RU2311038C2 - Product for enteral feeding - Google Patents

Abstract

FIELD: dairy industry, in particular product for tube and peroral feeding for adult and infant of 3 years old or older.

SUBSTANCE: claimed product contains concentrate of whey proteins, hystidine amino acid, concentrate of medium chain triglycerides, rape oil, soy oil in mass ratio of medium chain triglycerides, soy oil, and rape oil of 2:1:1, respectively., maltodextrin, glucose syrup, minerals, vitamins and water.

EFFECT: product of increased nutrient value, improved quality, dietary, and organoleptic characteristics.

1 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 for chronic kidney diseases and acute renal failure.

Known liquid milk product for enteral and oral nutrition ″ Nepro ™ "(″ Henpo ™ ″) manufactured by Ross Laboratories, USA, containing caseinates of calcium, magnesium and sodium, milk protein isolate, safflower oil and rapeseed oil, corn syrup (maltodextrin) , sugar, fructooligosaccharides, mineral salts, fat-and water-soluble vitamins and water [1]. This product is used for chronic kidney disease and renal failure.

The disadvantage of this product is the use of calcium, magnesium and sodium caseinates in it as a protein source, the production technology of which includes the stages of treatment with acids, alkalis, and 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 lack of certain essential amino acids (methionine) leads to a decrease in the biological value of this protein source. The amino acid composition of this protein component is not adequate to the needs of renal patients - too many interchangeable amino acids that create an additional nitrogen load, leading to the accumulation of nitrogen metabolism products in the blood (urea, etc.) with a deterioration in the well-being and quality of life of patients. At the same time, the protein content in the product is too high for kidney patients (16% by weight of solids, 14% by total calorie content), which can lead to the same adverse consequences.

The fat component of this product contains safflower and rapeseed oil. In this composition, there is a relative excess of omega 6 fatty acids and a relative lack of omega 3 (w3), which can negatively affect the development of inflammatory processes in the kidneys (insufficient synthesis of prostaglandins with anti-inflammatory action - derivatives of w3 fatty acids). The fat component does not contain medium chain triglycerides, which impairs the absorption of fat in the intestines of the patient. In addition, since safflower oil contains almost exclusively PUFA (polyunsaturated fatty acids) w6, to maintain them in balance with PUFA w3, it is necessary to introduce additional amounts of rapeseed oil, which increases the cost of the product, and also introduces undesirable erucic acid into it in additional quantities, resulting in to metabolic disorders of fats and cholesterol. Thus, another disadvantage of the product is the non-optimal composition of its fat component.

The carbohydrate component of the product is represented by corn syrup and sugar (sucrose). The use of sucrose in the composition of the product does not seem to be optimal, since this sugar can create an undesirable increased load on the pancreatic insular apparatus in patients weakened due to chronic renal failure. In addition, the introduction of sucrose increases the osmolarity of the product (which impairs the absorption of the product components and creates a risk of developing diarrhea, especially with the probe method of administration), and can also cause undesirable fermentation processes, especially with prolonged use of the product. The last adverse effect can be compensated by introducing a prebiotic component - fructooligosaccharides, however, it should be borne in mind that the use of this additive significantly increases the cost of the product.

These shortcomings of the protein, carbohydrate and fatty components of the product lead to a decrease in its nutritional value for the considered group of patients.

The closest in technical essence and the achieved result to the claimed technical solution is liquid milk product Renalcal ™ Diet (Renalkal), manufactured in Switzerland by Nestle, containing whey proteins, a complex of essential amino acids, including the amino acid histidine, a fraction of medium chain triglycerides (represented by fractionated coconut oil) , rapeseed oil, corn oil, maltodextrin, modified starch, mineral salts of zinc and selenium, choline, water-soluble vitamins and water [2].

Renalkal is a lactose-free mixture of oral and tube nutrition for sick children older than 3 years and adults suffering from chronic kidney disease and acute renal failure.

The disadvantage of this product is that the total protein content in it is underestimated (7.9%), which may not satisfy the patient's needs for essential amino acids. In addition, the use of a large number of free amino acids significantly increases the osmolarity of the product, resulting in poor absorption of its components in the intestine.

The fat component of this product includes a large amount of medium chain triglycerides (the amount of medium chain triglycerides fraction is 70%). This can have a side effect on the central nervous system due to the passage of fatty acids through the blood-brain barrier.

Fractionated coconut oil is the main source of medium chain triglycerides in this product. However, certain amounts of higher saturated and unsaturated fatty acids may also be present in it. Excessive saturated fatty acids with a large chain length can adversely affect lipid metabolism in patients (increase in total cholesterol, cholesterol in low-density lipoproteins, serum triglycerides, which can create an additional risk of developing atherosclerosis. The rapeseed and corn oil Since corn oil contains almost only PUFA w6, to maintain them in balance with PUFA w3 it is necessary to add additional amounts of rapeseed oil, which makes the product more expensive, and also introduces undesirable erucic acid in it in additional quantities, leading to undesirable changes in fat and cholesterol metabolism, creates an additional risk of atherosclerosis and diseases of the cardiovascular system.

The use of modified starch in the carbohydrate component is dictated by the need to reduce the osmolarity of the product, however, on the other hand, the use of this component is undesirable, since it leads to a deterioration in the absorption of carbohydrates, a decrease in the organoleptic properties of the product when taken orally (deteriorates in taste) and causes an increase in the viscosity of the product, which complicates its introduction through the probe.

Most mineral substances (mineral salts) are completely absent in the product. This is undesirable, since, in particular, calcium deficiency can cause osteoporosis, calcium, potassium and magnesium deficiency - convulsions, iodine - goiter, iron, copper and manganese - anemia. Of the minerals, only zinc and selenium are in the composition of the product - in the form of sodium selenate. This salt is undesirable for use due to its high toxicity. All of the above reduces the nutritional value of the product.

The vitamin composition of the product is unbalanced - fat-soluble vitamins are completely absent, which reduces the nutritional value of the product and can lead to long-term use for diseases: Vitamin A deficiency - damage to the retina, Vitamin D - osteoporosis, Vitamin E - impaired function of the heart muscle, sex glands and system immunity. In addition, there is an insufficient content of vitamin C. An insufficient intake of vitamin C leads to the development of oxidative stress, accompanied by an increase in fragility of blood vessels, hemorrhages, damage to the mucous membranes, and a decrease in anti-infection resistance.

All of the above reduces the nutritional value of the product, the quality of the product, worsens the organoleptic and dietary properties of the product, can create problems (adversely affect health) with chronic use of the product by chronic patients, especially with probe administration.

The technical result of the claimed invention is to increase the nutritional value of the product, giving the product prophylactic properties, improving the quality and organoleptic properties of the product, improving the dietary properties of the product.

The technical result is achieved by the fact that the product of enteral nutrition, including whey proteins, the amino acid histidine, maltodextrin, a source of medium chain triglycerides, rapeseed oil, lecithin, mineral salts of zinc and selenium, water-soluble vitamins and water, additionally contains glucose syrup, soybean oil, fat-soluble vitamins , D ₃ , E, K ₁ , ascorbyl palmitate, mineral salts - potassium citrate, calcium phosphate, calcium carbonate, sodium citrate, magnesium chloride, sodium chloride, iron sulfur acidic, manganese chloride, copper sulfate, potassium iodide, sodium bicarbonate, ammonium molybdenum acid, chromium chloride, zinc sulfate as a mineral salt of zinc, and sodium selenite as a mineral salt of sodium, medium chain triglycerides are used as a source of medium chain triglycerides; the mass ratio of the concentrate of medium chain triglycerides, rapeseed and soybean oil, respectively, is 2: 1: 1 in the following ratio of components, wt.% (in terms of dry ie the substance):

Whey Protein Concentrate 12.4 ÷ 14.1 Histidine 0.66 ÷ 0.75 Maltodextrin 32.5 ÷ 40.0 Glucose syrup 21.0 ÷ 27.1 Medium Chain Triglyceride Concentrate 10.7 ÷ 11.4 Rapeseed oil 5.35 ÷ 5.70 Soybean oil 5.35 ÷ 5.70 Lecithin 0,037 ÷ 0,040 Potassium citrate 0.38 ÷ 0.58 Calcium phosphate 0.36 ÷ 0.56 Calcium carbonate 0.1 ÷ 0.19 Sodium Citrate 0.34 ÷ 0.57 Magnesium chloride 0.47 ÷ 0.70 Sodium Chloride 0,079 ÷ 0,089 Zinc Sulfate 0.012 ÷ 0.016 Iron sulfate 0.013 ÷ 0.018 Manganese chloride 0.0010 ÷ 0.0013 Copper sulfate 0.0011 ÷ 0.0015 Potassium iodide 0.000035 ÷ 0.000048 Sodium bicarbonate 0.00008 ÷ 0.00016 Lemon acid 0.00009 ÷ 0.00012 Sodium Selenite 0.000009 ÷ 0.000021 Ammonium Molybdenum Acid 0.000023 ÷ 0.000033 Chromium chloride 0.000028 ÷ 0.000037 Vitamin A 0,00024 ÷ 0,00039 Vitamin D ₃ 0.0000006 ÷ 0.0000011 Vitamin E 0.0021 ÷ 0.0050 Vitamin K ₁ 0.000015 ÷ 0.000029 Water soluble vitamins 0.1300747 ÷ 0.2596632 Ascended palmitate 0.0051 ÷ 0.0055 Water Rest

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

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

- 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 (SCT) into the product can improve the digestibility of the fat component and the product as a whole in patients with impaired digestive function due to improved intestinal emulsification and absorption of fat in conditions of insufficient digestive factors: pancreatic lipase, phospholipids and bile acids of bile. SCT concentrate is a product of a strictly defined composition, in which there are practically no higher saturated fatty acids, leading to an increased risk of atherosclerosis;

- the use of a composition of maltodextrin and glucose syrup can improve the taste of the product in comparison with maltodextrin and corn starch, and to ensure the osmolarity of the product is within acceptable values.

All of the above allows you to increase the nutritional value of the product, give the product preventive properties, improve the quality and organoleptic properties of the product, improve its dietary properties - that is, increase the efficiency of its use by patients with renal failure, which is expressed in a general improvement in well-being, improvement of the nutritional (trophological) status of patients and increasing the time intervals between hemodialysis sessions.

The protein component of the inventive enteral nutrition milk product contains whey protein concentrate (KSB) and the amino acid histidine. A decrease in the mass fraction of both KSB and histidine below the minimum declared values can lead to a lack of protein in patients consuming the product for a long time as the main source of nutrition. An increase in the content of KSB and histidine in excess of the maximum declared (indicated in the formula) values will lead to an increase in the load of nitrogenous substances, an increase in the concentration of products of nitrogen metabolism (urea, ammonia, uric acid) in the blood serum of patients and, as a result, worsen their well-being and quality of life. Secondly, excessive amounts of whey protein can increase potential allergenicity and thus worsen product tolerance.

The fat component of the claimed product is represented by a mixture of a medium chain triglyceride concentrate, soybean and rapeseed oil, taken in a mass ratio of 2: 1: 1, respectively. Unlike the fat component of the prototype, the claimed product uses soybean oil instead of corn, which contains significant quantities of 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 of soy and rapeseed 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. A content of medium chain triglycerides of less than 50% may lead to insufficient absorption of fat in the intestines of the patient. The mass ratio of 1: 1 between low eruca rape 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: 1. This provides a sufficient amount of w3 PUFA necessary for tissue regeneration and stimulating the activity of the immune system, and w6 PUFA involved in the synthesis of series 4 prostaglandins 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 oil can also cause the accumulation in the product of certain amounts of erucic acid, 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.

If the amount of soybean oil in the product is excessive, in excess of the claimed ratio, the intake of essential PUFAs of the w3 family decreases, which is undesirable for patients suffering from inflammatory diseases of the kidneys and decreased immune function. A lack of PUFA w3 can lead to impaired synthesis of some important intracellular mediators (eicosanoids) involved in the regulation of the function of the excretory system, and cause undesirable changes in the structure of the membranes of kidney cells.

In the claimed product, maltodextrin and glucose syrup are taken in a mass ratio of 1.22: 1 ÷ 1.86: 1, respectively. Deviation from this ratio of less than 1.22: 1 is undesirable, since an increase in the glucose syrup in the carbohydrate component can lead to an excess level of glucose in the patient’s blood and cause diarrhea. Deviation from this ratio in the direction of more than 1.86: 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 for consumption as a drink.

The product is enriched with a complex of essential trace elements necessary for the normal functioning of the patient's body, including the system of excretory organs.

While the prototype is completely absent most of the minerals, in the inventive low-salt product, the content of trace elements and the form of their application are optimal and meet the needs of renal patients, altered due to the disease.

In contrast to the prototype, the vitamin composition of the claimed product is also balanced. Both water-soluble and fat-soluble vitamins are included in the inventive product, taking into account the needs of renal patients. The optimal amounts of vitamin C and vitamin B ₆ have been introduced into the product, which leads to the complete provision of patients with these vitamins, contributes to the normalization of vascular permeability, the condition of the mucous membranes (vitamin C) and the normalization of protein metabolism (vitamin B ₆ ).

The preparations of vitamins and mineral salts were introduced taking into account the needs of the human body for these nutrients per 1 unit of energy value according to the "Norms of the physiological need 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 and an increased intake of antioxidant nutrition factors in the body when using the product as the sole source of nutrition.

The claimed combination of features allows you to get a milk product of enteral nutrition with increased nutritional value, improved quality and organoleptic properties, improved dietary properties, and also allows you to give the product preventive properties (in comparison with the prototype) by optimizing, first of all, the qualitative composition of fat and carbohydrate component, the quality of the vitamin and mineral complex, as well as the amount of the protein component used. Deviation to a greater or lesser extent from the declared values leads to a decrease in both the nutritional value of the claimed product and its quality, organoleptic and dietary properties, and does not allow the product to be used for preventive purposes.

Nutrien Nefro enteral nutrition product is produced from: a whey protein concentrate of milk powder with a mass fraction of protein of at least 80% authorized by the State Sanitary and Epidemiological Supervision Authority of the Ministry of Health of Russia for use in the production of baby food;

- amino acids L-histidine,

- maltodextrin with a dextrose equivalent of 18-20 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 Epidemiological Supervision of the Ministry of Health of Russia for use in the production of baby food.

The following 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) according to VFS 42-2479-95; biotin (vitamin H); β-carotene according to TU 57 494-88-05-02; choline chloride according to FS 42-1997-93, or choline dihydrocytrate or bitartrate. Instead of vitamins, a vitamin premix can be used (if available), approved by the bodies of the Sanitary Inspection 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 , Sun, H).

Use mineral salts: 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; calcium phosphate according to GOST 3204-76; calcium citrate, or calcium carbonate according to GOST 4530-76, 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, sodium bicarbonate 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 salts, 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 in 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 - as for baby food).

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

A method of obtaining the claimed product is carried out, for example, as follows.

A dry whey protein concentrate intended for base production (85 ÷ 90% of the total weight of KSB) is sequentially dissolved in a continuous circulation mode in drinking water with a temperature of 43 ÷ 47 ° С until an aqueous solution with a mass fraction of solids of 3 ÷ 4% is formed, cooled to a temperature of 2 ÷ 6 ° C and maintained with constant stirring 2 ÷ 2.5 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 6.7 ÷ 7.0 (if the active acidity is less than 6.7, then bring to normal 5% - aqueous solution of potassium hydroxide, if the active acidity is greater than 7.0, then - 5% aqueous solution of citric acid). In a protein solution, a purity group is determined. If necessary, clean the solution is heated to a temperature of 38 ÷ 42 ° C, cleaned, pasteurized at a temperature of 74 ÷ 78 ° C, incubated for 15-17 s and cooled to a temperature of 2 ÷ 6 ° C.

Preparation of a protein-carbohydrate mixture.

Maltodextrin (65 ÷ 90% of the total mass of maltodextrin) and glucose syrup are dissolved in the above protein mixture, heated to a temperature of 58 ÷ 62 ° C, mixed for 20 ÷ 30 minutes. The resulting protein-carbohydrate mixture is pasteurized at a temperature of 76 ÷ 80 ° C, with a holding time of 15-17 s and cooled to 2 ÷ 6 ° C.

Preparation of an oil-vitamin mixture

Soybean, rapeseed 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, K ₁ 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 95 ÷ 100 ° C and stirred for 10 ÷ 15 minutes. The resulting solution is introduced into an oil-vitamin mixture, preheated to a temperature of 60 ÷ 65 ° C, stirred for 10 ÷ 15 minutes and sent to the preparation of the emulsion.

Preparation of a normalized mixture

Protein-carbohydrate mixture and oil-vitamin mixture in a ratio of 10: 1, heated to a temperature of 60 ÷ 65 ° C, are sent to 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.

Calcium phosphate and calcium carbonate 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%, mixed until completely dissolved 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 and magnesium chloride are dissolved in drinking water with a temperature of from 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.

Manganese chloride, copper sulfate 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 2 to 3%, 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 Bs (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 introduced 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 15 to 20 ° C until an aqueous solution with a mass fraction of choline of 4 to 5% is obtained, stirred 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.

The resulting normalized mixture is stirred for 20–30 min and the active acidity is determined, which should be equal to 6.7–7.0 (if the active acidity is less than 6.7, then it is brought to normal with a 5% aqueous solution of potassium hydroxide, if the active acidity is greater 7.0, then a 5% aqueous solution of citric acid).

Thickening and drying the base.

The normalized mixture is concentrated to a mass fraction of solids from 40 to 45% and pasteurized at a temperature of 76 ÷ 80 ° C with a holding time of 45-75 s, 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 170 to 180 ° C; the temperature at the outlet of the drying tower is from 75 to 85 ° C.

During the drying process, the base is continuously discharged into the pneumatic conveying system, collected in containers and sent for intermediate storage.

Preparation of dry ingredients for mixing.

L-histidine, a whey protein concentrate (10-15% by weight of KSB), maltodextrin (10-35% by weight of maltodextrin) are mixed for 30-40 minutes.

Mixing the components.

A dry base, a mixture of maltodextrin with an amino acid and a whey protein concentrate are added to the mixer. All components are thoroughly mixed for 30-40 minutes. Received dry product is stored before packaging for no more than 48 hours. The finished product is sent for packaging.

The obtained dry milk product of Nutrien Nefro enteral and probe nutrition is a fine dry powder (lumps easily crumbled upon mechanical action are allowed) of a cream color. Taste and smell - specific, a slight taste of vegetable oil is allowed. The moisture content of the dry product ranges from 2 to 4%. In reduced form, the product is a homogeneous liquid without sediment.

As a medium chain triglyceride concentrate, for example, Delios V product 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 (g | / 100 g) ≤0.5 0.02 Hydroxyl number (mg KOH / g) ≤5 3 Pericidal number (1/8 mmol 0 / 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

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) SO2 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 Comp. (G / dm ³ ) Bulk density 425 600 A1101 free (g / dm ³ ) Vibr. screening> 52μM 70.0 100.0 A1113 Vibr. sieving> 150μM (%) 0,0 50,0 A1113 Vibr. screening> 250μM (%) 0,0 10.0 A1113 Vodn. muddy dextrose 1,5 1,5 0,0 5,0 A1042 Microbe. total number (in 10 g) four 16 0 <1000 A1924 Yeast agar, 5 days, 25 ° C (per 10 g) 2 10 0 1,0E2 A1923 Agar mold, 5 days, 25 ° C (in 10 g) 16 2 0 1,0E2 A1923 Coliforms (in 10 g) not available. not available. A1937 E. Koli (in 10 g) not available. not available. A1937 Salmonella not available. not available. not available. not available. 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, mcg / 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 metrics comply with agreed specifications.

As a 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.

CAS no: 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 / g max. - YEAST MMS 2003A 50 / g max. - MOLD MMS 2003A 50 / g max. - E. COLEY MMS 2009A Absent AT 10 - SALMONELLA MMS 2010 Absent At 25 - C.S.R. DISPUTES MMS 2015 50/10 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 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey Protein Concentrate 129.72 Histidine 6.90 Maltodextrin with Dextrose equivalent to 18 DE 353.23 Glucose Syrup with Dextrose 40 DE equivalent 235.49 Medium Chain Triglyceride Concentrate 109.32 Rapeseed oil 54.66 Soybean oil 54.66 Lecithin 0.38 Potassium citrate 4.91 Calcium phosphate 4.85 Calcium carbonate 1,56 Sodium Citrate 4,55 Magnesium chloride 5.90 Sodium Chloride 0.89 Zinc Sulfate 0.14 Iron sulfate 0.16 Manganese chloride 0.012 Copper sulfate 0.013 Potassium iodide 0,00048 Sodium bicarbonate 0.0016 Lemon acid 0.0012 Sodium Selenite 0,00021 Ammonium Molybdenum Acid 0,00033 Chromium chloride 0,00037 Vitamin A 0.0039 Vitamin D ₃ 0.000011 Vitamin E 0,050 Vitamin K ₁ 0,00029 Vitamin C 0.40 Vitamin PP 0,057 Vitamin B ₁ 0.0068 Vitamin B ₂ 0.0058 Vitamin B ₃ 0.017 Vitamin B ₆ 0.0087 Vitamin B _s 0,00086 Vitamin B ₁₂ 0.000012 Vitamin H 0,00046 Ascended palmitate 0,055 Choline bitartrate 2.04 Water The rest is up to 1000

The ratio of maltodextrin: glucose syrup is 1.5: 1.

Example 2. To prepare 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 124.08 Histidine 6.60 Maltodextrin with Dextrose equivalent to 18 DE 369.12 Glucose Syrup with Dextrose 40 DE equivalent 246.08 Medium Chain Triglyceride Concentrate 106.96 Rapeseed oil 53.48 Soybean oil 53.48 Lecithin 0.37 Potassium citrate 3.97 Calcium phosphate 3.96 Calcium carbonate 1,02 Sodium Citrate 3.61 Magnesium chloride 4.80 Sodium Chloride 0.79 Zinc Sulfate 0.12 Iron sulfate 0.13 Manganese chloride 0.010 Copper sulfate 0.011 Potassium iodide 0,00035 Sodium bicarbonate 0,0008 Lemon acid 0,0009 Sodium Selenite 0.00012 Ammonium Molybdenum Acid 0,00023 Chromium chloride 0,00028 Vitamin A 0.0024 Vitamin D ₃ 0.000006 Vitamin E 0,021 Vitamin K ₁ 0.00015 Vitamin C 0.15 Vitamin PP 0,035 Vitamin B ₁ 0.0036 Vitamin B ₂ 0.0033 Vitamin B ₃ 0.013 Vitamin B ₆ 0.0051 Vitamin Be 0,00045 Vitamin B ₁₂ 0.000007 Vitamin H 0,00029 Ascended palmitate 0.051 Choline chloride 1.09 Water The rest is up to 1000

The ratio of maltodextrin: glucose syrup is 1.5: 1

Example 3. To prepare 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 141 Histidine 7.50 Maltodextrin with Dextrose equivalent to 18 DE 331.89 Glucose Syrup with Dextrose 40 DE equivalent 221.27 Medium Chain Triglyceride Concentrate 114.04 Rapeseed oil 57.02 Soybean oil 57.02 Lecithin 0.40 Potassium citrate 5.79 Calcium phosphate 5.62 Calcium carbonate 1.86 Sodium Citrate 5.66 Magnesium chloride 6.98 Sodium Chloride 0.85 Zinc Sulfate 0.16 Iron sulfate 0.18 Manganese chloride 0.013 Copper sulfate 0.015 Potassium iodide 0,00048 Sodium bicarbonate 0.0016 Lemon acid 0.0012 Sodium Selenite 0,00021 Ammonium Molybdenum Acid 0,00033 Chromium chloride 0,00037 Vitamin A 0.0039 Vitamin D ₃ 0.000011 Vitamin E 0,050 Vitamin K ₁ 0,00029 Vitamin C 0.40 Vitamin PP 0,057 Vitamin B ₁ 0.0068 Vitamin B ₂ 0.0058 Vitamin B ₃ 0.017 Vitamin B ₆ 0.0087 Vitamin B _s 0,00086 Vitamin B ₁₂ 0.000012 Vitamin H 0,00046 Ascended palmitate 0,055 Choline Dihydrocytrate 2.10 Water The rest is up to 1000

In the product obtained according to examples 1 ÷ 3, the ratio of carbohydrate components of maltodextrin: glucose syrup is 1.5: 1.

Example 4. For the preparation of 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 129.72 Histidine 6.90 Maltodextrin with Dextrose equivalent to 18 DE 331.04 Glucose Syrup with Dextrose 40 DE equivalent 270.85 Medium Chain Triglyceride Concentrate 109.32 Rapeseed oil 54.66 Soybean oil 54.66 Lecithin 0.38 Potassium citrate 3.91 Calcium phosphate 3.85 Calcium carbonate 1,02 Sodium Citrate 3,55 Magnesium chloride 4.77 Sodium Chloride 0.80 Zinc Sulfate 0.12 Iron sulfate 0.13 Manganese chloride 0.010 Copper sulfate 0.011 Potassium iodide 0,00035 Sodium bicarbonate 0,0008 Lemon acid 0,0009 Sodium Selenite 0.00011 Ammonium Molybdenum Acid 0,00023 Chromium chloride 0,00028 Vitamin A 0.0024 Vitamin D ₃ 0.000006 Vitamin E 0,021 Vitamin K ₁ 0.00015 Vitamin C 0.15 Vitamin PP 0,035 Vitamin B ₁ 0.0036 Vitamin B ₂ 0.0033 Vitamin B ₃ 0.013 Vitamin B ₆ 0.0051 Vitamin B _s 0,00045 Vitamin B ₁₂ 0.000007 Vitamin H 0,00029 Ascended palmitate 0,053 Choline chloride 1.99 Water The rest is up to 1000

The ratio of carbohydrate components of maltodextrin: glucose syrup is 1.22: 1.

Example 5. To prepare 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 141.0 Histidine 7.50 Maltodextrin with Dextrose equivalent to 18 DE 325,10 Glucose Syrup with Dextrose 40 DE equivalent 266.00 Medium Chain Triglyceride Concentrate 109.04 Rapeseed oil 54.52 Soybean oil 54.52 Lecithin 0.38 Potassium citrate 3.80 Calcium phosphate 3.61 Calcium carbonate 1.00 Sodium Citrate 3.42 Magnesium chloride 4.72 Sodium Chloride 0.81 Zinc Sulfate 0.12 Iron sulfate 0.13 Manganese chloride 0.010 Copper sulfate 0.011 Potassium iodide 0,00035 Sodium bicarbonate 0,0008 Lemon acid 0,0009 Sodium Selenite 0.00009 Ammonium Molybdenum Acid 0,00023 Chromium chloride 0,00028 Vitamin A 0.0024 Vitamin D ₃ 0.000006 Vitamin E 0,021 Vitamin K ₁ 0.00015 Vitamin C 0.15 Vitamin PP 0,035 Vitamin B ₁ 0.0036 Vitamin B ₂ 0.0033 Vitamin B ₃ 0.013 Vitamin B ₆ 0.0051 Vitamin B _c 0,00045 Vitamin B ₁₂ 0.000007 Vitamin H 0,00029 Ascended palmitate 0,052 Choline bitartrate 1.99 Water The rest is up to 1000

In the product obtained according to examples 4, 5, the ratio of carbohydrate components of maltodextrin: glucose syrup is 1.22: 1.

Example 6. For the preparation of 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 129.72 Histidine 6.90 Maltodextrin with Dextrose equivalent to 18 DE 391.23 Glucose Syrup with Dextrose 40 DE equivalent 210.66 Medium Chain Triglyceride Concentrate 109.32 Rapeseed oil 54.66 Soybean oil 54.66 Lecithin 0.38 Potassium citrate 3.91 Calcium phosphate 3.85 Calcium carbonate 1,02 Sodium Citrate 3,55 Magnesium chloride 4.77 Sodium Chloride 0.80 Zinc Sulfate 0.12 Iron sulfate 0.13 Manganese chloride 0.010 Copper sulfate 0.011 Potassium iodide 0,00035 Sodium bicarbonate 0,0008 Lemon acid 0,0009 Sodium Selenite 0.00011 Ammonium Molybdenum Acid 0,00023 Chromium chloride 0,00028 Vitamin A 0.0024 Vitamin D ₃ 0.000006 Vitamin E 0,021 Vitamin K ₁ 0.00015 Vitamin C 0.15 Vitamin PP 0,035 Vitamin B ₁ 0.0036 Vitamin B ₂ 0.0033 Vitamin B ₃ 0.013 Vitamin B ₆ 0.0051 Vitamin B _c 0,00045 Vitamin B ₁₂ 0.000007 Vitamin H 0,00029 Ascended palmitate 0,053 Choline chloride 1.99 Water The rest is up to 1000

In the product obtained according to example 6, the ratio of carbohydrate components of maltodextrin: glucose syrup is 1.86: 1.

Example 7. To prepare 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 124.1 Histidine 6.60 Maltodextrin with Dextrose equivalent to 18 DE 399.88 Glucose Syrup with Dextrose 40 DE equivalent 215.32 Medium Chain Triglyceride Concentrate 106.96 Rapeseed oil 53.48 Soybean oil 53.48 Lecithin 0.37 Potassium citrate 3.97 Calcium phosphate 3.96 Calcium carbonate 1,02 Sodium Citrate 3.61 Magnesium chloride 4.80 Sodium Chloride 0.79 Zinc Sulfate 0.12 Iron sulfate 0.13 Manganese chloride 0.010 Copper sulfate 0.011 Potassium iodide 0,00035 Sodium bicarbonate 0,0008 Lemon acid 0,0009 Sodium Selenite 0.00012 Ammonium Molybdenum Acid 0,00023 Chromium chloride 0,00028 Vitamin A 0.0024 Vitamin D ₃ 0.000006 Vitamin E 0,021 Vitamin K ₁ 0.00015 Vitamin C 0.15 Vitamin PP 0,035 Vitamin B ₁ 0.0036 Vitamin B ₂ 0.0033 Vitamin B ₃ 0.013 Vitamin B ₆ 0.0051 Vitamin B _s 0,00045 Vitamin B ₁₂ 0.000007 Vitamin H 0,00029 Ascended palmitate 0.051 Choline chloride 1.09 Water The rest is up to 1000

In the product obtained according to example 7, the ratio of carbohydrate components of maltodextrin: glucose syrup is 1.86: 1.

The dry product obtained according to examples 1 ÷ 7 is a fine dry cream-colored powder with a pure milky taste and smell. The product is highly soluble in water, in reduced form it is a homogeneous liquid without sediment, balanced in physicochemical composition and meets biomedical requirements. The product provides preventive and therapeutic nutrition in the form of a drink or supplement or enteral tube nutrition for children over 3 years old, as well as adults suffering from chronic kidney diseases and acute renal failure, as well as those at risk for the development of these diseases, as well as patients receiving medically indicated hemodialysis procedures.

Example 8. For the preparation of 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 124.1 Histidine 6.60 Maltodextrin with Dextrose equivalent to 18 DE 334.20 Glucose Syrup with Dextrose 40 DE equivalent 279.01 Medium Chain Triglyceride Concentrate 106.96 Rapeseed oil 53.48 Soybean oil 53.48 Lecithin 0.37 Potassium citrate 3.97 Calcium phosphate 3.96 Calcium carbonate 1,02 Sodium Citrate 3.61 Magnesium chloride 4.80 Sodium Chloride 0.79 Zinc Sulfate 0.12 Iron sulfate 0.13 Manganese chloride 0.010 Copper sulfate 0.011 Potassium iodide 0,00035 Sodium bicarbonate 0,0008 Lemon acid 0,0009 Sodium Selenite 0.00012 Ammonium Molybdenum Acid 0,00023 Chromium chloride 0,00028 Vitamin A 0.0024 Vitamin D ₃ 0.000006 Vitamin E 0,021 Vitamin K ₁ 0.00015 Vitamin C 0.15 Vitamin PP 0,035 Vitamin B ₁ 0.0036 Vitamin B ₂ 0.0033 Vitamin B ₃ 0.013 Vitamin B ₆ 0.0051 Vitamin B _s 0,00045 Vitamin B ₁₂ 0.000007 Vitamin H 0,00029 Ascended palmitate 0.051 Choline chloride 1.09 Water The rest is up to 1000

In the product obtained according to example 8, the ratio of maltodextrin and glucose syrup is 1.20: 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 1000 kg of dry enteral nutrition product, the starting components are taken in the following quantities, kg:

Whey protein concentrate 124.1 Histidine 6.60 Maltodextrin with Dextrose equivalent to 18 D 401.65 Glucose Syrup with Dextrose 40 DE equivalent 211.56 Medium Chain Triglyceride Concentrate 106.96 Rapeseed oil 53.48 Soybean oil 53.48 Lecithin 0.37 Potassium citrate 3.97 Calcium phosphate 3.96 Calcium carbonate 1,02 Sodium Citrate 3.61 Magnesium chloride 4.80 Sodium Chloride 0.79 Zinc Sulfate 0.12 Iron sulfate 0.13 Manganese chloride 0.010 Copper sulfate 0.011 Potassium iodide 0,00035 Sodium bicarbonate 0,0008 Lemon acid 0,0009 Sodium Selenite 0.00012 Ammonium Molybdenum Acid 0,00023 Chromium chloride 0,00028 Vitamin A 0.0024 Vitamin D ₃ 0.000006 Vitamin E 0,021 Vitamin K ₁ 0.00015 Vitamin C 0.15 Vitamin PP 0,035 Vitamin B ₁ 0.0036 Vitamin B ₂ 0.0033 Vitamin B ₃ 0.013 Vitamin B ₆ 0.0051 Vitamin B _s 0,00045 Vitamin B ₁₂ 0.000007 Vitamin H 0,00029 Ascended palmitate 0.051 Choline chloride 1.09 Water The rest is up to 1000

The product obtained according to example 9 is not suitable for consumption as a drink - it is very tasteless (the ratio of malto dextrin and glucose syrup is 1.9: 1, respectively).

Currently, clinical testing of the dry enteric product Nutrien Nefro is being conducted.

The table shows the chemical composition of the Nutrien Nefro product.

Table
The chemical composition of the Nutrien Nefro product The average composition of the product in 100 g of product in 100 ml of the product 1 ml / 1 kcal Calories, kcal 478 one hundred Protein, g 11.0 2,3 Fat g 22.0 4.6 Carbohydrates, g 59.0 12.3 Minerals: calcium mg 300 63 phosphorus mg 150 31 potassium mg 250 52 sodium mg 200 42 magnesium mg one hundred 21 copper, mcg 360 75 manganese, mcg 360 75 iron mg 3,5 0.7 zinc mg 3.6 0.7 chlorides, mg 300 62 iodine, mcg 36 7.5 chromium, mcg 7.0 1,5 molybdenum, mcg 17 3,5 selenium, mcg 17 3,5 Vitamins: retinol (A), mcg 209 44 tocopherol (E), mg 2.1 0.4 calciferol (D), mcg 0.6 0.1 vitamin K, mcg fifteen 3,1 thiamine (B ₁ ), mcg 302 63 riboflavin (B ₂ ), mcg 350 73 pantothenic acid, mcg 1400 293 pyridoxine (B ₆ ), mcg 442 92 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 3,5 biotin, mcg thirty 6.3 choline mg one hundred 21 Osmolarity, mOsm / l 314

The inventive product is intended for use in the form of a drink, enteral tube nutrition or food supplement for children over three years old and adults suffering from chronic kidney disease and acute renal failure. The composition of the claimed product optimally meets the needs of patients suffering from acute and chronic kidney diseases, including those undergoing hemodialysis. 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 therapeutic products for enteral and oral nutrition of children and adults.

The claimed therapeutic product of enteral nutrition is characterized by increased nutritional value and better digestibility in renal patients in comparison with the prototype due to the following factors:

- the use of a concentrate of whey protein of milk with high biological value and digestibility, additionally enriched with the amino acid histidine in optimal amounts for renal patients;

- the use of a fat composition represented by a mixture of a medium chain triglyceride concentrate, soybean and low eruca rapeseed oil in a ratio of 2: 1: 1, which allows optimizing the absorption of fat in the digestive tract, fully satisfying the needs of patients in essential polyunsaturated fatty acids of series w6 and w3;

- the use of a carbohydrate component, which is glucose syrup and maltodextrin in a ratio that allows you to reduce (minimize) the osmolarity of the finished product, improve the digestibility of carbohydrates, which are the main source of energy for patients, and also improve the taste properties of the product;

- enrichment of the product with all essential macro- and microelements in a ratio optimal for renal patients;

- enrichment of the product with all major vitamins in proportions optimal for renal patients.

Information sources

1. ROSS MEDIKAL NUTRITIONAL SYSTEM. Ross Abbot Laboratories. USA 1995, Nepro ™, p. 28, 29.

2. Enteral Product Guide. Nestle. Clinical Nutrition. Switzerland. 1996 Renalcal ™ Diet (Renalkal), p. 64, 65 (prototype).

Claims (1)

Enteral nutrition product, including whey proteins, the amino acid histidine, maltodextrin, a source of medium chain triglycerides, rapeseed oil, lecithin, mineral salts of zinc and selenium, water-soluble vitamins and water, characterized in that it additionally contains glucose syrup, soybean oil, fat-soluble vitamins A D _3, E, K _1, ascorbyl palmitate, mineral salts - potassium citrate, calcium phosphate, calcium carbonate, sodium citrate, magnesium chloride, sodium chloride, sulfuric acidic iron, manganese loric, copper sulfate, potassium iodide, sodium bicarbonate, ammonium molybdenum acid, chromium chloride, zinc sulfate as a mineral salt of zinc, and sodium selenite as a mineral salt of sodium, sodium chloride is used as a medium chain triglyceride concentrate, and the concentration of medium chain triglycerides is used, medium chain triglycerides, rapeseed and soybean oils, respectively, is 2: 1: 1 in the following ratio of components, wt.% (in terms of dry matter): Whey Protein Concentrate 12.4 ÷ 14.1 Histidine 0.66 ÷ 0.75 Maltodextrin 32.5 ÷ 40.0 Glucose syrup 21.0 ÷ 27.1 Medium Chain Triglyceride Concentrate 10.7 ÷ 11.4 Rapeseed oil 5.35 ÷ 5.70 Soybean oil 5.35 ÷ 5.70 Lecithin 0,037 ÷ 0,040 Potassium citrate 0.38 ÷ 0.58 Calcium phosphate 0.36 ÷ 0.56 Calcium carbonate 0.1 ÷ 0.19 Sodium Citrate 0.34 ÷ 0.57 Magnesium chloride 0.47 ÷ 0.70 Sodium Chloride 0,079 ÷ 0,089 Zinc Sulfate 0.012 ÷ 0.016 Iron sulfate 0.013 ÷ 0.018 Manganese chloride 0.0010 ÷ 0.0013 Copper sulfate 0.0011 ÷ 0.0015 Potassium iodide 0.000035 ÷ 0.000048 Sodium bicarbonate 0.00008 ÷ 0.00016 Lemon acid 0.00009 ÷ 0.00012 Sodium Selenite 0.000009 ÷ 0.000021 Ammonium Molybdenum Acid 0.000023 ÷ 0.000033 Chromium chloride 0.000028 ÷ 0.000037 Vitamin A 0,00024 ÷ 0,00039 Vitamin D ₃ 0.0000006 ÷ 0.0000011 Vitamin E 0.0021 ÷ 0.0050 Vitamin K ₁ 0.000015 ÷ 0.000029 Water soluble vitamins 0.1300747 ÷ 0.2596632 Ascended palmitate 0.0051 ÷ 0.0055 Water Rest