US20040087490A1 - Nutritional compositions - Google Patents

Nutritional compositions Download PDF

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US20040087490A1
US20040087490A1 US10/662,678 US66267803A US2004087490A1 US 20040087490 A1 US20040087490 A1 US 20040087490A1 US 66267803 A US66267803 A US 66267803A US 2004087490 A1 US2004087490 A1 US 2004087490A1
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amino acids
composition
total
weight
essential
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John Troup
Robert Wolfe
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Nestec SA
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Assigned to NOVARTIS AG reassignment NOVARTIS AG MERGER (SEE DOCUMENT FOR DETAILS). Assignors: NOVARTIS NUTRITION AG
Assigned to NESTEC S.A. reassignment NESTEC S.A. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: NOVARTIS AG
Priority to US13/687,796 priority patent/US8703725B2/en
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    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23L—FOODS, FOODSTUFFS, OR NON-ALCOHOLIC BEVERAGES, NOT COVERED BY SUBCLASSES A21D OR A23B-A23J; THEIR PREPARATION OR TREATMENT, e.g. COOKING, MODIFICATION OF NUTRITIVE QUALITIES, PHYSICAL TREATMENT; PRESERVATION OF FOODS OR FOODSTUFFS, IN GENERAL
    • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
    • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
    • A23L33/115—Fatty acids or derivatives thereof; Fats or oils
    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23L—FOODS, FOODSTUFFS, OR NON-ALCOHOLIC BEVERAGES, NOT COVERED BY SUBCLASSES A21D OR A23B-A23J; THEIR PREPARATION OR TREATMENT, e.g. COOKING, MODIFICATION OF NUTRITIVE QUALITIES, PHYSICAL TREATMENT; PRESERVATION OF FOODS OR FOODSTUFFS, IN GENERAL
    • A23L2/00—Non-alcoholic beverages; Dry compositions or concentrates therefor; Their preparation
    • A23L2/52—Adding ingredients
    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23L—FOODS, FOODSTUFFS, OR NON-ALCOHOLIC BEVERAGES, NOT COVERED BY SUBCLASSES A21D OR A23B-A23J; THEIR PREPARATION OR TREATMENT, e.g. COOKING, MODIFICATION OF NUTRITIVE QUALITIES, PHYSICAL TREATMENT; PRESERVATION OF FOODS OR FOODSTUFFS, IN GENERAL
    • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
    • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
    • A23L33/17—Amino acids, peptides or proteins
    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23L—FOODS, FOODSTUFFS, OR NON-ALCOHOLIC BEVERAGES, NOT COVERED BY SUBCLASSES A21D OR A23B-A23J; THEIR PREPARATION OR TREATMENT, e.g. COOKING, MODIFICATION OF NUTRITIVE QUALITIES, PHYSICAL TREATMENT; PRESERVATION OF FOODS OR FOODSTUFFS, IN GENERAL
    • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
    • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
    • A23L33/17—Amino acids, peptides or proteins
    • A23L33/175—Amino acids
    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23L—FOODS, FOODSTUFFS, OR NON-ALCOHOLIC BEVERAGES, NOT COVERED BY SUBCLASSES A21D OR A23B-A23J; THEIR PREPARATION OR TREATMENT, e.g. COOKING, MODIFICATION OF NUTRITIVE QUALITIES, PHYSICAL TREATMENT; PRESERVATION OF FOODS OR FOODSTUFFS, IN GENERAL
    • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
    • A23L33/30—Dietetic or nutritional methods, e.g. for losing weight
    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23L—FOODS, FOODSTUFFS, OR NON-ALCOHOLIC BEVERAGES, NOT COVERED BY SUBCLASSES A21D OR A23B-A23J; THEIR PREPARATION OR TREATMENT, e.g. COOKING, MODIFICATION OF NUTRITIVE QUALITIES, PHYSICAL TREATMENT; PRESERVATION OF FOODS OR FOODSTUFFS, IN GENERAL
    • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
    • A23L33/40—Complete food formulations for specific consumer groups or specific purposes, e.g. infant formula
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
    • A61K31/404—Indoles, e.g. pindolol
    • A61K31/405—Indole-alkanecarboxylic acids; Derivatives thereof, e.g. tryptophan, indomethacin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/4164—1,3-Diazoles
    • A61K31/4172—Imidazole-alkanecarboxylic acids, e.g. histidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
    • A61P21/06—Anabolic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/02—Nutrients, e.g. vitamins, minerals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
    • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
    • A23V—INDEXING SCHEME RELATING TO FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES AND LACTIC OR PROPIONIC ACID BACTERIA USED IN FOODSTUFFS OR FOOD PREPARATION
    • A23V2002/00—Food compositions, function of food ingredients or processes for food or foodstuffs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

  • Cachexia is a condition of severe malnutrition and negative nitrogen balance characterized by anorexia (i.e. a lack or severe loss of appetite), weight loss, and muscle atrophy.
  • anorexia i.e. a lack or severe loss of appetite
  • the physiological, metabolic, and behavioral changes in cachexia are associated with patient complaints of weakness, fatigue, gastrointestinal distress, sleep/wake disturbances, pain, listlessness, shortness of breath, lethargy, depression, malaise and the fear of being burdensome on family and friends.
  • cachexia has been classically associated with chronic infections and malignant conditions, it has also been identified in patients after extensive traumatic injury and sepsis and in aging persons with failure to thrive syndrome.
  • Loss of lean body mass associated with cancer cachexia not only weakens the individual and makes activities of daily living difficult, but can weaken the patient to the point that they do not have the strength to undergo chemo-and/or radiation therapy.
  • a dietary supplement when dietary intake is limited below the optimal level for physiological or patho-physiological reasons, a dietary supplement must be more effective than normal food intake in order to provide a benefit. This is because in this circumstance, when a dietary supplement is given, normal food intake is likely to be reduced by a calorically equivalent amount. Consequently, a supplement designed to limit cancer cachexia should stimulate muscle protein synthesis to a greater extent than normal food intake and should not interfere with the response to meal intake.
  • compositions of the present invention e.g. in the form of dietary means, e.g. supplements, or nutritional or pharmaceutical formulations, for the treatment or prevention of cachexia, e.g. cancer cachexia and/or anorexia can be self-administered for extensive periods without risk of adverse side-effects, yet have the potential to reverse cachexia, e.g. cancer cachexia, and/or improve associated symptoms that affect quality of life.
  • cachexia e.g. cancer cachexia and/or anorexia
  • the compositions as described herein have excellent taste and thus have particularly good patient compliance and patient acceptance due to their increased ease of administration and ingestion.
  • compositions of the invention comprising at least one of isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine, or histidine, e.g. leucine and at least one of isoleucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine, or histidine, in free form and/or in salt form, e.g. pharmaceutically or nutritionally acceptable salt form, wherein leucine is present in an amount of at least about 10 to about 95%, e.g. about 10 to about 60%, e.g. at least about 15, 20, 25, 30 or 35% to about 40, 45, 50 or 55%, based on the weight of amino-nitrogen source, hereinafter referred to as compositions of the invention.
  • amino-nitrogen source refers to amino acids, e.g. essential amino acids, conditionally essential amino acids or non-essential amino acids, in free form or salt form, either alone or in combination with, e.g. in addition to, intact protein.
  • the term “intact protein” refers to protein, e.g. hydrolyzed, e.g. partially hydrolyzed protein and to peptides, e.g. to amino acids which are not in free or salt form.
  • the “intact protein” may be chosen from at least one of casein, whey protein, soy protein, collagen or wheat protein.
  • composition of the invention wherein leucine in free and/or salt form is present in amount of at least about 10 to about 35%, e.g. about 11, 12, 13, 14 or 15 to about 20, 25 or 30%, e.g. at least about 14 or 15% by weight, based on the weight of total amino acids.
  • composition of the invention wherein leucine is present in free form and/or salt form in an amount of at least about 20 to about 80%, e.g. about 20 to about 65%, e.g. about 25, 30 or 35% to about 40, 45, 50 or 55%, e.g. about 65% by weight, based on the weight of amino acids in free form and/or salt form.
  • amino acids refers to amino acids in free form and/or in salt form chosen from at least one of essential amino acids, e.g. isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine, or histidine, conditionally essential amino acids, e.g. tyrosine, cysteine, arginine, or glutamine, or non-essential amino acids, e.g. glycine, alanine, proline, serine, glutamic acid, aspartic acid, asparagines, taurine or carnitine.
  • essential amino acids e.g. isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine, or histidine
  • conditionally essential amino acids e.g. tyrosine, cysteine, arginine, or glutamine
  • non-essential amino acids e
  • composition of the invention wherein leucine is present in free form and/or salt form in an amount of at least about 20 to about 95%, e.g. about 25, 30, 35, 40 or 45% to about 50, 55, 60, 65, 70, 75, 80, 85 or 90%, e.g. about 95% by weight, based on the weight of essential amino acids in free form and/or salt form.
  • essential amino acids refers to essential amino acids in free form and/or salt form chosen from at least one of isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine, and histidine. It is to be understood that “leucine” as used herein, unless otherwise stated, refers to leucine in free form and/or salt form.
  • total leucine or “total amino acid, e.g. essential or conditionally essential or non-essential amino acid” as used herein refers to leucine or amino acid in free and/or salt form plus leucine or amino acid derived from, or bound in, intact protein.
  • composition of the invention wherein total leucine, i.e. the sum of leucine in free and/or salt form plus leucine derived from intact protein, is at least about 10 to about 40%, e.g. at least about 15 to about 35%, e.g. at least about 20 to about 30, e.g. about 21, 22, 23, 24 or 25%, e.g. about 22% by weight based on the weight of total amino acids.
  • Total leucine content of the compositions of the invention may be from about 25 to about 45, e.g. about 30 to about 40%, e.g. about 36% of the total essential amino acids.
  • compositions of the invention may comprise leucine in free and/or salt form:leucine in form of intact protein in a ratio of about 3:1 to about 1:3, for example in a ratio of about 2: about 1.
  • a composition of the invention comprising a ratio of total leucine:leucine in free and/or salt form of about 3:1 to about 1:3, e.g. about 1.5:1.
  • the present invention provides a composition of the invention, wherein the amount of leucine, e.g. total leucine, is up to three times higher than the highest amount of any other essential amino acid, e.g. total essential amino acid.
  • compositions further comprising branched-chain amino acids, e.g. valine, leucine, isoleucine, or mixtures thereof, in free and/or in salt form and/or in form of intact protein, in an amount of about 30 to 60%, e.g. of about 35 to 55%, e.g. about 30 or 35 to 45% by weight based on the weight of amino-nitrogen source, e.g. of total amino acids.
  • branched-chain amino acids e.g. valine, leucine, isoleucine, or mixtures thereof
  • composition of the invention with a reduced amount of tryptophan or hydroxytryptophan in free and/or in salt form and/or in form of intact protein, e.g. about less than 5%, e.g. less than about 3% by weight based on the weight of amino-nitrogen source, e.g. of total amino acids.
  • compositions of the invention also relates to compositions of the invention further comprising threonine in free and/or in salt form and/or in form of intact protein in an amount of about 3 or 5 to about 11% by weight based on the weight of amino-nitrogen source, e.g. of total amino acids.
  • compositions of the invention further comprising valine in free and/or in salt form and/or in form of intact protein in amount of about 6% to about 16%, e.g. about 8 to about 10% by weight based on the weight of amino-nitrogen source, e.g. based on the weight of total of amino acids.
  • compositions of the invention may further comprise conditionally essential amino acids in free and/or in salt form and/or in form of intact protein chosen from at least one of arginine, glutamine, tyrosine, and cysteine.
  • the compositions of the invention comprise arginine in free form and/or salt form, e.g. in an amount of about 5% or 10% to about 40%, e.g. about 15% to about 25%, 30% or 35%, e.g. about 15 to 20% by weight based on the weight of amino-nitrogen source, e.g. of the total essential and conditionally essential amino acids.
  • free arginine constitutes about 5% to about 10%, e.g. about 7% of the total amino acids of the compositions of the invention.
  • compositions e.g. pharmaceutical or nutritional compositions
  • the compositions may have the following amino acid composition: leucine 20 to 35%, e.g. 30%, isoleucine 3 to 6%, e.g. 3 to 4%, valine 5 to 15%, e.g. 8 to 12%, methionine 0.5 to 7%, e.g. 2 to 5%, phenylalanine 8 to 12, e.g. 9 to 10%, lysine 10 to 14%, e.g. 12 to 13%, threonine 8 to 12%, e.g. 9 to 11%, histidine 8 to 12%, e.g.
  • compositions of the invention may comprise the following concentration rage of amino acids (% molar base): leucine 20 to 40%, e.g. about 35 to 40%, isoleucine 3 to 10%, e.g. about 7%, valine 5 to 15%, e.g. about 10%, methionine 0.5 to 7%, e.g. about 5%, phenylalanine 5 to 12, e.g. about 5%, lysine 8 to 20%, e.g. about 9%, threonine 6 to 12%, e.g.
  • compositions of the invention may comprise arginine, leucine and methionine in free form and/or salt form, for example in the amounts of about 5% to about 15% arginine, about 10% to about 30% leucine, and about 0.5% to about 5% methionine by weight based on the weight of amino-nitrogen source, e.g. of total amino acids.
  • compositions of the invention may comprise arginine:leucine:methionine in free form and/or salt form in a ratio of about 0.1 to about 5:about 0.5 to about 10:about 0.01 to about 1, e.g. in a ratio of about 0.5:about 1:about 0.05.
  • compositions of the invention may further comprise glutamine, e.g. glutamine peptide, e.g. in an amount of about 4 to 9 g per daily dose.
  • compositions of the invention further comprise intact protein, e.g. protein chosen from at least one of casein, whey protein, soy protein, collagen or wheat protein, preferably whey protein and/or soy protein and/or casein may be used.
  • the invention provides a composition comprising leucine in free form and/or in salt form and intact protein wherein leucine in free form and/or in salt form is present in an amount of about 10%, 15% or 20% to about 25%, 30% or 35%, e.g. about 15% to about 20%, e.g. about 18% by weight based on the weight of intact protein.
  • compositions of the invention may comprise intact protein:leucine in free and/or salt form in a ratio of about 10:1 to about 1:10, for example in a ratio of about 5:1 to about 1:5, for example in a ratio of about 5:1.
  • the ratio of total amino acids:total leucine may be from about 3:1 to about 6:1, e.g. about 4 to 5:1.
  • compositions comprising a combination of
  • compositions according to the invention provide a ratio of total essential and, optionally, conditionally essential amino acids versus total non-essential amino acids of about 0.65:about 0.45.
  • compositions of the invention comprise about 40 to about 95%, e.g. about 45, 50, 55 or 60% to about 70, 75, 80 or 90%, e.g. about 65% by weight of total essential and, optionally, conditionally essential amino acids based on the weight of total amino acids.
  • compositions of the present invention comprise a mixture of essential amino acids solely in free form and/or in salt form, e.g. leucine solely in free form and/or in salt form and at least one essential amino acid solely in free form and/or in salt form.
  • compositions of the invention may be provided in form of dietary means, e.g. supplements, or in the form of a nutritional formulation, e.g. a medical food or beverage product, e.g. in form of a complete meal, part of a meal, as food additive or as powder for dissolution, or in the form of a pharmaceutical formulation, e.g. in form of a tablet, pill, sachet or capsule.
  • a nutritional formulation e.g. a medical food or beverage product, e.g. in form of a complete meal, part of a meal, as food additive or as powder for dissolution
  • a pharmaceutical formulation e.g. in form of a tablet, pill, sachet or capsule.
  • a medical food or beverage product, dietary supplement or nutritional or pharmaceutical formulation comprising a composition of the invention.
  • compositions of the invention in form of dietary means e.g. supplements, or pharmaceutical formulations may consist exclusively of the compositions of the invention, and optionally pharmaceutically or nutritionally acceptable carriers.
  • compositions of the invention may be in medical food or beverage product form, e.g. in form of a powder for dissolution.
  • the powder may be combined with a liquid, e.g. water, or other liquid, such as milk or fruit juice, e.g. in a ratio of powder to liquid of about 1 to about 5, to obtain a ready-to-consume composition, e.g. ready-to-drink composition or instant drink.
  • the compositions according to the invention may be nutritionally complete, i.e. may include vitamins, minerals, trace elements as well as nitrogen, carbohydrate and fat and/or fatty acid sources so that they may be used as the sole source of nutrition supplying essentially all the required daily amounts of vitamins, minerals, carbohydrates, fat and/or fatty acids, proteins and the like.
  • the compositions of the invention may be provided in the form of a nutritionally balanced complete meal, e.g. suited for oral or tube feeding, e.g. by means of nasogastric, nasoduodenal, esophagostomy, gastrostomy, or jejunostomy tubes, or peripheral or total parenteral nutrition.
  • the compositions of the invention are for oral administration.
  • compositions for promotion of muscle protein synthesis or controlling tumor-induced weight loss such as cachexia, e.g. cancer cachexia
  • cachexia e.g. cancer cachexia
  • n-3 polyunsaturated fatty acids including, but not limited to ⁇ -linolenic acid (LNA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), either alone or in combination with each other.
  • LNA ⁇ -linolenic acid
  • EPA eicosapentaenoic acid
  • DHA docosahexaenoic acid
  • the present invention further pertains to a combination comprising
  • leucine e.g. total leucine
  • leucine is at least about 10 to about 40%, e.g. at least about 15 to about 35%, e.g. at least about 20 to about 30, e.g. about 15% to about 25%, e.g. about 22%, by weight based on the weight of amino-nitrogen source, e.g. of total amino acids, and
  • n-3 fatty acid chosen from alpha-linolenic acid, eicosapentaenoic acid, and docosahexaenoic acid,
  • leucine may be present in form of a combination of leucine in free and/or salt form and leucine derived from intact protein and the n-3 fatty acid(s) may be present in free form or in form of an oil or fat, e.g. for promotion of muscle protein synthesis or controlling tumor-induced weight loss, such as cachexia, e.g. cancer cachexia.
  • Such a combination is preferably a combined preparation or a pharmaceutical or nutritional composition.
  • compositions of the invention may comprise EPA and DHA, e.g. EPA and DHA in a ratio of EPA:DHA of about 2:1 to about 1:2, e.g. about 1.5:1.
  • compositions of the invention may comprise EPA and DHA either alone or in combination, e.g. EPA alone, in an amount of at least about 600 mg to about 2 g, e.g. about 1.5 g to about 1.8 g per serving.
  • EPA may be present in amount of about 500 mg to about 1.5 g, e.g. about 1 g
  • DHA may be present in an amount of about 250 mg to about 1.5 g, e.g. about 500 mg to about 750 mg, e.g. about 650 mg, per serving.
  • compositions of the invention may comprise a mixture of n-6, e.g. linoleic acid, and n-3 polyunsaturated fatty acids, e.g. chosen from linolenic acid, EPA and DHA, e.g. in a ratio of n-6:n-3 polyunsaturated fatty acids of about 0.1:1 to about 1:0.1, e.g. about 0.2, 0.5 or 0.8 to about 1, 1.2 or 1.5, e.g. about 1.1:1.
  • n-6 e.g. linoleic acid
  • n-3 polyunsaturated fatty acids e.g. chosen from linolenic acid, EPA and DHA, e.g. in a ratio of n-6:n-3 polyunsaturated fatty acids of about 0.1:1 to about 1:0.1, e.g. about 0.2, 0.5 or 0.8 to about 1, 1.2 or 1.5, e.g. about 1.1:1.
  • compositions of the invention may comprise about 2 g or 2.5 to about 3.5 g, e.g. about 2.5 g or 3 g per serving of monounsaturated fatty acids (MUFA) and about 3 g or 3.5 g to about 4 g or 6 g, e.g. about 4.5 g or 5 g per serving of polyunsaturated fatty acids (PUFA).
  • MUFA monounsaturated fatty acids
  • PUFA polyunsaturated fatty acids
  • Nutritional formulations comprising the compositions of the invention, e.g. medical food or beverage product, comprise other nutritional components, e.g. fats and/or carbohydrates, in addition to the mixture of essential amino acids in free and/or in salt form and optionally the n-3 fatty acid(s).
  • Dietary oils may be used in the preparation of the nutritional compositions of the invention. Dietary oils include but are not limited to canola, medium chain triglycerides (MCT), fish, soybean, soy lecithin, corn, safflower, sunflower, high-oleic sunflower, high-oleic safflower, olive, borage, black currant, evening primrose and flaxseed oil.
  • MCT medium chain triglycerides
  • fish e.g., soy lecithin, corn, safflower, sunflower, high-oleic sunflower, high-oleic safflower, olive, borage, black currant, evening primrose and flaxseed oil.
  • an oil comprising about 45% EPA and about 10% DHA, e.g. as known and commercially available under the trade name EPAX® 4510 from Pronova Biocare (Lysaker, Norway), or concentrated fish oil, comprising e.g. about 70% EPA.
  • the dose of dietary oil per serving may comprise for example about 0.5 g to about 3 g, e.g. about 1.5 g to about 2 g, of n-3 polyunsaturated fatty acids.
  • the dose of dietary oil per serving may comprise for example about 2.5 g, 3.5 g or 4.5 g to about 5.5 g, 6.5 g or 7.5 g, e.g. about 5.5 g of fish oil and/or about 0.5 g, 1 g, 1.5 g, 2 g or 2.5 g to about 3 g, 3.5 g, 4 g, 4.5 g or 5 g, e.g. about 1 g to about 3 g, e.g. about 1 g of medium chain triglycerides (MCT).
  • MCT medium chain triglycerides
  • up to 5 or 6, e.g. about 2 to 3 servings may be given per day.
  • compositions of the invention may further comprise soluble fibers, e.g. agar, alginates, carubin, pectin and its derivatives, e.g. pectins from fruits and vegetables, and more preferably pectins from citrus fruits and apple, beta-glucan, such as oat beta-glucan, carrageenans, e.g. kappa, lambda and iota carrageenans, furcellaran, inulin, arabinogalactan, cellulose and its derivatives, scleroglucan, psyllium, such as psyllium seed husk, mucilages and gums.
  • soluble fibers e.g. agar, alginates, carubin, pectin and its derivatives, e.g. pectins from fruits and vegetables, and more preferably pectins from citrus fruits and apple
  • beta-glucan such as oat beta-glucan
  • carrageenans e.g
  • gums and mucilages are preferably plant exudates.
  • the term “gum” as used herein refers to the commonly available vegetable gums and more particularly to konjac gum, xanthan gum, guar gum (guaran gum), locust bean gum, tara bean gum, gum tragacanth, arabic gum, karaya gum, gum ghatti, gellan gum and other related sterculia gum, alfalfa, clover, fenugreek, tamarind flour.
  • Native and modified, e.g. hydrolyzed, soluble fibers may be used according to the invention.
  • guar gum e.g. hydrolyzed guar gum, may be used.
  • compositions of the invention may further deliver about 5 g to about 15 g per day, e.g. about 9 g per day soluble fiber, for example in the form of inulin and hydrolyzed guar gum, e.g. in 3 servings of about 3 g.
  • the daily delivery of amino-nitrogen source may be from about at least 10 g to about 60 g, e.g. from about 15 g to about 55 g, e.g. about 20 to about 50 g, e.g. about 44 to about 54 g.
  • at least about 6 g to about 18 g, e.g. about 10 g to about 12 g of the total amino-nitrogen source per daily dose are amino acids in free form and/or in salt form.
  • about 8 g of the total amino-nitrogen source per daily dose are essential amino acids in free form and/or in salt form.
  • the daily dose of e.g. about 15 g essential amino acids, e.g. in free and/or salt form, may be given 3 times per day, e.g. in 3 servings of about 5 g, with equal effectiveness.
  • the daily delivery of leucine in free and/or salt form may be from about 5 g to about 10 g, e.g. in an amount of about 8 g.
  • the daily delivery of total leucine may be from about 10 g to about 20 g, e.g. about 12 g to about 15 g, e.g. about 12 g.
  • total essential and, optionally, conditionally essential amino acids may be delivered in an amount of from about 6 to about 21 g per serving, e.g. from about 6 to about 12 g per serving.
  • the nutritional product provides at least 100%, e.g. 100%, of the U.S. RDA for vitamins and minerals per daily dose.
  • vitamin E is useful in the compositions as hereinabove described for promotion of muscle protein synthesis or controlling tumor-induced weight loss, such as cachexia, e.g. cancer cachexia.
  • compositions of the invention further comprising tocopherol and/or tocotrienol, e.g. Vitamin E ( ⁇ -tocopherol), in an amount of about 50 mg to about 400 mg, e.g. about 100 mg or 200 mg to about 300, e.g. about 150, 240 mg or 300 mg per daily dose, e.g. in three servings of about 50 or 100 mg.
  • tocopherol and/or tocotrienol e.g. Vitamin E ( ⁇ -tocopherol)
  • Vitamin E ⁇ -tocopherol
  • the caloric density of the compositions may be about 1.5 kcal/mL, e.g. about 600 to about 1500 kcal per day, e.g. about 720 to about 900 kcal per day, in the form of about two to about five or six servings per day, e.g. in three servings of about 310 kcal.
  • a suitable serving size may be in the range of about 20 to about 500 ml, preferably about 50 to about 250 ml, e.g. about 200 or 240 ml.
  • the compositions of the invention may provide benefit with as few as for example two servings per day.
  • Levels of amino-nitrogen source e.g.
  • a typical nutritional composition useful according to the invention will have a caloric distribution of about 12 to about 24%, e.g. about 23% from a source of amino nitrogen, e.g. protein, e.g. amino acids in free form and/or in salt form in combination with intact protein, about 40 to about 65%, e.g. about 46% from carbohydrate, for example in the form of maltodextrin and sucrose, and about 10 to about 35%, e.g. about 30% from fat, for example in the form of fish and vegetable oil.
  • Nutritional compositions in accordance with the present invention may be provided as a medical food or beverage product, e.g. in oral nutritional form, e.g. as a health drink, as a ready-made drink, optionally as a soft drink, including juices, milk-shake, yogurt drink, smoothie or soy-based drink, in a bar, or dispersed in foods of any sort, such as baked products, cereal bars, dairy bars, snack-foods, soups, breakfast cereals, muesli, candies, tabs, cookies, biscuits, crackers (such as a rice crackers), and dairy products.
  • oral nutritional form e.g. as a health drink, as a ready-made drink, optionally as a soft drink, including juices, milk-shake, yogurt drink, smoothie or soy-based drink, in a bar, or dispersed in foods of any sort, such as baked products, cereal bars, dairy bars, snack-foods, soups, breakfast cereals, muesli, candies, tabs, cookies, biscuits
  • compositions of the invention may be administered as a nutritional formulation, e.g. as part of a meal, e.g. in the form of a health drink, e.g. ready-to-use drink.
  • Nutritional compositions in accordance with the present invention may be administered in form of a single composition that contains all components, e.g. essential amino acids, fatty acids and/or soluble fibers, or each component may be administered individually.
  • a liquid nutritional formulation e.g. in the form of a syrup, suspension, emulsion or solution, may contain all components except for the essential amino acids, e.g. except for the branched-chain amino acids and/or glutamine, e.g. glutamine peptide, if present.
  • the branched-chain amino acids and/or glutamine, e.g. glutamine peptide, if present may be administered in form of a solid oral dosage form, e.g. in form of a capsule, pill, tablet, dragées, or sachet.
  • Solid oral dosage forms are prepared in a manner known per se, for example by means of conventional mixing, granulating, confectioning, dissolving or lyophilizing processes.
  • compositions for oral administration may be obtained by combining the active ingredients with solid carriers, optionally granulating a resulting mixture and processing the mixture or granules, if desired or necessary after the addition of suitable excipients, to form tablets or dragée cores.
  • Suitable physiologically acceptable carriers may be especially fillers, such as sugars, for example lactose, mannitol or sorbitol, cellulose preparations and/or calcium phosphates, for example tricalcium phosphate or calcium hydrogen phosphate, and also binders, such as starch pastes using, for example, corn, wheat, rice or potato starch, gelatin, tragacanth, methylcellulose and/or polyvinylpyrrolidone, and, if desired, disintegrators, such as the above-mentioned starches, and also carboxymethyl starch, cross-linked polyvinylpyrrolidone, agar, or alginic acid or a salt thereof, such as sodium alginate.
  • fillers such as sugars, for example lactose, mannitol or sorbitol, cellulose preparations and/or calcium phosphates, for example tricalcium phosphate or calcium hydrogen phosphate
  • binders such as starch pastes using, for example, corn
  • compositions of the invention may be lactose-free.
  • Further excipients may be especially flow-conditioners and lubricants, for example silicic acid, talc, stearic acid or salts thereof, such as magnesium or calcium stearate, and/or polyethylene glycol.
  • Dragée cores are provided with suitable coatings, there being used inter alia concentrated sugar solutions which may contain Arabic gum, talc, polyvinylpyrrolidone, polyethylene glycol and/or titanium dioxide, or coating solutions in suitable organic solvents or solvent mixtures. Dyes or pigments may be added to the tablets or dragée coatings, for example for identification purposes or to indicate different doses of active ingredient.
  • compositions may be in the form of hard gelatin capsules or soft, sealed capsules consisting of gelatin and a plasticizer, such as glycerol or sorbitol.
  • the hard gelatin capsules may comprise the composition of the invention in the form of granules, for example in admixture with fillers, such as lactose, binders, such as starches, and/or glidants, such as talc or magnesium stearate, and, if desired, stabilizers.
  • fillers such as lactose
  • binders such as starches
  • glidants such as talc or magnesium stearate
  • stabilizers such as talc or magnesium stearate
  • suitable liquids such as fatty oils, paraffin oil or liquid polyethylene glycols, it is likewise being possible to add stabilizers.
  • compositions of the invention may be included in the compositions of the invention, including any of those selected from preservatives, chelating agents, osmotic agents, buffers or agents for pH adjustment, effervescing agents, sweeteners, e.g. artificial sweeteners, flavoring agents, coloring agents, taste masking agents, acidulants, emulsifiers, stabilizers, thickening agents, suspending agents, dispersing or wetting agents, antioxidants, acidulants, texturizers, antifoams, and the like.
  • sweeteners e.g. artificial sweeteners, flavoring agents, coloring agents, taste masking agents, acidulants, emulsifiers, stabilizers, thickening agents, suspending agents, dispersing or wetting agents, antioxidants, acidulants, texturizers, antifoams, and the like.
  • the present invention also provides a process for the production of a composition, e.g. nutritional or pharmaceutical formulation, as hereinbefore defined, which process comprises bringing the individual components thereof into intimate admixture and, when required compounding the obtained composition in a food or beverage product, for example ready-made drink, or in unit dosage form, for example filling said composition into gelatin capsules.
  • a composition e.g. nutritional or pharmaceutical formulation, as hereinbefore defined, which process comprises bringing the individual components thereof into intimate admixture and, when required compounding the obtained composition in a food or beverage product, for example ready-made drink, or in unit dosage form, for example filling said composition into gelatin capsules.
  • the present invention provides a method for controlling tumor-induced weight loss, such as cachexia, e.g. cancer cachexia, e.g. treating or preventing or ameliorating the effects of cachexia, e.g. cancer cachexia, and/or anorexia, comprising enterally administering to a human in need of such treatment any composition disclosed herein.
  • cachexia e.g. cancer cachexia
  • anorexia e.g. enterally administering to a human in need of such treatment any composition disclosed herein.
  • the present invention provides for promotion of or stimulating muscle protein synthesis, or ameliorating loss of muscle in a human comprising enterally administering to a human in need of such treatment a composition of the invention.
  • the invention provides a method of preventing catabolism and increasing protein synthesis in a subject undergoing metabolic stress, which comprises administering to a human in need of such treatment a composition of the invention.
  • the invention further provides a use of the compositions as described herein for the dietary management of malnutrition, e.g. protein-energy malnutrition.
  • malnutrition e.g. protein-energy malnutrition.
  • compositions of the invention in the manufacture of a medicament for the treatment and/or prevention of tumor-induced weight loss, such as cachexia, e.g. cancer cachexia, and/or anorexia, ameliorating the effects of cachexia, e.g. cancer cachexia, and/or anorexia, stimulating muscle protein synthesis, or ameliorating loss of muscle in a human.
  • tumor-induced weight loss such as cachexia, e.g. cancer cachexia, and/or anorexia
  • ameliorating the effects of cachexia e.g. cancer cachexia, and/or anorexia, stimulating muscle protein synthesis, or ameliorating loss of muscle in a human.
  • the method of treatment or use as claimed herein is applicable to tumor-induced weight loss, such as cancer cachexia, or anorexia in human patients suffering from different cancers, e.g. liver, breast, lung, prostate, gastrointestinal or pancreatic cancer.
  • Cachexia or anorexia may be related to the disease itself or the effects of treatment.
  • compositions of the invention may be combined with anti-cancer drugs, such as 5-fluorouracil, mitomycin-C, adriamycin, chloroethyl nitrosureas and methotrexate.
  • anti-cancer drugs such as 5-fluorouracil, mitomycin-C, adriamycin, chloroethyl nitrosureas and methotrexate.
  • interleukin-15 the compositions may be combined with interleukin-15.
  • a combined pharmaceutical formulation for simultaneous, separate or sequential use for the treatment or prevention of cachexia e.g. cancer cachexia, and/or anorexia comprising a composition of the invention, and one or more anti-cancer drug(s).
  • compositions of the invention may be taken once daily to five or six times daily.
  • the daily dose may be two servings per day.
  • up to six servings per day may be recommended.
  • the compositions of the invention may be served without restriction to time of day, e.g. together with the main meals, preferably between meals.
  • compositions of the invention may be administered under the supervision of a medical specialist, or may be self-administered.
  • compositions of the invention may be provided in form of a kit for separate, sequential or simultaneous administration in conjunction with one or more anti-cancer drug(s).
  • the composition e.g. nutritional composition or dietary supplement, of the invention is consumed for the duration of patient care and treatment, e.g. until weight is regained or lean body mass is increased. Since these formulations are safe to consume, cachectic or anorectic patients, can continue taking these supplements for as long as required, e.g. until normal weight or lean body mass has been resumed. Early intervention may be a critical success factor for improved outcome in patients with cachexia, e.g. cancer cachexia.
  • compositions of the invention may be particularly indicated for patients with solid tumors with cachexia or at risk of developing it.
  • the compositions of the invention By stimulating muscle protein anabolism, the compositions of the invention have the potential to reduce the rate of or reverse tumor-induced weight loss, e.g.
  • cachexia to promote weight gain, stimulate muscle growth, enhance immune function, restore metabolic balance, support increased resistance to infection, improve tolerance to cancer therapy, enhance response to cancer therapy, reduce morbidity, improve associated symptoms that affect quality of life, such as weakness, fatigue, gastrointestinal distress, sleep/wake disturbances, pain, listlessness, shortness of breath, lethargy, depression, malaise.
  • compositions of the present invention may be observed in standard clinical tests in, for example, indications as described hereinabove, for example using dosages of amino acids in free form and/or in salt form, in the range of about 0.05 to about 0.3 g/kg body weight/day, preferably from about 0.085 to about 0.25 g/kg body weight/day, more preferably from about 0.1 or 0.15 to about 0.2 g/kg body weight/day, or using dosages of total essential amino acids in the range of from about 6 to about 12 g or up to about 21 g per serving, or from about 36 to about 72 g total essential amino acids per day, for a mammal, e.g. adult, and in standard animal models.
  • compositions of the invention on prevention and treatment of tumor-induced weight loss, e.g. cachexia can be monitored by any of the methods known to one skilled in the art, e.g. food intake, body weight, anthropometric measurements, serum levels of lipids, fatty acids, amino acids, levels of serologic markers, serotonin, C-reactive protein, TNF alpha, IL-1, changes in the morphology of tumors.
  • compositions of the invention e.g. using dosages of amino acids in free form and/or in salt form, in the range of about 0.05 to about 0.3 g/kg body weight/day, preferably from about 0.085 to about 0.25 g/kg body weight/day, more preferably from about 0.1 or 0.15 to about 0.2 g/kg body weight/day and dosages of n-3 polyunsaturated fatty acids in the range of about 0.05 to about 0.3 g/kg body weight/day, preferably from about 0.06 to about 0.2 g/kg body weight/day, more preferably from about 0.06 to about 0.13 or 0.15 g/kg body weight/day, or using dosages of total essential amino acids in the range of from about 6 to about 12 g or up to about 21 g per serving, or from about 36 to about 72 g total essential amino acids per day, to a standard nutritional supplement may be performed in patients with advanced pancreatic cancer aiming at comparison of the effect on lean body mass
  • 125 patients per treatment group may be tested, e.g. assessing the following parameters:change in lean body mass between baseline and week 12, body weight, nutritional intake and fatty acid analysis.
  • baseline versus three weeks investigations may be undertaken for: Urinary Proteolysis Inducing Factor, acute phase protein response (C-reactive protein concentration) and pro-inflammatory cytokines, Ubiquitin metabolism (muscle biopsy in 15 patients) and the acceptability of the product, e.g. taste, and compliance with the treatment regimen.
  • FIG. 1 shows response of plasma phenylalanine concentration and net balance (reflection of net protein synthesis) to ingestion of 15 g of whey protein.
  • FIG. 2 shows phenylalanine concentration and net balance in response to 15 g of a solution of essential amino acids (EAAs).
  • FIG. 3 shows comparison of total response of net muscle protein synthesis to EAAs vs whey protein. Significantly different, p ⁇ 0.001.
  • the groups were as follows: Controls: No amino acids AA group: A balanced AA solution (10% TRAVASOL ®) containing all amino acids (27.3 umol ⁇ kg ⁇ 1 ⁇ min ⁇ 1 ) EAA group: Only essential amino acids (27.3 umol ⁇ kg ⁇ 1 ⁇ min ⁇ 1 ) Leu (25%) + Leucine was added to the balanced AA solution to AA group: account for 25% of total nitrogen and infused at the same total nitrogen group as others (27.3 umol ⁇ kg ⁇ 1 ⁇ min ⁇ 1 ) Leu (35%) + Same as above, except Leu comprised 35% of total AA group: Leu only: Leucine only at 8.3 umol ⁇ kg ⁇ min
  • Table 3 compares the amount of leucine infused as a function of total N. TABLE 3 (1) Leucine infusion Leu infused Total N infused % of Leu Solution ⁇ mol ⁇ kg ⁇ 1 ⁇ min ⁇ 1 ⁇ mol ⁇ kg ⁇ 1 ⁇ min ⁇ 1 to total N TRAVASOLI ® 1.39 27.3 5% EAA 4.37 27.3 16% Leu (25%) + AA 6.93 27.3 25% Leu (35%) + AA 9.58 27.3 35% Leu alone 8.75 8.75 100%
  • a cancer supplement in form of a ready to drink composition is provided.
  • Method Water is heated to 160° F. and all ingredients except for EPAX® 4510, DHA GOLD®, flavor, sucralose, sodium chloride, sodium ascorbate and lactic acid are added. The mixture is cooled to less than 100° F. and the pH adjusted to 6.5 with lactic acid. The mixture is heated to 140° F. under agitation and after five minutes holding time homogenized at 2500 psi. The remaining ingredients are added and the mixture preheated to 150° F., heated at 290° F. for sec and homogenized at 2500 psi.
  • the vitamin/mineral pre-mix may comprise the following: Maltodextrin powder DE 37.404155 Dipotassium phosphate 35.701500 Magnesium oxide 8.330400 Vitamin E acetate 7.168900 Tricalcium phosphate 4.760200 Ferrous sulfate 1.387600 Zinc sulfate 1.042500 Biotin, 1% trituration 0.933000 Niacinamide (B 3 ) 0.761600 Vitamin A palmitate 0.606900 Calcium pantothenate 0.430800 Copper gluconate 0.380800 Vitamin K 0.297500 Cyanocobalamin (B 12 ) 0.202300 Manganese sulfate (monohydrate) 0.172860 Vitamin D 3 0.119000 Pyridoxine hydrochloride (B 6 ) 0.095200 Potassium iodide 10% 0.055258 Thiamine hydrochloride (B 1 ) 0.054700 Riboflavin (B 2 ) 0.054700 Chromic acetate (monohydrate)
  • the individual components can be sourced from the following sources.
  • Canola oil is from Columbus Foods (Chicago, Ill.).
  • MCT oil is from Stepan Company (Northfield, Ill.).
  • EPAX® 4510 (Marine oil) is from Pronova Biocare (Lysaker, Norway)
  • DHA GOLD® (Algae oil) is from Martek Biosciences Corporation (Columbia, Md.)
  • Calcium caseinate is from New Zealand Milk Products (Weston, Fla.)
  • Hydrolyzed guar gum is from Novartis Nutrition Corporation (Minneapolis, Minn.)
  • Arginine, Leucine, Valine, Methionine, Phenylalanine are from Ajinomoto (Raleigh, N.C.)
  • 25 DE corn syrup is from Cargill, Inc. (Minneapolis, Minn.)
  • Vit/min Premix is from Fortitech Inc. (Schenectady, N.Y.)
  • Antifoam is from Dow Corning Corp. (Midland, Mich.)
  • a cancer supplement in form of a ready to drink composition is prepared according to the method described in Example 5.

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