、脂肪、糖質、ビタミン、ミネラル、特に亜鉛および銅を適正に配合し、この上グルタミン酸や５’−ヌクレオチドを配合することで腸管の状態を高め吸収能力を高めた総合経腸栄養組成物を提供することである。さらには、窒素供給源として用いるたんぱく質の配含量を最大限に高めても、たんぱく質が沈殿を起こさないようにナトリウムを配合し、ビタミンＢ１、ビタミンＢ２を高含量とした、効率よい栄養状態の回復、低栄養状態の予防、褥瘡の改善および予防効果のある新規な総合経腸栄養組成物を提供することである。 An object of the present invention is to provide an improved total enteral nutrition composition that can supply all the nutrients that are needed alone to elderly people, inpatients, and the like who cannot take sufficient nutrition by meals. Is to supply. Specifically, proteins, fats, carbohydrates, which are effective in improving serum albumin levels and pressure ulcers, which are nutritional indicators, and in improving blood mineral balance and remarkably improving the recovery of undernutrition. It is to provide a comprehensive enteral nutritional composition that is appropriately formulated with vitamins and minerals, particularly zinc and copper, and further contains glutamic acid and 5′-nucleotides to improve the state of the intestinal tract and enhance the absorption capacity. Furthermore, even if the protein content used as a nitrogen supply source is maximized, sodium is added so that the protein does not precipitate, and vitamin B1 and vitamin B2 are high in content, thereby efficiently restoring the nutritional state. It is to provide a novel integrated enteral nutrition composition having prevention of malnutrition, improvement of pressure ulcer, and prevention.
本発明の総合経腸栄養組成物は、消化管の器質的障害を有しないヒトに使用するものであって、たんぱく質、糖質、脂肪、ミネラル、ビタミンを含み、以下の特徴を総合的に組み合わせることによって所期の目的を達成するものである。
（１）組成物１００kcalあたり、ナトリウムを１６５mg以上含有し、グルタミン酸、グルタミン酸を含むジペプチド若しくはトリペプチド、５’−ヌクレオチド又はそれらの塩から選ばれる少なくとも一種を含む。ナトリウムの欠乏を防止するためには、高濃度のナトリウムを含有させる必要がある。高濃度のナトリウムは、たんぱく質を高濃度とした場合、塩析によるたんぱく質の沈殿を起こすが、この問題は、主たるナトリウム源として燐酸ナトリウムおよびクエン酸ナトリウム等を用いることによって防止できる。グルタミン酸、グルタミン酸を含むジペプチド若しくはトリペプチド、５’−ヌクレオチド又はそれらの塩を配合することによって、消化管の上皮組織の状態を高め、吸収低下による低栄養を防止できるという知見を応用したものである。組成物中のグルタミン酸等の含有量は０.０５〜２.０質量％とすることが望ましい。
（２）窒素供給源としてはアミノ酸配合物ではなく、たんぱく質を用い、該たんぱく質は乳たんぱく質または植物性たんぱく質の少なくとも一種以上を含有する。好ましくは、組成物１００kcalあたり、たんぱく質を４.０ｇ以上、より好ましくは５.０ｇ以上含有する。
（３）組成物１００kcalあたり、銅含量を０.１５mg以下とし、亜鉛と銅の質量比を１０〜２５、好ましくは１０〜２０、さら好ましくは１３〜２０、特に好ましくは１５〜１８とする。この場合、亜鉛含量を１.５mg以上とし、銅含量を０.０７５〜０.１５mgとすることがなお好ましい。これは、銅の含有量が高いと亜鉛の吸収が阻害されるという知見に基づいて導かれる特徴点である。
（４）組成物１００kcalあたり、ビタミンＢ１を少なくとも０.３０mgおよびビタミンＢ２を少なくとも０.２５mg含む。これは、糖質からのエネルギー産生に必要なビタミンＢ１、脂質からのエネルギー産生に必要なビタミンＢ２を高濃度に入れることによって、エネルギー産生を効率よく出来ることを応用したものである。The general enteral nutrition composition of the present invention is used for humans who do not have an organic disorder of the gastrointestinal tract, and includes proteins, sugars, fats, minerals, vitamins, and the following features are combined in a comprehensive manner. To achieve the intended purpose.
(1) The composition contains at least 165 mg of sodium per 100 kcal and contains at least one selected from glutamic acid, dipeptides or glutamic acids containing glutamic acid, 5′-nucleotides or salts thereof. In order to prevent sodium deficiency, it is necessary to contain a high concentration of sodium. A high concentration of sodium causes protein precipitation due to salting out when the protein concentration is high, but this problem can be prevented by using sodium phosphate, sodium citrate, or the like as the main sodium source. Glutamic acid, dipeptide or tripeptide containing glutamic acid, 5'-nucleotide or their salts are applied to improve the state of the epithelial tissue of the digestive tract and prevent undernutrition due to reduced absorption. . The content of glutamic acid or the like in the composition is preferably 0.05 to 2.0 mass%.
(2) As a nitrogen source, a protein is used instead of an amino acid compound, and the protein contains at least one kind of milk protein or vegetable protein. Preferably, it contains 4.0 g or more, more preferably 5.0 g or more of protein per 100 kcal of the composition.
(3) The copper content is 0.15 mg or less per 100 kcal of the composition, and the mass ratio of zinc to copper is 10 to 25, preferably 10 to 20, more preferably 13 to 20, and particularly preferably 15 to 18. In this case, it is more preferable that the zinc content is 1.5 mg or more and the copper content is 0.075 to 0.15 mg. This is a characteristic point derived based on the knowledge that zinc absorption is inhibited when the copper content is high.
(4) The composition contains at least 0.30 mg of vitamin B1 and at least 0.25 mg of vitamin B2 per 100 kcal of the composition. This is an application of the fact that vitamin B1 necessary for energy production from carbohydrates and vitamin B2 necessary for energy production from lipids can be put in high concentrations to efficiently produce energy.
さらに詳しく説明すれば、組成物１００kca1あたり、亜鉛を１.５〜３.０mg、銅を０.０７５〜０.１５mg、ナトリウムを１６５〜３８５mg含有することが望ましい。さらに好ましくは、組成物１００kcalあたり、亜鉛を１.８〜３.０mg、銅を０.０９〜０.１２mg、ナトリウムを１８５〜３８５mg含有する。また、糖質、脂肪の体内での燃焼を助長するために、これまで既知のビタミンの使用量よりも高めて、組成物１００kcalあたり、ビタミンＢ１を０.４〜２mg、ビタミンＢ２を０.２５〜２.０mg含有することが望ましい。その他のビタミンとして、ビタミンＢ６を少なくとも０.３mg、好ましくは０.５〜２.０mg、ビオチンを少なくとも１.０μg、好ましくは１.０〜１０μg配合することが望ましい。さらに１００kca1あたりビタミンＢ１２を０.２０〜０.７０μg、葉酸を２０〜８０μg、β−カロチンを１００〜４５０μg、ビタミンＣを１０〜７０mg添加することがより良い効果を与える。 More specifically, it is desirable to contain 1.5 to 3.0 mg of zinc, 0.075 to 0.15 mg of copper, and 165 to 385 mg of sodium per 100 kca1 of the composition. More preferably, the composition contains 1.8 to 3.0 mg of zinc, 0.09 to 0.12 mg of copper, and 185 to 385 mg of sodium per 100 kcal of the composition. In addition, in order to promote the burning of carbohydrates and fats in the body, vitamin B1 is 0.4-2 mg and vitamin B2 is 0.25 per 100 kcal of the composition by increasing the amount of vitamins known so far. It is desirable to contain ~ 2.0 mg. As other vitamins, it is desirable to add vitamin B6 at least 0.3 mg, preferably 0.5 to 2.0 mg, and biotin at least 1.0 μg, preferably 1.0 to 10 μg. Further, it is better to add 0.20 to 0.70 μg of vitamin B12, 20 to 80 μg of folic acid, 100 to 450 μg of β-carotene, and 10 to 70 mg of vitamin C per 100 kca1.
本発明の総合経腸栄養組成物のエネルギー源は、たんぱく質、糖質、脂肪である。たんぱく質、糖質、脂肪によって供給されるエネルギーの比率は、たんぱく質から１０〜４０％、糖質から４０〜８０％、脂肪から１０〜４０％の範囲で調節するのが好ましい。たんぱく質は、組成物１００kcalあたり、好ましくは４.０ｇ以上、より好ましくは５.０ｇ以上含有させる。たんぱく源としては、酸カゼイン、カゼインナトリウム、カゼインカルシウム、乳清ホエーたんぱく質、魚肉たんぱく質、卵たんぱく質などやこれらの加水分解物を例とする動物性たんぱく質、および大豆たんぱく質、小麦たんぱく質、とうもろこしたんぱく質などやこれらの加水分解物を例とする植物性たんぱく質の如何なるものも利用できる。動物性たんぱく質と植物性たんぱく質を混合使用し、その比率を４：１〜１：４とすることが望ましい。たんぱく質としてグルタミンペプチドと、大豆たんぱく質あるいはその加水分解物を含むことが望ましい。さらに、組成物１００kcalあたり、たんぱく質中の総グルタミンが少なくとも０.６ｇであることが望ましい。特に好ましくは、グルタミンあるいはグルタミンペプチドと、大豆たんぱく質あるいはこの加水分解物の比率が４：１〜１：４である。 The energy source of the total enteral nutrition composition of the present invention is protein, sugar and fat. The ratio of energy supplied by proteins, carbohydrates, and fats is preferably adjusted in the range of 10 to 40% from proteins, 40 to 80% from carbohydrates, and 10 to 40% from fats. The protein is preferably contained in an amount of 4.0 g or more, more preferably 5.0 g or more, per 100 kcal of the composition. Protein sources include acid casein, sodium caseinate, calcium caseinate, whey whey protein, fish protein, egg protein, and animal proteins such as these hydrolysates, soy protein, wheat protein, corn protein, etc. Any of the plant proteins exemplified by these hydrolysates can be used. It is desirable to use a mixture of animal protein and vegetable protein, and the ratio is 4: 1 to 1: 4. It is desirable to include glutamine peptide and soy protein or a hydrolyzate thereof as proteins. Furthermore, it is desirable that the total glutamine in the protein is at least 0.6 g per 100 kcal of the composition. Particularly preferably, the ratio of glutamine or glutamine peptide to soy protein or a hydrolyzate thereof is 4: 1 to 1: 4.
脂肪源としては、動物性および植物性の吸収可能な脂肪が使用できる。中鎖脂肪酸油を少なくとも脂肪中３５質量％含み、かつ脂肪中のω３系脂肪酸：ω６系脂肪酸の質量比が１：１０〜１：１であるものが好ましい。さらに、中鎖脂肪酸トリグリセリドが脂肪中４０〜６５質量％でかつ脂肪中のω３系脂肪酸：ω６系脂肪酸の質量比が１：４〜１：１であることが望ましい。中鎖脂肪酸は炭素数６〜１２の脂肪酸であり、消化吸収が早いので高齢者、入院患者の治療食として適している。 Animal and vegetable absorbable fats can be used as the fat source. A medium chain fatty acid oil containing at least 35% by mass of fat and having a mass ratio of ω3 fatty acid: ω6 fatty acid in the fat of 1:10 to 1: 1 is preferable. Furthermore, it is desirable that the medium-chain fatty acid triglyceride is 40 to 65% by mass in the fat and the mass ratio of ω3 fatty acid to ω6 fatty acid in the fat is 1: 4 to 1: 1. Medium chain fatty acids are fatty acids having 6 to 12 carbon atoms, and are suitable as a therapeutic food for elderly and hospitalized patients because of their rapid digestion and absorption.
糖質源としては、デキストリン、オリゴ糖、蔗糖、グルコース、果糖などを単独で若しくは組み合わせて用いる。 As the carbohydrate source, dextrin, oligosaccharide, sucrose, glucose, fructose and the like are used alone or in combination.
上記の成分のほかに、栄養価をさらに高めるためにたんぱく質に、必須アミノ酸であるロイシン、イソロイシン、バリン、スレオニン、リジン、メチオニン、フェニルアラニン、トリプトファンを必要に応じて添加する。また、ミネラルとしては、先に特記したナトリウム、亜鉛、銅のほかに、カルシウム、鉄、リン、マグネシウム、カリウム、ヨウ素、マンガン、セレン、クロム、モリブデンなどを必要に応じて添加する。 In addition to the above components, the essential amino acids leucine, isoleucine, valine, threonine, lysine, methionine, phenylalanine, and tryptophan are added to the protein as necessary in order to further increase the nutritional value. As minerals, calcium, iron, phosphorus, magnesium, potassium, iodine, manganese, selenium, chromium, molybdenum, and the like are added as necessary in addition to the sodium, zinc, and copper specified above.
本発明の総合経腸栄養組成物は、たんぱく質・エネルギー低栄養(PEM)のヒトの治療あるいは予防、褥瘡の予防・改善、血中のアルブミン値の改善、アルブミン−グロブリン比の改善、低下したナトリウム含量の改善、ヘモグロビン値の改善、ヘマトクリット値の改善、血中および生体内ミネラルバランスの改善、亜鉛含量の増加、末梢リンパ球数の増加、消化管上皮組織の機能上昇などの顕著な効果を奏する。 The general enteral nutrition composition of the present invention is the treatment or prevention of protein / energy undernutrition (PEM) human, prevention / improvement of pressure ulcer, improvement of albumin level in blood, improvement of albumin-globulin ratio, reduced sodium Significant effects such as improved content, improved hemoglobin level, improved hematocrit level, improved blood and in vivo mineral balance, increased zinc content, increased peripheral lymphocyte count, and increased function of gastrointestinal epithelial tissue .
本発明の総合経腸栄養組成物では、精製された動物性たんぱく質、植物性たんぱく質あるいはこれらの組み合わせをたんぱく源として用いる。特に脳血管障害のあるヒトまたは高脂血症のヒトには、栄養素バランスの１つとして動物性たんぱく質と植物性たんぱく質の比率を適当な範囲として摂取することが動脈硬化防止や血中脂肪低下のために重要である。本発明の総合経腸栄養組成物では、動物性たんぱく質と植物性たんぱく質の比率を１：４〜４：１とすることが推奨される。さらに、免疫栄養素材として注目されるグルタミンを豊富に含むとヒトの全身や腸管免疫状態がよいことも確認され、必要な状況のヒトにはグルタミンあるいは小麦グルテン加水分解物由来のグルタミンペプチド、さらにはアラニルグルタミンやグリシルグルタミン等の精製されたグルタミンの配合が推奨される。本発明組成物中の総グルタミン量は、１００kcalあたり０.６ｇ以上が望ましい。 In the total enteral nutrition composition of the present invention, purified animal protein, plant protein, or a combination thereof is used as a protein source. In particular, for people with cerebrovascular disorders or hyperlipidemic patients, taking an appropriate ratio of animal protein to plant protein as one of the nutrient balances can prevent arteriosclerosis and reduce blood fat. Is important for. In the total enteral nutrition composition of the present invention, it is recommended that the ratio of animal protein to vegetable protein is 1: 4 to 4: 1. Furthermore, it has also been confirmed that the presence of abundant glutamine, which is attracting attention as an immunonutrition material, has good human general intestinal and intestinal immunity, and glutamine peptides derived from glutamine or wheat gluten hydrolyzate, Formulation of purified glutamine such as alanylglutamine or glycylglutamine is recommended. The total amount of glutamine in the composition of the present invention is preferably 0.6 g or more per 100 kcal.
本発明に使用するグルタミン酸、グルタミン酸を含むジペプチド若しくはトリペプチド、５’−ヌクレオチド又はそれらの塩としては次のものが例示されるが、これに限定されるものではない。遊離のグルタミン酸、Ｌ−グルタミン酸、グルタミン酸を含むジペプチド（アラニルグルタミン）やトリペプチド、５’−イノシン酸又はそれらのナトリウム塩、カリウム塩、カルシウム塩、マグネシウム塩である。特に好ましいのは、グルタミン酸ナトリウム、５’−イノシン酸ナトリウムである。腸管上皮細胞の良好な状態の保全、回復、すなわち上皮細胞のジアミンオキシダーゼ（ＤＡＯ）活性の維持に対しては、適切なたんぱく質量の補給が必要であり、さらにグルタミン酸は上皮細胞の回復を促進する。この腸管上皮の維持は、ひいては吸収効率の低下を防止する効果がある。この改善維持効果には、適切な遊離グルタミン酸とたんぱく質総量の割合が重要であるとの知見を得た。この割合（遊離グルタミン酸：たんぱく質総量）は１：１２０〜１：３が好ましい。 Examples of glutamic acid, dipeptides or tripeptides containing glutamic acid, and 5'-nucleotides or salts thereof used in the present invention include, but are not limited to, the following. They are free glutamic acid, L-glutamic acid, dipeptides containing glutamic acid (alanylglutamine), tripeptides, 5'-inosinic acid or their sodium, potassium, calcium, and magnesium salts. Particularly preferred is sodium glutamate, sodium 5'-inosinate. In order to maintain and restore the good state of the intestinal epithelial cells, that is, to maintain the diamine oxidase (DAO) activity of the epithelial cells, supplementation with an appropriate protein mass is required, and glutamate promotes the recovery of epithelial cells. . This maintenance of the intestinal epithelium is effective in preventing a decrease in absorption efficiency. It was found that an appropriate ratio of free glutamic acid and total protein is important for the improvement maintenance effect. This ratio (free glutamic acid: total protein) is preferably from 1: 120 to 1: 3.
本発明の総合経腸栄養組成物に用いる脂肪は、ヒトが摂取できる脂肪源であればよい。とくに、高率のエネルギー供給が必須の場合、グルコースに匹敵する腸管からの吸収速度を有し、エネルギー産生率が大きい中鎖脂肪酸トリグリセリド、中鎖脂肪酸ジグリセリドや中鎖脂肪酸をその構造の中に含む脂肪が推奨される。また、抗炎症作用を有するエイコサペンタエン酸やαリノレン酸などのω３系脂肪酸を含むことも、消化管以外に炎症を持った患者や炎症予防が必要なヒトなど、これらの脂肪が必須なヒトには積極的な給与が必要である。本発明の総合経腸栄養組成物では、とくに中鎖脂肪酸油を総脂肪の３５質量％以上含み、かつ脂肪中のω３系脂肪酸：ω６系脂肪酸の質量比が１：１０〜１：１とすることが好ましい。 The fat used in the total enteral nutrition composition of the present invention may be any fat source that can be ingested by humans. In particular, when a high rate of energy supply is essential, medium-chain fatty acid triglycerides, medium-chain fatty acid diglycerides, and medium-chain fatty acids that have absorption rates comparable to glucose and have a large energy production rate are included in the structure. Fat is recommended. In addition, the inclusion of omega-3 fatty acids such as eicosapentaenoic acid and α-linolenic acid, which have anti-inflammatory effects, can also be used in humans who need these fats, such as patients with inflammation other than the gastrointestinal tract and those who need inflammation prevention Need an active salary. In the total enteral nutrition composition of the present invention, in particular, medium chain fatty acid oil is contained in an amount of 35% by mass or more of the total fat, and the mass ratio of ω3 fatty acid: ω6 fatty acid in the fat is 1:10 to 1: 1. It is preferable.
ミネラルの必要量は、日本人の食事摂取基準を基本に定めることを原則とする。しかし、高齢者では摂取量が低下して低ナトリウム血症が問題となるため、本発明の総合経腸栄養組成物ではナトリウムを強化した。ナトリウム源は、ヒトが摂取または給与されるものであればよくその種類は問われないが、塩析によってたんぱく質を沈殿させないために、クエン酸ナトリウム、燐酸ナトリウムを主たるナトリウム源として用いる。本発明においては、ナトリウム含量が１００kcalあたり１６５mg以上で有効性が示されるが、特に、１００kcalあたり１８５〜３８５mgで著しい効果を有する。さらには２００〜３８５mgであることが好ましい。 In principle, the required amount of minerals is determined based on Japanese dietary intake standards. However, since the intake is reduced in elderly people and hyponatremia becomes a problem, the total enteral nutrition composition of the present invention has fortified sodium. The sodium source is not particularly limited as long as it is ingested or fed by humans, but sodium citrate and sodium phosphate are used as main sodium sources in order to prevent protein precipitation by salting out. In the present invention, the effectiveness is shown when the sodium content is 165 mg or more per 100 kcal, but it has a remarkable effect particularly at 185 to 385 mg per 100 kcal. Furthermore, it is preferable that it is 200-385 mg.
生体の多くの酵素の機能、構造に大きく関わる亜鉛は、栄養状態が低いヒトには不足する。亜鉛の補給は、血中の亜鉛濃度を上昇させ、特に褥瘡など創傷をもつ患者あるいはこのリスクのあるヒトに有用である。さらに亜鉛の吸収は２価イオンである銅と競合することから、銅と亜鉛の配合割合と銅の含有量を、亜鉛の吸収に有利なように配合する必要がある。本発明の総合経腸栄養組成物においては、１００kcalあたり亜鉛を少なくとも１.５mg、好ましくは１.５〜３.０mg、銅を０.０７５〜０.１５mg配合し、亜鉛と銅の質量比を１０〜２５、好ましくは１３〜２０、特に好ましくは１５〜１８、最も好ましくは１５とすることにより、褥瘡などの創傷治癒を促進させる効果が得られる。さらに、栄養補給が必要なヒトの炎症状態に応じて、抗酸化作用をもつ微量元素であるセレンを１００kcalあたり４.５〜１８μg程度本品に添加することは有用である。 Zinc, which greatly affects the functions and structures of many enzymes in the body, is deficient in humans with low nutritional status. Zinc supplementation increases blood zinc levels and is particularly useful for patients with or at risk for wounds such as pressure ulcers. Furthermore, since zinc absorption competes with copper which is a divalent ion, it is necessary to mix the blending ratio of copper and zinc and the copper content so as to be advantageous for zinc absorption. In the total enteral nutrition composition of the present invention, at least 1.5 mg of zinc per 100 kcal, preferably 1.5 to 3.0 mg, and 0.075 to 0.15 mg of copper are blended, and the mass ratio of zinc and copper is adjusted. By setting it to 10-25, preferably 13-20, particularly preferably 15-18, and most preferably 15, the effect of promoting wound healing such as pressure ulcers can be obtained. Furthermore, it is useful to add about 4.5 to 18 μg per 100 kcal of selenium, which is a trace element having an antioxidant effect, depending on the inflammatory state of humans who need nutritional supplementation.
ビタミンは、エネルギー産生、たんぱく質代謝、皮膚や粘膜の生理機能保持などの多くの生体活動に必須の補酵素として重要である。しかし、低栄養状態のヒトに対して配合されるべき量の検討はこれまで十分になされていない。本発明の総合経腸栄養組成物においては、１００kcalあたりビタミンＢ１を少なくとも０.３０mg、ビタミンＢ２を少なくとも０.２５mg、ビタミンＢ６を少なくとも０.３mg、ビオチンを少なくとも１.０μg配合する。さらに最も効果的な配合は、１００kcalあたりビタミンＢ１が０.４〜２.０mg、Ｂ２が０.２５〜２.０mg、ビタミンＢ６が０.５〜２.０mg、ビオチンが１.０〜１０μgである。さらに、その他のビタミンの添加が栄養状態の改善・維持、低栄養状態の予防、褥瘡の治療あるいは予防、貧血の治療あるいは予防のために有効である。本発明の総合経腸栄養組成物では、抗炎症作用、抗酸化作用、褥瘡防止作用のあるビタミンＢ１２、葉酸、β−カロチン、ビタミンＣなどを配合することが推奨される。具体的には、本発明の総合経膓栄養組成物１００kcalあたり、例えばビタミンＢ１２を０.２０〜０.７０μg、葉酸を２０〜８０μg、β−カロチンを１００〜４５０μg、ビタミンＣを１０〜７０mg配合する。これらすべての配合ビタミンはヒトが摂取できるものであればいずれの原材料でもよく、由来等が特定されるものではない。 Vitamins are important as coenzymes essential for many biological activities, such as energy production, protein metabolism, and maintaining physiological functions of the skin and mucous membranes. However, the amount to be formulated for undernourished humans has not been sufficiently studied so far. In the total enteral nutrition composition of the present invention, at least 0.30 mg of vitamin B1, at least 0.25 mg of vitamin B2, at least 0.3 mg of vitamin B6, and at least 1.0 μg of biotin are blended per 100 kcal. The most effective formulation is 0.4 to 2.0 mg of vitamin B1 per 100 kcal, 0.25 to 2.0 mg of B2, 0.5 to 2.0 mg of vitamin B6, and 1.0 to 10 μg of biotin. is there. Furthermore, the addition of other vitamins is effective for improving and maintaining nutritional status, preventing malnutrition, treating or preventing pressure ulcers, and treating or preventing anemia. In the total enteral nutrition composition of the present invention, it is recommended to add vitamin B12, folic acid, β-carotene, vitamin C and the like, which have anti-inflammatory action, antioxidant action, and anti-decubitus action. Specifically, per 100 kcal of the total vaginal nutrition composition of the present invention, for example, vitamin B12 is added in an amount of 0.20 to 0.70 μg, folic acid is 20 to 80 μg, β-carotene is 100 to 450 μg, and vitamin C is 10 to 70 mg. To do. All these mixed vitamins may be any raw material as long as they can be ingested by humans, and their origin is not specified.
本発明の総合経腸栄養組成物には、経口摂取を容易にするために、適当な香料、アスパルテームなどのノンカロリー甘味料を加えることが可能である。さらに、排便促進のための難消化性食物繊維などの成分、場合によっては経口投与される医薬品なども、本発明の総合経腸栄養組成物の機能を妨げない範囲で必要に応じて添加することができる。 In order to facilitate oral intake, the general enteral nutrition composition of the present invention can be added with a non-caloric sweetener such as a suitable fragrance or aspartame. In addition, components such as indigestible dietary fiber for promoting defecation and, in some cases, pharmaceuticals to be orally administered should be added as necessary within the range that does not interfere with the function of the total enteral nutrition composition of the present invention. Can do.
低栄養状態のヒトは、経口摂取が困難なことが多くこの場合にはチューブを使って経管による栄養補給が積極的に実施される。しかし、これまでは、必要なたんぱく質を本発明のように高比率に配合し、さらにミネラルを十分添加すると沈殿が生じたり、液の粘度が高くなり経管給与は不可能であった。成分の配合比率、製造法の研究の結果、低粘度の液状総合経腸栄養組成物を完成し、経管給与を初めて可能とした。すなわち、その組成物の粘度は６〜１８mPa・s(25℃)の範囲にも調整が可能であり、流動性に優れることが必須の時にはこれを実現できる。さらに、嚥下困難者などへの給与において、栄養組成物に適度な粘度をつける場合には、低粘性の本発明の総合経腸栄養組成物に増粘剤を適量加えることにより、患者ごとに適切な粘度をつけることができる利点も有する。 Undernourished humans are often difficult to ingest orally, and in this case, tube feeding is actively performed by tube feeding. However, until now, when a necessary protein is blended at a high ratio as in the present invention and a sufficient amount of mineral is further added, precipitation occurs or the viscosity of the liquid becomes high and tube feeding is impossible. As a result of research on the blending ratio of ingredients and manufacturing method, we have completed a low-viscosity liquid total enteral nutritional composition and made tube feeding possible for the first time. That is, the viscosity of the composition can be adjusted in the range of 6 to 18 mPa · s (25 ° C.), and this can be realized when excellent fluidity is essential. Furthermore, when giving a proper viscosity to the nutritional composition when feeding to persons with difficulty in swallowing, etc., it is appropriate for each patient by adding an appropriate amount of a thickener to the low-viscosity total enteral nutritional composition of the present invention. There is also an advantage that a high viscosity can be obtained.
本発明の総合経腸栄養組成物は、栄養状態が低下したヒトに提供されるが、例えば、たんぱく質・エネルギー低栄養(PEM)、低アルブミン血症、低ナトリウム血症、亜鉛欠乏状態、貧血、ヘモグロビン値およびヘマトクリット値の低下、褥瘡あるいは創傷、免疫能力低下などに苦しむヒトには特に有効である。したがって、これまで有効な組成物がなかったこれらの人々には本発明の総合経腸栄養組成物は大きな貢献をするものである。 The total enteral nutrition composition of the present invention is provided to humans with reduced nutritional status.For example, protein / energy undernutrition (PEM), hypoalbuminemia, hyponatremia, zinc deficiency, anemia, It is particularly effective for humans suffering from decreased hemoglobin and hematocrit levels, pressure ulcers or wounds, and decreased immune capacity. Therefore, the total enteral nutrition composition of the present invention greatly contributes to these people who have not had an effective composition so far.
〔実施例１〕
総合経腸栄養組成物の調製(組成物１)
低栄養状態に対する最適栄養効果を熟考し、栄養素組成〔表１〕を組み立てた。これを具現化するための液状物の原料配合表を〔表２〕に示す。乳化安定性に優れ、たんぱく質等の沈殿を起こさない組成物とするため、ナトリウム原材料とたんぱく質原材料および乳化剤を原料配合表に従い配合し、高圧乳化機の圧力を５００〜１,０００kg／cm2として複数回乳化工程を実施することによって、液状総合経腸栄養組成物を調製した。すなわち、原材料と水とを高圧乳化機を用いて高圧乳化を繰り返し良好な乳化液を調製した。動物性たんぱく質と植物性たんぱく質の比率は１：１.５とした。また、グルタミンペプチドと、大豆たんぱく質あるいはこの加水分解物の比率は１：１.４であり、さらに脂肪酸組成においてω３系脂肪酸：ω６系脂肪酸の比率は１：３となるよう配合した。これを通常の充填機を用いてアルミ製袋に充填し、レトルト殺菌機に入れ、通常の条件で滅菌を実施した。この液は１年後においても全成分は安定であり、粘度は９mPa・s(25℃)であった。[Example 1]
Preparation of total enteral nutrition composition (Composition 1)
Considering the optimum nutritional effect on the undernutrition state, the nutrient composition [Table 1] was assembled. [Table 2] shows a raw material composition table of the liquid material for realizing this. In order to make the composition excellent in emulsification stability and not causing precipitation of proteins, etc., sodium raw materials, protein raw materials and emulsifiers are blended according to the raw material blending table, and the pressure of the high pressure emulsifier is set to 500 to 1,000 kg / cm 2. A liquid integrated enteral nutrition composition was prepared by carrying out a mulch emulsification step. That is, a good emulsion was prepared by repeating high-pressure emulsification of raw material and water using a high-pressure emulsifier. The ratio of animal protein to vegetable protein was 1: 1.5. Further, the ratio of glutamine peptide to soy protein or hydrolyzate thereof was 1: 1.4, and the ratio of ω3-fatty acid: ω6-fatty acid in the fatty acid composition was 1: 3. This was filled into an aluminum bag using a normal filling machine, placed in a retort sterilizer, and sterilized under normal conditions. All components of this liquid were stable even after one year, and the viscosity was 9 mPa · s (25 ° C.).
〔実施例２〕
総合経腸栄養組成物の調製(組成物２)
実施例１と同様に〔表３〕に示される栄養素組成を組み立てた。これを具現化するための液状物の原料配合表を〔表４〕に示す。実施例１と同様に、ナトリウム原材料とたんぱく質原材料および乳化剤の配合量を組み合わせ、さらに高圧乳化機の圧力を５００〜１,０００kg／cm2として複数回乳化工程を実施し、液状総合経腸栄養組成物を調製した。すなわち、原材料と水とを高圧乳化機を用いて高圧乳化を繰り返し良好な乳化液を調製した。動物性たんぱく質と植物性たんぱく質の比率は１：２とした。また、グルタミンペプチドと、大豆たんぱく質加水分解物の比率は３：１であり、さらに脂肪酸組成においてω３系脂肪酸：ω６系脂肪酸の比率は１：１とした。これを通常の充填機を用いてアルミ製袋に充填し、レトルト殺菌機に入れ、通常の条件で滅菌を実施した。この液は１年後においても全成分は安定であり、粘度は６mPa・s (25℃)であった。[Example 2]
Preparation of general enteral nutrition composition (Composition 2)
The nutrient composition shown in [Table 3] was assembled in the same manner as in Example 1. [Table 4] shows a raw material composition table of the liquid material for realizing this. In the same manner as in Example 1, the sodium raw material, the protein raw material, and the emulsifier were combined, and the emulsification step was carried out a plurality of times with the pressure of the high-pressure emulsifier being 500 to 1,000 kg / cm 2 , so that the liquid total enteral nutrition composition A product was prepared. That is, a good emulsion was prepared by repeating high-pressure emulsification of raw material and water using a high-pressure emulsifier. The ratio of animal protein to vegetable protein was 1: 2. The ratio of glutamine peptide to soy protein hydrolyzate was 3: 1, and the ratio of ω3-fatty acid: ω6-fatty acid in the fatty acid composition was 1: 1. This was filled into an aluminum bag using a normal filling machine, placed in a retort sterilizer, and sterilized under normal conditions. Even after one year, all components of this liquid were stable, and the viscosity was 6 mPa · s (25 ° C.).
〔実施例３〕
総合経腸栄養組成物の調製(組成物３)
実施例１と同様に〔表５〕に示される栄養素組成を組み立てた。これを具現化するための液状物の原料配合量を〔表６〕に示す。実施例１と同様に、ナトリウム原材料とたんぱく質原料および乳化剤を組み合わせ、さらに高圧乳化機の圧力を５００〜１０００kg／cm2として複数回乳化工程を実施し、液状総合経腸栄養組成物を調製した。すなわち、原材料と水とを高圧乳化機を用いて高圧乳化を繰り返し良好な乳化液を調製した。これを通常の充填機を用いてアルミ製袋に充填し、レトルト殺菌機に入れ、通常の条件で滅菌を実施した。この液は１年後においても全成分は安定であり、粘度は１０mPa・s(25℃)であった。Example 3
Preparation of total enteral nutrition composition (Composition 3)
The nutrient composition shown in [Table 5] was assembled in the same manner as in Example 1. The raw material compounding amount of the liquid material for realizing this is shown in [Table 6]. In the same manner as in Example 1, a sodium raw material, a protein raw material, and an emulsifier were combined, and the emulsification step was performed a plurality of times at a pressure of a high-pressure emulsifier at 500 to 1000 kg / cm 2 to prepare a liquid integrated enteral nutrition composition. That is, a good emulsion was prepared by repeating high-pressure emulsification of raw material and water using a high-pressure emulsifier. This was filled into an aluminum bag using a normal filling machine, placed in a retort sterilizer, and sterilized under normal conditions. Even after one year, all components of this liquid were stable, and the viscosity was 10 mPa · s (25 ° C.).
［有効性試験］
低栄養モデルにおける発明組成物の栄養状態回復試験
ＳＤ系雄性ラットをＡＩＮ９３ｇ飼料からたんぱく質を除いた無たんぱく食で３週間飼育し低栄養モデルを作製した。これらと同様のモデルは事前に実験し、消化管に対して炎症や壊死など病的変化が見られないことを確認した。これら作製した低栄養ラットを無作為に３群にわけ（各群7匹）た。経腸栄養組成物の投与は、同一カロリーとした実施例１の総合経腸栄養組成物（Ａ）、実施例１からグルタミン酸ナトリウムのみを除き、その窒素量をグリシンで代替して同一にした試験液（Ｂ）、さらに市販経腸栄養製品（Ｃ）を用いた。試験動物のそれぞれの群に５日間の間、一日４０kcalの割合で経腸栄養組成物を胃瘻からポンプで投与した。投与６日目に血液を採取し、総たんぱく質、アルブミン、血中のナトリウム、カリウム、鉄を測定した。また、各群のラットを解剖して腸管上皮細胞のジアミンオキシダーゼ（DAO）活性、腸管たんぱく質量を測定しそれぞれ栄養指標とした。その結果を表７に示した。[Efficacy test]
Nutritional state recovery test of invention composition in undernutrition model SD male rats were bred for 3 weeks on a protein-free diet in which protein was removed from the AIN 93g diet to prepare an undernutrition model. Similar models were tested in advance and confirmed that no pathological changes such as inflammation or necrosis were observed in the digestive tract. These prepared malnutrition rats were randomly divided into 3 groups (7 animals in each group). Administration of enteral nutrition composition was the same calorie test, except that only the sodium glutamate from Example 1 was replaced with glycine. The liquid (B) and a commercially available enteral nutrition product (C) were used. Enteral nutritional compositions were pumped from the gastrostomy to each group of test animals at a rate of 40 kcal per day for 5 days. On day 6 of administration, blood was collected, and total protein, albumin, blood sodium, potassium, and iron were measured. In addition, each group of rats was dissected and the diamine oxidase (DAO) activity and intestinal protein mass of the intestinal epithelial cells were measured and used as nutritional indicators. The results are shown in Table 7.
表７に示すように血液検査において、総たん白質さらにアルブミンが実施例１（Ａ）において上昇し低栄養からの回復が明らかとなった。一方、市販栄養製品（Ｃ）を投与した群は、栄養状態の回復が遅れた。この（Ｃ）に比べ試験液（Ｂ）は有効であることが認められたが、本発明品である（Ａ）と比較しては劣る結果であった。さらに、血液中のミネラルを測定した結果、主要ミネラルのナトリウムやカリウム、さらに亜鉛や銅などの微量元素の代表である鉄についても実施例１が高値であり、投与されたミネラルの体外損失を防止する効果が認められた。したがって、血液中のヘモグロビンの高値とも考え合わせると鉄の上昇は貧血や褥瘡に対しても有効である。 As shown in Table 7, in the blood test, total protein and albumin increased in Example 1 (A), and recovery from malnutrition was revealed. On the other hand, in the group to which the commercially available nutritional product (C) was administered, recovery of nutritional status was delayed. The test solution (B) was found to be more effective than (C), but the results were inferior to those of the product (A) of the present invention. Furthermore, as a result of measuring the minerals in the blood, Example 1 has a high value for iron, which is a representative of trace elements such as sodium and potassium as main minerals, and zinc and copper, and prevents in vitro loss of the administered minerals. The effect to do was recognized. Therefore, the increase in iron is effective against anemia and pressure ulcers when combined with the high level of hemoglobin in the blood.
他方、低栄養では腸管の上皮の保全をはかることが難しく、したがって栄養素の吸収不全に陥る。今回の実験では実施例１（Ａ）で腸管上皮の総たんぱく質が高値に保たれておりさらに腸管の機能的指標であるＤＡＯ活性は極めて高値であった。これは、添加したグルタミン酸ナトリウムが吸収低下の防止効果を示した結果と考えられる。総合的な判定として、本発明の総合経腸栄養組成物は低栄養状態からの回復に非常に有効であることが証明された。 On the other hand, undernutrition makes it difficult to maintain the epithelium of the intestinal tract, and thus suffers from nutrient absorption failure. In this experiment, the total protein of the intestinal epithelium was maintained at a high level in Example 1 (A), and the DAO activity, which is a functional index of the intestinal tract, was extremely high. This is considered to be a result of the added sodium glutamate showing the effect of preventing the decrease in absorption. As a comprehensive judgment, it has been proved that the total enteral nutrition composition of the present invention is very effective in recovering from a malnutrition state.
なお、実施例２および３においても同様な実験を行ったが、同様な効果が認められた。 Although similar experiments were performed in Examples 2 and 3, similar effects were observed.
本発明の総合経腸栄養組成物は、含有されるグルタミン酸や５’−ヌクレオチドの添加による吸収低下の防止効果によって、たんぱく質・エネルギー低栄養(PEM)のヒトの治療あるいは予防のために優れた効果を奏し、栄養指標である血清アルブミン値の改善、褥瘡の改善、血中で低下したナトリウムやカリウム量の改善、ヘモグロビン値の改善、ヘマトクリット値の改善、血清中の鉄や亜鉛などの微量元素量の増加を促す。したがって、本発明の組成物、特に低アルブミン血症の治療あるいは予防のため、褥瘡あるいは創傷の治癒、予防のために用いることができる。さらに、本発明の組成物は高濃度のナトリウムを含有するので、低ナトリウム血症の治療あるいは予防のために有用である。さらに、本発明の組成物は高濃度の亜鉛を含有するので、亜鉛欠乏状態の患者の治療あるいは予防のために用いられる。 The general enteral nutrition composition of the present invention has an excellent effect for the treatment or prevention of humans of protein / energy undernutrition (PEM) due to the effect of preventing decrease in absorption due to addition of glutamic acid or 5′-nucleotide contained therein. Improved serum albumin level, improvement of pressure ulcer, improvement of sodium and potassium levels decreased in blood, improvement of hemoglobin level, improvement of hematocrit level, amount of trace elements such as iron and zinc in serum Urge increase. Therefore, the composition of the present invention can be used for the treatment or prevention of hypoalbuminemia, for the healing or prevention of pressure ulcers or wounds. Furthermore, since the composition of the present invention contains a high concentration of sodium, it is useful for the treatment or prevention of hyponatremia. Furthermore, since the composition of the present invention contains a high concentration of zinc, it is used for the treatment or prevention of patients with zinc deficiency.
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