Description
treatment in support of the effectiveness of the immune response, in patients who can take an oral product. Formulation enriched with immunomodulating (RNA, arginine, omega-3 fatty acids) and additive of soluble fiber (PHGG). It comes from avant-garde technology, as well as from the experience and clinical research carried out on different groups of surgical patients, such as preoperative treatment, effective in reducing the incidence of complications and improving the clinical out-come of the patient. The treatment allowed to reduce the incidence of infectious post-operative complications and to shorten the period of decency in treated patients, compared to controls.
- Preoperative treatment in case of major surgery: abdominal surgery, ORL surgery, cardiosurgery;
- Post-operative infectious surgical patients;
- Pre-postoperative immunonutritional treatment in oncological surgery;
- Pre-postoperative immunonutritional treatment within the ERAS approach;
- For oral nutrition of critical patients with immunodepression, in which the primary objective is to support or improve the effectiveness of the immune response, for example: cancer patients in radio-chemotherapy treatment; patients with decubital injuries.

Property
Arginine: is a semi-essential amino acid, indispensable to T lymphocytes for their growth and duplication; promotes anabolicism, nitrogen retention and wound healing process; promotes optimal immune response in metabolic stress situations.
Oil of marine origin: provides fatty acids in the series 3: linolenic acid, and its EPA and DHA derivatives, important to contain inflammatory processes and inhibit the immuno-deprit action of fatty acids in the series 6; Impact contains a 6/3 report Nucleotis: they are substrates indispensable for cells, especially for rapid turnover, such as mucosal cells, lymphocytes and macrophages; under non-stress conditions, the daily requirement is covered by normal endogenous synthesis or dietary intake; in case of metabolic stress, extra nucleotides is needed to promote proper 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; acidifier: citric acid; emulsifiers: E471, soy lecithin; rich yeast extract in nucleotides (RNA), choline bitartrate, aromas, vitamins (C, niacin, pantothenic acid, E, B6, A, thiamin, riboflavin, D, K, folic acid, B12, biotin); stabilizers: E460, carragenine, E466; antioxidant: rich extract in tocopherols; coloring: beta-carotene.

Nutritional characteristics

Average values	for 100 ml	for 237 ml
Energy	144 kcal 606 kJ	341 kcal 1.436 kJ
Protein	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
Carbohydrate	18.9 g	44.8 g
- maltodextrin	7.8 g	18.4 g
- sucrose	11.1 g	26.3 g
- lactose		-
Soluble fibre (PHGG)	1,4 g	3.3 g
Water	76 ml	182 ml
Sodium	150 mg	355 mg
Chloride	169 mg	40 mg
Potassium	190 mg	450 mg
Football	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 mc	590 mc
I hate	21 mc	50 mc
Selenium	6,6 mcg	15.6 m
Manganese	0.3 mg	0,71 mg
Chrome	14 mc	33 mc
Molybdenum	22.5 mcg	53,3 mcg
Fluore	0.2 mg	0.5 mg
Vitamin A	139 mc	329 mc
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	0.2 mg	0.5 mg
Niacin	2,2 mg	5.2 mg
Folic acid	28 mc	66 mc
Vitamin B12	0.8 mcg	1,9 mcg
Pantothenic acid	1,1 mg	2,6 mg
Bio	10,1 mc	24 mc
Colina	38 mg	90 mg
Osmolarity: 680 mOsm/l Hospitality: 890 mOsm/kg H2O Viscosity: 50 cP (at 20°C) pH: 6,8 Omega-3/omega-6 report: 0.9

Amino Acid

Amino acids per 100 g
Isoleucine	4.1
Leucine	7.12
Lyrics	5.83
Methionine	2.09
Cysteine	0.29
Phenylalanine	3,81
Tyrosine	4.1
Treonina	3,24
Tripophan	1,01
Valina	5,18
Arginine	24,73
Country	2,23
Alan	2,16
Aspartic acid	5,18
Glutamic acid	15,69
Glinne	1,37
Proline	7,41
Seine	4,46

Mode of use
The standard daily dose is 3 bricks per day, or according to prescription.

Warnings
Check the integrity of the container and the expiration date. Respect hygienic rules during manipulation. Shake well before use. To better appreciate the taste, preferably serve cold.

Format
Impact Oral is available in practical tripack packaging, 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 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.