Feeding composition

Abstract

A feeding composition for treating and / or preventing muscle atrophy in critically ill patients is provided comprising 60% to 90% fat in kCal contribution, 5% to 35% protein in kCal contribution, and at most 10% carbohydrate in kCal contribution. The fat comprises medium chain triglyceride and long chain triglyceride. The proportion of fats comprising medium chain triglycerides is from 25% to 90% by kCal contribution. The long-chain triglyceride is derived from a plant source. The feeding composition is suitable for administration via a nasogastric tube.

Description

Technical Field

[0001] This invention relates to a feeding composition for treating and / or preventing muscle atrophy in critically ill patients, and a method for preparing said feeding composition. Background Technology

[0002] An estimated 195,000 patients are admitted to intensive care units (ICUs) in the UK each year. Common causes of ICU admission include severe accidents (e.g., road accidents, severe head injuries, severe falls, or severe burns), severe short-term conditions (e.g., heart attacks or strokes), severe infections (e.g., sepsis), or recovery from major surgery. Without care or medical intervention, they are unlikely to survive their conditions. More than 50% of these patients are at risk of muscle atrophy, which is muscle wasting due to metabolic disturbances, prolonged bed rest, immobilization, and sedation in many cases. Currently, there are no satisfactory techniques to prevent muscle atrophy in critically ill patients.

[0003] Critically ill patients, especially those who are unconscious, often receive enteral nutrition, or tube feeding, because they cannot effectively feed themselves. This feeding is usually done via nasogastric tube, allowing food to be carried through the nose and directly into the stomach, but it can also be done via a gastrostomy. However, even with such feeding, critically ill patients continue to lose muscle rapidly. One reason for this may be that these patients cannot utilize the protein or calories in their diet to maintain muscle mass.

[0004] In healthcare settings, dietary compositions are often provided to deliver a specific distribution of macronutrients, vitamins, and minerals. One known dietary composition is the ketogenic diet, which has been used medicinally since the 1920s and consists primarily of high fat content, moderate protein, and very low carbohydrate content. The ketogenic diet has been used to treat the neurological disorder epilepsy, particularly in pediatric patients. For example, EP2813149 discloses a composition for treating refractory epilepsy in children, comprising about 4% to about 12% by weight of protein, less than 5% by weight of carbohydrates, and about 25% to about 38% by weight of fat.

[0005] The ketogenic diet has also been used to treat patients with nerve damage. For example, US5308832 discloses a composition comprising about 70% to 85% fat, 15% to 30% protein, and less than 5% carbohydrates based on kcal contribution. In a preferred embodiment, the fat comprises up to about 20% medium-chain triglycerides based on kcal contribution.

[0006] WO2015 / 034812 discloses a composition comprising 50% to 80% fat, 10% to 35% protein, and 0% to 10% carbohydrates based on kcal contribution. The fat includes medium-chain triglycerides and fish oil, which is rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), i.e., omega-3 fatty acids.

[0007] The ketogenic diet has also been recommended for the treatment of obesity and diabetes, kidney disease and cancer, but there is little evidence to support this.

[0008] During acute illness, the ability to generate energy from carbohydrates and lipids is greatly reduced, leading to energy loss and a catabolic state. Ketosis provides an alternative energy source in the form of ketone bodies, replacing glucose and lipids as the primary energy source. Ketone bodies synthesized in the body can be readily used to generate energy from the heart, muscle tissue, kidneys, and brain. Critically ill patients still require protein sources. Summary of the Invention

[0009] According to a first aspect of the invention, a feeding composition for treating and / or preventing muscle atrophy in critically ill patients is provided, comprising 60% to 90% fat, 5% to 35% protein, and up to 10% carbohydrates based on kCal contribution.

[0010] The fats mentioned therein include medium-chain triglycerides and long-chain triglycerides;

[0011] The proportion of fats containing medium-chain triglycerides ranges from 25% to 90% based on kcal contribution; and

[0012] Long-chain triglycerides are derived from plant sources.

[0013] The term "muscular atrophy" as used in this article describes, but is not limited to, changes in the structure and function of muscles. Typically, muscle atrophy is characterized by generalized muscle weakness and loss of muscle mass.

[0014] As used herein, the term "critically ill" describes, but is not limited to, patients suffering from life-threatening conditions or at risk of developing such conditions, and patients requiring medical interventions of the form of treatment and monitoring. Typically, critically ill patients reside in an ICU (Intensive Care Unit, also known as an ITU, which is short for Intensive Care Unit), a specialized hospital ward. These patients are often unable to move due to their condition and / or due to the equipment required for treatment, increasing the risk of muscle atrophy. Critically ill patients may also suffer from metabolic disturbances, where the normal function of metabolic processes is disrupted. Therefore, critically ill patients include those receiving intensive care, and include patients in cardiac critical care, patients in high-dependency units (HDUs), patients in respiratory support units, and neurocritically ill patients receiving neurocritical care. In this invention, the feeding composition is preferably used on patients presumed to have survived their critical illness. Preferably, the patient receiving the feeding composition is an adult.

[0015] The amounts of fat, protein, and carbohydrates present in a feeding composition are determined by their contribution in kilocalories (kCal). Fat, protein, and carbohydrates are generally classified under the term "macronutrient." The proportions and amounts of macronutrients are chosen to match the individual patient's nutritional needs, while ideally maintaining a ketogenic diet to keep the patient in ketosis. Typically, total calorie intake for critically ill patients is based on the patient's body weight and aims to achieve a target of approximately 25 kcal per kilogram per day.

[0016] In the field of nutrition, energy contribution is usually given in kcal. A calorie is a unit of energy, equal to 4.184 J, and one kcal equals 4.184 kJ.

[0017] The composition contains fat. Examples of fat types that may be used alone or in combination in the composition include saturated fatty acids, monounsaturated fatty acids, and polyunsaturated fatty acids. The type of fat is medium-chain triglycerides (MCTs) and / or long-chain triglycerides (LCTs). The MCTs used in the feeding composition may be derived from animal or plant sources.

[0018] LCTs are triglycerides with fatty chains containing 16 to 20 carbon atoms. Examples of such fatty chains include oleic acid and linoleic acid. Vegetable oils typically contain LCTs with fatty chains including oleic acid and linoleic acid.

[0019] The LCT in the feeding composition is derived from plant sources, such as vegetable oils like rapeseed oil. Rapeseed oil typically contains about 65% oleic acid and about 20% linoleic acid (not indicated by kCal contribution). Other known vegetable oils with similar oleic and linoleic acid contents include avocado oil, olive oil, peanut oil, and sunflower oil.

[0020] LCT is not derived from fish oil. Fish oil is typically rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both EPA and DHA are known as omega-3 fatty acids. The feeding composition is preferably free of fish oil, EPA, or DHA.

[0021] The total fat content in the feeding composition is at least about 60% based on kCal contribution, preferably at least about 65% based on kCal contribution, and most preferably at least about 70% based on kCal contribution.

[0022] The total amount of fat in the feeding composition is at most about 90% in terms of kCal contribution. However, in some embodiments, the amount of total fat in the feeding composition is no more than about 85% of the feeding composition in terms of kCal contribution, for example, no more than about 80% of the feeding composition in terms of kCal contribution.

[0023] The total amount of fat in the feeding composition ranges from about 60% to about 90% based on kCal contribution, preferably from about 65% to about 85% based on kCal contribution, and most preferably from about 70% to about 80% based on kCal contribution. In one embodiment, the feeding composition contains about 75% total fat based on kCal contribution. In another embodiment, the feeding composition contains about 70% total fat based on kCal contribution.

[0024] Alternatively, the amounts of total fat, MCT, protein, and carbohydrates in the feeding composition can be determined as weight percentages.

[0025] As a weight percentage (ratio of fat (total), protein, and carbohydrates), the total fat content in the feeding composition is at least about 40% by weight, preferably at least about 45% by weight. The total fat content in the feeding composition is at most about 65% by weight. However, in some embodiments, the total fat content in the feeding composition does not exceed about 60% by weight of the feeding composition.

[0026] Preferably, the total amount of fat in the feeding composition (the ratio of fat (total), protein, and carbohydrates) is in the range of about 40% by weight to about 65% by weight, more preferably in the range of about 45% by weight to about 60% by weight. In one embodiment, the feeding composition contains about 50% by weight of total fat. In another embodiment, the feeding composition contains about 56% by weight of total fat.

[0027] At least one type of fat present in the feeding composition is MCT. These are triglycerides with short fatty acid chains having 6 to 12 carbon atoms. Examples of such fatty acid chains include caproic acid, caprylic acid, capric acid, and lauric acid. Common sources of MCT include palm kernel oil and coconut oil. Advantageously, ketosis can be induced when a high proportion of the total fat in the feeding composition is MCT. The amount of MCT in the feeding composition, that is, the proportion of total fat, i.e., MCT, is also determined by the kCal contribution.

[0028] The proportion of total fat, i.e. MCT, in the feeding composition is at least about 25% based on kCal contribution, preferably at least about 30% based on kCal contribution, and most preferably at least about 35% based on kCal contribution.

[0029] In some embodiments, the proportion of total fat, i.e., MCT, is up to about 90% based on kCal contribution. However, in other embodiments, the proportion of total fat, i.e., MCT, in the feeding composition is no more than about 85% based on kCal contribution, for example, no more than about 80% based on kCal contribution.

[0030] The proportion of total fat, i.e. MCT, in the feeding composition is typically from about 25% to about 90% based on kCal contribution, preferably from about 30% to about 85% based on kCal contribution, and most preferably from about 35% to about 80% based on kCal contribution.

[0031] High-fat sedatives are frequently administered to critically ill patients in the ICU. One example of a high-fat sedative used in the ICU is propofol, which significantly contributes to the total daily fat intake of patients because it is often formulated as an emulsion containing oils such as soybean oil.

[0032] High-fat sedatives are typically administered via peripheral intravenous (IV) therapy. The dosage of high-fat sedatives varies from patient to patient and is not solely a function of patient weight. Generally, critically ill patients will receive an initial dose of high-fat sedatives, which is then reduced over time. Therefore, the amount of MCT in the feeding composition can be varied to meet the individual patient's desired nutritional needs while maintaining a ketogenic diet.

[0033] In these embodiments, the proportion of total fat, i.e., MCT, in the feeding composition is typically at least about 55% based on kCal contribution, preferably at least about 60% based on kCal contribution, and most preferably at least about 65% based on kCal contribution. In these embodiments, the proportion of total fat, i.e., MCT, based on kCal contribution is at most about 90%. However, in other embodiments, the proportion of total fat, i.e., MCT, in the feeding composition is no greater than about 85% based on kCal contribution, for example, no greater than about 80% based on kCal contribution.

[0034] In these embodiments, the proportion of total fat, i.e. MCT, is in the range of about 55% to about 90% based on kCal contribution, preferably about 60% to about 85% based on kCal contribution, and most preferably about 65% to about 80% based on kCal contribution.

[0035] In a particularly preferred embodiment, the critically ill patient is receiving a high-fat sedative, and the total fat, i.e., MCT, in the feeding composition accounts for 70% of the total fat content, calculated as a kcal contribution.

[0036] In a particularly preferred embodiment, the critically ill patient was not receiving a high-fat sedative, and the proportion of total fat, i.e. MCT, in the feeding composition was 76% based on kCal contribution.

[0037] As a percentage of total fat, protein, and carbohydrate kCal, the amount of MCT in the feeding composition is at least about 40% by kCal contribution, preferably at least about 45% by kCal contribution. However, in some embodiments, the amount of MCT as a percentage of total fat, protein, and carbohydrate kCal contribution is no more than 65% by kCal contribution, for example, no more than about 60% by kCal contribution.

[0038] Preferably, the amount of MCT as a percentage of total fat, protein and carbohydrate kCal is in the range of about 40% to about 65% based on kCal contribution, more preferably about 45% to about 60% based on kCal contribution.

[0039] In a particularly preferred embodiment, the critically ill patient is receiving a high-fat sedative, and the proportion of kCal from total fat, protein, and carbohydrates, i.e., MCT, in the feeding composition is 50% based on kCal contribution.

[0040] In a particularly preferred embodiment, the critically ill patient was not receiving a high-fat sedative, and the proportion of kCal from total fat, protein, and carbohydrates, i.e., MCT, in the feeding composition was 57% based on kCal contribution.

[0041] As a weight percentage (ratio of fat (total), protein, and carbohydrates), the amount of MCT in the feeding composition is at least about 30% by weight of the feeding composition, preferably at least about 35% by weight. Up to about 55% by weight of the feeding composition may be MCT. However, in some embodiments, the amount of MCT in the feeding composition is no more than about 50% by weight of the feeding composition.

[0042] Preferably, the amount of MCT in the feeding composition (the ratio of fat (total), protein, and carbohydrates) is in the range of about 30% by weight to about 55% by weight, preferably about 35% by weight to about 50% by weight. In a preferred embodiment, the feeding composition contains about 38% by weight of MCT. In another preferred embodiment, the feeding composition contains about 45% by weight of MCT.

[0043] Another option for altering the amount of MCT to meet the nutritional needs of individual patients who are receiving or not receiving high-fat sedatives, while maintaining a ketogenic diet, is to adjust the volume of the feeding composition administered to critically ill patients.

[0044] The amount of feeding composition administered to each critically ill patient is individualized to reflect not only the patient's body mass index but also their clinical status.

[0045] In an embodiment where a critically ill patient is receiving a high-fat sedative, the volume of the feeding composition administered to the critically ill patient is typically at least about 300 mL, preferably at least about 375 mL, and most preferably at least about 450 mL.

[0046] In an embodiment where a critically ill patient is receiving high-fat sedation, the volume of the feeding composition administered to the critically ill patient may be up to about 800 mL. However, in other embodiments, the volume of the feeding composition administered to the critically ill patient is no greater than about 725 mL, for example, no greater than about 650 mL.

[0047] In embodiments where critically ill patients are receiving a high-fat sedative, the volume of the feeding composition administered to the critically ill patient is typically in the range of about 300 mL to about 800 mL, preferably about 375 mL to about 725 mL, and most preferably about 450 mL to about 650 mL. In these embodiments, the feeding composition supplements the critically ill patient with the large amount of nutrients obtained from the high-fat sedative.

[0048] In embodiments where the critically ill patient is not receiving a high-fat sedative, the volume of the feeding composition administered to the critically ill patient is typically at least about 600 mL, preferably at least about 675 mL, and most preferably at least about 750 mL.

[0049] In embodiments where the critically ill patient is not receiving high-fat sedation, the volume of the feeding composition administered to the critically ill patient may be up to about 1400 mL. However, in other embodiments, the volume of the feeding composition administered to the critically ill patient is no greater than about 1325 mL, for example, no greater than about 1250 mL.

[0050] In embodiments where the critically ill patient is not receiving a high-fat sedative, the volume of the feeding composition administered to the critically ill patient is typically in the range of about 600 mL to about 1400 mL, preferably about 675 mL to about 1325 mL, and most preferably about 750 mL to about 1250 mL. In these embodiments, the feeding composition supplies at least most, for example, all, of the macronutrients to the critically ill patient. Therefore, the amount of feeding composition administered to a critically ill patient who is not receiving a high-fat sedative is typically greater than the amount administered to a critically ill patient who is receiving a high-fat sedative.

[0051] In an alternative implementation where critically ill patients are receiving high-fat sedation, the proportion of total fat, i.e., MCT, in the feeding composition is in the range of about 40% to about 50% based on kCal contribution. In a specific alternative implementation where critically ill patients are receiving high-fat sedation, the proportion of total fat, i.e., MCT, in the feeding composition is 47% based on kCal contribution.

[0052] In other alternative embodiments, the proportion of total fat, i.e., MCT, is in the range of about 60% to about 90% based on kCal contribution, for example, about 65% to about 85% based on kCal contribution. These embodiments are alternative embodiments for patients not receiving high-fat sedation. In alternative embodiments, for critically ill patients not receiving high-fat sedation, the proportion of total fat, i.e., MCT, in the feeding composition is in the range of about 70% to about 80% based on kCal contribution. In a specific alternative embodiment for critically ill patients not receiving high-fat sedation, the proportion of total fat, i.e., MCT, in the feeding composition is 75% based on kCal contribution.

[0053] In a preferred embodiment, the fat and MCT source used to feed the composition includes K. Quik. TM (formerly BETAQUIK) TM ) and / or FRESUBIN TM 5kcal Shot. K. Quik TM and FRESULBIN TM The amounts of energy and macronutrients present in the food are provided in Table 1.

[0054] Table 1

[0055]

[0056] K.Quik TM The MCT in the product comes from coconut oil and palm kernel oil.

[0057] FRESUBIN TM The LCT in the 5kcal shot comes from rapeseed oil.

[0058] The composition also contains protein. Protein is a macronutrient composed of amino acids and can be derived from both animal-based and plant-based sources. Typically, the amount of protein required for critically ill patients fed via nasogastric tube is 0.88–1.25 g per kilogram of body weight per day. The amount of protein required in the feeding composition is also determined by the kcal contribution.

[0059] The amount of protein in the feeding composition is at least about 5% of the feeding composition in terms of kcal contribution, preferably at least about 10% of the feeding composition in terms of kcal contribution.

[0060] The feeding composition comprises up to about 35% protein, based on its kcal contribution. However, in some embodiments, the amount of protein in the feeding composition is no more than about 30% of the feeding composition based on its kcal contribution.

[0061] The amount of protein in the feeding composition is in the range of about 5% to about 35% based on kCal contribution, preferably about 10% to about 30% based on kCal contribution. In one embodiment, the feeding composition contains about 20% protein based on kCal contribution. In another embodiment, the feeding composition contains about 26% protein based on kCal contribution.

[0062] As a weight percentage (ratio of fat (total), protein, and carbohydrates), the amount of protein in the feeding composition is typically at least about 25% by weight, preferably at least about 30% by weight. Up to about 50% by weight of the feeding composition may be protein. However, in some embodiments, the amount of protein in the feeding composition is no more than about 45% by weight.

[0063] The amount of protein in the feeding composition (the ratio of fat (total), protein, and carbohydrates) is typically in the range of about 25% by weight to about 50% by weight, preferably about 30% by weight to about 45% by weight. In a preferred embodiment, the feeding composition contains about 33% by weight of protein. In another preferred embodiment, the feeding composition contains about 41% by weight of protein.

[0064] In a preferred embodiment, the protein source used in the feeding composition is RENAPRO. TM Shot, which includes bovine collagen peptides. RENAPRO TM The amounts of energy and macronutrients present in the food are provided in Table 2.

[0065] Table 2

[0066]

[0067] The feeding composition also contains carbohydrates. Preferably, the feeding composition contains a relatively low amount of carbohydrates compared to fat and protein to provide a ketogenic diet, i.e., the amount of carbohydrates is preferably lower than the amount of fat and protein in the feeding composition.

[0068] Preferably, carbohydrate sources that can be used alone or in combination in the composition include polysaccharides, oligosaccharides, disaccharides, and monosaccharides. Particularly preferred carbohydrate types are monosaccharides, such as glucose. In one embodiment, the carbohydrate source in the feeding composition includes super-soluble Maxijul TM It contains dried glucose syrup.

[0069] Super-soluble Maxijul TM The amounts of energy and macronutrients present in the food are provided in Table 3.

[0070] Table 3

[0071]

[0072] The carbohydrates are present in an amount of up to about 10% of the feeding composition based on its kcal contribution, more preferably up to about 8% based on its kcal contribution, and most preferably up to about 6% based on its kcal contribution. In a preferred embodiment, the feeding composition contains about 5% carbohydrates based on its kcal contribution. In another preferred embodiment, the feeding composition contains about 3% carbohydrates based on its kcal contribution.

[0073] As a weight percentage (ratio of fat (total), protein, and carbohydrates), carbohydrates are preferably present in an amount of up to about 15% by weight of the feeding composition, more preferably in an amount of up to about 13% by weight of the feeding composition. In a preferred embodiment, the feeding composition contains about 9% by weight of carbohydrates. In another preferred embodiment, the feeding composition contains about 11% by weight of carbohydrates.

[0074] In a particularly preferred embodiment according to the first aspect, the feeding composition comprises about 70% to about 75% of fat (of which about 70% to about 76% is MCT based on kCal contribution), about 20% to about 26% of protein based on kCal contribution, and about 3% to about 5% of carbohydrates based on kCal contribution.

[0075] As a weight percentage (ratio of fat (total), protein and carbohydrates), the feeding composition comprises about 50% to about 56% fat, about 38% to about 45% MCT, about 33% to about 41% protein and about 9% to about 11% carbohydrates.

[0076] The composition may further comprise micronutrients, including vitamins, minerals, and / or trace elements. Minerals and trace elements may include, but are not limited to, sodium, potassium, chloride, calcium, phosphorus, iron, magnesium, and zinc. Vitamins may include, but are not limited to, vitamin A, vitamin B (including B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 ​​(pyridoxine), B7 (biotin), B9 (folic acid), and B12 (cobalamin)), vitamin C, vitamin D, vitamin E, and vitamin K.

[0077] Preferably, the feeding composition is delivered to the patient via enteral feeding, meaning the feeding composition is delivered directly into the gastrointestinal tract. Examples of enteral feeding include delivery via a nasogastric tube (using a thin, flexible tube that passes through the nose, down to the back of the throat, through the esophagus, and into the stomach) or a gastrostomy tube (a feeding tube inserted endoscopically or surgically through the abdominal wall and directly into the stomach). Devices for enteral feeding are called “giving sets,” which typically include a feeding tube with suitable attachments for connecting to a feeding bag. Enteral feeding is advantageous because critically ill patients are often unable to be fed orally due to their condition or due to equipment such as a ventilator. Most preferably, the feeding composition is delivered via a nasogastric tube.

[0078] Alternatively, the feeding composition can be administered to the patient orally, for example as a beverage. This oral administration of the feeding composition is particularly advantageous for patients who are not sedated and have sufficient ability to swallow the composition. Where appropriate, this form of administration allows for the feeding composition to be delivered in a less invasive manner.

[0079] Preferably, the feeding composition is in a flowable liquid state. By providing a flowable liquid state, the feeding composition is suitable for administration via the gastroesophageal tract, such as a nasogastric tube or gastrostomy tube. The flowable liquid state also allows the feeding composition to be administered as a beverage. Water may be present in the feeding composition to form a flowable liquid feeding composition.

[0080] The amount of water can be up to about 85% of the volume of the feeding composition, more preferably up to about 80% of the volume of the feeding composition, and most preferably up to about 75% of the volume of the feeding composition.

[0081] The feeding composition is preferably administered continuously. The rate of continuous feeding is determined by the individual patient's weight, with a target feeding rate of 25 kcal / kg / day. Typically, the feeding composition is administered at a rate of up to about 70 mL / hour to about 80 mL / hour. When critically ill patients in the ICU are taken away for a period of time for medical scans, treatments, and / or surgery, it is often not possible to provide the feeding composition to the patient. In such cases, when the patient returns to the ICU, they can receive a top-up of the feeding composition, which is achieved by administering the feeding composition at an increased feeding rate to meet the patient's daily kcal target.

[0082] Alternatively, the feeding composition may be administered intermittently as a bolus. If the bolus is administered orally, it is preferably given as a beverage.

[0083] In embodiments where the feeding composition is administered via bolus or beverage, it is preferred to feed the patient the feeding composition 3 to 6 times daily. In these embodiments, the amount of feeding composition provided is also determined by the individual patient's weight, with a target feeding rate of 25 kcal / kg / day.

[0084] Less preferred examples of feeding compositions are provided in Tables 4 and 5.

[0085] Table 4

[0086] Macronutrient components %kCal contribution weight% Fat (total) 75 15 MCT (Total Fat Percentage) 47 12 protein 20 13 carbohydrate 5 3

[0087] Table 5

[0088] Macronutrient components %kCal contribution weight% Fat (total) 75 17 MCT (Total Fat Percentage) 75.5 14 protein 20 10 carbohydrate 5 3

[0089] According to a second aspect of the present invention, a method for preparing a feeding composition is provided, comprising:

[0090] Mix the feeding composition according to the first aspect of the invention in a container;

[0091] And arbitrarily,

[0092] The mixture is poured into a feeding bag, which is optionally equipped with a feeding component.

[0093] The feeding composition can be used immediately after preparation, or it can be stored at a temperature of 0°C to 5°C until it is needed for feeding.

[0094] As a weight percentage (ratio of fat (total), protein, and carbohydrates), a method for preparing a feeding composition according to the second aspect is provided, comprising mixing 40% to 65% by weight of fat, 25% to 50% by weight of protein, and up to 15% by weight of carbohydrates in a container, and optionally pouring the mixture into a feeding bag, wherein the feeding bag is optionally provided with a dispensing component. The feeding composition may be used immediately after preparation or may be stored at a temperature of 0°C to 5°C until it is needed for feeding.

[0095] Unwilling to be bound by theory, the inventors believe that MCT-induced ketones in the ketogenic feeding composition provide an alternative substrate to proteins for cellular energy production. In critical illness, carbohydrate metabolism shifts to an anaerobic state via the Pasteur effect, producing far less adenosine triphosphate (ATP). Fatty acid β-oxidation, the process by which fatty acids are broken down to produce energy, is blocked.

[0096] The features described in connection with one aspect of the invention can be used in conjunction with any aspect of the invention. Detailed Implementation

[0097] The invention will now be described by way of the following non-limiting embodiments.

[0098] Example 1 – Patients receiving propofol

[0099] Tables 6 and 7 provide the proportions of total fat, MCT, protein, and carbohydrates in the exemplary feeding compositions according to the invention for patients receiving propofol, expressed as a percentage of kCal contribution and a percentage by weight.

[0100] Table 6

[0101]

[0102]

[0103] In Table 6, the combined %kCal contribution of fat (total), protein, and carbohydrates equals the 100%kCal contribution. The %kCal contribution of MCT as a percentage of total fat is 70%, meaning 70% of the fat's kCal contribution comes from MCT. The %kCal contribution of MCT as a percentage of the total kCal from fat (total), protein, and carbohydrates is 49.5%, meaning 49.5% of the total kCal in the diet comes from MCT. If the patient receives an average daily volume of 367 mL of propofol, then 46% of the fat's kCal contribution comes from MCT, meaning the total amount of MCT received by the patient from the feeding composition and propofol is 46% kCal contribution.

[0104] Table 7

[0105]

[0106] In Table 7, the combined weight % of fat (total), protein, and carbohydrates equals 100% by weight. The combined weight % of fat (total), protein, and carbohydrates therefore excludes other components in the feeding composition, such as water. The weight % of MCT is not the weight % percentage of total fat, but rather the weight % percentage of the combined weight % of fat (total), protein, and carbohydrates. The water content is approximately 70% by volume.

[0107] Table 8 provides the ingredients for obtaining the feeding compositions in Tables 6 and 7. In the ICU food room, the ingredients are measured in a measuring cup and mixed together using a sterile spoon. The resulting composition is then poured into a feeding bag containing the administration components and stored in the refrigerator until needed.

[0108] Table 8

[0109]

[0110]

[0111] The total volume of the feeding composition was 561 mL.

[0112] Example 2 – Patients who did not receive propofol

[0113] Tables 9 and 10 provide the proportions of total fat, MCT, protein, and carbohydrates in the exemplary feeding compositions according to the invention for patients not receiving propofol, expressed as a percentage of kCal contribution and a percentage by weight.

[0114] Table 9

[0115]

[0116] In Table 9, the combined %kCal contribution of fat (total), protein, and carbohydrates equals the 100%kCal contribution. The %kCal contribution of MCT as a percentage of total fat is 75.5%, meaning 75.5% of the fat's kCal contribution comes from MCT. The %kCal contribution of MCT as a percentage of the total kCal from fat (total), protein, and carbohydrates is 57.1%, meaning 57.1% of the total kC in the feed comes from MCT.

[0117] Table 10

[0118]

[0119] In Table 10, the combined weight % of fat (total), protein, and carbohydrates equals 100% by weight. The combined weight % of fat (total), protein, and carbohydrates therefore excludes other components in the feeding composition, such as water. The weight % of MCT is not the weight % of total fat, but rather the weight % percentage of the combined weight % of fat (total), protein, and carbohydrates. The water content is approximately 70% by volume.

[0120] Table 11 provides the ingredients for obtaining the feeding compositions in Tables 9 and 10. The compositions were prepared as in Example 1.

[0121] Table 11

[0122] Element quantity <![CDATA[K.Quik TM ]]> 639.5mL <![CDATA[RENAPRO TM ]]> 298.5mL <![CDATA[Super solubility Maxijul TM > 17.35g <![CDATA[FRESUBIN TM 5kcal Shot]]> 65mL

[0123] The total volume of the feeding composition is 1003 mL.

[0124] The feeding compositions of Examples 1 and 2 were administered to a group of 29 patients in the ICU to meet an individualized target feeding rate of 25 kcal / kg / day. Patients receiving propofol were fed the composition of Example 1, while those not receiving propofol were fed the composition of Example 2. Any changes to patient routines such as medical scans, treatments, or surgeries were recorded, and the feeding rate was subsequently increased in a "supplementary" manner to achieve the target daily calorie intake. The amount of feeding composition administered to each patient daily was monitored, and the average was taken to provide a feeding composition for future use. It was found that the feeding compositions induce ketosis in the patients.

[0125] Table 12 shows the mean (from higher and lower levels) %kCal contribution of MCT administered to patients over a 10-day period. Patients received the feeding composition in addition to propofol. The propofol dose was reduced over the 10-day period. The mean (from higher and lower levels) %kCal contribution of MCT is the total amount of MCT received by patients from the feeding composition and propofol, expressed as a %kCal contribution of fat. The %kCal contribution of MCT increased from a mean of 44.41%kCal contribution to a mean of 73.96%kCal contribution, while patients were monitored to ensure that the %kCal contribution of MCT was safe, tolerable, and feasible for critically ill patients. Following patient monitoring, it was determined that the %kCal contribution of MCT administered to the patient group was safe.

[0126] Table 12

[0127]

[0128] Aspects of the present invention include:

[0129] #1. A feeding composition for treating and / or preventing muscle atrophy in critically ill patients, comprising 60% to 90% fat, 5% to 35% protein, and up to 10% carbohydrates based on kCal contribution.

[0130] #2. The feeding composition as described in #1, wherein the composition is suitable for oral administration and / or enteral feeding, such as via gastrostomy or nasogastric administration.

[0131] #3. A feeding composition as described in #1 or #2, wherein the patient is an adult.

[0132] #4. The feeding composition according to any of the foregoing aspects comprises 75% fat based on kCal contribution.

[0133] #5. The feeding composition according to any of the foregoing aspects, wherein the fat comprises medium-chain triglycerides.

[0134] #6. The feeding composition according to #5, wherein the proportion of fat containing medium-chain triglycerides is preferably 25% to 90% based on kCal contribution, more preferably 35% to 60% based on kCal contribution, and most preferably 40% to 55% based on kCal contribution.

[0135] #7. The feeding composition according to #5, wherein the proportion of fat containing medium-chain triglycerides is 60% to 90% based on kCal contribution, preferably 65% ​​to 85% based on kCal contribution.

[0136] #8. The feeding composition according to #5, wherein the proportion of fat containing medium-chain triglycerides is 47% based on kCal contribution.

[0137] #9. The feeding composition according to #5, wherein the proportion of fat containing medium-chain triglycerides is 75% based on kCal contribution.

[0138] #10. The feeding composition according to any of the foregoing aspects comprises 20% protein based on kCal contribution.

[0139] #11. The feeding composition according to any of the foregoing aspects comprises 5% carbohydrates based on kCal contribution.

[0140] #12. The feeding composition according to any of the foregoing aspects further comprises micronutrients selected from vitamins, minerals and trace elements.

[0141] #13. A feeding composition comprising 75% fat, 20% protein, and 5% carbohydrates based on kcal contribution.

[0142] #14. The feeding composition as described in #13, wherein the fat comprises medium-chain triglycerides.

[0143] #15. The feeding composition according to #14, wherein the proportion of fat containing medium-chain triglycerides is 47% based on kCal contribution.

[0144] #16. The feeding composition according to #14, wherein the proportion of fat containing medium-chain triglycerides is 75% based on kCal contribution.

[0145] #17. A method for preparing a feeding composition, the method comprising:

[0146] Mix 60% to 90% fat, 5% to 35% protein, and up to 10% carbohydrates by kCal contribution in a container; and optionally, pour the mixture into a feeding bag, wherein the feeding bag is optionally provided with a feeding component.

[0147] #18. The method according to #17, further comprising storing the mixture at a temperature of 0°C to 5°C.

[0148] #19. A feeding composition for treating and / or preventing muscle atrophy in critically ill patients, comprising 9% to 21% by weight of fat, 6% to 17% by weight of protein and up to 5% by weight of carbohydrates.

[0149] #20. The feeding composition according to #19, which contains 15% by weight or 17% by weight of fat.

[0150] #21. The feeding composition according to any one of #19 to #20, wherein the fat comprises medium-chain triglycerides.

[0151] #22. The feeding composition according to #21, comprising 8% to 18% by weight of medium-chain triglycerides.

[0152] #23. The feeding composition according to #21 or #22, comprising 12% or 14% by weight of medium-chain triglycerides.

[0153] #24. The feeding composition according to any one of #19 to #23, comprising 10% by weight or 13% by weight of protein.

[0154] #25. The feeding composition according to any one of #19 to #24, comprising 3% by weight of carbohydrates.

Claims

1. A feeding composition for treating and / or preventing muscle atrophy in critically ill patients, comprising 60% to 90% fat, 5% to 35% protein, and up to 10% carbohydrates based on kCal contribution. The fats mentioned therein include medium-chain triglycerides and long-chain triglycerides; The proportion of fats containing medium-chain triglycerides ranges from 25% to 90% based on kcal contribution; and The long-chain triglycerides mentioned therein are derived from plant sources.

2. The feeding composition according to claim 1, wherein the plant source is rapeseed oil.

3. The feeding composition according to claim 1 or 2, wherein the fat content is 65% to 85% based on kCal contribution, preferably 70% to 80% based on kCal contribution.

4. The feeding composition according to any one of the preceding claims, wherein, The proportion of fats containing medium-chain triglycerides is 55%-90% based on kCal contribution, preferably 60%-85% based on kCal contribution.

5. The feeding composition according to any one of the preceding claims, wherein, The protein's contribution, calculated in kcal, is between 10% and 30%.

6. The feeding composition according to any one of the preceding claims, wherein, The carbohydrate contribution is at most 8% per kcal, preferably at most 6% per kcal.

7. The feeding composition according to any one of the preceding claims further comprises a micronutrient selected from vitamins, minerals and trace elements.

8. The feeding composition according to any one of the preceding claims, wherein the composition is suitable for oral administration and / or enteral feeding, for example, via gastrostomy or nasogastric administration.

9. The feeding composition according to any one of the preceding claims, wherein, The patient is an adult.

10. The feeding composition according to any one of the preceding claims, wherein the patient is receiving a high-fat sedative.

11. The feeding composition according to any one of claims 1 to 9, wherein the patient is not receiving a high-fat sedative.

12. The feeding composition according to any one of the preceding claims, comprising 70% fat, 26% protein, and 3% carbohydrates based on kcal contribution; The proportion of fats containing medium-chain triglycerides is 70% based on kCal contribution.

13. The feeding composition according to any one of the preceding claims, comprising 75% fat, 20% protein, and 5% carbohydrates based on kcal contribution; The proportion of fats containing medium-chain triglycerides is 76% based on kCal contribution.

14. A method for preparing a feeding composition, the method comprising: Mix the feeding composition according to any one of claims 1 to 13 in a container; And optional location, The mixture is poured into a feeding bag, which is optionally equipped with a feeding component.

15. The method of claim 14, further comprising storing the mixture at a temperature of 0°C to 5°C.

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