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The POWER of WHEY & MCT For Critically Ill Patients
The POWER of WHEY & MCT For Critically Ill Patients
Time is critical
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Early Enteral Nutrition helps to1: 1. maintain gut integrity 2. modulate stress and the systemic immune response 3. attenuate disease severity and improve clinical outcomes
1. S. A. McClave 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 (A.S.P.E.N.) Journal of Parenteral and Enteral Nutrition / Vol. 33, No. 3, May/June 2009.
Clinical study has shown that cumulative energy deficit is associated with worse clinical outcomes2
Longer ICU length of stay More days on mechanical ventilation More complications
2. Villet S et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 2005; 24:502-509.
Nutrisi Enteral
Nutrisi enteral merupakan metode pemenuhan zat gizi dengan menggunakan saluran pencernaan, baik secara alami melalui mulut ataupun dengan bantuan alat (tube/sonde)
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Lemak
Vitamin dan Mineral Contoh
Nabati, jenuh, tidak jenuh tunggal (MUFA), tak jenuh ganda (PUFA)
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Formula Pilihan ?
Formula Polimerik
Membutuhkan kerja saluran cerna yang baik Intact Nutrition Formula standard, Fully functional GI tract, Normal digestion, Normal absorption Macronutrients are intact and require digestion Formula standar misalnya Nutren, Peptisol, Entramix, Ensure, dll
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'FAST'
Whey protein kualitas tinggi kaya asam amino essensial CYSTEIN, homogen pada pH asam tetap berbentuk cair sehingga lebih mudah dicerna
'SLOW'
Casein menggumpal pada pH asam bersifat padat saat protein diasamkan dalam lambung- dominan untuk formula dewasa (Mahe 1996)
Whey Protein Casein Protein Casein adalah protein utama dalam susu sapi (80%) dan keju. Whey protein: terdiri atas beta-lactoglobulin (~65%), alpha-lactalbumin (~25%), & serum albumin (~8%) Kaya asam amino essensial CYSTEIN Sebagai Sumber Antioksidan yang baik
Fungsi Saluran Cerna adalah kunci ketika akan memberikan dukungan nutrisi
TPN
1-10 tahun
(AAP 1998)
Whey Protein Helps Support the Body's Antioxidative Defense System Whey protein helps support the bodys antioxidative defense system
Cystein is the rate-limiting amino acid for the synthesis of glutathione,
a principal protective antioxidant mechanism of the cells11,12
LCT
Delayed
Yes
Yes Yes Lymphatics Blood liver
Micelle formation
Absorptive route
MCT Absorption
5. Khoshoo V et al. Incidence of Gastroesophageal Reflux with Whey- and Casein-Based Formulas in Infants and in Children with Severe Neurological Impairment. J Ped Gastroent Nutr. 1996, 22:48-55. 6. Fried MD et al. Decrease in gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Ped. 1992,120:569-572. 7. Khoshoo V and Brown S. Gastric emptying of two wheybased formulas of different energy density and its clinical implication in children with volume intolerance. Eur J Clin Nutr. 2002, 56:1-3.
PROOF 1
Randomized to receive either Peptamen or Osmolite (Ross) within 24 hours after injury
Measured serum transferrin, prealbumin and retinol-binding protein day 1, 3 and 7 after injury
(Zaloga 1992)
PROOF
(Zaloga 1992)
2006 Nestl Nutrition HealthCare, Switzerland
PROOF
PROOF
Meningkatkan respon protein hepatic dengan protein hidrolisat dibandingkan dengan intact protein" Zaloga et al, Crit Care Med 1992; 20:S94
Improved hepatic protein responses with hydrolyzed protein versus intact protein diets after trauma
(Tome 2001)
2006 Nestl Nutrition HealthCare, Switzerland
Prevalence of reflux
Pediatrics:
Healthy children
2 18% have symptoms associated with reflux Young children tend to have higher reflux
Adults:
Healthy adults
3 23% (varies per race)
Neurologically disabled
7/10 children (up to 70%) have pathological reflux
Intellectually disabled
50 65%
ensures optimal protein absorption during times of stress and critical illness
It is nutritionally complete:
Protein
16% 40 g protein/L CHO 100% whey peptides 50% 300 mOsm/L Fat 34% 70% of fat as MCT Omega 6 BCAA Vitamins and minerals meet 100% of the US RDA with 1500 mL (1500 kcal) Gluten free, Lactose free
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Decreased amino acid absorption Amino acid diets associated with gut atrophy
Peptide carriers remain intact
Peptide carrier
Peptide absorption
a dual transport system
Peptamen is a Specific Enteral Nutrition Formula Designed for Early Feeding in Critically Ill Patients
Designed for better tolerance for early nutrition 100% whey formula to help manage oxidative stress and catabolism
With PEPTAMEN
A Specific Enteral Nutrition Formula Designed for Early Feeding in Critically Ill Patients
Pasien Critically Ill perlu mengkonsumsi Makanan Sarat Nutrisi Pasien Critically Ill seringkali terjadi :
Penurunan antioksidan alami tubuh Terjadi hipermetabolisme Menyebabkan penurunan kadar protein visceral plasma Hipoalbuminemia Penurunan Lean Body Mass.
Para pasien Critically Ill yang sedang menjalani terapi dan yang sudah selesai terapi dianjurkan mengkonsumsi makanan yang sehat dengan gizi yang seimbang. Status nutrisi pada pasien kanker memiliki peranan penting dalam mempertahankan kualitas hidup
The Power of WHEY
In summary
Thank You!