Determination of the Chemical Stability of Cyanocobalamin in Medical Food by a Validated Immunoaffinity Column-Linked HPLC Method

Cyanocobalamin, which plays an essential role in the body, is a synthetic form used in medical food. This present study aimed to develop an HPLC analysis method for determination cyanocobalamin and investigate the stability of cyanocobalamin in medical food. Validation of the developed method for cyanocobalamin was evaluated with linearity, LOD, LOQ, and accuracy. The linearity of this method was calculated with a value of the coefficient of determination (R2) ≥ 0.999. LOD and LOQ were 0.165 and 0.499 μg/kg, respectively. The recovery of medical food matrixes for accuracy was more than 97.63%. The validated method was applied for determining cyanocobalamin from medical foods. The developed method was used to examine the additives for cyanocobalamin protection. Ferric chloride and sorbitol alleviated cyanocobalamin degradation from heat and ascorbic acid. Especially, sorbitol showed a superior protective effect during the medical food production process. Therefore, this study suggests that sorbitol is a sweetener additive that prevents cyanocobalamin degradation by heat and the food matrix in medical food processing.

Prospects for the use of apiproducts in human healthy nutrition

It has been established, that the development and implementation of the practice of using biologically active components of nutrition is one of the areas of modern dietetics, which are developing dynamically. Apiproducts are a very promising source of biologically active substances. Fundamental studies of domestic and foreign scientists have proven their high biological value, versatile pharmacological activity (anti-inflammatory, antimicrobial, analgesic, antioxidant, immunostimulatory, anti-radiation, etc.). The use of apiproducts for the prevention and treatment of a number of human diseases is a comprehensively studied phenomenon in terms of beekeeping, botany, chemistry, microbiology, pharmacology, medicine and pharmacy. It has been proved, that the action of individual apiproducts and their components allows to use them effectively in practical apitherapy. Because these products differ significantly depending on their chemical composition, they are divided into two groups. The first includes honey, flower pollen, perga (a product of conservation of flower pollen in a hive) and, in part, drone brood. As mixtures of valuable BAS and metabolites, they are used mainly to increase the biological value of traditional foods and create new compositions. The second group includes bee venom, propolis and, in part, royal jelly, which are therapeutic agents by their nature and are used to correct physiological functions and metabolism, have regulatory effects, and their action is realized through the effect on the lipid matrix of biological membranes and membrane proteins. It has been established, that the use of these food components in health nutrition and production of health and medical foods is a promising area

Usefulness of semi-solid medical foods administered after percutaneous endoscopic gastrostomy

Background: Even if preoperative enteral nutrition is administered without any issues, some patients suffer from gastrointestinal symptoms (e.g., vomiting and diarrhea) after initiating gastrostomy feeding. Because of the amino acid composition and limited amount of lipids, elemental diets may reduce the risk of gastrointestinal symptoms. However, elemental diets are expensive. Semi-solid medical foods are inexpensive and more closely mimic normal physiology than elemental diets. The aim of the present study was to investigate the usefulness of semi-solid medical foods when administered after percutaneous endoscopic gastrostomy (PEG).Method: This retrospective study analyzed 91 patients who had PEG performed by the author who was the attending physician. All patients received preoperative enteral nutrition with liquid nutrients, and there were no instances of gastrointestinal symptoms before PEG tube placement. The types of nutrients administered after PEG were divided into three categories: semi-solid medical foods (n = 20), polymeric formulas (n = 26), and elemental diets (n = 45). The incidence of gastrointestinal symptoms was compared among the three groups.Results: No gastrointestinal symptoms occurred in the semi-solid medical foods group; the incidence of gastrointestinal symptoms in the semi-solid medical foods group was significantly lower than that of the polymeric formulas group [0% vs. 26.9% (7/26), p 0.05] and was similar to that of the elemental diets group [0% vs. 2.2% (1/45), p = 1].Conclusion: If preoperative enteral nutrition is administered without any issues, semi-solid medical foods are useful as nutrients administered after PEG tube placement.

Medical food development by dietetic management of the endocannabinoid system through dietary sources of β-caryophyllene

Objective: To research the biological impact on the endocannabinoid system (ECS) from dietary sources of [Formula: see text]-caryophyllene (BCP). This will encompass pre-clinical and clinical research for BCP. The bioavailability of BCP will be explored, focusing on bioavailability improvement. This research will establish if there is justification to warrant the development of a medical food for supporting the ECS through dietetic supplementation of BCP. Methods: Research and review papers were identified through the search engines Google Scholar, PubMed, and ScienceDirect. Main keywords included [Formula: see text]-caryophyllene, endocannabinoid system, dietary cannabinoids, cannabinoid type-2 receptor, and bioavailability. Results: The human body is limited in the digestion of BCP from food. This is because BCP is poorly absorbed in the gut. Everyone has different underlying endocannabinoid efficiency and most people do not have the full potential of supporting their ECS through diet. Conclusion: A medical food can be developed to use BCP with a delivery system, so that the bioactive food cannabinoid is readily absorbed. This will deliver dietary support to the ECS, that otherwise would be available from food. This review provides insight into the efficacy of using BCP in medical foods as dietary support for the ECS. Supporting the ECS can assist in maintaining homeostasis, regulating immune function, pain intensity, inflammatory markers, sleep patterns, mood, appetite, and stress susceptibility.

Medical Foods: Science, Regulation, and Practical Aspects. Summary of a Workshop

ABSTRACT On August 13–14, 2019, the Healthcare Nutrition Council and the ASN held the Medical Foods Workshop: Science, Regulation, and Practical Aspects. Medical food products help patients manage their disease and improve their quality of life. Yet many hurdles exist to getting patients new products. In this workshop, participants addressed some of these hurdles, with specific emphasis on topics like the statutory term distinctive nutritional requirements, the regulatory term modification of the diet alone, the role of clinical guidelines, the requirement that medical foods be used under medical supervision, and differentiation of foods for special dietary use from medical foods, as well as product innovation and future research. Real-world examples were discussed for intractable epilepsy, diabetes, end-stage renal disease, and inflammatory bowel disease.

Inconsistencies in the Nutrition Management of Glutaric Aciduria Type 1: An International Survey

Glutaric aciduria type 1 (GA-1) is a cerebral organic aciduria characterized by striatal injury and progressive movement disorder. Nutrition management shifted from a general restriction of intact protein to targeted restriction of lysine and tryptophan. Recent guidelines advocate for a low-lysine diet using lysine-free, tryptophan-reduced medical foods. GA-1 guideline recommendations for dietary management of patients over the age of six are unclear, ranging from avoiding excessive intake of intact protein to counting milligrams of lysine intake. A 22–question survey on the nutrition management of GA-1 was developed with the goal of understanding approaches to diet management for patients identified by newborn screening under age six years compared to management after diet liberalization, as well as to gain insight into how clinicians define diet liberalization. Seventy-six responses (25% of possible responses) to the survey were received. Nutrition management with GA-1 is divergent among surveyed clinicians. There was congruency among survey responses to the guidelines, but there is still uncertainty about how to counsel patients on diet optimization and when diet liberalization should occur. Ongoing clinical research and better understanding of the natural history of this disease will help establish stronger recommendations from which clinicians can best counsel families.

What Is Required for Edible Insects to Become Medical Food? From a Health Professionals and Caregivers’ Perspective

The challenge in the edible insect industry is to reverse consumers’ aversion to insects, which is a barrier to their consumption. This requires innovation by users rather than producers. This study aimed to present how edible insects could be promoted as medical foods from the health professionals and caregivers’ perspective. By analyzing the characteristics of the medical foods market, this study found a niche market and plan to develop medical foods using edible insects as an alternative to meet the needs of consumers. The survey participants were caregivers, nurses, and doctors as providers of medical foods. Based on the survey results, this study proposed strategies to reduce consumers’ aversion to edible insects and increase their consumption. To promote insect medical foods, it is required to hold frequent insect-related events and use clean raw materials.

Determining Ideal Balance Among Branched-Chain Amino Acids (BCAA) as a Proof of Concept Study in Healthy Children

Objectives Medical foods for children with in-born errors of metabolism (propionic academia, PROP) are formulated with imbalanced mixture of the BCAA (high leucine, to minimal or no valine and isoleucine), and therefore their use is controversial. The objective of the current study was to determine an ideal BCAA ratio at which total body protein synthesis is optimized in healthy children using the indicator amino acid oxidation (IAAO) method. Methods The study design was based on the oxidation of the stable isotope L-[1–,13C] phenylalanine to ,13CO2 to compare protein synthesis among seven different BCAA ratios. Leucine intake was gradually reduced from current high doses in medical foods; isoleucine and valine were kept constant. This study was done as a proof of concept in healthy children, to allow characterization of the metabolic responses to wide range of leucine test intakes, to help design narrow BCAA ratio range to test in children with PROP. Results A total of 8 healthy children were studied, completing 42 study days. ANOVA showed significant differences in F13CO2 with different BCAA ratios; P value <0.001. A BCAA ratio of (leucine: Isoleucine: Valine = 1:0:0) was associated with the highest F13CO2 compared to other ratios (p value <0.001), indicating low total body protein synthesis. By reducing leucine intake, with BCAA ratio between (1: 0.26: 0.28 to 1:0.35:0.4) protein synthesis was optimized. Conclusions Using the IAAO method in healthy children, we tested for the first time the effect of different BCAA ratios on protein synthesis. Results from this study confirmed that the BCAA ratio of (leucine: Isoleucine: Valine = 1:0:0), which is similar to the ratio in medical foods, limited total body protein synthesis. Furthermore, a balanced BCAA ratio that optimized protein synthesis was found to be between (1: 0.26: 0.28) and (1: 0.35:0.4). Thus, we propose reformulating the BCAA mixture in medical foods, by reducing leucine content by 50%. Future research in children with PROP with our proposed BCAA ratio is necessary to confirm improved patient growth outcomes. Funding Sources Faculty of Applied Medical Sciences, Department of Clinical Nutrition, King Abdulaziz University and BC Children's Hospital Research Institute.