SHS Checklist by Nic Corke

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The SHS Product Areas

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Inborn Errors

Page 4

Nutritionally Complete

Page 28

Energy

Page 66

Protein

Page 78

Vitamins, Minerals and Trace Elements

Page 86

Flavours & Amino Acids

Page 92

Reference Tables

Page 98

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Introduction This SHS Checklist has been designed as an easy to use reference to our wide range of specialist clinical nutrition products. It has been compiled by our team of dietitians in Nutrition Services who are available to give further practical and technical advice. Contact: nutrition@shsint.co.uk The sections are colour coded to help you in selecting the appropriate product. Certain products may not be available in every country; please check availability with your local distributor, details enclosed at the back of The Checklist. All the information contained in The Checklist is correct at time of printing. Product specifications can change between issues of The Checklist; updated product information will be provided on our web site. www.shsweb.co.uk February 2006 Due to EU legislation the free from claims have been removed. Please contact the e-mail address above for further information. 1

Disease Area Guide

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Disease Area

Products

Cow Milk Allergy and Multiple Food Protein Intolerance (MFPI)

Neocate, Neocate Advance

Crohnâ&#x20AC;&#x2122;s Disease

Elemental 028, Elemental 028 Extra, Elemental 028 Extra Liquid, Pepdite 1+, Emsogen

Cystic Fibrosis

Emsogen

Epilepsy

Ketocal

Failure to thrive

Super Soluble Duocal, Super Soluble Maxijul, Calogen, Solagen

Hepatic Disease

Hepatamine, Generaid, Generaid Plus, Caprilon, Heparon Junior, Hepatical

HIV/AIDS

Elemental 028, Elemental 028 Extra, Elemental 028 Extra Liquid, Emsogen

Malabsorption

Neocate, Neocate Advance, Pepdite, Pepdite 1+, MCT Pepdite, MCT Pepdite 1+, Elemental 028, Elemental 028 Extra, Elemental 028 Extra Liquid, Emsogen, Monogen, Liquigen

Phenylketonuria

XP Analog, XP Analog LCP, XP Maxamaid, Minaphlex, Anamix, Lophlex, XP Maxamum, Easiphen, Phlexy-10, Phlexy-Vits, Energivit, Duobar

Renal Disease

Kindergen, Dialamine, Super Soluble Maxipro, Maxisorb, Maxijul LE, Calogen

Short Bowel Syndrome

Neocate, Neocate Advance, Elemental 028, Elemental 028 Extra, Elemental 028 Extra Liquid, Emsogen, Pepdite, Pepdite 1+, MCT Pepdite, MCT Pepdite 1+

Inborn Errors XP Analog XP Analog LCP XP Maxamaid Minaphlex Anamix XP Maxamum Easiphen Lophlex Phlexy-10 System Phlexy-Vits Energivit

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Energy (continued) Page Solagen Super Soluble Duocal Liquid Duocal MCT Duocal Super Soluble Maxijul Liquid Maxijul Maxijul LE Duobar

70 71 72 73 74 75 76 77

Protein

Page Hepatamine 80 Generaid 81 Nutritionally Super Soluble Maxipro 82 83 Complete Page Maxisorb Dialamine 84 Neocate 30 Neocate Advance 32 Elemental 028 34 Vitamins, Minerals and Elemental 028 Extra 36 Trace Elements Page Elemental 028 Extra Liquid 38 Emsogen 40 Paediatric Seravit 88 Pepdite 42 Metabolic Mineral Mix 90 Pepdite 1+ 44 MCT Pepdite 46 Flavours & Amino MCT Pepdite 1+ 48 Acids Page Monogen 50 Flavour Modjul 94 Kindergen 52 95 Caprilon 54 Flavour Sachets 96 Locasol 56 Adamin-G Ketocal 58 Generaid Plus 60 Reference Tables 98 Hepatical 62 Heparon Junior 64

Energy Calogen Liquigen

Product Index

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XP Analog

Anamix

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XP Maxamaid

XP Maxamum

Easiphen

Minaphlex

Lophlex

Phlexy-10 System

Tablets

Bars

Phlexy-Vits 4

Drink mix

Energivit

Capsules

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Inborn Errors A range of products designed for use in the dietary management of phenylketonuria.

XP Analog XP Analog LCP XP Maxamaid - Unflavoured, Orange flavour Minaphlex - Unflavoured, Tropical Twist, Pineapple & Vanilla flavour

Anamix - Unflavoured, Pineapple & Vanilla, Forest Berries flavour XP Maxamum - Unflavoured, Orange, Carribean Crush flavour Easiphen - Grapefruit, Forest Berries flavour Lophlex - Unflavoured, Orange, Berry flavour Phlexy-10 System - Tablets, Bars, Drink Mix, Capsules Phlexy-Vits Energivit The SHS Metabolic Product Reference Guide is available on request detailing the extensive range of SHS products designed for other inborn errors of metabolism. Precautions Not for parenteral use Use under medical supervision Not suitable for use as a sole source of nutrition Additional precautions noted for individual products Low Protein Products A full range of low protein breads, mixes, biscuits, pasta and drinks are available - a detailed list can be obtained from SHS. 5

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XP Analog

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• Phenylalanine free

DESCRIPTION XP Analog is a phenylalanine free powdered infant feed, containing essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals, and trace elements. A food for special medical purposes. INDICATIONS XP Analog is for use in the dietary management of proven phenylketonuria in infants from birth to 1 year. SUGGESTED INTAKE The quantity of XP Analog should be determined by a clinician or a dietitian only and is dependent on the age, body weight, and medical condition of the patient. As a guide 20g/kg bodyweight / day is recommended. The suggested daily amino acid requirements recommended by the MRC1, for infants of 0 - 2 years of age is at least 3g amino acids per kg bodyweight. However, some natural protein must be supplied in addition to provide phenylalanine in controlled amounts, which is essential for normal growth. This is provided in the form of breast milk or standard infant formula or later from suitable weaning foods. XP Analog should be given in divided doses throughout the day and preferably given in conjunction with the natural protein source. WEANING XP Analog should continue to provide the majority of nutritional requirements as the child is weaned. Foods naturally low in protein are gradually introduced from 4 to 6 months of age, e.g. puréed fruit and vegetables initially, followed by permitted cereal foods, using the local exchange system. Proprietary low protein products (breads, mixes, biscuits, pasta, egg replacers and milk substitutes) are available to increase variety as the child starts to take a mixed diet. During the weaning process an alternative phenylalanine free amino acid supplement may be introduced, which will gradually replace XP Analog, and meet the nutritional needs of children from one year of age onwards, e.g. XP Maxamaid, Anamix, Minaphlex. PREPARATION AND ADMINISTRATION Each level scoop (5g) of XP Analog requires 30ml (approx. 1 fl.oz) of water to yield the recommended feed concentration (15%). 1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to wrist. Pour the required amount of water into a sterilised feeding bottle. 6

3. Fill the scoop provided with XP Analog and level off with clean, dry knife. Do not press the powder into scoop. Only use scoop provided. 4. Add the prescribed number of scoops of XP Analog to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding, ensure that the formula is at the correct temperature by placing a few drops on the wrist. 5. Formula remaining in the bottle after one hour should be discarded. Formula must not be rewarmed during feeding. Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding. XP Analog is now ready for use. When bottle feeding, prolonged or frequent contact of feeds with the infant's teeth should be discouraged as this increases the risk of tooth decay. Cleaning the infant's teeth after the last feed at night should be encouraged. OSMOLALITY The osmolality of XP Analog at a 15% w/v concentration is 353 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE XP Analog is available in 400g cans. SHELF LIFE 2 years. References: 1. Recommendations on the Dietary Management of PKU. Arch. Dis. Child. 1993; 68(3):426-427

• Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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XP Analog

• Phenylalanine free NUTRITION INFORMATION

per 100g powder

per 100ml*

Energy kJ 1990 300 kcal 475 72 Protein Equivalent g 13 1.95 Total Amino Acids g 15.5 2.32 Carbohydrate g 54 8.1 of which sugars g 4.9 0.7 Fat g 23 3.5 of which saturates g 7 1.0 monounsaturates g 10.6 1.6 polyunsaturates g 4.2 0.7 % LCT 95 95 % MCT 4.5 4.5 Ratio n6 : n3 fatty acids 10 : 1 % energy from linoleic acid 7.3 % energy from α linolenic acid 0.7 Fibre g nil added

Vitamins

per 100g per powder 100ml*

Vitamin A µg RE 528 IU 1758 Vitamin D µg 8.5 IU 340 Vitamin E mg α TE 3.3 IU 4.95 Vitamin C mg 40 Vitamin K µg 21 Thiamin mg 0.39 Riboflavin mg 0.6 Niacin mg 4.5 mg NE 9.8 Vitamin B6 mg 0.52 Folic Acid µg 38 Vitamin B12 μg 1.25 Biotin µg 26 Pantothenic Acid mg 2.65 Choline mg 50 Inositol mg 100

79.2 263.7 1.28 51 0.5 0.74 6 3.15 0.06 0.09 0.68 1.5 0.08 5.7 0.19 3.9 0.4 7.5 15

Amino Acid Profile L-Alanine L-Arginine L-Aspartic Acid L-Cystine L-Glutamic Acid Glycine L-Histidine L-Isoleucine L-Leucine L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine L-Carnitine mg Taurine mg L-Glutamine

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium : Phosphorus

g per per 100g 100mls powder

Fatty Acid Profile

g per 100g Fatty Acids

0.61 0.09 1.08 0.16 1.01 0.15 0.4 0.06 1.23 0.18 0.95 0.14 0.62 0.09 0.95 0.14 1.63 0.24 1.11 0.17 0.26 0.04 nil added 1.16 0.17 0.71 0.11 0.8 0.12 0.32 0.05 1.44 0.22 1.04 0.16 10 1.5 30 4.5 0.11 0.017

C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3

0.15 2.1 2.4 14.46 4.8 7.33 1.1 0.83 47.37 17.53 1.73

per 100 g per powder 100ml*

120 5.22 420 10.77 290 8.17 325 230 34

18 0.78 63 1.62 43.5 1.23 48.8 34.5 5.1

Trace Elements

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

per 100g per powder 100ml*

7 0.45 5 0.6 47 35 15 15

1.05 0.07 0.75 0.09 7.05 5.25 2.25 2.25

1.4 : 1

* At the recommended concentration of 15% w/v NOTE If formula is prepared in advance, it must be cooled rapidly, stored in the refrigerator (2OC to 4OC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer than 15 minutes prior to feeding. Do not boil formula and do not use a microwave oven to prepare or warm formula. For tube feeding "hang time" should not exceed 4 hours.

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XP Analog LCP

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• Phenylalanine free

DESCRIPTION XP Analog LCP is a phenylalanine free powdered infant feed supplemented with long chain polyunsaturated fatty acids (LCPUFA’s), particularly Docosahexaenoic Acid (DHA) and Arachidonic Acid (AA), containing essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals, and trace elements. A food for special medical purposes. INDICATIONS XP Analog LCP is for use in the dietary management of proven phenylketonuria in infants from birth to one year where LCPUFA’s are desirable. It is thought that LCPUFA’s found in breast milk, particularly DHA (C22:6 n-3) when added to formulae such as XP Analog LCP play an important role in infant CNS development and function.1,2 SUGGESTED INTAKE The quantity of XP Analog LCP should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. As a guide 20g/kg bodyweight/day is recommended. The suggested daily amino acid requirements recommended by the MRC3, for infants of 0 - 2 years of age is at least 3g amino acids/kg bodyweight/day. However, some natural protein must be supplied in addition to provide phenylalanine in controlled amounts, which is essential for normal growth. This is provided in the form of breast milk or standard infant formula or later from suitable weaning foods. XP Analog LCP should be given in divided doses throughout the day and preferably given in conjunction with the natural protein source. WEANING XP Analog LCP should continue to provide the majority of nutritional requirements as the child is weaned. Foods naturally low in protein are gradually introduced from 4 to 6 months of age, e.g. puréed fruit and vegetables initially, followed by permitted cereal foods, using the local exchange. Proprietary low protein products (breads, mixes, biscuits, pasta, egg replacers and milk substitutes) are available to increase variety as the child starts to take a mixed diet. During the weaning process an alternative phenylalanine free amino acid supplement may be introduced, which will gradually replace XP Analog LCP, and meet the nutritional needs of children from one year of age onwards, e.g. XP Maxamaid, Anamix, Minaphlex. PREPARATION AND ADMINISTRATION Each level scoop (5g) of XP Analog LCP requires 30ml (approx. 1fl.oz) of water to yield the recommended feed concentration (15%).

1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to the wrist. Pour the required amount of water into a sterilised feeding bottle. 3. Fill the scoop provided with XP Analog LCP and level off with a clean, dry knife. Do not press the powder into the scoop. Only use the scoop provided. 4. Add the prescribed number of scoops of XP Analog LCP to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding, ensure that the formula is at the correct temperature by placing a few drops on the wrist. 5. Formula remaining in the bottle after one hour of feeding should be discarded. Formula must not be re-warmed during feeding. Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding. XP Analog LCP is now ready for use. When bottle feeding, prolonged or frequent contact of feeds with the infant's teeth should be discouraged as this increases the risk of tooth decay. Cleaning the infant's teeth after the last feed at night should be encouraged. OSMOLALITY The osmolality of XP Analog LCP at a 15% w/v concentration is 353 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use.

If formula is prepared in advance, it must be cooled rapidly, stored in the refrigerator (2OC to 4OC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer than 15 minutes prior to feeding. Do not boil formula and do not use a microwave oven to prepare or warm formula. For tube feeding "hang time" should not exceed 4 hours.

• Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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XP Analog LCP

• Phenylalanine free NUTRITION INFORMATION

per 100g powder

per 100ml*

Energy kJ 1990 300 kcal 475 72 Protein Equivalent g 13 1.95 Total Amino Acids g 15.5 2.32 Carbohydrate g 54 8.1 of which sugars g 4.9 0.7 Fat g 23 3.5 of which saturates g 6.6 1.0 monounsaturates g 10.5 1.6 polyunsaturates g 4.8 0.7 Ratio C18:2n-6: C18:3n3 fatty acids 6:8 % energy from linoleic acid 7 % energy from α linolenic acid 1 Fibre g nil added

Vitamins

79.2 263.7 1.28 51 0.5 0.74 6 3.15 0.06 0.09 0.68 1.5 0.08 5.7 0.19 3.9 0.4 7.5 15

g per 100g powder

L-Alanine L-Arginine L-Aspartic Acid L-Cystine L-Glutamic Acid Glycine L-Histidine L-Isoleucine L-Leucine L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine L-Carnitine Taurine L-Glutamine

per 100g per powder 100ml*

Vitamin A µg RE 528 IU 1758 Vitamin D µg 8.5 IU 340 Vitamin E mg α TE 3.3 IU 4.95 Vitamin C mg 40 Vitamin K µg 21 Thiamin mg 0.39 Riboflavin mg 0.6 Niacin mg 4.5 mg NE 9.8 Vitamin B6 mg 0.52 Folic Acid µg 38 Vitamin B12 µg 1.25 Biotin µg 26 Pantothenic Acid mg 2.65 Choline mg 50 Inositol mg 100

Amino Acid Profile

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium : Phosphorus

per 100ml*

0.61 0.09 1.08 0.16 1.01 0.15 0.4 0.06 1.23 0.18 0.95 0.14 0.62 0.09 0.95 0.14 1.63 0.24 1.11 0.17 0.26 0.04 nil added 1.16 0.17 0.71 0.11 0.8 0.12 0.32 0.05 1.44 0.22 1.04 0.16 0.01 0.002 0.03 0.004 0.11 0.017

Fatty Acid Profile

g per 100g Fatty Acids 0.8 6.4 2.8 12.3 0.9 5.9 49.1 16.9 Trace 2.5 Trace 0.7 Trace 0.06 0.3

C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 n-6 C18:3 n-6 C18:3 n-3 C20:3 n-6 C20:4 n-6 † C20:4 n-3 C20:5 n-3 C22:6 n-3 ††

†

AA - Arachidonic Acid

†† DHA - Docosahexaenoic Acid

per 100 g powder

per 100ml*

Trace Elements

120 5.22 420 10.77 290 8.17 325 230 34

18 0.78 63 1.62 43.5 1.23 48.8 34.5 5.1

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

per 100g powder

7 0.45 5 0.6 47 35 15 15

per 100ml*

1.05 0.07 0.75 0.09 7.05 5.25 2.25 2.25

1.4 : 1

* At the recommended concentration of 15% w/v STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE XP Analog LCP is available in 400g cans.

SHELF LIFE 1 year. References: 1. 2. 3.

Harvie et al JIMD 1998; 21 Suppl 2:13 Harvie. JIMD 2000; 23 Suppl 1:26 Recommendations on the Dietary Management of PKU. Arch. Dis. Child. 1993 68:3 426-427

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XP Maxamaid

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â&#x20AC;˘ Phenylalanine free

DESCRIPTION XP Maxamaid is a phenylalanine free drink mix containing essential and non-essential amino acids, carbohydrate, vitamins, minerals and trace elements. Available in Orange flavour (contains colours, sugar and sweeteners) or Unflavoured. A food for special medical purposes. INDICATIONS XP Maxamaid is recommended for use in the dietary management of children 1 - 8 years of age with proven phenylketonuria. SUGGESTED INTAKE The quantity of XP Maxamaid should be determined by a clinician or a dietitian only and is dependent on the age, body weight, and medical condition of the patient. The diet must be supplemented with natural protein and other nutrients in medically prescribed quantities to supply the phenylalanine and general nutrient requirements of the patient.

PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool, dry place. Always replace container lid after use. Once opened use within one month. PACK SIZE XP Maxamaid is available in 500g cans. SHELF LIFE 3 years.

PREPARATION AND ADMINISTRATION The recommended dilution is 1 to 5 i.e. 20g XP Maxamaid plus 100ml water. It is advised for osmotically sensitive patients to start with a 1 to 7 dilution. 1. Add a small amount of water to the prescribed amount of XP Maxamaid. Stir with a fork until a smooth paste is obtained. 2. Continue stirring whilst adding water up to the required volume. XP Maxamaid is now ready for use. XP Maxamaid can be taken as a chilled drink. It can also be taken as a paste, additional water or diluted drinks must be consumed at the same time. OSMOLALITY The osmolality of XP Maxamaid (Unflavoured): 1 to 5 dilution = 690 mosm/kg. 1 to 7 dilution = 490 mosm/kg. The osmolality of XP Maxamaid (Orange flavour): 1 to 5 dilution = 930 mosm/kg. 1 to 7 dilution = 650 mosm/kg.

10 â&#x20AC;˘ Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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• Phenylalanine free NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g Fat g of which saturates g Fibre g

Minerals

per 100g powder

Amino Acid Profile

1311 309 25 30 51 4.6 (42.5) <0.5 Trace nil added

per 100g

Trace Elements

powder Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

580 25.2 840 21.5 450 12.7 810 810 200

g per 100g powder 1.1 2.3 2 0.7 2.5 1.9 1.3 1.8 3.1 2.3 0.5 nil added 2.2 1.3 1.5 0.6 2.7 1.9 0.02 0.1 0.33

XP Maxamaid Vitamins

per 100g

powder Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K μg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic acid μg Vitamin B12 μg Biotin μg Pantothenic Acid mg Choline mg Inositol mg

525 1748 12 480 4.35 6.5 135 30 1.08 1.2 12 22 1.4 240 3.9 120 3.7 110 55.5

per 100g

powder Iron mg Copper mg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

12 1.8 13 1.6 100 100 40 40

Note: Figures in brackets represent flavoured XP Maxamaid

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Minaphlex

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• Phenylalanine free

DESCRIPTION Minaphlex is a palatable phenylalanine free drink mix containing essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. Available Unflavoured or in Pineapple & Vanilla flavour (contains colour, sugar and sweeteners) and Tropical Twist flavour (contains colour, sugar and sweeteners). A food for special medical purposes. INDICATIONS Minaphlex can be used in the dietary management of children aged 1 - 10 years with proven phenylketonuria (PKU). It contains a balanced blend of essential fatty acids (4:1 ratio). Children with PKU often have a diet high in linoleic acid and thus low levels of α-LA*, DHA††1. Initial trial results indicate that the use of Minaphlex may help improve their α-LA status2.

STORAGE Store in a cool, dry place.

SUGGESTED INTAKE The quantity of Minaphlex should be determined by a clinician or a dietitian only and is dependent on the age, body weight and medical condition of the patient.

References:

The diet must be supplemented with natural protein and other nutrients in medically prescribed quantities to supply the phenylalanine and general nutrient requirements of the patient.

2. The addition of fat to a protein substitute designed for children with PKU. Dr. M. Cleary: presented at the Dietitians meeting, Prague 2001.

PACK SIZE Minaphlex is available in 30 x 29g sachets. SHELF LIFE 1 year.

1. Cockburn F, Clark BJ, Caine EA, Harvie A, Farquharson J, Jamieson EC, Robinson P, and Logan, RW. Fatty Acids in the Stability of Neuronal Membrane: Relevance to PKU. Intl. Pediatr. 1996; 11(1):56-60

* ††

α−LA DHA

α − Linolenic Acid Docosahexaenoic Acid

PREPARATION AND ADMINISTRATION The recommended dilution is 100ml of water to 1 sachet (29g) of Minaphlex. Minaphlex is easy to mix: 1. Pour the required volume of cold water into a glass or cup. 2. Add the prescribed amount of Minaphlex and stir. Minaphlex is now ready for use. Minaphlex is best served chilled. OSMOLALITY The osmolality of Minaphlex at the recommended dilution (1 sachet (29g) to 100ml water) is: Unflavoured: 1110 mosm/kg. Flavoured: 1160 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not suitable for infants. Not for parenteral use.

12 • Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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Minaphlex

• Phenylalanine free NUTRITION INFORMATION

per 29g sachet Energy kJ 1639 (1571) 474 (455) kcal 390 (374) 113 (108) Protein Equivalent g 29 8.4 Total Amino Acids g 35 10 Carbohydrate g 38 (34) 11 (9.9) of which sugars g 3.8 (3.3) [3.6] 1.1 (1.0) Fat g 13.5 3.9 of which saturates g 1.5 0.4 monounsaturates g 8.4 2.4 polyunsaturates g 2.8 0.8 % LCT 95 % MCT 5 Ratio n6 : n3 fatty acids 4:1 % energy from linoleic acid 5.3 % energy from α linolenic acid 1.4 Fibre g nil added

Vitamins

per 100g powder

per 100g per 29g powder sachet

Vitamin A µg RE 570 IU 1898 Vitamin D µg 14 IU 560 Vitamin E mg α TE 6.04 IU 9 Vitamin C mg 55 Vitamin K µg 25 Thiamin mg 0.93 Riboflavin mg 1.07 Niacin mg 15 mg NE 26.7 Vitamin B6 mg 1.28 Folic Acid µg 100 Vitamin B12 µg 1.3 Biotin µg 35 Pantothenic Acid mg 3.85 Choline mg 80 Inositol mg 35

165 550 4.1 162 1.8 2.6 16 7.3 0.27 0.3 4.4 7.7 0.37 29 0.38 10.2 1.1 23.2 10.2

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

g per 100g powder 1.25 2.36 2.19 0.87 nil added 2.2 1.33 2.08 3.56 2.72 0.57 nil added 2.52 1.56 1.74 0.7 3.14 2.28 17.5 132 3.82 per 100g powder

680 30 980 25 525 15 945 480 165

Fatty Acid Profile

g per 100g Fatty Acids

C8:0 C10:0 C12:0 C16:0 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:1 C24:0

2.85 2.11 <1 4.51 1.47 65.1 17.2 4.46 <1 <1 <1 <1

per 29g sachet

Trace Elements

197 8.7 284 7.3 152 4.4 274 139 47.9

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

per 100g per 29g powder sachet

14 1.05 10 0.8 100 43 56 28

4.1 0.31 2.9 0.23 29 12.5 16.2 8.1

* At the recommended concentration of 1 sachet (29g) + 100ml water Note: Figures in brackets represent: ( ) Pineapple and Vanilla flavour Minaphlex [ ] Tropical Twist flavour Minaphlex

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Anamix

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• Phenylalanine free

DESCRIPTION Anamix is a phenylalanine free drink mix containing essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. Available in Pineapple & Vanilla flavour (contains colours, sugar and sweeteners), Forest Berries (contains colours, sugar and sweeteners) or Unflavoured. A food for special medical purposes. INDICATIONS Anamix can be used in the dietary management of children aged 1 - 10 years with proven phenylketonuria (PKU). It contains a balanced blend of essential fatty acids (4:1 ratio). Children with PKU often have a diet high in linoleic acid and thus low levels of α-LA* and DHA††. Initial trial results indicate that the use of Anamix may help improve their α-LA* status1. SUGGESTED INTAKE The quantity of Anamix should be determined by a clinician or a dietitian only and is dependent on the age, body weight, and medical condition of the patient.

PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not suitable for infants. Not for parenteral use. STORAGE Store in a cool, dry place. PACK SIZE Anamix is available in 30 x 29g sachets. SHELF LIFE 1 year. References:

1. The addition of fat to a protein substitute designed for children with PKU. Dr. M. Cleary: presented at the Dietitians meeting, SSIEM, Prague 2001. 2. The addition of fat to a protein substitute designed for children with PKU. Dr. M. Cleary: presented at the Dietitians meeting, Prague 2001.

* ††

α−LA DHA

α − Linolenic Acid Docosahexaenoic Acid

Anamix is easy to mix: 1. Pour the required volume of cold water into a glass or cup. 2. Add the prescribed amount of Anamix and stir. Anamix is now ready for use. Anamix is best served chilled. OSMOLALITY The osmolality of Anamix at the recommended dilution (1 sachet (29g) plus 100mls water) is: Unflavoured: 1012 mosm/kg. Pineapple & Vanilla flavour: 1205 mosm/kg. Forest Berries flavour: 1210 mosm/kg.

14 • Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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Anamix

• Phenylalanine free NUTRITION INFORMATION

per 100g powder

Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g

1639(1571) 390(374) 29 35 38 (34) 3.8 (3.3)

Fat g of which saturates g monounsaturates g polyunsaturates g % LCT % MCT Ratio n6 : n3 fatty acids % energy from linoleic acid % energy from α linolenic acid Fibre g

Vitamins

Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K μg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic Acid µg Vitamin B12 µg Biotin µg Pantothenic Acid mg Choline mg Inositol mg

13.5 1.5 8.4 2.8 95 5

per 29g sachet 474 (455) 113 (108) 8.4 10 11 (9.9) 1.1 (0.1) [0.96] 3.9 0.4 2.4 0.8

4:1 5.3 1.4 nil added

per 100g powder

570 1898 14 560 6.04 9 55 25 0.93 1.07 15 26.7 1.28 100 1.3 35 3.85 80 35

per

g per 100g powder

1.25 2.36 2.19 0.87 nil added 2.2 1.33 2.08 3.56 2.72 0.57 nil added 2.52 1.56 1.74 0.7 3.14 2.28 0.017 0.132 3.82

Minerals

29g sachet 165 550 4.1 162 1.8 2.6 16 7.3 0.27 0.31 4.4 7.7 0.37 29 0.38 10.2 1.1 23.2 10.2

Fatty Acid Profile

Amino Acid Profile

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100g powder

680 30 980 25 525 15 580 480 165

per

29g sachet 197 8.7 284 7.3 152 4.4 168 139 47.9

C8:0 C10:0 C12:0 C16:0 C18:0 C18:1 C18:2 C18:3 C20 C20:1 C22:1 C24:0

Trace Elements

g per 100g Fatty Acids 2.85 2.11 <1 4.51 1.47 65.1 17.2 4.46 <1 <1 <1 <1

per 100g powder

14 Iron mg 1.05 Copper mg 10 Zinc mg 0.8 Manganese mg 100 Iodine µg 43 Molybdenum µg 56 Selenium µg 28 Chromium µg

per

29g sachet 4.1 0.31 2.9 0.23 29 12.5 16.2 8.1

* At the recommended concentration of 1 sachet (29g) + 100ml water Note:Figures in brackets represent: ( ) Pineapple & Vanilla flavour Anamix [ ] Forest Berries flavour Anamix

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XP Maxamum

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• Phenylalanine free

DESCRIPTION XP Maxamum is a phenylalanine free drink mix containing essential and non-essential amino acids, carbohydrate, vitamins, minerals and trace elements. Available in Orange flavour (contains colours, sugar and sweeteners), Caribbean Crush Flavour (contains colours, sugar and sweeteners) or Unflavoured form. A food for special medical purposes. INDICATIONS XP Maxamum is for use in the dietary management of children over 8 years of age, and adults, including pregnant women, with proven phenylketonuria.

OSMOLALITY The osmolality of XP Maxamum (Unflavoured): 1 to 5 dilution = 1000 mosm/kg. 1 to 7 dilution = 690 mosm/kg.

SUGGESTED INTAKE The quantity of XP Maxamum should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient.

The osmolality of XP Maxamum (Orange flavour): 1 to 5 dilution = 1150 mosm/kg. 1 to 7 dilution = 800 mosm/kg.

The diet must be supplemented with natural protein and other nutrients in medically prescribed quantities to supply the phenylalanine and general nutrient requirements of the patient. PREPARATION AND ADMINISTRATION XP Maxamum can be taken as a chilled drink or it can be taken as a paste. If taken as a paste additional water or diluted drinks must be consumed at the same time. MIXING INSTRUCTIONS: AS A DRINK XP Maxamum Volume of water Final volume Dilution (g) to be used (ml) (ml) 1 1 1 1

Sachet Sachet Sachet Sachet

50g 50g 50g 50g

100 150 200 250

130 186 240 290

AS A PASTE* XP Maxamum (g)

Volume of water to be added (ml)

1 Sachet 50g 2 Sachets100g 3 Sachets 150g

10 15 20

1 1 1 1

to to to to

PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool, dry place. Always replace container lid after use. Once opened, use within one month. PACK SIZE XP Maxamum is available in: 500g cans - Unflavoured and Orange flavour 30 x 50g sachets - Orange and Caribbean Crush flavours SHELF LIFE 3 years.

2† 3† 4† 5†

†NOTE: If taken as a paste or as a concentrated drink (e.g. 1 to 2 dilution) it is important to take additional fluid such as water or permitted juice/squash immediately after XP Maxamum.

XP Maxamum is now ready for use.

16 • Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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XP Maxamum

• Phenylalanine free NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g Fat g of which saturates Fibre g

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100g powder

Amino Acid Profile

1260 297 39 47 34 3.1 (31.7) [18.2] <0.5 Trace nil added

per 100g powder

560 24.3 700 17.9 560 15.8 670 670 285

Trace Elements

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

g per 100g powder 1.7 3.2 3 1.2 nil added 3 1.8 2.8 4.8 3.7 0.8 nil added 3.4 2.1 2.3 0.9 4.2 3.1 0.02 0.15 5.2

Vitamins

per 100g powder

710 2364 7.8 312 5.2 7.7 90 70 1.4 1.4 13.6 29.3 2.1 500 3.6 140 5.0 321 85.7

per 100g powder

23.5 1.4 13.6 2.1 107 107 50 50

Note: Figures in brackets represent: ( ) Orange flavour XP Maxamum [ ] Carribean Crush flavour XP Maxamum

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Easiphen

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â&#x20AC;˘ Phenylalanine free

DESCRIPTION Easiphen is a unique 'ready to drink' phenylalanine free liquid product containing a balanced mixture of the other essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. Available in Forest Berries and Grapefruit flavours. A food for special medical purposes. INDICATIONS Easiphen is for the dietary management of Phenylketonuria in children > 8 years, adolescents and adults. SUGGESTED INTAKE The quantity of Easiphen should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight, and medical condition of the patient. The diet must be supplemented with some natural protein and other nutrients in medically prescribed quantities to supply the phenylalanine and general nutrient requirements of the patient. PREPARATION & ADMINISTRATION Easiphen is best presented as a chilled drink. Shake before use. Part opened cartons can be stored in a refrigerator but must be consumed within 24 hours. OSMOLALITY The osmolality of Easiphen is 1130 mosm/kg PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool, dry place. PACK SIZE Easiphen is available in trays of 18 x 250ml cartons SHELF LIFE 1 year.

18 â&#x20AC;˘ Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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Easiphen

• Phenylalanine free NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Amino Acids g Carbohydrate g as sugars g Fat g as saturates g monounsaturates g polyunsaturates g % LCT Ratio n6:n3 fatty acids % energy from linoleic acid % energy from α linolenic acid Fibre g

per 100ml 275 65 6.7 8 5.1 4.7 2 0.3 1.2 0.4 100

per 250ml 688 163 16.8 20 12.8 11.8 5 0.75 3 1

3.6:1 4.2 1.2 0.12

0.3

Vitamins

per 100ml

per 250ml

Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α T.E. IU Vitamin C mg Vitamin K μg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folacin mg Vitamin B12 μg Biotin mg Pantothenic Acid mg Choline mg Inositol mg

121 303 403 1008 1.3 3.3 52 130 0.88 2.2 1.3 3.3 15 37.5 11.9 29.8 0.23 0.58 0.23 0.58 2.3 5.8 5.3 13.3 0.35 0.9 85 213 0.65 1.6 24 60 0.85 2.1 54 135 14.6 36.5

Amino Acid Profile

per 100ml

Fatty Acid Profile

L-Alanine L-Arginine L-Aspartic Acid L-Cystine Glycine L-Histidine L-Isoleucine L-Leucine L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine L-Carnitine mg Taurine mg

0.32 0.6 0.56 0.22 0.57 0.34 0.53 0.91 0.7 0.15 nil added 0.65 0.4 0.45 0.18 0.81 0.59 4.7 35.5

Minerals

per 100ml

per Trace Elements 250ml

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

95 4.1 120 3.1 95 2.7 160 115 48.5

238 10.3 300 7.8 238 6.8 400 288 121

C14 C16 C18 C18:1 (n - 9) C18:2 (n - 6) C18:3 (n - 3) C20 C20:1 (n - 9) C22:0 C22:1

Iron mg Copper µg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

g per 100g Fatty Acids 0.1 4.7 10.6 63.3 15.8 4.4 <0.5 <1 <0.5 <0.5

per 100ml

per 250ml

4 230 2.3 0.35 18.2 18.2 8.5 8.5

10 575 5.8 0.88 45.5 45.5 21.3 21.3

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Lophlex

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â&#x20AC;˘ Phenylalanine free

DESCRIPTION Lophlex is a lower calorie, low volume, concentrated powdered phenylalanine free protein substititute. Lophlex contains a balanced mixture of the other essential and non-essential amino acids, carbohydrate, fat, vitamins, trace elements and some minerals. Available in convenient dose-related sachets unflavoured or in Berry or Orange flavours. A food for special medical purposes. INDICATIONS Lophlex is for use in the dietary management of Phenylketonuria in children > 8 years, adolescents and adults, including pregnant women with proven Phenylketonuria. SUGGESTED INTAKE The quantity of Lophlex should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight, and medical condition of the patient. The diet must be supplemented with some natural protein and other nutrients in medically prescribed quantities to supply the phenylalanine and general nutrient requirements of the patient. PREPARATION & ADMINISTRATION The recommended dilution of Lophlex is 1 sachet plus 65mls cold water and can be prepared by either pasting or shaking: 1. To make a paste, mix the contents of one sachet of Lophlex with a small amount of water. Continue stirring while adding water to make a final volume of approximately 80mls. 2. Alternatively, to prepare Lophlex by shaking, pour 65mls cold water into a container with a screw top lid. Empty the contents of the sachet into the container. Seal and shake well until the powder is dissolved. Lophlex is best prepared with chilled water and consumed immediately after preparation. Lophlex should be given in divided doses throughout the day. Water or diluted drinks should be consumed at the same time as Lophlex. For osmotically sensitive patients, Lophlex may initially need to be introduced at a lower concentration. PRECAUTIONS Use under medical supervision. Not suitable as a sole source of nutrition. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool, dry place. PACK SIZE Lophlex is available in trays of 30 x 28g sachets SHELF LIFE 18 months.

20 â&#x20AC;˘ Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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Lophlex

• Phenylalanine free NUTRITION INFORMATION

per 100g powder

per 28g* sachet

Energy kJ

1384 385 (1316) (366) [1316] [366] kcal 326 91 (310) (86) [310] [86] Protein Equivalent g 72 20 Carbohydrate g 9 2.5 (5) (1.4) [5] [1.4] as sugars g 0.82 0.23 (0.42) (0.11) [0.7] [0.19] Fat g 0.2 0.06 as saturates g 0.05 0.01 monounsaturates g 0.01 <0.01 polyunsaturates g 0.13 0.04 Fibre g Vitamins

Amino Acid Profile

g per 100g powder

3.3 5.8 5.4 2.2 5.1 3.3 5.1 8.7 5.9 1.4 nil added 6.2 3.8 4.3 1.7 7.8 5.6 57 113 3950

0.8

0.22

per 100g powder

per 28g* sachet

Minerals

285 948 3.6 142 3.2 4.8 17.8 24.9 0.42 0.5 7.1 15 0.58 249 1.8 53.4 1.8 152 40.6

Sodium mg mmol Potassium mg

Vitamin A μg RE 1024 IU 3410 Vitamin D μg 12.8 IU 512 Vitamin E mg α T.E. 11.5 IU 17.1 Vitamin C mg 64 Vitamin K μg 89.6 Thiamin mg 1.5 Riboflavin mg 1.8 Niacin mg 25.6 mg NE 53.9 Vitamin B6 mg 2.1 Folic Acid µg 896 6.4 Vitamin B12 μg Biotin µg 192 Pantothenic Acid mg 6.4 Choline mg 546 Inositol mg 146

per 100g powder

per Trace Elements 28g* sachet

<20 <5.6 <0.87 <0.24 <10 <2.8 (<25) (<7) [<25] [<7] mmol <0.26 <0.07 (<0.64) (<0.18) [<0.64] [<0.18] Chloride mg <5 <1.4 mmol <0.14 <0.04 Calcium mg 1280 356 Phosphorus mg 992 276 Magnesium mg 384 107 Calcium : Phosphorus 1.3 : 1

Iron mg Copper µg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

per 100g powder

per 28g* sachet

19.2 1900 14.1 1.9 210 90 96 38

5.3 528 3.9 0.53 58.4 25 26.7 10.6

* Each 28g sachet contains 27.8g powder. Note: Figures in brackets represent: ( ) Berry flavour Lophlex [ ] Orange flavour Lophlex

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Phlexy-10 System

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â&#x20AC;˘ Phenylalanine free

DESCRIPTION Phlexy-10 is a system comprising of interchangeable, phenylalanine free amino acid supplements (Drink Mix, Bar, Capsules and Tablets) for the dietary management of phenylketonuria (PKU). A food for special medical purposes. INDICATIONS The Phlexy-10 System is for use in the dietary management of children and adults with proven phenylketonuria. SUGGESTED INTAKE The quantity of Phlexy-10 should be determined by a clinician or a dietitian only and is dependent on the age, body weight and medical condition of the patient. The Phlexy-10 System consists of 4 interchangeable components (Bar, Capsules, Drink Mix and Tablets) so that each component (1 x 42g Bar, 20 Capsules, 1 sachet Drink Mix, 10 Tablets) provides 10g amino acids.

PACK SIZE Phlexy-10 Drink Mix is supplied in packs of 30 x 20g sachets. Phlexy-10 Bars are supplied in packs of 20 x 42g bars. Phlexy-10 Capsules are supplied in packs of 4 x 200 capsules. Phlexy-10 Tablets are supplied in packs of 6 x 75 tablets. SHELF LIFE Phlexy-10 Drink Mix: 3 years. Phlexy-10 Bars: 1 year. Phlexy-10 Capsules: 3 years. Phlexy-10 Tablets: 2 years.

PREPARATION AND ADMINISTRATION The Phlexy-10 Drink Mix: Paste the contents of one sachet (20g) with a small amount of water. Continue stirring whilst adding the remaining volume of water. Chill if desired, stir again prior to serving. The Phlexy-10 Bar, Capsules and Tablets: Consume as directed. Water or diluted drinks must be taken at the same time. OSMOLALITY The osmolality of Phlexy-10 Drink Mix at a 1 to 5 dilution (1 sachet plus 100ml): Apple and Blackcurrant: 1172 mosm/kg Tropical Surprise: 1140 mosm/kg Citrus Burst: 1180 mosm/kg PRECAUTIONS Not suitable for use as a sole source of nutrition. Not for parenteral use. Requires an additional source of vitamins, minerals and trace elements such as Phlexy-Vits. Not suitable for infants. STORAGE Phlexy-10 Drink Mix, Tablets and Capsules should be stored in a cool, dry place. Phlexy-10 Bars should be stored in a refrigerator. Allow to return to room temperature before consumption.

22 â&#x20AC;˘ Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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• Phenylalanine free

Phlexy-10 System

PHLEXY-10 DRINK MIX A flavoured powder free from phenylalanine but containing a balanced mixture of essential and non-essential amino acids, carbohydrate, colouring, sweetener and flavouring. Available in Citrus Burst, Apple and Blackcurrant and Tropical Surprise flavours. NUTRITION INFORMATION

per 100g powder

per 20g sachet

Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g Fat g Fibre g

1456 343 41.65 50 44 40.6 nil added nil added

291 69 8.33 10 8.8 8.1

Amino Acid Profile L-Alanine L-Arginine L-Aspartic Acid L-Cystine Glycine L-Histidine L-Isoleucine L-Leucine

g per 100g powder 2.05 3.6 3.4 1.35 3.2 2.05 3.2 5.45

g per 20g sachet 0.41 0.72 0.68 0.27 0.64 0.41 0.64 1.09

Amino Acid Profile L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine L-Carnitine Taurine L-Glutamine Minerals Sodium mg Potassium mg

g per 100g powder 3.7 0.85 nil added 3.85 2.35 2.7 1.1 4.85 3.5 0.04 0.07 2.5

g per 20g sachet 0.74 0.17 nil added 0.77 0.47 0.54 0.22 0.97 0.7 0.007 0.014 0.5

per 100g powder

per 20g sachet

<5 (nil added ) <1 (nil added†) 35 (nil added††) 7 (nil added††) †

(†) Tropical Surprise (††) Apple and Blackcurrant

PHLEXY-10 TABLETS Tablets free from phenylalanine but containing a balanced mixture of essential and non-essential amino acids. NUTRITION INFORMATION

per 100 tablets

Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g Fat g of which saturates g Fibre g

1601 377 83.3 100 6.5 0.5 2 1.9 30

Amino Acid Profile L-Alanine L-Arginine L-Aspartic Acid L-Cystine L-Glutamic Acid Glycine L-Histidine L-Isoleucine L-Leucine

g per 100 tablets 4.1 7.2 6.8 2.7 nil added 6.4 4.1 6.4 10.9

*1 tablet weighs 1.4g

per 10 tablets* 160 38 8.33 10 0.65 0.05 0.2 0.19 3 g per 10 tablets 0.41 0.72 0.68 0.27 nil added 0.64 0.41 0.64 1.09

Amino Acid Profile L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine L-Carnitine Taurine L-Glutamine

g per 100 tablets 7.4 1.7 nil added 7.7 4.7 5.4 2.2 9.7 7 0.07 0.14 5

Typical Fatty Acid Profile

g per 100g Fatty Acids 50 50

C16:0 C18:0 Minerals Sodium mg Chloride mg mmol Magnesium mg

g per 10 tablets 0.74 0.17 nil added 0.77 0.47 0.54 0.22 0.97 0.7 0.007 0.014 0.5

per 100g tablets <50 1179 50.8 35.2

per 10 tablets <5 178 5.1 3.5

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Phlexy-10 System

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• Phenylalanine free

PHLEXY-10 BAR A Citrus Fruit flavoured bar free from phenylalanine, but containing a balanced mixture of essential and non-essential amino acids, carbohydrate and colouring. NUTRITION INFORMATION

per 100g

Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g Fat g of which saturates g monounsaturates g polyunsaturates g % LCT Ratio n6 : n3 fatty acids % energy from linoleic acid % energy from α linolenic acid Fibre g

1562 371 19.8 23.8 48.8 44.8 10.7 2.4 6.2 1.6 100

Amino Acid Profile

g per 100g

L-Alanine L-Arginine L-Aspartic Acid L-Cystine L-Glutamic Acid Glycine L-Histidine L-Isoleucine L-Leucine

0.98 1.71 1.62 0.64 nil added 1.52 0.98 1.52 2.6

per 42g bar 657 156 8.33 10 20.5 18.8 4.5 1 2.6 0.67

57:1

Fatty Acid Profile

3.7 0.06 4.1

Amino Acid Profile L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine L-Carnitine Taurine L-Glutamine

1.7 g per 42g bar 0.41 0.72 0.68 0.27 nil added 0.64 0.41 0.64 1.09

C14:0 C16:0 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:0 C24:0

n-9 n-6 n-3 n-9

Minerals

g per 100g

g per 42g bar 0.74 0.17 nil added 0.77 0.47 0.54 0.22 0.97 0.7 0.007 0.014 0.5

1.76 0.4 nil added 1.83 1.12 1.28 0.52 2.31 1.67 0.017 0.033 1.19

g per 100g Fatty Acids 0.28 17.3 3.9 60.6 14.9 0.26 0.56 0.69 1.1 0.41 g per 100g

Sodium mg

0.01

PHLEXY-10 CAPSULES Cellulose capsules free from phenylalanine but containing a balanced mixture of essential and non-essential amino acids. NUTRITION INFORMATION

g per 200 capsules

g per 20* capsules

Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g Fat g Fibre g

1416 333 83.3 100 nil added nil added 16

142 33 8.33 10 nil added nil added 1.6

* 20 capsules = 10g of amino acids. # A negligible amount of phenylalanine is present in the cellulose of the capsules (<0.2mg phenylalanine per 20 capsules).

g per 200 capsules 4.1 7.2 6.8 2.7 nil added 6.4 4.1 6.4 10.9 7.4 1.7 # negligible 7.7 4.7 5.4 2.2 9.7 7 0.07 0.14 5

g per 20* capsules 0.41 0.72 0.68 0.27 nil added 0.64 0.41 0.64 1.09 0.74 0.17 # negligible 0.77 0.47 0.54 0.22 0.97 0.7 0.007 0.014 0.5

24 • Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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• Phenylalanine free

Phlexy-Vits

DESCRIPTION Phlexy-Vits is a concentrated powdered vitamin, mineral and trace element preparation. A food for special medical purposes. INDICATIONS Phlexy-Vits may be used as the vitamin, mineral and trace element component of restrictive, therapeutic diets, and has been designed to meet the micronutrient requirements of older children (from approximately 11 years) and adults. Phlexy-Vits forms part of the SHS Phlexy-10 System for use in the management of phenylketonuria. SUGGESTED INTAKE The quantity of Phlexy-Vits should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. The suggested intake is 7g per day for children over the age of 11 years and adults. The suggested intake may need lowering if vitamins, minerals and trace elements are provided in the diet from other sources. Phlexy-Vits is designed for use with the Phlexy-10 System. It can be added to Phlexy-10 Drink Mix or to orange or lemon cordial (not blackcurrant). PREPARATION AND ADMINISTRATION Mix one sachet of Phlexy-Vits with one sachet of dry powdered Phlexy-10 Drink Mix. Add a small amount of water and mix to a smooth paste. Add the remaining water to give a final volume of approximately 100ml. Alternatively, mix one sachet of Phlexy-Vits to a smooth paste with a small amount of orange or lemon cordial (approx. 20ml). Dilute with water up to 50ml. The amount of cordial and water used will vary according to taste. NB: Natural discolouration of this product will occur after reconstitution. For best results, consume immediately. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool, dry place. PACK SIZE 30 x 7g sachets. SHELF LIFE 1 year.

NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Carbohydrate g of which sugars g Fat g of which saturates Fibre g Vitamins Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K μg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic Acid µg Vitamin B12 µg Biotin µg Pantothenic Acid mg Minerals

per 100g per 7g powder dose 14 1 3 0.2 0.3 0.02 0.5 0.04 0.5 0.04 nil added nil added 5.8 0.4 per 100g per 7g powder dose 11430 800 38062 2664 143 10 5720 400 192.3 13.5 129 9 715 50 1000 70 17.1 1.2 20.0 1.4 286 20 286 20 22.9 1.6 10000 700 71.5 5 2143 150 71.5 5 per 100 g powder 125 5.4 <20 <0.5 <5 <0.1 14286 11072 4286

per 7g dose 8.8 0.4 <1.4 <0.04 <0.35 <0.01 1000 775 300

Trace Elements

per 100g powder

per 7g dose

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

215 21.5 158 21.5 2143 1000 1072 429

15 1.5 11 1.5 150 70 75 30

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

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Energivit DESCRIPTION Energivit is a powdered mixture containing carbohydrate, fat, vitamins, minerals and trace elements. A food for special medical purposes. INDICATIONS Energivit is for the dietary management of infants and children who require additional energy, vitamins, mineral and trace elements or who are following a protein restricted diet. Energivit can be used in conjunction with specific amino acid mixtures to provide a formula individually tailored to meet the patients specific needs. It can also be used as a convenient protein-free feed in the short term, for example, as an emergency regimen or when awaiting a diagnosis. SUGGESTED INTAKE The quantity of Energivit should be determined by a clinician or dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION Each level scoop (5g) Energivit requires 30ml (approx. 1 fl. oz) water to yield the recommended feed concentration (15% w/v).

OSMOLALITY The osmolality of Energivit at a 15% w/v concentration is 190 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool, dry place. Always replace container lid after use. Once opened use within one month.

N I E P C F

% % R % % F

PACK SIZE Energivit is available in 400g cans. SHELF LIFE 2 years. V

1. Wash hands. Sterilise feeding bottle and teat. 2. Boil fresh water. Cool boiled water so that it feels warm to the wrist and pour desired amount into a sterilised feeding bottle. Keep bottles capped until use. 3. Fill the scoop provided in the pack and level of by passing the back of a clean, dry knife across the rim. Do not press the powder down into the scoop. Use only the scoop provided. 4. Add the prescribed number of Energivit scoops to water. 5. Replace the cap on the bottle and shake until the powder dissolves. Before feeding, ensure that the formula is at the correct temperature by placing a few drops on the wrist. Energivit is now ready for use. This feed concentration achieves 10% carbohydrate (by weight) per 100ml product. For children Energivit may be given in a more concentrated solution (e.g. 1 to 4) or added to permitted foods and drinks in the diet.

V V V V T R N V F V B P C I

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Energivit NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 2059 309 kcal 492 74 Protein g nil added Carbohydrate g 66.7 10 of which sugars g 6.0 0.9 Fat g 25 3.75 of which saturates 7.6 1.14 monounsaturates g 11.6 1.7 polyunsaturates g 4.6 0.7 % LCT 95 % MCT 4.5 Ratio n6 : n3 fatty acids 10:1 % energy from linoleic acid 7.6 % energy from α linolenic acid 0.75 Fibre g nil added

Fatty Acid Profile

g per 100g Fatty Acids

C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3

0.15 2.1 2.4 14.46 4.8 7.33 1.1 0.83 47.37 17.53 1.73

Vitamins

per 100g powder

per 100ml*

Minerals

per 100g powder

Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K μg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic acid μg Vitamin B12 μg Biotin μg Pantothenic Acid mg Choline mg Inositol mg

528 1758 8.5 340 3.3 4.95 40 21 0.39 0.6 4.5 4.5 0.52 38 1.25 26 2.65 50 100

79.2 264 1.28 51 0.49 0.74 6 3.15 0.06 0.09 0.68 0.68 0.08 5.7 0.2 3.9 0.4 7.5 15

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium: Phosphorus

120 5.22 420 10.77 290 8.3 325 230 34

per 100ml*

Trace Elements

18 0.78 63 1.62 43.5 1.2 48.8 34.5 5.1

Iron mg Copper mg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

per 100g per powder 100ml*

7 0.45 5 0.6 47 35 15 15

1.05 0.07 0.75 0.09 7.05 5.25 2.25 2.25

1.4:1

* At the recommended concentration of 15% w/v

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Neocate

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Elemental 028 Extra Liquid

Pepdite & Pepdite 1+

Ketocal 28

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Neocate Advance

Elemental 028 Extra

Monogen

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MCT Pepdite

Kindergen

Generaid Plus

Caprilon

Hepatical

Elemental 028

Emsogen

MCT Pepdite 1+

Locasol

Heparon Junior

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Nutritionally Complete A range of products providing a choice of nitrogen sources ranging from amino acids, to peptides and whole protein.

Neocate Neocate Advance - Unflavoured, Banana-Vanilla flavour Elemental 028 - Unflavoured, Orange flavour Elemental 028 Extra - Unflavoured, Orange, Citrus & Banana flavour

Elemental 028 Extra Liquid - Grapefruit, Orange & Pineapple, Summer Fruits flavours

Emsogen - Unflavoured, Orange flavour Pepdite Pepdite 1+ - Unflavoured, Banana flavour MCT Pepdite MCT Pepdite 1+ Monogen Kindergen Caprilon Locasol Ketocal - Unflavoured, Vanilla flavour Generaid Plus Hepatical - Unflavoured, Banana-Caramel, Lemon & Lime flavour Heparon Junior Precautions Not for parenteral use Use under medical supervision Additional precautions noted for individual products When these products are used as a supplementary feed in a restrictive therapeutic diet it is advisable to ensure that adequate intakes of all nutrients are provided. 29

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Neocate

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• Milk protein free • Hypoallergenic • Lactose free

DESCRIPTION Neocate is a palatable, hypoallergenic, nutritionally complete, powdered elemental infant formula consisting of a mixture of essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. A food for special medical purposes. INDICATIONS Neocate is a hypoallergenic,1 elemental diet for infants designed for use as a sole source of nutrition or as a supplementary feed for the dietary management of:

5. Formula remaining in the bottle after one hour should be discarded. Formula must not be rewarmed during feeding. Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding.*

1. Cow milk allergy.1 2. Multiple food protein intolerance.2,3 3. Gastroesophageal reflux in infants who fail to respond to anti reflux medication.4,5 4. Eosinophilic Eosophagitis.6(EE) 5. Short bowel syndrome.7 6. Transition from parenteral to enteral nutrition.7 7. Growth failure in cow milk allergy.8 8. Protracted intractable diarrhoea. 9. Colic.6,9 10. Allergy to breast milk10 - symptoms of food allergy while breast feeding.

* If formula is prepared in advance, it must be cooled rapidly, stored in the refrigerator (2ºC to 4ºC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer that 15 minutes prior to feeding. Do not boil formula and do not use a microwave oven to prepare or warm formula. For tube feeding “hang time” should not exceed 4 hours. Neocate is now ready for use.

SUGGESTED INTAKE The quantity of Neocate should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient.

When bottle feeding, prolonged or frequent contact of feeds with the infant's teeth should be discouraged as this increases the risk of tooth decay. Cleaning the infant's teeth after the last feed at night should be encouraged.

PREPARATION AND ADMINISTRATION Each level scoop (5g) of Neocate requires 30ml (approx. 1 fl.oz) of water to yield the recommended feed concentration (15%).

OSMOLALITY The osmolality of Neocate at 15% w/v concentration is 360 mosm/kg.

Approx age of baby from

Birth 3 Months 4 Months 7 Months 10 Months

Approx weight of baby kg 3.5 6 7.5 8.5 9.5

PRECAUTIONS Use under medical supervision. Not for parenteral use. STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Neocate is available in 400g cans. SHELF LIFE 2 years.

Level scoops of Neocate lb 7.75 13.25 16.5 18.75 21

3 4 6 7 8

Cooled, boiled water ml 90 120 180 210 240

Feed in 24 hours fl oz 3 4 6 7 8

6 6 5 5 5

The infant may require more or less than the quantities given here. If other foods are introduced, the amount of Neocate should be reduced accordingly.

30 • Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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• Milk protein free • Hypoallergenic • Lactose free NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 1990 298 kcal 475 71 Protein Equivalent g 13 1.95 Total Amino Acids g 15.5 2.33 Carbohydrate g 54 8.1 of which sugars g 4.9 0.7 Fat g 23 3.5 of which saturates g 7 1 monounsaturates g 10.6 1.6 polyunsaturates g 4.3 0.6 % LCT 95 % MCT 5 Ratio n6 : n3 fatty acids 10 : 1 % energy from linoleic acid 7 % energy from α linolenic acid 0.7 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

Vitamin A µg RE IU Vitamin D µg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K µg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic Acid µg Vitamin B12 µg Biotin µg Pantothenic Acid mg Choline mg Inositol mg

528 1758 8.5 340 3.3 4.95 40 21 0.39 0.6 4.5 9.8 0.52 40 1.25 26 2.65 50 100

79 264 1.3 51 0.5 0.74 6 3.2 0.06 0.09 0.68 1.5 0.08 6 0.19 3.9 0.4 7.5 15

Amino Acid Profile L-Alanine L-Arginine L-Aspartic Acid L-Cystine L-Glutamic Acid Glycine L-Histidine L-Isoleucine L-Leucine L-Lysine L-Methionine L- Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine L-Carnitine Taurine L-Glutamine Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium : Phosphorus

g per 100g powder 0.61 1.08 1.01 0.4 nil added 0.95 0.62 0.95 1.63 1.11 0.26 0.73 1.16 0.71 0.8 0.32 0.73 1.04 0.01 0.03 1.34

per 100 g powder

120 5.2 420 10.8 290 8.2 325 230 34

Fatty Acid Profile C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3

per 100ml*

Trace Elements

18 0.78 63 1.6 43.5 1.2 49 35 5.1

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

Neocate g per 100g Fatty Acids 0.15 2.1 2.4 14.4 4.8 7.33 1.1 0.83 47.37 17.53 1.73

per 100g per powder 100ml*

7 0.38 5 0.38 47 14.25 11 10

1.05 0.06 0.75 0.06 7 2.14 1.65 1.5

1.4 : 1

* At the recommended concentration of 15% w/v. References Sampson et al. Safety of an amino acid derived infant formula in children allergic to cow milk. Pediatrics 1995; 90(3): 463-465 Hill DJ et al. The natural history of intolerance to soy and extensively hydrolysed formula in infants with multiple food protein intolerance. J Pediatr 1999;135:118-121 3. Hill DJ et al. Challenge confirmation of late onset reactions to extensively hydrolysed formulas in infants with multiple food protein intolerance. J Allergy Clin. Immunol 1995;96(3): 386-394 4. Hill DJ et al. Role of food protein intolerance in infants with persistent distress attributed to reflux esophagitis. J Pediatr 2000;136(5): 641-646 5. Miele E et al. Clinical response to amino acid based formulain neurologically impaired children with refractory esophagitis.JPGN 2002;35:314-319 6. Kelly et al. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid based formula. Gastroenterology 1995;109:1503-1512 7. Bines J et al. Reducing parenteral requirement in children with short bowel syndrome: impact of an amino acid-based complete infant formula. J Pediatr Gastroenterol. Nutr 1998;26(2):123-128 8. Niggemann et al. Prospective, controlled multi center study on the effect of an amino acid based formula in infants with cows milk allergy/intolerance and atopic dermatitis. Pediatr Allergy Immunol 1999;12: 78-82 9. Estep DC et al. Colic in breast-milk-fed infants: treatment by temporary substitution of neocate infant formula. Acta Paediatr 2000;89: 795-802 10. Isolauri et al. Breast feeding of allergic infants. J Pediatr 1999;134: 27-32 1. 2.

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Neocate Advance

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• Milk protein free • Hypoallergenic • Lactose free

DESCRIPTION Neocate Advance is a paediatric, hypoallergenic, nutritionally complete, elemental formula consisting of a mixture of essential and non-essential amino acids, carbohydrates, fat, vitamins, minerals and trace elements. Available in Banana Vanilla flavour (contains colours, sugar and sweeteners) or Unflavoured. A food for special medical purposes. INDICATIONS Neocate Advance can be recommended for use in children over 1 year as a sole source of nutrition or as a supplementary feed for the dietary management of the following conditions:

OSMOLALITY The osmolality of Neocate Advance at a 1 in 4 w/v dilution is Unflavoured: 610 mosm/kg. Banana Vanilla: 662 mosm/kg

1. Cow milk allergy. 2. Multiple food protein intolerance. 3. Gastroesophageal reflux in children who fail to respond to anti-reflux medication. 4. Eosinophilic Eosophagitis.(EE) 5. Short bowel syndrome. 6. Transition from parenteral to enteral nutrition. 7. Growth failure in CMA. 8. Protracted intractable diarrhoea.

For osmotically sensitive patients a 1 in 7.5 w/v dilution may be required. Unflavoured: 1 sachet plus 680ml water: 288 mosm/kg Banana Vanilla: 1 sachet plus 340ml water: 310 mosm/kg

SUGGESTED INTAKE The quantity of Neocate Advance should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended dilution is 1 in 4 weight to volume (25% w/v) i.e. Unflavoured: 1 sachet (100g) added to 340ml water. Banana Vanilla: 1 sachet (50g) added to 170ml water. This dilution provides 1kcal/ml. 1. 2. 3. 4.

Wash hands. Measure required volume of water into a container. Add 1 sachet of Neocate Advance to the water. Cover and shake the product until the powder has dissolved or liquidise for up to 10 seconds. 5. Shake or stir the product immediately before serving.

PRECAUTIONS Use under medical supervision. When used to supplement a restricted diet it is advisable to ensure that adequate intakes of all nutrients are provided. Children on milk-free diets may require a calcium supplement. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool, dry place. Once opened a sachet should be stored in an airtight container and used within 2 - 3 days. Once can opened use within one month. PACK SIZE Neocate Advance is available in: Unflavoured: packs of 10 x 100g sachets and 400g can. Banana Vanilla: 15 x 50g sachets. SHELF LIFE 1 year.

Neocate Advance is now ready for use. Neocate Advance is best served chilled. For oral feeding Unflavoured Neocate Advance can be served unflavoured or flavoured using a separate flavour from the SHS flavour range.

32 • Free from statement indicates that the highlighted food constituent is not added to the product as an ingredient.

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Neocate Advance

• Milk protein free • Hypoallergenic • Lactose free NUTRITION INFORMATION

per 100g per powder 100ml*

1683 420 Energy kJ 400 100 kcal 10 2.5 Protein Equivalent g 12 3 Total Amino Acids g 58.5 14.6 Carbohydrate g 5.3 (5.9) 1.3 (1.5) of which sugars g 14 3.5 Fat g 5.3 1.3 of which saturates g 6.1 1.5 monounsaturates g 1.9 0.5 polyunsaturates g 65 % LCT 35 % MCT Ratio n6 : n3 4:1 fatty acids % energy from 3.4 linoleic acid % energy from 0.85 α linolenic acid nil added Fibre g

Vitamins

per 100g powder

per 100ml*

148 493 3.24 130 2.3 3.4 13.2 14 0.24 0.32 3.8 7.3 0.32 40 0.28 8 1 76.8 7.56

37 123 0.81 32.5 0.58 0.85 3.3 3.5 0.06 0.08 0.95 1.8 0.08 10 0.07 2 0.25 19.2 1.89

Amino Acid Profile

g per 100g powder

0.39 1.76 0.71 0.04 nil added 0.63 0.46 0.63 1.06 0.77 0.5 0.88 0.74 0.46 0.53 0.21 0.18 0.67 0.01 0.02 1.38

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100 g powder

240 10.4 468 12 368 10.4 200 155 50

Fatty Acid Profile

per 100ml*

60 2.6 117 3 92 2.6 50 39 12.5

g per 100g Fatty Acids

C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:0 C22:1

Trace Elements

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

0.03 20.4 14 0.03 0.02 3.2 0.13 1.25 45 11.5 2.9 0.45 0.6 0.23 0.26

per 100g per powder 100ml*

2.48 0.24 2 0.2 28 14 10 5

0.62 0.06 0.5 0.05 7 3.5 2.5 1.25

* At the recommended concentration of 25% w/v. Figures in brackets represent flavoured Neocate Advance

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Elemental 028 DESCRIPTION Elemental 028 is a nutritionally complete powdered, elemental feed, consisting of a mixture of essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. Available in Orange flavour (contains colours & sugars) or Unflavoured. A food for special medical purposes. INDICATIONS Elemental 028 can be used in children and adults as a sole source of nutrition or as a supplementary feed from 1 year of age for the dietary management of the following conditions: 1. 2. 3. 4. 5. 6.

Crohnâ&#x20AC;&#x2122;s disease.1,2 Short bowel syndrome. Intractable malabsorption. Bowel fistulae. Diagnosis of food allergy.3 Radiation Enteritis.4

SUGGESTED INTAKE The quantity of Elemental 028 should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION For sip or tube feeding the recommended feed concentration is 20% w/v (1 in 5 dilution). 1. Wash hands. 2. Add small amount of water to the prescribed amount of Elemental 028. Stir with a fork until a smooth paste is achieved. 3. Continue stirring whilst adding water up to the required volume.

OSMOLALITY The osmolality of Elemental 028 at a 20% w/v (1 in 5 i.e. 20g made up to 100ml) concentration: Elemental 028 (Unflavoured) = 496 mosm/kg. Elemental 028 (Orange flavour) = 711 mosm/kg. For osmotically sensitive patients an initial dilution of 1 in 7.5 (20 g made up to 150ml) is advised until osmotic tolerance is achieved. The osmolality of Elemental 028 at this dilution is: Elemental 028 (Unflavoured) = 317 mosm/kg. Elemental 028 (Orange flavour) = 456 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool dry place. Once opened a sachet should be stored in an airtight container and used within 2 - 3 days. Not suitable for infants. PACK SIZE Elemental 028 is available in packs of 10 x 100g sachets. SHELF LIFE 2 years.

Elemental 028 is now ready for use. References Elemental 028 is best presented as a chilled drink. Unflavoured Elemental 028 may be flavoured with a separate flavour from the SHS flavour range.

1. Riordan et al. Treatment of Active Crohns disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 1993; 342:1131-1134 2. Verma et al. Oral Nutritional Supplementation is effective in the maintenance of remission in Crohns disease Dig Liv Dis 2000; 32:769-774 3. Poulsen et al. Poster presentation. EAACI 2001. Data on file. 4. McArdle et al. Prophylaxis against radiation injury: the use of elemental diet prior and during radiotherapy for invasive bladder cancer and in early postoperative feeding following radical cystectomy and ileal coduit. Arch Surg 1986; 121:879-885

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Elemental 028 NUTRITION INFORMATION

per 100g powder

per 100ml*

Amino Acid Profile

Energy kJ 1640 (1614) 328 (323) kcal 388 (382) 78 (76) Protein Equivalent g 10 2 Total Amino Acids g 12 2.4 Carbohydrate g 72 (71) 14.4(14.1) of which sugars g 6.5 (43) 1.3 (8.6) Fat g 6.6 (6.64) 1.3 (1.33) of which saturates g 0.8 0.16 monounsaturates g 4.2 0.84 polyunsaturates g 1.3 0.26 % LCT 95 % MCT 5 Ratio n6 : n3 fatty acids 4:1 % energy from linoleic acid 2.5 % energy from α linolenic acid 0.6 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

330 1098 2.5 100 6.1 9.1 28.3 25 0.6 0.6 4.2 8.03 0.8 83 1.7 18 2 92 9.2

66 219 0.5 20 1.2 1.8 5.7 5 0.12 0.12 0.84 1.6 0.16 16.7 0.36 3.6 0.4 18.4 1.8

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

g per 100g powder 0.41 0.93 0.8 0.05 nil added 0.7 0.51 0.68 1.18 0.88 0.40 0.98 0.81 0.50 0.58 0.23 0.20 0.75 0.01 0.03 1.38

Fatty Acid Profile C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20 C20:1 C22:1

per 100 g powder

per 100ml*

Trace Elements

300 13 466 11.9 333 9.4 245 200 82

60 2.6 93.2 2.4 66.6 1.9 49 40 16.3

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

g per 100g Fatty Acids 3 2 0 <1 4.6 0.2 1.8 65.2 16.6 4.2 0.65 0.87 0.38

per 100g per powder 100ml*

4.2 0.4 4.2 0.6 33.3 33.3 15.0 15.0

0.84 0.08 0.84 0.12 6.66 6.66 3 3

* At the recommended concentration of 20% w/v. Note: Figures in brackets represent flavoured Elemental 028

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Elemental 028 Extra DESCRIPTION Elemental 028 Extra is a nutritionally complete elemental diet, consisting of a mixture of essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. Available as Orange, Citrus and Banana flavours (contains sugars, sweetener and colours) or Unflavoured. A food for special medical purposes. INDICATIONS Elemental 028 Extra can be used in children and adults as a sole source of nutrition or as a supplementary feed from age 1 year for the dietary management of the following conditions: 1. 2. 3. 4. 5. 6.

Crohnâ&#x20AC;&#x2122;s disease.1,2 Short bowel syndrome. Intractable malabsorption. Bowel fistulae. Diagnosis of food allergy.3 Radiation Enteritis.4

SUGGESTED INTAKE The quantity of Elemental 028 Extra should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight, and medical condition of the patient. PREPARATION AND ADMINISTRATION For sip or tube feeding the recommended feed concentration is 20% w/v (1 in 5 dilution i.e. 20g made up to 100ml). 1. Wash hands. 2. Add small amount of water to the prescribed amount of Elemental 028 Extra. Stir with a fork until a smooth paste is achieved. 3. Continue stirring whilst adding water up to the required volume. Elemental 028 Extra is now ready for use. Elemental 028 Extra is best presented as a chilled drink. Elemental 028 Extra (Unflavoured) may be flavoured with a separate flavour from the SHS flavour range. OSMOLALITY The osmolality at a 20% w/v (1 in 5 i.e. 20g made up to 100ml) concentration: Elemental 028 Extra (Unflavoured) = 502 mosm/kg. Elemental 028 Extra (Orange flavour) = 636 mosm/kg. Elemental 028 Extra (Citrus flavour) = 590 mosm/kg. Elemental 028 Extra (Banana flavour) = 570 mosm/kg.

For osmotically sensitive patients an initial dilution of 13.3% (1 in 7.5 i.e. 20g made up to 150ml) is advised until osmotic tolerance is achieved. The osmolality at this concentration: Elemental 028 Extra (Unflavoured) = 340 mosm/kg. Elemental 028 Extra (Orange flavour) = 389 mosm/kg. Elemental 028 Extra (Citrus flavour) = 360 mosm/kg. Elemental 028 Extra (Banana flavour) = 350 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool dry place. Once opened a sachet should be stored in an airtight container and used within 2 - 3 days. PACK SIZE Elemental 028 Extra is available in packs of 10 x 100g sachets. SHELF LIFE 2 years. References 1. Riordan et al. Treatment of Active Crohns disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 1993; 342:1131-1134 2. Verma et al. Oral Nutritional Supplementation is effective in the maintenance of remission in Crohns disease Dig Liv Dis 2000; 32:769-774 3. Poulsen et al. Poster presentation. EAACI 2001. Data on file. 4. McArdle et al. Prophylaxis against radiation injury: the use of elemental diet prior and during radiotherapy for invasive bladder cancer and in early postoperative feeding following radical cystectomy and ileal coduit. Arch Surg 1986; 121:879-885

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Elemental 028 Extra NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g

1871 (1793) 374 (358) 443 (427) 89 (85) 12.5 2.5 15.0 3.0 59 (55) 11.8 (11) 5.31 [23.3] 1.8 [4.7] 〈9.3〉 {7.9} 〈1.9〉 {1.6} Fat g 17.45 3.5 of which saturates g 6.7 1.3 monounsaturates g 7.4 1.5 polyunsaturates g 2.4 0.5 % MCT 35 % LCT 65 Ratio n6 : n3 fatty acids 4:1 % energy from linoleic acid 4 % energy from α linolenic acid 1 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

Vitamin A µg RE IU Vitamin D µg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K µg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic Acid µg Vitamin B12 μg Biotin µg Pantothenic Acid µg Choline mg Inositol mg

330 1099 2.5 100 6.1 9.1 28.3 25 0.6 0.6 4.2 9 0.8 83.3 1.7 18 2 91.6 9.2

66 220 0.5 20 1.2 1.8 5.7 5 0.12 0.12 0.84 1.8 0.16 16.7 0.34 3.6 0.4 18.3 1.8

Amino Acid Profile

g per 100g powder

0.51 1.16 1.00 0.07 nil added 0.87 0.63 0.86 1.48 1.10 0.50 1.22 1.01 0.62 0.72 0.29 0.25 0.94 0.02 0.03 1.72

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100 g powder

305 13.3 466 11.9 333 9.4 245 200 81.6

Fatty Acid Profile C8:0 C10:0 C12:0 C14:0 C16:0 C18:0 C18:1 C18:2 C18:3 > C20:0

per 100ml*

Trace Elements

61 2.7 93.2 2.4 66.6 1.9 49 40 16.3

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

g per 100g Fatty Acids 20.1 14 0.1 0.2 3.8 1.2 44.6 11.8 3.0 1.2

per 100g per powder 100ml*

4.2 0.4 4.2 0.6 33.3 33.3 15 15

0.84 0.08 0.84 0.12 6.7 6.7 3 3

* At the recommended concentration of 20% w/v. Note: Figures in brackets represent: ( ) all flavours of Elemental 028 Extra [ ] orange flavour Elemental 028 Extra 〈 〉 citrus flavour Elemental 028 Extra { } banana flavour Elemental 028 Extra

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Elemental 028 Extra Liquid DESCRIPTION Elemental 028 Extra Liquid is a convenient and palatable nutritionally complete liquid elemental diet, consisting of a mixture of essential and non-essential amino acids, carbohydrate, fat, vitamins, minerals, trace elements and flavourings with sugars & sweeteners. Available in Grapefruit, Orange & Pineapple and Summer Fruits flavours. A food for special medical purposes. INDICATIONS Elemental 028 Extra Liquid can be used in children over 5 years and adults as a sole source of nutrition (or as a supplementary feed from 1 year of age) for the dietary management of the following conditions: 1. 2. 3. 4. 5.

Crohnâ&#x20AC;&#x2122;s disease.1,2 Short bowel syndrome. Intractable malabsorption. Bowel fistulae. Radiation Enteritis.3,4

SUGGESTED INTAKE The quantity of Elemental 028 Extra Liquid should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight, and medical condition of the patient. PREPARATION AND ADMINISTRATION Elemental 028 Extra Liquid is best presented as a chilled drink. It can be diluted if necessary for osmotically sensitive patients. OSMOLALITY Grapefruit = 673 mosm/kg. Orange and Pineapple = 725 mosm/kg. Summer Fruits = 695 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool dry place. Once opened store in a refrigerator and use within 24 hours. PACK SIZE Elemental 028 Extra Liquid is available in trays of 18 x 250ml. SHELF LIFE 9 months.

References 1. Riordan et al. Treatment of Active Crohns disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 1993; 342:1131-1134 2. Verma et al. Oral Nutritional Supplementation is effective in the maintenance of remission in Crohns disease Dig Liv Dis 2000; 32:769-774 3. Poulsen et al. Poster presentation. EAACI 2001. Data on file. 4. McArdle et al. Prophylaxis against radiation injury: the use of elemental diet prior and during radiotherapy for invasive bladder cancer and in early postoperative feeding following radical cystectomy and ileal coduit. Arch Surg 1986; 121:879-885

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Elemental 028 Extra Liquid NUTRITION INFORMATION

per 100ml

per 250ml

Energy kJ 360 900 kcal 86 215 Protein Equivalent g 2.5 6.3 Total Amino Acids g 3 7.5 Carbohydrate g 11 27.5 of which sugars g 4.7 11.8 Fat g 3.5 8.8 of which saturates g 1.35 3.3 monounsaturates g 1.6 4 polyunsaturates g 0.45 1.2 % LCT 65 % MCT 35 Ratio n6 : n3 fatty acids 4:1 % energy from linoleic acid 4 % energy from α linolenic acid 1 Fibre nil added

Vitamins

per 100ml

40 133 0.48 19.2 1.7 2.5 5.7 5 0.12 0.12 0.84 2 0.16 16.7 0.4 3.6 0.4 18.3 1.8

per 250ml

100 333 1.2 48 4.3 6.3 14.3 12.5 0.3 0.3 2.1 5 0.4 41.8 1 9.0 1 45.8 4.5

Amino Acid Profile

g per 100ml

0.12 0.26 0.24 0.01 0.2 0.15 0.2 0.34 0.26 0.15 0.25 0.24 0.15 0.17 0.07 0.04 0.21 0.003 0.006

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

Fatty Acid Profile C8:0 C10:0 C12:0 C14:0 C16:0 C18:0 C18:1 C18:2 C18:3

g per 100g Fatty Acids 20.1 14.9 0.1 Trace 2.6 1.6 46 10.5 3

per 100ml

per 250ml

Trace Elements

per 100ml

per 250ml

61 2.7 93.2 2.4 66.6 1.9 45 40 16.3

153 6.8 233 6 166.5 4.8 113 100 40.8

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

0.84 0.08 0.84 0.12 6.66 6.66 3 3

2.1 0.2 2.1 0.3 16.7 16.7 7.5 7.5

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Emsogen DESCRIPTION Emsogen is a powdered elemental feed consisting of a mixture of essential and non-essential amino acids, carbohydrate, fat (83% MCT), vitamins, minerals and trace elements. Available in Orange flavour (contains colours and sweeteners) or Unflavoured. A food for special medical purposes. INDICATIONS Emsogen can be used as a supplementary feed for the dietary management of severe malabsorption where long chain triglycerides are poorly tolerated. It can also be used for overnight feeding in cystic fibrosis where the need for pancreatic enzymes is reduced. Emsogen can be used in children over 5 years and adults as a sole source of nutrition, when supplemented with Îą-linolenic acid. SUGGESTED INTAKE The quantity of Emsogen should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient being treated. PREPARATION AND ADMINISTRATION The recommended dilution is 20% w/v (1 in 5 i.e. 20g made up to 100ml). For sip or tube feeding: 1. Wash hands. 2. Add small amount of water to the prescribed amount of Emsogen. Stir with a fork until a smooth paste is achieved. 3. Continue stirring whilst adding water up to the required volume. Emsogen is now ready for use. Emsogen is best presented as a chilled drink. Unflavoured Emsogen may be flavoured with a separate flavour from SHS flavour range. OSMOLALITY The osmolality at a 20% w/v (1 in 5 i.e. 20g made up to 100ml) concentration. Emsogen (Unflavoured) = 580 mosm/kg. Emsogen (Orange flavour) = 610 mosm/kg.

For osmotically sensitive patients an initial dilution of 1 in 7.5 (20 g made up to 150ml) is advised until osmotic tolerance is achieved. The osmolality at this dilution is: Emsogen (Unflavoured) = 370 mosm/kg. Emsogen (Orange flavour) = 380 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. Not suitable for infants. Not suitable for use as a sole source of nutrition unless supplemented with a source of Îą-linolenic acid such as walnut oil. STORAGE Store in a cool dry place. Once opened a sachet should be stored in an airtight container and used within 2 - 3 days. PACK SIZE Emsogen is available in packs of 10 x 100g sachets. SHELF LIFE 2 years.

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Emsogen NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 1839 (1754) 368 (351) kcal 438 (418) 88 (83.6) Protein Equivalent g 12.5 2.5 Total Amino Acids g 15 3 Carbohydrate g 60 (55) 12 (11) of which sugars g 7.9 (8.6) 1.6 (1.7) Fat g 16.4 3.3 of which saturates g 13.2 2.6 monounsaturates g 0.6 0.12 polyunsaturates g 1.7 0.34 % LCT 17 % MCT 83 Ratio n6 : n3 fatty acids 46.5:1 % energy from linoleic acid 3.4 % energy from α linolenic acid 0.07 Fibre g nil added

Vitamins

per 100g powder

Vitamin A µg RE 330 IU 1099 Vitamin D µg 2.5 IU 100 Vitamin E mg α TE 6.1 IU 9.1 Vitamin C mg 28.3 Vitamin K µg 25 Thiamin mg 0.6 Riboflavin mg 0.6 Niacin mg 4.2 Niacin equivalent mg NE 9 Vitamin B6 mg 0.8 Folic Acid µg 83.3 Vitamin B12 µg 1.8 Biotin µg 18 Pantothenic Acid mg 2 Choline mg 91.6 Inositol mg 9.2

per 100ml*

66 220 0.5 20 1.2 1.8 5.7 5 0.12 0.12 0.84

Amino Acid Profile

g per 100g powder

Fatty Acid Profile

0.51 1.16 1 0.07 nil added 0.87 0.63 0.86 1.48 1.10 0.5 1.22 1.01 0.62 0.72 0.29 0.25 0.94 0.02 0.03 1.72

C6:0 C8:0 C10:0 C12:0 C16:0 C18:0 C18:1 C18:2 C18:3

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100 g powder

per 100ml*

Trace Elements

300 13 466 11.9 327 9.2 245 200 81.6

60 2.6 93.2 2.4 65.4 1.8 49 40 16.3

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

g per 100g Fatty Acids 1.4 59.2 20.4 1.9 2 0.27 3.9 10.7 0.23

per 100g per powder 100ml*

4.2 0.4 4.2 0.6 33.3 33.3 15 15

0.84 0.08 0.84 0.12 6.7 6.7 3 3

1.8 0.16 16.7 0.36 3.6 0.4 18.3 1.8

*At the recommended concentration of 20% w/v. Note: Figures in brackets represent flavoured Emsogen.

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Pepdite DESCRIPTION Pepdite is a nutritionally complete powdered infant formula consisting of a mixture of low molecular weight peptides (non-milk derived), essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. A food for special medical purposes. INDICATIONS Pepdite can be recommended for use in infants as a sole source of nutrition or as a supplementary feed where there is severe impairment of the gastrointestinal tract such as:

1. Malabsorption. 2. Bowel fistulae. 3. Short bowel syndrome. 4. Protracted diarrhoea

SUGGESTED INTAKE The quantity of Pepdite should be determined by a clinician or dietitian only and is dependent on age, bodyweight and medical condition of the patient. (See table below)

OSMOLALITY The osmolality of Pepdite at a 15% w/v concentration is 237 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use.

PREPARATION AND ADMINISTRATION Each level scoop (5g) of Pepdite requires 30ml (approx. 1 fl.oz) of water to yield the recommended feed concentration (15%).

STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened use within one month.

Approx age of baby from

Birth 3 Months 4 Months 7 Months 10 Months

Approx weight of baby kg 3.5 6 7.5 8.5 9.5

PACK SIZE Pepdite is available in 400g cans. SHELF LIFE 1 year. L

If formula is prepared in advance it must be cooled rapidly, stored in the refrigerator (2OC to 4OC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer than 15 minutes prior to feeding. Do not boil formula and do not use a microwave oven to prepare or warm formula. For tube feeding "hang time" should not exceed 4 hours.

Level scoops of Pepdite lb 7.75 13.25 16.5 18.75 21

3 4 6 7 8

Cooled, boiled water ml 90 120 180 210 240

Feed in 24 hours fl oz 3 4 6 7 8

6 6 5 5 5

The infant may require more or less than the quantities given here. If other foods are introduced, the amount of Pepdite should be reduced accordingly.

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Pepdite NUTRITION INFORMATION

per 100g powder

per 100ml*

Energy kJ 1977 297 kcal 472 71 Protein Equivalent g 13.8 2.1 Carbohydrate g 52 7.8 of which sugars g 4.7 0.7 Fat g 23.2 3.5 of which saturates g 7.1 1.1 monounsaturates g 10.6 1.6 polyunsaturates g 4.4 0.7 % LCT 95 % MCT 5 Ratio n6 : n3 fatty acids 10 : 1 % energy from linoleic acid 7.4 % energy from α linolenic acid 0.73 Fibre g nil added

Vitamins

per 100g powder

Vitamin A µg RE 528 IU 1758 Vitamin D µg 8.5 IU 340 Vitamin E mg α TE 3.3 IU 4.95 Vitamin C mg 40 Vitamin K µg 21 Thiamin mg 0.39 Riboflavin mg 0.6 Niacin mg 4.5 mg NE 10.3 Vitamin B6 mg 0.52 Folic Acid µg 38 Vitamin B12 µg 1.25 Biotin µg 26 Pantothenic Acid mg 2.65 Choline mg 50 Inositol mg 100 *

per 100ml*

79 264 1.3 51 0.5 0.74 6 3.2 0.06 0.09 0.7 1.5 0.08 5.7 0.19 3.9 0.4 7.5 15

Amino Acid Profile

g per 100g powder

Fatty Acid Profile

g per 100g Fatty Acids

0.8 0.94 1.0 0.34 1.7 1.5 0.25 0.9 1.4 1.2 0.26 0.66 1.1 0.51 0.77 0.35 0.26 0.9 0.01 0.03

C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3

0.15 2.1 2.4 14.4 4.8 7.33 1.1 0.83 47.37 17.53 1.73

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium : Phosphorus

per 100 g powder

230 10 385 9.9 250 7.1 300 232 34

per 100ml*

34.5 1.5 58 1.5 37.5 1.1 45 35 5.1

Trace Elements

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

per 100g per powder 100ml*

7 0.38 5 0.38 47 14.25 11 10

1 0.06 0.75 0.06 7.1 2.1 1.7 1.5

1.3 : 1

At the recommended concentration of 15% w/v.

The peptides used have a molecular weight distribution as follows: 64% <1000 Daltons, 34.2% 1000 - 5000 Daltons, 1.8% >5000 Daltons.

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Pepdite 1+ DESCRIPTION Pepdite 1+ is a nutritionally complete powdered feed consisting of a mixture of low molecular weight peptides (non-milk derived), essential amino acids, carbohydrate, fat, vitamins, minerals and trace elements. Available in Banana flavour (contains colours, sugars and sweeteners) or Unflavoured. A food for special medical purposes. INDICATIONS Pepdite 1+ can be recommended for use in children over 1 year as a sole source of nutrition or as a supplementary feed, where there is severe impairment of the gastrointestinal tract and where a semi-elemental diet is required such as: 1. 2. 3. 4.

Crohnâ&#x20AC;&#x2122;s disease. Malabsorption. Bowel fistulae. Short bowel syndrome following intestinal resection.

SUGGESTED INTAKE The quantity of Pepdite 1+ should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended feed concentration is 22.8% (ie. 100g powder made up to 440ml or 1 sachet made up to 250ml). This provides a 1kcal/ml feed. For sip or tube feeding: 1. Wash hands. 2. Measure out prescribed quantity of Pepdite 1+ or place contents of one sachet in a clean glass or cup. 3. Add a small amount of the water prescribed. Stir with a fork until a smooth paste is obtained. 4. Continue stirring whilst adding the rest of the prescribed water. Shake or stir immediately before use. Pepdite 1+ is now ready for use. Can be flavoured with SHS flavours or other suitable flavours. OSMOLALITY The osmolality of Unflavoured Pepdite 1+ at a 22.8% w/v concentration is 465 mosm/kg. The osmolality of flavoured Pepdite 1+ at a 22.8% w/v concentration is 461 mosm/kg. For osmotically sensitive patients a lower concentration may be required initially, until tolerance is achieved. 44

PRECAUTIONS Use under medical supervision. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Unflavoured Pepdite 1+ is available in 400g cans. Banana flavoured Pepdite 1+ is available in packs of 15 x 57g sachets. SHELF LIFE 1 year. NUTRITION INFORMATION

per 100g powder

per 100ml*

Energy kJ 1844 423 kcal 439 100 Protein Equivalent g 13.8 3.1 Carbohydrate g 57.0 13.0 as sugars g 5.1 1.2 Fat g 17.3 3.9 as saturates g 6.6 1.5 monounsaturates g 7.6 1.7 polyunsaturates g 2.3 0.52 % LCT 65 % MCT 35 Ratio n6 : n3 fatty acids 4:1 % energy from linoleic acid 4 % energy from Îą linolenic acid 1 Fibre g nil added

* At a concentration of 22.8% (1kcal/ml).

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Pepdite 1+ Amino Acid Profile

g per 100g powder

0.8 0.94 1.0 0.34 1.7 1.5 0.25 0.9 1.4 1.2 0.26 0.66 1.1 0.51 0.77 0.35 0.26 0.9 0.01 0.03

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

Fatty Acid Profile C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3

per 100 g powder

210 9.1 515 13.2 170 4.8 245 210 71.2

g per 100g Fatty Acids 0.04 20.58 14.18 0.04 0.03 3.14 0.13 1.23 44.57 11.39 2.89

per 100ml*

47.9 2.1 117 3 38.8 1.1 55.9 47.9 16.2

Vitamins

per 100g powder

per 100ml*

Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K μg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic Acid μg Vitamin B12 μg Biotin μg Pantothenic Acid mg Choline mg Inositol mg

378 1259 2.6 104 6.5 9.7 33 25 0.67 0.67 4.8 10.6 0.87 100 2 20 2.3 106 9.2

86.2 287 0.59 23.7 1.5 2.2 7.5 5.7 0.15 0.15 1.1 2.4 0.2 22.8 0.46 4.6 0.52 24.2 2.1

Trace Elements

per 100g powder

Iron mg Copper mg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

4.8 0.48 4.8 0.72 38.7 38 15 15

per 100ml*

1.1 0.11 1.1 0.16 8.8 8.7 3.4 3.4

* At the concentration of 22.8% w/v (1 kcal / ml). The peptides used have a molecular weight distribution as follows: 64% <1000 Daltons, 34.2% 1000 - 5000 Daltons, 1.8% >5000 Daltons.

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MCT Pepdite DESCRIPTION MCT Pepdite is a nutritionally complete powdered infant feed consisting of low molecular weight peptides (non-milk derived), supplemented with essential amino acids, carbohydrate, fat (75% MCT), vitamins, minerals and trace elements. A food for special medical purposes. INDICATIONS MCT Pepdite can be recommended for use in infants to provide complete nutritional support or as a supplementary feed where there is severe impairment of the gastrointestinal tract and where a high MCT, semi-elemental diet is required such as: 1. Severe malabsorption where there are difficulties with fat absorption e.g. lymphatic disorders. 2. Short bowel syndrome following intestinal resection. 3. Bowel fistulae. 4. Transition from parenteral to enteral nutrition.

Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding. NOTE: If formula is prepared in advance it must be cooled rapidly, stored in the refrigerator (2OC to 4OC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer than 15 minutes prior to feeding. Do not boil formula and do

SUGGESTED INTAKE The quantity of MCT Pepdite should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION Each level scoop (5g) of MCT Pepdite requires 30ml of water (approximately 1fl.oz) to yield the recommended feed concentration of 15%. 1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to the wrist. Pour the required amount of water into a sterilised feeding bottle. 3. Fill the scoop provided with MCT Pepdite and level off with a clean, dry knife. Do not press the powder into the scoop. Only use the scoop provided. 4. Add the prescribed number of scoops of MCT Pepdite to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding ensure that the formula is at the correct temperature by placing a few drops on the wrist. 5. Formula remaining in the bottle after one hour of feeding should be discarded. Formula must not be rewarmed during feeding.

not use a microwave oven to prepare or warm formula. For tube feeding "hang time" should not exceed 4 hours.

MCT Pepdite is now ready for use. When bottle feeding, prolonged or frequent contact of feeds with the infants teeth should be discouraged as this increases the risk of tooth decay. Cleaning the infants teeth after the last feed at night should be encouraged. OSMOLALITY The osmolality of MCT Pepdite at a 15%w/v dilution is 290 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened, use within one month. PACK SIZE MCT Pepdite is available in 400g cans. SHELF LIFE 2 years.

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MCT Pepdite NUTRITION INFORMATION

per 100g per powder 100ml*

1903 286 Energy kJ 453 68 kcal 13.8 2 Protein Equivalent g 59 8.8 Carbohydrate g 8.1 1.2 of which sugars g 18 2.7 Fat g 2 of which saturates g 13.2 0.8 0.12 monounsaturates g 3 0.45 polyunsaturates g 25% % LCT 75% % MCT Ratio n6 : n3 6.9 : 1 fatty acids % energy from 5.1 linoleic acid % energy from 0.75 α linolenic acid nil added Fibre g

Vitamins

per 100g powder

per 100ml*

528 1758 8.5 340 3.3 4.95 40 21 0.39 0.6 4.5 10.3 0.52 38 1.25 26 2.65 50 100

79 264 1.3 51 0.5 0.74 6 3.2 0.06 0.09 0.7 1.5 0.08 5.7 0.19 3.9 0.4 7.5 15

Amino Acid Profile

g per 100g powder

0.8 0.94 1 0.34 1.7 1.5 0.25 0.9 1.4 1.2 0.26 0.66 1.1 0.51 0.77 0.35 0.26 0.9 0.01 0.03

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium : Phosphorus

Fatty Acid Profile

g per 100g Fatty Acids

C6:0 C8:0 C10:0 C12:0 C16:0 C18:0 C18:1 C18:2 C18:3

per 100g powder

per 100ml*

Trace Elements

230 10.0 385 9.9 250 7.1 300 232 34.0

34.5 1.5 58 1.5 37.5 1.1 45 35 5.1

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

0.4 55.2 19.8 0.5 1.6 0.4 4.8 15.1 2.2

per 100g per powder 100ml*

7 0.38 5.0 0.38 47 14.25 11 10

1 0.06 0.75 0.06 7 2.1 1.7 1.5

1.3:1

* At the recommended concentration of 15% w/v. The peptides used have a molecular weight distribution as follows: 64% <1000 Daltons, 34.2% 1000 - 5000 Daltons, 1.8% >5000 Daltons.

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MCT Pepdite 1+ DESCRIPTION MCT Pepdite 1+ is a nutritionally complete powdered feed consisting of low molecular weight peptides (non-milk derived), essential amino acids, carbohydrate, fat (75% MCT), vitamins, minerals and trace elements. A food for special medical purposes. INDICATIONS MCT Pepdite 1+ can be recommended for use in children over 1 year and adults to provide complete nutrition support or as a supplementary feed where there is severe impairment of the gastrointestinal tract and where a high MCT, semi-elemental diet is required such as: 1. Severe malabsorption where there are difficulties with fat absorption. 2. Short bowel syndrome following intestinal resection. 3. Bowel fistulae. 4. Transition from parenteral to enteral nutrition. SUGGESTED INTAKE The quantity of MCT Pepdite 1+ should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended feed concentration is 20% w/v (1 in 5 i.e. 20g MCT Pepdite 1+ made up to 100ml with water). For Sip or Tube Feeding: 1. Wash hands. 2. Add small amount of water to the prescribed amount of MCT Pepdite 1+. Stir with a fork until a smooth paste is achieved. 3. Continue stirring whilst adding water up to the required volume. MCT Pepdite 1+ is now ready for use. Can be flavoured with SHS flavours or other suitable flavourings.

OSMOLALITY The osmolality of MCT Pepdite 1+ at a 20% w/v concentration is 460 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. Not suitable for infants. STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened, use within one month. PACK SIZE MCT Pepdite 1+ is available in 400g cans. SHELF LIFE 2 years.

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MCT Pepdite 1+ NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 1903 381 kcal 453 91 Protein Equivalent g 13.8 2.8 Carbohydrate g 59 11.8 of which sugars g 8.1 1.6 Fat g 18 3.6 of which saturates g 13.6 2.7 monounsaturates g 0.83 0.17 polyunsaturates g 3 0.6 % LCT 25% % MCT 75% Ratio n6 : n3 fatty acids 6.9 : 1 % energy from linoleic acid 5.1 % energy from α linolenic acid 0.75 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

378 1259 2.6 104 6.5 9.7 33 25 0.67 0.67 4.8 10.6 0.87 100 2 20 2.3 106 9.2

76 252 0.52 20.8 1.9 1.3 6.6 5 0.13 0.13 0.96 2.1 0.17 20 0.4 4 0.46 21.2 1.8

Amino Acid Profile

g per 100g powder

0.8 0.94 1 0.34 1.7 1.5 0.25 0.9 1.4 1.2 0.26 0.66 1.1 0.51 0.77 0.35 0.26 0.9 0.01 0.03

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100 g powder

210 9.1 515 13.2 170 4.8 245 210 71.2

Fatty Acid Profile

g per 100g Fatty Acids

C6:0 C8:0 C10:0 C12:0 C16:0 C18:0 C18:1 C18:2 C18:3

per 100ml*

Trace Elements

42 1.8 103 2.6 34 0.96 49 42 14.2

Iron mg Copper μg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

0.95 55.5 19.3 1.4 1.9 0.91 4.9 15.2 2.2

per 100g per powder 100ml*

4.8 0.48 4.8 0.72 38.7 38 15 15

0.96 0.1 0.96 0.14 7.7 7.6 3 3

* At the recommended concentration of 20% w/v. The peptides used have a molecular weight distribution as follows: 64% <1000 Daltons, 34.2% 1000 - 5000 Daltons, 1.8% >5000 Daltons.

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Monogen DESCRIPTION Monogen is a nutritionally complete, low fat, powdered feed containing whey protein, carbohydrate, fat (low in long chain triglycerides (LCT's) and high in medium chain triglycerides (MCT's)), vitamins, minerals and trace elements. A food for special medical purposes. INDICATIONS Monogen can be recommended for use in infants as a sole source of nutrition or as a supplementary feed for children for the dietary management of the following conditions: 1. 2. 3. 4. 5.

Hyperlipoproteinaemia type 1. Long chain fatty acid oxidation defects (LCHADs). Intestinal lymphangectasia. Chylothorax (some patients may require lower fat). Intractable malabsorption with steatorrhoea.

Monogen was specifically designed to keep the level of LCT to a minimum whilst meeting the basic requirements of essential fatty acids as recommended at the time of formulation. It contains 1% of calories as linoleic acid 1, which is regarded as adequate for infants, children and adults. Higher levels are recommended by the Infant Formula Guidelines. 2,3 The level in Monogen is designed to meet minimum requirements due to the varying severity of presentation of LCHADâ&#x20AC;&#x2122;s where there can be minimal tolerance of LCTâ&#x20AC;&#x2122;s. Patients should therefore have their essential fatty acid levels monitored in case of biochemical deficiency. SUGGESTED INTAKE The quantity of Monogen should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended feed concentration is 17.5% w/v (17.5g Monogen made up to 100ml with water). Each level scoop (5g) of Monogen requires 25ml of water to yield the recommended feed concentration (17.5%). 1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to the wrist. Pour the required amount of water into a sterilised feeding bottle. 3. Fill the scoop provided with Monogen and level off with a clean, dry knife. Do not press the powder into the scoop. Only use the scoop provided. 4. Add the prescribed number of scoops of Monogen to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding ensure that the formula is at the correct temperature by placing a few drops on the wrist.

5. Formula remaining in the bottle after one hour of feeding should be discarded. Formula must not be rewarmed during feeding. Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding. NOTE: If formula is prepared in advance it must be cooled rapidly, stored in the refrigerator (2OC to 4OC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer than 15 minutes prior to feeding. Do not boil formula and do not use a microwave oven to prepare or warm formula. For tube feeding "hang time" should not exceed 4 hours.

Monogen is now ready for use. When bottle feeding, prolonged or frequent contact of feeds with the infant's teeth should be discouraged as this increases the risk of tooth decay. Cleaning the infant's teeth after the last feed at night should be encouraged. Monogen may be flavoured with a separate flavour from the SHS flavour range. Flavouring is not recommended for infants less than six months. OSMOLALITY The osmolality of Monogen at a 17.5% w/v dilution is 280 mosm/kg. PRECAUTIONS Use under medical supervision. Patients should have their essential fatty acid levels monitored in case of biochemical deficiency. Additional supplementation of essential fatty acids may be necessary in some patients, using a source such as walnut oil. Not for parenteral use. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Monogen is available in 400g cans. SHELF LIFE 18 months.

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Monogen NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 1786 313 kcal 424 74.2 Protein Equivalent g 11.4 2 Carbohydrate g 68 12 of which sugars g 6.7 1.2 Fat g 11.8 2.1 of which saturates g 10.3 1.8 monounsaturates g 0.35 0.06 polyunsaturates g 0.6 0.11 % LCT 10 % MCT (<C12:0) 90 Ratio n6 : n3 fatty acids 4.6 : 1 % energy from linoleic acid 1 % energy from α linolenic acid 0.21 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

325 56.9 1082 189 6.6 1.2 264 46.2 2.75 0.5 4.1 0.7 35 6.2 21 3.7 0.35 0.06 0.52 0.09 3.9 0.68 7.4 1.3 0.4 0.07 47 8.2 0.86 0.15 22.3 3.9 1.46 0.25 56 9.75 85.7 15

Amino Acid Profile

g per 100g powder

0.52 0.3 1.1 0.32 0.7 0.2 0.29 0.8 1.3 1.14 0.31 0.52 0.6 0.45 0.94 0.24 0.51 0.73 0.01 2 0.03

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium : Phosphorus

per 100 g powder

200 8.7 360 9.2 214 6 257 200 35

Fatty Acid Profile C6 C8 C10 C12 C14:0 C16:0 C18:0 C18:1 C18:2 C18:3

per 100ml*

35 1.5 63 1.6 37.5 1.1 45 35 6.1

Trace Elements

Iron mg Copper mg Zinc mg Manganese mg Iodine μg Molybdenum µg Selenium µg Chromium µg

g per 100g Fatty Acids 2.5 49 36 2.5 0.4 0.8 0.6 3.1 4.2 0.9

per 100g per powder 100ml*

4.2 0.34 3.3 0.33 40.6 21.4 10.8 10

0.74 0.06 0.6 0.06 7.1 3.75 1.9 1.75

1.3 : 1

* At the recommended concentration of 17.5% w/v. References 1. Department of Health. Report of the Panal on Dietary Reference Values of the Committee on Medical Aspects of Food Policy (COMA). Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report on Health and Social Subject 41. London: HMSO, 1991.

3. Statutory Instrument 1995 No. 77 The Infant Formula and Follow-on Formula Regulations 1995. ISBN 0110523989

2. 96/4/EC Commission Directive. Infant Formulae and follow-on formulae. Offical Journal of the European Communities. No L 49/12. 28/02/96

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Kindergen DESCRIPTION Kindergen is a nutritionally complete powdered feed consisting of whey protein, carbohydrate, fat, vitamins, minerals and trace elements with low levels of potassium, chloride, calcium, phosphorus and vitamin A. A food for special medical purposes. INDICATIONS Kindergen is specifically designed as a sole source of nutrition or as a supplementary feed for the dietary management of infants and children with chronic renal failure where peritoneal rapid overnight dialysis (PROD) or continuous cycling peritoneal dialysis (CCPD) is required. In order to minimise the risk of bone disease the phosphate level was designed to be low and the calcium adjusted accordingly to give a calcium to phosphorus ratio of 1.2:1. Other modifications include a slightly higher sodium and a higher percentage of calories from fat. SUGGESTED INTAKE The quantity of Kindergen should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION Every 4 scoops of Kindergen (20g) requires 84ml of water to yield the recommended feed concentration of 20%. Each level scoop weighs approximately 5g of Kindergen. 1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to the wrist. Pour the required amount of water into a sterilised feeding bottle. 3. Fill the scoop provided with Kindergen and level off with a clean, dry knife. Do not press the powder into the scoop. Only use the scoop provided. 4. Add the prescribed number of scoops of Kindergen to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding, ensure that the formula is at the correct temperature by placing a few drops on the wrist. 5. Formula remaining in the bottle after one hour of feeding should be discarded. Formula must not be rewarmed during feeding. Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding. 52

NOTE: If formula is prepared in advance it must be cooled rapidly, stored in the refrigerator (2OC to 4OC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer than 15 minutes prior to feeding. Do not boil formula and do not use a microwave oven to prepare or warm formula. For tube feeding "hang time" should not exceed 4 hours.

For tube and sip feeding preparation 1. Use the scoop (5g) provided or weigh out the prescribed amount of Kindergen. 2. Add a small amount of the prescribed water to required amount of Kindergen and stir with a fork until a smooth paste is obtained. Continue stirring whilst adding the rest of the water until the prescribed dilution is achieved. Kindergen is now ready for use. When bottle feeding, prolonged or frequent contact of feeds with the infant's teeth should be discouraged as this increases the risk of tooth decay. Cleaning the infant's teeth after the last feed at night should be encouraged. OSMOLALITY The osmolality of Kindergen at a 20% w/v concentration is 215 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. Due to the low content of potassium, chloride, calcium, phosphorus and vitamin A in this product which maybe required in chronic renal failure, levels should be monitored and individual nutrients supplemented if required. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Kindergen is available in 400g cans. SHELF LIFE 1 year.

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Kindergen NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 2104 421 kcal 503 101 Protein g 7.5 1.5 Carbohydrate g 59 11.8 of which sugars g 6.1 1.2 Fat g 26.3 5.3 as saturates g 8.6 1.7 monounsaturates g 11.9 2.4 polyunsaturates g 4.5 0.9 % LCT 93 % MCT 7 Ratio n6:n3 fatty acids 11:1 % energy from linoleic acid 7.4 % energy from α linolenic acid 0.7 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

130 433 5.4 216 2.8 4.2 42 25.4 0.35 0.45 4.6 6.9 0.45 82 0.9 23 1.6 37.6 17.6

26 86.6 1.1 43.2 0.56 0.84 8.4 5.1 0.07 0.09 0.92 1.4 0.09 16.4 0.18 4.6 0.3 7.5 3.5

Amino Acid Profile

g per 100g powder

Fatty Acid Profile

g per 100g Fatty Acids

0.34 0.2 0.75 0.21 0.48 0.12 0.14 0.52 0.85 0.75 0.2 0.34 0.38 0.3 0.62 0.16 0.34 0.48 0.01 1.4 0.03

C4:0 C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1

2.7 0.1 2.1 2.4 13.6 5.3 7.3 0.1 1 47.4 16.5 1.5 0.19 0.21

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium: Phosphorus

per 100 g powder

per 100ml*

Trace Elements

232 10 120 3 85 2.4 112 93 55

46.4 2 24 0.6 17 0.48 22.4 18.6 11

Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

per 100g per powder 100ml*

4.8 0.45 4.2 0.45 35 30.5 13 12.5

0.96 0.09 0.84 0.09 7 6.1 2.6 2.5

1.2:1

* At the recommended concentration of 20% w/v (1 in 5 dilution).

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Caprilon DESCRIPTION Caprilon is a nutritionally complete, high medium chain triglyceride (MCT), powdered formula containing cowâ&#x20AC;&#x2122;s milk protein, carbohydrate, fat, vitamins, minerals and trace elements. A food for special medical purposes. INDICATIONS Caprilon is designed as a sole source of nutrition for infants or as a supplementary feed in children for the dietary management of disorders of long chain triglyceride (LCT) digestion, absorption or transport such as hepatic disease. SUGGESTED INTAKE The quantity of Caprilon should be determined by the clinician or dietitian and is dependent on the age, bodyweight, and medical condition of the patient. PREPARATION AND ADMINISTRATION Each level scoop (4.2g) of Caprilon requires 30ml of water (approximately 1fl.oz) to yield the recommended feed concentration of 12.7%. 1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to the wrist. Pour the required amount of water into a sterilised feeding bottle. 3. Fill the scoop provided with Caprilon and level off with a clean, dry knife. Do not press the powder into the scoop. Only use the scoop provided. 4. Add the prescribed number of scoops of Caprilon to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding ensure that the formula is at the correct temperature by placing a few drops on the wrist. 5. Formula remaining in the bottle after one hour of feeding should be discarded. Formula must not be rewarmed during feeding. Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding.

Caprilon is now ready for use. When bottle feeding, prolonged or frequent contact of feeds with the infant's teeth should be discouraged as this increases the risk of tooth decay. Cleaning the infant's teeth after the last feed at night should be encouraged. OSMOLALITY The osmolality of Caprilon at 12.7% w/v concentration is 233 mosm/kg. PRECAUTIONS Use under medical supervision. Not for parenteral use. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Caprilon is available in 420g cans. SHELF LIFE 2 years.

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Caprilon NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 2184 277 kcal 522 66.3 Protein g 11.8 1.5 Carbohydrate g 55.1 7.0 of which sugars g 10.5 1.3 Fat g 28.3 3.6 of which saturates g 21.8 2.8 monounsaturates g 1.6 0.2 polyunsaturates g 3.7 0.47 % LCT 25% % MCT 75% Ratio n6 : n3 fatty acids 7.5:1 % energy from linoleic acid 5.6 % energy from α linolenic acid 0.75 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

600 1998 15 600 6.4 9.5 60 40 0.3 0.8 4.8 7.6 0.45 80 1.6 12 2.0 55 20.7

76 254 1.9 76.2 0.8 1.2 7.6 5.1 0.04 0.10 0.61 0.97 0.06 10.2 0.20 1.5 0.25 7.0 2.6

Amino Acid Profile

g per 100g powder

0.52 0.37 1.13 0.17 2.5 0.23 0.27 0.71 1.2 1.2 0.3 0.5 0.88 0.69 0.75 0.17 0.47 0.75 0.007 0.03

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium : Phosphorus

per 100 g powder

160 6.9 525 13.5 315 9 420 230 40

Fatty Acid Profile C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:1 C24:0 Other fatty acids

per 100ml*

20.3 0.88 67 1.7 40 1.14 53.3 29.2 5.1

Trace Elements

g per 100g Fatty Acids 0.4 43.7 31 0.5 0.3 2.9 0.07 1.1 5.8 12 1.6 0.07 0.05 0.1 0.02 0.3

per 100g per powder 100ml*

4.0 Iron mg 340 Copper µg 3 Zinc mg 0.65 Manganese mg 78 Iodine µg 18.5 Molybdenum µg 13.5 Selenium µg 10.3 Chromium µg

0.51 43.2 0.38 0.08 9.9 2.35 1.71 1.31

1.8:1

* At the recommended concentration 12.7% w/v.

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Locasol DESCRIPTION Locasol is a nutritionally complete powdered feed containing cowâ&#x20AC;&#x2122;s milk protein, carbohydrate, fat, vitamins, minerals and trace elements with a very low calcium and vitamin D content. A food for special medical purposes.

INDICATIONS Locasol is designed for use as a sole source of nutrition in infants or as a supplementary feed in children and adults in the dietary management of those conditions where an extreme restriction of calcium and vitamin D is required. SUGGESTED INTAKE The quantity of Locasol should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION Each level scoop (4.4g) of Locasol requires 30ml of water (approximately 1fl.oz) to yield the recommended feed concentration of 13.1%.

Locasol is now ready for use. 1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to the wrist. Pour the required amount of water into a sterilised feeding bottle. 3. Fill the scoop provided with Locasol Formula and level off with a clean, dry knife. Do not press the powder into the scoop. Only use the scoop provided. 4. Add the prescribed number of scoops of Locasol Formula to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding ensure that the formula is at the correct temperature by placing a few drops on the wrist. 5. Formula remaining in the bottle after one hour of feeding should be discarded. Formula must not be rewarmed during feeding.

OSMOLALITY The osmolality of Locasol at a 13.1% concentration is 310 mosm/kg. PRECAUTIONS Use under medical supervision. Only intended for use by patients with hypercalcaemia. Not for parenteral use.

STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened, use within one month. PACK SIZE Locasol is available in 400g cans. SHELF LIFE 2 years.

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Locasol NUTRITION INFORMATION

per 100g per powder 100ml*

2125 278 Energy kJ 508 66 kcal 14.6 1.9 Protein g 53.7 7.0 Carbohydrate g 52.5 6.9 of which sugars g 26.1 3.4 Fat g 9.2 1.2 of which saturates g 12.6 1.7 monounsaturates g 3.1 0.4 polyunsaturates g Ratio n6 : n3 fatty 5.4 acids % energy from 4.6 linoleic acid % energy from 0.85 α linolenic acid nil added Fibre g

Vitamins

per 100g powder

per 100ml*

Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α T.E. IU Vitamin C mg Vitamin K μg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic acid μg Vitamin B12 μg Biotin μg Pantothenic Acid mg Choline mg Inositol mg

600 78.6 1998 262 nil added nil added 7.4 0.97 11 1.4 60 7.9 40 5.2 0.3 0.04 0.8 0.1 4.5 0.59 7.8 1 0.3 0.04 80 10.5 1.5 0.2 12 1.6 2 0.26 50 6.5 25 3.3

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg Calcium: Phosphorous

g per 100g powder 0.55 0.54 1.23 0.1 3.5 0.29 0.42 0.85 1.5 1 0.44 0.75 1.3 0.93 0.79 0.2 0.79 1 0.007 0.03

per 100g powder

205 8.9 600 15.4 460 13.1 <55 350 50

Fatty Acid Profile

g per 100g Fatty Acids

C4:0 C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:1 C24:0 Other fatty acids

per 100ml*

26.8 1.2 78.5 2.0 60 1.7 <7 46 6.5

Trace Elements

Iron mg Copper μg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

0.05 0.1 1.3 1.1 8.3 3.8 18.1 0.2 3.6 49.3 10.6 1.95 0.4 0.4 0.1 0.14 0.5

per 100g per powder 100ml*

4.0 310 3.0 0.4 78 35 11.5 30

0.52 41 0.39 0.05 10 4.6 1.5 3.9

0.16:1

* At the recommended concentration: 13.1% w/v.

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Ketocal DESCRIPTION Ketocal is a very high fat (73%), low carbohydrate powdered formula, containing milk protein, supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. Available in Vanilla flavour (contains sweetners) or Unflavoured. A food for special medical purposes.

INDICATIONS Ketocal is a nutritionally complete powdered product which can be used to administer the classical (4:1)1 ketogenic diet for the dietary management of intractable epilepsy. Ketocal can provide complete nutritional support or supplementary feeding for children over 1 year of age. SUGGESTED INTAKE The quantity of Ketocal should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended dilution is 1 in 5 i.e. 20g plus 80ml to yield a final volume of 100ml. For a less concentrated feed a 1 in 7 dilution can be used, i.e. 20g plus 120ml water to yield a final volume of 140ml. The volume of feed may need to be increased gradually over several days to minimise the risk of any possible gastrointestinal symptoms. For tube or sip feeding: 1. Measure the required amount of warm water into a container that seals with a screw top lid. Ketocal must be made up with hot water (45 – 500C or 1130 – 1220F) to fully dissolve. Measure the temperature using a thermometer or mix freshly boiled water and cold tap water in a 1 : 1 ratio to achieve this temperature. 2. Add the prescribed amount of Ketocal to the water. 3. Whisk or shake vigorously until the powder is completely dissolved 4. Remove the lid carefully. Chill in a refrigerator if desired and use within 24 hours of preparation. 5. Stir before use. On standing, some settling of Ketocal may occur which is a normal feature of the product. This settling should not block an enteral tube however it is recommended that the tube is flushed with water between each feed. Carbohydrate – free flavourings may be added to the reconstituted product to taste based on individual preference. Ketocal (g) 20 100 200

+ water (mls)

Final Volume (ml)

Calorie per ml

80 400 800

100 500 1000

1.46 1.46 1.46

OSMOLALITY Osmolality of Ketocal at a 20% w/v dilution: Unflavoured = 230 mosm/kg Flavoured = 240 mosm/kg Osmolality of Ketocal at a 1 in 7 dilution: Unflavoured = 160 mosm/kg Flavoured = 170 mosm/kg PRECAUTIONS Use under medical supervision. Not suitable for infants. Not for parenteral use. Patients should be monitored closely for hypoglycaemia, renal stones, adequate growth and hyperlipidaemia. STORAGE Store in a cool, dry place. Always replace container lid after use. Once opened, use within one month. PACK SIZE Ketocal is available in 300g cans. SHELF LIFE Unflavoured: 1 year. Flavoured: 1 year. Reference 1. The classical ketogenic diet is a high fat, low carbohydrate and low protein diet providing 4:1 ratio of 4g fat to every 1g of non fat (protein and carbohydrate) energy.

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Ketocal NUTRITION INFORMATION

per 100g per per powder 100kcal* 100ml**

Amino Acid Profile

Energy kJ 3011 413 602 kcal 730 100 146 Protein g 15.25 2.1 3.1 Carbohydrate g 3 0.4 0.6 of which sugars g 0.59 0.08 0.12 Fat g 73 10 14.6 of which saturates g 16.2 2.2 3.2 monounsaturates g 17.4 2.4 3.5 polyunsaturates g 10.9 1.5 2.2 total trans fatty acids g 25.3 3.5 5.1 % LCT 100 Ratio n6 : n3 fatty acids 11 : 1 % energy from linoleic acid 13.8 % energy from α linolenic acid 1.3 Fat : protein + carbohydrate 4:1 Fibre g nil added nil added Vitamins per 100g per per powder 100kcal* 100ml**

Vitamin A μg RE 380 IU 1265 Vitamin D μg 5.2 IU 208 Vitamin E mg α TE 7.4 IU 11 Vitamin C mg 45 Vitamin K μg 30 Thiamin mg 0.7 Riboflavin mg 0.75 Niacin mg 7.5 mg NE 14.2 0.75 Vitamin B6 mg Folic Acid μg 110 Vitamin B12 μg 0.8 Biotin μg 20 Pantothenic Acid mg 3 Choline mg 250 Inositol mg 20

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

52.1 173 0.71 28.5 1 1.5 6.2 4.1 0.1 0.1 1 1.9 0.1 15.1 0.11 2.7 0.41 34.3 2.7

76 253 1 41.6 1.5 2.2 9 6 0.14 0.15 1.5 2.8 0.15 22 0.16 4 0.6 50 4

Minerals

Trace Elements

Iron mg Copper μg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

g per 100g powder 0.49 0.52 1.05 0.35 3.2 0.28 0.44 0.8 1.45 1.2 0.41 0.74 1.5 0.78 0.85 0.4 0.78 0.96 0.04 0.03

Fatty Acid Profile C12:0 C14:0 C16:0 C18:0 C18:1 C18:1 C18:2 C18:2 C18:3 C18:3 C20:0 C22:0

per 100 g powder

g per 100g Fatty Acids

cis trans cis trans cis trans

0.1 0.1 12.1 10.3 25.0 34.3 14.5 1.6 1.2 0.3 0.3 0.2

per 100kcal*

per 100ml**

68.5 3 110 2.8 103 3 58.9 58.9 15.1

100 4.3 160 4.1 150 4.3 86 86 22

per 100g powder

per 100kcal*

per 100ml**

7.4 600 6 0.65 90 30 22 15

1 82.2 0.82 0.09 12.3 4.1 3 2.1

500 21.7 800 20.5 750 21.4 430 430 110

1.5 120 1.2 0.13 18 6 4.4 3

* Approximately 13.7g powder. ** At recommended concentration of 20%w/v.

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Generaid Plus DESCRIPTION Generaid Plus is a powdered feed based on whey protein supplemented with branched chain amino acids (BCAA) and other essential amino acids, carbohydrates, fat, vitamins, minerals (low in sodium) and trace elements. A food for special medical purposes. INDICATIONS Generaid Plus can be used as a sole source of nutrition or as a supplementary feed for children over 1 year of age for the dietary management of hepatic disease, particularly cholestatic liver disease such as biliary atresia. The whey protein in Generaid Plus is low in aromatic amino acids and supplemented with branched chain amino acids, which may be preferentially utilised in liver disease, enhancing positive nitrogen balance. Generaid Plus has 32% of the fat in the form of MCT, which can be absorbed in the absence of bile acids, therefore may be tolerated in conditions such as cholestasis. The sodium level of Generaid Plus is low, and enables the feed to be concentrated if necessary to provide additional nutrition without excessive intake of sodium if ascites is present. SUGGESTED INTAKE The quantity of Generaid Plus should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient.

Generaid Plus may be flavoured with a separate flavour from the SHS flavour range. OSMOLALITY The osmolality of Generaid Plus at a 22% w/v dilution is 390 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for infants. Not for parenteral use. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Generaid Plus is available in 400g cans. SHELF LIFE 2 years.

PREPARATION AND ADMINISTRATION The recommended feed concentration is 22% w/v (i.e. 22g Generaid Plus made up to 100ml with water). Each level scoop weighs 5g of Generaid Plus. For sip or tube feeding: 1. Wash hands. 2. Add small amount of water to the prescribed amount of Generaid Plus. Stir with a fork until a smooth paste is achieved. 3. Continue stirring whilst adding water up to the required volume. Generaid Plus is now ready for use.

Dilution % w/v

Generaid Plus

Water (ml) (made up to 100mls)

kcal/ml

88.5

0.8

Osmolality mosm/kg 280

84.5

390

74.6

1.6

810

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Generaid Plus NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ 1944 428 kcal 463 102 Protein Equivalent g 11 2.4 % as BCAA 32 Carbohydrate g 62 13.6 of which sugars g 6.3 1.4 Fat g 19 4.2 of which saturates g 7.9 1.7 monounsaturates g 7.8 1.7 polyunsaturates g 2.4 0.53 % LCT 68 % MCT 32 Ratio n6 : n3 fatty acids 4:1 % energy from linoleic acid 3.7 % energy from α linolenic acid 0.95 Fibre g nil added

Vitamins

per 100g powder

267 890 5.9 236 4.2 6.2 23.7 25.5 0.44 0.59 6.9 10.2 0.59 73 0.51 12.7 1.8 138 13.6

per 100ml*

58.7 196 1.3 51.9 0.9 1.4 5.2 5.6 0.1 0.13 1.5 2.2 0.13 16.1 0.11 2.8 0.4 30.4 3

Amino Acid Profile

g per 100g powder 0.38 0.72 0.83 0.33 0.54 0.14 0.16 0.82 2.04 0.87 0.32 0.47 0.74 0.33 0.72 0.2 0.44 1.27 1.39

per 100 g powder

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

69 3 470 12.1 430 12.3 312 235 43

Fatty Acid Profile C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:0 C22:1

per 100ml*

15.2 0.7 103 2.6 94.6 2.7 68.6 51.7 9.5

Trace Elements

Iron mg Copper μg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

g per 100g Fatty Acids 0.32 18.9 13.1 0.21 0.7 6.2 0.2 3.6 42 10.6 2.7 0.48 0.55 0.21 0.23

per 100g per powder 100ml*

4.1 380 3.2 0.32 49 20.8 17.5 8.1

0.9 83.6 0.7 0.07 10.8 4.6 3.9 1.8

*At the recommended concentration of 22% w/v (1kcal/ml).

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Hepatical DESCRIPTION Hepatical is a nutritionally complete, powdered feed containing whey protein, supplemented with branched chain and other essential amino acids, fat, carbohydrate, vitamins, minerals and trace elements. Available in Lemon & Lime flavour, Banana-Caramel flavour or Unflavoured. A food for special medical purposes. INDICATIONS Hepatical can be used to provide complete nutritional support or as a supplementary feed for adults for the dietary management of acute hepatitis and end stage liver disease.1 SUGGESTED INTAKE The quantity of Hepatical should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The suggested dilution of Hepatical is 1 in 2.5 (100g made up to 250mls) which will yield a 1.5kcal/ml solution To prepare a 1 in 2.5 dilution paste the contents of 1 sachet (100g) of Hepatical with a small amount of cold water until a smooth paste is obtained. Continue stirring whilst gradually adding additional water until a final volume of 250ml is reached. Alternatively measure 180ml into a container with a lid, add 1 sachet (100g) to the water. Replace the lid and shake until the product is dissolved. This gives a final volume of 250ml. This dilution is a guideline only. The amount of water prescribed will depend on individual fluid requirements and tolerance. Hepatical is now ready for use. OSMOLALITY The osmolality of Hepatical at a 40% w/v dilution is: Unflavoured: 1250 mosm/kg. Banana Caramel flavour: 1380 mosm/kg PRECAUTIONS Use under medical supervision. Not suitable for infants. Not for parenteral use.

STORAGE Store in a cool, dry place. Once opened, a sachet should be stored in an airtight container and used within 2-3 days. PACK SIZE Hepatical is available in packs of 10 x 100g sachets. SHELF LIFE 2 years. References 1. CabrĂŠ E et al. Short and long Term Outcome of Severe Alcohol Induced Hepatitis treated with Steroids or Enteral Nutrition: A multicenter Randomised Trial. Hepatology 2000; 32:36-42

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Hepatical NUTRITION INFORMATION

per 100g per powder 100ml*

Energy kJ kcal Protein Equivalent g % BCAA Carbohydrate g of which sugars g

1647 659 390 156 14 5.6 31 67 26.8 5.8(11.3) 2.3 (4.5) [6.5] [2.6] Fat g 7.3 2.9 of which saturates g 3 1.2 monounsaturates g 3 1.2 polyunsaturates g 0.9 0.36 % LCT 68 % MCT 32 Ratio n6 : n3 fatty acids 4:1 % energy from linoleic acid 1.6 % energy from α linolenic acid 0.40 Fibre g nil added

Vitamins

per 100g powder

per 100ml*

Vitamin A μg RE IU Vitamin D μg IU Vitamin E mg α TE IU Vitamin C mg Vitamin K µg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic acid μg Vitamin B12 μg Biotin μg Pantothenic Acid mg Choline mg Inositol mg

280 932.4 2.7 108 2.2 3.3 30 20 0.7 0.8 6 11.3 0.8 65 0.8 19 1.6 70 9

112 373 1.1 43.2 0.88 1.3 12 8 0.28 0.32 2.4 4.5 0.32 26 0.32 7.6 0.64 28 3.6

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

g per 100g powder 0.49 0.91 1.1 0.45 1.2 0.18 0.2 1 2.6 0.98 0.4 0.61 0.72 0.42 0.91 0.32 0.57 1.6 1.8

per 100g powder

180 8 440 11 320 9 215 180 70

Fatty Acid Profile

g per 100g Fatty Acids

C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0

0.92 17.9 12.7 0.6 1.9 7.1 0.39 2.8 42.4 10.3 2.6 0.39

per 100ml*

Trace Elements

72 3.2 176 4.4 128 3.6 86 72 28

Iron mg Copper mg Zinc mg Manganese mg Iodine μg Molybdenum μg Selenium μg Chromium μg

per 100g per powder 100ml*

4.8 0.55 5.2 0.8 60 43 17 17

1.9 0.22 2.1 0.32 24 17.2 6.8 6.8

* At a 1 in 2.5 dilution : 40g made up to 100mls. Note: Figures in brackets represent: ( )Banana-Caramel flavour Hepatical [ ]Lemon & Lime flavour Hepatical

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Heparon Junior DESCRIPTION Heparon Junior is a nutritionally complete powdered formula containing cow’s milk protein, carbohydrate, fat, vitamins, minerals and trace elements with significantly increased levels of vitamins A, D, E and K, increased BCAA and zinc content, and low levels of sodium and very low levels of copper. INDICATIONS Heparon Junior is designed to provide complete nutritional support or supplementary feeding for infants and young children with acute and chronic liver failure. SUGGESTED INTAKE The quantity of Heparon Junior feed and the dilution should be determined by a clinician or a dietitian only and is dependent on the age, bodyweight and medical condition of the patient. Contraindicated in Galactosemia. PREPARATION AND ADMINISTRATION The recommended feed concentration is 18% w/v i.e. 18g Heparon Junior made up to 100ml with water. For bottle feeding preparation: THE HEALTH OF YOUR INFANT DEPENDS ON CAREFULLY FOLLOWING THE DIRECTIONS FOR PREPARATION AND USE. INCORRECT PREPARATION CAN MAKE YOUR BABY ILL.

OSMOLALITY The osmolality of Heparon Junior is 357 mos/kg* Estimated Renal Solute Load - 165.5 mosm/litre. PRECAUTIONS Must only be used under strict medical supervision. Not for parenteral use. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Heparon Junior is available in 400g cans. SHELF LIFE 2 years.

Always use 4 level scoops (4 x 4.5g) of Heparon Junior for every 90 mls (approx 3 fl oz) of water to yield the recommended feed concentration (18%). 1. Wash hands thoroughly and clean preparation area. Sterilise bottles and teats. 2. Boil fresh water for 5 minutes and allow to cool for at least 30 minutes so that it feels warm to the wrist. Pour the required amount of water into a sterilised feeding bottle. 3. Fill the scoop provided with Heparon Junior and level off with a clean, dry knife. Do not press the powder into the scoop. Only use the scoop provided. 4. Add the prescribed number of scoops of Heparon Junior to the water. Replace the cap on the bottle and shake until the powder dissolves. Before feeding ensure that the formula is at the correct temperature by placing a few drops on the wrist. 5. Formula remaining in the bottle after one hour of feeding should be discarded. Formula must not be rewarmed during feeding. Important Notice: Powdered infant formula is not sterile. Where possible, and especially for infants who are vulnerable to infection, prepare formula immediately prior to feeding*. 64

NOTE: If formula is prepared in advance it must be cooled rapidly, stored in the refrigerator (2ºC to 4ºC) and used within 24 hours of preparation. Any formula remaining after 24 hours from preparation must be discarded. Shake or stir formula immediately before use. Formula should not be warmed for longer than 15 minutes prior to feeding. Do not boil formula and do not use a microwave oven to prepare or warm formula. For tube feeding “hang time” should not exceed 4 hours.

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Heparon Junior NUTRITION INFORMATION

per 100g per powder 100ml*

Amino Acid Profile

Fatty Acid Profile

g per 100g powder

C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 Other fatty acids

Energy kJ 2016 363 kcal 480 86.4 Protein Equivalent g 11.1 2 % as BCAA 30 Carbohydrate g 64.2 11.6 of which sugars g 16.9 3 Fat g 19.9 3.6 of which saturates g 11.0 2 monounsaturates g 2.3 0.41 polyunsaturates g 5.7 1.0 % LCT 50.8 % MCT 48.9 Ratio n6 : n3 fatty acids 7.2 % energy from linoleic acid 9.3 % energy from α linolenic acid 1.3 Fibre g nil added

Vitamins

Minerals

per 100 g per powder 100ml*

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

72 3.1 420 10.8 260 7.4 509 277 39

per 100g powder

Vitamin A µg RE 1329 IU 4425 Vitamin D µg 33 IU 1320 Vitamin E mg α TE 72 IU 107 Vitamin C mg 44 Vitamin K µg 277 Thiamin mg 0.32 Riboflavin mg 0.55 Niacin mg 4.8 mg NE 7.5 Vitamin B6 mg 0.96 Folic Acid µg 55 Vitamin B12 µg 1.1 Biotin µg 8.3 Pantothenic Acid mg 1.7 Choline mg 39 Inositol mg 19

per 100ml*

239.2 797 5.9 237.6 13 19.3 7.9 49.9 0.06 0.1 0.86 1.4 0.17 9.9 0.2 1.5 0.31 7 3.4

Calcium : Phosphorus

0.48 0.33 1 0.18 1.7 0.21 0.22 0.86 1.6 1 0.26 0.44 0.79 0.63 0.67 0.16 0.42 1.1 0.007 0.03

13 0.56 75.6 1.9 46.8 1.3 91.6 50 7.0

g per 100g Fatty Acids 0.3 28.6 20.3 0.3 0.2 5.5 0.1 2.1 11.9 26.1 3.6 0.2 0.9

Trace Elements

per 100g powder

per 100ml*

Iron mg Copper µg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

7.2 22 7.2 0.48 55 17.2 13.2 11.6

1.3 4 1.3 0.09 9.9 3.1 2.4 2.1

1.8

* At the recommended concentration: 18% w/v

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Liquigen

Calogen

Solagen

MCT Duocal

Maxijul LE 66

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Super Soluble Duocal

Super Soluble Maxijul

Duobar

Liquid Duocal

Liquid Maxijul

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Energy A range of products offering a choice of calorie sources derived from carbohydrate, fat or a combination of both.

Calogen - Unflavoured, Butterscotch, Strawberry, Banana flavours Liquigen Solagen Super Soluble Duocal Liquid Duocal MCT Duocal Super Soluble Maxijul Liquid Maxijul - Unflavoured, Orange, Blackcurrant, Lemon & Lime flavours

Maxijul LE Duobar - Neutral, Strawberry, Toffee flavours

Precautions Not for parenteral use Use under medical supervision Not suitable for use as a sole source of nutrition Additional precautions noted for individual products 67

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Calogen DESCRIPTION Calogen is a fat emulsion consisting of long chain triglycerides (LCT) from highly refined peanut oil. Available in Unflavoured, Strawberry, Butterscotch and Banana flavours. A food for special medical purposes. INDICATIONS Calogen is a concentrated source of energy for the dietary management of conditions requiring a high energy diet, with or without fluid and electrolyte restrictions. Calogen is also useful as an energy enhancer in tube and sip feeds or can be used as a milk replacer in protein restricted diets. SUGGESTED INTAKE The quantity of Calogen should be determined by a clinician or dietitian and is dependent on the age, bodyweight and medical condition of the patient. Unflavoured Calogen is suitable for infants, children and adults, although it may require dilution for children under 5 years of age. Strawberry, Butterscotch and Banana Calogen should not be given to children under 1 year. 3 x 30ml cups daily provides approximately 400kcal.

PREPARATION AND ADMINISTRATION Shake well before use. Calogen may be taken undiluted or diluted with water or milk. Calogen can be used to fortify a wide variety of drinks and foods. Recipe ideas are available upon request. PRECAUTIONS Use under medical supervision. Strawberry, Butterscotch and Banana Calogen are not suitable for children under 1 year of age. This product contains peanut oil. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store at ambient temperatures (e.g. 18-25째C). Once opened, keep in refrigerator and use within 14 days. PACK SIZE Calogen is available in 250ml bottles and 1litre bottles. SHELF LIFE 1 year.

NUTRITION Unflavoured INFORMATION per 100ml Energy kJ 1850 kcal 450 Protein g nil added Carbohydrate g nil added of which sugars nil added of which lactose nil added Fat g 50 of which saturates g 9.6 monounsaturates g 28.2 polyunsaturates g 10 Fibre g nil added

Strawberry per 100ml 1918 466 nil added 4 4 nil added 50 9.6 28.2 10 nil added

Butterscotch per 100ml 1871 455 nil added 1.25 1.25 nil added 50 9.6 28.2 10 nil added

Banana per 100ml 1916 466 nil added 4 4 nil added 50 9.6 28.2 10 nil added

Fatty Acid Profile C12:0 C14:0 C16:0 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:0 C24:0 Minerals Sodium mg (mmol)

g per 100g fatty acids <1 <1 10 3 58 20 <1 1 1 3 1 per 100ml <10 (<0.4)

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Liquigen DESCRIPTION Liquigen is a fat emulsion consisting of medium chain triglyceride (MCT) from fractionated coconut oil. A food for special medical purposes. INDICATIONS Liquigen is a source of MCT for the dietary management of patients with fat malabsorption or for use in the ketogenic diet. Liquigen is also useful as an energy enhancer in tube and sip feeds or can be used as a milk substitute where MCT is required. SUGGESTED INTAKE The quantity of Liquigen should be determined by a clinician or dietitian only and is dependent on the age, bodyweight and medical condition of the patient. Liquigen is suitable for infants, children and adults, although it may require dilution for children under 5 years of age. Liquigen should be introduced gradually into the diet over a period of days according to the patients tolerance. PREPARATION Shake well before use. Liquigen can be used to fortify a wide variety of drinks and foods. Recipe ideas are available upon request.

NUTRITION INFORMATION Energy kJ kcal Protein g Carbohydrate g Fat g of which saturates g monounsaturates g polyunsaturates g % MCT Fibre g Fatty Acid Profile C6:0 C8:0 C10:0 C12:0

per 100ml 1850 450 nil added nil added 50 47.1 nil nil 98 nil added g per 100g fatty acids 0.7 82.1 15.9 1.3

Minerals

per 100ml

Sodium mg mmol

28 1.2

PRECAUTIONS Use under medial supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store at ambient temperatures (18 - 25째C). Once opened, keep in a refrigerator and use within 14 days. PACK SIZE Liquigen is available in 250ml and 1 litre bottles. SHELF LIFE 1 year.

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Solagen DESCRIPTION Solagen is a fat emulsion consisting of long chain triglycerides (LCT) from highly refined soya oil. A food for special medical purposes. INDICATIONS Solagen is a concentrated source of energy for the dietary management of conditions requiring a high energy diet, with or without fluid and electrolyte restrictions. Suitable for infants, children and adults. Solagen is also a concentrated source of essential fatty acids, particularly useful in paediatrics. Solagen is also useful as an energy enhancer in tube and sip feeds or can be used as a milk replacer in protein restricted diets. SUGGESTED INTAKE The quantity of Solagen should be determined by a clinician or dietitian only and is dependent on the age, bodyweight and medical condition of the patient. Solagen is suitable for infants, children and adults, although it may require dilution for children under 5 years of age. PREPARATION AND ADMINISTRATION Shake well before use. Solagen may be taken undiluted or diluted with water or milk. Solagen can be used to fortify a wide variety of drinks and foods. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use.

NUTRITION INFORMATION Energy kJ kcal Protein Carbohydrate g Fat g of which saturates g monounsaturates g polyunsaturates g % LCT Ratio n6 : n3 fatty acids % of energy from linoleic acid % of energy from linolenic acid % of energy from essential fatty acids Fibre g Fatty Acid Profile C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 Minerals

STORAGE Store at ambient temperatures (18 - 25째C). Once opened, keep in a refrigerator and use within 14 days. PACK SIZE Solagen is available in 250ml bottles. SHELF LIFE 1 year.

Sodium mg

per 100ml 1850 450 nil added nil added 50 6.9 12 28.9 100 7:1 50.7 7.2 57.9 nil added g per 100g Fatty Acids <0.1 10.5 <1 3.5 24.5 53 7.5 <1 per 100ml nil added

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Super Soluble Duocal DESCRIPTION Super Soluble Duocal is a powder consisting of a balanced blend of fat and carbohydrate. A food for special medical purposes. INDICATIONS Super Soluble Duocal can be used for the dietary management of a wide range of conditions where a high energy, low fluid, low electrolyte diet is required such as renal disease, liver disease and catabolic states. Suitable for use in infants, children and adults. SUGGESTED INTAKE The quantity of Super Soluble Duocal should be determined by a clinician or dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION Supplementation of Infant Formula Care should be taken when supplementing standard infant formula that the protein : energy ratio still meets that recommended for adequate growth and nutrition. Introduce Super Soluble Duocal gradually according to infant tolerance. 1. Initially add 1g Super Soluble Duocal per 100ml Infant formula. 2. Increase daily by 1g increments as tolerated by the infant. 3. The usual maximum tolerance is 7g Super Soluble Duocal per 100ml formula in infants under 6 months of age, and 10g Super Soluble Duocal per 100ml formula in infants 6-12 months of age. Consideration should be given to protein: energy ratio when supplementing above 3g per 100ml. Food Fortification Super Soluble Duocal is a useful energy enhancer and can be easily incorporated into normal foods and drinks. Super Soluble Duocal can be added to moist foods by sprinkling on the recommended amount and then stirring thoroughly. Alternatively, Super Soluble Duocal can be made into a paste by gradually adding a small volume of water and then mixing the paste into moist foods. Recipes are available upon request. Modular Feeds Super Soluble Duocal can be used as the fat and carbohydrate component of modular feeds or as an energy enhancer in tube or sip feeds. It is recommended to paste Super Soluble Duocal with a small amount of the feed or water, before adding to ensure thorough mixing. OSMOLALITY 1 to 4 dilution (37.5g Super Soluble Duocal + 150ml water) = 196 mosm/kg. 1 to 3 dilution (50.0g Super Soluble Duocal + 150ml water) = 310 mosm/kg. 1 to 2 dilution (75.0g Super Soluble Duocal + 150ml water) = 525 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use.

STORAGE Store in a cool, dry place. Always replace container lid after use. Once opened use within one month. PACK SIZES Super Soluble Duocal is available in 400g cans. SHELF LIFE 18 months. NUTRITION INFORMATION

Energy kJ kcal Protein (g) Carbohydrate (g) of which sugars Fat (g) of which saturates monounsaturates polyunsaturates % LCT % MCT Ratio n6 : n3 fatty acids % of energy from linoleic acid % of energy from Îą linolenic acid Fatty Acid Profile C6:0 C8:0 C10:0 C12:0 C14:0 C16:0 C16:1 C18:0 C18:1 C18:2 C18:3 C20:0 C20:1 C22:1 Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg

per 100g

2061 492 nil added 72.7 6.5 22.3 8.4 9.7 3.1 65 35 4:1 4.4 1.13 g per 100g Fatty Acids

0.03 20.45 14.08 0.03 0.02 3.16 0.13 1.24 44.92 11.48 2.92 0.45 0.6 0.26 per 100g

<20 <0.9 <5 <0.1 <20 <0.6 <5 <5

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Liquid Duocal DESCRIPTION Liquid Duocal is an emulsion consisting of a blend of carbohydrate and fat. A food for special medical purposes. INDICATIONS Liquid Duocal can be recommended as a dietary supplement to provide a concentrated source of energy for the dietary management of conditions requiring extra calories from a combined fat and carbohydrate source. SUGGESTED INTAKE The quantity of Liquid Duocal should be determined by the clinician or dietitian and is dependent on the age, bodyweight and medical condition of the patient. Liquid Duocal may require dilution for children under 5 years of age. PREPARATION AND ADMINISTRATION Shake well before use. Liquid Duocal may be taken undiluted or diluted with water. Liquid Duocal can be used to fortify a wide variety of drinks and foods and is also useful as an energy enhancer in tube and sip feeds. Liquid Duocal can also be used as a protein free milk substitute in patients requiring protein restriction. OSMOLALITY The osmolality of Liquid Duocal is 440 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store at ambient temperatures (e.g. 18 - 25°C). Once opened, keep in a refrigerator and use within 14 days. PACK SIZE Liquid Duocal is available in 250ml and 1 litre bottles. SHELF LIFE 1 year.

NUTRITION INFORMATION Energy kJ kcal Carbohydrate g of which sugars g Protein Fat g of which saturates g monounsaturates g polyunsaturates %LCT %MCT Fibre g Fatty Acid Profile

per 100ml 661 158 23.4 2.1 nil added 7.1 2.6 1.3 2.8 70 30 nil added g per 100g Fatty Acids

C8:0 C10:0 C16:0 C18:0 C18:1 C18:2 C18:3 Vitamins

25.5 4.5 7.7 1.4 18.9 41.3 0.7 per 100ml

Vitamin E mg µg

1.2 1.72

Minerals Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg mmol Phosphorus mg mmol

per 100ml 20 0.9 30 0.8 40 1.1 30 0.8 15 0.5

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MCT Duocal DESCRIPTION MCT Duocal is a powdered supplement consisting of a blend of carbohydrate and fat, high in medium chain triglycerides (MCT). A food for special medical purposes. INDICATIONS MCT Duocal can be used as a supplement in the dietary management of conditions requiring extra calories from a combined fat and carbohydrate source, where there is fat malabsorption or where assimilation of LCT's is impaired. SUGGESTED INTAKE The quantity of MCT Duocal is dependent on the age, bodyweight and medical condition of the patient. MCT Duocal should be introduced gradually into the diet over a period of days according to the patient's tolerance. PREPARATION MCT Duocal can be used to fortify a wide variety of drinks and foods. A range of recipes are available upon request. MCT Duocal is also useful as an energy enhancer in tube and sip feeds. MCT Duocal can be mixed with water to form a bland tasting, high energy, low electrolyte liquid. To make a solution of MCT Duocal paste the powder with a small amount of the water prescribed and then add the remaining water, stirring briskly with a fork. OSMOLALITY 1 to 3 dilution (100g MCT Duocal + 300ml water) = 427 mosm/kg. 1 to 2 dilution (100g MCT Duocal + 200ml water) = 729 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use.

NUTRITION INFORMATION* Energy kJ kcal Protein g Carbohydrate g of which sugars g Fat g of which saturates g monounsaturates g polyunsaturates g % LCT % MCT Fibre g Fatty Acid Profile C6:0 C8:0 C10:0 C12:0 C16:0 C18:0 C18:1 C18:2 C18:3 Minerals Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100g 2082 497 nil added 72 10.1 23.2 17.1 1.0 3.8 25 75 nil added g per 100g fatty acids 0.4 55.2 19.8 0.5 1.6 0.4 4.8 15.1 2.2 per 100g

<30 <1.3 <20 <0.5 <20 <0.6 nil added nil added nil added

STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZES MCT Duocal is available in 400g cans. USEFUL MEASURES 1 heaped teaspoon MCT Duocal is approx 9g. 1 heaped dessertspoon MCT Duocal is approx 19g. 1 heaped tablespoon MCT Duocal is approx 28g. SHELF LIFE 3 years.

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Super Soluble Maxijul DESCRIPTION Super Soluble Maxijul is a convenient powdered carbohydrate energy supplement. A food for special medical purposes. INDICATIONS Super Soluble Maxijul can be recommended for the dietary management of conditions requiring a high energy, low fluid diet in infants, children and adults. SUGGESTED INTAKE The quantity of Super Soluble Maxijul should be determined by a clinician or dietitian and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION Super Soluble Maxijul can easily be incorporated into a wide variety of drinks and foods. Super Soluble Maxijul is also useful as an energy enhancer in tube and sip feeds. Recipe ideas are available upon request.

PACK SIZE Super Soluble Maxijul is available in: 4 x 132g Sachets, 200g cans, 2.5kg tub and 25kg tub. SHELF LIFE 3 years. NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Carbohydrate g of which sugars g Fat g Fibre g

To make a solution of Super Soluble Maxijul put the required amount of powder into water and stir briskly with a fork, leave to stand until clear.

Minerals

OSMOLALITY Super Soluble Maxijul in solution has an osmolality one fifth of an equivalent solution of glucose allowing administration at higher concentrations. This is because the lower osmotic load improves patient tolerance.

Sodium mg mmol Potassium mg mmol Chloride mg mmol Phosphorus mg mmol

1 to 3 dilution (1kcal/ml) (e.g. 50g Super Soluble Maxijul + 150ml water) = 420 mosm/kg. 1 to 2 dilution (1.4 kcal/ml) (e.g 75g Super Soluble Maxijul + 150ml water) = 759 mosm/kg. PRECAUTIONS Use under medical supervision. Use with caution in diabetes. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened, use within one month. Useful Measures 1 heaped teaspoon Super Soluble Maxijul is approx 5g. 1 heaped tablespoon Super Soluble Maxijul is approx 15g.

per 100g 1615 380 nil added 95 8.6 nil added nil added per 100g <20 <0.86 <5 <0.12 <50 <1.4 <5 <0.16

I L d c m l S T a I c c P L b t L c l O T P U U F i N N S S O w P L S 2

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Liquid Maxijul DESCRIPTION Liquid Maxijul is a convenient liquid carbohydrate energy source. Liquid Maxijul is a 50% solution of Super Soluble Maxijul in water. Available in Unflavoured, Blackcurrant, Lemon and Lime and Orange flavours. A food for special medical purposes. INDICATIONS Liquid Maxijul is a liquid carbohydrate source designed as a supplementary source of nutrition for children and adults for use in the dietary management of conditions requiring a high energy, low fluid diet. SUGGESTED INTAKE The quantity of Liquid Maxijul is dependent on the age, bodyweight and medical condition of the patient. It is recommended that this product is diluted for children under 5 years of age and possibly for children under 12 years of age. PREPARATION AND ADMINISTRATION Liquid Maxijul is a useful energy enhancer and is best served chilled. Liquid Maxijul can also be used to fortify a wide variety of drinks and food. Liquid Maxijul can be consumed directly from the carton or alternatively can be frozen to make ice lollies. OSMOLALITY The osmolality of Liquid Maxijul is 1100 mosm/kg.

NUTRITION INFORMATION Energy kJ kcal Carbohydrate g of which sugars g Protein Fat Fibre g Minerals Sodium mg mmol Potassium mg mmol Phosphorus mg Fluid Content/ml

per 100ml

per 200ml

850 1700 200 400 50 100 4.5 (4.9) 9 (9.8) nil added nil added nil added nil added <23 <46 <1 <2 <4 <8 <0.1 <0.2 <5 <10 70

140

Figures represent Unflavoured, Blackcurrant, and Lemon & Lime flavour Liquid Maxijul. Figures in brackets represent Orange flavour Liquid Maxijul.

PRECAUTIONS Use under medical supervision. Use with caution in diabetes. Flavoured Liquid Maxijul is not recommended for infants under 6 months. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool, dry place. Once opened store in a refrigerator and consume within 24 hours. PACK SIZE Liquid Maxijul is available in 200ml cartons. SHELF LIFE 2 years.

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Maxijul LE DESCRIPTION Maxijul LE is a dried glucose syrup powder with a lower electrolyte content than Super Soluble Maxijul. A food for special medical purposes. INDICATIONS Maxijul LE can be recommended for the dietary management of conditions requiring a high energy low fluid and low electrolyte diet. SUGGESTED INTAKE The quantity of Maxijul LE should be determined by a clinician or dietitian and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION Maxijul LE can be easily incorporated into a wide variety of drinks, foods and tube feeds. To make a solution of Maxijul LE put the required amount of powder into water and stir briskly with a fork, leave to stand until clear. OSMOLALITY 1 to 10 dilution (e.g. 50g of Maxijul LE + 500ml water) = 150 mosm/kg. 1 to 5 dilution (e.g. 50g of Maxijul LE + 250ml water) = 315 mosm/kg. 1 to 2 dilution (e.g. 50g of Maxijul LE + 100ml water) = 1045 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened, use within one month. PACK SIZE Maxijul LE is available in a 200g can and 2kg container. Useful measures 1 heaped teaspoon Maxijul LE is approx. 5g. 1 heaped tablespoon Maxijul LE is approx. 15g. SHELF LIFE 3 years.

NUTRITION INFORMATION

per 100g powder

Energy kJ kcal Protein g Carbohydrate g of which sugars g Fat g Fibre g

1632 384 nil added 96 14 nil added nil added

Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

per 100g powder

<2 <0.1 <1 <0.03 5 <0.1 nil added nil added nil added

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Duobar DESCRIPTION Duobar is a high energy supplement based on fat and carbohydrate. Available in Natural, Strawberry and Toffee flavours. A food for special medical purposes. INDICATIONS Duobar can be used for children and adults for the dietary management of a wide range of conditions requiring a high calorie, low fluid diet such as: • • • •

Disorders of amino acid metabolism. Protein restricted diets. Renal disease. Liver disease.

SUGGESTED INTAKE The quantity of Duobar should be determined by the clinician or dietitian only and is dependent on the age, bodyweight, and medical condition of the patient. PREPARATION AND ADMINISTRATION Duobar can be incorporated into the diet in many ways to increase variety and enhance patient acceptability. Recipe ideas available upon request. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool dry place. Once opened, refrigerate and consume within one week. PACK SIZE Duobar is available in 8 x 45g bars.

NUTRITION INFORMATION

per 100g Product

per 45g Bar

Energy kJ kcal Protein Equivalent g Phenylalanine mg Carbohydrate g of which sugars g Fat g of which saturates g monounsaturates g polyunsaturates g % LCT Fibre g

2692 1211 648 292 <0.05 <0.02 0.4 0.18 49.9 22.5 49.9 22.5 49.9 22.5 29.5 13.3 17.7 8 2.4 1.1 100 nil added

Minerals

per 100 g

per 45g Bar

Sodium mg Potassium mg Chloride mg Calcium mg Phosphorus mg

<5 <10 <5 <5 <10

<2 <5 <2 <2 <5

Fatty Acid Profile C12:0 C14:0 C16:0 C18:0 C18:1 C18:2 C20:0 C22:0 Other fatty acids

g per 100g Fatty Acids 0.1 0.6 34.8 22.5 35.5 4.8 1.1 0.1 0.5

SHELF LIFE 1 year.

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Hepatamine

Generaid

Maxisorb

Super Soluble Maxipro

Dialamine 78

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Protein A range of products based on either whole protein, pepdites or amino acid mixtures.

Hepatamine - Orange flavour Generaid Super Soluble Maxipro Maxisorb - Vanilla, Strawberry, Chocolate flavours Dialamine - Orange flavour

Precautions Not for parenteral use Use under medical supervision Not suitable for use as a sole source of nutrition Additional precautions noted for individual products 79

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Hepatamine DESCRIPTION Hepatamine is an Orange flavoured amino acid drink mix containing carbohydrate and supplemented with branched chain amino acids (BCAA). A food for special medical purposes. INDICATIONS Hepatamine is a BCAA drink mix, designed as a supplementary source of nutrition for use in the dietary management of severe liver disease for children over 3 years of age and adults. Hepatamine is low in aromatic amino acids and supplemented with branched chain amino acids, which may be preferentially utilised in liver disease, enhancing positive nitrogen balance. SUGGESTED INTAKE The quantity of Hepatamine should be determined by the clinician or dietitian and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended dilution is 1 to 5 w/v dilution. (i.e. one 50g sachet added to 250ml of water). Hepatamine can be given in a more concentrated form (e.g. 1 to 4 dilution), however care should be taken with osmotically sensitive patients. 1. Add a small amount of the water prescribed to a 50g sachet of Hepatamine. Stir with a fork until a smooth paste is obtained. 2. Continue stirring whilst adding the rest of the prescribed amount of water. Hepatamine is now ready for use. Hepatamine is best presented as a chilled drink. OSMOLALITY 1 to 7 dilution (50g Hepatamine + 350ml of water) = 669 mosm/kg. 1 to 5 dilution (50g Hepatamine + 250ml of water) = 940 mosm/kg. 1 to 4 dilution (50g Hepatamine + 200ml of water) = 1204 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use.

STORAGE Store in a cool, dry place. Once a sachet is opened it should be stored in an airtight container and used within 2-3 days. PACK SIZE Hepatamine is available as 4 x 50g sachets. SHELF LIFE 2 years. NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Total Amino Acids g (of which 40% BCAA) Carbohydrate g of which sugars g Fat g Fibre g Amino Acid Profile L-Alanine L-Arginine L-Cystine Glycine L-Histidine L-Isoleucine L-Leucine L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Valine Minerals

Sodium mg mmol Potassium mg mmol Chloride mg mmol

per 100g powder 1530 360 25 30 65 58.5 nil added nil added g per 100g powder 2.1 3.3 0.16 2.7 0.93 3.75 4.65 2.4 0.25 0.36 2.5 1.5 1.65 0.25 3.6 per 100g powder <10 <0.4 <10 <0.3 <10 <0.3

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Generaid DESCRIPTION Generaid is a powdered whey protein enriched with branched chain amino acids (BCAA). A food for special medical purposes. INDICATIONS Generaid is a whey protein enriched with branched chain amino acids designed as a supplementary source of nutrition for use in the dietary management of infants, children and adults with hepatic disorders. Branched chain amino acids may be preferentially utilised in liver disease thus enhancing positive nitrogen balance. Generaid can also be used as part of a modular feed. SUGGESTED INTAKE The quantity of Generaid should be determined by the clinician or dietitian and is dependent on the age, bodyweight, and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended dilution is a 1 to 7.5 w/v (i.e.10g powder plus 75ml water). 1. Measure the required amount of water into a container. 2. Sprinkle the required amount of Generaid onto the water and whisk with a fork. Generaid is now ready for use. Generaid may be flavoured with a separate flavour from the SHS flavour range. Flavouring is not recommended for infants less than 6 months old. OSMOLALITY The osmolality of Generaid at a 1 to 7.5 w/v dilution is 316 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool, dry place. Always replace container lid after use. Once opened use within one month. PACK SIZE Generaid is available in 200g tubs. SHELF LIFE 3 years.

NUTRITION INFORMATION

per 100g powder

Energy kJ kcal Protein Equivalent g % BCAA Carbohydrate g of which sugars g Fat g of which saturates g monousaturates g polyunsaturates g Fibre g

1586 374 76 33 5 5 5.5 3.7 1.4 0.13 nil added

Typical Amino Acid Profile L-Alanine L-Arginine L-Aspartic Acid L-Cystine L-Glutamine Glycine L-Histidine L-Isoleucine L-Leucine L-Lysine L-Methionine L-Phenylalanine L-Proline L-Serine L-Threonine L-Tryptophan L-Tyrosine L-Valine

g per 100g powder 2.5 4.1 5.4 2.4 9 0.93 2.3 5.1 13.8 6.3 2.3 4.9 3 2.5 5.2 1.5 3 7.9

Minerals

per 100g powder

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

140 6.1 420 10.8 40 1.1 260 200 35

Reference Chin SE et al. Nutritional support in children with end-stage liver disease: a randomized crossover trial of a branchedchain amino acid supplement. AJCN 1992; 56: 158- 163

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Super Soluble Maxipro DESCRIPTION Super Soluble Maxipro is a powdered whey protein of high biological value supplemented with free amino acids. A food for special medical purposes. INDICATIONS Super Soluble Maxipro is a high biological value protein supplement designed for children over 1 year and adults for the dietary management of conditions requiring a high protein supplement such as: 1. Catabolic states e.g. burns, trauma, post operative stress. 2. Conditions where there are significant protein losses e.g. protein losing enteropathies and continuous ambulatory peritoneal dialysis (C.A.P.D.) Super Soluble Maxipro has a low electrolyte and phosphate content making it suitable for this type of renal patient. 3. As part of a modular feed. SUGGESTED INTAKE The quantity of Super Soluble Maxipro should be determined by a clinician or dietitian only and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION Super Soluble Maxipro may be used to fortify a wide variety of foods and drinks. Put the required amount of fluid into a container and sprinkle on the required amount of Super Soluble Maxipro powder, shake vigorously until dissolved.

NUTRITION INFORMATION

per 100g powder

Amino Acid Profile

Energy kJ kcal Protein g Carbohydrate g of which sugars g of which lactose g Fat g of which saturates g monounsaturates g polyunsaturates g Fibre g

1688 400 75.5 7.5 7.5 7.5 7.5 4.7 1.8 0.2 nil added

Alternatively, paste the required amount of Super Soluble Maxipro with a small amount of fluid to a smooth paste. Gradually add the remaining fluid and mix well. OSMOLALITY The osmolality of Super Soluble Maxipro at a 20% w/v concentration is 139 mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool dry place. Always replace the container lid after use. Once opened, use within one month. PACK SIZE Super Soluble Maxipro is available as 200g tub. SHELF LIFE 3 years.

g per 100g powder 3.5 1.6 7.4 2.3 1.3 1.6 4.5 7.3 6.1 2.1 3.5 4.2 3.4 4.9 1.7 3.6 5 12.2

Minerals

per 100g powder

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

200 8.7 600 15.4 65 1.9 390 295 55

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Maxisorb DESCRIPTION Maxisorb is a palatable, convenient, high protein, powdered supplement, based on whey protein. Available in Chocolate, Strawberry and Vanilla flavours. A food for special medical purposes. INDICATIONS Maxisorb can be used for children and adults for the dietary management of a range of conditions requiring protein supplementation such as: 1. Catabolic states e.g. burns, trauma, post operative stress. 2. Conditions where protein losses are high e.g. Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.), protein losing enteropathies. Maxisorb has low electrolyte and phosphorus levels making it a suitable protein supplement for renal patients. Maxisorb may also be a convenient protein supplement for patients with dysphagia, as the consistency can be easily altered or as a nutritional supplement for pre-operative feeding. SUGGESTED INTAKE The quantity of Maxisorb should be determined by a clinician or dietitian only and is dependent on the age, bodyweight and medical condition of the patient. Each sachet of Maxisorb provides 12g of protein. PREPARATION Maxisorb powder can be made up in three ways: 1. As a drink, by adding 120ml of cold water* to one 30g sachet, and whisking. 2. As a creamy dessert, by mixing one 30g sachet with a little cold water* to form a paste, then gradually diluting with the remaining water * (total 50ml), stirring continuously. Place in the refrigerator for 1/2 to 1 hour to thicken. NUTRITION INFORMATION Flavour

Energy kJ kcal Protein equivalent g Carbohydrate g of which sugars g as lactose g Fat g of which saturates g monounsaturates g polyunsaturates g Fibre g Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorous mg Magnesium mg

per 100g

per 30g sachet

Chocolate 1850 440 40 34 33.4 13.7 16 12 2.6 0.68 0.42 195 8.5 680 17.4 327 9.2 560 433 65

The prepared Maxisorb should be refrigerated if not for immediate use and must not be kept longer than 24hrs from time of preparation., 3. As a frozen dessert, by preparing as in (2) , then freeze for 2-3 hours. Remove from the freezer 15 minutes before eating. If frozen consume within one week. * Milk may be substituted for water providing additional milk is not contra indicated in the diet. OSMOLALITY The osmolality of Maxisorb at the recommended dilution is 300mosm/kg. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not suitable for infants. Not for parenteral use. STORAGE Store in a cool, dry place. Once opened a sachet of Maxisorb should be stored in a cool dry place and used within 2-3 days. Unopened shelf life 2 years. PACK SIZES Maxisorb is available as 5 x 30g sachets. SHELF LIFE 2 years. per 100g

per 30g sachet

per 100g

Strawberry

555 132 12 10.2 10 4.1 4.8 3.6 0.78 0.2 0.13 58.5 2.6 204 5.2 98 2.8 168 130 19.5

1850 440 40 34 33.4 13.7 16 12 2.6 0.68 nil added 195 8.5 529 13.6 327 9.2 560 433 40

555 132 12 10.2 10 4.1 4.8 3.6 0.78 0.2 nil added 58.5 2.6 204 5.2 98 2.8 168 130 12

per 30g sachet

Vanilla 1850 440 40 34 33.4 13.7 16 12 2.6 0.68 nil added 195 8.5 529 13.6 327 9.2 560 433 40

555 132 12 10.2 10 4.1 4.8 3.6 0.78 0.2 nil added 58.5 2.6 159 4.1 98 2.8 168 130 12 83

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Dialamine DESCRIPTION Dialamine is a pale orange powder containing 30% essential amino acids, carbohydrate, flavouring and low levels of minerals. Available in Orange flavour only. A food for special medical purposes. INDICATIONS Dialamine can be given to infants over 6 months, children and adults as an essential amino acid supplement for the dietary management of the following conditions: 1. Advanced chronic renal failure. 2. Certain urea cycle disorders e.g. OTC and CPS deficiency. SUGGESTED INTAKE The quantity of Dialamine should be determined by a clinician or dietitian and is dependent on the age, bodyweight and medical condition of the patient. PREPARATION AND ADMINISTRATION The recommended dilution is 1 to 5 (i.e. 20g Dialamine plus 100ml water). Osmotically sensitive patients may require an initial dilution of 1 to 7. 1. Add a small amount of water to the prescribed amount of Dialamine. Stir with a fork until a smooth paste is obtained. 2. Continue stirring whist adding the remaining volume of water. Dialamine is now ready for use.

NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Total Amino Acids g Carbohydrate g of which sugars g Fat g of which saturates g Fibre g

PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in cool, dry place. Always replace the container lid after use. Once opened use within one month.

g per 100g powder 1.2 1.2 3.3 5.13 4.2 1.2 1.8 3.6 0.75 3.0 4.62

L-Cystine L-Histidine L-Isoleucine L-Leucine L-Lysine L-Methionine L-Phenylalanine L-Threonine L-Tryptophan L-Tyrosine L-Valine Minerals

per 100 g powder

per 100ml*

Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

<10 <0.4 <10 <0.27 <20 <0.57 <5 <5 <5

<1.7 <0.07 <1.7 <0.05 <3.5 <0.1 <0.86 <0.86 <0.86

Vitamins

per 100 g powder

per 100ml*

Vitamin C mg

125

* at the recommended dilution. PACK SIZE Dialamine is available in 200g securitainers. SHELF LIFE 2 years.

per 100ml*

1530 264 360 62.1 25 4.3 30 5.2 65 11.2 59 10.3 nil added nil added nil added

Amino Acid Profile

Dialamine is best served as a chilled drink. OSMOLALITY The osmolality of Dialamine at a 1 to 5 dilution is 900 mosm/kg.

per 100g powder

21.6

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Notes

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Paediatric Seravit

Metabolic Mineral Mix

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Vitamins, Minerals and Trace Elements

Paediatric Seravit - Unflavoured, Pineapple flavour Metabolic Mineral Mix

Precautions Not for parenteral use Use under medical supervision Not suitable for use as a sole source of nutrition Additional precautions noted for individual products 87

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Paediatric Seravit DESCRIPTION Paediatric Seravit is a comprehensive vitamin, mineral and trace element mixture containing only trace amounts of sodium, potassium and chloride on a carbohydrate base. Available in Pineapple flavour (contains sugars, sweeteners and colours) or Unflavoured. A food for special medical purposes. INDICATIONS Paediatric Seravit is a vitamin, mineral and trace element supplement for infants and children designed for use in the dietary management of restrictive therapeutic diets such as: 1. Inborn errors of metabolism such as PKU, MSUD. 2. Elimination diets. 3. As a component of a modular feed.

Flavouring is not recommended for infants less than six months old. OSMOLALITY 17g powder plus 85ml water (i.e. 1 to 5 w/v dilution) = 638 mosm/kg of water. 17g powder plus 170ml water (i.e. 1 to 10 w/v dilution) = 216 mosm/kg of water.

PREPARATION AND ADMINISTRATION The quantity of Paediatric Seravit should be determined by a clinician or dietitian only and is dependant on the age, bodyweight and clinical condition of the patient. The suggested intake may need lowering if vitamins, minerals and trace elements are provided in the diet from other sources. In any event, it is advisable to check the total intake of each patient against the recommended dietary intakes. Whenever Paediatric Seravit is administered, care must be taken to ensure that a complete, balanced diet is provided for the patient.

PRECAUTIONS Use under medical supervision. Not suitable as a sole source of nutrition. Not for parenteral use.

SUGGESTED INTAKE

SHELF LIFE 2 years.

Suggested intakes of Paediatric Seravit (g) 0-6 months

14 *

6-12 months

1-7 years 7-14 years

17-25 25-35

* flavoured PAEDIATRIC SERAVIT is not recommended for infants less than 6 months. One yellow No 4 scoop contains approximately 5g of Paediatric Seravit. For infants: 1. Weigh out the required amount of Paediatric Seravit 2. Add to the infant formula. If the infant formula/feed is made up three times daily, Paediatric Seravit should be divided into three daily portions and added to each feed. For the older infants and children: 1. Paediatric Seravit can be taken as a drink or paste; water or diluted drinks should be offered at the same time. 2. If preferred, the unflavoured drink or paste may be flavoured with a suitable flavouring from the SHS range of Flavours.

STORAGE Store in a cool, dry place. Always replace the container lid after use. Once opened use within one month. PACK SIZE Paediatric Seravit is available as 200g cans.

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Paediatric Seravit NUTRITION INFORMATION Energy kJ kcal Protein g Carbohydrate g of which sugars Fat g Fibre g

Vitamins

per 100g 1275 (1139) 300 (268) nil added 75 (67) 6.75(29.4) nil added nil added

per

Minerals

per

100g Sodium mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

<20 <0.9 <30 <0.8 <20 <0.6 2570 1714 357

Trace Elements

100g Vitamin A μg RE Vitamin D3 μg Vitamin E mg α TE IU Vitamin C mg Vitamin K1 µg Thiamin mg Riboflavin mg Niacin mg mg NE Vitamin B6 mg Folic Acid µg Vitamin B12 µg Biotin µg Pantothenic Acid mg Choline mg Inositol mg

4200 55.5 21.4 31.9 400 166 3.2 4.4 35 35 3.4 303 8.6 214 17 350 700

per

100g Iron mg Copper mg Zinc mg Manganese mg Iodine µg Molybdenum µg Selenium µg Chromium µg

69 4.6 46 4.6 332 351 137 137

Note: Figures in brackets represent Flavoured Paediatric Seravit.

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Metabolic Mineral Mix DESCRIPTION Metabolic Mineral Mixture can be used to supply minerals and trace elements only in the dietary management of inborn errors of metabolism and other restrictive, therapeutic diets. It can also be used as the mineral component of tube feeds. Further information available upon request from Nutrition Services: Email: nutrition@shsint.co.uk Tel: +44(0)151 228 8161

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Notes

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Flavour Sachets

Flavour Modjul

Adamin-G 92

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Flavours and Amino Acids

Flavour Modjul Flavour Sachets Adamin-G

Precautions Not for parenteral use Use under medical supervision Not suitable for use as a sole source of nutrition Additional precautions noted for individual products 93

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Flavour Modjul DESCRIPTION The Flavour Modjul is a flavouring system on a carbohydrate base with sugar and sweeteners. For use with the SHS range of amino acid and peptide based products. Available in Pineapple, Orange, Blackcurrant and Savoury Tomato flavours. INDICATIONS The Flavour Modjul is for use with the SHS range of amino acid and peptide based products used for the dietary management of: 1. Metabolic diseases. 2. Gastrointestinal diseases. SUGGESTED INTAKE For example: Unflavoured Elemental 028 Use 1 level SHS No. 4 scoop per 100g of product. Unflavoured Maxamaid Use 2 level SHS No. 4 scoops per 100g of product. Unflavoured Maxamum Use 2 level SHS No. 4 scoops per 100g of product. Neocate Use 1 level SHS No. 4 scoop per 100g of product. Pepdite Use 2 level SHS No. 4 scoops per 100g of product.

PREPARATION AND ADMINISTRATION 1. Add flavouring to powdered product and mix as directed on product pack. 2. The amount of flavouring required will vary according to protein source and patient preference. PRECAUTIONS Use under medical supervision. Not suitable for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool, dry place. Always replace lid after use. Once opened use within one month. PACK SIZE The Flavour Modjul is available in 100g tubs. SHELF LIFE 2 years.

The amount of flavouring required may vary according to individual taste and the product used. Flavouring is not recommended for infants less than six months old. NUTRITION INFORMATION Energy kJ kcal Protein g Carbohydrate g of which sugars Fat g Fibre g

Blackcurrant

per 100g of product Pineapple

Orange

853 201 nil added 50 22 nil added 10

725 172 nil added 30 1.4 nil added nil added

1301 308 nil added 47 22.3 nil added nil added

Blackcurrant

per 100g of product Pineapple

Minerals

Sodium

mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

<150 <6.6 <180 <4.7 <100 <2.9 <60 <60 <20

<200 <8.7 <300 <7.7 <90 <2.6 <120 <80 <20

Orange <100 <5 <50 <1.3 <50 <1.5 <100 <50 <20

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Flavour Sachets DESCRIPTION The Flavour Sachets are a flavouring system on a carbohydrate base with sugars and sweeteners. For use with the SHS range of amino acid and peptide based products. Available in Lemon and Lime, Cherry Vanilla or Grapefruit flavours. INDICATIONS The Flavour Sachets are for use with the SHS range of amino and peptide based products used for the dietary management of:

PRECAUTIONS Use under medical supervision. Not intended for use as a sole source of nutrition. Not for parenteral use.

1. Metabolic diseases. 2. Gastrointestinal diseases.

STORAGE Store in a cool, dry place.

SUGGESTED INTAKE 1 ⁄2 - 1 sachet per 100g of product.

PACK SIZE The Flavour Sachets are available as 20 x 5g sachets.

The amount of flavouring required may vary according to individual taste and the product used.

SHELF LIFE 2 years.

Flavouring is not recommended for infants less than six months old. PREPARATION AND ADMINISTRATION Add 1⁄2 - 1 sachet (5g) to 100g of product. Add to the dry powdered product and mix as directed on the product package.

NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Carbohydrate g of which sugars Fat g Fibre g

Lemon-Lime 1250 294 nil added 25.5 12.7 nil added nil added

Lemon-Lime mg mmol Potassium mg mmol Chloride mg mmol Calcium mg Phosphorus mg Magnesium mg

1115 260 nil added 35 2.3 nil added nil added

Grapefruit 1291 300 nil added 27 15.4 nil added 2.7

per 100g of product

Minerals

Sodium

per 100g of product Cherry Vanilla

<30 <1.3 <650 <16.7 <30 <0.86 <30 <50 <20

Cherry Vanilla <100 <5 <900 <23 <150 <4.5 <50 <100 <20

Grapefruit <50 <2.2 <700 <18 <30 <0.9 <30 <30 <20

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Adamin-G DESCRIPTION Adamin-G is L-Glutamine powder. A food for special medical purposes.

INDICATIONS Adamin-G is an amino acid powder designed as a supplement. This can be used for the dietary management of conditions where requirements for L-Glutamine may be increased such as: 1. 2. 3. 4. 5.

Catabolic stress. Post surgery. Multiple trauma. Sepsis. Chemotherapy and radiotherapy.

SUGGESTED INTAKE The quantity of Adamin-G should be determined by a clinician or dietitian and is dependent on age, bodyweight and medical condition of the patient. PREPARATION For use in sip or tube feeds: • The required quantity of Adamin-G can be added directly to liquid formula. • For powdered formula, Adamin-G is best added to the powder before reconstitution. As a drink. • Adamin-G may be sprinkled on to cold water and taken as a neutral tasting drink. • Add one 5g sachet per 200ml water and stir vigorously to ensure all the L-Glutamine is fully dissolved. Adamin-G is now ready for use. Adamin-G may be flavoured with a separate flavour from the SHS flavour range. PRECAUTIONS Use under medical supervision. Not intended for use as a sole source of nutrition. Not for parenteral use. STORAGE Store in a cool, dry place. PACK SIZE Adamin-G is available as 20 x 5g sachets. SHELF LIFE 3 years.

NUTRITION INFORMATION Energy kJ kcal Protein Equivalent g Nitrogen g L-Glutamine g Carbohydrate g of which sugars g Fat g of which saturates g Fibre g Sodium g

per 100g powder 2037 479 119.8** 19.17 100 nil nil nil nil nil nil

per 200ml (approx)*

102 24 6 0.96 5 added added added added added added

*1 sachet (5g) + 200ml of water. **Calculated from N2 value (i.e. N2 x 6.25).

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Trade Marks The following are trademarks owned by SHS International Ltd.

Adamin-G Generaid Analog Hepatamine Calogen Hepatical Dialamine Ketocal Duobar Kindergen Duocal Liquigen Elemental 028 Maxamaid Emsogen Maxamum Energivit Maxijul

Maxipro Maxisorb Monogen Neocate Pepdite Phlexy-10 Phlexy-Vits Seravit

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Reference Tables Conversion Factors, Dietary Reference Values; United Kingdom, EU Reference Intakes; Europe, Dietary Reference Intakes; United States, Recommended Dietary Intakes; Australia.

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CONVERSION FACTORS NITROGEN 1 gram dietary nitrogen = 6·25 grams protein ENERGY 1 kilocalorie (kcal) 1 gram protein 1 gram carbohydrate 1 gram fat 1 gram alcohol MILLIGRAMS Na mg x K mg x Cl mg x Ca mg x

= = = = =

TO MILLIMOLES 0·043 = mmol 0·025 = mmol 0·028 = mmol 0·025 = mmol

4·184 kilojoules (kJ) 4 kilocalories (kcal) 4 kilocalories (kcal) 9 kilocalories (kcal) 7 kilocalories (kcal)

P mg x 0·032 = mmol Mg mg x 0·041 = mmol Zn mg x 0·015 = mmol

VITAMINS Vitamin A 1µg = 3·33 International units (IU) Vitamin D 1µg = 40 International units (IU) Vitamin E 1 mg α Tocopherol Equivalent = 1·49 International units (IU) WEIGHTS & MEASURES 1 ounce (oz) = 28·35g 1 pound (lb) = 453·6g 1 pint (pt) = 568ml

100g = 3·53oz 1 kg = 2·2lb (2lb 3oz) 1 litre = 1·76pt

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Dietary Reference Values for UK Table 1.1

Estimated Average Requirements (EARs) for Energy

Age

0-3 months 4-6 months 7-9 months 10-12 months 1-3 years 4-6 years 7-10 years 11-14 years 15-18 years 19-50 years 51-59 years 60-64 years 65-74 years 75 + years

EARs MJ/d (kcal/d) males

females

2.28 2.89 3.44 3.85 5.15 7.16 8.24 9.27 11.51 10.60 10.60 9.93 9.71 8.77

2.16 2.69 3.20 3.61 4.86 6.46 7.28 7.72 8.83 8.10 8.00 7.99 7.96 7.61

( 545) ( 690) ( 825) ( 920) (1,230) (1,715) (1,970) (2,220) (2,755) (2,550) (2,550) (2,380) (2,330) (2,100)

( 515) ( 645) ( 765) ( 865) (1,165) (1,545) (1,740) (1,845) (2,110) (1,940) (1,900) (1,900) (1,900) (1,810)

Pregnancy

+0.80*( 200)

Lactation: 1 month 2 months 3 months 4-6 months (Group 1)** 4-6 months (Group 2) >6 months (Group 1) >6 months (Group 2)

+1.90 +2.20 +2.40 +2.00 +2.40 +1.00 +2.30

(450) (530) (570) (480) (570) (240) (550)

* Last trimester only ** See para 2.5.2

Extracts from “Dietary Reference Values for Food Energy and Nutrients for the United Kingdom” Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. HMSO, London, 1991. Eleventh Impression 2001. Crown copyright. Reproduced with the permission of the Controller of Her Majesty’s Stationery Office.

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Dietary Reference Values for UK Table 1.3

Reference Nutrient Intakes for Protein

Age

Reference Nutrient Intakea g/d

0-3 months 4-6 months 7-9 months 10-12 months 1-3 years 4-6 years 7-10 years

12.5b 12.7 13.7 14.9 14.5 19.7 28.3

Males: 11-14 years 15-18 years 19-50 years 51+ years

42.1 55.2 55.5 53.3

Females: 11-14 years 15-18 years 19-50 years 50 + years

41.2 45.0 45.0 46.5

Pregnancyc

+ 6

Lactationc: 0-4 months 4 + months

+11 + 8

Extracts from “Dietary Reference Values for Food Energy and Nutrients for the United Kingdom” Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. HMSO, London. 1991. Eleventh Impression 2001. Crown copyright. Reproduced with the permission of the Controller of Her Majesty’s Stationery Office.

Dietary Reference Values for UK

a These figures, based on egg and milk protein, assume complete digestibility. b No values for infants 0-3 months are given by WHO. The RNI is calculated from the recommendations of COMA. (See Table 7.1.) c To be added to adult requirement through all stages of pregnancy and lactation.

+0.5 +0.5

+0.3 +2 +2

12 14 13 12

+60 +60

+100

200 200 200 200

50 50 50 50 70 100 150

µg/d

*** For last trimester only

+0.5 +0.5

1.2 1.5 1.5 1.5

0.3 0.3 0.4 0.4 0.5 0.8 1.0

µg/d

+30 +30

+10***

35 40 40 40

25 25 25 25 30 30 30

mg/d

Vitamin C

+350 +350

+100

600 600 600 600

600 700 700 700

350 350 350 350 400 400 500

µg/d

Vitamin A

10 10

– – – **

8.5 8.5 7.8 7.8 7.8 – –

µg/d

Vitamin D

†Based on protein providing 14.7 per cent of EAR for energy

Folate

Crown copyright. Reproduced with the permission of the Controller of Her Majesty’s Stationery Office.

* *

1.0 1.2 1.2 1.2

1.2 1.5 1.4 1.4

** After age 65 the RNI is 10 µg/d for men and women

+0.2 +0.2

* No increment

+0.1***

1.1 1.1 1.1 1.1

15 18 17 16

0.2 0.2 0.3 0.4 0.7 0.9 1.0

mg/d†

Vitamin B12

10:04

Lactation: 0-4 months 4 + months

0.7 0.8 0.8 0.8

Females 11-14 years 15-18 years 19-50 years 50 + years

1.2 1.3 1.3 1.3

3 3 4 5 8 11 12

mg/d

Niacin Vitamin (nicotinic B6 acid equivalent)

15/8/06

Pregnancy

0.9 1.1 1.0 0.9

Males 11-14 years 15-18 years 19-50 years 50 + years

0.4 0.4 0.4 0.4 0.6 0.8 1.0

mg/d

0.2 0.2 0.2 0.3 0.5 0.7 0.7

Riboflavin

Thiamin

0-3 months 4-6 months 7-9 months 10-12 months 1-3 years 4-6 years 7-10 years

Age

Reference Nutrient Intakes for Vitamins

Dietary Reference Values for UK

Table 1.4

CHECKLIST 2006 Pabs Page 106

+14.3 +14.3

Pregnancy

Lactation: 0-4 months 4 + months +14.3 +14.3

20.0 20.0 17.5 17.5

1 mmol sodium = 23 mg

+2.1 +2.1

11.5 12.3 10.9 10.9

11.5 12.3 12.3 12.3

* *

70 70 70 70

9 12 14 15 22 30 50

Sodium mmol/d

1 mmol potassium = 39 mg

* *

80 90 90 90

20 22 18 18 20 28 50

Potassium mmol/d

* *

260 5 260 5 260 5 160

200 200 160 160

30 80 140 140 120 110 160

Iron µmol/d

Corresponds to sodium 1 mmol = 35.5mg

* *

70 70 70 70

9 12 14 15 22 30 50

Chloride 4 mmol/d

+5 +5

13 16 19 19

5 5 5 5 6 9 11

Copper µmol/d

+0.2 +0.2

0.6 0.8 0.8 0.8

0.6 0.9 0.9 0.9

0.1 0.2 0.1 0.1 0.2 0.3 0.4

* *

1.0 1.1 1.1 1.1

1.0 1.0 1.0 1.0

0.4 0.5 0.5 0.5 0.6 0.8 0.9

Selenium Iodine µmol/d µmol/d

Insufficient for women with high menstrual losses where the most practical way of meeting iron requirements is to take iron supplements (see table 28.2)

+90 +40

140 110 110 110

140 145 145 145

60 60 75 75 75 100 110

Zinc µmol/d

Dietary Reference Values for UK

Crown copyright. Reproduced with the permission of the Controller of Her Majesty’s Stationery Office.

Phosphorus RNI is set equal to calcium in molar terms

20.0 20.0 17.5 17.5

Females 11-14 years 15-18 years 19-50 years 50 + years

25.0 25.0 17.5 17.5

2.2 2.5 3.2 3.3 3.5 4.8 8.0

Magnesium mmol/d

10:04

25.0 25.0 17.5 17.5

Males 11-14 years 15-18 years 19-50 years 50 + years

13.1 13.1 13.1 13.1 8.8 11.3 13.8

Phosphorus1 mmol/d

15/8/06

* No increment

13.1 13.1 13.1 13.1 8.8 11.3 13.8

Calcium mmol/d

0-3 months 4-6 months 7-9 months 10-12 months 1-3 years 4-6 years 7-10 years

Age

Reference Nutrient Intakes for Minerals (SI Units)

Dietary Reference Values for UK

Table 1.5

CHECKLIST 2006 Pabs Page 107

800 800 700 700 *

+550 +550

Females 11-14 years 15-18 years 19-50 years 50 + years

Pregnancy

Lactation: 0-4 months 4 + months

* No Increment

+440 +440 1 mmol sodium = 23 mg

* *

1,600 1,600 1,600 1,600

210 280 320 350 500 700 1,200

1 mmol potassium = 39 mg

* *

3,100 3,500 3,500 3,500

800 850 700 700 800 1,100 2,000

Corresponds to sodium 1 mmol = 35.5mg

* *

2,500 2,500 2,500 2,500

320 400 500 500 800 1,100 1,800

* *

+6.0 +2.5

9.0 7.0 7.0 7.0

9.0 9.5 9.5 9.5

4.0 4.0 5.0 5.0 5.0 6.5 7.0

+0.3 +0.3

0.8 1.0 1.2 1.2

0.2 0.3 0.3 0.3 0.4 0.6 0.7

+15 +15

45 60 60 60

45 70 75 75

10 13 10 10 15 20 30

* *

130 140 140 140

50 60 60 60 70 100 110

Selenium Iodine µg/d µg/d

Insufficient for women with high menstrual losses where the most practical way of meeting iron requirements is to take iron supplements (see table 28.2)

14.8 5 14.8 5 14.8 5 8.7

11.3 11.3 8.7 8.7

1.7 4.3 7.8 7.8 6.9 6.1 8.7

Copper mg/d

Crown copyright. Reproduced with the permission of the Controller of Her Majesty’s Stationery Office.

+50 +50

280 300 270 270

280 300 300 300

55 60 75 80 85 120 200

Zinc mg/d

10:04

625 625 550 550

775 775 550 550

400 400 400 400 270 350 450

Phosphorus1 Magnesium Sodium Potassium Chloride4 Iron mg/d mg/d mg/d2 mg/d3 mg/d mg/d

15/8/06

Phosphorus RNI is set equal to calcium in molar terms

1,000 1,000 700 700

Males 11-14 years 15-18 years 19-50 years 50 + years

525 525 525 525 350 450 550

Calcium mg/d

Reference Nutrient Intakes for Minerals (continued)

0-3 months 4-6 months 7-9 months 10-12 months 1-3 years 4-6 years 7-10 years

Age

Table 1.5

Dietary Reference Values for UK

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Dietary Reference Values for UK Table 1.6

Safe intakes

Nutrient Vitamins: Pantothenic acid adults infants Biotin Vitamin E men women infants Vitamin K adults infants Minerals: Manganese adults infants and children Molybdenum adults infants, children and adolescents Chromium adults children and adolescents Fluoride children over 6 years and adults children over 6 months infants under 6 months

Safe intake*

3–7 mg/d 1.7 mg/d 10–200 µg/d above 4 mg/d above 3 mg/d 0.4 mg/g polyunsaturated fatty acids 1 µg/kg/d 10 µg/d

above 1.4 mg/dw (26 µmol/d) above 16 µg/kg/d (0.3 µmol/kg/d) 50-400 µg/d 0.5–1.5 µg/kg/d above 25 µg (0.5 µmol/d) 0.1–1.0 µg (2-20 nmol)/kg/d 0.5 mg/kg/d (3 µmol/kg/d) 0.12 mg/kg/d 6 µmol/kg/d) 0.22 mg/kg/d (12 µmol/kg/d)

*(See para 1.3.18)

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EU Reference Intakes Table 37.1 Multiple Values Proposed for Adults (Amounts per day, unless given in other items. If that for women is different from that for men, it is in parentheses)

Nutrient

Average Requirement

Protein (g) 0.6/kg body wt Vitamin A (μg) 500 (400) Thiamin (μg) 72/MJ Riboflavin (mg) 1.3 (1.1) Niacin (mg niacin 1.3/MJ equivalents) Vitamin B6 (μg) 13/g protein Folate (μg) 140 Vitamin B12 (μg) 1.0 Vitamin C (mg) 30 Vitamin E (mg α-tocopherol equivalents) n-6 PUFA* (as percentage of 1 dietary energy) n-3 PUFA* (as percentage of 0.2 dietary energy) Calcuim (mg) 550 Phosphorus (mg) 400 Potassium (mg) Iron (mg) 7 (10, 6a) Zinc (mg) 7.5 (5.5) Copper (mg) 0.8 Selenium (μg) 40 Iodine (μg) 100

Population Reference Intake

Lowest Threshold Intake

0.75/kg body wt 700 (600) 100/MJ 1.6 (1.3) 1.6/MJ

0.45/kg body wt 300 (250) 50/MJ 0.6 1.0/MJ

15/g protein 200 1.4 45 0.4/g PUFA*

85 0.6 12 4 (3)/d regardless of PUFA* intakes 0.5

2 0.5

0.1

700 550 3100 9 (16b, 8a) 9.5 (7) 1.1 55 130

400 300 1600 5 (7, 4a) 5 (4) 0.6 20 70

For the following, acceptable ranges of intake are give Pantothenic acid (mg) Biotin (μg) Vitamin D (μg) Sodium (g) Magnesium (mg) Manganese (mg)

3-12 15-100 0-10 0.575-3.5 150-500 1-10

* PUFA: Polunsaturated fatty acids a Postmenopausal b PRI to cover 90% of women Reproduced from Reports of the Scientific Committee for food (thirty first series) (1993). Nutrient and Energy Intakes for the European Community. Luxembourg: Office for Official Publications of the European Communities, with permission granted by European Communities.

0.5

950

700

600 600 600

100

100 100 100

100 100 100 100

1.7

1.6

1.2 1.3 1.3

1.4 1.6 1.6

0.4 0.8 1.0 1.2

(mg/d)

Riboflavin

1.6 (+2mg/d)

1.6

1.6 1.6 1.6

1.6 1.6 1.6 1.6

(mg/MJ)

Niacin

15 15 15

15 15 15 15

(μg/g protein)

Vitamin B6

350

400

180 200 200b

180 200 200

50 100 130 150

(μg/d)

Folate

1.9

1.6

1.3 1.4 1.4

0.5 0.7 0.9 1.0

(μg/d)

Vitamin B12

35 40 45

20 25 25 30

(mg/d)

Vitamin C

Neutral tube defects have been shown to be prevented in offspring by periconceptual ingestion of 400 μg folic acid per day in the form of supplements.

0.5 0.5 0.5

600 700 700

350 400 400 500

(μg/MJ)

Thiamin

Reproduced from Reports of the Scientific Committee for food (thirty first series) (1993). Nutrient and Energy Intakes for the European Community. Luxembourg: Office for Official Publications of the European Communities, with permission granted by European Communities.

Polyunsaturated fatty acids

0.75 (+16 g/d)

Lactation

0.75 (+10 g/d)

2 2 2

0.5 0.5 0.5

0.5 0.5 0.5 0.5

(μg/d)

Vitamin A

10:04

Pregnancy

11-14 y 15-17 y 18+ y

Females

2 2 2

4.5 3 2 2

% of dietary energy

n-3 PUFA

15/8/06

0.95 0.85 0.75

1.0 0.9 0.75

11-14 y 15-17 y 18+ y

Males

1.6 1.1 1.0 1.0

% of dietary energy

(g/kg body weight/d)

n-6 PUFA

Protein

6-11 m 1-3 y 4-6 y 7-10 y

Age group

Table 37.2 Population Reference Intakes

EU Reference Intakes

CHECKLIST 2006 Pabs Page 111

1000 1000 700

Pregnancy

Lactation

625

950

550

3100

22* 18** 21* 17** 20* 16** 8*** ****

10 13 9

6 4 4 6

Zinc

9 9 9.5

4 4 6 7

(mg/d)

1.4

1.1

1.0

0.8

0.8 1.0 1.1

0.3 0.4 0.6 0.7

(mg/d)

Copper

35 45 55

8 10 15 25

(Îźg/d)

Selenium

To cover 95% of population To cover 90% of population Post-menopausal Supplements necessary

700

1200

18+ y

625

3100 3100 3100

Iron (mg/d)

160

130

120

120 130 130

50 70 90 100

(Îźg/d)

Iodine

10:04

* ** *** ****

800

700

15-17 y

800

775 775 550

800 800 1100 2000

(mg/d)

Potassium

15/8/06

11-14 y

Females

Males

11-14 y 15-17 y 18+ y

300 300 350 450

(mg/d)

400 400 450 550

Phosphorus

Calcium

6-11 m 1-3 y 4-6 y 7-10 y

Age Group

Table 37.2 Population Reference Intakes (continued)

EU Reference Intakes

CHECKLIST 2006 Pabs Page 112

Lactation

1.1

1.0c

0.9 0.9 0.9 0.6

1.0 1.2 1.1 0.8

0.3 0.5 0.7 0.8

(mg)

Thiamin

14 14 14 11

15 18 18 15

5 9 11 13

(mg)

Niacin

1.4d

1.3d

1.1 1.1 1.1 1.0

1.3 1.5 1.5 1.3

0.4 0.7 0.9 1.1

(mg)

Vitamin B6

5.5

Population Reference Intakes (PRI) except where indicatated as Average Requirements (AR). (Calculated as mean group intake x PRI or AR) Polyunsaturated Fatty Acids From 10th week of pregnancy Based on protein increments in pregnancy and lactation

Pregnancy

1 1 1 0.5

1 1.5 1.5 0.6

0.5 0.7 1 1

(g)

n-3 PUFA

4 5 4.5 2.5

5 6 6 3

10:04

42 46 47 37

11-14 y 15-17 y 18+ y (PRI) (AR)

44 55 56 45

4 4 4 4

(g)

(g) 15 15 20 29

n-6 PUFA

Protein

15/8/06

Females

11-14 y 15-17 y 18+ y (PRI) (AR)

Males

6-11 m 1-3 y 4-6 y 7-10 y

Age Group

Table 37.3 Daily intakes of those nutrients for which the recommendations are given in relation to body weight, energy or protein intakes

EU Reference Intakes

CHECKLIST 2006 Pabs Page 113

40* 50*

15 25

45 75 90 90 90 90

45 65 75 75 75 75

80 85 85

115 120 120

300 400

600 900 900 900 900 900

600 700 700 700 700 700

750 770 770

1,200 1,300 1,300

Vitamin C (mg/d)

400* 500*

Vitamina A (µg/d)

19 19 19

15 15 15

11 15 15 15 15 15

6 7

4* 5*

75* 90* 90*

60* 75* 90* 90* 90* 90*

60* 75* 120* 120* 120* 120*

30* 55*

2.0* 2.5*

1.4 1.4 1.4

0.9 1.0 1.1 1.1 1.1 1.1

0.9 1.2 1.2 1.2 1.2 1.2

0.5 0.6

0.2* 0.3*

Thiamin (mg/d)

1.6 1.6 1.6

1.4 1.4 1.4

0.9 1.0 1.1 1.1 1.1 1.1

0.9 1.3 1.3 1.3 1.3 1.3

0.5 0.6

0.3* 0.4*

Riboflavin (mg/d)

17 17 17

18 18 18

12 14 14 14 14 14

12 16 16 16 16 16

6 8

2* 4*

2.0 2.0 2.0

1.9 1.9 1.9

1.0 1.2 1.3 1.3 1.5 1.5

1.0 1.3 1.3 1.3 1.7 1.7

0.5 0.6

0.1* 0.3*

Niacin Vitamin B6 (mg/d)e (mg/d)

500 500 500

600j 600j 600j

300 400i 400i 400i 400 400

300 400 400 400 400 400

150 200

65* 80*

Folate (µg/d)f

2.8 2.8 2.8

2.6 2.6 2.6

1.8 2.4 2.4 2.4 2.4h 2.4h

1.8 2.4 2.4 2.4 2.4hh 2.4

0.9 1.2

0.4* 0.5*

7* 7* 7*

6* 6* 6*

4* 5* 5* 5* 5* 5*

2* 3*

1.7* 1.8*

Vitamin B12 Pantothenic (µg/d) Acid (mg/d)

35* 35* 35*

30* 30* 30*

20* 25* 30* 30* 30* 30*

8* 12*

5* 6*

Biotin (µg/d)

550* 550* 550*

450* 450* 450*

375* 400* 425* 425* 425* 425*

375* 550* 550* 550* 550* 550*

200* 250*

125* 150*

Cholineg (mg/d)

b c d

As retinol activity equivalents (RAEs). 1 RAE = 1 μg retinol, 12 µg β-carotene, 24 µg α-carotene, or 24 µg β-cryptoxanthin. The RAE for dietary provitamin A carotenoids is two-fold greater than retinol equivalents (RE), whereas the RAE for preformed vitamin A is the same as RE. cholecalciferol. 1 µg cholecalciferol = 40 IU vitamin D. In the absence of adequate exposure to sunlight. As α-tocopherol. α-Tocopherol includes RRR-α-tocopherol, the only form of α-tocopherol that occurs naturally in foods, and the 2R-stereoisomeric forms of α-tocopherol (RRR-, RSR-, RRS-, and RSS-α-tocopherol) that occur in fortified foods and supplements. It does not include the 2S-stereoisomeric forms of α-tocopherol (SRR-, SSR-, SRS-, and SSS-a-tocopherol), also found in fortified foods and supplements. As niacin equivalents (NE). 1 mg of niacin = 60 mg of tryptophan; 0–6 months = preformed niacin (not NE). As dietary folate equivalents (DFE). 1 DFE = 1 µg food folate = 0.6 µg of folic acid from fortified food or as a supplement consumed with food = 0.5 µg of a supplement taken on an empty stomach.

Although AIs have been set for choline, there are few data to assess whether a dietary supply of choline is needed at all stages of the life cycle, and it may be that the choline requirement can be met by endogenous synthesis at some of these stages. h Because 10 to 30 percent of older people may malabsorb food-bound B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with B12 or a supplement containing B12. i In view of evidence linking folate intake with neural tube defects in the fetus, it is recommended that all women capable of becoming pregnant consume 400 µg from supplements or fortified foods in addition to intake of food folate from a varied diet. j It is assumed that women will continue consuming 400 µg from supplements or fortified food until their pregnancy is confirmed and they enter prenatal care, which ordinarily occurs after the end of the periconceptional period—the critical time for formation of the neural tube.

10:04

5* 5* 5*

5* 5* 5* 5* 10* 15*

5* 5*

Vitamin K (µg/d)

Food and Nutrition Board, Institute of Medicine, National Academies Vitaminb,cD Vitamin dE (µg/d) (mg/d)

15/8/06

NOTE: This table (taken from the DRI reports, see www.nap.edu) presents Recommended Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type followed by an asterisk (*). RDAs and AIs may both be used as goals for individual intake. RDAs are set to meet the needs of almost all (97 to 98 percent) individuals in a group. For healthy breastfed infants, the AI is the mean intake. The AI for other life stage and gender groups is believed to cover needs of all individuals in the group, but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake.

Infants 0–6 mo 7–12 mo Children 1–3 y 4–8 y Males 9–13 y 14–18 y 19–30 y 31–50 y 51–70 y > 70 y Females 9–13 y 14–18 y 19–30 y 31–50 y 51–70 y > 70 y Pregnancy ≤ 18 y 19–30 y 31–50 y Lactation ≤ 18 y 19–30 y 31–50 y

Life Stage Group

Dietary Reference Intakes (DRIs): Recommended Intakes for Individuals, Vitamins

Dietary Reference Intakes for US

CHECKLIST 2006 Pabs Page 114

0.2* 5.5*

11* 15*

25* 35* 35* 35* 30* 30*

21* 24* 25* 25* 20* 20*

29* 30* 30*

44* 45* 45*

210* 270*

1,300* 1,300* 1,000* 1,000* 1,200* 1,200*

1,300* 1,000* 1,000*

Chromium (µg/d)

500* 800*

Calcium (mg/d)

3* 3* 3*

2* 3* 3* 3* 3* 3*

2* 3* 4* 4* 4* 4*

0.7* 1*

0.01* 0.5*

Fluoride (mg/d)

290 290 290

220 220 220

120 150 150 150 150 150

90 90

110* 130*

Iodine (µg/d)

10 9 9

27 27 27

8 15 18 18 8 8

8 11 8 8 8 8

7 10

0.27* 11*

Iron (mg/d)

360 310 320

400 350 360

240 360 310 320 320 320

240 410 400 420 420 420

80 130

30* 75*

Magnesium (mg/d)

2.6* 2.6* 2.6*

2.0* 2.0* 2.0*

1.6* 1.6* 1.8* 1.8* 1.8* 1.8*

1.9* 2.2* 2.3* 2.3* 2.3* 2.3*

1.2* 1.5*

0.003* 0.6*

Manganese (mg/d)

50 50 50

34 43 45 45 45 45

17 22

2* 3*

Molybdenum (µg/d)

1,250 700 700

1,250 1,250 700 700 700 700

460 500

100* 275*

Phosphorus (mg/d)

Food and Nutrition Board, Institute of Medicine, National Academies

70 70 70

60 60 60

40 55 55 55 55 55

20 30

15* 20*

Selenium (µg/d)

14 12 12

13 11 11

8 9 8 8 8 8

8 11 11 11 11 11

3 5

2* 3

Zinc (mg/d)

SOURCES: Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamine E, Selenium, and Carotenoids (2000); and Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001). These reports may be accessed via www.nap.edu.

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1,300 1,300 1,300

1,000 1,000 1,000

700 890 900 900 900 900

340 440

200* 220*

Copper (µg/d)

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NOTE: This table presents Recommended Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type followed by an asterisk (*). RDAs and AIs may both be used as goals for individual intake. RDAs are set to meet the needs of almost all (97 to 98 percent) individuals in a group. For healthy breastfed infants, the AI is the mean intake. The AI for other life stage and gender groups is believed to cover needs of all individuals in the group, but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake.

Life Stage Group

Dietary Reference Intakes (DRIs): Recommended Intakes for Individuals, Elements

Dietary Reference Intakes for US

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1,800 2,000

2,800 3,000

50 50

50 50 50 50

800 1,000

600 800 1,000 1,000

200 300

ND ND

ND ND ND ND

ND ND

ND ND ND ND

ND ND

ND ND ND ND

ND ND

30 35

20 30 35 35

10 15

ND ND

Niacin (mg/d)d

80 100

60 80 100 100

30 40

ND ND

Vitamin B6 (mg/d)

800 1,000

600 800 1,000 1,000

300 400

ND ND

Folate (µg/d)d

ND ND

ND ND ND ND

ND ND

Vitamin B12

ND ND

ND ND ND ND

ND ND

Pantothenic Acid

ND ND

ND ND ND ND

ND ND

Biotin

3.0 3.5

2.0 3.0 3.5 3.5

1.0 1.0

ND ND

Choline (g/d)

ND ND

ND ND ND ND

ND ND

Carotenoidse

UL = The maximum level of daily nutrient intake that is likely to pose no risk of adverse effects. Unless otherwise specified, the UL represents total intake from food, water, and supplements. Due to lack of suitable data, ULs could not be established for vitamin K, thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, or carotenoids. In the absence of ULs, extra caution may be warranted in consuming levels above recommended intakes. As preformed vitamin A only. As α-tocopherol; applies to any form of supplemental α-tocopherol. The ULs for vitamin E, niacin, and folate apply to synthetic forms obtained from supplements, fortified foods, or a combination of the two. β-Carotene supplements are advised only to serve as a provitamin A source for individuals at risk of vitamin A deficiency. ND = Not determinable due to lack of data of adverse effects in this age group and concern with regard to lack of ability to handle excess amounts. Source of intake should be from food only to prevent high levels of intake.

1,200 1,800 2,000 2,000

1,700 2,800 3,000 3,000

50 50

ND ND

Riboflavin

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b c d e f

400 650

600 900

25 25

Thiamin

Food and Nutrition Board, Institute of Medicine, National Academies Vitamin E (mg/d)c,d Vitamin K

15/8/06

NDf ND

600 600

Vitamin A Vitamin C Vitamin D (µg/d)b (mg/d) (µg/d)

Infants 0-6 mo 7-12 mo Children 1-3 y 4-8 y Males, Females 9-13 y 14-18 y 19-70 y > 70 y Pregnancy ≤ 18 y 19-50 y Lactation ≤ 18 y 19-50 y

Life Stage Group

Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels (ULa) , Vitamins

Dietary Reference Intakes for US

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2.5 2.5

17 20

ND ND

ND ND ND ND

8,000 10,000

5,000 8,000 10,000 10,000

1,000 3,000

10 10

10 10 10 10

1.3 2.2

0.7 0.9

900 1,100

600 900 1,100 1,100

200 300

ND ND

45 45

40 45 45 45

40 40

350 350

350 350 350 350

65 110

ND ND

9 11

6 9 11 11

2 3

ND ND

1,700 2,000

1,100 1,700 2,000 2,000

300 600

ND ND

1.0 1.0

0.6 1.0 1.0 1.0

0.2 0.3

ND ND

4 4

3.5 3.5

4 4 4 3

3 3

ND ND

400 400

280 400 400 400

90 150

45 60

ND ND

ND ND ND ND

ND ND

ND ND 1.8 1.8

ND ND

34 40

23 34 40 40

7 12

4 5

2.5 2.5 2.5 2.5

11 17 20 20

ND ND

UL = The maximum level of daily nutrient intake that is likely to pose no risk of adverse effects. Unless otherwise specified, the UL represents total intake from food, water, and supplements. Due to lack of suitable data, ULs could not be established for arsenic, chromium, and silicon. In the absence of ULs, extra caution may be warranted in consuming levels above recommended intakes. Although the UL was not determined for arsenic, there is no justification for adding arsenic to food or supplements. The ULs for magnesium represent intake from a pharmacological agent only and do not include intake from food and water. Although silicon has not been shown to cause adverse effects in humans, there is no justification for adding silicon to supplements. Although vanadium in food has not been shown to cause adverse effects in humans, there is no justification for adding vanadium to food and vanadium supplements should be used with caution. The UL is based on adverse effects in laboratory animals and this data could be used to set a UL for adults but not children and adolescents. ND = Not determinable due to lack of data of adverse effects in this age group and concern with regard to lack of ability to handle excess amounts. Source of intake should be from food only to prevent high levels of intake.

2.5 2.5

3 6

ND ND

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b c d e

ND ND

Zinc (mg/d)

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Food and Nutrition Board, Institute of Medicine, National Academies

Boron Calcium Copper Fluoride Iodine Iron Magnesium Manganese Molybdenum Nickel Phosphorus Selenium Vanadium Arsenicb (mg/d) (g/d) Chromium (µg/d) (mg/d) (µg/d) (mg/d) (mg/d)c (mg/d) (µg/d) (mg/d) (g/d) (µg/d) Silicond (mg/d)e

Infants 0-6 mo NDf 7-12 mo ND Children 1-3 y ND 4-8 y ND Males, Females 9-13 y ND 14-18 y ND 19-70 y ND > 70 y ND Pregnancy ≤ 18 y ND 19-50 y ND Lactation ≤ 18 y ND 19-50 y ND

Life Stage Group

Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels (ULa), Elements

Dietary Reference Intakes for US

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Dietary Reference Intakes for US Table S-1 Criteria and Dietary Reference Intake Values for Energy by Active Individuals by Life Stage Groupa

Life Stage Group

Criterion

0 through 6 mo 7 though 12 mo 1 through 2 y 3 through 8 y 9 through 13 y 14 through 18 y >18 y

Energy Energy Energy Energy Energy Energy Energy

Pregnancy 14 through 18 y 1st trimester 2nd trimester 3rd trimester 19 through 50 y 1st trimester 2nd trimester 3rd trimester Lactation 14 through 18 y 1st 6 mo 2nd 6 mo 19 through 50 y 1st 6 mo 2nd 6 mo

expenditure expenditure expenditure expenditure expenditure expenditure expenditure

Active PALb EER (kcal/d) Male Female plus plus plus plus plus plus

energy energy energy energy energy energy

deposition deposition deposition deposition deposition deposition

570 743 1,046 1,742 2,279 3,152 3,067 c

520 676 992 1,642 2,071 2,368 2,403 c

Adolescent female EER plus change in TEE plus pregnancy energy deposition

2,368 (16 y) 2,708 (16 y) 2,820 (16 y) 2,403c (19 y) 2,743c (19 y) 2,855c (19 y)

Adolescent female EER plus milk energy output minus weight loss Adult female EER plus milk energy output minus weight loss

(3 mo) (9 mo) (24 mo) (6 y) (11 y) (16 y) (19 y)

2,698 (16 y) 2,768 (16 y) 2,733c (19 y) 2,803c (19 y)

a For healthy moderately active Americans and Canadians. b PAL = physical activity level, EER = estimated energy requirement, TEE = total energy

expenditure. The intake that meets the average energy expenditure of individuals at the reference height, weight and age (see table 1-1) c Subtract 10kcal/day for males and 7kcal for females for each year of age above 19 years. Source - Dietary Reference Intake for Energy, Carbohydrates, Fiber, Protein and Amino Acids (Macronutrients) (2003). This report may be accessed via www.nap.edu Copyright 2002 by the National Academy of Sciences. All rights reserved. Reproduced with permission.

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Recommended Dietary Intakes for Australia Tables of recommended dietary intakes of nutrients for use in Australia are given below.

Table 1A:

Recommended dietary intakes for children under 7 years (expressed as mean daily intake)

Infants 0–6 months Breast-fed Bottle-fed Vitamin A 425 (µg retinol equivalents) Thiamin (mg) 0.15 Riboflavin (mg) 0.4 Niacin (mg 4 niacin equivalents) Vitamin B-6 (mg) 0.25 Total folate (µg) 50 Vitamin B-12 (µg) 0.3 Vitamin C (mg) 25 Vitamin E (mg alpha 2.5 tocopheral equivalents) Zinc (mg) 3 Iron (mg) 0.5 Iodine (µg) 50 Magnesium (mg) 40 Calcium (mg) 300 Phosphorus (mg) 150 Selenium (µg) 10 Sodium (mmol) 6–12 Sodium (mg) 140–280 Potassium (mmol) 10–15 (mg) 390–580 Protein (g) *

Young Children 7–12 months

1–3 years

4–7 years

425

300

350

0.25 0.4 4

0.35 0.6 7

0.5 0.8 10

0.7 1.1 12

0.25 50 0.3 25 4.0

0.45 75 0.7 30 4.0

0.6–0.9 100 1.0 30 5.0

0.8–1.3 100 1.5 30 6.0

3–6 3.0 50 40 500 150 10 6–12 140–280 10–15 390–580 2.0/kg body wt

4.5 9.0 60 60 550 300 15 14–25 320–580 12–35 470–1370 1.6/kg body wt

4.5 6–8 70 80 700 500 25 14–50 320–1150 25–70 980–2730 14–18

6 6–8 90 110 800 700 30 20–75 460–1730 40–100 1560–3900 18–24

* No recommendation has been made for protein for breast-fed infants under the age of 6 months. Many observations show that infants breast-fed by healthy well-nourished mothers will grow at a satisfactory rate for the first 4–6 months. It can therefore be assumed that protein requirements are met if the volume of milk maintains growth at an acceptable rate.

Reprinted, with kind permission, from National Health and Medical Research Council Recommended Dietary Intakes for use in Australia, Australian Government Publishing Service, Canberra, 1991. Copyright Commonwealth of Australia reproduced with permission.

hs. at

d 1.2 1.8 20 1.4–2.1 200 2.0 30 10.5 12 10–13 150 260 1200 1200 85 40–100 920–2300 50–140 1950–5460 42–60

0.9 1.4 15 1.1–1.6 150 1.5 30 8.0 9 6–8 120 180 800 800 50 26–100 600–2300 50–140 1950–5460 27–38

12 10–13 150 320 1000 1100 85 40–100 920–2300 50–140 1950–5460 64–70

1.5–2.2 200 2.0 40 11.0

1.2 1.9 21

750

16–18 years

9 6–8 120 160 900 800 50 26–100 600–2300 50–140 1950–5460 27–39

1.0–1.5 150 1.5 30 8.0

0.8 1.3 15

500

8–11 years

12 10–13 120 240 1000 1200 70 40–100 920–2300 50–140 1950–5460 44–55

1.2–1.8 200 2.0 30 9.0

1.0 1.6 18

725

Girls 12–15 years

12 10–13 120 270 800 1100 70 40–100 920–2300 50–140 1950–5460 57

1.1–1.6 200 2.0 30 8.0

0.9 1.4 16

750

16–18 years

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725

Boys 12–15 years

500

8–11 years

Recommended dietary intakes for children over 7 years (expressed as mean daily intake)

Vitamin A (µg retinol equivalents) Thiamin (mg) Riboflavin (mg) Niacin (mg niacin equivalents) Vitamin B-6 (mg) Total folate (µg) Vitamin B-12 (µg) Vitamin C (mg) Vitamin E (mg alpha tocopheral equivalents Zinc (mg) Iron (mg) Iodine (µg) Magnesium (mg) Calcium (mg) Phosphorus (mg) Selenium (µg) Sodium (mmol) Sodium (mg) Potassium (mmol) (mg) Protein (g)

Table 1B:

Recommended Dietary Intakes for Australia

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750 0.9 1.3 16 1.0-1.5 200 2.0 40 10.0 12 7 150 320 800 1000 85 40-100 920-2300 50-140 1950-5460 55

1.1 1.7 19 1.3-1.9 200 2.0 40 10.0 12 7 150 320 800 1000 85 40-100 920-2300 50-140 1950-5460 55

64 years

750

Men

12 12-16 120 270 800 1000 70 40-100 920-2300 50-140 1950-5460 45

0.9-1.4 200 2.0 30 7.0

0.8 1.2 13

750

19–54 years

Women

12 5-7 120 270 1000 1000 70 40-100 920-2300 50-140 1950-5460 45

0.8-1.1 200 2.0 30 7.0

0.7 1.0 11

750

54+ years

+4 +10-20 +30 +30 +300 +200 +10 +0 +0 +0 +0 +6

+0.1 +200 +1.0 +30 +0

+0.2 +0.3 +2

Pregnant

+6 +0 +50 +70 +400 +200 +15 +0 +0 +0 +0 +16

+0.7-0.8 +150 +0.5 +45 +2.5

+0.4 +0.5 +5

+450

Lactating

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19–64 years

Recommended dietary intakes for adults (expressed as mean daily intake)

Recommended Dietary Intakes for Australia

Table 1C:

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Recommended Dietary Intakes for Australia

RECOMMENDED ENERGY INTAKES FOR GROUPS Table 4

Recommended energy intakes for infants

Age (months) 0–0.9 1–2 2–3 3–4 4–5 5–6

kJ/kg

Age (months)

520 485 455 430 415 405

kJ/kg

6–7 7–8 8–9 9–10 10–11 11–12

395 395 395 415 420 435

Source: FAO–WHO–UNU (1985)

Table 5

Recommended energy intakes for children 1–10 years MJ/day

Age (years) 1–2 2–3 3–4 4–5 5–6 6–7 7–8 8–9 9–10

Males

Females

5.0 5.9 6.5 7.1 7.6 7.9 8.3 8.7 9.0

4.8 5.5 6.0 6.4 6.8 7.1 7.4 7.7 7.9

Source: FAO–WHO–UNU (1985)

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Recommended Dietary Intakes for Australia

Table 6

Recommended energy intakes for adolescents 10–18 years MJ/day

Age (years) 10–11 11–12 12–13 13–14 14–15 15–16 16–17 17–18

Males 8.1–9.1 8.7–9.8 9.2–10.3 9.8–11.0 9.8–11.8 11.1–12.5 11.7–13.2 12.0–13.5

Females 7.3–8.2 7.7–8.7 8.1–9.1 8.4–9.5 8.6- 9.8 8.7–9.9 8.8–10.0 8.8–10.0

Source: FAO–WHO–UNU (1985) Note: Level of energy expenditure: males 1.6–1.8 BMR females 1.5–1.7 BMR Note: BMR estimated from Schofield et al. (1985). Hum. Nutr.: Clin. Nutr. 39c (Suppl 1):1-96

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Recommended Dietary Intakes for Australia Table 7

Recommended energy intakes for adults (MJ/day)

Age group(years)

Males

Females

Weight (kg) 50.6 57.6 65.0 72.9 81.2 90.0

09.1– 9.1–10.4 9.8–11.2 10.5–12.0 11.2–12.8 12.0–13.7

7.2–8.3 7.9–9.0 8.5–9.7 9.2–10.5 9.9–11.3 9.9–

30–60 Height (cm) 150 160 170 180 190 200

Weight (kg) 50.6 57.6 65.0 72.9 81.2 90.0

09.0– 9.0–10.3 9.5–10.8 10.0–11.4 10.6–12.1 11.2–12.8

7.2–8.3 7.7–8.8 8.0–9.2 8.4–9.6 8.8–10.1 8.8–

Over 60 Height (cm) 150 160 170 180 190 200

Weight (kg) 50.6 57.6 65.0 72.9 81.2 90.0

7.4– 7.4–8.5 7.9–9.0 8.4–9.6 9.0–10.3 9.6–11.0

6.5–7.5 6.9–7.9 7.3–8.4 7.7–8.8 8.2–9.3 8.2–

18–30 Height (cm) 150 160 170 180 190 200

Source: BMI at mid-point of acceptable range (22.5); NHMRC (1984) Table of acceptable weight-forheight. From Report of the 98th session, National Health and Medical Research Council, AGPS, Canberra. Level of energy expenditure 1.4–1.6 BMR BMR estimated from Schofield et al. (1985). Hum.: Clin Nutr. 39c (suppl 1): 1-96

d Reprinted, with kind permission, from National Health and Medical Research Council Recommended Dietary Intakes for use in Australia, Australian Government Publishing Service, Canberra, 1991. Copyright Commonwealth of Australia reproduced with permission.

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