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Supplementation and nutritional support

SUPPLEMENTATION AND
NUTRITIONAL SUPPORTS

Description

Malnutrition can be defined as a state of functional, structural and developmental alteration of the body resulting from a discrepancy between nutrient needs, intakes and utilisation, leading to excess morbidity and mortality or impaired quality of life. In economically advanced countries, protein-calorie malnutrition (PCM) occurs almost exclusively in the elderly population and/or predominantly in patients suffering from certain categories of disease, such as renal, cardiac or hepatic insufficiency and congenital malformative diseases, neurological (vascular, hypoxic or degenerative), respiratory, gastroenterological, pulmonary, or cancer (particularly of the head and neck and digestive system) and related treatments (surgery, chemotherapy, radiotherapy). It adversely affects a patient’s prognosis by leading to a depression of the immune response, but also to a reduction in the ability to heal or the functional impairment of organs. All this implies that malnutrition can be considered ‘a disease within a disease’. The early identification of situations at risk of malnutrition would make it possible to reduce its negative effects, through the elaboration of a specific nutritional treatment plan, which includes the appropriate changes in eating habits and, if not sufficient to meet all nutritional needs, the use of different types of oral nutritional support (SNO). SNOs are defined as products with a defined formulation, to be used as nutritional support (supplements) to the common diet. The aim of this strategy is to provide patients who are still able to feed themselves naturally with an additional share of nutrients, in particular: mineral salts, vitamins, antioxidants, polyunsaturated and omega-3 fatty acids, proteins, dietary fibre/prebiotics, and other substances with a favourable physiological effect sufficient to cover nutritional requirements. In conclusion, the use of SNOs represents a useful therapeutic aid in preventing malnutrition and its adverse clinical effects by improving nutritional status and survival. It should be remembered that the supplement is not suitable for use as a sole source of nutrition.

Anaemia in the elderly

Iron is a key component of haemoglobin, the protein that transports oxygen from the lungs to the rest of the body, and myoglobin, the protein that supplies oxygen to the muscles.

This mineral is involved in the activity of many enzymes (e.g. cytochrome, catalase, peroxidase) and the body needs it to produce hormones and connective tissue.

The recommended daily intake for an adult is 14mg. This requirement varies according to age, gender and particular conditions such as pregnancy and breastfeeding, with women needing to take more than men.

The first consequence of iron deficiency is anaemia, i.e. a reduction in the number of red blood cells in the blood and thus a loss of the ability to distribute oxygen to organs and tissues. The effects are: fatigue, lack of energy, gastrointestinal disorders, memory and concentration difficulties, lowered immunity and thermoregulation problems.

Anaemia in the elderly is particularly relevant as it has a number of serious consequences: increased incidence of cardiovascular disease, cognitive impairment with reduced physical performance, increased risk of falls and fractures. In addition, iron deficiency leads to the rapid loss of iron-dependent enzymes and degeneration of the oesophageal mucosa, resulting in the development of oesophageal stenosis and thus difficulty in swallowing.

The presence of anaemia is significantly associated with longer hospital stays and an increased risk of mortality.

The prevalence of anaemia increases with age and is often multifactorial.

  • nutritional deficiency. Malnutrition contributes to the development of anaemia with a significant increase in morbidity and a deterioration in quality of life. It represents a treatable subgroup and includes a lack of iron, vitamin B12 or folic acid;
  • chronic disease (ACD). The pathophysiology of ACD is multifactorial: reduced efficiency of iron recycling; apoptosis of erythroid progenitor cells in the marrow; inadequate production of erythropoietin (EPO) and reduced body response to this hormone.
  • unexplained anaemia (UA): constitutes about one third of all anaemias in the elderly and is mainly represented by a diagnosis of exclusion. The pathophysiology is complex and poorly understood; the subject has a high frequency of comorbidities and high levels of pro-inflammatory factors.
Fatty liver

Non-alcoholic fatty liver disease (NAFLD), more commonly known as ‘fatty liver’, is the most common liver disease among children and adolescents in Western countries. It consists of the accumulation of fat in the liver as a result of an imbalance in the breakdown of lipids in the liver.

However, it can develop into a more severe form of steatosis, Alcoholic Steatohepatitis (NASH), which can progress into even more severe forms such as liver fibrosis and cirrhosis. The mechanism underlying steatosis is insulin resistance, i.e. the body’s increased resistance to the action of insulin, a problem associated with the development of diabetes, obesity, high blood pressure and atherosclerosis, thus also increasing the risk of cardiovascular disease.

Although the diagnosis of metabolic hepatopathy can be made by exclusion of other causes and non-invasive techniques for ‘staging’ the disease (e.g. transient elastography) can be useful in assessing the presence of fibrosis, histological examination by liver biopsy is the only one that can provide reliable information and identify the microscopic features of steatohepatitis (inflammation and degeneration of liver cells) and assess the presence of fibrosis and structural changes (such as cirrhosis) in the liver. The search for factors potentially responsible for fat accumulation (dyslipidaemia, glucose intolerance, diabetes, overweight or obesity, alcohol intake) is essential.

NAFLD (non-alcoholic fatty liver disease) must be combated by changing eating and behavioural habits, decreasing daily calorie intake; promoting physical activity.

Unfortunately, there are no approved drug therapies against steatosis and steatohepatitis; recent studies have evaluated the efficacy of specific therapies aimed at weight loss and reducing liver damage through the intake of lipo-normalising, anti-inflammatory and antioxidant agents.

FoodAR has designed and developed the Prodha Steatolip product containing:

  • DHA, LCPUFA – omega3 supplementation reduces blood triglyceride levels and has anti-inflammatory effects on hepatocytes, with loss of fat mass, and insulin-sensitising effects with restoration of a normal lipid profile;
  • vitamin E, useful for protecting cells from oxidative stress;
  • choline, for maintenance of normal liver function.

The aim is to halt the progression of NAFLD and NASH, regress the disease and recover the metabolic functions of the liver.

Pain and analgesia in the newborn

Pain is an unpleasant sensory and emotional experience associated with a condition of actual or potential tissue damage. The painful sensation is produced by multiple stimuli that can be classified as mechanical, thermal and chemical, with an intensity that makes them potentially harmful.

The threshold of pain perception is extremely variable from person to person and, within the same individual, also from moment to moment. This is partly due to the ability of the nervous system to modulate the afferent of pain signals by activating a control apparatus called the ‘analgesic system’.

Babies and infants are subjected to stressful events that inevitably cause pain with more or less detectable and quantifiable behaviour, neurovegetative manifestations and metabolic-hormonal changes.

In this context, facial expressions seem to be the most specific and sensitive indicator of pain in infants (swollen forehead, squinting eyes, nasolabial furrow, open mouth), thus reflecting externally the sign induced by harmful stimuli. Crying is also an important source of information about the state of the baby. The characteristic of respiratory activity is another useful expression to understand how the infant reacts to pain. A painful stimulus also induces a series of motor reactions characteristic of the neonatal age, with flexion and abduction of the four limbs, extension of the fingers and arching of the back.

One of the main differences between pain perception in infants and later life lies in the functional immaturity of the analgesic system at birth, which is only partially able to modulate peripheral nociceptive afferents.

it is therefore essential to treat, or even prevent, pain in infants.

Procedures that cause prolonged but intense pain can be managed with non-pharmacological approaches and preventive strategies. These treatments include the use of the mother’s breast, changing position, cradling in the arms, soft lighting: all approaches used with infants and young children that have been more or less successful in managing pain.

Several controlled studies have shown that highly concentrated sweet-tasting solutions administered orally prior to painful intervention are able to calm crying fits and reduce pain in infants undergoing: capillary sampling under the heel; vaccination; venous sampling.

Sucrose is the easiest solution to use with documented efficacy and no side effects.

With this in mind, FoodAR has developed a single-dose oral solution based on sucrose (24% concentrate) for simple and safe use with maximum compliance with the hygienic conditions for administering a sterile product: Baby sucrose 24% free of preservatives and colourants.

However, it can develop into a more severe form of steatosis, Alcoholic Steatohepatitis (NASH), which can progress into even more severe forms such as liver fibrosis and cirrhosis. The mechanism underlying steatosis is insulin resistance, i.e. the body’s increased resistance to the action of insulin, a problem associated with the development of diabetes, obesity, high blood pressure and atherosclerosis, thus also increasing the risk of cardiovascular disease.

Although the diagnosis of metabolic hepatopathy can be made by exclusion of other causes and non-invasive techniques for ‘staging’ the disease (e.g. transient elastography) can be useful in assessing the presence of fibrosis, histological examination by liver biopsy is the only one that can provide reliable information and identify the microscopic features of steatohepatitis (inflammation and degeneration of liver cells) and assess the presence of fibrosis and structural changes (such as cirrhosis) in the liver. The search for factors potentially responsible for fat accumulation (dyslipidaemia, glucose intolerance, diabetes, overweight or obesity, alcohol intake) is essential.

NAFLD (non-alcoholic fatty liver disease) must be combated by changing eating and behavioural habits, decreasing daily calorie intake; promoting physical activity.

Unfortunately, there are no approved drug therapies against steatosis and steatohepatitis; recent studies have evaluated the efficacy of specific therapies aimed at weight loss and reducing liver damage through the intake of lipo-normalising, anti-inflammatory and antioxidant agents.

FoodAR has designed and developed the Prodha Steatolip product containing:

  • DHA, LCPUFA – omega3 supplementation reduces blood triglyceride levels and has anti-inflammatory effects on hepatocytes, with loss of fat mass, and insulin-sensitising effects with restoration of a normal lipid profile;
  • vitamin E, useful for protecting cells from oxidative stress;
  • choline, for maintenance of normal liver function.

The aim is to halt the progression of NAFLD and NASH, regress the disease and recover the metabolic functions of the liver.

Foodar Solutions

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