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Jevity® 1.2 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 1.2 CAL is a high-protein, fiber-fortified formula that provides complete, balanced nutrition for long- or short-term tube feeding. 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 (1.2 Cal/mL) and high in protein (18.5% of Cal) to help tube-fed patients gain and maintain healthy weight. Protein is needed for lean body tissue maintenance and repair z Meets or exceeds 100% of the DVs for 24 essential vitamins and minerals in 1200 Cal (1 liter) 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]) supplies the minimum recommended daily fiber intake. Fiber helps maintain bowel function z Moderate osmolality is beneficial for those intolerant of hyperosmolar feedings 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 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 285 1200 1800 — Protein, g 13.2 55.5 83.3 18.5 Total Fat, g 9.3 39.3 59.0 29.0 Total Carbohydrate, g* 40.9 171.5 257 52.5 Water, g† 191 805 1208 — *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 53118 Ross Ready-To-Hang® 1000-mL prefilled containers; 8/case Flavor List Number Unflavored 53124 Ross Ready-To-Hang 1500-mL prefilled containers; 6/case Flavor List Number Unflavored 53114 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 10 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 10 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: -D water, corn maltodextrin, corn syrup solids, sodium and calcium caseinate, high oleic safflower oil, soy protein isolate, fructooligosaccharides, canola oil, medium chain triglycerides, soy fiber, oat fiber, calcium phosphate, gum arabic, sodium citrate, magnesium phosphate, soy lecithin, potassium chloride, potassium citrate, carboxymethylcellulose, magnesium chloride, ascorbic acid, choline chloride, potassium phosphate, L-carnitine, taurine, zinc sulfate, ferrous sulfate, dl-alpha-tocopheryl acetate, niacinamide, calcium pantothenate, manganese sulfate, cupric sulfate, thiamine chloride hydrochloride, pyridoxine hydrochloride, riboflavin, beta-carotene, 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. (768103) Protein: The total calorie/nitrogen (Cal/N) ratio of JEVITY 1.2 CAL (135:1) has been demonstrated to maintain nitrogen balance in long-term tube-fed patients.3 The amino acid profile of the protein system in JEVITY 1.2 CAL meets or surpasses the standard amino acid profile for high-biologicvalue protein. Protein Profile Percent of total calories from protein 18.5 Protein content 55.5 g/L Cal/N ratio 135:1 Nonprotein Cal/N ratio 110:1 Fat: The fat in JEVITY 1.2 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 1.2 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 29.0 Total Fat 39.3 g/L Polyunsaturated fatty acids 6.7 g/L Monounsaturated fatty acids 20.2 g/L Saturated fatty acids 9.8 g/L omega-6/omega-3 ratio 4.2:1 Cholesterol <20 mg/L Carbohydrate: The carbohydrate sources in JEVITY 1.2 CAL are corn syrup solids, corn maltodextrin, the patented fiber blend, and fructooligosaccharides. The composition of the FOS and patented fiber blend, the dietary fiber sources in JEVITY 1.2 CAL, is provided in the Fiber section. Carbohydrate Profile Percent of total calories from carbohydrate 52.5 Total carbohydrate 171.5 g/L Fiber: JEVITY 1.2 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 1.2 CAL is 12 g/L (2.9 g/8 fl oz) or 10 g/1000 Cal, within the recommended range—10 to 13 g/1000 Cal—for daily fiber intake by the U.S. Department of Health and Human Services.9 The blend of insoluble and soluble fibers in JEVITY 1.2 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/1000 Cal) 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), which 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. The FOS content of JEVITY 1.2 CAL is 2.4 g/8 fl oz (10 g/L and 15.0 g/1500 mL). Dietary fiber is considered the sum of FOS and total dietary fiber. JEVITY 1.2 CAL provides 5.3 g/8 fl oz (22 g/L and 33 g/1500 mL). Vitamins and Minerals: JEVITY 1.2 CAL meets or exceeds 100% of the DVs for 24 key vitamins and minerals (except chloride) in 1200 Cal (1000 mL) or about 4.2 eight-fl-oz servings. JEVITY 1.2 CAL is supplemented with the conditionally essential nutrients L-carnitine and taurine at levels within the range of typical daily intakes (150 mg/L). JEVITY 1.2 CAL is fortified with beta-carotene (2.5 mg/L; 3320 IU/L), which makes up approximately 66% of the total vitamin A activity. Osmotic Concentration: The main determinants of the osmolality of a formula are simple carbohydrates, electrolytes, and amino acids or small peptides. JEVITY 1.2 CAL contains corn syrup solids, corn maltodextrin, the patented fiber blend, and FOS as the carbohydrate sources, and an intact protein system. Osmolality (mOsm/kg H2O) 450 Osmolarity (mOsm/L) 365 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 58.7 58.7 Potassium 47.4 47.4 Chloride 42.4 42.4 Protein content 55.5 g/L x 5.7 = 316.4 Total RSL 465 Analysis: Nutrient Facts 8 fl oz 1000 mL 1500 mL FAN (label number) 7818-03 7681-03 7681-03 Cal/mL 1.20 1.20 1.20 Energy, Cal 285 1200 1800 Protein, g 13.2 55.5 83.3 % of total Calories 18.5 18.5 18.5 Fat, g 39.3 59.0 % of total Calories 29.0 9.3 29.0 29.0 Cholesterol, mg <5 <20 <30 171.5 257 52.5 52.5 Carbohydrate, g 40.9 % of total Calories 52.5 Water, g* 191 805 1208 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 2.4 g/8 fl oz (10.0 g/L and 15.0 g/1500 mL) of FOS and 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. Vitamins 8 fl oz 1000 mL 1500 mL Vitamin A, IU 1190 5000 7500 Vitamin D, IU 96 400 600 Vitamin E, IU 11 45 68 Vitamin K, mcg 20 80 120 Vitamin C, mg 72 300 450 Folic Acid, mcg 145 600 900 Thiamin (Vitamin B1), mg 0.55 2.3 3.5 Riboflavin (Vitamin B2), mg 0.62 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 Includes 795 IU/8 fl oz (3320 IU/L and 4980 IU/1500 mL) of vitamin A activity from 0.60 mg/8 fl oz of beta-carotene (2.5 mg/L and 3.8 g/1500 mL). Minerals 8 fl oz 1000 mL 1500 mL Sodium, mg (mEq) 325 (14.1) 1350 (58.7) 2030 (88.3) Potassium, mg (mEq) 440 (11.3) 1850 (47.4) 2780 (71.3) Chloride, mg (mEq) 360 (10.2) 1500 (42.4) 2250 (63.6) Calcium, mg 285 1200 1800 Phosphorus, mg 285 1200 1800 Magnesium, mg 96 400 600 Iodine, mcg 36 150 225 Manganese, mg 1.2 5 7.5 Copper, mg 0.48 2 3 Zinc, mg 5.5 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 356 1499 2249 Isoleucine*, mg 620 2609 3915 Leucine*, mg 1188 4995 7497 Lysine, mg 950 3996 5998 Methionine, mg 370 1554 2332 Phenylalanine, mg 660 2775 4165 Threonine, mg 528 2220 3332 Tryptophan, mg 145 611 916 Valine*, mg 779 3275 4915 Alanine, mg 383 1610 2416 Arginine, mg 436 1832 2749 Aspartic Acid, mg 924 3885 5831 Cystine, mg 53 222 333 Glutamic Acid, mg 2825 11877 17826 Glycine, mg 238 999 1499 Proline, mg 1399 5883 8830 Serine, mg 726 3053 4582 Tyrosine, mg 647 2720 4082 Nonessential * Branched-chain amino acids. Fatty Acids 8 fl oz 1000 mL 1500 mL Linoleic (18:2), mg 1281 5414 8127 α-Linolenic (18:3), mg 300 1284 1928 Caprylic (8:0), mg 998 4219 6334 Capric (10:0), mg 707 2987 4484 Lauric (12:0), mg 15 63 95 Myristic (14:0), mg 17 71 106 Palmitic (16:0), mg 388 1639 2461 Stearic (18:0), mg 166 702 1054 Oleic (18:1), mg 4789 20236 30379 Arachidic (20:0), mg 24 101 151 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 1.045 pH 6.5 Osmolality, mosm/kg H2O 450 Osmolarity, mosm/L 365 Renal Solute Load, mosm/L 465 Cal to meet 100% RDIs 1200 mL to meet 100% RDIs 1000 Total Cal/g nitrogen 135:1 Nonprotein Cal/g nitrogen 110:1 References: The Effects of Handling on Prolonged Hangtime for Ross Ready-To-Hang Containers. Columbus: Abbott Laboratories, 2002 (#65472). 1. Royall D, Wolever TMS, Jeejeebhoy KN: Clinical significance of colonic fermentation. Am J Gastroenterol 1990;85:1307-1312. 2. 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. 3. 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. 4. Bach AC, Babayan VK: Medium-chain triglycerides: An update. Am J Clin Nutr 1982;36:950962. 5. 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. 6. 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. 7. 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. 8. Federation of American Societies for Experimental Biology: Physiological Effects and Health Consequences of Dietary Fiber. US Dept of Health and Human Services, 1987. 9. Prosky L, Hoebregs H: Methods to determine food inulin and oligofructose. J Nutr 1999;129 (suppl 7):1418S-1423S. 10. Gibson G, Wang X: Bifidogenic properties of different types of fructo-oligosaccharides. Food Microbiol (London) 1994;11:491-498. 11. Cummings JH, Macfarlane GT: The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991;70:443-459. 12. 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. 13. Jenkins DJ, Kendall CW, Vuksan V: Inulin, oligofructose and intestinal function. J Nutr 1999;129:1431S-1433S.