RU2290824C2 - Milky product for enteral feeding - Google Patents

Abstract

FIELD: dairy industry, in particular products for tube and enteral feeding for adult and infants of 3-years and older.

SUBSTANCE: claimed product contains milky protein concentrate obtained by ultra- and diafiltering (13.0-14.0 %): whey protein concentrate (8.6-9.4 %); medium chain triglycerides concentrate (7.68-8.42 %); rape oil (3.84-4.21 %); soybean oil (3.84-4.21 %) in mass ratio (pts) of medium chain triglycerides concentrate, rape and soybean oils 2:1:1, respectively; glucose syrup (2.1-4.5 %); maltodextrin (48.6-56.1 %); minerals, vitamins, and water.

EFFECT: product with increased nutrient and biological value and prophylaxis properties.

2 tbl, 9 ex

Description

The invention relates to the dairy industry, namely the production of dairy products of probe and oral nutrition for adults and children 3 years of age and older, used as additional or main nutrition.

The known milk product for enteral and oral nutrition Ensure (Ensure), produced in the USA by Abbot Laboratories (Abbot Laboratories), contains whey protein, sodium and calcium caseinate, soy protein isolate, corn oil, safflower oil, Canola oil, maltodextrin , sucrose, calcium phosphate, magnesium phosphate, potassium citrate, magnesium chloride, sodium chloride, sodium citrate, iron sulfate, sodium molybdate, sodium selenite, potassium iodide, a source of dietary fiber is carrageenan, fat-and water-soluble vitamins [1]. This product is used in the pre- and postoperative period with progressive weight loss, trauma, oncology, malnutrition and inflammatory diseases of the colon.

The disadvantage of this product is the use of sodium and calcium caseinate as a protein source, the technology for which includes the stages of treatment with acids, alkalis, high temperature. Using this method of producing protein reduces the biological value and digestibility of the final protein product, its organoleptic properties and solubility.

The fatty component of this product includes corn oil and Canola oil. A disadvantage of corn oil is the low content of polyunsaturated fatty acids of the w3 series, which are necessary for cell regeneration and the synthesis of anti-inflammatory prostaglandins of the 3rd row. Canola oil (low eruca rapeseed oil) is poor in medium chain triglycerides, which impairs the digestibility of fat, and hence the product itself.

Among the mineral substances introduced upon receipt of this product, magnesium and calcium phosphates are used. These forms of salts, from the point of view of their bioavailability, are very unfavorable - magnesium and calcium are poorly absorbed. Given the low bioavailability of magnesium phosphate, a deficiency of magnesium (necessary for heart function) can cause cardiac abnormalities in patients. Calcium deficiency can cause cramps and osteoporosis.

The disadvantages of the product when used for the above purposes include the presence of dietary fiber in it, which is contraindicated in inflammatory diseases of the colon.

The closest in technical essence and the achieved result to the claimed technical solution is the Nutren dry milk product, manufactured in Switzerland by Nestle, containing a source of milk proteins in the form of whey protein and casein, taken in a mass ratio of 1: 1, a fraction of medium chain triglycerides (MCT), low eruca rapeseed oil, corn oil, soya lecithin, maltodextrin, corn syrup, sucrose, sodium phosphate, potassium phosphate, magnesium chloride, calcium carbonate, calcium chloride, sodium ascorbate. Potassium citrate, zinc sulfate, iron sulfate, manganese sulfate, copper sulfate, potassium iodide, sodium molybdate, chromium chloride sodium selenite, vitamins: A, D ₃ , E, K ₁ , C, PP, B ₁ , B ₂ , B ₃ , B ₆ , B ₁₂ , B _c , H, choline and water [2]. The chemical composition of the product is presented in table 1.

Table 1.
The chemical composition of the Nutren product Ingredients amount In 100 g of dry product In 100 ml of reconstituted mixture Protein, g 18,4 4.0 Fats, g 17.5 3.8 including vegetable oils, g 17.5 3.8 saturated fatty acids, g 5.25 1.14 monounsaturated fatty acids, g 6.48 1.4 polyunsaturated fatty acids, g 5.77 1.25 linoleic acid, g 3.44 0.75 α-linolenic acid, g 0.83 0.18 Carbohydrates, g 58.2 12.63 Glucose, g 0 0.36 Maltose, g 0 1,5 Lactose, g 0 0.19 Sucrose, g FROM one Dextrin, g 58.5 11.7 Vitamins: A (retinol), ME 1800 400 D ₃ (cholecalciferol), ME 130 28 E (tocopherol), ME 13 2,8 K (phylloquinone), mcg 23 5,0 B ₁ (thiamine), mg 0.92 0.2 B ₂ (riboflavin), mg 1,1 0.24 B ₃ (pantothenic acid), mg 6.5 1.4 B ₆ (pyridoxine), mg 1.8 0.4 B ₁₂ (cyanocobalamin), mcg 3,7 0.8 B _s (folic acid), mcg 250 54 PP (niacin), mg 13 2,8 C (ascorbic acid), mg 65 fourteen N (biotin), mcg 180 40 Choline, mg 210 45 Taurine, mg 37 8.0 Carnitine mg 37 8.0 Minerals: sodium mg 402 87 potassium mg 573 124 chlorides, mg 551 120 calcium, mg 307 67 phosphorus mg 307 67 magnesium mg 123 26.7 iron mg 5.5 1,2 zinc mg 6.5 1.4 copper mg 0.65 0.14 manganese, mg 1,239 0.27 molybdenum, mcg 55 12 selenium, mcg eighteen four chromium, mcg eighteen 4.0 iodine, mcg 46.0 10.0 choline mg 210 45 1-carnitine, mg 37 8 Taurine, mg 37 8 Energy value, kcal 461 one hundred

Nutren is a lactose-free mixture of oral and tube nutrition for patients in need of additional nutrition. It is used for anorexia, oncology, malnutrition, with nutritional support in the pre- and postoperative periods, with maxillofacial trauma, and inflammatory diseases of the colon.

The disadvantage of this product can be attributed to the fact that it uses caseinate as a protein source, the production technology of which includes the stages of treatment with acids, alkalis, and high temperature. Using this method of obtaining protein reduces the biological value of the protein (and hence the product itself), the digestibility of the final protein product, as well as its solubility.

The fat component of this product includes corn and low eruca rapeseed oil. The use of corn oil due to the extremely low content of w3 polyunsaturated fatty acids is undesirable, since w3 fatty acids are necessary for the regeneration of cells (tissue), especially the nervous system, immune system and have anti-inflammatory effects, which is important for a patient with a body weight deficit . To compensate for the low level of w3 PUFA in corn oil in this product, too much low erucic rapeseed oil has to be used (to balance the fatty acid composition of the w6 and w3 series), which makes the product more expensive. At the same time, even this type of rapeseed oil contains certain amounts of erucic acid, which adversely affects cholesterol metabolism, which in turn is not indicated for patients with cardiovascular diseases.

This product is characterized by an increased sodium content (table 1), which leads to an increase in the osmolarity of the product, adversely affecting the cardiovascular system, as well as causing diarrhea.

All of the above reduces the nutritional value of the product.

The technical result of the claimed invention is to increase the nutritional and biological value of the product, giving the product prophylactic properties.

The technical result is achieved by the fact that the milk product of enteral nutrition, including a source of whey proteins, a source of medium chain triglycerides, rape seed oil, maltodextrin, lecithin, minerals, vitamins and water, additionally contains a milk protein concentrate obtained by ultra- and diafiltration, soybean oil glucose syrup contains whey protein concentrate as a source of whey proteins, and medium concentrate as a medium chain triglyceride source netsepochechnyh triglycerides, wherein the weight ratio of medium trigitseridov concentrate, soy and canola oils nizkoerukovogo respectively is 2: 1: 1, with the following ratio of components, wt% (on dry substance).:

The milk protein concentrate obtained ultra and diafiltration method 13.0 ÷ 14.0 Whey Protein Concentrate 8.6 ÷ 9.4 Medium Chain Triglyceride Concentrate 7.68 ÷ 8.42 Rapeseed oil, low erucic 3.84 ÷ 4.21 Soybean oil 3.84 ÷ 4.21 Maltodextrin 48.6 ÷ 56.1 Glucose syrup 2.1 ÷ 4.5 Lecithin 0.027 ÷ 0.03 Minerals 2.149273 ÷ 3.320299 Vitamins 0.1688611 ÷ 0.30510937 Water Rest

The claimed technical result is achieved by a combination of the following factors:

- the use of whey protein concentrate can increase the biological value of the protein component of the product due to the high content of essential amino acids in whey protein;

- the use of milk protein concentrate (obtained by dia- and ultrafiltration) instead of caseinate in the prototype product, improves the digestibility of the protein component, improves the organoleptic properties (pleasant milk taste, solubility), and also reduces the cost of the product without compromising the biological value of the protein component;

- the use of soybean oil (instead of corn) allows you to ensure the patient's need for essential PUFAs of the w6 family and part of the need for essential PUFAs of the w3 family, thereby reducing the proportion of low-eric rapeseed oil in the product, which, in turn, reduces the cost of the product and reduces it the concentration of unhealthy erucic acid;

- the introduction of a medium chain triglyceride concentrate into the product can improve the digestibility of the fat component and the product as a whole in patients with impaired digestion due to improved intestinal emulsification and absorption of fat in conditions of insufficiency of digestive factors: pancreatic lipase, phospholipids and bile acids of bile;

- the use of the composition of maltodextrin and glucose syrup (instead of the composition of maltodextrin, corn syrup and sucrose in the prototype) can improve the tolerance of the carbohydrate component in patients with insufficient glucose tolerance, as well as improve the organoleptic properties of the product when used as a drink.

- the use of the above forms of mineral substances can improve their bioavailability in patients.

The dry milk product of enteral nutrition contains, as a source of milk proteins, a milk protein concentrate (KMB) obtained by the method of ultra- and diafiltration of skim or whole milk. Ultra- and diafiltration of milk raw materials allows to obtain milk protein concentrates of high nutritional and biological value, lactose and some mineral substances are removed from the raw materials. This protein differs from casein in its greater biological value and more optimal composition of essential amino acids, since it contains up to 20% of whey proteins with the highest biological value. The milk protein concentrate used enriches the product with sulfur-containing essential amino acids. The technology for producing this milk protein concentrate excludes the stages of processing with acids, alkalis, and high temperature, which ensures that the protein retains its native structure (lack of denaturation) and helps to improve organoleptic properties, solubility of the product, and digestibility in the digestive tract. The difference between casein prototype and casein in KMB is that casein prototype is obtained by multi-stage processing (precipitation-dissolution) under the action of acids, alkalis and high temperatures. Casein of the claimed product is obtained as a part of the KMB fraction from whole milk in one stage (filtration) at physiological pH values and a gentle temperature regime. The milk protein concentrate and whey protein concentrate in the claimed composition are selected so that the ratio of whey proteins to casein in the product is 1: 1, respectively. This ratio provides the maximum approximation of the content of essential amino acids in the product to the composition of the ideal protein according to the FAO scale, that is, to a protein that has the highest possible biological value. This allows you to best meet the needs of the patient (adult and child older than 3 years) in the case of using this product as the only source of nutrition. A change in the ratio 1: 1 is undesirable, because with an increase in the proportion of casein and a decrease in whey proteins in the product, the biological value of the protein component and the nutritional value of the product as a whole decrease, which is undesirable for patients suffering from protein deficiency, negative nitrogen balance and weight loss. With a decrease in the proportion of casein and an increase in serum proteins, the risk of developing hypersensitivity reactions (allergies) in patients with individual intolerance to whey proteins is increased, and the cost of the product is unacceptably increased without a significant further increase in the biological value of its protein.

Within the specified ratio of whey proteins: caseins, equal to 1: 1, the mass fraction of KMB and KSB (in total) should be about 22.5%, which provides a protein content in the final dry product of 18% by weight (based on the protein content equal to 80% in both concentrates). Deviations from the declared values of KMB and KSB both in the direction of increase and decrease are undesirable. A decrease in the mass fraction of both KSB and KMB below 13.0% and 8.6%, respectively, can lead to a lack of protein in patients who consume the product for a long time as the main source of nutrition. An increase in the content of KMB and KSB in excess of 14.0% and 9.4%, respectively, will lead, firstly, to an excess supply of total protein nitrogen, which may adversely affect the state of renal function in debilitated patients. Secondly, excessive intake of protein (especially KSB) creates an additional risk of food sensitization and the development of allergic reactions, especially with the intra-intestinal route of administration of the product.

The fat component of the claimed product is represented by a mixture of a concentrate of medium chain triglycerides, soybean and rapeseed low erucic oils taken in a mass ratio of 2: 1: 1, respectively. Unlike the fat component of the prototype, the claimed product uses soybean oil, which contains polyunsaturated fatty acids of the w3 series, which are necessary for the regeneration of tissues of the nervous and immune systems, especially the nervous system. The ratio 2: 1: 1 is due to the fact that the ratio (mass) of medium chain triglycerides to long chain triglycerides (their source is soybean and rapeseed low erucic oil) should be 1: 1 - for optimal absorption of fat in the intestines of the patient, and therefore the product itself. An increase in medium chain triglycerides of more than 50% can cause a violation of the central nervous system. The content of medium-chain triglycerides of less than 50% can lead to insufficient absorption of fat in the intestines of the patient. The mass ratio of 1: 1 between low eruca rapeseed and soybean oils is caused by the need to maintain a balance between the polyunsaturated fatty acids of the w6 and w3 series: the w6 / w3 ratio in the claimed product is 4.2: 1. This provides a sufficient amount of w3 PUFA necessary for tissue regeneration and stimulates the immune system, and w6 PUFA involved in the synthesis of row 4 prostaglanditis, necessary to maintain normal barrier function of the gastric mucosa and small intestine, as well as arachidonic acid, which is an important component part of cell membranes and some important intracellular mediators. An increase in the proportion of rapeseed oil in the product over the claimed amount will lead to insufficient intake of w6 PUFA necessary for maintaining the normal barrier function of the gastric mucosa and small intestine, as well as other epithelial barriers, and can also lead to activation of undesired lipid peroxidation processes in the body patient and in the product itself during storage. The consequence of the latter may be a deterioration in the organoleptic properties of the product (the appearance of rancid taste) and a reduction in the warranty period. An increase in the proportion of rapeseed low erucic oil can also cause the accumulation of certain amounts of erucic acid in the product, which is unfavorable for patients suffering from atherosclerosis and cardiovascular diseases. In addition, an increase in the content of rapeseed oil of the claimed brand (low erucic) greatly increases the cost of the product.

With an excess, over the claimed ratio, the amount of soybean oil in the product, the intake of essential PUFAs of the w3 family decreases, which is undesirable for patients suffering from inflammatory diseases and reduced immune function.

In the claimed product, in comparison with the prototype, the sodium content is balanced (see table 2). While in the prototype, excess sodium can have an adverse effect on the cardiovascular system of patients, as well as cause diarrhea in them.

Preparations of vitamins and minerals are introduced taking into account the needs of the human body in these nutrients per 1 unit. energy value according to the "Norms of physiological needs for nutrients and energy", approved by the Ministry of Health of the USSR in 1991

The components in the product are introduced in ratios that ensure a balanced intake of all nutrients into the body when using the product as the sole source of nutrition.

The claimed combination of characteristics allows to obtain an enteral nutrition product with prophylactic properties, with increased biological and nutritional value in comparison with the prototype. Deviations to a smaller or greater side from the claimed values leads to a decrease in the biological and nutritional value of the claimed product, to a decrease in its prophylactic properties.

Nutrien Standard enteral nutrition dry product is produced from: KMB-75 dry milk protein product according to TU 9229-120-17023360-2001 or dry milk protein concentrate with a mass fraction of protein of at least 80% authorized by the State Sanitary and Epidemiological Supervision Ministry of Health of Russia for use in production baby food; dry whey protein concentrate with a mass fraction of protein of at least 80%, approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- maltodextrin with a dextrose equivalent of at least 18 DE obtained from genetically unmodified raw materials approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food; dry glucose syrup with dextrose equivalent 38-40 DE, obtained from genetically unmodified raw materials approved by the bodies of the Sanitary Inspection of the Ministry of Health of Russia for use in the production of baby food;

- soybean oil in accordance with GOST 7825-76, refined deodorized with a peroxide value of not more than 2 mmol of active oxygen / kg, obtained from genetically unmodified raw materials approved by the bodies of the State Sanitary Inspection of the Ministry of Health of Russia for use in the production of baby food;

- refined deodorized rapeseed oil with an erucic acid content of not more than 5% of the sum of fatty acids, with a peroxide number not exceeding 2 mmol of active oxygen / kg, approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- a medium chain triglyceride concentrate authorized by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- lecithin obtained from genetically unmodified raw materials authorized by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food;

- Ascorbed palmitate allowed by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food.

Vitamins are used: retinol acetate (vitamin A acetate) according to FS 42-3029-94 or a solution of retinol acetate in oil 3.44% and 8.60% according to FS 42-3183-95 or retinol palmitate (vitamin A palmitate) according to VFS 42 -2229-94 or a solution of retinol palmitate in oil 55% according to FS 42-1875-95; cholecalciferol (vitamin D ₃ ) pharmacopoeial quality; α-tocopherol acetate (vitamin E acetate) according to VFS 42-2442-94 or according to VFS 42-1642-81; phylloquinone (vitamin K ₁ ); ascorbic acid (vitamin C) according to FS 42-2668-95; nicotinamide (vitamin PP) according to the State Pharmacopoeia of the USSR-X st. 452 or nicotinic acid (vitamin PP) according to FS 42-2357-94; thiamine hydrochloride (vitamin B ₁ ) according to the State Pharmacopoeia of the USSR-X st. 674 or thiamine bromide (vitamin B ₁ ) according to FS 42-2413-92; riboflavin (vitamin B ₂ ) according to FS 42-2954-93; calcium pantothenate (vitamin B ₃ ) according to FS 42-2530-95; pyridoxine hydrochloride (vitamin B ₆ ) according to the GF USSR-X st.567; cyanocobalamin (vitamin B ₁₂ ) according to FS 42-2518-94; folic acid (vitamin B _c ) according to VFS 42-2479-95; biotin (vitamin H); choline chloride according to FS 42-1997-93, or choline dihydrocytrate or bitartra. Instead of vitamins, a vitamin premix can be used (if available), approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food (includes vitamins A, D, E, K ₁ , C, PP, B ₁ , B ₂ , B ₃ , B ₆ , B ₁₂ , B _c , H).

Use mineral substances: sodium chloride according to GOST 4233-77; potassium citrate according to GOST 5538-78, or according to OST 10 289-01; sodium citrate according to GOST 22280-76, or according to OST 10 290-01; potassium phosphate according to GOST 2493-75; magnesium chloride according to GOST 4209-77; zinc sulfate according to GOST 4174-77; copper sulfate according to GOST 4165-78; iron sulfate according to GOST 4148-78; manganese chloride according to GOST 612-75; potassium iodide according to GOST 4232-74; chromium chloride according to GOST 4473-78; ammonium molybdenum acid in accordance with GOST 3765-78; sodium selenite; bicarbonate sodium according to GOST 2156-76, first grade; citric acid according to GOST 3652-69, or food citric acid according to GOST 908-79E, Extra grade or premium; potassium hydroxide according to GOST 24363-80; drinking water according to SanPiN 2.1.4.1074-01. Instead of mineral substances, a mineral premix can be used, approved by the bodies of the State Sanitary and Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food (includes manganese chloride, potassium iodide, ferrous sulfate, zinc sulfate, copper sulfate, chromium chloride, ammonium molybdate, sodium selenite).

It is allowed to use similar types of domestic and imported components with a quality not lower than the above.

The main raw materials and components of domestic production and obtained by import in terms of safety indicators must meet the requirements of SanPiN 2.3.2.1078-01 (index 3.6).

Mineral salts according to microbiological indicators must meet the requirements of SanPiN 2.3.2.1078-01 (index 3.6.10.2).

The method of obtaining the claimed product is as follows.

The dry concentrate of milk proteins, the dry concentrate of whey proteins are sequentially dissolved in continuous circulation in drinking water with a temperature of 43 ÷ 47 ° C until an aqueous solution with a mass fraction of solids of 5 ÷ 6% is formed, cooled to a temperature of 2 ÷ 6 ° C and kept at constant stirring for at least 2 hours. Then the proteins are treated with salts, for this potassium citrate, sodium citrate is dissolved in drinking water with a temperature of 15 to 20 ° C until a solution with a mass fraction of salts of 9 ÷ 10% is obtained and mixed until completely dissolved.

The resulting solution is introduced with stirring into a cooled mixture of proteins, kept with constant stirring for 30 ÷ 40 minutes and determine the active acidity, which should be equal to from 6.7 to 7.0. If the active acidity is less than 6.7, then normalize with a 5% aqueous solution of potassium hydroxide, if the active acidity is more than 7.0, then the calculated amount of a 5% aqueous solution of citric acid is added.

Preparation of a protein-carbohydrate mixture.

The protein mixture with the added citric acid salts is heated to a temperature of 48 ÷ 52 ° C. Maltodextrin and glucose syrup are dissolved in a protein mixture until an aqueous solution with a mass fraction of solids of 15-16% is formed, purified, cooled to a temperature of 2 ÷ 6 ° C, stirred for 20 ÷ 30 minutes.

Preparation of an oil-vitamin mixture

Soybean, rapeseed low-erucic oil and a medium-chain triglyceride concentrate are pumped into the tank for the preparation of an oil-vitamin mixture, add fat-soluble vitamins A, D ₃ , E, K1 and lecithin, previously dissolved in 0.5-1.0 kg of soybean oil, and mix 10 -15 minutes.

Ascorbyl palmitate is dissolved in soybean oil in a ratio of 1:35 at a temperature of 100 ÷ 105 ° C and stirred for 10 ÷ 15 minutes. The resulting solution with a temperature of 63 ÷ 67 ° C is introduced into the oil-vitamin mixture, preheated to a temperature of 63 ÷ 67 ° C, stirred for 10-15 minutes and sent to the preparation of the emulsion.

Preparation of a normalized mixture.

The protein-carbohydrate mixture and the oil-vitamin mixture in a ratio of 8: 1, heated to a temperature of 63-67 ° C, are sent for emulsification and homogenization.

Homogenization is carried out at a pressure in the first stage of 120 ÷ 130 kgf / cm ² and in the second stage of 45 ÷ 55 kgf / cm ² . The normalized mixture should have fat globules with a diameter of not more than 5 microns and not form clusters.

The normalized mixture is pasteurized at a temperature of 74 ÷ 78 ° C with a holding time of 29 ÷ 31 s, cooled to a temperature of 2 ÷ 6 ° C.

Magnesium chloride, potassium phosphate, sodium chloride are dissolved in drinking water with a temperature of 15 to 20 ° C until a solution is obtained with a mass fraction of salts of 10 to 15%, stirred until complete dissolution and introduced into the normalized mixture with constant stirring.

Citric acid is dissolved in drinking water with a temperature of from 15 to 20 ° C until an aqueous solution with a mass fraction of acid from 0.01 to 0.02% is obtained, iron sulfate is added, mixed until completely dissolved and introduced into the normalized mixture with constant stirring.

Zinc sulfate, manganese chloride, copper sulfate are dissolved in drinking water with a temperature of 15 to 20 ° C until a solution with a mass fraction of salts from 2 to 3% is obtained, mixed until completely dissolved and introduced into a normalized mixture with constant stirring.

Ascorbic acid (vitamin C) is dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of vitamin 2 to 3% is obtained, mixed until completely dissolved and vitamins PP, B ₁ , B ₂ are added with constant stirring. In ₃ , ₆ , B ₁₂ mix until complete dissolution and bring into the normalized mixture with constant stirring.

Vitamin B ₆ (folic acid) and sodium bicarbonate are dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of vitamin from 0.02 to 0.03% is obtained, then biotin and potassium iodide are added, mixed until complete dissolution and bring with constant stirring into the tank with a normalized mixture.

Choline dihydrocytrate, or choline chloride, or choline bitartrate is dissolved in drinking water with a temperature of from 15 to 20 ° C until an aqueous solution with a mass fraction of choline from 4 to 5% is mixed until complete dissolution and introduced into the normalized mixture with constant stirring.

Chromium chloride, ammonium molybdenum acid, sodium selenite are dissolved in drinking water with a temperature of 15 to 20 ° C until an aqueous solution with a mass fraction of salts of 3 to 4% is obtained, stirred until complete dissolution and introduced into the normalized mixture with constant stirring.

After each addition of solutions to the normalized mixture, the container is washed with drinking water, which is added to the normalized mixture.

The resulting normalized mixture is stirred for 20-30 minutes and determine the active acidity, which should be equal to from 6.7 to 7.0. If the active acidity is less than 6.7, then a calculated amount of a 5% aqueous solution of potassium hydroxide is added; if the active acidity is higher than 7.0, then a calculated amount of a 5% aqueous solution of citric acid is added.

The mass fraction of solids of the normalized mixture sent for thickening should not exceed 20%, if necessary, the concentration of solids is adjusted with drinking water with a temperature of 15-20 ° C to normal with constant stirring.

Then the normalized mixture is thickened to a mass fraction of solids from 45 to 48% and pasteurized at a temperature of 108 ÷ 112 ° C without exposure, after which the condensed mixture is sent for drying.

Drying of the condensed mixture is carried out under the following conditions: temperature at the entrance to the drying tower - from 175 to 185 ° C; the temperature at the outlet of the drying tower is from 75 to 85 ° C.

The temperature of the dry product leaving the drying tower should be 33 ÷ 37 ° C.

During the drying process, the product is continuously discharged into the pneumatic conveying system, where the powder is cooled to a temperature of 23 ÷ 27 ° С, collected in containers and sent to intermediate storage.

The resulting Nutrien Standard enteral and probe nutrition product is a fine, dry powder (or lumps that easily crumble under mechanical action) of light yellow color. Taste and smell - purely milky, without extraneous taste and smell. A slight taste of vegetable oil is allowed. The moisture content of the dry product ranges from 2 to 4%.

As a concentrate of medium chain triglycerides, for example, the product Delios V (firm GRÜNAU ILLERTISSEN GmbH, Germany) is used:

Chemical and physical data: Parameter Specification Analysis Hue 5 1/4 " yellow ≤2 0.9 red ≤0.5 0.3 Acid number (mg KOH / g) ≤0.1 0,0 Iodine number (gI / 100 g) ≤0.5 0.02 Hydroxyl number (mg KOH / g) ≤5 3 Pericidal number (1/8 mmol O / kg) ≤0.5 0,0 Saponification Body (mg KOH / g) 330-345 336 Water (%) ≤0.1 0.02 Fatty Acid Distribution (%) C6 <2 <2 C8 55-65 55-65 C10 35-45 35-45 C12 <2 <2

As maltodextrin with a dextrose equivalent of 18-20 DE, for example, Maldex 180 (AMYLUM EUROPE N.V.) is used.

ANALYSIS CERTIFICATE
This certificate is printed by a computer from the quality laboratory database. Lot number: Weight, kg Date of production E130791 4125 04/11/01 E131091 15675 11/06/01 Fact Min Max E130791 E131091 Humidity 105 ° C (%) 4.09 4.09 0,0 5,0 A0102 (according to ISO 1741) Dextrose 18.0 18.5 17.0 19.9 A0201 (according to ISO 5377) Equivalent to LaneEyno (%) Dextrose (%) 0,0 3.0 A0210 (according to ISO 10504) Maltose (%) 4.0 8.0 A0210 (according to ISO 10504) Triose (%) 7.0 11.0 A0210 (according to ISO 10504) Higher Sugars (%) 78.0 89.0 A0210 (according to ISO 10504) SO ₂ syrup iodometer. (mg / kg) 5,0 9.0 0,0 10.0 A0901 (according to CRA E-67 // E67a) pH crystal. - 50% s.v 4.6 4.2 6.0 5,0 A0922 (acc. CRA F-42) Ash (sulph.) At 525 ° С 0 0.1 A0701 (according to ISO 5809) Iodine test Ok Ok ok ok A1020 Black blotches 0 0 0 5 A0601 Bulk density 525 675 A1101 cf. (g / dm ³ ) Bulk density 425 600 A1101 free (g / dm ³ ) Vibr. screening> 52 μM 70.0 100.0 A1113 Vibr. sieving> 150 μM (%) 0,0 50,0 A1113 Vibr. sieving> 250 μM (%) 0,0 10.0 A1113 Vodn. muddy dextrose 1,5 1,5 0,0 5,0 A1042 Microbe, the total number (in 10 g) four 16 0 <1000 A1924 Yeast agar, 5 days, 25 ° C (in 10 g) 2 10 0 1,0 E2 A1923 Agar mold, 5 days, 25 ° C (in 10 g) 16 2 0 1,0 E2 A1923 Coliforms (in 10 g) lack of lack of A1937 E. Koli (in 10 g) lack of lack of A1937 Salmonella lack of lack of lack of lack of A1930 Arsenic, AS mcg / kg 90 90 0 250 Cadmium, Cd mcg / kg fifteen fifteen 0 fifty Copper, Cu mcg / kg 350 350 0 1000 Lead, Pb mcg / kg thirty thirty 0 one hundred Zinc, Zn mcg / kg 1500 1500 0 5000 Mercury, Hq mcg / kg 0 0 0 10 Pesticides μg / kg 0 0 0 10 Strontium - 90 Bq / kg 0 0 0 40 Cesium - 137 Bq / kg 0 0 0 fifty

In the event that no result is entered, the Amylum Group ensures that the indicators meet agreed specifications.

As glucose syrup with a dextrose equivalent of 38-40 DE, for example, dried glucose syrup Glucidex 40 is used. Glucidex 40 is a mixture of food saccharides produced by controlled acid hydrolysis, purification and spray drying of edible corn starch.

Casno: 68131-37-3 EINECS: 268-616-4

SPECIFICATION: PHYSICAL AND CHEMICAL INDICATORS APPEARANCE MCL 086G White powder SMELL MCL 178D Neutral TASTE Sweet DRY LOSS MCL 002E 5% max CONTENT PROTEIN MCL 030A 0.15% max SULFURED ASH MCL 225A 0.1% max SO ₂ MCL 060P 20 ppm max. pH IN SOLUTION MCL 020B 4.5-5.5 DEXTROSE EQUIVALENT MCL 050B 38-42 BULK DENSITY MCL 095A 550 g / l approx. PARTICLE SIZE MCL 110A - RESIDUAL ON Sieve 250 MK 10% max - RESIDUAL ON Sieve 40 MK 50% min MICROBIOLOGICAL INDICATORS - TOTAL MMS 2002A 1000 / gmax. - YEAST MMS 2003A 50 / g max. - MOLD MMS 2003A 50 / g max. - E.KOLI MMS 2009A Absent In 10 g - SALMONELLA MMS 2010 Absent In 25 g - C.S.R. DISPUTES MMS 2015 50/10 g max TYPICAL PROPERTIES CARBOHYDRATE COMPOSITION MCL 190A - Glucose 17% approx. - DISACHARIDES 12% approx. - HIGH POLYSACCHARIDES 71% approx. MINERAL COMPOSITION: - SODIUM 50 ppm approx. - CHLORIDE 50 ppm approx. - CALCIUM 10 ppm approx. - POTASSIUM 10 ppm approx. ENERGY VALUE calculated on 100 g of the sold product 1605 kJ (384 kcal.) COMPLIANCE WITH STANDARDS: - Council Directive 73/437 / EEC of 11/12/73 (JO CEL L 356/71 of 27/12/73) - CODE STAN 10-1981 - US Federal Regulation Code 21CFR - 1994 §168.121. - FOOD CHEMICALS CODE, 3rd edition.

MCL, MMS: ROCKETT Techniques

Example 1. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 13.0 Whey Protein Concentrate 8.6 Medium Chain Triglyceride Concentrate 7.68 Rapeseed oil, low erucic 3.84 Soybean oil 3.84 Maltodextrin 53.8 Glucose syrup 2.83 Lecithin 0,027 Potassium citrate 0.72 Sodium Citrate 0.59 Potassium phosphate 0.34 Sodium Chloride 0.22 Magnesium chloride 0.35 Zinc Sulfate 0.011 Iron sulfate 0.015 Manganese chloride 0.0014 Copper sulfate 0.0015 Potassium iodide 0.00004 Sodium bicarbonate 0.00016 Lemon acid 0.00010 Ammonium Molybdenum Acid 0.000010 Chromium chloride 0,000051 Sodium Selenite 0.000012 Vitamin A 0,00039 Vitamin D ₃ 0.0000011 Vitamin E 0.005 Vitamin K ₁ 0,000029 Vitamin C 0,040 Vitamin PP 0.0057 Vitamin B ₁ 0,0007 Vitamin B ₂ 0,0006 Vitamin B ₃ 0.0017 Vitamin B ₆ 0,0009 Vitamin B _c 0.00009 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline chloride 0.11 Ascended palmitate 0.0037 Water The rest is up to 100 kg

Example 2. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 13.3 Whey Protein Concentrate 8.9 Medium Chain Triglyceride Concentrate 7.92 Rapeseed oil, low erucic 3.96 Soybean oil 3.96 Maltodextrin 53.1 Glucose syrup 2.79 Lecithin 0,028 Potassium citrate 0.65 Sodium Citrate 0.75 Potassium phosphate 0.62 Sodium Chloride 0.24 Magnesium chloride 0.49 Zinc Sulfate 0.012 Iron sulfate 0.015 Manganese chloride 0.0012 Copper sulfate 0.0012 Potassium iodide 0.00004 Sodium bicarbonate 0.00019 Lemon acid 0.00010 Ammonium Molybdenum Acid 0,000014 Chromium chloride 0,000023 Sodium Selenite 0.000017 Vitamin A 0,00041 Vitamin D ₃ 0.0000012 Vitamin E 0.006 Vitamin K ₁ 0.000032 Vitamin C 0,046 Vitamin PP 0.0065 Vitamin B ₁ 0,0008 Vitamin B ₂ 0,0007 Vitamin B ₃ 0.0020 Vitamin B ₆ 0.0010 Vitamin B _c 0.00010 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline bitartrate 0.21 Ascended palmitate 0.0038 Water The rest is up to 100 kg

Example 3. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 14.0 Whey Protein Concentrate 9,4 Medium Chain Triglyceride Concentrate 8.42 Rapeseed oil, low erucic 4.21 Soybean oil 4.21 Maltodextrin 51.3 Glucose syrup 2.7 Lecithin 0,03 Potassium citrate 0.63 Sodium Citrate 0.83 Potassium phosphate 0.87 Sodium Chloride 0.30 Magnesium chloride 0.56 Zinc Sulfate 0.016 Iron sulfate 0,020 Manganese chloride 0.0018 Copper sulfate 0.0020 Potassium iodide 0.00005 Sodium bicarbonate 0,00021 Lemon acid 0.00013 Ammonium Molybdenum Acid 0.000019 Chromium chloride 0.000068 Sodium Selenite 0.000022 Vitamin A 0,00050 Vitamin D ₃ 0.00000137 Vitamin E 0.006 Vitamin K ₁ 0.000036 Vitamin C 0,052 Vitamin PP 0.0074 Vitamin B ₁ 0,0009 Vitamin B ₂ 0,0008 Vitamin B ₃ 0.0022 Vitamin B ₆ 0.0011 Vitamin B _c 0.00011 Vitamin B ₁₂ 0.000002 Vitamin H 0.00006 Choline Dihydrocytrate 0.23 Ascended palmitate 0.0040 Water The rest is up to 100 kg

In the product obtained according to examples 1 ÷ 3, the ratio of carbohydrate components of maltodextrin: glucose syrup is 19: 1.

Example 4. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 14.0 Whey Protein Concentrate 9,4 Medium Chain Triglyceride Concentrate 8.42 Rapeseed oil, low erucic 4.21 Soybean oil 4.21 Maltodextrin 50,2 Glucose syrup 2.1 Lecithin 0,03 Potassium citrate 0.62 Sodium Citrate 0.83 Potassium phosphate 0.87 Sodium Chloride 0.30 Magnesium chloride 0.56 Zinc Sulfate 0.016 Iron sulfate 0,020 Manganese chloride 0.0018 Copper sulfate 0.0015 Potassium iodide 0.00005 Sodium bicarbonate 0.00019 Lemon acid 0.00013 Ammonium Molybdenum Acid 0.000019 Chromium chloride 0.000068 Sodium Selenite 0.000022 Vitamin A 0,00041 Vitamin D ₃ 0.0000012 Vitamin E 0.006 Vitamin K ₁ 0.000032 Vitamin C 0,046 Vitamin PP 0.0065 Vitamin B ₁ 0,0008 Vitamin B ₂ 0,0007 Vitamin B ₃ 0.0020 Vitamin B ₆ 0.0010 Vitamin B _c 0.00010 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline bitartrate 0.22 Ascended palmitate 0.0040 Water The rest is up to 100 kg

In the product, the ratio of carbohydrate components of maltodextrin: glucose syrup is 24: 1.

Example 5. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained

ultra and diafiltration method 13.0 Whey Protein Concentrate 8.6 Medium Chain Triglyceride Concentrate 7.68 Rapeseed oil, low erucic 3.84 Soybean oil 3.84 Maltodextrin 56.1 Glucose syrup 2,34 Lecithin 0,027 Potassium citrate 0.72 Sodium Citrate 0.59 Potassium phosphate 0.34 Sodium Chloride 0.22 Magnesium chloride 0.35 Zinc Sulfate 0.011 Iron sulfate 0.015 Manganese chloride 0.0014 Copper sulfate 0.0015 Potassium iodide 0.00004 Sodium bicarbonate 0.00019 Lemon acid 0.00010 Ammonium Molybdenum Acid 0.000010 Chromium chloride 0,000051 Sodium Selenite 0.000012 Vitamin A 0,00041 Vitamin D ₃ 0.0000012 Vitamin E 0.006 Vitamin K ₁ 0.000032 Vitamin C 0,046 Vitamin PP 0.0065 Vitamin B ₁ 0,0008 Vitamin B ₂ 0,0007 Vitamin B ₃ 0.0020 Vitamin B ₆ 0.0010 Vitamin B _c 0.00010 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline bitartrate 0.20 Ascended palmitate 0.0037 Water The rest is up to 100 kg

In the product obtained according to examples 4 ÷ 5, the ratio of carbohydrate components of maltodextrin: glucose syrup is 24: 1.

Example 6. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 14.0 Whey Protein Concentrate 9,4 Medium Chain Triglyceride Concentrate 8.42 Rapeseed oil, low erucic 4.21 Soybean oil 4.21 Maltodextrin 48.6 Glucose syrup 3.72 Lecithin 0,03 Potassium citrate 0.62 Sodium Citrate 0.83 Potassium phosphate 0.87 Sodium Chloride 0.30 Magnesium chloride 0.56 Zinc Sulfate 0.016 Iron sulfate 0,020 Manganese chloride 0.0018 Copper sulfate 0.0015 Potassium iodide 0.00005 Sodium bicarbonate 0.00019 Lemon acid 0.00013 Ammonium Molybdenum Acid 0.000019 Chromium chloride 0.000068 Sodium Selenite 0.000022 Vitamin A 0,00041 Vitamin D ₃ 0.0000012 Vitamin E 0.006 Vitamin K ₁ 0.000032 Vitamin C 0,046 Vitamin PP 0.0065 Vitamin B ₁ 0,0008 Vitamin B ₂ 0,0007 Vitamin B ₃ 0.0020 Vitamin B ₆ 0.0010 Vitamin B _c 0.00010 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline bitartrate 0.22 Ascended palmitate 0.0040 Water The rest is up to 100 kg

Example 7. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 13.0 Whey Protein Concentrate 8.6 Medium Chain Triglyceride Concentrate 7.68 Rapeseed oil, low erucic 3.84 Soybean oil 3.84 Maltodextrin 54.3 Glucose syrup 4.15 Lecithin 0,027 Potassium citrate 0.72 Sodium Citrate 0.59 Potassium phosphate 0.34 Sodium Chloride 0.22 Magnesium chloride 0.35 Zinc Sulfate 0.011 Iron sulfate 0.015 Manganese chloride 0.0014 Copper sulfate 0.0015 Potassium iodide 0.00004 Sodium bicarbonate 0.00019 Lemon acid 0.00010 Ammonium Molybdenum Acid 0.000010 Chromium chloride 0,000051 Sodium Selenite 0.000012 Vitamin A 0,00041 Vitamin D ₃ 0.0000012 Vitamin E 0.006 Vitamin K ₁ 0.000032 Vitamin C 0,046 Vitamin PP 0.0065 Vitamin B ₁ 0,0008 Vitamin B ₂ 0,0007 Vitamin B ₃ 0.0020 Vitamin B ₆ 0.0010 Vitamin B _c 0.00010 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline bitartrate 0.20 Ascended palmitate 0.0037 Water The rest is up to 100 kg

In the product obtained according to examples 6 and 7, the ratio of carbohydrate components of maltodextrin: glucose syrup is 13: 1.

The dry product obtained according to examples 1-7, is a fine dry powder of light yellow color with a clear milk taste and smell. The product is highly soluble in water, balanced in physicochemical composition and meets biomedical requirements. The product provides preventive nutrition for children over 3 years of age, as well as for adults with nutritional deficiency, cachexia, and impaired absorption of fats, during the transition from parenteral to enteral nutrition, in combination with parenteral nutrition; with enteral nutrition of patients in critical conditions, in intensive care units; with severe forms of protein-calorie malnutrition, with physical and emotional overload; with loss of appetite, inability or refusal to eat; as food in the pre- and postoperative period; in case of damage to the maxillofacial area (trauma, operation), violation of the act of swallowing; with a disease of the nervous system (cerebrovascular accident, stroke, impaired consciousness); with neurosurgical interventions; with complications of the postoperative period in the gastrointestinal tract; with injuries of craniocerebral, burn, bone fractures; with malnutrition of cancer patients; in cases of malnutrition in chronic diseases of the gastrointestinal tract (peptic ulcer of the stomach and duodenum, Crohn's disease, ulcerative colitis, gastritis); with acute exogenous poisoning, with infectious diseases; with AIDS.

In the claimed product, maltodextrin and glucose syrup are taken in a mass ratio of 13: 1 ÷ 24: 1, respectively. Deviation from this ratio of less than 13: 1 is undesirable, since an increase in the glucose syrup in the carbohydrate component can lead to excessive glucose in the patient’s blood and cause diarrhea. Deviation from this ratio to a side of more than 24: 1 is undesirable, since an increase in the carbohydrate component of maltodextrin leads to a deterioration in the taste of the product and makes it unsuitable in the form of a drink.

Example 8. For the preparation of 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 14.0 Whey Protein Concentrate 9,4 Medium Chain Triglyceride Concentrate 8.42 Rapeseed oil, low erucic 4.21 Soybean oil 4.21 Maltodextrin 49.2 Glucose syrup 3.99 Soya lecithin 0,03 Potassium citrate 0.62 Sodium Citrate 0.83 Potassium phosphate 0.87 Sodium Chloride 0.30 Magnesium chloride 0.56 Zinc Sulfate 0.016 Iron sulfate 0,020 Manganese chloride 0.0018 Copper sulfate 0.0015 Potassium iodide 0.00005 Sodium bicarbonate 0.00019 Lemon acid 0.00013 Ammonium Molybdenum Acid 0.000019 Chromium chloride 0.000068 Sodium Selenite 0.000022 Vitamin A 0,00041 Vitamin D ₃ 0.0000012 Vitamin E 0.006 Vitamin K ₁ 0.000032 Vitamin C 0,046 Vitamin PP 0.0065 Vitamin B ₁ 0,0008 Vitamin B ₂ 0,0007 Vitamin B ₃ 0.0020 Vitamin B ₆ 0.0010 Vitamin B _c 0.00010 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline bitartrate 0.22 Ascended palmitate 0.0040 Water The rest is up to 100 kg

In the product obtained according to example 8, the ratio of maltodextrin and glucose syrup is 12.3: 1, respectively. The use of this product is undesirable, as it can lead to excessive glucose in the patient’s blood and cause diarrhea.

Example 9. To prepare 100 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

The milk protein concentrate obtained ultra and diafiltration method 14.0 Whey Protein Concentrate 9,4 Medium Chain Triglyceride Concentrate 8.42 Rapeseed oil, low erucic 4.21 Soybean oil 4.21 Maltodextrin 51,2 Glucose syrup 2.05 Lecithin 0,03 Potassium citrate 0.62 Sodium Citrate 0.83 Potassium phosphate 0.87 Sodium Chloride 0.30 Magnesium chloride 0.56 Zinc Sulfate 0.016 Iron sulfate 0,020 Manganese chloride 0.0018 Copper sulfate 0.0015 Potassium iodide 0.00005 Sodium bicarbonate 0.00019 Lemon acid 0.00013 Ammonium Molybdenum Acid 0.000019 Chromium chloride 0.000068 Sodium Selenite 0.000022 Vitamin A 0,00041 Vitamin D ₃ 0.0000012 Vitamin E 0.006 Vitamin K ₁ 0.000032 Vitamin C 0,046 Vitamin PP 0.0065 Vitamin B ₁ 0,0008 Vitamin B ₂ 0,0007 Vitamin B ₃ 0.0020 Vitamin B ₆ 0.0010 Vitamin B _c 0.00010 Vitamin B ₁₂ 0.000001 Vitamin H 0.00005 Choline bitartrate 0.22 Ascended palmitate 0.0040 Water The rest is up to 100 kg

The product obtained according to example 9 is not suitable for consumption - very tasteless (the ratio of maltodextrin and glucose syrup is 24.9: 1, respectively).

Table 2 presents the chemical composition of the Nutrien Standard product

Table 2.
The chemical composition of the product "Nutrien Standard" The average composition of the product in 100 g of product in 100 ml of the product 1 ml / 1 kcal Energy value, kcal 448 one hundred Protein, g 18.0 4.0 Fat g 16,0 3.6 Carbohydrates, g 58.0 12.9 Minerals: calcium, mg 330 73 phosphorus mg 330 73 potassium mg 550 123 sodium mg 350 78 magnesium mg one hundred 22 copper, mcg 360 80 manganese, mcg 360 80 iron mg 3,5 0.8 zinc mg 3.6 0.8 chlorides, mg 500 111 iodine, mcg 36 8.0 chromium, mcg fifteen 3.3 molybdenum, mcg 17 3.8 selenium, mcg 17 3.8 Vitamins: retinol (A), mcg 209 46 tocopherol (E), mg 2.1 0.5 calciferol (D), mcg 0.6 0.1 vitamin K, mcg fifteen 3.3 thiamine (B ₁ ), mcg 302 67 riboflavin (B ₂ ), mcg 350 78 pantothenic acid, mcg 1400 312 pyridoxine (B ₆ ), mcg 442 98 niacin (PP), mg 3,7 0.8 folic acid, mcg 47 10 cyanocobalamin (B ₁₂ ), mcg 0.7 0.15 ascorbic acid (C), mg 17 3.8 biotin, mcg thirty 6.7 choline mg one hundred 22 Osmolarity, mOsm / l - 356

Clinical testing of a nutritious balanced Nutrien Standard nutritional formula was conducted at the Main Military Clinical Hospital named after Acad. NN Burdenko on the basis of resuscitation and intensive care units of the Center of Anesthesiology and Resuscitation.

The purpose of clinical testing is to study the possibilities and evaluate the effectiveness of using the Nutrien Standard mixture for the correction of metabolic disorders and adequate provision of the energy-plastic needs of the body in the complex treatment of patients with a surgical and therapeutic profile.

Accordingly, the objectives of this work, the Nutrien Standard mixture was used in the intensive care complex of 49 patients and patients with peritonitis; combined trauma; traumatic brain injury; cancer cachexia; in the postoperative period in patients with coronary heart disease who underwent surgical myocardial revascularization; strokes (table 3). Of the total number of patients (Table 3), 20.4% received the mixture orally in the form of a drink (group 1), 32.6% received it intragastrically through a nasogastric tube (group 2), and 46.9% received it intra-intestinally (3- I am a group). The age of patients is from 19 to 75 years. The duration of nutrition ranged from 5 to 20 days.

Table 3.
DISTRIBUTION OF PATIENTS BY THE CHARACTER OF THE DISEASE AND WAYS OF INTRODUCTION OF THE MIXTURE "Nutrien Standard" Diagnosis Number of patients Mixture introduction orally into the stomach into the small intestine 1 group 2 group 3 group Peritonitis 9 - - 9 Combined eleven - four 7 TBI 5 - 5 Stomach cancer four - - 7 Ischemic, hemorrhagic stroke 7 7 - Ischemic heart disease 10 10 - - TOTAL 49 10 (20.4%) 16 (32.6%) 23 (46.9%)

Indications for enteral nutrition were disturbances in water-electrolyte and protein balance, increased energy expenditures as a result of surgical operations, injuries, purulent-septic complications, weight loss, the need to correct hypermetabolism syndrome, and maintenance of an adequate nutritional status.

Monitoring the effectiveness of using the Nutrien Standard mixture in the system of artificial medical nutrition was carried out according to clinical, laboratory and functional research methods, determining the degree and type of malnutrition.

The clinical criteria for the good absorption of the Nutrien Standard mixture were the absence of signs of dyspeptic disorders (nausea, vomiting, flatulence, diarrhea). The metabolic and nutritional status was evaluated according to biochemical studies, somatometry results. Daily requirements for basic nutritional ingredients were determined using balanced calculations. In addition, at all stages of treatment, the state of the main functions of the gastrointestinal tract was monitored.

In patients of the 1st group, the integrity of the intestinal tube and the main functions of the gastrointestinal tract were preserved. At the same time, as our studies have shown, cardiosurgical interventions lead to the development in the postoperative period of severe nutritional deficiency due to the loss of plasma proteins on the membranes of the heart-lung machine in combination with the development of the postoperative syndrome of hypermetabolism-hypercatabolism, nitrogen loss in urine, and negative nitrogen. It should also be noted that in patients with coronary heart disease chronic circulatory failure and prolonged tissue hypoxia lead to severe metabolic disorders with the formation of protein-energy deficiency. So, before surgery, in 77.3% of patients, nutritional insufficiency was defined as mild, in 22.7% of cases - moderate with weight loss, hypoproteinemia. On the first day after performing surgical myocardial revascularization, metabolic processes increase - the actual main metabolism exceeds the initial one by 140-170%. Loss of nitrogen reaches 12-15 g per day, and total protein is reduced to 56-58 g / l.

As our earlier studies showed, against the background of traditional therapy (partial parenteral nutrition with the transition to a hospital diet), within 10 days after surgery, the patient’s body weight progressively decreases by 5 days by 7.5%, by 10 days by 10 ,9%. The negative dynamics of both anthropometric and biochemical parameters indicated the presence of uncorrected nutritional deficiency, and the number of patients with moderate nutritional deficiency increased (68.9%). The complication rate in the postoperative period reached: CCH - 27.8%, respiratory failure - 44.4%, cardiac arrhythmias - 44.4%, encephalopathy - 16.6%, pericarditis - 61.1%, sternum failure - 12.9%. The postoperative period was 49.4 ± 7.9 days.

Patients of the 1st group received nutrition with the Nutrien Standard mixture orally from 2-3 days after the operation. In the first 3 days after surgery, 3 patients received food through a tube and then orally. Based on calculations of the daily need for nutrients and energy in conditions of varying severity, 90% of patients were corrected for violations with the Nutrien Standard mixture as the main source of nutrition. The daily volume of the injected mixture was 1000-1500 ml, energy intensity - 1 kcal / ml. If necessary, limiting the volume of injected fluid calorie was increased to 1.25-1.5 kcal / ml

In 2 patients of the 1st group, a 20% solution of the mixture supplemented dietary nutrition. With an increase in dietary intake, the volume of the mixture ranged from 400 to 1000 ml per day (150-200 ml - 3-5 times a day) of a 20% solution (400-1000 kcal).

Good taste of the Nutrien Standard mixture was noted by all patients. Medical staff drew attention to the easy solubility of the mixture in drinking water at room temperature. A mixer was not required to dissolve the mixture. The mixture easily passed through probes of any diameter, including nipple ones.

The results of the studies showed that, in contrast to "normal nutrition", nutritive support with the early use of oral / probe nutrition with the Nutrien Standard mixture has a pronounced clinical effect. So the decrease in body weight within 10 days after surgery compared with the preoperative period did not exceed 1.5-2%. An increase in the total protein of blood serum and albumin, a positive nitrogen balance, an increase in the absolute number of lymphocytes was noted (Table 4). Against this background, a decrease in postoperative bed day by 44.2% was revealed. In addition, the number of complications significantly decreased: CCH by 15.3%, encephalopathy by 6.2%, cardiac arrhythmias by 31.9%, pericarditis by 29.8%, sternum failure by 8.7%.

Table 4.
Dynamics of anthropometric and biochemical parameters during oral enteral nutrition with the Nutrien Standard mixture of patients of the 1st group. indicators research stages before surgery after operation 1-3 days 5-7 days 10-15 days OP, cm 24.2 ± 1.9 22.5 ± 0.8 23.1 ± 1.1 23.7 ± 0.5 KZhST, mm 9.1 ± 0.7 8.3 ± 1.1 8.9 ± 0.5 9.0 ± 0.9 WMD, cm 22.9 ± 1.2 21.8 ± 0.4 22.1 ± 0.7 22.8 ± 0.3 total protein, g / l 59.6 ± 3.5 54.8 ± 2.1 61.2 ± 1.3 64.4 ± 1.1 albumin, g / l 32.7 ± 2.8 29.9 ± 1.2 31.5 ± 1.4 33.1 ± 1.9 lymphocytes 1300-1400 1000-1100 1200-1300 1300-1400 nitrogen balance, g / 24 hours -3-4 -13-15 + 0.8-0.9 + 2.9-3.5

Conducting nutritional support in patients with severe head injury, combined trauma (without compromising the integrity of the digestive tract) and cerebrovascular accident has features due to the nature of the pathology and the approach to the implementation of primarily enteral nutrition. This category of patients has no organic damage to the gastrointestinal tract. At the same time, there is severe damage to the brain, the central nervous system, which regulates not only metabolic processes, but also the function of all organs and systems of the body. The reaction of the body to trauma, cerebral ischemia is characterized by a combination of general changes characteristic of the post-aggressive reaction of any etiology, and specific, caused by damage to the brain (coma, anorexia, swallowing disorder). One of the manifestations of the nonspecific reaction of the body to aggression in this category of patients is gastrointestinal failure due to mesenteric ischemia and hypoxia of the intestinal mucosa, up to the development of paresis, erosive gastritis, and acute stress ulcers.

Patients of the 2nd group introduced the mixture through a probe intragastrically using a dropper by the gravimetric method at a speed of 40-50 drops / min, continuously for 15-16 hours. Good rheological properties of the mixture made it possible to use silicone probes of small diameters (0.3-0.4 cm), which, when they are in the oropharynx and esophagus for a long time, do not cause local and general complications, often arising when using large-diameter probes. On average, from 2000 to 3500 ml of the mixture was administered per day. Given the functional state of the gastrointestinal tract in the early postoperative period, we started with a 5% solution, gradually switching to 10-20% solution of the mixture (2000-3000 kcal per day). Such a scheme for introducing the Nutrien Standard mixture avoids the development of possible dyspeptic reactions. If it is necessary to increase the energy intensity of enteral nutrition according to daily requirements, the density of the mixture was increased to 1.5 kcal / ml, while the rheological properties of the mixture did not change, the flow rate did not decrease and it easily passed through small-diameter probes. No complications were noted.

Given the severity of the condition of patients of the 2nd group (5-8 points on the Glasgow scale), during the first three days they were given infusion-transfusion therapy (40-45 ml / kg per day), including parenteral nutrition aimed at stabilizing hemodynamics, detoxification correction of anemia, volemic, water-electrolyte and protein disorders. With the beginning of a full-fledged intragastric tube feeding (2-3 days), the volume of infusion-transfusion therapy was reduced by 1.5-3 times, primarily due to parenteral nutrition preparations, and, subsequently, the complete abolition of infusion therapy. The results of biochemical and immunological studies indicate the effectiveness of enteric therapy with the Nutrien Standard mixture, which allows adequately correcting metabolic disturbances to normal levels in a relatively short period of time and fully providing the energy and plastic needs of the body in patients and victims with head injury, combined trauma, hemorrhagic and ischemic a stroke. It should also be noted a significantly better neurological outcome in this category of patients and a reduction in the duration of rehabilitation, reduction in mortality to 7.5%, the frequency of secondary complications (pneumonia by 21.3%) and the duration of mechanical ventilation (by 2–3 days) (Table 5) .

Table 5.
Changes in biochemical and immunological parameters against the background of enteral probe nutrition with the Nutrien Standard mixture in patients of group 2. indicators research stages 1-3 days 5-7 days 10-15 days Total protein, g / l 56.4 ± 2.5 61.3 ± 3.3 63.1 ± 2.6 Albumin, g / l 27.1 + 1.1 29.3 + 0.9 32.3 + 0.7 Energy consumption, kcal / kg / 24 hours 43.1 ± 1.6 41.9 ± 1.4 30.2 ± 1.3 Nitrogen balance, g / 24 hours -17.5 ± 2.1 -8.3 ± 1.7 + 4.9 ± 1.4 lymphocytes 900 -1000 1200-1400 1600-1700

The implementation of intragastric tube nutrition in patients with preserved gastrointestinal function is not particularly difficult. However, intragastric tube feeding is not always possible. The use of this method, especially in critical conditions, is hampered by severe violations of the gastrointestinal tract, characteristic of the post-aggressive period of any etiology, even in the absence of organic damage to the stomach and intestines. From this perspective, it is of interest to carry out an EZP with the Nutrien Standard mixture by directly introducing it into the small intestine and the effectiveness of nutritional support.

The third group consisted of 23 patients. Including - 9 operated on an emergency basis for general fibrinous-purulent peritonitis in the toxic (63%) and terminal (37%) phase; 7 - severe combined trauma with damage to the hollow and parenchymal organs of the abdominal cavity; 7 - operated (total-subtotal gastrectomy) in a planned manner for cancer of the output section of the stomach and the development of gastrointestinal dysfunction in the postoperative period.

The results of the examination of patients of the third group (Table 6) indicated the presence of hypermetabolism syndrome with impaired water-electrolyte and protein metabolism, severe protein-energy deficiency.

When studying the main indicators of metabolism on the 1st day after the operation, a pronounced metabolic reaction of the body with impaired water-electrolyte and protein metabolism, activation of the sympathetic-adrenal and hypothalamic-pituitary-adrenal systems was found in patients. An increase in blood levels of hormones - ACTH to 42.3 ± 14.01 pg / ml and cortisol to 37.9 ± 6.92 μg / dl indicated the activation of catabolic processes. Violation of the basic functions of the liver was characterized by an increase in the activity of aminotransferases (670.1 ± 106.8 nmol / s · l) and alkaline phosphatase (968.5 ± 116.5 nmol / s · l), an increase in the blood ammonia content (1.41 ± 0.088 mmol / L), LDH, LDH, GDH. Hypo- and dysproteinemia indicated a decrease in the protein-forming function of the liver and an increase in protein losses (total protein level 52-55 g / l, A / G coefficient 0.78). An increase in intoxication was indicated by an increase in blood levels of creatinine (114.9 ± 9.95 mmol / L) and urea nitrogen (14.74 + 1.5 mmol / L), high leukocytosis (up to (10-11) · 10 ⁹ / l of leukocytes) with a shift of the formula to the left (stab 35–40%, segmented 57–60%), the level of average molecules in the blood is 0.432-0.497 conventional units When examining the biochemical parameters of urine, the increased excretion of potassium (93.34 ± 6.39 mmol / day) and nitrogenous products (creatinine 18.5 ± 0.4 mmol / day, urea 561.4 ± 54.9 mmol / day). Loss of nitrogen in the urine was quite large - 15-17 g / day.

Table 6.
DYNAMICS OF BIOCHEMICAL INDICES IN PATIENTS OF THE THIRD GROUP AT INTRA-SCENE INTRODUCTION OF THE MIXTURE "NUTRIEN STANDARD" IN THE POST-OPERATION PERIOD. INDICATORS Stages of the study (day after surgery) 1st 3rd 5th 7th Total protein, g / l 59.1 + 0.38 56.1 + 0.14 60.7 + 0.11 62.2 + 0.27 Albumin, g / l 31.3 + 1.6 26.2 + 0.8 30.1 + 0.65 32.7 + 0.7 Globulins, g / l 27.7 + 2.7 29.8 + 1.5 30.6 + 0.92 29.6 + 0.87 A / G ratio 1.01 + 0.02 0.87 + 0.01 0.98 + 0.03 1.1 + 0.05 Potassium plasma, mmol / l 4.01 + 0.23 3.3 + 0.09 3.95 + 0.11 3.81 + 0.12 Red blood potassium, mmol / l 88.3 ± 5.8 89.5 ± .1.8 91.3 + 1.3 89.9 ± .3.5 Plasma sodium, mmol / l 138.8 ± 1.3 136.5 ± 0.8 138.6 ± 3.9 139.4 ± 1.1 The number of leukocytes, 10 ⁹ / l 11.5 ± .1.4 7.11 ± .0.4 6.7 ± .0.46 7.53 ± .0.47 Glucose, mmol / L 10.1 + 1.7 6.5 + 0.49 6.8 + 0.61 6.2 + 0.19 ALT, nkat / l 1396.7-1415.1 1078.3-1130.5 590.0-636.1 475.0-518.3 ACT, nkat / l 1103.3.-1196.5 997.7-1014.3 528.3-581.6 425.0-446.7 LDH (total), nmol / (s · l) 6954.7 ± 1135.06 6594.6 ± 7652 5312.7 ± 486.7 61863 ± 565.1 GGTP, nmol / (s · l) 775.2 ± 98.8 2770.5 ± 488.4 785.2 ± 226.8 510.1 ± 80.8 Urea nitrogen, mmol / l 15.1 ± 3.5 16.1 ± 1.45 13.44 ± 1.04 12.7 ± 2.05 Osmolarity of plasma, mOsm / l 303.2-327.6 295.1-296.2 290.0-291.5 288.4-290.5 The number of lymphocytes in peripheral blood in 1 ml 910.5 + 89.1 893.7 ± 101.2 1076.9 ± 112.7 1120.6 ± 95.3 URINE Creatinine, mmol / day 18.56 ± 0.9 16.8 ± 0.69 9.6 ± 0.8 9.01 ± 0.85 Urea, mmol / day 549.4 ± 66.7 561.3 ± 22.7 379.6 ± 42.5 266.3 ± 19.4

Energy expenditures reached 43-46 kcal / kg / 24 hours. The balance of nitrogen and energy was negative, respectively - 16-20 g / 24 hours, - 25-27 kcal / kg / 24 hours. The number of lymphocytes in 1 ml of blood did not exceed 900.

The amount of stagnant contents in the gastrointestinal tract reached 1000-2000 ml / day. Enterography testified to the presence of intestinal insufficiency syndrome. In order to restore the functions of the gastrointestinal tract, correct metabolic disorders and provide early enteral nutrition for all patients of the third group, a two-channel multifunctional probe (ZKS 21) was installed intraoperatively in the initial sections of the small intestine (50-70 cm distal to the Treitz ligament). From the first hours after surgery, the probe was used for decompression, intestinal lavage, and enterosorption. Intestinal lavage was performed with glucose-salt solution (potassium 0.9 g / l, sodium - 2.5 g / l, glucose - 6 g / l) with a volume of up to 3000 ml / day. The mixture was injected via a perfusion pump or dropper through the infusion channel of the probe at a rate of 100 ml / hour. The decompression channel of the probe was connected to the suction, creating a vacuum of 10-15 mm H ₂ O Art. During this period, the correction of volemic and metabolic disorders was achieved by adequate infusion-transfusion therapy (60-70 ml / kg / day). For parenteral nutrition, infusion therapy included medium solutions of amino acids (14 ml / kg / day), 20% glucose solution - 1200 ml / day, 20% Lipofundin MCT / LCT solution - 500 ml / day. Under objective control over the state of the digestive and absorption functions of the small intestine by the method of segmental perfusion, we gradually phased in the intra-intestinal introduction of the Nutrien Standard mixture of increasing calorie content and nutritional value. At the first stage, on average 24 hours after the operation, the intestinal absorption capacity in relation to the glucose-electrolyte solution was restored. This allowed on the second day to enter intracutally up to 2 l of glucose electrolyte solution, and from 3 to 4 days - 1000-1500 ml of 5% solution of the Nutrien Standard mixture. From the beginning of intra-intestinal infusions, the volume of solutions administered intravenously, including parenteral nutrition preparations, was reduced on average 1.5-2 times. On days 5-6, when switching to enteral administration, 10%, and then a 20% solution of the Nutrien Standard mixture (2000-2500 ml / day = 2000-25000 kcal) infusion therapy was almost completely stopped. At the same time, the total volume of fluid and nutrients entering the body remained adequate to the losses and provided for the needs of the patient's body. This is confirmed not only by the data of clinical observations, but also by the results of biochemical studies (tab. 6). The duration of intraintestinal tube nutrition ranged from 7 to 11 days. No complications and reactions to the introduction of the Nutrien Standard were noted intradermally. Subsequently, after being transferred to the hospital ward, patients continued to take the mixture orally in the form of a drink up to 1000 ml / 24 hours in combination with diet food for 5-7 days.

In general, the results of studies on the use of Nutrien Standard as an enteral nutrition in the intensive care complex for critical conditions in patients and patients with a surgical profile indicate the clinical efficacy of its use, which allows adequately correcting metabolic disorders and fully ensuring the energy-plastic needs of the body, reducing the volume and terms of parenteral nutrition, provide the most natural way of introducing nutrients, reduce frequent from postoperative and post-traumatic complications, reduce the treatment time for patients. Preparation of the mixture for use does not require special equipment, it is well diluted with ordinary drinking water without additional heat treatment and technical means (mixer). Nutrien Standard can be used as the sole source of nutrition as a supplement to regular or parenteral nutrition. Good rheological properties of the mixture and low viscosity allow the mixture to be introduced into probes of any diameter, including nipple ones. As a probe supply, the mixture can be introduced into the stomach, the duodenum, or the initial sections of the small intestine. The Nutrien Standard mix is a complete balanced diet. The composition of the mixture and its high clinical effectiveness meet modern requirements for mixtures of artificial medical nutrition. The presence of medium chain triglycerides increases the digestibility of the mixture in the digestive tract, its energy value. The content of medium chain triglycerides expands the list of clinical conditions in which the Nutrien Standard mixture can be used - insufficient digestion of fats and pancreatic enzymes, impaired lipid transport through the lymphatic system, chylous ascites, in the treatment of intestinal fistulas. Such conditions include pancreatitis, pancreatic insufficiency, liver diseases, biliary atresia, etc. The positive data on the effectiveness and tolerance obtained as a result of testing allow recommending Nutrien Standard for wide clinical use in various categories of patients and victims.

Clinical testing of Nutrien Standard nutrient mixture was also conducted in City Clinical Hospital No. 64, in the second intensive care unit.

Research objectives: to study and evaluate the clinical and metabolic efficacy of the Nutrien Standard balanced nutritional mixture when providing nutritional support to patients in critical conditions, as well as to study the possibility and effectiveness of early enteral nutrition in various categories of patients being treated in the intensive care unit.

Materials and research methods. Enteral probe nutrition was started in the early postoperative period after various surgical interventions, or in the early period of a traumatic disease after receiving a severe combined injury. This type of nutritional support was prescribed to 31 patients, among them 15 men and 16 women. The average age of patients is 57 years. Enteral probe nutrition was carried out by patients after extensive surgical interventions, such as stomach resections, gastrectomy, operations for peritonitis of various etiologies, operations for intestinal obstruction, hemicolectomy, pancreato-duodenal resections, surgical interventions for acute pancreatitis and nancreonecrosis. etc., as well as victims with severe combined injuries, including patients with severe craniocerebral injuries; oral nutritional support was given to patients who were conscious, who did not have signs of anorexia.

All patients were divided into three groups. The first group consisted of 7 patients who received Nutrien Standard orally in the form of a drink, the second group consisted of patients who were injected into the stomach through a nasogastric tube - 16 people. The third group includes patients receiving the nutrient mixture into the small intestine through enteral probes - 8 people.

The method of nutritional support was to install a nasogastric tube, and to exclude food stimulation of the pancreas, decompression of the intestine or intestinal lavage, a naso-intestinal tube (intraoperative or endoscopic methods). Nutritional support began to be carried out as the function of the gastrointestinal tract was restored (the appearance of intestinal motility, a decrease in the amount of discharge by the probe), usually by the end of the second or at the beginning of the third day after surgery or after removing the victim from shock after serious injuries. On the first or second day, as a rule, in conditions of paresis of the gastrointestinal tract, infusion into the probe of isosmolar glucose-salt solutions was carried out, and the patient was given parenteral nutrition. Subsequently, the Nutrien Standard polymer mixture began to be applied enteral, with a gradual increase in its concentration to 1 kcal / ml and the volume of the injected mixture to 2-3 liters per day (daily calorie intake was prescribed depending on individual energy needs). Food was started by the drip method at an initial rate of 40 ml / hour, and with good tolerance, the rate of administration was increased by 25 ml / hour every 10-12 hours.

Somatometric (body mass index, circumference of the shoulder muscles, thickness of the skin-fat folds above the triceps), clinical, functional (analysis of the balance of the water sectors of the body), as well as laboratory (total protein, absolute number of lymphocytes, blood amylase, blood glucose, were regularly evaluated: electrolytes, platelets, etc.) indicators characterizing the nutritional status of patients, as well as their tolerance to the mixture (nausea, vomiting, belching, abdominal pain, bloating, the nature and frequency of stools, a feeling of fullness). The duration of enteral probe nutrition with the Nutrien Standard mixture lasted from 2 to 23 days.

In the process of dynamic observation against the background of the ongoing complex intensive care, including enteral tube nutrition "Nutrien Standard". a fairly rapid normalization of the main parameters of homeostasis, an increase in the blood of total protein, lymphocytes, hemoglobin, and compensation of volemic indicators were noted; earlier restoration of bowel function; improving the well-being of patients. By 4-5 days, the nitrogen balance became positive, respectively, the excretion of creatinine and urea decreased. In addition, the enteral use of Nutrien Standard in the early postoperative and post-traumatic period created favorable conditions for rational infusion therapy, early activation and prevention of postoperative complications.

The results of clinical, biochemical and functional research methods.

I) Analysis of the balance of the water sectors of the body by the method of spectral bioimpedansometry by the hardware and software complex "A BC-01 MEDASS":

A) Dynamics of the balance of water sectors in the first group of patients (% of due):

Liquid sector / day since the start of nutritional support Before the start of the EP 2 days from the beginning of enteral nutrition 5 days from the beginning of enteral nutrition Studded Ox 91.4% 97.6% 98.9% Extracellular water 85.2% 84.6% 98.4% Intracellular water 89.3% 99.1% 99.6% Bcc 84.6% 88.3% 93.7% OCP 84.8% 89.1% 95.6% Interstitial space 90.4% 102.5% 99.5%

B) Dynamics of the balance of water sectors in the second group of patients (% of due):

Liquid sector / day since the start of nutritional support Before the start of the EP 2 days from the beginning of enteral nutrition 5 days from the beginning of enteral nutrition Total water 90.2% 98.4% 99.5% Extracellular ox 82.1% 85% 99.4% Intracellular ox 89% 104% 101% Bcc 77.3% 84% 89% OCP 75.5% 82.1% 87.8% Interstitial space 85.6% 88.5% 98.7%

C) Dynamics of the balance of water sectors in the third group of patients (% of due):

Liquid sector / day since the start of nutritional support Before the start of the EP 2 days from the start of ES 5 days from the start of ES Total water 92.4% 101, .3% 100.5% Extracellular water 90.2% 95.7% 98.5% Intracellular water 93.3% 95.2% 99.6% Bcc 85% 88.4% 89.5% OCP 90.7% 92% 97.6% Interstitial space 91% 102% 98.5%

2) Data from clinical blood tests:

A) Dynamics of clinical blood tests in patients of the first group:

Laboratory indicator / day since the onset of EP Before the start of the EP 2 days from the start of ES 4 days from the start of ES 6 days from the start of ES Hemoglobin, g / l 91.4 96.6 104.2 109.8 Red blood cells, million in mm ³ 3.2 3.42 3.8 4.2 White blood cells, thousand in mm ³ 9.7 9.8 9.9 8.4 Lymphocytes, thousand in mm ³ 1.19 1.38 1.55 1.76 Platelets, thousand in mm ³ 168.4 161.7 185.2 285.4

B) Dynamics of clinical blood tests in patients of the second group:

Laboratory indicator / day from the onset of EP Before the start of the EP 2 days from the start of ES 4 days then the onset of ES 6 days from the start of ES Hemoglobin, g / l 90,4 92.4 98.1 103.7 Red blood cells, million in mm ³ 3.05 3.42 3.58 4.32 White blood cells, thousand in mm ³ 11.2 10,4 9.5 9.1 Lymphocytes, thousand in mm ³ 1,1 1.25 1.68 1.84 Platelets, thousand in mm ³ 173.5 182.4 185.7 219.3

C) Dynamics of clinical blood tests in patients of the third group:

Laboratory indicator / day from the onset of EP Before the start of the EP 2 days from the start of ES 4 days from the start of ES 6 days from the start of ES Hemoglobin, g / l 94.3 96.2 98.5 104.8 Red blood cells, million in mm ³ 3.2 3.6 4.1 4,5 White blood cells, thousand in mm ³ 10,2 9.9 9.6 8.1 Lymphocytes, thousand in mm ³ 1,1 1.19 1.3 1,5 Platelets thousand in mm ³ 155 170 192 216

3) Data from a biochemical blood test:

A) Dynamics of biochemical blood tests in patients of the first group:

Laboratory indicator / day from the onset of EP Before the start of the EP 2 days from the start of ES 4 days from the start of ES 6 days from the start of ES Total protein, g / l 52,2 54.3 57.8 62.6 Urea, mmol / L 6.1 6.8 5,4 5.2 Creatinine, μmol / L 77.23 75.1 71.14 66.32 Glucose, mmol / L 6.3 4.2 5.1 4.4 Potassium, mmol / L 3.8 3.87 4.09 4.3 1 Sodium, mmol / L 135 137.3 141.5 142.4 Chlorides, mmol / L 99 one hundred 101 one hundred ALT 65 60,4 50,2 35.4 ACT 55.2 51,4 44.8 34.3 34.3 Total bilirubin, µmol / l 18.2 12.5 10.7 8.6

B) Dynamics of biochemical blood tests in patients of the second group:

Laboratory indicator / day from the onset of EP Before the beginning 2 days from the start of ES 4 days from the start of ES 6 days from the start of ES Total protein, g / l 48.9 53.6 56.5 61.4 Urea, mmol / L 7.1 6.2 5.8 5.1 Creatinine, μmol / L 77.2 68.4 68.1 60.5 Glucose, mmol / L 6.7 4.78 4.6 4.8 Potassium, mmol / L 3.5 4.0 4.1 4.3 Sodium, mmol / L 135.2 137 139 141 Chlorides, mmol / L 98 100.1 105.5 102.1 ALT 55 47.3 38.56 21.48 ACT 38.1 32,3 28.6 22.7 Total bilirubin, µmol / l 18.1 16,4 12.5 9.9

C) Dynamics of biochemical blood tests in patients of the third group:

Laboratory indicator / day from the onset of EP Before the start of the EP 2 days from the start of ES 4 days from the start of ES 6 days from the start of ES Total protein, g / l 52.4 53.8 55.6 63.5 Urea, mmol / L 6.4 7.1 6.1 5.3 Creatinine, μmol / L 77.0 75,2 71.2 66.7 Glucose, mmol / L 6.47 5.2 4.8 4.6 Potassium, mmol / L 3.4 3.8 4,5 4.4 Sodium, mmol / L 129 135 135 141 Chlorine, mmol / L 98.2 99,4 100.1 100.0 ALT 65 60.1 51.01 35.4 ACT 48.7 45,2 40.12 32.6 Total bilirubin, µmol / l 15.6 10.9 9.6 9.3

Findings:

1. The balanced polymer mixture Nutrien Standard has high clinical and metabolic efficacy in different categories of patients and provides effective correction of the energy and plastic needs of the body, and also contributes to a fairly rapid stabilization and normalization of biochemical and clinical indicators of homeostasis.

2. The beginning of early enteral nutrition in the postoperative period using the Nutrien Standard mixture promotes a more rapid restoration of the functions of the gastrointestinal tract.

3. Due to the beginning of early enteral nutrition, it is possible to quickly compensate for volemic indices and reduce the volume of infusion therapy to the required minimum, which is especially important in patients with heart and respiratory failure.

4. Comparison of controlled parameters in three groups of patients did not reveal a significant difference, which indicates the possibility of the effective use of Nutrien Standard for various routes of administration.

5. The use of the Nutrien Standard mixture as part of complex therapy led to accelerated reparative processes, improved overall well-being of patients, their activity increased; reduced treatment time in the intensive care unit.

6. The Nutrien Standard mixture is well tolerated by patients, when used correctly it does not cause complications, is convenient to use, and can be recommended as an enteral probe as well as oral nutrition in critically ill patients.

The inventive product is intended for enteral and oral nutrition of children older than three years, as well as adults. It is intended for enteral nutrition through a tube or for use as a drink, as an additive to food. It can be used for nutritional deficiency, cachexia; with a violation of the absorption of fats; during the transition from parenteral to enteral nutrition, in combination with parenteral nutrition; with enteral nutrition of patients in critical conditions, in intensive care units; with physical and emotional overload; with loss of appetite, inability or refusal to eat; as food in the pre- and postoperative period; in case of damage to the maxillofacial area (trauma, operation), violation of the act of swallowing; with a disease of the nervous system (cerebrovascular accident, stroke, impaired consciousness); with neurosurgical interventions; with complications of the postoperative period in the gastrointestinal tract; with injuries of craniocerebral, burn, bone fractures; with malnutrition of cancer patients; in cases of malnutrition in chronic diseases of the gastrointestinal tract (peptic ulcer of the stomach and duodenum, inflammatory diseases of the colon, gastritis); with acute exogenous poisoning, with infectious diseases; with AIDS. In the claimed product, the lactose content is less than 0.1%, i.e. this product can be used as the main source of nutrition (instead of dairy products) for patients with lactase deficiency (with a low-lactose or lactose-free diet).

The creation of this product allows you to expand the range of prophylactic products for enteral and oral nutrition of children and adults.

Information sources

1. Popova TS, Shestopalov A.E., Tamazashvili T.Sh., Leiderman I.N. Nutritional support for patients in critical conditions. M .: Publishing house "M-Vesti", 2000, p.150-151.

2. Product "Nutren" ("Nutren"). Switzerland. Release date 01.2001, SH-PP7AS ACB008 (prototype).

Claims (1)

Enteral nutrition dairy product, including a source of whey proteins, a medium chain triglyceride source, low eruca rapeseed oil, maltodextrin, lecithin, minerals, vitamins and water, characterized in that it additionally contains a milk protein concentrate obtained by ultra- and diafiltration, soybean oil, glucose syrup contains a whey protein concentrate as a source of whey proteins, and a medium chain concentrate as a source of medium chain triglycerides tseridov, wherein the weight ratio of the concentrate of medium chain triglycerides, soybean and rapeseed oils nizkoerukovogo respectively is 2: 1: 1, with the following ratio of components, wt% (on dry substance).: Milk protein concentrate, obtained by ultra and diafiltration 13.0 ÷ 14.0 Whey concentrate protein 8.6 ÷ 9.4 Medium Chain Concentrate triglycerides 7.68 ÷ 8.42 Rapeseed oil, low erucic 3.84 ÷ 4.21 Soybean oil 3.84 ÷ 4.21 Maltodextrin 48.6 ÷ 56.1 Glucose syrup 2.1 ÷ 4.5 Lecithin 0.027 ÷ 0.03 Minerals 2.149273 ÷ 3.320299 Vitamins 0.1688611 ÷ 0.30510937 Water Rest