TR2022012656T2 - NUTRIENT COMPOSITIONS FOR IMPROVING PEDIATRIC HEALTH - Google Patents
NUTRIENT COMPOSITIONS FOR IMPROVING PEDIATRIC HEALTHInfo
- Publication number
- TR2022012656T2 TR2022012656T2 TR2022/012656 TR2022012656T2 TR 2022012656 T2 TR2022012656 T2 TR 2022012656T2 TR 2022/012656 TR2022/012656 TR 2022/012656 TR 2022012656 T2 TR2022012656 T2 TR 2022012656T2
- Authority
- TR
- Turkey
- Prior art keywords
- vitamin
- composition according
- mcg
- oil
- acid
- Prior art date
Links
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- ABSPRNADVQNDOU-UHFFFAOYSA-N Menaquinone 1 Natural products C1=CC=C2C(=O)C(CC=C(C)C)=C(C)C(=O)C2=C1 ABSPRNADVQNDOU-UHFFFAOYSA-N 0.000 claims description 5
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Abstract
Mevcut buluş, malnütrisyon ve büyüme geriliği görülen bir yaşından büyük pediatrik hastalarda günlük enerji ihtiyacının karşılanmasına yardımcı olan, eksiksiz ve dengeli beslenme sağlayan sıvı kompozisyonlarla ilgilidir.The present invention relates to liquid compositions that provide complete and balanced nutrition and help meet the daily energy needs of pediatric patients over one year old with malnutrition and growth retardation.
Description
Tarifname PEDIATRIK SAGLIGIN IYILESTIRILMESINE YÖNELIK BESIN KOMPOZISYONLARI Teknik Alan Mevcut bulus, malnütrisyon ve büyüme geriligi görülen bir yasindan büyük pediatrik hastalarda günlük enerji ihtiyacinin karsilanmasina yardimci olan, eksiksiz ve dengeli beslenme saglayan sivi kompozisyonlarla ilgilidir. Teknigin Bilinen Durumu Çocuklarin çogu besin açisindan eksiksiz bir diyet için gerekli miktarda gida almamaktadir. Bu çocuklara yardimci olmak amaciyla besin takviyeleri gelistirilmistir. Besin takviyeleri çogunlukla besin açisindan eksiksiz bir diyet için gereken tüm besinleri saglama amaci tasimamakta olup, genellikle bu takviyelerin amaci diyete destek olarak besin açisindan daha eksiksiz hale gelmesini saglamaktir. Bununla birlikte, bazi durumlarda bu takviyeler eksiksiz beslenme saglayabilir. Çocuklarda malnütrisyon tüm dünyada önemli bir saglik sorunu olup, morbidite, mortalite, zeka gelisim geriligi, düsük yetiskin çalisma kapasitesi ve yetiskinlik döneminde hastalik riskinde artisa katkida bulunmaktadir. Özellikle çocuklar, ek gidalar düsük besin yogunluguna sahip oldugunda ve mikro besin biyoyararlanimi düsük oldugunda malnütrisyona yatkin hale gelmektedir. Dünya Saglik Örgütüne (DSÖ) göre malnütrisyon, "vücudun büyümeyi, islevlerini sürdürmeyi ve belirli fonksiyonlari saglayabilmesi için ihtiyaci olan besin ve enerji ile vücuda saglanan besin ve enerji miktari arasindaki hücresel dengesizlik" olarak tanimlanmaktadir. Bu dinamik besin dengesizligi çocuklari yetiskinlerden daha farkli etkilemekte olup, gelisme dönemindeki çocuklar için önemli sonuçlar dogurabilir. Asiri zayif ve gelismesi durmus olan çocuklarin besin ihtiyaçlarinin farkli olmasi muhtemeldir. Asiri zayif çocuklarda, genellikle düsük kas kütlesi ve depolanmis yag miktari nedeniyle yagsiz vücut kütlesi boya kiyasla düsüktür. Bu durumda normal bir vücut kompozisyonuna ulasmak açisindan kas ve yag doku sentezi için alinmasi gereken enerji, protein ve diger tüm gidalarin miktari da daha yüksek olacaktir. Asiri zayif olmayan fakat gelisimi durmus çocuklarda boya kiyasla kas ve yag kütlesi normale yakin olsa da kemik gelisim geriligi mevcuttur. Kemik gelisimi enerji tüketen bir proses olmadigindan, bu çocuklara fazladan enerji saglanmasi çok yardimci olmayacaktir. Ayni zamanda fazladan alinan enerjinin gereksiz yere yag kütlesini arttirmasi da mümkündür. Diger yandan, bu çocuklarin hem kemik gelisimi hem de yagsiz doku artisi için daha fazla besin maddesi almasi gereklidir, fakat fakir ailelerin çocuklarinin beslenmesinde genellikle böyle bir durum söz konusu degildir. Malnütrisyonla iliskili bir hastaligi olan bir yasindan büyük çocuklarin enerji, karbonhidrat, protein, yag, mineral, vitamin ve esansiyel yag asidi ihtiyaci, malnütrisyonun ortadan kaldirilmasi için kullanilacak herhangi bir formülasyon hazirlanmadan önce yaklasik olarak belirlenmelidir. Mineral, vitamin, L-karnitin, taurin, ß-alanin, glutamin ve kreatinin gibi mikro besinlerin veya protein, karbonhidrat, yag, uzun zincirli çoklu doymamis yag asitleri gibi makro besinlerin eksikligi, çocuklarda klinik açidan anlamli bagisiklik yetmezligine ve büyüme geriligine yol açabilir. Mikro veya makro besin alimindaki eksikligin yani sira, çocuklarin çogunda vitamin ve takviye alimi da yetersizdir. Takviye eksiklikleri, malnütrisyonla iliskili hastalik, total gastrektomi sonrasi kanitlanmis inflamatuar bagirsak hastaligi, bagirsak fistülü, disfaji, kisa bagirsak sendromu ve dirençli malabsorpsiyon gibi çocuklarda yaygin görülen bozukluklarla iliskilendirilmistir. Çogu besin kompozisyonlari, özellikle de pediatrik kompozisyonlar, tüm besin sisteminin lipid bileseninin bir parçasi olarak çesitli çoklu doymamis yag asitleri (PUFA) içermektedir. Örnegin, uzun zincirli PUFA'Iarin çocuklarda bagisiklik yetmezligi ve büyüme geriliginin önlenmesi ve kontrolünde faydali oldugu gösterilmistir. Bununla birlikte, bu uzun zincirli PUFA'Iar besin kompozisyonlarinda siklikla bulunan diger içerik maddelerine kiyasla oksidasyona karsi daha hassas olma egilimindedir. Kimyasal yapilari nedeniyle isi ve atmosferik oksijen düzeylerine maruz kalmalari sonucunda, karbon:karbon çift baglariyla ilgili bir dizi reaksiyon meydana gelerek serbest radikal olusumu görülebilir. Bu serbest radikaller, oto-oksidatif bir proses içerisinde çoklu doymamis yag asitlerini parçalamaya devam edebilir. Bunun sonucunda da istenmeyen kötü tatlar ve kokular meydana gelerek, faydali olan çoklu doymamis yag asitleri bozulabilir. Bu uzun zincirli PUFA'Iar, özellikle yüksek isiyla islem gördüklerinde, püskürtmeli kurutma islemi esnasinda veya formül sizdirmaz sekilde kapatilip paketlendikten sonra nispeten kisa olan bir depolama süresi esnasinda bile oksidasyona duyarlidir. Özellikle yakin zamanda çikan ve bagisiklik sistemini güçlendirmek ve beyin gelisimini arttirmak amaciyla nispeten yüksek konsantrasyonlarda uzun zincirli çoklu doymamis yag asidi içeren çocuklara yönelik kompozisyonlar nedeniyle, oksidatif stabilite konusu daha da zorlayici bir hal almistir. Yüksek DHA konsantrasyonlari da, üretim esnasinda balik aromasini ortadan kaldirmak ve bu aromanin raf ömrü boyunca ortaya çikmamasini saglamak açisindan oksidatif stabilite konusunu daha da karmasik hale getirecektir. Toz seklindeki besin kompozisyonlarinda bulunan çoklu doymamis yag asitlerinin istenmeyen oksidasyonunu kontrol altina almanin bir yöntemi, 5,234,702 numarali Amerika Patentinde (Katz ve ark.) açiklandigi üzere, askorbil palmitat, beta karoten, tokoferol karisimlari ve digerleri dahil olmak üzere antioksidanlarin eklenmesidir. U.S. 7,090,879 numarali baska bir patentte, karbonhidrat, protein ve çoklu doymamis yag asidi içeren bir lipid bileseni ile lutein, likopen ve beta karotenin bir kombinasyonunu içeren toz seklinde bir bebek formülü ortaya konmaktadir. Patent literatüründe de özel olarak farkli yas araliklari ve farkli amaçlar için formüle edilmis besin kompozisyonlari mevcuttur. Bu kompozisyonlar yetersiz beslenme için takviye olarak veya engelli hastalar için eksiksiz bir besin kaynagi olarak kullanilabilir. Yukarida bahsedildigi üzere, yaglar oksidasyona egilimlidir. Bu durum özellikle yüksek oranda DHA içeren balik yaglari için geçerlidir. Oksidasyon, yag içerisindeki çoklu doymamis yag asitleri ve oksijen arasindaki reaksiyonlarin sonucunda meydana gelmektedir. Bu reaksiyonlar oksijen ve oksidasyon hizlandiricilarin varliginda hizlanmaktadir. Formüller yüksek oranda oksidasyon hizlandirici içerdiginden bu sorun daha da karmasik hale gelmektedir (Demir, Bakir, Çinko). Bununla birlikte, teknigin bilinen durumu oksijen ile yaglar arasindaki temas süresini en aza indirecek spesifik bir proses açisindan yetersizdir. Bulusun Amaçlari ve Kisa Açiklamasi Mevcut bulusun ana amaci, malnütrisyon ve büyüme geriligi görülen bir yasindan büyük pediatrik hastalarda enerji ihtiyacinin karsilanmasina yardimci olan, eksiksiz ve dengeli beslenme saglayan sivi besin kompozisyonlarinin elde edilmesidir. Bu bulus ayrica, bulusa konu olan kompozisyonlarin elde edilmesi için bir proses ve bu kompozisyonlarin uygulanmasiyla da ilgilidir. Mevcut bulusun baska bir amaci, sedimentasyonu ve oksidasyonu ayni anda azaltarak stabiliteyi arttirmak amaciyla en az bir antioksidan kaynagi içeren bir besin kompozisyonunun elde edilmesidir. Mevcut bulusun bir diger amaci, ozmolarite ve ozmolalitenin azaltilmis oldugu ve dolayisiyla hasta uyumunu arttiran besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun baska bir amaci, hastanin günlük enerji ihtiyacini karsilayacak sekilde dengeli bir karbonhidrat içerigine sahip besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun bir diger amaci, fazlalik veya kompetitif emilim olmaksizin biyouyumlu bilesenler içeren besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun baska bir amaci, esasen su, en az bir protein kaynagi, en az bir karbonhidrat kaynagi, en az bir yag kaynagi, en az bir lif kaynagi, vitamin ve mineral içeren besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun baska bir amaci, her biri digerinin emilimini arttiran taurin ve L-karnitin içeren besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun bir diger amaci, gastrointestinal sistemi destekleyecek sekilde yüksek lif oranina sahip besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun baska bir amaci, düsük ozmolarite ve sedimentasyon saglamak amaciyla protein kaynagi olarak spesifik araliklarda kazeinat içeren besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun baska bir amaci, oksidasyonu azaltmak ve kokuyu gidermek amaciyla kapsül formunda dokosahekzaenoik asit ve eikosapentaenoik asit içeren besin kompozisyonlarinin elde edilmesidir. Mevcut bulusun bir diger amaci, homojenizasyonu arttirmak ve oksidasyonu azaltmak amaciyla bu tür kompozisyonlarin hazirlanmasi için bir proses gelistirilmesidir. Mevcut bulusun baska bir amaci da, süt ürünlerinde büyük bir risk olan siddetli köpüklenme riskini ortadan kaldiran ve hizli sekilde homojen karisma saglayan bir prosesin saglanmasidir. Mevcut bulusun bir diger amaci, sivi besin kompozisyonundaki isi hasarinin azaltilmasi amaciyla yüksek sicakligin kisa bir süre boyunca uygulanmasini barindiran bir proses saglanmasidir. Bulusun Ayrintili Açiklamasi Yukarida belirtilen amaçlara uygun olarak, mevcut bulusun ayrintili özellikleri burada verilmektedir. Mevcut bulus, malnütrisyon ile iliskili bir hastaligi olan bir yasindan büyük pediatrik hastalarda enerji ihtiyacinin karsilanmasina yardimci olan, eksiksiz ve dengeli beslenme saglamak açisindan uygun bir sivi kompozisyonla ilgili olup, bu kompozisyon asagidakileri içermektedir: - en az bir protein kaynagi, - en az bir karbonhidrat kaynagi, - en az bir yag kaynagi, - en az bir uzun zincirli çoklu doymamis yag asidi, - en az bir lif kaynagi, - karotenoidler, askorbik asit, askorbil palmitat, retinil palmitat, tokoferoller, askorbat tuzlari, yagda çözünen biberiye ekstrakti ve bunlarin karisimlarini içeren gruptan seçilen en az bir antioksidan kaynagi, - vitaminler, - mineraller, ve özelligi, kompozisyonun asagidaki adimlari içeren bir prosesle elde edilmesidir: - suda çözünen bilesenlerin su içerisine karistirilmasi - karisima yag kaynaklarinin eklenmesi -tüm karisimin UHT islemine tabi tutulmasi Burada kullanildigi üzere "çocuk" ve "çocuklar" terimleri, 36 aydan büyük olmayan ve 12 ay ila 36 aylik çocuklari kapsamaktadir. Sterilize edilmis sivi kompozisyonlarin hazirlanmasi için, süt için optimize edilmis olan gelismis bir isleme teknolojisi kullanilmaktadir. Çok yüksek sicaklikta isleme (UHT), çok yüksek isil islem veya ultra pastörizasyon, sivi gidalari bakteri endosporlarini 2 ila 5 saniye içerisinde öldürmek için gerekli sicaklik olan 135°C ( üzerindeki sicakliklara getirerek sterilize eden gida isleme teknolojisidir. UHT en yaygin olarak süt üretiminde kullanilsa da ayni zamanda besinler, meyve sulari, krema, soya sütü, yogurt, sarap, çorba, bal ve sulu yemeklerde de kullanilmaktadir. UHT prensiplerinin kullanilmasi, yüksek viskozite ve protein bozulmasi riskini ortadan kaldirmaktadir. Buhar Enjeksiyon ve Infüzyon sistemleri, yüksek viskoziteli ürünler için en uygun sistemler olup, temizleme islemleri arasindaki üretim süresini uzatacaktir. Toz haline getirilmis içerik maddelerinin çözünmesi için vakumlu karistirici kullanilmasi, süt proteinlerinde büyük bir risk olan siddetli köpüklenme riskini ortadan kaldirmak ve hizli sekilde homojen karisma saglamak gibi birtakim avantajlara sahiptir. Karisim, patojenleri ortadan kaldirmak ve raf ömrünü uzatmak amaciyla genellikle 100°C'nin (212°F) altindaki sicakliklarda pastörize edilmektedir. Proses adimlari bu sekilde arka arkaya uygulandiginda sasirtici sekilde oksidasyonun azaldigi görülmüstür. Tercih edilen bir uygulamaya göre, kompozisyon antioksidan olarak beta karoten, lutein ve likopenin bir kombinasyonunu içermektedir. Tercih edilen bir uygulamaya göre, bahsedilen uzun zincirli çoklu doymamis yag asidi kaynagi, arasidonik asit, linoleik asit, linolenik asit, eikosapentaenoik asit (EPA), dokosahekzaenoik asit (DHA) veya bunlarin karisimlarini içeren gruptan seçilmektedir. En çok tercih edilen, balik aromasi ve kokusunun ortadan kaldirilmasi için kompozisyon içerisinde kapsüllenmis formda en az iki uzun zincirli çoklu doymamis yag asidi bulunmasidir. Ek olarak, kapsülleme sonucunda üretim prosesi ve raf ömrü boyunca oksidasyon azalmaktadir. Tercih edilen bir uygulamaya göre, kompozisyon uzun zincirli çoklu doymamis yag asidi olarak dokosahekzaenoik asit ve eikosapentaenoik asit içermektedir. Tercih edilen bir uygulamaya göre, toplam beta karoten, lutein ve likopen miktarinin toplam kullanildiginda oksidasyonun azaldigi görülmüstür. Tercih edilen uygulamaya göre, kompozisyon ayrica L-karnitin, taurin, ß-alanin, glutamin, kreatinin veya bunlarin karisimlari içerisinden seçilen en az bir bilesen içermektedir. Karnitin, memeli dokularinda enerji kaynagi olarak uzun zincirli yag asitlerinin kullanimi açisindan önemli bir metabolit olan, kuaterner amin, ß-hidroksi, y-N-tri-metilaminobütirik asittir. L-karnitin ise vitamin benzeri bir antioksidan olup, vücudun enerji üretimi ve normal beyin fonksiyonlari üzerinde oldukça pozitif etkilere sahiptir. L-karnitin serbest yag asitlerinin mitokondri zarindan geçisini kolaylastirmasi sebebiyle, yag asidi oksidasyonu ve ketogenezde rol oynamaktadir. L-karnitin 100 ml içerisinde en az 1 mg, özellikle 1 ila 5 mg miktarinda mevcuttur. Taurin, tüm memeli santral sinir sistemi dokularindaki serbest amino asit havuzunun ana yapi taslarindan biridir. Taurinin en önemli fizyolojik fonksiyonlari içerisinde, safra konjugasyonu, ozmoregülasyon, nörotransmisyon, nöroregülasyon ve membran stabilizasyonu bulunmaktadir. Taurin, beyin, kemikler, kalp kasi ve kan hücrelerinde yüksek miktarda mevcuttur. Beyin ve sinir sisteminde kalsiyum ve potasyum dengesinin düzenlenmesinde rol oynamaktadir. Taurin, hücre zari fonksiyonu ve safra asidi konjugasyonu dahil olmak üzere birçok proseste görev almaktadir ve çocuklarda bu amino asidi sentezleme kabiliyeti sinirli oldugundan taurin takviyesinin tercih edilebilecegi düsünülmektedir. Taurin 100 ml içerisinde en az 2.5 mg, özellikle 2.5 ila 10 mg arasinda mevcuttur. Tercih edilen uygulamaya göre, L-karnitinin taurine orani agirlikça 1:0.1 ile 1:20, tercihen 1:1 ile 1:10, daha tercihen 1:3 ile 1:5 arasindadir. Bu birlestirme oranlari kullanildiginda taurin ve L-karnitin emilimi es zamanli olarak arttigindan en etkili sonuçlar elde edilmektedir. Buradan da bu kombinasyonun çocuklarda beyin gelisimi açisindan önemli bir rol oynadigi görülmektedir. Bir uygulamaya göre, bahsedilen karbonhidrat kaynagi sukroz, maltodekstrin, fruktoz, hidrolize misir nisastasi, kati misir surubu, yüksek fruktozlu misir surubu veya bunlarin karisimlarini içeren gruptan seçilmektedir. Tercih edilen bir uygulamada, kompozisyon maltodekstrin ve sukroz içermektedir. ile 1:0.7 arasindadir. Spesifik olarak bu araliklar kullanildiginda sasirtici olarak kompozisyonun ozmolalitesinin düsürülebildigi görülmüstür. mOsm/L araligindadir. Bir uygulamaya göre, bahsedilen protein kaynagi kazein, soya, pirinç, bezelye, keçi boynuzu, yulaf, peynir alti suyu, kazeino-gliko-makropeptidler veya bunlarin karisimlarini içeren gruptan seçilmektedir. Tercihen, kompozisyon dengeli bir kati içerigi saglamak, isiya karsi iyi bir stabilite elde etmek ve tübüler sistemlerin kullanildigi bir üretim tesisinde akiciligi saglamak amaciyla peynir alti suyu içermemektedir. Tercih edilen uygulamaya göre, kompozisyon protein kaynagi olarak sodyum kazeinat ve kalsiyum kazeinat içermektedir. Sodyum kazeinatin kalsiyum kazeinata orani agirlikça 1:0.01 kullanildiginda zaman içerisinde sedimantasyon azalarak yüksek stabilite saglanmakta ve dolayisiyla raf ömrü artmaktadir. Protein kaynagi olarak sodyum kazeinat ve kalsiyum kazeinat kullaniminin ozmolalite düsüsünü destekledigi de görülmüstür. Bir uygulamaya göre, bahsedilen yag kaynagi balik yagi, orta zincirli trigliseritler, kanola yagi, ayçiçegi yagi, yüksek oleikli ayçiçegi yagi, aspir yagi, soya yagi, zeytinyagi, misir yagi, yerfistigi yagi, pirinç kepegi yagi, tereyagi, findik yagi, yapilandirilmis lipidler veya bunlarin karisimlarini içeren gruptan seçilmektedir. Tercih edilen bir uygulamaya göre, bahsedilen yag kaynagi balik yagi, orta zincirli trigliseritler, kanola yagi, ayçiçegi yagi, yüksek oleikli ayçiçegi yagi veya bunlarin karisimlarini içeren gruptan seçilmektedir. Yag kaynaginin bunlar içerisinden seçilmesiyle kompozisyonun raf ömrünün uzadigi ve oksidasyonun azaldigi gösterilmistir. Bir uygulamaya göre, bahsedilen lif kaynagi fruktooligosakkaridler, inülin, guar zamki, ksantan zamki, ksilo-oligosakkaridler, arap zamki, pektin, akasya zamki, dirençli nisasta, dekstranlar veya bunlarin karisimlarini içeren gruptan seçilmektedir. Tercih edilen uygulamaya göre kompozisyon, fruktooligosakkarid ve inülin içermektedir. g/100mL arasindadir. Spesifik olarak suda çözünen bu liflerin ve önceki teknige kiyasla nispeten yüksek olan bu miktarlarin seçilmesiyle, pediatrik hastalarin bagirsakfonksiyonlarinin iyilestirilmesi hedeflenmektedir. Bir uygulamaya göre, bahsedilen vitaminler A vitamini, D3 vitamini, E vitamini, K1 vitamini, C vitamini, folik asit, B1 vitamini, B2 vitamini, B3 vitamini, B5 vitamini, B6 vitamini, B7 vitamini, B8 vitamini, B12 vitamini, kolin veya bunlarin karisimlarini içeren gruptan seçilmektedir. Bir uygulamaya göre, bahsedilen mineraller sodyum, potasyum, klorür, kalsiyum, fosfor, magnezyum, florür, demir, çinko, manganez, bakir, iyot, selenyum, krom, molibden, fosfat veya bunlarin karisimlarini içeren gruptan seçilmektedir. Bir uygulamaya göre, kompozisyonun enerji degeri, pediatrik hastalarda günlük enerji ihtiyacini karsilamak amaciyla 140-170 kcal/100 mL araligindadir. Bulusun bir uygulamasina göre, kompozisyon asagidakileri içermektedir: - 2-10 g/100mL protein - 15-18 g/100mL karbonhidrat - 5-10 g/100mL yag - 15-300 mg/100mL dokosahekzaenoik asit - 5-30 mg/100mL eikosapentaenoik asit - 0.5-5 g/100mL Iif - 2.5-20 mg/100mL taurin - 0.8-5 mg/100mL L-karnitin Bulusun tercih edilen bir uygulamasina göre, kompozisyon ayrica asagidakileri içermektedir: - 90-250 mcg/100mL A vitamini - 1-5 mcg/100mL D3 vitamini - 1-5 mcg/100mL E vitamini - 5-10 mcg/100mL K1 vitamini - 10-30 mg/100mL C vitamini - 20-70 mcg/100mL folik asit - 0.2-0.5 mcg/100mL B12 vitamini - 0.75-3 mg/100mL B3 vitamini - 0.5-5 mg/100mL B5 vitamini - 3-10 mcg/100mL B7 vitamini - 10-40 mg/100mL kolin - 50-100 mg/100mL sodyum - 150-300 mg/100mL potasyum - 75-200 mg/100mL klorür - 100-300 mg/100mL kalsiyum - 50-200 mg/100mL fosfor - 10-50 mg/100mL magnezyum - 0.75-5 mg/100mL demir - 0.75-5 mg/100mL çinko - 0.1-1 mg/100mL manganez - 50-100 mcg/100mL florür - 100-500 mcg/100mL bakir - 10-50 mcg/100mL iyot - 1-20 mcg/100mL selenyum - 1-20 mcg/100mL krom - 5-30 mcg/100mL moIibden - 100-300 mg/100mL fosfat Analitik olarak seçilmis bu oranlar eksiksiz beslenme, toksik güvenlilik ve hasta uyumu için gerekli etkili dozlari saglamanin yani sira, stabiliteyi ve raf ömrünü de arttirmaktadir. Tüm bu uygulamalara göre, asagida belirtilen formülasyonlar, bulusun konusu olan sivi kompozisyonda kullanilabilir. Örnek 1: Pediatrik hastalar için eksiksiz ve dengeli beslenme saglayan sivi kompozisyon Içerik maddeleri Miktar protein 2-10 g/100mL karbonhidrat 15-18 g/100mL yag 5-10 g/100mL dokosahekzaenoik asit 15-300 mg/100mL eikosapentaenoik asit 5-30 mg/100mL lif 0.5-5 g/100mL taurin 2.5-20 mg/100mL L-karnitin 0.8-5 mg/100mL karotenoid 0.03-1.1 mg/100mL A vitamini 90-250 mcg/100mL D3 vitamini 1-5 mcg/100mL E vitamini 1-5 mcg/100mL K1 vitamini 5-10 mcg/100mL C vitamini 10-30 mg/100mL folik asit 20-70 mcg/100mL B1 vitamini 0.1-0.5 mg/100mL 82 vitamini 0.1-0.5 mg/100mL BG vitamini 0.1-0.5 mg/100mL B3 vitamini 0.75-3 mg/100mL B5 vitamini 0.5-5 mg/100mL B7 vitamini 3-10 mcg/100mL kolin 10-40 mg/100mL sodyum 50-100 mg/100mL potasyum 150-300 mg/100mL klorür 75-200 mg/100mL kalsiyum 100-300 mg/100mL fosfor 50-200 mg/ 100mL magnezyum 10-50 mg/100mL demir 0.75-5 mg/100mL çinko 0.75-5 mg/100mL manganez 0.1-1 mg/100mL florür 50-100 mcg/100mL bakir 100-500 mcg/100mL iyot 10-50 mcg/100mL selenyum 1-20 mcg/100mL krom 1-20 mcg/100mL moIibden 5-30 mcg/100mL fosfat 100-300 mg/100mL Örnek 2: Pediatrik hastalar için eksiksiz ve dengeli beslenme saglayan sivi kompozisyon Içerik maddeleri Miktar protein 4.5 g/100mL karbonhidrat 16.39 g/100mL yag 7.47 g/100mL dokosahekzaenoik asit 55 mg/100mL eikosapentaenoik asit 13 mg/100mL 1.5 g/100mL taurin 10 mg/100mL L-karnitin 2.6 mg/100mL karotenoid 0.15 mg/100mL A vitamini 110 mcg/100mL D3 vitamini 1.6 mcg/100mL E vitamini 1.9 mcg/100mL K1 vitamini 8.6 mcg/100mL C vitamini 15 mg/100mL folik asit 34 mcg/100mL B1 vitamini 0.26 mg/100mL B2 vitamini 0.32 mg/100mL B6 vitamini 0.29 mg/100mL B12 vitamini 0.36 mcg/100mL B3 vitamini 1.4 mg/100mL B5 vitamini 0.71 mg/100mL B7 vitamini 7.7 mcg/100mL koIin 30 mg/100mL sodyum 60 mg/100mL potasyum 203 mg/100mL klorür 102 mg/100mL kalsiyum 126 mg/100mL fosfor 76 mg/100mL magnezyum 25 mg/100mL demir 1.4 mg/100mL çinko 1.6 mg/100mL manganez 0.3 mg/100mL florür 80 mcg/100mL bakir 140 mcg/100mL iyot 13 mcg/100mL selenyum 4.5 mcg/100mL krom 3.8 mcg/100mL molibden 8.1 mcg/100mL fosfat 220 mg/100mL Örnek 1 ve 2'de verilen yukarida sözü edilen sivi kompozisyonlar asagidaki adimlar takip edilerek hazirlanmaktadir: a. Suda çözünen bilesenler su içerisine karistirilir b. Karisim pastörize edilir c. Karisima yag kaynaklari eklenir d. Tüm karisim UHT islemine tabi tutulur TR TR TR Description NUTRIENT COMPOSITIONS FOR IMPROVING PEDIATRIC HEALTH Technical Field The present invention relates to liquid compositions that provide complete and balanced nutrition and help meet the daily energy needs of pediatric patients over one year old with malnutrition and growth retardation. State of the Art Most children do not consume the required amount of food for a nutritionally complete diet. Nutritional supplements have been developed to help these children. Dietary supplements are generally not intended to provide all the nutrients needed for a nutritionally complete diet, but are generally intended to supplement the diet to make it more nutritionally complete. However, in some cases these supplements can provide complete nutrition. Malnutrition in children is a major health problem worldwide, contributing to morbidity, mortality, mental developmental delay, low adult working capacity and increased risk of disease in adulthood. Children, in particular, are prone to malnutrition when supplementary foods have low nutrient density and micronutrient bioavailability. According to the World Health Organization (WHO), malnutrition is defined as "the cellular imbalance between the nutrients and energy the body needs to grow, maintain its functions and provide certain functions, and the amount of nutrients and energy provided to the body." This dynamic nutritional imbalance affects children differently than adults and can have significant consequences for children during their developmental period. It is likely that the nutritional needs of children who are underweight and whose development has stopped are different. In underweight children, lean body mass is generally relatively low due to low muscle mass and the amount of stored fat. In this case, the amount of energy, protein and all other foods required for muscle and fat tissue synthesis will be higher in order to achieve a normal body composition. In children who are not overly thin but whose development has stopped, there is bone growth retardation even though the muscle and fat mass are close to normal. Since bone development is not an energy-consuming process, providing these children with extra energy will not be very helpful. At the same time, it is also possible that the extra energy taken will increase fat mass unnecessarily. On the other hand, these children need to take more nutrients for both bone development and lean tissue increase, but this is usually not the case in the nutrition of children from poor families. The energy, carbohydrate, protein, fat, mineral, vitamin and essential fatty acid needs of children over one year of age with a malnutrition-related disease should be approximately determined before preparing any formulation to be used to eliminate malnutrition. Deficiency of micronutrients such as minerals, vitamins, L-carnitine, taurine, ß-alanine, glutamine and creatinine or macronutrients such as protein, carbohydrates, fat, long-chain polyunsaturated fatty acids can lead to clinically significant immunodeficiency and growth retardation in children. In addition to the deficiency in micro or macronutrient intake, most children also have inadequate vitamin and supplement intake. Supplementation deficiencies have been associated with common disorders in children, such as malnutrition-related disease, proven inflammatory bowel disease after total gastrectomy, intestinal fistula, dysphagia, short bowel syndrome, and refractory malabsorption. Most nutritional compositions, especially pediatric compositions, contain various polyunsaturated fatty acids (PUFA) as part of the lipid component of the entire nutritional system. For example, long-chain PUFAs have been shown to be useful in the prevention and control of immunodeficiency and growth restriction in children. However, these long-chain PUFAs tend to be more susceptible to oxidation compared to other ingredients frequently found in nutritional compositions. Due to their chemical structure, as a result of exposure to heat and atmospheric oxygen levels, a series of reactions related to carbon:carbon double bonds may occur, resulting in the formation of free radicals. These free radicals can continue to break down polyunsaturated fatty acids in an auto-oxidative process. As a result, undesirable bad tastes and odors may occur and beneficial polyunsaturated fatty acids may deteriorate. These long-chain PUFAs are susceptible to oxidation, especially when treated with high temperatures, during the spray drying process, or even during a relatively short storage period after the formula has been hermetically sealed and packaged. The issue of oxidative stability has become even more challenging, especially due to the recent introduction of compositions for children that contain relatively high concentrations of long-chain polyunsaturated fatty acids to strengthen the immune system and enhance brain development. High DHA concentrations will also further complicate the oxidative stability issue in terms of eliminating fishy flavor during production and ensuring that this flavor does not appear during shelf life. One method of controlling the undesirable oxidation of polyunsaturated fatty acids present in powdered nutritional compositions is the addition of antioxidants, including ascorbyl palmitate, beta carotene, tocopherol mixtures, and others, as disclosed in U.S. Patent No. 5,234,702 (Katz et al.). BASE. Another patent numbered 7,090,879 discloses an infant formula in powder form containing a combination of lutein, lycopene and beta carotene with a lipid component containing carbohydrates, protein and polyunsaturated fatty acids. There are nutritional compositions specifically formulated for different age ranges and different purposes in the patent literature. These compositions can be used as supplements for malnutrition or as a complete nutritional source for disabled patients. As mentioned above, fats are prone to oxidation. This is especially true for fish oils containing high amounts of DHA. Oxidation occurs as a result of reactions between polyunsaturated fatty acids and oxygen in the oil. These reactions are accelerated in the presence of oxygen and oxidation accelerators. This problem becomes even more complex as formulas contain high amounts of oxidation accelerators (Iron, Copper, Zinc). However, the state of the art is insufficient for a specific process that would minimize the contact time between oxygen and oils. Purposes and Brief Description of the Invention The main purpose of the present invention is to obtain liquid nutritional compositions that provide complete and balanced nutrition and help meet the energy needs of pediatric patients over one year old with malnutrition and growth retardation. This invention also relates to a process for obtaining the compositions of the invention and to the application of these compositions. Another object of the present invention is to obtain a nutritional composition containing at least one antioxidant source in order to increase stability by simultaneously reducing sedimentation and oxidation. Another aim of the present invention is to obtain nutritional compositions in which osmolarity and osmolality are reduced and therefore increase patient compliance. Another aim of the present invention is to obtain nutritional compositions with a balanced carbohydrate content to meet the daily energy needs of the patient. Another aim of the present invention is to obtain nutritional compositions containing biocompatible components without excess or competitive absorption. Another object of the present invention is to obtain nutritional compositions comprising essentially water, at least one protein source, at least one carbohydrate source, at least one fat source, at least one fiber source, vitamins and minerals. Another object of the present invention is to obtain nutritional compositions containing taurine and L-carnitine, each of which increases the absorption of the other. Another aim of the present invention is to obtain nutritional compositions with high fiber content to support the gastrointestinal system. Another aim of the present invention is to obtain nutritional compositions containing caseinate in specific ranges as a protein source in order to provide low osmolarity and sedimentation. Another aim of the present invention is to obtain nutritional compositions containing docosahexaenoic acid and eicosapentaenoic acid in capsule form in order to reduce oxidation and eliminate odor. Another aim of the present invention is to develop a process for the preparation of such compositions in order to increase homogenization and reduce oxidation. Another aim of the present invention is to provide a process that eliminates the risk of severe foaming, which is a major risk in dairy products, and provides rapid homogeneous mixing. Another aim of the present invention is to provide a process that involves the application of high temperature for a short period of time in order to reduce heat damage in the liquid nutritional composition. Detailed Description of the Invention In accordance with the above-mentioned purposes, detailed features of the present invention are given herein. The present invention relates to a liquid composition suitable for providing complete and balanced nutrition that helps meet the energy needs of pediatric patients over one year of age with a disease associated with malnutrition, the composition comprising: - at least one source of protein, - at least one carbohydrate. source, - at least one source of fat, - at least one long-chain polyunsaturated fatty acid, - at least one source of fiber, - carotenoids, ascorbic acid, ascorbyl palmitate, retinyl palmitate, tocopherols, ascorbate salts, fat-soluble rosemary extract and their At least one antioxidant source selected from the group containing mixtures, - vitamins, - minerals, and characterized in that the composition is obtained by a process involving the following steps: - mixing water-soluble components into water - adding oil sources to the mixture - subjecting the entire mixture to UHT processing As used herein The terms "child" and "children" include children not older than 36 months and 12 months to 36 months. For the preparation of sterilized liquid compositions, an advanced processing technology optimized for milk is used. Ultra-high temperature processing (UHT), ultra-high heat treatment or ultra-pasteurization, is a food processing technology that sterilizes liquid foods by bringing them to temperatures above 135°C (135°C), the temperature required to kill bacterial endospores within 2 to 5 seconds. Although UHT is most commonly used in milk production. It is also used in foods, fruit juices, cream, soy milk, yoghurt, wine, soup, honey and stews. The use of UHT principles eliminates the risk of high viscosity and protein degradation. Steam Injection and Infusion systems are the best for high viscosity products. They are suitable systems and will extend the production time between cleaning processes. Using a vacuum mixer to dissolve the powdered ingredients has a number of advantages, such as eliminating the risk of severe foaming, which is a major risk with milk proteins, and ensuring rapid homogeneous mixing. The mixture is effective in eliminating pathogens and It is generally pasteurized at temperatures below 100°C (212°F) to extend its shelf life. Surprisingly, it was observed that oxidation decreased when the process steps were applied consecutively in this way. According to a preferred embodiment, the composition contains a combination of beta carotene, lutein and lycopene as antioxidants. According to a preferred embodiment, said long chain polyunsaturated fatty acid source is selected from the group consisting of arachidonic acid, linoleic acid, linolenic acid, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) or mixtures thereof. Most preferred is the presence of at least two long-chain polyunsaturated fatty acids in encapsulated form in the composition to eliminate fishy flavor and odor. Additionally, as a result of encapsulation, oxidation is reduced throughout the production process and shelf life. According to a preferred embodiment, the composition contains docosahexaenoic acid and eicosapentaenoic acid as long-chain polyunsaturated fatty acids. According to a preferred embodiment, it has been observed that oxidation decreases when the total amount of beta carotene, lutein and lycopene is used. According to the preferred embodiment, the composition further comprises at least one component selected from L-carnitine, taurine, ß-alanine, glutamine, creatine or mixtures thereof. Carnitine is a quaternary amine, ß-hydroxy, γ-N-tri-methylaminobutyric acid, which is an important metabolite for the use of long-chain fatty acids as an energy source in mammalian tissues. L-carnitine is a vitamin-like antioxidant and has very positive effects on the body's energy production and normal brain functions. L-carnitine plays a role in fatty acid oxidation and ketogenesis because it facilitates the passage of free fatty acids across the mitochondrial membrane. L-carnitine is present in an amount of at least 1 mg, in particular 1 to 5 mg, per 100 ml. Taurine is one of the main building blocks of the free amino acid pool in all mammalian central nervous system tissues. The most important physiological functions of taurine include bile conjugation, osmoregulation, neurotransmission, neuroregulation and membrane stabilization. Taurine is present in high amounts in the brain, bones, heart muscle and blood cells. It plays a role in regulating calcium and potassium balance in the brain and nervous system. Taurine is involved in many processes, including cell membrane function and bile acid conjugation, and since the ability to synthesize this amino acid is limited in children, it is thought that taurine supplementation may be preferred. Taurine is present in 100 ml at least 2.5 mg, especially between 2.5 and 10 mg. According to the preferred embodiment, the ratio of L-carnitine to taurine by weight is between 1:0.1 and 1:20, preferably between 1:1 and 1:10, more preferably between 1:3 and 1:5. When these combination ratios are used, the most effective results are achieved as the absorption of taurine and L-carnitine increases simultaneously. From here it can be seen that this combination plays an important role in terms of brain development in children. According to one embodiment, said carbohydrate source is selected from the group consisting of sucrose, maltodextrin, fructose, hydrolyzed corn starch, solid corn syrup, high fructose corn syrup, or mixtures thereof. In a preferred embodiment, the composition includes maltodextrin and sucrose. It is between 1:0.7 and 1:0.7. It has been observed that, surprisingly, when these ranges are used specifically, the osmolality of the composition can be reduced. It is in the range of mOsm/L. According to one embodiment, said protein source is selected from the group consisting of casein, soy, rice, pea, carob, oats, whey, caseino-glyco-macropeptides or mixtures thereof. Preferably, the composition does not contain whey in order to provide a balanced solids content, good stability to heat and to ensure fluidity in a production facility using tubular systems. According to the preferred embodiment, the composition contains sodium caseinate and calcium caseinate as protein sources. When the ratio of sodium caseinate to calcium caseinate is used as 1:0.01 by weight, sedimentation decreases over time, providing high stability and therefore increasing the shelf life. It has also been observed that the use of sodium caseinate and calcium caseinate as protein sources supports the decrease in osmolality. According to one embodiment, said fat source is fish oil, medium chain triglycerides, canola oil, sunflower oil, high-oleic sunflower oil, safflower oil, soybean oil, olive oil, corn oil, peanut oil, rice bran oil, butter, hazelnut oil, structured lipids. or mixtures thereof. According to a preferred embodiment, said fat source is selected from the group consisting of fish oil, medium chain triglycerides, canola oil, sunflower oil, high-oleic sunflower oil or mixtures thereof. It has been shown that by choosing the oil source among these, the shelf life of the composition is extended and oxidation is reduced. According to one embodiment, said fiber source is selected from the group consisting of fructooligosaccharides, inulin, guar gum, xanthan gum, xylo-oligosaccharides, gum arabic, pectin, acacia gum, resistant starch, dextrans or mixtures thereof. According to the preferred embodiment, the composition contains fructooligosaccharide and inulin. It is between g/100mL. By specifically selecting these water-soluble fibers and these relatively high amounts compared to the prior art, it is aimed to improve the intestinal functions of pediatric patients. According to one embodiment, said vitamins are vitamin A, vitamin D3, vitamin E, vitamin K1, vitamin C, folic acid, vitamin B1, vitamin B2, vitamin B3, vitamin B5, vitamin B6, vitamin B7, vitamin B8, vitamin B12, choline or is selected from the group containing mixtures thereof. According to one embodiment, said minerals are selected from the group consisting of sodium, potassium, chloride, calcium, phosphorus, magnesium, fluoride, iron, zinc, manganese, copper, iodine, selenium, chromium, molybdenum, phosphate or mixtures thereof. According to one embodiment, the energy value of the composition is in the range of 140-170 kcal/100 mL in order to meet the daily energy needs of pediatric patients. According to one embodiment of the invention, the composition comprises: - 2-10 g/100mL protein - 15-18 g/100mL carbohydrate - 5-10 g/100mL fat - 15-300 mg/100mL docosahexaenoic acid - 5-30 mg/100mL eicosapentaenoic acid - 0.5-5 g/100mL Iif - 2.5-20 mg/100mL taurine - 0.8-5 mg/100mL L-carnitine According to a preferred embodiment of the invention, the composition further contains: - 90-250 mcg/100mL vitamin A - 1 -5 mcg/100mL Vitamin D3 - 1-5 mcg/100mL Vitamin E - 5-10 mcg/100mL Vitamin K1 - 10-30 mg/100mL Vitamin C - 20-70 mcg/100mL folic acid - 0.2-0.5 mcg/100mL Vitamin B12 - 0.75-3 mg/100mL Vitamin B3 - 0.5-5 mg/100mL Vitamin B5 - 3-10 mcg/100mL Vitamin B7 - 10-40 mg/100mL choline - 50-100 mg/100mL sodium - 150-300 mg /100mL potassium - 75-200 mg/100mL chloride - 100-300 mg/100mL calcium - 50-200 mg/100mL phosphorus - 10-50 mg/100mL magnesium - 0.75-5 mg/100mL iron - 0.75-5 mg/100mL zinc - 0.1-1 mg/100mL manganese - 50-100 mcg/100mL fluoride - 100-500 mcg/100mL copper - 10-50 mcg/100mL iodine - 1-20 mcg/100mL selenium - 1-20 mcg/100mL chromium - 5-30 mcg/100mL molybdenum - 100-300 mg/100mL phosphate These analytically selected ratios provide effective doses required for complete nutrition, toxic safety and patient compliance, while also increasing stability and shelf life. According to all these applications, the formulations mentioned below can be used in the liquid composition that is the subject of the invention. Example 1: Liquid composition providing complete and balanced nutrition for pediatric patients Ingredients Quantity protein 2-10 g/100mL carbohydrate 15-18 g/100mL fat 5-10 g/100mL docosahexaenoic acid 15-300 mg/100mL eicosapentaenoic acid 5-30 mg/100mL fiber 0.5-5 g/100mL taurine 2.5-20 mg/100mL L-carnitine 0.8-5 mg/100mL carotenoid 0.03-1.1 mg/100mL Vitamin A 90-250 mcg/100mL Vitamin D3 1-5 mcg/100mL E vitamin 1-5 mcg/100mL vitamin K1 5-10 mcg/100mL vitamin C 10-30 mg/100mL folic acid 20-70 mcg/100mL vitamin B1 0.1-0.5 mg/100mL vitamin 82 0.1-0.5 mg/100mL vitamin BG 0.1 -0.5 mg/100mL Vitamin B3 0.75-3 mg/100mL Vitamin B5 0.5-5 mg/100mL Vitamin B7 3-10 mcg/100mL choline 10-40 mg/100mL sodium 50-100 mg/100mL potassium 150-300 mg/100mL chloride 75-200 mg/100mL calcium 100-300 mg/100mL phosphorus 50-200 mg/100mL magnesium 10-50 mg/100mL iron 0.75-5 mg/100mL zinc 0.75-5 mg/100mL manganese 0.1-1 mg/100mL fluoride 50-100 mcg/100mL copper 100-500 mcg/100mL iodine 10-50 mcg/100mL selenium 1-20 mcg/100mL chromium 1-20 mcg/100mL moIibdenum 5-30 mcg/100mL phosphate 100-300 mg/100mL Example 2 : Pediatric patients, which provide complete and balanced nutrition for pediatric patients, the quantity of constiper substances amount of protein 4.5 g/100ml carbohydrate 16.39 g/100ml yag 7.47 g/100ml dokosahekzaenoic acid 55 mg/100ml eikosapentaenoic acid 13 mg/100ml 1.5ml 1.5 g/100ml TAURIN 10 mg/100ml Taurin 10 mg/100ml L-carnitine 2.6 mg/100ml carotenoid 0.15 mg/100ml vitamin A 110 mcg/100ml D3 vitamin 1.6 mcg/100ml vitamin E 1.9 mcg/100ml K1 vitamin 8.6 mcg/100ml vitamin C1/100ml Folic Acid 34 McG/100ml B1 B1 B1 B1 B1 B1 B1 B1 vitamin 0.26 mg/100mL vitamin B2 0.32 mg/100mL vitamin B6 0.29 mg/100mL vitamin B12 0.36 mcg/100mL vitamin B3 1.4 mg/100mL vitamin B5 0.71 mg/100mL vitamin B7 7.7 mcg/100mL choline 30 mg/100mL sodium 60 mg/ 100mL potassium 203 mg/100mL chloride 102 mg/100mL calcium 126 mg/100mL phosphorus 76 mg/100mL magnesium 25 mg/100mL iron 1.4 mg/100mL zinc 1.6 mg/100mL manganese 0.3 mg/100mL fluoride 80 mcg/100mL copper 14 0mcg/100mL iodine 13 mcg/100mL selenium 4.5 mcg/100mL chromium 3.8 mcg/100mL molybdenum 8.1 mcg/100mL phosphate 220 mg/100mL The above mentioned liquid compositions given in Examples 1 and 2 are prepared by following the following steps: a. Water-soluble components are mixed into water b. The mixture is pasteurized c. Oil sources are added to the mixture d. The entire mixture is subjected to UHT treatment TR TR TR
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