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Jevity® 1.5 Cal high-protein nutrition with FOS and a patented fiber blend Usage Features Availability Administration Ingredients Protein Fat Carbohydrate Fiber Vitamins and Minerals Osmotic Concentration Renal Solute Load Analysis References Support Materials Usage: JEVITY 1.5 CAL is a calorically dense liquid food with a patented fiber blend that provides complete, balanced nutrition. z z z For tube feeding For supplemental or sole-source nutrition May be used for oral feeding of patients with altered taste perception Features: Concentrated calories (1.5 Cal/mL) to help tube-fed patients gain and maintain healthy weight z 22 g of dietary fiber in 1 liter (12 g of a patented soluble and insoluble fiber blend and 10 g of fructooligosaccharides [FOS]), which helps meet daily fiber needs. Fiber helps moderate bowel function z Includes 2.4 g of FOS/8 fl oz (10 g/L and 15 g/1500 mL). FOS are prebiotics that stimulate the growth of beneficial bacteria in the colon2 z Meets or exceeds 100% of the DVs for 24 essential vitamins and minerals in 1500 Cal (1 liter) z Lactose- and gluten-free z Kosher z Contains milk and soy ingredients Caloric Distribution Per 8 fl oz Per Liter Per 1500 mL % Calories Calories 355 1500 2250 — Protein, g 15.1 63.8 95.7 17.0 Total Fat, g 11.8 49.8 74.7 29.4 Total Carbohydrate, g* 51.0 215.7 323.6 53.6 Water, g† 180 760 1140 — *Includes 2.9 g/8 fl oz (12.0 g/L and 18.0 g/1500 mL) of total dietary fiber from a patented fiber blend and 2.4 g/8 fl oz (10.0 g/L and 15.0 g/1500 mL) of FOS. †1 g water = 1 mL water = 1 cc water. Availability: Ready-To-Use 8-fl-oz cans; 24/case Flavor List Number Unflavored 57333 Ross Ready-To-Hang® 1000-mL prefilled containers; 8/case Flavor List Number Unflavored 57329 Ross Ready-To-Hang 1500-mL prefilled containers; 6/case Flavor List Number Unflavored 57331 See the Reimbursement section of Ross.com for third-party reimbursement information. The Reimbursement link can be found at the top of each page of Ross.com. Product information and values listed are subject to change. Please refer to product label or packaging for the most current information. Administration: Use under medical supervision. Not for parenteral use. Use by date on container. 8-fl-oz cans: Oral feeding: May be fed at room temperature or chilled. Tube feeding: Follow physician's instructions. Adjust flow rate and volume according to patient's condition and tolerance. Gravity feed at room temperature with a 12 Fr or larger tube; use a pump with smaller tubes. Additional fluid requirements should be met by giving water between or after feedings, or when flushing the tube. Avoid contamination during preparation and use. Ross Ready-To-Hang: Pump feeding is recommended. Gravity feed at room temperature with a 12 Fr or larger tube; use a pump with smaller tubes. Note: Hang product up to 48 hours after initial spike when clean technique and only one new feeding set are used. Otherwise, hang no longer than 24 hours. The availability of extended hangtime does not supersede your institution's policies, procedures, or good clinical practice guidelines. (See attached PDF at the top of this page, "Ross Ready-To-Hang® Suggested Setup Procedure.") Click Here To View Administration Schedule. Ingredients: (U)-D water, corn syrup solids, corn maltodextrin, sodium and calcium caseinates, high oleic safflower oil, canola oil, soy protein isolate, fructooligosaccharides, medium chain triglycerides, oat fiber, soy fiber, potassium citrate, calcium phosphate, gum arabic, sodium citrate, magnesium phosphate, soy lecithin, magnesium chloride, carboxymethylcellulose, ascorbic acid, choline chloride, potassium chloride, taurine, L-carnitine, zinc sulfate, ferrous sulfate, dl-alpha-tocopheryl acetate, niacinamide, calcium pantothenate, manganese sulfate, cupric sulfate, thiamine chloride hydrochloride, pyridoxine hydrochloride, riboflavin, vitamin A palmitate, folic acid, biotin, chromium chloride, sodium molybdate, potassium iodide, sodium selenate, phylloquinone, cyanocobalamin and vitamin D3. Allergy information: Contains milk and soy ingredients. (7818-02) Protein: The protein in JEVITY 1.5 CAL consists of sodium and calcium caseinates and soy protein isolate. The total calorie/nitrogen (Cal/N) ratio of JEVITY 1.5 CAL (147:1) has been demonstrated to maintain nitrogen balance in long-term tube-fed patients.3 The amino acid profile of the protein system in JEVITY 1.5 CAL meets or surpasses the standard amino acid profile for high-biologicvalue protein. Protein Profile Percent of total calories from protein 17.0 Protein content 63.8 g/L Cal/N ratio 147:1 Nonprotein Cal/N ratio 122:1 Fat: The fat blend in JEVITY 1.5 CAL contains high oleic safflower oil, canola oil, MCT oil, and soy lecithin. As recommended by the American Heart Association, less than 30% of calories in JEVITY 1.5 CAL come from fat, with less than 10% of calories from polyunsaturated fatty acids and less than 10% of calories from saturated fatty acids.4 MCTs are added to provide lipid substrates, which are rapidly absorbed, metabolized, and oxidized by the liver.5 MCTs are an excellent energy source that may be helpful in providing an alternative source of energy for patients with increased energy needs. Fat Profile Percent of total calories from fat 29.4 Total fat 49.8 g/L Polyunsaturated fatty acids 7.5 g/L Monounsaturated fatty acids 26.0 g/L Saturated fatty acids 13.8 g/L omega-6/omega-3 ratio 5.4:1 Cholesterol <20 mg/L Carbohydrate: The carbohydrate sources in JEVITY 1.5 CAL are corn maltodextrin, corn syrup solids, the patented fiber blend, and FOS. The composition of the FOS and patented fiber blend, the dietary fiber source in JEVITY 1.5 CAL, is provided in the Fiber section. Carbohydrate Profile Percent of total calories from carbohydrate 53.6 Total carbohydrate 215.7 g/L Fiber: JEVITY 1.5 CAL contains a unique patented blend of 75% insoluble and 25% soluble fibers, a proportion that represents the types of fiber found in a diet containing a wide variety of foods.6 The sources are oat fiber, soy fiber, gum arabic, and carboxymethylcellulose. This blend of fiber sources was selected for its water-absorbing ability, fermentability, contribution to stool bulking, and minimal contribution to product viscosity.7, 8 The total dietary fiber content of JEVITY 1.5 CAL is 22 g/L, which meets the recommendation of 20 g to 35 g/day for daily fiber intake by the US Department of Health and Human Services.9 The blend of insoluble and soluble fibers in JEVITY 1.5 CAL is an effective fiber source, as demonstrated in animal models, healthy subjects, and in the clinical setting.10-14 In studies comparing formulas containing either a fiber blend or soy polysaccharide, animals and healthy people who consumed the fiber blend produced stools of heavier weight and similar consistency.10,11 In the clinical setting, long-term care patients receiving formulas containing a lower level of the fiber blend (10.0 g total dietary fiber/1000Cal) had stool weights and stool consistencies similar to those of patients receiving a higher intake of soy fiber (13.6 g total dietary fiber/1000 Cal).12,13 FOS are indigestible, highly fermentable carbohydrates that occur naturally in many foods, such as onions, bananas, tomatoes, honey, garlic, barley, and wheat. FOS are prebiotics that stimulate the growth of beneficial GI bacteria (eg, bifidobacteria) in the colon. FOS are fermented by bacteria in the colon to short-chain fatty acids (SCFAs) that inhibit the growth of C difficile in at-risk patients. SCFAs enhance water and electrolyte uptake in the colon, which is important in the management of diarrhea.2 The FOS content of JEVITY 1.5 CAL is 2.4 g/8 fl oz (10 g/L and 15 g/1500 mL). Dietary fiber is considered the sum of FOS and total dietary fiber. JEVITY 1.5 CAL provides 5.3 g/8 fl oz (22 g/L and 33 g/1500 mL). Vitamins and Minerals: JEVITY 1.5 CAL meets or exceeds 100% of the DVs for 24 key vitamins and minerals (except chloride) in 1500 Cal (1000 mL) or about 4.2 eight-fl-oz servings. JEVITY 1.5 CAL is supplemented with the conditionally essential nutrients L-carnitine and taurine at levels within the range of typical daily intakes (150 mg/L). Osmotic Concentration: The main determinants of the osmolality of a formula are simple carbohydrates, electrolytes, and amino acids or small peptides. JEVITY 1.5 CAL contains corn maltodextrin, corn syrup solids, the patented fiber blend, and FOS as the carbohydrate sources, and an intact protein system. Osmolality (mOsm/kg H2O) 525 Osmolarity (mOsm/L) 477 Renal Solute Load: Renal solute load represents the solutes excreted per liter of product consumed. The major determinants of renal solute load are dietary protein and electrolytes. Each milliequivalent of sodium, potassium, and chloride contributes approximately 1 mOsm to the renal solute load; in adults, each gram of protein contributes approximately 5.7 mOsm. Renal Solute Load (RSL) Electrolyte Content (mEq/L) Contribution to RSL (mOsm/L) Sodium 60.9 60.9 Potassium 55.1 55.1 Chloride 38.4 38.4 Protein content 63.8 g/L x 5.7 = 363.7 Total RSL 518 Analysis: Nutrient Facts 8 fl oz 1000 mL 1500 mL FAN (label number) 7818-02 7818-02 7818-02 Cal/mL 1.50 1.50 1.50 Energy, Cal 355 1500 2250 Protein, g 15.1 63.8 95.7 % of total Calories 17.0 17.0 17.0 11.8 49.8 74.7 % of total Calories 29.4 29.4 29.4 Cholesterol, mg <5 <20 <30 215.7 323.6 Fat, g Carbohydrate, g 51 53.6 53.6 Water, g* % of total Calories 53.6 180 760 1140 Dietary Fiber, g 5.3 22.0 33.0 L-carnitine, mg 36 150 225 Taurine, mg 36 150 225 m-Inositol, mg * 1 g water = 1 mL water = 1 cc water. Includes 2.9 g/8 fl oz (12.0 g/L and 18.0 g/1500 mL) of total dietary fiber from a patented fiber blend and 2.4 g/8 fl oz (10.0 g/L and 15.0 g/1500 mL) of FOS. Vitamins 8 fl oz 1000 mL 1500 mL Vitamin A, IU 1185 5000 7500 Vitamin D, IU 95 400 600 Vitamin E, IU 11 45 68 Vitamin K, mcg 19 80 120 Vitamin C, mg 72 300 450 Folic Acid, mcg 145 600 900 Thiamin (Vitamin B1), mg 0.54 2.3 3.4 Riboflavin (Vitamin B2), mg 0.61 2.6 3.9 Vitamin B6, mg 0.72 3 4.5 Vitamin B12, mcg 2.2 9 14 Niacin, mg 7.2 30 45 Choline, mg 145 600 900 Biotin, mcg 110 450 675 Pantothenic Acid, mg 3.6 15 23 Minerals 8 fl oz 1000 mL 1500 mL Sodium, mg (mEq) 330 (14.3) 1400 (60.9) 2100 (91.3) Potassium, mg (mEq) 510 (13.1) 2150 (55.1) 3225 (82.7) Chloride, mg (mEq) 320 (9.0) 1360 (38.4) 2040 (57.6) Calcium, mg 285 1200 1800 Phosphorus, mg 285 1200 1800 Magnesium, mg 95 400 600 Iodine, mcg 36 150 225 Manganese, mg 1.2 5 7.5 Copper, mg 0.48 2 3 Zinc, mg 5.4 23 34 Iron, mg 4.3 18 27 Selenium, mcg 17 70 105 Chromium, mcg 29 120 180 Molybdenum, mcg 36 150 225 Amino Acids 8 fl oz 1000 mL 1500 mL Essential Histidine, mg 433 1832 2748 Isoleucine*, mg 764 3234 4852 Leucine*, mg 1466 6204 9306 Lysine, mg 1124 4758 7137 Methionine, mg 399 1689 2533 Phenylalanine, mg 824 3488 5232 Threonine, mg 683 2892 4338 Tryptophan, mg 166 702 1081 Valine*, mg 957 4051 6077 Alanine, mg 527 2230 3345 Arginine, mg 639 2704 4057 Aspartic Acid, mg 1268 5365 8048 Cystine, mg 61 255 393 Glutamic Acid, mg 3706 15676 23515 Glycine, mg 362 1534 2301 Proline, mg 1607 6800 10200 Serine, mg 913 3864 5796 Tyrosine, mg 780 3300 4951 Nonessential * Branched-chain amino acids. Fatty Acids 8 fl oz 1000 mL 1500 mL Linoleic (18:2), mg 1572 6749 10117 α-Linolenic (18:3), mg 290 1248 1871 Caprylic (8:0), mg 1266 5434 8146 Capric (10:0), mg 889 3817 5721 Lauric (12:0), mg 319 1371 2057 Myristic (14:0), mg 23 99 148 Palmitic (16:0), mg 489 2100 3147 Stearic (18:0), mg 203 875 1311 Oleic (18:1), mg 6063 26024 59009 Arachidic (20:0), mg 47 203 304 Fatty acids equal approximately 95% of total fat. Key for values In parentheses (carbon atoms:double bonds). Other Values Density at 23°C, g/mL 1.104 pH 6.4 Osmolality, mosm/kg H2O 525 Osmolarity, mosm/L 477 Renal Solute Load, mosm/L 518 Cal to meet 100% RDIs 1500 mL to meet 100% RDIs 1000 Total Cal/g nitrogen 147.1 Nonprotein Cal/g nitrogen 122:1 References: 1. The Effects of Handling on Prolonged Hangtime for Ross Ready-To-Hang Containers. Columbus: Abbott Laboratories, 2002 (#65472). 2. Royall D, Wolever TMS, Jeejeebhoy KN: Clinical significance of colonic fermentation. Am J Gastroenterol 1990;85:1307-1312. 3. Mitchell CO, Lipschitz DA: Nitrogen balance in long-term tube feeders on diets of varying calorie to nitrogen ratios (abstract). J Am Coll Nutr 1984;3:249. 4. Krauss R, Eckel R, Howard B, et al: AHA dietary guidelines: Revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000;102:2296-2311. 5. Bach AC, Babayan VK: Medium-chain triglycerides: An update. Am J Clin Nutr 1982;36:950962. 6. Tisdale MJ, Beck SA: Inhibition of tumour-induced lipolysis in vitro and cachexia and tumour growth in vivo by eicosapentaenoic acid. Biochem Pharmacol 1991;41:103-107. 7. Wigmore SJ, Fearon KCH, Maingay JP, Ross JA: Down-regulation of the acute-phase response in patients with pancreatic cancer cachexia receiving oral eicosapentaenoic acid is mediated via suppression of interleukin-6. Clin Sci 1997;92:215-221. 8. Wigmore SJ, Barber MD, Ross JA, et al: Effect of oral eicosapentaenoic acid on weight loss in patients with pancreatic cancer. Nutr Cancer 2000;36:177-184. 9. Federation of American Societies for Experimental Biology: Physiological Effects and Health Consequences of Dietary Fiber. US Dept of Health and Human Services, 1987. 10. Prosky L, Hoebregs H: Methods to determine food inulin and oligofructose. J Nutr 1999;129 (suppl 7):1418S-1423S. 11. Gibson G, Wang X: Bifidogenic properties of different types of fructo-oligosaccharides. Food Microbiol (London) 1994;11:491-498. 12. Cummings JH, Macfarlane GT: The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991;70:443-459. 13. Macfarlane GT, Cummings JH: The colonic flora, fermentation, and large bowel digestive function, in Phillips SF, Pemberton JH, Shorter RG (eds): The Large Intestine: Physiology, Pathophysiology, and Disease. New York: Raven Press, 1991, pp 51-92. 14. Jenkins DJ, Kendall CW, Vuksan V: Inulin, oligofructose and intestinal function. J Nutr 1999;129:1431S-1433S.