New progress in fat milk

Fat emulsion, one of the components of parenteral nutrition, can provide energy to the body and prevent the lack of essential fatty acids in the body, which has become a consensus in clinical practice. Fat emulsions are generally prepared from long chain triglycerides and egg yolk phospholipids extracted from soybean oil. Compared with long-chain triglycerides ( LCT ), medium-chain triglycerides ( MCT ) have good solubility in enteral nutrition, can be absorbed into plasma faster, oxidize fast, and do not require carnitine. Can enter the mitochondria. MCT can be mixed with LCT and then administered intravenously. It can also be imported in the form of structured fat emulsion. In structural fat emulsions, triglycerides contain medium and long chain fatty acids in a single molecule. Like LCT , the import of MCT is accompanied by the formation of lipoprotein particles. Therefore, MCT will compete with LCT for the hydrolysis site of lipoproteinase. Compared with LCT , there are reports of increased and decreased plasma clearance of MCT/LCT mixed milk. MCT is faster than LCT and can effectively save protein. However, there are also reports that the catabolism of proteins is increased. The toxicity of MCT has been observed, so further research on the safety and efficacy of MCT- containing fat emulsions is recommended for critically ill patients .
Structural triglycerides are expected to be less toxic than physically mixed fat emulsions, and the tendency to cause metabolic acidosis is reported to be less pronounced. The results of in vitro experiments show that structural fat emulsions release fatty acids more efficiently than mixed types. However, in plasma, the release of fatty acids largely depends on the amount of MCT itself. Clinical trials have been conducted to demonstrate that fatty milk containing structural triglycerides is safe and that its hydrolysis is fast and complete.
An important function of fat in the diet is that it binds to the structure of the cell membrane. The content and traits of lipids in the cell membrane will affect the permeability of the cell membrane and the properties of membrane-bound enzymes and receptors. Membrane-bound phospholipids can be stimulated by enzymes to release fatty acids in the growing chain, which are precursors to synthetic alkanes. When the LCT fat emulsion is input , the arachidonic acid is released.
The fat emulsion ( LCT ) extracted from soybean oil is rich in essential polyunsaturated fatty acids, linoleic acid and a- linolenic acid, which have a carbon chain of 18 carbon atoms. These fatty acids are very effective oxidizing substrates, but they also compete with each other for W - 6 -desaturase. In the metabolic process, and linoleic - linolenic acid is elongated and desaturated. The main fatty acids derived from linoleic acid ( W 6 series) are a- linolenic acid ( c18:3 6) , bis - linolenic acid ( c20:3 6) and arachidonic acid ( c20:4 6) . The fatty acids derived from a- linolenic acid ( Series 3 ) are alkanoic acids ( c20:5 3, EPA) and docosahexaenoic acid ( c22:6 3, DHA) , which are high in fish oil. The input of legume fat milk is accompanied by an increase in fatty acids in the growing chain, resulting in the release of various alkane species. With the exception of PGI2 , all alkane derived from arachidonic acid is more prone to procoagulant and proinflammatory than the corresponding media.
The fat in the diet can produce a specific regulator of immune response. The understanding of the importance of this effect leads to the hypothesis that the fish oil partially replaces the W 6 fatty acid, which is the main component of fat milk, and uses this fat milk for stress. The patient will have some positive effects and improve the patient's prognosis. At present, fat emulsion containing fish oil has entered clinical application abroad.
The input of the soy emulsion will be accompanied by the production of some products due to the action of free radicals on the polyunsaturated fatty acids, accompanied by the consumption of plasma antioxidants such as VitE . The content of VitE in most fat emulsions is insufficient, so it is recommended to increase the supply of antioxidants.
The composition of fat emulsions is very similar, but there are some small differences in fatty acid content. Different formulations of different phospholipid fatty acids can result in differences in the various media. Other clinically relevant factors associated with the safety of fat emulsions are the levels of phytosterols, lysophospholipids, and cholesterol. Due to the production process and raw materials, the content of the above substances in the fat emulsion prepared from the same oil is also different. High levels of phytosterols cause their accumulation in the circulatory system - a pathological condition that causes fat to deposit in various organs and damage to liver function.
Phospholipids contain a certain amount of lysophospholipid, which is a hydrolysate of lecithin. For all fat emulsions, the level of lysophospholipid will increase with storage time. In blood, lysophospholipids either bind to circulating fat particles or bind to plasma albumin. If a fat emulsion is introduced into a patient with reduced lysophospholipid binding capacity, the " free " lysophospholipid will bind to the erythrocyte membrane resulting in hemolysis. The content of lysophospholipids in different fat emulsions is not the same.
Fatty milk not only powers the body, but also changes the composition of the cell membrane and regulates the production of multiple media. This represents an exciting new development and stimulates further research. But it is also considering the multiple effects of various components of fat emulsion in the metabolic reaction, therefore, we should realize that a study can only focus on a limited number of aspects.
In 2006, the sales of fat milk infusions in 100 top three hospitals nationwide totaled about 340 million yuan. Together with the fat infusion of other hospitals, it is estimated that the total sales of fat infusion in the country is about 500 million to 600 million yuan.

According to the statistics released by the relevant departments, in 2006, the national pharmaceutical enterprises produced a total of 5.26 billion bottles of large infusions, and each Chinese had an average of about 4 bottles. Last year, Americans consumed only about 0.04 bags of infusions.

China's use of large infusions is more related to national conditions. Many Chinese people believe that after going to the hospital to hang water, the disease will be better, and the effect of oral solid preparations will be slower. On the contrary, Westerners are less willing to accept infusion therapy and prefer to use oral preparations that are safer for the human body. The two different concept of medication in China and the West determine that China's infusion product market will maintain its growth momentum for a long time to come.

The number of large infusion producers in China has exceeded 300, and 80% of the total infusion products are basic low-end products such as glucose and sodium chloride. The large number of participants contributed to the fierce competition, coupled with the unreasonable product structure, which led to the unfavorable situation of low market prices. However, the mode of treatment for “large infusion and dosing” is still prevalent in hospitals across the country and abroad. Therefore, the domestic large infusion market still maintains a steady development.

It is worth noting that although the overall benefits of large infusion products are not very good, fat emulsion infusion has become a new bright spot in domestic infusion products.

In fact, vegetable oils suitable as raw materials for the production of fat emulsions are not only one type of soybean oil. According to the research results, vegetable oil suitable for the production of fat emulsion in addition to soybean oil is sesame oil, linseed oil, safflower oil, cottonseed oil, saffron oil and corn oil. In addition, fish oil rich in "long-chain polyunsaturated fatty acids" is also a high-quality raw material for fat emulsion production. Last year, Huarui Company officially launched a large infusion of omega-3 fatty acids with imported fish oil as its raw material. The trade name is “Juwen”. "Juwen" has a variety of effects on severe trauma patients, major surgery patients and emergency patients under stress, which can reduce excessive inflammatory response, protect important organ functions, reduce infection and complications. Fatty milk infusion products. Since the listing last year, the market of “Juventus” has been well received.

It is also reported that Japanese pharmaceutical manufacturers are stepping up efforts to develop a new product of Suzi oil fat milk infusion processed with Chinese "Suzi oil" (ie, oil extracted from perilla seed). Suzi oil contains up to 60% "γ-linolenic acid" and is an excellent unsaturated fatty acid. The results of animal experiments confirmed that the fat oil infusion of succulent oil not only provides the necessary energy for the body, but more importantly, it also has blood lipid lowering, blood sugar lowering, anti-oxidative damage, anti-allergy, anti-cell aging and anti-cardiovascular sclerosis. And a variety of therapeutic effects. Because perilla oil fat emulsion infusion can provide energy and therapeutic effects into one, therefore, the Japanese pharmaceutical industry authority believes that once the fat emulsion infusion of Suzi oil is approved, it will trigger a 21st century international fat milk infusion market. The field "Great Earthquake."

"Souvenirs" have great potential

China has already developed domestic fat emulsion injection products, such as Kanglaite injection (coix seed oil fat milk), Brucea javanica injection and zedoary oil fat emulsion (mainly elemene). Among them, Kanglaite fat emulsion injection sales in the domestic market is good, the total sales in 2006 has exceeded 150 million yuan, and has entered the pharmaceutical market in Russia, Ukraine and other countries. According to Zui's new report, Kanglaite is doing clinical trials in the United States. Because it has been used as an anticancer drug in China, Russia and other countries, it has not been found to have any side effects, so it is expected to be listed in the US. The American medical community is looking forward to it. . If Kanglaite fat emulsion injection can be listed in the world's large pharmaceutical market in the United States, this will be a new milestone for China's traditional Chinese medicine preparations to truly enter the international market.

As far as the scope of treatment is concerned, the traditional Chinese medicine fat emulsion injections such as Kanglaite, Brucea javanica and zedoary turmeric oil which have been listed so far in China are all anti-tumor drugs, and have been applied in domestic clinical practice for more than 10 years, and the sales situation is good. China has an unusually rich source of Chinese herbal medicine. Many Chinese herbal medicines contain a certain amount of vegetable oil or aromatic oil, such as succulent oil, citron oil, musk oil, sea buckthorn oil, Chuanxiong oil, angelica oil, blackcurrant oil, etc. It is believed that more of these Chinese herbal medicines can be developed. A new fat-milk infusion product for therapeutic use.

According to the statistics of relevant departments, the annual sales volume of domestic fat emulsion infusion products has remained between 15 million and 16 million bottles in the past few years. This is because the unit price of fat infusion is relatively expensive, and the average retail price per bottle of fat milk is about 80 yuan, which is about several times that of the basic large infusion, thus limiting its application in ordinary people. As China's national income grows year by year, the clinical use of nutritive fat emulsion infusion or therapeutic fat emulsion infusion will increase in the future.

In the past 15 years, the incidence of cancer in China has nearly doubled. Therefore, the market prospects of anti-tumor traditional Chinese medicines for fat emulsion injections are very broad, such as the newly marketed omega-3 fatty acid infusion and the anti-cancer traditional Chinese medicine fat emulsion injection. The volume will continue to climb.

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