Istanbul, July 2015
Temporary formula
specifically
designed to allow
infants (from birth)
to recover from
acute diarrhea
- Diarrhoea: causes, consequences, management
- Our answer & the composition
 Energy
 Macronutriments (carbohydrates, proteins, lipids)
 Micronutriments (minerals, vitamins, CEN)
-
Summary
Diarrhoea: causes and consequences
Other
23%
25%
Perinatal
Diarrhoea is one of the major
causes of death among children <
5y in developing countries
(WHO, 2004)
HIV/AIDS 4%
Measles
5%
18%
10%
Malaria
Acute repiratory
infections
This corresponds to a death rate of
1.5 millions children <5 per year
(Boschi-Pinto et al., 2008)
15%
Diarrhoea
Acute gastroenteritis is a decrease in the consistency of stools
and/or an increase in the frequency of evacuation (ESPGHAN 2008)
 Dehydration
 Electrolytes losses
 Impaired digestion and absorption
 Can be accompanied with vomiting and fever
Nutritional implication of diarrhoea
•Dehydration
•Loss of electrolytes
•Secondary intolerance to lactose
•Impaired absorption of proteins
•Impaired fat digestion and absorption
Aims of the management of acute diarrhoea
1. Replacement of water loss
2. Replacement of electrolytes loss
ORS
MAINTAIN nutrition in the recovery phase of acute diarrhoea is
ESSENTIAL
1.Adverse effects of fasting on metabolic and intestinal
functions
2. Gluconeogenesis of fat stocks and β-oxydation of muscular
proteins:
• Stop of growth and development
• Loss of weight
Aims of the management of acute diarrhoea
WHO
recommends
that
besides
rehydration with oral rehydration salts,
one should : « …continue feeding during
the episode of acute diarrhoea and
increase feeding after the episode… »
(WHO, 2004)
GASTRO-FIX is a temporary nutritional formula
specifically designed for the recovery from acute
diarrhoea of infants and young children.
• When diarrhoea is caused by an infectious agent
• During the episode of acute diarrhoea (on average during
5-7 days after successful rehydration of the baby)
• When stools have normalized, the regular diet given
before the onset should be gradually reintroduced
- Diarrhoea: causes, consequences, management
- Our answer & the composition
 Energy
 Macronutriments (carbohydrates, proteins, lipids)
 Micronutriments (minerals, vitamins, CEN)
-
Summary
ENERGY
The energy intake of the infant is necessary to:
1. Ensure growth of the infant
2. Balance (replace) losses of energy
In case of diarrhoea it is essential to maintain the nutritional
state of the infant, GASTRO-FIX brings 57 kcal/100 ml in the
form of:
• Carbohydrates : 64 % of total energy
Answers specifically
• Fats : 18 % of total energy
the needs of infants
• Proteins : 18 % of total energy
with acute diarrhoea
CARBOHYDRATES
• 64% of total energy in GASTRO-FIX is provided by carbohydrates
• Carbohydrates are
o well tolerated by the digestive tract recovering from
diarrhoea.
o Easily digested and absorbed => source of immediately
available energy
• Carbohydrates stimulates the absorption of electrolytes
GASTRO-FIX IS LACTOSE FREE
Digestion of lactose in the bowel of a healthy infant
BLOOD
Glucose
LACTOSE
Galactose
Intestinal wall
Lactase
Villosities (brush border)
Secondary lactose intolerance in case of acute diarrhoea
BLOOD
LACTOSE
LACTOSE
Diarrhoea => NO or NOT ENOUGH lactase
SECONDARY (temporary) LACTOSE INTOLERANCE
 No hydrolysis of lactose
 No absorption of glucose and galactose
Malnutrition
 Lactose excreted with liquid stools
Enhance diarrhoea
(osmotic gradient)
Gastroenteritis has an impact on villosities structure
Healthy intestine
Intestine damaged by diarrhoea
CARBOHYDRATES : Starch and maltodextrin
•Starch and maltodextrin are hydrolysed into
glucose & easily absorbed by the organism (the
activity of maltase and iso-maltase are not affected
by diarrhoea)
•Pre-cooked starch in GASTRO-FIX comes from rice
cream.
• Source of glucose
• Slow down the intestinal transit time (allows
other nutrients to be digested and absorbed)
• Relieve the damaged intestinal mucosa
CARBOHYDRATES : Banana and apple flakes
Brings
pectin
GASTRO-FIX
contains fruits
(banana and
apple) powder
Brings
natural
sucrose
Gives a
good taste
to the
formula
•Fiber allowing the regulation/slow down of
transit time
•Improve absorption and metabolisation
•Source rapidly available energy
•Increases palatability
•Enhances ingestion of all needed nutrients
LIPIDS, a specific input
GASTRO-FIX
g/100 kcal
% TE
2
18%
•Fat tolerance and absorption are impaired during an
episode of acute diarrhoea
•Too much fat contribute to vomiting which is already
a symptom associated with diarrhoea
LIPIDS, a specific input
Lipids come from a specifically studied blend of
vegetable oils.
The fat content of GASTRO-FIX has being limited &
a special attention has been given to:
• the content of unsaturated fatty acids
(more easily to be absorbed)
• the content of essential fatty acids, linoleic acid
(ω6 - 279 mg/100 kcal) and a-linolenic acid (ω3 - 28
mg/100 kcal) in an optimal ration of 9.9.
PROTEINS
GASTRO-FIX brings 4.5 g of proteins per 100
kcal, contributing to 18% of total energy
 In excess of the requirements of infants because of the
reduced absorption in case of acute diarrhoea.
 Sufficient protein is supplied, even in case of reduced
intake
The ratio of casein/whey is of 82/18.
 At the acid pH of the stomach casein has the particularity
to flocculate/precipitate => less vomiting, well
tolerated
MINERALS: supplemented with electrolytes
•The electrolyte content of GASTRO-FIX is specifically
designed to correct the mineral imbalances
consequent to the acute diarrhoea.
•In order to compensate for the increased losses of Na,
K and Cl in acute diarrhoea, GASTRO-FIX has been
supplemented with these minerals.
mg/100 kcal
GASTRO-FIX
BIOMIL Plus 1
68
35
K
165
113
Cl
120
69
Na
MINERALS: Zn
•Research have demonstrated that zinc
supplementation given to infants and young
children during an episode of acute diarrhoea
reduced the duration and severity of the
episode.
•GASTRO-FIX brings 1 mg Zn/100 kcal,
MINERALS: Iron
GASTRO-FIX voluntary does
not contain iron because:
MINERALS: Iron
•Iron is a growth factor for all intestinal bacteria,
including pathogenic bacteria.
•In case of inflammation of the intestinal wall, iron is
not used by the organism but rather by the causative
agent.
Adding iron would promote growth of pathogenic bacteria
•Stimulation of diarrhoea
•Stimulation of other pathogen that can overcome the intestinal
immune defense and cause other symptoms
MINERALS: Iron
The absence of iron in GASTRO-FIX can not
lead to deficiency symptoms because:
• GASTRO-FIX is a temporary solution (57 days). Once the stools have normalized,
BIOMIL containing Fe is reintroduced
• The infant body has a stock of iron that
can temporarily be mobilized in case of
inadequate intake.
Osmolarity
Osmolarity: the concentration of osmotically active
particules in solution, which may be quantitatively
expressed in osmoles of solute per liter of solution
(blood osmolarity = 300 mmol/l)
The digestive tract of infants do not tolerate high
osmolarity feedings, particularly when they recover
from acute diarrhoea => stimulation of water
excretion and thus of diarrhoea.
GASTRO-FIX and low osmolarity
• Contains pree-cooked rice starch and
maltodextrin => high molecular weight, do not
affect the osmolarity
• Sucrose : disaccharide => contributes less to
osmolarity than monosaccharides
• Proteins are present in their natural form =>
contribute to a lower osmolarity of the feed
Osmolarity of reconstituted GASTRO-FIX makes it well
tolerated by the digestive tract of infants recovering from
diarrhoea.
Instruction for use
First stage
Rehydration (ORS during 4-5 hours)
Second stage
Dietary management of the recovery phase as soon as possible
•Give GASTRO-FIX simultaneously or right after successful rehydration
•GASTRO-FIX should only be used under medical supervision
•GASTRO-FIX is suitable for feeding through feeding bottle or enteral tube
feeding.
•Use GASTRO-FIX during a limited period of time (5-7 days unless otherwise
advised by the doctor).
•When stools have normalized, the regular diet (BIOMIL) from before the onset
should be gradually reintroduced.
•Breastfeeding, if available, should continue during the episode of acute
diarrhoea, unless otherwise advised by the doctor.
- Diarrhoea: causes, consequences, management
- Our answer & the composition
 Energy
 Macronutriments (carbohydrates, proteins, lipids)
 Micronutriments (minerals, vitamins, CEN)
-
Summary
Conclusions
GASTRO-FIX IS MORE THAN A LACTOSE FREE…
GASTRO-FIX is a formula specifically designed to contribute to the recovery
and to fulfill the nutritional needs of infants recovering from acute diarrhoea
WHY IS GASTRO-FIX SO SPECIFIC?
It is lactose free…
…AND it contains rice starch and maltodextrin
It contains no added iron…
…AND it is supplemented with electrolytes (Na, P, Cl, Zn)
…BUT is supplemented with unsaturated fatty acids and
especially essential fatty acids
It contains a limited quantity of lipids…
…AND it contains high level of proteins (mainly casein)
…AND it contains high level of selected carbohydrates
• GASTRO-FIX has a good taste and palatability
• GASTRO-FIX is produced with the high quality standards of FASSKA
• GASTRO-FIX has given outstanding results since its launch
Thank you for your
attention
Babies deserve the
best nutrition, we
provide it !