Peptamen

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Peptamen

For complex needs and reliable tolerance

Peptamen products are designed at the high end of nutritional technology, enabling the use of different products within the range for the more complex patients with demanding and changing nutritional needs.

All Peptamen products are made with medium chain triglycerides (MCT) to improve feeding tolerance.

The importance of MCT vs long chain triglycerides (LCTs) in nutrition

  • A mixture of MCTs (8-12 carbons in length) in contrast to LCTs (saturated fats of 14 carbons or more)
  • During malnutrition, stress or if the GI tract is compromised, LCT malabsorption is very common
  • Fat malabsorption is characterised by stool abnormalities but can be improved by providing formulas rich in MCT oil to minimise risk of fat malabsorption
  • MCTs are digested, absorbed and metabolised faster than LCT 11,12

Digestion

  • Stress related to acute diseases and/or drugs may decrease GI motility and gastric emptying, increasing the risk of reflux and lung aspiration
  • MCTs are well tolerated, as they are emptied from the stomach faster than LCTs 13
  • MCTs are more water-soluble than traditional LCTs, do not require bile salts and are easily hydrolysed by pancreatic lipase, leading to better and faster digestion compared to LCTs

Metabolism

  • MCTs are not stored as adipose tissue, but quickly removed from the blood and rapidly metabolised to ketone bodies, providing a readily available non-carbohydrate energy source14

Absorption

  • MCTs are a good energy source for patients with fat malabsorption15
  • MCTs also provide more readily available energy than LCTs
  • MCTs are easily absorbed and hydrolysed by malnourished patients with reduced lipase activity and bile production
  • Enteral formulas containing from 25 to 50% MCTs or even more are commonly used in patients requiring intensive clinical nutrition16 – this combination ensures the supply of essential fatty acids by LCTs and the advantages of a better digestion, absorption and metabolism from MCTs16-18

Further benefits of MCTs:26-28

  • Intraluminal hydrolysis is more rapid and complete vs LCTs
  • MCTs are relatively water soluble and do not require bile salts and micelle formation for intestinal absorption
  • MCTs do not induce cholecystokinin release and gallbladder contraction
  • MCTs may enter the intestinal cell without prior hydrolysis
  • Medium-chain fatty acids (MCFAs) are transported directly from mucosal cells into portal venous blood
  • MCFAs do not require carnitine palmitoyl transferase for intramitochondrial transport, which allows for rapid energy production

*First introduced in the 1950s as a calorically-dense, well absorbed nutrient to treat patients, both enterally and parenterally, suffering from impaired absorption of traditional LCT and increased resting energy expenditure.25,26 The level of MCT in formulas ranges from zero to 70% of the lipid calories.25,26

Peptamen – powered by science

100% whey protein

A high-quality protein with a protein digestibility corrected amino acid score (PDCAAS) of 1 and which contains approximately 50% essential amino acids (IAA)

  • Whey protein contains high levels of branch chain amino acids to help supports muscle anabolism29
  • Whey protein is a rapidly digested protein, which may lead to improved tube feeding tolerance30,31
  • Whey protein can help increase serum glutathione concentration, enhancing antioxidant status, more than other protein sources32
  • Hydrolysation leads to improved glycaemic response and insulin secretion33

Peptamen® 1. Ochoba JB, et al. Use of a very high protein enteral nutrition formula assists in meeting the protein needs of patients receiving intravenous sedation with propofol. Clinical Nutrition Week, ASPEN 2017. 2. Wieser J, et al. Availability of a very high protein enteral nutrition formula leads to change in practice in nutrition prescription. Clinical Nutrition Week, ASPEN 2017. 3. Gregg D, et al. The need to feed: balancing protein needs in a critically ill patient with Fournier’s gangrene. Nutr Clin Pract 2016;31[6). 4. McClave SA, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine
(SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enteral Nutr 2016;40(2):159-211. 5. Hoffer LJ, Bistrian BR. Appropriate protein provision in critical illness: a systematic and narrative review. Am J Clin Nutr 2012;96:591-600. 6. Choban P, et al. ASPEN Clinical Guidelines: Nutrition Support of Hospitalized Adult Patients with obesity. J Parenter Enteral Nutr 2013;37(6):714-744. 7. Pennings B, et al. Whey protein stimulates postprandial muscle protein accretion more effectively than do casein and casein hydrolysate in older men. Am J Clin Nutrition 2011;93:997-1005. 8. Little JP, Phillips SM. Resistance exercise and nutrition to counteract muscle wasting. Appl Physiol Nutr Metab 2009;34:817-828. 9. Breen L, Phillips S. Skeletal muscle protein metabolism in the elderly: Interventions to counteract the ‘anabolic resistance·of ageing. Nutr Metab 2011;8[68]. 10. Adams RL, Broughton KS. Insulinotropic effects of whey: Mechanism of action, recent clinical trials, and clinical applicaions. Ann Nutr Metab 2016;69)(1):56-63.
11. Gottschlich MM. Selection of optimal lipid sources in enteral and parenteral nutrition. Nutr Clin Pract 1992;7(4):152-165. 12. Mahan LK, E.-S. S. (1996). Krause’s Food Nutrition & Diet Therapy. 1996. 9th Edition (Philadelphia. WB Saunders). 13. Bach AC, et al. The usefulness of dietary medium-chain triglycerides in body weight control: fact or fancy? J Lipid Res 1996;37(4):708-726. 14. ISOSOURCE® family – Regulatory Dossier – version 1.1. 15. Salomon SB, et al. An elemental diet containing medium-chain triglycerides and enzymatically hydrolyzed protein can improve gastrointestinal tolerance in people infected with HIV. J Am Diet Assoc 1998;98(4):460-462. 16. Simopoulos 2002. 17. Bach AC, Babayan VK. Medium-chain triglycerides: an update. Am J Clin Nutr 1982;36(5):950-962. 18. Blackburn GL. Nutrition and inflammatory events: highly unsaturated fatty acids (omega-3 vs omega-6) in surgical injury. Proc Soc Exp Biol Med 1992;200(2):183-188.
19. Metges CC, Wolfram G. Medium-and long-chain triglycerides labeled with 13C: a comparison of oxidation after oral or parenteral administration in humans. J Nutrit 1991;121(1):31-36. 20. Hopman WP, et al. Effect of equimolar amounts of long-chain triglycerides and medium-chain triglycerides on plasma cholecystokinin and gallbladder contraction. Am J Clin Nutr 1984;39(3):356-359. 21. Salomon SB, et al. An elemental diet containing medium-chain triglycerides and enzymatically hydrolyzed protein can improve gastrointestinal tolerance in people infected with HIV. J Am Diet Assoc 1998;98(4):460-462. 22. Hegazi RA, Wischmeyer PE. Clinical review: Optimizing enteral nutrition for critically ill patients--a simple data-driven formula. Crit Care 2011;15(6):234. 23. Heyland DK, et al. Enhanced protein-energy provision via the enteral route feeding protocol in critically ill patients: results of a cluster randomized trial. Crit Care Med 2013;41(12):2743-2753. 24. Qiu C, et al. A Fat-Modified Enteral Formula Improves Feeding Tolerance in Critically Ill Patients: A Multicenter, Single-Blind, Randomized Controlled Trial. JPEN J Parenter Enteral Nutr 2017;41(5):785-795. 25. Bach AC, Babayan VK. Medium-chain triglycerides: an update. Am J Clin Nutr 1982;36(5):950-962. 26. Traul KA, et al. Review of the toxicologic properties of medium-chain triglycerides. Food Chem Toxicol 2000;38(1):79-98. 27. Bauer J. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002;26:1-138. 28. Lochs H, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics. Clin Nutr 2006;25(2):180-186.
Peptamen® Science (Page 15): 29. Katsanos CS, et al. A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Am J Physiol Endocrinol Metab 2006;291:E381-E387. 30. Donald P et al. Repletion of nutritional parameters in surgical patients receiving peptide versus amino acid elemental feedings. Nutr Res 1994;14:3-12. 31. Borlase BC et al. Tolerance to enteral tube feeding diets in hypoalbuminemic critically ill, geriatric patients. Surg Gynecol Obstet 1992;174:181-188. 32. de Aguilar-Nascimento JE et al. Early enteral nutrition with whey protein or casein in elderly patients with acute ischemic stroke: a double-blind randomized trial. Nutrition 2011;27:440-444. 33. Wieser J, et al. Availability of a very high protein enteral nutrition formula leads to change in practice in nutrition prescription. Clinical Nutrition Week, ASPEN 2017.