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Optimental®
specialized elemental nutrition with structured lipids and FOS for malabsorptive conditions
Usage Features Availability Preparation Administration Ingredients Protein Fat Carbohydrate
Fiber Vitamins and Minerals Osmotic Concentration Renal Solute Load References
Usage:
OPTIMENTAL is a ready-to-feed elemental formula containing a specialized protein system,
structured lipids, fructooligosaccharides (FOS), and elevated levels of antioxidants. It is scientifically
designed for the dietary management of patients with malabsorptive conditions, such as Crohn's
disease or metabolic stress, and acute trauma.
Malabsorptive conditions such as:
z
z
z
Metabolic stress
Crohn's disease
Short-bowel disease
Features:
z Complete, balanced nutrition
z For sole-source or supplemental nutrition
z Provides at least 100% of the RDI for 24 key vitamins and minerals in 1422 Cal (six 8-fl-oz
servings)
z Structured lipid system combines medium-chain triglycerides (MCTs) with eicosapentaenoic acid
(EPA) for increased absorption of omega-3 fatty acids
z Contains elevated levels of antioxidants: vitamins C and E, and beta-carotene
z Lactose- and gluten-free
z Supplemented with L-arginine
z Low residue
z FOS to help support digestive tract health
z Vanilla flavor
Caloric Distribution
Per 8 fl oz
Per Liter
% Calories
Calories
237
1000
—
Protein, g
12.2
51.3
20.5
Fat, g
6.7
28.4
25.0
Carbohydrate, g
32.9
138.5
54.5
Water, g*
198
835
—
* 1 g water = 1 mL water = 1 cc water.
Availability:
Ready-To-Use
8-fl-oz cans; 24/case
Flavor
List Number
Vanilla
54638
Preparation:
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.
Administration:
Use under medical supervision. Not for parenteral use.
Minimum tube size for gravity feeding is 8 F; 5 F for pump feeding. Use of a pump is recommended
when smaller tubes are used.
Click Here To View Administration Schedule.
Ingredients:
-D Water, maltodextrin (corn), sugar (sucrose), soy protein hydrolysate, structured lipid
[interesterified sardine oil and medium-chain triglycerides (fractionated coconut oil)], partially
hydrolyzed sodium caseinate, fructooligosaccharides (FOS), canola oil, soy oil, calcium phosphate
tribasic, natural and artificial flavors, L-arginine, sodium citrate, magnesium phosphate dibasic,
diacetyl tartaric acid esters of mono-diglycerides, magnesium chloride, potassium citrate, ascorbic
acid, choline chloride, gellan gum, taurine, d-alpha-tocopheryl acetate, taurine, L-carnitine, zinc
sulfate, ferrous sulfate, niacinamide, calcium pantothenate, manganese sulfate, thiamine chloride
hydrochloride, pyridoxine hydrochloride, beta-carotene, riboflavin, cupric sulfate, vitamin A palmitate,
folic acid, biotin, potassium iodide, sodium selenate, phylloquinone, cyanocobalamin and vitamin D3.
Protein:
OPTIMENTAL contains a protein blend that includes soy protein hydrolysate (SPH). Animal
research has indicated that SPH may be enterotropic by increasing cell number and reducing cell
death in the GI tract.1 This characteristic of a hydrolyzed protein source may help support normal
gut structure, reduce epithelial cell loss, and facilitate absorption. The amino acid profile of
OPTIMENTAL meets or surpasses the standard amino acid profile for high-biologic-value protein set
by the National Academy of Sciences.2
Protein Profile
Percent of total calories from protein
20.5
Protein content
51.3 g/L
Cal/N ratio
122:1
Nonprotein Cal/N ratio
97:1
Fat:
OPTIMENTAL contains a structured lipid combining fish oil with MCTs. Structured triglycerides are
formed by randomly re-esterifying the fatty acids from long-chain triglycerides (LCTs) and MCTs.3
This rearrangement can result in improved absorption and metabolism of long-chain fatty acids
(LCFAs) compared to absorption of LCFAs from physical mixes of fish oil and MCT oil.4 Fish oil
(refined, deodorized sardine oil) is an abundant source of omega-3 fatty acids, including EPA and
docosahexaenoic acid (DHA). EPA functions as a precursor of certain prostaglandins and
leukotrienes that have inflammation-modulating properties.5 OPTIMENTAL contains EPA at a level
of 540 mg/8 fl oz (2290 mg/L) and DHA at a level of 230 mg/8 fl oz (970 mg/L). The level of MCT oil
in OPTIMENTAL is 1.9 g/8-fl-oz serving (8.0 g/L), which provides 28% of fat calories. As
recommended by the American Heart Association,6 less than 30% of calories in OPTIMENTAL are
provided from fat. The fat calories supply a balanced amount of polyunsaturated, monounsaturated,
and saturated fatty acids.
Fat Profile
Percent of total calories from fat
25.0
Fat Content
28.4 g/L
Polyunsaturated fatty acids (9%)
9.7 g/L
Monounsaturated fatty acids (6%)
5.96 g/L
Saturated fatty acids (10%)
11.32 g/L
Cholesterol
<30 mg/L
Carbohydrate:
The carbohydrate sources in OPTIMENTAL are maltodextrin, sucrose, and FOS. FOS are
indigestible sugars that occur naturally in onions, barley, bananas, and other common foods.7 FOS
are not digested by the gastrointestinal enzymes.8 These oligosaccharides remain intact through the
small intestine and pass into the large intestine, where they are fermented by bifidobacteria and
other microorganisms in the colon to lactate and the short-chain fatty acids (SCFAs) acetate,
propionate, and butyrate,9,10 which serve as a nutrient source for the cells that line the colon.11,12
Several studies have shown that supplementing human diets with FOS increases the number of
bifidobacteria.9,13,14 In an in vitro study, FOS fermentation resulted in the greatest growth of acidproducing bacteria and the lowest pH. These factors, in turn, did not support the growth of some
pathogenic bacteria, eg, Clostridium difficile.10,15
Carbohydrate Profile
Percent of total calories from carbohydrate
54.5
Carbohydrate content
138.5 g/L
Fiber:
Vitamins and Minerals:
OPTIMENTAL provides at least 100% of the RDIs for 24 key vitamins and minerals in 1422 Cal (six
8-fl-oz servings). Carnitine and taurine are conditionally essential nutrients that may become
depleted during periods of metabolic stress.16,17 OPTIMENTAL contains 25 mg/8 fl oz (110 mg/L) of
both L-carnitine and taurine.
OPTIMENTAL also contains elevated levels of the antioxidants vitamin C, vitamin E, and betacarotene. Antioxidants act as scavengers and control potentially damaging intracellular biochemical
reactions by eliminating prooxidants and free radicals.18 The amount of vitamin C in OPTIMENTAL
is 50 mg/8 fl oz (215 mg/L).
The all-natural form (R,R,R stereoisomer; d-alpha-tocopherol) of vitamin E has been shown to be
preferentially absorbed and accumulated in the central and peripheral nervous systems, unlike
synthetic isomers. It may be advantageous to consume the R,R,R stereoisomer to maximize
transport and replenish deficient nervous system tissues.19 OPTIMENTAL contains 50 IU/8 fl oz of
R,R,R-d-alpha-tocopherol.
Beta-carotene, a carotenoid compound, has provitamin A activity and is found naturally in the diet.
Beta-carotene is useful for dietary supplementation of retinol equivalents to the diet. OPTIMENTAL
is fortified with 0.84 mg/8 fl oz (3.6 mg/L) beta-carotene, which provides 1115 IU/8 fl oz (4660 IU/mL)
of the vitamin A activity in the product.
Osmotic Concentration:
The main determinants of the osmolality of a formula are simple carbohydrates, electrolytes, amino
acids, and small peptides. OPTIMENTAL contains maltodextrin, sucrose, and FOS as the
carbohydrate sources, and a hydrolyzed protein system containing small peptides and free amino
acids.
Osmolality* (mOsm/kg H2O)
540
Osmolarity (mOsm/L)
583
*Measured on undiluted product using vapor pressure methodology.
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
46
46
Potassium
45
45
Chloride
38
38
Protein content
51.3 g/L x 5.7 =
292
Total RSL
421
Other Values
Density at 23°C, g/mL
1.08
pH
6.5
Osmolality, mosm/kg H2O
540
Osmolarity, mosm/L
583
Renal Solute Load, mosm/L
421
Cal to meet 100% RDIs
1422
mL to meet 100% RDIs
1422
Total Cal/g nitrogen
122:1
Nonprotein Cal/g nitrogen
97:1
References:
Clinical Documentation
Griffiths AM, Pendley FC, Issenman RM, et al: Elemental versus polymeric enteral nutrition as
primary therapy for active Crohn's Disease: A multi-centre pediatric randomized controlled trial
(abstract). J Ped Gastroenterol Nutr 2000;31(suppl 2):S75.
References
1. Birke H, Thorlacius-Ussing O, Hessov I: Trophic effect of dietary peptides on mucosa in the rat
small bowel (abstract). JPEN 1990;14(suppl):26S.
2. National Research Council: Recommended Dietary Allowances, ed 10. Washington, DC:
National Academy Press, 1989.
3. Merolli A, Lindemann J, Cerrito E, Del Vecchio AJ: Medium-chain lipids: New sources, uses.
Inform 1997;8:597-603.
4. Kenler AS, Swails WS, Driscoll DF, et al: Early enteral feeding in postsurgical cancer patients:
Fish oil structured lipid-based polymeric formula versus a standard polymeric formula. Ann
Surg 1996;233:316-333.
5. Gottschlich MM: Selection of optimal lipid sources in enteral and parenteral nutrition. Nutr Clin
Pract 1992;7:152-165.
6. Dietary guidelines for healthy American adults: A statement for physicians and health
professionals by the Nutrition Committee, American Heart Association. Circulation
1988;77:721A-724A.
7. Spiegel JE, Rose R, Karabell P, et al: Safety and benefits of fructooligosaccharides as food
ingredients. Food Technol 1994;48:85-89.
8. Molis C, Flourie B, Ouarne F, et al: Digestion, excretion, and energy value of
fructooligosaccharides in healthy humans. Am J Clin Nutr 1996;64:324-328.
9. Hidaka H, Eida T, Takizawa T, et al: Effects of fructooligosaccharides on intestinal flora and
human health. Bifidobacteria Microflora 1986;5:37-50.
10. May T, Mackie RI, Fahey GC Jr, et al: Effect of fiber source on short-chain fatty acid
production and on the growth and toxin production by Clostridium difficile. Scand J
Gastroenterol 1994;19:916-922.
11. Cummings JH, Macfarlane GT: A review: 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 The Large Intestine: Physiology, Pathophysiology, and Disease. New York: Raven
Press Ltd, 1991, pp 51-92.
13. Mitsuoka T, Hidaka H, Eida T: Effect of fructooligosaccharides on intestinal microflora. Die
Nahrung 1987;31:427-436.
14. Garleb KA, Snook JT, Marcon MJ, et al: Effect of fructooligosaccharide containing enteral
formulas on subjective tolerance factors, serum chemistry profiles, and faecal bifidobacteria in
healthy adult male subjects. Microb Ecol Health Dis 1996;9:279-285.
15. Modler HW, McKellar RC, Yaguchi M: Bifidobacteria and bifidogenic factors. Can Institute
Food Sci Tech J 1990;23:29-41.
16. Iapichino G, Radrizzani D, Colombo A, Ronzoni G: Carnitine excretion: A catabolic index of
injury. JPEN 1988;12:35-36.
17. Paauw JD, Davis AT: Taurine concentrations in serum of critically injured patients and ageand sex-matched healthy control subjects. Am J Clin Nutr 1990;52:657-660.
18. Sies H, Stahl W, Sundquist AR: Antioxidant functions of vitamins: Vitamins E and C, betacarotene, and other carotenoids. Ann N Y Acad Sci 1992;669:7-20.
19. Sokol RJ, Butler-Simon N, Conner C, et al: Multicenter trial of d-a-tocopheryl polyethylene
glycol 1000 succinate for treatment of vitamin E deficiency in children with chronic cholestasis.
Gastroenterology 1993;104:1727-1735.