FIBTENEXR

FINANCIADO

SNS

INGREDIENTS: water, hydrolysed corn starch, fructose, milk serum protein, medium-chaintriglyceride (MCT), vegetable oil, sodium caseinate, calcium caseinate. FIBRE: wheat dextrin andoligofructose, fat-free cocoa. MINERAL SALTS: sodium citrate, potassium phosphate, magnesiumchloride, calcium chloride, potassium citrate, iron lactate, zinc sulfate, manganese sulfate, cupricgluconate, sodium molybdate, potassium iodine, sodium fluoride, chromium chloride, sodium selenite.EMULSIFIER: E472, soy lecithin, choline citrate, inositol. POLIVITAMIN CONCENTRATE: vitamin C,niacin, vitamin E, calcium pantothenate, vitamin B1 , vitamin B2 , vitamin B6 , vitamin A, folic acid, biotin, vitamin K1 , vitamin D3 , vitamin B12 , aroma. STABILIZERS: carrageenan, xanthan gum.SWEETENERS: sodium cyclamate, sodium saccharin.

Complete diet, with fiber and balanced.Dietary food for special medical uses.It is especially designed for patientswho require extra fibre intake.

It is suitable for diabetics too.

special

FIBER

C.N. 504099.8

chocolate flavorC.N. 504253.4

vanilla flavor

It is used in the diabetes dietarytreatment when patients are affected bymoderate or serious malnutritionsymptoms.

This product is appropriate to treatpatients with diarrhoea or bowel/colonmucus dysfunctions and also inmoderate or serious ingestion,assimilation or malnutrition problems.

Fibtenex must be used undermedical supervision.This product can be taken asthe only source of food .It can be administered orally or viafeeding tube.

Do not give this food to childrenunder 12 years old.

Unsuitable for galactosemic patients.

Presentation in boxes of:24 x 250 ml bottle.

If considered as the only source offood, administer approximately 30ml/kg of body weight per day in adults.

DOSE:

Follow the instructions given byyour doctor. The flow, volume anddilution parameters will depend onthe patient's physiological state andits tolerance.

FEEDING VIA TUBE:

Shake it briskly before using.Keep a strict metabolic controlwhen impaired glucose toleranceis diagnosed.

INSTRUCTIONS FOR USE:

FIBTENEX contains fructoseand sweeteners.

PRODUCTOS SANITARIOS Y DIETÉTICOS farma, S.l.

FIB

TEN

EX

MINERALSChloridePotassiumSodiumCalciumPhosphorusMagnesiumIronZincManganeseCopperMolybdenumIodideFluorideSeleniumChromium VITAMINSVitamin CVitamin B3 (Niacin)Vitamin EPantothenic acidVitamin B6Vitamin B2Vitamin B1Vitamin AVitamin B9 (Folic acid)BiotinVitamin K1Vitamin D3Vitamin B12InositolCholine citrate

mgmgmgmgmgmgmgmgmgμgμgμgμgμgμg

mgmgmgmgmgmgmgμgμgμgμgμgμg

mgmg

113,00102,90100,00

59,2040,8018,00

1,200,800,20

89,9010,00

7,403,002,501,25

6,001,801,000,600,200,160,14

80,0020,00

6,005,500,500,10

20,0020,00

282,50257,25250,00148,00102,00

45,003,002,000,50

224,7525,0018,50

8,006,253,13

15,004,502,501,500,500,400,35

200,0050,0015,0013,75

1,250,25

50,0050,00

(37%)(25%)(30%)(43%)(25%)

(25%)

(50%)(50%)(50%)(50%)(50%)(50%)(50%)(50%)(50%)(23%)

(50%)(50%)

NUTRITIONAL INFORMATION: in 100 ml in 250 ml (% RDA)Energetic valueCarbohydrates of which: - sugarsFats of which: - saturatesProteinsFiber

Kcal/kJgggggg

99/41410,40

2,504,202,804,101,50

247/1.03526,00

6,2510,50

7,0010,25

3,75

RDA: Recommended Dietary Allowances 365 mOsm/l

Product manufactured in Spain

In a more colloquial language, FIB TENEX KEEPS THE PATIENT WITH A CORRECTGLYCEMIC INDEX FOR A LONGER PERIOD OF TIME since carbohydrates that compose itare of low glycemic index, such as maltodextrin and wheat dextrin. Its unsaturated fats such asmedium chain triglycerides have better cardiovascular risk parameters and the inclusion of MCTin the diet increases the use of long chain fat (fat deposits in the body) as an energy source,promoting the loss of body fat. Therefore, they are used in enteral and parenteral nutritionbecause of its good absorption.

FIB TENEX ENTERAL-ORALNUTRITION IN DIABETIC PATIENTSBoth diabetes mellitus type 1 and 2 diabetes is a common condition in both the general population and in the hospital. Nutritional support is no different from a diabetic to one that is not patient. The goal of metabolic control in diabetic patients receiving enteral nutrition should be reach adequate nutritional requirements, but keeping an optimal glycemic and lipid profile. Proper formulation of FIB TENEX influencesimproving metabolic control of diabetic patients (glycemic andlipid).

In people with diabetes or stress hyperglycemia, as in the usual diet, the use of FIB TENEX with a moderate content of medium chain triglycerides have a favorable effect on metabolic control in the short and medium term (reducing the risk of diseases heart, raising your HDL, lowering triglyceride and LDL levels) these fats provide a more stable supply of energy during the day that carbohydrates, which can cause fluctuations in blood sugar. Addition of soluble fiber as wheat dextrin , type of carbohydrates, oligofructose, low glycemic index are contributing factors in thedecrease of postprandial glucose response, while maintaining adequate levels of glucose in blood .

In our country the prescription of home enteral nutrition (HEN) is gradually increasing. The most used route by far is oral, followed by nasogastric tubes, and greater distance, ostomy. The main indications for the use of the NED in Spain are neurological disorders that prevent swallowing and cancer, whichare more common disorders in elderly life. This implies that the prevalence of diabetes in patients who are prescribed home enteral nutrition is very high.

The nutritional requirements of people with diabetes who receive artificial enteral nutritional support (oral or tube) are similar to those of people without diabetes. On the one hand, it is necessary to provide individualized nutritional requirements depending on their clinical status , body composition , age and sex , this implies not provide excessive calories in a population with very often obesity. Generally one can estimate the energy intake between 25 and 35 kcal / kg body weight per day, depending on the estimated degree of patient stress. Also estimated in the absence of kidney or liver disease that limits, protein intake will depend on the degree of metabolic stress present patient, generally between 1 g / kg / day in patients with stress and 1.5 g /kg / day. Less than 20% of the total caloric content as protein, less than 5 % saturated fat, dividing the remaining 60 to 70 % from carbohydrates (oligofructose and wheat dextrin). The Nutrition Group of the Spanish Diabetes Society recommends no change dietary habits of patients in the percentage of fat with the clear exception of reducing the content of saturated fats below 10%.

Regarding the type of carbohydrate ingested in the medical literature has proposed the concept ofglycemic index (GI) to classify foods containing carbohydrates based on their potential to raise blood glucose levels after ingestion. The GI is defined as the area under the curve of increased glycemic response of a portion of 50 g of carbohydrate foods test, expressed as a percentage response to the same amount of HC from a standard food (normally, white bread, glucose). Foodswith a low GI are digested and absorbed more slowly than foods with a High GI. FIB TENEXwith oligofructose and wheat dextrin as HC and the latter as soluble fiber are a clear example of low GI HC and a total low glycemic load (GL).

Epidemiological studies in the general population, it has been suggested that long-term consumption of a diet with high glycemic load would be an independent risk factor for developing type 2 diabetes and cardiovascular disease.Likewise, a low GI diet may protect against development of obesity and even some cancers (such asbreast or colon).

Also, a recent analysis of several randomized controlled trials indicates that choosing low GI foods in people with diabetes (both type 1 and 2) have a clinically useful effect on medium-term glycemic control. The added benefit is similar to that obtained with pharmacological agents directed to treatpostprandial hyperglycemia (approximately a decrease of between 0.2 and 0.4% in glycated hemoglobin).

The European Association for the strudy of Diabetes (EASD) also recommends choosing foods that cause a lower glycemic response after ingestion. Finally, the ADA recommends for people with diabetes who regularly consume a diet with soluble fiber. A high intake of dietary fiber appears to improve glycemic discreetly and lipid metabolic control in diabetes between 20 and 30 g per day.

FIB TENEX formula addition to diabetes fiber added with a ( " soluble " ) high proportion of fermentable which preferably is associated with improved glucose and lipidprofile production of short chain fatty acids in the colon (after fermentation).FIB TENEX is normocaloric, with a caloric density and normoproteic kcal/100ml 0.96 with less than 20 % of the total caloric value.FIB TENEX is cataloged by the Ministry of Health as "complete diet", so it is funded by the Spanish National Health System.

CLINICAL EXPERIENCES WITH SPECIAL DIETS FOR DIABETES: A SHORT TERM STUDY.These studies compared in people with diabetes, the postprandial glycemic response to breakfast makingtest (or test meals) of different enteral formulas. Some also study other aspects, such as the lipid response or production of ketone bodies.When we compared the intake of high enteral formulas in HC (specific to diabetes) compared to diets high in monounsaturated fat, has proven significantly lower glycemic response in the past.It has also been observed that the increase in blood glucose is lower when a diet for diabetes is discussed moderately rich in fat ( 38% of total caloric value ) fatty acids suchas medium chain triglycerides , compared to standard formulations and standard fiber . It is possible that the synergy of several factors in this type of diet (HC content against lipid and starch type, fructose, adding fiber , and even protein source ) causes the beneficial effect on blood sugar. When this type of diet (for diabetes with moderate fat intake) compared (after a test shot) with other specific diabetes diet high in fat (49% of total caloric value) glycemic response is slightly lower in the last(although not statistically significant).

It seems therefore that , when ingested formula low in HC and high in monounsaturated fat, the postprandial glycemic response depends primarily on the total content of HC contributed , and has little HC source (starch, fructose ) or even the content and fiber type. As the content of the formulas HC increases, especially if compared with diets high in carbohydrates, these factors may play a greater role to the attenuation of the glycemic response. In all cases when used diets with moderate or high in monounsaturated fats has not been modified or lipid profile were caused ketosis.

CONCLUSIONSOf the above papers several conclusions can be drawn:1. In people with diabetes or stress hyperglycemia, as in the usual diet, the use of enteral formulas with a low content of saturated fat has a favorable effect on metabolic control in the short and medium term. The addition of fiber (preferably fermentable as wheat dextrin HC type, oligofructose, are contributing factors in reducing the glycemic response.Two. The 2 models of diabetic diets that have been studied in the medium term to date (high in fat and higher in HC) are generally well tolerated and safe. Although there is a tendency to improve the metabolic profile (glycemic and lipid) in the group fed the high-fat diet, these formulations maybe useful in patients with diabetes if properly estimated calorie requirements.Three. Are needed work with more patients, with lower rates of dropout protocol, longer duration, randomized, preferably double-blind, in different clinical situations, where its effectiveness and efficiency (cost / effectiveness) is assessed on metabolic effect and morbidity to offerevidence-based recommendations.