Targeted Nutrition Intervention Introduction¹,²

NuTriVene-D®, or any TNI, is not a "cure" for Down syndrome, nor does it eliminate the need for early intervention and therapies. The Scientific Advisory Committee of Trisomy 21 Research feels it is the best approach currently available to deal with the metabolic errors that occur in Down syndrome and does help decrease the incidence of infection and improve growth; secondarily, it helps improve muscle tone and the level of alertness. Trisomy 21 Research recommends that individuals who are using NuTriVene have blood testing completed 6 to 12 months after beginning NuTriVene. This will ensure that fat soluble vitamins are not being stored as well as determine any nutrient deficiencies.
In the future, NuTriVene-D® will likely evolve as new research becomes available to document safely changing it only under the approval of the Scientific Advisory Committee of Trisomy 21 Research.

Trisomy 21 Research recommends the following products as nutrition and/or drug therapy for infants, children, and adults with Down syndrome.
*Optional
§Longvida is a registered trademark of Verdure Sciences, Inc.
†Aricept is a registered trademark of Eisai Co., Ltd.
‡Namenda is a registered trademark of Forest Laboratories, Inc.

Trisomy 21 Research recommends that infants, children, and adults with Down syndrome consume essential fatty acids. However, if the individual consumes fish or eggs fortified with DHA (docosahexaenoic acid) in significant amounts in his or her diet, you may wish to reduce the dosage of DHA. If the infant is being breastfed, the mother may wish to consume Neuromins DHA at 200-300 mg (2-3 gelcaps) per day rather than provide it to the infant directly. If the infant is taking infant formulas with essential fatty acids (lipils), it may not be necessary to provide additional DHA in the diet.
Essential fatty acid products may be mixed with NuTriVene-D products. For infants, children, or adults who are not able to swallow capsules, you may pierce the gelcaps with a pin or needle or cut off the top of the gelcap and put in infant formula, drinks, food, etc.
Shoud you child experience diarrhea while on DHA/EPA products, reduce the dosage you are providing by one-half.
DHA is the primary building block of the brain and retina essential for brain and eye function.
As of June 2005, Trisomy 21 Research Foundation does not recommend the use of Evening Primrose Oil (EPO), as there is evidence that omega 6 fatty acids can interfere with omega 3 balance which does not favor omega 3 fatty acids (DHA) and increases inflammation in the older population.3
Trisomy 21 Research Foundation announced in August 2005 the new guidelines for essential fatty acid consumption in Down syndrome. These general guidelines follow the International Society for the Study of Fatty Acids and Lipids (ISSFAL) recommendations for docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) consumption. To comply with these guidelines Nordic Naturals® ProDHA™ is suggested which requires less capsules per day than Neuromins® DHA
Warnings: Omega-3 fatty acids may increase the blood-thinning effects of aspirin or warfarin. While the combinations of aspirin and omega-3 fatty acids may actually be helpful under certain circumstances (such as heart disease), they should only be taken together under the guidance and supervision of a healthcare provider.

Probiotic. Optional recommendation for children with a history of antibiotic use, food allergies, constipation, diarrhea, or colic. Product should include a Bifidobacterium for children and Lactobacillus for adults. Follow directions for use from manufacturer.

Daily Supplement Changes

Summer 1996
NuTriVene-D® introduced.
Spring 1997
Acetyl L-carnitine and Lipoic Acid added.
Summer 1997
Vitamin A Palmitate and Beta Carotene (reduced)
Based on an analysis of blood profiles, results indicate that adequate levels of Vitamin A and Beta Carotene are being derived from regular dietary food intake.
Biotin (reduced)
Biotin is necessary for the formation of fatty acids and glucose which are used as fuels by the body. It is also important for the metabolism of amino acids and carbohydrates.
Choline (increased)
Choline aids in the sending of nerve impulses, specifically those in the brain used in the formation of memory.
Betaine Hydrochloride (increased)
Betaine Hydrochloride helps to increase the secondary pathway for resynthesis of the essential amino acid methionine since the primary pathway has been compromised due to the extra chromosome.
Sugar (removed)
Replaced with rice flour, considered the most hypo-allergenic carrier or flow agent in the pharmaceutical industry.
Winter 1997
Folic Acid (reduced)
It has been determined by the Scientific Advisory Committee of Trisomy 21 Research that this lower level, along with regular dietary intake, is more than adequate.
Dosage (reduced)
The dosages have changed slightly to accommodate the bulk density changes of the product.
Winter 2000
Betaine Trimethylglycine (TMG) (added)
Betaine Hydrochloride replaced by adding 200 mg of TMG to NuTriVene-D® and 250 mg to NuTriVene-AD®. Further testing is underway to determine the most appropriate dosages of TMG in Down syndrome. At this time, Trisomy 21 Research does not recommend supplementing over 1000 mg of TMG per day in Down syndrome.
Summer 2001
Calcium Citrate (increased)
Helps to maintain proper cell membrane permeability, is important for strong bones and teeth, and beneficial of healthy gums.
Calcium Carbonate (removed)
Methionine (increased)
An essential amino acid that is required by the body for metabolism and growth. This nutrient in important as its required for the production of SAMe, a precursor ot serotonin (a brain neurotransmitter that regulates emotions, sleep quality, etc.). Methionine is typically deficient in individuals with Down syndrome.
Folinic Acid (added)
A more metabolically active form of folate that is readily transported into the central nervous system. This is important in Down syndrome as the folate cycle is impaired.
Folic Acid (reduced)
Zinc (increased)
Helps with proper functioning of the immune system and assists with thyroid function.
Selenium (increased)
Inhibits the oxidation of fats and protects the immune system by preventing the formation of free radicals. Selenium is also needed to activate thyroid hormones.
Vitamin D3 (increased)
Aids in immunity and is necessary for thyroid function. Vitamin D3 is also necessary for the development of bones and teeth.
Betaine Trimethylglycine [TMG] (increased)
Is a nutrient that functions as a methyl donor, converting homocysteine into useful methionine. TMG is important for proper liver and detoxification reactions in the body.
Dosage (increased)
The dosages have increased reflecting the above added formula changes.
Winter 2006
Vitamin D3 (increased to 300 IU)
Is necessary for growth, enhanced immunity, and thyroid function.
Zinc (increased to 30 mg)
Helps to regulate the immune system, is important to thyroid function, and is required for sensory perception including taste, smell, and vision.
Mixed Carotenoids (source changed from Beta Carotene)
Antioxidants that are a highly colored group of fat-soluble plant pigments. Preliminary studies suggest that higher intakes of carotenoids offer protection against certain types of cancer, cataracts, macular degeneration, and other conditions associated with increased oxidative stress.
Selenium (source changed to Selenomethionine)
Now in a more absorbable form. This mineral helps reduce lipid peroxidation, neutralize hydrogen peroxide radicals, and detoxify heavy metals mercury and cadmium.
R-Lipoic Acid (source changed from Alpha Lipoic Acid)
A new, more absorbable form. This antioxidant helps neutralize free radicals by enhancing Vitamins C & E and glutathione. It also reduces toxicity from heavy metals mercury, cadmium, and lead.
Blueberry Powder (added)
A phytonutrient and antioxidant that is thought to lower cholesterol and promote urinary tract health. Research indicates that blueberries may slow impairment in memory and motor coordination in the aging brain.
Lutein (added)
A carotenoid and antioxidant that is thought to play a role in eye health by filtering out damaging forms of light.
Lycopene (added)
A carotenoid and antioxidant that research suggests may be important in reducing the risk of macular degeneration and some forms of cancer.
Curcumin (added)
An antioxidant ingredient that is thought to protect the liver from toxic compounds and helps to reduce platelets from sticking together. This anti-inflammatory nutrient is also being studied for its role in slowing the formation of and reducing brain plaque in Alzheimer's.
Dosage
Established new weight groups and more convinient teaspoon dosages.
June 2009
Vitamin D
Recommended dosage is 500 IU for children under 6 and 1000 IU for patients 6 years of age and older, beyond what is provided in the NuTriVene-D Daily Supplement.
January 2011
Vitamin D3 (increased)
From 300 IU to 2000 IU at full dosage.
Studies indicate that Vitamin D improves immune function, aids calcium absorption in the gut, promotes modulation of cell growth, and reduces inflammation.
Recommended dosage is 1000 IU for children under 6 and 2000 IU for children over years of age, beyond what is provided in the NuTriVene-D Daily Supplement:

Up to 20 lbs.   Additional 700 IU of D required
21-40 lbs.   Additional 400 IU of D required
61-80 lbs.   Additional 400 IU required (capsule) or
  500 IU (Powder or Microencapsulated) of D required
Vitamin K2 (added)
Added Vitamin K2 (as Menaquionone-7) at 100 µg at full dosage.
Research suggests that Vitamin K promotes cardiovascular health, healthy bones, and cartilage.
Vitamin E (Source changed from Succinate to Mixed Tocopherols)
Now in a more nutritionally complete form of E
Vitamin E is important for heart health and plays a critical role in protecting cell membranes by neutralizing free radicals.
Blueberry Powder (removed)
Removal of Blueberry Extract as possible allergen.
Curcumin (removed)
Removal of Curcumin as possible gastrointestinal issue in some individuals.
Dosage
Established new dosages.
Source: 1. International Nutrition, Inc.
2. Genetics and Disabilities Diagnostic Care Center Revised: April 26, 2011.
3. Frank Thies, Gerhard Nebe-von-Caron, Jonathan R Powell, Parveen Yaqoob, Eric A Newsholme and Philip C Calder. (2001 Mar) Dietary supplementation with eicosapentaenoic acid, but not with other long-chain n-3 or n-6 polyunsaturated fatty acids, decreases natural killer cell activity in healthy subjects aged >55 y. Am J Clin Nutr. 73, (3): 539-48.
4. Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents. Pediatrics. 2008 Nov;122(5):1142-52