Description
Treatment to support the effectiveness of the immune response in patients able to take an oral product. The formulation is enriched with immunomodulators (RNA, arginine, omega-3 fatty acids) and added with soluble fiber (PHGG). It is based on cutting-edge technology, as well as experience and clinical research conducted on various groups of surgical patients. As a preoperative treatment, it is effective in reducing the incidence of complications and improving patient outcomes. The treatment has reduced the incidence of postoperative infectious complications and shortened hospital stays in treated patients compared to controls.
- Preoperative treatment in case of major surgery: abdominal surgery, ENT surgery, cardiac surgery;
- Postoperative immunonutrition in malnourished surgical patients;
- Pre- and postoperative immuno-nutritional treatment in oncological surgery;
- Pre- and postoperative immuno-nutritional treatment as part of the ERAS approach;
- For oral nutrition in critically ill patients with immunosuppression, in which the primary objective is to support or enhance the effectiveness of the immune response, for example: oncology patients undergoing radiotherapy or chemotherapy; patients with pressure ulcers.

Property
Arginine : is a semi-essential amino acid, essential for T lymphocytes' growth and replication; it promotes anabolism, nitrogen retention, and wound healing; it promotes an optimal immune response in situations of metabolic stress.
Marine oil : provides series 3 fatty acids: linolenic acid, and its derivatives EPA and DHA, important for containing inflammatory processes and inhibiting the immunosuppressant action of series 6 fatty acids; Impact contains a 6/3 <1 ratio, ideal for critically ill patients.
Nucleotides : These are essential substrates for cells, especially those with rapid turnover, such as mucosal cells, lymphocytes, and macrophages. In non-stressful conditions, the daily requirement is met by normal endogenous synthesis or dietary intake. In cases of metabolic stress, an additional supply of nucleotides is necessary to promote adequate proliferation of T lymphocytes.

Ingredients
Water, sucrose, milk protein (contains lactose), maltodextrin, L-arginine, partially hydrolyzed guar gum, fish oil, mineral salts (potassium citrate, sodium citrate, calcium phosphate, sodium chloride, magnesium chloride, potassium chloride, magnesium phosphate, calcium citrate, ferrous phosphate, zinc sulfate, copper gluconate, manganese sulfate, sodium fluoride, potassium iodide, sodium molybdate, sodium selenite, chromium chloride), medium chain triglycerides, corn oil; acidifier: citric acid; emulsifiers: E471, soy lecithin; Yeast extract rich in nucleotides (RNA), choline bitartrate, flavorings, vitamins (C, niacin, pantothenic acid, E, B6, A, thiamine, riboflavin, D, K, folic acid, B12, biotin); stabilizers: E460, carrageenan, E466; antioxidant: tocopherol-rich extract; coloring: beta-carotene.

Nutritional characteristics

Average values	per 100 ml	for 237 ml
Energy	144 kcal 606 kJ	341 kcal 1,436 kJ
Proteins	7.6 g	18 g
L-arginine	1.8 g	4.3 g
RNA	0.18 g	0.43 g
Lipids	3.9 g	9.2 g
- saturated fatty acids, of which:	1.8 g	4.3 g
- MCT	1.1 g	2.6 g
- monounsaturated fatty acids	0.7 g	1.7 g
- polyunsaturated fatty acids	1.3 g	3.1 g
- omega-3 fatty acids	0.6 g	1.42 g
- EPA + DHA	0.5 g	1.2 g
Carbohydrates	18.9 g	44.8 g
- maltodextrins	7.8 g	18.4 g
- sucrose	11.1 g	26.3 g
- lactose	<0.1 g	-
Soluble fiber (PHGG)	1.4 g	3.3 g
Waterfall	76 ml	182 ml
Sodium	150 mg	355 mg
Chlorine	169 mg	401 mg
Potassium	190 mg	450 mg
Soccer	114 mg	270 mg
Phosphorus	101 mg	239 mg
Magnesium	32 mg	76 mg
Iron	1.7 mg	4 mg
Zinc	2.1 mg	5 mg
Copper	250 mcg	590 mcg
Iodine	21 mcg	50 mcg
Selenium	6.6 mcg	15.6 mcg
Manganese	0.3 mg	0.71 mg
Chrome	14 mcg	33 mcg
Molybdenum	22.5 mcg	53.3 mcg
Fluorine	0.21 mg	0.5 mg
Vitamin A	139 mcg	329 mcg
Vitamin D	0.94 mcg	2.2 mcg
Vitamin E	4.2 mg	10 mg
Vitamin K	9.4 mcg	22.3 mcg
Vitamin C	30 mg	71 mg
Vitamin B1	0.17 mg	0.4 mg
Vitamin B2	0.25 mg	0.6 mg
Vitamin B6	0.21 mg	0.5 mg
Niacin	2.2 mg	5.2 mg
Folic acid	28 mcg	66 mcg
Vitamin B12	0.8 mcg	1.9 mcg
Pantothenic acid	1.1 mg	2.6 mg
Biotin	10.1 mcg	24 mcg
Choline	38 mg	90 mg
Osmolarity: 680 mOsm/l Osmolality: 890 mOsm/kg H 2 O Viscosity: 50 cP (at 20°C) pH: 6.8 Omega-3/omega-6 ratio: 0.9

Aminoacidogram

Amino acids per 100 g
Isoleucine	4.10
Leucine	7.12
Lysine	5.83
Methionine	2.09
Cysteine	0.29
Phenylalanine	3.81
Tyrosine	4.10
Threonine	3.24
Tryptophan	1.01
Valine	5.18
Arginine	24.73
Histidine	2.23
Alanine	2.16
Aspartic acid	5.18
Glutamic acid	15.69
Glycine	1.37
Proline	7.41
Serina	4.46

How to use
The standard daily dose is 3 bricks per day, or as prescribed by your doctor.

Warnings
Check the integrity of the container and the expiration date. Observe hygiene rules when handling. Shake well before use. To best appreciate the flavor, serve chilled.

Format
Impact Oral is available in a practical tripack, containing 3 237 ml bricks, corresponding to the daily dosage of preoperative immuno-nutritional therapy.

Cod. 12172175

Bibliography
1. McClave, S. et al. JPEN 2009; 33: 277-316.
2. Zhu X et al. Ann Surg. 2014 Jan; 259(1):171-8.
3. Kinsella JE et al. Nutrition 1990; 6 (1): 24-25.
4. Koller M et al. Clin. Nutr. 2003; 22:59.
5. Drover JW et al. Am Coll Surg. 2011 Mar; 212(3): 385-99.e1.