Nepro Carb Steady - 8 oz cans

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Ross Nepro Carb Steady  - 8 oz cans
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Features

Ross Nepro Carb Steady - 8 oz cans

  • Complete, balanced nutrition for those on dialysis
  • Contains fructooligosaccharides (FOS)
  • For people with chronic or acute renal failure
  • Lactose and gluten free

Product Overview

Ross Nepro Carb Steady - 8 oz cans

Nepro Carb Steady


Usage of Nepro Carb Steady:
Nepro Carb Steady is a moderate-protein, nutritionally complete formula with a vitamin-mineral profile specifically designed for people with chronic or acute renal failure requiring dialysis.
Features of Nepro Carb Steady:
  • Complete, balanced nutrition for people on dialysis
  • For supplemental or sole-source nutrition
  • For oral or tube feeding
  • 2 Cal/mL, 475 Cal/8 fl oz, and a moderate protein content; 8 fl oz provides at least 25% of recommended levels of 18 key vitamins and minerals for dialyzed patients
  • Low in vitamins A and D, high in folic acid and vitamin B6 because metabolism of these nutrients is altered in renal patients—2:1 Ca/P ratio to help optimize calcium and phosphorus balance
  • Lactose- and gluten-free
  • Contains fructooligosaccharides (FOS)—indigestible carbohydrates that ferment in the colon to produce short-chain fatty acids
  • Three flavors—vanilla, butter pecan, and mixed berry supreme
NEPRO Caloric Distribution
Per 8 fl oz % Calories
Calories 475
Protein, g 16.6 14.0
Fat, g 22.7 43.0
Carbohydrate, g* 52.8 43.0
Water, g 166
* Includes 3.7 g/8 fl oz (15.6 g/L) as FOS.
1 g water = 1 mL water = 1 cc water.
Availability:
Ready-To-Use

8-fl-oz cans, 24/case
Vanilla #50632


Product information and values listed are subject to change. Please refer to product label or packaging for the most current information.

Administration:

Use under medical supervision. Not for parenteral use.

Nutrient-dense products have a higher viscosity than standard 1.0 to 1.5 Cal/mL formulas. When tube feeding NEPRO by gravity drip, a 10 F or larger tube is recommended; 8 F for pump feeding.
Ingredients:
NEPRO Vanilla: -D Water, corn syrup, high-oleic safflower oil, (calcium, magnesium and sodium) caseinates, canola oil, sugar (sucrose), milk protein isolate, fructooligosaccharides, soy lecithin, natural and artificial flavors, potassium citrate, calcium carbonate, sodium citrate, cellulose gel, choline chloride, salt (sodium chloride), ascorbic acid, L-carnitine, taurine, calcium phosphate tribasic, cellulose gum, zinc sulfate, alpha-tocopheryl acetate, ferrous sulfate, niacinamide, calcium pantothenate, manganese sulfate, pyridoxine hydrochloride, cupric sulfate, thiamine chloride hydrochloride, riboflavin, beta-carotene, folic acid, vitamin A palmitate, biotin, potassium iodide, sodium selenate, phylloquinone, cyanocobalamin and vitamin D3.


Note: Other flavors have similar composition. For specific information, see product label.

Protein:
The protein content of NEPRO is adequate to replace protein and amino acids lost during dialysis and prevent catabolism of tissue proteins. The high-quality protein of NEPRO meets or surpasses the standard amino acid profile for protein of high biological value. NEPRO is gluten-free.


NEPRO Protein Profile

Percent of total calories from protein 14.0
Protein content 70 g/L

NEPRO Protein Source
Calcium, magnesium, and sodium caseinates 75%
Milk protein isolate 25%

Cal/N ratio 179:1
Nonprotein Cal/N ratio 154:1
NEPRO Fat:
The fat blend in NEPRO is high-oleic safflower oil, canola oil, and lecithin. This combination meets American Heart Association recommendations1 of < 10% of calories from both saturated and polyunsaturated fatty acids. Fat levels in NEPRO, although somewhat higher than suggested for healthy persons,1 are within the range suggested for renal patients2 to achieve the high nutrient density needed to accommodate fluid restrictions.


Fat Profile

Percent of total calories from fat 43

Fat content 95.6 g/L
Polyunsaturated fatty acids 18.4 g/L
Monounsaturated fatty acids 62.6 g/L
Saturated fatty acids 7.9 g/L

NEPRO Fat Source
High-oleic safflower oil 67%
Canola oil 29%
Lecithin 4%

omega-6/omega-3 ratio 5.5:1
Cholesterol <30 mg/L

NEPRO Carbohydrate:
NEPRO contains corn syrup, sucrose, and fructooligosaccharides as the carbohydrate sources. Because renal patients may have hypertriglyceridemia and/or aversions to sweet tastes, simple sugars have been minimized. NEPRO is lactose-free.


Carbohydrate Profile

Percent of total calories from carbohydrate 43
Carbohydrate content 222.3 g/L

NEPRO Carbohydrate Source
Corn syrup 83%
Sucrose 10%
Fructooligosaccharides 7%
NEPRO Fiber:
NEPRO Vitamins and Minerals:
NEPRO provides nutrients at levels that meet either the RDI or Estimated Safe and Adequate Daily Dietary Intake,3 or recommended intakes for dialyzed renal patients2 for 18 key vitamins and minerals in 1900 Cal (947 mL, four 8-fl-oz servings). Compared to traditional medical nutritional formulations, levels of calcium, folic acid, and pyridoxine (vitamin B6) are supplemented to meet the increased requirements of dialysis patients. Vitamin A, vitamin D, vitamin C, phosphorus, sodium, potassium, chloride, and magnesium levels are reduced in comparison to standard enteral products. Molybdenum and chromium are not added to NEPRO because blood levels of these nutrients may be elevated in renal patients. NEPRO is supplemented with the conditionally essential nutrients L-carnitine and taurine at levels within the range of typical daily intakes (261 mg/L and 160 mg/L, respectively).
NEPRO Osmotic Concentration:
The main determinants of the osmolality of a formula are simple carbohydrates, electrolytes, and amino acids or small peptides. Calorically dense (> 1.0 Cal/mL) formulas have, as a result, a higher osmotic concentration.
Osmolality* (mosm/kg H2O) 665
Osmolarity (mosm/L) 446

* Measured on undiluted product using vapor pressure methodology.
Renal Solute Load:

Renal solute load represents the solutes excreted per liter of product consumed. The major determinants of renal solute load are dietary protein and electrolytes. Each milliequivalent of sodium, potassium, and chloride contributes approximately 1 mosm to the renal solute load; in adults, each gram of protein contributes approximately 5.7 mosm. The electrolyte content of NEPRO is low to facilitate individualization of intake based on residual renal function, underlying disease(s), and other sources of electrolytes. Because of the number of clinical factors that influence electrolyte requirements, nutritional care must be individualized and electrolyte intake adjusted as necessary.

Renal Solute Load (RSL)

Electrolyte Content (mEq/L) Contribution to RSL (mosm/L)
Sodium 36.7 36.7
Potassium 27.1 27.1
Chloride 28.5 28.5
Protein content 70 g/L x 5.7 399
Total RSL 491
Analysis:

Nutrient Facts
8 fl oz
FAN (label number) 7237-04
Cal/mL 2.00
Energy, Cal
Protein, g 16.6
% of total Calories
14.0
Fat, g 22.7
% of total Calories
43.0
Cholesterol, mg
< 10
Carbohydrate, g 52.8
% of total Calories
43.0
Water, g* 166
Dietary Fiber, g 0
L-carnitine, mg 62
Taurine, mg 38
m-Inositol, mg 0
* 1 g water = 1 mL water = 1 cc water.
Carbohydrate includes 3.7 g/8 fl oz (15.6 g/L) as FOS.
NEPRO Vitamins
8 fl oz
Vitamin A, IU 1000
Vitamin D, IU 20
Vitamin E, IU 12
Vitamin K, mcg 20
Vitamin C, mg 25
Folic Acid, mcg 250
Thiamin (Vitamin B1), mg 0.6
Riboflavin (Vitamin B2), mg 0.68
Vitamin B6, mg 2.1
Vitamin B12, mcg 2.4
Niacin, mg 8
Choline, mg 150
Biotin, mcg 120
Pantothenic Acid, mg 4
Includes 750 IU/8 fl oz (3518 IU/L) of vitamin A activity from 0.57 mg/8 fl oz (2.7 mg/L) beta-carotene.
NEPRO Minerals
8 fl oz
Sodium, mg (mEq) 200 (8.7)
Potassium, mg (mEq) 250 (6.4)
Chloride, mg (mEq) 240 (6.8)
Calcium, mg 325
Phosphorus, mg 165
Magnesium, mg 50
Iodine, mcg 38
Manganese, mg 1.3
Copper, mg 0.5
Zinc, mg 5.6
Iron, mg 4.5
Selenium, mcg 24
Chromium, mcg 0
Molybdenum, mcg 0
NEPRO Amino Acids
8 fl oz
NEPRO Essential
Histidine, mg 415
Isoleucine*, mg 730.4
Leucine*, mg 1527.2
Lysine, mg 1245
Methionine, mg 481.4
Phenylalanine, mg 830
Threonine, mg 730.4
Tryptophan, mg 199.2
Valine*, mg 979.4
NEPRO Nonessential
Alanine, mg 514.6
Arginine, mg 564.4
Aspartic Acid, mg 1245
Cystine, mg 99.6
Glutamic Acid, mg 3502.6
Glycine, mg 315.4
Proline, mg 1759.6
Serine, mg 946.2
Tyrosine, mg 830
* Branched-chain amino acids.
NEPRO Fatty Acids
8 fl oz
Linoleic (18:2), mg 3688
a-Linolenic (18:3), mg 680
Caprylic (8:0), mg 0
Capric (10:0), mg 0
Lauric (12:0), mg 24
Myristic (14:0), mg 41
Palmitic (16:0), mg 1167
Stearic (18:0), mg 524
Oleic (18:1), mg 14858
Arachidic (20:0), mg 110
Fatty acids equal approximately 95% of total fat.
In parentheses, carbon atoms/double bonds.
References:
Clinical Research Seventy-nine patients were fed one of three products as a sole source of nutrition for 2 weeks following a 1-week baseline period (used to collect normative biochemical and gastrointestinal function data).4 The treatment arms were a standard 2.0 Cal/mL enteral formula (STD; n = 27), NEPRO without FOS or beta-carotene (N-; n = 26), and NEPRO with FOS and beta-carotene (N+; n = 26). This study was designed to evaluate the safety and tolerance of reformulated NEPRO as a sole source of nutrition in chronic hemodialysis patients using a prospective, randomized, single-blinded, parallel design at three sites. After 7 days, the randomly assigned diet was consumed as a sole source of nutrition for 14 days. Fasting routine blood chemistries were obtained initially and at the beginning and end of the baseline and sole-source periods (Day 1, Day 8, and Day 22). Patients recorded consumption of product and any GI symptoms daily.

The mean (± SEM) intakes for the STD, N-, and N+ groups were, respectively, 35.47 ± 1.22, 33.43 ± 1.67, and 34.87 ± 1.91 Cal/kg/day. There was no difference in the frequency or severity of GI symptoms in patients fed the FOS-containing formula compared to FOS-free formulas. There were no changes in GI symptoms with initiation of enteral feeding compared to the frequency and severity of symptoms on renal diets. The low-phosphorus/high-calcium formulations, in contrast to the high-phosphorus standard medical nutritional formulation, decreased serum phosphorus (P = 0.02) and calcium-phosphorus product (P = 0.02) without causing hypercalcemia. Thus, NEPRO was found to be safe and well tolerated, and its nutrient profile offered advantages over standard formulations for the dietary management of ESRD patients. Specifically, low-phosphorus/high-calcium formulations resulted in lower serum phosphorus levels and decreases in the serum calcium-phosphorus product without altering the risk of hypercalcemia. This finding is significant because the products, when used as sole sources of nutrition, essentially eliminated the need for phosphate binders and calcium supplements in the population. The remaining routine blood chemistries remained constant throughout the study.

NEPRO Clinical Documentation

Ross Study BE51, October 1992: Use of NEPRO as a sole source of nutrition in hemodialyzed renal patients. Data available on request, Medical Nutrition Product Research and Development Department, Ross Products Division, Columbus, Ohio.

References

1. Dietary guidelines for healthy American adults: A statement for physicians and health professionals by the Nutrition Committee, American Heart Association. Circulation 1986;74:1465A-1468A.

2. Kopple JD: Nutrition, diet and the kidney, in Shils ME, Young VR (eds): Modern Nutrition in Health and Disease, ed 7. Philadelphia: Lea & Febiger, 1988, pp 1230-1268.

3. National Research Council: Recommended Dietary Allowances, ed 10. Washington, DC: National Academy Press, 1989.

4. Cockram DB, Hensley MK, Rodriguez M, et al: Safety and tolerance of medical nutritional products as sole sources of nutrition in people on hemodialysis. J Ren Nutr 1998;8(1):25-33.

Part Number(s): 54106, 59666, 59660

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