Frequently Asked Questions & Answers About Nuvista

What is Nuvista?

Nuvista is a specialized nutrition product formulated to meet the dietary needs of pre-and post bariatric surgery candidates.  Nuvista meets minimum ASMBS guidelines for a variety of key nutrients including iron, calcium, vitamin D and B12 and is a low volume, nutrient dense, and lactose free powder mix. Nuvista contains a prebiotic fiber blend that enhances calcium absorption, and when combined with our high-quality protein source, may help to induce satiety supporting you as you adjust to a new relationship with food.

How is Nuvista different from other nutritional products on the market?

Nuvista can effectively replace all of the supplements you are currently taking for nutritional pre and post surgery support. Ask your doctor to be certain. Nuvista meets or exceeds minimum ASMBS guidelines for a variety of key nutrients and has been fortified with the key micronutrients found to be most deficient in gastric bypass and sleeve patients. Two servings of Nuvista per day provide 100% of the recommended daily value of calcium, phosphorous, iron, vitamin D and vitamin B12.  You will no longer need to remember to take individual calcium tablets, iron supplements, multi-vitamins and B12 pills each day.

There are virtually no clinically proven supplemental nutrition products that meet ASMBS guidelines for pre and post- bariatric surgery patients. With so few effective options, many patients turn to weight loss and protein drinks or meal replacements.  Protein drinks are simply not nutritionally optimal for use in pre and post  surgery patients. While they have high levels of protein, they lack much needed nutrients such as calcium, fiber, iron and B12. Nutritional drinks and meal replacements tend to be calorie dense, high sugar, large volume drinks that lack key micronutrients and do little to help with satiety.

What are the benefits of Nuvista?

For the surgeon, Nuvista showed an average 43.3% left lateral pre-operative liver shrinkage in a clinical study.  This reduction helps simplify laparoscopic procedures by easing the ability to manipulate the liver away from the cardia and fundus.  This leads to more reliable procedure completion times to maximize OR scheduling.

For the practice nutrition staff, Nuvista takes away the need for counseling patients on calcium, multi-vitamin, B12, protein and other vitamin and mineral supplement regimens.  Nuvista replaces the multiple pills and doses throughout the day with just two doses in three different delicious flavors.

If you are having weight loss surgery, in addition to making your surgical procedure be more easily completed, Nuvista supports your body during a critical period of transition after surgery and for as long as you need nutritional support as determined by your surgical support team.

Is Nuvista a meal replacement?

No. Nuvista is not intended as a sole source of nutrition and is formulated to support weight loss as a part of a 1,200-1,500 calorie restricted diet.  

Who was Nuvista designed for?

Nuvista is suitable for use as a four-week supplement to a 1,200-1,500 calorie diet for pre-operative bariatric patients and was designed for all people regardless of their surgical procedure type. With two-doses per day, post surgery, the product was designed to meet the special dietary needs of gastric bypass and sleeve patients who experience the greatest nutritional deficits.  

How are the ingredients in Nuvista important?

In only two daily doses, Nuvista provides 100+% of ASMBS minimum key nutrient guidelines for RYGB patients.  The product is lactose-free and has been enriched with protein, calcium, phosphorous, iron, vitamin D and vitamin B12, key nutrients found to be most deficient in post-gastric bypass surgery patients. It also contains a patented inulin prebiotic fiber blend that supports calcium absorption and bowel regularity.

What is the recommended dosage?

One sachet of Nuvista is a dose. To meet ASMBS nutritional requirements, the recommended daily intake is 2 sachets per day mixed with 2.5fl oz of water for a “power shot” or with 1fl oz for a creamy pudding. Nuvista should be taken only under the medical supervision of a physician.

What flavors are available?

Nuvista is available in strawberry, vanilla and chocolate and can also be mixed conveniently into smoothies.  Some patients prefer mixing Nuvista with 1 oz of water to form a Nuvista  pudding.  Some patients find this creamier pudding format easier to tolerate during periods of transition (e.g., post band adjustments) and others find it helps trigger a faster / better level of satiety due to the stronger oral fixation the pudding provides.

Instead of taking Nuvista, can someone get the same effect through diet and vitamins?

It is true that patients can take a combination of various individual supplements to get a similar nutritional effect. However, compliance is often an issue. Nuvista is a convenient concentrated 3oz drink that replaces the handful of vitamins and supplements that patients have to remember to take.

Can Nuvista be mixed and made into smoothies?

Yes, the Vanilla flavor in particular easily blends with berries, bananas or other fruits to provide a more enjoyable and flexible way to get needed nutrition.  Also available in Strawberry and European Chocolate flavors that blend nicely with ice, skim milk and low fat yogurt to make a satisfying and nutritious mid-day snack. Our Nutritionists have developed a number of recipes to help during the particularly challenging phases post surgery when solids are gradually introduced.

What is inulin prebiotic fiber?

Nuvista contains 5g per packet of prebiotic fiber which is an oligofructose enriched inulin, consisting of a combination of short and long chain oligosaccharides in a ratio comparable to those reported in adult intakes.

Prebiotics are non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth and / or activity of one or more of a limited number of bacteria in the colon, that can improve the host’s health

Prebiotics are fermented in the gut resulting in the production of short chain fatty acids which have several beneficial effects including providing an energy substrate for colonocytes, stimulating colonic blood flow resulting in proliferation and differentiation of the intestinal lining which leads to a healthier gut, reduction in pH of the colonic contents which can help to suppress growth of harmful bacteria and stimulation of water and sodium uptake which can help reduce watery stools.

Another key benefit of prebiotics is their ability to increase calcium absorption. 8-12g/day of fiber has been proven in clinical studies to enhance calcium absorption and incorporation into bones.  This could have potential benefit in obese individuals who are more at risk of suffering osteoarthritis, osteoporosis and weak bones in later life and in patients following gastric bypass surgery who may be at risk of bone demineralisation due to vitamin D and calcium deficiencies.

How much protein is in Nuvista?

Nuvista contains 15g of protein per packet, providing a total of 30g per day, with the remainder being obtained from the diet. Post-gastric bypass surgery, deficiency of protein generally occurs as a result of the overall decreased food intake and intolerance to meats. Mal-absorption of protein may occur in those with distal RYGBP resulting in a longer Roux limb, >150cm.  Protein supplementation is required to help prevent the loss of lean body mass associated with any rapid weight loss program or very low calorie diet. Nuvista has the highest PCDAA (protein digestibility corrected amino acid) score available of 1.05 (105%), which is the preferred method of measurement of the protein value in human nutrition adopted by FAO/WHO, emphasizing the high protein quality of the product. PDCAA indicates the overall quality of a protein.

Daily requirements are 60-70g per day for bariatric patients. Thus Nuvista will meet between 42% and 50% of daily requirements for protein in these patients in two daily doses.

Can I take Nuvista if I am a diabetic?

Yes. Nuvista has a low glycemic index which ensures a slow but sustained release of sugar into the blood stream.

What is Nuvista’s impact on gastric dumping?

An important consideration with patients following gastric bypass surgery is the possibility of dumping syndrome which occurs when sugars move too quickly through the stomach and intestines.  Dumping syndrome causes nausea, weakness, sweating, faintness and possibly diarrhea soon after eating.  Nuvista has a low glycemic index which ensures a slow but sustained release of sugar into the blood stream. The product provides a total of 17g of carbohydrate (including fiber) per packet, giving a total daily intake of 34g per day in two servings.

What is the level of B12 in Nuvista?

The level of Vitamin B12 in Nuvista is 175mcg per packet providing total daily intakes of 350mcg. In normal, healthy individuals, gastric acid and peptic acid are required to release Vitamin B12 in food. Following surgery, these digestive acids may be significantly reduced and thus the need for significantly higher levels of Vitamin B12.

What type of calcium is used in the product?

While there are five different sources of calcium in Nuvista, the main source of calcium is Calcium Phosphate tribasic, an optimal blend of calcium and phosphate. The level of calcium in this product is 750mg per packet, providing 1500mg per day at the recommended intake of 2 packets daily.

Given its solubility and ease of absorption calcium citrate is often recommended to patients as a supplement.  However, the Nuvista development team formulated the product with calcium phosphate tribasic for several reasons:
1) Citrate has a sour taste and does not work well with milk based products
2) Nuvista contains a patented inulin prebiotic blend  which has been proven to aid in calcium absorption
3) The iron in Nuvista is encapsulated to reduce its interaction with calcium, which is likely to further improve absorption of calcium

The calcium quality and quantity in Nuvista has been carefully considered.

Can I take Nuvista if I am lactose intolerant?

Yes, Nuvista is lactose free. Lactose intolerance is often experienced post surgery and maybe secondary to lactase deficiency or previously masked intolerance. Nuvista is therefore lactose free to aid tolerance in patients that may have lactose intolerance.

Can Nuvista be mixed with other ingredients?

Yes, Nuvista can be mixed into other ingredients served cold or room temperature such as smoothies, puddings and shakes.

Is Nuvista a supplement or a medical food?

Under US regulations (21 C.F.R. § 105.3), Nuvista is a Food for Special Dietary Use.  http://edocket.access.gpo.gov/cfr_2005/aprqtr/pdf/21cfr105.3.pdf
The FDA uses this classification to describe products that are specifically formulated to meet the dietary needs of patients with certain medical conditions.

What are the mixing instructions?

Nuvista is best prepared with 3 fl oz of chilled water and consumed immediately after preparation.  To prepare it as a milk shake, it is best to add a little water to the powder to make a smooth paste and slowly add the remaining water. To prepare it as a pudding, add one packet to a bowl, measure 1 fl oz water and blend in slowly to achieve a pudding consistency.

ORDER PLACEMENT AND SUPPORT

What is the cost of Nuvista to my patients?

There is a 4-box or 1 case minimum on all orders of Nuvista. Cases can be configured with any flavor variation.

• When you purchase Nuvista directly from Nutricia the cost is $199 per case, 4 week product supply (appx $50 per week).

• However if your physician maintains a supply of Nuvista, you may purchase Nuvista through your doctor’s office. The pricing will be at the discretion of the physician.  

Who should I call if I have more questions?

For orders and questions, please contact us at 1-800-365-7354. Our customer service team will ensure that you are transferred to the appropriate contact.

GENERAL

Why is Nutrition important before and after bariatric surgery?

Morbidly obese patients have been found to have abnormal serum calcium and vitamin D levels prior to surgery. Fujioka teal and Ybarra et al., reported that approximately 20% of morbidly obese patients were found to have low 25-OH-Vitamin D and elevated parathyroid hormone (PTH). These deficiencies are further exacerbated depending on the type of surgery performed. Gastric bypass surgery results in anatomical and metabolic changes which predispose patients to other micronutrient deficiencies including iron, vitamin B12 and protein.  Following surgery it is estimated that up to one-third of patients suffer nutritional deficiencies that cannot be corrected by normal diet alone. 

For what duration should patients be kept on Nuvista before and after surgery?

We recommend that for optimal weight loss and liver shrinkage that patients remain on Nuvista for 4 weeks prior to their surgery and then for a minimum of 6-10 weeks post surgery.  Nuvista was designed with gastric bypass patients in mind who will require nutritional support Indefinitely, certainly well beyond 6-10 weeks post surgery. However, we recommend that all patients stick with Nuvista for at least 10 weeks for consistency. Beyond the 10 week period will depend on the type of surgery and individual patient requirements.

Who Is Nutricia? How do I know I can trust Nutricia?

Nutricia Advanced Medical Nutrition is a recognized leader in specialized medical nutrition. Nutricia is part of Groupe Danone (Dannon in the USA). The Company stands for a unique range of medical foods or nutritional products each targeted to particular medical conditions and specifically designed to improve patient recovery and independence.