Description
A treatment to support the effectiveness of the immune response in patients able to take a product orally. Formulation enriched with immunomodulators (RNA, arginine, omega-3 fatty acids) and supplemented with soluble fiber (PHGG). It is born from cutting-edge technology, as well as from the experience and clinical research conducted on different groups of surgical patients, as a preoperative treatment, effective in reducing the incidence of complications and improving the patient's clinical outcome. The treatment has reduced the incidence of postoperative infectious complications and shortened the length of hospital stay in treated patients, compared to controls.
- Preoperative treatment for major surgery: abdominal surgery, ENT surgery, cardiac surgery;
- Postoperative immunonutrition in malnourished surgical patients;
- Pre-postoperative immunonutritional treatment in oncological surgery;
- Pre-postoperative immunonutritional treatment as part of the ERAS approach;
- For the oral nutrition of critically ill patients with immunodeficiency, in whom the primary objective is to support or improve the effectiveness of the immune response, for example: oncological patients undergoing radio-chemotherapy; patients with pressure ulcers.

Properties
Arginine: is a semi-essential amino acid, essential for T lymphocytes for their growth and duplication; it promotes anabolism, nitrogen retention and the wound healing process; it promotes an optimal immune response in situations of metabolic stress.
Marine oil: provides omega-3 series fatty acids: linolenic acid, and its derivatives EPA and DHA, important for containing inflammatory processes and inhibiting the immune-depressing action of omega-6 series fatty acids; Impact contains a 6/3 ratio <1, ideal for critically ill patients.
Nucleotides: are essential substrates for cells, especially for those with rapid turnover, such as mucosal cells, lymphocytes and macrophages; in non-stress conditions, the daily requirement is covered by normal endogenous synthesis or dietary intake; in case of metabolic stress, an extra supply of nucleotides is necessary to promote adequate proliferation of T lymphocytes.

Ingredients
Water, sucrose, milk proteins (contains lactose), maltodextrins, 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, iron 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	per 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
Water	76 ml	182 ml
Sodium	150 mg	355 mg
Chlorine	169 mg	401 mg
Potassium	190 mg	450 mg
Calcium	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
Chromium	14 mcg	33 mcg
Molybdenum	22.5 mcg	53.3 mcg
Fluoride	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 H2O Viscosity: 50 cP (at 20°C) pH: 6.8 Omega-3/omega-6 ratio: 0.9

Amino acid profile

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
Serine	4.46

Directions for use
The standard daily dose is 3 bricks per day, or as prescribed by a doctor.

Warnings
Check the integrity of the container and the expiry date. Observe hygiene rules during handling. Shake well before use. For a better taste, serve chilled.

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

Code 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 J.E. 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.