Title of Invention

A NUTRITIONAL COMPOSITION

Abstract The invention provides a nutritional or pharmaceutical composition containing a fat component, a protein component and a carbohydrate component and comprising whey and casin Said composition is characterized in that, the weight ration of casin to whey is 1:1 To 1:24 and that the composition contains: 1) at least 3 grams arginine per 100 grams protein; b) at least 10 wt% linoleic acid based on total fatty acids; c) at least 1 wt% alpha linolenic acid based on total fatty acids; d) at least one long chain polyunsaturated fatty acid in an amount exceeding 0.1 wt.% based on total fatty acids, said long chain polyunsaturated fatty acid being selected from the group consisting of docosahexaenoic acid, arachidonic acid and eicosapentaenoic acid; e) 5 to 25 wt.% of at least one polyunsaturated fatty acid based on total fatty acids; and f) 2 to 12 grams indigestible oligosaccharides having a degree of polymerization of 2 to 100 per 100 gram dry weight of the composition. The composition of the invention reduces among others the risks attached to feeding whey dominant infant formula.
Full Text IMMUNE STIMULATORY INFANT NUTRITION
Description

FIELD OF THE INVENTION
The present invention relates to a nutritional composition containing a fat component and a carbohydrate component and comprising whey and casein and to the use
of said composition
BACKGROUND OF THE INVENTION
Breastfeeding optimally supports the development of the infant and
protects against infections. However, not all infants are in the position to
receive human milk. It is therefore a continuing aim to provide infant
formula, which simulates the functions of human milk. In addition to the
desired compositional similarity between infant formula and human milk,
it is also particularly desirable to mimic the protective effects of human
milk. Human milk has for example been shown that human milk protects
against infections and allergies.
In current infant formulas, the casein to whey ratio resembles that of
human milk as closely as possible. It is believed that this ratio results in
optimal growth for the infant. However, there are still several downsides
attached to the use of bovine, whey dominant protein sources. These
whey dominant formulas do not optimally protect against infections.
Administration of such formula results in an impaired development of the
intestinal flora of the infant compared infants fed with human milk,
particularly in the first three to four weeks of life. The flora of infants fed
with the whey dominant formula contains more or less the same bacterial
genera as the human milk fed infants, however, the quantity of beneficial
bacteria is reduced in infants receiving the whey dominant formula
compared to infants receiving human milk. Moreover, the flora of infants
fed with formulas containing whey dominant bovine protein source
contain increased amounts pathological bacteria such as Clostridia and

enterobacteria. Hence, feeding an infant with whey dominant formula
results in the formation of a "suboptimal intestinal flora".
As the very young infants have an immature immune system and an
immature intestinal tract, development of the suboptimal intestinal flora
may result in infection, diarrhea, allergy and inflammation. Especially
infants with the age between 0 and 30 days and fed with bovine whey-
dominant protein containing formula suffer from these risk as their faecal
flora is most different from those infant fed human milk.
SUMMARY OF THE INVENTION
It is the object of the present invention to provide a nutritional or
pharmaceutical composition which reduces the risks attached to feeding
whey dominant infant formula.
This object is solved by a composition according to claim 1.
The composition of the present invention is characterized in that
the weight ratio of casein to whey is 1:1 to 1:2.4 and
that the composition contains:
a) at least 3 grams arginine per 100 grams protein;
b) at least 10 wt.% linoleic acid (LA) based on total fatty acids,
c) at least 1 wt.% alpha linolenic acid (ALA) based on total fatty acids;
d) at least one long chain-polyunsaturated fatty acid (LCPUFA) in an
amount exceeding 0.1 wt.% based on total fatty acids, said long chain-
polyunsaturated fatty acid (LCPUFA) being selected from the group
consisting of docosahexaenoic acid (DHA), arachidonic acid (ARA) and
eicosapentaenoic acid (EPA);
e) 5 to 25 wt.% of at least one polyunsaturated fatty acid based on total
fatty acids; and
f) 2 to 12 grams indigestible oligosaccharides having a degree of
polymerisation of 2 to 100 per 100 gram dry weight of the composition.
The present composition stimulates the maturation of the immune system
and the maturation of the intestinal tract. The composition of the

invention is particularly suitable for preventing and/or treating
inflammatory disorders in infants, such as infection, diarrhea and allergy.
The present composition:
• stimulates the development of a "optimal intestinal flora" (i.e. a flora
similar to the flora resulting by feeding human milk);
• stimulates the maturation the gastrointestinal tract, thereby preventing
entry of allergens such as pathological bacteria, toxins and food
allergens into the systemic circulation;
• stimulates the maturation of the immune system, resulting in a better
defense in case an allergen, pathogen or toxin crosses the intestinal
barrier and/or enters the systemic circulation;
• while providing optimal nutrition to the infant.
It is believed that physiological processes underlying the development of
a "low risk intestinal flora", the maturation of the gut and the maturation
of immune system are highly inter-related and co-dependent. Hence,
infant formula should include all those ingredients, in a proper balance,
which stimulate the maturation of the gut, the maturation of the immune
system and the development of a low risk intestinal flora. With the
optimal combination of ingredients, the infant is better protected from
allergens. The present composition provides such optimal combination of
ingredients. Because the ingredients often act on different mechanisms,
the ingredients of the present composition act synergistically, providing
the infant with an improved resistance and reducing the incidence of
inflammatory disorder, particularly allergy.
The present composition comprises oligosaccharides with a low degree of
polymerization. The oligosaccharides stimulate the formation of a low risk
intestinal flora, particularly reducing the count of (potentially) pathological
intestinal bacteria such as Clostridia, enterobacteriae and/or enterococci;
and stimulating the colonization by bifidobacteria and lactobacilli. The
bifidobacteria and lactobacilli stimulate the maturation of the gut e.g. by

stimulating the synthesis of fuco-oligosaccharides by intestinal epithelial
cells. Optimal stimulation is achieved by inclusion of a mix of different
oligosaccharides, particularly a mix of oligosaccharides including both
neutral and acidic oligosaccharides. The oligosaccharides also have a
"direct" effect on the immune system through lowering the Th2 response
and increasing the Th1 response. It was found that the present
composition which includes oligosaccharides can be advantageously
used to restore disbalance in the Th1/Th2 responses and for the
treatment and prevention of disorders which are associated with Th1/Th2
disbalance, such as autoimmunity and allergy.
However, even when combining oligosaccharides with non-human whey
dominant protein, the infants receiving this composition are suffering from
increased risks of infections during the first month of life. Hence it is
desirable to further improve immune system and/or gut maturity.
It has been surprisingly found that LCPUFA's effectively reduce epithelial
paracellular permeability. In contrast to what Usami et al (Clinical
Nutrition 2001, 20(4): 351-359) have reported, it has been found that C18
and C20 polyunsaturated fatty acids, particularly eicosapentaenoic acid
(EPA; C20:5 n3) docosahexaenoic acid (DHA; C22:56 n3) and
arachidonic acid (AA; C20:4) are capable of effectively reducing
intestinal tight junction permeability, thereby stimulating the maturation of
the gut. Hence, the present composition advantageously includes
LCPUFA's. In addition the essential fatty acids linoleic acid (C18:2 n6)
and alpha linolenic acid (C18:3 n3) are indispensable for both maturation
of the immune system as well as for maturation of the intestinal tract. In a
further particularly preferred embodiment, the present composition also
contains gamma-linolenic acid (GLA; C18:3 (n-6)). The present
composition therefore contains linoleic acid and alpha linolenic acid.
Optionally, but highly preferably the present composition also comprises
nucleotides and/or nucleosides. Nucleotides stimulate the maturation of
the intestinal tract, reduce the incidence of diarrhea and stimulates the
immune system. Infants fed nucleotide supplemented versus non-

supplemented formula have increasing antibody titers following exhibition
to antigen and stimulating antigen natural killer cell activity. (Carver et al
Acta Paediatrica, (1999) Vol. 88, No. Sup 430, pp. 83-88).
DETAILED DESCRIPTION
The composition of the present invention comprises a whey dominant
non-human protein source, long chain-polyunsaturated fatty acids and
oligosaccharides.
As already said above the present invention provides a composition
comprising whey and casein in a weight ratio casein to whey of 1:1 to
1:2.4 and at least 3 grams arginine per 100 grams protein.
The range of 1:1 to 1:2.4 for the casein/whey ratio comprises all values
lying in this range and therefore for instance the following ratios of casein
to whey: 1:1, 1:1.1, 1:1.2, 1:1.3, 1:1.4, 1:1.5, 1:1.6, 1:1.7, 1:1.7, 1: 1.9,
1:1.2, 1:1.3, 1:1.4, 1:1.5, 1:1.6, 1:1.7, 1:1.8, 1:1.9, 1:2.0, 1:2.1, 1:2.2,
1:2.3, and 1:2.4. In a preferred embodiment the casein:whey ratio is 1:
1.4 - 1.6, even more preferably about 1:1.5 (40:60)
The arginine is preferably present in an amount of 3 to 8 grams arginine
per 100 grams protein component. This range discloses all values and in
particular all integer values lying in this range such as 3, 4, 5, 6, 7, and 8
grams. The composition contains preferably 4 to 5 grams arginine per
100 gram protein.
The LCPUFA's present in the composition are selected from the group
consisting of DHA, AA and EPA. This means that one or two or three of
said long chain-polyunsaturated fatty acids can be present.
The range of 5 to 25 wt.-% given for the polyunsaturated fatty acids
discloses all values falling in this range.
The present composition does not include a composition consisting of
human milk. The present method does not include a method comprising
the administration of a composition consisting of human milk. Hence,

preferably the present method includes the administration of a
composition comprising a substance of non-human origin, preferably a
fiber carbohydrate, fat and/or protein of non-human origin, preferably
from plant, animal, bacterial or synthetic origin. Preferably all off the
components and constituents out of which the composition of the
invention is prepared originate from non-human sources.
Macronutrients
The present composition can be advantageously used as an infant
formula. Such infant formula preferably contains a lipid component, a
protein component and a carbohydrate component and is preferably
administered to the infant in liquid form.
In a preferred embodiment the present invention relates to a composition
and in particular to an infant formula which comprises 30 to 60 en% lipid;
5 to 15 en% protein; and 25 to 75 en% carbohydrate. Preferably the
composition comprises 5 to 15 en% protein, 30 to 60 en% fat and 25 to
65 en% carbohydrate. More Preferably, the present composition contains
43 to 53 en% lipid; 7 to 11 en% protein; and 43 to 53 en% carbohydrate
(en% is short for energy percentage and represents the relative amount
each constituent contributes to the total caloric value of the preparation).
The protein component of the present infant formula contains casein and
whey in a weight ratio mentioned above. The casein and/or whey are
preferably derived from non-human mammalian milk. For providing
optimal nutrition to the infant, the composition contains arginine in the
specified amount, The term "protein" or protein component in this context
is the cumulative of protein, polypeptides, peptides and amino acids.
Arginine is indispensable in the present composition. It reduces the
incidence of inflammatory conditions of the intestine (Amin et al Journal
of Pediatrics, (2002) Vol. 140, No. 4, pp. 425-431). Furthermore, arginine
stimulates the immune system, and is required for maintenance of a
healthy immune system (Niever et al, Biomedicine & Pharmacotherapy,
(2002) Vol. 56, No. 10, pp. 471-482). Casein and whey contain arginine,

but for most milk sources (e.g. bovine whey and casein) the casein and
whey provide an insufficient arginine. Preferably at least part of the
arginine supplemented to the composition in the form a free amino acid
base, e.g. as L-arginine, or in the form of a salt or ester thereof whereby
the free amino acid is preferred The present composition preferably
comprises between 75 and 500 mg arginine in the form of free amino acid
per 100 gram of the dry infant formula, more preferably with between 150
and 400 mg arginine in the form of free amino acid per 100 gram of the
dry infant formula.
The carbohydrate in the present composition is preferably provided
largely by lactose, i.e. preferably at least 75 wt.% of total digestible
carbohydrate is provided by lactose, preferably at least 90 wt.%.
Low threonine protein
Whey dominant infant formulas from non-human protein source typically
have a high content of bioavailable threonine compared to human milk.
Human milk contains relatively small amounts of bioavailable threonine.
Hence, processes for the reduction of the threonine content of whey
dominant formulas are provided for in the art (see for example
EP1048226, WO0111990 and EP741522). Administering reduced
threonine whey dominant infant formula gives in vivo threonine profiles,
which are comparable to those of breast fed infants. The present
composition preferably is a low-threonine composition, i.e. composition
which comprises 2 to 6 grams threonine per 100 gram protein. The low-
threonine content can for example be accomplished by using whey
products prepared by ultrafiltration or certain acidic whey products.
Essential fatty acids content
The present composition contains at least 10 wt.% linoleic acid (LA)
based on total fatty acids, preferably between 11 and 20 wt.%, more
preferably between 12 and 15 wt.%. The present composition preferably
contains at least 1 wt.% alpha linolenic acid (ALA) based on total fatty

acids, preferably between 1.5 and 4 wt.% ALA, even more preferably
between 2 and 2.5 wt.%. To reduce intestinal stress, the weight ratio
LA/ALA is preferably between 2 and 10, preferably between 5 and 7.5.
The present composition preferably includes between 0.05 and 5 wt%
gamma-linolenic acid (GLA) based on total fatty acids, preferably
between 0.1 and 1 wt.%.
Long chain-polyunsaturated fatty acid content
The present composition comprises at least one long chain-
polyunsaturated fatty acid with 20 or 22 carbon atoms (LCPUFA) in an
amount exceeding 0.1 wt.% based on total fatty acids, selected from the
group consisting of docosahexaenoic acid (DHA), arachidonic acid (AA)
and eicosapentaenoic acid (EPA). Preferably the composition contains
DHA in an amount exceeding 0.1 wt.% based on total fatty acids; and AA
in an amount exceeding 0.1 wt.% based on total fatty acids.
Preferably at least one LCPUFA of this group is included in an amount
between 0.15 and 1 wt.% based on total fatty acid content of the
composition. Preferably at least two of these LCPUFA's are present in an
amount of between 0.15 and 1 wt.% based on total fatty acid content of
the composition. Preferably the composition contains AA and DHA, even
more preferably AA, DHA and EPA.
The AA content preferably does not exceed 5 wt.%, more preferably does
not exceed 1 wt.%, most preferably between 0.1 and 0.6 wt.% of the total
fatty acids. In the present composition, EPA and/or DHA are
advantageously added to balance the action of AA, e.g. reduce the
potential pro-inflammatory action of AA metabolites. Excess metabolites
from AA may cause inflammation. Hence, the present composition
preferably comprises AA, EPA and/or DHA, wherein the weight ratio
AA/DHA preferably is above 0.25, preferably above 0.5, even more
preferably above 1. The ratio AA/DHA is preferably below 25, preferably
below 10. The weight ratio AA/EPA is preferably between 1 and 100,

more preferably between 5 and 20. The weight ratio EPA/DHA is
preferably 1 or lower, more preferably below 0.5.
In a preferred embodiment, the content of LCPUFA does not exceed 3
wt.% of the total fatty acids as it is desirable to mimic human milk as
closely as possible. For the same reason, the present composition
preferably contains less than 1 gram omega-3 LCPUFA per 100 gram
fatty acids, more preferably between 0.1 and 0.75 gram per 100 gram
fatty acids. The omega-6 LCPUFA content preferably does not exceed 2
gram per 100 gram fatty acids and is preferably between 0.1 and 0.75
gram per 100 gram fatty acids.
The LCPUFAs and the other fatty acids may be provided as free fatty
acids, in triglyceride form, in phospholipid form, or as a mixture of one of
more of the above. The present composition advantageously comprises
at least one of AA and DHA in phospholipid form, as these reduce the
incidence of inflammatory disorders of the intestine. The present
composition preferably comprises between 0.1 and 5 mg AA from
phospholipid per gram total fat and between 0.1 and 5 mg DHA from
phospholipid per gram total fat. Preferably the AA and/or DHA are at
least partly present in the form of phosphatidylcholine (PC) and/or
phosphatidylethanolamine (PE), e.g. AA and/or DHA containing PE
and/or PC.
Monounsaturated fatty acid
The present nutritional composition preferably also contains omega-9 (n-
9) fatty acid (preferably oleic acid, 18:1), to provide sufficient nutrition.
Preferably the present composition provides at least 15 wt.% n-9 fatty
acid based on the weight of the total fatty acids, more preferably at least
25 wt.%. The content of n-9 fatty acids is preferably below 80 wt.% based
on the weight of the total fatty acids. To provide sufficient nutrition, the
present composition preferably has a weight ratio saturated fatty
acid/polyunsaturated fatty acid between 2 and 5. The weight ratio

monounsaturated fatty acid/saturated fatty acid is preferably between 0.5
and 2.
The present composition preferably comprises between 5 and 25 wt.%
polyunsaturated fatty acids based on total fatty acids, preferably between
10 and 20 wt.%.
The present composition can be even further improved by inclusion of
stearidonic acid (C18:4n3). The composition preferably contains between
0.05 and 2 wt.% stearidonic acid based total fatty acids, even more
preferably between 0.1 and 1 wt.%.
Oligosaccharides
The present composition comprises 2 to 12 grams indigestible
oligosaccharides with a degree of polymerisation (DP) of 2 and 100 per
100 gram dry weight of the composition, preferably between 3 and 8
grams, more preferably between 5 and 7.5 grams. After reconstitution of
the powder in liquid and administration of the liquid formula to the infant,
these amounts of indigestible oligosaccharides provide the desired
effects without causing intestinal discomfort. Suitable indigestible
oligosaccharides are not or only partially digested in the intestine by the
action of acids or digestive enzymes present in the human upper
digestive tract (small intestine and stomach), but are fermentable by the
human intestinal flora. The oligosaccharides are preferably water-soluble
(exceeding a solubility of 1 gram oligosaccharide per liter water). The
average DP of the present oligosaccharide is preferably below 40, even
more preferably below 20. Optimally, the present composition comprises
between 2 and 12 grams oligosaccharides with a DP of 2 to 60, more
preferably with a DP of 2 to 10 (i.e. the sum of the weights of those
oligosaccharides with a DP of 2, 3, 4, 5, 6, 7, 8, 9 and 10).
According to a further embodiment at least one of the oligosaccharides of
the present composition is selected from the group consisting of inulin,
fructooligosaccharides, indigestible dextrins, galactooligosaccharides

(including transgalactooligosaccharides), xylooligosaccharides,
arabinooligosaccharides, glucooligosaccharides, mannooligo-
saccharides, lacto-N-neotetraose, fucooligosaccharides (containing at
least one fucose saccharide unit), acidic oligosaccharides (see below,
e.g. uronic acid oligosaccharides such as pectin hydrolysate) and
mixtures thereof.
Preferably the present composition comprises at least one selected from
the group consisting of inulins and fructooligosaccharides and at least
one selected from the group consisting of galactooligosaccharides
(including transgalactooligosaccharides) and pectin hydrolysate. In a
particularly preferred embodiment, the present composition comprises 2
to 12 grams oligosaccharides with a DP of 2 to 10 and piinked galactose
and glucose saccharides, more preferably transgalactooligosaccharides
(i.e. [gal]n -glu, wherein n is 2 to 10). In a particularly preferred
embodiment, the present composition comprises
transgalactooligosaccharides (i.e. [gal]n -glu, wherein n is 2 to 10), pectin
hydrolysate and at least one selected from the group consisting of
fructooligosaccharides and inulin. The present oligosaccharide can also
be an oligosaccharide derived from animal milk, a mixture of
oligosaccharides derived from animal milk or a fucosylated
oligosaccharide (oligosaccharide containing at least one fucose
saccharide unit).
For further improvement of gut maturation over the whole area of the
colon, preferably at least 10 wt.% of the oligosaccharides in the present
composition has a DP of 2 to 5 (i.e. 2, 3, 4 and/or 5) and at least 5 wt.%
has a DP of 10 to 100. Preferably at least 50 wt.%, more preferably at
least 75 wt.% of the oligosaccharides have a DP of 2 to 10 (i.e. 2, 3, 4, 5,
6, 7, 8, 9 and/or 10), because these are believed to work throughout the
ileum and proximal and middle parts of the colon and because the weight
percentage of oligosaccharides that needs to be incorporated in the
composition to achieve the desired effect is reduced.
Preferably the weight ratios:

(oligosaccharides with DP 2 to 5) : (oligosaccharides with DP 6 to 9); and
(oligosaccharides with DP 10 to 100) : (oligosaccharides with DP 6 to 9)
are both above 1.
Preferably both weight ratios are above 2, even more preferably above 5.
The present composition preferably comprises 0.5 to 10 gram
galactooligosaccharide with DP between 2 and 10 per 100 gram dry
weight of the composition, more preferably between 1 and 5 gram. The
preferred galactooligosaccharides is transgalactooligosaccharide, as this
best mimics human milk oligosaccharides. The present invention
preferably comprises 0.5 to 10 gram fructopolysaccharide with DP
between 10 and 60 per 100 gram dry weight of the composition, more
preferably between 1 and 5 gram. The term "fructopolysaccharide" refers
to a polysaccharide carbohydrate comprising a chain of at least 10 p-
linked fructose units.
Acidic oligosaccharides
To further improve barrier integrity, the present composition preferably
includes acidic oligosaccharides with a DP between 2 and 100, preferably
2 to 60. The term acid or acidic oligosaccharide refers to
oligosaccharides comprising at least one acidic group selected from the
group consisting of N-acetylneuraminic acid, N-glycoloylneuraminic acid,
free or esterified carboxylic acid, sulfuric acid group and phosphoric acid
group. The acidic oligosaccharide preferably comprises uronic acid units
(i.e. uronic acid polymer), more preferably galacturonic acid units. The
present composition preferably contains between 0.1 and 10 grams acid
oligosaccharides per 100 gram dry weight of the present composition,
more preferably between 1 and 6 grams per 100 gram dry weight.

Structure I: Polymeric acid oligosaccharide

wherein:
R is preferably selected from the group consisting of hydrogen, hydroxy
or acid group, preferably hydroxy; and
at least one selected from the group consisting of R2, R3, R4 and R5
represents N-acetylneuraminic acid, N-glycoloylneuraminic acid, free or
esterified carboxylic acid, sulfuric acid group and phosphoric acid group,
and the remaining of R2, R3, R4 and R5 representing hydroxy and/or
hydrogen. Preferably one selected from the group consisting of R2, R3,
R4 and R5 represents N-acetylneuraminic acid, N-glycoloylneuraminic
acid, free or esterified carboxylic acid, sulfuric acid group or phosphoric
acid group, and the remaining represent hydroxy and/or hydrogen. Even
more preferably one selected from the group consisting of R2, R3, R4
and R5 represents free or esterified carboxylic acid and the remaining of
R2, R3, R4 and R5 representing hydroxy and/or hydrogen; and
n is an integer and refers to a number of hexose units (see also Degree
of Polymerisation, below), which may be any hexose unit. Suitably n is an
integer between 1-5000. Preferably the hexose unit(s) is a uronic acid
unit.
Most preferably R1, R2 and R3 represent hydroxy, R4 represent
hydrogen, R5 represents carboxylic acid, n is any number between 1 and

250, preferably between 1 and 10 and the hexose unit is galacturonic
acid.
The detection, measurement and analyses of the preferred acid
oligosaccharides as used in the present method are given in applicants
earlier patent application relating to acid oligosaccharides, i.e. WO
0/160378.
Preferably, the acid oligosaccharide has one, preferably two, terminal
uronic acid units, which may be free or esterified. Preferably the terminal
uronic acid unit is selected from the group consisting of galacturonic acid,
glucuronic acid, guluronic acid, iduronic acid, mannuronic acid, riburonic
acid and altruronic acid. These units may be free or esterified. In an even
more preferred embodiment, the terminal hexose unit has a double bond,
which is preferably situated between the C4 and C5 position of the
terminal hexose unit. Preferably one of the terminal hexose units
comprises the double bond. The terminal hexose (e.g. uronic acid)
preferably has a structure according to the following structure II:
Structure II: Preferred terminal hexose acid group

wherein;
R is preferably selected from the group consisting of hydrogen, hydroxy
or acid group, preferably hydroxy (see above); and
at least one selected from the group consisting of R2, R3, R4 and R5
represents N-acetylneuraminic acid, N-glycoloylneuraminic acid, free or
RECTIFIED SHEET (RULE 91)

esterified carboxylic acid, sulfuric acid group and phosphoric acid group,
and the remaining of R2, R3, R4 and R5 representing hydroxy and/or
hydrogen. Preferably one selected from the group consisting of R2, R3,
R4 and R5 represents N-acetylneuraminic acid, N-glycoloylneuraminic
acid, free or esterified carboxylic acid, sulfuric acid group and phosphoric
acid group, and the remaining of R2, R3, R4 and R5 represent hydroxy
and/or hydrogen. Even more preferably one selected from the group
consisting of R2, R3, R4 and R5 represents free or esterified carboxylic
acid and the remaining of R2, R3, R4 and R5 represent hydroxy and/or
hydrogen; and n is an integer and refers to a number of hexose units (see
also Degree of Polymerisation, below), which may be any hexose unit.
Suitably n is an integer between 1-5000 representing the number of
hexose units said hexose units preferaby being uronic acid, even more
preferably being galacturonic acid units. The carboxylic acid groups on
these units may be free or (partly) esterified, and are preferably at least
partly methylated.
Most preferably, R2 and R3 represent hydroxy, R4 represent hydrogen
and R5 represents free or esterified carboxylic acid.
The acid oligosaccharides used in the invention are preferably prepared
from pectin, pectate, alginate, chondroitine, hyaluronic acids, heparine,
heparane, bacterial carbohydrates, sialoglycans, fucoidan,
fucooligosaccharides or carrageenan, more preferably from pectin and/or
alginate. Preferably pectin hydrolysate is used.
Nucleotides
The present composition preferably also comprises between 5 and 100
mg nucleosides and/or between 5 and 100 mg nucleotides per 100 gram
dry weight of the composition, more preferably between 5 and 50 mg.
The nucleotides and/or nucleosides further stimulate the immune system,
acting synergistically with the other ingredients of the present
composition.

Zinc
Zinc is an essential micronutrient for growth and development of the
immune function. Zinc deficiency impairs overall immune function and
resistance to infection. Hence the present composition advantageously
comprises zinc, preferably in an amount 2 to 100 mg zinc per 100 gram
dry weight of the present composition, even more preferably at least 4-
25 mg zinc per 100 g dry weight of the present composition. The weight
of zinc is calculated as elementary zinc.
Liquid
The present composition is preferably in powder or liquid form or an
tablet form, wherein said tablet has a weight between 5 and 25 grams.
Preferably, the present composition is provided in powered form as this
increases shelf life. The present composition is preferably administered
orally in liquid form. Prior to the administration of the present
composition, it is preferably admixed with a liquid, preferably water. As
the liquid composition is preferably administered while having a
temperature of 35-40°C (preferably about 37°C), the liquid formula is
preferably prepared by:
Process a: mixing water with a temperature below of 30°C and the
composition according to any one of claims 1-10, in a weight ratio water:
composition of 1-10:1; and heating the mixture obtained in step a) to a
temperature between 35 and 50 °C; or
Process b: mixing water with a temperature below of 60°C and the
composition according to any one of claims 1-10, in a weight ratio water:
composition of 1-10:1; and cooling the mixture obtained in step a) to a
temperature between 35 and 40 °C. Process a) is more suitable for
preparation of liquid formula from powder, while process b) is more
suitable for preparing ta liquid formula from the tablet.
Stool irregularities (e.g. hard stools, insufficient stool volume, diarrhea) is
a major problem in many babies and ill subjects that receive liquid foods.

It was found that stool problems may be reduced by administering the
present composition in liquid form, having an osmolality between 50 and
500 mOsm/kg, more preferably between 100 and 400 mOsm/kg, most
preferably between 220 and 300 mOsm/kg.
In view of the above diarrhea problem, it is also important that the liquid
food does not have an excessive caloric density as this causes significant
intestinal stress. However, the formula needs to provide sufficient
calories to feed the infant. Hence, the liquid food preferably has a caloric
density between 0.5 and 0.9 kcal/ml, preferably between 0.6 and 0.8
kcal/ml.
Application
The present composition is advantageously administered to infants with
the age between 0 and 2 years. The present composition can also be
advantageously used in a method for providing the nutritional
requirements of a premature infant (an infant born before 37 weeks
gestation). In a preferred embodiment, the present invention provides a
method for feeding infants with an age between 0 and 30 day.
The present composition can be advantageously used to treat or prevent
diseases wherein a comprised immune system and/or intestinal barrier
immaturity is underlying the development of the course of the disease.
The present composition can thus be advantageously used to treat or
prevent diarrhea or allergy, particularly in infants with an age between 0
and 2. The present composition is particularly suitable for the treatment
and/or prevention of allergic rhinitis, allergic conjunctivitis, allergic
dermatitis, atopic dermatitis and/or food allergy.
The present composition is preferably provided as a packaged powder or
packaged ready-to-feed formula. To prevent spoilage of the product,
packaging size of ready-to-feed formula preferably does not exceed one
serving, e.g. preferably does not exceed 500 ml; and packaging size of
the present composition in powder form preferably does not exceed 250

servings. Suitable packaging sizes for the powder are 2000 grams or
less, preferably per 1000 grams or less.
The packaged products provided with labels that explicitly or implicitly
direct the consumer towards the use of said product in accordance with
one or more of the above or below purposes, are encompassed by the
present invention. Such labels may for example including wording like,
"stimulates maturation of the intestine and/or immune system", "reduces
allergic reaction", "less stress", "improved resistance" or "reduced
sensitivity" or similar wording.
It is therefore a subject matter of the present invention to use the
composition as described herein for the manufacture of a formula food or
a medicament to be administered to a mammal for the treatment and/or
prevention of an inflammatory disease, of diarrhea, of eczema and/or of
atopic dermatitis.
It is furthermore a subject matter of the present invention to use the
composition as described herein for the manufacture of a medicament for
use in a method for the treatment and/or prevention of an inflammatory
disease, of diarrhea, of eczema and/or of atopic dermatitis said method
comprising administering said composition enterally or per os to a
mammal and in particular to a human infant. In a preferred embodiment,
the present method provides for a method for the treatment and/or
prevention of infections, said method comprising administering the
present composition.
The invention is described furthermore by the following examples:

Example 1: Infant nutrition
A liquid infant nutrition, prepared by admixing 13.9 g powder with water to
yield 100 ml final product, said liquid product comprising per 100 ml:
Energy: 66 kcal
Protein: 8 en%
1.3 g (containing 0.6 g casein; 0.8 g whey;
0.072 g L-arginine)
Digestible Carbohydrates: 44 en%
7.4 g (containing 7.3 g lactose)
Fat: 48 en%
3.5 g (containing 0.41 g linoleic acid ; 0-08 g a-linolenic acid; 0.012 g
arachidonic acid; 0.002 g eicosapentanoic acid; 0.006 g docosahexaenoic
acid; 1.4 g oleic acid; )
Fibre: 0.8 g (containing 0.05 g
fructopolysaccharide (Raftiline HP™, Orafti,
Tienen, Belgium); 0.55 g
transgalactooligosaccharides (Vivinal-GOS™
(Borculo Domo Ingredients, Netherlands);
0.20 g pectin hydrolysate prepared as
described in EP1373543, example 1.
Nucleotides: 0.89 mg Cytidine-5-monophosphate;
0.55 mg Uridine-5-monophosphate;
0.82 mg Adenosine-5-monophosphate;
0.20 mg Guanosine-5-monophosphate;
0.34 mg lnosine-5-monophosphate.

Osmolarity: 300 mOsmol/l
The composition further contains choline (6 mg/100 ml) and taurine (6.3
mg/100 ml); minerals and trace elements (including 2 mg zinc/100 ml)
and vitamins in amounts in compliance with the international guidelines
for infant milk formula.
Example 2:
Packaged infant milk formula according to example 1, wherein the
packaging is provided with a label indicating that the formula can be
suitably used to prevent or treat allergy.
Example 3:
Experimental setup
The effect of diets comprising acid oligosaccharides, optionally combined
with neutral oligosaccharides were tested on the delayed-type
hypersensitivity (DTH) response, which is a parameter for Th1
immunological response and is determined by measuring the increase in
ear swelling after local antigen challenge.
Acid oligosaccharides (AcOl) used, with an average DP between 2 and 10, were
obtained by the method described in WO 02/42484 (see example 1). Diets
containing 1 wt.%, 2.5 wt.%, 5 wt.% and 10% wt.% AcOl based on total weight of
the diet were tested. Neutral oligosaccharide mixture (GF) containing
galactooligosaccharides (GOS) (Vivinal-GOS™ (Borculo Domo Ingredients,
Netherlands) and fructooligosaccharides (FOS) (Raftiline HP™, Orafti, Tienen,
Belgium) were used in a weight ratio GOS:FOS of 9:1. Diets containing 1, 2.5 and 5
wt.% GF based on total weight of the diet were tested. The effects of a combination
of acid and neutral oligosaccharides (GF and AcOl) was tested in a diet containing 1
wt.% GF and 1 wt.% AcOl based on total weight of the diet.

All data is presented as percentages relative to control values, i.e. the
relative values of the oligosaccharide supplemented group compared to
the group receiving the control diet (without oligosaccharides).
Animals and diets
Female, 6 weeks old C57BI/6 mice (Harlan Nederland BV, Horst, the
Netherlands) were group-housed under a regular 12 hours light/dark
regime. Group size was 10 animals per group and 3 animals in the
negative control groups. The animals were given semi-synthetic diets
(Research Diet Services, Wijk bij Duurstede, the Netherlands). Control
diets were made to the AIN93G specifications (Reeves et al (1993)
Development and Testing of the AIN93 purified diets for rodents: results
on growth kidney calcification and bone mineralisation in rats and mice. J
Nutrition 123(11): 1923-31), oligosaccharide supplemented diets were
based on these specifications. Carbohydrate content of the supplemented
diets were kept constant by the exchange of total carbohydrates for the
oligosaccharides on a weight basis. The separate carbohydrate
components were substituted respective to their normal ratio in the diet.
The carbohydrates in the normal diet consist of cornstarch (40% of total
weight), dextrinized cornstarch (13.2%), sucrose (10%) and cellulose
(5%).
Vaccination protocol
Vaccinations were started after a period of two to four weeks of
adaptation to the new housing and diets. At day 0, a blood sample was
collected prior to vaccination. At day 1, the first vaccination was
administered subcutaneously. After three weeks, a blood sample was
collected (day 21) and a booster vaccination was given (day 22). Nine
days after booster injection (day 31), basal ear thickness was measured
with a Digimatic outside micrometer (Mitutoyo, Veenendaal, the
Netherlands) and a delayed-type hypersensitivity (DTH) response was

induced by injecting antigen solution i.e. (intracutaneous) in the mouse
ear pinnae. 24 h therafter (day 32), the DTH response was measured, a
bloodsample was taken and the mice were sacrificed. Spleens were
isolated and prepared for ex-vivo restimulations.
The vaccinations consisted of a 100 µl i.e. (intracutaneous) injection of a
1:1 mix of antigen solution and Stimune adjuvant (Specol, Cedi-
diagnostics BV, Lelystad, the Netherlands). The antigen solution was a
1:100 dilution of Influvac 2002/2003 (Solvay Pharmaceuticals, Weesp,
the Netherlands) in PBS . Influvac is a trivalent protein vaccine,
containing 3x30 pg/ml haemagglutinin of three different influenza strains.
For the DTH responses, mice were i.e. injected with 25 µl dialysed
Influvac in both ears as a DTH challenge.
Cell cultures
Splenocytes were isolated from the spleens using fine-mesh cell strainers
(Becton Dickinson, Erembodegem, Belgium). Red blood cells were lysed
by 5 minutes incubation on ice. After washing with culture medium
without phenol red, cells were counted (Coulter Counter, Beckman
Coulter, the Netherlands) and kept on ice. Cultures were set up using 0.1
pg/ml dialysed Influvac as a stimulus. Cells were seeded in 96-well
culture plates at 1*106 cells per well. The culture medium consisted of
RPMI-1640 with HEPES buffer and 2 mM L-Glutamine (Invitrogen,
Merelbeke, Belgium) with 10% fetal calf serum (FCS). Cultures were
incubated for 5 days at 37°C at 5% CO2. Thereafter supernatants were
harvested and frozen at -80°C until analysis. Cell proliferation was
measured in parallel cultures by 3H-thymidine incorporation, which was
added to the cultures for the last 18 hours at 0.4 µCu/well. After 5 days,
the cells were harvested using a Filtermate harvester (Perkin Elmer,

Zaventem, Belgium) and counted on a Micro-Beta counter (Perkin Elmer,
Zaventem, Belgium). Radioactive decay was measured for 1 minute per
well and the counts per minute (cpm) were recorded as a measure for
proliferation speed.
Cytokines were analysed in supernatants of Influvac stimulated cultures. IL-2, IL-5,
IL-10 and IFN-gamma were measured using the Bio-Plex system with a custom
mixed beadset for the cytokines mentioned (Bio-Rad, Veenendaal, the
Netherlands). Cytokines were measured according to the manufacturer's
specifications. IL-4 was measured by ELISA using the Pharmingen OptEIA mouse
IL-4 kit (Becton Dickinson, Erembodegem, Belgium), according the manufacturer's
specifications.
Results
DTH response acid oligosaccharides
The diets containing dosages of 1 wt.%, 2.5 wt.% and 5 wt.% AcOl
induced a statistically significant increase in the DTH response, showing
a dose-dependent increase (see Table 1). The observed effect is
indicative for the advantageous use of acid oligosaccharides in the
present method.



* indicates significantly different (P DTH response acid and neutral oligosaccharides
The combination of 1 wt.% GF, 2.5 wt.% GF and the mixture of 1 wt.% GF
and 1 wt.% AcOl induce a statistically significant increase in the DTH
(see Table 2). The observed effect is indicative for the advantageous use
of a indigestible oligosaccharides, particularly the combination of acid
and neutral oligosaccharides in the present method.

* indicates significantly different (P
Influvac specific proliferation of acid oligosaccharides
Administration of diets containing 2.5 wt% and 5 wt.% acid
oligosaccharides (AcOl) induced a significant lowering effect on the
influvac specific proliferation ex vivo (see Table 3). The observed effect
is indicative for the advantageous use of acid oligosaccharides in the
present method.
Influvac specific proliferation of a combination of acid and neutral
oligosaccharides
Administration of a combination of 1 wt.% GF and 1 wt.% AcOl induced
significant lowering effects on the antigen specific proliferation (see
Table 3). As the effect is significantly improved over the DTH responses
from diets containing the acid or neutral oligosaccharides alone, these
results are indicative for the synergistic effect provided by the
administration of acid and neutral oligosaccharides. The observed effect
is indicative for the advantageous use of a combination of acid and
neutral oligosaccharides in the present method. Reduced proliferation is
indicative for the reduction of Th2 response, and the Th1/Th2 balancing
effect of the present method.



* indicates significantly different (P Th1/Th2 balance: Cytokine profiles after administration of acid
oligosaccharides
Cytokine profiles were measured in the culture supernatants of the
influvac specific splenocytes. Data are presented as percentage relative
to values of the vaccinated control group (i.e. receiving no
oligosaccharides). Compared to controls, diets containing 2.5 wt.% and 5
wt.% AcOl resulted in a decrease in the Th2-related cytokines IL-4 , IL-5
and IL-10, while the Th1-related cytokines IL-2 was increased and IFN-y
was not significantly lowered (see Table 4). These results are indicative
for the Th1/Th2 balancing effect of acid oligosaccharides and indicative
for the advantageous use of acid oligosaccharides in the present method,
e.g. for the treatment and/or prevention of diseases with relatively low
Th1 immunity.
Th1/Th2 balance: Cytokine profiles after administration of acid and neutral
oligosaccharides
Compared to controls, administration of a combination of 1 wt.% GT and
1 wt.% AcOl resulted in a decrease in the Th2-related cytokines IL-4, IL-
5 and IL-10, while the Th1-related cytokines IL-2 and IFN-y were not
lowered (see Table 4, wherein data are presented as percentage relative
to values of the vaccinated control group (i.e. receiving no
oligosaccharides)). These results are indicative for the Th1/Th2 balancing


* indicates significantly different (P effect of a combination of acid- and neutral oligosaccharides and
indicative for the advantageous use of acid oligosaccharides in the
present method, e.g. for the treatment and/or prevention of diseases with
relatively low Th1 immunity. Particularly the IL-4/IFN ratio reflects the
Th2/Th1 balance. In other words, a lower ratio is indicative for stimulation
of Th1 and/or inhibition of Th2, and in any case indicative for the Th1-
Th2 balancing effect of the present oligosaccharides.

WE CLAIM:
1. A nutritional composition formulated as an infant formula and
containing a fat component, a protein component and a carbohydrate
component and comprising whey and casein,
characterized in that,
the weight ratio of casein to whey is 1:1 to 1:2.4 and that the
composition contains:
a) at least 3 grams arginine per 100 grams protein;
b) at least 10 wt.% linoleic acid based on total fatty acids;
c) at least 1 wt.% alpha linolenic acid based on total fatty acids;
d) at least one long chain-polyunsaturated fatty acid in an amount
exceeding 0.1 wt.% based on total fatty acids, said long chain
polyunsaturated fatty acid being selected from the group consisting of
docosahexaenoic acid, arachidonic acid and eicosapentaenoic acid;
e) 5 to 25 wt.% of at least one polyunaaturated fatty acid based on total
fatty acids;
f) 2 to 12 grams indigestible oligosaccharides having a degree of
polymerisation of 2 to 100 per 100 gram dry weight of the composition
and
g) acidic oligosaccharides with a degree of polymerisation of 2 to 100.
2. Composition as claimed in claim 1, comprising
transgalactooligosaccharide, pectin hydrolysate and at least one selected
from the group consisting of fructooligosaccharides and insulin.
3. Composition as claimed in any one of the preceding claims, wherein
the composition contains docosahexaenoic acid, arachidonic acid and
eicosapentaenoic acid.

4. Composition as claimed in any one of the preceding claims, wherein
the composition comprises 2 to 100 mg zinc per 100 gram dry weight of
the composition.
5. Composition as claimed in any one of the preceding claims, wherein
the protein component accounts for 5 to 15 en%; the fat component for
30 to 60 en%; and the carbohydrate component for 25 to 75 en%.
6. Composition as claimed in any one of the preceding claims, wherein
the composition further comprises between 5 and 100 mg nucleotides
and/or between 5 and 100 mg nucleosides per 100 gram dry weight of
the composition.
7. Composition as claimed in any one of the preceding claims, wherein
the composition contains 2 to 6 grams threonine per 100 gram protein
component.
8. Composition as claimed in any one of the preceding claims, wherein
the composition contains docosahexaenoic acid in an amount exceeding
0.1 wt.% based on total fatty acids and arachidonic and in an amount;
exceeding 0.1 wt % based on total fatty acids and that the weight ratio
arachidonic acid / docosahexaenoic acid is between 0.25 and 25.


ABSTRACT

The invention provides a nutritional or pharmaceutical composition containing a fat
component, a protein component and a carbohydrate component and comprising whey
and casin Said composition is characterized in that, the weight ration of casin to whey
is 1:1 To 1:24 and that the composition contains: 1) at least 3 grams arginine per 100
grams protein; b) at least 10 wt% linoleic acid based on total fatty acids; c) at least 1
wt% alpha linolenic acid based on total fatty acids; d) at least one long chain
polyunsaturated fatty acid in an amount exceeding 0.1 wt.% based on total fatty acids,
said long chain polyunsaturated fatty acid being selected from the group consisting of
docosahexaenoic acid, arachidonic acid and eicosapentaenoic acid; e) 5 to 25 wt.% of at
least one polyunsaturated fatty acid based on total fatty acids; and f) 2 to 12 grams
indigestible oligosaccharides having a degree of polymerization of 2 to 100 per 100 gram
dry weight of the composition. The composition of the invention reduces among others
the risks attached to feeding whey dominant infant formula.

Documents:

00691-kolnp-2007-correspondence-1.1.pdf

00691-kolnp-2007-p.a.pdf

0691-kolnp-2007 abstract.pdf

0691-kolnp-2007 claims.pdf

0691-kolnp-2007 correspondence others.pdf

0691-kolnp-2007 description(complete).pdf

0691-kolnp-2007 form-1.pdf

0691-kolnp-2007 form-2.pdf

0691-kolnp-2007 form-3.pdf

0691-kolnp-2007 form-5.pdf

0691-kolnp-2007 international publication.pdf

0691-kolnp-2007 international search authority report.pdf

0691-kolnp-2007 pct form.pdf

0691-kolnp-2007 priority document.pdf

691-KOLNP-2007-(13-07-2012)-CORRESPONDENCE.pdf

691-KOLNP-2007-(16-01-2012)-ABSTRACT.pdf

691-KOLNP-2007-(16-01-2012)-AMANDED CLAIMS.pdf

691-KOLNP-2007-(16-01-2012)-CORRESPONDENCE.pdf

691-KOLNP-2007-(16-01-2012)-DESCRIPTION (COMPLETE).pdf

691-KOLNP-2007-(16-01-2012)-FORM 1.pdf

691-KOLNP-2007-(16-01-2012)-FORM 2.pdf

691-KOLNP-2007-(16-01-2012)-FORM 5.pdf

691-KOLNP-2007-(16-01-2012)-OTHERS.pdf

691-KOLNP-2007-(16-01-2012)-PETITION UNDER SECTION 8(1).pdf

691-KOLNP-2007-(25-01-2012)-CORRESPONDENCE.pdf

691-KOLNP-2007-(25-01-2012)-OTHERS.pdf

691-KOLNP-2007-CORRESPONDENCE 1.1.pdf

691-KOLNP-2007-CORRESPONDENCE 1.2.pdf

691-KOLNP-2007-EXAMINATION REPORT.pdf

691-KOLNP-2007-FORM 18 1.1.pdf

691-kolnp-2007-form 18.pdf

691-KOLNP-2007-FORM 26.pdf

691-KOLNP-2007-FORM 3.pdf

691-KOLNP-2007-FORM 5.pdf

691-KOLNP-2007-GRANTED-ABSTRACT.pdf

691-KOLNP-2007-GRANTED-CLAIMS.pdf

691-KOLNP-2007-GRANTED-DESCRIPTION (COMPLETE).pdf

691-KOLNP-2007-GRANTED-FORM 1.pdf

691-KOLNP-2007-GRANTED-FORM 2.pdf

691-KOLNP-2007-GRANTED-SPECIFICATION.pdf

691-KOLNP-2007-INTERNATIONAL PRELIMINARY EXAMINATION REPORT.pdf

691-KOLNP-2007-INTERNATIONAL SEARCH REPORT.pdf

691-KOLNP-2007-IPRB.pdf

691-KOLNP-2007-OTHERS 1.1.pdf

691-KOLNP-2007-OTHERS.pdf

691-KOLNP-2007-REPLY TO EXAMINATION REPORT 1.1.pdf

691-KOLNP-2007-REPLY TO EXAMINATION REPORT.pdf

691-KOLNP-2007-TRANSLATED COPY OF PRIORITY DOCUMENT.pdf


Patent Number 254020
Indian Patent Application Number 691/KOLNP/2007
PG Journal Number 37/2012
Publication Date 14-Sep-2012
Grant Date 13-Sep-2012
Date of Filing 26-Feb-2007
Name of Patentee N.V.NUTRICIA
Applicant Address EERSTE STATIONSSTRAAT 186, NL-2712 HM ZOETERMEER
Inventors:
# Inventor's Name Inventor's Address
1 BOEHM, GUNTHER HASELHECKSTRASSE 1, 61209 ECHZELL
2 STAHL,BERND: BRESLAUER STRASSE 77, 61191 ROSBACH
3 M'RABET, LAURA: GELE PLOMP 38, NL-3824 WK AMERSFOORT
4 GARSSEN, JOHAN: GRAFF JOHANLAAN 7, NL-3434 SG NIEUWEGEIN
5 BEERMANN,CHRISTOPHER: BAHNHOFSTRASSE 120A, 61267, NEU-ASPACH
PCT International Classification Number A61K 35/20
PCT International Application Number PCT/EP2005/008999
PCT International Filing date 2005-08-19
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 04019856.6 2004-08-20 EPO