36 ISSUE 4

VOL. 36 SUPPLEMENT 1 AUGUST 20172017

SEPTEMBER ISSN 0261-5614
0261-5614
14

Clinical Nutrition Vol. 36/4 (2017) 915–1186

S1–S308
2
Abstracts of the 39th ESPEN Congress,
The Hague, Netherlands, 9–12 September 2017

ELSEVIER

Cover.indd All Pages 11-Aug-17 5:05:51 PM

 Clinical
Nutrition
An international journal devoted to
clinical nutrition and metabolism
Official Journal of ESPEN — The European Society for Clinical Nutrition and Metabolism

Editor
N.E.P. Deutz, MD, PhD
Center for Translational Research in Aging & Longevity,
Department of Health & Kinesiology,
Texas A&M University,
College Station, Texas 77843-4253, U.S.A.
E-mail: espenjournals@espen.org

Managing Editor
J.A. Mays
Center for Translational Research in Aging & Longevity,
Department of Health & Kinesiology,
Texas A&M University,
College Station, Texas 77843-4253, U.S.A.
E-mail: espenjournals@espen.org
S.C. Roeske
Center for Translational Research in Aging & Longevity,
Department of Health & Kinesiology,
Texas A&M University,
College Station, Texas 77843-4253, U.S.A.
E-mail: espenjournals@espen.org

Associate Editors
M.D. Ballesteros-Pomar, MD,PhD (Spain) K. Norman, MSc, PhD (Germany)
J. Bauer, MD, PhD (Germany) C. Pichard, MD, PhD (Switzerland)
M. Beattie (UK) C. Prado, PhD (Canada)
M.M. Berger, MD, PhD (Switzerland) P. Ravasco, RD, MD, Msc, PhD (Portugal)
F. Carli, MD (Italy) M. Rondanelli, MD, PhD (Italy)
E. Cereda, MD, PhD (Italy)
O. Rooyackers, PhD (Sweden)
A. Forbes, BSc, MD, FRCP, FHEA (UK)
P. Singer, MD (Israel)
P. Greenhaff, (UK)
Y. Hamada, MD, PhD (Japan) M.R. Soeters, MD, PhD (The Netherlands)
K. Joosten, MD, PhD (The Netherlands) M. Usami, MD, PhD (Japan)
S. Klek, MD, PhD (Poland) E. Volpi, MD, PhD (USA)
A. Laviano, MD (Italy) D.L. Waitzberg, MD (Brazil)
D. Lobo, MS, DM, FRCS, FACS (UK) P. Wischmeyer, MD (USA)

Amsterdam • Boston • London • New York • Oxford • Paris • Philadelphia • San Diego • St. Louis
Past Editor–in–Chief
M.A. Gassull (Spain)

Past Associate Editors

G. Biolo (Italy) L. Gramlich (Canada) B. Morio (France) B.M. Winklhofer-Roob
E. Cabré (Spain) R. Griffiths (UK) H. Ohyanagi (Japan) (Austria)
T. Cederholm (Sweden) B. Koletzko (Germany) M.A.E. van Bokhorst – de T. Ziegler (USA)
A. Davies (Australia) H. Lochs (Germany) van der Schueren
X. Forceville (France) Y. Luiking (USA) (The Netherlands)

Editorial Advisory Board/ESPEN Faculty

J. Arends (Germany) E. Fiaccadori (Italy) O. Ljungqvist (Sweden) R. Shamir (Israel)
M. Bahar (Turkey) G. Filippatos (Greece) D. Lobo (UK) A. Shenkin (UK)
M.D. Ballesteros-Pomar E. Fontaine (France) H. Lochs (Austria) D. Silk (UK)
(Spain) A. Forbes (UK) C. Löser (Germany) P. Singer (Israel)
R. Barazzoni (Italy) X. Forceville (France) Y. Luiking (USA) R.J.E. Skipworth (UK)
J.Bauer (Germany) C. Fusch (Canada) K. Lundholm (Sweden) L. Sobotka (Czech Republic)
J. Baxter (UK) M.A. Gassull (Spain) J. MacFie (UK) M.R. Soeters (The Netherlands)
M.M. Berger (Switzerland) L. Genton (Switzerland) E.M.H. Mathus-Vliegen
P. Soeters (Belgium)
Y.N. Berner (Israel) O. Genzel-Boroviczeny (The Netherlands)
Z. Stanga (Switzerland)
H.K. Biesalski (Germany) (Germany) R. Meier (Switzerland)
J.-C. Melchior (France) M. Staun (Denmark)
J. Bines (Australia) A. Gil (Spain)
G. Biolo (Italy) J.M. Gómez Sáez (Spain) K. Melzer (Switzerland) R. Stratton (UK)
S.C. Bischoff (Germany) F. Gottrand (France) M. Merli (Italy) H. Szajewska (Poland)
B. Bistrian (USA) O.J. Goulet (France) B. Messing (France) P. Szitányi (Czech Republic)
G. Bodoky (Hungary) L. Gramlich (Canada) W.A. Mihatsch (Germany) K.A. Tappenden (USA)
Y. Boirie (France) E. Granot (Israel) A. Miján (Spain) L. Tappy (Switzerland)
I. Bosaeus (Sweden) R. Griffiths (UK) J.M. Moreno (Spain) V. Teplan (Czech Republic)
F. Bozzetti (Italy) R.F. Grimble (UK) B. Morio-Liondore P. Tesinsky (Czech Republic)
M. Braga (Italy) I. Grintescu (Romania) (France) D. Teta (Switzerland)
I. Bretón (Spain) G. Guarnieri (Italy) S. Mühlebach J.-P.M. Thissen (Belgium)
A. Buchman (USA) D.C. Guttridge (USA) (Switzerland) A.G. Thomas (UK)
R. Burgos Peláez (Spain) Y. Hamada (Japan) M.M.J. Müller (Germany) A. Thorell (Sweden)
E. Cabre (Spain) G. Hardy (New Zealand) M. Muscaritoli (Italy)
M. Usami (Japan)
P. Calder (UK) X. Hébuterne (France) G. Nitenberg (France)
M. Uyar (Turkey)
M.E. Camilo (Portugal) B.L. Heitmann (Denmark) K. Norman (Germany)
B. Campillo (France) I.B. Nyulasi (Australia) N. Vaisman (Israel)
O. Hernell (Sweden)
A.C.L. Campos (Brazil) M. Holst (Denmark) J.G. Ockenga (Germany) L. Valentini (Germany)
N. Cano (France) P. Howard (UK) H. Ohyanagi (Japan) M.A.E. van Bokhorst – de
Y.A. Carpentier (Belgium) G. Iapichino (Italy) R. Olav (Sweden) van der Schueren
J.J. Carrero (Sweden) Ø. Irtun (Norway) M. Pertkiewicz (Poland) (The Netherlands)
T. Cederholm (Sweden) K.N. Jeejeebhoy (Canada) C. Pichard (Switzerland) G. van den Berghe
E. Cereda (Italy) G.L. Jensen (USA) L. Pironi (Italy) (Belgium)
I. Chermesh (Israel) P.B. Jeppesen (Denmark) M. Pirlich (Germany) A. van Gossum (Belgium)
I. Correia (Brazil) C.G. Jonkers-Schuitema C. Pison (France) P.A.M. van Leeuwen
A.G. Cosslett (UK) (The Netherlands) M. Plauth (Germany) (The Netherlands)
M. Cravo (Portugal) K. Joosten (Netherlands) C. Prado (Canada) C.W. Van Way (USA)
C. Cuerda (Spain) F.E. Kalfarentzos (Greece) J.-C.E.A.M. Preiser M.F.J. Vandewoude
L. Cynober (France) S. Kilicturgay (Turkey) (Belgium) (Belgium)
E. Dárdai (Hungary) S. Klek (Poland) J. Puntis (UK) E. Volpi (USA)
A. Davies (Australia) S.S.K. Kolaček (Croatia) P. Ravasco (Portugal) M. von Meyenfeldt
J.-P. de Bandt (France) B. Koletzko (Germany) O. Riggio (Italy) (The Netherlands)
I. de Blaauw R. Komsa-Penkova O. Rooyackers (Sweden) J. Wahren (Sweden)
(The Netherlands) (Bulgaria) F. Rossi-Fanelli (Italy)
D.L. Waitzberg (Brazil)
P. Dechelotte (France) J. Kondrup (Denmark) G.S. Rozen (Israel)
C.H.C. Dejong S.M. Schneider (France) A. Weimann (Germany)
Z. Krznaric (Croatia)
(The Netherlands) J. Ksiazyk (Poland) A.(AMWJ). Schols J. Wernerman (Sweden)
N.E.P. Deutz (USA) A. Lapillonne (France) (The Netherlands) B.M. Winklhofer-Roob
S.J. Dudrick (USA) A. Laviano (Italy) J.M.G.A. Schols (Austria)
M. Elia (UK) M. Leon-Sanz (Spain) (The Netherlands) P. Wischmeyer (USA)
J. Faintuch (Brazil) E. Lerebours (France) T. Schütz (Germany) Z. Zadak (Czech Republic)
K.C.H. Fearon (UK) B. Lindholm (Sweden) J.L. Shaffer (UK) M. Ziva (Slovenia)
 ESPEN

Abstracts of the

39th
37th ESPEN Congress
The Lisbon,
Hague, Netherlands,
Portugal, 5 89–12 September
September 2017
2015

Authors are responsible for content and language quality of abstracts

Clinical Nutrition Aims and Scope
Clinical Nutrition, the official journal of ESPEN, The European Society
for Clinical Nutrition and Metabolism, is an international journal providing
scientific information on nutritional and metabolic care and the relationship
between nutrition and disease both in the setting of basic science and
clinical practice. Published bi-monthly, each issue combines original
articles and reviews providing an invaluable reference for any specialist
concerned with these fields.
Nutrition and nutritional care have gained wide clinical and scientific
interest during the past decades. The increasing knowledge of metabolic
disturbances and nutritional assessment in chronic and acute diseases has
stimulated rapid advances in design, development and clinical application
of nutritional support. The aims of ESPEN are to encourage the rapid
diffusion of knowledge and its application in the field of clinical nutrition
and metabolism.
Being the journal of ESPEN with members from various interests, either
focused on basic research or clinical disciplines, the journal reflects the
scientific nature of this multidisciplinary background and encourages the
coordination of investigation and research from these disciplines. The
journal publishes high quality papers like guidelines, consensus statements,
review papers, original articles, short communications, and letters to the
Editor on those factors in acute and chronic diseases, which have metabolic
and nutritional implications. It also publishes scientific works related to the
development of new techniques and their application in the field of clinical
nutrition.
Clinical Nutrition is abstracted/indexed in Current Contents, Science
Citation Indexed Expanded, Index Medicus, PubMed/Medline, EMBASE.
Also covered in the abstract and citation database SCOPUS®.

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 Clinical
Volume 36
Number 4 1
Supplement
August 2017
September 2017
Pages S1–S328
915–1186

Nutrition
For details of where
this journal is
abstracted and
indexed, please go to
http://www.elsevier.
com/locate/clnu
An international journal devoted to clinical nutrition and metabolism
and click on the link
“Abstracting/Indexing” Official Journal of ESPEN—The European Society for Clinical Nutrition and Metabolism
on the right hand
navigation bar.
CONTENTS
Abstracts Page(s)

Programme
EDITORIAL Overview vii
Clinical nutrition education in medical schools: Results of an ESPEN survey
Oral communications
C. Cuerda, S.M. Schneider, A. Van Gossum 915
Oral Communication I: Macro and Micronutrient Metabolism OR01-OR09 S1-S4
Oral Communication II: Nutrition and Chronic Disease OR10-OR18 S4-S7
Oral Communication III: Nutritional Assessment, Epidemiology
REVIEWS
and Formulations OR19-OR27 S8-S11
Towards
ESPEN Besta multidisciplinary approach
Abstracts 2017 & ESPEN to Awards
Travel understand and manage obesity and related
OR28-OR32 S11-S13
diseases
Oral Communication
S.C. IV:, Nutrition
Bischoff, Y. Boirie in the, Surgical
T. Cederholm Patient
M. Chourdakis OR33-OR41
, C. Cuerda, N.M. S14-S17
Delzenne, N.E. Deutz ,
Oral Communication V: Paediatrics OR42-OR50
D. Fouque, L. Genton, C. Gil, B. Koletzko, M. Leon-Sanz, R. Shamir, J. Singer, P. Singer S17-S20
,
N. Stroebele-Benschop
Oral Communication VI:, A. Thorell
Liver, , A. Weimann,Tract
Gastrointestinal R. Barazzoni 917
and Cancer OR51-OR59 S21-S24
Oral Communication
Effectiveness VII:
and effi cacyCritical Care
of nutritional therapy: A systematic review OR60-OR68 S24-S27
following Cochrane
methodology
Poster
M. tours
Muscaritoli, Z. Krznarić, P. Singer, R. Barazzoni, T. Cederholm, A. Golay, A.Van Gossum, N. Kennedy,
G. Kreymann
Poster , A.
Tour 1: Laviano, T. Pavić, L. Puljak, D. Sambunjak, A. UtrobičićPT01.1-PT01.6
Geriatrics , S.M. Schneider 939S29-S31
Poster Tour 2: Liver and GI PT02.1-PT02.6 S31-S33
Hospital malnutrition in Latin America: A systematic review
Poster Tour
M.I.T.D. 3: Nutrition
Correia and Chronic
, M.I. Perman Disease 1 958
, D.L. Waitzberg PT03.1-PT03.6 S34-S36
Poster Tour 4: Obesity and Metabolic Syndrome PT04.1-PT04.6 S36-S38
Recent advances in complementary and replacement therapy with nutraceuticals in
Poster Tour 5: Nutritional Assessment PT05.1-PT05.6 S39-S40
combating gastrointestinal illnesses
Poster Tour 6: Paediatrics
N. Yang, K. Sampathkumar, S.C.J. Loo 968 PT06.1-PT06.6 S41-S43
Poster Tour 7: Nutrition and Chronic Disease 2 PT07.1-PT07.6 S43-S45
Poster Tour 8: Nutrition and Cancer PT08.1-PT08.6 S46-S48
RANDOMIZED CONTROLtechniques
Poster Tour 9: Nutritional TRIALS PT09.1-PT09.5 S48-S50
Poster Tour 10: Micronutrients PT10.1-PT10.6 S50-S52
High-dose vitamin D3 reduces circulating hepcidin concentrations: A pilot, randomized,
double-blind, placebo-controlled trial in healthy adults
Poster
E.M. Smith, J.A. Alvarez, M.D. Kearns, L. Hao, J.H. Sloan, R.J. Konrad, T.R. Ziegler, S.M. Zughaier,
V. Tangpricha and
Carbohydrate 980lipid metabolism SUN-P001-SUN-P009 S53-S55
Critical Care 1 SUN-P010-SUN-P035 S56-S65
Geriatrics 1 SUN-P036-SUN-P059 S66-S75

Contents continued
Contents continued over
over page
page

Available online at www.sciencedirect.com

ScienceDirect
http://www.elsevier.com/locate/clnu
Liver and gastrointestinal tract 1 SUN-P060-SUN-P075 S75-S81
Nutrition and cancer 1 SUN-P076-SUN-P114 S81-S96
Nutrition and chronic diseases 1 SUN-P115-SUN-P152 S96-S110
Nutritional assessment 1 SUN-P153-SUN-P217 S111-S134
Nutritional epidemiology 1 SUN-P218-SUN-P234 S135-S141
Obesity and the metabolic syndrome 1 SUN-P235-SUN-P254 S141-S147
Paediatrics 1 SUN-P255-SUN-P263 S148-S151
Perioperative care 1 SUN-P264-SUN-P275 S151-S155
Protein and amino acid metabolism 1 SUN-P276-SUN-P284 S155-S159
Qualitative design studies SUN-P286-SUN-P293 S159-S162
Vitamins, antioxidants and minerals 1 SUN-P294-SUN-P303 S162-S166
Late Breaking Abstract 1 SUN-LB304-SUN-LB338 S166-S179
Critical Care 2 MON-P001-MON-P026 S179-S189
Geriatrics 2 MON-P027-MON-P050 S189-S198
Hormones, mediators and immunity MON-P051-MON-P061 S198-S202
Liver and gastrointestinal tract 2 MON-P062-MON-P077 S202-S208
Nutrition and cancer 2 MON-P078-MON-P116 S208-S222
Nutrition and chronic diseases 2 MON-P118-MON-P154 S222-S236
Nutritional assessment 2 MON-P155-MON-P219 S236-S259
Nutritional epidemiology 2 MON-P220-MON-P233 S259-S264
Nutritional techniques and formulations MON-P234-MON-P245 S264-S268
Obesity and the metabolic syndrome 2 MON-P246-MON-P264 S268-S276
Paediatrics 2 MON-P265-MON-P273 S276-S279
Perioperative care 2 MON-P274-MON-P285 S279-S283
Protein and amino acid metabolism 2 MON-P286-MON-P293 S284-S286
Vitamins, antioxidants and minerals 2 MON-P294-MON-P302 S287-S290
Late Breaking Abstract 2 MON-LB303-MON-LB343 S290-S307

Author index S309

Clinical Nutrition
Nutrition (2017) 34(S1), vii–x
(2015) 36(S1), vii–viii

Contents lists available at ScienceDirect

Clinical Nutrition
journal homepage: http://www.elsevier.com/locate/clnu

Programme Overview

37th

Time Friday 4 September 2015 Room

09:00 13:00 LLL Sessions (See LLL information section)
TIME 14:00 Lunch
13:00 FRIDAY
break8 SEPTEMBER 2017 ROOM
14:00 18:00 LLLLLL
09:00–13:00 Sessions
Session (See LLL information
Session section)
1: Nutritional Support in GI Diseases Yangtze 1
09:00–13:00 LLL Session Session 2: ICU Nutrition and Problem Solving Yangtze 2
Time
09:00–13:00Saturday 5 September 2015
LLL Session Session 3: Nutrition in the Perioperative Period Room
Europe 1&2
09:00–13:00 LLL Session
07:30 11:30 Special Interest Groups Meetings Session(SIGs
4: Nutrition
listed ininprogramme
Obesity day by day) Oceania
13:00–14:00
09:00 13:00 LLLLLL LUNCH
Sessions BREAK
(See LLL information section)
14:00–18:00
12:00 LLL Session
13:30 Satellite Symposium AbbottSession
Nutrition5: Nutritional Support in Cancer
Health Institute Yangtze
Audi II 1
14:00–18:00 LLL Session
12:00 13:00 Satellite Symposium Shire Session 6: Nutrition in Metabolic Syndrome Audi VI 2
Yangtze
14:00–18:00 LLL
13:30 14:00 Break Session Session 7: Nutrition and Prevention of Diseases Asia
14:00–18:00
14:00 LLL Session
15:00 Opening Session Session 8: Nutrition in Neurological Diseases Europe
Audi I 1&2
14:00–18:00
15:00 LLL Session
16:30 Nutrition Session 9: Nutrition in Older Adults
for obese adult in-patients Oceania
Audi II
TIME SATURDAY 9 SEPTEMBER
15:00 16:30 How to make home parenteral 2017
nutrition safer? ROOM
Audi VIII
15:00 16:30 Fatty
09:00–13:00 LLLliver disease is it allSession
Session about 10:
food?Nutrition and Sports Audi I
Yangtze 1
15:00 16:30 Towards
09:00–13:00 personalized nutrition
LLL Session Session 11: Approach to Oral and Enteral Nutrition Audi VII 2
Yangtze
09:00–13:00
15:00 16:30 OralLLL Session
Communications Session
1: Critical 12: Home Parenteral Nutrition in Adult Patients
Care Asia VI
Audi
09:00–13:00
16:30 LLL Break
17:00 Coffee Session Session 13: Approach to Parenteral Nutrition Europe 1&2
Exhibition Area
09:00–13:00
17:00 LLL Session
18:30 Malnutrition Session
in hospital patients 14: insights
with Nutritional
fromsupport in pediatric patients II
nD results Oceania
Audi II
10:00–11:30
17:00 Symposium
18:30 Nutrition PROMISS /
and age related cognitive MaNuEL Symposium
decline Amazon
Audi I
12:30–13:30
17:00 18:30 NewSymposium
perspectives on glutenAbbott Nutrition Health Institute Symposium
toxicity KingVII
Audi Willem Alexander
13:30–14:00
17:00 BREAKand atherosclerosis
18:30 Nutrition Audi VIII
14:00–15:30
17:00 18:30 OralEducational
CommunicationsSession2: Clinical
Geriatrics Guideline
Nutrition consensus meeting
and Metabolism 1 OnyxVI
Audi
14:00–15:30
18:30 Scientific
20:30 Welcome Session
Reception Improving outcomes for cancer patients: dedicated to Kenneth King Willem
Entrance Alexander
Foyer LCC
CH Fearon
14:00–15:30Sunday
Time LLL Live Session 2015LLL live course 1- Let’s talk about nutrition (NESG)
6 September Yangtze 1&2
Room
14:00–15:30 Educational Session Novel approaches to optimize dietary intake in older adults Mississippi
07:30 08:30 Special
14:00–15:30 Interest
Scientific Groups (SIGs
Session Thelisted in programme
link between day by day)
environment and energy metabolism Amazon
08:00 10:00
15:30–16:00LLL Live Course
COFFEE BREAK Nutrition and Sports Audi VIII
EXHIBITION AREA
08:30 10:00 Keep
16:00–17:30 fit for life
Scientific Nutritional
Session and functional
Debate: Saturatedenhancement
fat – harmful of
or older adults
harmless? Audi I
Amazon
08:30 10:00 Living happily with our gut microbiota Audi II
viii Programme Overview

08:30 10:00 Nutritional

16:00–17:30 Scientificresearch
Session in ICU Metabolic
from trials to clinical
pathways and practice
muscle maintenance Audi
KingVIIWillem Alexander
16:00–17:30
08:30 10:00 OralAbstract Session 3: Nutrition
Communications Oral Communications
and Cancer I: Macro and Micronutrient Metabolism OnyxVI
Audi
16:00–17:30
10:00 Scientific
10:30 Coffee break Session Pediatrics Yangtze 1&2
Exhibition Area
16:00–17:30
10:30 Educational
11:15 Sir David SessionLecture
Cuthbertson Using the gut in acute care patients Mississippi
Audi I
17:30–19:00
11:15 12:00 ESPENMain Session
best abstracts 2015 & Opening
ESPEN Session
travel awards KingI Willem Alexander
Audi
19:00–21:00
12:00 14:00 LunchSocial
and poster viewing Welcome Reception Queen Maxima
Exhibition & Poster Area
12:30
TIME 13:30 Poster Tours 10 SEPTEMBER 2017
SUNDAY Poster
ROOMArea
13:30 15:30
08:00–10:00 LLL Live Course
LLL Live SessionNutrition LLL
in the
Liveperioperative period Support in Diabetes and Dyslip-
course 2 - Nutritional Audi VI 1&2
Yangtze
14:00 15:30 Nutritional challenges in the community
idemia Audi II
14:00 15:30 Clinical
08:30–12:30 Nutrition Symposium
LLL Session TTT-LLL Audi
Asia VII
14:00 15:30
08:30–10:00 Specific substrates
Educational in ICU Meeting nutritional needs of acute care patients
Session Audi
KingI Willem Alexander
14:00 15:30 Adipose
08:30–10:00 tissueSession
Scientific as a dynamicNutrition,
organ bile acids and metabolic health Audi VIII
Mississippi
15:30 16:00 Coffee
08:30–10:00 breakSession
Abstract Oral Communications II : Nutrition and Chronic Disease Exhibition
Amazon Area
16:00 17:30 Nutritional
08:30–10:00 Abstractissues in Crohn’sOral
Session disease
Communications III: Nutritional assessment, epidemiology Audi
OnyxVIII
16:00 17:30 Case discussion Frail ICU and patient
formulations Audi II
16:00 17:30 Food,
10:00–10:30 moodBREAK
COFFEE and appetite Audi I
EXHIBITION AREA
16:00 17:30 Social
10:30–11:15 Maindeterminants
Session of malnutrition
Sir David Cuthbertson Lecture Audi
KingVIIWillem Alexander
16:00 17:30 OralMain
11:15–12:00 communications
Session 4: Gut-adipose-liver Axis 2017 & ESPEN Travel Awards
ESPEN Best Abstracts Audi
KingVI Willem Alexander
12:00–14:00
18:00 LUNCH
19:30 Satellite BREAK & POSTER
Symposium FreseniusVIEWING
Kabi EXHIBITION
Audi I AREA &
18:00 19:30 Satellite Symposium Nutricia Advanced Medical Nutrition ­PACIFIC/ATLANTIC
Audi VII
18:00 19:00 Satellite Symposium Nestlé nutrition institute FOYER
Audi VIII& LEVEL 0
12:30–14:15 Working Group ICU Guideline meeting Europe 1&2
Time
12:30–13:30Monday 7 September
Abstract Session 2015Poster Tour 1 - Geriatrics Room
Pacific
12:30–13:30
07:30 Abstract
08:30 Special Session
Interest Groups (SIGsPoster
listedTour 2 - Liver andday
in programme GI by day) Pacific
12:30–13:30 Abstract Session Poster Tour 3 - Nutrition and Chronic Disease 1 Pacific
08:00 10:00 LLL live course Nutrition and prevention Audi VIII
12:30–13:30 Abstract Session Poster Tour 4 - Obesity and Metabolic Syndrome Pacific
08:30 10:00 Nutritional management in stoma care Audi II
12:30–13:30 Abstract Session Poster Tour 5 - Nutritional Assessment Pacific
08:30 10:00 Protein across the life course Audi I
13:30–15:30 LLL Live Session LLL Live course 3 - Nutritional Assessment and Techniques, Yangtze 1&2
08:30 10:00 Metabolic therapy for cancer Audi VII
Body Composition and Energy Balance
08:30 10:00 Oral communications 5: Nutrition and chronic diseases Audi VI
14:00–15:30 Educational Session Altering lifestyle to improve nutritional status in older adults Onyx
10:00 10:30 Coffee break Exhibition Area
14:00–15:30 Scientific Session Health consequences of fat storage Amazon
10:30 11:15 Arvid
14:00–15:30 WretlingSession
Scientific Lecture Scientific rationale for feeding or starving Audi
KingI Willem Alexander
11:15 12:15 Optimal
14:00–15:30 Nutritional
Educational Care for
Session All Integrate
Specific nutritional
needs of patients withtherapy
chronicin clinical care for
disease Audi I
Mississippi
15:30–16:00 oncology patients
COFFEE BREAK EXHIBITION AREA
12:00 14:00 Lunch
16:00–17:30 and poster
Scientific viewing Nutrition and the gut microbiome
Session Exhibition
King Willem& Poster Area
Alexander
12:30 13:30 Poster
16:00–17:30 Tours Session
Scientific Nutrition, metabolism and circadian rhythm Poster Area
Mississippi
13:30 15:30 LLL Abstract
16:00–17:30 Live CourseSessionNutritionOral
in the elderly patients
Communications IV: Nutrition in the Surgical Patient Audi
OnyxVIII
14:00 15:30 Nutritional
16:00–17:30 support
Educational of stroke
Session patients specificities of nutritional assessment
Paediatric Audi II 1&2
Yangtze
14:00 15:30 Nutrition
16:00–17:30 and pathways
Educational Session to cancer
Taste and food intake in older adults Audi I
Amazon
14:00 15:30 Optimizing
18 :00–19 :30 Symposium post surgical recovery
Nutricia Advanced Medical Nutrition Symposium Audi
KingVII
Willem Alexander
14:00 15:30 OralSymposium
18 :00–19 :30 communications 6: Nutritional epidemiology
Nestlé Nutrition Institute Audi VI
Mississippi
18 :00–19 :30
15:30 Symposium
16:00 Coffee break Shire-Sponsored Symposium Amazon Area
Exhibition
16:00
TIME 17:30 Satellite
MONDAY Symposium BBraun 2017
11 SEPTEMBER Audi
ROOMI
16:00 17:30 Satellite Symposium Baxter Audi VIII
08:00–10:00 LLL Live Session LLL Live course 4 - Nutritional Support in Liver and Pancreatic Yangtze 1&2
17:30 19:00 ESPEN General Assembly (for ESPEN Members only) Audi I
diseases
08:30–10:00
Time Educational Session
Tuesday 8 September 2015 Hospital discharge: and now? Amazon
Room
08:30–10:00 Scientific Session Microbiome beyond the gut Mississippi
08:30 10:00 Putting
08:30–10:00 on diet
Abstract a large planet:
Session Oralopportunities
Communications andV:challenges
Paediatrics Audi
OnyxI
08:30 10:00 ESPEN
08:30–10:00 Guidelines
Scientific Session Rehabilitation of the intestine Audi
KingIIWillem Alexander
10:00–10:30
08:30 10:00 ESPENCOFFEE
Rese BREAK
arch Fellowship I EXHIBITION
Audi VII AREA
10:30–11:15
08:30 Main D:
10:00 Vitamin Session
potion or poison? Arvid Wretlind Lecture KingVIII
Audi Willem Alexander
11:15–12:15
08:30 10:00 OralMain Session
communications ESPEN-ENHA-MNI Joint Session: Optimal Nutritional Care for All –
7: Geriatrics KingVI
Audi Willem Alexander
10:00 10:30 Coffee break Innovative and Patient-Centric Care Exhibition Area
12:15–14:00
10:30 12:00 CaseLUNCH BREAK &
discussion POSTER obstruction
Intestinal VIEWING by malignancy EXHIBITION
Audi II AREA &
10:30 12:00 1000 days nutrition and lifetime consequences PACIFIC/ATLANTIC
Audi I
10:30 12:00 ESPEN Research Fellowship II FOYER
Audi VII & LEVEL 0
12:30–13:30
10:30 12:00 SugarSymposium
intake: pro and con GEDSA Symposium Europe
Audi VIII 1&2
12:30–13:30
10:30 12:00 OralAbstract Session 8: Clinical
communications PosterNutrition
Tour 6 - Paediatrics
and Metabolism 2 Pacific
Audi VI
12:30–13:30 Abstract Session Poster Tour 7 - Nutrition and Chronic Disease 2 Pacific
12:30–13:30
Note Abstract Session Poster Tour 8 - Nutrition and Cancer Pacific
12:30–13:30 Abstract Session Poster Tour 9 - Nutritional techniques Pacific
Kindly find the Abstract
12:30–13:30 detailed Session
programme of Poster
the Congress
Tour 10in- Micronutrients
the ESPEN 2015 Final Programme Pacific
Programme Overview ix

13:30–15:30 LLL Live Session LLL Live course 5 - Nutrition in Respiratory Diseases Yangtze 1&2
14:00–15:30 Educational Session Case discussion: œsophagectomy Mississippi
14:00–15:30 Scientific Session Interactions between nutrition and physical activity King Willem Alexander
14:00–15:30 Scientific Session Metabolic phenotyping in precision medicine Amazon
14:00–15:30 Abstract Session Oral Communications VI: Liver, Gastrointestinal Tract and Cancer Onyx
15:30–16:00 COFFEE BREAK EXHIBITION AREA
16:00–17:30 Symposium B.Braun Melsungen AG Symposium Onyx
16:00–17:30 Symposium Fresenius Kabi Symposium King Willem Alexander
17:30–19:00 Main Session ESPEN General Assembly King Willem Alexander
TIME TUESDAY 12 SEPTEMBER 2017 ROOM
08:30–10:00 Educational Session Case discussion: bone marrow transplant King Willem Alexander
08:30–10:00 Scientific Session ESPEN Research Fellowship Amazon
08:30–10:00 Scientific Session Metabolic consequences of disease co-existence Yangtze 1&2
08:30–10:00 Abstract Session Oral Communications VII: Critical Care Onyx
08:30–10:00 Scientific Session Sensory perception through the course of life Mississippi
10:00–10:30 COFFEE BREAK EXHIBITION AREA
10:30–12:00 Scientific Session Clinical Nutrition Symposium Mississippi
10:30–12:00 Scientific Session Nutrition and ageing Yangtze 1&2
10:30–12:00 Scientific Session Regulation of food intake and clinical applications Amazon
10:30–12:00 Educational Session Specific nutritional care in children Onyx
10:30–12:00 Educational Session Upcoming ESPEN Guidelines King Willem Alexander

Note
Kindly find the detailed programme of the Congress in the ESPEN 2017 Final Programme.
Clinical Nutrition (2017) 36(S1), S1–S28

Contents lists available at ScienceDirect

Clinical Nutrition
j o u r n a l h o m e p a g e : h t t p : / / w w w. e l s e v i e r . c o m / l o c at e / c l n u

Oral communications
Oral Communication I: Macro and
Micronutrient Metabolism
OR01
N-3 POLYUNSATURATED (N-3 PUFA) FATTY ACID ENRICHMENT
PREVENTS INTRAVENOUS LIPID-INDUCED ACUTE
STIMULATION OF MITOCHONDRIAL REACTIVE OXYGEN
SPECIES GENERATION AND LOWERS ATP PRODUCTION IN RAT
SKELETAL MUSCLE
G. Gortan Cappellari1 *, A. Semolic1, P. Vinci1, R. Munaò1,
M. Zanetti1, G. Ruozi2, M. Giacca2, R. Barazzoni1. 1Medical,
Surgical and Health Sciences, University of Trieste, 2Molecular
Medicine Laboratory, International Centre for Genetic
Engineering and Biotechnology (ICGEB), Trieste, Italy
appears to be associated with reduced mitochondrial energy
metabolism.
Disclosure of Interest: None declared.
OR02
AD LIBITUM FEEDING OF A LOW CARBOHYDRATE-HIGH FAT
DIET REDUCES PLASMA AND INTESTINAL PRO-INFLAMMATORY
CYTOKINE LEVELS AFTER GUT ISCHEMIA REPERFUSION
IN MICE
T. Watanabe1,2 *, K. Fukatsu1, S. Murakoshi1, T. Moriya2,
K. Higashizono1, A. Watkins1, H. Ueno2, J. Yamamoto2,
H. Yasuhara1. 1Surgical Center, The University of Tokyo
Hospital, Bunkyoku, 2Surgery, National Defense Medical
College, Tokorozawa city, Japan

Rationale: Acute increments in lipid availability may be Rationale: Low carbohydrate-high fat diets (LCHFDs) report-
associated with enhanced skeletal muscle mitochondrial edly reduce the risk of metabolic syndrome. However, whether
reactive oxygen species (ROS) generation, with potential LCHFDs are also beneficial in terms of the host response to
negative metabolic consequences. The potential differential surgical insults is controversial. We previously demonstrated
impact of different fatty acids on skeletal muscle ROS ad libitum feeding of LCHFD, as compared with normal diet, to
generation and energy metabolism remains however to be improve survival at early time points after gut ischemia
determined. reperfusion (gut I/R) in mice. Overproduction of pro-inflam-
Methods: 150-minute iv saline (300 µl/h; C), n-3 PUFA- matory cytokines is known to be an important mechanism
enriched (Omegaven© 300 µl/h 20% emulsion; PUFA) or underlying poor survival after gut I/R. Herein, we evaluated
monounsaturated- and n-6 PUFA-enriched soybean-based pro- and anti-inflammatory cytokine levels in plasma and
fatty acid emulsions (Intralipid© 300 µl/h 20% emulsion; intestinal tissues of mice which had been fed LCHFD or normal
Mixed) were infused in 12-week-old Wistar rats (n = 6–8 per diet and then undergone gut I/R.
group). Skeletal muscle ATP production and ROS generation Methods: Male ICR mice were randomized to normal feeding
from mitochondria and non-mitochondrial sources were mea- (NF) (n = 10:fat18%) or the LCHFD (n = 10:fat60%). The mice
sured by fluorimetry or chemoluminescence. were fed the respective diets ad libitum for 3 weeks and then
Results: Gastrocnemius muscle ATP production was unchanged underwent 60-min gut I/R. At 3 or 6 hours after reperfusion,
but global and mitochondrial ROS generation was higher blood and small intestinal tissues were harvested. Pro(TNF-α,
(P < 0.05) in Mixed compared to C. In contrast, PUFA was not MCP-1, IL-6)- and anti(IL-10)-inflammatory cytokine levels in
associated with higher global and mitochondrial ROS gener- plasma and intestinal tissue homogenates were determined by
ation (P < 0.05 vs SFA, P = NS vs C), while it lowered ATP flow cytometry.
production (P < 0.05 vs Mixed). Superimposable differential Results: The results are expressed as means ± SD( pg/ml).
effects of PUFA and Mixed on mitochondrial ROS production
were confirmed in vitro in C2C12 myotubes. In vivo non-
Time after TNF-α MCP-1 IL-6 IL-10
mitochondrial ROS production through xanthine (XO) or NADPH reperfusion
oxidase (N-Ox) was unaffected by either treatment.
Plasma NF 3 h(n = 5) 95.2 ± 8.6 112.6 ± 16.7 112.6 ± 16.7 14.3 ± 3.0
Conclusion: Soybean-based mixed fatty acid infusion acutely 6 h(n = 5) 105.4 ± 31.4 9,104.5 ± 4,620.5 9,104.5 ± 4,620.5 27.4 ± 4.5
enhances mitochondrial ROS generation in rat skeletal muscle. LCHFD 3 h(n = 5) 12.2 ± 2.9* 177.2 ± 99.3 177.2 ± 99.3 19.8 ± 6.1
6 h(n = 5) 28.8 ± 4.8† 5,891.2 ± 1,377.5 5,891.2 ± 1,377.5 20.1 ± 4.1
n-3 PUFA enrichment prevents lipid-induced enhancement of Intestine NF 3 h(n = 5) 37.3 ± 1.7 15.7 ± 1.2 15.7 ± 1.2 16.0 ± 1.6
ROS generation while lowering mitochondrial ATP production. 6 h(n = 5) 42.6 ± 4.0 902.5 ± 255.1 902.5 ± 255.1 13.9 ± 2.9
LCHFD 3 h(n = 5) 33.0 ± 4.1 15.3 ± 1.0 15.3 ± 1.0 17.3 ± 2.7
These results suggest a potential beneficial effect of enhanced 6 h(n = 5) 36.1 ± 1.1† 240.9 ± 30.9† 240.9 ± 30.9† 19.5 ± 5.2
n-3 PUFA lipid availability on skeletal muscle redox state, which
*p < 0.05 vs NF at 3 h †p < 0.05 vs NF at 6 h (ANOVA).
S2
Conclusion: Reduction of pro-inflammatory but not anti-
inflammatory cytokine levels in plasma and intestinal tissues
might be among the mechanisms underlying the survival
benefit after gut I/R in the LCHFD group.
Disclosure of Interest: None declared.
OR03
NO ASSOCIATION BETWEEN IMPAIRED GLYCEMIC CONTROL
AND ADVERSE OUTCOME IN HIP FRACTURE PATIENTS
J. Thörling1 *, O. Ljungqvist2, O. Sköldenberg3, F. Hammarqvist1.
1
Department of Clinical Science, Intervention and Technology
(CLINTEC), Karolinska Institutet, Stockholm, 2Surgery, Faculty
of Medicine and Health, Örebro, 3Department of Clinical
Sciences at Danderyd Hospital, Stockholm, Sweden
Rationale: Several observational studies have shown an
association between hyperglycemia and increased complica-
tions in surgical non-ICU patients. The aim of the study was to
clarify whether preoperative glycemic control, estimated by
HbA1c, or perioperative stress hyperglycemia (SH) are asso-
ciated with adverse events in hip fracture patients.
Methods: HbA1c and glucose were prospectively measured in
159 patients with hip fracture. All patients were divided into
two groups: Group 1 (n = 115) with normal glycemic control and
Group 2 (n = 44) with either SH or HbA1c ≥42 mmol/mol,
indicating impaired glycemic control. Rates of complications
within 30 days of surgery and 1-year mortality were compared
between the groups. SH was defined as at least two plasma
glucose (mmol/L) analyzed on admission in hospital ≥11.1, pre-
lunch ≥12.2 or fasting ≥7.0. Glucose was analyzed on admission
and three days after the hip fracture surgery. Complications
were classified according to Clavien-Dindo1 and stratified as
grade 0 ‘no complication’, 1-3a ‘easy to moderate complica-
tion’ and 3b-5 ‘Severe to fatal complication’. The difference in
the incidence of complications was analyzed by chi square-test.
Difference in survival was determined using the log-rank test.
Results: The patients (114 women, 45 men) had a mean age of
80 (±10), mean BMI of 24 (±4). Of the 159 patients, 18 had
diabetes and 4 more had likely occult diabetes (HbA1c ≥48).
Distribution of complications: Group 1 had 50% grade 0, 43% gr
1-3a and 7% gr 3b-5. Group 2 had 45% gr 0, 48% gr 1-3a and 7% gr
3b-5. There were no statistically significant differences in 30-
day complications ( p = 0.83) or 1-year mortality ( p = 0.34)
between the groups.
Conclusion: HbA1c or SH are not associated with increased
complications or mortality after hip fracture surgery, a finding
that may be explained by older age and multiple comorbidities
in this group of patients.
Reference
1. PubMedID 15273542
Disclosure of Interest: None declared.
OR04
RELEVANCE OF INULIN TYPE PREBIOTICS IN THE
IMPROVEMENT OF POSTPRANDIAL HYPERLIPEMIA: A
MECHANISTIC APPROACH
S. Hiel1 *, B. Pachikian1, J. Rodriguez1, A. Neyrinck1,
J.-P. Thissen2, N. Delzenne1. 1LDRI, Metabolism and Nutrition
Research Group, 2Pole of Endocrinology, Diabetology and
Nutrition, Université Catholique de Louvain, Brussels, Belgium
Oral communications
Rationale: Postprandial hyperlipemia is a key factor in the
onset of cardiovascular diseases. Chronic treatment with inulin
type prebiotic targeting the gut microbiota, has shown to
decrease lipogenesis and fasting serum lipid levels in mice and
in humans. In this study, we have assessed the effect of native
inulin supplementation on postprandial triglyceridemia after
an oral fat load in obese and lean mice
Methods: Mice were divided into 4 groups and were fed 6 weeks
with a control (CT) or a western diet (WD), supplemented or not
with inulin (Inu). After 6 weeks, mice were given an oral fat
load (olive oil, 10 µl/g BW) with or without a previous injection
of tyloxapol (a known inhibitor of lipoprotein lipase).
Triglyceridemic response was evaluated on a 4-hour period.
The expression of genes involved in the capture and secretion
of lipids in the jejunum, liver, muscle and adipose tissue was
analyzed.
Results: Inulin treatment significantly lessened post-load
hypertriglyceridemia induced by WD, namely by decreasing
jejunal fatty acid uptake (i.e. CD36 expression). APOC3
expression was downregulated in WD + Inu versus WD suggesting
also a potential effect on lipoprotein lipase activity. Indeed,
tyloxapol injection blunted the effect of inulin on post-load
triglyceridemia. Post-load non-esterified fatty acids were
slightly decrease by the treatment.
Conclusion: Our data show for the first time that in addition to
their well-known effect on gut microbiota, Inulin-type fructans
may also modulate nutrients (lipid) absorption in the upper
part of the gut, and the systemic catabolism of triglyceride-rich
lipoproteins. Both phenomenon could contribute to a nutrition-
based improvement of health, if proven in humans. Further
investigation are currently in progress to evaluate the effect of
inulin on lipoprotein lipase activity and on the metabolism of
lipids within the enterocytes.
Disclosure of Interest: None declared.
OR05
POST-PRANDIAL PROTEIN HANDLING FOLLOWING INGESTION
OF DIFFERENT AMOUNTS OF PROTEIN DURING POST-
EXERCISE RECOVERY IN OLDER MALES
A. M. Holwerda1,2 *, K. J. Paulussen2, M. Overkamp2,
I. F. Kramer2, J. P. Goessens2, W. K. Wodzig3, L. B. Verdijk1,2,
L. J. van Loon1,2. 1Top Institute Food and Nutrition (TIFN),
Wageningen, 2NUTRIM School of Nutrition and Translational
Research in Metabolism, Maastricht University, 3Central
Diagnostic Laboratory, Maastricht University Medical Centre+,
Maastricht, Netherlands
Rationale: The age-related decline in skeletal muscle mass is,
at least partly, attributed to anabolic resistance to food intake.
Resistance-type exercise sensitizes skeletal muscle to the
anabolic properties of amino acids.
Methods: We aimed to define the amount of ingested protein
needed to maximize post-exercise myofibrillar protein synthe-
sis rates in older individuals. In a parallel design, 48 healthy
older males (66 ± 1 y) were randomly assigned to ingest 0, 15,
30 or 45 g protein after performing resistance-type exercise.
Post-prandial protein digestion and absorption kinetics, whole-
body protein metabolism, and myofibrillar protein synthesis
rates were assessed using continuous infusions of L-[ring-2H5]-
phenylalanine, L-[1-13C]-leucine and L-[ring-2H2]-tyrosine
Oral Communication I: Macro and Micronutrient Metabolism
combined with the ingestion of intrinsically L-[1-13C]-phenyl-
alanine and L-[1-13C]-leucine labeled milk protein.
Results: A total of 76 ± 2% (11.4 ± 0.3 g), 63 ± 3% (18.9 ± 0.9 g)
and 60 ± 3% (26.8 ± 1.2 g) of the protein-derived amino acids
were released in the circulation during 6 h after ingesting
15, 30 or 45 g protein, respectively (P < 0.01). Whole-body
net protein balance increased in a dose-dependent manner
after ingesting 0, 15, 30 and 45 g protein (0.02 ± 0.00, 0.11 ±
0.00, 0.16 ± 0.01, 0.22 ± 0.01 μmol phe·kg−1 min−1, respect-
ively; P < 0.001). Myofibrillar protein synthesis rates, assessed
using L-[1-13C]-leucine, were higher after ingesting 45 g (0.0725
± 0.0031% h−1) when compared to 0 g (0.0574 ± 0.0037% h−1,
P < 0.05). The incorporation of dietary protein-derived
amino acids (L-[1-13C]-phenylalanine) into de novo myofibrillar
protein was greater after ingesting 45 g (0.0397 ± 0.0026 MPE)
when compared to the ingestion of 15 g (0.0171 ± 0.0017 MPE;
P < 0.001) and 30 g (0.0296 ± 0.0030 MPE; P < 0.05) protein.
Conclusion: Ingestion of 45 g protein is required to increase
post-exercise myofibrillar protein synthesis rates in older
individuals.
Disclosure of Interest: None declared.
OR06
PLASMA ACYLCARNITINES AND AMINO ACIDS, FATTY ACIDS,
LEPTIN/ADIPONECTIN AND HUMAN MERCAPTALBUMIN IN
STUDY SUBJECTS WITH MILDLY IMPAIRED RENAL, VASCULAR
AND METABOLIC HEALTH COMPARED TO ‘SUPER HEALTHY’
SUBJECTS
B. M. Winklhofer-Roob1 *, G. Faustmann1,2,
H. Hafner-Giessauf2, P. Kieslinger3, J. Grabher2, M. C. Sattler1,
G. Fauler3, K. Öttl4, B. Tiran3, J. M. Roob2. 1Human Nutrition &
Metabolism Research and Training Center, Institute of
Molecular Biosciences, Karl Franzens University of Graz,
2
Clinical Division of Nephrology, Department of Internal
Medicine, 3Clinical Institute of Medical and Chemical
Laboratory Diagnostics, 4Institute of Physiological Chemistry,
Medical University oif Graz, Graz, Austria
Rationale: The aim of this study was to identify and validate
new biomarkers in an integrated approach in the BIOCLAIMS
cohort consisting of 1,310 study participants, 607 M, 704 F, aged
18–85 years.
Methods: Four contrasting groups were studied: Group 1,
impaired renal health (glomerular filtration rate eGFR 30–
60 ml/min/1.73 m2); Group 2, impaired vascular health
(intima-media thickness, IMT, left and right >75th percentile;
Group 3, impaired metabolic health (HOMA index >2.5 and
HbA1c 38.8–44 mmol/mol); Group 4, ‘super healthy’ subjects
(clinical chemistry variables within normal range ±10%, IMT
not >75th percentile at both sides, not taking medications).
Care was taken to avoid overlaps between the groups; matching
for age was not possible (age of group 1 > 2, 4 and 3 > 4).
Results: Plasma metabolomics biomarkers (28 acylcarnitines,
17 amino acids and 21 plasma fatty acids) showed significant
(P < 0.001) differences between groups for serine, threonine,
histidine (4 > 1) and glycine + lysine, glutamine and carnitine
(1 > 4); all plasma acylcarnitines differed significantly
(P < 0.001; 1 > 2,3,4) except C22-6 and C6DC + C7OH (4 > 1).
Fatty acid profiles also differed significantly, such as C22:4n-6
(P < 0.001; 1 > 2,3,4), C22:5n-3 (P = 0.006; 1 > 3,4), C22:6n3
(P = 0.002; 1 < 2,4). Leptin:adiponectin ratios were higher
S3
(P < 0.001; 3 > 2,4 and 1 > 4) in the metabolic and renal
impairment groups. Reduced to oxidized human mercaptalbu-
min ratios differed significantly (P < 0.001; 2,3,4 > 1 and 4 > 3)
in the presence of significant differences (P < 0.001) in
antioxidant status (ascorbate, 1 < 2,4 and 2 > 3 and 4 > 3; α-
tocopherol, 1,3 > 4).
Conclusion: These results demonstrate significant differences
of promising new ‘biomarkers of health’ in subjects with
impaired health and the human ‘super healthy’ model that
could be useful for health claim support.
Disclosure of Interest: None declared.
OR07
HYPOXIA INCREASE CITRULLINE PRODUCTION BY HUMAN
ENTEROCYTES: AN IN VITRO STUDY
M. Couchet1 *, S. Pestour2, C. Breuillard1, F. Lamarche1,
C. Corne3, E. Fontaine1, C. Moinard1. 1Laboratory of
Fundamental and Applied Bioenergetics INSERM-U1055, UGA,
Grenoble Cedex 9, 2Gastroenterology Unit, 3Biochemistry,
Pharmacology and Toxicology Unit, Grenoble-Alpes University
Hospital, Grenoble, France
Rationale: Citrulline (CIT) production by the enterocytes is
usually fallen down among intensive care patients and
combined with hypoxia and inflammation [1].
The aim of this study was to determine, in vitro, if hypoxia and
inflammation had an impact on CIT production through the
ornithine carbamoyl transferase enzyme (OCT) pathway. Those
effects were evaluated by using a model of human duodenal
explant incubation [2].
Methods: Duodenal biopsies were removed from selected
patients and incubated in a cell culture medium during 6 h of
time within 4 conditions: control, inflammation (IL-1β, 1 μg/l ±
TNFα, 20 μg/l ± IFNγ, 10 μg/l), hypoxia (3% O2) and hypoxia
coupled to inflammation. Levels of CIT released in the culture
medium, OCT activity and OCT protein expression were
measured. OCT activity was weighed up in relation to the
amount of cell death. The statistical analyses were performed
with a repeated measures ANOVA test followed by a fisher post-
hoc test.
Results: The percentages of cell death at the end of the
incubation period were the same in each condition.
CIT production and OCT activity in the 4 groups, after 6 h of
incubation (mean ± SEM):
Condition CIT (μmol/mg/6 h) OCT activity (%)
Control 0.062 ± 0.022 100.000 ± 0.000
Inflammation 0.082 ± 0.021 110.321 ± 9.314
Hypoxia 0.155 ± 0.033* 117.452 ± 7.633
Hypoxia- 0.214 ± 0.043** 119.612 ± 10.495
Inflammation
*p = 0.05 vs control. **p = 0.004 vs control.
CIT production was increased after 6 h of incubation in Hypoxia
and Hypoxia coupled to Inflammation conditions without
modification of the enzyme activity or the protein amount.
Conclusion: CIT production by the enterocytes seems
increased in hypoxia +/− inflammation conditions without
modifications of the OCTactivity or the OCT protein expression.
So the underling mechanisms need to be further determined.
S4
References
1. Piton C. et al. Intensive Care Med. 2010.
2. Coëffier M. et al. Cytokine 2001.
Disclosure of Interest: None declared.
OR08
THE PROTECTIVE EFFECT OF VITAMIN D3 ON INTESTINAL
FAILURE-ASSOCIATED LIVER DISEASE IN A RAT MODEL OF
SHORT BOWEL SYNDROME
Y. Li1, S. Fan2, Y. Huang3*. 1Department of Surgery, Shanghai
Ninth People′s Hospital, Shanghai Jiaotong University School of
Medicine, Shanghai, 2Department of Surgery, Gulou Hospital,
Nanjing University School of Medicine, Nanjing, 3General
Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
Rationale: 1,25(OH)2D3 could induce the activation of farne-
soid X receptor (FXR), which is the most important bile acid
sensor. The purpose of this study was to explore the effect of
vitamin D3 on intestinal failure-associated liver disease in a rat
model of short bowel syndrome.
Methods: Twelve adult male rats with a central catheter placed
in the right jugular vein were assigned into two groups: control
group (n = 6) and experimental group (n = 6). All rats underwent
75% intestinal resection and accepted total parenteral nutri-
tion (TPN) for 14 days. The experimental group received
intraperitoneal injection of vitamin D3 at a dose of 4 μg/kg
body weight once a day for 14 days. Serum alanine transamin-
ase (ALT), aspartate transaminase (AST), direct bilirubin
(DBIL), and total bilirubin (TBIL) were observed. After blood
collection the bile flow was determined and the liver tissue
specimens was obtained for pathological examination.
Results: The serum values of liver function were increased as
time went on. The serum ALT (55.23 ± 6.41 U/L vs. 64.01 ±
7.23 U/L, P < 0.05), AST (177.22 ± 26.42 U/L vs. 209.00 ± 31.24
U/L, P < 0.05), TBIL (3.23 ± 0.21 μmol/L vs. 3.65 ± 0.23 μmol/L,
P < 0.05), DBIL (0.99 ± 0.03 μmol/L vs. 1.15 ± 0.06 μmol/L,
P < 0.05) of experimental group were significantly lower than
those of control group at day 14 postoperatively. In addition,
the bile flow of experimental group (8.23 ± 1.26 μml/min)
wassignificantly higher than that of control group (5.85 ± 1.41
μml/min) (P < 0.05). The pathological score of experimental
group (1.23 ± 0.26) were significantly lower than those of
control group (1.85 ± 0.41) (P < 0.05).
Conclusion: Vitamin D3 could lead to amelioration in serum ALT,
AST, TBIL and DBIL in short bowel syndrome patients depending
on parenteral nutrition. In addition, vitamin D3 could reduce
liver damage of intestinal failure associated liver disease.
Disclosure of Interest: None declared.
OR09
SUPPLEMENTATION WITH CURCUMIN IMPROVED AGE-
RELATED LOSS OF MUSCLE FUNCTION IN OLD RATS
C. Boutry1 *, O. Rizzo2, E. Cazaubon1, J.-P. Godin1,
M.-N. Horcajada1, F. Membrez1, D. Breuillé1. 1Nestlé Research
Center, 2Nestlé Institute of Health Science, Lausanne,
Switzerland
Rationale: Sarcopenia is defined as a syndrome characterized
by an age-related loss of skeletal muscle mass and function-
ality. The objective of this study was to determine the effects
Oral communications
of 2 types of curcumin, the natural curcumin and a hydro-
genated version (white), known for their wide range of
physiological effects especially the management of oxidative
stress and inflammation, as new nutritional solution for
sarcopenia in old rats.
Methods: Forty four 20 months-old rats received a complete
diet supplemented with either natural curcumin (CUR, n = 11)
or hydrogenated curcumin (WCUR, n = 11) for 3 months. A
control group (CON, n = 22) received cellulose instead of
curcumin. Exact Wilcoxon test associated with Hodges-
Lehmann to estimate the difference between groups has
been performed for statistical analysis.
Results: Evolution of gait speed from baseline to 3 months
measured with the cat walk were greater in the CUR (P < 0.05)
than in the CON group and was associated with an increase in
lean mass gain measured by nuclear magnetic resonance
(P = 0.056). Such benefit was not observed in WCUR group.
Body weight gain was significantly higher in the CUR and WCUR
groups compared to CON. Alpha2-macroglobulin, a blood
marker of inflammation, was lower and plasma total antioxi-
dant capacity, a marker of oxidative stress, was improved in
CUR than in CON (P < 0.05) but not in WCUR. The 3 months
supplementation with polyphenols had no effect on food
intake, fat gain, muscles weight and gastrocnemius muscle
protein synthesis.
Conclusion: Muscle functionality, lean mass and body weight
gain were enhanced after supplementation of natural curcumin
in old rats. This was associated with a decrease of low grade
inflammation and an improvement of total oxidant capacity.
Disclosure of Interest: C. Boutry Other: Working for Nestlé, O. Rizzo
Other: Working for Nestlé, E. Cazaubon Other: Working for Nestlé, J.-P.
Godin Other: Working for Nestlé, M.-N. Horcajada Other: Working for
Nestlé, F. Membrez Other: Working for Nestlé, D. Breuillé Other:
Working for Nestlé.
Oral Communication II: Nutrition and
Chronic Disease
OR10
BASELINE CHARACTERISTICS AND CLINICAL RESPONSE TO
TEDUGLUTIDE IN PATIENTS WITH SHORT BOWEL SYNDROME
BASED ON RESIDUAL BOWEL ANATOMY
P. B. Jeppesen1 *, S. M. Gabe2, D. L. Seidner3, H.-M. Lee4,
C. Olivier5. 1Rigshospitalet, Copenhagen, Denmark, 2St Mark′s
Hospital, Northwick Park, United Kingdom, 3Vanderbilt
University Medical Center, Nashville, 4Shire Human Genetic
Therapies, Inc., Lexington, United States, 5Shire International
GmbH, Zug, Switzerland
Rationale: Intestinal failure associated with short bowel
syndrome (SBS–IF) arises from different etiologies resulting in
a heterogeneous population. This is a post hoc analysis of SBS–IF
patients ( pts) based on residual bowel anatomy.
Methods: STEPS (NCT00798967; EudraCT2008-006193-15) was
a 24-wk, placebo (PBO)–controlled study of teduglutide (TED)
0.05 mg/kg/day in pts with SBS−IF. Three groups were
evaluated: Grp1 (no colon/stoma present/no colon-in-continu-
ity), Grp2 (≥50% colon/no stoma/colon-in-continuity), and
Grp3 (other bowel anatomies). Clinical response was defined as
Oral Communication II: Nutrition and Chronic Disease S5

≥20% reduction from baseline in weekly parenteral support weeks. Data were compared in univariate analysis to identify
(PS) volume at Wks20–24. Data presented as mean (SD). predictive factors for very early response and withdrawal from
Results: Baseline pt details are shown in Table. TED-induced PS PS at 12 weeks.
volume reduction (change in L/wk) took longer to be realized in Results: 42 SBS patients (21 F/21M, mean age 53.2 (23–84) yrs),
Grp2 (Wk12: −0.9 [1.2], Wk24: −2.5 [2.1]) vs Grp1 (Wk12: −5.5 with a PS duration of 11 (0.5–31) yrs, a PS weekly volume of
[3.8], Wk24: −6.4 [4.5]) or Grp3 (Wk12: −2.7 [1.2], Wk24: −5.1 10,860 (2,000–38,500) ml were treated with TED for at least 3
[3.7]). Response rates were higher with TED vs PBO in all grps, months. At week 12, 25/42 (59.5%) were VER, 13/42 had no
but the difference was significant only in Grp1 (76% vs 19%, change in PS, 4/42 had a PS reduction < than 20%. At week 12,
P = 0.001; Grp2: 56% vs 40%, P = 0.36; Grp3: 57% vs 29%, 9/42 were weaned off PS. VER had a significantly higher oral
P = 0.33). Adverse events were reported by 94% (Grp1), 72% intake at baseline (2,709 vs 2,108 kcal, p = 0.012) regardless of
(Grp2), and 86% (Grp3) of TED pts. age, gender and BMI. Factors associated with PS discontinu-
ation were the presence of high baseline food intake (2,938 vs
Grp1 Grp2 Grp3 2,237 kcal/d, p = 0.013) and low initial PS volume (1,646 vs
2,533 ml/d, p = 0.001). No patient or SBS characteristic
TED, PBO, TED, PBO, TED, PBO,
predicted the therapeutic response and withdrawal of PS.
n = 17 n = 16 n = 18 n = 20 n=7 n=7
Conclusion: This first ‘real life’ study evaluating in a large
Cause of SBS−IF, % cohort the very early efficacy of TED in adult SBS patients
Crohn′s disease 53 44 0 0 14 14
Vascular
confirms, as early as 3 months, a significant reduction of PS.
complications 12 13 50 65 29 14 Hyperphagia appears as a major predictive factor of very early
Other 35 44 50 35 57 71 response. Evaluation and dietary optimization should be the
Colon-in-
continuity, % 0 0 100 100 100 100
focus of attention prior to any initiation of TED treatment. An
Stoma present, % 100 100 0 0 57 14 assessment of this ongoing cohort at 6 months will confirm the
Ileocecal valve benefit of treatment over a longer period of time.
present, % 0 0 17 40 0 14
Mean (SD) estimated 137.7 113.7 52.2 39.2 59.3 49.3 Disclosure of Interest: None declared.
remaining small (70.9)* (79.8)* (27.4) (30.4)† (44.4) ‡
(30.0)‡
bowel length, cm
Mean (SD) PS 14.5 18.8 10.6 10.5 12.4 9.1
OR12
volume, L/wk (9.6) (7.9) (5.8) (5.3) (7.1) (3.9) NEUROPROTECTIVE EFFECT OF EGCG LOADED
NANOPARTICLES ON ALUMINIUM CHLORIDE INDUCED
*
n = 15. ALZHEIMER DISEASE IN WISTAR RATS
†
n = 19.
‡
n = 6. N. A. Singh1 *, C. Ravi2, Z. A. Khan3, A. K. A. Mandal2.
1
Integrative Biology, 2Biotechnology, VIT University, Vellore,
3
Conclusion: SBS−IF pts in Grp1 had the highest baseline PS Centre for Interdisciplinary Biomedical Research, Adesh
volume needs and responded most and fastest to TED with PS University, Bathinda, India
volume reductions compared with pts in Grp2 or Grp3.
Rationale: Alzheimer’s disease is a neurodegenerative path-
Disclosure of Interest: P. Jeppesen Consultant for: Shire, Speaker ology characterized by the presence of senile plaques and
Bureau of: Shire, S. Gabe Consultant for: Shire, D. Seidner Consultant neurofibrillary tangles. Aluminium has been reported to play an
for: Shire, H.-M. Lee Other: Employee for Shire, C. Olivier Other:
important role in the aetiology and pathogenesis of this
Employee for Shire.
disease. Hence, the present study aimed to evaluate the
neuroprotective role of epigallocatechin-gallate (EGCG)
loaded nanoparticles (nanoEGCG) against aluminium chloride
OR11
(AlCl3) induced neurobehavioral and pathological changes in
FIRST STUDY IN ‘REAL LIFE’ ON THE EFFECT OF
Alzheimeric rats.
TEDUGLUTIDE AT 3 MONTHS IN A COHORT OF ADULT PATIENTS
Methods: 100 mg/kg body weight AlCl3 was administered orally
WITH SHORT BOWEL SYNDROME (SBS)
for 60 days, which was followed by 10 mg/kg body weight free
F. Joly1 *, D. Quilliot2, P. Beau3, F. Poullenot4, EGCG and nanoEGCG treatment for 30 days. Morris water maze,
L. Armengol-Debeir5, C. Chambrier6, J. Lallemand7, V. Boehm8, open field and novel object recognition tests were employed
A. Nuzzo8, O. Corcos8, S. Schneider9. 1Gastroenterology and for neurobehavioral assessment of the rats. This was followed
Nutrition Support, Beaujon, Clichy, 2CHU Nancy, Nancy, 3CHU by histopathological assessment of the cortex and the
Poitiers, Poitiers, 4CHU Bordeaux, Bordeaux, 5CHU Rouen, hippocampus of the rat brain. Further validation was done
Rouen, 6Hospices civiles, Lyon, 7Clinique Vert Coteau, with biochemical and western blot assays.
Marseille, 8Beaujon, Clichy, 9CHU Nice, Nice, France Results: Aluminium exposure reduced the exploratory and
locomotor activities in open field test and significantly reduced
Rationale: Phase III clinical studies have shown that treatment
the memory and learning curve of rats in morris water maze and
with teduglutide (TED) was associated with at least 20%
novel object recognition tests. These neurobehavioral impair-
reduction in PS at 6 months in SBS patients. The aim of the
ments were significantly attenuated in nanoEGCG treated rats.
study was to evaluate in a ‘real life’ SBS cohort, the predictive
Histopathological assessment of the cortex and the hippocam-
factors of very early response in SBS patients treated with TED.
pus of aluminium-exposed rat brains showed the presence of
Methods: This is a national retrospective multicentre study. All
both senile plaques and neurofibrillary tangles. In nanoEGCG
consecutive SBS patients treated by TED with a follow-up of at
treated rats this pathology was absent. Significant increase in
least 3 months were analysed. The very early responders (VER)
biochemical and protein expression levels of AChE, APP, PDK1
were: TED patients achieving ≥20% PS volume reduction at 12
S6
and GSK3 was noted in aluminium-exposed rats, while these
levels were greatly reduced in nanoEGCG treated rats.
Conclusion: In conclusion, this study strengthens the hypoth-
esis that EGCG nanoparticles can reverse memory loss, senile
plaque and neurofibrillary tangles formation.
Disclosure of Interest: None declared.
OR13
LONG-TERM EFFICACY OF A NUTRITIONAL INTERVENTION
STRATEGY TO OPTIMIZE AND MAINTAIN EFFICACY OF
PULMONARY REHABILITATION IN COPD: THE NUTRAIN TRIAL
M. van Beers1 *, C. van de Bool1, A. van Helvoort2,3,
S. Kremers4, F. Franssen5, E. Wouters1, A. Schols1. 1Department
of Respiratory Medicine, 2School of Nutrition and Translational
Research in Metabolism, Maastricht University Medical Center
(MUMC+), Maastricht, 3Nutricia Research, Nutricia Advanced
Medical Nutrition, Utrecht, 4Department of Health Promotion,
Maastricht University Medical Center (MUMC+), Maastricht,
5
Department of Research and Education, CIRO, Center of
Expertise for Chronic Organ Failure, Horn, Netherlands
Rationale: The 4-month placebo-controlled part of the
NUTRAIN trial showed that targeted nutritional supplementa-
tion (NS) during outpatient pulmonary rehabilitation in COPD
patients with moderate airflow obstruction and low muscle
mass did not enhance muscle regain and improvements in
physical performance, but improved nutritional status and
prevented a decline in daily step count. The current study
investigates if the changes obtained during nutritional
rehabilitation consolidated during the 8-month maintenance
phase.
Methods: 81 patients were randomized to 4 months outpatient
rehabilitation ± NS (3 portions enriched with leucine, vitamin D
and polyunsaturated fatty acids) or ± PLACEBO. In an 8-month
maintenance program thereafter, both groups received feed-
back on their physical activity level using accelerometry. The
NS group additionally received nutritional counseling sessions
based on motivational interviewing and maintenance NS (1
portion).
Results: Significant between-group differences were found
at 12 months for leucine (Δ 16.5 µmol/l, p = 0.04), vitamin D
(Δ 14.0 nmol/l, p < 0.001), EPA (Δ 8.8 mgL, p < 0.001) and
DHA (Δ 12.0 mgL, p < 0.001) plasma levels, and body weight
(Δ 1.5 kg, p = 0.04). The latter was a net result of an increase
in NS (Δ 0.64 kg) and a decrease in PLACEBO (Δ −0.90 kg).
Enhanced physical functioning after 4 months maintained
after 12 months in both groups, but step count was
significantly higher in NS (Δ 1,030 steps per day, p = 0.03).
Intrinsic and extrinsic motivation towards a healthy lifestyle
were high in both groups and did not change; only negative
motivation towards eating decreased in NS ( p = 0.04).
Conclusion: The short-term effects of nutritional supplemen-
tation on body weight, targeted plasma nutrient levels and
daily step count were retained during the 8-month mainten-
ance phase.
Disclosure of Interest: None declared.
Oral communications
OR14
OBSTRUCTIVE SLEEP APNEA AND MALNUTRITION: A
PRELIMINARY STUDY
C. Breuillard1 *, S. Moulin2, S. Bouyon2, M. Couchet1,
G. Maillard1, C. Moinard1, E. Belaidi2. 1Laboratory of
Fundamental and Applied Bioenergetics - INSERM U1055,
2
HP2 Laboratory, INSERM U1042, Grenoble Alpes University,
Grenoble, France
Rationale: Obstructive sleep apnea (OSA) is well known to be
associated to metabolic disturbances, including glucose and
lipid metabolism (1,2). But, surprisingly, no data are available
concerning possible malnutrition associated to OSA whereas it
often goes along with an anorexia which is an important factor
leading to malnutrition.
Methods: 24 Wistar male rats were divided into 3 groups and
submitted to different O2 pressure for 14 days: intermittent
hypoxia (IH - 21–5% FiO2, 60-s cycle, 8 h/day a validated model
of OSA), normoxia (N), and normoxia pair fed to IH group (PF).
Food intake and body weight of the animals were measured
throughout the study. At the end of the study, muscles (EDL,
Tibialis, Soleus), intestine mucosa ( jejunum and ileon), liver,
rate, heart and thymus were weighed. Data are presented as
(mean ± SEM).
Results: Cumulated food intake was well lower in IH group
compared to N group (IH: 390 ± 16 g vs N: 536 ± 20; p < 0.05),
and it was accompanied by a lower body weight (IH: 362 ± 7 g vs
N: 407 ± 6; p < 0.05). But, interestingly, body weight of PF group
was different to IH group, and not different to N group (PF:
400 ± 6 g vs IH: 362 ± 7; p < 0.05; PF: 400 ± 6 g vs N: 407 ± 6;
p > 0.05). Furthermore, thymus weight was lower in IH group
compared to N and PF groups (IH: 0.56 ± 0.04 g, N: 0.73 ± 0.03,
PF: 0.77 ± 0.03; p < 0.05), while the other organs were not
affected.
Conclusion: This preliminary study shows that IH specifically
induces body weight loss, and thymic involution suggesting a
possible nutritional alteration that remains to be character-
ized. For that, further studies will investigate AA content,
protein content and protein anabolism.
References
1. Iiyori N. et al. Am J Respir Crit Care Med, 2007.
2. Pauly M. et al. Scientific Report, 2017.
Disclosure of Interest: None declared.
OR15
OMEGA 3 FATTY ACIDS ATTENUATE ENDOTHELIAL
DYSFUNCTION BY RESTORING NITRIC OXIDE AVAILABILITY IN
CHRONIC KIDNEY DISEASE
G. Gortan Cappellari1 *, A. Semolic1, R. Barazzoni1, M. Zanetti1.
1
Medical Sciences, University of Trieste, Trieste, Italy
Rationale: Omega 3 polyunsaturated fatty acids (n-3 PUFA)
exert antioxidant and anti-inflammatory effects and may
positively impact cardiovascular disease in chronic kidney
disease (CKD). We tested the hypothesis that n-3 PUFA dietary
enrichment may improve endothelial dysfunction in a rodent
model of CKD.
Methods: CKD was induced by 5/6 nephrectomy in 12-week-old
male Wistar rats, that were then maintained on a regular
(Fat = 5.5% total, mainly from soybean oil; CKD: n = 8) or n-3
PUFA diet (Fat = 5.5% total; 27% total fat EPA + DHA, replacing
Oral Communication II: Nutrition and Chronic Disease
soybean oil; CKD-PUFA: n = 8). An additional group underwent
sham-surgery and was fed regular diet (SHAM; n = 10). At 40
days, aortas were harvested. Analyses included assessment of
endothelium-dependent (EDD) and -independent (EID) vaso-
dilation in organ chambers, endothelial nitric oxide synthase
(eNOS) and NADPH oxidase NOX4 and p22phox subunit protein
expression by Western blot
Results: Compared to SHAM rats, CKD rats exhibited impaired
( p < 0.05) EDD and reduced ( p < 0.05) eNOS expression while
EID, NOX4 and p22phox protein expression were unchanged.
Incubation in the presence of the antioxidant Tiron failed to
improve endothelial dysfunction in CKD. In aortas from CKD-
PUFA endothelial dysfunction was partly ( p < 0.05) reverted
compared with CKD, while blockade of eNOS by L-NAME
worsened ( p < 0.05) EDD. In addition, treatment with n-3
PUFA restored eNOS expression in CKD rats and decreased NOX 4
protein expression.
Conclusion: Thus, oral administration of n-3 PUFA reduces
endothelial dysfunction in a chronic experimental model of
CKD by restoring eNOS protein expression and activity and by
lowering vascular oxidative stress, suggesting a role of dietary
n-3 PUFA to treat CKD-associated vascular disease.
Disclosure of Interest: None declared.
OR16
THE ONSET OF DYNAPENIA MAY PRECEDE SARCOPENIA DUE
TO METABOLIC DERANGEMENTS IN ADULT WOMEN WITH
OBESITY
E. Poggiogalle1 *, C. Lubrano1, L. Gnessi1, S. Mariani1, A. Lenzi1,
L. M. Donini1. 1Department of Experimental Medicine- Medical
Pathophysiology, Food Science and Endocrinology Section,
Sapienza University, Rome, Italy
Rationale: The aim of the present study was to investigate the
phenotype of sarcopenic obesity- lean body mass, muscle
strength and muscle quality (namely, myosteatosis) in women
with and without the Metabolic Syndrome (MetS).
Methods: Study participants were enrolled at the Sapienza
University, Rome, Italy. Body composition was assessed by DXA.
The Handgrip strength test (HGST) was performed. HGST was
normalized to arm lean mass; intramuscular adipose tissue
(IMAT) and intramyocellular lipid content (IMCL) were mea-
sured by magnetic resonance spectroscopy, as indicators of
myosteatosis. Different indices of sarcopenia were calculated,
based on appendicular lean mass (ALM, kg) divided by height
squared, or weight, or BMI. The NCEP-ATPIII criteria were used
to diagnose the MetS. HOMA-IR was calculated. The physical
activity level (PAL) was assessed through the IPAQ
questionnaire.
Results: 54 women (age: 48 ± 14 years, BMI: 37.9 ± 5.4 kg/m2)
were included. 54% had the MetS (metabolically unhealthy).
HGST/arm lean mass was lower in metabolically unhealthy
women than women without the MetS (6.3 ± 1.8 vs. 7.8 ± 1.6,
p = 0.03). No differences emerged in terms of absolute ALM (kg)
or other indices of sarcopenia (ALM/h2, ALM/weight, or ALM/
BMI) between metabolically healthy vs. unhealthy women
( p > 0.05) after adjustment for age, body fat, hs-CRP and PAL.
HGST/arm lean mass was negatively associated to HOMA-IR
( p = 0.02), after adjustment for age, body fat, hs-CRP levels,
and PAL. IMATand IMCL were not different in obese women with
the MetS compared to women without the MetS ( p > 0.05). No
S7
association emerged between HGST/arm lean mass and IMAT
or IMCL.
Conclusion: Insulin resistance, and not myosteatosis per se,
may play a role in the decline of muscle strength, leading to the
phenotype of dynapenic obesity. Dynapenia may precede the
decline of lean body mass in metabolically unhealthy obese
women.
Disclosure of Interest: None declared.
OR17
CITRULLINE AND LPS-INDUCED OXIDATIVE STRESS DURING
NONALCOHOLIC FATTY LIVER DISEASE
W. Ouelaa1, P. Jegatheesan1, J. M’bouyou-Boungou1,
C. Vicente1, S. Nakib1,2, E. Nubret1, J.-P. De Bandt1,2 *.
1
EA4466, Université Paris Descartes, 2Clinical Chemistry dpt,
Hôpital Cochin, APHP, Paris, France
Rationale: Hepatic lipid accumulation during nonalcoholic fatty
liver disease (NAFLD) is believed to sensitize the liver to the
adverse effects of endotoxin via increased oxidative stress and
inflammation thus contributing to the progression of the
disease. We evaluated whether the protective effect of citrul-
line against fructose-induced NAFLD may be related to its ability
to prevent oxidative stress. This was tested using perfused livers
isolated from NAFLD rats subjected to endotoxemia.
Methods: Thirty SD male rats were given either a standard diet
or a 60%>fructose diet alone or supplemented with citrulline
(1 g/kg/d) for 4 weeks. Thereafter, fasted animals received an
IP injection of LPS (2.5 mg/kg) and, one hour later, the livers
were isolated and perfused under standard conditions for the
study of hepatic function, metabolism and oxidative and
inflammatory status. Statistical analysis: ANOVA and Fischer
PLSD.
Results: The 60% fructose diet induced a moderate steatosis
associated with insulin resistance and dyslipidemia signifi-
cantly attenuated by the administration of citrulline. In the
isolated livers from fructose-fed rats, endotoxemia led to a
increase in hepatic cytolysis (ALT + 80%, p < 0.05) and TLR4
expression ( p = 0.08); this was prevented by citrulline.
Oxidative stress (4-hydroxynonenal) and antioxidant defenses
(vitamins A and E, glutathione) were similar between the 3
groups. Hepatic amino acid exchanges and metabolism (urea,
glucose, ammonia) did not differ significantly between groups.
Conclusion: In this model of moderate steatosis, fructose leads
to increased sensitivity to inflammation but not to LPS-induced
oxidative stress. The protective effect of citrulline on
endotoxin appears to be independent of its antioxidant
properties.
Disclosure of Interest: W. Ouelaa: None declared, P. Jegatheesan:
None declared, J. M’Bouyou-Boungou: None declared, C. Vicente: None
declared, S. Nakib: None declared, E. Nubret: None declared, J.-P. De
Bandt Shareholder of: Citrage.
OR18
RANDOMISED TRIAL SHOWS LOW VOLUME ENERGY DENSE
ORAL NUTRITIONAL SUPPLEMENTS IMPROVE TOTAL
NUTRITIONAL INTAKE WITH LITTLE SUPPRESSION OF FOOD
INTAKE IN MALNOURISHED FREE LIVING OLDER PEOPLE
T. Smith1 *, A. L. Cawood2, N. Guildford3, R. J. Stratton2.
1
Department of Gastroenterology, University Hospital
Southampton NHS Foundation Trust, 2Faculty of Medicine,
S8
University of Southampton, 3Department of Nutrition and
Dietetics, University Hospital Southampton NHS Foundation
Trust, Southampton, United Kingdom
Rationale: Large randomised trials assessing the effect of low
volume energy dense oral nutritional supplements (ONS) and
simple dietary advice (DA) on food and total nutrient intake in
older free living people are lacking.
Methods: 308 free living older people (>50 y) recruited through
GPs (mean ± SD; age 71.5 ± 10.7 y, BMI 19.4 ± 2.5 kg/m2,
Charleston Comorbidity Index (CCI) 1.02 ± 0.93, 67% female)
at risk of malnutrition (‘MUST’) were randomised to receive DA
(as a diet sheet) (n154) or readymade low volume ONS (Fortisip
Compact range, Nutricia; 2.4 kcal/ml) plus DA (n154) for 12
weeks. At baseline, 4, 8 and 12 weeks, energy and protein
intake was measured (24 h recalls, analysed by WISP) and the
extent to which ONS intake was additive to the diet calculated
(1). Intention to treat analysis was undertaken controllng for
baseline, age, gender, ‘MUST’ category and CCI.
Results: Dietary intake of energy and protein did not differ
between groups at baseline. Over the 12 weeks, total energy
and protein intakes were significantly greater in the ONS + DA
group than the DA group alone (2,300 ± 43 kcal, 89 ± 1.7 g vs.
1,899 ± 45 kcal, 74.0 ± 1.9 g; mean ± SE; p < 0.001), due to no
significant difference between groups in food intake
(1,820 kcal/d, 68 g protein/d vs.1,848 kcal/d, 71 g protein/d)
and a mean daily ONS intake of 480 kcal and 21 g protein in the
ONS + DA group. Overall, 94% of the energy and 83% of the
protein of the ingested ONS was additive to food intake.
Conclusion: This large randomised trial shows that low volume
energy dense ONS are effective at increasing total energy and
protein intakes with little suppression of food intake in free
living older people. Further evaluation is needed of the effect
of ONS and DA on micronutrient intakes and relevant clinical
outcomes.
Reference
1. Stratton & Elia 1999. Clin Nutr 18, 29–84.
Disclosure of Interest: T. Smith: None declared, A. Cawood Other:
Nutricia Ltd, N. Guildford: None declared, R. Stratton Other: Nutricia Ltd.
Oral Communication III: Nutritional
Assessment, Epidemiology and
Formulations
OR19
PREVALENCE OF TACHYPHAGIA AT LUNCH AND ASSOCIATED
FACTORS IN 415 FRENCH WORKERS
C. Millotte1, P. Fayemendy2,3,4, M. Druet-Cabanac2,3,5,
M. Perrier6, M. Gravelat7, M. Dupont Cuisinier8, C. Le Flahec9,
J. C. Desport2,3,4,10 *, P. Jésus2,3,4,10. 1Department of General
Medicine, University Hospital of Limoges, 2UMR_S 1094,
Tropical Neuroepidemiology, Institute of Neuroepidemiology
and Tropical Neurology, CNRS FR 3503 GEIST, University of
Limoges, 3INSERM, U1094, Tropical Neuroepidemiology, School
of Medicine, 4Nutrition Unit, 5Department of Occupational
Medicine, University Hospital of Limoges, 6Interprofessional
Association for Occupational Health 87 (AIST87), 7Inter-
Company Medical Service of the Health Insurance of the Haute-
Vienne, 8Department of Occupational Health of the
Oral communications
Agricultural Social Mutual (MSA) of Haute Vienne, 9Legrand
Society Autonomous Medical Department, 10Specialized
Center of Obesity of Limousin, University Hospital of Limoges,
Limoges, France
Rationale: Obesity is a worldwide public health problem. In
France, prevalence of obesity is of 15.0%. The food behavior of
French workers evolves with society and tachyphagia can
promote weight gain. The aim of our work was to study the
modalities of the lunch break and the link with obesity in
French workers
Methods: This prospective study was conducted from January
to May 2016 in 5 departments of Occupational Medicine of the
French region of Haute-Vienne. With an anonymous self-
questionnaire, declarative data concerning general informa-
tion including weight and height with calculation of the body
mass index (BMI) and the modalities of the lunch break
including the time of meal were collected. Statistical analysis
included Student t test, Chi2 and logistic regression.
Results: Four hundred and fifteen workers with a mean age of
41.1 ± 12.6 years were included. The mean BMI was 23.8 ± 4.6
kg/m2 and the prevalence of obesity was of 15.9%. Tachyphagia
(meal time <15 min) was found in 20.3%. In multivariate
analysis, eating alone and eating fast food were positively
associated with tachyphagia (OR = 4.59 [95% CI: 2.44–9.08],
p < 0.0001 and OR = 2.03 [95% CI: 1.10–3.70], p = 0.023,
respectively) but also with obesity (OR = 2.14 [95% CI: 1.21–
3.79]; p = 0.008 and OR = 2.40 [95% CI: 1.25–4.52], p = 0.009,
respectively). But we did not found a significant association
between tachyphagia and obesity.
Conclusion: Our study provides important information on
the modalities of lunch in French workers. Indeed, tachyphagia
was found in 20%. It is essential to investigate the eating habits
of workers during their meal break, especially in patients with
excess of weight. The General Practitioner and the
Occupational Medicine departments are therefore key players
in the screening of nutritional disorders of workers.
Disclosure of Interest: None declared.
OR20
FACTORS THAT AFFECT SURVIVAL IN TYPE 3 INTESTINAL
FAILURE; A SINGLE CENTRE EXPERIENCE OF 978 PATIENTS
OVER 37 YEARS
S. Oke1 *, D. A. Lloyd2, J. M. Nightingale1, S. M. Gabe1. 1Lennard
Jones Intestinal Failure Unit, St Mark’s Hospital, Harrow,
2
Hampshire Hospitals NHS Foundation Trust, Winchester,
United Kingdom
Rationale: Standard management of type 3 intestinal failure
(IF) is long-term parenteral support (PS). While it is clear that
PS is lifesaving treatment for IF, it carries significant morbidity
and mortality. We report the largest single-centre series
assessing the long-term survival of adult patients on all forms
of home PS ( parenteral nutrition and parenteral fluids) for
type 3 IF.
Methods: Clinical records of 978 adult patients receiving home
parenteral support for IF at our tertiary referral centre were
analysed from January 1979 until October 2016. Demographic
data including survival was recorded. Differences between
groups were analysed by chi-squared tests. Kaplan-Meier and
Oral Communication III: Nutritional Assessment, Epidemiology and Formulations
Cox’s regression models were used to assess factors affecting
survival.
Results: Overall rates of survival for all patients on PS without
active malignancy as a cause of IF, were 90%, 66%, 55%, 45%, 33%
and 25% at 1, 5,10, 15, 20 and 30 years respectively. There is a
significant difference in survival dependent on underlying IF
aetiology. The worst 1-year survival of 62% was seen for
malignancy and the best with pseudo-obstruction (excluding
scleroderma) at 93%. Multivariate analysis demonstrated a
significant relationship between survival and the following
factors; age at start of PS; HR 1.03 ( p < 0.001), form of PS; HR
0.48 ( p = 0.04), presence or absence of colon in continuity; HR
0.42–0.70 ( p = 0.03), and the aetiologies underlying IF HR 0.74–
8.19 ( p < 0.001).
Conclusion: Our data have shown a better prognosis was
associated with an earlier age of onset of type 3 IF and the
presence of colonic continuity, while a worse prognosis was
associated with underlying aetiologies such as malignancy and
radiation enteritis. To our knowledge, this is the largest single-
centre case series looking at survival in type-3 IF to date and
adds to our current understanding of the long-term outcomes in
type 3 IF.
Disclosure of Interest: None declared.
OR21
ASSOCIATION BETWEEN MALNUTRITION AND ORAL HEALTH IN
DUTCH NURSING HOME RESIDENTS: RESULTS OF THE LPZ-
STUDY
L. C. de Groot1 *, V. Huppertz1, G.-J. van der Putten2,3,
R. J. Halfens4, J. M. Schols4. 1Human Nutrition and Health,
Wageningen University, Wageningen, 2Dept Oral Function and
Prosthetic Dentistry, Radboud University Medical Centre,
Nijmegen, 3Amaris Zorggroep, Hilversum, 4Department of
Health Services Research, Maastricht University, Maastricht,
Netherlands
Rationale: Malnutrition as well as bad oral health are of great
concern to global health, especially among frail older
population. Beyond sole prevalence estimations of malnutri-
tion, dentures problems, chewing problems and xerostomia,
this study aimed to assess the associations between malnutri-
tion and oral health problems in somatic and psychogeriatric
wards from Dutch nursing homes.
Methods: Data were collected in the cross-sectional National
Prevalence Measurement of Quality of Care study (LPZ-study) in
the study rounds of 2013, 2014 and 2015 in the Netherlands.
3,220 residents, aged 65 or older and living in somatic or
psychogeriatric wards in Dutch nursing homes were included.
Malnutrition was based on the valid ESPEN definition; age-
adjusted BMI combined with weight loss (%). Oral health was
assessed by means of a standardized questionnaire. To examine
associations between malnutrition and oral health factors,
prevalence ratios (PR) were generated from Cox regression.
Results: Mean age of the study population was 84.3 (±7.4)
years, with 70.2% female and 65.2% living in psychogeriatric
wards. Among the total population, 11.7% were malnourished
28.6% suffered from xerostomia, 25.6% from chewing problems
and 10.1% experienced problems with eating due to dentures
problems. Increased risks for malnutrition was found for
S9
residents with dentures problems (PR 1.6, 95% CI 1.2–2.1).
Within somatic wards, 9.0% were malnourished, where 13.2% of
residents in psychogeriatric wards were malnourished.
Increased risk for malnutrition was found among psychogeriat-
ric residents that had problems with eating due to dentures
problems (PR 1.6, 95% CI 1.1–2.3).
Conclusion: Poor oral health, mostly problems with eating due
to dentures problems, was associated with an increased risk for
malnutrition in older residents in Dutch nursing homes.
Disclosure of Interest: None declared.
OR22
COMPATIBILITY STUDY WITH A NATURAL FOOD-BASED TUBE
FOOD
S. B. Schmidt1 *, A. S. Vasold2, R. Winter3, J. D. Rollnik1.
1
Institut für neurorehabilitative Forschung (InFo), Hessisch
Oldendorf, 2Medizinische Einrichtung des Bezirkes Oberpfalz
KU, Klinik für Neurologische Rehabilitation, Bezirksklinikum
Regensburg, Regensburg, 3SRH Kurpfalzkrankenhaus
Heidelberg gGmbH, Heidelberg, Germany
Rationale: Diarrhea is frequently observed in patients receiv-
ing enteral tube feeding (ETF). Anecdotal observations suggest
that the composition of food administered via tube may be
among the factors determining the development of diarrhea.
The current study investigates the effect of natural food-based
tube feed (NFTF) versus standard used tube feed on the
incidence of low consistence stools or diarrhea.
Methods: Neurological patients (n = 117) obtained NFTF (HIPP;
intervention group n = 59) or standard tube feed (Fresenius;
control group n = 58). For a maximum of 30 days following data
was recorded daily: nutrition protocol (amount of nutrition,
feed rate, daily amount of liquid); changes in medication;
result of stool microbiology (when conducted); number of
defecations and the consistence of stools classified according
to the Bristol Stool Chart.
Results: A two sided ANCOVA with the factors group, age,
centrum and duration of antibiotic treatment revealed that the
patients of the intervention group showed significant lower
number of low consistence stools as compared to the control
group after 15 days as well as after 30 days of ETF. In addition,
the number of days with low consistence stools (3.8 vs. 9.6;
p < 0.001) as well as the number of days with ≥3 low consistence
stools (0.6 vs. 1.7; p < 0.05) was significant lower in the
intervention group.
Conclusion: NFTF showed reduced incidence of low consist-
ence stools during ETF in neurological patients compared to
standard tube feed produced from powdered raw materials.
Disclosure of Interest: S. Schmidt Paid Instructor at: Working position
(50%) of the first author was funded by HIPP GmbH & Co KG during study
investigation. Furthermore, HIPP incur any expenses for the congress
participation., A. Vasold: None declared, R. Winter: None declared,
J. Rollnik: None declared.
S10
OR23
OCCURRENCE & SALVAGE OF INFECTED CENTRAL VENOUS
CATHETERS IN HOME PARENTERAL NUTRITION: EXPERIENCE
FROM A NATIONAL UK CENTRE
A. Bond1, A. Teubner 1 *, M. Taylor1, A. Abraham1, M. Dibb2,
P. Chadwick3, S. Lal1. 1Intestinal Failure Unit, Salford Royal
Foundation Trust, Salford, 2Gastroenterology, Royal Liverpool
and Broadgreen University Hospital Trust, Liverpool,
3
Microbiology, Salford Royal Foundation Trust, Salford,
United Kingdom
Rationale: Prevention and salvage of catheter related blood
stream infections (CRBSI) is vital in patients on home
parenteral nutrition (HPN)[1]. It is unclear if patients are best
trained for catheter care at home or in hospital or whether
CRBSIs are lower in CVC self caring patients.
Methods: We conducted a retrospective study of CRBSI and CVC
salvage in patients on HPN at a UK centre between 2012 & 2016.
Pre 2012, patients were primarily trained in hospital; there-
after, patients underwent home training. A standardised 14-day
protocol involving antibiotic/urokinase locks and systemic
antibiotics was used for CVC salvage in most cases [1]; in
2013, this was reduced to 10-days for Coagulase-negative
Staphylococci (CNS) CRBSIs.
Results: 134 CRBSIs were recorded in 92 patients from a cohort
of 559 HPN patients (1,163 HPN years). The overall CRBSI rate
was 0.316/1,000 catheter days (cds). CNS were the commonest
isolates 41/134 (30.5%), polymicrobial 14/134 (10.4%) and
Klebsiella 16/134 (11.9%). Salvage was not attempted in 34
cases MRSA infection 1/34, fungal 19/34, clinical instability
14/34. 68/100 CVC attempted salvages were successful. 36/41
CNS infections had attempted salvage (80.5% successful
salvage); there was no difference in salvage rates between
CNS CRBSIs salvaged for 10-days (27/36) vs 14-days (7/9)
( p = 0.5). CRBSI rate, per 1,000 cds, in those cared for by
trained nurses was the lowest 0.270 (self 0.342, family carer
0.320)( p = 0.03). The median time from discharge to first CRBSI
was 406 days (range 77–1,717)
Conclusion: We report a sustained very low CRBSI rate in a large
cohort of HPN patients as previously described [1]; we now
further report that this is not influenced by training patients at
home but is lower when trained nurses manage the CVC at
home. CNS CRBSIs can be successfully salvaged with a reduced
duration of antibiotic therapy.
Reference
1. Dibb et al. JPEN 2016;40:699–704.
Disclosure of Interest: None declared.
OR24
A NOVEL IN-HOSPITAL MEAL SERVICE IMPROVES PROTEIN AND
ENERGY INTAKE, A PROSPECTIVE STUDY
D. N. Dijxhoorn1 *, G. J. A. Wanten1, M. G. A. van den Berg2.
1
Gastroenterology, 2Dietetics, Radboudumc, Nijmegen,
Netherlands
Rationale: Improvement of hospital meal services is a strategy
to optimize protein and energy intake and prevent or treat
malnutrition during hospitalization. This study aimed to
investigate whether FoodforCare (FfC), a new concept com-
prising 6- protein-rich meals per day, provided directly at the
Oral communications
bedside following proactive advise from a nutritional assistant,
improves dietary intake and patient satisfaction, compared to
the traditional 3-meals a day service (TMS).
Methods: We performed a prospective cohort study at medical
(Gastroenterology) and surgical (Gynaecology, Urology,
Orthopedics) wards, between July 2015 and December 2016.
Patients were offered TMS (n = 326) or FfC meal service
(n = 311). Protein and energy intake was measured at days 1
and 4 of full oral intake. Patient satisfaction comprised rating of
the experienced quality of the meals and the meal service
(scale 0–10) and a questionnaire developed by Naithani et al.
was used. Differences in metric variables were evaluated using
unpaired t-tests.
Results: Patient demographics between groups were similar,
with the exception of a higher proportion of oncology patients
in the FfC group ( p = 0.028). FfC improved daily protein intake
relative to requirements at day 1 (mean ± SD: 79 ± 33 vs.
59 ± 28; p < 0.05) and day 4 (73 ± 38 vs. 59 ± 29; p < 0.05). Mean
daily energy intake relative to requirements improved at day 1
(88 ± 34 vs. 70 ± 30; p < 0.05) and day 4 (84 ± 40 vs. 73 ± 31;
p = 0.05). Satisfaction was maintained, both in terms of food
quality (7.7 ± 1.5 vs. 7.4 ± 1.4; p = 0.09) and service (7.8 ± 1.3
vs. 7.7 ± 1.1; p = 0.29). The FfC group was more satisfied with
the appearance ( p < 0.05) and smell of the meals ( p < 0.05).
Conclusion: Implementation of this novel meal service
substantially improved protein and energy intake while main-
taining, and on some points, improving patient’s satisfaction.
Disclosure of Interest: D. Dijxhoorn Grant/Research Support from:
FoodforCare Foundation, G. Wanten: None declared, M. van den Berg:
None declared.
OR25
VALIDITY OF PREDICTIVE EQUATIONS FOR RESTING ENERGY
EXPENDITURE FOR OVERWEIGHT OLDER ADULTS WITH AND
WITHOUT DIABETES
A. M. Verreijen1 *, V. Garrido1,2, M. F. Engberink1,
R. G. Memelink1, M. Visser3,4, P. J. Weijs1,3. 1Faculty of Sports
and Nutrition, Amsterdam University of Applied Sciences,
Amsterdam, Netherlands, 2University CEU-San Pablo, Madrid,
Spain, 3Department of Nutrition and Dietetics, Internal
Medicine, VU University Medical Center, 4Department of
Health Sciences, Faculty of Earth and Life Sciences, Vrije
Universiteit Amsterdam, Amsterdam Public Health research
institute, Amsterdam, Netherlands
Rationale: Predictive equations for resting energy expenditure
(REE) are used in the treatment of overweight and obesity, but
the validity of these equations in overweight older adults is
unknown. This study evaluates which predictive REE equation is
the best alternative to indirect calorimetry in overweight older
adults with and without diabetes.
Methods: In total 273 adults aged ≥55 years with a BMI of
≥25 kg/m2 were included. REE (by indirect calorimetry), body
weight, body height, age, gender, and fat-free and fat mass
(from air-displacement plethysmography) were measured. The
measured REE was used as a reference and compared with 28
existing REE equations. The accuracy of the equations was
evaluated by the percentage accurate predictions (within 10%
of REE measured), the root mean squared error (RMSE), and the
mean percentage difference (bias) between predicted and
ESPEN Best Abstracts 2017 & ESPEN Travel Awards
measured REE. Subgroup analyses were performed for type 2
diabetics (T2D) and non-T2D.
Results: Mean age was 64 ± (SD 6) years, 42% had T2D (n = 116),
and mean BMI was 32.8 ± (SD 4.5) with range 25–54 kg/m2. The
adjusted Harris & Benedict (1984) provided the highest
percentage accurate predictions in all adults (70%) and in T2D
(74%), and second best in non-T2D (67%). RMSE was 184, 175
and 191 kcal/day, and bias −1.2%, −1.5% and −1.0% for all
adults, T2D and non-T2D, respectively.
Conclusion: For Dutch overweight older adults with and
without diabetes the adjusted Harris–Benedict (1984) predict-
ive equation for REE seems to be the best alternative to indirect
calorimetry.
Disclosure of Interest: None declared.
OR26
NATIONAL OBLIGATORY SCREENING LEAD TO DECREASED
MALNUTRITION RATES IN PAEDIATRIC INPATIENTS
A. van den Berg1 *, A. Brinksma2, J. Olieman3, K. Joosten4,
J. Hulst5, on behalf of the Dutch Malnutrion Steering Group.
1
Paediatrics, Juliana Children’s Hospital, The Hague, 2Health
Sciences, University Medical Center, Groningen, 3Dietetics,
4
Paediatric Intensive Care, 5Paediatric Gastroenterology,
Erasmus MC/Sophia Children’s Hospital, Rotterdam,
Netherlands
Rationale: Disease related malnutrition in children is asso-
ciated with adverse outcome. From 2008, Dutch hospitals have
been required to screen for and treat acute malnutrition in
paediatric patients on admission as part of a national quality
indicator. The indicator stipulate that all hospitals report the
number of children screened on admission and the energy and
protein intake on day 4 in malnourished children. The aim of
this study was to assess if the malnutrition quality indicator
altered (1) the number of children screened for malnutrition on
admission and (2) the treatment of malnutrition.
Methods: Centrally reported data of all Dutch hospitals with a
paediatric inpatient ward regarding screening for malnutrition
(weight, height), and its treatment (energy and protein intake
on day 4) from 2008 to 2015 were analysed. Acute malnutrition
was defined as weight for age <−2 SD in patients <1 year and as
weight for height <−2 SD in patients aged 1–18 years. For
children >1 year nutritional intake on day 4 was compared to set
minimum energy requirements using Schofield formula + 30%
and protein intake of 1.2–1.5 g/kg/day.
Results: Data of 667.291 admissions taken together since 2008
show that screening for malnutrition on admission rose from
22% to 75% and from 34 to 90 institutions. Prevalence of acute
malnutrition dropped from 9.4% to 6.5%. From 2008, the % of
children with an adequate energy and protein intake on day 4
remained more or less the same (adequate protein and energy
intake in respectively 67% and 65% of the malnourished
children).
Conclusion: Since 2008, the national quality indicator on acute
malnutrition has lead to significantly increased screening
numbers, whereas prevalence of malnutrion in paediatric
patients has dropped. Although the percentage of children
with adequate energy and protein intake on day 4 of admission
remained practically the same, the number of registering
hospital almost tripled.
Disclosure of Interest: None declared.
S11
OR27
LET’s DIAGNOSE SARCOPENIA WITH A DEEP BREATH
O. Deniz1 *, S. Kaya1, N. B. Demir2, M. C. Pence2,
H. Dogan Varan1, M. C. Kizilarslanoglu1, S. Ozhan Oktar2,
B. Goker1. 1Department of Geriatrics, 2Department of
Radiology, Gazi University, Ankara, Turkey
Rationale: Previous preclinical studies have shown that
sarcopenic mice may have thinner diaphragmatic muscle than
non-sarcopenic ones, however, to the best of our knowledge,
there are no clinical studies on diaphragm thickness in
sarcopenic patients. The aim of this study is to investigate
whether the sarcopenic patients have thinner diaphragmatic
muscles compared to non-sarcopenic controls.
Methods: Thirty sarcopenic and 30 non-sarcopenic elderly
patients aged over 65 were included in the study. The patients
known to have any type of pulmonary disorder, such as asthma
or chronic obstructive pulmonary disease were excluded from
the study. Diagnosis of sarcopenia was made according to the
criteria of the European Working Group on Sarcopenia in Older
People. Ultra-sonographic evaluations of the patients were
carried out by experienced radiologists. Diaphragm thickness
was measured at 3 positions: at the end of deep inspiration,
neutral and at the end of expiration. Peak expiratory flow (PEF)
rates of the patients was also evaluated by a peak flow meter.
Results: The mean age of the patients was 76.7 ± 6.4 years and
56.7% were female. Gender rate was similar between sarco-
penic and non-sarcopenic groups ( p = 0.602). Diaphragmatic
thicknesses in three different positions (deep inspiration
[2.35 mm (min-max: 1.30–4.10) vs. 2.50 mm (min-max: 1.90–
4.90)], neutral [1.80 mm (min-max: 1.00–2.80) vs. 2.00 mm
(min–max: 1.30–3.90)] and end of expiration [1.15 mm (min–
max: 0.70–2.50) vs. 1.55 mm (min–max: 0.50–3.40)] were found
to be thinner in sarcopenic patients compared to non-
sarcopenic group ( p = 0.023, p = 0.017, p = 0.003, respect-
ively). Moreover, PEF results were also lower in sarcopenic
patients compared to non-sarcopenic group (245 L/min [min–
max: 150–500] vs. 310 L/min [min–max: 220–610], p = 0.001).
Conclusion: Results of the study suggest that sarcopenia may
be associated with lower diaphragmatic thickness and asso-
ciated lower PEF rates.
Disclosure of Interest: None declared.
ESPEN Best Abstracts 2017 & ESPEN
Travel Awards
OR28
PERFORMANCE OF CT-BASED DIAGNOSIS OF SARCOPENIA
(SCT) AND BIOELECTRIC IMPEDANCE DERIVED LOW PHASE
ANGLE (PA) IN THE DETECTION OF AN INCREASED RISK OF
NUTRITION RELATED MORTALITY
M. Wäsch1, M. Plauth1 *. 1Dessau Community Hospital, Dessau-
Roßlau, Germany
Rationale: The aim of this study was to examine in a
prospective study whether hospitalized patients with SCT
show an increased mortality risk as assessed by Pandora score
(PS) in a head to head comparison with PA.
Methods: A total of 7.736 patients were hospitalized in Dessau
community hospital (Nov 11, 2016–Feb 05, 2017). In 227/7.736
S12
patients a CT scan was obtained and muscle index (SCT cutoff:
female≤ or >38.5 cm2/m2; male ≤ or >52.4 cm2/m2) was deter-
mined at L3 level using Slice-O-Matic. In 180/227 patients
malnutrition screening (NRS-2002 ≥3 or <3), determination of
PA (<5th or ≥ 5th percentile) and calculation of 30-day mortality
risk (PS ≥ 5% or <5%) were done within 6 days after the CT scan.
Results: Muscle index (41.8 ± 8.0 vs 47.6 ± 8.2 cm2/m2; p <
0.001) and PA (3.4 ± 1.1 vs 5.0 ± 1.2; p < 0.001) were lower in
70/180 patients with a mortality risk of ≥5%. SCT had a
sensitivity of 68.8%, a specificity of 50.0%, a positive predictive
value of 50.5% and a negative predictive value of 74.1% in the
detection of increased mortality risk. PA <5th percentile had a
sensitivity of 87.1%, a specificity of 50.0%, a positive predictive
value of 52.6% and a negative predictive value of 85.9% in the
detection of increased mortality risk. ROC characteristics
showed an AUC of 0.780 for PA <5th percentile and 0.694 for
SCT alone and 0.805 for the combination of PA <5th percentile
with NRS ≥ 3 and 0.742 for the combination of SCTwith NRS ≥ 3.
The combination of PA <5th percentile with SCT showed a
prediction accuracy of >95%.
Conclusion: Determination of phase angle <5th percentile is a
convenient non-invasive bedside method with an acceptable
sensitivity and negative predictive value to detect patients at
risk of nutrition related mortality.
Disclosure of Interest: None declared.
OR29
REDUCED INTESTINAL FADS1 GENE EXPRESSION AND PLASMA
OMEGA-3 FATTY ACIDS AFTER ROUX-EN-Y GASTRIC BYPASS
P. C. G. El-Gohary1 *, P. Calder2, P. C. Sala1, D. L. Waitzberg1.
1
Gastroenterology, University of São Paulo, São Paulo, Brazil,
2
Nutritional Immunology, University of Southampton,
Southampton, United Kingdom
Rationale: Roux-en-Y gastric bypass (RYGB) is an effective
method to treat severe obesity, enabling weight loss and
reversing type 2 diabetes mellitus (T2DM). Anatomical changes
induced by RYGB may alter the expression of gastrointestinal
genes involved in the resolution of metabolic disorders. Aside
from limiting food intake, the anatomical changes may reduce
absorption of omega-3 which may lead to deficiency in the
postoperative patient (1). Aim: To investigate the gastrointes-
tinal expression of genes involved in lipid metabolism, plasma
total lipids, and omega-3 in obese women with T2DM pre and
post RYGB.
Methods: Gastrointestinal biopsies were collected through
double-balloon endoscopy in 20 obese women (age, 46.9 ± 6.2
yr; BMI, 46.5 ± 5.3 kg/m2) before, 3 and 12 months after RYGB.
Gastrointestinal gene microarray analysis was performed on all
biopsy samples and validated by RT-qPCR and protein expres-
sion by mass spectrometry. Plasma samples were collected to
assess fatty acids by gas chromatography.
Results: FADS1 gene expression, a component of the metabolic
pathway that catalyzes biosynthesis of PUFAs, was significantly
reduced in duodenum (−0.479 fold change, p < 0.05), jejunum
(−0.116 fold change, p < 0.05) and ileum (−0.358 fold change,
p < 0.05) in obese women who underwent T2DM resolution
following RYGB. Plasma total lipids and omega-3 α-linolenic
(ALA), eicosapentaenoic (EPA) were reduced 3 months and 1
year after RYGB ( p < 0.001) compared with the pre-operative
period.
Oral communications
Conclusion: The inhibited intestinal FADS1 gene expression
after RYGB suggests a decrease in ability to synthesize bioactive
omega-3. Our data suggest that supplementation of omega-3
may be required for obese patients undergoing RYGB.
References
1. Rhee NA, et al. Effect of Roux-en-Y gastric bypass on the
distribution and hormone expression of small-intestinal enteroen-
docrine cells in obese patients with type 2 diabetes. Diab. 2015; 58
(10):2254–8.
Disclosure of Interest: None declared.
OR30
A HIGHER PROTEIN INTAKE IS NOT ASSOCIATED WITH 5-YEAR
CHANGE IN MID-THIGH MUSCLE CROSS-SECTIONAL AREA BY
COMPUTED TOMOGRAPHY IN OLDER ADULTS: THE HEALTH,
AGING, AND BODY COMPOSITION (HEALTH ABC) STUDY
A. M. Verreijen1 *, M. F. Engberink1, D. K. Houston2,
I. A. Brouwer3, P. M. Cawthon4, A. B. Newman5, F. A. Tylavsky6,
T. B. Harris7, P. J. Weijs1,8, M. Visser3,8. 1Faculty of Sports and
Nutrition, Amsterdam University of Applied Sciences,
Amsterdam, Netherlands, 2Sticht Center on Aging, Wake Forest
University School of Medicine, Winston-Salem, NC, United
States, 3Department of Health Sciences, Faculty of Earth and
Life Sciences, Vrije Universiteit Amsterdam, Amsterdam
Public Health research institute, Amsterdam, Netherlands,
4
California Pacific Medical Center Research Institute,
San Francisco, CA, 5University of Pittsburgh, Pittsburgh, PA,
6
Health Science Center, Preventive Medicine, University of
Tennessee, Memphis, TN, 7National Institute on Aging,
Bethesda, MD, United States, 8Department of Nutrition and
Dietetics, Internal Medicine, VU University Medical Center,
Amsterdam, Netherlands
Rationale: A higher protein intake is suggested to preserve
muscle mass during aging, and may therefore reduce the risk
for sarcopenia. We explored whether the amount, type
(animal/vegetable) and essential amino acid (EAA) compos-
ition of protein intake were associated with 5-year change in
mid-thigh muscle cross-sectional area (CSA) in older adults.
Methods: Protein intake was assessed at year 2 by a Block food-
frequency questionnaire in 2,597 participants of the Health ABC
study, aged 70–79 y. At year 1 and year 6 mid-thigh muscle CSA
(cm2) was measured by computed tomography. Multiple linear
regression analysis was used to examine the association between
energy adjusted protein residuals (total, animal and vegetable
protein) and muscle CSA at year 6, adjusted for muscle CSA at
year 1 and potential confounders including prevalent health
conditions, physical activity and 5-year change in fat mass. EAA
intake was expressed as percentage of total protein intake.
Results: Mean protein intake was 0.90 (SD 0.36) g/kg/d and
mean 5-year change in muscle CSA was −9.8 (17.0) cm2
(n = 1,561). No association was observed between energy
adjusted total (β = −0.00 cm2; SE = 0.03; P = 0.98), animal
(β = −0.00 cm2; SE = 0.03; P = 0.92), and plant (β = +0.07 cm2;
SE = 0.07; P = 0.291) protein intake and muscle CSA at year 6,
adjusted for baseline mid-thigh muscle area and potential
confounders. No associations were observed for the EAAs.
Conclusion: A higher total, animal or vegetable protein intake
was not associated with 5 year change in mid-thigh cross-
sectional area in older adults. This conclusion contradicts
ESPEN Best Abstracts 2017 & ESPEN Travel Awards
some, but not all previous research, therefore optimal protein
intake for older adults is currently not known.
Disclosure of Interest: None declared.
OR31
SHORT AND LONG TERM EFFECT OF ENDOSCOPIC DUODENAL
SLEEVE FOR THE TREATMENT OF DIABETES AND OBESITY
T. Engel1 *, G. Segal-Lieberman2, R. Eliakim1, M. Lahav1,
A. Lang1. 1Gastroenterolgy, 2Endocrinology, Chaim Sheba
Medical Center, Sackler School of Medicine, Tel-Aviv University,
Ramat Gan, Israel
Rationale: To evaluate the short and long term effect of
EndoBarrier, an endoscopically-delivered sleeve anchored in
the duodenum, for the treatment of diabetes and obesity in
patients with uncontrolled diabetes.
Methods: Open-label, two phase trial, 1 year with the
implanted sleeve and one year of follow up without it.
Patients with BMI over 30 and HbA1C ≥ 8 were included.
Clinical assessment and blood test were performed monthly.
We report the final results after 104 weeks follow up
Results: 45 patients underwent sleeve implantation. Early
sleeve retrieval was performed in 12 patients, out of them 8
were before 6 month follow up. Reasons for early retrieval
were: abdominal pain (n = 7), occlusion or migration (n = 3),
bleeding (n = 1), Liver abscess (n = 1). Thirty-tree patients
completed 1 year of follow up with the implanted sleeve and 22
completed the year after sleeve explant follow up. At 56
weeks, the average BMI decreased from 37.7(±4.6) at baseline
to 32.8 (Sd ± 5.07) the average EWL was 32.6% (±2.9), the
average weight loss was 13.04 Kg (±1.1). The average HbA1C
decreased from 9.4(±1.2) at baseline to 6.8 gr/dl (±1.04).
Average Insulin units requirement dropped by 54% to 34.1 units
(±6.2) and average FPG decreased by 33.7% to 128.1 mg/dl
(±35.05) indicated improvement in glucose control. At 104
weeks (n = 22), the average BMI, EWL and weight loss was 35.6
(±4.6), 14.27%(±3.8%), 6.3 kg (±1.6) respectively. Average
HbA1C was 8.4 gr/dl (±1.4) and average insulin units was 47 U
(±4.8) a 24.2% decrease compare to baseline. Average FPG was
157.8 (±12.6), a 17.1% decrease compare to baseline.
Conclusion: Endobarrier is an effective short term treatment
for weight loss and glucose control in obese patient with
uncontrolled diabetes. The effect is still apparent 1 year post
retrieval but wanes with time.
Disclosure of Interest: None declared.
OR32
TAUROLIDINE LOCKING PREVENTS CATHETER-RELATED
BLOODSTREAM INFECTIONS IN PATIENTS ON HOME
PARENTERAL NUTRITION – A RANDOMIZED CONTROLLED
TRIAL
Y. Wouters1 *, M. Theilla2, P. Singer2, S. Tribler3, P. Jeppesen3,
L. Pironi4, L. Vinter-Jensen5, H. Rasmussen5, F. Rahman6,
G. Wanten1. 1Gastroenterology and Hepatology, Radboudumc,
Nijmegen, Netherlands, 2General Intensive Care, Beilinson
Hospital, Petah Tikva, Israel, 3Medical Gastroenterology,
Copenhagen University Hospital Rigshospitalet, Copenhagen,
Denmark, 4Medical and Surgical Science, University of
S13
Bologna, Bologna, Italy, 5Gastroenterology, Aalborg University
Hospital, Aalborg, Denmark, 6Gastroenterology, University
College London Hospital, London, United Kingdom
Rationale: Both taurolidine 2% and saline 0.9% solution are
used as catheter lock solutions (CLS) to prevent catheter-
related bloodstream infections (CRBSI) in patients on home
parenteral nutrition (HPN). The optimal agent however,
remains unclear. We hypothesized that taurolidine 2% locking,
when compared with saline 0.9% locking, decreases the risk for
CRBSI in HPN patients.
Methods: This multicenter, parallel-group, double blinded trial
randomly assigned HPN patients to use either the CLS
taurolidine 2% or saline 0.9% for one year. Primary outcome
was the number of CRBSI/1,000 catheter days.
Results: Of 105 randomized patients, 102 were enrolled as
modified intention-to-treat population. With taurolidine, 5
CRBSI occurred during 15,318 catheter days. In the saline arm
18 CRBSI occurred over 12,493 catheter days. CRBSI/1,000
catheter days were 0.33 and 1.44 in the taurolidine and saline
groups, respectively (relative risk, 0.23; 95%CI, 0.07 to 0.63;
P = 0.002). The cumulative proportion of CRBSI-free patients
after one year was 88% in the taurolidine group and 49% in the
saline group (P = 0.002). The number of catheter removals due
to CRBSI was two (4%) in the taurolidine group and eight (16%)
in the saline arm (P = 0.049). The cumulative proportion of
patients without a catheter removal due to CRBSI was higher in
the taurolidine group (P = 0.025). Exit-site infection and
catheter occlusion rates were similar in both groups. Except
for occurrence of CRBSI (P = 0.002), there was no difference in
(serious) adverse events between groups. Drug-related adverse
events were rare and generally mild to moderate.
Conclusion: Taurolidine 2% decreased the risk for CRBSI by
more than four times in HPN patients compared to saline 0.9%.
Given its favorable safety profile and lack of evidence for
altering microbial susceptibility, taurolidine locking therefore
seems a key strategy to prevent CRBSI.
Disclosure of Interest: Y. Wouters Grant/Research Support from:
Financial support for study from Geistlich Pharma AG, M. Theilla Grant/
Research Support from: Financial support for study from Geistlich
Pharma AG, P. Singer Grant/Research Support from: Financial support
for study from Geistlich Pharma AG, S. Tribler Grant/Research Support
from: Financial support for study from Geistlich Pharma AG, P. Jeppesen
Grant/Research Support from: Financial support for study from
Geistlich Pharma AG, L. Pironi Grant/ Research Support from: Baxter,
B. Braun, NPS/Nycomed and Shire. Financial support for study from
Geistlich Pharma AG, Consultant for: Baxter, B. Braun, NPS/Nycomed
and Shire, L. Vinter-Jensen Grant/Research Support from: Financial
support for study from Geistlich Pharma AG, H. Rasmussen Grant/
Research Support from: Financial support for study from Geistlich
Pharma AG, F. Rahman Grant/Research Support from: Financial support
for study from Geistlich Pharma AG, G. Wanten Grant/Research Support
from: Baxter, B. Braun, and Fresenius. Financial support for study from
Geistlich Pharma AG, Consultant for: Baxter, B. Braun, and Fresenius.
S14
Oral Communication IV: Nutrition in the
Surgical Patient
OR33
RANDOMIZED CONTROLLED TRIAL OF AN ENHANCED
RECOVERY AFTER SURGERY PROTOCOL IN PATIENTS
UNDERGOING PANCREATICODUODENECTOMY
K. Takagi1 *, R. Yoshida1, T. Yagi1, Y. Umeda1, D. Nobuoka1,
T. Kuise1, T. Fujiwara1. 1Department of Gastroenterological
Surgery, Okayama University Graduate School of Medicine,
Okayama, Japan
Rationale: Evidence of the advantages of Enhanced Recovery
After Surgery (ERAS) in pancreaticoduodenectomy (PD) is
limited. The aim of this study was to examine the efficiency
of ERAS protocols in patients following PD.
Methods: Between June 2014 and October 2016, patients
undergoing PD were randomly assigned to receive ERAS
protocols (ERAS group, n = 40) or standard care (control
group, n = 40). The primary endpoint was the postoperative
length of hospital stay. Secondary endpoints were post-
operative complications, postoperative quality-of-life (QoR-
40J), readmission, and medical cost. Analysis was performed by
intention-to-treat principles.
Results: Among 80 patients who were randomized, 74 (92.5%)
completed the study. The mean hospital stay was significantly
shorter in the ERAS group than in the control group (20.1 ± 5.4
vs. 26.9 ± 13.5 days, P < 0.001). The ERAS group had a
significantly lower overall morbidity (P = 0.038) and readmis-
sion (P = 0.038). Quality-of-life was also significantly better in
the ERAS group (P = 0.022). The total medical cost was
decreased in the ERAS group, but not significantly (P = 0.085).
Conclusion: This randomized controlled trial showed that
optimization of ERAS protocols in patients undergoing PD was as
safe as standard care, and ERAS accelerated perioperative
recovery, thereby reducing hospital stay. Mortality, morbidity,
and medical costs were not increased. General implementation
of ERAS protocols during PD should be considered.
Disclosure of Interest: None declared.
OR34
HIGH-FAT ENTERAL NUTRITION ACTIVATES CHOLECYSTOKININ
RECEPTORS TO PRESERVE INTESTINAL MUCOSAL BARRIER
FUNCTION AFTER PERITONEAL AIR EXPOSURE
S. Tan1 *, G. Wu1, Q. Xi1, Q. Zhuang1, Q. Meng1, Y. Jiang1,
Y. Han1, C. Yu2, Z. Yu3, N. Li4. 1Department of Surgery,
Zhongshan Hospital, Fudan University, 2Department of
Nephrology & Rheumatology, Shanghai Tenth People’s
Hospital, Tongji University School of Medicine, 3Department of
General Surgery, Shanghai Tenth People’s Hospital, Tongji
University School of Medicine, Shanghai, 4Research Institute of
General Surgery, Jinling Hospital, Medical School of Nanjing
University, Nanjing, China
Rationale: Previous studies have shown that high-fat enteral
nutrition (EN) could reduce intestinal mucosal barrier damage
after peritoneal air exposure. However, the mechanism is still
unknown. It is suggested that high-fat EN administration could
activate cholecystokinin receptors mediated vagal anti-inflam-
matory pathway and further protect against intestinal com-
promise in critical illness. This study was to investigate the
Oral communications
involvement of cholecystokinin receptors on the protective
effects of high-fat EN on intestinal mucosal barrier function
after peritoneal air exposure.
Methods: Male adult rats underwent peritoneal air exposure for
3 hours. High-fat EN was administrated via gavage before and
after surgery, and antagonists to cholecystokinin receptors
were administrated intraperitoneally before surgery but after
preoperative high-fat EN administration. Twenty four hours
after surgery, blood and intestinal samples were collected to
assess intestinal inflammation status by analyzing intestinal
levels of tumor necrosis factor-α, interleukin (IL)-1β, and IL-6,
and to assess intestinal mucosal barrier changes in serum D-
lactate levels, intestinal permeability, and intestinal
histopathology.
Results: High-fat EN significantly reduced peritoneal air
exposure induced intestinal inflammatory response, and pre-
servered intestinal mucosal barrier function when compared to
the control group (P < 0.05). However, administration of
antagonists to cholecystokinin receptors significantly pre-
vented high-fat EN’s anti-inflammatory activity and further
offseted its protective effects on the intestinal mucosal barrier
function (P < 0.05).
Conclusion: High-fat EN could protect against intestinal
mucosal barrier damage induced by peritoneal air exposure,
and the underlying mechanism may be associated with the
activation of cholecystokinin receptors mediated vagal anti-
inflammatory pathway.
Disclosure of Interest: None declared.
OR35
IMPACT OF EARLY ENTERAL NUTRITION WITH AN
IMMUNOMODULATING DIET ENRICHED WITH HYDROLYZED
WHEY PEPTIDE ON OUTCOMES AFTER LIVER
TRANSPLANTATION
N. Kamo1 *, T. Kaido1, Y. Hamaguchi1, A. Kobayashi1, H. Shirai1,
S. Yagi1, H. Okajima1, Y. Tamai2, S. Uemoto1. 1Division of
Hepato-Biliary-Pancreatic and Transplant Surgery,
2
Department of Metabolism and Clinical Nutrition, Kyoto
University, Kyoto, Japan
Rationale: Infection is the leading cause of death after liver
transplantation (LT). Therefore, prevention of infection is
crucial to improve outcomes after LT. In the present study, we
examined the impact of early enteral nutrition with an
immunomodulating diet (IMD) enriched with hydrolyzed whey
peptide (HWP) on outcomes in patients undergoing living donor
LT (LDLT) especially focusing on postoperative infection and
sarcopenia.
Methods: Two hundred and seventy-nine patients who under-
went LDLTat our institute between January 2008 and April 2015
were enrolled. The IMD enriched with HWP and conventional
elemental diet were administered enterally to 164 (HWP group)
and 115 (control group) patients respectively within the first
24 h after surgery. Incidence of rejection and bacteremia were
compared between the two groups in all patients and according
to sarcopenia (low muscle mass). Moreover, risk factors for
posttransplant bacteremia were examined.
Results: The incidence of rejection did not differ between the
2 groups. The incidence of bacteremia was significantly lower
in HWP group (24.4%) than in the control group (41.7%)
(P = 0.002) in all patients, and higher in the sarcopenia group
Oral Communication IV: Nutrition in the Surgical Patient S15

than in the non-sarcopenia group. Absence of enteral nutrition OR37

with HWP, MELD score (≥25), ABO incompatibility, massive NURSE-INITIATED POSTOPERATIVE ENTERAL NUTRITIONAL
bleeding (≥10,000), and steroid administration were independ- INTERVENTION FOR PATIENTS UNDERGOING
ent risk factors for bacteremia. GASTROINTESTINAL OPERATIONS: A PROSPECTIVE
Conclusion: Postoperative early enteral nutrition with an IMD CONTROLLED STUDY
enriched with HWP was useful to prevent posttransplant J. W. Ho1 *, T. P. Cheng1, D. Y. Fong2, A. H. Wu3, M. W. K. Lee1,
bacteremia. C. Au-Yeung1, W. S. Kan3, C. K. Chan1, S. S. Kwok3, C. F. Lam1,
Disclosure of Interest: None declared. S. Y. Lau3, S. O. Lee1, W. S. Lau3, W. S. Leung1, L. K. Leung3,
C. K. Tam1, O. Y. Tsui3, K. Y. Wong3. 1Department of Surgery,
OR36 QUEEN MARY HOSPITAL, 2School of Nursing, The University of
INFLUENCE OF SHORT-TERM FASTING AND CARBOHYDRATE Hong Kong, 3Department of Surgery, United Christian Hospital,
ADMINISTRATION ON GUT IMMUNITY AND MUCOSAL Hong Kong, Hong Kong
MORPHOLOGY IN MICE
Rationale: Malnutrition adversely affects outcomes of GI
K. Higashizono1 *, K. Fukatsu2, A. Watkins2, M. Noguchi2, operations. Integration of enteral nutrition (EN) supplementa-
T. Watanabe2, S. Murakoshi2, H. Yasuhara2, Y. Seto1. tion into postoperative nursing care may optimize nutritional
1
Department of Gastrointestinal Surgery, Graduate School of intakes and surgical outcomes. This study assessed the
Medicine, The University of Tokyo, 2Surgical Center, The feasibility and safety of this proposed nursing intervention.
University of Tokyo Hospital, Tokyo-to, Japan Methods: Chinese adult patients undergoing GI operations
were recruited during two 9-month periods (observation and
Rationale: Carbohydrate (CHO) administration prior to surgery intervention periods) before and after education program for
is recommended in the ERAS® guideline. However, its effects on nurses in surgical wards of two acute hospitals in Hong Kong.
gut immunity remains unclear. We examined the effects of Preoperative malnutrition risk was assessed by C-MUST. During
short-term fasting and CHO administration on gut associated the intervention period, patients were given EN supplement to
lymphoid tissue (GALT) lymphocyte numbers and phenotypes, take ad libitum by nurses once oral intake were allowed.
mucosal immunoglobulin A (IgA) levels, and intestinal morph- Postoperative estimated nutritional requirement and actual
ology in mice. intakes were assessed daily.
Methods: ICR mice (n = 60) were divided into 5 groups: control Results: 578 patients (321 controls, 257 cases; 63% male; mean
(C), 12 h fasting without CHO (F), and 12 h fasting with CHO age 67.8+/−12.7 years) underwent GI resections (79% elective
administration at 2 h, 4 h, or 8 h before sacrifice(2 h, 4 h or 8 h). procedures) were recruited. According to C-MUST, 31.7% were
Then, lymphocytes were isolated from Peyer’s patches (PPLs), at high-to-moderate risk of malnutrition. The median daily
the intraepithelial spaces (IELs), and the lamina propria (LPLs) volume and total duration of EN supplement intakes by cases
of the small intestine. GALT lymphocyte numbers and pheno- were 116.7 ml (IQR 203.7 ml) and 2 days (IQR 4 days),
types (αβTCR+, γδTCR+, CD4+, CD8+, B220+) were evaluated. respectively. When compared with control group, intervention
IgA levels in respiratory and small intestinal washings were group had significantly lesser extent and shorter duration of
determined with ELISA. Morphology, proliferation and apoptosis postoperative caloric and protein deficiency before and after
of the intestinal epithelium were also evaluated. control of potential confounders (all p values ≤0.001). Nurses
Results: Data are shown below were compliant in prescribing EN supplement to eligible
patients (compliance rate >85%). No patient had aspiration
C F 2h 4h 8h pneumonia; 11 patients (4.2%) developed diarrhea after EN
6
PPLs(×10 /body) 11.8 ± 0.9 10.1 ± 0.5 10.6 ± 0.8 10.6 ± 0.9 9.7 ± 0.9 supplement and 1 patient died from unrelated causes.
IELs (×106/body) 12.0 ± 1.9 5.4 ± 0.9* 10.4 ± 1.8 6.4 ± 1.6* 7.3 ± 1.6* Conclusion: Nurse-initiated postoperative EN supplementation
LPLs (×106/body) 6.9 ± 1.3 3.3 ± 0.6* 5.8 ± 1.4 6.4 ± 1.0 4.2 ± 0.9* is feasible and safe for patients after GI resection. The reduced
Jejunal villous 499.1 ± 429.7 ± 463.4 ± 430.9 ± 424.3 ±
height (μm) 13.2 16.3* 17.0 22.8* 18.4* extent and duration of postoperative nutritional deficiency
Ileal villous 256.5 ± 9.5 230.7 ± 7.8 232.1 ±11.9 223.2 ± 6.3 241.5 ± 6.5 have the potential to improve surgical outcomes.
height (μm)
Jejunal crypt 112.4 ± 4.8 96 ± 7.7* 108.6 ± 4.7 98.6 ± 5.5* 94.2 ± 4.5*
Disclosure of Interest: None declared.
depth (μm)
Ileal crypt depth 99.5 ± 4.0 87.2 ± 4.3* 86.7 ± 3.9* 83.3 ± 3.1* 83.3 ± 3.7* OR38
(µm)
Jejunal cell 14.1 ± 0.8 9.0 ± 0.4* 13.0 ± 0.3 9.6 ± 0.5* 9.1 ± 0.4* DOES EARLY TOTAL PARENTERAL NUTRITION IMPROVE
proliferation (%) POST-OPERATIVE OUTCOME FOR INTESTINAL
Jejunal cell 1.0 ± 0.1 2.1 ± 0.4* 2.0 ± 0.2* 2.5 ± 0.3* 2.3 ± 0.2* OBSTRUCTION? – A RANDOMIZED CONTROLLED TRIAL
apoptosis (%)
V. Wong1 *, M. Y. Yung1, L. Chan1, J. Lee1, K. F. Lee1, P. Chiu1,
Mean ± SE, *P < 0.05 vs. C, ANOVA. S. Wong1, E. Ng1. 1Department of Surgery, The Chinese
University of Hong Kong, Hong Kong, Hong Kong
No significant differences in phenotypic percentages were
observed among these groups. Intestinal IgA levels tended to be Rationale: Patients suffering from intestinal obstruction also
lower in the F than in the other groups. suffers from malnutrition due to intolerance to oral intake,
Conclusion: Fasting causes rapid immunological and morpho- potentially affecting surgical outcome. This study aims to
logical atrophy in the gut. However, CHO at 2 h reverses determine whether early administration of total parenteral
partially these changes. nutrition (TPN) in patients that have received laparotomy for
Disclosure of Interest: None declared.
S16
intestinal obstruction would decrease post-operative
complications.
Methods: Single-center randomized controlled trial studying
patients or age 18 and above who received emergency
laparotomy for intestinal obstruction of all causes. Patients
who received surgery for intestinal obstruction were rando-
mized post-operatively to either the ‘TPN group’ (receiving
TPN right after operation) or the control ‘IVF group’ (receiving
plain intravenous fluids only until 7 days of fasting). Patients
with carcinomatosis, or metastatic disease and KPS less than 50
were excluded. Subjects’ baseline data, post-operative blood
test results, recovery and complication details were recorded.
Data were analysed by intention-to-treat, using the SPSS
software.
Results: From October 2013 to January 2017, 100 patients
(mean age 64.54 ± 15.32, 62 males) were randomized. These
patients are similar at baseline demographic data and pre-
operative nutritional screening. There is no significant differ-
ence in terms of recovery, surgical complications, medical
complications, or catheter-related complications. Biochemical
data showed that patients in TPN group had a significantly
higher ALP and triglyceride at post-operative days 4 and 7, but
results still lie within the normal range and pose no clinical
significance.
Conclusion: Immediate post-operative use of total parenteral
nutrition in patients suffering from intestinal obstruction that
requires emergency surgery does not decrease post-operative
complication rate, compared with its use after 7 days of fasting.
Disclosure of Interest: None declared.
OR39
CHANGES IN RESTING ENERGY EXPENDITURE IN PATIENTS
WITH EXTREME OBESITY AFTER BARIATRIC SURGERY
M. Giribes1, G. Cárdenas2 *, E. Fidilio1, M. Guerrero3,
M. Velasquez4, A. Ortiz3, D. Romero3, J. Mesa3, A. Ciudin3,
H. Segurola1, R. Burgos1. 1Nutritional Support Unit,
Universitary Hospital Vall d’Hebron, 2Nutritional Support Unit,
University Vall d’Hebron Hospital, 3Nutritional Support Unit,
4
Nutriotional Support Unit, University Hospital Vall d’Hebron,
Barcelona, Spain
Rationale: Patients with extreme obesity (EO) are very difficult
to estimate their resting energy expenditure (REE), necessary
for a correct dietary approach. Major metabolic changes occur
after bariatric surgery (BS), some of them even before
significant weight loss. The evolution of REE is unknown in
these patients. To know the changes of REE in patients with EO
by indirect calorimetry (IC) after BS. To evaluate the
correlation between REE measured by CI and the percentage
of excess weight lost (% PEW) after one and 12 months post BS.
Methods: Prospective study in patients with EO. REE was
determined by IC in 39 patients (SensorMedica Vmax).
Furthermore, in 12 cases the REE was determined also at one
month and at 12 months post BS. Statistical study SPSS 14.0.
Results: Mean age 46.5 ± 11.7 years, 25 women. BMI pre BS:
56.2 ± 5.6 kg/m2 and baseline REE: 2,320.4 ± 750.8 kcal/day.
At one month of BS the REE decreased to 1,537.6 ± 117.5 Kcal/
day ( p = 0.023 vs baseline) and remained similar at 12 months
(1,526.00 ± 123.3 Kcal/day, p = 0.682). The mean BMI at the
first month was 47.7 ± 7.5 kg/m2 and 36.2 ± 5.2 kg/m2 at 12
months with a % PEW per year of 60.38 ± 17.93%. REE at one and
Oral communications
twelve months after BS correlated inversely with initial excess
weight (r = −0.714, p = 0.047 and r = −0.681, p = 0.014,
respectively). Logistic regression analysis showed that the
predictors of PEWat 12 months post BS were patient’s age and %
PEW at one month.
Conclusion: REE in patients with EO after BS was reduced by
33% at one month in the studied patients and, despite weight
loss, this reduction remained without significant changes
during the 12-months study period. Baseline REE is not a
predictor of weight loss at one year after BS.
Disclosure of Interest: None declared.
OR40
REDUCED DUODENAL BCO1 AND RBP4 GENE EXPRESSION
AFTER ROUX-EN-Y GASTRIC BYPASS SUGGESTS A POTENTIAL
MECHANISM CONTRIBUTING FOR POSTOPERATIVE VITAMIN A
DEFICIENCY
P. Sala1, P. Garla1 *, R. S. M. M. Torrinhas1, N. M. Machado1,
D. C. Fonseca1, G. Belarmino1, M. M. Silva1, S. Barcelos1,
D. Seiva1, R. Ishida1, I. F. M. S. Guarda1, E. G. H. Moura1,
P. Sakai1, M. A. Santo1, C. C. A. Pereira2, I. D. C. G. Silva2,
S. B. Heymsfield3, D. Giannella Neto4, D. L. Waitzberg1.
1
University of São Paulo - Medical School, 2UNIFESP, São Paulo,
Brazil, 3Pennington Biomedical Research Center, Baton Rouge,
United States, 4University Nove de Julho, São Paulo, Brazil
Rationale: Roux-en-Y gastric bypass (RYGB) remains an
important treatment option for obese patients. The one year
prevalence of vitamin A deficiency after RYGB is about 11%. The
absorption of vitamin A occurs mainly in duodenum. The
protein encoded by the beta-carotene oxygenase 1 (BCO1)
gene is a key enzyme in the conversion of beta-carotene to
vitamin A. RBP4 encode a specific carrier for vitamin A,
responsible for transport vitamin A to the circulation.
Aim: To examine potential mechanisms associated with early
vitamin A deficiency after RYGB.
Methods: Intestinal biopsies were acquired through double-
balloon endoscopy in 20 obese women (age, 46.9 ± 6.2 yrs; BMI,
46.5 ± 5.3 kg/m2) before and three months after RYGB (BMI,
38.2 ± 4.2 kg/m2). Gene microarray analysis was performed in
samples using a Affymetrix Human GeneChip 1.0 ST array.
Vitamin A intake was assessed from seven-day food records
(7dR) analyzed with Virtual Nutri Plus software. Serum vitamin
A levels were evaluated by high performance liquid
chromatography.
Results: BCO1 and RBP4 gene expression were significantly
decreased in duodenum: BCO -0.455 fold change, RBP4 -0.103
fold change ( p < 0.05). There was no significant change in
vitamin A intake (783.6 ± 694.2 RE pre-op vs. 808.6 ± 752.7 RE
post-op period) both higher than the minimum value recom-
mended by the DRIs (700 RE/day).1 The patients were routinely
supplemented with 3.500 UI/day of oral vitamin A. However,
even with vitamin A supplementation, the serum concentration
was lower in the post-op period ( pre-op 0.523 ± 0.325 mg/L vs.
post-op 0.348 ± 0.135 mg/L – P < 0.05).
Conclusion: After RYGB, the conversion of beta-carotene to
vitamin A and its transporter may be impaired and could
contribute to vitamin A deficiency.
FAPESP 2011/09612-3 and Scholarship 2016/19170-1.
Oral Communication V: Paediatrics
Reference
1. Dietary Reference Intakes. Washington DC: National Academy Press,
2003.
Disclosure of Interest: None declared.
OR41
WEIGHT GAIN AND OBESITY ARE RELATED TO EATING
BEHAVIOR AND FOOD CRAVING AFTER LIVER
TRANSPLANTATION
S. C. Ferreira1, L. Anastácio2, F. Penaforte3, A. Cardoso4,
M. Silva4, A. Lima5, M. I. Correia5 *. 1Food Science Post-
Graduation Program, 2Food Department, Federal University of
Minas Gerais, Belo Horizonte, 3Nutrition Department, Federal
University of Triângulo Mineiro, Uberaba, 4Nutrition
Department, 5Surgery Department, Federal University of
Minas Gerais, Belo Horizonte, Brazil
Rationale: Excessive weight gain (WG) and obesity are frequent
in patients who have undergone liver transplantation (LTx).
Methods of assessing dietary intake failed to demonstrate an
association between these problems and dietary intake. Eating
behavior (EB) and food craving (FC) are unknown in these
patients.
Methods: Cross-sectional study. Post LTx patients and >18 y were
evaluated in relation to EB (Three Factor Eating Questionnaire-
21-TFEQ-21) and FC (Food Cravings Questionnaire (FCQ)-State
e Trait). Punctuation of TFEQ-21 for main EB [emotional eating
(EE), uncontrolled eating (UE) and cognitive restraint (CR)]
was determined. WG was assessed by the difference between
the current weight and the first post-LTx outpatient weight.
Obesity was classified as a BMI ≥ 30 kg/m2. The data were
evaluated using SPSS 17.0. Correlation between post-LTx WG,
the different EB and FC was assessed using the Pearson or
Spearman tests. The association between EB, FC and obesity
were assessed using Student’s t test or Mann-Whitney test. The
level of significance was 5%.
Results: A total of 301 patients (age of 55.1 ± 12.7 y, time since
LTx 6.6 ± 4.4 y, 64.1% men) who had as the most frequent
indications for LTx ethanolic (29.2%) and hepatitis C virus
cirrhosis (26.2%) were assessed. The observed WG was
8.1 ± 9.7 kg and the mean BMI was 26.2 ± 5.1 kg/m2. EB and FC
in relation to obesity and WG after LTx are depicted in Table 1.
Table 1: Eating behavior and food craving in relation to obesity and weight gain
after LTx.
All Obesity
No (n = 256) Yes (n = 45)
EB EU 19.4 ± 17.6 5.0(0–100) 25.0(0–70)**
CR 53.5 ± 27.5 52.3 ± 28.1 60.7 ± 23.0*
EE 16.2 ± 22.0 14.0(0–85) 16.0(0–100)**
FC FCQ-Trait 73.5 ± 25.1 68.0(39–163) 72.0 (39–128)
FCQ-Stait 33.6 ± 9.0 33.7 ± 9.0 33.0 ± 9.3
*p < 0.05;**p < 0.01.
Conclusion: Post-LTx WG was related to behavioral patterns of
UE, EE and FCQ-trait. Individuals with obesity had higher scores
of all EB than the others.
Disclosure of Interest: None declared.
S17
Oral Communication V: Paediatrics
OR42
IS THERE ANY EFFECT OF DIETARY GLYCEMIC INDEX AND LOAD
DURING PREGNANCY ON BIRTH WEIGHT OF INFANT IN WOMEN
WITH AND WITHOUT GESTATIONAL DIABETES MELLITUS?
G. Ede1 *, G. Samur1. 1Nutrition and Dietetics, Hacettepe
University, Ankara, Turkey
Rationale: Maternal diet during pregnancy, as measured by the
glycemic index (GI) and load (GL), may influence fetal growth
and infant birth weight. Maternal diet with a high GI and GL is
associated with fetal overgrowth and higher infant body
adiposity. This study aimed to examine the association
between birth weight and dietary GI, GL during pregnancy.
Methods: This study included 40 women with gestational
diabetes mellitus (GDM) diagnosed with two-step oral glucose
tolerance test and 40 healthy pregnant recruited from the
Department of Obstetrics and Gynecology of Gulhane Military
Medical Academy. Participants with polycystic ovary syndrome,
kidney disease, thyroid disease, pre-GDM, or multiple preg-
nancies were excluded. Dietary information was obtained by
mean intakes of a 3-day food record on 2 weekdays and 1
weekend day. Dietary GI and GL were calculated with food
records and International Tables of GI and GLValues: 2008.
Results: The mean maternal age was 32.1 ± 4.9 vs. 28.7 ± 4.9
years in cases and controls, respectively. Average dietary GI
(80.2 ± 9.9 vs. 62.3 ± 9.7, p < 0.05) and GL (253.8 ± 8 versus
145.0 ± 34.59, p < 0.05) were higher in the case group than in
the control group. There was a strong positive correlation
between birth weight and dietary GI (r = 0.72, p < 0.05). Mean
infant birth weight (g) was 3,448 ± 369.5 vs. 3,624 ± 443.1 in
low and high GI group ( p < 0.05), respectively. Mean infant birth
weight (g) was higher in high GL group than in low GL group
(3,568 ± 491.2 vs. 3,411 ± 144.6, p < 0.05, respectively).
Conclusion: In this study, we found a significant positive
relation between dietary GI, GL and infant birth weight.
Healthy nutritional habits and medical nutritional therapy are
feasible for preventing and management of complications
related to increased birth weight.
Disclosure of Interest: None declared.
OR43
STEROID TREATMENT, CRANIAL IRRADIATION AND RISK OF
OVERWEIGHT AFTER CHILDHOOD CANCER
Weight
Gain F. N. Belle1,2 *, R. Kasteler1, C. Schindera1, M. Bochud2,
R. A. Ammann3, N. von der Weid4, C. E. Kuehni1,5. 1Swiss
R = 0.297** Childhood Cancer Registry, Institute of Social and Preventive
R = 0.045 Medicine, University of Bern, Bern, 2Division of Chronic
R = 0.277**
R = 0.137*
Diseases, Institute of Social and Preventive Medicine,
R = 0.061 Lausanne University Hospital, Lausanne, 3Department of
Paediatrics, Inselspital, Bern University Hospital, University of
Bern, Bern, 4University Children’s Hospital Basel (UKBB),
Basel, 5Children’s University Hospital of Bern, University of
Bern, Bern, Switzerland
Rationale: Childhood cancer survivors (CCS) treated with
cranial radiation therapy (CRT) have an increased risk to
become overweight, but less is known about other treatment
effects like steroids. This study investigated the association
S18
between treatment with steroids and CRT and development of
overweight in a national cohort study of long-term CCS.
Methods: As part of the Swiss Childhood Cancer Survivor Study,
we sent a questionnaire to all Swiss resident CCS diagnosed
1976–2005 aged <21 yrs at diagnosis who had survived ≥5 yrs.
We assessed CRT (≥20 Gray) and cumulative doses of steroids
( prednisone and dexamethasone) from study protocols and
medical records and calculated BMI from self-reported heights
and weights at the time of the survey. We compared prevalence
of overweight between CCS, their siblings, and participants
from the Swiss Health Survey (SHS), a representative survey of
the general population. The association of overweight with
treatment-related risk factors was explored by ordinal multi-
variable logistic regression.
Results: The study included 2,365 CCS, 819 siblings, and 9,591
SHS participants. Mean (sd) age at survey was 24 (9), 26 (9), and
31 (9) yrs. At survey, in average 15 yrs after diagnosis (IQR 10–
21), 22% of siblings and 25% of the SHS participants were
overweight, and 23% of CCS treated with no CRT or steroids
(n = 1,068), and 25% with steroids only (n = 801). Prevalence of
overweight was higher in CCS treated with CRT (34%, n = 141),
or CRT plus steroids (47%, n = 102), p < 0.001. After age and
gender adjustment, overweight was not associated with
steroids only (OR = 1.1, 95% 0.9; 1.4, 4,963 ± 4,340 mg/m2),
but with CRT only (1.8, 1.2; 2.6), and both steroids and CRT
(2.2, 1.4; 3.3, 6,382 ± 5,043 mg/m2), compared to those CCS
who did not get steroids and CRT.
Conclusion: Long-term CCS treated with CRT only, or CRT plus
steroids were at increased risk of being overweight 15 yrs after
diagnosis compared to peers.
Disclosure of Interest: None declared.
OR44
IRON DEFICIENCY ANEMIA IN CHILDREN IN HOME PARENTERAL
NUTRITION PROGRAMME
A. Zyla-Pawlak1 *, M. Danko2, K. Popińska1, M. Sibilska1,
K. Olszewska1, J. Żydak1, J. Książyk1. 1The Children’s Memorial
Health Institute, Warsaw, 2The Children’s Memorial Health
Institute, Warszawa, Poland
Rationale: The intravenous trace elements formulations
available for children in Poland are Peditrace(Fresenius-
Kabi®) which does not contain iron and Addamel(Fresenius-
Kabi®) which contains 2 µg Fe/ml but is registered for children
with body weight >15 kg.
The aim of the study was to assess iron deficiency anemia in
children on long-term parenteral nutrition.
Methods: 24 children (age 5–168 months, median 34 months) on
long-term parenteral nutrition were included into the study. 16
patients were additionally supplemented with oral iron
formulation. All patients received Peditrace as an intravenous
trace elements formulation. Laboratory parameters of RBC,
haemoglobin, ferritin and iron concentration, MCV, MCH, MCHC
and TIBC, were analyzed using Mann-Whitney test and
Spearman correlation.
Results: The prevalence of anemia in the whole group was
41,6%(10 out of 24) and was the highest in the group of children
older than 2 years– 61,5%(8 out of 13). Only 2(18%) children out
of 11 below the age of two had haemoglobin concentration
lower than normal for the age. In children <2 y.o. with short
bowel syndrome the length of remnant small intestine was
Oral communications
significantly longer than in older patients ( p < 0.05). The
median iron and ferritin concentration was very low in the
whole group of patients – 41 µg/dl (range 18–147) and 19,2 ng/
ml (range 3–253) respectively. Iron and ferritin concentration
was significantly correlated with MCV, MCH, RBC and TIBC
especially in group of the youngest children(<2 y.o. – p < 0,05).
In group of patients who recived oral iron supplementation we
did not observe an improvement of anemia and iron status but
the doses of iron administered were low (median 1,9 mg/kg/d).
Conclusion: Iron deficiency anemia is common in children on
long term parenteral nutrition, especially in those who are
older than 24 months. The supplementation of iron with low
doses of oral formulations is not efficient in these patients.
Disclosure of Interest: None declared.
OR45
DOES FOOD INSULIN INDEX IN THE CONTEXT OF MIXED MEALS
AFFECT METABOLIC PARAMETERS IN OBESE ADOLESCENTS?
Z. Caferoglu1 *, N. Hatipoglu2, H. Gokmen Ozel3. 1Department
of Nutrition and Dietetics, Erciyes University Faculty of Health
Science, 2Department of Pediatric Endocrinology, Erciyes
University Faculty of Medicine, Kayseri, 3Department of
Nutrition and Dietetics, Hacettepe University Faculty of
Health Science, Ankara, Turkey
Rationale: The food insulin index (FII) is a more accurate
predictor of postprandial insulin responses to composite meals
than carbohydrate content in both healthy and obese subjects.
This study aimed to compare the postprandial glucose, insulin
and c-peptide responses to two nutrient-matched meals either
high or low FII in obese adolescents with insulin resistance (IR).
Methods: A randomized crossover trial included 15 obese
adolescents aged 12–18 years (median = 15 years) with IR. All
participants were submitted two different breakfasts: low
glycemic index, low insulin index (LGI-LII) and low glycemic
index, high insulin index (LGI-HII), with a 1-week washout
period between meals. The two meals were matched for
energy, macronutrients and GI but had a 2-fold difference in II.
At time 0 ( just before breakfast), 15, 30, 45, 60, 90, 120, 180
and 240 minutes after the meal, serum glucose, insulin and c-
peptide levels were measured. Postprandial responses were
quantified as area under the curve, which was calculated
according to the trapezoidal rule. Student’s 2-tailed t test for
paired data was applied to determine statistical differences
between the meals.
Results: Early (0–30 min) postprandial glucose and C-peptide
responses were found similar after LGI-LII and LGI-HII meals
( p > 0.05). Similarly, there was not a difference between LGI-LII
and LGI-HII meals in late (45–240 min) and total (0–240 min)
postprandial glucose and C-peptide responses. However, early
postprandial insulin response was lower by 40.1% after LGI-LII
meal vs LGI-HII meal ( p = 0.003). Also, late and total
postprandial insulin responses were lower by 23.9% and 25.1%
after LGI-LII meal vs LGI-HII meal ( p = 0.007 and p = 0.008,
respectively).
Conclusion: The calculating FII of meals or diets may be a
useful approach for reducing postprandial hyperinsulinemia in
obese adolescents, thereby potentially improving IR and
preventing from type 2 diabetes.
Disclosure of Interest: None declared.
Oral Communication V: Paediatrics
OR46
ESPEN SURVEY ON CHRONIC INTESTINAL FAILURE (CIF) IN
CHILDREN
L. Pironi1 *, on behalf of Home Artificial Nutrition & Chronic
Intestinal Failure Special Interest Group of ESPEN. 1University
of Bologna, Bologna, Italy
Rationale: To investigate the current clinical feature of CIF and
HPN management in children (age < 18 yr), a cross sectional
international multicenter study was carried out using the
structured database devised for the ESPEN ‘CIF Action Day’.
Methods: Seventeen pediatric centers from Croatia, Finland,
France, Israel, Italy, The Netherlands and United Kingdom
enrolled all the patients who were on home parenteral
nutrition (HPN) for CIF on March 1st 2016. Anagraphic and
anthropometric data, CIF mechanism, underlying disease, HPN
characteristics were recorded. HPN provider was categorized
as by health care system local pharmacy (LP) or by home care
company (HCC). Intravenous supplementation (IVS) type was
categorized as fluids and electrolytes alone (FE) or parenteral
nutrition admixture either commercially premixed (PA) or
customized to the individual patient (CA). Statistics: median,
Spearman regression.
Results: A total of 428 patients were included: females 41%,
age 5.1 yrs (<1, 8%; 2–5, 41%; 5–10, 23%; >10, 28%), HPN
duration 37 mos (<12, 20%; 12–36, 29%; 36–60, 17%; 60–120,
21%; >120, 14%), body weight (BW) 17 kg and height 104 cm.
Pathophysiological mechanism of CIF: short bowel 51% (with
end-jejunostomy 16%); dysmotility 21%, mucosal disease 24%,
mechanical occlusion 4%. HPN provider: LP 56%, HCC 44%. IVS
type: PA 12%, CA 88%. Days of IVS, 5/week. IVS volume, 60 mL/
kg BW. IVS energy, 50 kcal/kg BW. Correlation between IVS vol/
kg and energy/kg, r = 0.81 (P < 0.001).
Conclusion: The spectrum of CIF in children observed by this
multicenter survey is similar to those previously described by
individual center cohorts. HPN characteristics shows that an
IVS-admixture customized to the individual patient is used in
almost all the cases. The good correlation between IVS fluid
and energy requirements suggest that either the one or the
other can be used to devise a clinical classification of CIF such
as in adults [1].
Reference
1. Clinical Nutrition 34 (2015) 171–180.
Disclosure of Interest: None declared.
OR47
NUCLEAR TOMOGRAPHIC IMAGING AND NUTRITIONAL
REHABILITATION FOR CEREBRAL FUNCTIONS FOLLOW UP IN
KWASHIORKOR
E. R. Abdelhamid1 *, S. Y. Shaaban2, R. G. Helal1,
Y. G. El-gendy2, L. F. Matta3, H. M. Elshakankiry4, A. Bayoumy4.
1
Child Health Department, National Research Center,
2
Pediatrics Department, 3Radiotherapy Department,
4
Pediatrics, Ain Shams University, Cairo, Egypt
Rationale: Kwashiorkor represents a group of related disorders
known as protein-energy malnutrition (PEM), it is associated
with cerebral changes which consequently would give rise to
intellectual and developmental delay. The present study seeks
S19
to define and document cerebral changes and abnormalities in
a sample of infants with kwashiorkor using brain imaging.
Methods: Prospective cohort study included 20 infants had
admitted to the children hospital Ain Shams University, Cairo,
Egypt for the treatment of Kwashiorkor aged 4–18 months
compared to 5 normal weight matched age infants as a control.
Clinical assessment, laboratory investigation, brain computed
tomography and 99m-HMPAO brain SPECT was done for all
infants twice; first on admission and repeated after 10–12
weeks of nutritional rehabilitation.
Results: Most infants with moderate disease and all infants
with severe disease showed significant cerebral changes and
hypoperfusion in certain areas of the brain, which significantly
resolved after nutritional rehabilitation in all infants except
one with sever disease. A positive correlation was found
between severity of the disease and extent of cerebral
hypoperfusion.
Conclusion: Kwashiorkor is associated with cerebral atrophy
and impaired dynamic functional activity of the brain that may
be detrimental to intellectual development; brain SPECT is
more accurate in assessing deleterious effect of PEM on growing
brain.
Disclosure of Interest: None declared.
OR48
NONALCOHOLIC FATTY LIVER DISEASE IN CHILDREN WITH
EXCESS OF WEIGHT
R. Blais1, A. Lienhardt-Roussie1, P. Fayemendy2,3,4,
J. C. Desport2,3,4,5 *, P. Jésus2,3,4,5. 1Pediatric Department,
2
Nutrition Unit, University Hospital of Limoges, 3INSERM,
U1094, Tropical Neuroepidemiology, School of Medicine,
4
UMR_S 1094, Tropical Neuroepidemiology, Institute of
Neuroepidemiology and Tropical Neurology, CNRS FR 3503
GEIST, University of Limoges, 5Specialized Center of Obesity of
Limousin, University Hospital of Limoges, Limoges, France
Rationale: Obesity in children is a public health problem.
Obesity can be complicated by liver damage. The aim of our
study was to investigate the nonalcoholic fatty liver disease
(NAFLD) in children with excess of weight and factors
associated with NAFLD.
Methods: Children with overweight and obesity had measures
of body mass index (BMI), waist circumference (WC), blood
pressure (BP), fasting serum glucose and lipids (total choles-
terol, HDL-c, LDL-c and triglycerides) and hepatic function
(ASAT, ALAT, γGT). The NAFLD was researched with ultrasound
and predictive score of NAFLD was calculated : hepatic
steatosis index (HSI). Metabolic syndrome was diagnosed with
WC, BP, serum glucose, HDL-c and triglycerides. Statistical
analysis used Student’s t tests, Chi2 and logistic regression.
Results: Seventy-six children were included, 46% of males with
a mean age of 11.3 ± 3.4 years. The mean BMI was of
29.1 ± 5.9 kg/m2 and 77.6% of children were obese. The
serum glucose and lipid levels were no different between
overweight and obese children. In contrast, the ALAT/ASATratio
was higher in obese (1.0 ± 0.4 vs. 0.8 ± 0.3, p = 0.02). The HSI
score was higher in obese (40.0 ± 7.0 vs. 30.2 ± 6.8, p < 0.0001).
With ultrasound NAFLD was found in 38.2%, 43.4% in obesity.
Metabolic syndrome was found in 50.0% in children with NAFLD.
The HSI was positive in 92.0% in children with NAFLD. WC
(OR = 1.09 [95% CI: 1.09–1.16]; p = 0.0034), systolic BP
S20
(OR = 1.06 [95% CI: 1.01–1.12]; p = 0.03) and triglycerides
(OR = 1.03 [95% CI 1.001–1.05]; p = 0.016) were positively
associated with NAFLD.
Conclusion: Over one third of children had a NAFLD. NAFLD was
two time more present in obesity. Criteria of metabolic
syndrome (WC, systolic BP and triglyceride) were positively
associated with NAFLD. Considering the risk of progression, it
seems essential to follow these children mainly in case of
obesity with metabolic syndrome and continue this follow up in
adulthood.
Disclosure of Interest: None declared.
OR49
COST STUDY OF THE MULTICENTER RANDOMIZED
CONTROLLED TRIAL ‘EARLY VERSUS LATE PARENTERAL
NUTRITION IN CRITICALLY ILL CHILDREN’
E. Van Puffelen1 *, S. Polinder2, I. Vanhorebeek3, P. J. Wouters3,
N. Bossche4, G. Peers5, S. Verstraete3, K. F. Joosten1,
G. Van den Berghe3, S. C. Verbruggen1, D. Mesotten3. 1Pediatric
and Pediatric Surgery, 2Public Health, ERASMUS MC,
Rotterdam, Netherlands, 3Cellular and Molecular Medicine, KU
Leuven, Leuven, Belgium, 4Control and Compliance, ERASMUS
MC, Rotterdam, Netherlands, 5Medical Administration,
University Hospitals Leuven, Leuven, Belgium
Rationale: The multicenter randomized controlled trial ‘early
versus late parenteral nutrition in critically ill children
(PEPaNIC)’ showed that omitting parenteral nutrition (PN)
during the first week in critically ill children was clinically
superior to providing early PN. This study describes the direct
medical costs of early versus late PN from a hospital
perspective in an international context, provides a detailed
insight into the distribution of cost components, and assesses
the impact of acquiring a new infection on hospital costs.
Methods: The direct medical costs were calculated, using a
micro-costing approach. We compared the mean costs of late
PN (n = 673) with those of early PN (n = 670) in the Belgian and
Dutch patients, aged 0–17 years. Costs were divided into 10 cost
categories (PICU hospitalization, post-PICU hospitalization,
PN, medication, laboratory diagnostics, other diagnostics,
ventilator support, renal replacement therapy and mechanical
hemodynamic support, surgery, and consultations). Main cost
drivers were identified and the impact of new infections on the
total costs was explored.
Results: Mean direct medical costs of patients receiving late PN
(€26.680) were 21% lower (€-7.180, p = 0.003) than of patients
receiving early PN (€33.860). The costs for PN contributed only
2.1% in the total cost reduction. Main cost driver was PICU
hospitalization costs (€-4.120, p = 0.003). The 14% patients who
acquired a new infection were responsible for 41% of the costs.
The incremental cost-effectiveness ratio was €-96.480 per
prevented new infection, meaning that late PN is more
effective and less costly than early PN and thus highly cost-
effective.
Conclusion: Late initiation of PN decreased the direct medical
costs in critically ill children, beyond the expected lower costs
for PN during the first week. Avoiding new infections yielded a
large cost reduction.
Disclosure of Interest: None declared.
Oral communications
OR50
OVERWEIGHT IN CHILDHOOD CANCER PATIENTS AT
DIAGNOSIS AND THROUGHOUT THERAPY: A MULTICENTRE
COHORT STUDY
F. N. Belle1,2 *, J. Wenke-Zobler3, E. Cignacco3, R. A. Ammann4,
C. E. Kuehni2,5, K. Zimmermann3,6. 1Division of Chronic
Diseases, Institute of Social and Preventive Medicine,
Lausanne University Hospital, Lausanne, 2Swiss Childhood
Cancer Registry, Institute of Social and Preventive Medicine,
University of Bern, Bern, 3Nursing Science (INS), Department
Public Health (DPH), Faculty of Medicine, University of
Basel, Basel, 4Department of Paediatrics, Inselspital, Bern
University Hospital, 5Children’s University Hospital of Bern,
University of Bern, Bern, 6Children’s Research Center,
University Children’s Hospital of Zurich, University of Zurich,
Zurich, Switzerland
Rationale: Some childhood cancer patients (CCP) have
been reported to be at increased risk of becoming
overweight during treatment. We assessed prevalence of
overweight in CCP at diagnosis and at the end of treatment,
identified weight change during treatment by type of cancer,
and determined risk factors for being overweight at end of
treatment.
Methods: In a multicentre cohort study, we collected
height and weight measurements of CCP at diagnosis and
repeatedly during treatment. We calculated age and sex
adjusted BMI z-scores using International references of the
International Obesity Taskforce for children. Weight change
during treatment was described by segmented linear regres-
sion, and risk factors for overweight by multivariable logistic
regression.
Results: The study included 327 CCP with a median age of 7
years (IQR 3–12) at diagnosis (55% males). Diagnoses included
acute lymphoblastic leukaemia (ALL, 29%), lymphoma (16%),
central nervous system (CNS) tumours (13%), sarcoma (18%),
and other types of cancer (24%). At diagnosis, 27 CCP (8%)
were overweight. This increased to 43 (13%) at end of
treatment in average 0.7 years after diagnosis (IQR 0.4–1.8).
In ALL and lymphoma patients BMI z-scores increased
continuously during treatment (coef= 0.3, 95% CI 0.2; 0.3,
p < 0.001). In older patients (≥10 years at diagnosis) BMI-Z-
score dropped shortly after diagnosis (coef = −5.2, 95% CI
−9.1; −1.2, p = 0.011) after which an increase was seen. In
patients diagnosed with CNS tumours and sarcoma BMI z-
scores dropped during the first months after diagnosis, but
increased afterwards (all p < 0.05). Body mass index at
diagnosis was the strongest predictor of overweight at end
of treatment (OR = 50, 95% CI 16–155).
Conclusion: CCP diagnosed with ALL or lymphoma, and
those who are overweight at diagnosis are at increased risk of
weight gain during treatment, and might need special
attention.
Disclosure of Interest: None declared.
Oral Communication VI: Liver, Gastrointestinal Tract and Cancer
Oral Communication VI: Liver,
Gastrointestinal Tract and Cancer
OR51
SHORT-TERM OUTCOME OF PATIENTS ON HOME PARENTERAL
NUTRITION (HPN) FOR CHRONIC INTESTINAL FAILURE (CIF)
L. Pironi1 *,
on behalf of Home Artificial Nutrition & Chronic Intestinal
Failure Special Interest Group of ESPEN. 1University of Bologna,
Bologna, Italy
Rationale: To investigate the clinical predictive factors for
short-term outcome on HPN for CIF, a one year prospective
international multicenter study was carried out using the
structured database devised for the ESPEN ‘CIF Action Day’.
Methods: In March 2015, 65 centers enrolled 3,239 adult
patients (benign disease 90%, cancer 10%), recording
anagraphic data, body mass index (BMI), CIF mechanism,
underlying disease, intravenous supplementation (IVS)
characteristics. Patient outcome on March 2016 was classified
as still on HPN (stillHPN), weaned off HPN (WEA) or deceased
(DEC) and was analyzed for the following factors: patient age
and BMI categories, HPN-duration categories, CIF pathophysio-
logical mechanisms and IVS. IVS was classified as fluid and
electrolyte alone (FE) or parenteral nutrition (PN). PN was
categorized by daily volume: <1, 1–2, 2–3, >3 L/day. Statistics:
nominal regression analysis to investigate factors independ-
ently associated with probability of WEA or DEC.
Results: One year outcome was available for 2,221 benign and
302 cancer CIF. In benign (%): stillHPN 77, WEA 13, DEC 8, lost
2. In cancer (%): stillHPN 41, WEA 15, DEC 41, lost 3.
In benign CIF, WEA probability was negatively associated with
age ( p < 0.002) and duration of HPN ( p < 0.001) and positively
with BMI ( p < 0.001) and PN < 1 L/day ( p < 0.003), whereas DEC
probability was negatively associated with BMI ( p < 0.048),
duration of HPN ( p < 0.001) and FE ( p < 0.021) and positively
with age ( p < 0.001).
In cancer CIF, WEA probability was negatively associated with
duration of HPN ( p < 0.001) and DEC probability was negatively
associated with BMI ( p < 0.004), duration of HPN ( p < 0.001)
and PN < 1 L/day ( p < 0.004).
Conclusion: The results indicate that in patients on HPN for CIF,
patient age and BMI, duration of the ongoing HPN and IVS
characteristics are independent predictive factors for short-
term probability of intestinal rehabilitation and of risk of
death.
Disclosure of Interest: None declared.
OR52
RESTRICTED VS UNRESTRICTED ORAL INTAKE IN HIGH
OUTPUT END JEJUNOSTOMY SYNDROME PATIENTS
J. Sobocki1 *, P. Jurczak1, K. Lachowicz1, K. Majewska1.
1
Department of General Surgery and Clinical Nutrition,
Medical University of Warsaw, Warsaw, Poland
Rationale: There is a different approach to high output end
jejunostomy syndrome patients with regard to oral intake.
Some centers arguing that restriction of oral intake is
unacceptable for patient and patient should be allowed to
eat ad libitum. The aim of the study is to estimate result of two
S21
approaches: restricted and unrestricted oral intake in this
group of patients
Methods: Twenty patients were involved into the study (2015
and 2016 yr) and divided into two groups according to their
preference: A – oral intake restricted to keep stoma output
under 1,000 ml, B- unrestricted oral intake. The following
parameters were evaluated: output, self-estimation of condi-
tion, body weight gain in 6 months, bilirubin, creatinine,
number of hospitalizations prior to surgery, need to empty
ostomy bag at nighttime, filing of hunger and thirst in the
daytime, time to reconstructive surgery.
Results: Patients in group B experienced lower quality of life
(QoL) and more HPN complications
A B
No of pts 10 10
M/F 6/4 5/5
Ostomy output at admission to clinic (ml) 3,500 3,200
Ostomy output in 1st month on HPN (ml) 850 2,800
Nil per os (no of patients) 5 0
Volume of HPN (ml) 3,150 4,850
Need for empty ostomy bag at nighttime (times) 0 1,8 (2–5)
Filling of thirst or hunger in the daytime +/− +++
Weakness (self estimation) − +++
Wait gain in 6th month on HPN (kg) 5,5 2,1
Bilirubin in 6th month on HPN (mg%) 1,3 2,8
Creatinine in 6th month on HPN (mg%) 0,9 3,4
No of hospitalizations prior to surgery 0,5 3,2
Deaths before surgery qualification 0 1
Time to surgery (months) 7,5 22,1
Conclusion: Restricted oral intake seems to be more effective
for prevention of HPN complications and shortening of time to
surgery. Oral intake increase stoma output, does not reduce
hunger or thirst, but alters QoL. Psychological support for these
patients is crucial to reach nutritional goals.
Disclosure of Interest: None declared.
OR53
A MULTICENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-
CONTROLLED TRIAL OF EXTRACT OF HERBAL MEDICINE
DAIKENCHUTO TO PREVENT BOWEL DYSFUNCTION AFTER
ADULT LIVER TRANSPLANTATION
T. Kaido1 *, M. Yamamoto2, S. Morita2, S. Uemoto1,
on behalf of DKB 14 study group. 1Hepato-Biliary-Pancreatic
and Transplant Surgery, Kyoto University, 2Advancement of
Clinical and Translational Science, Kyoto University Hospital,
Kyoto, Japan
Rationale: Postoperative early oral or enteral intake is a crucial
element of the Enhanced Recovery After Surgery (ERAS)
protocol. However, normal food intake or enteral feeding
cannot be started when a patient has bowel dysfunction,
especially after liver transplantation (LT). Therefore, we
conducted a multicenter, randomized, double-blind, placebo-
controlled trial to determine the enhancement effects of
Daikenchuto (DKT) upon oral/enteral caloric intake in patients
undergoing LT (UMIN000014326).
Methods: One hundred and twelve patients undergoing LTat 14
leading Japanese centers were enrolled. Patients were
randomly assigned to receive either DKT (15.0 g/day) or
matching placebo from postoperative day (POD) 1 to 14.
S22
Primary endpoints were total oral/enteral caloric intake,
abdominal distension and pain on POD 7. Secondary endpoints
included sequential changes of total oral/enteral caloric intake
after LT, numeric rating scales for abdominal distention and
pain, portal venous flow and speed to the graft and so on.
Results: A total of 104 patients (DKT, n = 55; placebo, n = 49)
were included and evaluated in the statistical analysis. There
were no significant differences between the two groups in
terms of primary endpoints. However, postoperative total
oral/enteral calorie intake was significantly accelerated in
the DKT group than in the placebo group ( p = 0.023).
Moreover, portal venous flow (POD 10, 14) and speed (POD
14) were significantly higher in the DKT group compared
with the placebo group ( p = 0.047, p = 0.025, p = 0.014,
respectively).
Conclusion: Postoperative administration of DKT effectively
enhances total oral/enteral calorie intake after LT and would
contribute to performance of ERAS.
Disclosure of Interest: T. Kaido Grant/Research Support from: Tsumura
& Co., Tokyo, Japan, M. Yamamoto Grant/Research Support from:
Tsumura & Co., Tokyo, Japan, S. Morita Grant/Research Support from:
Tsumura & Co., Tokyo, Japan, S. Uemoto Grant/Research Support from:
Tsumura & Co., Tokyo, Japan.
OR54
EFFECTS OF FIBERS DERIVED FROM CEREALS IN THE
MODULATION OF INFLAMMATION INDUCED BY AN OVER-
CONSUMPTION OF FRUCTOSE: IMPLICATION OF THE GUT
MICROBIOTA
F. Suriano1 *, A. Neyrinck1, J. Verspreet2, C. Courtin2, P. Cani1,
L. Bindels1, N. Delzenne1. 1LDRI-Metabolism and Nutrition
Research Group, Université catolique de Louvain, Brussels,
2
Laboratory of Food Chemistry and Biochemistry, Leuven Food
Science and Nutrition Research Center (LFoRCe), KU Leuven,
Leuven, Belgium
Rationale: The prevalence of non-alcoholic fatty liver disease
(NAFLD) has increased in parallel to a rapid rise in fructose
consumption. In this study we evaluated the effects of two
wheat fractions characterized by different particle size on
hepatic inflammation induced by fructose, in relationship with
their potential effect on the gut microbiota.
Methods: Mice were divided in 4 groups (n = 6/group) receiving
a control diet (CT), a CT diet plus fructose 30% w/v in the
drinking water (F), a CT diet supplemented with 5% of crude
wheat bran plus 30% fructose in water (normal particle size
1,690 µm, F + WB; WB with small particle size 150 µm, F + WBs)
for 8 weeks.
Results: Fructose supplementation significantly increased the
expression -at the mRNA level- of key inflammatory genes
(MCP-1, TNFα, TLR2) and macrophage-related markers (CD11c)
in the liver compared to the CT group. Neither fructose nor WB
fractions significantly modified the expression of markers of
inflammation, intestinal immune function or barrier function in
the ileum and colon. WBs was the sole fraction to reduce
hepatic (mRNA) and systemic ( protein-multiplex immunoassay)
markers of inflammation (IL1β, IL6, IL10, IFNγ, MCP1, TNFα).
Moreover, gut microbiota analyses (qPCR of 16SrDNA) revealed
that both wheat bran fractions differently affected the gut
microbiota. WB increased Akkermansia muciniphila caecal
level, whereas only WBs significantly counteracted the
Oral communications
increase in Enterobacteriaceae induced by fructose.
Enterobacteriaceae were positively correlated (r = 0.55 p =
0.008) with the hepatic expression of MCP1.
Conclusion: Our findings suggest that the different effect of
WB and WBs on hepatic inflammation could be attributed to the
different impact exerted on the gut microbiota. It is worth
noticing that, reducing Enterobacteriaceae levels may reflect
the anti-inflammatory properties of WBs.
Disclosure of Interest: None declared.
OR55
DISTURBED ENTEROHEPATIC BILE SALT SIGNALING IN
INTENSIVE CARE PATIENTS WITH DIARRHEA
R. van Gassel1,2,3 *, F. Schaap1,3, K. Koelfat1,3, M. Baggerman2,
M. Bol2, G. Nicolaes4, D. Beurskens4, M. van de Poll1,2,3,
S. Olde Damink1,3. 1NUTRIM School of Nutrition and
Translational Research in Metabolism, Maastricht University,
2
Intensive Care Medicine, 3General Surgery, Maastricht
University Medical Centre, 4Biochemistry, CARIM
Cardiovascular Research Institute Maastricht, Maastricht
University, Maastricht, Netherlands
Rationale: Diarrhea occurs in over 60% of critically ill patients
admitted to the intensive care unit for 7 days or more and is an
independent risk factor for cholestatic liver injury. We
hypothesize that diarrhea disturbs the enterohepatic circula-
tion of bile salts, potentially contributing to the development
of liver injury.
Methods: We investigated plasma levels of bile salts, FGF19 (a
bile salt-induced gut hormone controlling hepatic bile salt
synthesis) and C4 (a marker of bile salt synthesis) in critically ill
patients. Following inclusion, allocation to the diarrhea group
(N = 12) or no diarrhea group (N = 18) was based on 24 hour fecal
production ≥350 mg/day. Data were tested for normality and
are presented as median [IQR] or mean ± SD. Mann-Whitney or
t-tests were used as appropriate to test for statistical
significance.
Results: Decreased FGF-19 levels were observed in the
diarrhea group (0.20 ± 0.12 vs. 0.29 ± 0.10 ng/mL, p = 0.03)
indicating disturbed enterohepatic signaling. Plasma bile salt
levels were increased in patients with diarrhea (9.8 [5.0–23.9]
vs. 4.5 [2.9–7.4] µmol/L, p = 0.01]), while C4 levels were not
different between the two groups (6.8 ± 4.0 vs. 6.4 ± 3.6 ng/
ml, p = 0.77). Bilirubin, alkaline phosphatase (ALP) and
gamma-GT levels also were not different between the two
groups.
Conclusion: Diarrhea in critical illness disturbs the normal
enterohepatic circulation of bile salts, as evidenced by reduced
plasma levels of FGF-19. There was no anticipated elevation of
plasma C4 levels, suggesting that hepatic bile salt synthesis is
not increased in patients with diarrhea. Furthermore,
increased systemic bile salt levels suggest that hepatic
uptake is affected in critically ill patients with diarrhea. The
consequences of these disturbances in bile salt signaling and
their relation gut function and cholestatic liver injury during
critical illness requires further investigation.
Disclosure of Interest: None declared.
Oral Communication VI: Liver, Gastrointestinal Tract and Cancer
OR56
EARLY PER ORAL FOOD INTAKE DOES NOT INCREASE
THE INCIDENCE OF COMPLICATIONS AFTER
PANCREATODUODENECTOMY
M. Bezmarevic1 *, M. Panisic-Sekeljic1, A. Popadic2,
I. Soldatovic3, M. Mitrovic1, D. Mirkovic1. 1Clinic for General
Surgery, 2Clinic of Anesthesiology and Intensive Care, Military
Medical Academy, 3Institute of Statistic and Informatics,
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Rationale: Pancreatoduodenectomy (PD) is associated with
significant incidence of morbidity, including postoperative
pancreatic and biliary fistula (POPF and POBF), delayed
gastric emptying (DGE), and other major and minor surgical
and general complications which affecting the need for
nutritional support and prolonged hospital stay. The reluctance
to initiate early oral feeding arises from the fear of an increased
risk for postoperative complications.
Methods: The prospective observational study included 72
patients underwent PD due to pancreatic cancer. Patients were
divided into 2 groups regarding introduction of per oral food
intake (A from 3–5 and B >5 postoperative day). The groups were
compared in relation to the occurrence of POPF, POBF, DGE and
the Clavien-Dindo grade. ations.
Results: Group A included 24 (33%), and group B included 48
(67%) patients. POPF (grade A to C) occurred in 15 (20%)
patients. POBF occurred in 6 (8%) patients. DGE was present in
16 (22%) patients. POPF had 5 (21%) patients in group A and 10
(21%) patients in group B, ( p = 1). POBF had 0 patients in group
A and 6 (12%) patients in group B, ( p = 0.17). DGE had one (4%)
patient in group A and 15 (31%) patients in group B, ( p = 0.001).
Clavien-Dindo grade ≥3 had 4 (17%) patients in group A and 21
(44%) patients, ( p = 0.001). The presence of Clavien-Dindo
grade ≥3 was associate with delayed introduction of per oral
food intake ( p = 0.009). Significant correlation between
Clavien-Dindo grade and time of the introduction of per oral
food intake was found ( p < 0.001).
Conclusion: Early introduction of per oral food intake in
patients after PD has no impact on POPF and POBP occurrence,
but delayed introduction of per oral food intake is associate
with the presence of DGE and Clavien-Dindo grade ≥3.
Disclosure of Interest: None declared.
OR57
CITRULLINE, AN EARLY PREDICTIVE MARKER OF HIGH-GRADE
ACUTE GRAFT-VERSUS-HOST DISEASE
T. Hueso1 *, M. Joncquel Chevalier Curt2, J. Gauthier3,
B. Carpentier3, R. Dulery4, I. Yakoub-Agha3, D. Seguy5. 1LIRIC
UMR 995, 2Department of Biochemistry, 3Stem Cell
Transplantation Department, CHR Lille, Lille, 4Stem Cell
Transplantation Department, Saint Antoine Hospital, Paris,
5
Department of Nutrition, CHR Lille, Lille, France
Rationale: Acute graft-versus-host disease (GVH) is the main
complication within the 3 months following allogeneic hem-
atopoietic stem-cell transplantation (allo-SCT). Over 70% of
patients who develop high-grade intestinal GVH (Grade III-IV)
die within 6 months from allo-SCT. To date, risk factors are well
known but no accessible biomarker suitable to predict GVH III-
IV before allo-SCT is available. We investigated citrulline, an
S23
amino-acid reflecting enterocyte health, in patients before
allo-SCT procedure.
Methods: Plasma citrulline levels were assessed by high
performance liquid chromatography combined with mass
spectrometry. Characteristics of hematological malignancy,
previous chemotherapies, and allo-SCT procedure were
noticed. The incidence of GVH, non-relapse mortality (NRM)
and overall survival (OS) at 2 years after transplantation were
also recorded. Patients with GVH III-IV were compared to those
with GVH 0-II according to citrulline levels.
Results: Between 2013 and 2015, 192 patients were included.
Thirty-eight patients developed GVH III-IV and 154 did not (GVH
0-II). Mortality at 2 years was 37%, 26%, 34%, 65% and 96% from
grade 0 to grade IV, respectively. Citrulline (mean ± SE, μmoL/
L) was lower in the GVH grade III-IV group (24 ± 8) compared to
the GVH 0-II group (29 ± 9), p = 0.0004. To discriminate both
groups, a citrulline threshold (26 μmoL/L) was determined
using ROC procedure (AUC = 0.68; p = 0.0006). Under this cut-
off, GVH III-IV incidence increased (log-rank test, p = 0.005).
Conversely, both NRM and OS decreased (log-rank test,
p = 0.033 and p = 0.047). The multivariate cox model analysis
confirmed that citrulline was an independent predictive
biomarker of GVH III-IV (Hazard ratio = 2.68, 95%CI [1.21–
65.96], p = 0.015).
Conclusion: This finding supports the beneficial effect of
enteral nutrition in strengthening intestinal barrier during allo-
SCT procedure and in limiting GVH incidence and severity.
Disclosure of Interest: None declared.
OR58
MICRO RNA ANALYSIS FROM A PHASE II TRIAL INTO
INTRAVENOUS OMEGA 3 AND CONVENTIONAL
CHEMOTHERAPY IN PALLIATIVE OESOPHAGOGASTRIC
CANCER PATIENTS
J. Isherwood1 *, W. Chung1, A. El-Tweri1, C. Pollard1,
J. Thompson2, W. Chi-Sheng3, Y.-S. Chang3, A. Dennison1.
1
Department of Hepatobiliary and Pancreatic Surgery,
Leicester General Hospital, 2Department of Health Sciences,
College of Medicine, Biological Sciences and Psychology,
University of Leicester, Leicester, United Kingdom, 3Molecular
Medicine Research Cente, Chang Gung University, Taipei,
Taiwan, Province of China
Rationale: Oesophagogastric carcinoma (OC) is a devastating
disease that is often detected late and has an extremely poor
prognosis. Micro RNAs (miRNAs) are a group of single stranded,
short (19–25 ribonucleotides) non-coding RNA transcripts.
MiRNAs have been shown to play a role in the diagnosis,
response to treatment, disease progression and chemoresis-
tance in OC.
Methods: This was a prospective, single arm phase II clinical
trial; evaluating the effect of adding an intravenous (IV)
omega-3 to conventional platinum-based palliative chemo-
therapy in participants with advanced oesophagogastric
cancer. Patients were treated for 3 weeks followed by a rest
week for up to eight cycles. Data was analysed using a mixed
effects logistic regression model with STATA(v14.0). 46 micro
RNAs were investigated. 250 times points in 21 patients were
analysed for each miRNA.
Results: Twenty-one patients were included in the analysis (5
female and 16 male). Median age at presentation was 67 years
S24
old. Thirty-nine of forty-six miRNAs were significantly changed
during the weekly treatment over a cycle (33 were down
regulated and 3 were up regulated). Two miRNA were
significantly down regulated in all patients over treatment:
miRNA-143 (P = 0.03, 95% CI = −0.154 to −0.041) & miRNA-27b
(P = 0.04, 95% CI = −0.184 to −0.047). MirRNA-451 showed a
decreasing trend and this correlated with improved progression
free survival (P = 0.002).
Conclusion: Intravenous omega-3 in combination with conven-
tional chemotherapy significantly reduces miRNA-143 and
miRNA-27b. MiRNA-143 is implicated in tumour invasion and
lymph node metastasis. MirRNA-27b has been shown to play a
role in chemo resistance. A reduction in miRNA-451 levels
correlated with progression free survival, this miRNA has been
implicated in invasion and metastasis. A randomised trial is
indicated to investigate this further.
Disclosure of Interest: None declared.
OR59
NUTRITIONAL COUNSELING WITH OR WITHOUT SYSTEMATIC
USE OF ORAL NUTRITIONAL SUPPLEMENTS IN HEAD AND
NECK CANCER PATIENTS UNDERGOING RADIOTHERAPY
E. Cereda1 *, S. Cappello1, S. Colombo2, C. Klersy3, I. Imarisio4,
A. Turri1, M. Caraccia1, T. Monaco4, M. Benazzo5, P. Pedrazzoli4,
F. Corbella2, R. Caccialanza1. 1Nutrition and Dietetics Service,
2
Division of Radiation Oncology, Department of Hemato-
Oncology, 3Biometry and Statistics Service, 4Division of Medical
Oncology, Department of Hemato-Oncology, Fondazione IRCCS
Policlinico San Matteo, 5Department of Otolaryngology Head
Neck Surgery, University of Pavia and Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
Rationale: To evaluate the benefit of oral nutritional supple-
ments (ONS) in addition to nutritional counseling in head and
neck cancer (HNC) patients undergoing radiotherapy (RT).
Methods: In a single-center, randomized, pragmatic, parallel-
group controlled trial (NCT02055833), 159 newly diagnosed
HNC patients suitable for to RT regardless of previous surgery
and induction chemotherapy were randomly assigned to
nutritional counseling in combination with omega-3 enriched
ONS (N = 78) or without ONS (N = 81) from the start of RT and
continuing for up to 3 months after its end. The primary
endpoint was the change in body weight at the end of RT.
Secondary endpoints included changes in protein-calorie
intake, muscle strength, phase angle and quality of life (QoL)
over the study time points and anti-cancer treatment
tolerance.
Results: In patients in whom all the variables could be
assessed, counseling plus ONS (N = 67) resulted in smaller loss
of body weight than nutritional counseling alone (N = 69; mean
difference, 1.6 kg [95%CI, 0.5–2.7]; P = 0.006). Imputation of
missing outcomes provided consistent findings. In the ONS-
supplemented group, higher protein-calorie intake and
improvement in QoL over time were also observed (P < 0.001
for all). The use of ONS reduced the need for changes in
scheduled anti-cancer treatments (i.e. for RT and/or systemic
treatment dose reduction or complete suspension, HR = 0.40
[95%CI, 0.18–0.91], P = 0.029). Nine patients reported gastro-
intestinal intolerance to ONS.
Oral communications
Conclusion: In HNC patients undergoing RT or RT plus systemic
treatment, and receiving nutritional counseling, weight loss
could not be completely prevented, but the use of ONS resulted
in better weight maintenance, increased protein-calorie
intake, improved quality of life and was associated with
better anti-cancer treatment tolerance.
References: Supported by a grant from ESPEN (Research
Fellowship 2013)
Disclosure of Interest: None declared.
Oral Communication VII: Critical Care
OR60
GASTROINTESTINAL ORGAN FAILURE SYMPTOMS INCLUDED IN
SOFA SCORES IMPROVE MORTALITY PREDICTION IN THE ICU: A
MATHEMATICAL APPROACH
P. Singer1 *, L. Cohen Fox2, Y. Aperstein2, J. Cohen1, M. Theilla1,
I. Kagan1. 1Intensive Care Department and Institute for
Nutrition Research, RABIN MEDICAL CENTER, Petah Tikva,
2
Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
Rationale: SOFA (Sequential Organ Failure Assessment) score
predicts mortality in critically ill patients but does not include
gastrointestinal tract (GIT) organ dysfunction. Previous inclu-
sion of this organ to the 6 organs assessment of SOFA did not
improve the predictive value of the score (1), reaching only
70%. Consecutive evaluation of daily SOFA added to GIT
symptoms (SOFA i) has never been tested. We evaluated 3
days (SOFA i to improve the predictive value of SOFA.
Methods: A cohort of 2,709 ICU patients was included from our
ICU database to assess SOFA scores, after IRB approval. 1.304
patients with 3 SOFA scores and 3 GIT available symptoms
(vomiting, bowel movements and reaching REE through enteral
feeding) were analyzed (20 × 106 items) for mortality predic-
tion. Area under the curve (AUC) was evaluated for the
following analysis: ANN (artificial neural network), SVM
(support vector machine), Linear Regression, Logistic
Regression.
Results: From the 1,304 patients included, 909 survived and
394 died. The best predictive AUC values (0.91 and 0.93) were
obtained using the association of linear regression and logistic
regression, and ANN and linear regression respectively, when
SOFA i was used. These results are reaching a much stronger
predictive value than those previously published in a compar-
able population. Sensitivity was 84.7%, Specificity 86.3%,
Accuracy 85.6%, Positive predictive value and Negative
predictive value were respectively 84.7% and 13.7%.
Conclusion: Our results suggest that SOFA score predictive
value for mortality can be improved when GIT symptoms are
included. A new SOFAi score should be considered. The
importance of GIT failure is stressed.
Reference
1. Blaser Reintam A, et al. Gastrointestinal symptoms during the first
week of intensive care are associated with poor outcome: a
prospective multicentre study. Intensive Care Medicine 2013; 39:
899–909.
Disclosure of Interest: None declared.
Oral Communication VII: Critical Care
OR61
VISCERAL ADIPOSE TISSUE PROTECTS AGAINST MUSCLE LOSS
IN SEPSIS
M. R. Baggerman1 *, D. P. van Dijk2,3, M. J. Ariës1, M. E. Bol1,
R. van Gassel1,2,3, E. E. Blaak3,4, R. M. Schnabel1, F. C. Bakers5,
S. W. Olde Damink2,3, M. C. van de Poll1,2,3. 1Department of
Intensive Care Medicine, 2Department of Surgery, Maastricht
UMC+, 3School of Nutrition and Translational Medicine in
Metabolism (NUTRIM), 4Department of Human Biology,
Maastricht University, 5Department of Radiology, Maastricht
UMC+, Maastricht, Netherlands
Rationale: Low skeletal muscle mass is associated with
increased mortality, whereas obesity appears to be protective
in critical illness. We hypothesize that this is due to changes in
metabolic responsiveness in obesity, leading to resistance to
catabolic stimuli. This metabolic inflexibility may particularly
be mediated by visceral adipose tissue.
We aimed to study the effect of body composition on muscle
loss in septic patients.
Methods: We assessed 60 patients (29 male) with abdominal
sepsis. All patients underwent abdominal CTscanning between 8
days before and 2 days after ICU admission, and repeated CT
scanning 8–20 days thereafter. Areas of muscle, visceral and
subcutaneous adipose tissue were measured at the level of L3
and ajdusted to height (area (cm2)/height (m2)) according to
established methods. Patients were divided into groups with
either a high or low visceral adipose tissue index (VATi) using sex-
specific group medians as cut-off values. Changes in muscle and
adipose tissue indexes were expressed as loss from baseline (%)
and tested using a t-test. This was repeated using subcutaneous
and total adipose tissue indexes (SATi, TATi) as grouping factors.
Results: At baseline mean ± SE skeletal muscle mass in patients
with a low or high VATi was similar (44.2 ± 1.7 vs. 44.6 ± 1.5
cm2/m2; p = 0.8). Also the timepoint of the second CT-scan was
similar between groups (13.2 ± 0.6 vs. 12.1 ± 0.6 days; p = 0.2).
Muscle loss was higher in patients with a low VATi (8.3 ± 1.9%)
than in patients with a high VATi (2.0 ± 2.3%; p = 0.041). Other
changes in body composition were unrelated to baseline VATi.
When SATi or TATi were used as a grouping factor no significant
differences in muscle loss were found.
Conclusion: Skeletal muscle loss in sepsis is blunted in patients
with a higher visceral adipose tissue mass. This supports the
hypothesis that metabolic inflexibility in obesity protects
against catabolic stimuli in sepsis.
Disclosure of Interest: None declared.
OR62
ASSOCIATION OF BODY MASS INDEX AND OUTCOME IN
CHRONIC HEMODIALYSIS PATIENTS REQUIRING INTENSIVE
CARE THERAPY
W. Druml1 *, W. Winnicki1, P. Metnitz2, P. Zajic3, T. Fellinger4,
B. Metnitz4. 1Klinik für Innere Medizin III, Nephrologie, Wien,
2
Department of Anaesthesiology and Intensive Care Medicine,
Medical University of Graz, 3Department of Anaesthesiology
and Intensive Care Medicine, Medical University of Graz, Graz,
4
Austrian Centre for Documentation and Quality Assurance in
Intensive Care, Wien, Austria
Rationale: In patients with end-stage renal disease (ESRD) a
positive association of body mass index (BMI) and outcome, the
S25
‘obesity paradox’ has been described. In a large group of
intensive care patients we assessed whether a potential
beneficial effect of a high body mass is also seen in ESRD
patients with critical illness.
Methods: In a retrospective analysis of a prospectively
collected data base of 82,323 patients from 98 Austrian
intensive care units (ICUs) in whom BMI was available, in
9,869 patients with ESRD the association of 6 groups of BMI and
outcome was assessed. Results were adjusted for severity of
disease, age, sex and other acute and chronic comorbidities.
Results: The 9,869 patients with ESRD were older, sicker, had a
longer ICU stay and a higher ICU and hospital mortality. Within
the group of ESRD patients a high BMI (>25) was associated with
an improved survival in a multivariate analysis (BMI 25–30: OR
0.88, CI 0.77–0.99; 30–35: OR 0.8; CI 0.68–0.93; 35–40, OR 0.74,
CI 0.6–0.92) but this was not seen in morbidly obese patients
with a BMI > 40. The association was significant in patients
with the highest disease severity (SAPS-3 Score >56) but
remarkably, also in those patients without systemic inflamma-
tory response syndrome (SIRS) and those not requiring
mechanical ventilation.
Conclusion: Also in ESRD patients who have acquired an acute
intermittent diseases and are admitted to an ICU an increased
BMI is associated with an improved outcome. This association
however, is not seen in morbidly obese patients with a BMI > 40.
This improved tolerance to acute disease processes may in part
explain the ‘obesity paradox’ observed in ESRD patients.
Disclosure of Interest: None declared.
OR63
EFFECT OF COMBINED PROTEIN ENRICHED ENTERAL FEEDING
AND EARLY CYCLE ERGOMETRY IN MECHANICALLY
VENTILATED CRITICALLY ILL PATIENTS: A PROSPECTIVE,
RANDOMIZED, COMPARATIVE, SINGLE-BLIND CONTROLLED
STUDY
I. Kagan1 *, S. Kremer2, M. Theilla1, I. Bendavid1, P. Singer1,
J. Cohen1. 1Intensive Care Department and Institute for
Nutrition Research, 2Physiotherapy Department, Rabin
Medical Center, Petah Tikva, Israel
Rationale: High protein intake associated with physical can
overcome anabolic resistance. In the ICU, a stationary bicycle
with a motor enabling passive and/or active movement of the
lower extremities has been shown to be safe. We studied the
use of cycle ergometry (CE) associated with high protein
enteral intake on duration of mechanical ventilation, length of
stay and mortality.
Methods: 75 ventilated patients (>48 h) expected to be
ventilated for the next 7 days were intended to be included.
BMI > 45 kg/m2, open abdominal wounds, and conditions
impairing cycling were exclusion criteria. After consent,
patients were prospectively randomized in a control group
receiving conventional physiotherapy and a regular enteral
feeding (Jevity, Abbott, USA) (G1). The second group received
the same formula with CE (20 min/d) (G2). The third group (G3)
had same CE training with a protein enriched formula (Promote,
Abbott, USA). Patients received 80% REE. Successful weaning
was defined if the patient was breathing for 48 hours without
support. One way ANOVA was used for statistical analysis.
Results: There was no difference between the groups regarding
demographic, APACHE II, SOFA, REE. Group 3 (n = 19) received
S26
83 ± 25 g/d protein, significantly more than G1 (n = 22) and G2
(n = 21) ( p < 0.02). ICU LOV was 20 ± 19, 23 ± 17 and 22 ± 22 days
for the 3 ITT groups respectively (NS). A lower rate of
pneumonia (37%) in G3 was observed compared to G1 (43%)
and G3 (72%) ( p = 0.06). No difference was found in hospital LOS
or mortality. Patients successfully extubated were 10, 8 and 10
respectively (NS).
Conclusion: A high protein regimen associated with cycle
ergometry showed a trend to VAP decrease but did not show a
decrease in length of ventilation, length of stay or mortality in
ICU ventilated patients.
Disclosure of Interest: I. Kagan: None declared, S. Kremer: None
declared, M. Theilla: None declared, I. Bendavid: None declared,
P. Singer Grant/Research Support from: Abbott research grant,
J. Cohen: None declared.
OR64
FASTING IS THE STRONGEST RISK FACTOR FOR HOSPITAL
MORTALITY IN CRITICALLY ILL UNDERWEIGHT PATIENTS
M. V. Viana1,2, L. V. Viana3,4 *, L. A. Gross5, V. L. Costa5,
A. L. J. Tavares5, T. A. Tonietto2,6, R. B. Moraes6, M. J. Azevedo3.
1
Critical Care, Hospital de Clinicas de Porto Alegre, 2Critical
Care, Hospital Nossa Senhora da Conceição, 3Endocrinology
Division, 4Medical Nutrition Division, 5Universidade Federal do
Rio Grande do Sul, 6Critical Care, Hospital de Clinicas de Porto
Alegre, Porto Alegre, Brazil
Rationale: Critically ill underweight patients have worse
outcomes than normal or overweight patients. The impact of
fasting in this population is not stablished.
Methods: Prospective, two-center, observational study, was
designed to assess the effect of fasting in underweight critically
ill patients. All patients consecutively admitted (November
2015 to February 2017) to general intensive care units (ICU)
with IMC <20 kg/m2 were included. Exclusion criteria were:
palliative care, exclusively oral nutrition, pregnancy, life
expectancy <24 h and discharge before day 5 of ICU admission.
Patients had their fasting status evaluated after ICU admission
between days 2 and 3 (1st evaluation) and 5 and 7 (2nd
evaluation). Patients were divided into two groups: fasting
group those that did not receive nutrition support at least in
one evaluation and fed group those that received nutrition
support both evaluations. Patients were followed until hospital
discharge.
Results: The hospital mortality rate of 189 included patients
was 60.8% after 10(6–26) days of follow-up (age 54.2 ± 16.8
years, male 114(60.3%), SAPS3 68.4 ± 13.3, BMI 17.5 ± 2.2,
NUTRIC 4.4 ± 1.7). The fasting group had higher NUTRIC scores
(4.9 ± 1.8 vs 4.2 ± 1.6 p = 0.012) and were more commonly
surgical patients (69.9% vs 56.4% p = 0.001) compared with the
fed group. The fasting group had higher lactate levels (mmol/L)
(1.6[1–2.6] vs 1.3 [1.0–1.8] p = 0.046) compared to the fed
group. There was no difference between fasting and fed group
regarding SAPS3 score, BMI and gender. In cox regression
multivariate regression model (HR, 95%), fasting was inde-
pendently associated with mortality (fasting 2.08[1.33–3.27];
SAPS3 1.01[0.99–1.03]; NUTRIC 1.14[0.99–1.30]; surgical
admission 0.94 [0.44–2.0]; lactate 1.13[1.06–1.21]).
Conclusion: In underweight critically ill patients fasting was
the strongest predictor for in-hospital mortality.
Disclosure of Interest: None declared.
Oral communications
OR65
A RANDOMIZED TRIAL OF SELENIUM SUPPLEMENTATION IN
HIGH-RISK CARDIAC SURGERY PATIENTS: RESULTS OF A
MULTICENTRE PILOT STUDY
C. Stoppe1 *, B. Mcdonald2, A. Goetzenich3, M. Lemieux4,
D. Heyland4. 1Intensive Care Medicine, RWTH Aachen
University, Aachen, Germany, 2Division of Cardiac
Anesthesiology and Critical Care Medicine, University of
Ottawa Heart Institute, Ottawa, Canada, 3Department of
Thoracic, Cardiac and Vascular Surgery, RWTH Aachen
University, Aachen, Germany, 4Clinical Evaluation
Research Unit, Kingston General Hospital, Kingston,
Kingston, Canada
Rationale: The development of organ failure frequently occurs
after cardiac surgery, particularly in high-risk patients with
complex procedures. Selenium is considered as cornerstone of
antioxidant defense mechanisms and its perioperative supple-
mentation may offer therapeutic benefits. Prior to launching a
large-scale trial we conducted a multicenter, randomized pilot
trial to determine its feasibility.
Methods: Patients scheduled to undergo elective cardiac
surgery with a high perioperative risk profile were randomized
to receive placebo or high dose IV selenium supplementation
(2,000 µg prior sugery, 2,000 µg postoperative and 1,000 µg
daily in ICU). Patients with severe renal dysfunction, chronic
liver disease, heart transplant or LVAD insertion were excluded.
The 3 main outcomes of the pilot study were to determine
feasibility, recruitment rates, adherence to the protocol and
contamination. We plan to roll the pilot study into a large-scale
trial and therefore, only cohort data will be reported.
Results: 73 patients from 6 ICUs were enrolled in Canada and
Germany. The recruitment rate was 2.6 patients/month (0.9–
2.3). The average duration of the study intervention was 5.0
days [3.0, 12.0] and there was a 94% compliance with dose
administration. Three (4.1%) patients died by day 30 and 30-day
post-op organ dysfunction plus death was 4 (5.5%). Selenium
levels (434 µg/ml) remained multiple times below the refer-
ence range of 1,000 µg/ml. 50% of patients showed a significant
intraoperative decrease of selenium and selenoprotein-P
(SePP), whereas 50% demonstrated a intraoperative increase.
Explorative correlation analysis revealed a significant inverse
correlation between SePP and IL-6 ( p < 0.001).
Conclusion: Selenium supplementation in cardiac surgery
patients seems feasible based on the multi-centre inter-
national pilot study. A larger, definitive trial is warranted and
currently being launched.
Disclosure of Interest: None declared.
OR66
REGULATION OF POSTNATAL MYONUCLEAR ACCRETION
ASSESSED BY A NOVEL IN VITRO MODEL
A. E. M. Kneppers1 *, L. B. Verdijk2, C. C. de Theije1,
L. J. C. van Loon2, A. M. W. J. Schols1, R. C. J. Langen1.
1
Respiratory Medicine, 2Human Biology and Movement
Sciences, NUTRIM School of Nutrition and Translational
Research in Metabolism, Maastricht University
Medical Centre+, Maastricht, Netherlands
Rationale: Postnatal myogenesis is an essential process for
muscle maintenance, and is facilitated by satellite cells.
Oral Communication VII: Critical Care
Alterations in myogenesis markers have been shown in skeletal
muscle biopsies of patients affected by sarcopenia. Although
satellite cell proliferation and differentiation have been
studied in vivo and in vitro, the regulation of fusion with
muscle fibres (i.e. postnatal myonuclear accretion) remains
largely unexplored because of methodological limitations. We
developed an in vitro model of postnatal myonuclear accretion
and explored the responses to regulatory cues of muscle growth
and recovery.
Methods: We established a Cre/LoxP-based reporter system,
which allows the expression of luciferase only after fusion of
LoxP-Luc myoblasts (MB) with 4 days differentiated Cre
myotubes (MT). Luciferase activity was assessed luminome-
trically as a measure of postnatal myonuclear accretion.
Results: Treatment of co-cultures with the myogenic factor
IGF-I ( p < 0.001), the metabolic cue Eicosapentaenoic acid
( p < 0.001), and the cytokines IL-13 and IL-4 ( p < 0.05, p <
0.001) increased myonuclear accretion, while treatment with
the myogenic inhibitor Myostatin ( p < 0.05), and TNF-α ( p <
0.001) decreased myonuclear accretion. Furthermore, recov-
ery from MT atrophy and damage (induced by LY294002 and
electrical stimulation resp.) was accompanied by increased
myonuclear accretion ( p < 0.001, p = 0.052 resp.).
Conclusion: We developed a physiologically relevant, sensi-
tive, high throughput in vitro cell system for quantitative
assessment of postnatal myonuclear accretion, which will
contribute to a better comprehension of the molecular
regulation of myonuclear accretion and the modulatory
effects of metabolic cues, and as such, will help optimize
current and develop new interventions for sarcopenia.
Disclosure of Interest: None declared.
OR67
EFFECTS OF THE INFUSION OF INTRAVENOUS FLUIDS ON THE
CALORIC AND PROTEIN DEFICITS IN CRITICALLY ILL PATIENTS
S. Arantes1, J. E. De Aguilar-Nascimento1 *,
D. B. Dock-Nascimento2. 1Varzea Grande University (UNIVAG),
2
Federal University of Mato Grosso, Cuiaba, Brazil
Rationale: Overload of intravenous fluids (IVF) may lead to
dismotility that may impair the delivery of early enteral
nutrition (EEN). The aim of this study was to correlate the
amount of volume of IVF with the occurrence of caloric and
protein deficits in ICU patients
Methods: This is a cohort study involving 86 (39 males)
mechanical ventilated critically ill patients (mean SAPS III:
62 ± 10) with a mean age 68 (18–91) years old. EEN was initiated
in all patients aiming to a goal of 25–30 kcal/kg/day and 1.25–
2.0 g of protein/kg/day. Patients were divided in those with
caloric deficit below or above 480 kcal/day and with protein
deficit below or above 20 g of protein/day. The endpoint of the
study was to correlate the amount of IVF infused with the
deficit caloric and protein. Comparisons were done using
unpaired T Student test with a significance level of 5%
( p < 0.05).
Results: Patients received a median of 2,969 (920–5,960)
ml/day of IVF, which corresponded to a median of 41.6 (17.0–
88.2) ml/kg/day and 10.7 (3.31–21.45) g of sodium/day. All
S27
patients presented caloric deficit with a mean (SD) of 1,812
± 850 kcal in 5 days. Twenty-three (27.0%) presented a deficit
greater than 480 kcal/day. The mean (SD) protein deficit was
94.6 ± 45.9 g in 5 days and 34 (40%) patients had protein déficit
above 20 g/day. Both caloric and protein deficits were
associated with greater amount of IVF and higher infusion of
sodium ( p < 0.001). Patients with caloric deficit >480 kcal/day
received approximately 1.5 L of IVF and 10 g of NaCl more than
others. Patients with protein deficit >20 g/day received
approximately 3 L of IVF and 25 g of NaCl more than others.
Conclusion: In critically ill patients receiving enteral nutrition
the amount of intravenous fluids may influence the delivery of
the diet and increase the deficit of both calories and protein.
Disclosure of Interest: None declared.
OR68
PARENTERAL OMEGA-3 REDUCED LEVELS OF PRO-
INFLAMMATORY INTERLEUKIN-17, RESULTS OF A
RANDOMISED CONTROLLED TRIAL IN CRITICALLY ILL
PATIENTS WITH SEPSIS
D. K. Bilku1 *, T. Hall1, D. Al-Leswas1, C. Horst1, J. Cooke1,
M. Metcalfe1, A. Dennison1. 1University Hospitals of Leicester
NHS Trust, Leicester, United Kingdom
Rationale: Severe sepsis in Intensive Care Units (ICU) is
associated with high mortality (40%). Omega-3 (ω-3) has been
shown to attenuate uncontrolled inflammation and produce
clinical benefit. This study explores the role of omega-3 in
sepsis.
Methods: 60 consecutive septic patients in ICU were rando-
mised to receive either parenteral ω-3 or standard medical
therapy. The primary outcome was effect of ω-3 on cytokine
profile. The secondary outcome was to examine the association
between cytokine concentrations, maximum Sequential Organ
Failure Assessment (max-SOFA) score and 28-day mortality.
Data was analysed using mixed linear regression.
Results: Omega-3 significantly reduced Interleukin (IL-17) in
ω-3 group ( p = 0.035). Also, concentration of other pro-
inflammatory cytokines (E-selectin, VCAM, ICAM, TNFR1,
TNF-α, IL-17, IL-12, IL-6, IL-1b) were higher in the control (C)
group as compared to the fish oil (FO) group. Max-SOFA scores
for cytokines IL1RA ( p = 0.001), IL-6 (0.01) and TNFR1 ( p <
0.001) were significantly associated with cytokine concentra-
tion. There was significant association between 28-day
mortality and concentration of VCAM on day 1 (0.05) and day
5 (0.03). Similarly, significant association was observed
between mortality and concentration of IL-17 on day 3
(0.02). ICAM and 28-day mortality were associated on day 1
(0.05) and day 5 (0.05).
Conclusion: Cytokine IL-17 was the best predictor of patient
outcome and its concentration was significantly affected by ω-
3. In future, it may be used as a marker of patient severity and
to measure the effect of FO on the patient. There was
significant association between Max-SOFA, 28-day mortality
and concentration of some cytokines.
Disclosure of Interest: None declared.
Clinical Nutrition (2017) 36(S1), S29–S52
Contents lists available at ScienceDirect
Clinical Nutrition
j o u r n a l h o m e p a g e : h t t p : / / w w w. e l s e v i e r . c o m / l o c at e / c l n u
Poster tours
Poster Tour 1: Geriatrics
PT01.1
AGREEMENT OF HANDGRIP STRENGTH AND QUADRICEPS
STRENGTH DEPENDENT ON AGE AND HEALTH STATUS
S. S. Y. Yeung1,2 *, E. M. Reijnierse2, M. C. Trappenburg3,4,
J.-Y. Hogrel5, J. S. Mcphee6, M. Piasecki6, S. Sipila7,
A. Salpakoski8, C. G. M. Meskers1,9, A. B. Maier1,2. 1Human
Movement Sciences, MOVE Research Institute Amsterdam,
Vrije Universiteit, Amsterdam, Netherlands, 2Medicine and
Aged Care, University of Melbourne, Melbourne, Australia,
3
Internal Medicine, Section of Gerontology and Geriatrics, VU
University Medical Center, Amsterdam, 4Internal Medicine,
Amstelland Hospital, Amstelveen, Netherlands,
5
Neuromuscular Physiology Laboratory, Institut de Myologie,
Paris, France, 6School of Healthcare Science, Manchester
Metropolitan University, Manchester, United Kingdom,
7
Gerontology Research Centre, Faculty of Sport and Health
Sciences, University of Jyvaskyla, Jyvaskyla, 8Research and
Development, Mikkeli University of Applied Sciences, Mikkeli,
Finland, 9Rehabilitation Medicine, VU University Medical
Center, Amsterdam, Netherlands
Rationale: Low muscle strength, i.e. dynapenia is predictive
for various negative health outcomes and usually assessed by
hand held dynamometry (handgrip strength - HGS). However
whether HGS can be used as a proxy for overall muscle strength
and whether this depends on age and health status is unknown.
This study aimed to assess the agreement between HGS and
quadriceps strength (QS) in various populations of individuals
differing in age and health status.
Methods: Five cohorts (in total 960 individuals) encompassing
young and old healthy individuals and geriatric outpatients of
which both HGS and QS data were available were included.
Pearson correlation coefficients were calculated to analyse the
overall association between HGS and QS. To allow further
comparison between HGS and QS, HGS and QS were standar-
dized into z-scores. Intraclass correlation coefficients (ICC)
were subsequently calculated to examine the agreement
between z-score of HGS and z-score of QS at population level.
Results: Pearson correlation coefficients were between 0.45
and 0.73 in healthy young, 0.36 and 0.68 in healthy old, and
0.60 and 0.73 in geriatric outpatients ( p < 0.05 for all cohorts).
ICC values were weak to moderate over all populations: i.e.
healthy young (0.41–0.45), healthy old individuals (0.36–0.41)
and geriatric outpatients (0.54).
Conclusion: Based on both Pearson correlation coefficients and
ICC, HGS and QS show overall insufficient agreement. HGS
assessment cannot be used as a proxy for overall muscle
strength. Further studies are warranted to identify if measure-
ment of HGS and QS predict the same health outcomes in
clinical practice.
Disclosure of Interest: None declared.
PT01.2
ASSOCIATION BETWEEN CLINICAL VARIABLES AND
NUTRITIONAL STATUS WITH EVOLUTION TO DEATH FOR
ELDERLY CANCER PATIENTS – A MULTICENTRIC STUDY
C. D’almeida1,2 *, R. B. Martucci1,3, V. D. Rodrigues1, N. Pinho1,
W. Peres2, A. Ramalho2. 1Nutrition and Dietetics, National
Cancer Institute, Brazil, 2Nutrition Institute, Federal
University of Rio de Janeiro, 3Nutrition Institute, State
University of Rio de Janeiro, Rio de Janeiro, Brazil
Rationale: Nutritional assessment and intervention plays an
important role in the treatment of elderly cancer patients. The
objective was to evaluate the association between clinical and
nutritional status variables with death evolution in elderly
cancer patients.
Methods: Multicenter, hospital-based cohort study, included 44
institutions. 3,061 elderly cancer hospitalized individuals were
submitted to Mini Nutritional Assessment-Short Form (MNA-SF)
within 24 hours after hospitalization date. Both genders, over
65 years old, cancer diagnosis, regardless of location or staging
disease, were included. A univariate analysis was performed to
identify the explanatory variables related to the death
outcome in up to 30 days; Considering gender, age range, Calf
Circumference (CC), MNA-SF score and classification. Results
were expressed as frequency and percentage or mean and
standard deviation. The relative risk (RR) was calculated
according to logistic regression individually.
Results: The mean age was 73.4 ± 6.6 years, mean CC
32.0 ± 4.2 cm. 1,339 women (43.7%) and 1,722 men (56.3%)
were identified. According to MNA-SF, 33.5% patients were
malnourished, while 39.3% were nutritional risk and 27.2% were
classified normal nutritional status. CC values were obtained in
92% of the cases, where 33.5% presented values <31 cm and
≥31 cm were 58.5%. Of all the variables studied, those
associated with death within 30 days, were the female
gender (RR = 1.54, 1.19–2.01 CI95%, p = 0.001); Age range ≥75
years (RR = 1.63, 1.18–2.26 CI95%, p = 0.003); CC <31 cm
(RR = 2.65, 2.00–3.53 CI95%, p < 0.0001); MNA-SF score ≤7
points (RR = 8.60, 6.25–11.7 CI95%, p < 0.0001) and malnutri-
tion according to MNA-SF (RR = 17.2, 9.29–31.8 CI95%,
p < 0.0001).
S30
Conclusion: The MNA-SF classification and Score, and the CC
were shown to be an efficient nutritional indicator capable of
identifying the 30-day mortality risk in this population.
Disclosure of Interest: None declared.
PT01.3
A REVIEW OF NUTRITIONAL SCREENING TOOLS USED IN
OLDER ADULTS
L. C. Power1,2 *, D. Mullally1,2, M. A. de van der Schueren3,4,
E. R. Gibney2,5, M. Clarke2,5, L. A. Bardon2,5, C. Corish1,2,
on behalf of the MaNuEL Consortium. 1School of Public Health,
Physiotherapy and Sports Science, 2Institute of Food and
Health, University College Dublin, Dublin, Ireland,
3
Department of Nutrition and Dietetics, VU University Medical
Centre, Amsterdam, 4Department of Nutrition and Health,
HAN University of Applied Sciences, Nijmegen, Netherlands,
5
Department of Agriculture and Food Science, University
College Dublin, Dublin, Ireland
Rationale: Many nutritional screening tools (NSTs) are used in
older adults (>65 years), each containing a diverse range of
parameters and validated against different standards. An
objective of the EU Malnutrition in the Elderly Knowledge
hub (MaNuEL) project is to review existing NSTs used in older
adults in various healthcare settings.
Methods: A literature review using a systematic approach was
conducted. Electronic searches were performed in the following
databases; PubMed Central, CINAHL Plus and Science Direct.
Results: 48 NSTs and 110 validation studies were identified.
Validation results vary greatly, with sensitivities and specifi-
cities ranging from 0.06–1.0 and 0.12–1.0 respectively. Poor
study designs (i.e. tools not validated against an appropriate
‘gold standard’ method) were apparent for many of the tools.
Twenty-three (47%) tools were designed specifically for older
adults (e.g. MNA-SF) and twenty-five (53%) were designed for
general adult use (e.g. NRS-2002, MUST). Furthermore, each
tool included different parameters (54 different parameters
were identified), some of which are considered more appro-
priate for malnutrition screening in older adults (e.g. weight
loss) than others (e.g. serum albumin).
Conclusion: Although many NSTs are recommended for use in
older adults, their derivation and/or validation in younger
populations mean that they may not be reliable in older adults
or in settings outside those in which they have been validated.
Further work of the MaNuEL project involves the creation of a
scoring system to determine the most appropriate NSTs for use
in older adults.
This work was supported by funding from the Department of
Agriculture, Food and the Marine and Health Research Board
through the Joint Programming Initiative – A Healthy Diet for a
Healthy Life (JPI HDHL) Knowledge Hub on Malnutrition in the
Elderly (MaNuEL).
Disclosure of Interest: None declared.
PT01.4
ENERGY AND MACRONUTRIENT INTAKE AT AGE 70 IS NOT
ASSOCIATED WITH PREVALENCE OF SARCOPENIA AT AGE 88
M. Karlsson1 *, T. Cederholm1, W. Becker1, P. Sjogren1.
1
Department of Public Health and Caring Sciences, Uppsala
University, Clinical Nutrition and Metabolism, Uppsala, Sweden
Poster tours
Rationale: An unfavorable change in body composition with
increasing age, i.e. loss of muscle mass, will influence
functionality and risk of developing sarcopenia. However
there are indications that macronutrient (e.g. protein) may
affect protein turn-over in skeletal muscle. Against this
background we examined how energy and macronutrient
intake at age 70 was associated to sarcopenia approximately
18 years later.
Methods: The participants are part of a larger study population
of men (Uppsala Longitudinal Study of Adult Men) born
between 1920 and 1924, living in Uppsala county, Sweden.
Dietary intake at age 70 was determined by a 7-day estimated
food record. Dual-energy X-ray absorptiometry (DXA), gait-
speed and handgrip strength were examined approximately 18
years later. The criteria established by the European Working
Group on Sarcopenia in Older People were used to define
sarcopenia. T-test was used for statistical analysis.
Results: A total of 255 elderly men, identified as adequate
dietary reporters, (mean age 86.6 ± 1.0 year, BMI 25.6 ± 3.5 kg/m2
and weight 76.3 ± 11.4 kg) were include of which 54 men
(21.2%) were defined as sarcopenic (mean age 86.6 ± 1.0 year,
BMI 23.4 ± 2.6 kg/m2 and weight 67.9 ± 9.1 kg). The non-
sarcopenic men (n = 201, mean age 86.6 ± 1.0 year, BMI 26.2 ±
3.4 kg/m2 and weight 78.6 ± 10.9 kg) had a significantly
higher ( p = 0.0001) BMI and body weight compared to the
sarcopenic men.
There was no significant difference in the intake of energy or
macronutrients between the sarcopenic (energy 1,803 ± 447
kcal, fat 70.8 ± 23.1 g, carbohydrate 216.5 ± 59.8 g and protein
68.2 ± 17.3 g) and non-sarcopenic men (energy 1,870 ± 439
kcal, fat 73.3 ± 20.5 g, carbohydrate 225.7 ± 60.4 g and protein
69.5 ± 15.8 g).
Conclusion: We found no correlation between energy or
macronutrient intake at age 70 and the prevalence of
sarcopenia 18 years later in this cohort of community dwelling
men.
Disclosure of Interest: None declared.
PT01.5
LONGITUDINAL ASSOCIATIONS BETWEEN VITAMIN D
METABOLITES AND SARCOPENIA IN OLDER AUSTRALIAN MEN:
THE CONCORD HEALTH AND AGEING IN MEN PROJECT
V. Hirani1 *, F. Blyth2, V. Naganathan2, R. Cumming3. 1School of
Life and Environmental Sciences, Faculty of Science, 2Concord
Clinical School, 3School of Public Health, University of Sydney,
Sydney, Australia
Rationale: Sarcopenia, an age associated reduction in skeletal
muscle mass and strength as well as hypovitaminosis D are
major clinical problems among older people. The aims of this
study are to explore the associations between serum 25-
hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D)
levels at baseline and incidence of sarcopenia over time in
older Australian community-dwelling older men.
Methods: Men aged ≥70 years (2005–07) from the Concord
Health and Ageing in Men Project were assesed at baseline, two
year and five year follow up. The main outcome measurement
was the incidence of sarcopenia defined as appendicular lean
mass adjusted for body mass index <0.789 and grip strength <
26.0 kg using the Foundation for the National Institutes of
Health definition of sarcopenia. Serum 25D and 1,25D levels
Poster Tour 2: Liver and GI
were measured at baseline by radioimmunoassay (Diasorin,
Stillwater, MN, USA) and categorised into quartiles as predictor
variables. Covariates included age, income, season of blood
collection, physical activity, vitamin D supplement and
medication use, measures of health, serum parathyroid
hormone and estimated glomerular filtration rate.
Results: Incidence of sarcopenia was 3.9% at the 2-year follow-
up and 8.6% at 5-year follow-up. Vitamin D levels in the lowest
quartiles (25D < 40 nmol/l;1,25D < 62 pmol/l) were associated
with the incidence of sarcopenia over 5 years after adjustment
for potential confounders and covariates of clinical signifi-
cance (25D:OR 2.53 (95%CI 1.14, 5.64) p = 0.02;1,25D:OR 2.67
(95%CI 1.28, 5.60) p = 0.01).
Conclusion: Low serum 25D and 1,25D concentrations at
baseline are independently associated with the incidence of
sarcopenia over the subsequent five years. Although our data
do not prove any causal relationship, it is conceivable that
maintaining vitamin D sufficiency may reduce the incidence of
sarcopenia in ageing men.
Disclosure of Interest: None declared.
PT01.6
DRUG USE AND SERUM MAGNESIUM IN DUTCH GERIATRIC
OUTPATIENTS
A. C. B. van Orten-Luiten1,2 *, A. Janse2,3,
E. M. Brouwer-Brolsma1, R. F. Witkamp1,2. 1Human Nutrition,
Wageningen University, Wageningen, 2Nutrition Alliance
Gelderse Vallei, 3Geriatric Medicine, Gelderse Vallei Hospital,
Ede, Netherlands
Rationale: This study aims to identify drug groups associated
with hypomagnesemia and to quantify the impact of their
usage on blood magnesium level. More knowledge on this type
of drug-nutrient interactions might be clinically relevant, as
low magnesium levels are related to cardiovascular problems,
diabetes, and other clinical problems.
Methods: Cross-sectional data of 358 geriatric outpatients of a
Dutch general hospital were analysed by multivariate linear
and logistic regression. Magnesium level and hypomagnesemia
(serum magnesium <0.70 mmol/l) in users of 22 different drug
groups were compared to the magnesium status of non-users.
Drug groups were coded according to the Anatomical
Therapeutic Chemical Classification System.
Results: Mean serum magnesium level was 0.80 ± 0.11 mmol/l,
overall prevalence of hypomagnesemia 12%, in males and
females 9% and 15%, respectively; 68% of the subjects used ≥5
medications ( polypharmacy). Associations between drug use
and hypomagnesemia were observed for proton pump inhibi-
tors ( prevalence odds ratio (POR) 2.09; 95% CI 1.03–4.24),
insulins (POR 4.99; 95% CI 1.64–15.20), metformin (POR 4.21;
95% CI 1.89–9.37), vitamin K antagonists (POR 2.78; 95% CI 1.25–
6.17), and selective beta blockers (POR 2.19; 95% CI 1.10–4.36)
after adjustment for gender, age, body mass index, Mini
Nutrition Assessment screening score, glomerular filtration
rate, and sodium blood level. Compared to non-users, users of
these drug groups had lower magnesium levels of respectively
0.03 mmol/l ( p = 0.01), 0.07 mmol/l ( p = 0.01), 0.10 mmol/l
( p < 0.01), 0.03 mmol/l ( p = 0.04), and 0.03 mmol/l ( p = 0.04).
S31
Conclusion: Geriatric outpatients using specific drug groups
had significantly lower magnesium levels compared to non-
users. For further research, routine magnesium measurement
in patient populations may provide deeper insight in effects of
drug use and other risk factors of hypomagnesemia and in
clinical implications.
Disclosure of Interest: None declared.
Poster Tour 2: Liver and GI
PT02.1
DYSREGULATED BILE SALT HOMEOSTASIS IN ADULT PATIENTS
WITH CHRONIC INTESTINAL FAILURE
A. Huijbers1 *, K. V. Koelfat2, F. G. Schaap2, M. Lenicek3,
G. J. Wanten1, S. W. Olde Damink2. 1Department of
Gastroenterology & Hepatology, Radboud University Medical
Center, Nijmegen, 2Maastricht University Medical Center and
NUTRIM School of Nutrition and Translational Research in
Metabolism, Maastricht University, Maastricht, Netherlands,
3
Department of Medical Biochemistry and Laboratory
Diagnostics, Charles University, Prague, Czech Republic
Rationale: Patients with chronic intestinal failure (CIF) can
develop Intestinal Failure Associated Liver Disease (IFALD).
Dysregulation of the ileal bile salt receptor FXR/FGF19 axis that
controls hepatic bile salt synthesis is implicated in the etiology
of pediatric IFALD. The objective of this study was to explore
this axis in adult CIF patients.
Methods: In 77 adult CIF patients, plasma levels of total bile
salts (TBS), C4 (a bile salt synthesis marker) and FGF19 were
determined. Comparisons were made between groups of
patients with and without terminal ileum. Correlations were
evaluated by Spearman (ρ) correlation coefficient. Multiple
linear regression analysis was performed to evaluate the
independent relationship of the studied variables. Data are
expressed as median [IQR].
Results: The main reason for home parenteral nutrition (HPN)
in the resection group (n = 36) was short bowel syndrome (78%).
Intestinal dysmotility was the main reason (68%) for HPN in the
group without terminal ileum resection (n = 41). ALP levels
were higher in the resection group (127 [103–163] vs. 98 [71–
120] IU/L, P < 0.001). Plasma FGF19 was markedly lower (14 [8–
33] vs. 148 [88–400] pg/mL, P < 0.0001), while C4 was notably
higher (171 [107–302] vs. 11.4 [5.0–27.1] ng/mL, P < 0.0001]) in
the resection group, in line with loss of FGF19-mediated
repression of bile salt synthesis. C4 and FGF19 levels were
negatively correlated (ρ = −0.80, P < 0.0001). Plasma TBS was
comparable in both groups. Frequency of HPN use was
independently associated with FGF19 levels (P = 0.02) in CIF
patients with terminal ileum resection.
Conclusion: This study indicates that disruption of the
enterohepatic circulation in CIF patients without terminal
ileum, results in and potentially promotes liver injury.
Restoring control of bile salt synthesis could be a therapeutical
option in these patients.
Disclosure of Interest: None declared.
S32
PT02.2
TREATMENT OF ENTEROATMOSPHERIC FISTULAS BY CHYME
REINFUSION IN 43 CONSECUTIVE PATIENTS
D. Picot1 *, S. Layec1, L. Dussaulx1, F. Trivin1, M. Carsin1.
1
Digestive and Nutritional Rehabilitation Unit, Clinique Saint
Yves, Rennes Cedex, France
Rationale: In case of enteroatmospheric (or exposed) fistula
(EAF), small bowel is completely interrupted. If enteric outputs
are high, parenteral nutrition (PN) is proposed. Otherwise,
chyme reinfusion (CR) is a technique of enteral nutrition (EN)
that artificially restores digestive continuity and functions till
the surgical repair (SR).
Aims: to study the efficacy of CR in 43 patients ( pts) with EAF
regarding intestinal function, nutritional status and reduction
of parenteral nutrition (PN).
Methods: Retrospective study of 43 pts admitted for EAF and
treated by CR from 1996 to 2016. Durations (d) were expressed
as medians ± interquartile ranges. Albumin (g/L), Nutritional
Risk Index (NRl = albumin × 1.519 + 41.77 × current weigh/usual
weight; severe undernutrition if <83.5) were compared by
paired Student’s t test and distribution of NRI by Chi2 test.
Results: Location of EAF: jejunum (32), ileum (11). Origin of
fistulas was cancer (5), mechanical (16), infection (22). Mean
fistula outputs were 1,686 ± 813 ml/24 h (max 4,022), nitrogen
absorption was 53% of ingesta. CR was begun 8 ± 12 d after
admission and continued for 38 patients until SR (86 ± 80 d).
During CR, 21 pts were exclusively fed orally, 4 had exclusive
EN, 18 had supplemental EN (total ingesta 35.6 ± 12.8 kcal/kg/
d, 1,7 ± 0.6 g/kg/d proteins). PN (n = 39) was stopped in 28 pts,
5 ± 15 d after the beginning of CR, saving 1,119 d of PN. The
nutritional status improved: albumin (37 pairs, +4.7 ± 6.4 g/L,
p < 0.001), NRI (32 pairs, +7,0 ± 10, p < 0.001). The number of
severely malnourished pts fell from 22/32 to 8/32 ( p < 0.01).
The CR was stopped after healing without surgery (1) and
because of cancer relapse (2). All others had a SR.
Conclusion: When the efferent part of the small bowel is
accessible, CR is a safe and inexpensive method of EN that
restores bowel function. In most cases, it enables stopping PN
and helps to improve the nutritional status until surgical
reconstruction.
Disclosure of Interest: None declared.
PT02.3
THE EFFECT OF A CONTROLLED GLUTEN CHALLENGE IN
PATIENTS WITH SUSPECTED NON-COELIAC GLUTEN
SENSITIVITY: A RANDOMIZED, DOUBLE-BLIND PLACEBO-
CONTROLLED CHALLENGE
H. F. Dale1 *, J. G. Hatlebakk1,2,3, N. Hovdenak3, S. O. Ystad1,2,
G. A. Lied1,2,3. 1Centre for Nutrition, Department of Clinical
Medicine, Faculty of Medicine and Dentistry, University of
Bergen, 2National Centre of Functional Gastrointestinal
Disorders, 3Section of Gastroenterology, Department of
Medicine, Haukeland University Hospital, Bergen, Norway
Rationale: Non-coeliac gluten sensitivity (NCGS) is a new entity
with unknown prevalence and mechanisms, and there is a need
for a standardized procedure to confirm the diagnosis. The
objective of this study was to identify NCGS in a patient group
without coeliac disease or wheat allergy, who reported
improvement of symptoms while on a gluten-free diet.
Poster tours
Methods: Twenty patients with suspected NCGS (14F/6M, age
range: 21–62 y) were included. All patients went through four
periods of double-blind provocation with gluten/placebo. They
randomly received two packages of muffin-mix with gluten,
and two packages with placebo, and were instructed to eat two
muffins a day (11 g gluten) for four days, followed by a three
days’ wash-out. Gastrointestinal symptoms were recorded with
symptom the questionnaires IBS-SSS and IBS-SQ after each
provocation.
Results: Four out of twenty patients (20%) correctly identified
the two periods when they received muffins containing gluten
as relapse of abdominal symptoms, hence were diagnosed with
NCGS. The diagnosed group showed higher symptom scores
than the not-diagnosed group both at baseline, after gluten
exposure and after placebo, and there was a significant
difference in gastrointestinal symptoms between the two
groups after provocation with gluten ( p = 0.047). The not-
diagnosed group showed the most severe symptoms after
placebo. Symptom severity increased significantly from base-
line to after gluten for the diagnosed group ( p = 0.045) and
from baseline to after placebo for the not-diagnosed group
( p = 0.032).
Conclusion: This randomized, double-blind placebo-controlled
challenge identified symptom relapse in accordance with
gluten intake in a small group of patients with suspected
NCGS. Baseline symptom severity may identify reliably the
subgroup of patients confirmed to be true non-coeliac gluten
intolerant.
Disclosure of Interest: None declared.
PT02.4
LATE EVENING SNACK WITH BRANCHED CHAIN AMINO ACID
IMPROVES FISCHER RATIO AT FASTING, IN THE NEXT MORNING
H. Maki1 *, H. Yamanaka-Okumura2, T. Katayama3, Y. Ozawa4,
A. Hosoda1, N. Kurata5, F. Amemiya6. 1Department of
Pharmacy, Kofu Municipal Hospital, Kofu, 2Department of
Clinical Nutrition and Food Management, Institute of
Biomedical Sciences, Tokushima University Graduate School,
Tokushima, 3Departments of Statistics and Computer Science,
College of Nursing Art and Science, University of Hyogo,
Akashi, 4Department of Nutrition management, Kofu
Municipal Hospital, Kofu, 5Department of Healthcare and
Regulatory Sciences, Showa University School of Pharmacy,
Tokyo, 6Department of Internal Medicine, Kofu Municipal
Hospital, Kofu, Japan
Rationale: Late evening snack (LES) is recommended to
improve liver cirrhosis, in early starvation. In patients with
liver cirrhosis, it is important to maintain branched chain amino
acid (BCAA) because muscles are synthesized at night.
Therefore, we investigated the effects of LES with BCAA on
Fischer ratio of liver cirrhosis patients.
Methods: Ten patients with liver cirrhosis were enrolled in
this study. They were outpatients without LES. The patient
characteristics were age, 73.1 ± 8.9 years; Male/Female, 5/5;
and BMI, 23.3 ± 2.4 kg/m2. The etiology was eight HCV and two
alcoholic. We measured the amino acid levels at four instances:
(1) before LES (Control) and after 1 month for each level of
BCAA given. (2) Aminoleban EN® as a LES with 6.1 g BCAA (LES).
(3) LIVACT® 2 packs a day and Aminoleban EN® until dinner with
14.1 g BCAA (BCAA-no LES). (4) LIVACT® 2 packs a day and
Poster Tour 2: Liver and GI S33

Aminoleban EN® as a LES with 14.1 g BCAA (BCAA-LES). The

0% Colon/ ≥50% Colon-in- Other Bowel
Friedman non-parametric test with post-hoc Dunn multiple Stoma Continuity/No Stoma Anatomy
comparison was used for statistical analyses.
Change at TED, PBO, TED, PBO, TED, PBO,
Results: There were no significant changes in the body weight
Wk24, n = 17* n = 16† n = 18 n = 20 n=7 n = 7‡
and serum albumin. Valine significantly increased in LES and Mean (SD)
BCAA-LES compared to that in Control. Isoleucine significantly
PS Volume
elevated in BCAA-LES compared to that in Control. There was mL/day −919 (644)§ −340 (436) −355 (306) −327 (349) −728 (532) −297 (498)
no significant difference in leucine and phenylalanine levels % −40 (18)# −19 (29) −23 (16) −24 (22) −40 (19) −19 (31)
among groups. Tyrosine significantly decreased in LES and Citrulline
µM 30.1 (18.9)§ 2.2 (6.9) 11.8 (9.9)§ 0.8 (5.3) 24.0 (20.9)§ −2.7 (7.6)
BCAA-LES compared to that in Control. Fischer ratio in LES and % 138 (50) § 8 (31) 87 (63) § 21 (71) 116 (85) § −1 (40)
BCAA-LES was significantly higher than that in Control, but
there was no significant difference from BCAA-no LES. *n = 14 with data; †n = 13 with data; ‡n = 6 with data; §P ≤ 0.01; #P < 0.05.
Furthermore, Fischer ratio was significantly higher in BCAA- Disclosure of Interest: P. Jeppesen Consultant for: Shire, Speaker
LES than that in BCAA-no LES. The Fisher ratios were as follows: Bureau of: Shire, S. Gabe Consultant for: Shire, D. Seidner Consultant
control, 1.8 ± 0.6; LES, 2.2 ± 0.8; BCAA-no LES, 1.8 ± 0.7; and for: Shire, H.-M. Lee Other: Employee for Shire, C. Olivier Other:
BCAA-LES, 2.3 ± 0.8. Employee for Shire.
Conclusion: These results suggested that it is not the BCAA
content, but LES, which is needed to improve Fischer ratio at PT02.6
fasting. CRITICAL ILLNESS IS ASSOCIATED WITH COMPROMISED FGF19
Disclosure of Interest: None declared. RESPONSE AFTER LIPID STIMULATION: AN OBSERVATIONAL
COMPARISON STUDY
PT02.5 K. V. Koelfat1,2 *, M. P. Plummer3,4, F. G. Schaap1,2, M. Lenicek5,
POST HOC ANALYSIS OF THE RELATIONSHIP BETWEEN A. M. Deane4,6, S. W. Olde Damink1,2,7. 1General Surgery,
PLASMA CITRULLINE AND PARENTERAL SUPPORT NEEDS IN Maastricht University Medical Center+, 2NUTRIM School for
PATIENTS WITH SHORT BOWEL SYNDROME WITH INTESTINAL Nutrition and Translational Research in Metabolism,
FAILURE (SBS–IF) RECEIVING TEDUGLUTIDE Maastricht, Netherlands, 3Discipline of Acute Care Medicine,
P. B. Jeppesen1 *, S. M. Gabe2, D. L. Seidner3, H.-M. Lee4, University of Adelaide, 4Department of Critical Care Services,
C. Olivier5. 1Rigshospitalet, Copenhagen, Denmark, 2St Mark’s Royal Adelaide Hospital, Adelaide, Australia, 5Department of
Hospital, Northwick Park, United Kingdom, 3Vanderbilt Clinical Biochemistry and Laboratory Diagnostics, First Faculty
University Medical Center, Nashville, 4Shire Human Genetic of Medicine, Charles University in Prague, Prague, Czech
Therapies, Inc., Lexington, United States, 5Shire International Republic, 6Discipline of Acute Care Medicine, Royal Adelaide
GmbH, Zug, Switzerland Hospital, Adelaide, Australia, 7Institute for Liver and Digestive
Health, University College London, London, United Kingdom
Rationale: Plasma citrulline ( p-cit) has been proposed as a
biomarker for remnant intestinal length, but it is unclear if p- Rationale: Gallbladder contraction and emptying is frequently
cit levels reflect intestinal absorptive function. This post hoc impaired in critical illness, and gallbladder dysmotility is
analysis investigated the relationship between parenteral associated with biliary sludge and its pancreatobiliary compli-
support (PS) volume reductions and p-cit changes with cations. Impaired gallbladder contraction can result in reduced
teduglutide (TED) in patients ( pts) with SBS–IF. intestinal delivery of bile salts, likely impacting signaling via
Methods: STEPS (NCT00798967; EudraCT2008-006193-15) was nuclear bile salt receptors (e.g. FXR) within the enterohepatic
a 24-week, placebo (PBO)–controlled study of TED 0.05 mg/kg/ tissues. In this study, serum excursions of bile salts and the FXR-
day in pts with SBS−IF. P-cit levels were assessed at baseline regulated enterokine FGF19 were studied in critically ill
(BL) and Wk24 in all pts randomized to TED and in pts stratified patients and controls following intraduodenal lipid challenge
by bowel anatomy. to induce gallbladder contraction.
Results: In the TED arm (n = 42), p-cit levels at BL were Methods: Total bile salts, FGF19 (negative regulator of bile salt
significantly correlated with remnant small bowel length synthesis) and C4 (marker for bile salt synthesis) were assayed
(R2 = 0.14; P = 0.02; n = 36) but not with BL PS volume in plasma of 24 critically ill patients (ICU) and 12 healthy
(R2 = 0.03; P = 0.30; n = 39). The correlation between BL p-cit controls (HC) during the course of a standardized intraduodenal
and p-cit change at Wk24 was significant (R2 = 0.80; P < 0.0001; lipid infusion (20% intralipid). Blood was sampled after an 8
n = 39). No correlation was found between change in p-cit hour fast, and 30 min intervals during lipid infusion (0–120 min)
levels and change in PS volume at Wk24 with TED (R2 = 0.05; until 1 hour thereafter. Differences between groups were
P = 0.16; n = 39). When pts were analyzed by bowel anatomy analyzed using Mann-Whitney U test.
subgroups, significant increases in p-cit were seen with TED but Results: At baseline, bile salts were increased in ICU patients
not PBO (Table). compared to the HC group (1.5 vs 3.3 μmol/l, p < 0.01), while
Conclusion: P-cit may serve as a marker of remnant small FGF19 and C4 levels were similar. In controls, lipid infusion
bowel length in pts with SBS–IF, but p-cit does not predict PS induced elevations of bile salts ( peak 90 min) and FGF19
volume reductions with TED. P-cit changes with TED may ( peak > 180 min). ICU patients had a similar rise in bile salts,
reflect increased enterocyte mass. but the FGF19 response was blunted, as reflected by declined
AUC ( p < 0.01). C4 levels were unchanged during the course of
lipid infusion.
S34
Conclusion: Serum FGF19 response following intraduodenal
lipid infusion is significantly blunted in critically ill patients.
Further studies are required to delineate functional conse-
quences of reduced prandial FGF19 levels in ICU patients, and
whether potentiation of intestinal FXR has therapeutic
potential in this vulnerable patient group.
Disclosure of Interest: None declared.
Poster Tour 3: Nutrition and Chronic
Disease 1
PT03.1
HYPERMETABOLISM IN AMYOTROPHIC LATERAL SCLEROSIS
PATIENTS; A CONFIRMATION BY A STUDY VERSUS CONTROL
AND USING DIFFERENT FORMULAS FOR CALCULATING
THEORETICAL RESTING ENERGY EXPENDITURE LEVEL
P. Jésus1,2,3, P. Fayemendy1,2,3, M. Nicol2,3,4, H. Sourisseau1,
Y. Boirie5,6, S. Walrand6, M. Coëffier7,8, P. M. Preux2,3,9,
B. Marin2,3,9, P. Couratier2,3,4, J. C. Desport1,2,3 *. 1Nutrition
Unit, University Hospital of Limoges, 2INSERM, U1094, Tropical
Neuroepidemiology, School of Medicine, 3UMR_S 1094, Tropical
Neuroepidemiology, Institute of Neuroepidemiology and
Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges,
4
ALS Center, University Hospital of Limoges, Limoges, 5Clinical
Nutrition Unit, University Hospital of Clermont-Ferrand, 6INRA
UMR 1019, Human Nutrition Unit, School of Medicine,
Clermont-Ferrand, 7INSERM UMR 1073, Nutrition,
Inflammation and Gut-Brain Axis Dysfunction, School of
Medicine, 8Clinical Nutrition Unit, University Hospital of
Rouen, Rouen, 9Center of Epidemiology, Biostatistics and
Research Methodology (CEBIMER), University Hospital of
Limoges, Limoges, France
Rationale: In Amyotrophic Lateral Sclerosis (ALS) hypermeta-
bolism is find in 50–60%, defined as an excessive level of resting
energy expenditure (REE) >10% of theoretical value. 1919
Harris and Benedict’s (HB) formulas are the main ones used to
obtain the theoretical values, but other predictive formulas are
also used in current practice. The aim of the study was to assess
the level of REE in ALS patients compared to control population
and using six predictive formulas of theoretical REE.
Methods: Nutritional assessments were performed in ALS
patient and in two control populations without hypermetabo-
lism: (control 1 and 2). Weight, height and body composition by
bioimpedance analysis were assessed. REE was measured
(mREE) by indirect calorimetry and calculated (cREE) using
1919 HB’s and 1984 HB’s formulas, and World Schofield, De
Lorenzo, Johnstone and Mifflin St. Jeor formulas. Mann-
Whitney and Chi2 tests were used for statistical analysis.
Results: 315 ALS patients, 80 control 1 and 54 control 2 were
analysed. mREE was 1,503 kcal/24 h in ALS patients,
1,220 kcal/24 h in control 1 and 1,344 kcal/24 h in control 2,
higher in ALS patients vs. cREE with all formulas ( p < 0.0001)
and higher vs. control 1 and control 2 (respectively p < 0.0002
and <0.0001). Depending on the predictive equation, hyper-
metabolism was found in 46.7% to 73.7% of ALS patients, with
REE variation of +8.1% to +19.0%. Percentage of hypermetabo-
lism and REE variation with the six formulas were higher in ALS
patients versus control ( p < 0.0001). Mifflin formulas produced
Poster tours
the lowest values of cREE, and the highest for percentage of
hypermetabolism and REE variation.
Conclusion: Compared to control populations, hypermetabo-
lism is confirmed in ALS patients. It is present with the six REE
predictive formulas used, but Mifflin equation seems the least
adapted.
Disclosure of Interest: None declared.
PT03.2
HIGH INTENSITY RESISTANCE EXERCISE INDUCES WHOLE
BODY PROTEIN CATABOLISM IN PATIENTS WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
C. Cruthirds1 *, N. Deutz1, E. Veley2, R. Harrykissoon3,
M. Engelen1. 1Healthy and Kinesiology, Texas A&M University,
2
Pulmonary and Critical Care, Scott and White Memorial
Hospital, 3Pulmonary, Critical Care & Sleep Medicine, College
Station Medical Center, College Station, United States
Rationale: Altered protein metabolism and exercise intoler-
ance are commonly present in patients with Chronic
Obstructive Pulmonary Disease (COPD). It remains unclear
whether a high intensity resistance exercise session, as
metabolic stressor, affects protein metabolism differently in
COPD patients as compared to healthy older adults.
Methods: In 14 patients with moderate to severe COPD (FEV1:
42.5 ± 4.6% pred) and 11 healthy control subjects, whole body
protein breakdown (PB) rate was measured and netPB assessed,
as marker of protein catabolism, via pulse IV infusion of L-[ring-
13C6]-Phenylalanine and L-[ring-D4]Tyrosine, before and twice
(1 and 24 h) after a whole body resistance exercise session
consisting of 8 × 3 repetitions of maximal extensions and
flexions for each arm and leg limb using isokinetic dynamo-
metry (KinCom). Fat-free mass was measured by DEXA, isotope
enrichments by LC-MS/MS and statistics (SE) by two-way
ANOVA/unpaired t-test. Significance was set at p < 0.05.
Results: The COPD patients completed less total work per kg
FFM than the healthy controls during the resistance exercise
protocol [114.0 ± 6.3 J/kg ffm vs. 164.8 ± 13.9 J/kg ffm,
respectively, p = 0.0016]. Resistance exercise did not induce
significant changes in PB and netPB in the control group at 1 h
or 24 hr post-exercise. Also in the COPD group, exercise did not
increase PB (Δ1h post-pre: −2.4 ± 5.3 µmol/kg ffm/h, ns) or
netPB (Δ1h post-pre: −0.4 ± 0.4 µmol/kg ffm/h, ns) one hour
after exercise. However, 24 hours after exercise both PB (Δ24h
post-pre: 15.4 ± 5.1 µmol/kg ffm/h, p < 0.001) and netPB (Δ24h
post-pre:1.3 ± 0.4 µmol/kg ffm/h, p < 0.001) were significantly
increased in COPD.
Conclusion: Despite completing less work, high intensity
resistance exercise induces whole body protein catabolism 24
hours post-exercise in patients with COPD but not healthy
controls.
Disclosure of Interest: None declared.
PT03.3
HYPERMETABOLISM IS A DELETERIOUS PROGNOSTIC FACTOR
IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS
P. Jésus1,2,3, P. Fayemendy1,2,3, M. Nicol2,3,4, G. Lautrette4,
H. Sourisseau1, P. M. Preux2,3,5, J. C. Desport1,2,3 *,
B. Marin2,3,5, P. Couratier2,3,4. 1Nutrition Unit, University
Hospital of Limoges, 2INSERM, U1094, Tropical
Poster Tour 3: Nutrition and Chronic Disease 1
Neuroepidemiology, School of Medicine, 3UMR_S 1094, Tropical
Neuroepidemiology, Institute of Neuroepidemiology and
Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges,
4
ALS Center, 5Center of Epidemiology, Biostatistics and
Research Methodology (CEBIMER), University Hospital of
Limoges, Limoges, France
Rationale: Hypermetabolism, defined as an excessive level of
resting energy expenditure (REE) has been reported in 50–60%
of patients with amyotrophic lateral sclerosis (ALS). The aim of
this study was to investigate a large cohort of ALS patients in
order to determine their nutritional, neurological and respira-
tory parameters and their survival according to the metabolic
level.
Methods: Nutritional, neurological and respiratory assess-
ments were prospectively recorded. Nutritional evaluation
included body mass index, REE measured by indirect calorim-
etry (hypermetabolism if REE variation [ΔREE] >10%) and fat
mass (FM) using impedancemetry. Neurological evaluation
included ALS phenotype at time of diagnosis, site at onset,
ALSFRS-R score. Respiratory evaluation included vital capacity
and SNIFF test. Survival analysis used the Kaplan-Meier method
and the multivariate Cox model.
Results: 315 patients were analysed. Median age at diagnosis
was 65.9 years. 55.2% of patients were hypermetabolic.
According to the metabolic level (ΔREE < 10%, 10–20% and
>20%), patients with a ΔREE >20% initially had a lower FM,
29.7% vs. 32.1% in those ≤10% ( p = 0.0054). SNIFF test tended
to be lower in ALS patients with ΔREE >20% ( p = 0.07). During
follow-up, nutritional status did not differ between the three
groups, The median slope of ALSFRS-R tended to evolve more
severely in patients with ΔREE >20%, −1.4 points/month vs.
−1.0 points/month in those ≤10% ( p = 0.07). Overall median
survival since diagnosis was 18.4 months. ΔREE >20% tended to
increase the risk of dying compared to ≤10% (HR = 1.33,
p = 0.055). In multivariate analysis, an increased REE/FM ratio
was independently associated with death (HR = 1.005,
p = 0.001).
Conclusion: Hypermetabolism is present in more than half of
ALS patients. It modifies the body composition at diagnosis, and
patients with hypermetabolism >20% have a worse prognosis.
Disclosure of Interest: None declared.
PT03.4
EFFECTS OF A DEXTROSE, AMINO ACID, AND L-CARNITINE-
BASED PERITONEAL DIALYSIS SOLUTION ON NUTRITIONAL
BIOMARKERS IN INCIDENT PERITONEAL DIALYSIS PATIENTS
L. S. Cervantes1 *, J. A. Leyva1, R. A. Cortina1,
I. Martinez Del Rio1, J. León1, O. O. Olea1, A. Biruete1,2.
1 liver. The chronic pulmonary hypertension may lead to stasis in
Clinical Nutrition Department, Hospital Lic. Adolfo López
Mateos ISSSTE, Mexico DF, Mexico, 2Nutritional Sciences,
University Illinois, Urbana, United States
Rationale: Chronic Kidney Disease (CKD) is a worldwide public
health problem. It has been estimated that 30–70% of
peritoneal dialysis (PD) patients are malnourished, being a
predictor of morbidity and mortality. Our objective was to
evaluate the effects of a modified PD solution based on
dextrose, amino acids, and L-carnitine on nutritional status in
incident PD patient
S35
Methods: A single-blind, randomized-controlled trial was
conducted in 30 incident PD patients. Patients were rando-
mized to: group A in which one of the PD dwells was substituted
with a modified PD solution (220 ml of 10% amino acid solution,
1 g of L-carnitine, and a final dextrose concentration of 1.07%),
or group B (standard care). Patients received the solutions for
one week. Biochemical (e.g., albumin and transferrin) and
functional (hand-grip dynamometry) markers of nutritional
status were assessed. Data was analysed using a repeated-
measures ANOVA in SPSS version 24.
Results: Albumin and transferrin were increased after a one-
week use of the modified PD solution in group A, but not after
the standard PD solution. Similarly, hand grip dynamometry
from both hands improved in group A, but not B. No changes in
other biochemical parameters.
Variable Group A (mean ± SEM) Group B (mean ± SEM) P
interaction
Pre Post Pre Post
Albumin 2.03 ± 0.13 2.21 ± 0.13 2.56 ± 0.13 2.28 ± 0.13 0.001
(g/dl)
Transferrin 128.38 ± 10.07 138.5 ± 9.7 130.41 ± 10.07 119.8 ± 9.7 <0.001
(mg/dl)
HGD (kg) 13.23 ± 1.59 17.76 ± 1.48 11.66 ± 1.59 8.96 ± 1.48 <0.0001
SEM, standard error of the mean; HGD, hand-grip dynamometry.
Conclusion: The implementation of a dialysis bag based on
dextrose, AA and L-carnitine was able to improve the
nutritional status of incident PD patients compared with
conventional PD solution. Further studies are needed to
assess the long-term effects of modified PD solutions and
their ability to reduce protein-energy wasting in PD patients
Disclosure of Interest: None declared.
PT03.5
SMALL INTESTINAL ABSORPTION IN PATIENTS WITH CHRONIC
OBSTRUCTIVE PULMONARY DISEASE COMPLICATED BY COR
PULMONALE – A PILOT STUDY
S. K. Andersen1 *, A. L. S. Hardis1, O. Tupper2, A. M. B. Soja3,
B. Nilsson3, C. S. Ulrik2,4, J. R. Andersen1. 1Department of
Nutrition, Exercise and Sports, University of Copenhagen,
2
Department of Pulmonary Medicine, 3Department of
Cardiology, Hvidovre Hospital, 4Institute of Clinical Medicine,
University of Copenhagen, Copenhagen, Denmark
Rationale: Cor pulmonale is a common complication to Chronic
Obstructive Pulmonary Disease (COPD), and may result in
increased pressure in the inferior caval vein and stasis of the
the veins from the small intestine and thereby compromise
absorption of nutrients. We wanted to investigate whether
patients with pulmonary hypertension have reduced absorption
capacity compared to COPD patients without of cor pulmonale.
Methods: Absorption of D-xylose (25 g) and zinc (132 mg),
administered as a single dose, was tested in 14 COPD patients,
seven with and seven without cor pulmonale. The presence of
cor pulmonale was determined by echocardiography. The
concentration of D-xylose and zinc were measured in periph-
eral blood one, two and three hours after ingestion and used as
marker of absorption. Furthermore, urine was collected for five
hours to determine the amount of excreted D-xylose.
S36
Results: No significant difference in absorption of D-xylose
( p = 0.28) or zinc ( p = 0.51) was found between the two groups.
However, a trend towards a delay in D-xylose absorption, as
assessed by time-to-peak concentration, was observed in
patients with cor pulmonale ( p = 0.08). There was no signifi-
cant difference in the amount of excreted D-xylose in the urine
between the groups ( p = 0.52). No correlation was found
between the tricuspid regurgitation gradient and the absorp-
tion of both test-markers (rs = 0.34 and rs = −0.25). Likewise,
no correlations were found between the inferior caval pressure
during the in- and expiration phases and the absorption of D-
xylose (rs = −0.09, rs = 0.23) or zinc (rs = −0.39, rs = −0.39).
Conclusion: We found no indications that small intestinal
absorption is affected in a clinically relevant degree in patients
with cor pulmonale.
Disclosure of Interest: None declared.
PT03.6
RESISTANCE EXERCISE INDUCES ALTERATIONS IN WHOLE
BODY BRANCHED CHAIN AMINO ACIDS (BCAA), KETO ACIDS
(BCKA), AND Β-HYDROXY-Β-METHYLBUTYRATE (HMB)
METABOLISM IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
C. Cruthirds1 *, N. Deutz1, D. Walker1, M. Engelen1. 1Healthy
and Kinesiology, Texas A&M University, College Station,
United States
Rationale: BCAA, BCKA, and HMB are understudied pathways of
the metabolic profile in Chronic Obstructive Pulmonary Disease
(COPD). It remains unclear if BCAA, BCKA and HMB metabolism
is different in COPD patients as compared to healthy older
adults when recovering from a metabolic stressor such as
exercise.
Methods: In 14 normal weight patients with moderate to severe
COPD (GOLD II-IV) and 11 healthy control subjects, whole body
rates of appearance (Ra) of the BCAA (leucine (LEU), valine
(VAL), isoleucine (ILE)), and BCKA (ketoisovaleric acid (KIV),
ketomethylpentanoate (KMV)), and HMB were measured via
pulse IV infusion of their stable tracers before and twice (1 and
24 h) after a high intensity whole body resistance exercise
session on an isokinetic dynamometer (KinCom). Fat-free mass
was measured by DEXA, enrichments by GC- and LC-MS/MS, and
statistics (SE; p < 0.05) by two-way ANOVA/unpaired t-test.
Results: Patients with COPD completed less total work per kg
FFM than the controls during the resistance exercise protocol
[114 ± 6.3 vs. 164.8 ± 13.9 J/kg ffm, p = 0.0016]. 24 h after
exercise, ILE Ra was similarly increased in both groups [COPD
Δ24h post-pre: 27.6 ± 13.6 µmol/kg ffm/h, p < 0.002], [Healthy
Δ24h post-pre:: 37.5 ± 10.7 µmol/kg ffm/h, p < 0.0001]. In the
COPD group only, LEU and HMB Ra were significantly increased
24 h post-exercise [Δ24h post-pre: 31.4 ± 11.6 µmol/kg ffm/h,
p < 0.01, and Δ24h post-pre: 0.43 ± 0.31 µmol/kg ffm/h, p =
0.07, respectively].
Conclusion: High intensity whole body resistance exercise
alters BCAA, BCKA, and HMB metabolism in patients with COPD.
Grants: ESPEN Fellowship 2016
Disclosure of Interest: None declared.
Poster tours
Poster Tour 4: Obesity and Metabolic
Syndrome
PT04.1
MATERNAL BMI AND FADS POLYMORPHISMS AFFECT PUFAS IN
BREAST MILK – THE PREOBE FOLLOW UP
A. de la Garza Puentes1,2 *, A. M. Chisaguano Tonato3,
R. Montes Goyanes4,5, I. Salas Lorenzo1,2,
M. L. García-Valdés6,7,8, M. T. Segura Moreno6,7,8,
M. García-Bermudez6,7,8, A. I. Castellote1,5, C. Campoy6,7,8,
M. C. López-Sabater1,5, on behalf of PREOBE team. 1Nutrition,
Food Sciences and Gastronomy, University of Barcelona,
2
Institute for Research on Nutrition and Food Safety (INSA-UB),
Barcelona, Spain, 3Nutrition, University of San Francisco de
Quito, Quito, Ecuador, 4Nutritional Research and Analysis
Institute, University of Santiago de Compostela, Santiago de
Compostela, 5CIBER Physiopathology of Obesity and Nutrition
(CIBERobn), Institute of Health Carlos III, Madrid, 6Centre of
Excellence for Paediatric Research (EURISTIKOS), 7Paediatrics,
University of Granada, Granada, 8CIBER Epidemiology and
Public Health (CIBEResp), Institute of Health Carlos III,
Madrid, Spain
Rationale: The aim of this study was to analyze the differences
of breast milk polyunsaturated fatty acids (PUFAs) according to
maternal pre-pregnancy body mass index (BMI) and fatty acid
desaturase (FADS) genotype.
Methods: Women (n = 61) from the PREOBE cohort were divided
in normal-weight (BMI: 18.5–24.9) and overweight/obese
(BMI ≥ 25) groups. Colostrum was collected 2–4 days post-
partum and used to analyze PUFAs that were expressed as
percentages of the total amount of FAs. Tag SNPs were
genotyped (3 in FADS1 and 3 in FADS2).
Results: Women with high BMI were associated with LC-PUFAn6
(β = 0.70, P = 0.003) and DHA:AA (β = −0.55, P = 0.016). Among
women who carried two major alleles, normal-weight group
had higher concentrations of EPA (0.05 vs. 0.03%), DHA (0.46 vs.
0.33%), EPA:AA (0.08 vs. 0.05%) and DHA:AA (0.73 vs. 0.50%)
and lower LC-PUFA n6:n3 (3.29 vs. 4.83%) than overweight/
obese women. These differences were lost in minor allele
carriers since PUFAs responded differently in BMI groups.
Normal-weight women who carried minor alleles showed a
tendency to decrease LC-PUFAs; they had lower levels of DHA
(0.46 vs. 0.33%) and AA:DGLA (1.24 vs. 0.97%) than major
homozygotes. Contrary, overweight/obese women who were
minor allele carriers had higher EPA (0.03 vs. 0.05%), EPA:ALA
(0.07 vs. 0.11%) and EPA:AA (0.05 vs. 0.08%) than major
homozygotes (P = 0.05). Dietary intake of DHA in late preg-
nancy correlated (R = 0.32, P = 0.035) with DHA level in
colostrum.
Conclusion: In conclusion, women with high BMI were
associated with altered FAs; however, FADS genotype modified
these results. Contrary to normal-weight group, overweight
and obese women could benefit from the FADS genetic variants
measured in this study. A high dietary DHA intake could prevent
the reduction of DHA in colostrum caused by overweight/
obesity or the presence of FADS minor alleles in normal-weight
women. Further research is needed to continue exploring gene-
BMI interaction.
Disclosure of Interest: None declared.
Poster Tour 4: Obesity and Metabolic Syndrome
PT04.2
IS TESTING FOR POSTPRANDIAL HYPERINSULINEMIC
HYPOGLYCEMIA AFTER GASTRIC BYPASS NECESSARY?
E. Aubry1 *, M. Gasser2, C. Meier2, S. Herren2, R. Steffen2,
Z. Stanga1. 1Department of Diabetes, Endocrinology,
Nutritional Medicine and Metabolism, Bern University Hospital
and University of Bern, 2European Center of Excellence for
Bariatric and Metabolic Surgery, Bern, Switzerland
Rationale: Bariatric surgery is the most efficient and only
durable treatment of severe obesity. Most long-term sequels
are well known and require a lifelong patient follow-up. One
increasingly reported complication is the postprandial hyper-
insulimic hypoglycemia ( pHH) which can cause life threatening
emergencies without warning symptoms. Provocative testing
can detect patients at risk. The aim of this study was to
determine the prevalence of pHH after Roux-en-Y gastric
bypass (RYGB) with or without symptoms of hypoglycemia.
Methods: Cohort study of consecutive, unselected patients
11–28 months after uncomplicated laparoscopic standard RYGP.
To simulate normal habits all patients received carbohydrate
rich standardized solid mixed meal. Insulin and glucose were
measured at 30, 60, 90, 120 and 150 min thereafter. Symptoms
were recorded and classified as autonomous or neuroglycope-
nic. Patients with hypoglycemia, defined as blood glucose of
<3.3 mmol/L, were tested a second time within a week with
protein rich standardized solid mixed meal.
Results: A total of 113 patients were included. Total
postoperative weight loss was 33.97 ± 9.3%. In 24.8% of patients
glucose dropped to less than 3.3 mmol/L, 13.8% to less than
3.0 mmol/L after carbohydrate solid mixed meal in contrast to
only one patient after a protein rich meal (0% with less than
3.0 mmol/L). Only 40.7% showed hypoglycemic symptoms. One
patient needed emergency treatment after sudden loss of
consciousness 80 min after carbohydrate meal. Asymptomatic
patients carry significant risk ( p < 0.01) for pHH.
Conclusion: pHH after RYGB can be life threatening and occur
without warning symptoms. Therefore, testing all patients is
necessary. How, when and how often remains to be investi-
gated. Standardized solid food test is an option close to daily
life situations. Patients should advised to avoid carbohydrate-
rich meals to prevent pHH according to the obtained results.
Disclosure of Interest: None declared.
PT04.3
VISCERAL ADIPOSITY IS A RISK MARKER OF DIABETIC
MACULAR EDEMA IN WOMEN
G. Verdes1 *, P. Calvo2, F. Bartol-Puyal2, M. Jiménez-Sanmartín2,
B. Abadía2, B. Lardiés3, I. Salas-García1, A. Ferreras2. 1alcañiz
Hospital, Alcañiz, 2Miguel Servet University Hospital, 3Royo
Villanova Hospital, Zaragoza, Spain
Rationale: Some studies have reported a relationship between
diabetic retinopathy (DR) and obesity, although the results are
inconsistent. DR has also been associated with visceral fat
accumulation. Neck (NC) and waist (WC) circumference and
waist-to-hip ratio (WHR) are good markers of visceral adiposity.
We hypothesized that type 2 diabetic (T2D) patients with
diabetic macular edema (DME) have greater body mass index
(BMI) and visceral adiposity than patients without DME.
S37
Methods: A sample of T2D patients was prospectively and
consecutively recruited. Participants underwent a comprehen-
sive examination, including ophthalmoscopy of the posterior
segment after pharmacological mydriasis, optical coherence
tomography (OCT) and anthropometric measurements. They
were divided into two groups according to the presence or
absence of DME, defined as macular central thickness ≥320 µm
in men and ≥305 µm in women using OCT. Since variables did
not follow a normal distribution, nonparametric Mann-Whitney
U test was applied.
Results: Non-DME patients had a mean age of 67.65 ± 8.29 years
and a BMI of 30.21 ± 5.63 kg/m2. DME subjects were
66.64 ± 6.98 years old and had a BMI of 31.61 ± 5.17 kg/m2.
There were no statistically significant differences in age
( p = 0.419) and BMI ( p = 0.08) between both groups. The
parameters of visceral adiposity are shown in the table
segregated by sex.
Non-DME DME p
Mean ± SD Mean ± SD
NC (cm) Male 42.42 ± 3.87 41.67 ± 3.78 0.461
NC (cm) Female 35.95 ± 3.33 38.99 ± 3.00 0.001
WC (cm) Male 107.13 ± 12.18 103.34 ± 10.51 0.245
WC (cm) Female 99.94 ± 12.55 113.96 ± 9.92 <0.001
WHR Male 1.03 ± 0.05 1.04 ± 0.04 0.791
WHR Female 0.94 ± 0.05 0.99 ± 0.05 0.003
Conclusion: Women with DME had higher NC, WC and WHR than
women without DME. BMI was similar in both groups. No
differences in anthropometric measurements were found
between men with and without DME. Visceral adiposity could
be a predictor of DME in T2D women.
Disclosure of Interest: None declared.
PT04.4
MR SPECTROSCOPY IN EXTREMELY OBESE PATIENTS: A PILOT
STUDY FOR THE EVALUATION OF INTRA- AND
EXTRAMYOCELLUAR LIPIDS AS POTENTIAL MARKER FOR
SIGNIFICANT WEIGHT LOSS
N. Oberänder1, M. Fischer1 *, A. Weimann1, on behalf of Kirsche
V, Kaufmann J, Schäfer Ao. 1Adipositaszentrum, Klinikum
St. Georg gGmbH Leipzig, Leipzig, Germany
Rationale: Lipid accumulation in the muscle is common in
extreme obesity and associated with increased risks for insulin
resistance. We used magnetic resonance spectroscopy (MRS) to
compare the intra- (IMCL) and extramyocellular lipid propor-
tion (EMCL) in the Musculus tibialis anterior of obese patients
before and after weight loss.
Methods: 19 non-diabetic patients with a Body Mass Index
(BMI) ≥40 kg/m2 that participated in a conservative multi-
modal weight loss program were recruited. Metabolite ratios of
IMCL and EMCL (metabolite/creatin) were assessed using
3Tesla-1Proton-MRS before and after 6 months therapy and
compared with changes in BMI, Waist-to-Hip-ratio (WHR), blood
pressure, body composition (BIA), functional exercise capacity
(6-min walking test, PWC-130), and quality of life (SF-36).
Statistical analyses were conducted using SPSS; group differ-
ences were tested (Wilcoxon rank test).
S38
Results: After 6 months the relative weight loss was 24.8%
(127.6 kg, 48.5 kg/m2 vs. 96 kg, 36.5 kg/m2). WHR, blood
pressure, and fat mass were also significantly reduced. MRS
data from 10 patients could be analyzed and provided IMCL/Cr
and EMCL/Cr ratios with different resonance. IMCL13/Cr was
reduced by nearly 50% ( p < 0.05). The difference for EMCL15/
Cr was not significant. An explorative correlation analysis
between MRS data and the conventional parameters (WHR,
BMI, weight etc.) did not reveal any significance.
Conclusion: A significant loss of IMCL following a Very Low
Calorie Diet is detectable by using MRS. This loss may indicate a
reduced risk of insulin resistance and therefore has the
potential to serve as an independent marker of significant
weight loss.
Acknowledgement: This study was supported by Institut
Danone Ernährung für Gesundheit e.V. (grant nr. 2014/4)
Disclosure of Interest: None declared.
PT04.5
L-NAME INHIBITS CITRULLINE-INDUCED LYPOLYTIC EFFECTS
IN SUBCUTANEOUS ADIPOSE TISSUE FROM ELDERLY
DYNAPENIC-OBESE PATIENTS
P. Noirez1,2 *, A. Meziani2,3, M. Dulac2,3, G. El Hajj Boutros2,3,
V. Marcangeli2,3, J. Morais4, C. Forest5,
M. Aubertin-Leheudre2,3. 1UFR Staps, IRMES, EA7329,
Universite Paris Descartes, Paris, France, 2Département des
Sciences de l’activité physique, UQAM, 3Centre de Recherche
l’Institut Universitaire de Gériatrie de Montréal, 4Geriatric
Department, Mc-Gill Universitary Hospital, Montréal, Canada,
5
INSERM UMR-S 1124, Universite Paris Descartes, Paris, France
Rationale: In animal studies, Citrulline (CIT) induces lipolysis
observed by the release of non-esterifed fatty acids (NEFA)
from white adipose tissue. This effect was suppressed by Nω-
Nitro-L-arginine methyl ester hydrochloride (L-NAME), a
nonselective nitric oxide (NO) synthase inhibitor. We aimed to
evaluate the effect of an acute exposure (24 h) of human
abdominal subcutaneous adipose tissue (SCAT) to CIT and L-
NAME in elderly dynapenic-obese (DO) patients.
Methods: Four women (w) (age: 69.6 ± 3.8 yrs; FM: 45.4 ± 5.5%;
handgrip strength/BodyWeight - HS/BW: 0.30 ± 0.06 kg/kg) and
5 men (m) (age: 67.1 ± 3.8 yrs; FM:34.4 ± 1.8%; HS/BW: 0.43 ±
0.09 kg/kg) dynapenic (HS/BW < 0.44 for women and <0.5 for
men) and obese (FM >30% for w and >25% for m) were recruited.
SCAT biopsies from all participants were incubated in KREBS
medium with glucose (5 mM), enriched or not with CIT (2.5 mM)
and L-NAME (1 mM) to evaluate whether NO was involved in CIT
effect. At 24 h of incubation, the medium was collected for the
estimation of NEFA (mM · mg−1) and glycerol (g · L−1 · mg−1)
release.
Results: The analyses of lipolytic products in the medium
showed that CIT increased NEFA (0.35 ± 0.09 vs 0.17 ± 0.04) and
glycerol (0.22 ± 0.05 vs 0.10 ± 0.06) release from SCAT ( p <
0.01). L-NAME abolished CIT effects on both NEFA (DOw:
0.184 ± 0.056 vs 0.329 ± 0.077; DOm: 0.190 ± 0.016 vs
0.368 ± 0.114) and glycerol (DOw: 0.130 ± 0.058 vs
0.227 ± 0.034; DOm: 0.074 ± 0.071 vs 0.215 ± 0.066) release
from SCAT of both gender ( p < 0.01).
Conclusion: As in animal studies, our human data show that CIT
stimulates the release of NEFA and glycerol from human SCAT in
a potential NO-dependent manner. Nevertheless, further
Poster tours
analyses should allow a better understanding of this process
in humans and whether this amino acid could potentially by
used for such a purpose in DO elderly adults.
Disclosure of Interest: None declared.
PT04.6
GLYCEMIC HOMEOSTASIS AFTER ROUX-EN-Y GASTRIC BYPASS
(RYGB) IS MORE ASSOCIATED WITH AN INCREASE IN GLP-1
THAN WEIGHT LOSS
D. C. Fonseca1, P. Garla1 *, P. Sala1, N. M. Machado1, R. Ishida1,
I. F. D. M. S. Guarda1, E. G. H. Moura1, P. Sakai1, M. A. Santo1,
I. D. C. G. Silva2, S. Heymsfield3, R. S. M. D. M. Torrinhas1,
D. Giannella-Neto4, D. L. Waitzberg1. 1Gastroenteroly, Medical
School of University of Sao Paulo, 2UNIFESP, Sao Paulo, Brazil,
3
Pennington Biomedical Research Center, Baton Rouge, United
States, 4Nove de Julho University, Sao Paulo, Brazil
Rationale: Improvement of glycemic control in type 2 diabetes
(T2D) patients after Roux-en-Y gastric bypass (RYGB) has been
frequently attributed to weight loss, but some patients do not
respond satisfactorily to surgery in relation to glycemic control
even with significant weight loss. However, intestinal hormones
have been associated with this benefic effect. Our aim was to
evaluate in 20 obese women with T2D, GLP-1 levels and if this
intestinal hormone is involved in glycemic control more than
weight loss.
Methods: We collected blood samples in 20 obese women
(age, 46.9 ± 6.2 yrs; BMI, 46.5 ± 5.3 kg/m2) before and 3
months after RYGB. Blood samples were collected after 12-h
fasts and 30, 60, 90, and 120 min after oral intake of 200 mL of a
liquid formula diet. The GLP-1 test was performed using
multiplex technique. After one year of RYGB the patients were
separated into 2 groups according to the American Diabetes
Association criteria to characterize partial remission or total
remission of T2D.
Results: After RYGB 12 patients were classified in total
remission group (TRG) and 8 patients in partial remission
group (PRG). Both groups presented significantly weight loss
after 3 months of RYGB ( p < 0.05) and there were no differences
between groups (Table 1). Moreover, only TRG group, presented
significantly increased in GLP-1 AUC after 3 months of RYGB.
Table 1: Weight and GLP-1 values in pre-operative and after 3 months of RYGB
Clinical Total remission group (TRG) Partial remission group (PRG)
Variable
Preop. 3m P Preop. 3m P
(n = 12) Postop. value (n = 8) Postop. value
(n = 12) (n = 8)
Weight (kg) 113.20 90.35 0.457 119.50 99.75 0.457
GLP-1 AUC 769.358 1,649.468 0.0109 650.753 1,528.065 0.1906
Values in median.
Conclusion: Our data suggest that the glycemic control after
RYGB occurs not only in association with weight loss, but in
response of increase production of GLP-1.
Disclosure of Interest: None declared.
Poster Tour 5: Nutritional Assessment
Poster Tour 5: Nutritional Assessment
PT05.1
PROPOSAL FOR NEW SELECTION CRITERIA CONSIDERING
PRETRANSPLANT MUSCULARITY AND VISCERAL ADIPOSITY IN
LIVING DONOR LIVER TRANSPLANTATION
Y. Hamaguchi1 *, T. Kaido1, S. Okumura1, A. Kobayashi1,
H. Shirai1, S. Yao1, S. Yagi1, N. Kamo1, H. Okajima1, S. Uemoto1.
1
Division of Hepato-Biliary-Pancreatic Surgery and
Transplantation, Department of Surgery, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
Rationale: We recently reported that both pretransplant
skeletal muscle mass and low skeletal muscle quality (muscle
steatosis) are independent risk factors for death after living
donor liver transplantation (LDLT). Based on this finding, for
better outcomes after LDLT, we have added new indication into
our selection criteria for LT since 2013: patients who can walk
unaided. In the present study, we investigated the significance
of muscularity as well as visceral adiposity, and aimed to
establish more objective selection criteria including these
parameters.
Methods: Using computed tomography imaging in 657 donors
for LDLT, skeletal muscle mass, muscle quality, and visceral
adiposity were evaluated by the skeletal muscle mass index
(SMI), intramuscular adipose tissue content (IMAC), and
visceral to subcutaneous adipose tissue area ratio (VSR),
respectively. The sex-specific cut-off values of SMI, IMAC, and
VSR were determined, and with evaluating their impact on
outcomes after LDLT in 277 recipients, we aimed to establish
the new selection criteria for LDLT.
Results: On the basis of the younger donor data, we
determined the sex-specific cut-off values for the low SMI,
high IMAC, and high VSR (mean ± 2 standard deviations). The
patients with all three factors showed the lowest survival rate
after LDLT (41.2% in 1-year survival; P < 0.001). On multivariate
analysis, low SMI (P = 0.002), high IMAC (P = 0.002), and high
VSR (P = 0.001) were identified as independent risk factors for
death after LDLT. Based on these findings, we have excluded
patients meeting these 3 factors (low SMI, high IMAC and high
VSR) from candidate for LDLT since October 2016.
Conclusion: Using the cut-off values provided from healthy
donors, we have established the new selection criteria for LDLT
including body composition, which would improve post-
transplant outcomes
Disclosure of Interest: None declared.
PT05.2
HIGH-RADIODENSITY SKELETAL MUSCLE INDEX: A BETTER
INDICATOR OF POOR PROGNOSIS THAN SKELETAL MUSCLE
INDEX IN ENDOMETRIAL CANCER PATIENTS
C. S. Rodrigues1, G. V. Chaves1 *. 1Nutrition and Dietetics,
Brazilian National Cancer Institute, Rio de Janeiro, Brazil
Rationale: To date, studies assessing the impact of low muscle
radiation attenuation in cancer prognosis are based on
comparing average muscle attenuation, assuming that higher
average attenuation indicates lower muscle adipose tissue
infiltration and higher muscle strength. It has not been
described whether the magnitude of the cross-sectional area
of high and low-radiodensity skeletal muscle is related to
S39
clinical outcomes in oncology. Thus, our aim was to investigate
whether the skeletal muscle radiodensity range, when divided
in sub-ranges of low or high-radiodensity, improves the
prediction of short-term survival in endometrial cancer (EC)
patients when compared to the mean muscle attenuation and
to the overall skeletal muscle radiodensity.
Methods: EC patients who had computed tomography (CT)
images available within 30 days before treatment were
enrolled (n = 208) in a retrospective cohort. CT images at the
third lumbar vertebra (L3) were used to assess overall skeletal
muscle index (SMI), which was afterwards divided into sub-
ranges of radiation attenuation: low-radiodensity skeletal
muscle index (LRSMI) and high-radiodensity skeletal muscle
index (HRSMI). The average muscle radiation attenuation
was also assessed. Sarcopenia was defined when SMI was
<=38.9 cm2/m2. One-yearsurvival was evaluated by Kaplan-
Meier method and Cox Regression.
Results: Sarcopenia was found in 26.4% of the patients. Roughly
80% of the patients in the highest quartile of LRSMI were obese.
All the skeletal muscle parameters were significantly asso-
ciated with shorter one-year survival, although HRSMI pre-
sented the strongest association (HR 5.91, Confidence Interval
2.16–16.17).
Conclusion: Classifying the skeletal muscle into sub-ranges of
radiodensity have an additional value then using the average
muscle attenuation of the overall skeletal muscle area.
Disclosure of Interest: None declared.
PT05.3
THE TAUROLIDINE-CITRATE-HEPARIN CATHETER LOCK
REDUCES CATHETER-RELATED BLOODSTREAM INFECTIONS
(CRBSIS) IN HIGH RISK, INTESTINAL FAILURE PATIENTS
RECEIVING HOME PARENTERAL NUTRITION (HPN): A DOUBLE-
BLINDED, RANDOMIZED AND PLACEBO-CONTROLLED
INVESTIGATION
S. Tribler1 *, C. F. Brandt1, K. A. Fuglsang1, A. H. Petersen2,
J. H. Petersen2, M. Staun1, P. Brøbech1, C. E. Moser3,
P. B. Jeppesen1. 1Department of Medical Gastroenterology,
University of Copenhagen Hospital, Rigshospitalet,
2
Department of Biostatistics, University of Copenhagen,
3
Department of Clinic Microbiology, University of Copenhagen
Hospital, Rigshospitalet, Copenhagen, Denmark
Rationale: CRBSIs inflict a frequent and major burden for HPN
patients. This study evaluated taurolidine-citrate-heparin
(TaurolockTMHep100) in preventing CRBSIs compared to
heparin.
Methods: Adult HPN patients with a previous mean CRBSI rate
of 2.4 episodes/1,000 days (95% Poisson CL; 2.12–2.71) were
randomized, in a double-blinded, placebo-controlled trial. An
external stratified randomization was performed according to
age, gender and prior CRBSI rate. The primary endpoint was
difference in mean CRBSI rate. The maximum treatment period
was two years or until the occurrence of a CRBSI or right-
censoring because of central venous catheter (CVC) removal.
Exact permutation tests were used to calculated p-values for
the log-rank tests, thereby eliminating small-sample issues.
Results: Twenty patients received the taurolidine lock and 21
heparin 100 IE/mL, with 9,622 and 6,956 treatment days,
respectively. Zero CRBSIs occurred in the taurolidine arm versus
7 in the heparin arm with a rate of 1.0/1,000 days (0.4–2.07)
S40
(P = 0.005). The CVC removal rates were 0.52 (0.17–1.21) and
1.72 (0.89–3.0) in the taurolidine and heparin arm, respect-
ively, tending to prolong CVC survival in the taurolidine arm
(P = 0.06). Local infection rates were 0.49 (0.13–1.25) and 1.58
(0.72–3.0) in the taurolidine and heparin arm, respectively
(P = 0.07). The costs per treatment year were lower in the
taurolidine arm (2,348 €) versus the heparin arm (6,744 €) due
to fewer admission days related to treatment of CVC-related
complications (P = 0.02).
Conclusion: The taurolidine-citrate-heparin catheter lock
(TaurolockTMHep100) demonstrates a clinically significant and
cost-beneficial reduction of CRBSI occurrence in high risk HPN
patients compared to heparin.
Disclosure of Interest: S. Tribler Grant/Research Support from:
TauroPharm GmbH, Jägerstr. 5a, D-97297 Waldbüttelbrunn,
Germany., C. Brandt: None declared, K. Fuglsang: None declared,
A. Petersen: None declared, J. Petersen: None declared, M. Staun:
None declared, P. Brøbech: None declared, C. Moser: None declared,
P. Jeppesen: None declared.
PT05.4
PERFORMANCE OF THICKNESS OF THE ADDUCTOR POLLICIS
MUSCLE (TAPM) TO PREDICT UNDERNUTRITION, MORBIDITY
AND MORTALITY IN A SURGICAL INTENSIVE CARE UNIT
J. S. Fink1 *, T. G. Pereira2, A. Marcadenti3,4, E. I. Rabito5,
F. M. Silva6. 1Serviço de Nutrição e Dietética, Hospital Nossa
Senhora da Conceição, 2Hospital Moinhos De Vento,
3
Departamento de Nutrição, Universidade Federal de Ciências
da Saúde de Porto Alegre (UFCSPA), 4PPG Ciências da Saúde:
Cardiologia, Instituto de Cardiologia/Fundação Universitária
de Cardiologia (IC/FUC), Porto Alegre, 5Departamento de
Nutrição, Universidade Federal do Paraná, Curitiba,
6
Departamento de Nutrição, Universidade Federal de Minas
Gerais, Belo Horizonte, Brazil
Rationale: There is not a simple and accurate method to
identify undernutrition in surgical intensive care unit (SICU).
This study aims to evaluate the performance of thickness of the
adductor pollicis muscle (TAPM) to identify undernutrition and
predict morbidity and mortality in critically surgical patients.
Methods: A cohort study was performed in a SICU of a South
Brazilian public hospital. Patients were evaluated in the first 72
hours after SICU admission and then followed until hospital
discharge. Patients with hand edema were excluded.
Nutritional status was classified according to subjective
global assessment (SGA). The measurement of TAPM was
performed on right hand with the patients lying in bed. The
outcomes of interest were length of stay in SICU, length of
hospital stay, duration of mechanic ventilation and mortality.
Results: The study included 65 patients (59.8 ± 17.0 years,
70.8% males). The majority of them underwent to surgery
related to the digestive (n = 30, 46.2%) and cardiovascular
(n = 18, 27.7%) systems. The TAPM did not differ ( p = 0.203)
between patients classified as SGA-A (15.7 ± 3.9), SGA-B
(14.5 ± 3.2), and SGA-C (13.4 ± 4.5) and the area of ROC curve
to assess the accuracy of TAPM to identify undernutrition was
not good [0.611 (IC95% 0.459–0.762]. Patients with length of
stay in SICU ≥ 3 days had TAPM significantly lower (13.1 ± 3.1
mm) than these with length of stay in SICU < 3 days (16.3 ± 3.8
mm). The odds of length of stay in IUC ≥ 3 days was 5.494
( p = 0.002) times greater in patients with TAPM ≥ 15 mm. The
Poster tours
length of hospital stay, the duration of mechanic ventilation
and incidence of death were not associated with TAPM.
Conclusion: The TAPM was positively associated with length of
stay in SICU, but did not have a satisfactory accuracy to identify
undernutrition in surgical patients.
Disclosure of Interest: None declared.
PT05.5
PHASE ANGLE PREDICTS READMISSIONS AND LENGTH OF
HOSPITAL STAY IN PATIENTS WITH INTESTINAL FAILURE ON
LONG-TERM PARENTERAL NUTRITION
M. Køhler1 *, H. H. Rasmussen1,2, S. S. Olesen2,3. 1Center for
Nutrition and Bowel Disease, Aalborg University Hospital,
2
Clinical Institute, Aalborg University, 3Center for Pancreatic
Diseases, Aalborg University Hospital, Aalborg, Denmark
Rationale: Patients with intestinal failure type 3 (IF) are at risk
of altered body composition and impaired muscle function
due to malnutrition, malabsorption and immobilization, which
may increase number of readmissions and length of hospital
stay (LOS). The aims of this study were to investigate the
predictive value of body composition and muscle function on
readmission rates and LOS in IF patients on long-term
parenteral nutrition (HPN).
Methods: In a prospective observational study, we observed IF
patients treated with HPN for a minimum of 1 year during a
period of 6 years (2010–2016). At inclusion, we recorded
gender, age, body mass index (BMI, kg/m2) and handgrip
strength (HGS, kg). Further, we recorded fat mass index (FMI,
kg/m2), fat free mass index (FFMI, kg/m2) and phase angle (PA,
degrees) measured by bioelectrical impedance analysis (BIA).
Outcome parameters were recorded as number of readmissions
and LOS.
Statistics: Age and gender adjusted univariate and stepwise
multivariate regression. Significance level: p < 0.05.
Results: We included 77 patients in the study (age 59 ± 15
years, BMI 20.0 ± 4.2 kg/m2, female 73%). The average LOS was
23.2 ± 23.6 days and the average number of readmissions was
2.0 ± 1.8 per year. In univariate analysis PA ( p = 0.009) and HGS
( p = 0.012) were associated with the number of readmissions.
Multivariate analysis confirmed the independence and signifi-
cance of the association for PA (coefficient −0.5 [95% CI; −0.9
to −0.2]; p = 0.007). In addition, PA was associated with LOS in
univariate analysis ( p = 0.019), while none of the remaining
parameters were significantly associated with LOS
Conclusion: Phase angle significantly predicted number of
readmissions and length of hospital stay in patients with
intestinal failure on long-term parenteral nutrition. Further,
we found an association between handgrip strength and
number of readmissions
Disclosure of Interest: None declared.
PT05.6
ASSESSMENT OF RESTING ENERGY EXPENDITURE AND BODY
COMPOSITION IN UNDERWEIGHT MALES
R. Sammarco1 *, M. Marra1, C. De Caprio1, E. De Filippo1,
F. Pasanisi1, F. Contaldo1. 1Clinical Medicine and Surgery,
University Federico II, Napoli, Italy
Rationale: Despite the increased prevalence of anorexia
nervosa among males in both community and clinical
Poster Tour 6: Paediatrics
samples, limited data are available in the literature. The aim of
this study is to evaluate REE and body composition in anorectic
patients and constitutional lean males compared with age-
matched control subjects.
Methods: we studied 17 anorectic (AN) males (age 22.3 ± 5.3
years, weight 51.8 ± 4.8 kg, BMI 17.1 ± 1.2 kg/m2), 15 consti-
tutional lean (CL) (age 23.3 ± 5.2 years, weight 56.1 ± 3.3 kg,
BMI 17.9 ± 0.6 kg/m2) and 18 control (CTR) subjects (age
22.3 ± 3.7 years, weight 70.3 ± 6.5 kg, BMI 22.3 ± 1.7 kg/m2).
REE was measured by indirect calorimetry (V max29-
Sensormedics) and bioimpedance analysis was performed at
50 kHz (DS Medica) early in the morning. Phase angle (a
bioimpedance variable related to nutritional status) was used
in order to differentiate the degree of malnutrition.
Results: REE both in absolute value and corrected for FFM was
significantly higher in CL and lower in AN than constitutional
lean and controls. (REE: CL 1,726 ± 216 kcal/die, AN 1,150 ±
169 kcal/die, CTR 1,678 ± 167 kcal/die p < 0.05; REE/FFM: CL
35.9 ± 6.2 kcal/kg, AN 25.2 ± 4.2 kcal/kg, CTR 30.0 ± 3.0 kcal/
kg p < 0.05). Body composition is similar in AN and CL males
(FFM: 46.0 ± 5.2 vs 48.6 ± 4.4 kg, ns; FAT %: 10.3 ± 5. vs
13.6 ± 5.7%, ns). Phase angles is similar in CL and ctr
(6.9 ± 0.6 vs 6.8 ± 0.4 degree, ns) whereas anorectic males
had the lowest phase angle (5.8 ± 1.2 degree, p < 0.05 vs CL
and CTR).
Conclusion: This study suggests that resting energy expend-
iture was higher in constitutionally lean and the REE/FFM ratio
allows to differentiate between CL and AN, despite a similar
BMI; phase angle appears to be an effective marker of
qualitative changes in body composition and is able to
discriminate between these two different forms of under-
weight (AN and CL).
Disclosure of Interest: None declared.
Poster Tour 6: Paediatrics
PT06.1
PERSISTENT INFLAMMATION, IMMUNOSUPPRESSION, AND
CATABOLISM SYNDROME (PICS) IN CRITICALLY ILL CHILDREN IS
ASSOCIATED WITH MORTALITY
D. B. Haushchild1, J. C. Ventura1, L. D. D. A. Oliveira1,
M. S. Farias2, E. Barbosa2, N. L. Bresolin3, Y. M. F. Moreno1 *.
1
Nutrition, Federal University of Santa Catarina, 2Nutrition,
3
Pediatric Intensive Care Unit, Joana de Gusmão Children’s
Hospital, Florianopolis, Brazil
Rationale: PICS has most recently been described as a
persistent inflammation, immune suppression, and protein
catabolism in critically ill adults, which may contribute to
unfavorable outcomes. However, PICS has not been evaluated
in critically ill children. This study aimed to characterize
critically ill children with PICS and verify its association with
mortality.
Methods: Prospective study conducted in a Pediatric Intensive
Care Unit (PICU), with children aged between 1 month and 15
years. PICS was defined as >14 days in PICU, C-reactive protein
(CRP) >6 mg/dL, lymphocytes <25% and reduction in mid-upper
arm circumference (MUAC) z-score or MUAC <−2 z-score.
Clinical, demographic, nutritional status (NS), nutritional
therapy (NT) parameters and clinical outcomes were assessed.
S41
Mann-Whitney, Fischer chi-square and logistic regression were
applied. P-value <0.05 was considered significant.
Results: Among 201 children included (median age 27 months,
63% male), 3.5% had PICS. Although not significant, children
with PICS were older (43.8 vs. 26.7 months). At admission, 49
children had chronic complex conditions and none developed
PICS. Mortality was observed in 13% of the cohort. Children with
PICS had longer PICU length of stay (LOS) (29 vs. 7 days;
p < 0.001), hospital LOS (59 vs. 21 days; p < 0.001) and duration
of mechanical ventilation (26 vs. 5 days; p < 0.001). Prevalence
of nosocomial infection was 43% in children with PICS and 25%
without PICS ( p = 0.265). Clinical, NS and NT variables were not
associated with PICS. PICS was associated with mortality in
crude (OR 5.44; p = 0.033) and adjusted analysis (OR 4.97;
p = 0.046).
Conclusion: PICS was associated with mortality in critically ill
children. More studies are needed to properly define PICS for
this population.
Disclosure of Interest: None declared.
PT06.2
MATERNAL BODY MASS INDEX ALTERS BREAST MILK FATTY
ACID COMPOSITION– THE PREOBE FOLLOW UP
A. de la Garza Puentes1,2 *, A. M. Chisaguano Tonato3,
R. Montes Goyanes4,5, M. Caballero Arredondo1,2,
M. L. García-Valdés6,7,8, M. T. Segura-Moreno6,7,8,
M. García-Bermudez6,7,8, A. I. Castellote1,5, C. Campoy6,7,8,
M. C. López-Sabater1,5, on behalf of PREOBE Team. 1Nutrition,
Food Sciences and Gastronomy, University of Barcelona,
2
Institute for Research on Nutrition and Food Safety (INSA-UB),
Barcelona, Spain, 3Nutrition, University of San Francisco de
Quito, Quito, Ecuador, 4Nutritional Research and Analysis
Institute, University of Santiago de Compostela, Santiago de
Compostela, 5CIBER Physiopathology of Obesity and Nutrition
(CIBERobn), Institute of Health Carlos III, Madrid, 6Centre of
Excellence for Paediatric Research (EURISTIKOS), 7Paediatrics,
University of Granada, Granada, 8CIBER Epidemiology and
Public Health (CIBEResp), Institute of Health Carlos III,
Madrid, Spain
Rationale: Breast milk fatty acid (FA) composition plays an
important role in children’s growth and development, but there
is limited information about it corresponding to maternal
nutritional status. The aim of this study was to analyze the
differences of mature breast milk FA composition in lactating
women of different pre-pregnancy body mass index (BMI).
Methods: Women (n = 65) from a population-based pregnancy
cohort of the PREOBE Project were divided in 3 different groups
according to pre-pregnancy BMI; normal-weight (BMI: 18.5–
24.9), overweight (BMI: 25–29.9) and obese (BMI ≥ 30).
Collection of mature breast milk was performed 28–32 days
postpartum and samples were used to analyze FAs that were
expressed as percentages of the total amount of FAs.
Results: FA levels in breast milk differed according to maternal
weight. Compared to normal-weight women, the obese group
displayed higher levels of total saturated FAs (27.80 vs.
25.83%), C22:2n-6 (0.06 vs. 0.04%), C22:5n-6 (0.09 vs. 0.05%)
and lower C18:1n-9 (36.63 vs. 39.69%), total monounsaturated
FAs (40.74 vs. 43.73%) and C18:3n-3 (ALA) (0.46 vs. 0.59%).
Whereas overweight women showed higher levels of C22:5n-6
(0.07 vs. 0.05%) and n6:n3 ratio (18.28 vs. 15.08%) and lower
S42 Poster tours

C22:6n-3 (DHA) (0.22 vs. 0.28%) and EPA:AA ratio (0.09 vs.
0.12%) than normal-weight group. Significance level was
established at a P value of 0.05.
Conclusion: In conclusion, maternal weight affects FA con-
centrations in mature breast milk. Our results suggest that the
quality of breast milk is compromised in women with a BMI ≥ 25
which could also affect the quality of nutrients supplied to the
neonate. Since diet influences breast milk FAs, overweight and
obese women could benefit from dietary recommendations to
optimize breast milk FA composition.
Disclosure of Interest: None declared.
PT06.3
FACTORS ASSOCIATED WITH RAPID WEIGHT GAIN IN
PRESCHOOL CHILDREN IN PUBLIC DAY CARE CENTERS, MOGI
DAS CRUZES, SAO PAULO, BRAZIL
A. D. S. N. Lourenço1 *, F. L. C. Oliveira1, D. A. Neri1,
T. Konstantyner1, D. Palma1. 1Departamento de Pediatria,
Universidade Federal de São Paulo, São Paulo, Brazil
Gastroenterology, University of Ghent, Ghent, Belgium,
3
Pediatric Gastroenterology, Academic Medical Center, Emma
Children’s Hospital, Amsterdam, Netherlands, 4Pediatric
Gastroenterology, Great Ormond Street NHS Foundation Trust,
London, United Kingdom
Rationale: We aimed to assess the clinical practice of pediatric
IF teams across Europe and compare the results to the current
guideline (1).
Methods: An online survey was sent to members of ESPGHAN
Network for IF and Transplantation in Europe, BSPGHAN and
members of the special interest group Pediatrics of ESPEN.
Results: Sixty-seven respondents completed the survey, repre-
senting 59 teams from 20 countries. The median number of
team members were as follows: 2 pediatric gastroenterologists
(min–max: 0–7), 2 pediatric surgeons (0–5), 1 dietician (0–4), 1
nurse (0–8), 1 pharmacist (0–3). Table 1 shows the current
clinical practice compared with the current guideline.
Table 1: Recommendations by ESPEN/ESPGHAN guideline (1) and current clinical
practice obtained from the survey.

Rationale: The growth of the child since intrauterine life can Care element Guideline Survey
be influenced by several factors, especially maternal nutrition Catheter lock Routine use of catheter 90% used catheter lock
and nutritional status of the first years of life, which may have solutions & lock solutions not solutions (taurolock/
an action on metabolic programming, increasing the risk of anticoagulation recommended. taurolidine/heparin).
Anticoagulation may be 46% used anticoagulation
chronic diseases. Thus, the objective of this study was to given
estimate the prevalence and identify factors associated with Bone health Bone densitometry 0.5–1 Yearly by 31% of teams,
rapid weight gain in preschool children. year interval never used in 21%
Nutritional Regular measurement of Weight (100%), height
Methods: A cross-sectional study was carried out with 136 assessment height, weight and head (98%), head
children between 24 and 35 months of age attending public circumference (if <3 yr) circumference (81%),
day-care centers in Mogi das Cruzes. Interviews were con- BMI (70%)
Micronutrient Zinc: 1–3 month interval Zinc: every 3 months by 41%
ducted with the mothers for clinical, sociodemographic and
assessment Vitamin A, E and D: 0.5–1 of teams Vitamin A, E
anthropometry characterization of the children. It was year interval and D according to
considered as rapid weight gain when the children presented guideline
difference greater than 0.67 between the z score of weight for
age from birth to the evaluation. A logistic regression model Conclusion: Practices of pediatric IF teams vary across Europe.
was adjusted for factors associated with rapid weight gain. Compared to the guideline, the use of catheter lock solutions
Results: 50 children (36.8%) presented rapid weight gain and 36 and monitoring of bone health varied most. This survey shows
(26.5%) were overweight. Of these, 22 children were in the the need for evaluation of the existing guideline. Moreover,
rapid weight gain group. The logistic model showed the highest expert-based practical protocols are needed for optimizing
total breastfeeding time [OR = 0.94 (95% CI 0.88–0.99), p = care.
0.031] as protection factor and low socioeconomic level
Reference
[OR = 4.18 (95% CI 1.04–18.60), p = 0.044] as a risk factor for
rapid weight gain. 1. Koletzko B et al., J Pediatr Gastroenterol Nutr 2005;41.
Conclusion: There was a high prevalence of rapid weight gain Disclosure of Interest: None declared.
and overweight among preschoolers in the third year of life
attending a sample of public day care centers in Brazil.
PT06.5
Encouraging the practice of breastfeeding of children in the
BONE STATUS AND ADIPOKINE LEVELS IN CHILDREN ON
first years of life and guiding adequate food, especially for
VEGETARIAN AND OMNIVOROUS DIETS
families with low socioeconomic status, potentially contributes
to reduce rapid weight gain and, consequently, future J. Ambroszkiewicz1 *, M. Chełchowska1, W. Klemarczyk2,
metabolic complications of overweight. G. Rowicka1, J. Gajewska1. 1Screening Department,
2
Department of Nutrition, Institute of Mother and Child,
Disclosure of Interest: None declared.
Warsaw, Poland

PT06.4 Rationale: Measurements of bone mineral density (BMD)

COMPARISON OF CLINICAL PRACTICE OF PEDIATRIC
INTESTINAL FAILURE TEAMS WITH ESPGHAN/ESPEN
GUIDELINE: A EUROPEAN SURVEY
E. Neelis1, B. De Koning1, M. van Winckel2, M. Tabbers3, S. Hill4,
J. Hulst1 *. 1Pediatric Gastroenterology, Erasmus MC, Sophia
Children’s Hospital, Rotterdam, Netherlands, 2Pediatric
reflect bone status but not the dynamics of bone turnover.
Biochemical markers, which show global skeletal activity, were
validated for the assessment of bone formation and resorption
processes. Adipokines play also a significant role in the
regulation of bone metabolism. The aim of this study was to
assess body composition, bone turnover markers and adipokine
levels in vegetarian and omnivorous children.
Poster Tour 7: Nutrition and Chronic Disease 2
Methods: The study included 60 healthy prepubertal children
(median age 6.5 years) divided into two subgroups: 30
vegetarians and 30 omnivores. Body composition and BMD
was assessed by dual-energy X-ray absorptiometry. Vitamin D
and parathormone (PTH) levels was measured by chemilumin-
escence method. Total osteocalcin (OC), carboxylated osteo-
calcin (c-OC), C-terminal cross-linking telopeptide of collagen
type I (CTX), leptin and adiponectin levels were determined by
immunoenzymatic assays. Statistical analyses were done using
SPSS software.
Results: Both groups of children were comparable in term of
body composition, except of fat mass, which was lower
( p < 0.05) in vegetarians. Vegetarians had lower vitamin D
(21.6 vs. 27.8 ng/ml, p < 0.01), higher PTH (44.2 vs.31.0 pg/
ml, p < 0.05) and higher CTX (1.98 vs. 1.61 ng/ml, p < 0.05)
levels than omnivores. Total osteocalcin concentrations were
comparable in both groups, however, c-OC was lower (27.4 vs.
34.1 ng/ml, p < 0.05) in vegetarians. Leptin level was about
2-fold lower in vegetarians, but adiponectin concentration was
similar in both groups. Mean values of total BMD were lower
( p < 0.05) in vegetarians than in omnivores.
Conclusion: Decreased vitamin D and c-OC levels coexisting
with increased PTH and CTX concentrations show disturbances
in bone turnover and might lead to reduced bone mineral
density. Lower fat mass and serum leptin levels in vegetarians
may also influence bone metabolism.
Disclosure of Interest: None declared.
PT06.6
IS FOOD INSULIN INDEX ASSOCIATED WITH HUNGER IN OBESE
ADOLESCENTS WITH INSULIN RESISTANCE?
Z. Caferoglu1 *, N. Hatipoglu2, H. Gokmen Ozel3. 1Department
of Nutrition and Dietetics, Erciyes University Faculty of Health
Science, 2Department of Pediatric Endocrinology, Erciyes
University Faculty of Medicine, Kayseri, 3Department of
Nutrition and Dietetics, Hacettepe University Faculty of
Health Science, Ankara, Turkey
Rationale: The food insulin index (FII) is a novel classification
for ranking foods based on their physiologic insulin demand
relative to an isoenergetic reference food and may be a valid
predictor of appetite, hunger and satiety. The aim of this study
was to determine the effect of FII on appetite in obese
adolescents with insulin resistance (IR).
Methods: A randomized crossover trial included 15 obese
adolescents aged 12–18 years (median = 15 years) with IR. All
participants were submitted two different breakfasts: low
glycemic index, low insulin index (LGI-LII) and low glycemic
index, high insulin index (LGI-HII), with a 1-week washout period
between meals. The two meals were matched for macronutrients
and GI but had a 2-fold difference in II. At time 0, 15, 30, 45, 60,
90, 120, 180 and 240 minutes after the meal, appetite (hunger,
satiety, fullness, prospective food consumption and desire to
eat something fatty, salty, sweet or savoury) was evaluated by
visual analog scale. At the end of four hours, participants were
served ad libitum lunch meal. The foods eaten at lunch were
recorded. Energy and macronutrient intakes were calculated.
Appetite scores were quantified as area under the curve.
Results: The feeling of hunger was lower by %21.6 after LGI-LII
meal compared to LGI-HII meal ( p = 0.037). Also, desire to eat
something sweet was lower by 14.5% after LGI-LII meal vs LGI-
S43
HII meal, but the difference was not statistically significant
( p = 0.228). It was not found a difference in other appetite
scores between test meals ( p > 0.05). On the other hand, it was
not found a difference between LGI-LII and LGI-HII meals in
terms of energy and macronutrients intake during the
subsequently ad libitum lunch ( p > 0.05).
Conclusion: These results were shown that only FII independ-
ent of GI or macronutrients in the context of mixed meal could
affect the perceived hunger in obese adolescents with IR.
Disclosure of Interest: None declared.
Poster Tour 7: Nutrition and Chronic
Disease 2
PT07.1
TWO COMPONENTS OF THE NEW ESPEN DIAGNOSTIC
CRITERIA FOR MALNUTRITION ARE INDEPENDENT
PREDICTORS OF LUNG FUNCTION IN HOSPITALIZED PATIENTS
WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
A. R. Ingadottir1,2 *, A. M. Beck3,4, C. Baldwin5, C. E. Weekes5,
O. G. Geirsdottir1,6, A. Ramel1, T. Gislason7,8,
I. Gunnarsdottir1,2. 1Unit for Nutrition Research, Landspitali
University Hospital & Faculty of Food Science and Nutrition,
University of Iceland, 2Department of Clinical Nutrition,
Landspitali University Hospital, Reykjavik, Iceland,
3
Department of Nutrition and Health, Faculty of Health and
Technology, Metropolitan University College, Copenhagen,
4
Research Unit for Nutrition, Herlev and Gentofte Hospital,
Gentofte, Denmark, 5Division of Diabetes and Nutritional
Sciences, King’s College London, London, United Kingdom,
6
The Icelandic Gerontological Research Center, Landspitali
University Hospital & University of Iceland, 7Faculty of
Medicine, University of Iceland, 8Department of Respiratory
Medicine and Sleep, Landspitali University Hospital,
Reykjavik, Iceland
Rationale: Low fat free mass index (FFMI) is a component of the
ESPEN diagnosis criteria of malnutrition, that only when
accompanied with weight loss is considered to be a determin-
ant of malnutrition. Our aims were to assess the prevalence of
malnutrition in patients with chronic obstructive pulmonary
disease (COPD) applying the ESPEN criteria, and to examine the
ability of different components of the criteria to predict COPD
severity, length of stay (LOS), hospital readmissions within 30
days and mortality.
Methods: Subjects were COPD patients (n = 121) admitted to
Landspitali University Hospital from March 2015–March 2016.
Patients were screened for nutritional risk using Icelandic
screening tool (ISS) and NRS-2002. Body composition was
measured by bioelectrical impedance analysis (BIA). Lung
function was measured by spirometry.
Results: The prevalence of malnutrition according to the
ESPEN criteria was 21%. The association between nutritional
assessment, applying different components of the ESPEN
criteria, and COPD severity was highly significant, with the
highest risk being associated with low FFMI OR (95% CI) 4.77
(2.03, 11.20; p < 0.001). There was a trend towards higher risk
of hospitalization for >7 days in subjects with low FFMI (OR 2.46
95% CI 0.92, 6.59; p = 0.074) and increased risk of 6 and 9
months’ mortality (OR 2.72 95% CI 0.88, 8.39, p = 0.082 and OR
S44
2.72 95% CI 0.94, 7.87, p = 0.065, respectively) in subjects
diagnosed as malnourished by the ESPEN criteria.
Conclusion: Our study is the first to describe the prevalence of
malnutrition in hospitalized COPD patients using the ESPEN
criteria from 2015. It might be suggested that FFMI should be
used independent of weight loss for diagnosis of malnutrition in
COPD patients.
Disclosure of Interest: None declared.
PT07.2
ACCURACY OF REE PREDICTIVE EQUATION IN FEMALE
PATIENTS WITH SEVERE ANOREXIA NERVOSA
R. Sammarco1 *, M. Marra1, C. De Caprio1, E. De Filippo1,
F. Pasanisi1, F. Contaldo1. 1Clinical Medicine and Surgery,
University Federico II, Napoli, Italy
Rationale: The assessment of resting energy expenditure (REE)
plays an important role in the management of severely
underweight AN patients. The aim of this study is to evaluate
in female patients with a chronic condition of anorexia nervosa
the accuracy of predictive equations for resting energy
expenditure (REE) already described in the literature,
derived from general population (Harris-Benedict equation)
and from specific equation for AN patients.
Methods: Two-hundred and eighty two young girls (age 18–35 y,
mean 23.7 ± 4.6 y) with severe anorexia nervosa (weight
36.5 ± 4.1 kg; BMI 14.2 ± 1.4 Kg/m2) were studied. REE was
misured (MREE) by indirect calorimetry (V max29-
Sensormedics) and predicted according to the Harris-
Benedict formula and Schebendach and Scalfi formula specif-
ically derived for anorexia nervosa.
Results: All the considered predictive equations underesti-
mated REE in AN patients (MREE: 883.5 ± 141.1 kcal/die vs
786.6 ± 102.5 kcal/die with Schebendach and 832.5 ± 89.2
kcal/die with Scalfi), whereas Harris Benedict significantly
overestimated REE vs MREE (1,207 ± 55 kcal/die, p < 0.05).
Schebendach reported an underestimation of −97 kcal/die
(−9.4%), Scalfi underestimated REE −51 kcal/die (−4%)
whereas Harris Benedict overestimated REE 140 Kcal/die
(+40%). Finally, accuracy at 10% level was low (<50%) in all
equations. None of the considered equations seems accurate to
predict REE in individual and therefore anorectic patients.
Conclusion: In severe anorectic patients, Scalfi equation
appears the most accurate predictive equation for population
studies whereas none of the equations seems to be accurate for
the prediction of REE in clinical practice. Therefore the
measurements of REE with indirect calorimetry is strongly
recommended in these patients.
Disclosure of Interest: None declared.
PT07.3
THE CLINICAL OUTCOMES AND MEDICAL COSTS IN CHRONIC
OBSTRUCTIVE PULMONARY DISEASE PATIENTS ON
PROLONGED MECHANICAL VENTILATION WITH AND WITHOUT
MALNUTRITION
C. Wen-Yi1 *, K.-Y. Hung2, C.-H. Tang3. 1Abbott Laboratories
Services Corp., Taipei, 2Hsinchu Branch, National Taiwan
University Hospital, Hsinchu City, 3School of Health Care
Administration, College of Management, Taipei Medical
University, Taipei, Taiwan, Province of China
Poster tours
Rationale: The study investigated the impacts of malnutrition
in clinical outcomes and medical costs in chronic obstructive
pulmonary disease (COPD) patients on prolonged mechanical
ventilation.
Methods: Data were retrieved from Taiwanese national health
insurance research database which included COPD patients on
prolonged mechanical ventilation during 2009–2013. COPD
patients with/without malnutrition were defined by ICD-9-CM
codes. We applied the propensity score matching with a
conventional 1:4 ratio for statistics. The outcomes included
mortality rate, 30-day readmission, and medical expenditure.
Survival curves were assessed by using Kaplan–Meier method,
and Cox proportional hazard regression models were used to
estimate the hazard ratios (HRs) of death with 95% CI. Medical
utilization was estimated by two-part models and differences
in the regression-adjusted utilization were examined using t-
tests.
Results: Among 4,40,305 COPD patients with prolonged
mechanical ventilation, 19,926 patients with malnutrition
were identified, matched with 79,704 patients without
malnutrition. We found COPD patients on prolonged mechan-
ical ventilation with malnutrition were at a significantly higher
risk of death (HR2.256, p < 0.001). The 30-day readmission rate
and mortality rate were significantly increased for COPD
patients on prolonged mechanical ventilation with malnutri-
tion, compared to those without malnutrition (39.51% vs.
35.20%, p < 0.001, 23% vs. 10%, p < 0.001). For medical
expenditure, the total cost during the hospital stay was
significantly higher (1.7 times) for COPD patients on prolonged
mechanical ventilation with malnutrition, compared to those
without malnutrition ( p < 0.001).
Conclusion: Malnutrition in COPD patients on prolonged
mechanical ventilation is associated with worse clinical out-
comes and higher medical costs than those without
malnutrition.
Disclosure of Interest: None declared.
PT07.4
THE CLINICAL OUTCOMES AND MEDICAL COSTS IN NON-
DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS WITH AND
WITHOUT MALNUTRITION
C. Wen-Yi1, K.-Y. Hung2, C.-H. Tang3, C.-T. Chao4 *. 1Abbott
Laboratories Services Corp., Taipei, 2Hsinchu Branch, National
Taiwan University Hospital, Hsinchu City, 3School of Health
Care Administration, College of Management, Taipei Medical
University, Taipei, 4Jin-Shan Branch, National Taiwan
University Hospital, New Taipei City, Taiwan, Province of China
Rationale: This study was to elucidate the clinical outcomes
and health economic influence between non-dialysis chronic
kidney disease (CKD) patients with and without malnutrition.
Methods: Non-dialysis CKD treated by ACEIs and ARBs, with/
without malnutrition defined by ICD-9-CM were selected from
Taiwanese national health insurance research database during
2009–2013. A propensity matching is based on a conventional
1:4 ratio for statistics. The mortality rate, 30-day readmission,
and health expenditure were examined. Survival curves were
analyzed by the Kaplan–Meier method, and Cox proportional
hazard regression models were used to calculate the hazard
ratios (HRs) of death with 95% CI. Medical utilization was
Poster Tour 7: Nutrition and Chronic Disease 2
determined by two-part models and differences in the
regression-adjusted utilization were assessed using t-tests.
Results: 67,915 non-dialysis CKD patients were enrolled;
among them 1,087 patients with malnutrition were identified.
They’re matched with 4,348 patients without malnutrition for
statistical analysis. The results showed that non-dialysis CKD
patients with malnutrition were at a significantly greater risk of
death (HR2.97, p < 0.001) compared to those without malnu-
trition. The 30-day readmission rate and mortality rate were
significantly elevated for non-dialysis CKD patients with
malnutrition, compared to those without malnutrition
(36.75% vs. 30.88%, p < 0.001, 19% vs. 7%, p < 0.001). For the
health expenditure analysis, the entire cost during the hospital
stay was significantly higher (1.6 times greater) for non-dialysis
CKD patients with malnutrition, compared to those patients
without malnutrition ( p < 0.001).
Conclusion: Non-dialysis CKD patients using ACEIs and ARBs
with malnutrition are associated with worse clinical outcomes
and increased health economic cost compared to non-dialysis
CKD patients without malnutrition.
Disclosure of Interest: None declared.
PT07.5
EVALUATING THE EFFECTS OF PHYSICAL ACTIVITY STATUS ON
METABOLIC PROFILE IN PATIENTS WITH SCHIZOPHRENIA
I. Türkoğlu1 *, E. Akal Yıldız2, S. M. Mercanlıgil2, G. Yoca3,
K. Yazıcı4. 1Department of Nutrition and Dietetics, Hacettepe
University Faculty of Health Sciences, Ankara, Turkey,
2
Department of Nutrition and Dietetics, East Mediterranean
University Faculty of Health Sciences, Famagusta, Cyprus,
3
Erbaa Government Hospital, Tokat, 4Department of
Psychiatry, Hacettepe University Faculty of Medicine,
Ankara, Turkey
Rationale: High morbidity and mortality in schizophrenia may
be attributed to an unhealthy lifestyle. Basic research about
energy metabolism in patients using atypical antipsychotics has
been neglected. The current study of patients with schizo-
phrenia taking atypical antipsychotic aimed to measure total
energy expenditure (TEE) and physical activity level (PAL) and
to assess the effects of physical activity level on metabolic
profile in patients with schizophrenia.
Methods: The study was conducted on 148 individuals with
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
diagnosis of schizophrenia or schizoaffective disorder and 77
age, gender matched healthy controls. Sociodemographic and
medical data were obtained through interviews and question-
naires. The energy expenditure and physical activity assessed
by using 24-h physical activity record.
Results: The patients and healthy controls were similar in age,
gender and there is no statistical difference on body mass index
between the groups ( p > 0.05). The total energy expenditure
was significantly higher in healthy controls than schizophrenia
patients, both in men and women. The physical activity level
was significantly less (respectively, male 1.54 ± 0.14, female
1.63 ± 0.15) in the schizophrenia group, than healthy controls
(respectively, male 1.83 ± 0.16, female 1.79 ± 0.17) ( p < 0.01).
When we examine individuals with the metabolic syndrome
according to IDF, it was found that although 82.3% of
S45
schizophrenia patients were sedantary, 63.2% of healthy
controls were moderately or vigorously active ( p < 0.01).
Conclusion: These findings suggest that physical activity habits
of patients with schizophrenia be partly responsible for an
adverse metabolic profile. Increasing physical activity and
reducing sedantary behaviour for people with schizophrenia
who take atypical antipsychotic may decrease the prevalence
of disease.
Disclosure of Interest: None declared.
PT07.6
AGE RELATED MACULAR DEGENERATION AND DIETARY
GLYCEMIC INDEX AND GLYCEMIC LOAD
S. Arslan1 *, S. Kadayıfçılar2, G. Samur1. 1Nutrition and
Dietetics, 2Department of Ophthalmology, Hacettepe
University, Ankara, Turkey
Rationale: Dietary factors are known risk factors for age-
related macular degeneration (AMD) the leading cause of visual
loss among persons aged ≥50 y. High-glycemic-index diets and
dietary glycemic load have been hypothesized as a risk factor
for AMD, but prospective data are unavailable.
Methods: This study was carried out in Hacettepe University
Hospital Department of Ophthalmology Polyclinic between July
2015 and February 2016. 200 individuals voluntarily partici-
pated into the study including 100 patients diagnosed with AMD
(50 women, 50 men) and 100 patients not diagnosed as AMD (50
women, 50 men) as control group. In order to evaluate dietary
glycemic index and load, food intake records were taken for
successively three days, one of which was in weekend. In the
statistical evaluation of data obtained from the study, SPSS
(Statistical Package for Social Science) 22.0 program was used.
Results: From 200 participants included in the study 100 were
AMD patients with an average age of 68.1 ± 8.4 and 100 were
healthy control group with an average age of 67.3 ± 8.5. There
was statistically meaningful difference found among partici-
pants glycemic index values mean between AMD group
(78.6 ± 7.8) and control group (70.9 ± 6.4) ( p < 0.001). It was
found that dieatry glycemic load mean (183.2 ± 61.0) was
higher in AMD group compared with control group (144.9 ± 33.2)
( p < 0.001).
Conclusion: Consequently, in our study, dietary glycemic index
and load of individuals with AMD was found higher, compared
with healthy individuals. AMD is a multi-factorial disease and
the nutrition is one of the most important changeable risk
factor. Especially for people who is older than 50 years old, who
do not make a habit of sufficient and balanced nutrition, it is
inevitable that this disease, which occurs based on age and
causes blindness year after year, will become widespread.
Disclosure of Interest: None declared.
S46 Poster tours

Poster Tour 8: Nutrition and Cancer
PT08.1
DNA DAMAGE IN BLOOD CELLS IN RELATION TO
CHEMOTHERAPY AND NUTRITIONAL STATUS IN COLORECTAL
CANCER PATIENTS
A. S. Kværner1,2 *, J. Minaguchia1, N. E. Yamaniac1,3,
C. Henriksen1, H. Ræder1,2, I. Paur1,2, H. B. Henriksen1,
T. M. Langleite1, G. Wiedswang4, S. Smeland5,6, R. Blomhoff1,5,
A. R. Collins1, S. K. Bøhn1. 1Department of Nutrition,
2
Norwegian National Advisory Unit on Disease-Related
Malnutrition, University of Oslo, Oslo, 3Norwegian Institute for
Air Research NILU, Health Effects Laboratory-MILK, Kjeller,
4
Department of Gastroenterological Surgery, 5Division of
Cancer Medicine, Oslo University Hospital, 6Institute of
Clinical Medicine, University of Oslo, Oslo, Norway
Rationale: The toxicity and adverse events induced by
adjuvant chemotherapy may impair treatment compliance
and efficiency. It is not known whether chemotherapy-induced
genotoxicity is associated with malnutrition. In the current
study, we assess chemotherapy-induced genotoxicity in
patients with non-metastatic colorectal cancer (CRC) and
explore associations with nutritional status.
Methods: Chemotherapy-induced genotoxicity was assessed by
previous study demonstrated ad libitum feeding of a low
carbohydrate-high fat diet(LCHFD) to worsen survival of mice
with carcinomatous peritonitis (CP). Because ad libitum LCHFD
increased body weight (BW) more than normal diet, whether
overfeeding or LCHFD is detrimental in terms of survival
remains unclear.
Methods: Male C57BL/6J mice (8 weeks old, n = 28) were
randomized to a normal diet (ND) (Protein: 15.0%, Fat: 9.0%,
Carbohydrate: 76.0%/kcal) or LCHFD (Protein: 18.2%, Fat:
62.2%, Carbohydrate:19.6%/kcal). Each group received either
ND or LCHFD isocaloric diet for the entire experimental period.
On day 8, mice were inoculated intraperitoneally with the
Panc02 cell line, generated from pancreatic cancer cells
derived from C57BL/6 mice. Survival, BW and food intake was
recorded.
Results: Survival after inoculation was poorer in the LCHFD
than in the ND group ( p < 0.01, log-rank test). There was a
significant difference in survival times between the LCHFD and
ND groups (LCHFD: 33.9 ± 0.95, ND: 38.6 ± 1.4, p = 0.0004, log-
rank test). BW and food intake were similar in the two groups
during throughout the entire observation period, reflecting
isocaloric feeding (t-test).
LCHFD ND

comparing DNA damage in patients receiving chemotherapy Days Initial 15 25 35 45 Initial 15 25 35 45

(n = 24) with those not receiving chemotherapy (n = 20) using
No. of 19 19 19 9 0 19 19 19 14 1
the Mann-Whitney U Test. DNA damage was measured in frozen alive
whole blood by the comet assay. Associations between DNA mice
damage and various indicators of malnutrition were explored, BW(g) 25.2 ± 28.8 ± 27.8 ± 25.0 ± 24.6 ± 27.4 ± 26.1 ± 25.9 ± 27.8
0.3 0.4 0.6 1.2 0.2 0.3 0.5 0.8
including Patient Generated-Subjective Global Assessment (PG-
SGA), bioelectrical impedance analysis (BIA) and anthropomet- mean ± SE.
ric measurements, using multiple linear regression models.
Results: Patients on chemotherapy have higher levels of DNA Conclusion: LCHFD may reduce survival of CP mice due to its
damage in blood cells than patients not receiving chemother- specific dietary composition but not overfeeding. Further
apy (median of 16.9 and 7.9% tail DNA respectively, p = 0.001). research on how LCHFD affects cancer cell progression and
The malnourished patients (PG-SGA category B and C), anti-tumor immunity in host is needed.
representing 41% of the study population, have higher levels
Disclosure of Interest: None declared.
of cellular DNA damage than patients with good nutritional
status (mean difference of 7.5% tail DNA, p = 0.033).
Conclusion: Adjuvant chemotherapy and malnutrition are both PT08.3
associated with increased levels of DNA damage in blood cells INCREASED AMINO ACID TURNOVER AND MYOFIBRILLAR
of CRC patients. Carefully controlled longitudinal studies or PROTEIN BREAKDOWN IN ADVANCED CANCER ARE
RCTs should be performed to determine whether a causal ASSOCIATED WITH DECREASED MUSCLE STRENGTH AND
relationship exists between good nutritional status and PHYSICAL FUNCTION
protection from chemotherapy-induced genotoxicity. B. S. Van Der Meij1,2,3 *, N. E. Deutz1, R. E. Rodriguez4,
Disclosure of Interest: None declared. F. Koeman1, T. C. Smit1, M. P. Engelen1. 1Center for
Translational Research in Aging and Longevity, Texas A&M
PT08.2 University, College Station, United States, 2Faculty of Health
DOES AMOUNT OF ENERGY INTAKE MATTER? -MECHANISM FOR Sciences and Medicine, Bond University, Gold Coast, 3Nutrition
POOR PROGNOSIS OF A LOW CARBOHYDRATE-HIGH FAT DIET and Dietetics, Mater Group, Brisbane, Australia, 4Division of
FED MICE WITH CARCINOMATOUS PERITONITIS Hematology/Oncology, Scott and White Memorial Hospital,
A. Watkins1 *, K. Fukatsu2, S. Murakoshi2, T. Watanabe3, College Station, United States
K. Higashizono4, M. Noguchi2, H. Yasuhara2. 1Surgical Sciences,
Rationale: Weight loss and muscle wasting are common in
Graduate School of Medicine, University of Tokyo, 2Surgical
cancer patients and negatively affect physical function and
Center, The University of Tokyo Hospital, Tokyo, 3Surgery,
quality of life. This study investigates the relationship between
National Defense Medical College, Saitama, 4Gastrointestinal
protein metabolism, muscle strength and physical function in
Surgery, Graduate School of Medicine, The University of Tokyo,
patients with advanced cancer.
Tokyo, Japan
Methods: In 16 patients with solid tumours (C) and 16 age- and
Rationale: Though high fat diets are recommended for gender-matched healthy controls (H), we assessed fasted
nutritional therapy of patients with cancer cachexia, our whole body net protein breakdown (netPB), myofibrillar PB
Poster Tour 8: Nutrition and Cancer
(MPB) and rate of appearance (Ra) by pulse IV administration of
stable tracers ([2H3]tau-methylhistidine, 2H3-LEU, 2H2-GLY).
We measured net protein synthesis (netPS), and protein
digestion (PD: gut function) after intake of a high-protein
meal with [1-13C]PHE and 15N-spirulina and primed continuous
infusion of [ring-2H5]PHE and [13C9-15N]TYR. We tested FFM-i,
handgrip, inspiratory,hand and leg muscle strength, physical
activity by PASE and physical function by EORTC-QLQc30
questionnaires. Amino concentrations/enrichments by LC-MS/
MS, and statistics by unpaired t-tests and spearman correlation
tests.
Results: FFM-i, handgrip strength and physical activity were
similar in C and H, leg and inspiratory muscle strength were
lower in C ( p < 0.05). Fasted netPB (5.9 vs. 6.8 µmol/kg ffm/h),
fed netPS (40.2 vs. 43.9 µmol/kg ffm/h) and protein digestion
were not different, MPB and leucine Ra (0.29 vs.0.20 and 114.3
vs. 66.3 µmol/kg ffm/h) and clearance (0.07 vs. 0.04 and 1.42
vs. 0.78 L/min) and glycine clearance (1.3 vs. 0.9 L/min) were
higher in C (P < 0.05). In C Ra-glycine was associated with leg
extension strength (r = 0.51, P = 0.06), glycine clearance with
impaired physical function (r = −0.59, P = 0.04).
Conclusion: Patients with advanced cancer with preserved
muscle mass and physical activity have an increased amino acid
turnover and myofibrillar protein breakdown, negatively
impacting muscle strength and physical function.
Disclosure of Interest: B. Van Der Meij Grant/Research Support from:
ESPEN Research Fellowship, N. Deutz: None declared, R. Rodriguez:
None declared, F. Koeman: None declared, T. Smit: None declared,
M. Engelen: None declared.
PT08.4
PLATINUM INDUCED FATTY ACIDS: ARE THEY PRESENT IN
PLASMA OF CANCER PATIENTS?
V. C. Mazurak1 *, B. van der Meij2, R. Murphy3, A. Stanislaus4,
V. Damaraju4, Q. Chu5, M. Sawyer5. 1Human Nutrition,
University of Alberta, Edmonton, Canada, 2Bond University,
Robina, Australia, 3University of British Columbia, Vancouver,
4
University of Alberta, Edmonton, Canada, 5Oncology,
University of Alberta, Edmonton, Canada
Rationale: Preclinical studies suggest that hexadeca-
4,7,10,13-tetraenoic [16:4(n-3)] induces resistance to plat-
inum-based therapies. One study in healthy volunteers
reported increases in 16:4(n-3) after consuming fish oil with
levels returning to normal after 12 hours. No study has
measured in 16:4(n-3) levels in non-small cell lung cancer
(NSCLC) patients receiving platinum based chemotherapy. This
study aimed to determine plasma levels of 16:4(n-3) in NSCLC
pts undergoing platinum-based chemotherapy in those using or
not using fish oil supplements.
Methods: A method to measure 16:4(n-3) in plasma of NSCLC
patients was developed and validated. Patients using fish oil
(capsules or oil equivalent, n = 15) and on standard of care
(n = 5) were selected for preliminary analysis. Plasma was
prospectively collected at baseline ( prior to receiving chemo-
therapy) and after 2 cycles of platinum-based chemotherapy.
The plasma range of 16:4(n-3) at baseline and subsequently
following chemotherapy were compared between those taking
fish oil and those on standard of care. Plasma (80 µL) fatty acids
were extracted with iso-octane, derivatized and analyzed by
S47
LC-MS/MS in positive ion mode, which enabled detection of
fatty acids at <1 nmol/L.
Results: At baseline, before starting chemotherapy or fish oil
supplementation, all patients had detectable levels of 16:4(n-
3) ranging from 8 to 160 nmol/L. Fish oil users had higher
absolute values of 16:4(n-3) than standard of care (mean = 47
vs 23 nmol/L; p = 0.03). Changes in 16:4(n-3) concentrations
after platinum based therapy were highly variable with some
patients increasing and others decreasing plasma 16:4(n-3).
Conclusion: These preliminary results suggest that 16:4(n-3)
may be present in NSCLC patients both before and after
receiving platinum-based chemotherapy. It will be important to
relate concentrations of 16:4(n-3) to chemotherapy response
and survival in a larger sample of cancer patients.
Disclosure of Interest: None declared.
PT08.5
ELEVATED C-REACTIVE PROTEIN, LOW SKELETAL MUSCLE
MASS, AND LOW VISCERAL ADIPOSE TISSUE ARE ASSOCIATED
WITH REDUCED OVERALL SURVIVAL IN PATIENTS WITH
RESECTABLE COLORECTAL LIVER METASTASES
D. P. J. Van Dijk1,2 *, M. Krill3, F. Farshidfar3, T. Li3,
S. S. Rensen1,2, S. W. M. Olde Damink1,2,4,5, V. C. Mazurak6,
V. E. Baracos7, O. F. Bathe3. 1Department of Surgery, Maastricht
University Medical Centre, 2NUTRIM School of Nutrition and
Translational Research in Metabolism, Maastricht University,
Maastricht, Netherlands, 3Department of Surgery and
Oncology, Tom Baker Cancer Center, Calgary, Canada,
4
Department of Visceral and Transplantation Surgery, RWTH
University Hospital Aachen, Aachen, Germany, 5Institute for
Liver and Digestive Health, University College London, London,
United Kingdom, 6Division of Human Nutrition, Department of
Agricultural, Food and Nutritional Science, 7Department of
Oncology, University of Alberta, Edmonton, Canada
Rationale: A variety of factors have been identified which
influence survival following resection of colorectal liver
metastases (CRLM). In this study, we aimed to assess the
association between overall survival and manifestations of
cachexia: depletion of skeletal muscle mass, depletion of
visceral adipose tissue (VAT), and systemic inflammation in
surgical patients with CRLM.
Methods: A prospective cohort of 87 patients with CRLM
undergoing partial hepatectomy was studied. Systemic inflam-
mation was assessed by measuring preoperative serum C-
reactive protein (CRP). Skeletal muscle mass and VAT were
assessed using computed tomography (CT) scans at L3 level and
were adjusted for sex and age by calculating the Z-score
(number of standard deviations above or below the sex- and
age-specific norms). Systemic inflammation was defined as a
CRP-level >5 mg/L. Low muscle mass and low VATwere defined
as a Z-score <0 (below median).
Results: Patients were divided into four groups according to
CRP level, musculature and visceral adiposity: high CRP only
(n = 10); low muscle and/or VAT only (n = 31), high CRP
combined with low muscle and/or VAT (n = 32), or none of
these factors (n = 14). Survival was lowest ( p = 0.01) in patients
with high CRP combined with low muscle and/or VAT (see
Table). There was no survival difference among patients with
only low muscle, only low VAT, or both factors combined
( p = 0.62).
S48
Risk factors n Median survival p-Value
(months, 95%-CI)
None 14 110 (–) 0.01
Only high CRP or Only low muscle 32 79 (49–109)
and/or VAT
High CRP and low muscle and/or VAT 31 43 (29–58)
Conclusion: The presence of systemic inflammation in com-
bination with low muscle mass and/or VAT is associated with
reduced survival in patients with CRLM. These findings stress
the importance of multidimensional phenotyping for adequate
preoperative risk-assessment.
Disclosure of Interest: None declared.
PT08.6
FOOD EXPERIENCES AND TASTE DYSFUNCTION IN PATIENTS
UNDERGOING HEMATOPOIETIC STEM CELLTRANSPLANTATION
J. M. F. Sicchieri1 *, C. S. Meirelles1, B. P. Simões2,
R. W. Diez-Garcia1. 1Division of Nutrition and Metabolism,
Department of Internal Medicine, 2Division of Hematology,
Department of Internal Medicine, University Hospital, Faculty
of Medicine of Ribeirão Preto, University of São Paulo, Ribeirao
Preto, Brazil
Rationale: The hematopoietic stem cell transplantation (HSCT)
is a procedure that causes severe susceptibility to infections,
changes associated with the gastrointestinal tract and taste
and other comorbidities that impair food intake. This descrip-
tive study, based on a qualitative approach, aimed to explore
the food experience and taste disturbance by chemotherapy in
patients undergoing HSCT.
Methods: Semi-structured interviews were conducted with 20
patients undergoing allogeneic HSCT in transplant specialized
unit in a quaternary hospital. For data analysis, we used
the method of thematic analysis proposed by Braun and Clarke.
The analyzes carried out during the study will be explored from
the perspective of three theoretical frameworks: biographical
rupture, coping and hospital food service, allied with comple-
mentary literature.
Results: Analysis of the material allowed us to elaborate three
main themes: Diagnosis, Illness and treatment; Variation of
taste disturbance; Management of treatment and eating. The
first two themes address the experience of patients between
diagnosis and the end of the transplant, bringing together
categories referring to attitudes changed by the HSCT. The
third theme deals with aspects that were related to the way
patients deal with the treatment and the consequences of taste
changes. We also discuss in this theme the beliefs and ability
related to treatment and the strategies associated to food.
Another relevant aspect is the socializing blocks generated by
the transplant process and the role of support networks.
Conclusion: It is noticed impasses and adversities related to
feeding during treatment, requiring a broad look at these
aspects because knowledge of the characteristics of the
described experiences may help improve therapeutic and
dietary strategies to face treatment, improving the hospital-
ization experience and reduce the negative consequences of
treatment.
Disclosure of Interest: None declared.
Poster tours
Poster Tour 9: Nutritional techniques
PT09.1
LONG-TERM CLINICAL OUTCOMES OF PATIENTS ON HOME
PARENTERAL NUTRITION USING TAUROLIDINE
CATHETER LOCKS
Y. Wouters1 *, B. Roosenboom1, W. Kievit2, G. Wanten1.
1
Gastroenterology and Hepatology, 2Health Evidence,
Radboudumc, Nijmegen, Netherlands
Rationale: Catheter-related complications (CRCs) in home
parenteral nutrition (HPN) patients are a threat to both
catheter and patient survival. Taurolidine 2%, an antimicrobial
catheter lock solution (CLS), is an effective agent for the
prevention of catheter-related bloodstream infections (CRBSI).
We evaluated long-term clinical outcomes of our HPN patient
cohort that uses the CLS taurolidine.
Methods: Between 2008 and 2016, all adult HPN patients
requiring a central venous catheter (CVC) or port-a-cath (PAC)
who used taurolidine as CLS were included. CRC incidence
rates/1,000 catheter days were described. Kaplan-Meier
analysis was used to determine the time until a first CRC. Cox
proportional hazard analysis was performed to identify risk
factors for a first CRC.
Results: In 221 HPN patients, 658 CVCs (418 Hickmans, 172
PACs, and 28 non-tunneled CVCs) were inserted, comprising
2,61,252 catheter days. Median survival for Hickmans, PACs and
non-tunneled catheters was 175 (43–544), 310 (61–827) and 14
(7–19) days, respectively. During eight years of follow-up, 176
CRBSI occurred and 80 catheter-related occlusions (CRO).
CRBSI and CRO rates/1,000 catheter days were 0.74 and 0.34,
respectively. In 47% and 32% of patients, at least one CRBSI and
CRO occurred, respectively. Median time to a first CRBSI or CRO
was 246 (54–817) and 215 catheter days (5–2070). Numerically,
but not significantly, CRBSI and CRO rates decreased over time.
The sole use of intravenous fluids was associated with a
significantly lower risk for CRBSI (RR 0.32). Twenty patients
reported adverse events (5 grade 1, 13 grade 2 and 2 grade 3)
which were possibly related to the use of taurolidine.
Conclusion: This study describes the largest cohort of HPN
patients to date on long-term taurolidine 2% as CLS. Overall,
CRC incidence rates were low when compared with the
literature. We found no evidence for a decreased effect of
taurolidine over time.
Disclosure of Interest: Y. Wouters Grant/Research Support from:
Research funding previously received from Geistlich Pharma AG,
B. Roosenboom: None declared, W. Kievit: None declared, G. Wanten
Grant/Research Support from: Baxter, B. Braun, Geistlich Pharma AG and
Fresenius, Consultant for: Baxter, B. Braun, Geistlich Pharma AG
and Fresenius.
PT09.2
TAUROLIDINE-CITRATE LOCK: RISK FACTORS ASSOCIATED
WITH A FAILURE OF CATHETER-RELATED BLOODSTREAM
INFECTION PREVENTION IN HOME PARENTERAL NUTRITION
IN ADULTS
M. Lauverjat1, S. Naudin1, D. Barnoud1, C. Bergoin1, S. Ait1,
N. Voirin1, C. Chambrier1 *. 169, Hospices Civils de Lyon, Pierre
Benite, France
Rationale: Several studies have shown an efficacy of tauroli-
dine to decrease about 50% in catheter-related bloodstream
Poster Tour 9: Nutritional techniques
infection (CRBSI). In our practice, taurolidine-citrate lock (TCL)
is used as primary and secondary prevention. The aim of this
study was to analyse the risk factors associated with a failure
of TCL.
Methods: 3-years retrospective study from 2012 including HPN
patients with chronic intestinal failure (IF) with a TCL. Data
collected included demographic, comorbidities, type of
intestinal failure, HPN length, kind of IV catheter, previous
catheter and CRBSI history. Patients and catheters were
described using median (min–max). Kaplan-Meier method was
used to study CRBSI occurrence and a multivariate Poisson
regression was used to estimate adjusted incidence rate ratios
(IRR) with their 95% confidence intervals (CI) of CRBSI.
Results: 141 patients were included (61 males); 271 catheters
(99,366 catheters-days): 115 Broviac, 89 PICC 1 lumen, 39
chambers and 24 PICC 2 lumens. Age was 57 years (18–86) and
indications of HPN included short bowel (68%) and CIPO (9%);
54% had a stomy. HPN duration was 2 years (0.3–27.4) with 6 (2–
7) bags per week. 57 patients (90 catheters – 31,401 catheter-
days) had 119 CRBSI (1–9), corresponding to a CRBSI incidence
rate of 1.2/1,000 catheter-days (95%CI 1.0–1.4). Multivariate
analysis indicated that PICC 2 lumens (IRR 14.4, 95%CI 4.9–
42.3), PICC 1 lumen (IRR 3.1, 95%CI 1.2–8.3), more than 4 bags
per week (IRR 3.5, 95%CI 1.7–7.1) and non-compounding PN bag
(IRR 1.5, 95%CI 1.0–2.3) were statistically and independently
associated with an increased risk of CRBSI.
Conclusion: Among HPN patients with IF, risk factors associated
with TCL failure are mostly in relation with venous access
(catheter type, frequency and kind of PN) rather than with the
nature of IF or comorbidities per se.
Disclosure of Interest: M. Lauverjat: None declared, S. Naudin: None
declared, D. Barnoud: None declared, C. Bergoin: None declared,
S. AIT: None declared, N. Voirin: None declared, C. Chambrier Grant/
Research Support from: PHAROLY, THERADIAL, Consultant for:
AGUETTANT, BAXTER, SHIRE.
PT09.3
DETERMINATION OF OXIDATIVE STRESS MARKERS IN THE
BLOOD OF PATIENTS RECEIVING PARENTAL NUTRITION
SUPPORT
J. Rogulska1 *, S. Osowska1, J. Giebułtowicz2, M. Kunecki3,
J. Tokarczyk4, K. Majewska1, P. Wroczyński2, J. Sobocki1.
1
Warsaw Medical University, Warsaw, Poland, 2Pharmacy,
Warsaw Medical University, Warsaw, 3Pirogow Hospital, Łódz,́
Poland, 4Clinical Nutrition, Pirogow Hospital, Łódz,́ Poland
Rationale: The aim of the study was to examine parameters of
oxidative stress in the plasma of patients receiving parenteral
nutrition (PN).
Methods: We obtained blood samples from 50 patients with
intestinal failure on long-term PN and 50 sex- and age-matched
healthy controls. The patients were on PN for more than 2
years. Patients with ongoing acute infections were excluded
from the study. Total glutathione peroxidase (GSH-Px),
selenium dependent glutathione peroxidase (Se-GSHPx) and
glutathione S-transferase (GST) from plasma were assayed by
spectrophotometry. Oxidative stress was assessed by deter-
mining the concentration of malondialdehyde (MDA) in plasma
by high performance liquid chromatography. Statistical analysis
was performed using Student’s t-test and Manna-Whitney test.
S49
A p-value <0.05 was considered to indicate statistical
significance.
Results: A significantly higher concentration of MDA was
observed in plasma of long-term PN patients compared to the
control group. The activity of GSH-Px was comparable ( p >
0.05). However, the activity of Se-GSHPx and of GST in plasma
was significantly lower in patients on long-term PN compared
to the controls ( p < 0.05).
Parameters of Long-term Healthy
oxidative stress PN patients controls
MDA [µM/L] 0.53 ± 0.25* 0.37 ± 0.20
Se-GSHPx [U/ml] 66 ± 22# 78 ± 30
GSH-Px [U/ml]] 130 ± 41 145 ± 45
GST [U/ml] 200 ± 95# 242 ± 119
*
Significantly higher in patients’ blood in comparison with the control group,
p < 0.05.
#
Significantly lower in patients’ blood in comparison with control group, p < 0.05.
Conclusion: Conclusions: Long-term parenterally fed patients
exhibit lower activity of antioxidant enzymes and higher
concentration of MDA in plasma. The results indicate that the
oxidant/antioxidant balance system is disturbed in patients on
long-term PN. The decrease of plasma Se-dependent enzyme
could also be a sign of too low selenium supply in those
patients.
Disclosure of Interest: None declared.
PT09.4
CORTRAK® DUODENAL TUBE PLACEMENTS: A SOLUTION FOR
ALL PATIENTS? A PRELIMINARY SURVEY TO THE
INTRODUCTION OF ELECTROMAGNETIC-GUIDED PLACEMENT
OF NASO-DUODENAL FEEDING TUBES
W. Arjaans1 *, M. Ouwehand1, G. Bouma2, T. Meulen van der2,
M. Schueren de van der1. 1Nutrition Support Team, Nutrition
and Dietetics, 2Gastroenterology, VU Medical Centre,
Amsterdam, Netherlands
Rationale: The Cortrak® feeding tube, an electromagnetic
guided feeding tube which is placed by a trained nurse at the
patient’s bedside, is reported to be a safe, patient friendly and
cost effective answer to the disadvantages of endoscopic
placement of naso-duodenal feeding tubes. This study aims to
evaluate whether introducing Cortrak® feeding tube placement
would be profitable in our hospital.
Methods: We re-evaluated all endoscopically placed post-
pyloric feeding tubes in the years 2012–2013. Taking into
consideration a learning curve for nurses placing Cortrak®, only
tube placements in patients with normal GI anatomy and non-
ICU admitted patients were evaluated for the initial phase. As a
secondary analysis we also evaluated ICU patients who were
referred for duodenal tube placement.
Results: Patient records of 506 duodenal feeding tube
placements in 330 patients were evaluated; 135 placements
(104 patients) where included. Exclusion criteria: ICU stay,
abnormalities of the upper GI tract, or endoscopy for diagnostic
reasons only. Main indications for placements were gastropar-
esis (36%) or insufficient food intake (19%). For the secondary
analysis, 81 placements in 77 ICU patients were re-evaluated,
with main indication gastroparesis (62%)
S50
Conclusion: Only one-third of patients referred for duodenal
tube placement would have been a possible candidate for
Cortrak® in the initial phase. This would add up to 1–2
placements per week. If ICU patients would be eligible for
placement too, this would add up to 3 placements per week.
This study help to decide on the profitability of introducing this
method in our hospital as still two-thirds of patients require
traditional endoscopic treatment. The advice to the GI
department is to make an business case based on the results
and conclusion with cost-benefit before introducing the
Cortrak®.
Disclosure of Interest: None declared.
PT09.5
STABILITY ASSESSMENT OF PAEDIATRIC PARENTERAL
NUTRITION ADMIXTURES CONTAINING HIGH CONCENTRATION
OF TRACE ELEMENTS AND CARNITINE
M. L. Forchielli1 *, A. Bonoli2, A. Stancari3, L. L. Bruno3, F. Piro3,
A. Pession1, C. Puggioli3, G. Bersani4. 1Paediatrics, S. Orsola-
Malpighi Medical School, 2Civil, Environmental and Materials
Engineering Department, University of Bologna, 3Pharmacy
Service, S. Orsola-Malpighi Medical School, 4Consulting
Pharmacist, Bologna, Italy
Rationale: High concentrations of trace elements, in particular
zinc and selenium, along with carnitine are often added to
parenteral admixtures in paediatric patients on long-term
Parenteral Nutrition (PN). We aim to evaluate whether particle
diameters of these admixtures are maintained in the range of
chylomicra (0.4–1 micron), as PN admixtures require to be
safely infused to patients, according to European Guidelines.
Methods: Stability studies were carried out on six PN
admixtures with carnitine, trace elements and electrolytes
added in different contents, each compounded with five
different lipid emulsions with and without fish oil. The analyses
were performed immediately at time 0 (t = 0) and 24, 48, 72, 96
(t = 96) hours after compounding. Particle diameter was
determined by Light Scattering-Reverse Fourier Optics
Technique. Every sample was stored at 4°C and triple tested
for a total of 450 analyses. Statistical significance was verified
by F-test.
Results: Physicochemical stability did not change between t = 0
and t = 96 and particle diameters were in the expected range of
0.4–1.0 micron regardless of trace element and carnitine
amounts, with the exception of the admixtures containing fish-
oil based emulsion and calcium concentration above 4.5 mmol/
L. In these last admixtures, 12% of particle diameters were
larger than 1.0 micron and 2% exceeded 5.0 micron immedi-
ately after compounding. These results matched our previous
observations.
Conclusion: Overall, high concentrations of trace elements and
carnitine do not affect PN admixtures stability and can be
safely infused in long-term home-PN paediatric patients,
provided calcium concentrations and the presence of fish oil
based lipid emulsions are carefully considered.
Disclosure of Interest: None declared.
Poster tours
Poster Tour 10: Micronutrients
PT10.1
ADAPTING BURN TRACE ELEMENT REPLETION: A NEW BURN
WOUND EXUDATE COLLECTION METHOD CONFIRMS
IMPORTANT CU LOSSES
P. Jafari1 *, O. Pantet1, M. Augsburger1, A. Thomas1,
W. Raffoul1, L. A. Applegate1, M. M. Berger1. 1Lausanne
University Hospital, Lausanne, Switzerland
Rationale: Major burn patients develop metabolic alterations
which increase their nutrient requirements. Exudative losses of
trace elements (TE) complicate the assessment of their
requirements and have been shown to cause acute deficien-
cies. Cu, Se and Zn repletion protocols have been associated
with clinical benefits. We aimed at measuring with actual
analytical methods the exact TE content of exudates to
improve the TE repletion.
Methods: Inclusion of patients admitted to the burn-ICU of
Lausanne University Hospital. Intravenous TE administration
was by protocol in 7 most severly burned patients. Exudate
collection: wound bed was covered with an occlusive dressing
(under negative pressure) with a silicon drain placed under-
neath and connected to a collecting bottle. Seventy TE were
measured in the samples by inductively coupled plasma mass
spectrometry. Losses were normalized for burned surface. Daily
blood sampling was done.
Results: Fifteen patients aged 44.4 years (mean), burned 29
+/−20% body surface were included. Average exudation period
was 5.5 days (3–8 days). Large losses of several TE were
observed. Serum levels of Zn and Cu were below or in the lower
limit of normal reference ranges despite repletion. Se supple-
ments (745 μg) normalized and even increased serum levels to
upper normal value. Large exudative losses of B, Br and Mg
were found, as well as of Fe and I. High levels of Al were
measured in exudate and serum (mean 45 ± 47 ug/l and
34 ± 37 ug/l respectively).
Conclusion: We show that the standardized IV doses of Cu and
Zn donot cover the requirements, while the Se doses seem too
high. This suggests revision of the supplementation protocols.
Also several other essential TEs that are lost in high amount
in exudates should probably be included in burn nutritional
supplementation. The measured Al levels suggest more
investigation is required to determine the source of this trace
element.
Disclosure of Interest: None declared.
PT10.2
RE-FEEDING SYNDROME IN ADULTS RECEIVING TOTAL
PARENTERAL NUTRITION: AN AUDIT IN A HIGHLY SPECIALIZED
INTESTINE FAILURE UNIT
F. Pantoja1,2 *, P. Patel1, N. Keane1, K. Fragkos1, M. Samaan1,
I. Barnova1, S. Di Caro1, S. Mehta1, F. Rahman1. 1Department of
Gastroenterology, University College London Hospital, London,
United Kingdom, 2Department of Clinical Nutrition, Hospital
Clinico San Borja Arriaran, Santiago, Chile
Rationale: The key for prevention of Re-feeding Syndrome (RS)
is the identification and management of patients at high risk.
The NCEPOD 2010 report identified inadequate clinical
assessment in 54.1% of patients prior to commencing
Poster Tour 10: Micronutrients
parenteral nutrition (PN). Thus, we aimed to evaluate our
clinical management of RS risk in patients starting PN in a high-
specialized Intestinal Failure Unit.
Methods: Prospective 7-day follow-up of patients commencing
PN at University College London Hospital between 1st January
and 30th of July 2015. 80 patients were categorized under RS
risk groups following NICE guidelines 2006. High (HRS) and low
(LRS) risk RS groups were compared focusing on the initial
clinical approach and onset of biochemical features of RS
(hypophosphatemia, hypokalemia and hypomagnesemia).
Results: 60 patients (75%) were at HRS and received lower
initial calories (12.8 [8.9–18.9] Kcal/Kg/Day, p < 0.05). All high
risk patients received a high potency vitamin preparation
compared to 35% in the low risk group (65% C.I.:44.1% – 85.9%,
p < 0.05). Daily phosphate, magnesium and potassium plasma
levels were monitored in 25%, 30% and 53.8% of patients,
respectively. Hypophosphatemia, and, hypomagnesaemia and
hypokalemia, developed in 30% and 27.5% patients, respect-
ively. 67 (83.8%) patients had at least one electrolyte
abnormality, occurring more frequently in HRS patients
( p < 0.05).
Conclusion: The nutritional assessment, treatment, and follow
up of patients on PN were conducted in accordance with
recommendations, though biochemical RS features occur
despite following NICE Guidelines. HRS vs. LRS patients were
more likely to have electrolyte abnormalities after receiving PN
regardless of precautions: irregular biochemistry monitoring
may have contributed to this and should be addressed. Further
research is required on the initial nutritional approach to
prevent RS in high risk patients.
Disclosure of Interest: None declared.
PT10.3
MICRONUTRIENTS-ARE OUR HOME PARENTERAL NUTRITION
PATIENTS GETTING ENOUGH?
M. Pearson1, D. Brundrett1 *, S. M. Gabe2, A. Culkin1. 1Nutrition
& Dietetics, 2Lennard-Jones Intestinal Failure Unit, St Mark’s
Hospital, London, United Kingdom
Rationale: Studies report a high prevalence of micronutrient
deficiencies in home parenteral nutrition (HPN) patients.1 We
audited the micronutrient status of patients in a tertiary
centre.
Methods: A retrospective analysis was performed on patients
receiving HPN for a minimum of six months. This included
vitamins A, E, D, B12, Folate, Zinc and Selenium. Patients were
excluded if they had undergone surgery or a change in
micronutrient provision in the past six months. Blood samples
were excluded if C-reactive protein (CRP) >15 mg/L.2
Demographic data was collected.
Results: A total of 93 patient samples were included. Samples
were excluded due to surgery (n = 8) or change in micronutrient
provision (n = 42) in the last 6 months or CRP >15 mg/L (n = 18).
Mean age 54 ± 14 years, 33M:60F and mean BMI 21.8 ± 3.1 kg/m2.
Aetiologies included inflammatory bowel disease (n = 28),
mesenteric infarction (n = 23), motility disorder (n = 22),
surgical complications (n = 6) and other (n = 14). Mean
number of days/week on HPN 5.7 ± 1.5 (range 2–7) with
S51
Cernevit® 4.7 ± 1.6 days/week (range 2–7) and Additrace®
5.7 ± 1.6 days/week (range 2–7).
Measurement N Below % Normal % Above %
Vitamin A 74 26 72 3
Vitamin D 93 33 63 3
Vitamin E 72 13 81 7
Vitamin B12 91 0 71 29
Folate 35 0 91 9
Zinc 88 19 57 24
Selenium 87 13 85 2
Current provision of micronutrients meets the needs of our
population as most results fell within normal ranges. Vitamin A
and D concentrations were below normal in 26% and 33%
respectively and may require supplementation. No patients had
B12 or folate deficiency but monitoring is required to prevent
excess provision which may have been due to over
supplementation.
Conclusion: To our knowledge this is the largest survey of
micronutrient status in stable HPN patients. Our results suggest
daily provision of micronutrients is essential but ongoing
monitoring is required to identify deficiencies and toxicities.1
References
1. Pironi et al. (2016) Clin Nutr, 35:247.
2. Duncan et al. (2012) Am J Clin Nutr, 95:64.
Disclosure of Interest: None declared.
PT10.4
ARE HBA1C LEVELS AFFECTED BY IRON DEFICIENCY ANEMIA?
G. Kaner1 *, N. Seremet Kurklu2, G. Pamuk3. 1Department of
Nutrition and Dietetics, Faculty of Health Sciences, İzmir Katip
Çelebi University, İzmir, 2Department of Nutrition and
Dietetics, Akdeniz University, Antalya School of Health,
Antalya, 3Department of Family Medicine, Faculty of
Medicine, İzmir Katip Çelebi University, İzmir, Turkey
Rationale: Iron deficiency is the most common nutritional
disorder in the world, it affects particularly women of
reproductive age. HbA1c is affected by iron deficiency and IDA
with a spurious increase in HbA1c values. We aimed to investigate
the effect of IDA on HbA1c levels in normoglycemic patients.
Methods: 63 women with IDA and 63 healthy controls aged 20–
49 years, who applied to Diet Clinic were included in the study.
Fasting blood glucose (FBG), HbA1c, iron, ferritin, unsaturated
iron binding capacity (UIBC) were involved in the study.
Hemoglobin levels <12 g/dL were accepted as IDA.
Results: A statistically significance was found between the IDA
and control group in hemoglobin (10.8 ± 0.87 g/dL and 13.2 ±
0.78 g/dL; respectively), iron (46.4 ± 23.18 µg/dL and 68.7 ±
27.67 µg/dL; respectively), UIBC (393.4 ± 76.12 µg/dL and
315.3 ± 59.43 µg/dL; respectively), and ferritin (7.8 ± 8.0 ng/
mL and 15.0 ± 10.1 ng/mL, respectively) ( p < 0.01). There was
no significant difference in FBG (88.7 ± 9.34 mg/dL and 90.1
± 8.77 mg/dL; respectively) and HbA1c (5.6 ± 0.41% and
5.5 ± 0.36%; respectively) between the groups ( p > 0.05). No
correlation was found between hemoglobin and HbA1c levels,
while positive correlation was determined between UIBC and
HbA1c levels (r = 0.185, p = 0.038).
S52 Poster tours

Conclusion: In this study, no significant difference was found PT10.6

between IDA and healthy group in HbA1c levels. The positive TOTAL OXIDANT (TOC) AND ANTIOXIDANT (TAC) CAPACITY IN
relationship between HbA1c levels and UIBC supports that PREGNANT WOMEN AND NEONATES EXPOSED AND NO-
HbA1c levels may be affected by the IDA. EXPOSED ON TOBACCO SMOKE
Disclosure of Interest: None declared. M. Chełchowska1 *, J. Ambroszkiewicz1, L. Lewandowski2,
J. Gajewska1, T. M. Maciejewski2, J. Mazur3. 1Screening,
2
PT10.5 Obstetrics and Gynecology, 3Child and Adolescent Health,
DIETARY INTAKE OF INORGANIC PHOSPHORUS RATHER THAN Institute of Mother and Child, Warsaw, Poland
ORGANIC PHOSPHORUS IMPAIRS ENDOTHELIAL FUNCTION IN
HEALTHY YOUNG MEN Rationale: Maternal smoking has been considered as an
additional source of oxidant stress in pregnant women and in
H. Kawamura1 *, Y. Ota2, S. Endo2, M. Tani1, M. Ishitani1, newborns exposed in utero, leading to perinatal and postnatal
S. Tanaka2, M. Sakaue1, M. Ito1. 1Graduated school of Human health consequences. Due to overproduction of reactive
Science and Environment, 2School of Human Science and oxygen (ROS) as well as inadequate induce of antioxidant
Environment, University of Hyogo, Himeji, Japan protection newborns are particularly susceptible to oxidative
injury. The aim of the study was to assess the effect of smoking
Rationale: Hyperphosphatemia in chronic kidney disease
on the level of total oxidant capacity (TOC), total antioxidant
patients is a risk factor for cardiovascular disease. High
capacity (TAC), and OSI (oxidative stress index) in matched
phosphorus (P) intake impairs endothelial function, however,
maternal-cord blood pairs.
the difference between inorganic P and organic P remains
Methods: The study included a consecutive series of 45 active
unclear. The purpose of this study was to compare the effect of
smokers who smoked minimum 5 cigarettes per day throughout
inorganic with organic P on endothelial function.
their pregnancy and a series of 45 non-smokers of similar age
Methods: In a double-blinded crossover design, six healthy
and age of gestation, who had never smoked and were not
men, aged 19–22 years, were served two different high P meal
exposed to environmental tobacco smoke during their preg-
(1,200 mg P) for breakfast with more than 1-week wash out.
nancy. Serum TOC and TAC levels were determined by
One of the test meal was organic P meal containing natural P
colorimetric assay. The statistical analyses were performed
sources, the other was inorganic P meal containing natural food
using SPSS software.
and 1,000 mg P additives. We measured flow mediated dilation
Results: Birth weights and body length of the smokers’
(FMD) of the brachial artery at fasting and 30, 60 and 120 min
newborns were found to be lower than those of non-smokers.
after meal ingestion. We collected blood and urine samples for
The smoking pregnant women and their newborns had
the measurement of P, calcium, ionized calcium, intact
significantly higher concentrations of serum TOC, and OSI but
parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (1,25
lower TAC levels compared with non-smoking pairs ( p < 0.001).
(OH)2D) and fibroblast growth factor 23 (FGF-23).
Important association between TOC levels and number of
Results: Serum P levels and urine P levels were significantly
cigarettes daily consumed was found in smokers group of
increased in inorganic P meal compared with organic P meal at
mothers and newborns (r = 0.394; r = 0.298, p < 0.05 respect-
after 30, 60 and 120 min, respectively ( p < 0.05). There were no
ively). In case of pregnant women total oxidant capacity level
significant differences in serum calcium, ionized calcium,
correlated also with serum cotinine concentrations (r = 0.374,
intact PTH, 1,25(OH)2D and FGF-23 levels. FMD decreased after
p < 0.05).
30 min in both meals. However, percent change of FMD from
Conclusion: Our data imply that, maternal smoking enhances
baseline was significantly more impaired in inorganic P meal
oxidative status and depletes antioxidant potential not only in
than organic P meal after 30 min (−20.0 ± 2.8% vs −10.1 ± 2.6%,
pregnant women but also in neonates exposed in utero to
p < 0.05).
tobacco smoke.
Conclusion: In healthy young men, inorganic P intake acutely
increased serum P levels, and impaired endothelial function Disclosure of Interest: None declared.
compared with organic P.
Disclosure of Interest: None declared.
Clinical Nutrition (2017) 36(S1), S53–S308
Contents lists available at ScienceDirect
Clinical Nutrition
j o u r n a l h o m e p a g e : h t t p : / / w w w. e l s e v i e r . c o m / l o c at e / c l n u
Poster
Carbohydrate and lipid metabolism
SUN-P001
METABOLIC AND MITOCHONDRIAL CHANGES IN AN
INTERMITTENT FASTING MODEL IN HUMANS
A. Pinarbasi1 *, F. B. Aksungar1,2, D. O. Arslan3, M. Kolay1,
M. Pak1, M. Serteser1,2, I. Unsal1,2. 1Department of
Biochemistry, Acibadem University, School of Medicine,
2
Department of Biochemistry, Acibadem Labmed Clinical
Laboratories, 3Department of Biophysics, Acibadem
University, School Of Medicine, İstanbul, Turkey
Rationale: Dietary composition and calorie intake are the key
factors for healthy aging and disease resistance. Intermittent
fasting (IF) is an alternative model which involves alternating
cycles of fasting and eating in a given time. In the present study
we have compared the changes in metabolic parameters and
mitochondrial functions during an IF model in humans.
Methods: Twenty-two female and 17 male subjects were
included in the study. Subjects fasted and refrained from
any oral intake including drinking and smoking during the
daylight hours for 30 days. Fasting duration was 15 hours
everyday and there were no restriction on the diet. Blood and
urine sampling were performed on the second and the 20th day
of fasting period. Glucose, insulin, glucagon, ketone bodies,
thyroid stimulating hormone (TSH), triglycerides were mea-
sured and compared to the basal values of each subject.
Mitochondrialfunctions from the leucocytes of pheripheral
blood samples were evaluated by flowcytometry.
Results: Significant decrease was detected in fasting glucose
levels on the 2nd fasting day when compared with that of the
20th fasting day( p = 0,009). Increased ketone body production
was observed in the 20th fasting day according to the basal
levels( p = 0,008). TSH, glucagon, insulin, triglyceride levels
were not statistically different. Furthermore, according to the
basal values mitochondrial functions of the subjects improved
not on the 2nd but on the 20th day.
Conclusion: Present study show that our IF model has a positive
impact on the glucose homeostasis, keton body production and
mitochondrial functions. Recent studies, imply that physiolo-
gically produced high ketone levels have beneficial effects on
neurons such as preventing hypoglycemia and epileptic attacks
which are resistant to medicines. Ketone bodies are a new area
for drug discovery, to prevent and treat human cancers.
Furthermore mitochondria are now therapeutic targets for
cancer and aging.
Disclosure of Interest: None declared.
SUN-P002
IS REVERSE CHOLESTEROL TRANSPORT AFFECTED FROM
HIGH FRUCTOSE INTAKE?
E. Ugur1 *, R. Nergiz-Unal1. 1Department of Nutrition and
Dietetics, Faculty of Health Sciences, Hacettepe University,
Ankara, Turkey
Rationale: Reverse cholesterol transport via high density
lipoprotein-cholesterol (HDL-C) and apolipoprotein-A1 (apo-
A1) has a protective role for cardiovascular diseases. It is not
clear whether dietary lipogenic carbohydrates like fructose
may affect reverse cholesterol transport. Hence, the purpose
of the study was to examine the effect of dietary high fructose
intake on HDL-C and apo-A1 levels in mice.
Methods: Male mice (C57BL/6 type, 8-week old, n = 20) were
divided in to two groups. Following the two weeks wash-out
period, one group were fed with a standard chow as a control
group, and second group were fed with high fructose (35%
calories from fructose) ad libitum for 15 weeks. After the
dietary manipulation period fasting blood was collected from
each mouse under the anesthesia. HDL-C and apo-A1 levels
were analyzed in plasma by ELISA method.
Results: It was determined that, plasma mean HDL-C level was
87.91 ± 12.19 mg/dL in high fructose containing diet group
while 102.2 ± 9.18 mg/dL in control group. Hence, plasma HDL-
C was lower in high fructose diet group compared to the control
group significantly ( p < 0.05). Furthermore, the mean plasma
apo-A1 content was 273.4 ± 71.28 ng/mL in high fructose
containing diet group whereas 422.18 ± 48.3 ng/mL in the
control group. Thus, high fructose intake resulted in lower
plasma apo-A1 levels significantly compared to the control
( p = 0.001).
Conclusion: In conclusion, this results reveal that dietary high
fructose intake might result in the inhibition of the reverse
cholesterol transport via HDL-C and apo-A1 in the body by
increasing circulating cholesterol and causing dyslipidemia.
Therefore, decreasing dietary fructose by less intake of
fructose containing food and beverage consumption may have
a lifelong protective role for cardiovascular disease risk.
Acknowledgments: Supported by TUBITAK 1001 – Scientific and
Technological Research Projects Funding Program Project
Number:114S726, Ankara, Turkey
Disclosure of Interest: None declared.
S54
SUN-P003
SATURATED VERSUS MONOUNSARURATED FATTY ACIDS
ELEVATE ACCUMULATION OF CHOLESTEROL IN THE LIVER:
PRELIMINARY DATA
E. Ugur1 *, R. Nergiz-Unal1. 1Department of Nutrition and
Dietetics, Faculty of Health Sciences, Hacettepe University,
Ankara, Turkey
Rationale: Dietary high saturated fatty acids (SFAs) may affect
cholesterol metabolism a risk factor for the cardiovascular
diseases. However, effect of dietary fatty acids on cholesterol
metabolism in the liver has not clarified yet. Hence, the aim of
the study was to examine effect of SFAs intake on the liver
cholesterol content in mice.
Methods: Male C57BL/6 type 8-week old mice (n = 20) were
divided in 2 groups. Following the two weeks wash-out period,
one group were fed with high monounsaturated fatty acids and
second group were fed with high SFAs ad libitum for 15 weeks.
After dietary manipulation period, the liver and blood were
collected from each mouse under anesthesia. The livers were
perfused with ice-cold saline. Total cholesterol contents in
homogenized liver tissues and plasma low density lipoprotein-
cholesterol level (LDL-C) were analyzed by ELISA method. Liver
protein concentrations were analyzed with BCA method,
normalized for tissue amount and stated as mg/g protein.
Results: The liver total cholesterol levels in high MUFA
containing diet group were 0.3 ± 0.05 mg/g protein whereas
in high SFA containing diet group were 0.4 ± 0.09 mg/g protein.
The plasma LDL-C levels were significantly lower in MUFA group
(76.06 ± 2.7 μg/mL) than SFA group (89.51 ± 2.42 μg/mL) ( p <
0.001). Although there was no significant difference in feed and
energy intake of the animals ( p > 0.05), accumulated choles-
terol content in liver in SFA group was significantly higher than
MUFA group ( p < 0.05).
Conclusion: This results reveal that high SFA intake can
influence cholesterol metabolism in the liver and may affect
cardiovascular health. Therefore, reducing SFA intake and
replacement of SFA with MUFA may be a strategy to prevent
chronic diseases related to the cholesterol metabolism.
Acknowledgments: Supported by TUBITAK 1001 – Scientific and
Technological Research Projects Funding Program Project
Number:114S726, Ankara, Turkey
Disclosure of Interest: None declared.
SUN-P004
VARIABILITY AND REPRODUCIBILITY OF THE POSTPRANDIAL
RESPONSE
E. C. Meessen1 *, H. M. Eggink1, K. A. van Galen1,
A. H. van der Spek1, G. J. Bakker2, M. J. Serlie1,
M. Nieuwdorp2,3, E. Fliers1, A. K. Groen2,4, S. W. Olde Damink5,
F. G. Schaap5, J. A. Romijn6, M. R. Soeters1. 1Department of
Endocrinology and Metabolism, 2Department of Vascular
Medicine, Academic Medical Center, 3Diabetes Center,
Department of Internal Medicine, VU University Medical
Center, Amsterdam, 4Department of Pediatrics, Laboratory of
Metabolic Diseases, University Medical Center Groningen,
Groningen, 5Department of Surgery, NUTRIM School of
Nutrition and Translational Research in Metabolism,
Maastricht University Medical Center, Maastricht,
Poster
6
Department of Internal Medicine, Academic Medical Center,
Amsterdam, Netherlands
Rationale: The postprandial state is an orchestrated interplay
of nutrients and enteroendocrine factors in response to food
intake. Plasma glucose levels after standardized meals show
little modest variation in contrast to plasma bile acids (BAs).
Methods: This study assessed variability and the reproducibility
of the postprandial enteroendocrine response during mixed
meal testing (MMT) in healthy lean men (N = 8). Moreover, we
aim to investigate the interrelationship of all nutrients and
enteroendocrine factors using a metabolomic data analysis
approach. Subjects consumed a liquid MMT (Nutridrink
Compact, Nutricia) on 3 separate study days after an overnight
fast. The meal contained 25% of the calculated daily energy
expenditure. Blood was sampled until 4 h after the meal. We
analysed intra- and inter-individual variance of the plasma
glucose and insulin concentrations. Other parameters (e.g.
individual BAs, glucagon-like peptide 1, fibroblast growth
factor 19 and 7α-hydroxy-4-cholesten-3-one, inflammatory
parameters) concentrations are currently analysed.
Results: A two-way repeated measures ANOVA showed no
significant effect for the 3 meal days (intra-individual variabil-
ity) and a significant effect ( p < 0.001) for subjects (inter-
individual variability) for both glucose and insulin concentra-
tions. However, the mean coefficient of variance (CV) within
subject of the total postprandial glucose curve was 0.11% (95% CI
0.09–0.14) and for insulin 0.38% (95% CI 0.29–0.48).
Conclusion: This study assesses reproducibility of the mixed
meal test in general and bile acid response specific.
Postprandial plasma glucose and insulin concentrations show
inter-individual variability. Repeated testing of postprandial
plasma glucose and insulin levels did not show significant
differences between study days even though intra-individual
variance was substantial especially for insulin.
Disclosure of Interest: None declared.
SUN-P006
MODIFIED ACETATE RINGER’s SOLUTIONS VERSUS LACTATE
RINGER’s SOLUTIONS IN PERIOPERATIVE PATIENTS: A
SYSTEMATIC REVIEW (664 PATIENTS)
H. Zhang1 *, Z. Jiang2. 1Cardiology, Guizhou Provincial People’s
Hospital, Guiyang, 2General Surgery, Peking Union Medical
College Hospital, Peking Union Medical College, Chinese
Academy of Medical Sciences, Beijing, China
Rationale: A systematic review for published randomized
controlled trials to evaluate the impact of perioperative
administration of Modified Acetate Ringer’s Solutions versus
Lactate Ringer’s solutions on outcomes.
Methods: PubMed, EMBASE, Cochrane library, Web of Science,
CSCD, SinoMed etc databases were searched to identify
randomized controlled trials for this study. Outcomes &
parameters were mortality, organ failure, pH, BE, PaCO2,
lactate concentration, HCO− 3 . Meta-analyses were conducted
for the eligible RCTs
Results: A total of 664 patients from 12 published papers were
subjected to systematic review. Modified Acetate Ringer’s
Solutions did significantly decrease the blood lactate concen-
tration than Lactate Ringer’s solutions (SMD-0.89, 95%CI
Carbohydrate and lipid metabolism
−1.05 ∼ −0.73, p = 0.000), Modified Acetate Ringer’s Solutions
group patients had higher arterial blood pH than Lactate
Ringer’s group (SMD 0.25, 95%CI: 0.8 ∼ 0.42, p = 0.04). Modified
Acetate Ringer’s Solutions group patients had lower PaCO2 than
Lactate Ringer’s group (SMD −0.26, 95%CI: −0.47 ∼ −0.05,
p = 0.013). There were no significant differences between two
groups in BE and HCO− 3.
Conclusion: Modified Acetate Ringer’s Solutions did reduce the
blood lactate concentration than Lactate Ringer’s solutions.
Disclosure of Interest: None declared.
SUN-P007
THE EFFECTS OF 25G FAT CONTAINING GLUCOSE TOLERANCE
TEST ON POSTPRANDIAL TRIGLYCERIDE RESPONSE IN BOTH
NORMAL VOLUNTEERS AND TYPE 2 DIABETIC PATIENTS
T. Nakamura1 *, L. M. Sugawara2. 1Endocrinology and
Metabolism, Omihachiman Community Medical Science,
Kusatsu, 2Endocrinology and Metabolism, Omihachiman
Community Medical Science, Otsu, Japan
Rationale: We have presented that the cookie consisting of 75 g
carbohydrate and 25 g fat is more informative than oral glucose
tolerance test (OGTT) to study both glucose and triglyceride
metabolism in type 2 diabetic subjects (Endocrine Journal,
2006).
Methods: To examine effects of the postprandial triglyceride
levels in normal volunteers (n = 56) and type 2 diabetic subjects
(n = 59), we examined the correlation between the fasting TG
levels and postprandial TG ones at 3 hours after loading tests. It
showed that the positive correlations between fasting TG and
the post prandial TG levels at 3 hours were observed in both
groups. It demonstrated a coefficient of correlation was 0.90,
0.92 respectively and it was statistically significant ( p < 0.001).
Results: Next, we classified patients with type II diabetes
mellitus in three groups by the area under the curve of TG level
until 3 hours after the test (AUC-TG0–3). AUC-TG0–3 level in each
group was from 0 to 500 (Group A), 501–700 (B), 701–1500 (C)
mg/dL-hour, respectively. Then, we examined its association
with blood insulin (INS), the ratio of AUC-TG 0–3/AUC-INS 0–3,
AUC-TG 0–3 and BMI. The ratio of AUC-TG 0–3/AUC-INS 0–3 was 5.2
in normal volunteers (N), 8.3, 16.8, 26.3 mg/mU in A, B, C
respectively. Those values were statistically significant
between N and B ( p < 0.01), N and C ( p < 0.001), A and C
( p < 0.001). Moreover, the positive correlation between AUC-
TG 0–3 and BMI was identified in diabetic patients.
Conclusion: These results indicated that diabetic patients with
elevated fasting triglyceride levels display exaggerated and
prolonged postprandial triglyceride responses and have an
effect of high insulin sensitivity, but not insulin amount to
produce triglyceride in both fasting and prandial.
Disclosure of Interest: None declared.
S55
SUN-P008
VALIDITY OF ADDING INTRAVENOUS CARNITINE TO
PARENTERAL NUTRITION WITH LIPID EMULSION FOR
DECEASING INFLAMMATORY REACTION OF POSTOPERATIVE
SURGICAL PATIENTS
Y. Koyama1 *, K. Moro2, K. Miura2, M. Nagahashi2, S.-I. Kosugi3,
J. Tsuchida2, M. Ikarashi2, M. Nakajima2, H. Ichikawa2,
Y. Shimada2, J. Sakata2, H. Kameyama2, T. Kobayashi2, T. Wakai2.
1
Niigata University Graduate School of Health Sciences,
2
Division of Digestive & General Surgery, Niigata University
Graduate School of Medical Sciences, Niigata, 3Department of
Digestive and General Surgery, Uonuma Institute of Community
Medicine, Niigata University Medical and Dental Hospital,
Urasa, Japan
Rationale: Lipid emulsion including long-chain fatty acids
(LCFA) should be added parenteral nutrition (PN) for supplying
appropriate nutrition. Carnitine is necessary for transporting
LCFA into mitochondria for beta-oxidation. In the present
study, we prospectively investigate the validity of carnitine
administration during postoperative PN with lipid emulsion.
Methods: Patients who receive surgery for gastric or colorectal
surgery during 2014–2016 were entered. The patients were
randomly divided into 2 groups: Group L (8patients) received
peripherally PN (PPN) solution of 7.5% glucose, 30% amino acid
and 20% lipid emulsion, and Group LC (8patients) received same
PPN solution plus carnitine intravenously. PPN was performed
from postoperative day (POD) 1–4 without oral nutrition. Oral
nutrition was stated from POD4. Clinical factors such as amount
of administered nutrients, pre- to postoperative serum
carnitine, albumin (Alb), rapid turnover protein (RTP), total
lymphocyte count (TLC), insulin resistance indicated by HOMA-
R, C-reactive protein (CRP) and postoperative complication
were compared. Statistical analyses were performed by
Kruskal-Wallis test, Mann-Whitney U test and Chi square test.
The statistical significance was defined as P < 0.05.
Results: Serum carnitine concentration was significantly higher
in Group LC at not only POD3 (P < 0.01) but also POD7 (P = 0.01).
Clinical factors including amount of administered nutrients,
pre- to postoperative change of Alb, RTP and TLC, insulin
resistance and frequency of postoperative infectious compli-
cation were comparable between 2 groups. Change of CRP from
POD 3–7 showed significantly more decrease in Group LC
compared with Group L (P = 0.011).
Conclusion: Our results showed that addition of carnitine to PN
with lipid emulsion is safe and valid for recovery from
postoperative inflammatory reaction.
Disclosure of Interest: None declared.
SUN-P009
ASSOCIATION BETWEEN CARBOHYDRATE INTAKE AND FATTY
ACIDS IN THE DE NOVO LIPOGENIC PATHWAY IN SERUM
PHOSPHOLIPIDS AND ADIPOSE TISSUE AMONG 60-YEAR OLD
MEN
Z. Alsharari1 *, K. Leander2, P. Sjögren1, A. Carlsson2,
T. Cederholm1, U. De Faire2, M.-L. Hellenius2, M. Marklund1,
U. Risérus1. 1Public Health and Caring Sciences, Clinical
Nutrition and Metabolism, Uppsala University, Uppsala, 2Unit
S56
of Cardiovascular Epidemiology, Institute of Environmental
Medicine, Karolinska Institute, Stockholm, Sweden
Rationale: Fatty acid composition in blood and adipose tissue is
useful to reflect dietary fat quality, although even-chain
saturated fatty acids (SFA) and monounsaturated fatty acids
(MUFA) are weaker biomarkers. Since SFA also can be produced
via de novo lipogenesis (DNL), and desaturated through SCD-1
to MUFA, we aimed to test the hypothesis that high carbohy-
drate intake, especially sugars, is related to serum and adipose
tissue SFA and MUFA, respectively.
Methods: Samples of 301 men were included (age 60, BMI 25.4)
with available food record data and fatty acid composition in
both serum phospholipids (PL) and adipose tissue (AT).
Exposure variables were intake of carbohydrate quantity and
quality, including sugar and fiber intake. The major SFA,
palmitic acid, was the primary outcome in serum PL and AT, and
the estimated SCD-1 and the SCD product 16:1n-7 was
secondary. RNA expression was conducted in adipose tissue
biopsies in a subsample of 81 subjects.
Results: There were no positive associations between carbo-
hydrate intake or sugar-rich foods and serum palmitic acid,
total SFA or 16:1n-7. After BMI-adjusted, carbohydrate intake
was inversely associated with 16:0 in PL (P = 0.005) and with
16:1 (P = 0.07) and SCD (P = 0.13) activity in AT. There was a
little evidence of linear associations of disaccharide intake
with FA or SCD activity (BMI-adjusted P ≥ 0.15). However,
disaccharide intake was non-linearly associated with 16:1 and
SCD activity in PL, but not adipose tissue (P for non-linearity ≤
0.02). In the subsample, we found no association between
carbohydrate intake and SCD-1 gene expression.
Conclusion: There was no clear evidence to suggest that high
carbohydrate intake or sugar-rich foods or beverages is
reflected by higher DNL-derived SFA in serum PL.
Disclosure of Interest: None declared.
Critical Care 1
SUN-P010
NUTRITIONAL STATUS AND EARLY NUTRITIONAL SUPPORT
AFTER LUNG TRANSPLANTATION IN PATIENTS WITH CYSTIC
FIBROSIS: A SINGLE CENTER, PRELIMINARY REPORT
A. Jirka1 *, D. Darmaun2, T. Lepoivre3, A. Haloun4,
I. Danner-Boucher4. 1HepatoGastroenterology and Nutrition
Support Unit, 2Nutrition Support Team, 3Cardiac Surgery
Intensive Care Unit, Anesthesiology Department, 4Thoracic
Transplantation Unit, University Hospital Nantes, Nantes,
France
Rationale: The prevalence of malnutrition, defined as
BMI < 18.5, reaches 40% in adult CF patients. Malnutrition is
known for its negative impact on the postoperative course.
Moreover, in ICU patients, the cumulative, postoperative
energy deficit increases the length of ventilation, ICU length
of stay (LOS), and infection risk. The aim of the current study
was to evaluate the impact of preoperative nutritional status
and of early postoperative nutrition support on short-term
post-transplant outcome in CF patients.
Methods: This was an observational, retrospective study.
In a single-center, 120 lung or combined lung/heart
Poster
transplantations (60 Tx for CF), were performed between
2010 and 2015. All medical records of patients operated for
lung Tx for CF between 2013 and 2015, were included.
Results: 22 patients (age: 31 ± 9 years, mean ± SD) were
included in the study. Preoperative BMI was 18.7 ± 1.2; 8
patients (36%) had a BMI < 18.5. Median ICU LOS was 29 days.
The nutrition support characteristics at the 5th and 10th
postoperative day were: energy intake 25 ± 10 and 25 ± 15 kcal/
kg/d; protein intake 1.0 ± 0.6 and 1.2 ± 0.7 g/kg/d; NP/NE ratio
for energy intake 2.5 and 1.0, respectively. ICU LOS did not
correlate with preoperative albumin, percent of IBW, nor with
postoperative energy and protein intake, nor with EN and
PN route.
Conclusion: To our knowledge, our study is first to assess the
effect of early nutritional support after lungTx in CF patients. A
third of transplanted patients are malnourished. The recom-
mended calorie intake was achieved at day5, but protein intake
was below recommended one during that period. In this
relatively small sample of patients in a fair nutritional status,
we failed to demonstrate any effect of preoperative nutritional
status, nor any shortening effect of postoperative nutrition
support on ICU LOS. Larger scale studies are underway to
explore this finding.
Disclosure of Interest: None declared.
SUN-P011
EFFECTS OF GLUTAMINE SUPPLEMENTATION ON CRITICALLY
ILL ADULTS: AN UMBRELLA REVIEW OF SYSTEMATIC REVIEWS
AND META-ANALYSES
A. Apostolopoulou1 *, A. B. Haidich1, K. Kofina2, M. Chourdakis1.
1
Department of Medicine, Aristotle University of Thessaloniki,
Thessaloniki, 2Medical School, Democritus University of
Thrace, Alexandroupolis, Greece
Rationale: The effect of supplementing immunonutrients in
critical illness has been widely examined but relevant results
offer differential conclusions. The purpose of this study is to
evaluate the clinical efficacy of the administration of glutam-
ine to severely ill patients.
Methods: Four bibliographic databases have been searched
(Medline, Scopus, The Cochrane Library, Prospero) til
01.03.2017. Systematic reviews and meta-analyses published
in English, including the comparison of immunomodulating
diets -containing exclusively glutamine- with standard diets for
critically ill adult patients were selected. A descriptive analysis
was performed to assess the outcome of glutamine supple-
mentation on mortality, infectious complications, length of
hospital (LOS) and length of ICU stay (LICU) and to synthesize
the results from the subgroup analyses of primary studies. The
extend of overlapping was also evaluated.
Results: Fifteen meta-analyses and one systematic review were
eligible for inclusion, involving 123 studies and 8,194 patients.
Mortality rate was examined as one of the endpoints in 14 of the
included studies. Five of these (36%) revealed a statistically
significant survival benefit by the administration of glutamine.
Fifteen of the studies examined the impact of glutamine
supplementation on infectious complications; a significant
decrease was found in the majority of the them (12; 80%) 15
studies dealing with the effect of glutamine on LOS, with 9
studies (60%) resulted in the conclusion that glutamine
Critical Care 1
administration has shortened LOS. Among 6 studies examinng
LICU, only 1 showed a beneficial effect (17%).
Conclusion: Glutamine may have the ability to play a beneficial
role in critical care patients, in regard to rate of infections and
LOS. Subgroup analysis might reveal in depth which patient
could benefit most from such a supplementation.
Disclosure of Interest: None declared.
SUN-P012
THE ASSOCIATION BETWEEN PHOSPHATASE AND TENSIN
HOMOLOGUE (PTEN) EXPRESSION, GLUCOSE CONTROL AND
CALORIES SUPPLEMENTED IN CRITICALLY ILL PATIENTS
A. Molfino1 *, F. Alessandri2, A. Farcomeni3, D. Dell’utri2,
P. Mosillo4, M. I. Amabile1, M. Muscaritoli1, A. Laviano1.
1
Department of Clinical Medicine, 2Department of
Cardiovascular, Respiratory, Nephrology, Anesthesiology and
Geriatric Sciences, 3Department of Public Health and
Infectious Diseases, 4Department of Physiology and
Pharmacology “Vittorio Erspamer”, Sapienza University of
Rome, Rome, Italy
Rationale: PTEN reduces insulin sensitivity and its expression
increases during sepsis. Considering that critically ill patients
present insulin resistance, we investigated the role of PTEN
expression on glucose control and clinical outcome(s) in
patients hospitalized in an intensive care unit (ICU) receiving
artificial nutrition.
Methods: This was an observational, single-center study
enrolling adult patients hospitalized for trauma. Plasma
glucose levels and its variability were recorded in patients
receiving artificial nutrition. PTEN expression via western
blotting analysis was measured and the associations between
PTEN, plasma glucose levels and its variability, and calories
administered were investigated. Parametric and non-paramet-
ric tests were used, as appropriate. P value <0.05 was
considered statistically significant.
Results: Twenty patients (13 men and 7 women, mean age of
37.3 ± 12.7 years) were enrolled. No correlation between
plasma glucose and PTEN was documented (r = −0.15,
P = 0.55), neither between glycemic variability and PTEN
expression (r = −0.00, P = 0.99). However, total kcal/day
administered and PTEN expression significantly correlated
(r = 0.56, P= 0.01). Patients with PTEN levels below the
median value received less kcal/day than those with PTEN
above the median (P = 0.048). This association was more
pronounced when adjusted for body weight (P = 0.03) and for
the average of insulin daily administered (P = 0.02).
Conclusion: PTEN expression might contribute to glucose
homeostasis and disposal in critically ill patients receiving
artificial nutrition.
Disclosure of Interest: None declared.
SUN-P013
ASSESSMENT OF SKELETAL MUSCLE MASS IN CRITICALLY ILL
CANCER PATIENTS BY COMPUTED TOMOGRAPHY
D. O. Toledo1, A. M. Carvalho2, J. Toloi2 *, A. R. Oliveira2. 1ICU,
Hospita São Luiz Itaim, São Paulo, 2ICU, Hospital do Cancer de
Barretos, Barretos, Brazil
Rationale: Recent findings, shown that computed tomography
CT have been used to identify critical ill patients with low SM
S57
associated with poor clinical outcomes and function1. So, we
have evaluated low muscle mass with CT and outcomes in
critical ill cancer patients
Methods: At the period of 1 year, we included patients who
performed abdominal CT from the 72 hours of admission in the
ICU. A ROC curve was applied to defined the groups of patients
with sarcopenia and non sarcopenia by CT. A multiple logist
regression was used Cox regression and held the 30 days survival
curve adjusted was used to the check the joint relationship of
these characteristics with the outcome.
Results: We evaluated 99 the mean age was 61 years, with 56%
male. 43.% of the patients were classified as malnourished
according to weight loss criteria and 19.4% according to BMI.
The BMI values showed no correlation with a sarcopenia
R2 = 0.39, P < 0.001. The cutoff point for determination of
sarcopenia by CTwas 41.2 cm2/m2. Therefore, the diagnosis of
sarcopenia by CTwith the parameters of nutritional evaluation
were correlated with 64.2% by weight loss criteria and only
19.4% by BMI. The patients considered sarcopenic by this
method presented had higher 30 days mortality by age and SAPS
3 (P < 0.01), hospital mortality (P = 0.006) and ICU complication
( p = 0,016) when compared to nonsarcopenic.
Conclusion: The sarcopenia assessed by CT demonstrated low
correlation with malnutrition by BMI and was a risk factor for
increased hospital mortality, complications, as well as lower
survival among 30 days for cancer patients.
Reference
1. Paris M, Mourtatizaks M. Assesment skeletal muscle mass in
critically ill patients: considerations for the utility computed
tomography imaging and ultrasonography. Curr Opin Clin Nutr
Metab Care 2016, 19:125–130.
Disclosure of Interest: None declared.
SUN-P014
IRON CONTAMINATION IN PEDIATRIC AND ADULT PARENTERAL
NUTRITION MIXTURES
A. M. Menéndez1 *, S. S. Farías2, I. Cortez3, H. J. Montemerlo4,
M. L. Pita Martín5. 1Clinical Pharmacy, Belgrano University,
Ciudad Autónoma de Buenos Aires, 2Analytical Chemistry,
Atomic Energy National Agency, San Martín, Prov. Buenos Aires,
3
Analytical Chemistry Laboratory, Benito Roggio Ambiental &
Belgrano University, 4Nutrition Research, Argentine Institute
for Education, 5Nutrition, Buenos Aires University, School of
Pharmacy and Biochemistry, Ciudad Autónoma de Buenos
Aires, Argentina
Rationale: Iron (Fe) is an essential trace element, and could be
present as a contaminant in the individual components used to
prepare TPN. This contamination must be taken into account by
the compatibility limitations regarding lipids destabilization.
The objectives were to determine Fe contamination levels in
commercial individual components available in Argentina to
prepare TPN mixtures, to calculate the Fe contamination
amount present in TPN mixtures prepared with individual
components and its relation regarding the Fe requirements
Methods: Fe was determined in 40 individual solutions, from
different labs and lots, belonging to 11 commercial products
available in Argentina, by Argon Inductively Coupled-Plasma-
Optical Emission Spectrometry. Samples containing organic
substances were digested in a laboratory microwave oven.
S58
Results: Fe levels for each individual solution were (μg/mL):
mean value ± SD: Dextrose 50%: 1.12 ± 0.03; Dextrose 70%:
1.32 ± 0.52; Amino acids 10%: 0.25 ± 0,11; Lipids 20%:
4.58 ± 0.80; Potassium chloride: 0.11 ± 0.03; Sodium chloride
20%: 0.11 ± 0,03; Magnesium sulfate: 0.11 ± 0,00; Sodium
glicerophosphate: 2.76 ± 0.48; Sodium phosphate: 4.51 ± 0.13;
Calcium gluconate: 2,01 ± 0,27; Zinc sulfate: 0.12 ± 0,04;
Sterile water: non detectable. According to the obtained
values, the calculated Fe total amount (mg) provided by the
individual components contamination would be for a typical TPN
mixture: adult 2.352; neonatology: 0.073; pediatric: 0.524.
Conclusion: Fe found as contaminant in the studied compo-
nents was not declared in the label. The Fe contamination
levels in adult TPN were 1.2 mg/L amount which would affect
the TPN stability. Regarding the iron daily requirements, Fe
contamination in TPN mixtures for adults would be very high.
Therefore, it would be advisable that manufacturers declare
the Fe contaminant content in the label products.
Disclosure of Interest: None declared.
SUN-P015
THE IMPACT OF EARLY ENTERAL NUTRITION IN LOW-VOLUME
REGIMEN ON CLINICAL EFFICIENCY OF THE METHOD OF
INSULIN THERAPY
A. Nikolenko1 *, I. Prelous2, I. Leiderman3. 1Head of the
Department of Anesthesiology and Reanimatology,
2
Department of Anesthesiology and Reanimatology, Perm State
Medical University, Perm, 3MD, Professor of the Department of
Anesthesiology, Reanimatology and Transfusiology, Ural State
Medical University, Ekterinburg, Russian Federation
Rationale: Correction of stress hyperglycemia is a pressing
problem in modern intensive care. The purpose of the study: To
evaluate the efficiency of various methods for stress hypergly-
cemia correction in patients with acute surgical pathology of
abdominal organs.
Methods: A two-centered randomized open controlled study
was performed using a conversion method. In Group 1 nutrition
was performed in the regimen of low-volume support method,
enteral component was Nutrison Advanced Diason feed
combined with administration of short-acting insulin, and in
Group 2, short-acting insulin was administered in combination
with enteral nutrition (Nutrison). Evaluation was performed
based on laboratory values, circadian dynamics of blood
glucose level, total insulin consumption, dynamics of systemic
inflammatory response, the period of stay in intensive care
unit, assessment of nutritional status. The study was performed
in 5 stages (Day 1, 3, 5, 7, 10). 60 patients with stress
hyperglycemia were included in the study.
Results: In Group 1, rapid correction of mean daily (P = 0.005)
fasted glycemia (P = 0.003) was observed, glycemia’s variabil-
ity was reduced, total and mean daily consumption of insulin
per person was reduced, (P = 0.006) as compared to Group
2. Alsoin Group 1, veracious reduction of multiple organ failure
manifestations (P = 0.001), white blood cell count (P = 0.005),
immature granulocytes (P = 0.04) and free-radicals’ activity
(P = 0.007) was revealed on Day 3. Periods of artificial
pulmonary ventilation were reduced (P1–2 = 0.002).
Conclusion: The method of early “low-volume” nutritional
support with the inclusion of Nutrison Diason feed in
combination with intensive insulin therapy stabilizes the
Poster
parameters of protein-energy metabolism, manifestations of
multiple organ failure, however, it requires strict control over
the patient due to the remaining risk as to the development of
hyperglycemia.
Disclosure of Interest: None declared.
SUN-P016
EVALUATION OF IMPLEMENTATION OF FASTING GUIDELINES
FOR ENTERALLY FED CRITICAL CARE PATIENTS
B. Jenkins1 *, L. Marino1, P. Calder2. 1Nutrition and Dietetics,
University Southampton Hospitals NHS Trust, 2Human
Development & Health Academic Unit, Faculty of Medicine
University of Southampton Institute of Developmental
Sciences, Southampton, United Kingdom
Rationale: Critically ill patients are often fasted prior to
procedures leading to the accumulation of nutritional deficits.
Therefore following guidelines on fasting is important to help
reduce such deficits. The aim of this work was to determine the
impact of implementation of local fasting guidelines on
nutrition support delivery and staff knowledge of the guidelines
with a General, Cardiac and Neurosurgical intensive care unit.
Methods: Enteral nutrition (EN) intake was audited in 74
critically ill adults (32 pre- and 42 post-guideline implemen-
tation) over 4–14 days at Southampton General Hospital.
Questionnaires were administered to staff assessing knowledge
and barriers to guideline use.
Results: There were significant differences in % EN received
76.4 ± 11.8 vs. 84.1 ± 10.8 ( p = 0.0009) and the number of hours
feeds were withheld 42 ± 26.6 vs. 28 ± 20.8 hours pre- and
post-guideline implementation ( p = 0.02). Although not sig-
nificant there were improvements pre- and post-implementa-
tion in the % of energy and protein delivered 80.7 ± 16.4 vs.
86 ± 17.3; 74 ± 18.3 vs. 79 ± 18.5 respectively.
77% of staff were familiar with the guidelines, whilst 42%
requested further education. The main barriers to compliance
were delays and unpredictable timing of procedures, and
differing guidance from senior staff and non-ICU teams.
Conclusion: Failure to meet nutritional goals during ICU
admission has been shown to negatively impact on nutritional
status, patient morbidity and length of stay. We have been able
to demonstrate that implementation of fasting guidelines
resulted in significant improvements in the amount of nutrition
support delivered and reduced duration of feed breaks. The use
of fasting guidelines is a positive step towards increasing
nutrition delivery in the ICU. Further staff education and better
planning around procedures is required to promote further
adherence to the fasting guidelines.
Disclosure of Interest: None declared.
SUN-P017
ASSESSMENT OF GLUTAMINE-SUPPLEMENTED ENTERAL
FORMULA AND PLASMA AMMONIA LEVELS IN PATIENTS IN
INTENSIVE CARE UNIT
D. Ebiloğlu1, Ç. Kaymak1 *, A. Özcan1, H. Başar1, N. Özcan1.
1
Anaesthesiology and Reanimation, Intensive Care Unit,
Ankara Training and Research Hospital, Health Science
University, Ankara, Turkey
Rationale: Glutamine is a nonessential amino acid that
contains free ammonia and it is the most important substrate
Critical Care 1
released to the bloodstream after renal ammoniagenesis. The
catabolism of glutamine can be increased without the
production of excessive amounts of specific metabolites. We
compared the plasma ammonia levels in critically ill patients
given standart and glutamine-supplemented enteral formula.
Methods: Forty patients were enrolled in the study. The
patients were randomized into two groups as isocaloric
glutamine-free (Control) and glutamine-supplemented
(Glutamine) enteral formula groups. In Glutamine group
0.3 g/kg/day enteral L-glutamine was given within 16 hours.
The isocaloric enteral formula was also administered during 16
hours. Plasma samples were collected at the 24th hour and
after 7., 14., 21. and 28 days. Demographics of patients were
recorded.
Results: Eleven of the patients were males in both groups.
APACHE II and SOFA scores of the Glutamine and Control Groups
at admission were also similar. Plasma ammonia levels at first
24 hour (80.77 ± 44.95 mcg/dL vs. 66.16 ± 26.48 mcg/dL, p =
0.53), 7th day (68.94 ± 29.32 mcg/dL vs. 58.81 ± 28.45 mcg/
dL, p = 0.17), 14th day (68.53 ± 42.97 mcg/dL vs. 85.88 ± 82.42
mcg/dL, p = 0.81), 21st day (83.51 ± 51.84 mcg/dL vs. 79.16 ±
70.80 mcg/dL, p = 0.54) and 28th day (71.73 ± 38.60 mcg/dL
vs. 77.05 ± 70.40 mcg/dL, p = 0.19) were comparable between
groups. Plasma ammonia changes within the groups throughout
the study were insignificant.
Conclusion: Plasma ammonia levels in patients fed with
glutamine-supplemented enteral nutrition and isocaloric glu-
tamine-free enteral nutrition were similar. An appropriate plan
for nutritional therapy should be developed and assessed
periodically during intensive care unit stay.
Disclosure of Interest: None declared.
SUN-P018
THE INCIDENCE OF UNINTENTIONAL UNDERFEEDING IN ICU
PATIENTS DURING ENTERAL NUTRITION
A. M. Mega1, T. Melissopoulou1, C. Dimosthenopoulos2 *,
E. Pappa1, I. Floros1. 1Intensive Care Unit, 2Department of
Clinical Nutrition, Laiko General Hospital of Athens,
Athens, Greece
Rationale: Unintentional underfeeding in ICU patients, under-
stood as a lower actual caloric and protein intake than the
amount prescribed, is a recurring occurrence in patients
receiving nutritional support with EN. The aim of the study
was to determine the incidence and the most frequent causes
of the problem.
Methods: An observational retrospective study was conducted
among patients admitted to the ICU over a six-month period.
Consecutive 188 patients were enrolled. One hundred and five
patients (55,8%) with ≤3 days length of stay in ICU were
excluded from the study. The remaining 83 patients’ data were
analyzed for nutritional support with TPN (total parenteral
nutrition) or EN (enteral nutrition) by nasogastric tube. The
total number of TPN and EN days were recorded as well as the
number of days of EN intrerruption.
Results: Sixty four patients were supported for a total of 838
days while 19 patients (22.9%) did not receive any nutritional
support. TPN was administered for 350 days (41,8%) and EN
(alone or with supplementary TPN) for 488 days (58,2%). Out of
the initially prescribed 675 days of EN a total of 187 days of
interruption were recorded resulting in patients receiving
S59
27.7% days of enteral feeding less than the planned. Leading
causes were: shock 43.31%, upper digestive intolerance with
GAV >500 mL or vomiting 39.03%, profuse diarrhea 10.7% and
carrying out diagnostic or therapeutic procedures (CT, bron-
choscopy, physical therapy, tracheotomy) 6.96%.
Conclusion: Despite evidence-based definite recommenda-
tions for the superiority of EN in critically ill patients practical
difficulties might lead to unintentional underfeeding. The
implementation of a specific nutritional management protocol
can help resolve difficulties and increase the use of EN in ICU
patients.
Disclosure of Interest: None declared.
SUN-P019
ADEQUACY OF ENTERAL ENERGY INTAKE IS ASSOCIATED WITH
MORTALITY IN CHILDREN ON EXTRACORPOREAL MEMBRANE
OXYGENATION
C. Ong1,2 *, C. Y. S. Lim2, Y. H. Mok1, Z. H. Tan3, B. Ang1,
T. H. Tan1, Y. J. Loh1, Y. H. Chan1, J. H. Lee1. 1KK Women’s and
Children’s Hospital, 2National University of Singapore, 3SBCC
Baby and Child Clinic, Singapore, Singapore
Rationale: Use of extracorporeal membrane oxygenation
(ECMO) in children is increasing. Yet, little is known about
optimal nutritional practices in these children. We aim to
describe nutritional practices and their association with out-
comes in children supported on ECMO.
Methods: This is a retrospective chart review of all patients 1
month – 18 years requiring ECMO from 2010 to 2016. Nutrition
intake in the first 7 days of ECMO was collected. Adequacy of
nutrition intake was defined as % intake vs. requirements.
Primary outcome was hospital mortality. Secondary outcomes
were ventilator-free days and paediatic intensive care unit
(PICU) length of stay.
Results: 51 patients of median age 3.3 [interquartile range
(IQR) 0.6–10.4)] years were included. 43 (84%) were supported
on veno-arterial ECMO. Main indications for ECMO were: post
cardiac surgery (n = 24, 47%) and acute respiratory distress
syndrome (n = 13, 26%). Median ECMO duration was 8.6 (IQR
6.1–16.2) days. Enteral nutrition (EN) was initiated in 31 (61%)
patients. Parenteral nutrition (PN) provided majority of
calories [median 95 (IQR 69–100)]% and protein [median 98
(IQR 73–100)%]. Median energy and protein adequacy across 7
days was 46.3 (IQR 28.0–66.4) and 59.5 (IQR 20.0–84.2)%
respectively.
28 (55%) patients died. Compared to survivors, non-survivors
were started on EN later [67.9 (IQR 40.9–157.6) vs. 36.0 (IQR
26.2–45.6) hours, p = 0.001], and had lower adequacy of EN
energy intake [0.5 (IQR 0–4.4) vs. 11.8 (IQR 0–24.5)%, p =
0.034]. After correcting for ECMO duration and need for
dialysis, EN energy adequacy remained significantly associated
with mortality [adjusted odds ratio 0.923 (95%CI 0.855–0.966).
There was no association between PN adequacy and outcomes.
Conclusion: There was an association between early EN and EN
energy adequacy with mortality in children requiring ECMO.
Strategies to optimize EN in these children may be warranted.
Disclosure of Interest: None declared.
S60
SUN-P020
CORRELATION BETWEEN ORAL INTAKE OF 5-
HYDROXYTRIPTOPHAN AND SEROTONIN LEVEL
C. Cobilinschi1 *, R. C. Tincu1, I. F. Tincu2, Z. Ghiorghiu1,
R. A. Macovei1,3. 1Anesthesiology and Intensive Care, Clinical
Emergency Hospital Bucharest, 2Pediatrics, Clinical Emergency
Hospital for Children Grigore Alexandrescu, 3Clinical
Pharmacology, Psychopharmacology and Toxicology, Universty
of Medicine and Pharmacy Carol Davila, Bucharest, Romania
Rationale: Serotonin is a neuroamine implicate din many
physiological processes. Low level of serotonin is associated
with Post-traumatic Stress Disorder (PSD), chronic headache,
depression, fibromyalgia, insomnia or feeding disorders.
Central nervous system is highly dependent to intrinsic
serotonin synthesis and precursors from nutrition are manda-
tory for this process. 5-hydroxytriptophan may easily pass the
hemato-encephalic barrier while L-tryptophan has many
biochemical limitations.
Methods: We conducted a randomized controlled trial on 30
patients. We dosed serotonin levels on admission day and after
30 days of treatment. Patients with psychiatric disorders,
chronic diseases and malignancies were excluded as those who
were in treatment with drugs that interfere with the
metabolism of serotonin. Selected patients were randomly
assigned either to receive placebo treatment (first group,
N = 15) or to received 300 mg of 5-hydroxytryptophan (5-HTP)
(second group, N = 15).
Results: At baseline, no significant differences were recorded
regarding serotonin plasma levels (223 ± 48.75 and 234.6 ±
39.59 μg/L, P > 0.05) or age (54.1 ± 13.38 and 53.66 ± 12.11,
P > 0.05), in both groups. During the procedures, dietary intake
was similar in both groups. After 30 days of treatment we
observed an increase in serotonin levels in 5-HTP group
(249.36 ± 39.35) comparative to placebo group (225.46 ±
38.57) and ( p < 0.001, T-value is 3.18). Sleeping quality was
improved for 82% of subjects in treatment group.
Conclusion: Serotonin acts as a neurotransmitter capable to
influence a variety of psychological functions. Low levels of
serotonin can affect the cardiovascular, endocrine, neurologic
system. Oral intake of tryptophan from food represents the
main source of serotonin synthesis, but many biochemical
limitations are known. 5 HTP is an immediate precursor capable
to maintain the normal level of serotonin in healthy population.
Disclosure of Interest: None declared.
SUN-P021
ALTERNATIVE TREATMENT WITH BOVINE THYMUS EXTRACT
FOR ANTIBIOTIC INDUCED LEUKOPENIA – A CASE REPORT
C. Cobilinschi1 *, R. C. Tincu1, I. F. Tincu2, Z. Ghiorghiu1,
R. A. Macovei1. 1Anesthesiology and Intensive Care, Clinical
Emergency Hospital Bucharest, 2Pediatrics, Clinical Emergency
Hospital for Children Grigore Alexandrescu, Bucharest,
Romania
Rationale: Imipenem/cilastatin is largely used in Intensive
Care Units for various serious infections produced of a wide
bacterial spectrum. Most common adverse effects include
allergies or seizures, however hematological changes are rare.
This is case report of imipenem/cilastatin-induced leucopenia
Poster
in a patient with extensive burns and pneumonia successfully
treated with bovine thymus extract.
Methods: A 21-year-old male patient was admitted for severe
extended burns, including airway implication.
Results: After aggressive and early surgical excision and skin
grafting for full-thickness burns, together with early manage-
ment of hemodynamic and respiratory failures, on 32nd day of
hospitalization he developed skin infection with Providencia
spp. His regim required imipenem/cilastatin (2,000 mg daily).
After twenty days of treatment he developed severe leuco-
penia, neutropenia, thrombocytopenia and anemia.
Hematologic evaluation was negative for any specific diagnosis
and in the absence of an alternative explanation, the
leucopenia was thought to be secondary to antibiotic treat-
ment. The patient was put on bovine thymus extract capsules
(520 mg daily for 10 days). This resulted in progressive response
in white cell count, turning to normal levels within the first 6
days of administration. In the meantime, imipenem/cilastatin
continued to be administered due to microbial resistance, and
a new episode of pancytopenia developed, requiring another 15
days of thymus extract treatment, as long as the antibiotic
treatment was necessary; blood count turned to normal values
again.
Conclusion: The drugs most commonly associated with
neutropenia are antibiotics. Severe neutropenia in burned
patients is a factor of negative prognostic. Both neutropenia
episodes responded to thymus extract administration without
any other intervention. This might be a well-accepted
treatment for antibiotic associated leukopenia.
Disclosure of Interest: None declared.
SUN-P022
ENTERAL NUTRITION COMPLICATIONS IN PATIENTS WITH
HEART DISEASE
I. C. P. Mota1, P. A. D. Oliveira1, L. G. D. Borba2, A. Moura2,
M. J. D. Santos2, A. G. D. M. R. Sousa2, D. Magnoni2 *. 1Nutrition
and Nutrology, Instituto Dante Pazzanese De Cardiologia, São
Caetano do Sul, 2Nutrition and Nutrology, Instituto Dante
Pazzanese De Cardiologia, São Paulo, Brazil
Rationale: Enteral nutritional therapy is an important tool to
reach nutritional needs, but intercurrences hamper the
achievement of caloric and protein goals, requiring attention
of the multiprofessional team. The objective of this study was
to observe and compare the prevalence of gastroesophageal
diarrhea and reflux among patients with cardiovascular disease
in nutritional therapy.
Methods: We analyzed the sequential record of 102 patients in
enteral nutritional therapy with cardiovascular disease and
observed the prevalence of diarrhea and gastroesophageal
reflux (GR) in this group for a period of 2 months.
ILL Patients Critical ILL Patients Total
n % n % n
Without DT 20 19,61 35 34,3 55
complications
Diarrhea 9 8,824 14 13,7 23
GR 2 1,961 20 19,6 22
Diarrhea + GR 1 0,98 1 0,98 2
Total 32 31,37 70 68,6 102
Critical Care 1 S61

Results: Digestive tract complications in patients with cardio- SUN-P024

vascular disease in nutrition therapy EARLY PARENTERAL NUTRITION IN CRITICALLY ILL ADULT
Conclusion: Not only diarrhea, but GR is an important PATIENTS: AN OBSERVATIONAL STUDY
complication and must be a clinical concern in critical ill D. Berlana1 *, L. Santulario1, M. Farre2, L. Betriu1, C. Puiggros3,
patients with cardiovascular disease receiving enteral tube R. Burgos3. 1Pharmacy, 2Intensive Care Unit, 3Nutrition
feeding. Aspiration can result in pneumonia leading to Support Unit, Vall Hebron University Hospital, Barcelona,
increases in the use of antibiotics, length of hospital stay, and Spain
the risk of mortality. As with diarrhea, GR prevents nutritional
goals from being attained, generating a greater risk of in- Rationale: Although the relationship between early parenteral
hospital malnutrition. nutrition (PN) and critically-ill patients has been studied a
Disclosure of Interest: None declared. consensus has not been reached.
Methods: An observational study was carried out to assess
morbi-mortality related to early PN. Critically-ill patients who
SUN-P023
received PN from July 2015-December 2016 were included.
ENTERAL NUTRITION IN PATIENTS ON MECHANICAL
Patients were classified as early-PN if PN started within first
VENTILATION AND PRONE POSITION
72 h after intensive care unit (ICU) admission, and late-PN after
M. Ramirez1, K. Papapietro1, D. Adjemian1 *, S. Wigodski1, 72 h. Univariate and multivariate analysis were performed to
C. Romero2. 1Surgery, 2ICU, Hospital Clinico Universidad Chile, assess relationship between early PN and hospital mortality and
Santiago, Chile lenght of stay (LOS) hospital and ICU stay. Patient’s demo-
graphic, admission category, severity-ill score; and routine
Rationale: Prone position in some patients on mechanical blood samples were taken following our Hospital protocol.
ventilation has shown to improve oxygenation. The tolerance Results: A total of 240 patients were included; 117 (48.8%)
and efficiency of enteral nutrition (EN) is variable. early-PN group vs. 123 (51.3%) late-PN. Mean amount of
The objective of this study was to evaluate the tolerance and protein/kg was greater in the late-PN group 1.0 (SD 0.4) vs 0.9
efficacy of EN in mechanically ventilated (MV) patients in prone (0.24). Baseline characteristics were similar between groups:
position age (mean 56.5 y), BMI (29.4), days with hyperglycemia,
Methods: This was a retrospective, observational study in 8 MV severity score, and NUTRIC score (4.2); as well as the use of
patients in prone position that received EN and were admitted PN as complementary nutrition (23.1% early vs 21.1 late).
to the Hospital Clínico Universidad de Chile’s intensive care Overall mortality was 36.7%; 37.6% early-PN vs 35.8% late-PN
unit (ICU) during the last four years. We evaluated days of EN ( p = 0.79). Early PN was related to shorter hospital-LOS and
during prone position, daily volume received, maximum ICU stay (beta coefficient −11.49 [CI95–19.73−3.25] and −8.77
volume reached per hour, percentage of prescribed volume, [CI95 −14.0−3.53] respectively). Mortality was related to
gastric residual volume and presence of diahrrea. We used NUTRIC score and lower energy intake (mean kcal/kg) (OR
average and SD, median and range to express results. 1.23[CI95 1.06 −1.43] and 0.87 [CI95 0.77–0.98])
Results: Conclusion: This study did not find differences between early
and late PN regarding mortality in adult patients at nutritional
Patient Days Average Administered Gastric Stool risk. However this observational single-center study found
of EN volume per volume/ residual (cc) differences in LOS related to lower amount of calories in
day (mL/day) prescribed volume (cc)
volume (%) agreement with optimal amount recommended. Delay in
delivering nutritional support as PN was also related to longer
1 2.4 989 78.1 58 0
2 2 597 76.5 205 0
hospital and ICU stay in patients at nutritional risk.
3 5 230 65.3 327 0 Disclosure of Interest: None declared.
4 4.7 495 78.1 180 0
5 6 930 100.4 147 193
6 4.5 795 102.4 280 0 SUN-P025
7 12 896 87.4 205 154 ENTERAL NUTRITION: IMPACT ON OXYGEN DELIVERY FOR
8 1.4 344 53.2 273 0
CHILDREN IN THE INTENSIVE CARE UNIT?
D. Tretyakov1 *, N. Shen2, D. Suchkov3, E. Tretyakova4. 1ICU,
There were 5 women and 3 men of 59 years old (range 44–69). Pegional City hospital №1, 2Professor, Head of the Department
Prone position was maintained for 5.4 ± 3.4 days on average and of Anesthesiology and Reanimatology, Tyumen State Medical
patients received EN during 4.8 ± 3.3 days. The average volume Academy, Tyumen, 3ICU, Regional City hospital №1, Tuymen,
received was 659 ± 286 mL/day and the maximum volume 4
ICU, Regional City hospital №1, Tuymen, Russian Federation
reached per hour was 49 ± 18 mL/h. Patients received
80 ± 17% of the volume prescribed. Mean residual gastric Rationale: The development of intra-abdominal hypertension
volume was 209 ± 85 mL/day. Only one patient had one (IAH) decreases the survivability of critically ill patients. The
episode of diarrhea following the administration of a para- choice of the enteral nutrition product may play an important
sympathomimetic drug. role in IAH prevention
Conclusion: It is feasible and well tolerated the prescription of Methods: During the first 7 days of intensive care, 63 children
EN in MV patients in prone position admitted to ICU. The underwent the dynamic monitoring of IAH parameters and
volume received in this population was adequate considering hemodynamics. IAH level was studied using the method of
prone position. intra-bladder pressure measurement. Group 1 received only
glucose-electrolyte mixture (GEM) in the course of parenteral
Disclosure of Interest: None declared.
S62
nutrition. Group 2 was administered a semi-element Neocate
mixture. Group 3 received a standard age-adapted enteral
diet. The criterion for IAH was the increase of intra-abdominal
pressure (IAP) above 12 cm Н2О.
Results: iDO2 decrease was observed along with IAP increase
amid children with unstable hemodynamics and shock ( p-0.05);
it was caused by a lower cardiac stroke index (SI), p-0.006. Risk
of IAH development was higher among children receiving only
enteral GEM, OR 3.3 (1.2–10.0; 0.95 CI). The earliest IAH
development was detected in the GEM and standard diet groups
(Me-1.0 for Group 1, Me-3.0 for Group 3). In the Neocate group,
IAH development occurred later (Me-5.0 for Group 2), which
proved better nutrition tolerability and enabled to stabilize
hemodynamic parameters by that time. Group differences
were statistically significant ( p-0.003).
Conclusion: (1) IAH development may impact SI and iDO2
among unstable patients. (2) Absence of enteral nutrition or its
intolerability may be associated with IAH development. (3)
Semi -element enteral diet may be recommended for unstable
patients with the high risk of IAH syndrome development.
Disclosure of Interest: None declared.
SUN-P026
EXPERIENCE WITH ORAL ALIMENTATION (SIPPING) IN
PATIENTS WITH ALCOHOLIC DELIRIUM
D. Kostin1 *. 1ICU, SFHI “Municipal Clinical Hospital n.a. S.S.
Yudin of Moscow Health Department”, Moscow, Russian
Federation
Rationale: Chronic alcoholism is often lead to nutritional status
deficiency, and the emergence of delirium in this patients is
accompanied by a more severe disease, extension lengts of
treatment, deterioration of prognosis and constitutes a serious
problem. The choice of optimal combination therapy, including
the correction of nutritional deficiency is a crucial task for
specialists in ICU
Methods: 10 patients with alcoholism and the development of
delirium were treated in ICU. Delirium was diagnosed using
CAM-ICU Questionnaire. Nutritional deficiency was evaluated
with the NRS 2002 screening protocol and NRI (Nutritional
Risk Index) within the first 24 h and on discharge from the
hospital. Patients’ alimentation was based on standard diets; 6
patients (60%) were getting special medical food, including the
use of ready-made balanced products for oral alimentation
(Nutridrink-200 mL) throughout the entire course of in-patient
treatment
Results: In a group where sippings and Nutridrink were used,
delirium duration (the length of a patient’s stay in ICU) was 1.2
days fewer; the length of in-treatment was also 4 days fewer. In
a group of people getting Nutridrink sipping, no infectious
complications were observed, while in the second group
incidence of pneumonia was observed in 2 patients, as well as
inflammation of paranasal sinuses in 1 person. No significant
changes in nutritional status were observed in the course of
treatment.
Conclusion: Nutritional deficiency during delirium leads to
deterioration of treatment results and is associated with a
higher risk of infectious complications. Well-timed and
adequate nutritional treatment helps to shorten the period of
stay in an intensive care unit and in-patient department, as
well as reducing treatment costs. The use of Nutridrink in
Poster
patients with delirium and nutritional deficiency may be
described as a more rational method
Disclosure of Interest: None declared.
SUN-P027
THE ENERGY EXPENDITURE OF PATIENTS ON ECMO IS NOT
ELEVATED: BEWARE WHEN YOU FEED THEM!
E. De Waele1 *, K. Staessens2, J. Demol1, M. La Meir2,
H. D. Sapen1. 1Intensive Care, 2Cardiac Surgery, UZ Brussel,
Brussel, Belgium
Rationale: Severely ill patients on Extra Corporeal Membrane
Oxygenation (ECMO) have a survival chance of 50%. Optimal
nutrition therapy should be implemented to provide maximal
quality of care. Energy expenditure is mandatory to set caloric
targets. Indirect calorimetry (IC) was made feasible recently.
The aim is to know the mean energy expenditure (EE) of
patients on ECMO to use in settings where IC is not available.
Methods: In 6 patients indirect calorimetry was performed at a
stable period in the ECMO run. Ventilator and ECMO gas
exchange was analysed and the modified Weir Formula was
used to calculate Resting Energy Expenditure.
Results: We studied 2 female and 4 male patients, mean age
69, height 1.73 m and weight 77 kg. Total mean VO2 was
211 mL/min and total mean VCO2 145 mL/min. The mean EE
was 1,430 kcal/24 h. Overall, the Energy Expenditure of ECMO
patients was 19 kcal/kg/day.
Conclusion: In absence of indirect calorimetry, a mean EE of
19 kcal/kg/day can be used when prescribing nutrition to ECMO
patients.
Disclosure of Interest: None declared.
SUN-P028
A NEW PROGNOSTIC MARKER IN THE INTENSIVE CARE UNIT
(ICU): THE PSOAS MUSCLE AREA INDEX MEASURED BY
ABDOMINAL COMPUTED TOMOGRAPHY (CT) TARGETED ON
THE THIRD LUMBAR VERTEBRA (L3)
E. Lascouts1 *, A. Mulliez2, G. d’Assignies3, N. Rotovnik Kozjek4,
A.-M. Makhlouf5, I. Ceniceros Rozalen6, J.-C. Preiser7,
Z. Krznaric8, K. Kupczyk9, N. Cano10, C. Pichard5,
R. Thibault1,11, on behalf of Phase angle project Investigators.
1
Unité de Nutrition, CHU De Rennes – Université De Rennes 1,
Rennes, 2DRCI, CHU Clermont Ferrand, Clermont-Ferrand,
3
Service de Radiologie, CHU De Rennes – Université De
Rennes 1, Rennes, France, 4Clinical Nutrition Unit, Institute of
Oncology, Ljubljana, Slovenia, 5Unité de Nutrition, Hôpitaux
Universitaires de Genève, Geneva, Switzerland, 6Department
of Intensive Care, Clinic USP Palmaplanas, Palma de Majorque,
Spain, 7Department of Intensive Care, Hôpital Universitaire
Erasme, Brussels, Belgium, 8Departement of Internal
Medicine, University Hospital Center Zagreb, Zagreb, Croatia,
9
Department of Anesthesiology and Intensive Care, University
Hospital no 1 CM NCU, Bydgoszcz, Poland, 10CRNH, CHU
Clermont Ferrand, Clermont-Ferrand, 11Institut NuMeCan
INRA-INSERM-UR1, Rennes, France
Rationale: Critical illness leads to fat-free mass loss that
worsens prognosis (1). Main aim: to assess whether the easy-
to-measure psoas muscle area is related to day (D) 28 mortality
in the ICU patients.
Critical Care 1
Methods: Ancillary study of the international PHASE ANGLE
(PhA) PROJECT (1). Inclusion criteria: adult medical/surgical
ICU, length of stay >48 h, no pacemaker or defibrillator, routine
abdominal CT within 9 days postadmission. Transversal (TDPM)
and axial right psoas diameters measured on a single L3 CT
image by a non-expert operator blinded of mortality. Psoas area
index (PAI) = TDPM*ADPM*1/height(m)2. PhA measured by
bioimpedance analysis (BIA) at admission. Statistics: area
under the Receiver Operating Characteristic (ROC) curve
(AUC) evaluating D28 mortality by PAI. Factors associated
with D28 mortality: multivariable logistic regression (adjusted
odd ratio (aOR) [95% confidence interval]).
Results: n = 931 patients analysed in PhA PROJECT, n = 193 with
abdominal CT; n = 154 included: Ljubljana (n = 49), Geneva
(n = 43), Palma de Majorque (n = 31), Brussels (n = 15), Zagreb
(n = 13), Bydgoszcz (n = 3); 64 ± 14 yrs, men 54%, body mass
index 26.1 ± 5.1, APACHE II 19 ± 9. TDPM (10 ± 4 vs 14 ± 4 mm/m,
p = 0.004) and PAI (245 ± 102 vs 363 ± 158 mm/m², p = 0.007)
were lower in non-survivors than in survivors in men (non-
significant in women). AUC ROC men: 0.75 [0.61–0.88];
women: 0.56 [0.32–0.81]. PAI thresholds associated with D28
mortality: <337.3 (men); <170.1 (women) mm/m2. Were
associated with D28 mortality: admission for pneumonia (aOR
14.84 [1.19–185.25], p = 0.04), low PAI (5.87 [1.97–17.51],
p = 0.001), age (1.05 [1.01–1.10], p = 0.01), and admission PhA
(0.52 [0.31–0.87], p = 0.01).
Conclusion: Muscle mass loss defined by psoas area index on
L3-targeted CT scan is associated with D28 mortality in the ICU
patients.
Reference
1. Thibault R. et al. Intensive Care Med 2016;42:1445–53.
Disclosure of Interest: None declared.
SUN-P029
MORNING GLUCOSE LEVELS AND OUTCOME AMONG BURN
PATIENTS. RESULTS FROM THE INTERNATIONAL NUTRITION
SURVEY 2014–5
E. Bouras1, M. Chourdakis1 *, I. Doundoulakis1, D. K. Heyland2.
1
Department of Medicine, Aristotle University of Thessaloniki,
Thessaloniki, Greece, 2Queen’s University, Kingston, Ontario,
Canada
Rationale: Our aim was to evaluate morning glucose(Glu)
variability, energy and protein intake in the first 12 ICU days
and investigate whether Glu is related to 60 day mortality in
burn patients included in the 2014–2015 International Nutrition
Survey (INS).
Methods: 14 centers from USA, Canada, Australia and South
Africa participated in the INS. “Morning Glucose Areas Under
the Curve (AUC)” (as produced from all patient-days in the
range 80–140 mg/dL) and “Days at range 80–140 mg/dL (Days at
80–140)’ were used as indicators of glucose control. We used
logistic regression to examine whether AUC or “Days at 80–140”
were related to outcome after adjusting for disease severity,
insulin administration and calorie/protein adequacy.
Results: In 283 patients (67,1% males) median age was 48ys
(IQR:31–60) and median BMI 26.9 (IQR:23.6–31.1). Patients
had on admission a median burn% of Total Body Surface Area
27.3% (IQR:10–45). Throughout the 12-d period, patients
received 74.8% (IQR:28.6–96.9) of the energy [30.9 kcal/kg
S63
(IQR:25.5–38.1)] and 73.4% (IQR:27.3–99.6) of the protein
[1.7 g/kg (IQR: 1.4–2.2)] respectively prescribed. Median Glu
was 137.1 mg/dL (IQR:118.1–161.2) and in a total of 3,085
patient-days, reported hypoglycemic days were 17 (0.6%).
Mortality (60-daycensored) was 19.1%(54 events). We found no
significant association between neither AUC (OR = 1.00, 95%
CI:1.00–1.00) nor “Days at 80–140” (OR = 0.94, 95%CI:0.82–
1.08, p = 0.395) 60-day mortality (after adjusting for calorie
adequacy, APACHE score, Abbreviated Burn Severity Risk Index,
BMI and insulin administration).
Conclusion: Glucose control among burn patients seems to be
adequate and only limited hypoglycemia is observed. On the
other hand, calorie and protein goals were not achieved in a
significant proportion of the patients studied. Overall, Glu in
the first 12 days after admission did not seem to be a significant
predictor of outcome.
Disclosure of Interest: None declared.
SUN-P030
THE EFFECT OF THE PRESENCE OF A CLINICAL PHARMACIST
ON THE NUTRITIONAL POLICY IN AN INTENSIVE CARE UNIT OF
A GENERAL HOSPITAL
E. Van Laer1 *, S. Desmet1, K. Verhelle1. 1Pharmacy, AZ
Groeninge, Kortrijk, Belgium
Rationale: Development of a standard of care for nutrition in
ICU patients based on the ESPEN guidelines with a multidiscip-
linary approach involving a clinical pharmacist, intensivist,
dietician and nurse.
Methods: For a period of 2 months, a clinical pharmacist was
present in the ICU of a general hospital in Flanders, Belgium.
Patients were screened for their nutritional status. The
pharmacist checked and evaluated a number of criteria and
transferred recommendations to the intensivist during a
moment of consultation.
Results: During 2 months 64 patients were screened for their
nutritional status. 35 patients were included in this research as
their LOS was longer than 5 days. A first administration of
nutrition was initiated after 5 days for 74% of the population.
Oral feeding was initiated in 21% of the patients, TPN was
administered in 31% and enteral tube feeding in 31%. 17% of the
patients received a combination of TPN and tube feeding. The
caloric and protein goals were estimated and compared with
the actual administered nutrition for all patients receiving
artificial nutrition. 75% of the compared patients received at
least 75% of the calculated caloric needs and 61% reached at
least 75% of the calculated protein goals. More protein rich
formulae were introduced, leading to a bigger proportion of
patients reaching their protein goals. 89% of the patients
receiving a protein rich formula reached at least 75% of their
protein goal, in comparison to only 38% of the patients
receiving the classic formula.
Conclusion: A multidisciplinary nutrition team with a clinical
pharmacist is a successful method, tracking the nutritional
status of patients and leading to a better understanding of
the importance of correct and adequate nutritional care. In the
following months, this research will be continued and the
results will be compared to the period prior to this project.
Disclosure of Interest: None declared.
S64
SUN-P031
BEDSIDE ULTRASOUND OF MUSCLE LAYER THICKNESS OF THE
QUADRICEPS IN THE CRITICALLY ILL PATIENT
D. O. Toledo1, B. J. Freitas1, D. Carneiro1, D. M. Santos1,
E. J. Figueiredo1 *, S. F. Piovacari1, J. M. Silva Junior1. 1ICU,
Hospital Israelita Albert Einstein, São Paulo, Brazil
Rationale: Survivors of critical illness experience significant
skeletal muscle wasting that may predict outcome. The
objective of this study was to evaluate the measuring
quadriceps muscle layer thickness using bedside ultrasound in
critically ill patient
Methods: Twenty patients were included in the ICU required
mechanical ventilation. Demographic data, anthropometric
data, SAPS 3, NRS and image of US QMLT were collected for
analysis. The thickness of the quadriceps musculature was
quantified with a portable B-mode ultrasound device. With the
patient lying supine, 2 landmarks on each quadriceps were
identified. The underlying tissues were then maximally
compressed by the ultrasound probe. Each landmark was
imaged and averaged across each leg and then between legs.
Measurements of the first (D1), third (D3) and seventh (D7) days
were performed and the percentage of QMLT was compared by
comparing the left and right legs.
Results: The mean age was 57.0 ± 20.2 years, 75% male, BMI
24.6 ± 3.0 kg/m2, SAPS 3 was 51.3 ± 17.4 and NRS 3.2 ± 1.0.
Overall, 8.4% of muscle wasting in the right leg and 5.2% in the
left leg assessed by the US occurred from the first to the
seventh day. In the right leg the median values evaluated by the
US were 1.16 (0.92–1.75) D1, 1.13 (0.92–1.60) D3, 1.02 (0.81–
1.41) D7; P = 0.005. In the left leg, the median values evaluated
by the US were 1.23 (0.93–1.43) D1, 1.16 (0.92–1.34) D3, 1.13
(0.89–1.31) D7; P = 0.017.
Conclusion: The measuring quadriceps muscle layer thickness
using ultrasound demonstrated that critical ill patients present
muscle wasting daily, and this procedure can be a great
differential to identify patients most likely to benefit from
enhanced nutritional and rehabilitation support.
Reference
1. Tillquist et al. Bedside Ultrasound Is a Practical and Reliable
Measurement Tool for Assessing Quadriceps Muscle Layer Thickness.
JPEN J Parenter Enteral Nutr. 2014; 38:886–890.
Disclosure of Interest: None declared.
SUN-P032
HIGHER CIRCULATING GLUTAMINE IS ASSOCIATED WITH
INCREASED MORTALITY AND BLUNTED IMMUNE RESPONSE IN
ELDERLY NON-ICU PATIENTS WITH SEPSIS: A MULTICENTER
STUDY
G. Biolo1, F. G. Di Girolamo1 *, N. Fiotti1, M. Zanetti1,
L. M. Castello2, C. Casarsa1, E. Lupia3, M. L. Muiesan4,
C. Ronco5, S. Di Somma6, G. C. Avanzi2, F. Mearelli1,
on behalf of The NEED Speed study group. 1University of
Trieste, Trieste, 2University of Eastern Piedmont, Novara,
3
University of Turin, Turin, 4University of Brescia, Brescia,
5
San Bortolo Hospital, Vicenza, 6Sapienza University of Rome,
Rome, Italy
Rationale: Glutamine (GLN) is actively taken up and utilized by
immune cells in critical illness. We have hypothesized that
Poster
variability of plasma GLN levels in elderly septic patients is
linked to degree of immunoactivation and outcome.
Methods: We recruited 507 consecutive patients (51% man,
age: 83, 76–88 yr, APACHE II score: 13, 10–16, median and
interquartile range) with sepsis or septic shock, according to
the new SEPSIS 3.0 criteria, admitted to 5 acute medical wards
in Italy. Plasma GLN and clinical parameters were assessed
within 24 hour from admission to emergency department.
Patient mortality rates at 7 (t7) and 30 (t30) days were
recorded. Plasma GLN was also determined in 196 free-living
older adult volunteers (51% men, age: 65, 62–69 yr).
Results: Plasma GLN levels (μmol/L) were lower ( p < 0.01) in
patients (414, 325–515) than in controls (483, 437–539). Septic
patients were divided into 3 groups according to tertiles of
plasma GLN: lower (LG, <353), intermediate (IG, 353–472) and
higher (HG, >472) GLN. Mortality rates significantly increased
from LG to IG and HG (t7: 9, 20, 26, p = 0.01; t30: 25, 39, 56,
p = 0.001; respectively). C-reactive protein (CRP, ng/mL),
leucocytes (WBC, 109/L) and body temperature (T, °C)
significantly ( p < 0.001) decreased from LG to IG and HG
(CRP: 135, 112, 57; WBC: 13.3, 13.8, 11.4; T: 38.0, 37.6, 36.9;
respectively). In a multiple linear regression model, lactate (β:
+0.34), CRP (β: −0.23), T (β: −0.19) and glycemia (β: −0.17)
significantly ( p < 0.001) predicted (r2: 0.22) glutamine vari-
ability in all patients.
Conclusion: In elderly non-ICU patients with sepsis, lower
plasma GLN was associated with lower mortality and higher
inflammatory response, while normal-to-higher GLN was
associated with increased mortality and blunted immune
response (i.e., lower CRP, WBC and T).
Disclosure of Interest: None declared.
SUN-P033
NUTRIC SCORE AND PROTEIN INTAKE ARE INVERSELY RELATED
TO MORTALITY IN CRITIC TRAUMA PATIENTS
G. D. Ceniccola1 *, F. C. Lima1, S. S. M. Dos Santos1,
A. R. D. C. Arruda1, D. O. D. Leão1, N. D. C. Dos Santos1,
P. F. S. Dos Santos1, A. B. Okamura1, L. P. S. Paz2. 1Hospital De
Base Do D.F, Brasília, 2University of Brasília, Ceilândia, Brazil
Rationale: It is not clear if higher protein intake could improve
mortality considering nutritional risk (NR) with NUTRIC score1
after a major trauma. Therefore, we aim to compare the effect
of nutritional risk and protein intake in the first 14 ICU days on
hospital mortality in a multivariate model.
Methods: This is a prospective cohort with adult trauma victims
in enteral nutrition admitted consecutively in one ICU from 4/
2015 to 4/2016. Patients underwent nutritional screening until
48h after admission, daily nutrition data was collected on the
amount of calories and protein intake during the first 14 ICU
days unless death/discharge occurred sooner. Outcomes were
determined at 60 days, patients were followed while in hospital
and after discharge. We excluded patients who remained in
ICU < 48 h, pregnant and with suspected cerebral death. Three
logistic models were made, M1- crude OR, M2- protein intake and
high/low NUTRIC, M3 - M2 + BMI, sex, head injure, mechanical
ventilation days.
Results: From 480 patients admitted, adopted criteria
excluded 236. High NR was present in 67 patients (26%). The
first 14 ICU days registered average intake of 15.85 kcal/kg (CI
95%; 15.0–16.6) and 1.08 g PTN/kg (CI 95% 1.0–1.1). Table 1
Critical Care 1 S65

shows Odds ratios and 95% confidence intervals for the models increase in Apache II, mortality risk is 14% higher (95%CI 1.09–
proposed. 1.19, Z = 6.14, p = 0.001).
Conclusion: This study showed the applicability of the AND-
Table 1:
ASPEN tool in the ICU setting as a predictor of mortality, despite
M1 M2 M3 (R2 0.2; p- limitations due to subjectiveness of the tool and patient
0.0001; lroc 0.78)
anamnesis. Important covariables as BMI, hospital stay and
Average Protein intake* 0.08; 0.03–0.18 0.06; 0.02–0.17 0.07; 0.02–0.19 disease severity were included and could be important
Receive ≥1.2 g PTN/Kg* 0.18; 0.09–0.39 0.17; 0.08–0.38 0.20; 0.09–0.46
High nutritional risk* 5.72; 3.04–10.75 6.12; 3.10–12.07 6.94; 3.4–14.04
subgroups of interest in following studies.
Reference
*p-value <0.0001.
1. White JV, et al. JPEN; 2012.
Conclusion: Protein intake in the first 2 ICU weeks may reduce Disclosure of Interest: None declared.
mortality for trauma patients requiring ICU meanwhile high
NUTRIC score indicates severity more precisely. Larger samples
SUN-P035
are needed to explore subgroups of interests such as extreme
COMPARISON OF CONTINUOUS AND INTERMITTENT ENTERAL
BMI range, age, renal failure and septic’s.
NUTRITION IN PATIENTS WITH SEVERE TRAUMA
Reference H. Slavuta1 *, S. Dubrov1, K. Dubrova2, I. Domin1.
1. Rahman A, et al. Clin Nutr. 2016. 1
Anesthesiology and Intensive Care, Bogomolets National
Disclosure of Interest: None declared. Medical University, 2Kyiv City Municipal Hospital #17, Kyiv,
Ukraine
SUN-P034
Rationale: Early beginning of enteral nutritive support is an
THE IMPACT OF MALNUTRITION USING AND-ASPEN CRITERIA
important measure within the intensive care of patients with
IN THE OUTCOME OF ADULT CRITICAL CARE PATIENTS
severe trauma. There are clear guidelines regarding timing,
G. D. Ceniccola1,2 *, R. S. F. Pequeno3, A. B. M. De Oliveira2, dosing and composition of nutrition, but there is lack of high-
T. P. Holanda3, V. S. Mendonça3, L. S. F. Carvalho4, quality evidence regarding choice between continuous or
I. D. Brito-Ashurst5, W. M. C. Araújo6. 1Núcleo de Nutrição e intermittent (bolus-based) nutrition regimes in patients with
Dietetica, 2Residência Multiprofissional em Terapia Intensiva, severe trauma.
3
Residência em Nutrição Clínica, Hospital de Base do Distrito Methods: A prospective randomized single-center clinical trial
Federal, Brasília, 4Universidade de Campinas (Unicamp), had been conducted from August till December 2016 in Kyiv city
Campinas, Brazil, 5Rehabilitation & Therapies Department, trauma center ICU. Inclusion criteria: age 18–60, trauma
Royal Brompton and Harefield NHS Foundation Trust, London, severity ≥ 15 points (ISS score) and informed consent of
United Kingdom, 6Universidade de Brasília (UnB), participation. Patients were randomized into either bolus
Brasília, Brazil feeding group (BFG) or continuous feeding group (CFG). In
total, 30 patients were included. BFG group (n = 14) received
Rationale: Malnutrition is prevalent in the intensive care unit,
prescribed dose of enteral feeding formula in 200–300 mL
yet, there is a paucity of validated tools. Consequently, this
boluses repeated each 3 hours. CFG (n = 16) group received
study aims to evaluate the validity of the malnutrition AND-
prescribed daily dose of enteral feeding formula as continuous
ASPEN criteria1 as a predictor of mortality in a general ICU
infusion with enteral feeding pump over 24 hours. Both groups
population.
were fed through nasogastric tube, start within 24 hours after
Methods: A one-day cross sectional study every semester for
trauma with isocaloric default enteral formula with caloric
the period of 2014–2016 in a large mixed ICU (72 beds) following
goal ≥20–25 kkals/kg per day and protein goal ≥1.2 g/kg per
all recruited subjects for their admission duration. Routine ICU
day to Day 5.
data were collected in the electronic health record (EHR) on
Results: Patients of both groups did not vary significantly in
sex, age, APACHE II and baseline nutrition assessment at ICU
demographic criteria, trauma severity (ISS), conscious impair-
admission. The AND-ASPEN criteria is the tool of choice to
ment (GCS) and overall severity (APACHE II). Within first day
recognize malnutrition in this hospital. Patients with short ICU
of ICU stay BFG patients daily tolerable volume was 813,4 ±
stay (<48 h) and with missing key data were excluded. Online
162,7 mL of formulae, while CFG patients tolerated 1382,6 ±
forms were elaborated to register data with a secure web-based
97,9 mL( p < 0,01). Within third day of ICU stay, BFG patient
platform. The main hypothesis was assessed with a logistic
tolerated 1274,1 ± 218,5 mL and CFG patients tolerated
regression model.
2486,3 ± 154,0 mL of formulae. ( p < 0,01).
Results: A total of 306 patties were eligible, we excluded 16%
Conclusion: During the early post-traumatic period, continu-
(49 subjects) by the adopted criteria. AND-ASPEN assessment
ous enteral feeding have significant benefit over bolus-based
was found in 93.8% of the EHR, malnutrition at ICU admission
enteral feeding and provides much better tolerance of enteral
was present in 28.1%. Binary logistic regression (n = 257, p-
feeding, leading to earlier meeting of caloric and protein goal.
value = 0.0001, r2 = 0.226, Roc(AUC) = 0.80) suggested that
mortality risk was 2.6x higher (95%CI, 1.3–5.1, Z = 2.72, Disclosure of Interest: None declared.
p = 0.006) in patients malnourished compared with non-
malnourished (controlled by sex, BMI, Apache II, days in
hospital, admission type, and nutritional therapy type),
crude OR was 3.2 (95% CI, 1.8–5.6). For every one (1) point
S66
Geriatrics 1
SUN-P036
ASSOCIATION OF ORAL STATUS WITH SARCOPENIA AND
MALNUTRITION IN POST-ACUTE STROKE PATIENTS:
IMPLICATIONS FOR ORAL SARCOPENIA
A. Shiraishi1 *, Y. Tsuji1, S. Shimazu2, Y. Yoshimura3.
1
Department of Dental Surgery, 2Nutritional Management,
3
Rehabiritation Medicine, Kumamoto Rehabilitation Hospital,
Kumamoto-City, Japan
Rationale: This study investigated the prevalence of stroke-
related sarcopenia and malnutrition its association with poor
oral status in post-acute stroke patients.
Methods: This cross-sectional study included 202 consecutive
stroke patients who were admitted to convalescent rehabilita-
tion wards in Japan. The Revised Oral Assessment Guide (ROAG)
was used to assess oral status. Sarcopenia was defined as a loss
of skeletal muscle mass index (SMI) with bioelectrical
impedance and decreased muscle strength as measured by
handgrip strength (HG); cut-off values were adopted from the
Asian Working Group for Sarcopenia. Univariate and multivari-
ate analyses were applied to examine the associations between
oral status, SMI, and HG.
Results: Study participants included 107 males and 95 females
with a mean age of 72 ± 12 years. According to the ROAG, 82.2%
of participants had slight to severe oral problems (median
score: 11 [9–14]). The prevalence of stroke-related sarcopenia
was 53.5%. Both SMI (mean: 6.1 ± 1.3) and HG (median: 15 [7–
25]) were significantly lower in the group with oral problems
(SMI = 5.8 ± 1.2, HG = 12 [6–20]) compared to individuals
without oral problems (SMI = 7.4 ± 0.8, HG = 27 [23–34]) ( p <
0.001). The ROAG score was independently associated with SMI,
after adjusting for sex, age, stroke severity, activities of daily
living, cognitive level, nutritional status, comorbidities, and
time from stroke onset.
Conclusion: Poor oral status was associated with sarcopenia,
reduced muscle mass and strength in post-acute stroke
patients. Poor oral status and stroke-related sarcopenia and
malnutrition were very common among the patients in this
study, suggesting that healthcare providers should monitor for
oral sarcopenia in post-acute stroke patients.
Disclosure of Interest: None declared.
SUN-P037
MALNUTRITION IS ASSOCIATED WITH MOBILITY PROBLEMS IN
BELGIAN NURSING HOME RESIDENTS AND COMMUNITY
DWELLING OLDER ADULTS
A. Van Gossum1 *, J. P. Van Wijngaarden2, D. Van Aarle3,
Y. C. Luiking2, M. Vandewoude4. 1Clinic of Intestinal Diseases
and Nutritional Support, Erasme Hospital, Brussels, Belgium,
2
Nutricia Research, Nutricia Advanced Medical Nutrition,
Utrecht, 3Nutricia Advanced Medical Nutrition, Zoetermeer,
Netherlands, 4Department of Geriatrics, University of
Antwerp, Antwerp, Belgium
Rationale: The prevalence of malnutrition in Belgian older
people is high1. Nutritional deficiencies could accelerate the
frailty process. Therefore, the occurrence of malnutrition,
mobility problems and dependence in activities of daily living
(ADL) were studied.
Poster
Methods: General practitioners and health care workers in the
community and nursing homes across Belgium were invited to
screen their patients for malnutrition and complete an online
questionnaire. Malnutrition was screened by MNA-SF; Mobility
problems were assessed and Katz-ADL index was determined.
Differences in the prevalence of mobility problems and Katz
ADL by nutritional status were analyzed (Chi-square).
Results: 3,299 people of ≥70 y were screened (85.4 y ± 6.4, 76%
women). Forty-four per cent of the people were at risk of
malnutrition (MNA-SF score 8–11) and 12% were malnourished
(MNA < 8). Independence in ADL (Katz ADL 0) was more
prevalent in well-nourished people (14.9%) than in those at
risk of malnutrition (3.2%) and those with malnutrition (1.5%)
( p < 0.001). Ninety-five per cent of those with malnutrition and
88% of those at risk of malnutrition could not climb 15-stairs,
versus 68% of the people with a normal nutritional status
( p < 0.001). Eighty six per cent of those with malnutrition and
72% of those at risk of malnutrition could not walk for 5-min,
versus 44% of the people with a normal nutritional status
( p < 0.001).
Conclusion: Malnutrition is associated with mobility problems
and dependence in ADL in Belgian older people. Its existence
may accelerate the transformation of frailty into disability.
Reference
1. Arvanitakis et al. ESPEN journal, 2013.
The following parties were involved in NutriAction II: Nutricia
Advanced Medical Nutrition, Vlaamse Vereniging voor Klinische
Voeding en Metabolisme (VVKVM), Société Belge de Nutrition
Clinique (SBNC), Domus Medica, Société Scientifique de
Médecine Générale (SSMG), Wit-Gele Kruis, Mobilab
Disclosure of Interest: None declared.
SUN-P038
MALNUTRITION IS UNDERESTIMATED BY HEALTH CARE
PROFESSIONALS IN OLDER ADULTS
J. Van Wijngaarden1, A. Van Gossum2 *, T. Rudka3, Y. C. Luiking1,
M. Vandewoude4. 1Nutricia Research, Nutricia Advanced
Medical Nutrition, Utrecht, Netherlands, 2Clinic of Intestinal
Diseases and Nutritional Support, Erasme Hospital, 3Nutricia
Advanced Medical Nutrition, Brussels, 4Department of
Geriatrics (ZNA), University of Antwerp, Antwerp, Belgium
Rationale: Prevalence of (risk of ) malnutrition is high in
Belgian older people (≥70 years), especially those living in
nursing homes1. To study the awareness of malnutrition among
health care professionals (HCPs) and patients, we compared
their subjective malnutrition estimate with a standardized
malnutrition screening tool (MNA-SF).
Methods: General practitioners and health care workers in the
community and nursing homes were invited to screen their
patients (aged ≥70 y) and complete an online questionnaire.
Malnutrition was screened by a validated instrument (MNA-SF),
while the HCP was asked: “Do you consider this patient as
malnourished?” and the patient: “Do you think you are
malnourished?” The use of oral nutritional supplements (ONS)
was assessed. Differences in the recognition of malnutrition by
living situation were analyzed with a Chi-square test.
Results: 3,299 people were screened: 2,480 (75%; 86.3 ± 6.2
years) lived in a nursing home (NH) and 819 (25%; 82.7 ± 6.1
years) were community dwelling (CD). Prevalence of
Geriatrics 1
malnutrition (MNA-SF score < 8) was 14% in NH, and 7% in CD
population. The HCP only recognized 49% of the malnourished
patients as being malnourished, whereas only 13% of the
malnourished patients classified themselves as being malnour-
ished; this percentage was higher in community dwelling
older people than in nursing homes (30% and 10%, respectively,
p < 0.001). Twenty per cent of the malnourished people
used ONS.
Conclusion: Health care professionals and patients themselves
greatly underestimate malnutrition in older people, both in
the community and in nursing homes.
Reference
1. Arvanitakis et al. ESPEN journal, 2013.
The following parties were involved in NutriAction II: Nutricia
Advanced Medical Nutrition, Vlaamse Vereniging voor Klinische
Voeding en Metabolisme (VVKVM), Société Belge de Nutrition
Clinique (SBNC), Domus Medica, Société Scientifique de
Médecine Générale (SSMG), Wit-Gele Kruis, Mobilab
Disclosure of Interest: None declared.
SUN-P039
MALNUTRITION IS HIGHLY PREVALENT IN BELGIAN NURSING
HOME RESIDENTS AND COMMUNITY DWELLING OLDER
ADULTS, ESPECIALLY IN THOSE WITH DEPRESSION AND
DEMENTIA
A. Van Gossum1 *, J. P. Van Wijngaarden2, J. Hofstede3,
Y. C. Luiking2, M. Vandewoude4. 1Clinic of Intestinal Diseases
and Nutritional Support, Erasme Hospital, Brussels, Belgium,
2
Nutricia Research, Nutricia Advanced Medical Nutrition,
Utrecht, 3Nutricia Advanced Medical Nutrition, Zoetermeer,
Netherlands, 4Department of Geriatrics (ZNA), University of
Antwerp, Antwerp, Belgium
Rationale: NutriAction (2008)1, showed that among Belgian
older people living in the community or in a nursing home, the
risk of malnutrition is highly prevalent (57%) and that 16% of the
total population was classified as malnourished (BMI < 20 kg/
m2). In 2013, this study was repeated to re-evaluate the risk
and the prevalence of malnutrition among Belgian older
people.
Methods: General practitioners and health care workers in
the community and in nursing homes across Belgium were
invited to screen their patients and complete an online
questionnaire. Malnutrition was screened by MNA-SF; presence
of pre-specified co-morbidities was reviewed. Differences in
the prevalence of malnutrition by living situation were
analyzed (Chi-square).
Results: 3,299 people aged ≥70 y were screened: 2,480 (75%;
86.3 ± 6.2 years) lived in a nursing home (NH), and 819 (25%;
82.7 ± 6.1 years) were community dwelling (CD); 76% were
women. The risk of malnutrition (MNA-SF score 8–11) was 49%
(NH) and 29% (CD) ( p < 0.001); 14% (NH) and 7% (CD) were
malnourished (MNA < 8) ( p < 0.001). Dementia was present in
36% (n = 1187) and depression in 13% (n = 414) of the popula-
tion. The highest prevalence of malnutrition and risk of
malnutrition was observed in patients with dementia (19%
and 60%, resp) and depression (21% and 52%, resp).
Conclusion: The prevalence of malnutrition has remained
stable among Belgian older people over the period 2008–2013.
Malnutrition remains a major problem, especially for those in
S67
nursing homes or with co-morbidities such as depression and
dementia.
Reference
1. Arvanitakis et al. ESPEN journal, 2013.
The following parties were involved in NutriAction II: Nutricia
Advanced Medical Nutrition, Vlaamse Vereniging voor Klinische
Voeding en Metabolisme (VVKVM), Société Belge de Nutrition
Clinique (SBNC), Domus Medica, Société Scientifique de
Médecine Générale (SSMG), Wit-Gele Kruis, Mobilab
Disclosure of Interest: None declared.
SUN-P040
EFFECTS OF AN INTERDISCIPLINARY GUIDELINE ON
NUTRITION PARAMETERS IN HIP FRACTURE PATIENTS
A. Kopp Lugli1 *, C. Kiss2, E. Kungler1,3, W. Ruppen1,
R. Bingisser4, N. Suhm3, R. Kressig5. 1Department of
Anaesthesia, Surgical Intensive Care, Prehospital Emergency
Medicine and Pain Therapy, 2Dietetic Service, Department
of Endocrinology, 3Department of Orthopaedics and
Traumatology, 4Department of Emergency Medicine,
University Hospital of Basel, 5University Center for Medicine
of Aging, Felix Platter Hospital, Basel, Switzerland
Rationale: Hip fracture is a serious consequence of trauma in
the growing geriatric population. The interdisciplinary POMME
(PeriOperative Medicine & Metabolism Expertise) guideline was
designed to improve perioperative outcome and nutritional
parameters focusing on the management of dietary intake,
pain control, delirium and planning of discharge.
Methods: The POMME guideline was developed by a multidis-
ciplinary team of caregivers (emergency room, traumatology,
anaesthesia, geriatrics, dietetic and nursing service) to
combine current standards of care. Patients admitted for hip
fracture surgery were enrolled for a quality control assessment
pre (CONTROL, n = 77, Dec 15-Apr 16) and post implementation
of the POMME guideline (POMME, n = 67, Aug–Dec 16). The
POMME management for nutrition involved malnutrition
screening, fortified meals, protein drinks, vitamin D supple-
mentation and preoperative carboloading. Baseline character-
istics and nutritional parameters were assessed during
hospitalisation and 1 mth after surgery.
Results: Baseline characteristics were comparable for both
groups (Table 1). POMME had lower Nutritional Risk Screening
(NRS) scores 1 mth after surgery compared to CONTROL and
when adjusted for in-hospital scores (−0.55 (95% CI: −0.11;
−0.99, p = 0.016)), whereas hand grip measurements showed
no difference for both groups (+2.47 kg (95% CI:5.26;−0.33,
p = 0.087). Mean vitamin D levels 1 mth after surgery were
comparable for both groups (POMME 75.3 ± 34.2 nmol/L;
CONTROL 81.3 ± 42.8 nmol/L) but with a higher percentage of
severe to moderate deficiency for CONTROL (27.3% vs. 22.2%).
Table 1:
POMME (n = 67) Control (n = 77)
Age (yrs) 78 ± 15 79 ± 12
Male/female 18/49 18/59
Penrode
1 23 18
2a/3a 25 32
2b/3b 4 11
3c/3d 15 16
S68
Conclusion: The preliminary results of this quality control
assessment revealed positive effects of the interdisciplinary
POMME guideline on nutritional outcome parameters in the
vulnerable population of hip fracture patients.
Disclosure of Interest: None declared.
SUN-P041
CORRELATION BETWEEN VASTUS LATERALIS MUSCLE
ULTRASOUND PARAMETERS AND APPENDICULAR LEAN MASS
IN OLDER PATIENTS WITH PHYSICAL FRAILTY
A. Ticinesi1 *, M. Narici2, F. Lauretani1, A. Nouvenne1,
E. Colizzi1, M. Mantovani1, M. Pedrazzoni1, T. Meschi1,
M. Maggio1. 1Department of Medicine and Surgery, University
of Parma, Parma, Italy; 2MRC-ARUK Centre of Excellence for
Musculoskeletal Aging Research, University of Nottingham,
Nottingham, United Kingdom
Rationale: Muscle ultrasound (MUS) is an easy and affordable
technique for estimation of muscle mass, not yet studied in the
physical frailty assessment of older patients. The aim of this
cross-sectional study was to verify the correlation between
right vastus lateralis MUS measures and dual-energy X-ray
absorptiometry (DXA)-derived appendicular lean mass (ALM) in
a group of older patients.
Methods: We enrolled 45 older (age 79 ± 5) community-dwell-
ers (28 F) with physical frailty, defined as Short Physical
Performance Battery (SPPB) score ≥3 and ≤9. DXA scans were
performed using a Hologic™ QDR4500 A densitometer (Hologic,
US). We also performed right vastus lateralis MUS using a MyLab
Gamma™ system (Esaote, Italy) equipped with a 5 MHz linear
probe, acquiring longitudinal and transversal scans with real-
time and extended-field-of-view (EFOV) techniques at the 65%
point of muscle length with the patient resting toes to the
ceiling. Muscle thickness (MT), fascicle length (FL), pennation
angle (PA) and EFOV-derived cross-sectional area (CSA) were
measured using the NIH ImageJ software. The age-adjusted
Pearson correlation coefficients between crude ALM and MUS
parameters were calculated after stratification by sex.
Results: Mean values of ALM, MT, FL, PA and CSA were
16.1 ± 2.6 kg, 1.7 ± 0.4 cm, 10.6 ± 2.6 cm, 9.3 ± 5.0° and 10.9 ±
4.8 cm2 in females, and 21.7 ± 3.2 kg, 1.8 ± 0.4 cm, 12.9 ±
3.1 cm, 9.1 ± 3.0° and 12.8 ± 3.1 cm2 in males, respectively.
ALM was significantly correlated with CSA in both genders
(r = 0.70, p < 0.001 in females; r = 0.46, p = 0.04 in males) and
with MT only in females (r = 0.58, p = 0.001), but not with FL
and PA.
Conclusion: In older patients with physical frailty, vastus
lateralis MUS-derived CSA exhibited a good correlation with
crude ALM, particularly in females, supporting the implemen-
tation of this technique in clinical practice.
SUN-P042
NUTRITIONAL CARE: PERCEPTIONS OF RESIDENTS IN
NURSING HOMES. A QUALITATIVE STUDY
A. Castaldo1 *, M. C. Gugiari1, E. Zanetti2, M. Zani3,
M. Lusignani4, M. Magri5, A. Nobili6, A. Verardi7, A. Ianes8,
M. Gussoni7, L. Bonetti9. 1Education, Provincia Religiosa Di
S. Marziano Di Don Orione – Piccolo Cottolengo, Milan,
2
Research, Gruppo di Ricerca Geriatrica, 3Nursing Home,
Le Rondini, Brescia, 4Nursing Bachelor, University of Milan,
Poster
5
Research, Nurse Council, 6Quality, Mario Negri, 7Nutrition-
Audit, Health Agency, 8Medical Direction, Korian Group, Milan,
Italy, 9Istituto oncologico della Svizzera italiana, Ente
Ospedaliero Cantonale Canton Ticino, Bellinzona, Switzerland
Rationale: Nutritional status in nursing homes(NHs) is a
relevant health and quality of life indicator. Few studies have
explored elderly perspective on the meaning of nutrition,
factors that promote it and nutritional care (Donini et al.,
2013). The aim of this study was to explore the nutritional care
in NHs, with specific focus on residents’ perception.
Methods: Participants were selected through purposeful
sampling. We interviewed residents, with moderate cognitive
ability, that lived in 29 NHs in Northern Italy. Interviews were
audio recorded, transcribed verbatim and analyzed using
content analysis.
Results: Interviews were carried out in November 2016. Overall
there were 61 participants, of which 82% women (83 ± 9 years).
We identified 6 main categories, that include specific themes:
Meaning of nutrition (importance of eating, the meals mark the
time of day); Possibility to choose and variety of food
(sometimes poor); Quality and quantity of foods (sensory
properties of food, unmet cultural food and preferences, food
temperature and presentation, adequate time to eat);
Nutritional care (staff levels, staff time to provide care,
attitude and skills in assistance with eating); Comfort and
environment (characteristics of dining area, noise, table
arrangements, meal times); Interactions during mealtime
with other residents (communication and hearing difficulties),
staff and relatives (little or no chance to eat with their families
or friends in or out of NH).
Conclusion: This study showed the complexity and multidi-
mensionality of eating and that healthier elderly have good
knowledge of nutrition. Eating is important and meals can be a
pleasant experience throughout the day for residents.
Interventions shoud be implement for improving the quality
and experience of mealtime for residents.
Reference
Donini LM, et al. Nutritional care in a nursing home in Italy. PLoS One.
Public Library of Science; 2013 Jan 6;8(2)
Disclosure of Interest: None declared.
SUN-P043
NUTRITION RISK FACTORS ASSOCIATED WITH MALNUTRITION
IN COMMUNITY-DWELLING OLDER ADULTS
A. van Amerongen1 *, I. Zwinkels1, S. van den Berghe1,
M. H. de Groot1, J. A. E. Langius1. 1Nutrition and Dietetics, The
Hague University of Applied Sciences, The Hague, Netherlands
Rationale: Malnutrition is a common health problem in
community-dwelling older adults. Several indirect medical,
physiological and social determinants are found to be associated
with malnutrition in this group. However, a complete overview
of the predictive value of nutritional determinants directly
related to malnutrition is lacking. Therefore, this study
investigated the nutrition risk factors associated with malnu-
trition in community-dwelling older adults.
Methods: Community-dwelling adults of at least 65 years of age
were screened for malnutrition by the SNAQ65+. Excluded were
people receiving home care and being cognitive impaired.
Nutrition risk factors were selected based on a thorough
Geriatrics 1
literature study and investigated by a questionnaire. Uni- and
multivariate logistic regression analyses were used to identify
risk factors associated with malnutrition, with adjustment for
age.
Results: Of the 548 screened participants, 400 people met the
inclusion criteria (59% female, aged 73.7 ± 6.9 year). According
to the SNAQ 65+, 52 elderly (13%) were undernourished and 5
persons (1%) were at risk of undernutrition. In multivariate
analyses, older adults who eat less than usual (OR = 2.76; 95%
CI = 1.46–5.22; p = 0.002), have lower tasting ability (OR = 3.81;
95%CI = 1.22–11.95, p = 0.021), skip meals on a weekly basis
(OR = 3.44; 95%CI = 1.56–7.60; p = 0.002), experience chewing
difficulties (OR = 2.31; 95%CI = 0.93–5.76; p = 0.042), and never
exercise for ≥30 minutes without interruption (OR = 3.13; 95%
CI = 1.21–8.13 p = 0.019) were at greater risk of being
malnourished.
Conclusion: Malnutrition was determined in 13% of the
community-dwelling older adults. Factors associated with
malnutrition were chewing difficulties, loss of taste, little to
no exercise, skipping meals and eating less than usual. These
factors should be taken into consideration regarding the
prevention and treatment of malnutrition in older adults.
Disclosure of Interest: None declared.
SUN-P044
PROTECTIVE EFFECT OF CITRULLINE AGAINST BETA AMYLOID
PRECURSOR PROTEIN (APP) CLEAVAGE
A. Ginguay1,2,3 *, J. Vincent4, P. Marquet-de Rougé5,
C. Clamagirand3, J.-P. De-Bandt1,2, L. Cynober1,2, Y. Cho6,
B. Allinquant7. 1Laboratory of Biological Nutrition, EA4466
PRETRAM, Faculté de Pharmacie, Université Paris Descartes,
2
Clinical Chemistry, Cochin Hospital, GH HUPC, AP-HP, 3Centre
de Psychiatrie et Neurosciences, LABORATOIRE INSERM, U894,
4
Institut de Neurosciences Cognitives et Intégratives
d’Aquitaine, Université Bordeaux 1, CNRS UMR 5287, Talence,
5
Laboratory of Biological Nutrition, EA 4466 PRETRAM, Faculté
de Pharmacie, Université Paris Descartes, Paris, 6Institut de
Neurosciences Cognitives et Intégratives d’Aquitaine,
Université Bordeaux 1, CNRS UMR 5287, Talence, 7Centre de
Psychiatrie et Neurosciences, LABORATOIRE INSERM, U 894,
Paris, France
Rationale: Amyloid deposits, one of the two pathological
hallmarks of Alzheimer disease (AD), can result from an
increased β amyloid-cleavage of APP or a decreased clearance
of Aβ peptide. Oxidative stress and Golgi apparatus (GA)
fragmentation, by promoting β amyloid-cleavage of APP, may
enhance the pathological process (1). GA fragmentation can be
due to impaired nitric oxide (°NO) metabolism (2). Citrulline
(Cit) supplementation, an antioxidant amino acid and °NO
precursor, could be an interesting nutritional approach to
prevent AD. In 23-months old rats, Cit leads to a decrease in C99
peptide levels (first step of β amyloid-cleavage) suggesting that
it could protect against Aβ peptide formation (3). Cit effects in
vitro in human neuroblastoma cells (SH-SY5Y) overexpressing
swedish APP (swAPP) or not (WT) and in vivo in swAPP
transgenic mice were studied.
Methods: In WT and swAPP cells incubated for 48 hours with or
without Cit 5 mM, we measured extracellular Aβ peptide,
sAPPα (non amyloid pathway), advanced glycation end-pro-
ducts (AGE) (antioxidative effect) and GA fragmentation. In
S69
swAPP mice we studied the effect of a 14-month Cit
supplementation on behavioural tests: nest-making and Y-
maze. Statistics: t-Test.
Results: Cit leads to a significant decrease in Aβ ( p < 0.02) and
sAPPα ( p < 0.005) in swAPP and WT cells. A decrease in AGE
levels ( p < 0.005) and a protective effect against GA fragmen-
tation is observed in swAPP cells. Last, Cit improves the results
of the two behavioural tests in swAPP mice.
Conclusion: Our results show a protective action of Cit on APP
metabolism probably due its effect on GA fragmentation. It
could be linked to a modulating effect of Cit on °NO
metabolism. This is further confirmed by the improvement of
behavioural tests in swAPP mice.
References
1. Joshi G, et al., Front Neurosci. 2015;9:340
2. Lee et al., Am J Physiol Heart Circ Physiol. 2011;300:H1141–58
3. Marquet-de Rougé P, et al., Age. 2013;35:1589–606
Disclosure of Interest: A. Ginguay: None declared, J. Vincent: None
declared, P. Marquet-de Rougé Shareholder of: CITRAGE company,
C. Clamagirand Shareholder of: CITRAGE company, J.-P. De-Bandt
Shareholder of: CITRAGE company, L. Cynober Shareholder of: CITRAGE
company, Y. Cho: None declared, B. Allinquant Shareholder of: CITRAGE
company.
SUN-P045
NUTRITIONAL STATUS AND BODY COMPOSITION IS ALTERED IN
PATIENTS WITH ALZHEIMER’s DISEASE AND MILD COGNITIVE
IMPAIRMENT
A. Doorduijn1,2 *, O. Van de Rest3, S. Boesveldt3,
W. Van der Flier2, M. Visser1,4, M. De van der Schueren1,5.
1
Nutrition and Dietetics, 2Alzheimer Center, Vu University
Medical Center, Amsterdam, 3Division of Human Nutrition,
Wageningen University & Research, Wageningen, 4Department
of Health Sciences, Vrije Universiteit, Amsterdam,
5
Department of Nutrition and Health, HAN University of
Applied Sciences, Nijmegen, Netherlands
Rationale: A poor nutritional status is frequently reported in
patients with Alzheimer’s disease (AD) and is thought to
develop even before the disease manifests. Our aim was to
evaluate and compare the nutritional status of patients with
AD, patients with Mild Cognitive Impairment (MCI), and
controls with Subjective Cognitive Decline.
Methods: At the VUmc Alzheimer Center we included 424
patients: 171 controls with SCD (age 60.1 ± 7.5, 46%F, MMSE
28.0 ± 1.7), 109 MCI (age 66.0 ± 7.3, 40%F, MMSE 26.0 ± 2.5), 144
AD (age 66.8 ± 7.5, 51%F, MMSE 23.5 ± 3.0). We assessed
nutritional status using Mini Nutritional Assessment (MNA)
and body composition using body mass index (BMI), fat free-
mass index (FFMI) and arm, calf and waist circumferences. We
compared groups using age adjusted ANOVA’s with diagnosis and
gender as independent variables.
Results: Groups differed in nutritional status, as observed by a
main effect of diagnosis for MNA. We also found main effects of
diagnosis for BMI and FFMI ( p < 0.05), but not for calf or waist
circumference. For arm circumference we found an interaction
between diagnosis and gender ( p = 0.055), indicating that
group differences were largely attributable to males.
S70
Controls MCI AD
MNA (0–30)¶ 26.3 ± 2.0 25.1 ± 2.7a 23.5 ± 3.0a,b
BMI (kg/m2)¶ 27.0 ± 4.7 25.8 ± 3.8 24.9 ± 3.8a
FFMI (kg/m2)¶ 17.7 ± 2.6 17.3 ± 2.1 16.9 ± 2.2a
Arm (cm) 29.6 ± 3.4 28.5 ± 3.2 28.1 ± 3.0
Calf (cm) 36.8 ± 3.4 35.5 ± 3.0 35.7 ± 3.5
Waist (cm) 92.3 ± 13.2 92.4 ± 11.9 88.8 ± 11.6
All data in mean ± SD
¶
Main effect for diagnosis
a
different from controls; bdifferent from MCI p < 0.05 *Interaction diagnosis*
gender p = 0.055
Conclusion: Patients with MCI and AD have a lower MNA score,
and BMI and FFMI compared to controls. We are currently
studying how nutritional status and body composition contrib-
ute to progression of cognitive decline.
Disclosure of Interest: A. Doorduijn Grant/Research Support from:
This project is funded by the “Food, Brain and Cognition” program of
NWO (057-14-004) and industry (Nutricia Research, Friesland Campina
and DSM), O. Van de Rest Grant/Research Support from: This project is
funded by the “Food, Brain and Cognition” program of NWO (057-14-
004) and industry (Nutricia Research, Friesland Campina and DSM),
S. Boesveldt Grant/Research Support from: This project is funded by
the “Food, Brain and Cognition” program of NWO (057-14-004) and
industry (Nutricia Research, Friesland Campina and DSM), W. Van der
Flier Grant/Research Support from: This project is funded by the
“Food, Brain and Cognition” program of NWO (057-14-004) and industry
(Nutricia Research, Friesland Campina and DSM), M. Visser Grant/
Research Support from: This project is funded by the “Food, Brain and
Cognition” program of NWO (057-14-004) and industry (Nutricia
Research, Friesland Campina and DSM), M. De van der Schueren
Grant/Research Support from: This project is funded by the “Food,
Brain and Cognition” program of NWO (057-14-004) and industry
(Nutricia Research, Friesland Campina and DSM).
SUN-P046
DEPRESSED MOOD AND COGNITIVE FUNCTIONS IN PATIENTS
WITH CANCER ARE ASSOCIATED WITH ALTERATIONS IN
TRYPTOPHAN METABOLISM
B. S. Van Der Meij1,2,3 *, C. K. Lieben1, N. E. Deutz1,
R. E. Rodriguez4, F. Koeman1, T. C. Smit1, M. P. Engelen5.
1
Center for Translational Research in Aging and Longevity,
Texas A&M University, College Station, United States, 2Faculty
of Health Sciences and Medicine, Bond University, God Coast,
3
Nutrition and Dietetics, Mater Group, Brisbane, Australia,
4
Division of Hematology/Oncology, Scott and White Memorial
Hospital, College Station, United States, 5Center for
Translational Research in Aging and Longevity, Texas A&M
University, College Station, Australia
Rationale: Depression and cognitive deficits have been
observed in patients with cancer. Although degradation of
tryptophan (TRP; precursor of serotonin) has been detected in
cancer, the exact association between whole body TRP
metabolism and neuropsychological functions in advanced
cancer remains unclear.
Methods: In 16 patients with solid tumours (C) and 16 age and
gender matched healthy controls, the rates of appearance (Ra)
and clearance of TRP were assessed by primed continuous
infusion of L-[indole-2H5]TRP. Plasma amino acid profile was
analyzed to measure plasma TRP level, and ratio plasma TRP to
Large neutral amino acids (LNAA = sum of tyrosine,
Poster
phenylalanine, isoleucine, leucine and valine) calculated as
p-
value marker of TRP uptake into the brain. Mood was assessed by the
Hospital Anxiety and Depression Score, and cognition by a test
0.000
0.021
battery consisting of the Auditory Verbal Learning, Verbal
0.038 Fluency, Trail Making, and Stroop tests. Plasma amino acid
0.274* levels and isotope enrichments were measured by LC-MS/MS.
0.323
Statistics were done by unpaired t-tests and Pearson’s
0.128
correlation.
Results: Depression scores were higher in C (5.0 vs 2.6,
P < 0.05), but cognitive outcomes were comparable between
the groups. In C, the depression scores correlated negatively
with plasma TRP (r = −0.69, P < 0.01) and positively with TRP
clearance rate (r = 0.60, P < 0.05). Additionally, we found that
only in C, TRP Ra was associated with word fluency (r = 0.70,
P < 0.01), processing speed (TMT completion time; r < −0.54,
P < 0.05), and verbal learning capacity and memory (immediate
and delayed recall, learning rate and recognition; r ≥ 0.63,
P ≤ 0.01). No relationship was found between plasma TRP/
LNAA ratio and mood or cognition.
Conclusion: These findings suggest that an imbalance in TRP
metabolism plays a role in the depressive symptoms in patients
with cancer and may increase their risk of developing cognitive
deficits.
Disclosure of Interest: B. Van Der Meij Grant/Research Support from:
ESPEN Research Fellowship, C. Lieben: None declared, N. Deutz: None
declared, R. Rodriguez: None declared, F. Koeman: None declared,
T. Smit: None declared, M. Engelen: None declared.
SUN-P047
THE ACUTE EFFECTS OF TRYPTOPHAN ENRICHED WHEY
PROTEIN ON COGNITIVE FUNCTIONS IN OLDER ADULTS WITH
MILD COGNITIVE IMPAIRMENT
C. K. Lieben1 *, N. E. Deutz1, A. Salentijn1,2, M. P. Engelen1.
1
Health and Kinesiology, Texas A&M University, College
Station, United States, 2Neuropsychology &
Psychopharmacology, Maastricht University, Maastricht,
Netherlands
Rationale: The essential amino acid tryptophan (TRP, precursor
of serotonin and kynurenine) regulates mood and memory.
Since aging modifies the serotonergic metabolism and TRP
enriched protein meals have mood and memory enhancing
properties, our hypothesis is that optimizing TRP availability
via intake of α-lactalbumin (ALAC) diminishes cognitive deficits
in older adults with mild cognitive impairment (MCI).
Methods: This randomized placebo controlled crossover study
examines the acute effects of ALAC on cognitive functions in
healthy older adults with and without MCI. Participants, older
than 55 years were stratified by cognitive complaints and a
Montreal Cognitive Assessment (MoCA) score of less than 26 in a
MCI group (n = 19) and an age and gender matched control
group (CON; n = 18). Plasma amino acid levels were measured
prior to and 3h after intake of the protein mixtures (Davisco)
containing ALAC or Whey protein as placebo (4.8 vs 2.7 g TRP/
100 g product, respectively) to determine changes in TRP and
TRP/large neutral amino acids (LNAA) ratio. Subsequently,
attention, executive and memory functions (using AVLT, VFT,
TMT, STROOP, and PASAT assessments) were evaluated in both
groups. Statistics were done by two-way analysis of variance.
Geriatrics 1
Results: Baseline characteristics, plasma TRP levels and TRP/
LNAA ratio were similar between the groups. Independent of
the group, each protein affected TRP levels and TRP/LNAA ratio
differently ( p < 0.01) as ALAC increased TRP/LNAA ratio by 92%
and 100%, while Whey induced an increase of 7% and 18% in
both CON and MCI group, respectively. Although the MCI group
performed worse on all cognitive tests relative to the CON
group ( p < 0.05), cognitive outcomes after ALAC intake did not
differ from Whey.
Conclusion: These findings indicate that a TRP enriched
dietary intake has no acute beneficial effects on cognitive
performance in older adults with MCI.
Disclosure of Interest: None declared.
SUN-P048
WHAT DO NURSES LEARN ABOUT MALNUTRITION IN OLDER
ADULTS?
D. Eglseer1 *, S. Schüssler1, I. Kravanja1, C. Lohrmann1.
1
Institute of Nursing Science, Medical University Graz, Graz,
Austria
Rationale: Evidence-based interventions for malnourished
older adults are rarely implemented in daily clinical practice.
One main reason may be the lack of sufficient nutritional
knowledge of nurses. Therefore, this study aimed at determin-
ing the provision and content of malnutrition education in basic
nursing education across European countries.
Methods: This cross-sectional study is part of the European
project Malnutrition in the Elderly Knowledge Hub (MaNuEL).
Based on an existing questionnaire, an online-survey question-
naire was developed by experts in the field of malnutrition. In
January 2017, the online-survey link was emailed to 926 nursing
education institutions in 31 European countries. The software
tool “SurveyMonkey” was used for the survey and SPSS for
descriptive data analysis.
Results: 86.3% of the institutions stated offering general
nutrition education. In 73%, malnutrition education in older
adults is part of the education. The most frequently mentioned
topics were malnutrition screening (70.8%), causes (67.2%) and
consequences (68.7%) of malnutrition. Rarely reported con-
tents were the responsibilities of various professions in
nutritional support (35.1%) as well as the cooperation in
multidisciplinary nutrition support teams (28.2%). In more than
half of the institutions, malnutrition is taught by nurses and not
by nutrition professionals.
Conclusion: Malnutrition in older adults is, for the most part,
integrated in basic nursing education. However, the multidis-
ciplinary approach is hardly covered in the respective courses.
Furthermore, (mal)nutrition education is often in non-nutri-
tion-professional’s hands. This might be a reason why adequate
nutritional support is not applied in clinical practice to a
satisfying degree. Adaptations of existing (mal)nutrition
education courses for nurses in European countries seem to
be necessary.
Disclosure of Interest: None declared.
S71
SUN-P049
NORDIC HEALTHY DIET AND MORTALITY IN A COHORT OF 70
YEAR-OLD SWEDES: WHAT IS THE CONTRIBUTION OF DAIRY
INTAKE?
E. Rothenberg1 *, G. Tognon2, L. Lissner2, M. Petrolo2, V. Sundh2.
1
Food and Meal Science, Kristianstad University, 2Section for
Epidemiology and Social Medicine (EPSO), Department of
Public Health and Community Medicine, Sahlgrenska Academy,
Gothenburg, Sweden
Rationale: Several definitions of the Nordic Healthy Diet have
been proposed, but there is no consensus on the role of dairy
products. We aim to study the impact of the Nordic diet on all-
cause mortality in a population of 70 year-olds, exploring
different versions of a Nordic Healthy Diet Score (NHDS) with
focus on the specific role of key dairy products.
Methods: Cox proportional hazard models, adjusted for
potential confounders, were used to assess the prediction of
all-cause mortality using two NHDS definitions (calculated
either including low-fat or without dairy products). In separate
Cox models, cheese intake and the combined intakes of milk,
soured milk and unsweetened yoghurt were tested as well as
intake of fat from these two sources.
Results: Neither of the standard versions of NHDS was
associated with mortality. However, cheese intake was pro-
tective of total mortality, whereas milk products (including
soured milk and unsweetened yoghurt) predicted increased risk
of mortality. Cheese fat intake was also inversely associated
with mortality, whereas fat from the other dairy products
positively predicted the outcome only when the model was
adjusted by energy intake.
Conclusion: The NHDS, as previously defined, was not
associated with all-cause mortality in this population of
elderly[GT1] Swedes. Intake of milk, soured milk and/or
unsweetened yoghurt was positively associated with all-cause
mortality whereas cheese intake was inversely associated with
this outcome.
Disclosure of Interest: None declared.
SUN-P050
INDIVIDUAL VARIANCE IN RESTING METABOLIC RATE AND
ENERGY BALANCE IN GERIATRIC OUTPATIENTS WITH
MOBILITY PROBLEMS
E. M. Reijnierse1 *, S. Verlaan2, M. C. Trappenburg2,3,
C. G. Meskers4,5, M. A. de van der Schueren6,7, A. B. Maier1,5.
1
Department of Medicine and Aged Care, University of
Melbourne, Melbourne, Australia, 2Department of Internal
Medicine, Section of Gerontology and Geriatrics, VU University
Medical Center, Amsterdam, 3Department of Internal
Medicine, Amstelland Hospital, Amstelveen, 4Department of
Rehabilitation Medicine, VU University Medical Center,
5
Department of Human Movement Sciences, MOVE Research
Institute, Vrije Universiteit, 6Department of Internal
Medicine, Section of Nutrition and Dietetics, VU University
Medical Center, Amsterdam, 7Department of Nutrition and
Health, Faculty of Health and Social Studies, HAN University of
Applied Sciences, Nijmegen, Netherlands
Rationale: In clinical practice, optimization of physical and
nutritional intervention (“tailored therapy”) requires patient
specific data on energy expenditure and nutritional intake
S72
tailored to the individual requirements; these data are
generally lacking. This study aimed to explore the nutritional
needs of geriatric outpatients regarding energy expenditure
and energy balance.
Methods: This inception cohort of older adults referred to
the geriatric outpatient clinic of the Center of Geriatric
Medicine Amsterdam, VU University Medical Center included
26 outpatients. Geriatric outpatients underwent standardized
phenotyping based on regular care and additional nutritional
(indirect calorimetry to measure resting metabolic rate (RMR),
three day food diary) and physical activity assessments
(accelerometry). Next to indirect calorimetry, RMR was
estimated using the equation by the World Health
Organization based on age, sex, body weight and height.
Total energy expenditure (TEE) was calculated by RMR times
the physical activity level. Energy balance was defined as TEE
versus the energy intake.
Results: A high individual variance was found in both RMR and
energy balance. Mean difference between the actual measured
RMR and the estimated RMR was 234 kcal/day on a population
level. On the individual level, estimated RMR underestimated
the actual measured RMR by more than 10% in more than half of
the outpatients. Mean difference between TEE and energy
intake was 429 kcal/day. Half of the outpatients had an energy
consumption lower than their needs by more than 10%.
Conclusion: RMR should be measured objectively due to the
high underestimation of estimating RMR. In geriatric out-
patients, it is important to individually quantify the nutritional
needs.
Disclosure of Interest: None declared.
SUN-P051
ASSESSMENT OF MAXIMAL HANDGRIP STRENGTH: HOW MANY
ATTEMPTS ARE NEEDED?
E. M. Reijnierse1 *, N. de Jong2, M. C. Trappenburg2,3,
G. J. Blauw4,5, G. Butler-Browne6, H. Gapeyeva7, J.-Y. Hogrel6,
M. V. Narici8, S. Sipilä9, L. Stenroth10, R. C. van Lummel11,12,
M. Pijnappels12, C. G. Meskers12,13, A. B. Maier1,12.
1 1
Department of Medicine and Aged Care, University of
Melbourne, Melbourne, Australia, 2Department of Internal
Medicine, Section of Gerontology and Geriatrics, VU University
Medical Center, Amsterdam, 3Department of Internal
Medicine, Amstelland Hospital, Amstelveen, 4Department of
Gerontology and Geriatrics, Leiden University Medical Center,
Leiden, 5Department of Geriatrics, Bronovo Hospital, The
Hague, Netherlands, 6UPMC UM 76, INSERM U 974, CNRS 7215,
Institute de Myologie, Paris, France, 7Institute of Sport
Sciences and Physiotherapy, University of Tartu, Tartu, Estonia,
8
Division of Medical Sciences and Graduate Entry Medicine,
MRC-ARUk Centre of Excellence for Musculoskeletal Ageing
Research, University of Nottingham, Royal Derby Hospital
Centre, Derby, United Kingdom, 9Gerontology Research Centre
and Department of Health Sciences, 10Department of Biology
of Physical Activity, University of Jyväskylä, Jyväskylä,
Finland, 11McRoberts BV, The Hague, 12Department of Human
Movement Sciences, MOVE Research Institute, Vrije
Universiteit, 13Department of Rehabilitation Medicine, VU
University Medical Center, Amsterdam, Netherlands
Rationale: Handgrip strength (HGS) is used to identify
individuals with low muscle strength (dynapenia). The
Poster
influence of the number of attempts on maximal HGS is not
yet known and may differ depending on age and health status.
This study aimed to assess how many attempts of HGS are
required to obtain maximal HGS.
Methods: Three cohorts (939 individuals) differing in age and
health status were included. HGS was assessed three times and
explored as continuous and dichotomous variable. Paired t-
test, intraclass correlation coefficients (ICC) and Bland-Altman
analysis were used to test reproducibility of HGS. The number
of individuals with misclassified dynapenia at attempts 1 and 2
with respect to attempt 3 were assessed.
Results: Results showed the same pattern in all three cohorts.
Maximal HGS at attempts 1 and 2 was higher than at attempt 3
on population level (P < 0.001 for all three cohorts). ICC values
between all attempts were above 0.8, indicating moderate to
high reproducibility. Bland-Altman analysis showed that 41.0–
58.9% of individuals had the highest HGS at attempt 2 and 12.4–
37.2% at attempt 3. The percentage of individuals with a
maximal HGS above the gender-specific cut-off value at
attempt 3 compared with attempts 1 and 2 ranged from 0% to
50.0%, with a higher percentage of misclassification in middle-
aged and older populations.
Conclusion: Maximal HGS is dependent on the number of
attempts, independent of age and health status. To assess
maximal HGS, at least three attempts are needed if HGS is
considered to be a continuous variable. If HGS is considered as a
discrete variable to assess dynapenia, two attempts are
sufficient to assess dynapenia in younger populations.
Misclassification should be taken into account in middle-aged
and older populations.
Disclosure of Interest: None declared.
SUN-P052
LACK OF KNOWLEDGE AND AVAILABILITY OF DIAGNOSTIC
EQUIPMENT HINDER THE DIAGNOSIS OF SARCOPENIA AND ITS
MANAGEMENT
E. M. Reijnierse1 *, M. A. de van der Schueren2,3,
M. C. Trappenburg4,5, M. Doves6, C. G. Meskers7,8, A. B. Maier1,8.
Department of Medicine and Aged Care, University of
Melbourne, Melbourne, Australia, 2Department of Internal
Medicine, Section of Nutrition and Dietetics, VU University
Medical Center, Amsterdam, 3Department of Nutrition and
Health, Faculty of Health and Social Studies, HAN University of
Applied Sciences, Nijmegen, 4Department of Internal Medicine,
Section of Gerontology and Geriatrics, VU University Medical
Center, Amsterdam, 5Department of Internal Medicine,
Amstelland Hospital, Amstelveen, 6Institute of Human
Movement Studies, Faculty of Health Care, University of
Applied Sciences Utrecht, Utrecht, 7Department of
Rehabilitation Medicine, VU University Medical Center,
8
Department of Human Movement Sciences, MOVE Research
Institute, Vrije Universiteit, Amsterdam, Netherlands
Rationale: Sarcopenia is an emerging clinical challenge in an
ageing population and is associated with serious negative
health outcomes. This study aimed to assess the current state
of knowledge about the concept of sarcopenia, diagnostic
strategy and management in a cohort of Dutch healthcare
professionals ( physicians, physiotherapists, dietitians and
others) attending a lecture cycle on sarcopenia.
Geriatrics 1
Methods: Healthcare professionals (n = 223) were asked to
complete a questionnaire before, directly after and five
months after attending a lecture cycle on the pathophysiology
of sarcopenia, diagnostic strategy and management of sarco-
penia, i.e. interventions and collaboration.
Results: Before attendance, 69.7% of healthcare professionals
stated to know the concept of sarcopenia and 21.4% indicated
to know how to diagnose sarcopenia. Handgrip strength was the
most frequently used objective diagnostic measure (33.9%).
Five months after attendance, reported use of diagnostic tests
was increased, i.e. handgrip strength up to 67.4%, gait speed up
to 72.1% and muscle mass up to 20.9%. Bottlenecks during
implementation of the diagnostic strategy were experienced by
67.1%; lack of awareness, acquisition of equipment and time
constraints to perform the diagnostic measures were reported
most often. Before attendance, 36.4% stated not to consult a
physiotherapists or exercise therapists (PT/ET) or dietitian for
sarcopenia interventions, 10.5% consulted a PT/ET, 32.7% a
dietitian and 20.5% both a PT/ET and dietitian. Five months
after attendance, these percentages were 28.3%, 21.7%, 30.0%
and 20.0% respectively. A lack of collaboration was experienced
by 36.8%.
Conclusion: The concept of sarcopenia is familiar to most
healthcare professionals but application in practice is ham-
pered, mostly by lack of knowledge, availability of equipment,
time constraints and lack of collaboration.
Disclosure of Interest: None declared.
SUN-P053
FACTORS ASSOCIATED WITH DIETARY SUPPLEMENT USE IN
PATIENTS WITH ALZHEIMER’s DISEASE AND MILD COGNITIVE
IMPAIRMENT
E. Hartman1 *, A. Doorduijn1,2, M. Visser1,3, W. Van der Flier2,
M. De van der Schueren1,4. 1Department of Nutrition and
Dietetics, 2Alzheimer Center, VU University Medical Center,
3 3
Department of Health Sciences, Vrije Universiteit,
Amsterdam, 4Department of Nutrition and Health, HAN
University of Applied Sciences, Nijmegen, Netherlands
Rationale: Patients with different stages of cognitive decline
often report dietary supplement use. This study investigates
factors associated with the number of dietary supplements in
controls with subjective cognitive decline (SCD), and in
patients with mild cognitive impairment (MCI) or Alzheimer’s
disease (AD).
Methods: Dietary supplement use of 140 subjects of the VUmc
Alzheimer center (63 SCD, 34 MCI, 43 AD), was inquired with the
validated HELIUS Food Frequency Questionnaire. After uni-
variate selection (determinants with p < 0.1), a multivariable
general linear model was constructed to study the association
between patient and disease characteristics and number of
supplements. All analyses were adjusted for diagnosis.
Results: 66 out of 140 subjects (47%) reported dietary
supplement use. Univariate analyses revealed significant
associations between the number of dietary supplements
used and education level (Verhage scale), having children,
number of diets adhered to, needing assistance during the
questionnaire, polypharmacy (>3), alcohol consumption
(units/day), protein intake, BMI, calf circumference (continu-
ous), mid-upper arm circumference (MUAC, continuous) and fat
free mass. In the multivariable model, independent
S73
associations were found for education level (B(eta)0.417, P
(-value)0.027), having children (B-1.220, P0.02), number of
diets adhered to (B0.518, P0.048), polypharmacy (B1.143,
P0.025), calf circumference (B0.171, P0.063) and MUAC (B-
0.267, P0.007). No significant effects were observed for
diagnosis, gender or age.
Conclusion: Approximately half of patients with SCD, MCI and
AD reported dietary supplement use, with no differences
between diagnoses. The here reported associations with
supplement use provide novel insights, which should be
further related to nutritional intake, nutritional status and
disease progression.
Disclosure of Interest: E. Hartman: None declared, A. Doorduijn
Grant/Research Support from: This project is funded by the “Food,
Brain and Cognition” program of NWO (057-14-004) and industry
(Nutricia Research, Friesland Campina and DSM), M. Visser Grant/
Research Support from: This project is funded by the “Food, Brain and
Cognition” program of NWO (057-14-004) and industry (Nutricia
Research, Friesland Campina and DSM), W. van der Flier Grant/
Research Support from: This project is funded by the “Food, Brain and
Cognition” program of NWO (057-14-004) and industry (Nutricia
Research, Friesland Campina and DSM), M. De van der Schueren
Grant/Research Support from: This project is funded by the “Food,
Brain and Cognition” program of NWO (057-14-004) and industry
(Nutricia Research, Friesland Campina and DSM).
SUN-P054
MALNUTRITION AND RELATED RISK PROFILES IN OLDER
ADULTS FROM DIFFERENT SETTINGS: AN ENABLE-STUDY
E. Kiesswetter1 *, M. G. Colombo2,3, D. Volkert1, A. Peters2,
B. Thorand2, R. Holle4, K.-H. Ladwig2, H. Schulz5, E. Grill6,
R. Diekmann7, E. Schrader1, P. Stehle8, C. C. Sieber1,
C. Meisinger2,9. 1Institute for Biomedicine of Aging, Friedrich-
Alexander Universität Erlangen-Nürnberg, Nuremberg,
2
Institute for Epidemiology II, Helmholtz Zentrum München,
German Research Center for Environmental Health, Munich,
MONICA/KORA Myocardial Infarction Registry, Central
Hospital of Augsburg, Augsburg, 4Institute of Health Economics
and Health Care Management, 5Institute for Epidemiology I,
Helmholtz Zentrum München, German Research Center for
Environmental Health, 6Institute for Medical Information
Processing, Biometrics and Epidemiology (IBE), and German
Center for Vertigo and Balance Disorders, Ludwig-Maximilians-
University Munich, Munich, 7Department of Health Services
Research, Carl von Ossietzky Universität Oldenburg,
Oldenburg, 8IEL-Nutritional Physiology, Universität Bonn,
Bonn, 9Institute for Epidemiology, Ludwig-Maximilians-
University Munich, UNIKA-T Augsburg, Augsburg, Germany
Rationale: The origin of malnutrition in older age is multifac-
torial and risk factors may vary according to the health and
living situation of older adults. The aim of this secondary data
analysis was (a) to compare the prevalence of malnutrition in
older adults from different health care settings and (b) to
identify setting-specific risk profiles of malnutrition.
Methods: Cross-sectional data of 1,073 community-dwelling
older adults from the Kora-Age study (CD), 187 patients of a
geriatric day hospital (GDH), 335 older adults receiving home
care (HC, ErnSiPP study), and 197 nursing home residents (NH)
were harmonized. Malnutrition was defined as body mass index
<20 kg/m² and/or weight loss >3 kg in the previous 3–6 months.
For each data set odds ratios of 27 potential risk factors from 5
S74
domains (demographics, nutrition related problems, dietary
behavior, health, functioning) were calculated. Variables
significantly associated with malnutrition in at least one data
set were entered into multivariable logistic regression models.
Results: The prevalence of malnutrition was 11% in CD older
adults, 19% in GDH-patients, 16% in HC-receivers, and 17% in
NH-residents ( p = 0.002). Twelve potential risk factors were
included in the multivariable models. Reduced appetite,
difficulties with eating, respiratory and gastrointestinal dis-
eases were identified as risk factors of malnutrition in CD older
adults. In GDH-patients the same risk profile except gastro-
intestinal diseases was found. In HC-receivers only reduced
appetite and in NH-residents only mobility limitations
increased the odds of malnutrition.
Conclusion: CD older adults showed the lowest prevalence of
malnutrition. Reduced appetite was a risk factor of malnutri-
tion in 3 of 4 settings. While in CD older adults and GDH-
patients several factors were related to malnutrition, in HC-
receivers and NH-residents one single factor was dominant.
Disclosure of Interest: None declared.
SUN-P055
EXPLORATION OF THE ASSOCIATION BETWEEN XEROSTOMIA,
HYPOSALIVATION AND MEDICATION USE IN NURSING HOME
RESIDENTS
G.-J. Van Der Putten1,2 *, H. Brand3, J. Schols4, C. De Baat1.
1
Department of Oral Function and Prosthetic Dentistry,
Radboud Univeristy Medical Centre, Nijmegen, 2Amaris
Gooizicht, Hilversum, 3Department of Dental Basic Sciences,
Academic Centre for Dentistry Amsterdam, Amsterdam,
4
Department General Practice/Caphri, Maastricht University,
Maastricht, Netherlands
Rationale: To maintain good oral health, an adequate amount
of saliva should be secreted. The first objective was to examine
the diagnostic suitability of a Dutch translation of the
Xerostomia Inventory (DXI) for determining the severity of
xerostomia. The second objective was to assess to investigate
the associations of saliva secretion rate and acidity with
gender, age, and some medical characteristics in a convience
sample of nursing home residents.
Methods: A cross-sectional study was carried out in 50 nursing
home residents. The DXI was completed for all residents.
Unstimulated saliva (UWS), parafilm-stimulated saliva (A-SWS)
and citric acid stimulated saliva (CH-SWS) flow rates were
determined. Current used (hyposalivation-related) medica-
tions of the residents were collected from residents’ medical
records and analyzed.
Results: The average age of the residents was 78.1 ± 9.7 years.
The suitability of the DXI appeared restricted. The prevalence
of xerostomia was 52%. The prevalence of hyposalivation was
24% for UWS, 60% for CH-SWS and 18% for A-SWS. In 48% of the
residents, the UWS was less than 0.2 mL/min. The CH-SWS and
A-SWS were less than 0.5 mL/min in 60% and 18% of the
residents respectively. All whole saliva secretion rates were
significantly lower in women than in men, even after correction
for age, smoking and the number of prescribed medications.
The number of prescribed medication was significant higher in
residents over the age of 70 and also in women. In residents
aged >70 years, the acidity of U-SWS was positively associated
with age.
Poster
Conclusion: The suitability of the DXI appeared restricted. In
this study, only the item “My mouth feels dry” was best
correlated with hyposalivation. In nursing homes, the preva-
lence of hyposalivation and xerostomia is high. Women and
residents ages over age of 70 years need special attention with
respect to oral health.
Disclosure of Interest: None declared.
SUN-P056
POOR NUTRITIONAL STATUS BUT NOT COGNITIVE OR
FUNCTIONAL IMPAIRMENT PER SE INDEPENDENTLY PREDICT
3- AND 6-MONTH MORTALITY N ELDERLY HIP-FRACTURE
PATIENTS
G. Gortan Cappellari1 *, P. De Colle2, E. Concollato3, V. Bonato1,
C. Ratti4, M. Zanetti1, L. Murena4, G. Toigo3, R. Barazzoni1.
1
Medical, Surgical and Health Sciences, University of Trieste,
2
Geriatrics Division, Azienda Sanitaria Universitaria Integrata
Trieste, 3Post-Graduate School of Geriatrics, University of
Trieste, 4Orthopaedic Surgery, Azienda Sanitaria Universitaria
Integrata Trieste, Trieste, Italy
Rationale: Hip fractures are a major health problem and are
strongly associated with mortality in elderly individuals.
Recent evidence suggested a potential negative impact of
poor nutritional, cognitive and functional status on hip fracture
patient survival, but their independent prognostic impact as
well as their potential interactions in modulating survival
remain undefined.
Methods: In 1,259 consecutive elderly patients admitted to a
orthopaedic surgery unit for hip fracture treatment [age 85
years (65–109); male gender: 22%], we assessed associations
between 3- and 6-month mortality (M) and malnutrition (Mini
Nutritional Assessment - MNA < 23.5), cognitive and functional
status (Short Portable Mental Status Questionnaire or Activities
of Daily Living scores).
Results: Malnutrition and increasing cognitive and functional
impairment were all associated with M ( p < 0.001). Both
cognitive and functional impairment were associated with
malnutrition (P < 0.001). Associations between malnutrition
and M were independent of age, gender, pre-fracture disease
conditions, type of surgery and post-surgical complications as
well as cognitive and functional impairment. Malnourished
patients accordingly presented worse mortality in Kaplan
survival analyses. On the other hand, associations between M
and cognitive and functional impairment were independent of
age, gender, disease conditions, surgery and its complications
but not of malnutrition.
Conclusion: In hip fracture elderly patients, malnutrition is a
strong independent risk factor for 3-and 6-month mortality.
Routine assessment and potentially treatment of malnutrition
could improve clinical risk assessment and prognosis of elderly
hip fracture patients. The negative prognostic impact of
cognitive and functional impairment appears to be mediated
at least partly by their association with poor nutritional status.
Disclosure of Interest: None declared.
Liver and gastrointestinal tract 1
SUN-P057
IMPROVING ENERGY INTAKE AND MALNUTRITION IN LONG
TERM CARE: USING A CONCEPTUAL MODEL TO IDENTIFY
DETERMINANTS AND POTENTIAL SOLUTIONS
H. Keller1 *, S. Slaughter2, C. Lengyel3, N. Carrier4,
J. Morrison5, V. Vucea1, C. Steele6, L. Duizer7. 1Applied Health
Sciences, University of Waterloo, Waterloo, 2Faculty of
Nursing, University of Alberta, Edmonton, 3Faculty of
Agriculture & Food Sciences, University of Manitoba,
Winnipeg, 4Ecole des sciences des aliments, de nutrition et
d’etudes familiales, Universite de Moncton, Moncton,
5
Applied Health Sciences, Unviersity of Waterlo, Waterloo,
6
Toronto Rehab, University Health Network, Toronto, 7Food
Science, University of Guelph, Guelph, Canada
Rationale: Poor food intake is the primary cause of malnutri-
tion in long term care (LTC). The Making the Most of Mealtimes
(M3) concept identifies diverse determinants and influences on
food intake (e.g. meal access, meal quality, and mealtime
experience). This study describes the predictors of energy
intake and malnutrition in residents.
Methods: Food intake was assessed with 3-day weighed and
estimated food records in 628 residents of 32 LTC homes in four
Canadian provinces. Average energy intake and malnutrition
risk as determined by the Mini-Nutritional Assessment-Short
Form (MNA-SF) were outcome variables. Risk factors related to
meal access, meal quality, and mealtime experience were
assessed with valid and reliable standardized measures.
Hierarchical, clustered regression modeling identified deter-
minants of energy intake and MNA-SF.
Results: Mean age of participants was 86.8 ± 7.83 years; 69%
were female. Mean energy intake was 1571.9 ± 411.93 kilo-
calories/day. M3 concepts amenable to change and positively
associated ( p < 0.05) with energy intake were: MNA-SF,
residing on a dementia care unit, receiving more person-
centred care at meals, and total eating assistance. Energy
intake was negatively associated with eating challenges,
including sometimes requiring eating assistance, and the
homelikeness of the dining room. The average MNA-SF score
was 10.6 ± 2.53 and was negatively associated with prescrip-
tion of a pureed or minced/moist texture diet (vs. regular
texture), use of oral nutritional supplements, cognitive
impairment, and eating challenges.
Conclusion: Poor food intake and malnutrition are common in
LTC. Modifiable determinants suggest that interventions
targeting meal quality (modified texture food), meal access
(eating challenges) and mealtime experience (environment)
are necessary to prevent malnutrition.
Disclosure of Interest: H. Keller Speaker Bureau of: Abbott Nutrition,
Nestle Health Sciences, S. Slaughter: None declared, C. Lengyel: None
declared, N. Carrier: None declared, J. Morrison: None declared,
V. Vucea: None declared, C. Steele Grant/Research Support from:
Nestle Health Sciences, Speaker Bureau of: Nestle Health Sciences,
L. Duizer: None declared.
S75
SUN-P059
“ARE YOU EATING PROPERLY?”: INCREASE AWARENESS OF
MALNUTRITION IN ELDERLY PEOPLE IN JAPAN THROUGH
SOCIAL ENTERPRISE
K. Akiyama1 *, T. Higashiguchi2. 1Surgery, Tokastu Clinic
Hospital, Matsudo, 2Surgery & Palliative Medicine, Fujita
Health University School of Medicine, Toyoake, Japan
Rationale: “WAVES” is an abbreviation for “We Are Very
Educators for Society”. Prof. T. Higashiguchi created and
proposed this organization. He is Chairman of the Board of
Trustees of the Japanese Society for Parenteral and Enteral
Nutrition (JSPEN). This organization is defined as a social
enterprise with the goal of creating a better super-aged
society, which includes a “People Education Program” aimed at
preventing sarcopenia.
Methods: “Are you eating properly?” are the words we used to
greet elderly people. This is the first step of WAVES. As part of a
sarcopenia awareness and prevention campaign we have held
events 4 times in 2015 and 2016. After these events, we
analyzed the results of questionnaire surveys from elderly
people who participated in these events.
Results: Of the 1,307 elderly people were replied, 391 were
men, 908 were women. The respondents were in the following
age groups: 604 (46%) aged under 65 years old, 309 (24%) aged
65–74 years old, 290 (22%) aged 75–84 years old and 94 (7%)
aged 85 or older. 187 respondents (14%) only eat twice a day and
11 (1%) eat only one meal a day. 833 (64%) eat meat or fish every
day, but 208 (16%) eat this less than 3 times a week. We also
found that 588 (71%) have never heard the term “sarcopenia”.
Conclusion: It was found that the nourishment level of
participants in these events was better than expected, but
these kinds of events will be important in our society. They
target people who will be at risk of malnutrition in the near
future as they become older and less healthy, many of whom
don’t recognize the concept of sarcopenia. These events are
only the first steps. Next, we plan to establish a nutritional
education program and, after that, an intervention system for
elderly people. I believe that this social enterprise through
nutrition will build social capital and lead us to a better society.
Disclosure of Interest: None declared.
Liver and gastrointestinal tract 1
SUN-P060
ASCITES VOLUME ASSESSED BY COMPUTER TOMOGRAPHY
I. Krijger1, A. Droop2 *, D. Bot2, J. Langius1,
S. Shahbazi Feshtali3, B. Van Hoek4. 1Nutrition and Dietetics,
The Hague University of Applied Sciences, The Hague,
2
Dietetics, 3Radiology, 4Gatroenterology and Hepatology,
Leiden University Medical Center, Leiden, Netherlands
Rationale: Nutritional assessment in patients with end stage
liver disease is difficult due to the presence of ascites.
Abdominal CT scans, performed for diagnostic purposes,
might be suitable for measuring the amount of ascites. We
compared two new methods for determining the amount of
ascites using CT-scans with the current ascites estimation.
Methods: In 49 patients with end stage liver disease, ascites
was assessed with three methods. A hepatologist estimated the
S76
amount of ascites by physical examination (HEP) and graded it
as none (0 kg), moderate (2–6 kg) or severe (>6 kg). Abdominal
CT scans were used to calculate the amount of ascites with a
five-point method (CT-5P) and by determining volume through
measuring ascites area (−10 to +10 HU) on 19 single slices
from T5 to femoral head with interpolation between the slices
(CT-VM). This method was adapted from a validated method to
measure ventricular boundaries. With all 3 methods the
amount of ascites was graded. Cohen’s Kappa was used to
analyse the degree of agreement between the ascites grade
ranking. A paired t-test and Pearson correlation coefficient
were used for analysing difference and correlation between the
two CT scan methods
Results: The agreement between CT-VM and HEP was moderate
(κ = 0.230) and between CT-5P and HEP reasonable (κ = 0.361).
The amount of ascites measured by CT-5P was significantly
lower than calculated with CT-VM (939 ± 1,275 vs. 2,152 ±
1,481 mL, p < 0.001). There was a high correlation between the
CT methods (R = 0.934).
Conclusion: Estimating ascites volume by physical examination
by the hepatologist and the five-point method lead to a lower
amount of ascites than the CT volume measurement.
Classification of ascites estimated by hepatologist had a
reasonable agreement with the CT five-point scale but not
with the CT volume measurement. The two new methods
provide an extra possibility for ascites measurement when an
exact volume of ascites is necessary for medical decisions.
Disclosure of Interest: None declared.
SUN-P061
EFFECTS OF L-CARNITINE SUPPLEMENTATION ON BODY
COMPOSITION IN PATIENTS WITH NONALCOHOLIC
STEATOHEPATITIS
S. Amiri-Moghadam1, M. Nematy2, S. Eghtesadi11, M. Khalili3,
M. Mojarrad4, S. Jazayeri1, H. Vosooghinia5, A. Khosravi5,
M. Salehi6, A. Beheshti-Namdar5, A. Mehdizadeh Hakkak7 *.
1
Nutrition, School of Public Health, Iran University of Medical
Sciences, Tehran, 2Nutrition, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, 3Neuroscience
Research Center, Tabriz University of Medical Sciences, Tabriz,
4
Medical Genetics, Mashhad University of Medicl Sciences,
5
Internal Medicine, Ghaem Hospital, Mashhad University of
Medical Sciences, 6Community Medicine, 7Nutrition,
Mashhad University of Medicl Sciences, Mashhad, Iran, Islamic
Republic Of
Rationale: Fat deposition and obesity are the primary events in
nonalcoholic steatohepatitis (NASH). L-carnitine with function
of fatty acid transporting to mitochondria and fat degradation
may influence body composition in NASH. This study conducted
to investigate the beneficial effect of L-carnitine supplement
on body composition in NASH patients following calorie-
restriction (CR) program.
Methods: This randomized double-blind placebo-controlled
clinical trial was performed among 67 patients with NASH and
34 control subjects. Subjects were randomly divided into three
groups: L-carnitine group (receive 2,000 mg L-carnitine sup-
plements daily plus CR) (n = 36), placebo group (receive
placebo plus CR) (n = 31) and control group (under calorie
restricted regimen) (n = 34) for 12 weeks. Body composition
analysis including Body Fat Mass (BFM), Total Body Water
Poster
(TBW), and Lean Body Mass (LBM) was done by bioelectric
impedance analysis.
Results: Significant decrease of weight, WC (Waist
Circumference), BMI and fat mass (kg) were found within
control, placebo and L-carnitine groups. After adjusting for
covariates, L-carnitine supplement decreased weight
(P = 0.03), BMI (P = 0.02) and fat mass (kg) (P = 0.018) compared
to placebo group.
Conclusion: L-carnitine supplement for 12 week along with a
calorie restricted diet decreased body weight, BMI and weight
of body fat (kg) but does not affect WC, total body water, lean
body mass and percent of body fat.
Disclosure of Interest: None declared.
SUN-P062
IMPACT OF SARCOPENIC OBESITY ON OUTCOMES IN PATIENTS
UNDERGOING HEPATECTOMY FOR HEPATOCELLULAR
CARCINOMA
A. Kobayashi1 *, T. Kaido1, Y. Hamaguchi1, S. Okumura1,
H. Shirai1, S. Yao1, N. Kamo1, S. Yagi1, K. Taura1, H. Okajima1,
S. Uemoto1. 1Hepato-Biliary-Pancreatic and Transplant
Surgery, Kyoto University, Kyoto City, Japan
Rationale: Recent studies have indicated that sarcopenia is
associated with morbidity and mortality in various pathologies,
including cancer, and that obesity or visceral adiposity
represents a significant risk factor for several cancers.
However, the impact of sarcopenic obesity on outcomes after
hepatectomy for hepatocellular carcinoma (HCC) has not been
fully investigated.
Methods: We retrospectively analyzed 465 patients who
underwent primary hepatectomy for HCC between April 2005
and March 2015. Skeletal muscle mass and visceral adipose
tissue were evaluated by preoperative computed tomography
to define sarcopenia and obesity. Patients were classified into
one of four body composition groups according to the presence
or absence of sarcopenia and obesity.
Results: Body composition was classified as non-sarcopenic
non-obesity in 184 patients (39%), non-sarcopenic obesity in
219 (47%), sarcopenic non-obesity in 21 (7%), and sarcopenic
obesity in 21 (7%). Compared with patients with non-
sarcopenic non-obesity, patients with sarcopenic obesity
displayed worse median survival (84.7 vs. 39.1 months,
P = 0.002) and worse median recurrence-free survival (21.4
vs. 8.4 months, P = 0.003). Multivariate analysis identified
sarcopenic obesity as a significant risk factor for death (hazard
ratio [HR] = 2.446, P = 0.005) and HCC recurrence (HR = 2.031,
P = 0.006) after hepatectomy for HCC.
Conclusion: Preoperative sarcopenic obesity was an independ-
ent risk factor for death and HCC recurrence after hepatectomy
for HCC.
Disclosure of Interest: None declared.
SUN-P063
PLENTY OF INTESTINAL FAILURE TO GO AROUND. REFERRALS
TO A NEWLY FORMED NUTRITION SUPPORT TEAM
B. Rye1 *, A. Culkin1. 1Nutrition & Dietetics, St Mark’s Hospital,
London, United Kingdom
Rationale: Parenteral nutrition (PN) is lifesaving but has
complications. Our hospital has an intestinal failure unit (IFU)
Liver and gastrointestinal tract 1
which has a dedicated nutrition support team (NST) as per
recommendations1. The demand for PN outside the IFU
increased by 22% over 3 years so funding for an additional
Gastroenterologist and Dietitian was approved in 2015 to
provide a new service. The aim of this audit was to assess this
new service.
Methods: All referrals to the newly established NST from June
2015 for a year were recorded. Demographics, route of
nutrition, days nil by mouth, type of IF2, days on PN, refeeding
risk, weight and BMI. Central venous catheter (CVC) infections
were recorded as determined from a positive blood culture.
Descriptive statistics were used.
Results: Over 12 months 218 patients were referred. Of these
69% (n = 151) were surgical and 31% (n = 67) medical. PN was
recommended in 88% (n = 191), enteral nutrition in 3% (n = 6)
and oral nutrition in 10% (n = 21). The Dietitian completed the
nutritional assessment and calculated requirements in 100% of
referrals. Mean days nil by mouth was 4 ± 6 (0–30). The Dietitian
assessed patients to be at risk of refeeding in 45% of cases
(n = 86). Mean weight was 58.3 ± 25.6 kg (31–139) and mean BMI
20.3 ± 8.8 kg/m2 (11.8–48). According to ESPEN classification of
IF 50% had type 1 (n = 95), 35% type 2 (n = 67) and 15% type 3
(n = 29). Existing home parenteral nutrition (HPN) patients
accounted for 24% of referrals and 16% of referrals were
initiated on HPN. Mean days on PN was 28 ± 41 (1–368). CVC
infections were found in 17% of patients.
Conclusion: There is a high demand for PN in our hospital with
the majority of referrals being appropriate. A significant
proportion were type 2 & 3 IF reflecting the presence of a
national IFU. CVC infection is an issue supporting the need for a
nutrition nurse on the NST.
References
1. Parenteral Nutrition: A mixed bag (2010) NCEPOD.
2. Pironi et al. (2016) Clin Nutr,35:247
Disclosure of Interest: None declared.
SUN-P064
SIX FOOD ELIMINATION DIET IN ADULT EOSINOPHILIC
ESOPHAGITIS, PRELIMINARY EXPERIENCES FROM A DIETITIAN
PERSPECTIVE
C. K. Jacobsen1 *, B.-E. G. Emken2, G. E. Kahrs3,4,
J. G. Hatlebakk1,2. 1University of Bergen, 2Department of
Medicine, 3Department of Clinical Nutrition, 4Department of
Occupational Medicine, Haukeland University Hospital,
Bergen, Norway
Rationale: Eosinophilic esophagitis (EoE) is a chronic inflam-
matory, allergy-mediated esophageal disease, characterized
histologically by an excess of eosinophilic cells in the
esophageal mucosa and clinically by dysphagia. Studies show
a Six Food Elimination Diet (SFED) as effective in both children
and adults with EoE, but is not implemented in diagnostic and
treatment algorithms. EEsAI is a validated questionnaire
assessing dysphagia severity.
We assessed the feasibility of a SFED for adult patients with EoE
in the Norwegian population, based on histology, EEsAI score
and body weight of the first included patients.
Methods: Patients 18–60 years with diagnosed EoE (esophageal
biopsies showing ≥15 eosinophils/hpf and with EoE-symptoms)
underwent a SFED for 6 weeks. Upper endoscopies with biopsies
of the proximal, middle and distal part of the esophagus,
S77
impedance manometry, blood tests and anthropometric mea-
surements were taken at baseline and after SFED. All
participants answered the EEsAI at baseline and after SFED.
Self-reported compliance with the diet was assessed, after 3
and 6 weeks. Oral supplements (Elemental 028 and Provide
Xtra) were prescribed and recommended to all patients.
Results: 10 patients were included by April 2017, and four (75%
male, mean age 28 y) had completed the SFED (3 excluded
after baseline measurements, 3 are undergoing SFED). After
SFED, EEsAI scores decreased in three patients, and increased
in one. All four had a decrease in eosinophilic cell count, food
triggers were identified in two. Weight loss, 1–5 kg, happened
in all patients, but least in those using oral supplements.
Conclusion: A 6week SFED improved dysphagia and reintro-
duction identified food triggers in a subset of adult Norwegian
patients with EoE. Still, a SFED is very restricted and led to
weight loss in all patients. The role of a dietician is important to
achieve adequate nutritional intake.
Disclosure of Interest: None declared.
SUN-P065
FAT-FREE MASS IS A STRONG PREDICTOR OF ORAL ENERGY
INTAKE IN SHORT BOWEL PATIENTS
C. Bétry1, M. Lauverjat2, T. Mouillot3, C. Bergoin2, D. Barnoud2,
S. Ait2, C. Chambrier2 *. 1University of Nottingham,
Nottingham, United Kingdom, 2Hospices Civils de Lyon, Pierre
Bénite, 3CHU de Dijon, Dijon, France
Rationale: The oral energy intake (OEI) is associated with
intestinal adaptation and reduced dependence of parenteral
nutrition in short bowel (SB) patients. Besides, it could be one
of the key factors for the glucagon-like peptide-2 analogue
efficacy. The purpose of this study was to determine the main
factors modulating the OEI in SB patients.
Methods: Data were retrospectively collected from patient
records. SB patients on parenteral nutrition were included if
they had received from a nutritional assessment including
indirect calorimetry, DEXA, dietary records, anthropometric
measurements, blood and stool tests. We excluded patients
with paediatric SB syndrome. Univariate and multivariate
analyses were performed to determine the associations
between OEI and the parameters collected during the
nutritional assessment.
Results: The patients (24 males and 14 females) had a median
age of 63 years [IC95%: 37–77]. The major cause of SB syndrome
was mesenteric ischemia (63%). The median period between
the bowel resection and the nutritional assessment was 52
months [IC95%: 16–214]. OEI was positively correlated with
weight, fat-free mass (FFM), hand-strength, resting energy
expenditure and negatively correlated with triiodothyronine
(T3). None of the parameters related to the parenteral
nutrition and the gastrointestinal function was correlated
with the OEI. When all significant variables were entered into
the regression model, only FFM remained correlated with OEI
independently of all other parameters (P = 0.011).
Conclusion: FFM is a strong predictor of OEI in SB patients. Even
if one limitation of this retrospective study is the lack of
information on physical activity, our results suggest that
improving the FFM with physical activity programs could be a
way to stimulate the OEI in SB patients.
Disclosure of Interest: None declared.
S78
SUN-P066
LIVER FIBROSIS IN WOMEN WITH NONALCOHOLIC FATTY
LIVER DISEASE USING BIOELECTRICAL IMPEDANCE ANALYSIS:
A CROSS-SECTIONAL STUDY
D. Uehara1 *, A. Naganuma1, T. Hatanaka1, T. Hoshino1,
H. Funakoshi2, Y. Ogawa2, M. Inagawa2, T. Tanaka2, T. Ogawa2,
K. Sato3, S. Kakizaki4. 1Department of Gastroenterology,
2
Nutrition Support Team, Takasaki General Medical Center,
National Hospital Organization, Takasaki, Gunma,
3
Department of Medicine and Molecular Science, 4Department
of Medicine and Molecular Science, Gunma University,
Maebashi, Gunma, Japan
Rationale: The information obtained through body compos-
ition analysis (BIA) has been utilized for evaluating the severity
of liver cirrhosis. The phase angle (PA) is a strong survival
predictor of hepatocellular carcinoma than traditional nutri-
tional indicators such as body measurement and blood tests. We
measured female patients with nonalcoholic fatty liver disease
(NAFLD) using the BIA method. A cross-sectional study was
performed to clarify whether each data obtained is useful for
evaluating liver fibrosis.
Methods: The subjects were 21 women diagnosed with NAFLD
from September 2014 to December 2016 at our hospital.
Height, weight, and grip strength were measured. The PA, body
cell mass (BCM), extracellular water/total body water (ECW/
TBW) ratio, skeletal muscle mass index (SMI), percent body fat
(PBF), and lower limb muscle mass/upper limb muscle mass
ratio (L/U LMM ratio) were obtained by InBody S10TM (InBody
Co. Ltd., Seoul). Fibrosis-4 (FIB4) was the marker for evaluating
liver fibrosis. We examined whether each data obtained with
the BIA method, grip strength, and age correlated with FIB4
using the Spearman correlation coefficient.
Results: The average age, BMI, PA, PBF, grip strength, and FIB4
were 60.5 ± 11.5 years, 26.0 ± 3.8 kg/m2, 5.25 ± 0.47, and
38.4 ± 6.7%, 23.1 ± 4.5 kg, and 2.31 ± 2.30, respectively. The
correlations between FIB4 and each item were as follows; PA
(r = −0.758, P < 0.0001), BCM (r = −0.452, P = 0.04), ECW/TBW
ratio (r = 0.544, P = 0.011), SMI (r = −0.234, P = 0.308), PBF
(r = 0.401, P = 0.072), L/U LMM ratio (r = 0.579, P = 0.006), grip
strength (r = −0.777, P < 0.0001), and age (r = 0.657, P = 0.001).
Conclusion: In women with NAFLD, the PA and grip strength
were very strongly correlated with FIB4. We plan to investigate
whether the PA and grip strength are related to long-term
prognosis of NAFLD in women in the future.
Disclosure of Interest: None declared.
SUN-P067
LOW MUSCLE ATTENUATION BEFORE LIVER
TRANSPLANTATION, LENGTH OF HOSPITAL AND ICU STAY AND
SURVIVAL IN PATIENTS AFTER LIVER TRANSPLANTATION
D. Bot1 *, A. Droop1, M. Lelieveld2, A. Donker1,
S. Shahbazi Feshtali3, J. Langius2, B. V. Hoek4. 1Dietetics,
Leiden University Medical Center, Leiden, 2Dietetics, The
Hague University of Applied Sciences, Den Haag, 3Radiology,
4
Hepatology and Gastroenterology, Leiden University Medical
Center, Leiden, Netherlands
Rationale: Malnutrition, characterised by loss of muscle mass,
is highly prevalent in patients receiving a liver transplant.
Computed Tomography (CT) is a reference method for analysing
Poster
muscle mass (MM) and provides the possibility to analyse the
quality of muscle mass by measuring the fat infiltration
(myosteatosis). This study aimed to identify the relationship
between low muscle attenuation (MA) and postoperative length
of hospital stay, duration of ICU stay and two-year survival rate
after liver transplantation.
Methods: 27 patients receiving liver transplantation were
included in this retrospective cohort study. MA was assessed by
a trained researcher on pre-operative CT scans at the level of
L3 using SliceOmatic (Tomovision, Canada). Cut-off values for
low MA were defined as a mean Hounsfield Unit (HU) of MM <41
(BMI < 24.9 kg/m2) or <33 (BMI ≥ 25.0 kg/m2). The difference in
postoperative length of (ICU) stay and survival between
patients with and without low MA before liver transplant was
analysed by respectively Mann-Whitney test and log rank test.
Results: CT scans of 21 patients (86% male, mean age 52 ± 12
year) were eligible for analysis. Mean MAwas 43.0 ± 7.5 HU. Low
MA was prevalent in 4 patients In this small group, low MA did
not lead to statistically significant prolonged length of hospital
stay ( p = 0.47) or a higher number of days in ICU ( p = 0.33),
although mean stay in ICU was higher in the low MA group. Two-
year survival rates were significant higher in the group without
low MA compared to the group with low MA ( p < 0.03).
Conclusion: Low MA before liver transplantation might be a
negative prognostic factor for survival in patients after
transplantation. To confirm this finding a study with a large
sample size is needed.
Disclosure of Interest: None declared.
SUN-P068
IONIZATION OF MAGNESIUM OCCURS IN SMALL INTESTINAL
LUMEN WITHOUT GASTRIC ACID INFLOW IN MICE
E. Tominaga1,2 *, K. Fukatsu1, Y. Nishihara2, S. Murakoshi1,
M. Ri3, T. Watanabe1, M. Noguchi1, N. Yamada2, M. Ohnawa2,
H. Yasuhara1. 1Surgical Center, The University of Tokyo
Hospital, 2Yoshida Pharmaceutical Co., Ltd., 3Gastrointestinal
Surgery, The University of Tokyo hospital, Tokyo, Japan
Rationale: Ionization of Mg by gastric acid is believed to be
essential for Magnesium Oxide (MgO) to exert its laxative
effect. However, our previous study demonstrated that
administration of gastric acid secretion inhibitors such as a
Proton Pump Inhibitor or H2 Blocker together with MgO does not
reduce Mg2+ levels in the small intestinal and colonic lumen,
thereby maintaining the laxative effect. In the present study,
we measured Mg2+ levels in the small intestines of mice to
which MgO had been directly administered into the small
intestinal lumen.
Methods: Male ICR mice (6 weeks old, n = 29) were randomized
to the MgO375 (375 mg/kg of MgO, n = 8), MgO750 (750 mg/kg,
n = 7), MgO1,125 (1,125 mg/kg, n = 7) and control groups
(n = 7), respectively. To avoid the influence of gastric acid and
the outflow of small intestinal contents into the colon, gastric
pylorus and distal colon were ligated. MgO solution or distilled
water (control) was injected into the small intestinal pouch. At
1 hour after injection, the small intestine was harvested, and
Mg2+ levels in the small intestinal washings were measured.
Results: Mg2+ levels in the washings were significantly higher in
all of the MgO groups than in the control group. Although the
MgO750 group showed significantly higher Mg2+ levels than the
MgO375 group, the MgO1,125 group had no additive effect as
Liver and gastrointestinal tract 1
compared with the MgO375 group. Mg2+ levels in small
intestinal washings obtained 1 hour after MgO injection
MgO dose 0 (Control, MgO375 MgO750 MgO1,125
(mg/kg) n = 7) (n = 8) (n = 7) (n = 7)
Mg2+ levels 0.88 ± 0.08 3.55 ± 0.37* 6.12 ± 1.02*,† 4.61 ± 0.63*
(mmol/L)
Means ± S.E.
*: p < 0.01 vs. Control
†
: p < 0.01 vs. MgO375
Conclusion: Ionization of Mg is observed in the small intestinal
lumen even when influx of gastric acid into the small intestine
is blocked. Lack of a dose-dependent Mg2+ increase may suggest
that a moderate dosage of MgO is optimal for achieving Mg
ionization in the small intestine.
Disclosure of Interest: E. Tominaga Other: Yoshida Pharmaceutical Co.,
Ltd, K. Fukatsu Grant/Research Support from: Yoshida Pharmaceutical
Co., Ltd, Y. Nishihara Other: Yoshida Pharmaceutical Co., Ltd,
S. Murakoshi: None declared, M. Ri: None declared, T. Watanabe:
None declared, M. Noguchi: None declared, N. Yamada: None declared,
M. Ohnawa: None declared, H. Yasuhara: None declared.
SUN-P069
INDICATORS OF PARENTERAL NUTRITION ASSOCIATED LIVER
FUNCTION TEST ALTERATION IN HOSPITALIZED ADULT
PATIENTS
E. Leiva-Badosa1 *, J. Llop-Talaveron1, C. Esteban-Sánchez1,
M. Colls-González1, T. Lozano-Andreu1, A. Suárez-Lledó1,
M. Badía-Tahull1. 1Pharmacy Department, Hospital De
Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
Rationale: In order to prevent or treat parenteral nutrition
(PN) associated liver disease in adult hospitalized patients
treated with PN, we studied which liver function test (LFT)
increase was more associated with PN.
Methods: Patients with >7 days of PN containing 0.8 g/kg/day
of olive/soybean lipid emulsion treated between 2015 and
2017, without liver disease, normal LFT values at the beginning
of NP were included. Patients were followed until the beginning
of oral/enteral feeding, triglycerides ≥3 mmol/L, or patient
transferred to ICU. Data were: demographics (sex, age);
clinical (diagnostic, infection, surgery, mortality); nutritional
(indication, days of PN); and analytical (C-reactive protein
[CRP], glucose, creatinine, triglycerides, prealbumin and LFT:
gamma-glutamyl transferase [GGT], alkaline phosphatase
[AP], alanine aminotransferase [ALT] and total bilirubin
[BIL]). 4 multiple linear regressions were developed to study
the association of each LFT with clinical variables. SPSS v.22
was the software used.
Results: 177 patients (27.1% woman, 66.8 ± 12.9 years) treated
with PN and followed for 8.5 ± 6.7 days. Final follow-up was due
to oral/enteral nutrition initiation in 67.8%. 48% had increases
of ≥2-fold the upper limit of normality (ULN) of GGT and 10.7%
of AP.
In the multivariate analysis, increases in GGT were associated
with days with PN (0.07, CI 95% 0.02–0.12) and surgery (1.11, CI
95% 0.36–0.18), and AP with days with PN (0.14, CI 95% 0.11–
0.16), infection (0.35, CI 95% 0.05–0.66), PCR increase (−0.000,
CI 95% −0.004–0.001) and surgery (0.48, CI 95% 0.13–0.82), BIL
only was associated with surgery (1.73, CI 95% 0.16–3.31). ALT
did not have any association.
S79
Conclusion: GGT increase is only associated with days of PN and
surgery, being the LFT recommended for the detection of
patients with LFT alterations associated with PN.
Disclosure of Interest: None declared.
SUN-P070
THE EFFICACY OF A THREE-DIMENSIONAL PRINTED TRAINING
SIMULATOR FOR PERCUTANEOUS ENDOSCOPIC
GASTROSTOMY OF THE STOMACH
H. K. Na1 *, G. H. Lee1, J. Y. Ahn1, J. H. Lee1, D. H. Kim1,
K. W. Jung1, K. D. Choi1, H. J. Song1, H.-Y. Jung1.
1
Gastroenterology, Asan Medical Center, Seoul, Korea,
Republic Of
Rationale: We developed a novel training simulator for
percutaneous endoscopic gastrostomy (PEG) and determined
its efficacy for improving the skills in PEG beginners.
Methods: This gastrostomy simulator was made using three-
dimensional (3D) printing technology with readily obtainable
materials. Gastrostomy simulator consists of 2 type of method,
pull and introducer type. We enrolled 20 participants consisting
of 10 beginners who had no experienced with PEG insertion and
10 experienced endoscopists with PEG insertion. We recorded
the simulation time, self-evaluation and difficulty score for
PEG insertion in the participants using 5 score scale and,
subsequently, simulator performance was assessed with a
questionnaire using 7-point Likert scale.
Results: The mean times to completion of PEG simulation
decreased from 11.9 ± 5.2 to 9.0 ± 4.0 minutes for pull type
simulator and 13.8 ± 7.0 to 12.0 ± 5.8 minutes, respectively in
beginner group. The mean self-evaluation scores of beginners
were increased from 2.2 ± 1.1 to 3.1 ± 0.7 ( pull type) and from
2.2 ± 1.2 to 3.3 ± 0.8 (introducer type), respectively. The mean
procedure difficulty scores of beginners were decreased from
3.4 ± 1.1 to 2.7 ± 0.9 ( pull type) and from 4.4 ± 0.5 to 3.0 ± 0.8
(introducer type), respectively. Improvement of skill score was
6.3 ± 1.2 by the beginner group. The general realism score of
the simulator for endoscopic handling was judged to be
6.0 ± 0.9 by the experienced group.
Conclusion: This new easy-to-manufacture PEG insertion
simulators can be useful for training in beginners and shows
good efficacy and realism.
Disclosure of Interest: None declared.
SUN-P071
THE ROLE OF GLUCOSE, INSULIN, AND GLUCAGON DURING
LIVER REGENERATION AFTER PARTIAL HEPATECTOMY
H.-S. Lai1 *, S.-L. Lai1, S.-C. Wu1, W.-J. Chen1. 1Department of
Surgery, National Taiwan University Hospital, Taipei, Taiwan,
Province of China
Rationale: Engergy substrate either creatine phosphate (CP) or
adenosine triphosphate (ATP) decreased markedly during liver
regeneration (LR) after partial hepatectomy (PH). This study
evaluated the role of glucose, insulin, and glucagon during LR
after PH.
Methods: Male Wistar rats weighing 200g with 67% PH was
performed. They were randomizedly assigned into Gr HG: high
glucose iv infusion; Gr I: insulin; Gr G: glucagon; Gr I + G:
insulin + glucagon injection; Gr C: control; and Gr S: sham
operation. All rats were sacrificed at 6, 24, 48, 72 h after PH.
S80
Transmission electron microscope (TEM), high energy phos-
phate (HEP) including CP, ATP in remnant liver, serum glucose,
insulin, glucagon level were measured. Remnant liver weight/
body weight (RLW/BW) ratio, DNA content, DNA synthetic rate,
in remnant liver were used as LR indicators.
Results: HEP (ATP and CP) in remnant liver decreased sharply
after PH. TEM revealed that glycogen in the cytoplasm of
hepatocyte disappeared at 6 h after PH. Serum glucose, insulin
decreased markedly with no change of glucagon at 6, 24 h after
PH. Increased LR including RLW/BW ratio, DNA content, DNA
synthetic rate was noted in HG, I + G groups rats (Table 1).
Table 1: DNA Synthetic Rate with [3H]-Thymidine Incorporation (DPM/mg DNA).
Group Before 6h 24 h 48 h
HG 582 ± 78 1732 ± 200 80123 ± 8111* 18322 ± 1723*
Insulin 569 ± 75 886 ± 202# 50882 ± 6871# 11224 ± 1802
Glucagon 602 ± 68 1611 ± 296 67212 ± 7789 12321 ± 1738
I+G 547 ± 59 2547 ± 442* 82117 ± 11767* 16471 ± 2112*
Control 512 ± 67 1502 ± 301 64099 ± 6428 12583 ± 2041
Sham 592 ± 64 562 ± 72 571 ± 89 508 ± 77
Mean ± SD; *p < 0.01 more than Control; #p < 0.01 less than Control
Conclusion: A marked consumed HEP with disappeared
glycogen in remnant liver occurred at early stage after PH.
HG and I + G rats have a better LR. It might indicate that glucose
is the predominant energy substrate during LR after PH. Insulin
plus glucagon can also play an important role for LR.
Disclosure of Interest: None declared.
SUN-P072
LOW SKELETAL MUSCLE MASS IS ASSOCIATED WITH
INCREASED HOSPITAL COSTS IN PATIENTS WITH CIRRHOSIS
LISTED FOR LIVER TRANSPLANTATION
J. Van Vugt1 *, S. Buettner1, L. Alferink2, N. Bossche3,
R. de Bruin1, S. Darwish Murad2, W. Polak1, H. Metselaar2,
J. Ijzermans1. 1Surgery, 2Hepatology, 3Compliance and Control,
Erasmus MC University Medical Center, Rotterdam,
Netherlands
Rationale: Low skeletal muscle mass (sarcopenia), a feature of
malnutrition, is associated with increased morbidity and
mortality in liver transplant candidates. Our aim was to
investigate the association between sarcopenia and hospital
costs in patients listed for liver transplantation (LT).
Methods: All patients with cirrhosis listed for LT between 2007
and 2014 were identified. Patients listed with high urgency or
for acute liver failure or re-transplantation were excluded.
Skeletal muscle mass was measured on computed tomography
(skeletal muscle index [SMI], cm2/m2) performed <90 days from
list placement. Sex-specific quartiles were created. The lowest
quartile represented patients with sarcopenia.
Results: In total, 363 patients were listed during the study
period, of which 225 were included. Median time on the waiting
list was 169 (IQR 46–306) days and median MELD-score was 16
(IQR 11–20). The median total hospital costs in patients with
sarcopenia were €11,294 (IQR 3,570–46,469) compared with
€6,878 (IQR 1,305–20,683) in patients without sarcopenia
( p = 0.008). In multivariable regression analysis, an incremen-
tal increase in SMI was significantly associated with a decrease
in total costs (€458 per incremental SMI, 95%CI 14–902,
p = 0.043), independent of the total time on the waiting list.
Although costs of hospitalization for LT did not significantly
Poster
differ between patients with and without sarcopenia, a
significant difference was found when these costs were added
to the waiting list costs (€98,703 [IQR 75,909–121,071] versus
€81,982 [IQR 58,999–111,497], p = 0.037).
Conclusion: Sarcopenia is independently associated with
increased health-related costs for patients on the waiting list
for liver transplantation. Optimizing skeletal muscle mass may
therefore lead to a decrease in hospital expenditure, in
addition to greater health benefit for the transplant candidate.
Disclosure of Interest: None declared.
SUN-P073
72 h SARCOPENIA IS ASSOCIATED WITH INCREASED HOSPITAL
EXPENDITURE IN PATIENTS UNDERGOING CANCER SURGERY
4022 ± 683
3362 ± 508
OF THE ALIMENTARY TRACT
3726 ± 495 J. Van Vugt1 *, S. Buettner1, S. Levolger1,
3907 ± 606
R. Coebergh van den Braak1, M. Suker1, M. Gaspersz1,
3187 ± 412
614 ± 65 R. de Bruin1, C. Verhoef2, C. van Eijck1, N. Bossche3,
B. Groot Koerkamp1, J. Ijzermans1. 1Surgery, Erasmus MC
University Medical Center, 2Surgical Oncology, Erasmus MC
Cancer Institute, 3Compliance and Control, Erasmus MC
University Medical Center, Rotterdam, Netherlands
Rationale: Sarcopenia is associated with poor postoperative
outcomes in cancer patients. Furthermore, it is associated with
increased healthcare costs in the United States. We investi-
gated its effect on hospital expenditure in a Western-European
healthcare system, with universal access.
Methods: Skeletal muscle mass (assessed by computed
tomography), patient characteristics, and costs were obtained
for patients who underwent major curative-intent abdominal
cancer surgery from 2005 to 2015. Sarcopenia was defined
based on pre-established cut-offs. The relationship between
sarcopenia and hospital costs was assessed using linear
regression analysis and Mann-Whitney U-tests.
Results: 501 patients were included (median age 64 (inter-
quartile range 58–72), 60.5% males). The majority of patients
had an ASA-classification of 1–2 (79.2%). Most patients
underwent a resection for colorectal cancer (36.3%, N = 182),
while 137 (27.3%) underwent surgery for colorectal liver
metastases, 126 (25.1%) for primary liver tumours, and 56
(11.2%) for pancreatic or periampullary cancer. In total, 45.3%
of patients had sarcopenia. Total hospital costs per patient in
the sarcopenia group were €2,813 higher compared with the
non-sarcopenia group (€17,953 versus €15,140; P < 0.001).
Total costs increased with lower sex-specific quartiles of
skeletal muscle mass (P = 0.003). Sarcopenia was associated
with higher costs in patients without postoperative complica-
tions, prolonged hospital stay, and in patients undergoing
major surgery. After adjustment for confounders, sarcopenia
was associated with a cost increase of €4,688 (P = 0.004).
Conclusion: Sarcopenia was independently associated with
increased hospital costs of about €5,000 per patient. Strategies
to reduce sarcopenia could reduce hospital costs in an era of
incremental healthcare costs and an increasingly ageing
population.
Disclosure of Interest: None declared.
Nutrition and cancer 1 S81

SUN-P074 remnant bowel anatomy. Recently, the idea that grading

HANDGRIP STRENGTH AND ADDUCTOR POLLICIS MUSCLE severity of SBS−IF is based on magnitude of PS volume needs
THICKNESS IN MALES IN PALLIATIVE CARE FOR led to this clinical trial data post hoc analysis of pts with SBS−IF
HEPATOCELLULAR CARCINOMA: PRELIMINARY DATA based on their baseline PS volume.
J. M. F. Sicchieri1 *, A. P. Paganno1, C. Passos1, M. Pereira1, Methods: STEPS (NCT00798967; EudraCT2008-006193-15): a
C. Manca1, A. Teixeira2, P. Chiarello1. 1Division of Nutrition and 24-week, placebo (PBO)–controlled study of teduglutide (TED)
Metabolism, Department of Internal Medicine, 2Division of 0.05 mg/kg/day in pts with SBS−IF. Three baseline PS volume
Hepatology, Department of Internal Medicine, University groups were evaluated: GrpI, ≤9 L/wk; GrpII, >9 to ≤18 L/wk;
Hospital, Faculty of Medicine of Ribeirão Preto, University of and GrpIII, >18 L/wk.
São Paulo, Brazil, Ribeirao Preto, Brazil Results: The predominant diagnosis leading to SBS−IF in GrpI
(12/28; 43%) and GrpII (15/41; 37%) was vascular gut
Rationale: Hepatocelular carcinoma (HCC) is a tumor predom- complications; in GrpIII (8/16; 50%), Crohn’s disease. Baseline
inant in males, of rapid evolution. Patients diagnosed with HCC PS volume and TED-induced volume reduction (% change) at
usually present ascites and loss of muscle mass. Furthermore,is Wk24 was highest in GrpIII (Table). Evaluation of individual pt
necessary to follow these variations to decide more specific response showed a close, linear, significant correlation
nutritional strategies. The objective of this study is to between absolute PS volume reduction at Wk24 in relation to
characterize the nutritional status of patients diagnosed with TED treatment and daily volume at baseline (y = −0.387x +
HCC in palliative care at Hospital das Clínicas, Medical School of 90.03, R2 = 0.61; P < 0.0001); no significant correlation was
Ribeirão Preto-USP (HCFMRP-USP). observed in the PBO group (y = −0.06x−220.15, R2 = 0.02;
Methods: A review of the medical records for the of nutritional P = 0.36). Adverse events were reported by 93% (GrpI), 80%
assessment to obtain data in the first consultation such as (GrpII), and 71% (GrpIII) of TED pts.
dynamometry and adductor pollicis muscle thicknes (APMT).
All variables were compared using non-parametric tests
Baseline PS Volume
(Wilcoxon and Mann Whitney). The associations between
variables were analyzed by Pearson’s nonparametric correl- ≤9 L/wk >9–≤18 L/wk >18 L/wk
ation test, with p > 0.05. Mean (SD) TED, PBO, TED, PBO, TED, PBO,
Results: 22 males were attended from August 2016 to January PS Volume, n = 15 n = 13 n = 20 n = 21 n=7 n=9
2017. The avarage of body mass index (BMI) in the first Actual Based
assessment was 25,5 kg/m², for dynamometry 23,3 kg and Baseline, 806.9 856.1 1791.8 1870.2 3826.1 3527.4
APTM 11,6 mm. A positive correlation between the APTM and mL/day (328.11) (310.24) (338.33) (408.27) (715.49) (749.04)
dynamometry ( p value = 0.0019; R = 0,6) Change at −28.5 −29.2 −33.5 −19.1 −36.7 −14.9
Wk24, % (18.45)* (35.49)† (20.97)‡ (20.40)‡ (13.97) (17.07)§
Conclusion: Although the sample size limits some inferences,
predictors of lean mass (dynamometry and APTM) have already *n = 13; †n = 12; ‡n = 19, §n = 8.
been depleted since the beginning of treatment, including in
patients with normal BMI, suggesting attention among these
nutritional parameters in the follow-up. Conclusion: Higher baseline PS volume in pts with SBS−IF
correlates with greater absolute reduction in PS volume with
References
TED treatment.
White JV, Guenter P, Jensen G, Malone A, Schofield M. Academy
Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E. Disclosure of Interest: P. Jeppesen Consultant for: Shire, Speaker
N. Board of Directors. Consensus statement: Academy of Nutrition Bureau of: Shire, S. Gabe Consultant for: Shire, D. Seidner Consultant
and Dietetics and American Society for Parenteral and Enteral for: Shire, H.-M. Lee Other: Employee for Shire, C. Olivier Other:
Nutrition: characteristics recommended for the identification and Employee for Shire.
documentation of adult malnutrition (undernutrition). Journal of
Parenteral & Enteral Nutrition; 2012 May;36(3):275–83.
Disclosure of Interest: None declared. Nutrition and cancer 1
SUN-P076
SUN-P075
EFFECTS OF ORAL NUTRITION SUPPORT ON QUALITY OF LIFE
PATIENTS WITH SHORT BOWEL SYNDROME STRATIFIED BY
IN CACHECTIC PANCREATIC CANCER PATIENTS
BASELINE PARENTERAL SUPPORT VOLUME: POST HOC
ANALYSIS OF THE CLINICAL EFFECT OF TEDUGLUTIDE A. Coker1 *, D. B. Hopanci2, N. Oruc3, A. Aydin3, R. Uslu2,
E. Goker2. 1General Surgery HPB Unit, 2Medical Oncology,
P. B. Jeppesen1 *, S. M. Gabe2, D. L. Seidner3, H.-M. Lee4, 3
Gastroenterology, EGE University, Izmir, Turkey
C. Olivier5. 1RIGSHOSPITALET, Copenhagen, Denmark, 2St
Mark’s Hospital, Northwick Park, United Kingdom, 3Vanderbilt Rationale: Pancreatic cancer is one of the most leading factor
University Medical Center, Nashville, 4Shire Human Genetic of cachexia, severe weight loss and muscle wasting. There is
Therapies, Inc., Lexington, United States, 5Shire International limited evidence into the use of Home Enteral Nutrition (HEN)
GmbH, Zug, Switzerland in ERAS era.
Methods: One hundred and fifty two pancreatic cancer(PanCa)
Rationale: Parenteral support (PS) volume needs vary depend-
patients with severe weight loss preoperatively more than 10%
ing on disease severity in patients ( pts) with intestinal failure
and 73 patients with ampullary tumor as a control patients
associated with short bowel syndrome (SBS−IF). Pt classifica-
evaluated retrospectively. Following discharge from a hospital,
tion has focused on the diagnosis that led to resection and the
oral feeding and oral nutrition support (specialized formula for
S82
cancer patients) has been started. At the end of 2nd month,
weight, quality of life (QLQ-C30 data) and ability to start
adjuvant therapy have been evaluated.
Results: QLQ-C30 improvement values were higher in cachectic
pancreatic cancer patients compared with the ampullary
tumors. Baseline QoL was measured as median of 61 ± 2.61 in
PanCa. Overall Quality of Life was 74 ± 3.05 after ONS ( p <
0.05), in pancreas cancer. Fatigue symptom score was 47 ± 3.81
after operation and 31 ± 4.69 and 24 ± 7.85 after ONS for 2
months and before starting adjuvant therapy respectively
( p < 0,05).
Conclusion: ONS after primary treatment of pancreas cancer
had positive impact on patients’ overall QoL and its compo-
nents or on main symptoms.
References
1. Wesseltoft-Rao N, Hjermstad MJ, Ikdahl T, Dajani O, Ulven SM,
Iversen PO, Bye A. Comparing two classifications of cancer cachexia
and their association withsurvival in patients with unresected
pancreatic cancer. Nutr Cancer. 2015;67(3):472–80.
2. Moningi S, Walker AJ, Hsu CC, Reese JB, Wang JY, Fan KY, Rosati
LM, Laheru DA, Weiss MJ, Wolfgang CL, Pawlik TM, Herman JM.
Correlation of clinical stage andperformance status with quality of
life in patients seen in a pancreasmultidisciplinary clinic. J Oncol
Pract. 2015 Mar;11(2):e216–21.
Disclosure of Interest: None declared.
SUN-P077
ADIPOSE-TISSUE DERIVED FACTORS AS POTENTIAL
BIOMARKERS OF CANCER CACHEXIA
A. Saray1 *, V. Papovic2, S. Glavas2, I. Rasic3. 1Gastroenterology
and Hepatology, 2Clinical Center University of Sarajevo,
Sarajevo, Bosnia and Herzegovina, 3Abdominal Surgery,
Clinical Center University of Sarajevo, Sarajevo, Bosnia and
Herzegovina
Rationale: Due to the role of adipose tissue in mediating human
metabolism, identification of prognostic biomarkers of fat loss
in cancer cachexia are crucial to achieve better outcomes for
cancer patients. The aim of the study was to analyze the role of
adipose-tissue derived adipokines in predicting cachexia in
cancer patients.
Methods: We evaluated 67 male patients with newly diagnosed
GI cancer Serum adiponectin (ADP), leptin (L), ghrelin, tumor
necrosis factor-alfa (TNF-alfa), and interleukin 6 (IL 6) were
tested at baseline and after a follow-up period of 6 months. Our
primary endpoint was 10% weight loss within 6 months.
Receiver operating characteristics (ROC) analysis was employed
to calculate the area under the curve (AUC). Survival analysis
used the Kaplan-Meier curve and the Cox proportional hazards
model.
Results: 41 of 67 patients met the primary endpoint. ADP levels
were inversely correlated with leptin levels (rho = −0.431,
P < 0.01) in patients showing weight loss (WL). Thus, ADP
concentration were corrected by leptin values (A/L ratio).
Ghrelin, TNF-alfa and IL-6 levels showed an overall increase in
the WL group, but the difference was statistically not
significant. High A/L ratio was the only independent predictor
of cachexia (beta = 0.655, P < 0.001). At ROC analysis the
diagnostic profile of A/L (AUC 0.962;sensitivity 83%;specificity
98%) in detecting cachexia was superior to that of leptin alone
(AUC 0.798;sensitivity 72%;specificity 81%). Kaplan-Meier
Poster
global survival analysis revealed a low A/L ratio was associated
with an increased survival compared to patients with high A/L
ratio (Cox F test = 2.260, P < 0.05).
Conclusion: This study suggests that the combined measure-
ment of adiponectin and leptin (A/L ratio) might provide better
prognostic information in predicting cancer cachexia and
survival than individual parameters.
Disclosure of Interest: None declared.
SUN-P078
USING PARENTERAL NUTRITION WITH AN IMMUNE-
ENHANCING FORMULA IN TREATMENT OF METABOLIC
DISORDERS IN SURGICAL PATIENTS
N. Arikan1, A. Shestopalov2 *, A. Mitichkin3,
on behalf of O. Varnavin, V. Stets. 1Anesthesiology and ICU
Department, Inozemtsev City Clinical Hospital, 2Russian
Medical Academy of Postgraduate Education, 3Нospital
Administrator, Inozemtsev City Clinical Hospital, Moscow,
Russian Federation
Rationale: Using nutrition support program with an immune-
enhancing formula has impact on postoperative course [1,2].
The aim of the study:to determine efficiency of the post-
operative parenteral nutrition (PN) with use of the 3 in 1 system
(including Ω-3 Fatty Acids + high doses vitamin E + taurine) in
early metabolic disoders correction in the patients with
esophageal cancer.
Methods: Patients (43 men at the age of 67,9 ± 10,5 years) were
divided into two groups depending on the program of
postoperative PN(1st n = 21,2nd n = 22): in the first group
patients received PN without pharmaconutrients, and in the
second – PN including an immune-enhancing formula.
Postoperative enteral nutrition programs were identical.
Indicators of protein, lipid and carbohydrate metabolism
were determined for the 1st,3rd,5th,10th day after operation.
Parameters were analysed by SSPS.
Results: Both groups showed positive changes in the same
direction for the metabolic parameters during the period of full
PN and the subsequent period of combined parenteral/enteral
nutrition. However, in Group 2 these changes occurred more
rapidly: energy intake management 4,9 ± 0,1 day (2nd group) vs
7,0 ± 0,2 day(1st group)( p < 0,05),nitrogen balance 5,2 ± 0,3
day (2nd group) vs 8,1 ± 0,7 day(1st group)(p < 0,05),carbohy-
drate metabolism-7,4 ± 0,2 day (2nd group) vs 10,2 ± 0,3 day
(1st group)( p < 0,05). Suppurative complications:3 cases-1st
group, 2-cases 2nd group. Mortality: no significant difference.
Conclusion: PN with an immune-enhancing formula can be
used as component of an effective treatment of metabolic
disorders in the early postoperative period.
References
1. Klek S, et al. The immunomodulating enteral nutrition in malnour-
ished surgical patients//Clin. Nutr. 2011. Vol. 30. № 3. Р. 282–288.
2. Sultan J, et al. Randomized clinical trial of omega-3 fatty acid-
supplemented enteral nutrition//Br. J. Surg. 2012. Vol. 99. № 3. Р.
346–355.
Disclosure of Interest: None declared.
Nutrition and cancer 1
SUN-P079
NUTRITIONAL STATUS AND CHEMOTHERAPY-INDUCED
NEUTROPENIA
A. T. D. C. F. Barata1, C. Santos1 *, G. Nunes1, H. Mansinho1,
J. Fonseca1. 1Hospital Garcia de Orta, Almada, Portugal
Rationale: Neutropenia is the most frequent complication
associated with myelosuppression induced by chemotherapy
drugs. The frequency and severity of neutropenia may reduce
the therapeutic options for cancer patients. Recent studies
identify malnutrition as a predictive factor, both for the
development of neutropenia and for its severity. The aim of this
study was to evaluate the nutritional status prior to chemo-
therapy and its association with chemotherapy-induced
neutropenia.
Methods: Nutritional status was assessed by using Body Mass
Index (BMI), Patient Generated Subjective Global Assessment
(PG-SGA), Calf Circumference (CC) and Mid-upper arm circum-
ference (MUAC). Muscle function was evaluated by Hand Grip
Dynamometry (HGS). Patients were evaluated on the first day
of chemotherapy and the presence of neutropenia was
observed up to eight weeks after the first cycle. To establish
the association between the nutritional status and the
presence of neutropenia we used the chi-square test.
Results: Forty five patients were enrolled. According to PG-
SGA, 27 patients (60%) were undernourished prior to chemo-
therapy. Seventeen (45%) Patients developed neutropenia
within 8 weeks after the first cycle, in this patients the PG-
SGA score and the mean BMI was lower at the beginning of
treatment. We found a significant association between
nutritional status according to low MUAC and the presence of
neutropenia ( p > 0,001).
Conclusion: Patients who developed neutropenia present more
frequent and severe malnutrition before starting chemother-
apy. It is mandatory to support these patients since the moment
of the malnutrition diagnosis in order to reverse or minimize
the negative impact of malnutrition and prevent chemother-
apy-induced neutropenia.
Disclosure of Interest: None declared.
SUN-P080
THE DETERMINANTS OF REDUCED DIETARY INTAKE IN
HOSPITALISED COLORECTAL CANCER PATIENTS
K. Arthey1, A. van der Werf1 *, J. Langius1, I. Sulz2,
K. Schindler2, A. Laviano3, P. Bauer2, M. De van der Schueren1.
1
VU University Medical Center, Amsterdam, Netherlands,
2
Medical University Vienna, Vienna, Austria, 3University of
Rome, Rome, Italy
Rationale: Patients with colorectal cancer (CRC) often
experience malnutrition and weight loss, which are associated
with worse clinical outcomes. We aimed to identify the
determinants of reduced dietary intake, facilitating early
recognition and treatment, in order to optimise nutritional
intake and prevent malnutrition.
Methods: This study is based on data from nutritionDay, an
international, 1 day cross-sectional survey investigating
patient, treatment and food intake profiles of hospitalised
patients. Data were analysed using multivariate backward
logistic regression to identify predictors of dietary intake,
S83
defined as normal vs. reduced (a bit less, half or less than a
quarter) in the past week. Using a multiple mediator model we
assessed whether associations were mediated by having pain,
feeling weak, feeling tired and/or depressed.
Results: A total of 1,131 hospitalised CRC patients were
included in the analyses (65 years, 56% men, 41% stage IV).
Reduced dietary intake was associated with hospital stay of 4–7
(OR:1.91,95% CI:1.34–2.73), 8–21 (OR:1.97,95% CI:1.42–2.73)
or >21 days (OR:1.92,95% CI:1.28–2.88) vs. <4 days, being
female (OR:1.38,95% CI:1.06–1.78), cancer stage III
(OR:1.52,95% CI:1.00–2.30) or IV (OR:1.70,95% CI:1.20–2.40)
vs. I, ECOG performance status 2 (OR:1.56,95% CI:1.04–2.32), 3
(OR:2.37,95% CI:1.50–3.72) or 4 (OR:4.15,95% CI:2.51–6.86) vs.
0 and unintentional weight loss (OR:2.56,95% CI:1.94–3.37).
These predictive relationships were significantly mediated by
feeling weak and having pain.
Conclusion: A reduced dietary intake is associated with
duration since admission, sex, cancer stage, performance
status and unintentional weight loss and these associations are
partly explained by feeling weak and having pain. These factors
can be used to identify patients at risk of malnutrition. Future
studies should determine efficient methods for correcting
them to prevent malnutrition related intercurrences.
Disclosure of Interest: None declared.
SUN-P081
INDICATORS FOR PROPHYLACTIC PERCUTANEOUS
ENDOSCOPIC GASTROSTOMY PLACEMENT IN PATIENTS WITH
HEAD AND NECK CANCER UNDERGOING
CHEMORADIOTHERAPY OR CETUXIMAB-RADIOTHERAPY: A
CONSENSUS PROTOCOL
A. Kok1 *, M. J. Leermakers-Vermeer1, L. A. Devriese2,
N. Kasperts3, R. de Bree4, C. H. Terhaard3. 1Dietetics, 2Medical
Oncology, 3Radiotherapy, 4Head and Neck Surgical Oncology,
University Medical Center Utrecht, Utrecht, Netherlands
Rationale: There is (inter)nationally no consensus on how to
identify head neck cancer (HNC) patients for prophylactic
percutaneous endoscopic gastrostomy (PEG) placement. The
Utrecht Head and Neck Cancer Working Group developed a
protocol for prophylactic PEG placement in HNC patients
scheduled for chemoradiotherapy or cetuximab-radiotherapy
(CRT).
Methods: A concept protocol for prophylactic PEG placement
was developed based on our published data1 of a retrospective
chart review combined with literature research aiming at
identifying indicators for PEG placement. Expert opinions were
used to specify suggested indicators. Consensus was reached
within the Utrecht Head and Neck Cancer Working Group.
Results: According to our protocol prophylactic PEG for HNC
patients scheduled for CRT is indicated when at least one of the
following criteria applies;
• Advanced tumour (T3/T4) of the oral cavity, oropharynx or
hypopharynx
• Nasopharyngeal tumour
• Bilateral neck node radiation field (with CRT as primary
treatment)
• Weight loss >5% in 1 month or >10% in 3 months
• Low Body Mass Index (BMI); aged <65 year: BMI < 18,5 kg/m2
or aged ≥65 year: BMI < 20 kg/m2
S84
• Pre-existing swallowing disorder with inadequate nutri-
tional intake (determined by a specialized oncology
dietitian), despite nutritional interventions (counselling,
oral nutritional support)
Conclusion: The hereby presented prophylactic PEG protocol
helps to improve clinical decision making and nutritional care
for HNC patients receiving CRT. Further research will focus on
examination of sensitivity and specificity of the proposed PEG
placement indicators.
References
1. van der Linden NC, Kok A, Leermakers-Vermeer MJ, et al. Nutr Clin
Pract. 2017 Apr;32(2):225–232.
Disclosure of Interest: None declared.
SUN-P082
COMPARISON OF THE “ESPEN GUIDELINES ON NUTRITION IN
CANCER PATIENTS 2016” WITH THE RECOMMENDATIONS OF
THE DUTCH DIETITIANS IN ONCOLOGY GROUP
A. Kok1 *, N. Doornink2, M. P. Ariëns3, S. Beijer4,
M. G. A. van den Berg5, H. Jager-Wittenaar6,7, R. van Lieshout8,
B. Sytema9, M. R. van Veen4,10, J. J. L. Breedveld-Peters11.
1
Division of Internal Medicine and Dermatology, Department of
Dietetics, University Medical Center Utrecht, Utrecht,
2
Department of Dietetics, Academic Medical Center,
3
Department of Dietetics, Netherlands Cancer Institute Antoni
van Leeuwenhoek, Amsterdam, 4Department of Research,
Netherlands Comprehensive Cancer Organisation (IKNL),
Utrecht, 5Dept. of Gastro-enterology and Hepatology,
Dietetics and Intestinal Failure, Radboud University Nijmegen
Medical Center, Nijmegen, 6Research group Healthy Ageing,
Allied Health Care and Nursing, Hanze University of Applied
Sciences, 7Dept. of Oral and Maxillofacial Surgery, University
of Groningen, University Medical Center Groningen,
Groningen, 8Máxima Medical Center, Veldhoven, 9Department
of Dietetics, UMCG Comprehensive Cancer Center, Groningen,
10
Division of Human Nutrition, Wageningen University,
Wageningen, 11Department of Epidemiology, GROW – School for
Oncology and Developmental Biology, Maastricht University,
Maastricht, Netherlands
Rationale: In 2016, a completely revised second version of the
“Handbook Nutrition in Cancer” (HNC, in Dutch) by the Dutch
Dietitians Oncology Group (DDOG) was published. In this
project, the DDOG evaluated similarities and potential
discrepancies between DDOG recommendations and the
ESPEN guidelines for the identification, prevention and
treatment of reversible elements of malnutrition during and
after cancer treatment.
Methods: The recommendations of the DDOG, as published in
the HCN, were systematically compared with the ESPEN
guidelines on nutrition in cancer patients.
Results: Overall, the DDOG recommendations are in line with
the ESPEN guidelines. However, DDOG recommendations are
more detailed, comprehensive, and practical.
The DDOG and the ESPEN guidelines differ in that the DDOG (1)
recommends the comprehensive PG-SGA and PG-SGA Short
Form for screening and nutritional assessment; (2) recom-
mends to start artificial nutrition at an earlier stage; (3) does
not recommend increasing the ratio of energy from fat/energy
from carbohydrates in weight-losing cancer patients with
Poster
insulin resistance; (4) includes a less conservative recommen-
dation on increasing energy intake for prevention of refeeding
syndrome; and (5) supports a longer period of corticosteroid
use to increase appetite (4–8 weeks vs ESPEN 1–3 weeks).
Additionally, the DDOG does not include a specific advice for
parenteral nutrition composition during intensive chemother-
apy, and includes the advice to avoid fatty fish/fish oil 24 hours
before and after specific chemotherapy treatment.
Both guidelines recommend nutritional care to be accompan-
ied by exercise training.
Conclusion: The DDOG and ESPEN recommendations are
generally in line with each other, but the DDOG recommenda-
tions are more specific and practical. DDOG and ESPEN are
complementary to each other.
Disclosure of Interest: A. Kok: None declared, N. Doornink Other:
editoral member of the Hanboek Nutrition in Cancer, M. Ariëns: None
declared, S. Beijer Other: editoral member of the Hanboek Nutrition in
Cancer, M. van den Berg: None declared, H. Jager-Wittenaar Other: co-
developer of the PG-SGA based Pt-Global app, R. van Lieshout Other:
editoral member of the Hanboek Nutrition in Cancer, B. Sytema: None
declared, M. van Veen: None declared, J. Breedveld-Peters: None
declared.
SUN-P083
IMPACT OF CHEMOTHERAPY ON NUTRITIONAL STATUS AND
ORAL HEALTH IN SENIOR PATIENTS WITH BREAST CANCER
N. El Osta1, R. Saad1, N. Naaman1, J. Fakhoury1, A. Aoun2 *,
M. Hennequin3, L. El Osta1. 1Saint Joseph University, Beirut,
2
Notre Dame University - Louaize, Zouk Mosbeh, Lebanon,
3
University of Auvergne, Clermont-Ferrand, France
Rationale: In the medical management of breast cancer, oral
lesions may affect nutritional status and quality of life. This
study assessed the relationship between oral health and
nutritional status in senior breast cancer sufferers.
Methods: This was an observational cross-sectional study. A
consecutive sample of non-institutionalised elderly aged 65
years or more was recruited from oncologic and primary care
outpatient units in Beirut. Data were collected from a
questionnaire including the mini-nutritional assessment
index, the geriatric oral health assessment index (GOHAI) and
questions about perception of xerostomia. Oral examination
recorded the presence of oral lesions.
Results: A total of 117 women were included. The sample
comprised 21 breast cancer patients receiving chemotherapy,
35 receiving non-chemotherapy regimen, 31 in complete
remission without treatment and 30 non-cancer patients. 42%
of participants undergoing chemotherapy were malnourished
or at risk of malnutrition. Oral health perceptions was worst in
chemotherapy patients, followed by patients receiving non
chemo-treatment regimen and was better in participants in
complete remission and non-cancer patients ( p-value < 0.001).
The presence of oral lesions was significantly more frequent in
patients taking chemotherapy ( p-value < 0.001). Nutritional
status was linked to the breast cancer treatment regimen
( p-value < 0.001), presence of oral lesions ( p-value = 0.040),
perception of xerostomia ( p-value = 0.010), and GOHAI score
( p-value < 0.001).
Conclusion: The presence of oral lesions and chemotherapy
were highly associated with nutritional status in older patients
with breast cancer. Dental professionals should interfere
Nutrition and cancer 1
preventively and per-therapy to optimize oral health status in
elderly breast cancer patients.
Disclosure of Interest: None declared.
SUN-P084
INFLUENCE OF BOTH SKELETAL MUSCLE DEPLETION AND
LOW MUSCLE QUALITY ON PROGNOSIS OF LOCALLY
ADVANCED PANCREATIC CANCER TREATED WITH
CHEMORADIOTHERAPY: A RETROSPECTIVE STUDY
A. Naganuma1 *, T. Hoshino1, H. Yasuoka1, T. Hatanaka1,
D. Uehara1, T. Kudo1, Y. Ogawa2, M. Inagawa2, T. Tanaka2,
T. Ogawa2, Y. Kitamoto3, M. Mizuide4, K. Sato4, S. Kakizaki4.
1
Department of Gastroenterology, 2Nutrition Support Team,
3
Department of Radiation Therapy, Takasaki General Medical
Center, National Hospital Organization, Takasaki, Gunma,
4
Department of Medicine and Molecular Science, Gunma
University, Maebashi, Gunma, Japan
Rationale: Skeletal muscle depletion and low muscle quality
are poor prognostic factors for pancreatic cancer. However, the
association between skeletal muscle quality and chemora-
diotherapy (CRT) in locally advanced pancreatic cancer (LAPC)
has not yet been reported. In this study, we measured the
skeletal muscle mass and muscle quality of patients with LAPC
treated with CRT, and retrospectively examined the association
between the treatment and prognosis.
Methods: Twelve LAPC patients were treated with CRT from
August 2010 to December 2015. Radiotherapy was delivered
through 4 fields at a dose of 50.4 Gy in 28 fractions. S-1 was
administered twice, orally, at a dose of 80 mg/m2, on the day of
irradiation. Medical records were retrospectively reviewed for
laboratory results and computed tomography (CT) images. The
L3 skeletal muscle index (L3-SMI) and intramuscular adipose
tissue content (IMAC), which indicate muscle quality, were
calculated from CT images. Data were analysed using a paired t-
test, the Kaplan-Meier method, and the Cox proportional
hazards regression model.
Results: Eight patients (66.7%) were men; the median age was
72 years. The tumour locations were the pancreatic head (6
cases), and body (6 cases). The mean L3-SMI level was
38.3 cm2/m2 (2 months after CRT, 36.9 cm2/m2, p = 0.068).
The mean IMAC level was −0.347 (2 months after CRT, −0.416,
p = 0.104). The median survival time and 2-year survival rate
were 7 months and 12.5%, respectively. In the univariate Cox
regression analysis, only the C-reactive protein level at 2
months post-CRT (hazard ratio, 1.77; 95% confidence interval,
1.05–2.98; p = 0.03) was associated with mortality, while L3-SMI
and IMAC were not.
Conclusion: Low muscle quality did not contribute to poorer
survival in LAPC patients.
Disclosure of Interest: None declared.
SUN-P085
EFFECTS OF AD LIBITUM FEEDING OF A LOW CARBOHYDRATE-
HIGH FAT DIET ON SURVIVAL AND INTRAPERITONEAL TUMOR
IMMUNITY OF MICE WITH CARCINOMATOUS PERITONITIS
A. Watkins1 *, K. Fukatsu2, S. Murakoshi2, T. Watanabe3,
K. Higashizono4, M. Noguchi2, H. Yasuhara2. 1Surgical Sciences,
Graduate School of Medicine, University of Tokyo, 2Surgical
Center, The University of Tokyo Hospital, Tokyo, 3Surgery,
S85
National Defense Medical College, Saitama, 4Gastrointestinal
Surgery, Graduate School of Medicine, The University of Tokyo,
Tokyo, Japan
Rationale: Low carbohydrate-high fat diets (LCHFD) are
thought to be beneficial in nutritional therapy of cancer
patients due to the preservation of normal fat metabolism even
in advanced cancers. However, whether LCHFD would improve
survival or not remains unclear. We examined influences of ad
libitum LCHFD on survival, peritoneal inflammation, and
systemic immunity in murine carcinomatous peritonitis (CP)
model.
Methods: Exp1: Male C57BL/6J mice (8 weeks old, n = 38) were
fed normal diets (ND)(Protein 15.0%, Fat 9.0%, Carbohydrate
76.0%/kcal) or LCHFD (18.2%, 62.2%, 19.6%) for 52 days. On day
8, Panc02 cancer cells (1 × 106/body) were inoculated i.p.
Survival after inoculation, body weight (BW) changes were
recorded during this period. Exp2: Mice (n = 14) subject to the
same protocol as and in Exp.1 were killed on day 35. All
peritoneal cancer nodules were harvested and weighed.
Cytokine levels (TNF-α, MCP-1, IL-6 and IL10) of peritoneal
washings were measured using the beads array method. Spleen
was harvested of counting total NK(NK1.1+) and activated NK
(NK1.1+&CD107a+) cell numbers.
Results: LCHFD mice gained more weight than ND from day 9 to
20 (t-test). All mice showed feature of cachexia.
LCHFD ND
Survival times (day)1 34.5 ± 1.0* 38.9 ± 1.0
Peritoneal cancer nodule weight (g)2 2.4 ± 0.3* 1.6 ± 0.2
NK cell number (×102)2 132.9 ± 14.3* 178.9 ± 14.3
CD107a+NK cell number (×102)2 3.2 ± 1.3‡ 4.9 ± 1.3
TNFα(pg/mL)3 10.6 ± 2.1* 5.0 ± 2.0
MCP-1(pg/mL)3 379.3 ± 64.9 309.9 ± 60.1
IL-6(pg/mL)3 1299.1 ± 265.2† 523.5 ± 245.6
IL-10 (pg/mL)3 8.5 ± 1.4* 4.1 ± 1.3
Mean ± SE *p < 0.05, †p = 0.06, ‡p = 0.09 vs. ND (1log-rank test 2t-test, 3Mann-
Whitney U–test)
Conclusion: Ad libitum LCHFD feeding worsens survival of CP
mice together with increased peritoneal tumor mass and
cytokine levels. Impaired splenic immunity may play a role in
accelerating accelerate tumor progression by LCHFD feeding.
Disclosure of Interest: None declared.
SUN-P086
MALNUTRITION PREDICTS LONG-TERM MORTALITY IN
HOSPITALIZED GASTROENTEROLOGICAL CANCER PATIENTS
B. Knappe-Drzikova1 *, S. Maasberg1, D. Vonderbeck1,
A. Sturm1, A. Pascher2, S. Knüppel3, U.-F. Pape1.
1
Gastroenterology and Hepatology, 2General, Visceral and
Transplantation Surgery, CHARITÉ, University Medicine Berlin,
Berlin, 3Department of Epidemiology, German Institute of
Human Nutrition, Potsdam-Rehbrücke, Germany
Rationale: Malnutrition (MT) is a common problem in onco-
logical diseases, influencing treatment outcomes, and overall
survival. The present study aimed to assess the predictive
potential of nutritional status (NT) parameters as character-
ized by Subjective Global Assessment (SGA), Nutritional Risk
Screening (NRS), anthropometry, serum surrogate parameters
S86
(SP), and BIA, resp. for overall long-term mortality in
gastroenterological (GI) cancer patients ( pts).
Methods: NT was assessed in 332 pts with GI-malignancies in a
cross-sectional study by SGA and NRS scores. Body mass index
(BMI), serum albumin (sALB), and serum transferrin (sTRANS)
were determined and BIA was performed. Mid-upper arm
circumference (MUAC) and triceps skinfold thickness (TST)
were measured. Pts were followed for a mean period of 38
months (range:1–108 months).
Results: 231 pts were diagnosed as well-nourished by SGA and
238 pts by NRS, resp. By screening score results an increased
risk of or manifest MT (NRS >3, SGA B or C) was found in 101 pts
(SGA) and 94 pts (NRS). Pts with MT had highly significant lower
BMI, sALB level, sTRANS level, TST, MUAC, and PhA as compared
with the well-nourish group ( p < 0.001 for all groups; TST
p = 0.001). As relevant clinical endpoint overall survival was
analyzed. Overall 1- and 5-year survival rates (YSR) were
significantly shorter in malnourished pts: SGA: 5-YSR 51.7% vs.
11%; NRS: 5-YSR 51.8% vs. 7.0%, resp. An increased relative risk
of death was associated with PhA <4.8° (5-YSR 49.3% vs. 5%),
sALB <35 mg/dL (5-YRS 53.8% vs. 1%), and sTRANS <150 mg/dL
(5-YRS 55.6% vs. 11.1%). By multivariate analysis SGA (HR
2.924, p < 0.001), NRS (HR 3.14, p < 0.001), PhA cut off 4.8° (HR
2.032, p < 0.004) were found to be independent risk factors of
long-term mortality.
Conclusion: In the present study we demonstrated that MT
characterized by SGA, NRS, SP and BIA not only predicts short-
term but also long-term survival in GI-pts.
Disclosure of Interest: None declared.
SUN-P087
THE PROGNOSTIC IMPACT OF RADIOLOGIC ASSESSMENT OF
SACROPENIA AND OSTEOPENIA IN STAGE III COLON CANCER
C. W. Chen1,2 *, J. Y. Wang3,4, Y. T. Lou5, Y. S. Yeh2, H. L. Tsai3,4,
C. W. Huang3,4. 1Department of Emergency Medicine, College
of Medicine, Kaohsiung Medical University, 2Trauma and
Surgical Critical Care Service, Kaohsiung Medical University
Hospital, 3Department of Surgery, College of Medicine,
Kaohsiung Medical University, 4Division of Colorectal Surgery,
Department of Surgery, Kaohsiung Medical University Hospital,
5
School of Medicine, I-Shou University, Kaohsiung, Taiwan,
Province of China
Rationale: Sarcopenia and osteopenia have been proposed as
prognostic factors in some surgical cohorts. Regarding the
colon cancer patients, we hypothesized that sarcopenia and
osteopenia measured by abdominal computerized tomography
(CT) could generate influence on oncological prognostication.
Methods: Between 2008 and 2012, all UICC stage III colon
cancer patients following surgery and adjuvant chemotherapy
were enrolled for this study. Preoperative abdominal CT scans
from the patients were analyzed to identify patients with
sarcopenia and/or osteopenia. Sarcopenia and osteopenia were
assessed via total cross-sectional muscle area and coronal-
sectional bone density at the L3 vertebral level. Clinical
information and postoperative outcomes including overall
survival, postoperative recurrence and disease-free survival
were recorded by trained abstractors. Univariate, multivariate
and survival analyses were conducted for recognizing prognos-
tic factors of oncological outcome.
Poster
Results: Of 292 patients with available CT assessment of L3
vertebral level, 170 (58.2%) were male. Mean age at surgery
was 61.6 years. Follow up was available on all participants with
a mean of 26 months. 116 (39.7%) were defined as osteopenia
and 95 (32.5%) as sarcopenia. Sarcopenia and osteopenia had
no influence on overall survival. Osteopenia was associated
with higher risk of postoperative recurrence. With risk
adjustment, osteopenia demonstrated to be the independent
risk factors of postoperative recurrence (Adjusted OR = 2.44,
p = 0.011).
Conclusion: Osteopenia assessed by CT scan appeared to be a
strong prognostic factor of postoperative recurrence in this
cohort. Total psoas area and psoas density as a proxy measure of
sarcopenia did not generate prognostic impact on survival or
recurrence. Future study is strongly warranted for evaluating
whether opportunistic screening of osteopenia in a selected
population have prognostic utility.
Disclosure of Interest: None declared.
SUN-P088
COMBINATION OF ARGININE, GLUTAMINE AND OMEGA-3
FATTY ACIDS SUPPLEMENT TO PERIOPERATIVE ENTERAL
NUTRITION IN SURGICAL PATIENTS WITH GASTRIC
ADENOCARCINOMA OR GASTROINTESTINAL STROMAL TUMOR
(GIST): A PROSPECTIVELY, RANDOMIZED AND DOUBLE-
BLINDED STUDY
C.-J. Ma1 *, J.-Y. Wang2. 1General Surgery, 2Colorectal Surgery,
Kaoshing Medical University Hospital, Kaohsiung, Taiwan,
Province of China
Rationale: Enteral nutrition (EN) is preferable with immune-
modulating substrates perioperatively for patients undergoing
major abdominal cancer surgery. Perioperative immune-modu-
lating nutrients enriched EN containing arginine, glutamine
and omega-3 fatty acids was evaluated for anti-inflammatory
efficacy in patients with gastric adenocarcinoma and gastro-
intestinal stromal tumor (GIST) receiving curative surgery.
Methods: In a prospectively, randomized, double-blinded
study, 34 patients with gastric adenocarcinoma and gastric
GIST undergoing elective curative surgery were recruited and
randomly assigned to either the study group, receiving
immune-modulating nutrients enriched EN, or the control
group, receiving standard EN from 3 days before surgery (day -3)
up to post-operative day 14 or to discharge. Laboratory and
inflammatory parameters were assessed on day -3 and post-
operative visits on day 14 or at discharge. Adverse events (AEs)
and clinical outcomes were documented daily and compared
between the groups.
Results: Chosen laboratory and inflammatory parameters
before, after treatment, and net change had no significant
differences between the 2 groups. AEs and clinical outcomes,
including infectious complications, overall complications, time
to first bowel action and length of hospital stays after surgery,
were comparable in the treatment groups (all P > 0.05).
Conclusion: Imumme-modulating nutrients enriched EN had no
prominent immune-modulation effect compared to standard
EN. Curative surgery for gastric adenocarcinoma and GIST may
induce hypercatabolism and need more caloric supplement.
Disclosure of Interest: None declared.
Nutrition and cancer 1
SUN-P089
EXPERIENCE OF HOME PARENTERAL NUTRITION IN PATIENTS
WITH GASTROINTESTINAL TRACT CANCER
C.-W. Huang1 *, L.-C. Sun2, J.-Y. Wang1. 1Surgery, 2Nursing,
Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,
Province of China
Rationale: Malnutrition is common in patients with gastro-
intestinal (GI) tract cancers (up to 80%), especially in advanced
stage. We analyze the incidence and characteristics of
complications associated with home enteral nutrition (HPN)
in patients with GI tract cancers.
Methods: From January 2012 to December 2015, 159 patients
with GI tract cancers on HPN at least 7 days were analyzed. The
demographic characteristics and complications were retro-
spectively investigated.
Results: Of 149 patients, the median age was 62 (range, 24–92)
years of age. There were 93 males (62.4%) and 56 females
(37.6%). The most common two cancers were colorectal cancer
and gastric cancer, 57.0% (85/149) and 35.6% (53/149),
respectively. The majority of patients had stage IV disease
(58.4%, 87/149). The median duration of HPN was 45 (7–368)
days. The caregivers were educated adequately for aseptic
care of catheters. The median estimated necessary calories
were 1,510 (1,081–2,642) kilocalorie per day and the median
provided calories were 1,404 (732–2,320) kilocalorie per day.
The median body mass index (BMI) was 19.82 (12.80–38.87).
Ports with central venous catheters were used in 93.3% of
patients and peripherally inserted central venous catheters
were used in 6.7% of patients. Catheter-related complications
included line infection (8.7%, 13/149), line obstruction (4%, 6/
149) and line fracture (0.7%, 1/149). Catheter-associated
bacteremia was noted in 8 patients (5.4%, 8/149). HPN-
related complications included hyperbilirubinemia (6.0%, 9/
149), hyperglycemia (1.3%, 2/149), electrolyte unbalance
(4.7%, 7/149) and dehydration (1.3%, 2/149).
Conclusion: HPN is feasible and safe with low incidence of
complications in patients with GI tract cancers. An adequate
educational program for caregivers is very important in
decreasing rate of catheter-related complications.
Disclosure of Interest: None declared.
SUN-P090
COMPARISON OF THE IMPACT OF ORAL GLUTAMINE AND
HYPERCALORIC ORAL NUTRITIONAL SUPPLEMENTATION IN
LUNG CANCER PATIENTS TREATED WITH RADIOTHERAPY +/−
CHEMOTHERAPY
S. A. Ergen1, D. Çolpan Öksüz1 *, M. Şahin1, N. Kaydıhan1,
E. Sedef1, F. Ö. Dinçbaş1. 1Radiation Oncology, I.U. Cerrahpasa
Medical Faculty, Istanbul, Turkey
Rationale: Acute radiation induced esophagitis (ARIE) may
cause morbidity, weight loss and unplanned treatment delays.
We investigated and compared the effects of oral glutamine
(Glt) and hypercaloric oral nutritional supplement (HypNS) on
ARIE and body mass index (BMI) in patients who were treated
with radical radiotherapy ± chemotherapy.
Methods: Forty-four patients were included and the median
age was 59 years (31–80). Thirty-two patients received
concurrent chemoradiotherapy. All patients were treated
with IMRT with a median dose of 61.2 Gy (50.4–66). HypNS
S87
(3 × 1) were given in 22 patients, the others received Glt
(30 mg/day) starting one week before radiotherapy and
continuing for two weeks after the completion of radiotherapy.
We assessed the baseline and weekly BMI of each patient via
TANITA® body composition analyzer and blood count/chemistry
were requested weekly. Factors in each group were compared
with independent samples-t test.
Results: All patients completed the treatment without
interruption. There was no grade ≥3 ARIE in Glt group, while
grade 3 ARIE was observed in one patient in HypNS group.
Diagnosis of grade 2 ARIE was delayed by one week with the use
of Glt compared to other group. Comparisons between two
groups revealed no significant difference in weight, BMI, fat
and muscle mass change. Median albumin, transferrin, uric
acid, leukocyte levels were decreased in both groups as
C-reactive protein level was increased in HypNS group.
Conclusion: Supplementation with Glt or HypNS during
radiotherapy prevents treatment interruptions. Although diag-
nosis of grade 2 ARIE was delayed in Glt group, we couldn’t
show significant difference between two groups, with respect
to the incidence of ARIE and prevention of weight loss, change
in BMI and blood count/chemistry.
Disclosure of Interest: None declared.
SUN-P091
A NOVEL ORAL NUTRITIONAL SUPPORT IN HCC AND LIVER
DISEASE MANAGEMENT: PRELIMINARY RESULTS
E. Rinninella1 *, M. Cintoni1, L. Basso1, S. Leone1,
G. A. D. Miggiano1, A. Gasbarrini1, M. C. Mele1. 1Clinical
Nutrition, Gastroenterology Area, Fondazione Policlinico
Agostino Gemelli, Rome, Italy
Rationale: HCC and liver diseases are associated to malnutri-
tion. BIA Phase angle (PhA) is an independent prognostic factor
in patients with HCC (1,2).
Methods: From November 2016 to February 2017 HCC cirrhotic
patients of our outpatient clinic, were enrolled. Patients with a
PhA < 4.8 (2) received an oral nutritional support (Fresubin®
Hepa Drink 200 mL), at the dose of 2 bottle/day per os.
Anthropometric measures, BMI, lab tests and BIA were
performed at baseline and at 1-month control visit. Etiology,
Child Pugh, BCLC classification were also collected. Data are
summarized in median, 25th and 75th percentile or numbers.
Wilcoxon signed rank test was used to compare numerical
variables at baseline and 1-month later. A p < 0.05 was
considered statistically significant.
Results: 10/32 patients seen received Fresubin Hepa drink: 7
were in Child A, 2 in B, 1 in C; according to BCLC, 2 were in A
stage; 6 in B, 1 and 1 in C and D. Five patients had a HCV-related
cirrhosis, 2 had an alcoholic cirrhosis, 2 metabolic and 1 HBV
related cirrhosis. At 1-month visit, reactance and PhA were
significantly higher, respectively from 33.5 Ohm (27.7–37.2) to
43 (38–44) ( p = 0.03) and from 3.6 (3.2–4) to 4.6 (4.1–4.7)
( p = 0.02). No difference were seen in other anthropometric
and lab tests. No serious adverse events were registered. Only 1
patient referred nausea and 2 referred satiety after the drink.
All patient referred to like the taste.
Conclusion: Fresubin® Hepa drink is safe and effective in
malnourished cirrhotic patient affected by HCC in improving
PhA and is a valid oral support in ambulatory patients affected
S88
by liver diseases. Further studies are required to confirm these
preliminary data.
References
1. Purnak T, Yilmaz Y, Liver disease and malnutrition. Best Pract Res
Clin Gastroenterol. 2013 Aug; 27:619–29.
2. Schütte K, et al. P.Malnutrition is a prognostic factor in patients with
hepatocellular carcinoma (HCC). Clin Nutr. 2015 Dec;34:1122–7.
Disclosure of Interest: E. Rinninella Grant/Research Support from:
Fresenius, M. Cintoni: None declared, L. Basso: None declared, S. Leone:
None declared, G. A. D. Miggiano: None declared, A. Gasbarrini: None
declared, M. C. Mele Grant/Research Support from: Fresenius.
SUN-P092
ARE SERUM VITAMIN D LEVELS RELATED WITH COLORECTAL
CANCER RISK?
E. Yassıbaş1 *, G. Samur2, O. Toka3. 1Department of Nutrition
and Dietetics, Gazi University, 2Department of Nutrition and
Dietetics, 3Department of Statistics, Hacettepe University,
Ankara, Turkey
Rationale: Colorectal cancer is the third most common cancer
in Turkey. Understanding the role of nutrition which is a
modifiable risk factor in colorectal carcinogenesis is one of the
primary prevention strategies and the most of studies has
addressed the relationship between vitamin D and colorectal
cancer risk. This research was planned and conducted to
evaluate the relationship between serum vitamin D levels,
nutrition, some lifestyle factors and colorectal cancer risk.
Methods: Fifty one colorectal cancer patients who were
diagnosed in last three months and 51 age and sex matched
control who were not diagnosed cancer or colon diseases and
have no family colorectal cancer history participated to this
study. A questionnaire which include information about general
characteristics, dietary habits and food consumption frequency
was applied to all participants. Serum vitamin D levels were
analysed from were obtained blood samples. Logistic regression
analyse was made for the serum vitamin D levels.
Results: As a result, mean serum vitamin D levels was
21.41 ± 12.90 ng/mL in colorectal cancer patients and 31.22 ±
19.05 ng/mL in controls. 10 ng/mL decrease in serum vitamin D
levels increased colorectal cancer risk by 0.45 fold (OR:1.046,
95%CI:1.013–1.086). It was determined that serum vitamin D
deficiency (<20 ng/mL) increase the colorectal cancer risk
approximately 5.5 times (OR:5.452, 95%CI:1.909–15.568). It
was not found significant association between body mass index,
body fat percentage, dietary vitamin D intake and serum
vitamin D levels in both groups.
Conclusion: Developing strategies for achieve normal serum
vitamin D levels and raising awareness of healthy nutrition of
individuals are important to decrease colorectal cancer
prevalence.
Disclosure of Interest: None declared.
SUN-P093
APPROACHES AND KNOWLEDGE OF MEDICAL ONCOLOGISTS
TO NUTRITION THERAPY: A QUESTIONNAIRE STUDY
F. Kirbiyik1 *, E. Ozkan1, M. Ertugrul1. 1Nutricia Medical
Nutrition, Istanbul, Turkey
Rationale: Undernutiriton and cachexia, which are the
indicators of poor prognosis, are common in oncology patients
Poster
and nutrition therapy is an important cornerstone in the
treatment of cancer patients. Nevertheless, it has been
reported that malnutrition is often neglected, screening
techniques are not sufficient, and there is insufficient
consensus on malnutrition evaluation criteria. This study
aimed to determine the awareness and knowledge of medical
oncologists in Turkey about nutrition therapy, to evaluate their
approaches to defining malnutrition and the importance of
malnutrition in the treatment, to determine their educational
status regarding clinical nutrition, and to investigate their
educational expectations.
Methods: A questionnaire form was used to obtain demo-
graphic and occupational information of the physicians as well
as their knowledge, attitudes, and behaviors about clinical
nutrition education through two scenario cases.
Results: Among the physicians who answered the questionnaire
(n = 109), 43.1% reported that they had clinical nutrition
education and 33.9% followed the oncology sections in the
ESPEN guidelines. A scoring system was established according
to the answers given to the knowledge questions by the
physicians. There were 31 (28.4%) physicians with a knowledge
score of <3 and 78 (71.6%) physicians with a knowledge score
of ≥3 (higher level of knowledge). The rate of physicians having
clinical nutrition education and the rate of physicians following
the oncology sections in the ESPEN guidelines were significantly
higher among those with a score of ≥3 as compared with those
with a score of <3.
Conclusion: Our findings emphasized the importance of
education and suggested that routine use of clinical nutrition
would be more frequent as the knowledge and awareness of
physicians increases.
Disclosure of Interest: F. Kirbiyik Other: Employee of Nutricia Medical
Nutrition, Turkey, E. Ozkan Other: Employee of Nutricia Medical
Nutrition, Turkey, M. Ertugrul Other: Employee of Nutricia Medical
Nutrition, Turkey.
SUN-P094
PLASMA PROTEOMIC ANALYSIS OF INTRAVENOUS OMEGA-3
FATTY ACID AND GEMCITABINE IN ADVANCED PANCREATIC
ADENOCARCINOMA
F. Runau1 *, A. Arshad1, J. Isherwood1, D. Jones2, A. Dennison1.
1
Department of Hepatobiliary and Pancreatic Surgery,
University Hospitals of Leicester, 2Department of Cancer
Studies, University of Leicester, Leicester, United Kingdom
Rationale: Intravenous omega-3 fatty acid (n-3FA) for advanced
pancreatic adenocarcinoma patients receiving gemcitabine
chemotherapy shows disease stabilisation and improved pro-
gression free survival. Utilising high definition plasma proteo-
mics we aimed to elucidate the underlying biological
mechanism.
Methods: Plasma from 13 patients with histologically con-
firmed un-resectable pancreatic adenocarcinoma, collected
pre-treatment (baseline, n = 3), after one month treatment
with intravenous gemcitabine and n-3FA (treatment, n = 5) and
intravenous gemcitabine only (control, n = 5). Plasma was 99%
immuno-depleted, reduced, alkylated and tryptically
digested. A 2 × 2 (baseline vs treatment, treatment vs control
group) experimental design where each individual sample was
labelled with TMT-6plex, then combined for high-pH reversed-
phase fractionation. Fractions were injected into a QExactive-
Nutrition and cancer 1
Orbitrap LC-MS/MS and analysed on Proteome Discoverer 2.1
and Scaffold 4.7. Bioinformatic analysis was performed on
Protein Centre for Gene Ontology Biological Process (GO-BP:
p < 0.05, Bonferroni corrected), Cytoscape for visualisation and
KEGG pathway analysis.
Results: 3,476 proteins were identified with 125 significant
pancreatic cancer markers. Anti-inflammatory markers (CRP,
Haptoglobin and Serum amyloid A1) were reduced in the
treatment group. GO-BP showed a reduction in angiogenesis,
upregulation of complement immune systems and epigenetic
modifications on histones. KEGG pathway analysis identified
direct action via the Pi3K-AKT pathway, with decreased HSP90
and increased inhibitory protein 14-3-3. Serum amyloid A1 was
significantly reduced ( p < 0.01) as a potential biomarker of
efficacy for n-3FA.
Conclusion: Administration of n-3FA has anti-inflammatory,
anti-angiogenic and pro-apoptotic effect via direct mechanism
on cancer signalling pathways in patients with advanced
pancreatic adenocarcinoma.
Disclosure of Interest: None declared.
SUN-P095
MALNUTRITION AND FAT FREE MASS INDEX IN ONCOLOGIC
PATIENTS AND ITS ASSOCIATION WITH LENGTH OF HOSPITAL
STAY AND MORTALITY
F. J. Sanchez-Torralvo1, V. Contreras-Bolivar1, G. Olveira1 *,
M. Ruiz-Vico2, J. Abuin-Fernandez1, I. Lopez-Martinez2,
M. Gonzalo1. 1Endocrinología y Nutrición, 2Oncología Médica,
Hospital Regional Universitario de Malaga, Malaga, Spain
Rationale: Malnutrition and cancer cachexia occur up to in 50%
of oncologic patients. Latest ESPEN guidelines have established
cut-off points according to fat free mass index (FFMI) as a
criteria of malnutrition: 17 kg/m2 for men and 15 kg/m2 for
women.
Methods: Objective: To study the association between FFMI
and Subjective Global Assessment test (SGA) in admitted
patients with solid and hematologic neoplasms and to associate
nutritional status with length of hospital stay and mortality.
Prospective study, in hospitalised patients in Oncology and
Hematology between August 2016 and February 2017. A
complete nutritional assessment was carried out and anthropo-
metric data was gathered.
Results: 153 patients, 51.6% men and 48.4% women, aged
60.6 ± 12.5 years. BMI was 24.42 ± 4.5 kg/m2, with FFMI of
16.23 ± 2.38 kg/m2 (16.8 ± 2.13 kg/m2 for men y 15.63 ± 2.49
kg/m2 for women).
SGA found 19.5% of normo-nourished, 24.8% of moderately
malnourished and 55.7% of severely malnourished.
Stratifying according to SGA, mean FFMI in men was 18.69 kg/
m2 in normo-nourished, 16.63 kg/m2 in moderately malnour-
ished and 16.21 kg/m2 in severely malnourished ( p = 0.001);
whilst in women was 17.83 kg/m2 in normo-nourished,
15.92 kg/m2 in moderately malnourished and 14.75 kg/m2 in
severely malnourished ( p = 0.001).
Length of stay in patients with malnutrition criteria according
to FFMI was 11.8 ± 6.3 days vs 8.3 ± 3 days in normo-nourished
patients ( p = 0.008).
A total of 28 deaths were registered: 22 in malnourished and 6
in normo-nourished ( p < 0.001).
S89
Conclusion: There is an association between SGA and FFMI. The
prevalence of malnutrition according to FFMI is associated with
prolongation of length of stay and mortality.
Disclosure of Interest: F. Sanchez-Torralvo: None declared,
V. Contreras-Bolivar Grant/Research Support from: ABBOTT-SANCYD,
G. Olveira Grant/Research Support from: ABBOTT-SANCYD, M. Ruiz-
Vico: None declared, J. Abuin-Fernandez: None declared, I. Lopez-
Martinez: None declared, M. Gonzalo: None declared.
SUN-P096
NUTRITIONAL ASSESSMENT IN HOSPITALISED ONCOLOGIC
PATIENTS
V. Contreras-Bolivar1, F. Sanchez-Torralvo1,
J. Abuin-Fernandez1, M. Ruiz-Vico2, I. Lopez-Martinez2,
V. Doulatram-Gamgaram1, G. Olveira1 *. 1Endocrinologia y
Nutricion, 2Oncologia Medica, Hospital Regional Universitario
De Malaga, Málaga, Spain
Rationale: To determine the prevalence of malnutrition in
hospitalised oncologic patients in our environment. Assess the
use of quadriceps dynamometer as an alternative to handgrip.
Relate FFMI, BMI and dynamometry with cut-off points
established by ESPEN.
Methods: Cross-sectional study, in hospitalised patients in
Oncology and Hematology between August and February of
2017. Subjective Global Assessment test (SGA), anthropomet-
ric data and muscular strength with handgrip (Jamar) and
quadriceps dynamometer (Commander) were determined. FFM
was calculated with Durnin and Siri formulae.
Results: 153 patients, 79.7% admitted in Oncology (122) and
20.3% in Hematology (31). 51.6% men and 48.4% women, aged
60.6 ± 12.5 years. BMI was 24.52 ± 4.5 kg/m2, with LBMI of
16.23 ± 2.38 g/m2 (16.8 ± 2.13 kg/m2 for men and 15.63 ± 2.49
kg/m2 for women).
We found positive correlation between quadriceps dynamo-
metry of both legs (r = 0.928; p < 0.001), as well as between
handgrip and quadriceps dynamometry (r = 0.546 and 0.549;
left and right respectively; p < 0.001). Positive correlation was
found between handgrip dynamometry and LBMI (r = 0.279,
p = 0.005).
Malnourished patients according to BMI obtained lesser
dynamometry values than normo-nourished in handgrip
(22.9 ± 9.2 kg vs 18.8 ± 7.7 kg; p = 0.02) and in quadriceps
(13.2 ± 5.1 kg vs 10.5 ± 5.4 kg; p = 0.009). No statistical differ-
ences were found out stratifying nutritional status according
to LBMI.
Conclusion: Malnutrition prevalence amongst our series
was high.
There is correlation between handgrip and quadriceps strength
measured by dynamometry. Quadriceps dynamometry can be
considered as an alternative to handgrip.
Patients with malnutrition criteria according to BMI presented
less muscular strength.
Disclosure of Interest: V. Contreras-Bolivar Grant/Research Support
from: Abbot-SANCYD, F. Sanchez-Torralvo: None declared, J. Abuin-
Fernandez: None declared, M. Ruiz-Vico: None declared, I. Lopez-
Martinez: None declared, V. Doulatram-Gamgaram: None declared,
G. Olveira Grant/Research Support from: Abbot-SANCYD.
S90
SUN-P097
HIGH-RADIODENSITY SKELETAL MUSCLE INDEX IS THE BEST
PREDICTOR OF MAJOR SURGICAL COMPLICATIONS IN
GYNECOLOGIC CANCER
N. S. de Paula1, K. A. Bruno1, M. A. Aredes1, G. V. Chaves1 *.
1
Nutrition and Dietetics, Brazilian National Cancer Institute,
Rio de Janeiro, Brazil
Rationale: This study aimed to evaluate the influence of
sarcopenia and other indicators of skeletal muscle mass quality
on surgical complications in women with ovarian and endo-
metrial cancer who underwent oncologic surgery.
Methods: Endometrial and ovarian cancer patients admitted
between 2008 and 2015 and who had computerized tomog-
raphy (CT) images available within 45 days before treatment
were enrolled in a retrospective cohort (n = 250). Skeletal
muscle index (SMI) was calculated in the range −29 + 150 HU;
reduced muscle attenuation (range −29 + 29HU) was classified
as low-radiodensity skeletal muscle index (LRSMI), represent-
ing SM area with increased intramyocellular triglycerides. By
subtracting the LRSMI area from total SMI, we created the high-
radiodensity skeletal muscle index (HRSMI), representing the
area with low fat infiltration. Sarcopenia was defined when SMI
was ≤ 38.9 cm2/m2. Multiple logistic regression evaluated
predictors of surgical complications. The variables were
considered statistically significant when p < 0.05.
Results: Patients in lower HRSMI quartiles as well as those in the
highest quartiles of LRSMI had more severe surgical complica-
tions and remained more time hospitalized. Both sarcopenia as
the quality indicators of skeletal muscle were predictors of
increased risk of severe postoperative surgical complication,
being the HRSMI the strongest predictor. In a combined
adjustment for HRSMI and sarcopenia, only HRSMI remained
in the model as an independent predictor for surgical
complication. Moreover, HRSMI was the only one associated
with early mortality (≤30 days).
Conclusion: The indicators of skeletal muscle quality were the
most significant predictors of surgical complications.
Classifying muscle quality in terms of low- or high-radiodensity
area is a promissing strategy to understand the impact of
muscle mass quality on unfavourable outcomes in oncology.
Disclosure of Interest: None declared.
SUN-P098
HYPERMETABOLISM IN THE ELDERLY CANCER PATIENT: A
PILOT STUDY
G. Ulmann1,2 *, A. Jouinot3, C. Tlemsani3, N. Neveux1,2,
J.-P. Durand3, F. Goldwasser3, J.-P. De Bandt1,2, L. Cynober1,2.
1
Clinical Chemistry, Hôpital Cochin-APHP, 2EA 4466 - Faculty of
Pharmacy, Paris Descartes University, 3Oncology dpt, Hôpital
Cochin-APHP, Paris, France
Rationale: Cancer and aging are both frequently associated
with malnutrition, a factor of poor prognosis, and this may be
related in part to alterations of energy metabolism. We
previously showed that about 50% of the patients of our
oncology department had higher than predicted resting energy
expenditure (REE)1. Our aim was to study the influence of age
on the hypermetabolic response to cancer and the underlying
potential determinants.
Poster
Methods: This was a cross-sectional case-control study on a
group of patients with non-small cell lung cancer aged 75 y or
over, and a group of patients younger than 75 y. REE was
measured by indirect calorimetry. Body composition was
determined by extrapolation from a single-slice CT-scan
imaging at L3 level. Endocrine, inflammatory, nutritional and
metabolic blood testing was done. Statistics: parametric
(Student, Pearson) or not (Mann-Whitney, Spearman) depend-
ing on data distribution.
Results: We included 20 patients below 75 y and 7 patients 75 y
or over. Though not significant, REE was higher in the younger
patients (1,564 kcal/d vs. 1,367 kcal/d, p > 0.1) but this trend
disappeared after correction for fat-free mass (FFM) (39 kcal/
kg/d in both groups). Linear correlations indicated that below
75 y, the main determinant of REE was FFM (r = 0.649, p < 0.01)
whereas after 75 y slight changes in endocrine (TSH, r = 0.929,
p < 0.01), metabolic (tryptophane plasma levels, r = −0.736,
p = 0.09) or inflammatory (IL-6, r = 0.900, p < 0.05) parameters
could influence REE/FFM.
Conclusion: Our pilot study suggests that the variations in REE
with aging in our cancer patients are mainly related to that in
body composition. However, it also seems that after 75 y REE
becomes more sensitive to variations in endocrine, inflamma-
tory and metabolic parameters.
References
1. Resting energy expenditure in the risk assessment of anticancer
treatments. Clin Nutr (2017).
Disclosure of Interest: None declared.
SUN-P099
THE ROLE OF HOME PARENTERAL NUTRITION IN ADVANCED
AND MALNOURISHED GASTROINTESTINAL CANCER PATIENTS
UNDERGOING NEOADJUVANT CHEMOTHERAPY
H.-L. Tsai1 *, J.-Y. Wang1. 1Surgery, Kaohsiung Medical
University Hospital, Kaohsiung, Taiwan, Province of China
Rationale: The tolerance of chemotherapy for advanced and
malnourished GI cancer patients was worse. This study aims to
clarify the role of HPN in patients with incurable and
malnourished GI cancer patients undergoing neoadjuvant
chemotherapy.
Methods: There were thirty advanced colorectal cancer (CRC)
patients and seventeen advanced gastric cancer (GC) patients
undergoing neoadjuvant chemotherapy to be enrolled. Among
them, 27 patients were malnourished and administrated with
HPN. We compared the nutritional status before the adminis-
tration of HPN and after HPN of the malnourished patients. The
average cycles of chemotherapy were compared between the
malnourished group and nourished group. The overall survival
rates between these two groups were calculated by Kaplan-
Meier.
Results: The value of albumin of malnourished group and
nourished group before administration of HPN was 2.91 ± 0.45
and 3.73 ± 0.69, respectively (P < 0.001). The value of albumin
of malnourished group and nourished group after administra-
tion of HPN was 3.39 ± 0.43 and 3.27 ± 0.65, respectively
(P = 0.475). The average cycles of neoadjuvant chemotherapy
between the malnourished group and nourished group were
8.59 ± 3.57 and 8.85 ± 4.09, respectively (P = 0.819). There was
not significant difference of cumulative overall survival rates
between advanced/malnourished GI cancer patients and
Nutrition and cancer 1
advanced/nourished GI cancer patients (19.16 ± 2.78 vs.19.79 ±
3.12; HR, 1.017; 95% CI, 0.522–1.980; P = 0.959).
Conclusion: HPN for advanced malnourished gastrointestinal
cancer patients with neoadjuvant chemotherapy was feasible
and demonstrated that it could markedly improve in the
nutrition status. The totally average cycles of neoadjuvant
chemotherapy was similar. The cumulative overall survival
rates was also not significantly difference.
Disclosure of Interest: None declared.
SUN-P100
TOMATO INTAKE, GLEASON SCORE, AND PROSTATE SPECIFIC
ANTIGEN IN PROSTATE CANCER PATIENTS
I. Paur1,2 *, M. H. Carlsen2, W. Lilleby3, N. Bolstad3, T. Bjøro3,
S. Smeland3, A. S. Karlsen2, R. Blomhoff4. 1Norwegian National
Advisory Unit on Disease-related Malnutrition, Oslo University
Hospital, 2Dept. of Nutrition, University of Oslo, 3Oslo
University Hospital, 4Dept. of Nutrition, Oslo University
Hospital and University of Oslo, Oslo, Norway
Rationale: A chemopreventive effect of tomato or lycopene
intake on prostate cancer has been suggested, however the
evidence remain inconclusive. Previously, we reported that
nutritional interventions (3 weeks) with tomato-products
affects the prostate cancer biomarker Prostate specific
antigen (PSA) in patients with non-metastatic prostate
cancer. In the current project, we therefore investigate the
relations between prior tomato intake, and PSA and Gleason
score which are both used in prostate cancer staging.
Methods: Prior to curative treatment, 79 prostate cancer
patients completed a food frequency questionnaire reflecting
the diet the previous year. Intake of tomato and tomato
products was calculated. Gleason score was routinely deter-
mined in diagnostic biopsies (range: 2–10). PSA was measured
with a DELFIA PSA immunoassay kit. For statistical analyses
Kruskal Wallis, Mann–WhitneyU tests and Spearman’s correl-
ation were used.
Results: Median tomato intake the year prior to diagnosis was
64 g/day (range 11–494 g/day). Gleason score distribution: 49%
Gleason score 6% and 46% Gleason score 7. Patients with
Gleason score 6 had a median intake of tomato and tomato
products of 87 g/day (range 11–494 g/day) which was signifi-
cantly higher ( p = 0.007) than patients with Gleason score 7
(56 g/day; range 12–139 g/day) in the year prior to diagnosis.
PSA levels at time of diagnosis did not correlate with prior
tomato intake.
Conclusion: In patients with non-metastatic prostate cancer,
those with the most differentiated tumors (Gleason 6) had
significantly higher intake of tomatoes and tomato products
during the year prior to diagnosis. We believe that further
testing of the “tomato/lycopene hypothesis” in prostate
cancer patients should be based on tomato products and not
lycopene. A possible target group is patients in active
surveillance programs to explore whether tomato-based
intervention extends radical treatment-free survival.
Disclosure of Interest: None declared.
S91
SUN-P101
NUTRITIONAL ASSESSMENT IN PANCREATIC CANCER PATIENTS
TREATED IN AN ONCOLOGICAL MONOGRAPHIC HOSPITAL
I. Peiró1 *, R. González-Tampán1, L. Hurtós1, E. Fort1,
R. López-Urdiales2, G. Creus2, L. Arribas1,3, C. Sánchez4,
B. Laquente4. 1Clinical Nutrition Unit, Catalan Institute of
Oncology (ICO-L’H)-IDIBELL, 2Endocrinology and Nutrition
Department, Hospital Universitari de Bellvitge, Hospitalet de
Llobregat, 3University of Barcelona, Barcelona, 4Medical
Oncology Department, Catalan Institute of Oncology (ICO-L’H)-
IDIBELL, Hospitalet de Llobregat, Spain
Rationale: Pancreatic cancer (PC) has a high rate of malnutri-
tion. A multimodal intervention through multidisciplinary
teams improves oncoespecific outcomes. In our center, PC
patients ( pts) are visited by the medical oncologist and the
endocrinologist within the pancreatic unit.
The purpose of this study is to evaluate the nutritional status of
all PC patients visited at the Clinical Nutrition Unit (CNU).
Methods: From January to December 2016 all consecutive PC
patients newly visited at the CNU were included. Demographic,
oncological and nutritional parameters: % weight (wt) loss in
the last 3–6 months (m), serum albumin level, pancreatic
insufficiency and nutritional intervention were recorded.
Results: 63 of 102 (61.8%) PC patients evaluated by the medical
oncologist were referred to the CNU for a nutritional
assessment. Mean age: 63.5 y (39–80), 52.4% men. 57.1% had
unresectable or metastatic disease, 15.9% resectable disease.
59 pts received oncological treatment: 19% neoadjuvant
chemotherapy (CT), 21.5% adjuvant treatment (CTor concomi-
tant CT/radiotherapy), 50.8% palliative CT and 4 pts with
symptomatic care. Mean body mass index: 23.8 kg/m2.
Exocrine pancreatic insufficiency (EPI) was present in 71.4%
of pts and 46% had hyperglycemia. Patients with EPI were
significatly more malnourished: 86.7% vs 13.3% ( p = 0.045). 81%
were moderate or severely malnourished (>5% wt loss in the last
3 m) with ≥ 10% wt loss the last 6 m in 76.2% of them. All
patients with serum albumin <35 mg/dL (15.9%) were mal-
nourished. All patients received nutritional counselling and 80%
needed oral nutritional supplementation.
Conclusion: A high prevalence of severe malnutrition and
pancreatic insufficiency was observed in our patients. EPI may
contribute to deteriorate nutritional status. To detect and
treat early stages of malnutrition and EPI is mandatory, in order
to improve their outcomes.
Disclosure of Interest: None declared.
SUN-P102
COMPLICATIONS OF NUTRITIONAL THERAPY IN HOME
ENTERALLY FED PATIENTS WITH CANCER
E. Zakrzewska1, K. Majewska2, J. Sobocki3 *. 1Department of
Surgery and Clinical Nutrition, 2Department of General
Surgery and Clinical Nutrition, Medical University of Warsaw,
3
Department of General Surgery and Clinical Nutrition,
Medical Universty of Warsaw, Warsaw, Poland
Rationale: Enteral nutrition is widely used in cancer patients in
perioperative and postoperative time, during radiotherapy,
chemotherapy and palliative care. Appropriate qualification
and training of patients are necessary to ensure safe enteral
nutrition at home. Treatment monitoring should prevent
S92 Poster

complications which could be dangerous for those patients. Table 1: Evaluation of nutrition screening tools compared to nutrition assessment
The aim of the study was to analyze the incidence of mechanic, SGNA.
septic and gastrointestinal complications of nutritional therapy SCAN mSTAMP mSCAN mSCAN
in patients with cancer enterally fed at home. (Cutoff ≥3) (≥4) (≥3) (≥2)
Methods: The study included 105 patients with cancer Specificity (%) 66.7 61.1 66.7 61.1
diagnosis aged 35–89 years old fed enterally at home, Sensitivity (%) 92.3 84.6 69.2 92.3
between January 2013 and October 2015. We performed Positive predictive 66.7 61.1 60 63.2
value (%)
retrospective analysis of medical records, patient medical Negative predictive 92.3 84.6 75 91.7
history, blood test results and reports of follow up visits. value (%)
Results: Septic complications were observed in 62,1% of K value (p) 0.56 0.43 0.35 0.50
patients. Mechanical and gastrointestinal complications were (0.001) (0.011) (0.048) (0.03)
Area under curve 0.85 0.80 0.78
observed in 31,8% and 6,1% respectively. There was no
significant correlation between the time of feeding and the
incidence, severity and number of complications. The analysis Conclusion: SCAN had the highest correlation with SGNA;
showed that women had significantly more complications than mSCAN, with cut-off ≥2, was comparable. mSCAN may be
men. The most common complications were septic complica- considered an acceptable tool at our unit.
tions such as inflammation and infection with discharge of pus Disclosure of Interest: None declared.
at the side of enteral access. There were minor hygienic
problems easy to eliminate by improvement in aseptic
preparation and administration of the diet. Gastrointestinal SUN-P104
complications such as diarrhea or constipation occurred rarely, HOME PARENTERAL NUTRITION FOR MALNOURISHED
and were easily managed with change of diet type or UNRESECTABLE/METASTATIC GASTRIC CANCER WITH SALVAGE
administration regimen. CHEMOTHERAPY
Conclusion: Providing proper training and instruction of the J. Y. Wang1,2,3 *, L.-C. Sun1,4, Y.-L. Shih1,4, H.-L. Tsai1,2,3.
1
patients, supervision by hospital and holding regular control Nutrition Support Team, 2Division of Colorectal Surgery,
visits allow fast diagnosis and prevention of HEN complications. Departments of Surgery, 3Department of Surgery, Faculty of
HEN is a safe method with few and mainly mild complications. Medicine, College of Medicine, 4Division of Nursing, Kaohsiung
Disclosure of Interest: E. Zakrzewska: None declared, K. Majewska: Medical University Hospital, Kaohsiung, Medical University,
None declared, J. Sobocki Paid Instructor at: Fresenius, BBraun, Baxter, Kaohsiung, Taiwan, Province of China
Nutricia.
Rationale: Although significant advances have been made in
the surgical techniques and the treatment, salvage chemo-
SUN-P103
therapy remains a major treatment strategy for unresectable/
VALIDATION OF MODIFIED NUTRITION SCREENING TOOLS FOR
metastatic gastric cancer (GC) patients. Practical and technical
CHILDHOOD CANCER IN A TERTIARY HOSPITAL IN SINGAPORE
advances have simplified safe and convenient use of home
J. Koo1 *, C. Ong1, W. M. Han1. 1Nutrition and Dietetics, KK parenteral nutrition (HPN). This study aims to clarify the role of
Women’s and Children’s Hospital, Singapore, Singapore HPN in patients with incurable GC undergoing salvage
chemotherapy.
Rationale: Early identification of undernutrition is essential for
Methods: Sixteen GC patients administrated with HPN were
timely intervention in children receiving anti-cancer therapy.
enrolled. A total caloric supplement of 910 kcal/day parenteral
However, existing screening tools are operationally challenging
nutrition, including 33 g amino acid/day, 120 g glucose/day,
to implement in our local hospital. Our aim was to explore the
30 g lipid/day and electrolyte, micro-element and vitamin
validity of modified nutrition screening tools at our unit.
according to the nutritional status of subjects, of which was
Methods: Three nutrition screening tools were examined in a infused continuously daily in an infusion time ranged between
convenient sample of 31 pediatric oncology patients admitted 18–24 hours. The nutritional status and laboratory data before
over a 3 week period in KK Women’s and Children’s Hospital, the administration of HPN and after HPN at 0.5, 1, 2, 3 months
Singapore. The tools were: (1) Nutrition Screening Tool were analyzed.
Childhood Cancer (SCAN), (2) Modified Screening Tool for Results: There were 10 (62.5%) males and 6 (37.5%) females,
Assessment of Malnutrition in Pediatrics (mSTAMP) tool, (3) with a mean age of 67.56 ± 11.52 years. Median HPN adminis-
SCAN tool without physical signs and 2-step scoring of intake tration period was 98 (range, 16–282) days. Nine patients and 6
(mSCAN). Criterion validity was assessed against nutrition patients were categorized to ECOG status 1 and 2, respectively.
assessment using the Pediatric Subjective Global Nutrition There was a significant improvement of serum prealbulmin
Assessment (SGNA). Results were analyzed using Cohen’s Kappa level (P < 0.001) after 0.5 month of HPN administration, while
and receiver-operator characteristic curve. The screening and inflammation-related cytokines were not significantly altered
assessment were performed by a single, trained dietitian. (all P > 0.05). The incidence of venous port-associated blood-
Results: Mean age of children was 8.5 ± 5.5 years. Using the stream infection was 1.3‰/person-days.
SGNA, 18 (58%) were well nourished, 12 (39%) were moderately Conclusion: HPN for malnourished unresectable/metastatic
malnourished and 1 (3%) was severely malnourished. GC patients with salvage chemotherapy was feasible and
SCAN was found to be the best tool to identify risk of revealed the markedly improvement in nutritional status after
malnutrition (Table 1). Adjusting the cutoff score from 3 to 2
0.5 month of administration without significant alterations of
increased the sensitivity, negative predictive value and
inflammatory cytokines.
agreement of mSCAN.
Disclosure of Interest: None declared.
Nutrition and cancer 1 S93

SUN-P105 SUN-P106
NORMAL ENTEROCYTE FUNCTION IN PATIENTS WITH LOCALLY PARENTERAL OMEGA 3 SIGNIFICANTLY INCREASES
ADVANCED PANCREATIC CANCER ENDOTHELIAL PROGENITOR CELLS IN PALLIATIVE PANCREATIC
J. Witvliet-Van Nierop1 *, H. Scheffer2, L. Vroomen2, PATIENTS RECEIVING GEMCITABINE AND INTRAVENOUS
M. Meijerink2, A. van Bodegraven3, M. De van der Schueren1, OMEGA 3 COMPARED TO PATIENTS RECEIVING GEMCITABINE
N. Wierdsma1. 1Department of Nutrition and Dietetics, ONLY
2
Department of Radiology and Nuclear Medicine, VU University J. Isherwood1 *, A. Arshad1, W. Chung1, F. Runau1, J. Cooke1,
Medical Center, Amsterdam, 3Department of Gastoenterology, C. Pollard1, J. Thompson2, M. Metcalfe1, A. Dennison1.
1
Geriatrics, Intensive care and Internal Medicine (Co-MIK), Department of Hepatobiliary and Pancreatic Surgery,
Zuyderland Medical Center, Heerlen-Sittard-Geleen, Leicester General Hospital, 2Department of Health Sciences,
Netherlands College of Medicine, Biological Sciences and Psychology,
University of Leicester, Leicester, United Kingdom
Rationale: This study was designed to investigate whether the
reactively inflamed duodenal wall, observed as a side effect of Rationale: Vasculogenesis describes new blood vessel forma-
Irreversible Electroporation (IRE) in patients with Locally tion and Endothelial Progenitor Cells (EPCs) are important
Advanced Pancreatic Cancer (LAPC)1, affects enterocyte regulators of this process. Advanced pancreatic cancer (APC) is
function (EF). characterised by a hypoxic environment known to promote
Methods: EF was assessed in 13 LAPC patients before and in 9 mobilisation of EPCs.
patients 3 months after IRE. EF was studied by Citrulline Methods: Trial patients were treated with weekly gemcitabine
Generation Test (CGT). This test measures plasma glutamine plus intravenous omega -3 rich lipid infusion (Lipidem® BBraun,
[GLU], a precursor of citrulline [CIT], and [CIT] levels after an Melsungen 200 mg/mL, up to 100 g/500 mLs) in patients with
overnight fast and [CIT] levels 15, 75 and 90 minutes after an APC. Control patients were treated with gemcitabine only.
oral bolus of 20g of dipeptide alanine-glutamine2. Results: 27 patients were included in the analysis (18 trial and 9
Results: control). 103 times points were analysed. Three EPC signatures
were analysed. CD45−, CD31+ and CD133+EPCs. There was a
Before IRE 3 months after Reference healthy significant increase in trial EPCs (P = 0.04), but not control EPCs
(n = 13) IRE (n = 9) subjects2 (n = 19) over treatment. There was no significant difference between
Mean ± SD Mean ± SD Mean ± SD
trial and control patients over time. There was a significant
Baseline [CIT] 24 ± 9 21 ± 9 38 ± 8 (range 20–60) difference in progression free survival (P = 0.002) & overall
(μmol/L) survival (P = 0.01) in patients with a high change in EPCs; trial
Baseline [GLU] 61 ± 36 50 ± 26 561 ± 77
(μmol/L) versus control patients. CD45−, CD31+ and CD34+ EPCs. There
Peak [CIT] (μmol/L) 37 ± 16 31 ± 13 55 ± 10 was a significant increase in trial EPCs (P = 0.0001), but not
Increment (%) 59 ± 40 65 ± 44 44 ± 13 control over treatment. There was a significant difference
Slope (μmol/L/min) 0.19 ± 0.13 0.15 ± 0.09 0.22 ± 0.08
between trial and control patients over time (P = 0.0001).
Progression free survival was significantly improved in trial
Low fasting [CIT] levels (<20 μmol/L) were found in 5/13 (38%) patients with a high change in EPCs compared to control patients
LAPC patients before and 6/9 (67%) patients after IRE. Fasting (P = 0.01). CD45−, CD31+, CD133+ and CD34+ EPCs. There was an
[GLU] levels were far below reference levels of healthy increase in trial EPCs (P = 0.007), but not control EPCs over
subjects (HS) in all patients, both before and after IRE. treatment. There was a significant difference between trial and
Altough at a lower level, a normal CGT curve is presented control patients over treatment (P = 0.0001). Progression free
with normal slope and increment of [CIT] levels after the survival was significantly improved in trial patients with a high
alanine-glutamine dose, indicating a normal enterocyte change in EPCs compared to control patients (P = 0.01).
function. Conclusion: Intravenous omega- 3FAs in combination with
Conclusion: Patients with LAPC had low fasting [CIT] levels and gemcitabine significantly increase EPCs in patients with APC.
very low fasting [GLU] levels, both before and after IRE
Disclosure of Interest: None declared.
procedure, likely representing a cancer induced catabolic
state. Fasting plasma [CIT] levels are inappropriate markers for
EF since low values can be explained by low [GLU] levels. The SUN-P107
normal slope and increment of [CIT] levels after CGT indicated PARENTERAL OMEGA 3 SIGNIFICANTLY REDUCES MYELOID-
normal EF, also post-IRE when duodenitis has been reported. DERIVED SUPPRESSOR CELLS IN PALLIATIVE PANCREATIC
PATIENTS RECEIVING GEMCITABINE AND INTRAVENOUS
References
OMEGA 3 COMPARED TO PATIENTS RECEIVING GEMCITABINE
1. Scheffer HJ, et al. Radiology 2017; 282(2):585–7 (doi: 10.1148/ ONLY TREATMENT
radiol.2016152835)
2. Peters JH, et al. APT 2008; 27(12):1300–10 (doi: 10.1111/j.1365- J. Isherwood1 *, A. Arshad1, W. Chung1, F. Runau1, J. Cooke1,
2036.2008.03678.x) C. Pollard1, J. Thompson2, M. Metcalfe1, A. Dennison1.
1
Department of Hepatobiliary and Pancreatic Surgery,
Disclosure of Interest: None declared.
Leicester General Hospital, 2Department of Health Sciences,
College of Medicine, Biological Sciences and Psychology,
University of Leicester, Leicester, United Kingdom

Rationale: Advanced pancreatic cancer (APC) is characterised

by a complex immune microenvironment involving a plethora of
S94
immune mediators. Myeloid-Derived Suppressor Cells (MDSCs)
have primarily been implicated in facilitating tumour growth by
suppressing anti-tumour immunity.
Methods: As part of a phase II trial investigating weekly
gemcitabine (1000 mg/m3 weekly for 3 weeks followed by a
rest week, up to 6 months) plus intravenous ω-3FA rich lipid
infusion (Lipidem® BBraun, Melsungen 200 mg/mL, up to 100 g/
500mLs over 4 hours) in patients with APC. Control patients
were treated with gemcitabine only. MDSCs with two antibody
signatures were analysed. (1) Lin1−, HLA-DR−, CD33+ & CD11b+
& (2) Lin1−, HLA-DR− & CD11b+. Cells were analysed with flow
cytometry using the FACSAria II (BD Biocsiences).
Results: 27 patients were included in the analysis (18 trial and
9 control). 134 times points were analysed. Four-antibody stain
MDSCs were analysed. There was a significant decrease of
MDSCs in trial patients during trial treatment (P = 0.0001).
There was no change in the control patients (P = 0.9). Overall
there was no significant difference between the trial and
control patients over time (P = 0.3). There was a significant
difference in progression free survival in patients with a high
change in MDSCs in trial versus control patients (P = 0.08).
Three-antibody stain MDSCs were analysed. There was a
significant decrease of MDSCs in trial patients during treatment
(P = 0.0001). There was no change in MDSCs in the control
patients (P = 0.3). Overall there was a significant difference
between the trial and control patients over time (P = 0.01).
Conclusion: Intravenous ω-3FAs in combination with gemcita-
bine significantly reduces MDSC cells in patients with APC
compared to those treated with gemcitabine alone.
Disclosure of Interest: None declared.
SUN-P108
T REGULATOR CELLS ARE SIGNIFICANTLY INCREASED IN
PALLIATIVE PANCREATIC PATIENTS TREATED WITH
GEMCITABINE ALONE COMPARED TO PATIENTS RECEIVING
GEMCITABINE AND INTRAVENOUS OMEGA 3
J. Isherwood1 *, A. Arshad1, W. Chung1, F. Runau1, J. Cooke1,
C. Pollard1, J. Thompson2, M. Metcalfe1, A. Dennison1.
1
Department of Hepatobiliary and Pancreatic Surgery,
Leicester General Hospital, 2Department of Health Sciences,
College of Medicine, Biological Sciences and Psychology,
University of Leicester, Leicester, United Kingdom
Rationale: Advanced pancreatic cancer (APC) is characterised
by a complex immune microenvironment involving a plethora of
immune mediators. T regulator cells (Tregs) are significantly
increased in APC and their levels have been shown to correlate
with survival
Methods: As part of a phase II trial investigating weekly
gemcitabine (1,000 mg/m3 weekly for 3 weeks followed by a
rest week, up to 6 months) plus intravenous ω-3FA rich lipid
infusion (Lipidem® BBraun, Melsungen 200 mg/mL, up to
100 g/500 mLs over 4 hours) in patients with APC. Control
patients were treated with gemcitabine only. Peripheral blood
mononuclear cells (PBMC) were stained with CD4, CD25 and
FOXP3 antibodies for Tregs. Cells were analysed with flow
cytometry using the FACSAria II (BD Biocsiences, San Jose,
USA).
Results: Twenty-seven patients were included in the analysis
(18 trial and 9 control). 136 times points were analysed. There
was a significant increase in Tregs in trial patients with a
Poster
survival less than 6 months at treatment end point compared to
baseline (P = 0.03, 95% CI = −6.309 – −0.266). Overall there was
an increasing trend in trial Tregs over treatment but this was
not significant (P = 0.23, 95% CI = −0.003–0.014). There was a
significant increase in control Tregs over treatment (P = 0.005,
95% CI = 0.007–0.041). There was no significant difference
between the trial and control patients over time (P = 0.586).
Conclusion: Tregs are significantly increased in patients
treated with gemcitabine alone compared to patents treated
with omega-3 and gemcitabine. Omega -3 fatty acids may
prevent an increase in Tregs in APC. More studies are required
to investigate this.
Disclosure of Interest: None declared.
SUN-P109
NUTRITIONAL INTERVENTION IN PATIENTS UNDERGOING
HAEMATOPETIC STEM CELL TRANSPLANTATION IN THE
CATALAN INSTITUTE OF ONCOLOGY - BADALONA
J. M. Sánchez-Migallón Montull1,2 *, M. J. Sendros Madroño1,2,
R. Puig Piña1, M. Martion Giol1, M. Cachero Triadú1,
E. Martínez López1, J. Julià Torras3, M. Sospedra Martínez1,
C. Joaquín Ortiz1. 1Dietetics and Nutrition Department,
Germans Trias i Pujol Hospital, 2Dietetics and Nutrition
Department, 3Comprehensive Support Services and Palliative
Care Department, Catalan Institut of Oncology, Badalona,
Spain
Rationale: To analyze the nutritional status of the patients
undergoing haematopoetic stem cell transplantation (HSCT)
and the nutritional support used during hospitalization.
Methods: All the patients undergoing HSCT during the years
2015 and 2016 were studied. Nutritional status was assessed by
Patient-Generated Subjective Global Assessment (PG-SGA) at
three different stages: admission, discharge from the hospital
and one month later. The nutritional supports were classified
into: Low Bacteria Diet (LBD) adapted to the preferences of the
patient, LBD combined with Oral Nutritional Supplementation
(ONS) or Parenteral Nutrition (PN). Statistical analysis was
performed using SPSS 15.0.
Results: 105 patients; Average age 52.4 (+/−12.7 years) of
whom 43.8% were women. 51.4% of the patients underwent
allogenic HSTC. 17% of the patients presented with malnutri-
tion at admission, 91.6% at discharge from the hospital and 40%
one month after the discharge. The nutritional supports
employed were LBD (11.4%), ONS (57.1%) and PN (31.4%).
Patients undergoing allogenic HSCT required PN more fre-
quently than the patients undergoing autogenic HSCT (38.8% vs
23.5%). No significant statistical differences we found in the
nutritional status at the time of discharge between the two
types of HSCT.
Conclusion: Monitoring the nutritional status during the
different phases of the HSCT is justified by the high percentage
of malnutrition. The majority of the patients didn’t present
with malnutrition at admission, but almost all presented with it
at discharge from the hospital. The most frequently employed
nutritional support was ONS followed by PN. The high
prevalence of malnutrition one month after discharge from
the hospital is a justification for the follow-up of these patients
until the recovery of an adequate nutritional status is achieved.
Disclosure of Interest: None declared.
Nutrition and cancer 1
SUN-P110
ASSOCIATION BETWEEN EARLY NUTRITIONAL STATUS AND
SURVIVAL TIME AMONG KOREAN ADULT PATIENTS WITH
PANCREATIC CANCER: A RETROSPECTIVE STUDY
J. S. Park1 *, H. M. Kim1, H. C. Jeung2. 1Clinical Nutrition,
2
Internal Medicine, Gangnam Severance Hospital, Yonsei
University College of Medicine, Seoul, Korea, Republic Of
Rationale: We investigated the associations between baseline
nutritional status and survival time among Korean patients with
pancreatic cancer.
Methods: A retrospective study was conducted on 412
inpatients with pancreatic cancer between January 2007 and
February 2015 at the department of Oncology of the Gangnam
Severance Hospital in Korea. Anthropometric and biochemical
data was collected from electronic medical records and likely
survival time was estimated. Screening for risk of under-
nutrition was performed using a tool, the “Nutritional Risk
Screening 2002 (NRS 2002)”. Patients who received a NRS 2002
score less than three were classified as “no-risk”, those who
received a score of three as “moderate-risk”, and those who
received a score of four or higher as “high-risk”.
Results: Following nutritional screening at baseline, 194
patients (47.1%, mean age 61.8 ± 9.9 years) were placed in
the “no-risk” group. A further, 81 patients (19.7%, mean age
65.4 ± 10.8 years) were placed in the “moderate-risk” group,
and 137 patients (33.2%, mean age 67.8 ± 12.0 years) were
placed in the “high-risk” group. Stepwise multiple linear
regression analysis was used to determine independent
predictive factors for survival time. Lymphocyte Percentage
was found to be the strongest predictor of survival among
patients with pancreatic cancer ( p < 0.001). NRS 2002 score
( p < 0.001) and age ( p < 0.05) were also significant predictors.
The estimated survival time showed that there were significant
differences in median survival time among groups according to
NRS 2002 score. Those in the “no-risk” group were predicted to
live 1.89 times longer than those in the “moderate-risk” group,
and 2.24 times longer than those in the “high-risk” group
( p < 0.001).
Conclusion: Improved early nutritional status was associated
with increased estimated survival time among Korean patients
with pancreatic cancer.
Disclosure of Interest: None declared.
SUN-P111
FOOD BEHAVIOR AND WEIGHT GAIN IN CHEMOTHERAPY FOR
BREAST CANCER
J. M. F. Sicchieri1 *, C. Palazzo2, C. C. Japur3, L. B. Araújo4,
R. W. Diez-Garcia5. 1Division of Nutrition and Metabolism,
Department of Internal Medicine, University Hospital, Faculty
of Medicine of Ribeirão Preto, University of São Paulo, Brazil,
2
Nutrition and Metabolism, Ribeirão Preto Medicine School,
University of São Paulo, Ribeirao Preto, 3Nutrition Course,
Medicine School, University of Uberlândia, 4Mathematics
School, University of Uberlândia, Uberlândia, 5Division of
Nutrition and Metabolism, Department of Internal Medicine,
University Hospital, Faculty of Medicine of Ribeirão Preto,
University of São Paulo, Brazil, Ribeirao Preto, Brazil
Rationale: Weight gain is a common issue during chemotherapy
for breast cancer, though its causes have not been explained
S95
yet. This study aimed to identify how patients experience diet
and to assess the relationship between food behavior,
preference and intake of sweet foods and weight gain.
Methods: It was assessed 31 breast cancer patients with
indication for chemotherapy at two moments: prior to
initiating (T0) and after the fourth chemotherapy session
(T1). They were evaluated for weight, height, sweet food
intake (split into two categories: “healthy sweets” for fruits
and natural juices and “non-healthy sweets” for cakes,
cookies, candies, ice creams, soft drinks, industrialized
juices, homemade sweets, and chocolate) and preferred
sucrose concentration in cashew juice (3%, 6%, 12%, 24%, and
36% w/v). An interview based on a semi-structured script was
applied at T1.
Results: The patients’ weight and BMI increased, as did the
“healthy sweets” intake ( p = 0.00), with positive correlation
between the variation of “healthy sweets” intake and weight
(r = 0.38; p = 0.04). The preferred sucrose concentration
remained stable. The interviews analysis shows that fear,
anxiety, and stress, as well as the coping attitude emerged in
face of the treatment and reflected in opposite food behaviors.
At times, the food behavior is driven by self-care intention,
conducting to a massive intake of fruits and vegetables and, at
other times, it is driven by the emotional vulnerability that
leads to an excessive and unorganized food intake.
Conclusion: The results found indicate opposed, thought
concomitant, food behavior patterns that may contribute to
the weight gain observed.
Disclosure of Interest: None declared.
SUN-P112
EVALUATION OF BODY COMPOSITION AND PROGNOSTIC
INDEXES IN HEMATOLOGIC MALIGNANCIES
J. M. F. Sicchieri1 *, M. V. Geraldi1, G. Marques1, B. Simões2,
R. W. Diez-Garcia1. 1Division of Nutrition and Metabolism,
Department of Internal Medicine, 2Division of Hematology,
Department of Internal Medicine, University Hospital, Faculty
of Medicine of Ribeirão Preto, University of São Paulo, Ribeirao
Preto, Brazil
Rationale: Hematopoietic cel transplantation has become
standart treatment for many hematologic malignancies.
Moreover, malnutrition with lean body mass losses, affecting
both the functional capacity and the metabolic health of
cancer survivors. The objective of this study was to describe
the body composition, the fat free mass index (FFMI) and fat
mass index (FMI) and to relate nutritional prognostic indicators
in patients hospitalized for treatment of hematologic malig-
nancies in Bone Marrow Transplantation Unit and the
Hematology of the Hospital of Clinics of the Medical School of
Ribeirão Preto (HCFMRP-USP)
Methods: A cross-sectional study was conducted between
August and December 2016 with hospitalized patients in
treatment to hematological malignancies who have been
agreed to participate this study. Percentage of body fat (%
BF), lean body mass and were determined by Impedance
Bioelectrical (BIA), wich was realized in the morning, with
fasting. Exclusion criteria: patients who present cognitive
problem or disagreeded to participate. The study protocol was
approved by the Research Ethics Committee of the HCFMRP-
USP (number 1,887,320).
S96
Results: 21 patients (9 females and 12 males) were evaluated,
presenting FFMI avarage 19.3 kg/m² in male and 17.1 kg/m² in
female. FMI avarage was 5.4 kg/m² and 8.4 kg/m² in male and
female respectively. According with this classification: 38.0%
(n = 8), obese, 42.9% (n = 9) eutrophic and 19.0% (n = 4)
sarcopenic patients which differs off BMI in 3 patients (14%).
Conclusion: The evaluation of body composition by BIA,
associated to analysis of fat free mass index, fat mass index,
can contribute to the identification of nutritional status and
prognosis more accurately.
References
Kyle U, Pirlich M, Loch H. Increased length of hospital stay in
underweight and overweight patients at hospital admission: a
controlled population study. Clinical Nutrition (2005) 24, 133–142
Disclosure of Interest: None declared.
SUN-P113
ORAL ADMINISTRATION OF AMINO ACIDS CYSTINE AND
THEANINE ATTENUATES 5-FLUOROURACIL-INDUCED
INTESTINAL INFLAMMATION BY SUPPRESSING THE
RECRUITMENT OF INFLAMMATORY MONOCYTE
J. Yoneda1 *, S. Iwayama1,1, M. Shiozaki1,1. 1Institute for
Innovation, Kawasaki, Japan
Rationale: Cystine/theanine (CT) is a supplement containing
700 mg of cystine and 280 mg of theanine. A recent clinical
study demonstrated that oral administration of CT reduced
adverse events and improved completion rate of an adjuvant
chemotherapy. CTattenuated intestinal mucositis and diarrhea
in 5-FU-induced mouse mucositis model, however mechanism is
unclear. The objective of this study is to verify mechanisms of
the suppressive effects of CTon the intestinal tissue using 5-FU-
induced mouse mucositis model.
Methods: Intestinal mucositis was induced in male BALB/c
mice by a single intraperitoneal injection of 5-FU (450 mg/kg).
Saline or CT (280 mg/kg) were orally administered once daily
starting 3 days before 5-FU administration until the end of the
experiment. FITC-conjugated microbeads-labeled bone
marrow derived Ly6Chi monocytes were i.v. inoculated into
BALB/c mice on day 1 and on day 2 after 5-FU i.p. injection.
One day following 2nd adoptive transfer (day 3 after 5-FU
injection), small intestine were collected and frozen sections
were examined by fluorescent microscopy.
Results: To determine the protective effects of the CT on the
inflammatory damage of small intestine, mice, that received
adoptive transfer of FITC-labeled Ly6Chi monocyte, were
sacrificed. While recruitment of Ly6Chi monocyte were
observed in the lamina propria region in the villi of 5-FU
administrated mice, CT reduced the number of monocytes
( p < 0.05). We also found increased MCP-1 levels in the plasma
in 5-FU treated mice, which were partially decreased by CT
administration ( p < 0.05).
Conclusion: CT treatment decreased the 5-FU induced
increase of MCP-1 in plasma and recruitment of inflammatory
Ly6Chi monocytes in intestinal tissue, which may results in
suppression of inflammatory response and promotion of
mucosal recovery.
Disclosure of Interest: None declared.
Poster
SUN-P114
HOME PARENTERAL NUTRITION IN PATIENTS WITH ADVANCED
CANCER: A SYSTEMATIC REVIEW
K. C. Fragkos1 *, L. Fini2, N. Keane3, H. Kwok1, E. Paulon1,
J. Barragry1, S. Mehta1, F. Rahman1, S. Di Caro1. 1GI Services,
University College London Hospitals NHS Foundation Trust,
London, United Kingdom, 2Busto Arstizio Hospital, Busto
Arstizio, Varese, Italy, 3Dietetics, University College London
Hospitals NHS Foundation TRUST, London, United Kingdom
Rationale: The use of Home Parenteral Nutrition (HPN) in
patients ( pts) with advanced cancer who cannot meet their
nutritional requirements by oral or enteral routes, remains
controversial with significant variation worldwide. Our aim was
to review data from literature and identify the potential
benefit of HPN in pts with advanced cancer.
Methods: Articles on HPN in advanced cancer from 2002 to
2016 were scrutined in PubMED. Primary end point was survival,
secondary end points were quality of life (QoL) and nutritional/
performance (Karnofsky score, KPS) status.
Results: Eighteen studies met the quality inclusion criteria (11
retrospective, 7 prospective and 2 randomized). Studies were
mainly conducted in Western countries (30% in Italy, 15% in USA,
10% in Canada and Germany), including overall 3,066 patients.
Mean age was 57,2 ± 6,4 years. Most common cancer site were
GI tract, ovary, breast, head and neck. Main indication for HPN
was bowel obstruction or cachexia. Mean duration of HPN was
3,8 ± 1,4 months. Median overall survival was 4,6 ± 2,4 months
(1,5 month in a selected cohort with peritoneal carcinoma-
tosis, 8 months in a study including only advanced ovarian
cancer). At baseline, mean weight was Kg 57,6 ± 5,1, mean BMI
20,7 ± 0,8 and mean KPS 55 ± 5. After 1–5 months of HPN, mean
weight and mean BMI increased to 61,9 ± 5.3 and 21,2 ± 0,5
respectively. KPS increased in 2 studies, stable in 2 studies. QoL
was analyzed through validated scales in 5 studies and resulted
significantly increased after HPN. On average, HPN related
complications were reported in 13 ± 6% of the pts.
Conclusion: Indications for HPN and overall survival (3,8 ± 1,4
months) in advanced cancer was in accordance with prognostic
parameters specified in International guidelines. Variation in
clinical practice is evident in different countries. A cultural
change and education of healthcare professionals is required to
ensure early access to HPN for appropriate patients.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 1
SUN-P115
OLDER ADULTS WITH REDUCED RENAL FUNCTION:
EVALUATION OF THE EFFECTS OF UNDERLYING RENAL
DISEASE ON NUTRITIONAL AND METABOLIC PROFILE
A. Molfino1 *, M. I. Amabile1, S. Altieri2, D. Mastroluca3, C. Lai4,
P. Aceto5, M. Crudo6, F. Rossi Fanelli1, M. Muscaritoli1, S. Lai1.
1
Department of Clinical Medicine, 2Department of Clinical and
Molecular Medicine, 3Department of Internal Medicine and
Medical Specialties, 4Department of Dynamic and Clinic
Psychology, Sapienza University of Rome, 5Department of
Nutrition and chronic diseases 1
Anesthesiology and Intensive Care, Catholic University of
Sacred Heart, 6Software House, INTECS S.p.A, Rome, Italy
Rationale: Chronic kidney disease is highly prevalent among
older adults. Metabolic and nutritional derangements are
associated with renal impairment, and increased risk of
cardiovascular disease is frequent in this condition. We
compared the metabolic, nutritional, and cardiovascular
impact of reduced renal function between patients with and
without known renal disease.
Methods: We enrolled consecutive outpatients aged ≥65 years
with reduced renal function divided into two groups: Group A
including patients with history of renal disease, and Group B
patients with unknown renal disease. Nutritional and meta-
bolic parameters, including involuntary body weight loss (BWL)
in the previous 6 months, inflammatory indices, mineral
metabolism, and left ventricular mass index (LVMI), were
evaluated. Parametric and non-parametric tests were per-
formed as appropriate, and p value < 0.05 was considered
statistically significant.
Results: A total of 76 patients were enrolled. Group A (n = 39,
M: 24, F: 15) showed greater BWL with a significant reduction of
25-hydroxyvitamin D, transferrin, cholinesterase, albumin, and
greater LVMI with respect to Group B ( p < 0.01). In addition,
Group A showed significantly increased intact parathyroid
hormone, total cholesterol, low-density lipoprotein, triglycer-
ides, and C-reactive protein when compared to Group B
( p < 0.05).
Conclusion: The positive history of renal disease may nega-
tively impact on several nutritional and metabolic parameters
related to increased cardiovascular risk among older adults.
Disclosure of Interest: None declared.
SUN-P116
IMMUNOPROTEASOME SUBUNIT BETA2I DEFICIENCY MODIFIES
COLONIC PROTEOME IN STRESSED MICE: PUTATIVE ROLE FOR
IRRITABLE BOWEL SYNDROME
A. Goichon1,2, I. Ghouzali1,2, W. Bahlouli1,2, P. Chan2,3,
D. Vaudry2,3,4, P. Déchelotte1,2,5 *, P. Ducrotté1,2,6,
M. Coëffier1,2,5. 1Normandie Univ., URN, INSERM Unit 1073,
2 Medicine, University of Iceland, 8Department of Respiratory
Institute for Research and Innovation in Biomedicine (IRIB),
University of Rouen Normandy, Rouen, 3Platform in Proteomics
PISSARO, University of Rouen Normandy, 4Normandie Univ.,
URN, INSERM Unit 1239, Mont-Saint-Aignan, 5Rouen University
Hospital, Nutrition Department, 6Rouen University Hospital,
Gastroenterology Department, Rouen, France
Rationale: A role for immunoproteasome in the regulation of
intestinal permeability has been previously suggested both in
mice during water avoidance stress (WAS) and in patients with
irritable bowel syndrome (IBS). We thus aimed (i) to evaluate
the colonic proteome in wild-type (wt) and β2i immunoprotea-
some subunit knock-out (β2i−/−) mice during WAS and (ii) to
investigate the colonic expression of 49 ubiquitinated-proteins
in diarrhea-predominant IBS patients (IBS-D).
Methods: Wt and β2i−/− C57BL/6 male mice (n = 5/group) were
subjected to WAS (1 h/day for 10 days) or not (control). Then, a
2D-PAGE-based comparative proteomic analysis was performed
and differentially expressed colonic proteins (at least ± 1.4 fold
change; two-way ANOVA, p < 0.05) were identified by LC-MS/
MS. From colonic biopsies of IBS-D and control patients (n = 8/
S97
group), the expression of ubiquitinated proteins was assessed
by using macroarrays.
Results: In mice, 50 proteins were differentially and signifi-
cantly expressed between the 4 groups ( p < 0.05, ANOVA). 20
proteins were downregulated in wt WAS mice ( p < 0.05 vs wt
control), suggesting altered energy and mitochondrial metab-
olism. Interestingly, 3 (PSMA3, PSAM5, UCHL3) and 4 (PSMA4,
ENO1, HSP60, GLUD1) proteins were significantly up- or down-
regulated in β2i−/− WAS mice ( p < 0.05 vs wt WAS), respectively.
UCHL3 and PSMA3/4/5 are involved in the ubiquitin prote-
asome pathway and GLUD1 is glutamate dehydrogenase 1. In
IBS-D patients, the colonic expression of 7 ubiquitinated
proteins (TRAF6, A20, Nrf2, HSP70, HSP90, IRF3, COX-2) was
significantly reduced.
Conclusion: Our results show specific alterations of colonic
protein metabolism in WAS mice. Immunoproteasome invali-
dation modified colonic proteome. Interestingly, IBS-D patients
exhibited alterations of ubiquitome, and particularly of
proteins involved in inflammatory signalling pathways.
Disclosure of Interest: None declared.
SUN-P117
ENERGY- AND PROTEIN INTAKE IN HOSPITALIZED PATIENTS
WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
AND ASSOCIATIONS WITH BODY COMPOSITION, LUNG
FUNCTION AND HEALTH RELATED OUTCOMES
A. Ingadottir1,2 *, A. M. Beck3,4, C. Baldwin5, C. E. Weekes5,
O. G. Geirsdottir1,6, A. Ramel1, T. Gislason7,8,
I. Gunnarsdottir1,2. 1Unit for Nutrition Research, Landspitali
University Hospital & Faculty of Food Science and Nutrition,
University of Iceland, 2Department of Clinical Nutrition,
Landspitali University Hospital, Reykjavik, Iceland,
3
Department of Nutrition and Health, Faculty of Health and
Technology, Metropolitan University College, Copenhagen,
4
Research Unit for Nutrition, Herlev and Gentofte Hospital,
Gentofte, Denmark, 5Division of Diabetes and Nutritional
Sciences, King’s College London, London, United Kingdom,
6
The Icelandic Gerontological Research Center, Landspitali
University Hospital & University of Iceland, 7Faculty of
Medicine and Sleep, Landspitali University Hospital,
Reykjavik, Iceland
Rationale: Low energy and protein intake has been associated
with increased risk of malnutrition in outpatiens with chronic
obstructive pulmonary disease (COPD). The aim was to assess
energy-/protein intake of hospitalized COPD patients and to
examine whether it predicts COPD severity, length of stay,
readmissions within 30 days and mortality.
Methods: Subjects were COPD patients (n = 99) admitted to
Landspitali University Hospital during one year (March 2015-
March 2016). Patients were screened for nutritional risk using
validated screening tool. Energy- and protein intake was
estimated using a validated plate diagram sheet. Body
composition was measured with a bioelectrical impedance
analyser. Lung function was measured with spirometry.
Results: The energy-/protein intake from the hospital meals
provided was lower in subjects defined at nutritional risk than
those not at risk (1,173 ± 358 vs. 1,360 ± 360 kcal; p = 0.013 and
49.0 ± 16.3 vs. 57.2 ± 16.7 g; p = 0.019). However, patients at
nutritional risk were provided with greater amount of oral
S98
nutritional supplements or food brought from home (194 ± 151
vs. 85 ± 89 kcal; p < 0.001 and 7.8 ± 6.1 vs. 3.3 ± 4.7 g; p <
0.001), resulting in no difference in total energy-/protein
intake. Energy-/protein intake was positively associated with
measures of body composition (fat free mass index and body
mass index), but no association was seen with outcomes.
Conclusion: Although energy-/protein intake was lower than
recommended during hospitalization we found no association
with outcomes. Long term studies, assessing energy-/protein
intake both during hospitalization and after discharge are
needed.
Disclosure of Interest: None declared.
SUN-P118
THE RELATIONSHIP BETWEEN HEALTHY EATING INDEX SCORE
AND SERUM LIPID PROFILE IN PATIENTS WITH CORONARY
ARTERY DISEASE
A. Aktaş1 *, E. B. Kaya2, G. Samur1. 1Nutrition and Dietetics,
2
Medicine, Hacettepe University, Ankara, Turkey
Rationale: The aim of this study is to evaluate the dietary
quality and determine serum cholesterol levels in patients with
coronary artery disease.
Methods: This study was conducted with 99 adults aged 40–80
years. Patients with coronary artery disease had more than 50%
stenosis in heart arteries who undergoing balloon angioplasty
or stent placement. They were taking cholesterol-lowering
drugs regularly. Food Frequency Questionnaire (FFQ) and 24-
hour dietary recall were used to assess dietary intake. Healthy
Eating Index (HEI-2005) scores were calculated. Biochemical
findings were taken from hospital database. Total diet quality
was classified into three categories: good diet quality (over 80
points), needs impovement (51–80 points), and poor diet
quality (50 and under) but there wasn’t found patients who
good diet quality was found. For that reason the subjects were
divided into two groups (needs improvement and poor) with
regard to HEI-2005 scores (³50 and <50, respectively).
Results: The average HEI score was 62,9 ± 8,3. When lipid
profile of patients with coronary artery disease evaluated,
serum concentrations of TC were 173,6 ± 44,9 mg/dL, high
density lipoprotein cholesterol (HDL) were 42,2 ± 9,7 mg/dL,
TC/HDL ratio were 4,2 ± 1,13, low density lipoprotein choles-
terol (LDL) were 118,1 ± 34,4 and triglyceride were
163,9 ± 101,7. The mean TC levels were slightly higher in poor
group than “needs improvement” group (179,5 ± 35,0 and
173,1 ± 45,9, respectively), but this difference was not
statistically significant( p > 0.05).
Conclusion: The results indicate that there is no relationship
between HEI scores and serum lipid levels in patients with
coronary artery disease.
Disclosure of Interest: None declared.
SUN-P119
BIOIMPEDANCE BODY MASS COMPOSITION DATA MIRROR
FUNCTIONAL RESERVE AND FRAILTY IN DIALYSIS PATIENTS
B. Knap1 *, Ž. Haler1, K. Knap1, J. Buturovic-́ Ponikvar1.
1
Nephrology, University Clinical Centre, Ljubljana, Slovenia
Rationale: Malnutrition, sarcopenia and hypervolemia are
indicators of increased cardiovascular risk, morbidity and
mortality and indicate the loss of quality of life in dialysis
Poster
patients. Early diagnosis and therapeutic interventions are the
best way to improve prognosis of those patients and to delay
frailty syndrome.
Methods: Body mass composition together with bioimpedance
body analysis are useful, noninvasive option for diagnosis of
malnutrition, sarcopenia and hypervolemia in dialysis patients.
In one single center study 183 dialysis patients were evaluated.
Over-hydration index (OH), fat tissue index (FTI), lean tissue
index (LTI) and Phase angle (Phi50) were evaluated and
compared to routine classical biochemical blood analysis data
(hemogram, creatinine, serum electrolyte, lipidogram, I-PTH.)
Results: Phi50 shows positive correlation with triglyceride
( p = 0.02), serum albumine ( p = 0.009), BMI ( p = 0.06), LTI
( p = 0.06), FTI( p = 0.06) and I-PTH(0.07) and negative correl-
ation with overhidration ( p = 0.0001) and age ( p = 0.0001).
Patients with severe hyperparathyrodism (cinacalcet therapy)
unexpectedly show increasing values of LTI ( p = 0,05) and lower
values of FTI ( p = 0.05).
Conclusion: Low values od I-PTH are more dangerous for
malnutrition and sarcopenia in dialysis patients than patients
wirh higher values of I-PTH. Bioimpedance body mass markers
show interesting data about functional reserve of dialysis
patients and with more experience this methods could be
indicate dangerous of frailty syndrome in dialysis patients and
possibility to its prevention.
Disclosure of Interest: None declared.
SUN-P120
DYSLIPIDEMIA AMONG CLIMACTERIC WOMEN IN SOUTHERN
BRAZIL
C. W. Gallon1 *, K. G. Mendes1, H. Theodoro1, J. G. D. Vargas1,
R. Miecinikovsski1, D. R. S. De Lorenzi1, M. T. A. Olinto2.
1
Universidade De Caxias Do Sul, Caxias do Sul, 2Unisinos, São
Leopoldo, Brazil
Rationale: The climacteric phase implies metabolic and
hormonal changes that might lead to adverse effects, such as
dyslipidemia and cardiovascular risks. Determine factors
associated with the prevalence of dyslipidemia among climac-
teric women treated in a reference clinic in southern Brazil.
Methods: Cross-sectional study with 550 women aged 40–65
years treated in a clinic specialized in climacteric therapies and
gynecologic surgeries. A precoded and pretested standardized
survey with questions about socioeconomic, demographic,
behavioral and reproductive features was applied. Laboratory
tests needed to define lipid profiles were the analysis of HDL
cholesterol, total cholesterol and triglycerides. This study was
approved by the Research Ethics Committee of the University of
Caxias do Sul (No. 124/08)
Results: 550 climacteric women were evaluated. An elevated
prevalence of dyslipidemia (83.8%) was found. The group
presenting the largest number of dyslipidemic women was the
group aged 56–65 years (92.5%). There was no significant
association between occurrence of dyslipidemia and meno-
pausal state. Multivariate analysis revealed that dyslipidemias
were 11% more prevalent in women aged 56–65 years (PR 1.11;
p = 0.03) and 16% more frequent among women with three or
more gestational periods ( p = 0.04). The prevalence of dyslipi-
demia was also higher among obese women than among the
eutrophic ones, however, the significance level remained in a
boundary zone (PR 1.12; p = 0.06).
Nutrition and chronic diseases 1
Conclusion: A higher prevalence of dyslipidemia was found
among women with multiple pregnancies, something that may
be linked to hormonal and metabolic issues, as well as dietary
issues during pregnancy. Possibly, the aging process and its
metabolic changes —more than the menopausal state itself— is
the main factor associated with dyslipidemia during the
climacteric years.
Disclosure of Interest: None declared.
SUN-P121
APPLICATION OF ONODERA PROGNOSTIC NUTRITION INDEX
AND NEUTROPHIL TO LYMPHOCYTE RATIO IN EVALUATION OF
POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN’S
DISEASE
C. Zhu1 *. 1Department of General Surgery, Peking Union
Medical College Hospital, Chinese Academy of Medical Science
and Peking Union Medical College, Beijing, China
Rationale: To study the application of Onodera prognostic
nutrition index (OPNI) and neutrophil to lymphocyte ratio(NLR)
in evaluation of postoperative complications in patients with
Crohn’s disease (CD)
Methods: Data of 108 CD patients with bowel resection was
analyzed. OPNI and NLR was calculated within one week before
surgery. The distributions of OPNI and NLR in clinical features
and correlation were analyzed. The cutoff values for OPNI and
NLR was calculated by Receiver Operating Characteristic (ROC)
curve and Youden index. the independent risk factors for
complications was investigated by logistic regression model.
Results: OPNI was 38.8 ± 8.2. when OPNI was 39.8, the Youden
index was maximal. CD patients were divided into high (≥39.8)
and low (<39.8) OPNI groups. OPNI were significantly lower
(P < 0.05) in patients whose CD were B3 subtype, lymphocytes,
hemoglobin, prealbumin, albumin were less than normal value,
and energy of enteral nutrition was less than 500 kcal/d within
two weeks before surgery; as was the same in two groups
(P < 0.05).
NLR was 5.9 ± 12.1. NLR was 4.1, the Youden index was
maximal. CD patients were divided into high (≥4.1) and low
(<4.1) NLR groups. NLR were significantly higher(P < 0.05) in
patients whose CD were B3 subtype, lymphocytes and
prealbumin were lower and neutrophils was higher than
normal value, energy of enteral nutrition was less than
500 kcal/d within two weeks before surgery. as was the same
in two groups(P < 0.05).
OPNI and NLR had significant negative correlation.
Smoking within 1 year before surgery, OPNI < 39.8 and
NLR ≥ 4.1were independent risk factors for postoperative
complications.
Conclusion: OPNI and NLR were important reference for
perioperative complications in CD patients. Smoking within 1
year before surgery, OPNI < 39.8 and NLR ≥ 4.1were independ-
ent risk factors for complications.
Disclosure of Interest: C. Zhu Grant/Research Support from: The
capital health research and development of special fund, Consultant
for: weimingkang.
S99
SUN-P122
A RARE CASE: EXTENSIVE SUBCUTANEOUS HEMORRHAGE AND
GASKET DISPLACEMENT TO SUBCUTANEOUS AFTER
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY(PEG)
C. Zhu1 *. 1Department of General Surgery, Peking Union
Medical College Hospital, Chinese Academy of Medical Science
and Peking Union Medical College, Beijing, China
Rationale: Endoscopic gastrostomy Percutaneous (PEG) has
many complications. But extensive subcutaneous hematoma
caused by muscle hemorrhage in site of paracentesis and gasket
displacement to subcutaneous after PEG in short-term was
extremely rare. A patient with dysphagia and forced crying has
this complication in our hospital. we summarized it to prevent
its recurrence.
Methods: Patient Zhang, female, 60 years old. Diagnosis is
dysphagia and forced crying loudly intermittently beyond self-
control. PEG was carried on in May10th, 2016.
Results: On second day after operation, Forced crying was
significantly worse than before. there existed a purple
ecchymosis, about 5*5 cm, at the left side of puncture point.
On third day, Forced crying was significantly worse. Dark red
liquid outflowed. The area of purple ecchymosis expanded to
iliolumbar. The decline of hemoglobin was 45 g/L. CT showed
local muscle was bleeding.
From fourth days to seventh days, Forced crying was more
frequently. Dark red liquid outflowed from puncture site. The
area of purple ecchymosis expanded to labium majus and
perineum. Hemoglobin was stable.
On eighth day, Ecchymosis were gradually narrowing, even
disappearing. But the massive clear gastric juice and gastric
contents outflowed from puncture site.
On twenty-first days, PEG gastric disc shifted from the stomach
to the subcutaneous tissue. Then PEG was removed. Daily
dressing change until the skin wound healing.
Conclusion: The most fundamental reason is blood pressure
and abdominal pressure increased dramatically for an instant
caused by forced crying over and over again. For the patients
who have forced crying beyond self-control and PEG indica-
tions, sedation and analgesia should be carried on timely after
operation to prevent this kind of complication.
Disclosure of Interest: C. Zhu Grant/Research Support from: The
capital health research and development of special fund, Consultant
for: weimingkang.
SUN-P123
DEFICITS IN COGNITIVE FLEXIBILITY IN COPD ARE LINKED TO
CHANGES IN METABOLISM OF BRANCHED-CHAIN AMINO ACIDS
C. K. Lieben1 *, N. E. Deutz1, R. Jonkers1, E. Veley2,
R. Harrykissoon3, A. Zachria3, M. P. Engelen1. 1Health and
Kinesiology, Texas A&M University, 2Pulmonary and Critical
Care, Scott and White Memorial Hospital, 3Pulmonary, Critical
Care & Sleep Medicine, College Station Medical Center, College
Station, United States
Rationale: There is growing awareness of cognitive dysfunc-
tions (i.e., impairment in visuoperceptual abilities, cognitive
processing speed and flexibility) in chronic obstructive pul-
monary disease (COPD). However to date, no studies have
explored the metabolic changes underlying cognitive
S100
impairment in COPD. This study evaluates the metabolic
signature of attentional and executive dysfunctions in COPD.
Methods: We enrolled 23 COPD patients (GOLD II-IV) and 17 age
and gender matched healthy control subjects. For the STROOP
test, a cut-off interference score (IS) of 60 sec between
incongruent and congruent parts was used as high IS (>60 sec)
reflects less mental flexibility. Plasma amino acid profile was
assessed by LC-MS/MS and the sum of branched-chain amino
acids (BCAA: valine, isoleucine, leucine) was calculated. As
markers of central precursor availability for the synthesis of
serotonin and dopamine, we calculated the ratios of trypto-
phan (TRP) and sum of tyrosine (TYR) and phenylalanine (PHE)
to other large neutral amino acids (i.e. TRP/LNAA and
(TYR + PHE)/(TRP + BCAA)), respectively. Statistics was done
by t-test.
Results: As the tasks became more cognitively demanding, a
high IS was more frequently observed in COPD (59%) compared
to the control group (23%; p < 0.05). COPD patients with high IS
showed reduced levels of plasma BCAA ( p < 0.01), increased
(TYR + PHE)/(TRP + BCAA) ratio ( p < 0.01), and a tendency
towards increased TRP/LNAA ratio ( p = 0.06). These effects
did not occur in healthy subjects with high IS.
Conclusion: Our findings indicate that impaired attentional
control in COPD patients are associated with increased central
uptake of TYR to promote dopamine synthesis. Since this effect
seems to be mediated by a metabolic imbalance, nutritional
intake of BCAAs might enhance attentional processes and
response inhibition in COPD with cognitive impairment.
Disclosure of Interest: None declared.
SUN-P124
HUNGER BEFORE MEALS AND ALCOHOLIC CRAVINGS AND
SELECTED CLINICAL, BIOCHEMICAL, AND NUTRITIONAL
VARIABLES IN PATIENTS WHO ARE ADDICTED TO ALCOHOL
D. Czarnecki1 *, M. Ziółkowski2, K. Antczak3, K. Pawlucha4,
W. Cieślak4, E. Holec4,5. 1Department of Psychiatry Nursing,
2
Deparment of Psychiatry Nursing, Nicolaus Copernicus
University in Torun, Collegium Medicum in Bydgoszcz,
3
University Hospital No. 1, 4Nicolaus Copernicus University in
Torun, Collegium Medicum in Bydgoszcz, 5University Hospital
No 1, Bydgoszcz, Poland
Rationale: It is known from clinical observations that patients
with alcohol dependence at the initial stage of abstinence
often experience both alcohol craving and severe hunger
before meals occurring coincidentally. The purpose of the study
was to assess whether alcoholism and pre-meal hunger depend
on similar clinical, biochemical, and nutritional variables in
patients hospitalized for alcohol dependence.
Methods: The study was conducted among 67 men hospitalized
for alcohol dependence. In the first week of treatment, each
patient was evaluated for age, clinical dependence (e.g. time
and depth of addiction, craving, smoking) and nutritional (e.g.
hunger, body mass, BMI, WHR,% FM) and biochemical (Eg leptin,
ghrelin, GTP or triglycerides) status. IMAGO 3 with linear
regression was used for statistical evaluation.
Results: It has been shown that in the group of clinical
variables, a predictor of pre-meal hunger intensity was tobacco
smoking (Beta 0.348; R2 = 0.12). In turn, a predictor of the
frequency of alcohol craving in the week was the number of
standard drinks (Beta 0.292; R2 = 0.07). From the group of
Poster
biochemical variables, no model of predictors was established
in relation to the strength and frequency of both studied hunger
due to lack of statistical significance. From the group of
nutritional variables, predictors of pre-meal hunger were BMI
(Beta −0.313; R2 = 0.08), and the frequency of alcoholic
beverage in the week was WHR (Beta −0.343; R2 = 0.11).
Conclusion: In male alcohol addicts initiating withdrawal
therapy, smoking is a significant contributing factor to pre-
meal hunger (12% of variance), and the frequency of alcohol
craving is the number of standard drinks (7% variance). The
lower the BMI value, the higher the pre-meal hunger
prevalence (8% variance), and the lower the WHRs, the
higher alcohol craving frequency (11% of the variance
explained).
Disclosure of Interest: None declared.
SUN-P125
APPLICATION OF THE FINDRISC QUESTIONNAIRE TO
SCREENING THE RISK OF DIABETES MELLITUS IN PATIENTS
WITH CARDIOVASCULAR DISEASE
K. G. D. Santos1, A. S. Monteiro1, C. C. J. Paiva1, F. C. Amparo1,
P. Moreira1, R. Alves1, C. Kovacs1, D. Magnoni1 *. 1Ambulatory of
Nutrition Clinic, Institute Dante Pazzanese of Cardiology, Sao
Paulo, Brazil
Rationale: Diabetes mellitus (DM) is associated with increased
of cardiovascular risk, complications and health costs. Among
the instruments validated, the Findrisc (Finnish Diabetes Risk
Score) is self-administered and estimates the risk of developing
DM in the next 10 years. The objective was to verify the risk of
developing DM in patients referred for nutritional follow-up
through the Findrisc.
Methods: Cross-sectional study at an Institute of Cardiology
with patients aged ≥18 years, without diagnosis of DM or
hypoglycemic drugs. Data were collected from the medical
record: age, gender, body mass index (BMI), abdominal
circumference (CA), fasting glucose (FG) and glycated hemo-
globin (HbA1c), physical activity, fruit and vegetable consump-
tion, antihypertensive drugs and family history of DM.
Descriptive analysis was performed using the Microsoft Excel®
program.
Results: Among the 95 patients evaluated, there was a
predominance of the female gender (64.2%), with a mean age
of 57.9 ± 13.1 years. According to Findrisc’s classification,
57.90% had a high or very high risk of developing DM (47.37%
and 10.53%, respectively). Among the analyzed variables, the
most important to the elevation of the score were BMI (32.63%
between 25 and 30 kg/m² and 48.42% ≥ 30 kg/m²), CA (16.84%
equivalent to high risk and 66.32% very high risk), sedentary
lifestyle (55,79%), use of antihypertensive drugs (73%) and
family history of DM (56.84%). The FG was altered in 33.68%,
with a mean of 95 ± 12.37 mg/dL and the HbA1c with a mean of
6.1 ± 3.81%, a value that also corresponds to the high risk for
the development of DM.
Conclusion: The Findrisc is a low cost and easy applicability
tool in clinical practice. Among the variables with a higher
prevalence of alterations, there are modifiable factors that can
be improved during nutritional follow-up, mainly in individuals
with a higher risk for the development of DM.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 1
SUN-P126
BIOELECTRICAL IMPEDANCE ANALYSIS PHASE ANGLE AS A
PROGNOSTIC MARKER FOR OUTCOME IN PATIENTS ADMITTED
IN HOSPITAL WITH ACUTE EXACERBATION OF CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
S. Kakavas1,2, D. Karayiannis3 *, A. Papanikolaou2, A. Baschali3,
M. Sarantidou3, A. Karachaliou3, A. Karli3, Z. Mastora1,
M. Palavra2, G. Boulbasakos2. 1First Department of Critical
Care Medicine and Pulmonary Services, 2Pulmonary
Department, 3Nutrition and Dietetics, Evangelismos Hospital,
Athens, Greece
Rationale: Changes in body composition are important extra-
pulmonary manifestations of chronic obstructive pulmonary
disease (COPD) that occur in all stages of disease and are
associated with poor outcome. Bioelectrical impedance ana-
lysis phase angle (BIAPA) is a strong functional and prognostic
marker in many disease states, but data in COPD with acute
exacerbation are lacking. Our aim was to determine the
relationship of BIAPA with established markers of function,
disease severity and prognosis.
Methods: A cross sectional observation study constituting 31
COPD patients consecutively hospitalized with acute exacer-
bation. Lung function was measured by routine spirometry.
Nutritional status was assessed by the measurement of
anthropometric indices, handgrip dynamometry and bioelec-
trical impedance analysis. Hospital outcome was also assessed.
Results: Thirty one COPD patients with acute exacerbation
(mean age 62.5 ± 7.1 years, mean BMI 26.5 ± 4.1 kg/m2) were
assessed. Phase angle correlated positively with Fat Free Mass
(FFM) (r = 0.351, p < 0.001), serum albumin at admission
(r = 0.298, p < 0.05) and handgrip strength (r = −0.288, p <
0.05). In multivariate adjusted models, participants in the
lowest tertile of BIAPA had significantly higher Length of
Hospital Stay (OR:2.21, 95% CI 1.38–2.84), after adjusting for
age, BMI, sex, Forced Expiratory Volume in one second (FEV1)
and forced vital capacity (FVC), compared to those in the third
tertile. Lower phase angle values were associated with more
exacerbations and hospital days in past year ( p < 0.05).
Conclusion: Bioelectrical impedance analysis phase angle
relates to markers of function, disease severity and length of
hospital stay in patients with acute exacerbation of COPD and
demonstrates promising prognostic utility.
Disclosure of Interest: None declared.
SUN-P127
EFFECTS OF NUTRITIONAL INTERVENTION ON LYMPHOCYTE
COUNT IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN G3-4
KDIGO STAGE
E. Perez-Cruz1 *, A. Pablo-Francisco1, B. R. Pardo-Pacheco1,
Y. Luna-Camacho1. 1Nutrition Support, Critical Medicine
Department, Hospital Juárez De México, CD Mexico, Mexico
Rationale: Chronic kidney disease (CKD) patients are at risk of
malnutrition (MNT). The aim of this study was to describe the
impact of a nutritional program in total lymphocyte count
(TLC) of patients with CKD.
Methods: A prospective, longitudinal study was conducted in
patients with CKD G3-G4 KDIGO during 4 months. Etiology
diagnostic and demographic information were obtained. The
protocol included anthropometry measurements, subjective
S101
global assessment (SGA) and laboratory. Nutritional status
was classified at the beginning and the end of nutritional
program based on the TLC: normal >2,000 mm3, MNT mild
1,500–1,999 mm3, moderate 1,200–1,499 mm3 and severe
<1,200 mm3. REE was calculated by Harris-Benedict and
protein requirement were 0.6 g/Kg/d in G4 and 0.7 g/Kg/d at
G3 KDIGO stage. Attachment was assessed with a 24-hour
reminder and weekly dietary diary. Data are presented as
percentages, means ± SD; paired Student’s tests were used; a
difference was significant for p < 0.05.
Results: 25 patients (19 women and 6 men) were included.
Mean age was 53.76 ± 10.96 years. According to the SGA were
classified 44% as SGA-A, 36% SGA-B and 20% SGA-C. REE
provided was 1871.8 ± 292.59 cal. BW (68.69 ± 18.16–65.90 ±
17.39 kg; p < 0.001), BMI (28.42 ± 7.0–26.90 ± 7.16 Kg/m2; p <
0.001) and serum creatinine levels decreased significantly
(2.4 ± 0.21–1.93 ± 0.12 mg/dL; p < 0.001) (Table).
Table: Effects of nutritional intervention on TLC in patients with CKD.
Nutritional status TLC mm3 0 months 4 months
Normal >2,000 44% 64%
MNT mild 1,500–1,999 12% 20%
MNT moderate 1,200–1,499 28% 8%
MNT severe <1,200 16% 8%
Conclusion: MNT is a persistent problem for CKD patients.
Nutritional intervention was associated with an improvement
of nutritional status and decreased of serum creatinine levels.
References
Leinig C, Morales T, Ribeiro S, Riella M, Olandosky M, Martins C.
Predictive value of malnutrition markers for mortality in peritoneal
dialysis patients. J Ren Nutr. 2011.
Disclosure of Interest: None declared.
SUN-P128
DIETARY HABITS IN PARKINSON’S DISEASE: ADHERENCE TO
MEDITERRANEAN DIET
M. Barichella1, E. Cereda2 *, E. Cassani1, V. Ferri1, G. Pinelli1,
L. Iorio1, C. Bolliri1, S. Caronni1, S. A. Faierman1,
A. Mottolese1, C. Pusani1, F. Monajemi1, M. Pasqua1,
A. Lubisco3, G. Pezzoli1. 1Parkinson Institute, ASST G.Pini-CTO,
ex ICP, Milano, 2Nutrition and Dietetics Service, Fondazione
IRCCS Policlinico San Matteo, Pavia, 3Department of Statistical
Sciences “P. Fortunati”, University of Bologna, Bologna, Italy
Rationale: Our objective is to describe the dietary habits, food
preferences and adherence to Mediterranean diet (MeDi) of a
large sample of Italian Parkinson’s Disease (PD) patients
compared to a group of healthy controls.
Methods: Dietary habits of 600 PD patients from throughout
Italy and 600 healthy controls matched by gender, age,
education, physical activity level and geographical residence,
were collected using the ON-GP Food Frequency Questionnaire.
Then, we compared patients by disease duration and the
presence of swallowing disturbances.
Results: Overall, adherence of PD patients (males, 53.8%;
mean disease duration, 9.2 ± 7.0 years) to MeDi was similar to
controls (score, 4.8 ± 1.7 vs. 4.9 ± 1.6; P = 0.294). Patients
consumed less alcohol and fish and drank significantly less
water, coffee, and milk (P < 0.05 for all) which resulted also in
lower total fluids intake. On the contrary, they ate more fruit,
S102
cooked vegetables, cereals and baked items, more dressings
and more sweets in general (P < 0.05 for all). Disease duration
was associated with increased intake of several food groups but
it was not was not associated with changes in MeDi score
(P = 0.721). Patients with swallowing disturbances (n = 72)
preferred softer and more viscous food but preferences did
not result in differences in dietary pattern. However, patients
with dysphagia drank less fluids (P = 0.043).
Conclusion: PD patients presented different dietary habits and
food preferences compared to the general population and
adherence to MeDi was not associated with disease duration.
Self-reported dysphagia was associated with reduced intake of
fluids. These aspects may be amenable to change in order to
improve the management of nutritional issues in this patient
population.
References
Barichella M, Cereda E, et al. Dietary habits and neurological features
of Parkinson’s disease patients: Implications for practice. Clin Nutr.
2016; In Press doi: 10.1016/j.clnu.2016.06.020.
Disclosure of Interest: None declared.
SUN-P129
EVALUATION OF MUSCLE-SKELETAL STRENGTH AND IN
SEVERELY MALNOURISHED PATIENTS WITH ANOREXIA
NERVOSA (AN)
E. Minano1 *, P. Bemer1, H. Ohanyan1, A. Pleple1, N. Kayser1,
J.-C. Melchior1,2, M. Hanachi2,3. 1Unité de Nutrition Clinique,
Hôpital Raymond Poincaré, Garches, 2Faculté de médecine,
Université de Versailles Saint Quentin en Yvelines INSERM
U1179, Montigny-le-Bretonneux, 3Raymond Poincaré Hospital
(AP-HP), Garches, Clinical Nutrition Unit, Garches, France
Rationale: Anorexia nervosa (AN) is a psychiatric pathology
with potential somatic consequences. Loss of autonomy and
functional impotence are not well known in severely malnour-
ished patients (BMI < 13) with AN. We aimed to study the
muscles strength at admission and after 5 weeks of nutritional
care.
Methods: A prospective cohort study was conducted during 6
months. Clinical and biological nutritional assessment and
weekly muscular testing using simplified muscle test* up to 5
weeks of evolution were organized.
Results: We included 24 AN female patients (79% AN restrictive
type and 21% AN purging type): BMI 11.7 ± 2.17, age 25.5 ± 6.3
years, duration of disease 9.06 ± 6.51 years. All patients showed
a global decrease in muscle strength at admission. This was
more marked on axial than peripheral levels (2/5 ± 1/5 vs 3/
5 ± 1/5, p < 0.0001). Concerning peripheral muscular force,
there was no significant difference between proximal and distal
muscles (Proximal vs Distal (3.2/5 + 0.51/5 vs 3.1/5 + 0.9/5,
p = 0.45). Global and segmental loss of muscle strength at
admission was significantly associated with severity of under-
nutrition (BMI: p < 0.0001, Alb: p = 0.02, Pre Alb: p = 0.02) and
severity of hypertransaminasemia (AST: p = 0.02, ALT: p =
0.005). After follow up under enteral nutrition, the evolution
of muscle strength was significantly positive (S1 vs S5:
p = 0.0012) as well as weight gain (BMI S5:12.7, p = 0.001)
With an average improvement in testing at S5 of more than 50%
of the initial value).
Poster
Conclusion: Severely undernourished AN patients present a
global decrease of muscular strength, more important in axial
muscles. This impairment is associated with severity of
undernutrition and hypertransaminasemia. An incomplete
recovery was observed after 5 weeks of enteral nutrition.
Ongoing larger study with electromyogram evaluation will
allow a better characterization of this muscular impairment
(neurogenic vs myogenic).
Disclosure of Interest: None declared.
SUN-P130
CARDIOVASCULAR RISK AND ATPIII GOALS ACHIEVEMENT IN
ECUADORIAN POPULATION
I. Hernandez1, A. Estrella1, J. L. Salazar2, Y. C. Duarte3,
E. Torres4, C. Lopez5, E. Teran1,6 *. 1Facultad de Enfermeria,
Pontificia Universidad Catolica del Ecuador, 2Servicio de
Endocrinologia, Hospital Especialidades Eugenio Espejo,
Quito, 3Servicio de Cardiología, Hospital Luis Vernaza,
Guayaquil, 4Servicio de Medicina Interna, Hospital Carlos
Andrade Marín, Quito, 5Servicio de Endocrinología, Hospital
Teodoro Maldonado Carbo, Guayaquil, 6Colegio de Ciencias de
la Salud, Universidad San Francisco De Quito, Quito, Ecuador
Rationale: ATPIII guidelines for dyslipidemia treatment are
aimed to reduce cardiovascular morbi-mortality and reduced
avoidable health care costs. In Ecuador, 19.9% of people
younger than 60 years old shows high LDLc and hypertriglycer-
idemia is present in 38.7%. The objective of the present study
was to investigate the percentage of ATPIII goals achievement
in Ecuadorian population.
Methods: 385 subjects older than 30 years, with confirmed
dyslipidemia by laboratory analysis and having received
medical care and pharmacological treatment for at least
three months were included from both public and private
institutions from the two main cities (Quito and Guayaquil) of
Ecuador. In an explanatory, observational and retrospective
study, subjects were randomly selected, and patient’s record,
age, gender, diagnosis, initial and 12 weeks values of lipids, and
treatment provided were collected.
Results: Results showed equal distribution by gender. Very high
cardiovascular risk was present in 77.6% of the subjects, and
this was significantly more frequent in women (86.6%, OR 2.97
95%IC 1.65–5.3; p = 0.0002). When comparing initial and post
treatment lipid values, the high-risk group showed a decrease
in the latter, although it was no significant, but allowed 62% of
the patients at this group to reach their goal. However, in very
high-risk subjects, although there was a significant decrease in
LDLc ( p < 0.0001) and triglycerides ( p = 0.0009), only 19%
patients reached their goal. Statins were the treatment of
choice in 91% of the cases, but in most of them, they were
prescribed at the lowest available doses.
Conclusion: In conclusion, in this representative sample of
Ecuadorian subject with high or very high cardiovascular risk,
independent of the treatment used, only 29% of patients
achieved ATP III goals.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 1
SUN-P131
FECAL SHORT CHAIN FATTY ACIDS CONCENTRATIONS AND
DIETARY INTAKE IN FEMALES WITH RESTRICTIVE ANOREXIA
NERVOSA
E. Speranza1 *, I. Cioffi1, L. Santarpia1, C. De Caprio1,
C. Del Piano1, E. De Filippo1, M. Marra1, F. Pasanisi2,
F. Contaldo2. 1Federico II University, 2Interuniversity Center for
Obesity and Eating Disorders, Federico II, Naples, Italy
Rationale: The composition of the intestinal microbiota could
affect body weight regulation. The role of gut microbiota in
undernourished subjects, including anorexia nervosa (AN), has
not been fully investigated. This study aims to analyze fecal
short chain fatty acids (SCFAs) and bacteria profiles along with
dietary intake in restrictive AN patients (r-AN) versus controls.
Methods: Fecal SCFA and bacteria concentrations were
evaluated in 11 females with r-AN and 7 healthy females
controls (age = r-AN: 22.4 ± 3.0 y, controls: 31.0 ± 5.5 y;
BMI = r-AN: 14.9 ± 1.0 kg/m2, controls: 22 ± 2.4 kg/m2). Fecal
SCFA were quantified with gas chromatography, while different
bacteria phyla (Bacteroidetes, Firmicutes, Lactobacillus, and
Bifidobacterium) were identified by quantitative Real-Time
PCR (qRT-PCR). Additionally, the r-AN patients and controls
underwent indirect calorimetry for measuring Resting Energy
Expenditure (MREE) and dietary intake was assessed by using
7-day food records in both groups.
Results: The concentrations of total fecal SCFA, butyrate,
propionate were reduced in r-AN patients compared to controls
( p = 0.013; p = 0.004; p = 0–018; respectively); while no differ-
ence was observed for different bacteria groups. As expected,
MREE (r-AN = 915 ± 165 kcal; controls = 1,359 ± 147 Kcal; p =
0.001) as well as reported energy intake was significantly
lower for r-AN versus controls (r-AN = 1,062 ± 321 kcal; controls =
1,507 ± 395 Kcal; p = 0.02). Fat intake was significantly lower in
r-AN patients whereas fiber intake did not differ between
groups.
Conclusion: The significant reduction in fecal SCFA in r-AN
compared to controls might represent an adaptive mechanism
of nutrients digestion in r-AN subjects.
Disclosure of Interest: None declared.
SUN-P132
THICKENER USE IN PEDIATRIC DYSPHAGIA: TREATMENT
RESULTS AND FAMILY EXPERIENCES
F. Ilgaz1 *, S. Serel Arslan2, H. Gökmen Özel1, N. Demir2,
A. A. Karaduman2. 1Department of Nutrition and Dietetics,
2
Department of Physical Therapy & Rehabilitation, Hacettepe
University Faculty of Health Sciences, Ankara, Turkey
Rationale: Thickened fluids are widely used in pediatric
dysphagia but little is known about the results and family
experiences regarding the use of commercially fluid thick-
eners. This study was designed to determine the results and
family experiences related to the use of thickeners in children
with liquid aspiration.
Methods: This cross-sectional study was conducted on children
using thickeners for management of thin liquid aspiration,
which was determined by videofluoroscopic swallowing study.
Data was obtained from families by a detailed questionnaire.
Statistical analyses were performed by chi-squared test.
S103
Results: A total of 30 children (43.3% male) with a median age
of 27.5 months (11–121 months) were included. Mean duration
of thickener use was 14.3 ± 11.4 months. A xanthan-gum based
thickener was the choice of thickener in 53.3% of children while
a modified-starch based or locust bean gum based thickener
was used in 26.7% and 20.0%, respectively. Most of the children
(93.4%) were recommended to drink nectar/honey-like con-
sistencies. The most common problems regarding the prepar-
ation of thickened fluids were lumpiness (53.3%), excessive
thickening with waiting (33.3%) and inability to obtain same
consistency in different liquids (23.3%). Families reported
reduced frequency of pulmonary infections (93.3%), decreased
feelings of thirst (83.3%) and increased liquid intake after
treatment (63.3%). Ease of preparation or treatment outcomes
were not statistically different according to types of thickener
or consistency level ( p > 0.05). All of the families reported that
thickened liquids were safe and 90.0% of families were satisfied
with the treatment.
Conclusion: Although the families experience some difficulties
in preparation of thickened liquids with appropriate thickness
level, they are still found to be safe and efficient by families,
particularly due to reduced pulmonary infections and
increased fluid intake.
Disclosure of Interest: None declared.
SUN-P133
MALNUTRITION AND PULMONARY FUNCTIONS IN PATIENTS
WITH CYSTIC FIBROSIS
H. Akbıyık1 *, N. Emiralioğlu2, E. Güneş Yalçın2, D. Doğru Ersöz2,
H. U. Özçelik2, N. Kiper2, H. Gökmen Özel1. 1Nutrition and
Dietetics, Faculty of Health Sciences, 2Department of Pediatric
Pulmonary Diseases, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
Rationale: Malnutrition is common in patients with cystic
fibrosis (CF). Lower body mass index Z (BMIZ) score is
associated with worse pulmonary function. The aim of this
study was to evaluate malnutrition and pulmonary functions in
CF patients.
Methods: Seventy-four patients with CF (37 boys, 37 girls), aged
between 9 and 19 years (mean ± SD = 11.4 ± 3.9 yrs) attending
Hacettepe University, Faculty of Medicine, Department of
Pediatric Pulmonary Diseases were included. Weight for age
(WAZ), height for age (HAZ) and BMIZ scores were calculated
using WHO Anthro and Anthro plus programmes. Forced
expiratory volume in 1 second (FEV1) was measured according
to standard guidelines in patients over 6 years of age. Patients
having FEV1 > 80%; ≤80% and ≥61%; ≥41% and ≤60% and ≤40%
were classified as normal, mild obstruction, moderate obstruc-
tion and severe obstruction, respectively.
Results: It was found that 11.6% of patients were underweight
(WAZ ≤−2SD) and 7.0% were stunted (HAZ ≤−2SD). The
percentage of patients whose BMIZ scores ≤−2SD was 9.9%.
There were no patients who had moderate and severe lung
disease. Mean FEV1 was %91.3 ± 10.1 and WAZ, HAZ and BMIZ
score was −0.84 ± 1.34, −0.86 ± 1.04 and −0.60 ± 1.28, respect-
ively. There was no relationship betweenWAZ, HAZ, BMIZ and
FEV1%.
Conclusion: Although it was not shown a relationship between
BMIZ score and pulmonary function in this study, it is important
S104
to assess nutritional status and pulmonary functions in cystic
fibrosis population.
Disclosure of Interest: None declared.
SUN-P134
ENERGY AND MACRONUTRIENT INTAKES IN PATIENTS WITH
CYSTIC FIBROSIS: DO THEY ACHIEVE GUIDELINES?
H. Akbıyık1 *, N. Emiralioğlu1, E. Güneş Yalçın1, D. Doğru Ersöz1,
H. U. Özçelik1, N. Kiper1, H. Gokmen Ozel2. 1Department of
Pediatric Pulmonary Diseases, Faculty of Medicine, 2Nutrition
and Dietetics, Faculty of Health Sciences, Hacettepe
University, Ankara, Turkey
Rationale: Most patients with cystic fibrosis (CF) require a
higher energy and protein intake than their healthy peer group.
There are few data on dietary intakes in our CF patient group.
The aim of this study was to evaluate daily energy and
macronutrient intakes and compare according to the recom-
mendations of the nutritional guidelines for CF.
Methods: One-hundred sixty four patients with CF, aged
between 2 and 20 years (mean ± SD = 7.4 ± 4.9 yrs) attending
Hacettepe University, Faculty of Medicine, Department of
Pediatric Pulmonary Diseases were included. Energy and
macronutrient intakes were calculated using a-24-hour
dietary recall method and compared according to ESPEN-
ESPGHAN-ECFS guidelines with CF. Mean percentage (±SD) of
energy from protein, carbohydrate and fat was calculated.
Results: The mean value of carbohydrate intake was
46.9 ± 8.8%, with mean values was close to the higher
recommended threshold (40–45%). Mean percentage of
energy from carbohydrate was higher than the recommended
threshold in 86 patients. The mean daily protein intake was
14.6 ± 3.6%, not reaching the recommendation of 20%. A total
149 patients’ mean percentage of energy from protein was
lower than recommendation. The mean fat intake (37.5 ± 8.3%)
was in the recommended ranges (35–40%). The recommended
lower (110%) and higher (200%) limit of daily energy intake was
not reached by 40% and 96% of the patients, respectively. The
mean value of was 236 kcal higher than the lower threshold and
−1,864 kcal lower than the higher threshold. Mean fat intake
decreased with age (r = −0.225, p < 0.01), while mean carbo-
hydrate intake increased (r = 0.182, p < 0.05). Percentage of
protein intake did not change with age.
Conclusion: It was shown that mean carbohydrate and fat
intakes were close to recommended guidelines, although
energy and protein recommendations were not met. Dietary
assessment is essential to identify the need for earlier
nutritional intervention.
Disclosure of Interest: None declared.
SUN-P135
INDIVIDUALLY TAILORED DIETARY TREATMENT IN PATIENTS
WITH MITOCHONDRIAL DISORDERS: THE DINAMITE STUDY
H. Zweers1, M. Rutten1,2, M. V. Rossum1,2, S. Leij1,2 *,
G. Wanten1, M. Janssen3. 1Department of Gastroenterology
and Hepatology, Radboudumc, 2Dietetics, HAN University of
Applied Sciences, 3Department of Internal Medicine,
Radboudumc, Nijmegen, Netherlands
Rationale: The DINAMITE study is the first explorative study in
adult patients with mitochondrial disease (MD) that explored
Poster
the effect of dietary treatment by achieving individual dietary
goals.
Methods: Individual treatment goals were set for each patient
and evaluated after 3 and 6 months. Goals were established to
improve or stabilize bodyweight, fat free mass, fat percentage,
handgrip strength (HGS), level of fatigue, and/or presence and
nature of intestinal problems. Analysis of individual goals was
performed at 3 and 6 months after starting the intervention by
scoring the rate of success for each goal.
Results: 38 adult patients with the m.3243A > G mutation (age:
47 yr ± 13, mean ± SD, 21% male) were enrolled. The majority of
these patients (74%) expressed a wish to decrease their level of
fatigue. Tailored dietary advice resulted in improvement or
stabilization of body composition (51%), HGS (51%), fatigue
(34%), and gastro intestinal problems (50%). Eighty-four
percent of the MD patients reported an improvement of one
or more goals related to body composition and/or functioning,
success of stabilization was registered in 95%. A total of 190
dietary goals at initiation decreased to 171 goals after 3 months
of the intervention. Each patient formulated an average of 5
(2–7) different goals of which 2,3 were achieved, thus resulting
in a success rate of 48%.
Conclusion: Almost half of the individually set dietary goals
were achieved. Individually tailored dietary treatment seems a
successful strategy in a substantial subset of adult MD patients
to improve or stabilize body composition, HGS, and/or gastro-
intestinal complaints.
Disclosure of Interest: H. Zweers Grant/Research Support from:
Vitaflo, M. Rutten: None declared, M. Rossum: None declared, S. Leij:
None declared, G. Wanten: None declared, M. Janssen: None declared.
SUN-P136
PATIENT SATISFACTION, ENERGY AND PROTEIN INTAKE IN A
GENERAL HOSPITAL POPULATION AFTER SWITCHING TO A
NEW HOSPITAL ROOM CATERING SERVICE
I. A. M. De Groot1 *, N. Kampman2, A. G. C. M. van Oort3,
H. Jongejan4, I. A. M. Gisbertz5. 1Dietetics, Bernhoven
Hospital, Uden, 2Nutrition and Dietetics, HAN Hogeschool van
Arnhem en Nijmegen, Nijmegen, 3Food Innovation, HAS
hogeschool Venlo, Venlo, 4Room & Lounge Services,
5
Gastroenterology, Bernhoven Hospital, Uden, Netherlands
Rationale: Traditional hospital meal service often does not
improve the nutritional status of hospitalised patients, allready
at risk for malnutrition. After introducing a new, flexible and
patient-friendly meal service in our (general) hospital we
aimed to investigate patient satisfaction and to determine the
percentage of patient-days in which nutrition goals were
achieved.
Methods: We prospectively collected data from general ward
patients in hospital Bernhoven (Uden, The Netherlands). A
questionnaire1 (40 questions in 6 domains) was used to
determine patient satisfaction in 90 patients. Energy and
protein intake was studied by comparing the exact weights of
meal components before and after meal consumption on 90
patient-days. This was compared to calculated energy (Harris
and Benedict) and protein (1,2 g/kg/day) requirements.
Results: Overall patients rated our meal service with a 8,4 on a
scale from 1 to 10. The calculated energy requirements were
achieved in 28% of the patient-days studied, protein goals were
achieved in 33% of days studied. Measurements in patients with
Nutrition and chronic diseases 1
a high (2 or more) versus a low (0 or 1) SNAQ (Short Nutritional
Assessment Questionnaire) score showed a clear difference:
measurements in high SNAQ score patients (supplied with
protein and energy enriched diets) showing sufficient protein
intake in 56% of patient-days studied, versus in 21% of patients-
days in patients with a low SNAQ score (supplied with normal
diets).
Conclusion: Patients reported to be quite satisfied with our
meal concept. This study shows again that it is very important to
find ways to improve energy and protein intake. One way could
be to supply energy and protein enriched diets to all hospitalised
patients, instead of in high SNAQ score patients only.
References
1. Nutrition-related Quality of Life Questionnaire. Developed by de
Roos ea. Wageningen University, the Netherlands, 2011.
Disclosure of Interest: None declared.
SUN-P137
INHIBITORY EFFECTS OF RESVERATROL ON STERILE
INFLAMMATION IN HIGH FAT DIET INDUCED OBESITY
I. Khodadadi Kohlan1 *, E. Siahpoushi1, H. Tayebinia1,
M. T. Goodarzi1, A. Zamani2. 1Clinical Biochemistry, Faculty of
Medicine, 2Immunology, Faculty of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic
Republic Of
Rationale: Activation of NLRP3 inflammasome/caspase-1
complex in oxidative stress and production of interleukin-1
beta (IL-1β) causes chronic inflammation observed in obesity.
This study aimed to investigate the antioxidant property of
resveratrol (RSV) on inhibiting the NLRP3 inflammasome and
reducing the production of IL-1β.
Methods: Forty male wistar rats (250 ± 14.3 g) were divided
into 4 groups. Normal control and RSV-treated control groups
received chow diet for 6 weeks whereas untreated obese and
RSV-treated obese (Ob + RSV) groups were fed high fat diet
(HFD) to induce obesity. Rats were then received chow diet or
chow diet plus daily i.p. injection of RSV (8 mg/kg) for 4 weeks.
Blood neutrophils, lymphocytes, and white blood cell count
(WBC), serum IL-1β level, liver enzymes activities, fasting
blood sugar (FBS), lipid profile, HbA1c and caspase-1 activity in
adipose tissues were determined. Normal distribution of the
results was tested using the Kolmogrov-Smirnov test. The one-
way ANOVA with post hoc Tukey test was used for comparison
between groups. Statistical significance was set at p < 0.05.
Results: Untreated obese rats showed mild liver steatosis with
elevated lipid profile and had significantly higher body weight,
FBS, HbA1c, WBC, neutrophil to lymphocyte ratio, IL-1β level,
and caspase-1 activity. Treatment with RSV remarkably reduced
body weight, FBS and HbA1c and favorably corrected lipid
profile, WBC count and neutrophil to lymphocyte ratio.
Interestingly, resveratrol completely ameliorated the detri-
mental increase in adipose tissue caspase-1 activity and serum
IL-1β, and improved steatosis in Ob + RSV group.
Conclusion: Resveratrol confers some protective roles by
reducing the activity of caspase-1 and IL-1β level, therefore,
it can be envisioned as a candidate therapeutic agent to reduce
systemic inflammation in obesity and prevent the risk of
chronic inflammatory diseases.
Disclosure of Interest: None declared.
S105
SUN-P138
RETROSPECTIVE ANALYSIS OF LABORATORY DATA AFTER USE
OF 2ND AND 3RD GENERATION LIPID-CONTAINING
PARENTERAL NUTRITION SOLUTIONS
I. G. Telessy1 *. 1Generacio Patika Bt, Gödöllö, Hungary
Rationale: Clinical laboratory (CL) parameters are accepted
indicators of adverse reactions during and after parenteral
nutrition (PN). According to our hypothesis retrospective
analysis of patient data can help in decision about nutrition
therapy of patients today. Data originated from an earlier study
we performed with other goal.
Methods: 27 routine CL parameters originated from randomly
selected 41 patients of Surgical Department of Debrecen
University, Hungary. Patient undervent subacute GI surgical
interventions and due to their nutritional status they were
nourished with total PN solutions from the first postoperative
day. PN mixtures were identical except fat emulsion and the
dosage per 1 kgBW was the same, too. Group-I received MCT-
LCT mixture and the Group-II received SMOFLipid. Blood was
collected after 12 hours fasting early morning before operation
and on the 4th postoperative day. Data were statistically
evaluated by Mann-Whitney tests and significant difference
between day 0 and day 4, as well as Group-I and Group-II was
stated if p < 0.05.
Results: Out of 27 laboratory parameters in Group-I 14
parameters and in Group-II 12 parameters were out of normal
range on 4th postoperative day. Statistically significant differ-
ence between day 0 and day 4 data were found in 11 parameters
(Group-I) and in 12 (Group-II). Intergroup differences were
found in 5 parameters (LDH, GGT, TG, CRP and se-Alb).
Conclusion: Postoperative periode is full of metabolic changes.
Parenteral nutrition can also influence these parameters,
therefore evaluation of changes in this periode needs thorough
consideration. The support with PN solutions containing
different lipid components shows that administration of 2nd
generation lipids resulted in significantly higher GGT, CRP and
TG levels in comparison to 3rd generation lipid emulsion.
Disclosure of Interest: None declared.
SUN-P139
“AWARENESS OF NUTRITIONAL SUPPORT IN HOSPICE CARE
SETTINGS AMONG MEDICAL STAFF – PRELIMINARY STUDY
FROM POLAND”
J. Januszczyk1,2,3 * on behalf of POLSPEN’s Palliative Care
Working Group, M. Stukan4 on behalf of POLSPEN’s Palliative
Care Working Group, M. Czyzewska3 on behalf of POLSPEN’s
Palliative Care Working Group, M. Renke2, S. Klek5 on behalf
of POLSPEN’s Palliative Care Working Group on behalf of
POLSPEN’s Palliative Care Working Group. 1Father Dutkiewicz
Hospice, Gdansk, 2Department of Occupational, Metabolic and
Internal Medicine, Medical University of Gdansk, Gdynia,
3
Department of Hematology, Nicolaus Copernicus Municipal
Specialist Hospital, Torun, 4Gynecologic Oncology
Department, Gdynia Oncology Center, Gdynia, 5General and
Oncology Surgery Unit and Intestinal Failure Center, 5 Stanley
Dudrick’s Memorial Hospital, Skawina, Poland
Rationale: The aim of the study was to evaluate awareness of a
nutritional status among medical staff and a need for imple-
mentation nutritional support in patients under hospice care.
S106 Poster

Methods: An electronic questionnaire was sent to all hospices

Average of 4 days ostomy output
(584) in Poland, using webpage www.hospicja.pl. Doctors and
nurses were asked to express their opinion about nutritional Patient No Water (mL) WHO ORS Water + TP
support. The survey consisted of 14 different questions was 1 1205 875 175
designed at the surveymonkey.com. These are preliminary data. 2 1800 1200 912
Results: We have collected 95 responses –33 from doctors and 3 1050 725 775
4 1450 1100 850
60 from nurses. 92% of responders felt that patients under 5 1200 950 637
hospice care were undernourished. Even though 44% of the staff 6 620 400 800
had nutritional experience >6 years, only in 58% cases they used 7 1300 1065 800
8 1640 1012 625
nutrition assessment as a routine procedure. Weight loss and Average 1283,1 915,6 696,8
anorexia was used in 91% cases along with physical examination
in 68% situations. NRS 2012 or SGA scale were used only in 17%
Conclusion: Consumption of water with thickening powder
and 16% cases respectively. 38% evaluated nutrition status with
significantly reduced ostomy output and feeling thirsty.
subjective patient’s handgrip strenght. Biochemical results (i.
e. albumin, lymphocytes, cholesterol) were used by 32% Disclosure of Interest: J. Sobocki Paid Instructor at: nutricia,
responders for nutrition assessment. Once decided to intro- K. Lachowicz: None declared, P. Jurczak: None declared, P. Groszek:
None declared, K. Majewska: None declared.
duce nutritional intervention a majority (95%) used oral
nutritional supplements and anticachectic drugs (70%).
Nasogastric tube, enteral nutrition, parenteral nutrition was SUN-P141
used in 41, 67% and 35% of cases respectively. Only 35% of IS THERE A NEED FOR ROUTINE BROVIAC CATHETER
patients were reffered to dietician, 31% to rehabilitant and to REPLACEMENT IN HPN PATIENTS AFTER 10 YEARS?
psychologist. Responders claimed nutrition intervention was J. Sobocki1 *, K. Lachowicz1, M. Omidi1, K. Majewska1.
1
needed for hospice patients, 98% of them suggested it could Department of Surgery and Clinical Nutrition, Medical
improve quality of life and 84% of the staff believed it could University of Warsaw, Warsaw, Poland
prolong patients’ lives.
Conclusion: Number of palliative patients increase. Based on Rationale: Incidence of catheter infections in HPN patiens
mediocre awareness of nutritional asessement among medical falled to less that 1 per 1,000 catheter-days. This resulted in
staff from our study, we see need to emphasize value of proper longer lifetime of catheters. Old catheters could be more prone
evaluation followed by an adequate nutrition support in this to rupture and provoke life-thretenning complications. The aim
group of patients. of the study was to evaluate after-effects/history of catheters
kept for longer than 10 years.
Disclosure of Interest: None declared.
Methods: In 2015–2016 years 410 patients were treated with
HPN. 23 patients have had catheters for longer than 10 years. A
SUN-P140 retrospective analysis of catheter-related complications was
THICKENING POWDER REDUCES OSTOMY OUTPUT AND preformed.
THIRST IN PATIENTS WITH END JEJUNOSTOMY SYNDROME – Results: Fifteen of 23 patients have never had their catheters
PRELIMINARY STUDY replaced. Patients have used them uneventfully so far (average
J. Sobocki1 *, K. Lachowicz2, P. Jurczak2, P. Groszek2, maintenance 13,5 yrs). The longest maintainence is 18 years.
K. Majewska2. 1Department of General Surgery and Clinical Eight patients required catheter removal (see table).
Nutrition, Medical Universty of Warsaw, 2Department of
General Surgery and Clinical Nutrition, Medical University of Patients No 1 2 3 4 5 6 7 8
Warsaw, Warsaw, Poland
Cauce of Occlusion Mechanical occlusion Tunel Mechanical occlusion occlusion Tunnel
catheter rupture infection rupture infection
Rationale: Liquids intake increases end jejunostomy output removal
more than solid food. On the other hand solid food is unable to Blood culture – – – – – – – –
reduce thirst. The aim of this study is to estimate effect of Catheter – – – – – – – +
culture
thickening powder (TP) mixed with water on ostomy output and
Maintenance 14 15 10 11 12 11 11 11
feeling thirsty. time
Methods: Eight patients with end jejunostomy syndrome were (years)

included into the study. For the first 4 days they were allowed to
drink 600 mL of water per day, than for 4 day 600 mLWHO ORS
and for last 4 days 600 mL water with TP to reach syrup
consistency (1st stage). Ingredients of the powder were as
follows: Dried glucose syrup, xanthan gum, guar gum (Nutrilis,
Nutricia)
Results: Filling thirsty was reduced after WHO ORS and almost
suppressed after water + TP, but not after water.
Two patients required vascular surgeon intervention (one
patient due to intravenal attachment of the catheter, which
required removal with a part of the vein and the other patient
due to intravascular erosion of the catheter). None of the
complications was fatal.
Conclusion: The analysis suggest that routin replacement of
catheter after 10 years is unjustified.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 1
SUN-P142
BIXIN INHIBIT THE EXPRESSION OF TH2 CYTOKINES
REPRESSING NF-KB TRANSCRIPTION FACTOR
J. Marrugo1 *, E. Zarate1, C. Meza2, Y. Ocampo3, L. Franco3,
B. Martinez1, L. Hernandez1, G. Lopez-Lluch2,
J. C. Rodriguez-Aguilera2. 1Immunology, University of
Cartagena, Cartagena, Colombia, 2Physiology, Anatomy and
Cell Biology, Universidad Pablo de Olavide, Sevilla, Spain,
3
Pharmacy, University of Cartagena, Cartagena, Colombia
Rationale: Bixin is a food colorant, with potent antioxidant,
anti-clastogenic and cytoprotector activities. The role of this
colorant in the Th2 allergic immune response has not been
established.
Methods: Freshly-isolated PBMC of five atopic patients were
culture in complete RPMI 1,640, pre-treated with Bixin
(12.5 mM and 25 mM) for one hour, and stimulated with PHA
(10 ug/mL) for six hours. Total RNA was extracted using Gene
Jet RNA purification kit (Thermo Scientific. E.U. Lithuania).
cDNA was generated with Transcriptor Universal cDNA Master
(Roche Diagnostics,Germany). Cytokine mRNA expression were
detected by RT-PCR using specific primers for IL4, IL5, IL13 and
GAPDH as a control. NF-kB p65 and pp65 were detected in PMBC
extracts by immunoblotting using specific antibodies (Abcam,
Cambridge, UK). Statistical analysis was performed using one-
way ANOVA, p < 0.05 were considered significant.
Results: Our results showed that bixin inhibits the expression of
IL4, IL5 and IL13 mRNA induced by PHA. NF-kB immunoblotting
analysis showed that bixin inhibits the PHA-dependent phos-
phorylation of p65 NF-kB subunit.
Conclusion: Bixin inhibits the expression of Th2 cytokines via
NF-kB transcription factor, suggesting that bixin has an
immunomodulatory effect on the allergic immune response
and may have a therapeutic potential.
References
Antunes LG, et al. Evaluation of the clastogenicity and antic-
lastogenicity of the carotenoid bixin in human lymphocyte cultures.
Mutation Research - Genetic Toxicology and Environmental
Mutagenesis 2005;585:113–9.
Mazzaron GR, et al. Bixin and Norbixin Protect Against DNA-Damage
and Alterations of Redox Status Induced by Methylmercury Exposure
In Vivo. Environmental and Molecular Mutagenesis 2012;53:535–41.
Tao S, et al. Bixin protects mice against ventilation-induced lung injury
in an NRF2-dependent manner. Nature 2016;1–13.
Disclosure of Interest: None declared.
SUN-P143
EFFECTS OF NUTRITIONAL STATUS ON THE MULTIPLE
SCLEROSIS DISEASE: SYSTEMATIC REVIEW
I. Rodenas Esteve1, C. Wanden-Berghe2, J. Sanz-Valero3 *.
1
Universidad Miguel Hernández De Elche, 2General University
Hospital, ISABIAL, 3Universidad Miguel Hernández De Elche,
ISABIAL, Alicante, Spain
Rationale: To review the available scientific literature about
the effects of nutritional status on the multiple sclerosis disease
Methods: A systematic review of the scientific literature in the
MEDLINE (PubMed), Scopus, Cochrane Library and Web of
Science databases through April 2016. Search equation:
(“Multiple Sclerosis” [Mesh] OR “Multiple Sclerosis” [Title/
Abstract] OR “Disseminated Sclerosis” [Title/Abstract] OR
S107
“Multiple Sclerosis Acute Fulminating” [Title/Abstract]) AND
(“Nutritional Status” [Mesh] OR “Nutritional Status” [Title/
Abstract] OR “Nutrition Status” [Title/Abstract]). The quality
of the selected articles was discussed using the STROBE
questionnaire. The search was completed through experts
inquiry and additional review of the bibliographic references
included in the selected papers. The concordance between
authors (Kappa Index) had to be higher than 80% for inclusion in
this review.
Results: Of the 160 references recovered, after applying
inclusion and exclusion criteria, 29 articles were selected for
review. Concordance between evaluators was 100.00%. The
most studies established vitamin D levels. Others focused their
research on finding out which nutrient deficits might be related
to the multiple sclerosis development.
Conclusion: Vitamin D may influence multiple sclerosis
improvement. Sunlight and physical activity would be import-
ant factors, with nutritional status, in the course of this
disease. It is necessary to produce new specific works that will
delve into the subject to find out more about the relationship
between nutritional status and multiple sclerosis.
Disclosure of Interest: None declared.
SUN-P144
PATIENT’S DIETARY BELIEFS AND BEHAVIOURS IN
INFLAMMATORY BOWEL DISEASE
B. Witteman1,2 *, M. Dijkhuizen2, P. Tap3, J. de Vries2.
1
Gastroenterology and Hepatology, Gelderse Vallei hospital,
Ede, 2Global Nutrition and Health, Wageningen University,
Wageningen, 3Communication, crohn en colitis ulcerosa
vereniging Nederland, Woerden, Netherlands
Rationale: The aim of this study was to assess the dietary
beliefs, behaviour and knowledge within a large adult Dutch
population with IBD, to enable taking into account the patient’s
perspective when giving dietary advice.
Methods: A self-administered online survey assessing the
general characteristics, dietary beliefs, eating behaviour,
source of nutritional knowledge and advice of IBD patients
was designed. The questionnaire was distributed to members of
the Dutch Crohn and Ulcerative Colitis patient association (in
Dutch: Crohn en Colitis Ulcerosa Vereniging Nederland). There
were a total of 294 respondents.
Results: Fifty nine per cent of the patients valued nutrition to
be either more or equally important compared to medication
for the treatment of their disease and 64% believed diet to be
more important in influencing the course of disease. Sixty two
per cent reported to be successful in controlling disease
symptoms through dietary adaptations, of whom almost half
reported to be always successful. Avoiding certain foods was
preferred over eating more beneficial foods and following
specific diets in order to influence disease symptoms (77% vs
57%, respectively). Dietary supplements were used by 68% of
the IBD patients. Even though over 71% have had dietary advice
mainly by dieticians, 81% stated that the main source of their
nutritional knowledge related to IBD was their own experience.
Conclusion: A majority of IBD patients consider diet a more
important and successful managing tool than medication to
relieve of their disease symptoms and claim own experience as
the most important source of their nutritional knowledge.
Disclosure of Interest: None declared.
S108
SUN-P145
SOCIAL SUPPORTAND EMPLOYMENT STATUS ARE ASSOCIATED
WITH NEGATIVE AFFECT IN PATIENTS WITH TYPE 3
INTESTINAL FAILURE
J. Ablett1 *, D. Vasant1, M. Taylor1, C. Cawley1, S. Lal1.
1
Intestinal Failure Team, Salford Royal NHS Foundation Trust,
Salford, United Kingdom
Rationale: Quality-of-life in patients with type 3 Intestinal
Failure (IF) on Home Parenteral Nutrition (HPN) has been
reported as poor. However, the influence of social support,
employment and levels of anxiety and depression have not
been previously described.
Methods: Patients requiring HPN managed at a national UK IF
Unit were invited to complete a postal survey. Data were
collected on demographics, HPN duration, employment and IF
aetiology. All patients completed the Hospital Anxiety &
Depression Scale (HADS) and the Multi-Dimensional Scale of
Perceived Social Support (MSPSS). HADS data, anxiety scores
(HADS-A), depression scores (HADS-D) and negative affect
(HADS-NA) were compared using regression and one-way ANOVA
analyses, where appropriate.
Results: 85/256 (33%) patients (median age 59 (range: 25–78),
60% Female, median length of time on PN 42 months (range: 2–
408)), responded. 22/85 (26%) patients were unemployed, 44/
85 (52%) retired, 10/85 (12%) employed. Overall, 48/85 (56%)
patients had clinical levels of anxiety and/or depression.
Regression analysis confirmed a significant relationship
between MSPSS and HADS scores (HADS-A: P < 0.0005,
R2 = 0.29, HADS-D: P < 0.0005, R2 = 0.21 and HADS-NA:
P < 0.0005, R2 = 0.29). Unemployment was associated with
significantly worse HADS scores (HADS-A: P = 0.004, HADS-D:
P = 0.008, HADS-NA: P = 0.003). By contrast, HADS scores were
not influenced by age, length of time on HPN or aetiology of IF.
Conclusion: Clinical anxiety and depression is common,
affecting over half of patients with type 3 IF; these data
suggest that patients requiring HPN should be routinely
screened for affective disorders. Patients with poor social
networks and those of working age who have ceased employ-
ment appear to be particularly vulnerable and should be
prioritised for psychological support.
Disclosure of Interest: None declared.
SUN-P146
EVALUATION OF QUALITY OF LIFE AND DISTRESS IN PATIENTS
USING HOME PARENTERAL NUTRITION AND THEIR
CAREGIVER: A CROSS SECTIONAL ANALYSIS
J. Beurskens Meijerink1 *, G. Huisman de Waal2, G. Wanten1.
1
Department of Gastroenterology and Hepatology, Intestinal
Failure Unit, Radboud University Nijmegen Medical Centre,
2
Scientific Institute for Quality of Healthcare, IQ Healthcare,
Nijmegen, Netherlands
Rationale: Home parenteral nutrition (HPN) is indicated in
chronic intestinal failure (CIF) to improve survival and quality
of life (Qol). The aim of this study was to compare Qol and
distress between CIF patients and their caregiver.
Methods: 193 patients with CIF and their caregivers were
invited. Qol and distress were assessed using the “Lastmeter”
[1] and the HPN Qol [2] for the patient with CIF and the Caregiver
Strain Index (CSI) [3] for the caregiver of the patient with CIF.
Poster
Results: 147 patients and 91 caregivers were included. 28 (19%)
patients were male, had been treated with HPN for more than a
year (mean 5 years). The most common underlying disease was
dysmotility (N = 62 (42%)) and the most prevalent indication
was short bowel disease (N = 72 (48%)). Patients experienced a
moderate distress of 5 (scale 0–10). Furthermore, findings
revealed that Qol during the past week was moderate 5, and it
was moderate affected by HPN (0 (scale −5 till +5; high
score = good Qol)) and not affected by the underlying disease (0
(scale −5 till +5; high score = good Qol)). Similarly to the
patient, the caregiver experienced a moderate distress of 6
(scale 0–12; high score is high strain).
Conclusion: This is the first evaluation of Qol and distress in
patients using HPN and their caregiver in the Netherlands. This
study shows that there is a moderate prevalence of burden
resulting in a moderate Qol for both the patient and their
caregiver, possibly due to the fact that CIF patients and their
caregiver have learned to cope with their circumstances to
some degree. Insight into distress and Qol can be used to
implement measurements improving Qol for patient and
caregiver.
References
1. Roskott A.M., et al., Clin Nutr, 2013.
2. Baxter JP, Fayers PM, McKinlay AW, JPEN, 2010.
3. MA & Bos, GAM van den (2004). Clinical Rehabilitation.
Disclosure of Interest: None declared.
SUN-P147
ORGANIZATION OF THE DIETETIC SERVICE IN A HOSPITAL –
LOCAL IN THE DEPARTMENT OR CENTRALIZED?
J. K. B. Clausen1,2 *, L. Martinsen3, B. Wilson3, S. Duncan2,
J. R. Andersen1. 1Department of Nutrition, Exercise and
Sports, University of Copenhagen, Copenhagen, 2Lung Section
230, Department of Medicine, 3Department of Medicine,
Nykøbing Falster Hospital, Nykøbing Falster, Denmark
Rationale: In Denmark the dieticians can be organized
centrally and called upon if needed, or locally in larger units,
or very locally related to bed-units. The organization form is
based on tradition not on measurements of quality. We wanted
to compare the very local form with the traditional
centralized.
Methods: Randomized, unblindet, parallel design. The inter-
vention group (IT) was nutritionally handled by the dietician,
and the control group (C) by the nurses as previously with the
possibility for dietetic help from the centre. All patients were
screened by NRS-2002 and had their estimated needs calcu-
lated (equations in IT, tables in C). The IT was in addition
assessed for adapted weight-loss, counseled with a plan for
nutrition and followed-up daily by the dietician if in nutritional
risk. All patients were re-screened weekly and had their intake
registered. Hand-grib-strength (HGS) was measured in both
groups at admittance and discharge, and weight three times
weekly. After discharge only death and re-admittance was
registered.
Results: We included 16 intervention- and 17 control-patients
(12 in each group had COPD). The intake was significantly
higher in the intervention group of both energy and protein
(mean 1,5 g/kg/d (SD 0,5) versus 0,8 (0,3)) ( p < 0.0001), also if
calculated as the fulfilment of the estimated needs: protein:
mean 98% (SD 16) versus 56% (12) ( p < 0.0001) and energy:
Nutrition and chronic diseases 1
mean 107% (SD 18) versus 73% (34) ( p < 0.0001). HGS did not
change in any of the groups. Four patients died in the
intervention group within the two months of observation
compared to two in the control group (not significant). Three
patients (one of those twice) were re-admitted within the two
months in the intervention group compared to 10 in the control
group ( p < 0.02).
Conclusion: We found very clear benefits with the very local
organization form, but did not calculate the costs in the two
groups.
Disclosure of Interest: None declared.
SUN-P148
EXPLORING NUTRITIONAL SUPPORT PRACTICES IN RENAL
NURSES IN HEMODIALYSIS UNITS WORLDWIDE – RESULTS OF A
PILOT STUDY
K. A. Poulia1 *, M. C. Casal2, M. Chourdakis3. 1Department of
Nutrition and Dietetics, Laiko General Hospital of Athens,
Athens, Greece, 2University Hospital 12 de Octubre, Madrid,
Spain, 3Department of Medicine, Aristotle University of
Thessaloniki, Thessaloniki, Greece
Rationale: Protein – energy wasting (PEW) is a common problem
in patients with chronic kidney disease (CKD) on dialysis.
Provision of adequate individualized nutrition support during
hemodialysis is an effective way of improving nutritional status
of the patients and thus minimizing the effect of malnutrition.
Methods: The aim of the present study was a preliminary
evaluation of the nutritional support practices applied by renal
nurses in hemodialysis units worldwide. Questionnaires were
distributed to renal nurses working in hemodialysis units in
Europe, Asia, Middle East, and Africa. One hundred and
two questionnaires were analyzed from twenty-three countries
(15 European, 2 from the Middle East, 3 from Africa and 1
from Asia).
Results: Seventy six per cent of the nurses replied that they
perform nutritional screening to the patients and 90.2% that
they provide -any kind of- nutritional support to their patients.
Related practice was perfromed mainly as a team decision
(45%), secondly per physicians’ decision (38%) and lastly equal
percentages were reported per nurses’ and dietitians’ decision
(9%). Common barriers for not providing nutritional support
were financial reasons (25%), lack of knowledge (20%),
physicians’ (11%) and patients’ disapproval (6%).
Conclusion: Provision of nutrition support seems to be a
common practice in hemodialysis units. To facilitate its
efficient provision there is a need for continuous education
among health professionals dealing with hemodialysis patients,
which shall be the main step towards the elimination of the
barriers of providing nutritional support in this sensitive
population.
References
1. Fouque D, et al.: Protein–energy wasting in kidney disease. Kidney
International (2008) 73, 391–398
Disclosure of Interest: None declared.
S109
SUN-P149
EFFECT OF ENTERAL NUTRITION WITH EICOSAPENTAENOIC
ACIDS (EPA) FOR PREVENTING PRESSURE ULCERS IN PATIENTS
WITH CEREBRAL INFARCTION
K. Ogawa1 *, Y. Kurokawa2, J. Kuwamura3, M. Watanabe4,
T. Yamamoto4. 1Clinical Medicine, 2Gerontological Nursing,
3
Adult Nursing, Juntendo University Faculty of Health Sciences
and Nursing, Mishima, 4Neurosurgery, Juntendo University
Shizuoka Hospital, Shizuoka, Japan
Rationale: Enteral diets enriched with EPA contributed to
preventing pressure ulcers in patients with cerebral infarction.
The beneficial effect of the EPA diets was associated with a
lower occurrence of new pressure ulcers in the clinical nutrition
management of outcomes.
Methods: Patients were randomly allocated into two groups:
one to be given the enteral diet enriched with EPA, and the
other to be fed with an isonitrogenous and isocaloric control
diet. All patients were evaluated regarding the incidence
frequency of pressure ulcers based on DESIGN-R. Feeding was
continued for a minimum of four days, while monitoring
continued for 14 days.
Results: In total 12 patients were enrolled in this study,
including 6 patients placed in the EPA enriched diet group and 6
patients in the control group. Regarding new occurrence of
pressure ulcers, only a single lesion was observed on day 7 in the
EPA enriched diet group, showing apparently lower incidence of
pressure ulcer compared to the control group, in which 2 lesions
on day 4, 4 lesions on day 7 and 4 lesions on day 14 were
observed. Investigation on changes in CRP, an inflammatory
index, showed more significant suppression of inflammation in
the EPA enriched diet group when compared to the control
group. Results made it clear that enteral
diets enriched with EPA, which can control the inflammation,
are more effective than other diets without EPA.
Conclusion: Nutritional management using EPA enriched
enteral diets could be a useful option for pressure ulcer
prevention in patients who need long-term immobile bed rest
in a supine position, as with cerebral infarction patients.
References
Matsui Y, et al. Development of the DESIGN-R with an observational
study. Wound Repair Regen 2011; 19: 309–315.
Disclosure of Interest: None declared.
SUN-P150
PREDICTING 3 AND 6- MONTH SURVIVAL FOR ADVANCED
CANCER PATIENTS ON HOME PARENTERAL NUTRITION: A
NOMOGRAM
K. C. Fragkos1 *, N. Keane2, P. S. Patel2, K. Murray1, S. Obbard1,
S. Ajibodu3, S. O’callaghan3, H. Kwok1, E. Paulon1,
J. Barragry1, S. Mehta1, S. Di Caro1, F. Rahman1. 1GI Services,
2
Dietetics, 3Pharmacy, University College London Hospitals
NHS Foundation Trust, London, United Kingdom
Rationale: We describe the largest cohort of Home Parenteral
Nutrition (HPN) patients with advanced cancer in the UK in
order to identify factors affecting prognosis and develop a
nomogram.
Methods: Data was collected retrospectively for all patients
receiving HPN between 01/01/2006 and 15/10/2016.
Demographic, anthropometric, biochemical and medical
S110
factors, Karnofsky Performance Status (KPS), Glasgow
Prognostic Score (GPS), and PN requirements were recorded.
Univariate and multivariate analyses were performed including
Kaplan-Meier curves, Cox Regression and correlation analyses.
Results: In total, 107 HPN patients (68 women, 39 men, mean
age 57 years) with advanced cancer were identified. The main
indications for HPN were bowel obstruction (74.3%) and high
output ostomies (14.3%). Cancer cachexia was present in 87.1%
of patients. The hazard ratio (HR) for upper gastrointestinal
and “other” cancers vs gynaecological malignancy was 1.75
( p = 0.077) and 2.11 ( p = 0.05), respectively. KPS score, GPS,
PN volume and PN potassium levels significantly predicted
survival (HRKPS≥50 vs <50 = 0.47; HRGPS=2 vs GPS=0 = 3.19). In multi-
variate Cox regression analyses after adjustment for covari-
ates, KPS and GPS remained significant predictors ( p < 0.05),
whilst PN volume reached borderline significance ( p = 0.094).
In general, people who score over 150 in the 3-month and over
100 in the 12-month survival prediction nomograms, respect-
ively, had less than 20% survival probability. Internal validation
is also presented.
Conclusion: Performance status, prognostic scoring and PN
requirements may predict survival in patients with advanced
cancer receiving HPN. PN volume and potassium content might
assist in decision making as predictors of survival. Further
research and education of healthcare professionals is needed to
identify which patients would most benefit from HPN and
ensure timely referral and access to HPN.
Disclosure of Interest: None declared.
SUN-P151
POST-HOSPITAL SYNDROME: DETERMINANTS OF
READMISSION IN MALNOURISHED, GERIATRIC PATIENTS
WITHIN 3 MONTHS OF HOSPITAL DISCHARGE
K. Franz1 *, L. Otten1, L. Bahr1, J. Kiselev1, U. Müller-Werdan1,
K. Norman1. 1CHARITÉ - University Medicine, Research Group
on Geriatrics, Berlin, Germany
Rationale: The post-hospital syndrome is an acquired, transi-
ent period of vulnerability due to e.g. reduced oral nutritional
intake, sleep deprivation and psychological distress in hospi-
talized patients and correlates with readmission rates (1). In
this longitudinal study, we analyzed influencing factors on 3
month readmissions of malnourished, geriatric patients after
hospital discharge.
Methods: Mini Nutritional Assessment Short Form was used to
identify manifest malnutrition or risk of malnutrition. Frailty
was classified according to Fried-criteria (2). Loss of weight in
the last 3 and 6 months was recorded. Loss of appetite, sleep
deprivation and fatigue were evaluated using the CES-
depression scale. Determinants of 3 month hospital readmis-
sion were analyzed using logistic regression.
Results: 177 patients (77.9 ± 6.8 years; 59% women) were
included in the analysis. At discharge, 46.4% were frail; 88.2%
had lost weight in the last 3% and 92% in the last 6 months.
38.8% reported hospital readmissions (mean length of hospital
stay:17.9 ± 15.5 days). While low BMI (r = −0.32, p = 0.041) and
higher frailty-score (r = 0.35, p = 0.038) correlated significantly
with increased length of hospital stay during readmission, >5%
weight loss within 3 months correlated with an increased risk
of 3 month readmission (r = 0.48, p = 0.02). However, in a
logistic regression sleep deprivation (OR:3.459,CI:1.244–9.619,
Poster
p = 0.017) and loss of appetite (OR:2.754, KI:1.010–7.512,
p = 0.048) were identified as the most powerful predictors of 3
month readmission in malnourished participants. Age, sex,
number of drugs, BMI, loss of weight in last 6 months, frailty and
fatigue had no influence.
Conclusion: Among geriatric persons, sleep deprivation and
decreased oral nutritional intake increase the risk of readmis-
sion within 3 months.
References
1. Krumholz HM. NEJM, 2013.
2. Fried LP, et al. J Gerontol A Biol Sci Med Sci, 2001.
Disclosure of Interest: None declared.
SUN-P152
MOBILITY, FUNCTIONAL STATUS AND FATIGUE IN
MALNOURISHED, GERIATRIC PATIENTS AT HOSPITAL
DISCHARGE
K. Franz1 *, L. Otten1, L. Bahr1, J. Kiselev1, U. Müller-Werdan1,
K. Norman1. 1CHARITÉ - University Medicine, Research Group
on Geriatrics, Berlin, Germany
Rationale: The majority of geriatric patients are at high risk for
malnutrition at hospital discharge, which negatively impacts
post-hospital outcome. In a cross-sectional analysis in mal-
nourished, geriatric patients, we evaluated functional status
using objective and subjective methods as well as the
prevalence of frailty at discharge.
Methods: Patients with malnutrition according to the Mini
Nutritional Assessment Short Form were included. Frailty was
evaluated with the Fried-criteria (1). Mobility was measured
based on the 4 m-walk test (gait speed) and the Timed Up & Go
(TUG) test. Muscle strength was determined using dynamome-
try. Validated questionnaires estimated functional restrictions
(LASA) and fatigue (BFI). Moreover, anorexia (CNAQ), depres-
sive symptoms (CES-D) and fall frequency within the previous
12 months was assessed.
Results: 145 patients (77.9 ± 6.8 years, 59% women) were
analyzed. 50% were classified prefrail, 46.4% frail. While 64.2%
had reduced gait speed (<0.8 m/sec), reduced TUG time was
found in 100% of patients (60–69 y: <8.1 sec; 70–79 y: <9.2 sec;
≥80 y: <11.3 sec). Decreased hand grip strength was observed
in 36.2% (male:<26 kg; female: <16 kg) and reduced knee grip
strength in 100% of patients (male: <0.97 kg/kg BW; female:
<0.84 kg/kg BW). The majority of patients showed functional
limitations (mild: 59.3%; severe: 38.6%). Fatigue was observed
in 95.6%; 26.7% even suffered severe fatigue. 73.6% had loss of
appetite. While 23.7% had moderate depressive symptoms,
32.4% exhibited a high risk for depression. 64.3% reported falls
in the previous 12 months.
Conclusion: Malnourished, geriatric patients are frequently
frail and suffer from impaired mobility and functional status as
well as increased fatigue at discharge. Moreover, they are at
increased risk of anorexia and depression which are known to
increase the risk of further weight loss.
References
1. Fried LP, et al. J Gerontol A Biol Sci Med Sci. 2001;56.
Disclosure of Interest: None declared.
Nutritional assessment 1
Nutritional assessment 1
SUN-P153
A CLINICAL AUDIT OF NUTRITIONAL SCREENING AND
SUPPORT OF HOSPITALIZED HEMATOLOGIC PATIENTS
1 1 1
A. Stamou , T. Liaskas , I.-G. Tzanninis , E. Kanioura ,1
D. Politis1, A. Kaoura1, L. Poulia2 *, M. Arapaki3, N.-A. Viniou1,
P. Diamantopoulos1. 11st Department of Internal Medicine,
Hematology Unit, Laikon General Hospital, National and
Kapodistrian University of Athens, 2Clinical Nutrition
Department, Laikon General Hospital, 3Hematology
Department, Laikon General Hospital, National and
Kapodistrian University of Athens, Athens, Greece
Rationale: Poor food intake is a common problem in patients
with hematologic diseases. Audits about the nutritional
support of hospitalized patients may detect significant failures
in patient care and help towards the correct application of the
international guidelines.
We performed a prospective observational audit on hospita-
lized hematologic patients to investigate their nutritional
status, as well as whether they received the appropriate
nutritional support.
Methods: The initial population consisted of 122 consecutive
hematologic patients admitted from March to June 2016 in two
Hematologic Units of a Tertiary University Hospital in Athens,
Greece. We designed a questionnaire based on the Malnutrition
Universal Screening Tool (MUST) with additional demographic,
somatometric and medical data. The questionnaire was applied
by medical students to all patients within 48 hours of
admission. Patients were classified as high, intermediate, and
low-risk per the MUST score and were reassessed accordingly.
During reassessment, we examined the quantity of food intake
and the nutritional interventions applied.
Results: The final analysis included 95 patients (27 were
excluded due to short-term hospitalization and for personal
reasons). A MUST score ≥2 was found in 41 (38%) patients only
on was supported ( parenteral nutrition).
Conclusion: Our audit revealed a lack of nutritional support of
the hospitalized patients. A meeting with the involved health
professionals and a presentation of the results and the possible
causes (lack of sensitization, high regimen cost, and shortness
of staff ) was performed. Proposals to change the current
situation were made such as detection of high risk patients by
medical students and further assessment by a nutritional
specialist. A brief MUST-based questionnaire was also proposed
to be used for all patients upon admission. A re-audit is already
in progress.
Disclosure of Interest: None declared.
SUN-P154
CAN THE “BODY INDEX-ADJUSTED WEIGHT LOSS GRADING
SYSTEM” BE APPLIED IN A HOSPITAL EMERGENCY SERVICE?
A. Marcadenti1,2 *, J. S. Fink3, E. I. Rabito4, A. S. do Carmo5,
F. M. Silva5. 1Departamento de Nutrição, Universidade Federal
De Ciências Da Saúde De Porto Alegre (UFCSPA), 2PPG Ciências
da Saúde: Cardiologia, Instituto De Cardiologia/Fundação
Universitária De Cardiologia (IC/FUC), 3Serviço de Nutrição e
Dietética, Hospital Nossa Senhora Da Conceição, Porto Alegre,
S111
4
Departamento de Nutrição, Universidade Federal Do Paraná,
Curitiba, 5Departamento de Nutrição, Universidade Federal De
Minas Gerais, Belo Horizonte, Brazil
Rationale: The objective was to assess the applicability of the
“Body Index-adjusted Weight Loss” Grading System in a hospital
Emergency Service.
Methods: A prospective cohort study was carried out in an
Emergency Service of tertiary public hospital. Usual body
weight (in kg) and anthropometric measurements (height, in
cm and actual weight, in kg) were assessed. Body mass index
(BMI) and percentage of weight loss (WL) were calculated.
Patients were classified according to BMI-adjusted WL Grading
System (Martin L et al.)1 in five categories: grade 0 was assigned
to the least risk subgroup (longest survival), and grades 1, 2, 3,
and 4 were assigned to the subgroups according to decreasing
survival. Outcome were length of hospital stay (LOS), infection
and death. LOS was considering very long when >16 days.
Relative risk (RR) and hazard ratio (HR) are presented with
confidence interval of 95% (95% IC).
Results: In total, 752 individuals were included, aged
53.6 ± 15.5 years and 54.5% females. According to the BMI-
adjusted WL Grading System, patients were classified as
follows: Grade 0: 38.3%; Grade 1: 18.0%; Grade 2: 14.0%;
Grade 3: 16.2%; and Grade 4: 13.5%. Patients in the five
categories of BMI-adjusted WL Grading System did not differ in
relation to sex, ethnicity and age. The frequency of infection
also did not differ among inpatients according to the five
categories ( p = 0.226). Only Grade 4 presented significant
association with very long LOS and with mortality (RR: 1.93
[1.30–2.86, p < 0.001] and HR: 5.90 [1.27–27.47, p = 0.024],
respectively).
Conclusion: BMI-adjusted WL Grading System may be a useful
tool in effort to predict outcomes in patients admitted at
hospital Emergency Services, and Grade 4 can identify patients
with worse prognosis.
References
1. Martin L, et al. Diagnostic criteria for the classification of cancer-
associated weight loss. J Clin Oncol. 2015;33(1):90–9.
Disclosure of Interest: None declared.
SUN-P155
THE IMPACT OF NUTRITIONAL RISK STATUS ON QUALITY OF
LIFE AND FUNCTION IN OLDER ADULTS AT THE HOSPITAL-
COMMUNITY INTERFACE
A. R. Julian1 *, G. S. Frost1, C. E. Weekes2, M. Hickson3. 1Division
of Diabetes, Endocrinology and Metabolism, Faculty of
Medicine, Imperial College London, 2Diabetes and Nutritional
Sciences Division, King’s College London, London, 3School of
Health Professions, Faculty of Health and Human Sciences,
Plymouth University, Plymouth, United Kingdom
Rationale: Older people are at high risk of undernutrition
particularly after a hospital admission1. This study aims to
explore the impact of undernutrition on the quality of life and
function of older adults at 3 months post-discharge from
hospital.
Methods: Patients aged 60+ approaching discharge partici-
pated in this prospective cohort study. Nutritional status was
assessed by Malnutrition Universal Screening Tool, quality of
S112
life by EQ5D-5L, and function using modified Townsend Index
and handgrip dynamometry.
Results: The cohort included 171 adults, mean (SD) age = 79
(10) years and 36% male. Participants were grouped by under-
nutrition status; 45% at risk, 55% low risk. Both groups’ function
worsened according to the Townsend score at 3 months (table).
This deterioration was greater in the at risk group; median (IQR)
increasing from 36 (19–58) to 50 (27–71) ( p = 0.001). Conversely,
EQ5D-5L index score improved over time, particularly in the
pain domain for the at risk group. Handgrip strength did not
change significantly within or between groups.
Nutritional risk status
Median change (IQR) Low risk Med/high risk
from baseline to 3
months
Modified Townsend −3 (−12, 1) −6 (−16, 0)
score
EQ5D-5L Index score −0.006 (−0.19, 0.08) −0.06 (−0.2, 0.11)
EQ5D-VAS score −8 (−20, 9.5) 0 (−10, 10)
Handgrip strength (kg) 0 (−2, 3) 0 (−1.75, 2)
*p < 0.05, derived from Wilcoxon test.
Conclusion: Irrespective of nutritional status, older adults
recently discharged from hospital exhibited reduced ability to
perform activities of daily living at 3 month follow-up.
Nevertheless, the at risk group showed greatest deterioration,
suggesting that worse nutritional status may compound adverse
effects on physical function following hospital admission.
Interestingly, quality of life was not affected by nutritional risk.
Reference
1. Liang et al. Nutrition. 2008;24(10):969–76
Disclosure of Interest: None declared.
SUN-P157
NORMATIVE VALUES FOR SKELETAL MUSCLE INDEX, -AREA
AND -RADIATION ATTENUATION BASED ON COMPUTED
TOMOGRAPHY IMAGING IN A HEALTHY CAUCASIAN
POPULATION
A. Van Der Werf1 *, J. Langius1, M. de Van Der Schueren1,
S. Nurmohamed2, K. Van Der Pant3,
S. Blauwhoff-Buskermolen1, N. Wierdsma1. 1Nutrition and
Dietetics, 2Nephrology, VUMC, 3Nephrology, AMC, Amsterdam,
Netherlands
Rationale: Muscle mass is a key determinant of nutritional
status and associated with outcomes in several patient groups.
Computed Tomography (CT) analysis is increasingly used to
assess skeletal muscle area (SMA), skeletal muscle index (SMI)
and muscle radiation attenuation (MRA). However, interpret-
ation is difficult since values in a healthy population are
lacking. Therefore we obtained sex specific percentiles and
provide cut-offs for low SMA, SMI and MRA of a healthy
Caucasian population.
Methods: In this study 420 CT scans of healthy persons were
used. All scans were made as part of kidney donor screening
with 120 kV without use of a contrast agent. A single slice at the
level of the 3rd lumbar vertebra was used to assess SMA, SMI and
MRA with SliceOmatic software V5.0 (Tomovision, Magog,
Canada), using a radiation attenuation range between −29
Poster
and 150 Hounsfield Units (HU). Sex specific distributions were
obtained and the association between age and SMI and between
BMI and SMI was analyzed with linear regression analyses. Based
on this correlation, age- and BMI specific predicted percentiles
were computed. The 5th percentile was considered as cut-off
for low SMA, SMI and MRA.
Results: Sex specific cut-offs of SMA, SMI and MRA were
134.0 cm2, 41.6 cm2/m2 and 29.3 HU in men and 89.2 cm2,
32.0 cm2/m2 and 22.0 HU in women, respectively. SMI was
negatively correlated with age (b = 0.16 in men, b = 0.13 in
women, both p < 0.001) and with BMI (b = 1.23 in men, b = 0.47
in women, both p < 0.001) resulting in specific cut-off points for
different age- and BMI categories.
Conclusion: This study provides sex specific percentiles and
P= cut-offs for SMA, SMI and MRA. In addition, age- and BMI
specific percentiles in a healthy Caucasian population have
been established, which may facilitate interpretation of
<0.001*
muscle parameters in disease.
0.02* Disclosure of Interest: None declared.
0.132
0.564
SUN-P158
CHANGE IN BODY COMPOSITION DURING TRAINING MEASURED
WITH DENSITOMETRY (BODPOD) AND BIO-ELECTRICAL
IMPEDANCE ANALYSIS (BIA), AND CALCULATED WITH THE
FORMULA OF GALLAGHER
A. V. Dijk1 *, A. Kok1, F. Hollander1, S. Runia1, E. Steenhagen2.
1
Dietitian, 2UMC UTRECHT, Utrecht, Netherlands
Rationale: Patients with hemophilia and other coagulation
disorders were on training for a cycle tour of 900 km. During
training, patients received nutritional advises by a sport
dietitian. Body composition was measured by densitometry
(BODPOD) and bio-electrical impedance analysis (BIA). An
estimation of body composition was made by the formula of
Gallagher (1). The aim of the study was to compare the results
of body composition measured by BODPOD and BIA, and
calculated with the formula of Gallagher.
Methods: Patients (>/=18 y) with hemophilia and other
coagulation disorders on training for a cycle tour were
included. Length, body weight and body composition
(BODPOD and BIA) were measured. BODPOD uses the formula
of Siri (2) and BIA the formula of Kyle (3) for determining body
composition. BMI, age, sex and race were used for calculating
body composition with the formula of Gallagher. Measurements
were repeated four times: before training(T1), twice during
training (T2, T3) and afterwards (T4).
Results: Eight patients were included (5 men, 3 women; age
range 21–53Y). Results of FM(%) are presented in the table
below. Body composition analysis by BODPOD at T1 are missing.
Only small differences in body composition were found between
the three methods, the formula of Gallagher showed a relative
low FM. All three methods show the same tendency, decrease in
FM at T1,T2,T3 and an increase in FM at T4.
T1 T2 T3 T4
BIA 28,0 27,0 25,5 27,7
BODPOD 27,0 24,4 27,5
Gallagher 23,8 23,1 21,0 24,4
Nutritional assessment 1 S113

Conclusion: Only small differences in body composition were SUN-P160

found between the BODPOD, BIA and the formula of Gallagher.
However we had a small study population, results must be
interpreted with caution.
References
1. Gallagher et al. Am J Clin Nutr 2000;72:694–701.
2. Siri et al. Natl Acad Sciences/Natl Res Council 1961:223–224.
3. Kyle et al. Nutr 2001;17:248–253.
Disclosure of Interest: None declared.
SUN-P159
SEVERE PAIN INTENSITY IS ASSOCIATED WITH INSUFFICIENT
ENERGY INTAKE IN HOSPITALISED PATIENTS
A.-M. Makhlouf1, L. Genton1 *, M. Kossovsky2, F. Gurba3,
S. Pautex4, M. Chikhi1, C. Pichard1. 1Nutrition Unit,
2
Rehabilitation and Geriatrics, University Hospital of Geneva,
3
Nutrition and Dietetic Department, HES-SO, 4Division of
Primary Care, University Hospital of Geneva, Geneva,
Switzerland
Rationale: The assessment of pain intensity in hospitalised
patients is part of routine care but the impact of pain on food
intake has been poorly studied. This cross-sectional study
assessed the influence of pain on coverage of energy needs in
hospitalized patients.
Methods: Dieticians assessed the energy intake on one day in
all patients hospitalized at the Geneva University Hospitals
who received three meals per day. Insufficient energy intake
was defined as energy intake ≤70% of energy requirements
determined by the Harris-Benedict formula. Pain intensity was
scored from 0 (no pain) to 10 (worst pain ever) with a visual
scale and stratified into no pain (0), slight (1–3), moderate (4–6)
or severe pain (>6). We evaluated the association of energy
intake and pain intensity by a multivariate logistic regression
with adjustment for gender, age and body mass index.
Results: This analysis included 776 patients (mean age
70.1 ± 19 y, BMI 25.4 ± 6 kg/m2, pain score 2.3 ± 2). The
multivariate logistic regression shows that severe pain and
age ≥85 years are risk factors for insufficient energy intake:
EATING DISORDERS AND POST-TRAUMATIC STRESS DISORDER
AMONG SYRIAN REFUGEES IN NORTH LEBANON: SCREENING
AND CORRELATION
A. Aoun1 *, J. Joundi1, N. El Gerges1, F. El Jabbour2, L. El Osta3.
1
Notre Dame University - Louaize, Zouk Mosbeh, 2Lebanese
University, Fanar, 3Saint Joseph University, Beirut, Lebanon
Rationale: Post-Traumatic Stress Disorder (PTSD) may be an
important risk factor for the development of eating disorders
(EDs) in refugees. The aim of this study was to assess the
prevalence of positive SCOFF screens among Syrian refugees in
North Lebanon, and its correlation with the prevalence of
positive test screening for PTSD.
Methods: This was a cross-sectional study including a repre-
sentative sample of 450 Syrian refugees aged between 14 and
45 years, living in North Lebanon. Participants were recruited
by random sampling method during February and March 2016
from different individual tented settlements, collective
shelters, and primary health care centers. Each participant
was interviewed individually using the SCOFF and PC-PTSD
questionnaires. Data on socio-demographic factors and health
status were collected. Informed consent form was signed by all
participants prior to contribution.
Results: The prevalence of positive SCOFF and PC-PTSD screens
were respectively 5.6% and 47.3%. The multiple linear
regression showed that subjects screened with PTSD had 3
times higher risk of having positive test screening for EDs
(OR = 3.14; 95%CI: 1.125–8.778).
Conclusion: Positive SCOFF and PC-PTSD screens were strongly
correlated among Syrian refugees included in our study.
Disclosure of Interest: None declared.
SUN-P161
EATING DISORDERS AMONG UNIVERSITY STUDENTS IN A
MIDDLE EASTERN URBAN SETTING: WHO IS AT RISK?
R. Chammas1, J. Bou Mosleh1, D. Jaalouk1, C. Bou Mitri1,
A. Aoun1 *. 1Notre Dame University - Louaize, Zouk Mosbeh,
Lebanon

Rationale: The purpose of this study was to estimate the

n b [95% CI]
proportion of Notre Dame University (NDU) students who are at
Gender male vs. female 776 0.43 [−0.01;0.86] high risk of developing EDs, and to examine the association of
Age (yrs) <65 255 1
EDs high risk with socio-demographic, lifestyle, dietary and
65–74 129 0.26 [−0.31;0.83]
75–84 200 −0.06 [−0.59;0.47] health-related factors.
≥85 192 −1.05 [−1.75;−0.34]* Methods: This was a cross-sectional study, conducted among
BMI (kg/m2) 18.5–24.9 348 1 a random sample of 457 NDU undergraduate students who
<18.5 64 0.19 [−0.69;1.07]
>24.9–29.9 222 0.04 [−0.48;0.56] were asked to complete a self-administered survey including
>29.9 142 0.35 [−0.25;0.95] a food frequency questionnaire, a background questionnaire,
Pain intensity No pain 349 1 and the Patient Health Questionnaire-9 (PHQ-9). Risk of
Slight pain 243 −0.24 [−0.78;0.29]
Moderate pain 106 0.57 [−0.04;1.18]
developing EDs was assessed using the SCOFF questionnaire
Severe pain 78 1.00 [0.38;1.63]* (The Sick, Control, One stone, Fat, Food). Anthropometric and
body composition measurements were obtained, using stand-
b, regression coefficient; CI, confidence interval. *P < 0.05 ard protocols and bioelectrical impedance analysis, respect-
ively. Informed consent form was signed by all students prior
Conclusion: Severe pain and an age ≥85 years were associated to participation. The study protocol was approved by NDU
with insufficient coverage of energy needs. This result suggests Research Board.
that pain control is essential to prevent malnutrition. Results: The sample consisted of 457 undergraduate students
Disclosure of Interest: None declared. with a mean age of 21.3 ± 1.9 years (63% males). Using the SCOFF
questionnaire, 146 (32.4%) students were found to be at high risk
of developing EDs with a significantly higher proportion of
S114
females than males (F (40%) vs. M (28.1%), P < 0.05). Students
who were found to be at high risk of EDs had significantly higher
depression score (8.26 vs. 6.20, P = 0.000), waist circumference
(85.4 vs. 82.4cm, P = 0.013), percentage of body fat (26.3 vs.
19.6, P = 0.004), body mass index (25.6 vs. 23.9 Kg/m2,
P = 0.000), potassium intake (1437.9 vs. 1325.5 mg, P = 0.003)
and magnesium intake (151.5 vs 143 mg, P = 0.04) adjusted for
energy intake. They had as well lower daily kilocalories intake
(4172.5 vs. 4860.1, P = 0.004).
Conclusion: Early detection and treatment of EDs may be
improved by routinely evaluation of several specific risk factors
in adolescence.
Disclosure of Interest: None declared.
SUN-P162
NUTRITIONAL HABITS OF AMATEUR AND PROFESSIONAL
FOOTBALL PLAYERS
A. Ilhan1 *, A. Tokay2, A. Ilhan3. 1Hacettepe University Faculty
of Health Sciences Department of Nutrition and Dietetics,
Ankara, 2Ondokuz Mayis University School of Health
Department of Nutrition and Dietetics, Samsun, 3Selcuklu
Community Health Center, Konya, Turkey
Rationale: The aim of this study is to investigate the dietary
habits of amateur and professional football players and to
examine their differences.
Methods: A total of 125 football players (25 professional,
100 amateur) in Samsun were participated to this study. The
professional football players were selected from Samsunspor
football club and amateur football players were selected from
Samsun Kadikoyspor football club. Subjects expected to
complete a questionnaire about their personal charac-
teristics, eating habits and using energy drinks and vitamin
and mineral supplements. The SPSS23 package software was
used for statistics, evaluating group differences by chi-square
test.
Results: Mean ages of participants were 25.72 ± 4.79 for
professionals and 20.05 ± 2.05 for amateurs. Lifting weight,
using vitamin mineral supplements and energy drinks were
statistically significant between professional and amateur
players ( p < 0.01). There was not significant difference for
using protein supplement ( p > 0.05). In the professional group;
consumption of milk and dairy products, meat and meat
products, vegetables and fruits were found significantly higher
than the amateur group ( p < 0.05). Professional football players
were more conscious for the diet under dietitian supervision
( p < 0.01).
Conclusion: Football is one of the most popular sports
branches all over the world. Just like in all sports, many
factors in football affect the performance of the players. With
the help of healthy nutrition, football players can reach their
maximum efficiency in the training sessions and feel more
fresh and fit. In conclusion; in the lights of the nutritional
knowledge based on scientific studies, we suggest that athle-
tes and their trainers should be supported by nutritional
instruction.
Disclosure of Interest: None declared.
Poster
SUN-P163
BIOELECTRICAL IMPEDANCE PHASE ANGLE IN CLINICAL
PRACTICE: THE RELATIONSHIP BETWEEN NUTRITIONAL RISK
SCREENING, BIOELECTRICAL IMPEDANCE ANALYSIS AND
SERUM SURROGATE PARAMETERS
B. Knappe-Drzikova1 *, S. Maasberg1, D. Vonderbeck1,
A. Sturm1, A. Pascher2, U.-F. Pape1. 1Gastroenterology and
Hepatology, 2General, Visceral and Transplantation Surgery,
CHARITÉ, University Medicine Berlin, Berlin, Germany
Rationale: Nutritional risk screening (NRS) is a widely accepted
complex approach to evaluate nutritional status (NT).
Bioelectrical impedance analysis (BIA) is a non-invasive, easy-
to-use and reproducible technique to evaluate changes in body
composition. The present study aimed to evaluate the
association between NRS, BIA, phase angle (PhA) and surrogate
parameters (SP), resp. for a NT assessment in gastroentero-
logical (GI) patients ( pts).
Methods: NTwas assessed in 611 GI pts by NRS. In addition, BMI,
serum albumin, and serum transferrin were determined and BIA
performed. Receiver Operating Curves (ROC) were estimated to
determine the optimal cut-off levels of PhA.
Results: An increased risk of malnutrition (score NRS > 3) was
found in 219 pts (35.8%). Well-nourished pts (score NRS 0–2) –
392 (64.2%) - had a statistically higher ( p < 0.001) mean phase
angle (5.4° ± 1.03°) as compared with the score NRS > 3 group
(4.1° ± 1.08°). Malnutrition was significantly associated with
poorer results for BMI ( p < 0.01), albumin (34.9 ± 7.4 vs. 40.5 ±
6.3; p < 0.001), transferrin (186.6 ± 67.7 vs. 253.5 ± 63.2; p <
0.001) and BIA (ECM/BCM-index 1.7 ± 0.8 vs. 1.12 ± 0.3; p <
0.001). A PhA of 4.85° in men was 74% sensitive and 71% specific
and of 4.5° in women was 79% sensitive and 74% specific for
detecting malnutrition[UP1] [ROC (for men): 0.797 ± 0.027;
95% CI.745-.849, p < 0.001; ROC (for women): 0.808 ± 0.026;
95% CI.757-.860, p < 0.001)].
Conclusion: The present study demonstrates that PhA is a good
indicator of risk for malnutrition in GI pts. There is a significant
association between NT risk, low PhA and SP, resp. The optimal
cut-off level of PhA is practical to identify pts with malnutrition
risk with the intent to limit the number of in-depth NT
assessments and it can easily be included into clinical NT status
evaluation and management.
Disclosure of Interest: None declared.
SUN-P164
NUTRITIONAL STATUS ACCORDING TO DIFFERENT
NUTRITIONAL ASSESSMENT TOOLS IN ELDERLY NURSING
HOME RESIDENTS AND AGREEMENT BETWEEN THEM
B. Lardiés-Sánchez1 *, A. Sanz-París2, G. Verdes-Sanz3,
L. Pérez-Fernández2. 1Endocrinology and Nutrition, H. Royo
Villanova, 2Endocrinology and Nutrition, H.U. Miguel Servet,
Zaragoza, 3Endocrinology and Nutrition, H. Obispo Polanco,
Teruel, Spain
Rationale: The aim of this study was to assess the nutritional
status in elderly nursing home residents with different
nutritional assessment tools and to check the agreement
between these tools.
Nutritional assessment 1
Methods: A cross-sectional study with 383 individuals of both
sexes was carried out in three public nursing homes in the urban
area of Zaragoza (Spain). For the assessment of nutritional
status in this elderly population, three nutritional tools were
used: MNA, the new ESPEN consensus definition of malnutrition,
and “CONtrolling NUTritional Status” (CONUT). Cohen’s kappa
(κ) statistic was calculated to determine diagnostic agreement
Results: 383 subjects met inclusion criteria and participated in
the study. Subjects had a mean age of 84.9 (SD 7.6) years old,
being 70.2% (n = 269) females. 20.4% of the participants had
diabetes mellitus, and dementia was documented in 57.4% of
this population. Regarding nutritional status according to MNA,
21.3% of the elderly were malnourished (MNA < 17 points), and
55.9% were at risk of malnutrition. With CONUT, a total of 67.6%
had a normal nutritional status, 11.7% had mild malnutrition
and 20.7% had moderate malnutrition. In the nutritional
assessment according to the new ESPEN definition of malnu-
trition, of the 72.5% of people with risk of malnutrition
identified with MNA-Short Form, 17.5% were malnourished.
The agreement between MNA and ESPEN criteria was moderate
(κ = 0.483, p = 0.003). The agreement between CONUT vs MNA
criteria and CONUT vs ESPEN criteria was low (κ = 0.19,
p = 0.046; and κ: 0.23, p = 0.037, respectively).
Conclusion: In this population there is a high prevalence of
malnutrition and risk of malnutrition assessed with MNA,
CONUT and the new ESPEN criteria of malnutrition. MNA and
ESPEN criteria are moderately correlated, but the agreement
with CONUT was low.
Disclosure of Interest: None declared.
SUN-P165
EVOLUTION OF THE INTAKE AND DIFFERENCES WITH
DIFFERENT BARIATRIC SURGERY PROCEDURES: SLEEVE
GASTRECTOMY VS BILIOPANCREATIC DIVERSION VS GASTRIC
BYPASS
B. Pintor De La Maza1 *, M. D. Ballesteros-Pomar1,
A. Urioste-Fondo1, L. M. Gajete-Martín1, M. Alejo-Ramos1,
D. Barajas-Galindo1, P. Fernández-Martínez1,
A. Hernandez-Moreno1, L. González-Herráez1,
I. Cano-Rodríguez1. 1High Risk Obesity Unit, Complejo
Asistencial Universitario De León, León, Spain
Rationale: Bariatric surgery(BS) appears to be the most
long-lasting technique for obtaining major weight loss. The
different used procedures might have a different impact in the
intake of patients that underwent Sleeve gastrectomy(SG),
Biliopancreatic diversion(BPD) and Gastric Bypass(GB).
Methods: The study was performed between July 2015 and
February 2017. All patients that underwent bariatric surgery
were included. All the data were collected before surgery and 6
and 12 months after surgery. Intake was collected using a 24-h
intake record and analyzed by a Registered Dietitian using
Dietsource 3.0® software (Novartis Consumer Health-
Cath Soft). The statistical analysis performed included an
ANOVA test.
Results: 24 patients with a mean age of 44.67(10.39) years
were included. 75% were female. Medium weight before
surgery was 121.36(22.60) kg. 8 patients underwent BDP, 12
SG and 4 GB. After 24-h dietary recall before surgery, medium
energy intake was 1600.82(500.57) kcal, 173.00(60.83) g of
carbohydrates, 73.07(21.32) g of protein and 68.88(35.21) g of
S115
fat. 6 months after surgery energy intake was 1257.73(456.85)
Kcal in DBP, 828.48(187.61) Kcal in SG and 1153.8(390.69) kcal
in GB( p = 0.034). One year after surgery no differences were
found on intake. Carbohydrates intake was statistically signifi-
cant( p = 0.039) being 216.30(6.22) g in BDP, 88.69(44.05) g in
SG and 115.4(93.05) g in GB. There was also a tendency to a
lower protein intake that was 98.7(4.24)g in BDP, 50.49(15.70)g
in SG and 62.90(49.07)g in GB( p = 0.072)
Conclusion: BDP and GB appear to help ensure the long-term
energy and carbohydrate intake. The small sample size does
not allow to either confirm nor deny the same situation aboyt
protein intaje although there is a clear tendency towards a
lower protein intake maintained over time in SG
Disclosure of Interest: None declared.
SUN-P166
IS THERE A DIFFERENCE ON HOW BARIATRIC SURGERY
AFFECTS THE QUALITY OF INTAKE AND FOOD TOLERANCE?
COMPARISON OF SLEEVE GASTRECTOMY VS BILIOPANCREATIC
DIVERSION VS GASTRIC BYPASS
B. Pintor De La Maza1 *, M. D. Ballesteros-Pomar1,
A. Urioste-Fondo1, L. M. Gajete-Martín1, M. Alejo-Ramos1,
D. Barajas-Galindo1, P. Fernández-Martínez1,
A. Hernandez-Moreno1, L. González-Herráez1,
I. Cano-Rodríguez1. 1High Risk Obesity Unit, Complejo
Asistencial Universitario De León, León, Spain
Rationale: Reduced food tolerance is often associated to
bariatric surgery and sometimes it is also related to vomiting.
The aim of this study was to know the food tolerance in patients
that underwent Sleeve gastrectomy (SG), Biliopancreatic
Diversion (BPD) and Gastric Bypass (GB).
Methods: The study was performed between July 2015 and
February 2017. All patients that underwent bariatric surgery
were included. The food test tolerance, described by Suter M.,
was administered to all patients 6 and 12 months after surgery.
This test included one question about the self-perception
quality of the intake [total score 1 (very poor) to 5 points
(excellent)], food tolerance of 7 food groups [total score 0
(food not tolerated) to 16 points (no difficulty with consump-
tion)] and the presence or not of vomiting [total score 0 (daily)
to 6 points (never)], giving a global test score of 0–27 points
(from worst to superior food tolerance). The statistical analysis
included ANOVA test.
Results: 24 patients with a mean age of 44.67 (10.39) were
included. 75% (18 patients) were female. Medium weight
before surgery was 121.36 (22.60) kg. 8 patients underwent
BDP, 12 SG and 4 GB. No differences were found in the three
questions asked and total score at 6 months. The quality of
the intake self-perception was statistically different ( p =
0.024) being 4.00 (0.00) in DBP, 4.86 (0.38) in SG and 5.00
(0.00) in GB.
Conclusion: It appears to be no differences in food tole-
rance, although the small sample size might require longer
studies.
Disclosure of Interest: None declared.
S116
SUN-P167
DIFFERENCES IN MUSCLE MASS LOSS DEPENDING ON THE
PROTEIN INTAKE AND THE BARIATRIC PROCEDURE
B. Pintor De La Maza1 *, M. D. Ballesteros-Pomar1,
A. Urioste-Fondo1, L. M. Gajete-Martín1, M. Alejo-Ramos1,
D. Barajas-Galindo1, P. Fernández-Martínez1,
A. Hernández-Moreno1, L. González-Herráez1,
I. Cano-Rodríguez1. 1High Risk Obesity Unit, Complejo
Asistencial Universitario De León, León, Spain
Rationale: Severe obesity is currently increasing worldwide
and bariatric surgery appears as an effective intervention
strategy for weight loss, causing changes in body composition
and protein intake. The aim of this study was to assess the
evolution of body composition related to protein intake in
patients that underwent Sleeve gastrectomy (SG),
Biliopancreatic Diversion (BPD) and Gastric Bypass (GB).
Methods: The study was performed between July 2015 and
February 2017. All patients that underwent bariatric surgery
were included. All data were collected before and 6 months
after surgery. Muscle mass (MM) was assessed by Bioelectrical
Impedance Analyzer (BIA - Tanita MC780). Protein intake was
collected using the 24-h intake record and analyzed by a
Registered Dietitian using Dietsource 3.0® software (Novartis
Consumer Health-Cath Soft, 1997–2003). The statistical ana-
lysis included a Pearson correlation test.
Results: 24 patients with a mean age of 44.67 (10.39) were
included. 75% (18 patients) were female. 8 patients underwent
BDP, 12 SG and 4 GB. MM before surgery was 65.8 (11.50) kg.
After 6 months MM was 63.74 (12.12) kg in DBP, 51.28 (6.23) kg
in SG and 61.60 (9.23) in GB. There was a positive correla-
tion between protein intake and MM (r = 0.427; p = 0.037).
Percentage of MM loss was similar among the three techniques
(13.22 DBP vs 13.18 SG vs 13.12 GB). There was a positive
correlation between protein intake and percentage of MM loss
(r = 0.435; p = 0.034).
Conclusion: Muscle mass loss appears to be lower after BDP in
patients with a higher protein intake, although the small
sample size requires longer studies.
Disclosure of Interest: None declared.
SUN-P168
IS THERE A RELATION BETWEEN HOSPITALIZATION RATE AND
MALNUTRITION RISK, AN ASSESSMENT STUDY WITH NRS-2002
B. Madali1, A. Ozdemir1 *, E. Inan-Eroglu1, D. Dikmen1.
1
Nutrition and Dietetics, Hacettepe University, Ankara, Turkey
Rationale: Number of hospitalization is one of the important
factors that affect hospital malnutrition. This study was
planned and conducted to investigate the effects of the
number of hospitalization on body weight and nutritional
status of patients with NRS2002 screening tool.
Methods: This study was carried out with 240 hospitalized
patients. A questionnaire that consists socio-demographic
characteristics and hospitalization periods were administered
and body weight and height were examined. Nutritional Risk
Screening (NRS)-2002 was assessed. The questionnaires were
analyzed with the statistical program SPSS.
Results: The mean age of patients was 44,9 ± 13,8 and mean
BMI was 26,9 ± 4,9 kg/m2. Of participants, 42,9% were men
and 57,1% were women. According to NRS2002 tool, 8,3% of
Poster
participants’ BMI was under <20,5 kg/m2, 25,4% of them lost
weight in last 3 months, 26,3% of them had a reduced dietary
intake, and 5,4% of them were severely ill. Of 68 patients who
were undertaken the second phase of the tool, 7 patient’s score
was assessed more than 3. About 35 of (14.6%) patients stayed
at least once in hospital, the rest of them (85.4%) stayed more
than once. The number of patients whose BMI status were under
20.5 kg/m2 were higher in the subjects who stayed more than
once in hospital than who stayed once ( p < 0,05). However
there was no significant correlation between hospitalization
rate and BMI scores. Also, there was a statistically significant
difference in education status in terms of weight loss
( p < 0,05).
Conclusion: Malnutrition is a common problem among hospi-
talized patients. NRS 2002 is recommended as the preferred
screening tool for hospitalized patients. This study showed a
relation between the number of hospitalization and BMI status
of hospitalized patients. In order to prevent from hospital
malnutrition, screening tools should be applied and nutritional
support should be supplied on time.
Disclosure of Interest: None declared.
SUN-P169
NUTRICIONAL STATUS AND THE ESTIMATE CONSUMPTION OF
NUTRIENTS IN WOMEN PARTICIPATING IN AN EXTENSION
PROGRAM IN THE SOUTH OF BRAZIL
C. W. Gallon1 *, J. Siviero1, S. C. Benincá1, C. P. Gabrielli1,
T. D. Justina1, T. Pedrollo1. 1Universidade De Caxias do Sul,
Caxias do Sul, Brazil
Rationale: Aging is a process characterized by physiological,
psychological and social changes that occur over the years.
These changes affect the nutritional status (NS) which, in turn,
relate to health. Healthy eating and consequent maintenance
of NS are essential factors for successful aging. The study was to
evaluate the nutritional status and the consumption of macro
and micronutrients in women participating in an extension
program.
Methods: Cross-sectional study. Realized with women older
than 50 years. The variables analyzed were socio demographic,
anthropometric and food consumption, correlating the NS with
the food consumption.
Results: From 176 women, the average age found was 63.2
years old (±7.4). The predominant scholarship level was high
school completed or higher (58.5%), overweight (52.3%) and
high risk due for cardio vascular disease (CVD) to the abdominal
circumference (AC) in 78.4%. The consumption of macronu-
trients is 57.7% carbohydrates, 17.2% protein and 25% lipids.
While analyzing the correlation between Body Mass Index (BMI)
with the AC, demographic data and food consumption, there
was a positive association ( p < 0.001). There was also a negative
association between BMI with the scholarship level ( p = 0.041),
with calories in the breakfast ( p = 0.040) and fibers ( p = 0.008).
While analyzing the correlation between AC with demographic
data and food consumption, there was a positive association
with age ( p = 0.039) and proteins, ( p = 0.011). There was also a
negative association between AC with level of scholarship
( p = 0.005) and fibers ( p = 0.007).
Conclusion: A high prevalence of overweight was found, as like
as AC with an elevated risk for CVD, also finding some
correlations between the NS with the food consumption. The
Nutritional assessment 1
nutritional education is fundamental; this way women can
readapt their food consumption, and consequently, improve
their NS.
Disclosure of Interest: None declared.
SUN-P170
BODY COMPOSITION BY BIOELECTRICAL IMPEDANCE VECTOR
ANALYSIS ACCORDING TO SEVERITY OF OROPHARYNGEAL
DYSPHAGIA IN HOSPITALIZED PATIENTS
C. A. Reyes-Torres1 *, A. Ramos-Vázquez2, S. Tapia-Valdés2,
L. Castillo-Martínez1, A. E. Serralde-Zúñiga1. 1Clinical
Nutrition Service, 2Instituto Nacional De Ciencias Médicas Y
Nutrición Salvador Zubirán, Mexico City, Mexico
Rationale: Oropharyngeal dysphagia (OD) has clinical compli-
cations as malnutrition and dehydration which can not always
be assessed using classical anthropometric parameters.
Bioelectrical impedance vector analysis (BIVA) offers advan-
tages in the evaluation of patients with OD, in addition the
phase angle is considered a prognostic factor. The aim is to
evaluate the body composition according to severity of OD in
hospitalized patients.
Methods: A cross-sectional study was performed recruiting
patients with diagnosis of OD. Body composition was assessed
by BIVA and phase angle. We have used the EAT-10 scale to
evaluate the risk of OD. If the score was ≥3, the Volume-
Viscosity Clinical Test was performed to confirm the diagnosis
and severity of OD (mild, moderate and severe). One-way
ANOVA test and Pearson’s χ2 test were used to compare the
three groups.
Results: Were recruited 46 patients (48% females) with age of
74 (RIQ 54–81) years, the mean BMI was 22 ± 5 kg/m2. The
diagnoses were: stroke (28%), dementia (20%), Parkinson’s
disease (13%), amyotrophic lateral sclerosis (13%), multiple
sclerosis (8%), neuroinfection (8%), Sjögren’s syndrome (4%)
and others (8%). The 33% of the patients had mild OD, 47%
moderate and 20% severe OD. Phase angle was higher between
the mild (4.8 ± 1.2) and moderate (4.9 ± 1.1) compared to the
severe OD group (3.4 ± 0.5) ( p=0.003). The frequency of
patients with cachexia was higher in the severe group (89%)
compared to the mild and moderate OD group (46% and 63%)
respectively ( p=0.04).
Conclusion: The phase angle was lower in severe OD group. The
frequency of cachexia evaluated by BIVA was higher in patients
with severe OD despite having a normal BMI. Clinical trials are
required to perform nutritional interventions to prevent
adverse events in patients with OD.
Disclosure of Interest: None declared.
SUN-P171
AUDIT OF COMPLIANCE WITH HOSPITAL WEIGHING
POLICY #241
C. La Spada1 *, J. Van Schalkwyk2, P. Fitzgerald1, M. Sin2.
1
Nutrition and Dietetics, 2Centre for Nursing Research, Sir
Charles Gairdner Hospital, Nedlands, Australia
Rationale: Patient weight is a crucial part of nutritional
assessment, intervention and evaluation. It is also necessary
for monitoring fluid status, ensuring correct dosage of certain
medication and for patient manual handling. The aim of this
S117
audit was to examine compliance of nursing staff with Sir
Charles Gairdner Hospital policy #241 - Weighing Patients.
Methods: Seven high risk wards were selected based on the last
hospital malnutrition audit. From these wards a total of 140
patients were audited to identify compliance with the five
items on the hospital weighing policy.
Results: The combined results showed only 51.5% of 140
patients audited had their weight recorded on admission
(range 41.7% > 70.6%), 36.4% of patients had their weight
recorded on the National Medication Chart (range 5.6% >
90.9%), 50.0% of patients had their weight recorded on the
Adult Observation Response Chart (13.6% > 100.0%), 57.1% had
their weekly weight recorded if they were admitted >7 days
(22.2% > 100.0%) and 68.6% had their weight recorded as
monitored in accordance with their special clinical need
(50.0–100.0%).
Conclusion: Despite the implementation of a weighing policy,
weighing patients is still not considered an essential part of
the information collected during a patient’s initial nursing
assessment. The lowest score was for documentation on the
Medication Chart, which is concerning given the risk of
preventable medication errors. Dietitians are often involved
with special clinical needs patients and routinely liaise with
nursing staff for patient weights, which may have contributed
to higher compliance. Ongoing education is indicated to ensure
all staff are familiar with this policy. A follow up survey of
nursing staff to determine the barriers to weighing patients/
documenting and identifying appropriate supports is
recommended.
Disclosure of Interest: None declared.
SUN-P172
NUTRITIONAL EVOLUTION OF HOSPITALIZED PATIENTS AFTER
ISCHEMIC ENCEPHALIC VASCULAR ACCIDENT WITH OR
WITHOUT DYSPHAGIA
C. Rodrigues1 *, C. Q. Brant1, Y. Juliano1, N. F. Novo1. 1Ciencias
Da Saude, Universidade Santo Amaro, Sao Paulo, Brazil
Rationale: Brain stroke is a disease caused by an alteration
of the blood flow in the brain. Dysphagia and malnutri-
tion affect 37–78% and 35–67% of brain stroke patients,
respectively.
Methods: Contemporary cohort study of hospitalized patients
admitted in intensive care units located in a public hospital in
southern São Paulo city.
Results: In the dysphagia group, the frequency of nutritional
supplementation was significantly bigger ( p = 0,0001) in order
to maintain their lean mass, as assessed by calf circumference,
and fat mass ( p = 0,0113), as assessed by triceps skinfold
thickness ( p = 0,0280).
Conclusion: We conclude that interventions, such as nutri-
tional state follow-up through anthropometry and modified
and offered food acceptance assessment, adequate use of
nutritional supplementation and dysphagia diagnose reduced
the eminent risk of malnutrition associated to brain stroke,
dysphagia and nutritional state triad during hospitalization.
Disclosure of Interest: None declared.
S118
SUN-P173
FUNCTIONAL CORRELATES OF DETAILED BODY COMPOSITION
IN HEALTHY ELDERLY (65+)
C. Geisler1 *, L. Schweitzer1, M. J. Müller1. 1Institute for Human
Nutrition, Christian-Albrechts Universität Zu Kiel, Kiel,
Germany
Rationale: Methods of body composition analysis (BCA) are
widely used to characterize health status, i.e. nutritional
status, metabolic rates and cardio-metabolic risk factors.
However, the functional correlates of individual body compo-
nents have not been systematically analyzed.
Methods: In a healthy population of 40 Caucasians aged 65–81
years (20 males; BMI: 18.6–37.2 kg/m²) body composition was
assessed by (i) air displacement plethysmographie (ADP) and
(ii) whole-body magnetic resonance imaging (MRI). Body
functions included vital functions, pulmonary function, hand-
grip strength (HGS) and mobility tests, resting energy expend-
iture (REE), liver and kidney functions (GFR), while metabolic
functions included insulin sensitivity (HOMA), inflammation,
plasma levels of lipids, leptin, hormones and vitamins.
Results: Individual body compartments were (i) inter-corre-
lated e.g. muscle mass (SM) was correlated with visceral
adipose tissue (VAT; r = 0.53) and kidney volumes (r = 0.62); (ii)
correlated with body functions e.g. SM (r = 0.58) and liver
volume (r = 0.63) with REE, SM with HGS (r = 0.57) and kidneys
with GFR (r = 0.57) and (iii) correlated with metabolic functions
and endocrine characteristics e.g. VAT was related to HOMA
(r = 0.59) and subcutaneous adipose tissue (SAT) to leptin
(r = 0.84). Moderator analysis showed that inflammation mod-
erated the SAT-leptin relationship (+4.0%). Using linear
regression analysis detailed BCA improved the explained
variance in REE (78.2%), HOMA (41.0%) and leptin (78.0%)
when compared to a BMI based model (REE 16.0%; HOMA 31.0%;
leptin 45.0%). By contrast, SM did not improve the explained
variance in HGS (74.0%).
Conclusion: BCA reflects health status related to (i) functional
(REE, GFR, HGS) and (ii) metabolic as well as endocrine (HOMA,
leptin) characteristics. Body composition needs a narrower
focus on metabolic and endocrine functions.
Disclosure of Interest: C. Geisler Grant/Research Support from:
DANONE Institute- Nutrition for Health, Germany (2013/13),
L. Schweitzer: None declared, M. Müller: None declared.
SUN-P174
EATING BEHAVIOR IS ASSOCIATED WITH NUTRITIONAL STATUS
IN KINDERGARTEN CHILDREN
D. Gumus1 *, M. Tengilimoglu Metin1, S. Sevim1, G. Topal1,
M. Kizil1. 1Hacettepe University, Ankara, Turkey
Rationale: The aim of this study was to evaluate the relation-
ship between children’s eating behavior and their nutritional
status.
Methods: This study was conducted with 47 kindergarten
children aged between 37 and 66 months in Ankara, Turkey.
Eating behavior of children were assessed through the
subjective perception of parents by answering the Children’s
Eating Behaviour Questionnaire (CEBQ).This questionnaire is
divided into 8 subscales.4 subscales investigate behaviors that
reflect “interest in food” –Food Response (FR), Enjoyment of
Food (EF), Desire to Drink (DD) and Emotional Overeating
Poster
(EOE)– and the other 4 subscales reflect behaviors related to
“lack of interest in food”– Emotional Undereating (EUE),
Satiety Responsiveness (SR), Slowness in Eating (SE)and Food
Fussiness (FF).The answers were given using a likert scale of 5
points, according to the frequency in which their children
presented each behavior.Anthropometric measurements were
collected by nutritionists.The nutritional status of children was
assessed as percentiles by using WHO Child Growth Standards of
weight and height for age standards.
Results: The mean weight of boys and girls were 25,6 ± 5,9 kg
and 22,9 ± 5,7 kg respectively. The mean height of boys and
girls were 116,2 ± 7,3 cmand 112,8 ± 5,2 cm respectively.12,8%
children (n = 6) was below 50th Percentil in height and 25,5%
(n = 12) children was below 50th Percentil in weight. The eating
behavior of boys and girls were similar ( p = 0,381). Children
who were below 50th Percentile in height had lower scores in FR
( p = 0,015), EF ( p = 0,035), DD ( p = 0,039) and EOE ( p = 0,025).
Children who were below 50th Percentile in weight had higher
scores at the subscales that reflect “lack of interest in food”
( p = 0,041).
Conclusion: The results of the present study suggest that
eating behavior is associated with nutritional status in children.
Thus, the study findings may help to promote healthy eating
behaviors in children.
Disclosure of Interest: None declared.
SUN-P175
RISK OF SARCOPENIA BY SCREENING TOOL SARC-F AND
PRESARCOPENIA BY THE CALF CIRCUMFERENCE
I. D. A. Vaez1, H. F. Bufato1, J. E. de Aguilar-Nascimento2,
D. D. Dock1 *. 1UFMT, 2UNIVAG, Cuiaba, Brazil
Rationale: This study aimed to determine the frequency of
sarcopenia risk by screening tool SARC-F (Strength; Assistance
with walking; Rise from a chair; Climb stairs Falls) and
presarcopenia by calf circumference in older people.
Methods: Cross-sectional study conducted with older people
from a community centre in Cuiabá-MT-Brazil. The screening
tool SARC-F to determine sarcopenia risk and calf circumfer-
ence (CC) to evaluate presarcopenia was measured. Body
weight, age, and height, body mass index (BMI), nutritional
status (mini nutritional assessment short form), adductor
pollicis muscle thickness; handgrip dynamometer and gait
speed was measured on a 4-meter distance. The older people at
risk, showed SARC-F score ≥4 and presarcopenia CC ≤ 33 cm for
women and ≤34 cm for males.
Results: One hundred and sixteen subjects were recruited for
this study, 90.5% was female and 28.5% was malnourished. The
prevalence of presarcopenia was 12.9% and the risk of sarcopenia
was 27%. Pre sarcopenic older people had lower weight (53 ± 1.8
vs 71.1 ± 1.2 Kg; p = 0.000), were oldest (74.6 ± 1.9 vs 69.7 ± 0.6
years; p = 0.02) showed lower BMI (23.5 ± 0.6 vs 30.0 ± 0.51 Kg/m2;
p = 0.000) and lower adductor pollicis muscle thickness
(15.4 ± 0.9 vs 18.2 ± 0.3 mm; p = 0.005). Older people at sarco-
penia risk by SARC-F, had lower handgrip strength (19.1 ± 0.82 vs
23.9 ± 0.75 Kg; p = 0.000) and gait speed (0.82 ± 0.04 vs 1.01 ±
0.02 m/s p = 0.000) than those without risk.
Conclusion: Considering screening tool SARC-F, almost 30% of
the sample was at sarcopenia risk and approximately 15% were
presarcopenic by CC.
Disclosure of Interest: None declared.
Nutritional assessment 1
SUN-P176
THE EFFECT OF AMINO ACID KETOANALOGS ON THE
NUTRITIONAL STATUS AND MORBIDITY OF MALNOURISHED
PERITONEAL DIALYSIS PATIENTS
P. Borek1, M. Chmielewski1, M. Lichodziejewska–Niemierko1,
E. Wernio2 *, S. Małgorzewicz2. 1Department of Nephrology,
Transplantology and Internal Diseases, 2Department of Clinical
Nutrition, Medical University of Gdansk, Gdańsk, Poland
Rationale: One reason for protein malnutrition in patients with
peritoneal dialysis is increased protein requirements due to
high protein loss of dialysate and loss of appetite due to uremic
toxemia. Among the possible nutritional interventions in CKD
patients ketoanalogues (KA) of amino acids supplementation
deserves particular attention. The purpose of the study was to
evaluate the effects of treatment with amino acid ketoanalo-
gues on the nutritional status and morbidity of peritoneal
dialysis patients with malnutrition.
Methods: The study group was composed of 24 PD patients with
diagnosed malnutrition. Patients were randomly assigned to
the intervention and control groups.
The intervention consisted of administration of KA for 3 months
at a dose of 9 tablets of Ketosteril® daily. The several laboratory
parameters and nutritional status were monitored during
the study.
Results: NRS 2002 and SNAQ showed significant improve-
ment of nutritional status and appetite in intervention group
after observation period. The increased of nPCR was noticed
in intervention group after 3 months of treatment (0.93 vs
1.14 g/kg/day), whereas in the control group nPCR was
decreased (1.13 vs. 0.98).
During the study lean body mass - LBM (kg) did not change in the
control group(36 vs 37 kg), but in the intervention group
increased (38 vs 44 kg). Laboratory markers of inflammation,
oxidative stress, urea, creatinine and other routine biochem-
ical parameters, and also the adequacy of dialysis were stable
in both groups.
Conclusion: Oral treatment with amino acid ketoanalogs in
malnourished peritoneal dialysis patients is safe. It results in
improved nutritional status, appetite and improves body
composition by increasing lean body mass.
Disclosure of Interest: None declared.
SUN-P177
THE RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND
POSTOPERATIVE COMPLICATIONS AFTER AORTIC VALVE
REPLACEMENT DUE TO AORTIC STENOSIS IN ELDERLY
PATIENTS
E. W. Wernio1,2 *, S. Małgorzewicz1, D. Jagielak2. 1Department
of Clinical Nutrition, 2Department of Cardiovascular Surgery,
Medical University of Gdańsk, Gdańsk, Poland
Rationale: Longer life expectancy is associated with the
increase incidents of aortic stenosis and rising number of
surgical treatment of this valve lesion. The aim of this study
was the identification of factors related to nutritional status
predisposing to the occurrence of postoperative complications
after aortic valve replacement (AVR) surgery.
Methods: The nutritional status of 111 patients [74.1 ± 5.3
years, 43% of women, mean AVA (cm2) 0.778 ± 0.21] with AS was
evaluated the day before AVR surgery. The questionnaire
S119
method, anthropometrics measurements, body composition
analysis and biochemical parameters were used for the
assessment of nutritional status.
Results: Postoperative complications were observed in 51%
(n = 57) of patients. The atrial fibrillation (25%), delirium (18%)
were the most common incidents. In comparison with those,
who did not develop complications, patients with post-
operative incidents were older [73 (66–82) vs 76 (65–87)
y. p = 0.0009], had poorer nutritional status according to f-
MNA (25.3 ± 2.1 vs 23.6 ± 2.7 p = 0.003) and lower level of
biochemical parameters such as prealbumin mg/dL (34 ± 7.6 vs
29.4 ± 8.2 p = 0.045), cholesterol mg/dL [146 (92–231) vs 118
(70–263), p = 0.038), triglycerides mg/dL [79.5 (35–923) vs 133
(33–417), p = 0.029]. Also, percent of ejection fraction was
lower and a number of taken medications was higher.
Differences in the Charlson Comorbidity Index were not
observed. The occurrence of complications positively corre-
lated with age and negatively with the results of full-MNA, scale
and 7-SGA scale and with the level of prealbumin (mg/dL),
cholesterol (mg/dL), triglycerides (mg/dL).
Conclusion: Poor nutritional status in elderly with AS before
AVR is related to the occurrence of postoperative complica-
tions. In this group of patients, nutritional support before AVR
may be considered, although further studies are needed.
Disclosure of Interest: None declared.
SUN-P178
ORAL SUPPLEMENTATION WITH THE OMEGA-3
DOCOSAHEXAENOIC ACID (DHA) IN PATIENTS WITH
AMYOTROPHIC LATERAL SCLEROSIS (ALS): A RANDOMIZED,
DOUBLE-BLIND, PLACEBO-CONTROLLED PILOT STUDY
E. Romero1,2,3 *, M. Virgili1,2,3, M. Barceló2,3,4, M. Povedano2,3,
J. C. Domingo5. 1Clinical Nutrition and Dietetics Unit.
Endocrinology and Nutrition Department, 2Multidisciplinary
Unit Motor Neurone Disease, Bellvitge Universitary Hospital,
3
IDIBELL, Hospitalet de Llobregat (Barcelona), 4Research
Group on Statistics, Econometrics and Health (GRECS),
University of Girona, Girona, 5Department of Biochemistry,
University of Barcelona, Barcelona, Spain
Rationale: Patients with ALS have progressive muscle atrophy
with high levels of circulating inflammatory markers and
altered lipidic profile. The anti-inflammatory activity of DHA
and their contribution to the normal function of the nervous
system is expected to have a positive effect on ALS patients.
Methods: To evaluate the possible benefits of DHA on ALS
patients an oral supplementation of 1 g of DHA (+vit E) was
given to a group of 14 patients, while another similar group
received 1g of olive oil as a placebo. The supplementation was
for 1 year. Blood samples of two groups were collected every 3
months to evaluate levels of cholesterol fractions, triglycerides
and inflammatory biomarkers. Besides this, weight loss pre-
diagnosis, ALS Functional Rate Scale (ALSFRS) and Forced Vital
Capacity (FVC) as clinical parameters were recorded.
Results: 28 ALS patients were included but only 16 completed
the follow up. No significant differences between treatment/
placebo group were found on demographic characteristics at
baseline: weight loss pre-diagnosis, diagnostic delay (median
250/300 days), gender (57/71% male), onset site (86/64% limb)
and age (53/58 years). Evolution of study variables in 1 year
was: no changes for Triglycerides and HDL cholesterol. FVC
S120
−11/−11, ALSFRS −12.5/−4.5 points, LDL cholesterol −0.260/
0.035, TNF alfa −0.570/1.59 meaning lower levels in the
treated group than in placebo group ( p = 0.022) at 1 year.
Conclusion: A clinical improvement in the treated group
cannot be concluded due to the small size of the sample (a
limitation of the study). TNF alfa levels differences are only
weakly significant. Lack of change in lipidic profile could be
disguised as the expected evolution of the disease. Further
studies with an increased number of ALS patients would be
necessary to confirm this anti-inflammatory activity.
Disclosure of Interest: None declared.
SUN-P179
NUTRITIONAL ASSESSMENT IN PATIENTS AFFECTED BY
MITOCHONDRIAL CYTOPATHY (NAMITO STUDY)
E. Aubry1 *, C. Aeberhard1, L. Bally1, S. Mühlebach2, Z. Stanga1.
1
Department of Diabetes, Endocrinology, Nutritional Medicine
and Metabolism, Bern University Hospital and University of
Bern, Bern, 2Department of Clinical Pharmacy and
Epidemiology, University of Basel, Basel, Switzerland
Rationale: Patients suffering mitochondrial cytopathy (MC) are
at high risk for malnutrition and often suffer from gastrointes-
tinal symptoms (e.g. dysphagia, dysmotility). It considerably
influences nutritional intake and therefore deteriorates nutri-
tional state. Literature in this regard is very sparse. Aim of this
study was to evaluate a simple screening tool for protein energy
malnutrition (PEM) and conduct extended nutritional assess-
ment to explore potential presence of PEM in patients with MC
compared to controls.
Methods: Prospective cohort study comparing outpatients
with MC to matched healthy controls. Nutritional screening
(NRS-2002) and full nutritional assessment were conducted,
including quantitative and qualitative dietary habits (food
recall protocol), body composition (bioimpedance analysis,
anthropometrics), rest energy expenditure (indirect calorim-
etry) and quality of life (QoL; SF36v2) measurements. Blood
and 24-hours urine analysis were done in the patients’ group.
Results: Twenty-six patients were included: 11 in the patients’
group and 15 in the control group. No patient was screened at
high risk for malnutrition according to the NRS-2002.
Nutritional assessment showed that patients had inadequate
energy intake and significantly lower protein intake. Nitrogen
balance and creatinine height index showed pathologic values.
Body composition and function were altered as well as QoL.
Conclusion: According to detailed nutritional assessment and
ESPEN guidelines1, all patients were malnourished. Thus, NRS-
2002 appears to be too less sensitive for outclinic chronic ill
patients. There is a rational to increase protein intake and
adapt energy supply to improve symptoms and QoL. Further
studies should investigate potential positive influence of
dietary management on disease’s course.
References
1. Cederholm T, et al. ESPEN Guidelines on definitions and terminology
of clinical nutrition. Clinical nutrition 36 (2017), 49–64
Disclosure of Interest: None declared.
Poster
SUN-P180
“LA DESCULTURIZACIÓN”: PERCEPTIONS ON TRADITIONAL
DIET AND NUTRITIONAL TRANSITION AMONG INDIGENOUS
COMMUNITIES OF ECUADOR
V. Chee1, L. Wright2, I. Hernandez3, M. Reina-Ortiz2,
S. Bejarano2, M. Flores4, E. Teran4 *, R. Izurieta2, J. Baldwin5,
D. Martinez-Tyson2. 1College of Public Health, 2College of
Public Health, University of South Florida, Tampa, FL, United
States, 3Facultad de Enfermeria, Pontificia Universidad
Catolica del Ecuador, 4Colegio de Ciencias de la Salud,
Universidad San Francisco de Quito, Quito, Ecuador,
5
Department of Health Sciences, Northern Arizona University,
Arizona, United States
Rationale: Nutrition transition refers to the global shift from
traditional, nutrient-dense foods to nutrient-poor, high-fat
foods. Chronic disease risk is further elevated by sedentary
lifestyles. Few studies have examined the nutrition transition
among indigenous communities in Ecuador despite the national
growing rates of overweight (40% men, 50% women) and obesity
(6% men, 16% women)1. Understanding dietary behavior
-within its cultural context- and its relationship to nutritional
transition -within its socioeconomic context- is a crucial step
for informing evidence-based interventions.
Methods: A qualitative study was conducted to explore
nutritional transition among Indigenous communities in the
province of Imbabura, Ecuador. A total of eight focus groups
(n = 55) were conducted. Focus group questions explored
perceptions of diet and nutrition. Data was analyzed using
grounded theory.
Results: A central role of diet in cultural identity among these
communities was reported. Additionally, changing trends
in household dietary behaviors were observed due to diurnal/
daily parental absenteeism as a result of employment oppor-
tunities. Grandparents had difficulty feeding children with
healthy foods at home while children were instructed to
consume “mestizo” food in schools. Participants were con-
cerned about “desculturización” – a loss of their traditions and
identity- in the face of the increased popularity of “mestizo”/
fast foods that were replacing traditional staples (quinoa, favas,
amaranth).
Conclusion: Economic needs, urban employment and institu-
tionalized education may have impacted household diets,
resulting in increased intake of nutrient poor, fatty fast foods.
The implications of nutritional transition and cultural identity
and its comparison with other Latin-American indigenous
communities will be discussed.
References:
1.
Disclosure of Interest: None declared.
SUN-P181
URINARY SODIUM EXCRETION AMONG ECUADORIAN ADULT
POPULATION: A CROSS-SECTIONAL STUDY
I. Sisa1, M. E. Herrera-Fontana1 *, M. M. Bovera2,
M. Palomeque3, E. Teran1. 1Colegio de Ciencias de la Salud,
Universidad San Francisco de Quito, 2Servicio de Laboratorio,
3
Hospital de los Valles, Quito, Ecuador
Rationale: It is well known that high dietary sodium intake
is associated with cardiovascular disease (CVD) through a
Nutritional assessment 1
mediated effect on blood pressure. In this sense, Ecuador is
currently facing a high prevalence of hypertension and other
health problems related with dietary patterns in their
population. The aim of this study was to determine the
sodium intake in Ecuadorian population.
Methods: It was conducted a cross-sectional study in a
representative sample of people living in Quito, Ecuador
(2,800 m above sea level). Study was reviewed and approved
by an IRB and sodium was measured in 24-hr urine collection
using an Ion-Selective Electrode indirect Na-K-Cl (Roche
Diagnostics, Switzerland). 24-hr sodium excretion was reported
in mmol/d, then transformed to mg sodium/d and finally g
salt/d. A WHO reference value of 2.0 g/d was used to
discriminate consumers. All statistical analyses were per-
formed using R v 3.3.2.
Results: Study population was 130 subjects. The median age
was 40 years old and the average sodium intake was 2,771 ±
1,771 mg/d (range, 1,736–3,404) equivalent to salt intake of
7.1 g/d (range, 4.4–8.7). Sixty-three percent (82 of 130) of
individuals had sodium levels higher than the reference value.
Sixty-five percent were overweight (BMI ≥ 25 kg/m2), 77%
considered themselves as proper salt consumers, and had
a mean potassium intake of 1226 ± 548 mg/d (range, 858–
1,511). In the univariate analysis individuals with higher
sodium intake were more likely to be service workers, had
higher BMI values and had no association with salt consumption
perception.
Conclusion: Sodium intake in the Ecuadorian population is
higher than expected and might be related with the increasing
cases of hypertension, obesity and other metabolic diseases.
There is then an urgent need to implement health policy to
reduce sodium intake and therefore successfully prevent CVD
at a community and country-level.
Disclosure of Interest: None declared.
SUN-P182
IMPACT OF DRINKING 1L WATER ON BIA MEASUREMENT IN
HEALTHY STUDENTS
E. Leistra1 *, H. Kruizenga2,3. 1Health Sciences, Vrije
Universiteit, 2Nutrition and Dietetics, VU University Medical
Center, Amsterdam, 3Dutch Dietetic Association, Houten,
Netherlands
Rationale: Bioelectrical Impedance Analysis (BIA) measure-
ments are often performed in clinical practice to determine
FFM/FM. Controversy exists on the necessity of emptying
the bladder before a BIA measurement. To answer this question
we assessed the influence of drinking 1L water on BIA
outcomes.
Methods: Healthy master students Health Sciences at the
VU University Amsterdam participated in this observational
study between 2011 and 2016. BIA measurements were
performed according to protocol with Bodystat 1,500 MDD
sober and with empty bladder (T0) and after intake of 1.0 L
water (T1). Time between measurements was max. 3 hours.
Paired sample t-tests were performed to explore differences in
weight, FFM, FM, and BIA raw values (resistance, reactance,
impedance).
Results: 166 students were included (88% female, mean age
24.3 ± 3.8 y, mean BMI 21.7 ± 2.5). After drinking 1.0 L water,
body weight increased by 0.9 ± 0.7 kg. Resistance decreased,
S121
and reactance and impedance increased. Both FFM and FM
increased by 0.3 ± 0.9 kg and 0.6 ± 1.0 kg respectively (Table 1).
Table 1: Differences in BIA results after ingestion of 1.0 L water in 166 students
(means ± SD).
T0 T1 p-value
Weight (kg) 63.9 ± 10.6 64.8 ± 10.6 <0.001
Resistance 50 kHz 603.3 ± 82.0 602.8 ± 80.6 <0.001
Reactance 50 kHz 66.5 ± 8.1 67.3 ± 8.1 <0.001
Impedance 50 kHz 606.5 ± 82.7 606.6 ± 80.7 <0.001
FFM (kg) 49.9 ± 9.2 50.3 ± 9.2 <0.001
FM (kg) 13.9 ± 4.2 14.6 ± 4.2 <0.001
T0 = sober and with empty bladder; T1 = after 1.0 L water intake
Conclusion: Our data suggest that water intake has a direct
effect on BIA outcomes. Drinking water increases a person’s
body weight, but as the water is not settled in the intracellular
space yet, it has minimal influence on the resistance and
reactance. Since FFM equations rely on age, sex, body weight,
and BIA raw values, increase in body weight incorrectly results
in an overestimation of FM. It is advised to measure patients
with empty bladder to minimize bias.
Disclosure of Interest: None declared.
SUN-P183
FATTY LIVER INDEX FOR PREDICTING NON-ALCOHOLIC FATTY
LIVER DISEASE BASED ON CAP GRADING
F. Razmpour1 *, M. Nematy1, Z. Dehnavi1, on behalf of Dehnavi
zahra. 1Department of Clinical Nutrition, Clinical Nutrition,
Mashhad, Iran, Islamic Republic Of
Rationale: Non-alcoholic fatty liver disease (NAFLD) is the most
common chronic liver disease which can contribute to some
clinical conditions such as: simple steatosis, non-alcoholic
Steatohepatatis (NASH), hepatic cirrhosis and also hepatocel-
lular carcinoma, so the early diagnosis of NAFLD is important.
The aim of this study is to investigate the ability of FLI (Fatty Liver
Index) in predicting NAFLD and then determining an optimal
cutoff point for FLI based on Fibro Scan and CAP diagnosis.
Methods: This cross sectional study consisted of 212 subjects.
Anthropometric parameters were measured and blood samples
were collected from participants, then hepatic steatosis of the
participants was determined by CAP. We calculated FLI from
body mass index, waist circumference (WC), triglyceride, and
gamma glutamyl transferase data. Logistic regression was used
to determine the relationship between FLI and NAFLD. The
sensitivity and specificity of FLI and also the optimal cutoff
points of it were determined by receiver operating character-
istic analysis.
Results: the mean age of participants was 39.26 ± 14.18. FLI was
significantly associated with NAFLD (OR = 1.062, 95%CI: 1.042–
1.082, P < 0.001). The AUC of FLI was 0.84 for diagnosis of NAFLD
and its optimal cutoff point was 26.2 (sensitivity = 0.833,
specificity = 0.696), also the optimal cutoff points of FLI were
30.4 in men (sensitivity = 0.817, specificity = 0.714) and 20.7 in
women (sensitivity = 0.892, specificity = 0.657). The optimal
cutoff points of FLI in different grades of steatosis were
determined which it was 26.2, 38.3 and 49.7, respectively in
grade 1, 2 and 3 of NAFLD.
Conclusion: FLI has a suitable performance in diagnosis of
NAFLD, and it can also predicts the grade of Steatosis in NAFLD
patients.
Disclosure of Interest: None declared.
S122
SUN-P184
THE EVANES STUDY: A PROTOCOL FOR THE NUTRITIONAL
ASSESSMENT OF SCHOOLCHILDREN IN THE RURAL
HIGHLANDS OF ECUADOR
F. Morales1,2 *, M. Guerendiain3. 1Metabolism and Nutrition
Disorders Research Group, Faculty of Health Sciences,
National University of Chimborazo, Riobamba, Ecuador,
2
Department of Organic Chemistry, Faculty of Chemistry,
University of Murcia, Murcia, Spain, 3School of Medicine,
Faculty of Health Sciences, National University of Chimborazo,
Riobamba, Ecuador
Rationale: Clinical studies have shown a high nutritional
vulnerability of rural populations, especially those of indigen-
ous origin that inhabit Ecuadorian highlands [1]. Herein, we
designed the EVANES study as a holistic strategy for the
nutritional assessment of schoolchildren living in the rural
highlands of Ecuador in order to identify nutritional problems
and their effects in these indigenous populations, as well as the
factors that may cause them.
Methods: We utilize a multi- and interdisciplinary approach
that will be conducted in five hundred children aged from 5 to
12 years old attending eleven different rural schools. In order
to achieve a complete analysis, we will evaluate the: (i)
nutritional status, (ii) dietary intake, (iii) intestinal parasitic
infections, (iv) hygienic, sanitary and environmental condi-
tions, (v) pre and postnatal factors, (vi) haematological and
metabolic profiles, and (vii) cognitive development.
Results: The EVANES study is expected to result in a useful data
set of the nutritional deficiencies, diseases and their risk
factors in Ecuador.
Conclusion: This study may be pertinent in establishing health
policies for disease prevention, health promotion and health
education oriented programs in this population.
Acknowledgments: We would like to thank the Universidad
Nacional de Chimborazo for its support, as well as the Ethics
Committee of the Universidad San Francisco de Quito for its
approval. F.M. also thanks the Fundación Seneca-CARM for her
Saavedra Fajardo contract and funding (Contract No. 20025/
SF/16).
Reference
1. Freire WB, Silva-Jaramillo KM, Ramírez-Luzuriaga MJ, Belmont P,
Waters WF (2014) The double burden of undernutrition and excess
body weight in Ecuador. The American Journal of Clinical Nutrition
100: 1636S–1643S.
Disclosure of Interest: None declared.
SUN-P185
OBSERVATIONAL STUDY: PROTEIN TARGET ADEQUACY AND
NEW CHALLENGES
L. T. M. Sanches1 *, F. R. Totti1, F. Alves1, M. P. Guimaraes1,
L. Lins1, A. V. Arrais1, V. M. C. Paraiso1, D. F. Ferreira1.
1
Nutrition, Hospital Samaritano de São Paulo, São Paulo, Brazil
Rationale: The adequate protein has been an important point
for clinical improvement of the patient. The objective of this
study was to evaluate the protein adequacy of patients
undergoing enteral nutritional therapy.
Methods: An observational, descriptive, and retrospective
study with patients undergoing exclusive enteral nutritional
therapy, both men and women, aged 18–99 years, hospitalized
Poster
in a private hospital in the city of São Paulo, Brazil. Data
collection started on the first day of introduction of the enteral
diet and follow-up was performed until the discontinuation of
the nutritional therapy, discharge, or death of the patient.
Monitoring was carried out from July 2016 to February 2017.
Protein requirements were calculated using predictive formu-
las based on the International Guidelines of American (ASPEN)
and European (ESPEN) Societies for Parenteral and Enteral
Nutrition, using the following categories: elderly with acute or
chronic diseases, critical, obese, cancerous, and surgical
patients. It was set a proposed target of 80% of patients
under protein adequacy.
Results: The percentage of protein requirement reached using
the enteral diet according to the established value was: July:
86% (1,178 follow-ups); August 92% (1010 follow-ups),
September 88% (793 follow-ups); October 96% (975 follow-
ups), November 93% (812 follow-ups); December 89% (588
follow-ups); January 93% (765 follow-ups) and February 97%
(731 follow-ups).
Conclusion: It was observed that the targets reached each
month were superior to those previously established. From the
outset, an adjustment of the target was suggested according to
the historical series. In view of the results, we were able to
guarantee the protein supply to the patients undergoing
enteral nutritional therapy. The continuous monitoring of
these data by an interdisciplinary team is of extreme
importance to improve the care provided to the patient.
Reference
BRASPEN, 2016. PROT-AGE, 2013. ESPEN, 2016.
Disclosure of Interest: None declared.
SUN-P186
IMPLEMENTATION OF THE TRAINING COURSE OF NURSING
REFERRAL IN NUTRITIONAL THERAPY
F. R. Totti1 *, M. Guimarães2, L. M. Sanches3, V. C. Paraizo4,
L. Lins3, R. L. Santos5, F. R. Alves3, D. F. Ferreirea6, C. Cukier2,
on behalf of Fernanda Ramires Totti. 1Enfermeira, 2Nutrologia,
3
Nutricionista, 4Gerente, 5ICEP, 6Superintendente Medico,
Hospital Samaritano de São Paulo, São Paulo, Brazil
Rationale: To divulge a work carried out with a Group of
Reference-Nurses in Multidisciplinary Team in Nutritional
Therapy promoted to encourage and educate nursing profes-
sionals to improve patient care in Nutrition Therapy.
Methods: Preparatory course accomplished in a private hospital
in the city of São Paulo, Brazil, with 10 monthly meetings, from
March to December 2016, with trained instructors with
theoretical and practical classes. The topics covered were:
Peripheral and Manipulated Parenteral Nutrition-care in hand-
ling and installation, Protein Caloric Support, Nasoenteral Probe
Care and Infusion Pump, Oral Supplementation, Gastrostomy
and Probes Fixation, Check Of Diet and Water Balance, Care
for Avoiding Bronchaspiration, Nasal Probe Medications-
Administration, interaction and obstruction, Final evaluation
and delivery of certificates. The presence in 80% of the classes
was obligatory.
Results: 21 employees from different sectors, Critical and Non-
Critical Adult and Infantile Units were enrolled. In the end, we
had 15 members (72%) who finished, 4(19%) failed due to lack
and 2(9%) due to the institution’s disengagement. The average
of the Pre-Course Evaluation was obtained with a grade of 8.0
Nutritional assessment 1
and Post Course of 9.6, representing 20% of knowledge gain. 4
participants had 100% presence.
Conclusion: The course promoted a better interaction
between the multidisciplinary team and the participants. We
were able to develop and work on the professionalś skills and
thus disseminate learning and add knowledge to all. Suggestion
for the next course of 2017 will be the multiplication of the
knowledge acquired to the professionals of the Reference Units
of each participant.
References
Education From Conceptualization to Evaluation. New York: National
League for Nursing; 2007.
Sharon D. Simulation: education and ethics. In: PamelaR, editor.
Simulation in Nursing
Disclosure of Interest: None declared.
SUN-P187
RESULTS OF NUTRITIONAL SCREENING (CONUT)
IMPLEMENTATION IN NON-CRITICALLY ILL INPATIENTS IN A
THIRD LEVEL HOSPITAL
F. J. Vílchez-López1 *, A. Doncel-Moriano2, J. Tamayo-Serrato1,
A. Montero-Galván1, M. Á. Bailén-García3, M. Aguilar-Diosdado1.
1
Endocrinology and Nutrition Department, Hospital Puerta
Del Mar, 2Medicine, School of Medicine, 3Clinical Analysis
Department, Hospital Puerta Del Mar, Cádiz, Spain
Rationale: Analyse the diffusion of nutritional screening system
(CONUT) at Hospital Puerta del Mar (Cádiz) in 2015 in different
departments. Evaluate mortality and hospital stay based on
nutritional risk at admission.
Methods: Retrospective cohorts study including patients older
than 18, admitted to hospital for more than 3 days in 2015. A
systematic analysis of CONUT was undertaken in general blood
tests analysed during the first 3 days’ admission. Positive risk
was defined by CONUT >4. The relationship between CONUT
result and clinical variables was evaluated.
Results: Of 674 patients included: 69.8% negative, 30.2%
positive. 53.1% men, mean age 67.3 (±16.7). 90.9% of screened
patients were admitted from Emergency, 55.9% were multi-
medicated (taking ≥5 drugs) and 34.6% were diabetic. CONUT
was more frequently analysed in patients admitted to
Gastroenterology (29.7%), Endocrinology (27.3%) and Internal
Medicine (23.7%). None of the patients were admitted to
Maxillofacial Surgery, Otorhinolaryngology, Plastic Surgery,
Heart Surgery. Patients with CONUT positive were older. The
percentage of women, urgent admissions and multimedicated
patients was significatively higher in CONUT positive than
CONUT negative. Length of stay (LOS) was longer in CONUT
positive (12.4 vs 10.1 days, p < 0.05). 11.4% of patients studied
died during their admission (24.1% CONUT positive vs 5.9%
negative, p < 0.05). Relative risk for mortality was 4,1 (CI 95%:
2,6–6,2) in patients with CONUT positive compared to CONUT
negative.
Conclusion: The implementation of CONUT on admission is
functioning well in medical departments, but greater uptake is
needed by surgical departments. Positive nutritional screening
is related to age, females, urgent admissions and multi-
medication. An increase in mortality and LOS were identified
in patients with CONUT positive compared to those with a
CONUT negative at admission.
Disclosure of Interest: None declared.
S123
SUN-P188
PREOPERATIVE NUTRITIONAL RISK ASSESSMENT IN
NEUROSURGERY PATIENTS
F. Yüzbaşıoğlu Marangoz1 *, G. Kaner2, N. Seremet Kurklu3.
1
Clinic of Neurosurgery, Ege University Faculty of Medicine,
İzmir, 2Faculty of Health Sciences, Department of Nutrition
and Dietetics, Izmir Katip Celebi University, Izmir,
3
Department of Nutrition and Dietetics, Akdeniz University
Antalya School of Health, Antalya, Turkey
Rationale: Nutritional Risk Screeening (NRS-2002) is a recom-
mended method by ESPEN for the evaluation of preoperative
nutritional status. This study aimed to evaluate malnutrition
risk of neurosurgery patients by using NRS 2002 and standar-
dized questionnaire
Methods: A total of 60 inpatients (30 males and 30 females)
aged 19–79 years in the neurosurgery service between February-
March 2016 were included to the study. Anthropometric
measurements, such as body weight and height were measured
and BMI was calculated. Obesity classification was made
according to WHO criteria. Evaluation of the patients nutri-
tional status was made according to the NRS-2002 system.
Patients were considered malnourished when NRS-2002 score
was ≥3. In addition, standardized questionnaire was used to
determine nutritional status of patients
Results: Mean age, body weight and BMI of patients were
52.6 ± 16.40 years, 73.1 ± 13.85 kg, and 25.9 ± 4.15 kg/m2,
respectively. According to WHO BMI classification, 3.3% of
patients were thin whereas 83.3% overweight. It was detected
that 26.6% of patients had involuntary weight loss history
(8.8 ± 4.08 kg) in the past year. Mean length of stay in hospital
was 8.8 ± 15.16 day (median 4.0 day). Only 1.7% of patients
recieved enteral nutrition support. On the other hand, the
majority of the patients ate their full meal provided by the
hospital. More than half of patients (78.3%) had 2 or lower NRS-
2002 scores. On the other hand, 11.7% of patients had 3 NRS-
2002 scores and they were considered as malnourished.
Conclusion: In spite of starving because of invasive diagnostic
procedures, changes in food intake because of psychical
alterations and repeated vomiting resulting from elevated
intracranial pressure, the percentages of malnutrition was very
low in our neurosurgery clinics. This condition may be due to
the lack of a long period of hospitalization of patients in our
clinic as well as other clinics.
Disclosure of Interest: None declared.
SUN-P189
DISEASE-RELATED UNDERNUTRITION, ETHNICITY AND
LENGTH OF HOSPITAL STAY: A PROSPECTIVE COHORT STUDY
AT THE DEPARTMENT OF SURGERY OF THE ACADEMIC
HOSPITAL PARAMARIBO (AZP)
G. van der Held-Horinga1 *, M. MaCdonald - Ottevanger2,
A. van Kanten3, L. Nahar-van Venrooij4. 1Dietetics, 2Research
Center, 3Surgery, Academic Hospital, 4Department of Public
Health, Faculty of Medical Sciences, Anton de Kom University,
Paramaribo, Suriname
Rationale: To assess prevalence of disease-related under-
nutrition (DRU) and its association with ethnicity and length of
stay (LOS) at the department of surgery of the AZP, in Suriname,
a middle-income, multi-ethnic country, in South America.
S124
Methods: Between February and May 2016 all patients
(≥18 yrs), except pregnant women, admitted at the depart-
ment of surgery (>24 h) were asked to participate. Within 48
hours of admission, weight (history), length, fat-free mas index
(FFMI) using bio-impedance analysis, and self-reported ethni-
city were collected. Age, sex and diagnosis were extracted
from medical files. DRU was defined as (1) unintended weight
loss (UWL) of >10%, or >5% over the last 3 months, and/or (2)
low FFMI (<17 kg/m2 in men and 15 kg/m2 in women).
Associations between ethnicity (Hindustan [reference cat-
egory], Creole, Javanese, Maroon, Amerindian, Mixed) and
DRU, UWL and low FFMI were adjusted for age, sex, diagnosis,
and severity of disease (NRS-2002) using multivariate logistic
regression analysis. For DRU and LOS (>7 days) similar
multivariate models were used extended with pre-admission
setting (at home without or with help, or institutionalized).
Results: In the total population (N = 351) 46.3% was found to be
undernourished; 31.3% had UWL and 27.4% had low FFMI. 10.7%
of Maroons had a low FFMI compared to 32.5% of Hindustani,
p = 0.02; (adj. OR 0.24, 95% CI 0.06–0.91). Both DRU and low
FFMI were associated with LOS >7 days (Adj OR 2.52, 95% CI
1.49–4.26 and OR 3.26, 95% CI 1.90–5.57, respectively).
Conclusion: Almost half of patients had DRU on admission.
Prevalence of low FFMI differed between ethnic groups, and
was, as DRU, associated with increased LOS. Future research
has to reveal if ethnicity should be part of risk assessment for
DRU as it is for obesity and cardiovascular disease.
Disclosure of Interest: None declared.
SUN-P190
ANALYSIS OF ENERGY EXPENDITURE IN CIRRHOTIC PATIENTS:
COMPARISON OF INDIRECT CALORIMETRY AND PREDICTION
EQUATIONS
G. Belarmino1, M. C. Gonzalez2, R. S. Torrinhas1, W. Andraus1,
L. A. C. D’Albuquerque1, L. Damiani3, P. Sala1,
S. B. Heymsfield4, D. L. Waitzberg1 *. 1Faculdade de Medicina
Da Universidade de São Paulo, São Paulo, 2Post-Graduate
Program in Health and Behavior - Catholic University of
Pelotas, Pelotas, 3Instituto de Pesquisa – Hospital do Coração
de São Paulo, São Paulo, Brazil, 4Pennington Biomedical
Research Center, Louisiana State University, Baton Rouge,
United States
Rationale: Malnutrition, which implies an imbalance between
energy intake and energy requirements, is common in patients
with cirrhosis. Predictive equations are used for estimating
resting energy expenditure (REE) when the measurements
obtained from indirect calorimetry (IC) are not available. Our
aim was estimates the resting energy expenditure through
indirect calorimetry and compares with energy requirements
according to Harris-Benedict equation (HB), ESPEN (EG) and
Brazilian guidelines - DITEN (BG).
Methods: In a prospective design, REE was measured in 124
male cirrhotic patients by indirect calorimetry and predicted
by Harris-Benedict, EG (35 Kcal/kg current weight) and BG
(30 Kcal/kg current weight) guidelines.
Results: The predicted REE by EG and BG were higher than the
measured (Table 1). The HB equation presented results closer
to the reference method, with a positive Pearson correlation
(r = 0.77), excellent accuracy (Cb = 0.98) and a positive Lin’s
concordance correlation (CCC = 0.75) observed between these
Poster
methods. The 95% limits of individual agreement between IC
and HB equation ranged from 316.33 to 363.83 Kcal. The
Pearson correlations between IC with EG and BG were 0.71
(CCC = 0.13 and Cb = 0.18) and 0.71 (CCC = 0.23 and Cb = 0.32),
respectively.
Table 1:
Methods Resting Energy
Expenditure
Indirect calorimetry 1612,26 ± 262,97
Harris-Benedict equation 1587,52 ± 222,49
ESPEN guidelines 2646,08 ± 488,44
Brazilian guidelines - DITEN 2268,07 ± 418,66
Conclusion: The HB equation showed good correlation with the
reference method (IC), while ESPEN and Brazilian guidelines -
DITEN overestimates energy requirements in this sample of
cirrhotic patients.
Reference
1. Riggio O, Angeloni S, Ciuffa L, Nicolini G, Attili AF, Albanese C,
Merli M. Malnutrition is not related to alterations in energy balance
in patients with stable liver cirrhosis. Clin Nutr. 2003;22:553–9.
Disclosure of Interest: None declared.
SUN-P191
DOES ADHERENCE TO MEDITERRANEAN DIET AFFECT
ANTHROPOMETRIC MEASUREMENTS IN UNIVERSITY
STUDENTS?
G. Ede1 *, I. Türkoğlu1, A. Açıkgöz1, T. Yalçın1, F. Ilgaz1,
A. Aksan1, A. A. Yürük1, K. Tel Adıgüzel1, A. Kabasakal Çetin1,
H. Gökmen Özel1, E. Yıldız1, G. Samur1. 1Nutrition and
Dietetics, Hacettepe University, Ankara, Turkey
Rationale: Mediterranean Diet (MD) has been widely used to
describe the healthy eating behavior and the Mediterranean
Diet Quality Index for Children and Adolescents (KIDMED) is
used to evaluate adherence to the MD. The aim of this study
was to examine the association between the Mediterranean
Diet Quality Index (KIDMED) and anthropometric measurements
in university students.
Methods: Nine-hundred fifty university students (426 men, 524
women) aged between 17 and 28 years (mean ± SD = 21.5 ±
1.85 yrs) were included. The KIDMED index was used to assess
the degree of adherence to the MD. Mean (±SD) total score was
3.71 ± 2.59 ranged from −4 to 11 (men = 3.96 ± 2.5 and women =
3.41 ± 2.6). KIDMED score was classified into 3 levels: ≥8
reflects “optimal”; 4–7, average; ≤3 very low diet quality. Body
weight, height, waist and hip circumference was measured.
Body mass index (BMI) and waist-hip ratio was calculated and
classified according to WHO Standards.
Results: In our population, 46.9%, 45.1%, 8.0% of the students
had poor, average, and optimal diet quality, respectively. The
percentage of overweight and obese students was 22.3% in poor
score group and 18.2% in the optimal score group. Mean BMI
(kg/m2) (22.4 ± 2.9 vs. 23.0 ± 3.9), waist-hip ratio (0.81 ± 0.8
vs. 0.80 ± 0.8), neck circumference (cm) (34.2 ± 3.2 vs.
34.0 ± 3.5) was not significantly different between poor and
optimal score groups. There was a strong negative correlation
between KIDMED scores and waist-hip ratio (r = −0.74,
p < 0.05).
Nutritional assessment 1
Conclusion: In this study we found a significant negative
relationship between KIDMED index and waist-hip ratio but no
significant relationship was found between KIDMED index and
other anthropometric measurements. Additional researches
are necessary to evaluate negative factors and to find ways to
improve the dietary pattern in our university population.
Disclosure of Interest: None declared.
SUN-P192
FEEDING BEHAVIOR IS ASSOCIATED WITH GENDER OF PARENTS
IN KINDERGARTEN CHILDREN
G. G. Topal1 *, M. Tengilimoglu Metin1, D. Gumus1, S. Sevim1,
M. Kizil1. 1Nutrition and Dietetics, Hacettepe University,
Ankara, Turkey
Rationale: It has been reported that irregularity in the eating
habits of adult obese patients is associated with parental
nutritional status. Although it is a fact that the mother still has
a primary role in the child’s feeding; the efficacy of fathers’
feeding of children may be increased compared to the past.
Studies conducted in recent years have shown that fathers are
beginning to take up more space in childhood and meal times.
The aim of this study was to determine the feeding practices
and styles of the children of their parents.
Methods: This study was conducted on children between the
ages of 3 and 5 between May and June 2015 at a Kindergarten.
The Child Feeding Questionnaire (CFQ) was used to investigate
the relationship between parents’ beliefs and attitudes
towards child feeding and the susceptibility of children to
obesity. The BMI of the parents was calculated and classified as
normal or abnormal.
Results: As a result of the study have reached 42 children and
their 67 parents. 42 parents of the children completed the
questionnaire with the mother (58.3%) and 25 as the father
(34.7%). The mean scores of the CFQ were 96.44 ± 13.60. The
mean scores of the father’s feeding questionnaire (88.40 ±
14.83) were found to be significantly lower than the mean scores
of the mother’s feeding questionnaire (99.97 ± 10.66) ( p <
0.001). But, there was no significant relationship between
parents’ BMI and the Child Feeding Questionnaire scores.
Conclusion: This study shows that mothers as a parent are more
restrictive in feeding their children. Despite the increased role
of mothers in working life, they are still predominant in feeding
their children.
Disclosure of Interest: None declared.
SUN-P193
ASSESSING AND PREVENTING BARRIERS TO FOOD INTAKE IN
ACUTE CARE MEDICAL PATIENTS: FINDINGS OF THE MORE-2-
EAT STUDY
H. Keller1 *, T. Mcnicholl1, R. Valaitis1, C. Laur1, Y. Xu2,
J. Dubin2, on behalf of More-2-Eat. 1Applied Health Sciences,
2
Statistics and Actuarial Science, University of Waterloo,
Waterloo, Canada
Rationale: Food intake barriers are common in acute care
patients and can lead to poor intake that slows recovery. A new
Mealtime Audit Tool (MAT) systematically assesses these
barriers.
Methods: The More-2-Eat study is an implementation project,
focused on preventing, detecting and treating malnutrition in
S125
medical patients. Conducted at five hospitals, each site
tailored strategies to improve nutrition care. This multi-
method study included a variety of data collection measures.
Eligible patients were recruited each month for 15 months to
demonstrate potential improvements in nutrition care pro-
cesses, including mealtime barriers. MATwas completed on ∼20
patients per month/site during baseline and implementation
phases. Prevalence of barriers across the entire study are
summarized and contrasted by site with a chi-squared test. The
change in prevalence barriers over time was determined with a
linear trend test.
Results: 963 patients with an average age of 68.2 (SD 15 = 4)
years, 55.8% female completed a MAT assessment. The average
number of barriers experienced over the entire study was 2.24
(SD 1.9) and there was a consistent decrease in barriers (3.16–
1.56/patient/month ( p < 0.0001)) with implementation of
interventions. The three most common barriers were: not
having all food/drink items (22.2%), unappetizing meal
(23.9%), not visited by staff mid-meal (54.6%). Site differences
( p < 0.0001) were noted for 14/20 barriers assessed.
Conclusion: Mealtime intake barriers are common in medical
patients and vary by site. The MAT is a useful tool for identifying
these barriers. Each site tailored interventions to reduce
barriers (e.g. volunteer assistant, increased food availability
outside mealtimes), and these strategies were successful at
reducing barriers overall. Further research will determine
impact on food intake for these patients.
Disclosure of Interest: H. Keller Speaker Bureau of: Abbott Nutrition,
Nestle Health Sciences, T. McNicholl: None declared, R. Valaitis: None
declared, C. Laur: None declared, Y. Xu: None declared, J. Dubin: None
declared.
SUN-P194
SUCCESSFUL MULTI-SITE IMPLEMENTATION OF NUTRITION
RISK SCREENING AND ASSESSMENT TRIAGE IN MEDICAL
INPATIENTS: THE MORE-2-EAT STUDY
H. Keller1 *, R. Valaitis1, T. McNicholl1, C. Laur1, J. Bell2,
on behalf of More-2-Eat. 1Applied Health Sciences, University
of Waterloo, Waterloo, Canada, 2School of Human Movement
and Nutrition Sciences, University of Queensland, St Lucia,
Australia
Rationale: Improving detection of malnourished patients is a
priority. The purpose of this study was to document how 5
diverse hospitals tailored implementation of screening and
assessment in a single medical unit.
Methods: Sites worked towards implementing the Integrated
Nutrition Pathway for Acute care, including screening
(Canadian Nutrition Screening Tool) and triage with
Subjective Global Assessment (SGA) to detect and diagnose
malnourished patients over a 12 month period. At baseline,
three sites were screening with other tools. Multi-method data
collection included: monthly audits of patient charts to
identify care practices (n = 3890); tracking and tallying
behaviour change techniques (BCT) used through written
scorecards (n = 190) and monthly coaching telephone calls
(n = 11); and baseline focus groups (n = 11) and key informant
interviews (n = 40) that identified the key facilitators to making
these changes.
Results: Different screening and assessment models were
implemented across sites. Fidelity with screening and SGA
to triage patients increased from baseline to end of
S126
implementation (Screening: 0–76% to 66–89%; SGA 0% to 76–
100% of those identified at risk). Data established environmen-
tal restructuring (e.g. adding screening question to existing
forms; n = 117/326 BCT) and education (n = 110/326 BCT) as
key drivers of nutrition care practice changes. Key facilitators
to screening and assessment with SGA included: building a
strong team, involving the relevant people and accounting for
context and climate of the unit and hospital.
Conclusion: Preliminary results suggest successful multi-site
implementation of nutrition risk screening and assessment
triage in medical inpatients. Drivers of success are coordinated
effort and tailored behaviour change techniques that build on
the current values, practices and strengths of each unit.
Disclosure of Interest: H. Keller Speaker Bureau of: Abbott Nutrition,
Nestle Health Sciences, R. Valaitis: None declared, T. McNicholl: None
declared, C. Laur: None declared, J. Bell: None declared.
SUN-P195
DIAGNOSTIC ACCURACY OF BIA VERSUS DXA IN ADULT
MITOCHONDRIAL DISEASE PATIENTS
H. Zweers1, V. Bodier2,3, M. Janssen4, G. Wanten1, S. Leij1,2 *.
1 equations. Then, we developed new predictive equations with
Department of Gastroenterology and Hepatology,
Radboudumc, 2Dietetics, HAN University of Applied Sciences,
Nijmegen, Netherlands, 3Nutrition, cSwiss Federal Institute of
Technology, Zürich, Switzerland, 4Department of Internal
Medicine, Radboudumc, Nijmegen, Netherlands
Rationale: In clinical practice, bioelectrical impedance ana-
lysis (BIA) is a cheaper, non-invasive alternative for DXA (Dual-
energy X-ray absorptiometry) to assess body composition (BC).
The validity of this double indirect technique, however, has not
been established yet in patients with mitochondrial disease
(MD). Therefore, the aim of this study was to test the accuracy
of BIA in comparison to DXA in MD patients.
Methods: BC was assessed after overnight fasting in adult MD
patients by both BIA (at 50 Hz) and DXA. BIA fat free mass (FFM)
was calculated using the formulas of Kyle (intended for healthy
subjects) and Dey (intended for the elderly). Linear regression
analysis was performed for FFM to determine the association
(R2) and the standard error of the estimate(SEE) to compare
these data with the results obtained for BIA and DXA in healthy
subjects as reported by Kyle (R2 = 0.97, SEE 1.8 kg). Sensitivity
and specificity were calculated using the formula of Kyle. For
diagnosing malnutrition, FFM Index cutoff points were used,
15 kg/m2 for males and 17 kg/m2 for females. To define
obesity, cutoff points for fatpercentage of >25% in males and
>30% in females were set.
Results: 36 MD patients (age 42 ± 12 yrs, 40% males) were
studied. R2 for FFM by Kyle was 0.90, with SEE 2.6 kg and for
Dey’s formula values of 0.89 and 2,4 kg, respectively, were
found. Sensitivity and specificity were 77% and 93% for
diagnosing malnutrition, and 86% and 29% for diagnosing
obesity, respectively.
Conclusion: For BIA-derived FFM, both the formulas of Kyle and
Dey show a good association with DXA, although less in MD
patients compared to healthy subjects. Since BIA sensitivity to
diagnose malnutrition is low and specificity to diagnose obesity
is even worse, DXA remains the preferred method to assess BC
in MD patients. Whenever BIA is used it should be taken into
account that BIA overestimates FFM in this setting.
Disclosure of Interest: None declared.
Poster
SUN-P196
NEW PREDICTIVE EQUATIONS FOR ESTIMATING RESTING
ENERGY EXPENDITURE IN NORMALWEIGHTAND OVERWEIGHT
SUBJECTS
I. Cioffi1 *, M. Marra1, R. Sammarco1, E. Speranza1,
O. Di Vincenzo1, L. Santarpia1, F. Contaldo1, F. Pasanisi1.
1
Federico II University, Naples, Italy
Rationale: Some of the most commonly used predictive
equations for estimating resting energy expenditure (REE) are
based on anthropometric measurement collected in the first
part of century. Body weight and height are changed in the last
three decades due to different lifestyle; therefore, the aim of
this study was to develop new predictive equations to estimate
REE in normal and overweight subjects.
Methods: Anthropometric measurements were obtained from
854 outpatients (M: 164; F: 690) aged between 18 and 40 y
(M = weight: 75.1 ± 11.7 kg, BMI: 24.5 ± 2.9 kg/m²; F: weight
62.9 ± 9.2 kg, BMI: 24.0 ± 3.0 kg/m²). As first, we compared REE
measured (MREE) by indirect calorimetry versus REE predicted
(PREE) by using Harris& Benedict (HB) and FAO predictive
anthropometric variables (age, weight, height and BMI) as
predictors.
Results: We found that HB and FAO equations provide a good
PREE-MREE difference, showing a bias lower than 5%y in both
sexes, whereas the level of accuracy was good for females with
HB equation (76%), but nor for males. We developed new
predictive equation for REE by using a multiple regression
analysis.
All subjects: REE (kcal/d) = 17.4 * weight + 155 * sex – 11.6 *
BMI + 600
Predictive equations specific for sex:
Males subjects: REE (kcal/d) = 15.5 * weight + 612
Females subjects: REE (kcal/d) = 17.9 * weight – 13.9 * BMI + 630
Conclusion: Although HB and FAO equations can be used for
estimating REE at the population level, the accuracy was not
always adequate at individual level, therefore new predictive
equations should be considered.
Disclosure of Interest: None declared.
SUN-P197
IS COMPUTED TOMOGRAPHY A BETTER ASSESSMENT TOOL
FOR CANCER PATIENTS COMPARED TO BODY MASS INDEX?
J. A. Leyva Islas1, M. A. García Castañeda1,
I. Martinez Del Rio Requejo1 *, A. F. Santini Sánchez1,
O. O. Olea Salinas1. 1Clinical Nutrition Department, Lic. Adolfo
López Mateos ISSSTE Hospital, Ciudad de México, Mexico
Rationale: Inflammation and poor nutritional status contri-
butes to cancer cachexia, which is associated with poor
outcomes including increased risk of infection, prolonged
hospitalizations, and mortality. Traditionally, BMI has been
used to assess nutritional status of cancer patients. However,
BMI does not discriminate between the loss of lean or fat mass.
Other techniques, such as computed tomography (CT) may be
more suitable for the assessment of nutritional status of cancer
patients. Therefore, the aim of the study is to determine the
utility of CT vs. BMI in sarcopenia diagnosis
Methods: A retrospective cross-sectional study of 100 cancer
patients referred to the Clinical Nutrition Department with a
surgical, pharmacology or palliative treatment were assessed.
Nutritional assessment 1
Patients were included if BMI was documented, as well as one
CT scan. The cut-point for sarcopenia was established in men
<50 mm2 and <40 mm2 for women at the L3 level.
Results: A total of 45 patients (56%men 66 ± years old) were
included in the study. According to BMI related to sarcopenia
see Table 1.
Table 1:
BMI <18 18.1–24.9 25–29.9
# Patients 4 23 14
Sarcopenia 2 4 2 0
% 50.00 17.39 14.29
Conclusion: BMI assessment may not be suitable for the
assessment of nutritional status in cancer patients as it may
underestimate patients that have sarcopenia. Other assess-
ments, such as CT scans may provide more information
regarding body composition, especially lean body mass,
which is a predictor of mortality in cancer patients.
Disclosure of Interest: None declared.
SUN-P198
NUTRITIONAL RISK ASSESSMENT IN PATIENTS UNDERGOING
GASTROINTESTINAL SURGERY: CAN NRS 2002 SCORE BE
SIMPLIFIED?
́ , I. Palibrk1,2 *, M. Žnidaršič2, S. Zec2,
J. Veličkovic1,2
M. Marnić , M. Đukanovic1́ . 1Center for Anesthesiology, Clinical
2
Center of Serbia, 2School of Medicine, University of Belgrade,
Belgrade, Serbia
Rationale: The NRS 2002 score is a tool for identification
of patients at nutritional risk who may benefit from nutritional
support. The aim of our study was to determine the prevalence
of nutritional risk and its impact on postoperative complica-
tions (POC) and length of hospital stay(LOS) following gastro-
intestinal surgery in a Serbian teaching hospital. We also aimed
to establish which components of NRS 2002 score show the
strongest association with postoperative outcomes.
Methods: We evaluated 132 unselected patients in a cross-
sectional study during the Nutrition Day (ND) 2016. Data
regarding nutritional intake and health status were collected
from questionnaires prepared by ND organization. For each
patient NRS 2002 score was calculated. Patients were followed
for complications until hospital discharge or readmission.
Results: The overall prevalence of nutritional risk (NRS ≥ 3) was
37.1%. Median LOS was significantly longer in patients at
nutritional risk (24 vs 14 days, p < 0.001). Patients with NRS ≥ 3
had a significantly higher complication rate of 57.1% (28/49)
compared to 13.3% (11/83) in patients with a normal score
( p < 0.001). Postoperative morbidity was increased 3.84 times
for each positive response to the initial four screening
questions (OR 3.84; 95% CI 2.31–6.39). Positive answer to the
question regarding weight loss in the last 3 months increased
the risk for POC by 88.21 (95% CI 11.53–674.42). AUROC for
discrimination between patients with and without POCs with
this question was 0.84 (0.77–0.90) as compared to 0.75 (0.65–
0.81) with the entire score.
Conclusion: The prevalence of nutritional risk in patients
undergoing gastrointestinal surgery in Serbia is high. The initial
screening questions of NRS2002 were strong predictors of POC
and LOS. Weight loss in the last three months was stronger
S127
predictor of poor outcome than the whole score which might
simplify nutritional risk screening.
Disclosure of Interest: None declared.
SUN-P199
FRAILTY SYNDROME AMONG PATIENTS UNDERGOING
NUTRITION SUPPORT THERAPY IN A BRAZILIAN TERTIARY
HOSPITAL
>30
I. A. O. Souza1 *, T. S. Vieira2, P. C. Ribeiro3, L. U. Taniguchi1,
4 on behalf of Nutrition Support Team Hospital Sirio-Libanes.
1
Intensive Care Unit, Hospital Sirio-Libanes, 2Intensive Care
0
Unit, Hospital Beneficência Portuguesa Mirante, 3Nutrition
Support Team, Hospital Sirio-Libanes, Sao Paulo, Brazil
Rationale: Frailty is a multidimensional syndrome character-
ized by loss of physiologic and cognitive reserves that confers
vulnerability to adverse outcomes during hospitalization, with
higher morbidity and mortality rates. We aimed to describe the
prevalence and outcomes associated with frailty among
patients who required nutrition support therapy in a Brazilian
tertiary hospital.
Methods: We conducted a prospective single-center cohort
study of patients admitted to Hospital Sirio-Libanes (Sao Paulo,
Brazil), between October 2015 and March 2017. Frailty
syndrome was classified using the Canadian Study on Health
and Aging Clinical Frailty Scale (CFS). Patients were divided in
three sub-groups according to the CFS: CFS 1–3, CFS 4–6, CFS 7–
9. Multivariable analyses were used to evaluate the independ-
ent association between frailty and hospital mortality.
Results: We studied 848 patients during the study period (mean
age was 72.2 years, 73.0% were admitted for non-surgical
reasons, 45.2% had cancer and 64.6% required ICU admission).
602 (71.0%) patients undergone enteral nutrition, 178 (21.0%)
parenteral nutrition and 68 (8%) required enteral and paren-
teral nutrition. The distribution of patients between the three
groups was: 220 (25.9%) CFS 1–3, 358 (42.2%) CFS 4–6 and 270
(31.8%) CFS 7–9. The mortality rates were 9.5% in the CFS 1–3
group, 24.9% in the CFS 4–6 group and 24.4% in the CFS 7–9
group. After controlling for baseline differences, adjusted odds
ratios for hospital death were 2.68 (95% CI 1.53–4.70) and 2.00
(95%CI 1.10–3.63), for sub-groups CFS 4–6 and CFS 7–9
compared to CFS 1–3, respectively.
Conclusion: Frailty is very common among patients undergoing
nutrition support therapy, and it was associated with higher
adjusted odds ratio for hospital mortality.
Disclosure of Interest: None declared.
SUN-P200
VALIDITY OF EQUATIONS USING KNEE HEIGHT TO PREDICT
OVERALL HEIGHT AMONG OLDER PEOPLE IN BENIN
P. Jésus1,2,3, P. Fayemendy1,2,3, C. Mizéhoun-Adissoda4,5,
D. Houinato2,3,5, P. M. Preux2,3, J. C. Desport1,2,3 *. 1Nutrition
Unit, University Hospital of Limoges, 2INSERM UMR1094,
Tropical Neuroepidemiology, School of Medicine, 3UMR_S 1094,
Tropical Neuroepidemiology, Institute of Neuroepidemiology
and Tropical Neurology, CNRS FR 3503 GEIST, University of
Limoges, Limoges, France, 4School of Nutrition and Dietetic,
5
Laboratory of Non-communicable and Neurologic Diseases
Epidemiology (LEMACEN), Faculty of Health Science,
University of Abomey-Calavi, Cotonou, Benin
Rationale: Chumlea’s formulas are a validated means of
predicting overall height from knee height (KH) among
S128
people over 60 years old, but no formula is validated for use in
African countries, including Benin. The purpose of this study
was to compare height provided by predictive formulas using
KH to measured height in an elderly population in Benin.
Methods: People over 60 years of age in Benin underwent
nutritional assessment with determination of weight, body
mass index (BMI), height and KH. A Bland and Altman analysis
was carried out by gender and age. The percentage of
predictions accurate to ± 5cm compared to the measured
height was calculated. The tested formulas were Chumlea’s
formulas for non-Hispanic Black people (CBP) and two formulas
for use among Caucasians (CC1, CC2).
Results: Data from 396 subjects were analysed. The mean age
was 66.6 ± 5.2 years and mean height of 165.4 ± 8.0 cm. The
sex-ratio was of 4.3. The three formulas achieved 98.0%
accuracy, but with 4.6% risk of error (±2 SD: −6 to +9 cm), which
appeared to make them unfitted for the whole population. The
predictions of the three formulas in the total population are
presented in Table 1. Nevertheless, if a level of prediction ±
5 cm is considered acceptable in clinical practice, the CBP
formula achieved 83.1% accuracy. Moreover, there was no
significant difference in BMI calculated with the measured and
the predicted height, and the nutritional status based on BMI
did not differ.
Table 1: Predictions of the three formulas studied.
n = 396 Acurate Overestimation Underestimation
prediction (%) (+5 cm) (%) (−5 cm) (%)
CBP 83.1 12.4 4.5
CC1 80.3 15.9 3.8
CC2 78.5 18.2 3.3
Conclusion: CBP formulas seem applicable in 83% of cases
(±5 cm) to assess the height with KH of older people in Benin
and do not overestimate the prevalence of malnutrition.
Disclosure of Interest: None declared.
SUN-P201
CONTRAST-ENHANCEMENT INFLUENCES SKELETAL MUSCLE
DENSITY, BUT NOT SKELETAL MUSCLE MASS, MEASUREMENTS
ON COMPUTED TOMOGRAPHY
J. Van Vugt1 *, R. Coebergh van den Braak1, H.-J. Schippers1,
K. Veen1, S. Levolger1, R. de Bruin1, M. Koek2, W. Niessen2,
J. Ijzermans1, F. Willemssen3. 1Surgery, 2Medical Informatics,
3
Radiology and Nuclear Medicine, Erasmus MC University
Medical Center, Rotterdam, Netherlands
Rationale: Low skeletal muscle mass and density are predictive
parameters to guide interventions in various populations,
including cancer patients. The gold standard for body
composition analysis in cancer patients is computed tomog-
raphy (CT). To date, the effect of contrast-enhancement on
muscle composition measurements has not been established.
We sought to determine the effect of contrast-enhancement on
skeletal muscle mass and density measurements on four-phase
CT studies.
Methods: In this observational study, two observers measured
cross-sectional skeletal muscle area corrected for patients’
height (skeletal muscle index [SMI]) and density (SMD) at the
level of the third lumbar vertebra on 50 randomly selected CT-
examinations with both unenhanced, arterial, and portal-
venous phases. The levels of agreement between enhancement
Poster
phases for SMI and SMD were calculated using intra-class
correlation coefficients (ICCs).
Results: Mean SMI was 42.5 (±9.9) cm2/m2 on the unenhanced
phase, compared with 42.8 (±9.9) and 43.6 (±9.9) cm2/m2 for
the arterial and portal-venous phase, respectively (both
p < 0.01). Mean SMD was lower for the unenhanced phase
(30.9 ± 8.0 HU) compared with the arterial (38.0 ± 9.9
Hounsfield units [HU]) and portal-venous (38.7 ± 9.2 HU)
phase (both p < 0.001). No significant difference was found
between SMD in the portal-venous and arterial phase ( p =
0.161). The ICCs were excellent (≥0.992) for all SMIs and for
SMD between the contrast-enhanced phases (0.949). The ICCs
for the unenhanced phase compared with the arterial (0.676)
and portal-venous (0.665) phase were considered fair to good.
Conclusion: Statistically significant, but not clinically relevant
differences were found in SMI between enhancement phases.
Contrast-enhancement strongly influenced SMD values. Studies
using this measure should therefore use the portal-venous
phase of contrast-enhanced CT-examinations.
Disclosure of Interest: None declared.
SUN-P202
SERUM ELECTROLYTES AND OUTCOME IN PATIENTS
UNDERGOING ENDOSCOPIC GASTROSTOMY
J. Vieira1, G. Nunes1, C. A. Santos1 *, J. Fonseca1. 1Artificial
Feeding Team, Hospital Garcia de Orta, Almada, Portugal
Rationale: Endoscopic Gastrostomy (PEG) is a gold standard
for long term enteral feeding. Neurological dysphagia and head
or neck cancer are the main indications. Sodium, calcium,
chlorine are extracellular electrolytes, while potassium,
magnesium, phosphorus are mostly intracellular. Changes in
serum electrolytes may have significant impact on metabolic
balance. The aim of our study is to evaluate the changes in
serum concentrations of the main electrolytes and its possible
association with the outcome.
Methods: Prospective study of patients followed in our
Artificial Nutrition Clinic, submitted to PEG from 2010 to
2016 and who died using PEG. Serum electrolytes, albumin,
transferrin and reactive C protein (RCP) were evaluated
immediately before to the gastrostomy procedure. Survival
was recorded in months after PEG until death.
Results: We evaluated 92 patients, 51 with electrolyte
alterations at the time of the gastrostomy. Sodium was
altered in 28 (27.2%), magnesium in 18 (19.6%), chlorine in 17
(18.5%), potassium in 14 (15.2%), calcium and phosphorus in 9
(9.7%) each. The mean post-gastrostomy survival was 6.65
months. The survival of low sodium patients (<135 mmol/mL)
was compared with patients with normal/high values. The
survival was 2.76 months vs 7.80 months ( p = 0.007). There was
also a negative correlation between survival and RCP
(R = −0.22; p = 0.034).
Conclusion: Changes in serum electrolytes of patients under-
going PEG are very common. More than half showed at least one
abnormality, at the time of the procedure. The most frequent is
hyponatremia, which is associated with significantly shorter
survival, probably reflecting severe systemic metabolic dis-
tress. The RCP reflects the inflammation. Higher RCP values are
associated with lower survival.
Disclosure of Interest: None declared.
Nutritional assessment 1
SUN-P203
DIAGNOSTIC ACCURACY OF THE PG-SGA SHORT FORM AND
NRS 2002 IN INTERNAL MEDICINE WARD
J. Pinho1 *, R. Marinho2, J. Silveira3, S. G. Silva4, A. Amado5,
A. Pessoa6, J. Rosinhas7, M. Lopes8, F. D. Ottery9,10,
H. Jager-Wittenaar9,11, A. Marinho12, on behalf of APNEP -
Nutrition and Internal Medicine Working Group. 1Nutrition
Services, CHMA, EPE, 2Internal Medicine Service, Centro
Hospitalar do Porto, 3Nutrition Services, Eurico de Almeida,
ORL Clinic, Porto, 4Nutrition Services, BioParadigma,
Integrative Medicine Clinic, Barcelos, 5Nutrition Services,
PortugalFoods, 6Internal Medicine Service, CHMA, EPE, Porto,
7 J. V. D. Helder1 *, I. Jansen1, S. Kruijning1, C. Dronkelaar1,
Internal Medicine Service, Unidade Local de Saúde de
Matosinhos, Matosinhos, 8Hemato-Oncology Service, Centro
Hospitalar do Porto, Porto, Portugal, 9Research Group Healthy
Ageing, Allied Health Care and Nursing, Hanze University of
Applied Sciences, Groningen, Netherlands, 10Ottery &
Associates, Vernon Hills (Chicago), United States,
11
Maxillofacial Surgery, University Medical Center Groningen,
Groningen, Netherlands, 12Intensive Care Department, Centro
Hospitalar do Porto, Porto, Portugal
Rationale: The PG-SGA is a validated instrument to assess
malnutrition and its risk factors. Its patient component, i.e.
the PG-SGA Short Form (SF), can be used as screening
instrument. In this multicenter study, we aimed to assess
diagnostic accuracy of the PG-SGA SF and NRS 2002, in patients
at the Internal Medicine ward.
Methods: In 192 patients (76.0 ± 13.5 years; 53% female) in 9
Portuguese internal medicine wards, malnutrition risk was
assessed by PG-SGA SF and NRS 2002. PG-SGA SF ≤8 was defined
as low/medium malnutrition risk and NRS 2002 ≤2 as low risk.
PG-SGA SF ≥9 and NRS 2002 ≥3 were defined as high
malnutrition risk. Nutritional status was assessed by the full
PG-SGA (reference method). Malnutrition was defined as PG-
SGA Stage B (moderate/suspected malnutrition) or Stage C
(severely malnourished). Diagnostic accuracy was tested by
sensitivity, specificity, positive and negative predictive value,
and receiver operating curve. Agreement between PG-SGA and
NRS-2002 was tested by McNemar’s test and Cohen’s kappa (κ).
Results: Forty-six % and 53% were categorized as at risk of
malnutrition by PG-SGA SF and NRS 2002, respectively. In total,
55% were malnourished. Sensitivity, specificity, positive and
negative predictive value of PG-SGA SF and NRS 2002 were
0.84, 1.00, 1.00, 0.83 and 0.74, 0.74, 0.77 and 0.70,
respectively. Area under curve of PG-SGA SF and NRS 2002
was 0.987 and 0.778 respectively. McNemar’s test showed no
significant disagreement ( p = 0.86) between PG-SGA SF and
NRS 2002. Cohen’s kappa showed weak agreement (κ=0.492;
p < 0.001) (Table 1).
Table 1: Agreement between PG-SGA SF and NRS 2002.
NRS 2002 Low risk NRS 2002 High
risk
PG-SGA SF Low/medium risk 73 31
PG-SGA SF High risk 18 70
Total 91 101
Conclusion: Our findings indicate that in patients at the
internal medicine ward, PG-SGA SF shows better diag-
nostic accuracy than NRS 2002, i.e. better sensitivity and
specificity.
S129
Disclosure of Interest: J. Pinho: None declared, R. Marinho: None
declared, J. Silveira: None declared, S. Silva: None declared,
A. Amado: None declared, A. Pessoa: None declared, J. Rosinhas:
None declared, M. Lopes: None declared, F. Ottery Other: Copyright
holder of the Patient-Generated Subjective Global Assessment (PG-
SGA), co-owner and co-developer of the PG-SGA based Pt-Global app,
H. Jager-Wittenaar Other: Co-developer of the PG-SGA based Pt-Global
app, A. Marinho: None declared.
SUN-P204
VALIDATION OF BIO-ELECTRICAL IMPEDANCE ANALYSIS TO
ASSESS SARCOPENIA IN OLDER ADULTS
R. Engelbert2,3, M. Tieland1, P. Weijs1,4. 1Faculty of Sports and
Nutrition, 2Faculty of Health, Amsterdam University of
Applied Sciences, 3Department of Rehabilitation, Academic
Medical Center, 4Nutrition and Dietetics, VU University
Medical Center, Amsterdam, Netherlands
Rationale: The increasing aging population causes sarcopenia
to be a rising phenomenon. Sarcopenia can be indicated by
whole body or low fat free mass (FFM). An easy, cheap and
feasible technique to measure these variables is bio-electrical
impedance analysis (BIA). The aim of this study was to validate
FFM measurements by BIA with dual energy X-ray absorpti-
ometry (DXA).
Methods: Older adults included into the VITAMINE trial were
assessed at baseline for whole body and appendicular FFM by
BIA (Tanita MC-780; 8-polar) and DXA (Hologic A). Pearson-
correlation was used to determine correlation between the FFM
of the BIA and DXA. The paired t-test was used to determine
whether there was a significant difference between the two
techniques. Agreement between the two techniques was
assessed by the Bland-Altman plot.
Results: Included were 45 older adults. Correlation between
whole body FFM by BIA and DXA was high (r = 0.952, p < 0.0001).
Whole body FFM by BIAwas not different from DXA (47.71 ± 6.78
vs 47.87 ± 6.14, p = 0.615). However, Bland-Altman plot showed
wide limits of agreement (LoA-3.94, 4.25). Appendicular FFM
of the BIA was significantly associated with appendicular FFM of
DXA (r = 0.934, p < 0.0001). Appendicular FFM by BIA was
significantly lower by 2.2% than from DXA (19.94 ± 2.81 vs
20.38 ± 3.33, p = 0.019). Bland-Altman plot showed wide limits
of agreement (LoA −1.96, 2.84).
Conclusion: The Tanita MC-780 appears to be accurate for
sarcopenia diagnosis on group level, however variation is high
for individual level.
Disclosure of Interest: None declared.
SUN-P205
INDICATION AND PRESCRIPTION OF ORAL NUTRITIONAL
SUPPLEMENTS IN A SWISS UNIVERSITY HOSPITAL
Total
J. Mareschal1 *, J. Altwegg2, D. Berthet3, M. Chikhi1,
P. Chopard4, S. Graf1, C. Sierro5, C. Pichard1, L. Genton1.
104 1
88 Nutrition Unit, Geneva University Hospitals, Geneva,
2
192 Nutradom - Homecare, Cortaillod, 3On behalf of Fresucare -
Homecare, 4Division of Quality of Care, Geneva University
Hospitals, Geneva, 5Proximos - Homecare, Carouge,
Switzerland
Rationale: Oral nutritional supplements (ONS) are a simple and
effective medical treatment of nutritional risk. In our hospital,
S130
ONS can be provided on medical prescription or on the
caregivers’ personal initiative. At discharge for home, in
Switzerland, a Nutrition Risk Screening-2002 (NRS-2002) ≥ 3,
a medical prescription and an ONS delivery at the patient’s
home by a homecare service are required for the reimburse-
ment of ONS by the public insurance. This survey aimed at
documenting: (1) the adequacy and existence of ONS medical
prescription during hospitalization and discharge for home, and
(2) the persistence of ONS treatment one month after discharge
for home.
Methods: Data of this prospective observational survey were
collected in patients hospitalized in surgery, medicine or
rehabilitation and about to receive ONS on their meal trays.
Patients already on ONS, with major consciousness disorders or
refusing to consume ONS were excluded. Adequacy of ONS
indication assessed by a NRS-2002 ≥ 3 and ONS prescription
were evaluated at first ONS delivery on the meal tray and at
hospital discharge. One month after discharge, the persistence
of ONS consumption was evaluated by the homecare service.
Results are presented as mean ± SD or percentages.
Results: 416 patients (71.7 ± 14.1yrs, 52.6%♂, BMI 23.6 ± 5.2
kg/m2) were included. At first ONS delivery on the meal tray,
82.7% (n = 344) of patients had an NRS-2002 ≥ 3 and 44.5%
(n = 185) had no ONS medical prescription. Out of 207 patients
discharged for home, only 24.2% (n = 50) had an adequate
homecare ONS prescription. One month after discharge, 76.3%
(n = 29) were still on ONS.
Conclusion: During hospitalization, ONS are mostly given to
patients at nutritional risk but medical prescription is often
missing. At discharge for home, few patients receive ONS
prescription and homecare service. If a medical ONS prescrip-
tion is performed, ONS are generally continued one month
after discharge.
Disclosure of Interest: None declared.
SUN-P206
UNHEALTHY DIET AMONG HOSPITALIZED PATIENTS – FOOD
INTAKE ASSESSMENT AS PART OF A ONE-DAY SURVEY OF
NUTRITIONAL STATUS
K. Kauppi1 *, S. Wegener2, I. Martinsson3. 1Unit for Health
Promoting Hospital, 2Unit for Clinical Nutrition, 3Unit for
Quality and Care, Uppsala University Hospital, Uppsala,
Sweden
Rationale: Unhealthy diet is the strongest contributor to the
burden of disease in Sweden. Approximately 20% of the general
population has considerably unhealthy diet. There is a lack of
studies in hospitalized patients. The aim was to investigate the
prevalence of unhealthy diet among hospitalized patients and
if they were offered dietary counselling.
Methods: A dietary index (DI) developed by the Swedish
National Board of Health and Welfare was included in a yearly
one-day survey of malnutrition at Uppsala University Hospital in
2015 (Y1) and 2016 (Y2). The index identifies individuals with
unhealthy diet from a disease-preventive perspective, to whom
dietary counselling should be offered. The DI is based on
consumption of fruit, vegetables, fish and low nutritious foods.
The hospital’s goal is to screen >50% of the patients, using the
DI and >70% of those at risk should be offered dietary
counselling.
Poster
Results: The number of patients included in the survey was 418
(Y1) and 411 (Y2). Screening with the DI increased from 38% to
59%. In both years just above one quarter of the patients had a
healthy diet and about one fifth had considerably unhealthy
diets. In this group the men were more likely to have unhealthy
diet, 78% (Y1) and 60% (Y2). In Y1 22% and in Y2 13%, of these
were underweight and 16% and 21% had a BMI >30. About 65%
had normal BMI in both years. Only one (Y1) and two (Y2)
patients with unhealthy diet received dietary counselling.
Conclusion: The goal of screening 50% of the patients was
obtained the second year. In this survey the number of
hospitalized patients with unhealthy diet corresponds fairly
well to the national prevalence. Men were more likely to have
unhealthy diets. Most patients had a “normal” BMI. Unhealthy
diets did not correspond to BMI. The goal of offering dietary
counselling was not obtained. Continuous improvement of the
nutrition process is ongoing.
Disclosure of Interest: None declared.
SUN-P207
TOWARDS A NEW MARKER OF NUTRITIONAL STATUS IN
ENTEROCUTANEOUS FISTULAE: LEAN BODY MASS IN CT
K. C. Fragkos1 *, K. Cheung2, D. Thong3, N. Keane4, S. Mehta1,
F. Rahman1, A. Plumb2, S. Di Caro1. 1GI Services, 2Imaging,
University College London Hospitals NHS Foundation Trust,
3
Division of Medicine, University College London, 4Dietetics,
University College London Hospitals NHS Foundation Trust,
London, United Kingdom
Rationale: We aimed to investigate the correlation between
body weight, body mass index, albumin levels and radiological
indices of lean body mass in patients undergoing
Enterocutaneous fistula (ECF) repair with surgical outcomes.
Methods: Biochemistry parameters and anthropometric
characteristics at the time of ECF surgery were collected for
a set of patients undergoing ECF repair. Skeletal muscle and
visceral and subcutaneous adiposity was measured at the level
of the L3 region (slice and volumetric analysis, Image J).
Statistical analysis was performed with percentages, means,
Spearman’s rho and dendrograms.
Results: 27 patients (14F, 55 ± 3.0 years) were identified in one
year. Aetiology of ECF was: surgical complications in 13
patients, extensive bowel disease in the remaining (Crohn’s
disease, diverticulitis, radiation enteropathy). 36% of patients
had a BMI less than 18.5 kg/m2, 50% had albumin less than 30 g/
L. None of the L3 measurements were statistically different
when compared between patients with albumin less or over
30 g/L. Parenteral nutrition was given peri-operatively in 48.1%
of patients. Pre-operative albumin had a strong positive
correlation with all radiological indices (rho 0.402–0.522,
p < 0.05) when sepsis was cleared. Weight and BMI were
strongly positively correlated with radiological indices (rho
0.527–0.918). Dendrograms identified two clusters that corre-
lated with imaging indices: heamatological parameters (largely
negative correlations) and nutritional parameters (weight,
albumin and others) (mainly positive correlations) None of the
L3 measurements were different with respect to ECF recur-
rence and PN administration ( p > 0.05).
Conclusion: L3 measurements strongly correlate with nutri-
tional parameters at the time of surgery when sepsis is cleared.
Surgical outcomes might be improved with early identification
Nutritional assessment 1
of patients requiring nutritional optimisation at initial radi-
ology scan.
Disclosure of Interest: None declared.
SUN-P208
EVALUATION OF NUTRITIONAL STATUS OF PATIENTS WITH
TRAUMATIC UNILATERAL LOWER EXTREMITY AMPUTATION
K. Tel Adıgüzel1 *, P. Bilgiç1, E. Adiguzel2, G. Kaner3, I. Safaz2.
1
Department of Nutrition and Dietetics, Faculty of Health
Sciences, Hacettepe University, Ankara, Turkey, 2Gaziler
Physical Medicine and Rehabilitation Education and Research
Hospital, University of Health Sciences, Ankara, 3Department
of Nutrition and Dietetics, Faculty of Health Sciences, Izmir
Katip Celebi University, İzmir, Turkey
Rationale: This study was aimed to evaluate the anthropomet-
ric measurements and nutritional status of patients with lower
extremity amputation.
Methods: Demographic data and anthropometric measure-
ments such as body weight, height, body mass index (BMI),
middle upper arm circumference (MUAC), and triceps skinfold
thickness (TST) were recorded. Corrected BMI was calculated
for each amputation level by adjusting weight with the
formula: adjusted weight = actual weight/ (1- amputation
percentage).
Results: Nine patients with above knee amputation and 11
patients with below knee amputation were included in this
study. All patients were male. Mean age of patients was
35.1 ± 8.4 yrs. Mean BMI, mean corrected BMI, MUAC and TST
measurements were 26.4 ± 6.2 kg/m2, 28.7 ± 6.9 kg/m2, 31.4 ±
6.1 cm and 15.2 ± 5.3 mm; respectively. Energy, protein, carbo-
hydrate, fat and fiber intake was 2421.1 ± 479.6 kcal, 90.8 ±
13.7 g, 274.9 ± 85.1 g, 102.7 ± 20.4 g, 21.5 ± 6.2 g, respectively.
Protein and carbohydrate intake per kg body weight per day was
1.2 ± 0.4 g and 3.5 ± 1.3 g. Cholesterol, saturated, mono-unsat-
urated and polyunsaturated fat intake was 317.0 ± 76.8 mg,
32.4 ± 5.8 g, 43.1 ± 7.8 g, 27.1 ± 11.2 g. Mean percentage of
energy from carbohydrates, protein and fat were 46.2 ± 5.8%,
15.6 ± 2.2% and 38.2 ± 4.5%, respectively.
Conclusion: The results of this study showed that, fiber intake
was lower while fat and cholesterol intakes were higher than
recommended intakes in this cohort. Since an unbalanced
nutritional pattern will lead to many chronic diseases including
cardiovascular diseases; it is thought that nutrition education
to be given to amputees has an important place in the
prevention of chronic diseases that may occur in the future.
Disclosure of Interest: None declared.
SUN-P209
CREATION OF A SCORING SYSTEM TO RATE NUTRITIONAL
SCREENING TOOLS FOR USE IN OLDER ADULTS
L. C. Power1,2 *, M. A. de van der Schueren3,4, S. Leij-Halfwerk4,
J. Bauer5, E. R. Gibney2,6, M. Clarke2,6, L. A. Bardon2,6,
C. Corish1,2, on behalf of the MaNuEL Consortium. 1School of
Public Health, Physiotherapy and Sports Science, 2Institute of
Food and Health, University College Dublin, Dublin, Ireland,
3
Department of Nutrition and Dietetics, VU University Medical
Centre, Amsterdam, 4Department of Nutrition and Health,
HAN University of Applied Sciences, Nijmegen, Netherlands,
S131
5
Department of Geriatric Medicine, Carl von Ossietzky
University, Oldenburg, Germany, 6School of Agriculture and
Food Science, University College Dublin, Dublin, Ireland
Rationale: Many nutritional screening tools (NSTs) are used to
screen for malnutrition risk in older adults. An objective of the
EU Malnutrition in the Elderly Knowledge hub (MaNuEL) project
is to devise recommendations on the best NSTs to use in older
adults in different healthcare settings across Europe.
Methods: Forty-eight published NSTs were identified. Criteria
to rate each tool were developed, based on scientific evidence
and expert opinion. These criteria were translated into a
scoring system with three equally weighted sections; valid-
ation, parameters and practicability.
Results: Overall, the highest scoring NSTs were DETERMINE your
health checklist for the community setting, the Nutritional
Form for the Elderly (NUFFE) for the rehabilitation setting,
the Short Nutritional Assessment Questionnaire-Residential
Care (SNAQ-RC) for institutions and both the Malnutrition
Screening Tool (MST) and the Mini Nutritional Assessment
Short Form (MNA-SF) version one (using BMI) for the hospital
setting. In terms of practicability alone, the Malnutrition
Screening Tool (MST), Canadian NST, Simplified Nutritional
Appetite Questionnaire (SNAQ-US) and the Short Nutritional
Assessment Questionnaire (SNAQ-NL) scored highest. The
Controlling Nutritional Status (CONUT) and the Nutrition Risk
Screening (NRS-2002) were ranked highest for validity alone.
Conclusion: These results will be used to create recommenda-
tions for the management of geriatric malnutrition across
Europe, as part of the MaNuEL project.
This work was supported by funding from the Department of
Agriculture, Food and the Marine and Health Research Board
through the Joint Programming Initiative - A Healthy Diet for a
Healthy Life (JPI HDHL) Knowledge Hub on Malnutrition in the
Elderly (MaNuEL).
Disclosure of Interest: None declared.
SUN-P210
PREVALENCE AND CHARACTERISTICS OF RISK FOR
MALNUTRITION IN PATIENTS WITH NEWLY DIAGNOSED HEAD
AND NECK CANCER
L. ter Beek1,2,3 *, L. Bras4, J. L. Roodenburg3,
C. P. van der Schans1,5,6, F. D. Ottery1,7, G. B. Halmos4,
H. Jager-Wittenaar1,3. 1Research Group Healthy Ageing, Allied
Health Care and Nursing, Hanze University of Applied Sciences,
2
Department of Pulmonary Diseases and Tuberculosis,
3
Department of Maxillofacial Surgery, 4Department of
Otorhinolaryngology, Division of Head and Neck Surgery,
5
Department of Rehabilitation Medicine, 6Department of
Health Psychology Research, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands,
7
Ottery & Associates, Vernon Hills (Chicago), United States
Rationale: Prevalence of malnutrition in patients with head
and neck cancer (HNC) ranges from 15% > 55%, as assessed by
weight loss. However, knowledge on the prevalence of
malnutrition operationalized as multidimensional construct is
lacking. Therefore, we aimed to assess prevalence and
characteristics of malnutrition risk by the Patient-Generated
Subjective Global Assessment Short Form (PG-SGA SF) in
patients with newly diagnosed HNC.
S132
Methods: Between August 2015 and January 2017, malnutrition
risk was assessed by PG-SGA SF in 236 newly diagnosed HNC
outpatients. The PG-SGA SF includes four Boxes. Box 1
addresses history of weight loss; Box 2 changes in food
intake; Box 3 nutrition impact symptoms (NIS); and Box 4
activities and function. “Medium risk” was defined as 4–8
points, and “high risk” as ≥9 points. PG-SGA ≥9 points indicates
critical need for interventions.
Results: In total, 25.8% (61/236) of the patients were at
medium risk for malnutrition, and 11.0% (26/236) were at high
risk. Overall, median total point score was 2 (IQR: 0.0–5.75),
and 7 (IQR: 5.0–9.0) in patients at medium/high malnutrition
risk. In patients at medium/high risk, highest score was on Box 3
(median 4; IQR: 2.0–5.0), mainly due to pain in the mouth or
throat area (76.7%; 66/86), difficulties with swallowing (38.3%;
33/86), and lack of appetite (25.6%; 22/86). Median scores on
Box 1, 2 and 4 were 1. Mean weight loss in all patients was 1.3%
in the last month and 2.9% in the last 6 months. In patients with
malnutrition risk, mean weight loss was 3.1% and 5.9%,
respectively.
Conclusion: Our findings show that a substantial proportion of
newly diagnosed HNC patients (36.8%) are at medium/high risk
for malnutrition, which is mainly related to specific NIS. These
findings demonstrate that interdisciplinary symptom manage-
ment and nutritional intervention are indicated in this patient
population.
Disclosure of Interest: L. ter Beek: None declared, L. Bras: None
declared, J. Roodenburg: None declared, C. van der Schans: None
declared, F. Ottery Other: Developer of the PG-SGA, co-developer of
the PG-SGA based Pt-Global app, G. Halmos: None declared, H. Jager-
Wittenaar Other: Co-developer of the PG-SGA based Pt-Global app.
SUN-P211
PREVALENCE AND FEATURES OF RISK FOR MALNUTRITION IN
PATIENTS PRIOR TO VASCULAR SURGERY
L. ter Beek1,2,3 *, L. B. Banning4, L. Visser4, J. L. Roodenburg3,
C. P. van der Schans1,5,6, R. A. Pol4, H. Jager-Wittenaar1,3.
1
Research Group Healthy Ageing, Allied Health Care and
Nursing, Hanze University of Applied Sciences, 2Department of
Pulmonary Diseases and Tuberculosis, 3Department of
Maxillofacial Surgery, 4Department of Surgery, Division of
Vascular Surgery, 5Department of Rehabilitation Medicine,
6 Methods: We selected 945 patients who presented to our
Department of Health Psychology Research, University of
Groningen, University Medical Center Groningen, Groningen,
Netherlands
Rationale: Malnutrition is an important indicator for adverse
post-operative outcomes. We aimed to assess prevalence and
features of malnutrition risk, using the Patient-Generated
Subjective Global Assessment Short Form (PG-SGA SF), and to
test how risk relates to co-variables, i.e. smoking, Body Mass
Index (BMI), comorbidities, and type of scheduled surgery.
Second, we aimed to compare the prevalence of risk for
malnutrition between the PG-SGA SF and the Malnutrition
Universal Screening Tool (MUST).
Methods: In total, 236 patients visiting the vascular surgery
outpatient clinic in 2015 were assessed for malnutrition risk by
PG-SGA SF. Demographics, medical history and data on MUST
were retrieved from the electronic hospital registry. Medium
risk was defined as PG-SGA 4–8 points, and high risk as ≥9
points. Associations between risk for malnutrition and smoking
Poster
status and BMI, were tested by Pearson Chi-Square and Mann
Whitney U test. Fisher’s exact was used to test difference in
prevalence of risk between MUST and PG-SGA SF scores.
Results: According to the PG-SGA SF, 24% of patients were
categorized as medium or high risk for malnutrition. In these
patients, domain scores were highest for nutrition impact
symptoms (NIS) (median 3.5; IQR: 2–5) and for activities and
function (median 2; IQR: 1–3). Patients who smoke (28/87) were
significantly more often at risk than non-smoking patients
(29/147) (P = 0.03). No differences in risk between patients with
BMI <25 kg/m2 (31/107) and BMI ≥25 kg/m2 (26/126) were
found (P = 0.14). Malnutrition according to MUST was 8% (9/
107).
Conclusion: Prior to vascular surgery, a substantial proportion
of patients (24%) is at risk for malnutrition, which is mainly
characterized by NIS and limitations in activities and function.
BMI appeared to be not discriminative for risk. Prevalence
of risk for malnutrition by PG-SGA SF is 3.5 times higher than
by MUST.
Disclosure of Interest: L. ter Beek: None declared, L. Banning: None
declared, L. Visser: None declared, J. Roodenburg: None declared,
C. van der Schans: None declared, R. Pol: None declared, H. Jager-
Wittenaar Other: Co-developer of the PG-SGA based Pt-Global app.
SUN-P212
ASSESSMENT OF RESTING METABOLIC RATE: COMPARISON OF
PREDICTION EQUATIONS WITH INDIRECT CALORIMETRY
VALUES; UN UPDATE
L. Valeriani1 *, F. Anzolin1, L. Zoni1. 1UOC Dietologia E
Nutrizione Clinica, ASL Bologna, Italy
Rationale: The evaluation of energy expenditure is a basic step
in the assessment of nutritional status. Indirect calorimetry is
the “gold standard” for measuring the resting metabolic rate
(RMR), but requires the use of expensive and not easily
transported equipment. Recently, a new handled indirect
calorimeter was introduced as an easy technique to assess
RMR. In clinical practice, energy requirements are calculated
by means of prediction equations, validated for use mainly in
healthy populations. The purpose of this study is to verify the
correspondence between measured RMR and RMR estimated
with different formulas available in the literature.
Clinical Unit from May 2004 to the end of January 2017 (mean
age = 40 years; mean BMI = 31.8; 258 males and 687 females). A
MedGem device was used to measure RMR. In the same
patients, we calculated the RMR with 4 commonly used
equations: Harris Benedict, Owen, Mifflin-ST Jeor and Korth.
We then stratified patients according to their BMI and made a
statistical study to determine whether the values of RMR
measured and those estimated are significantly different.
Results: The results showed that across the full spectrum of
BMI, there is no statistically significant difference between
measurements obtained with the MedGem device and the
values obtained with the formula of Mifflin-St Jeor. Owen
equations gives correct results for underweight and normal
weight patients. The Harris-Benedict and Korth equations
overstimate the REE in all the patients.
Conclusion: We have shown that only one equation selected
from the literature gives correct RMR values. The Harris
Benedict equation overestimates the RMR of our patients by
Nutritional assessment 1
1–10%, and this is of particular clinical relevance since this
equation is the most widely used in clinical practice.
Disclosure of Interest: None declared.
SUN-P213
SKELETAL MUSCLE MASS AND PHASE ANGLE EVALUATION IN
SUBSTANCE ADDICTION
M. P. P. Coelho1, K. G. D. Diniz1, T. Bering1, L. S. A. Ferreira1,
M. I. T. D. Correia2, R. Teixeira1, G. A. Rocha3, F. D. Garcia4,
D. A. Vieira1, L. D. Silva1 *. 1Internal Medicine, 2Department of
Surgery, 3Laboratory of Research in Bacteriology, 4Department
of Mental Health, Faculdade de Medicina da Universidade
Federal de Minas Gerais, Belo Horizonte, Brazil
Rationale: The illicit drug abuse is a global health problem that
affects approximately 246 million people worldwide. Among
the adverse consequences of drug addiction, the nutritional
disorders should be highlighted. The aim of this study was to
evaluate the prevalence of low skeletal muscle mass (SM) and
low phase angle (PhA) among substance users (SU).
Furthermore, the association between demographic, clinical
and life style data with nutritional parameters as SM and PhA
was also investigated.
Methods: 63 SU [65.1% males; mean age, 46.0 ± 13.2 years]
were prospectively included. The diagnosis of substance
addiction was based on the Diagnostic and Statistical Manual
of Mental Disorders IV (DSM IV) and the International
Classification of Diseases (ICD-10) criteria. SM and PhA were
estimated by BIA. Absolute SM was converted to an SM index
(SMI) by dividing height by meters squared (kg/m2). Subjective
Global Assessment (SGA) was used to assess the nutritional
status. The data were analysed by logistic regression model.
Results: Low SMI and low PhA was identified in 15.8% and 44.5%
of SU, respectively. Subjects with heavy alcohol consumption
had lower SMI and PhA values than those without heavy alcohol
drinking pattern. Low SMI was independently associated with
heavy alcohol consumption (OR = 2.02; 95%CI = 1.01–4.05; p =
0.05). Low PhA was also independently associated with heavy
alcohol consumption (OR = 2.11; 95%CI = 1.30–3.42; p = 0.002).
Conclusion: Heavy alcohol drinking was associated with low SMI
and low PhA. Considering substance addiction as a serious
public health problem in the world, all efforts must be made to
control the substance use. Furthermore, nutritional aspects as
SM and PhA should be meticulously evaluated in SU. An
integrated clinical/psychiatric/nutritional care must be pur-
sued in the management of patients with substance addiction.
Disclosure of Interest: None declared.
SUN-P214
BEDSIDE NUTRITIONAL ASSESSMENT TOOLS COMPARED WITH
CT BASED SKELETAL MUSCLE MASS ANALYSIS IN PATIENTS
AWAITING LIVER TRANSPLANTATION
M. C. van Kemenade1 *, J. L. A. van Vugt2, S. Riemslag Baas1,
H. J. Metselaar3, R. A. de Man3, J. N. M. Ijzermans2.
1
Department of Nutrition and Dietetics, 2Department of
Surgery, Division of HPB and Transplant Surgery, 3Department
of Gastroenterology and Hepatology, Erasmus MC University
Medical Center, Rotterdam, Netherlands
Rationale: Malnutrition is an independent predictor of mortal-
ity in patients awaiting liver transplantation(LT). Because many
S133
patients with end-stage liver disease experience fluid dis-
turbances, nutritional screening and nutritional assessment
(NA) is a challenge. Campillo validated alternative body mass
index (BMI) cut-off values depending on the degree of ascites to
define malnutrition. Cross-sectional skeletal muscle mass on
CT has been described as an objective measurement of
malnutrition. However, it remains unknown whether NA (i.e.
Malnutrition Universal Screening Tool (MUST), mid upper arm
circumference (MUAC), food intake and BMI) are herewith
correlated.
Methods: Patients (n = 54) screened for LT from January 2013
until November 2014 underwent NA by a dietitian. Patients
were classified as well-/malnourished according to Campillo.
Furthermore the cross-sectional skeletal muscle area adjusted
for patients’ height (skeletal muscle index (SMI, cm2/m2)) at
the level of the third lumbar vertebra was measured on CT. Non-
parametric statistical tests were used to explore the associ-
ation between NA measures and SMI.
Results: Malnourished patients identified by the dietitian
(MUST ≥ 2, n = 40) or by Campillo (n = 9) had lower SMI (both
P = 0.013) and lower BMI (both P < 0.001), while no significant
differences were found in intake compared with well-nourished
patients. SMI significantly decreased per incremental MUST
score (P = 0.003). MUAC was also significantly correlated with
SMI (Pearson’s correlation coefficient 0.59, P < 0.002). Due to
small numbers type II failures may have occurred.
Conclusion: Bedside nutritional assessment tools significantly
correlate with SMI in patients awaiting liver transplantation.
CT-assessed skeletal muscle mass may be an objective
measure to diagnose malnutrition. Nevertheless, validation
in larger cohorts is indicated and we are currently enlarging
our cohort
Disclosure of Interest: None declared.
SUN-P215
NUTRITIONAL STATUS ASSOCIATED WITH SLEEP IN
UNIVERSITY STUDENTS: CHILEAN MULTICENTRIC STUDY
M. Valladares1 *, M. Croveto2, V. Espinoza3, F. Mena4, G. Oñate5,
F. Macarena6, A. Muñoz7, A. M. Obregón8, S. Durán-Aguero9.
1
Departamento de ciencias químicas y biológicas, Universidad
Bernardo ÓHiggins, Santiago, 2Facultad de salud, Universidad
de Playa Ancha, Valparaiso, 3Escuela de nutrición y dietética,
Universidad Católica de Temuco, Temuco, 4Departamento de
nutrición y dietética, Universidad de Antofagasta,
Antofagasta, 5Escuela nutrición y dietética, 6Escuela de
nutrición y dietética, Universidad Autónoma de Chile, 7Escuela
de nutrición y dietética, Universidad Bernardo ÓHiggins,
Santiago, 8Escuela de nutrición y dietética, Universidad San
Sebastián, Concepción, 9Facultad de Ciencias de la Salud,
Universidad San Sebastián, Santiago, Chile
Rationale: Is there an association between eating habits and
sleep in Chilean University students? How correlate sleep,
eating habits and anthropometric measures in University
students?
Methods: 1,287 students from different universities and
regions of Chile were recruited, to which weight and height
were evaluate. “Survey on alimentary habits” was applied,
which is composed of two areas; healthy habits (9 questions)
and consumption of unhealthy foods or promoters of chronic
non-communicable diseases (6 questions). In addition,
S134
insomnia (determined by Insomnia Severity Index ISI) and
somnolence (evaluated with Epworth somnolence scale) were
determined. To compare between groups, t student test was
used; additionally, univariate logistic regression adjusted for
different variables was performed. The study was developed
following the Declaration of Helsinki regarding work with
human beings and approved by the Ethics Committee of the
participating universities.
Results: The 80% correspond to women, a mean of age and BMI
of 21.5 ± 2.6 years old and 23.4 ± 3.2 kg/m2 respectively in the
total sample. Women presented higher levels of somnolence
than men (P < 0.001) and no significant differences were found
according to nutritional status. Somnolence was positively
correlated with insomnia (correlation coefficient 0.134 p <
0.01) and sleeps latency (correlation coefficient 0.065 p < 0.05)
and negatively correlated with the amount of sleep (−0.109
p < 0.01) adjusted for sex, smoking, breakfast, sugar drinks and
alcohol. An association between greater amount of sleep and
risk of obesity is observed (OR = 0.54; IC95%:0.31–0.98) in a
model adjusted for physical activity, age, breakfast consump-
tion, fruits, vegetables and dairy products.
Conclusion: There is an association between the amount of
sleep, the risk of developing obesity and eating habits.
Disclosure of Interest: None declared.
SUN-P216
THE IMPACT OF GLYCEMIC CONTROL AND DISEASE DURATION
OF TYPE 2 DIABETES ON THE BODY COMPOSITION
T. A. Alaidarous1, M. M. A. Abulmeaty1,2 *, N. M. Alkhtani3.
1
Clinical Nutrition Program, Community Health Sciences, King
Saud University, Riyadh, Saudi Arabia, 2Medical Physiology
Department, Zagazig University, Zagazig, Egypt, 3Department
of Medicine, King Faisal Specialist Hospital & Research Centre,
Riyadh, Saudi Arabia
Rationale: Are the glycemic control and duration of type 2
diabetes (T2DM) have an impact on the body composition.
Methods: Case-control study was done in King Faisal Specialist
Hospital, Riyadh, SA. 25 non-diabetic controls (C) and 93 T2DM
cases were used (20–60 y). Cases were divided into 4 groups
according to the disease duration (early ≈ 6 months of diagnosis
and long lasting = >5 years) and glycemic control (based on A1C
level); the newly diagnosed controlled (NC, n = 25), the newly
diagnosed uncontrolled (NU, n = 17), the long lasting controlled
(LC, n = 25), and the long lasting uncontrolled (LU, n = 25).
Tanita BC-418 was used for body composition analysis along
with the anthropometric measurements. One-way ANOVA test
was used.
Results: The fat mass was significantly higher ( p < 0.05) in all
new diabetics versus C group whatever their glycemic control,
while the old diabetics showed insignificant changes in both
Table 1: (abstract: SUN-P216). The study parameters.
Parameters C Group NC Group
a a,b
HbA1cFraction 0.052 ± 0.00 0.060 ± 0.00 P < 0.001
2 a
BMIkg/m 26.3 ± 5.8 31.8 ± 4.6 P < 0.05
a a
WCcm 89.8 ± 11.6 108.0 ± 10.7 P < 0.001
a a,b
Percent body fat% 30.3 ± 10.04 38.5 ± 8.7 P < 0.05
a a
Fat massKg 22.3 ± 10.2 34.1 ± 10.6 P < 0.001
a a,b
Fat free massKg 49.9 ± 12.6 53.9 ± 11.1 P > 0.05
a b c
significant vs C, significant vs NC, & significant vs LC.
Poster
controlled and uncontrolled groups. The changes in fat free
mass with the disease duration and glycemic control remained
insignificant (Table 1).
Conclusion: The early T2DM is linked with more fat mass, which
get reduced with the long lasting disease, with insignificant
effect of the glycemic control.
Disclosure of Interest: None declared.
SUN-P217
CONSEQUENCES OF DELAY OF A SPECIALIZED NUTRITIONAL
SUPPORT IN HOSPITALIZED PATIENTS
C. Garcia-FIgueras Mateos1, M. Cayon-Blanco2 *,
L. Garcia Garcia-Doncel2. 1Internal Medicine Unit,
2
Endocrinology and Nutrition Unit, Hospital Sas De Jerez De La
Frontera, Jerez de la Frontera, Spain
Rationale: Specialized nutritional support (SPS) is crucial to
improve health status and nutritional outcomes in malnour-
ished in-patients. Ideally, it must be performed by a nutrition
support team (NST) but usually, intervention by NST is only
performed when it is required by other specialists. Our aim is to
investigate the effects on clinical and analytical outcomes
related to delay SPS and identify potential factors related to it.
Methods: Prospective study carried out in standard clinical
practice conditions. 52 hospitalized malnourished patients
(NRS_2002 criteria) attended by NSTof a tertiary hospital were
included. Date of onset of insufficient intake was defined as the
first day when patient’s intake was lower than 50% of daily
energy requirements. Date of nutritional assesment was
defined as the first day that patient received SPS. Number of
days between insufficient intake and SPS onset were divided in
tertiles (1st tertile: 0–3 days; 2nd tertile: 4–8 days; 3th tertile
≥9 days).
Results: Though there wasn’t significant difference among the
3 groups regarding to albumin levels at admission, patients who
received SPS after 9 days of insufficient intake had lower levels
of albumin (2.5 ± 0.7 vs 2.9 ± 0.5 g/dL; p = 0.021) when NST
intervention was initiated. and at discharge (2.7 ± 0.6 vs
3.3 ± 0.4 g/dL; p = 0.022). SPS was usually required later in
surgical departments as compared to medical (83.3% of
patients admitted in surgical wards in 3th tertile vs 62.5% in
medical wards; p = 0.016) and if the patients required previous
ICU admission (44% vs 14.8%; p = 0.02). According to length of
stay, no significant differences were observed among tertiles.
Conclusion: An early introduction of SPS by a NST improves
nutritional parameters among malnourished in-patients.
Nevertheless, it does not improve length of hospital stay. Our
results may encourage other specialists to require an early
nutritional intervention by NST.
Disclosure of Interest: None declared.
NU Group LC Group LU Group
a a,c
0.087 ± 0.01 P < 0.001 0.064 ± 0.00 P < 0.001 0.094 ± 0.01 P < 0.001
a b a a c
33.1 ± 4.5 P < 0.05 P > 0.05 30.6 ± 5.1 P < 0.05 30.7 ± 6.2 P < 0.05 P > 0.05
b a a c
108.5 ± 8.7 P < 0.001 P > 0.05 105.3 ± 12.5 P < 0.001 104.1 ± 11.3 P < 0.001 P > 0.05
a a,c
35.7 ± 8.3 P > 0.05 34.8 ± 9.1 P > 0.05 35.4 ± 9.0 P > 0.05
b a a,c
32.8 ± 9.2 P < 0.05 P > 0.05 28.3 ± 9.7 P > 0.05 29.5 ± 11.7 P > 0.05
a a,c
58.4 ± 8.4 P > 0.05 52.6 ± 10.9 P > 0.05 51.8 ± 7.3 P > 0.05
Nutritional epidemiology 1
Nutritional epidemiology 1
SUN-P218
PROTEIN INTAKE IS ASSOCIATED WITH MUSCLE INJURIES IN
CIRCUS ATHLETES: A PILOT STUDY
A. Bouville1, R. van Rhenen1 *, M. Engberink1, H. Zijlstra1,
R. V. van Rijn2, P. Weijs1,3, J. Stubbe1,2. 1Faculty of Sports and
Nutrition, Amsterdam University of Applied Sciences,
Amsterdam, 2Codarts University of the Arts, Rotterdam,
3
Department of Nutrition and Dietetics, Internal Medicine, VU
University Medical Center, Amsterdam, Netherlands
Rationale: Protein intake may play an important role in
preventing muscle injuries in athletes, however data on this
potential association is scarce. In the present pilot study, we
explored whether protein intake (quantity, type) was related to
muscle injuries in circus athletes.
Methods: Of the 34 invited athletes, 24 were willing to
participate (mean age: 22 y). Mean protein intake was
111 ± 35 g/d and all athletes achieved the recommended
protein intake of 1.2–1.7 g/kg bodyweight/d. During 3 months
34 injuries occurred of which 6 (17,6%) were classified as a
muscle injury. Mean animal protein intake was significantly and
inversely related to muscle injuries (OR 0.93, p < 0.05), while
mean total protein intake tended to be related (OR 0.95,
p = 0.08) and plant protein was not related (OR 1.00, p = 0.88).
Higher protein intake (>1,7 g/kg) tended to be associated with
lower prevalence of muscle injuries ( p = 0.09).
Results: Of the 34 invited athletes, 24 were willing to
participate (mean age: 22 y). Mean protein intake was
111 ± 35 g/d and all athletes achieved the recommended
protein intake of 1.2–1.7 g/kg bodyweight/d. During 3 months
34 injuries occurred of which 6 (17,6%) were classified as a
muscle injury. Mean animal protein intake was significantly and
inversely related to muscle injuries (OR 0.93, p < 0.05), while
mean total protein intake tended to be related (OR 0.95,
p = 0.08) and plant protein was not related (OR 1.00, p = 0.88).
Higher protein intake (>1,7 g/kg) tended to be associated with
lower prevalence of muscle injuries ( p = 0.09).
Conclusion: Protein intake was inversely related to muscle
injuries in first and second year circus athletes. Integrating
nutritional education and/or intervention when studying to
become a professional athlete may be of importance in
preventing muscle injuries. However, more research is
needed including larger sample sizes and possible confounding
factors.
Disclosure of Interest: None declared.
SUN-P219
THE PREVALENCE OF MALNUTRITION ASSOCIATED WITH
FOOD INTAKE IN NURSING HOMES. A MULTICENTER CROSS
SECTIONAL STUDY
A. Castaldo1 *, E. Zanetti2, M. Lusignani3, M. Zani4, A. Nobili5,
A. Verardi6, M. Magri7, A. Ianes8, G. Ardoino8, M. C. Gugiari1,
G. Marano9, P. Boracchi9, L. Bonetti10. 1Education, Provincia
Religiosa Di S. Marziano Di Don Orione - Piccolo Cottolengo,
Milan, 2Research, Gruppo di Ricerca Geriatrica, Brescia,
3
Nursing Bachelor, University of Milan, Milan, 4Nursing Home,
Le Rondini, Brescia, 5Quality, Mario Negri, 6Nutrition -Audit,
Health Agency, 7Research, Nurse Council, 8Medical Direction,
Korian Group, 9Statistic, University of Milan, Milan, Italy,
S135
10
Istituto oncologico della Svizzera italiana, Ente Ospedaliero
Cantonale Canton Ticino, Bellinzona, Switzerland
Rationale: Malnutrition continues to be an unsolved and
relevant problem in the elderly. The prevalence of malnutrition
is variable and depends on how it is measured. In nursing homes
(NHs) approximately 20% of residents are malnourished (Bell,
2015). A low food intake is the main etiological factor. The aim
of this study was to investigate the prevalence of malnutrition
and its associated factors in NHs. We also monitored food and
liquid intake.
Methods: We conducted a cross sectional study in NHs in
Northern Italy. In accordance to the ESPEN Consensus state-
ment we used Body Mass Index (BMI) <18.5 Kg/m2 in order to
detect malnourished residents (Cederholm et al., 2015). We
performed a descriptive analysis and logistic regression to
identify associated factors effecting malnutrition.
Results: We recruited 1,793 residents that lived in 29 NHs
between Oct-Dec 2016. 76% were female, with an average age
of 85.4 ± 8.5 years. 15.5% were malnourished. Malnutrition was
associated to: age, cognitive impairment, disability in daily life
activities, eating ability, swallowing and chewing problems.
Residents drank an average of 1,189 (±310 mL) per day. 2.8%
(27/951) of residents ate at most half of their meals, of those
26% had a BMI < 18.5 Kg/m2.
Conclusion: This is one of the only multicenter studies
investigating the prevalence and risk factors of malnutrition
in NHs in Italy. Results confirm that malnutrition in NHs is a
complex concern. We found a prevalence of malnourishment in
agreement with existing literature. Monitoring food and liquid
intake is a simple, cheap method for tracking residents’ eating.
Interventions to prevent malnutrition is a priority for future
research in NHs.
References
Cederholm T, et al. Diagnostic criteria for malnutrition – An ESPEN
Consensus Statement. Clin Nutr. 2015 Jun;34(3):335–40.
Bell CL, et al. Malnutrition in the nursing home. Curr Opin Clin Nutr
Metab Care. 2015 Jan;18(1):17–23.
Disclosure of Interest: None declared.
SUN-P220
FUNCTIONAL FOOD PREFERENCES OF TURKISH CONSUMERS
ACCORDING TO FOOD VALUE SCALE
A. S. Erdinc1 *, E. E. Ozturk-Duran1, D. Dikmen1. 1Nutrition and
Dietetics, Hacettepe University, Ankara, Turkey
Rationale: Food choice attitudes of consumers has an
important effect on health. Food value scale was developed
to understand human values and food preferences. This study
aimed to determine the attitudes of Turkish consumers to
functional foods with food value scale when purchasing yoghurt
and probiotic yoghurt.
Methods: In order to determine consumers’ attitudes towards
food choices two main food types have evaluated as yoghurt
and probiotic yoghurt. The food value scale evaluates 11 food
value (naturalness, taste, price, safety, convenience, nutri-
tion, tradition, origin, fairness, appearance, environment) and
55 questions which consist of binary combinations of these food
values. Questions on socio-demographic characteristics and
nutritional behaviours were also included. The sample com-
prised 385 women and 123 men, ranged from 18 to 64 years.
S136
Results: Participants mean age was 27.55 ± 11.70 years. More
than half of the consumers were normal weight (60%) and
nearly 29% of them were overweight and obese. Consumers
declared that safety, nutrition and naturalness were the most
important values when purchasing yoghurt and probiotic
yoghurt. While purchasing these products male consumers
pay more attention to origin than environment value when
compared with females ( p < 0.05). Both healthy and unhealthy
participants pay more attention naturalness than other food
values except for safety ( p < 0.05). Environment value was
important in healthy eaters compared to convenience however
convenience was more important value in unhealthy eaters.
Both groups pay attention to nutrition compare to other food
values ( p < 0.05).
Conclusion: This study showed that safety, nutrition and
naturalness of foods were the most important food values for
participants. Consumers food value preferences were same
while purchasing yoghurt and probiotic yoghurt as a
functional food.
Disclosure of Interest: None declared.
SUN-P221
MALNUTRION AND INADEQUATE FOOD CONSUMPTION IN
HOSPITALIZED PATIENTS
O. Gonen1, A. Erbakan2, I. Bozkurt Cakir3, B. Alparslan Mesci1,
M. V. Keskinler1, A. Oguz1 *. 1Internal Medicine, Istanbul
Medeniyet University Goztepe Training and Research Hospital,
2
Internal Medicine, Nisa Hospital, Istanbul, 3Internal
Medicine, Ardahan State Hospital, Ardahan, Turkey
Rationale: Hospital stay worsens inpatients’ nutritional status
including the patients without malnutrition at baseline. We
evaluated the nutritional risk status, adequacy and the factors
affecting the consumption of provided meals in patients
hospitalized in internal medicine clinics.
Methods: A total of 200 patients, hospitalized in Istanbul
Medeniyet University Goztepe Training and Research Hospital
Internal Medicine Clinics between February-March 2017, were
screened by Nutrition Risk Score (NRS-2002) within the first 48
hours of admission. Patients were questioned after the third
day of admission.
Results: Mean age was 66 ± 18 years (F/M = 1). NRS score was
found to be ≥3 in 48% (n:96) of the patients. In this group, 38.5%
(n:37) of the patients were receiving nutritional support. In the
whole group, the rate of the consumption of less than half of
the meals provided by the hospital was 75% in total, and 86.5%
in patients at nutritional risk at baseline.
Seventy-five percent of the patients stated that the meals were
not served at proper temperature, 70.5% of them stated the
meals were not appealing and only about 4% of the patients
expressed that they could prefer the hospital menus as a
dietary model after hospital discharge.
Nutritional Risk Grade
NRS < 3 NRS ≥ 3
(n = 104) (n = 96)
Consumption of meals Complete meal 37(35,6%) 13(13,5%)
provided by hospital, Almost 50% 27(26%) 26(27,1%)
number, proportion About one-third 32(30,8%) 38(39,6%)
Nothing 8(7,7%) 19(19,8%)
Poster
Conclusion: Half of the hospitalized patients in internal
medicine clinics are at malnutrition risk and most of them eat
less then half of the meals served. Nutritional support is also
inadequate. Precautions should be taken with the analysis of
the reasons to reduce the inadequate food consumption during
hospital stay, and to increase the nutritional support in
common and individual basis.
Disclosure of Interest: None declared.
SUN-P222
OVERWEIGHT AND SEDENTARY LIFESTYLE AMONG STUDENTS
IN A SCHOOL FROM SOUTHERN BRAZIL
C. W. Gallon1 *, K. G. Mendes1, H. Theodoro1, F. R. Motter2,
J. R. Bernardi3, J. P. Formolo1, J. Siviero1. 1Universidade De
Caxias Do Sul, Caxias do Sul, 2Unisinos, São Leopoldo,
3
Universidade Federal do Rio Grande do Sul, Porto
Alegre, Brazil
Rationale: In recent decades, the nutritional profile of the
Brazilian population has presented important changes follow-
ing the nutritional transition process that has affected various
countries in the world. An increase in the number of individuals
with overweight and obesity has been observed in children. It is
know that children with overweight spend more time watching
television and playing video games than eutrophic children,
who are more active and have a lower body mass index (BMI)
and fat percentage. This study evaluated the association
between sedentary lifestyle and overweight in students aged
6–14 years enrolled in an elementary school of the municipal
system in Brazil.
Methods: In order to evaluate the duration of sedentary
behavior, the sum of daily hours spent watching television,
using a computer, and playing video games was calculated.
Data were collected using a standardized questionnaire with a
sample of 88 students. This study was approved by the Research
Ethics Committee of the University of Caxias do Sul (No.
339.903).
Results: A high prevalence of overweight (21.6%; CI 95% 13.6–
29.6) was found. The daily average duration of sedentary
behavior was of 5.3 (SD = 2.6) hours; higher among boys (6.1,
SD = 2.4 hours) than among girls (4.7, SD = 2.6 hours); and
higher in students aged 10–14 years (6.1, SD = 2.8 hours)
compared those aged 6–9 years (4.7, SD = 2.3 hours).
Conclusion: Although the student presented a high prevalence
of overweight and spent a substantial amount of time in
activities considered sedentary. Is important to emphasize the
need for educational interventions regarding healthy lifestyles
promoted in the family environment.
Disclosure of Interest: None declared.
SUN-P223
SHORT AND LONG-TERM OUTCOMES FROM PERCUTANEOUS
ENDOSCOPIC GASTROSTOMY (PEG)
p- C. Joaquin1 *, A. Palanca1, J. M. Sanchez-Migallon1,
value M. J. Sendros2, E. Martinez1, M. Martin1, M. Cachero1, R. Puig1.
1
Endocrinology and Nutrition, Germans Trias i Pujol Hospital,
2
Endocrinology and Nutrition, Institu Català d’Oncologia-
0,001 Badalona, Badalona, Spain
Rationale: To review short and long-term outcomes from PEG
at a university hospital.
Nutritional epidemiology 1
Methods: All patients referred to our Nutrition Unit to assess
PEG placement between 2011 and 2017 were included.
Results: 96 patients (66%men), age 60.4 ± 14.3 years, BMI
22.2 ± 4.7 kg/m2. Neurological dysphagia was the most
common reason for referral for PEG placement (57.7%)
followed by dysphagia due to head and neck cancer (38.1%).
PEG was not placed in 19 patients due to obesity (1), patient
decision (6), pharyngo-oesophageal stenosis (4), other ana-
tomic causes (7) and exitus (1). In patients who had PEG placed
(77), mean follow-up was 223 (34–471) days. All patients except
4 presented weight loss(WL) in the previous 6 months
(11.4 ± 7.6%) although 77.9% of them were fed by nasogastric
tube prior to PEG insertion. PEG related complications occurred
in 48.1% of the subjects. 22 patients (28,6%) had early
complications (<30 days): 10.4% gastroparesis, 9.1% granuloma,
6.5% wound infection, 5.2% ileus, 1.3% tube dislodgement, 1.3%
tube removal, 1.3% cardiorespiratory arrest that responded to
CPR and 1 patient (1.3%) died due to peritonitis. Late
complications occurred in 21 patients (28,4%): 23.4% granu-
loma, 5.2% peristomal leakage, 3.9% tube removal, 1.3% wound
infection, 1.3% tube dislodgement and 1.3% tube obstruction.
During follow-up, 62.3% of the patients died: 7.8% within the
first month and 20.8% within 3 months. In multivariate logistic
regression analyses we did not find a correlation between global
or early mortality and the indication for PEG, diabetes, age,
gender, BMI, WL%, albumin, nor cholesterol levels at baseline.
Albumin concentration improved after 6 month of tube
placement (34.3 ± 5.2 vs. 37.8 ± 5.1, P < 0.0001).
Conclusion: Initiation of PEG feeding improved albumin levels
in our patients. However, minor PEG-related complications
were frequent and 3-month mortality rate after PEG placement
was high.
Disclosure of Interest: None declared.
SUN-P224
ADHERENCE TO A HEALTHY LIFETYLE AND IN VITRO
FERTILIZATION OUTCOME
D. Karayiannis1 *, M. Kontogianni1, C. Mendorou2,
M. Mastrominas2, N. Yiannakouris1. 1Nutrition and Dietetics,
School of Health Science and Education, Harokopio University,
2
Assisted Conception Unit, Embryogenesis, Athens, Greece
Rationale: Several modifiable lifestyle factors, including
smoking, physical activity, diet and anxiety may independently
influence assisted reproductive outcome; however, their
combined impact on reproductive performance is unknown.
We aimed at investigating the joint influence of these behaviors
on IVF outcomes in women attempting fertility.
Methods: We constructed a healthy lifestyle index (HLI) from
five health related behaviors/factors (smoking, physical
activity, diet - assesed by the Mediterranean Diet Score,
anxiety and waist circumference) and examined the association
of this HLI with IVF clinical outcomes. Nulliparous women
(n = 228, 22–41 years old, BMI < 30 kg/m2) undergoing their first
IVF cycle were recruited from an Assisted Conception Unit in
Athens, Greece, and completed questionnaires related to
lifestyle behaviors prior to the IVF. We assigned scores of 0, 1
or 2 to categories of each of the five components, for which
higher values indicate healthier behaviors, and added the five
scores to produce a combined HLI for each participant ranging
from 0 (least healthy) to 10 (healthiest). We used logistic
S137
regression to calculate odds ratios (OR) and 95% confidence
intervals (CI) across tertiles of the HLI for reproductive
outcomes and adjusted for multiple covariates, including
age, cause of infertility and supplements use.
Results: Overall, 104 women (45.6%) had intrauterine gestation
and 98 (43.2%) had a live birth. No association was found
between the HLI and the intermediate IVF outcomes. However,
the highest versus lowest tertile in the HLI was associated with
a significant higher likelihood of achieving clinical pregnancy
(OR 2.46, 95%CI 1.24–4.77) and live birth (OR 2.22, 95%CI 1.12–
4.39, both p for trend <0.05).
Conclusion: Adopting healthy lifestyle behaviors could be
important for increasing the chance of achieving clinical
pregnancy and live birth rates in women undergoing IVF.
Disclosure of Interest: None declared.
SUN-P225
ASSESSMENT OF CONSUMERS’ NUTRITION LABEL READING
HABITS IN TURKEY
E. E. Ozturk Duran1 *, L. Ozgen2. 1Hacettepe University, 2Gazi
University, Ankara, Turkey
Rationale: The incidence of obesity is rapidly increasing all
over the world. Reading and understanding nutrition labels on
food packaging can change the food choices of consumers and
create healthy eating behaviors in individuals. This study has
been planned and conducted to determine Turkish consumers’
nutrition label reading habits.
Methods: In order to determine consumers’ attitudes towards
nutrition label, a questionnaire consists of 15 questions about
information nutrition labeling was applied. There were also
questions on socio-demographic characteristics. Field inter-
views conducted in a random selected. The sample comprised
410 women and 190 men (14.5% normal weight, 46.7%
overweight, 38.8% obese), ranged from 19 to 64 years. The
questionnaires were analyzed with the statistical program
version SPSS 23.0.
Results: Approximately ¾ of the consumers did not read the
nutrition labels information. There is not a statistically
significant relationship between participants’ gender and
nutrition label reading status ( p > 0.05). Nutrition label
reading status is higher in normal weight individuals when
compared to overweight and obese ( p < 0.001). In addition,
normal weight consumers are more careful about labeling
information regarding brand name, date of manufacture, date
of expiry, product information, usage pattern and the name of
the additives used in the preparation of the product ( p < 0.05).
The expected characteristics of nutrition labels vary according
to whether individuals are in normal weight, overweight or
obese ( p < 0.05). While obese and overweight individuals
prefer to be easy to understand on the nutrition label, the
normal weight individuals opt to see well designed packet on
the nutritional label.
Conclusion: Since nutrition labels play an important role in the
prevention of obesity, health policies should be produced and
education programs may be organized to inform individuals
about the correct use of nutrition labels.
Disclosure of Interest: None declared.
S138
SUN-P226
MALNUTRITION PREVALENCE AMONG SECONDARY-CARE
HOSPITAL PATIENTS IN LATVIA
E. P. Borins1,2, G. Moisejevs1,3 *, J. Avdjukevics3, O. Zukova3,
J. Pokrotnieks1,4. 1Riga Stradins Unviersity, Riga, 2Northern
Kurzeme Regional Hospital, Talsi, 3Riga East Clinical University
Hospital, 4Pauls Stradins Clinical University Hospital,
Riga, Latvia
Rationale: The prevalence of malnutrition at secondary-care
hospitals has never been thoroughly assessed in Latvia. Various
studies show that the prevalence is very variable, ranging 10–
50% of hospital patients. The aim of this study was to assess the
prevalence of malnutrition at secondary-care hospitals in
Latvia on the basis of the Nutritional Risk Assessment
(NRS2002) tool, also associating malnutrition with various
potentially predictive factors.
Methods: The study was conducted at the Talsi clinic of the
Northern Kurzeme Regional Hospital in May–June 2016. All
patients were weighed, their height was measured, and they
were assessed on the basis of NRS2002 by an experienced
physician (E.P.B.) within 24 hours of admission. The diagnosis of
malnutrition was made if the NRS2002 score was ≥3. Data
related to age, gender, length of hospital stay (LOS) and health
conditions were collected. Age and LOS are shown as median
(interquartile range). The association of malnutrition with age,
LOS and various existing bodily organ pathologies was assessed
on the basis of binary logistic regression (SPSS 20.0). The local
ethics committee approved the study protocol.
Results: Malnutrition was identified in 28.7% (64/223) of
patients. Patients with malnutrition were older 69 (55–78)
versus 78.5 (70.25–85) years, p = 0.001 and had longer LOS 5 (3–
8) versus 7 (5.25–10) days, p = 0.012. During their hospital stay,
6 patients who were malnourished died ( p = 0.001).
Malnutrition is associated with oncological diseases OR 5.0,
p = 0.05 and was more frequently diagnosed among patients
with lung disease OR 3.2, p = 0.064.
Conclusion: Malnutrition is prevalent in secondary-care hospi-
tals in Latvia, mostly affecting elderly patients, patients with
oncological and lung diseases. Patients with malnutrition have
longer hospital stays and higher rates of mortality. The NRS2002
tool may be used in secondary-care hospitals in Latvia to
diagnose malnutrition.
Disclosure of Interest: None declared.
SUN-P227
FOOD CHOICE ACCORDING TO GENERAL HEALTH
PERCEPTIONS AND MENTAL HEALTH
G. Arman1 *, E. Tuncil1, M. Fisunoglu1. 1Nutrition and Dietetics,
Hacettepe University, Ankara, Turkey
Rationale: Food choice that has a clinical importance in terms
of some health problems such as obesity is an interaction
between non-sensory and sensory factors. The aim of the study
is to show the most effective factors at food choice in Turkey
according to General Health Perceptions (GHP) and Mental
Health (MH).
Methods: 209 women and 181 men (n = 390) participated in the
study voluntarily in Ankara, Turkey. Short Form 36 (SF36) and
Food Choice Questionnaire validated in Turkey were used. GHP
and MH scores were found with SF36. According to the
Poster
literature, no special cut point has been declared for SF36.
Therefore, GHP and MH scores were subjectively divided into
two groups in this study. 0–49 was considered low (GHP-L; MH-
L). 50–100 was considered high (GHP-H; MH-H). Descriptive
statistics (mean±SD) were used. The independent samples t
test was used to test differences between the food choice
factors and the subgroups of GHP and MH. P < 0.05 was
considered significant.
Results: Participants’ mean age was 43.7 ± 18.6. Sensory
appearance (8.05 ± 1.61), price (7.44 ± 1.90) and convenience
(7.33 ± 2.01) were the most effective factors. The mean GHP
and MH scores were 57.9 ± 20.4 and 66.1 ± 17.7, respectively.
The most important factors in GHP-L (n = 141) and GHP-H
(n = 249) were sensory appearance (GHP-L:7.94 ± 1.63/GHP-
H:8.11 ± 1.60), price (GHP-L:7.50 ± 1.81/GHP-H:7.41 ± 1.95)
and convenience (GHP-L:7.34 ± 2.16/GHP-H:7.33 ± 1.92).
There was no difference between GHP-L and GHP-H ( p > 0.05).
The most important factors in MH-L (n = 78) were convenience
(7.79 ± 1.78), sensory appearance (7.73 ± 1.80) and price
(7.28 ± 2.01). The most important factors in MH-H (n = 312)
were sensory appearance (8.13 ± 1.55), price (7.48 ± 1.87) and
familiarity (7.22 ± 1.69). Only convenience was found signifi-
cantly different between MH-L and MH-H ( p = 0.037).
Conclusion: The effective factors at food choice in Turkey were
sensory appearance, price and convenience. GHP didn’t affect
food choice, but MH did.
Disclosure of Interest: None declared.
SUN-P228
NUTRITIONDAY 2016 AUDIT IN CHINA
H. Sun1 *, L. Zhang1, P. Zhang2, J. Yu3, W. Kang3, S. Guo3,
W. Chen3, X. Li4, S. Wang4, L. Chen5, J. Wu5, Z. Tian6, X. Wu7,
X. Liu8, Y. Liu9, X. Zhang9, X. Wang1. 1Department of General
Surgery, Jinling Hospital, Medical School of Nanjing University,
Nanjing, 2Department of Clinical Nutrition, School of
Medicine, the Second Affiliated Hospital Zhejiang University,
Hangzhou, 3Peking Union Medical College Hospital, Beijing,
4
Department of General Surgery, The First Affiliated Hospital
of Xi’an Jiaotong University, Xian, 5National Cancer Center/
Cancer Hospital, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing, 6Department of
Gastroenterology, the Affiliated Hospital of Qingdao
University, Qingdao, 7The First Affiliated Hospital of Guangxi
Medical University, Nanning, 8Department of Gastrointestinal
Surgery, the First Affiliated Hospital Zhejiang University,
Hangzhou, 9Nutrition Department of People Liberation Army
General Hospital of China, Beijing, China
Rationale: We aimed to provide an actual and comprehensive
situation of nutrition characteristics, nutritional therapy and
malnutrition risk factors of hospitalized patients in China.
Methods: We enrolled the data of NutritionDay audit 2016 in
China that we have received by far. The international daylong
cross-sectional survey was performed on November 10, 2016 via
filling out four questionnaires about nutritional care, patients’
illness, food intake history and weight change. Re-assessment
of patients’ outcome questionnaire was performed 30 days
later. Malnutrition was defined as BMI <18.5 kg/m2 or uninten-
tional weight loss >5% in last 3 months.
Results: Total of 628 patients from 7 hospitals and 8 kinds of
departments were enrolled. 188 (29.9%) patients were
Nutritional epidemiology 1
identified as malnutrition, and most frequently in general
surgery (39.4%) and gastroenterology & hepatology (internal
medicine) department (37.1%). Parenteral nutrition (176/594,
29.6%) was the primary nutrition support therapy for hospita-
lized patients, of which, 42.0% was supported via central
venous. However, there were still 37.9% (69/182) malnutrition
patients not received any form of nutritional support, and
36.4% (150/412) well nourished patients did. Moreover, major
diseased organ, nutritional support form, self-rated health,
and food intake during last week were independent risk factors
for malnutrition (all p < 0.05). Patients with malnutrition had
higher hospital stay rate and lower discharge rate compared to
well-nourished patients according to 30-day outcomes.
Conclusion: The prevalence of malnutrition is still high and
associated with poor 30-day outcomes in Chinese hospital.
Inappropriate nutritional therapy is a common and burning
problem to be solved. Specific nutritional intervene should be
taken in patients with poor self-rated health or critical organ
disease. Moreover, further study may focus on the risk factors
for food intake loss and efficient method for protecting
patients from malnutrition.
Disclosure of Interest: None declared.
SUN-P229
NUTRITIONAL STATUS OF CANCER PATIENTS SEEN FROM
NUTRITIONDAY ONCOLOGY IN JAPAN 2015
H. Takemoto1 *, R. Fukushima2, S. Ishii3, R. Endo4, Y. Koyama5,
K. Saito6, S. Noda7, C. Mihara8, M. Yamaguchi9, J. Kotani10,
on behalf of nutrition Day Working Group in JSPEN. 1Kinki
Central Hospital, Itami, 2Teikyo University, Tokyo, 3Kurume
University, Kurume, 4Iwate Medical University, Morioka,
5
Niigata University, Niigata, 6Tokyo Medical and Dental
University, Tokyo, 7Takamatsu Hospital, Takamatsu, 8Yamada
Kinen Hospital, Mihara, 9Inabe General Hospital, Inabe,
10
Hyogo College of Medicine, Nishinomiya, Japan
Rationale: A survey specializing in cancer patients has also
been conducted on nutiritionDay since 2012. In response to the
publication of the 2015 national report this time, I will report
on the current situation of cancer patients in Japan.
Methods: In 2015, we conducted an investigation on November
10. In Japan, 1,114 patients were registered at 62 units, of
which 303 were cancer patients. We compared with 2,607
cancer patients registered from 275 units in the whole world.
Results: The average age was 71 in Japan, 65 in the world, the
female ratio was 44.8% in the world compared with 36.5% in
Japan. BMI was 21.4 in Japan and the world was 24.4. For goal
of therapy, curative, palliative, terminal was 53.8%, 38.6%,
4.3% worldwide, compared to 39.7%, 43.9%, 15.1% in Japan,
and the proportion of hospitalization not aimed for cure was
higher in Japan. Over 10% of cancer sites were colon, stomach,
lung, liver in Japan, colon, lung and stomach in the world.
Looking at nutritional therapy, ‘no special diet’ was the largest
number of people in both the world and Japan, however 21.5%
patients had been undergoing ‘pareteral nutrition’ in Japan,
9.2% in the world. Conversely, ‘energy rich/protein rich ONS’
was only 3.2% in Japan, whereas in the world it was 16.3%.
According to a questionnaire survey of patients, the proportion
of ‘patients having difficulties in complying with treatment’ is
20% in the world compared with 3.5% in Japan. The proportion
of ‘patients believing that including nutrition in their
S139
therapeutic approach could provide relevant benefit to them’
was 38.8% in Japan, 52.3% in the world.
Conclusion: nutiritionDay makes it possible to objectively
evaluate the current situation of cancer patients and nutri-
tional therapies in Japan and will be the basic data for
improving nutritional therapy in the future.
Disclosure of Interest: None declared.
SUN-P230
INSIGHT FROM ANALYSIS OF FEEDING PRACTICES AND
GROWTH OUTCOMES AMONG TIBETAN CHILDREN LESS THAN
3 YEARS OF AGE: WHAT, WHY AND HOW?
H. Shi1 *, J. Chen1. 1Shanghai Children Hospital, Shanghai,
China
Rationale: Children residence at highland are faced with an
unique set of nutrition problems. This study aimed to
investigate the infant feeding practices and the nutritional
outcomes among Tibetan children aged 0–3 years.
Methods: Data of 1,434 Tibetan children aged 0–3 years were
collected with multistage random sampling in Dec, 2016. The
outcomes of anthropometric measurement were defined as
stunning, underweight and wasting by common age- and sex-
cutoff value. Age-specific logistic regression was performed to
construct correlation between various categories of under-
nutrition and feeding risk factors.
Results: The prevalence of malnutrition was 18.0% for stunting,
49.2% for underweight and 25.4% for wasting, respectively. The
rate for mothers who could conduct exclusive breastfeeding
(EBF) for at least 4 complete months was only 10.4% among
infants older than 4 months. A considerable amount of infants
(66.12%) were introduced solids before 4 months old while
11.63% of the caregivers started complementary feeding (CF)
later than 7 months. Significant association was detected
between early introduction of solids before 4 months of age and
wasting in 0–3.99 months (95%CI 1.20–5.95), 4–6.99 months (95%
CI 2.25–7.24) and underweight in 7–23.99 months (95%CI 1.80–
5.86). Delay introduction of solids was risk factors for under-
weight (95%CI 2.36–13.04) and wasting (95%CI2.19–11.43) in 7–
23.99 months. Relationship could be seen between suboptimal
breastfeeding (non-EBF or EBF less than 4 months) and stunting in
children aged older than 24 months (95%CI 1.36–3.80 for
stunting). Delay introduction of CF kept a negative impact on
child height at 23–35.99 months group (95%CI 5.52–93.86).
Conclusion: There is an urgent need to improve EBF and timely
introduction of complementary as an element of crucial public
health policy to diminish health threats and problems in Tibet.
Disclosure of Interest: None declared.
SUN-P231
SHORT BOWEL SYNDROME EPIDEMIOLOGY, ANALYSIS FROM
NATIONAL HPN REGISTRY
J. Gojda1 *, M. Senkyrik2, P. Tesinsky1, on behalf of Czech
HPN working group. 12nd Internal Departement, Centre for
Research on Diabetes, Metabolism and Nutrtion, Charles
University in Prague, Prague 10, 2Internal and
Gastroenterology Dept., University Hospital Brno, Brno,
Czech Republic
Rationale: Short bowel syndrome (SBS) is the most common
indication for HPN in the Czech Republic. As new treatment
S140
modalities in SBS emerges, it is important to stratify the
group of HPN patients to identify those who could benefit
from it.
Methods: Retrospective analysis of data from national registry
of HPN patients was performed. Time-to-event analysis was
performed for catheter realted sepsis (CRS) using competing-
risks regression (Fine and Gray model) and was expressed as
hazard ratio (HR) with SBS syndrom category being the
reference. Other data are presented as median (min-max) or
mean with 95% CI, p value <0.05 was considered significant.
Results: From total of 753 records (1993–2016), 311 patients
were classified as SBS. Prevalence trends in the SBS group were
stable for the last 5 years, mean 28.684 (27.023–33.871)
catheter days. 40.8% of patients were categorized to be life-
long dependent on HPN. Major diagnose of SBS is cancer
(28.0%), vascular (22.5%) and non-cancer surgical (20.6%).
Majority of SBS were type I (59.1%) and II (21.3%), mean length
of residual bowel was 77.8 cm (0–250 cm). 50% of SBS patients
terminates HPN (weaning or death) within the first year.
Incidence of CRS was 0.39 per 1,000 catheter days in 2016.
When compared to other syndromes indicating HPN, signifi-
cance was reached only in comparison with GIT obstruction
where the risk of CRS was lower (HR 0.23, [0.1–0.5]).
Prevalence of metabolic bone disease in the whole sample is
34.2% with median time to manifestation 43.5 (1.7–194.5)
months and of liver disease is 36.4% with median time to
manifestation 28.9 (2.4–121.1) months.
Conclusion: Prevalence of SBS among HPN patients in
the Czech Republic is stable in the last years. Majority of
SBS patients are expected to be life-long dependent on HPN.
Risk of CRS in SBS is higher when compared to other syndromes
but the actual prevalence is low when compared to other
countries.
Disclosure of Interest: None declared.
SUN-P232
INDICATIONS AND TYPES OF HOME ENTERAL NUTRITIONAL
SUPPORT IN THE HEALTH AREA OF CUENCA (SPAIN)
J. Pérez Rodríguez1 *, J. González López1, D. Martín Iglesias1,
M. Alramadan1, D. Calderón Vicente1. 1Endocrinology and
Clinical Nutrition, Virgen de la Luz General Hospital,
Cuenca, Spain
Rationale: Enteral nutrition is indicated in patients who,
having a functioning and accessible gastrointestinal tract, can
not meet all their nutritional needs. Home enteral nutrition
(HEN) allows to receive it at home, which with proper
management and monitoring avoid hospitalization, prevents
and treats malnutrition and reduces morbidity and mortality.
The objectives of this study are to know the number of patients
with HEN being followed in our nutritional unit, as well as to
analyze the main indications and types of enteral nutritional
support (ENS) in our area.
Methods: We collected information from patients with HEN in
our nutrition unit between 2014 and 2016. For them we use as a
source the medical record. We classified the patients according
to the clinical situation that justified the need for ENS, as well
as the type of ENS they received.
Poster
Results: 267 patients received HEN in our nutritional unit (119
women and 148 man). The median age was 75+ -24 years. The
main indication was neurogenic dysphagia (56.2%), followed by
major surgery (14.6%), chemo-radiotherapy (9.7%), head and
neck surgery (8.2%), inflammatory bowel disease (3%), short
bowel syndrome (3%), pancreatopathy (3%), and others (2.2%).
The types of enteral nutritional support were: oral nutritional
supplements (ONS) (55.8%), nasogastric tube feeding (18.7%),
gastrostomy feeding (17.2%) and adapted oral diet (8.2%).
Conclusion: Patients who require enteral nutritional support in
our area are elderly, so the main indication was neurogenic
dysphagia. The main type of nutritional support was ONS,
followed by nasogastric tube feeding. Given the predictable
high prevalence of malnutrition or risk of malnutrition in our
area, we understand that few patients are treated in our
nutritional unit, probably due to an underdiagnosis of malnu-
trition. Better strategies for malnutrition screening are needed
for adequate detection and treatment of these patients.
Disclosure of Interest: None declared.
SUN-P233
EDUCATION ON SELF-MONITORING OF BLOOD GLUCOSE AS A
STATE-CONTROLLING ISSUE CAN BE EFFECTIVE IN PATIENTS
WITH TYPE 2 DIABETES MELLITUS WHO ARE NOT TAKING
INSULIN: A SYSTEMATIC LITERATURE REVIEW
K. Viligorska1,2 *, E. Kasapidou1, M. Chourdakis1. 1Laboratory of
Hygiene, Dept. of Medicine, School of Health Sciences,
Aristotle University of Thessaloniki, Thessaloniki, Greece,
2
Internal Medicine, Clinical Pharmacology and Occupational
Diseases, Bukovinian State Medical University, Chernivtsi,
Ukraine
Rationale: Clinical guidelines point out the benefits of self-
monitoring of blood glucose (SMBG). The aim was to system-
atically review evidence on effectiveness of SMBG educational
interventions encouraging lifestyle changes in type 2 diabetes
mellitus (T2DM) adults who are not using insulin.
Methods: In October 2016 according to Preferred Reporting
Items for Systematic Reviews and Meta-analyses guidelines a
publication search in 4 electronic databases was conducted.
Papers published in English, Spanish, French reporting on SMBG
education that promotes frequent glucose control with
exercise regimen and/or dietary adjustments in T2DM adults
with 3 and >month follow-up period, estimated progress in
comparison to control group were included. Glycated haemo-
globin (HbA1c,%) was chosen as psychical evidence of SMBG
education success.
Results: 10 studies (2,658 patients) were included and
stratified by intervention type. Positive effects were generally
observed in studies incorporating face-to-face counseling but
interventions using culture-tailored approach or self-monitor-
ing of urine glucose (SMUG) measurement seemed to present
sufficient alternative. Studies focused on SMBG impact on
quality of life regular SMBG was mentioned as the most
substantial problem causing statistically significant increase
of HbA1c up to 9.6% ( p = 0.02). Multicomponent interventions
on SMBG training and SMUG had better results, stable HbA1c
target level (6.5%): 35.3% ( p = 0.277) in SMBG patients and
38.9% ( p = 0.172) in SMUG group.
Obesity and the metabolic syndrome 1
Conclusion: SMBG training in combination with SMUG provides
positive effect in population subgroups (45% of reviewed
articles). More research is required to explore effectiveness
of specific components of interventions particularly exercise
and diet regimen in different populations.
Disclosure of Interest: None declared.
SUN-P234
INFLUENCE OF A CHANGE IN COST COVERAGE FOR
ORAL NUTRITIONAL SUPPLEMENTS IN HOME ARTIFICIAL
NUTRITION
L. J. Vogt1 *, M. Rühlin1,2, N. Wagener3, C. Möltgen2,4,
L. Genton2,5, P. E. Ballmer1,2. 1Departement of Medicine and
Division of Dietetics and Clinical Nutrition, Winterthur
Cantonal Hospital, Winterthur, 2Swiss Society for Clinical
Nutrition (GESKES), Geneva, 3SVK, Swiss Consortiums of
Health Insurance Companies for Joint Tasks in the Field of
Transplantation, Dialysis, HAN and Home Ventilation,
Solothurn, 4Hospital Pharmacy, Aarau Cantonal Hospital,
Aarau, 5Clinical Nutrition, Geneva University Hospitals,
Geneva, Switzerland
Rationale: Before 01.07.2012, the costs for oral nutritional
supplement (ONS) were not covered by health insurance
providers in Switzerland. Since 01.07.2012, the costs for ONS
have been covered, if the use is medically indicated. The aim of
this study is to examine whether the change in cost coverage for
ONS has influenced home artificial nutrition (HAN).
Methods: This study examined retrospectively all new cases of
HAN in Switzerland from 2010 to 2015 that were registered by
the Swiss Consortium of Health Insurance Companies (SVK).
Type of HAN, duration and cost of HAN before and after the due
date 01.07.2012 were examined.
Results: A total of 39,624 patient cases were registered in six
years and the number of cases with HAN increased from 4,667 in
2010 and 3,829 in 2011 to 6,147 in 2012, 7,315 in 2013, 8,097 in
2014 and 9,575 in 2015. After 01.07.2012, patients receiving
ONS increased from 61.4% to 87.7% while patients receiving
enteral nutrition (EN) and parenteral nutrition (PN) decreased
from 35.4% to 11.3% and from 3.1% to 1.0%, respectively. The
mean treatment duration for ONS significantly decreased from
329 ± 492 days to 181 ± 305 days ( p < 0.001), for EN from
455 ± 586 days to 323 ± 493 days ( p < 0.001) and for PN from
331 ± 524 days to 187 ± 363 days ( p = 0.003). The total cost for
ONS significantly decreased since 01.07.2012 for ONS from
2,689 ± 7,558 € to 1,603 ± 4,117 € ( p < 0.001) and for EN from
14,202 ± 21,019 € to 11,314 ± 17,484 € ( p < 0.001). The cost for
PN did not change significantly ( p = 0.108).
Conclusion: The change in cost coverage caused an increase in
use of ONS while the use of EN und PN decreased. This change in
treatment combined with the shorter treatment period led to
an important reduction of cost despite the increasing number
of patient cases.
Disclosure of Interest: None declared.
S141
Obesity and the metabolic syndrome 1
SUN-P235
SEMEN FLUID QUALITY AND ANTIOXIDANTS SUPPLEMENT IN
RATS FED HIGH FAT DIET
A. Vahidinia1 *, S. M. Hosseinipanah2, H. Abbasi3,
H. Mossavibahar4, H. Mahjoub5. 1Nutrition Sciences, 2Anatomy,
3
Hamadan University of Medical Sciences, Hamadan, Islamic
Republic of Iran, 4Endourology, 5Biostatistic, Hamadan
University of Medical Sciences, Hamadan, Islamic
Republic of Iran
Rationale: Obesity is associated with low serum antioxidant
capacity, alterations in sex hormone concentrations and male
infertility. Dietary Antioxidants are necessary for normal semen
quality and reproductive function in both animals and human.
The present study was designed to investigate effects of high-
fat diet with and without antioxidants supplement on quality of
male rat’s semen fluid.
Methods: Forty-eight male wistar rats were randomly assigned
to high-fat purified diet ad libitum (FD), high fat restricted diet
(FDR) (−30%wt), high-fat antioxidants ad libitum (HFA) and high
fat restricted (HFR) for 12 weeks. Antioxidants supplements
contain vitamin C, E and astaxanthin. Daily food intake, weekly
Weight gain, serum total antioxidant capacity, 8-epi-PGF2α,
and semen analysis measured.
Results: Dietary antioxidants suppress body weight gain in HFA
(−9.8%), and HFR (−18.1%) groups. 8-epi- PGF2α levels in FD
was 1,416.2 pg/ml and in FDR group was 1,209 pg/ml and equal
for other groups. lowest TAC was seen in FD group and highest
was in HFA group ( p < 0.005). Total sperm count in left testes
was 132.7 million and in right testes was 119.8 million. Mean
normal sperm morphology was 77.6% and abnormal morphology
was %23.4. High frequency of grade 4 motility and grade 0
motility in both testes were seen in HFA group.
Conclusion: These results suggest that antioxidants supple-
ment might be of value in reducing likelihood of obesity in rats
fed high-fat diet, especially if accompanying with restricted
diets. Antioxidants supplement and/or caloric restriction may
be improved TAC and partially suppressed stress oxidative
index, but in semen analysis, without effects on morphology
and sperm count, may be improved sperm motility grade 4
motility and grade 0 motility in both testes were seen in HFA
group.
Disclosure of Interest: None declared.
SUN-P236
LOW-GRADE INFLAMMATION IN OVERWEIGHT AND OBESE
ADULTS IS AFFECTED BY WEIGHT LOSS PROGRAM
A. Petelin1 *, M. Stubelj1, M. Černelič Bizjak1, M. Jurdana1,
T. Jakus1, Z. Jenko Pražnikar1. 1Faculty of Health Sciences,
University of Primorska, Izola, Slovenia
Rationale: Low grade systemic inflammation due to obesity is
considered to be the key link between obesity and obesity-
related disorders. The hypothesis was tested that significant
alterations in inflammatory markers and adipokines would
occur over a multidisciplinary intervention and that these
changes might also be important for improvement of cardio-
vascular risk factors.
S142
Methods: Thirty-tree overweight adults completed a 6-month
of multidisciplinary intervention program to evaluate the
effects of a personalized dietary program based on the
individual’s resting metabolic rate (RMR) on anthropometric
parameters, aerobic and anaerobic capabilities, metabolic
profile, inflammation and body image satisfaction. Body
composition, physical activity, anaerobic capabilities, RMR,
metabolic profile and low-grade inflammation were measured.
Diet composition and body image dissatisfaction were also
assessed.
Results: After 6-month of multidisciplinary intervention the
participants showed significantly decreased body weight, waist
circumference (WC) and the inflammatory markers tumor
necrosis factor-α, C-reactive protein and visfatin. They also
showed increased anti-inflammatory adiponectin and conse-
quently decreased serum insulin, HOMA-IR and total choles-
terol. The important findings of the study were that reduction
of sugars and saturated fatty acids in the diet, coupled with an
increase in exercise, significantly correlated with reduction of
WC and body mass index. In addition, positive correlations
between Δ BMI, Δ WC, Δ trunk fat, inflammation and
cardiovascular risk factors were demonstrated.
Conclusion: Weight loss in combination with increased physical
activity, a negative energy balance and diet adjustment was
associated with lower inflammation and consequently with
lower cardiovascular risk factors.
Disclosure of Interest: None declared.
SUN-P238
EFFECT OF MATERNAL CAFETERIA DIET AND TAURINE
SUPPLEMENTATION ON MATERNAL WEIGHT CHANGE AND
PLASMA ADIPONECTIN LEVELS IN RATS
A. Kabasakal Çetin1 *, A. Güleç1, A. Akyol Mutlu1. 1Hacettepe
University, Ankara, Turkey
Rationale: Maternal obesogenic environment leads to adverse
pregnancy outcomes and the effect of taurine supplementation
on maternal over nutrition and physiological changes are not
well documented. The aim of the present study was to evaluate
the effect of maternal cafeteria diet and taurine supplemen-
tation on maternal weight change and plasma adiponectin
levels in rats.
Methods: Female Wistar rats were fed a control (CON) diet,
CON supplemeted with 1.5% taurine in drinking water (CONT),
cafeteria diet (CAF) or CAF supplemented with taurine from
weaning. After 8 weeks all animals were mated and maintained
on the same diets during pregnancy and lactation. Maternal
food consumption, water intake and body weights were
measured during pre-gestation, gestation and lactation. At
the end of lactation animals were culled and blood samples
were collected.
Results: Maternal energy intake did not differ between groups
(CON: 330.4 ± 6.76 kJ/day, CONT: 330.3 ± 6.26 kJ/day, CAF:
339.3 ± 6.26 kJ/day and CAFT: 336.5 ± 6.26 kJ/day) ( p > 0.05),
but maternal cafeteria diet resulted in an overall increase in
maternal body weights in CAF group compared to CON (CON:
207.7 ± 1.81 g and CAF: 215.5 ± 1.68 g)( p < 0.01). CAFT dams
remained significantly leaner than CONT mothers (CONT:
219.4 ± 1.68 g and CAFT: 210.0 ± 1.68 g) ( p < 0.01). Plasma
Poster
adiponectin concentrations of CAF and CAFT dams were
significantly higher than CON and CONT mothers (CON: 3.10 ±
1.60 μg/mL, CONT: 3.50 ± 1.48 μg/mL, CAF: 11.53 ± 1.60 μg/mL
and CAFT: 13.92 ± 1.60 μg/mL) ( p < 0.01).
Conclusion: Maternal exposure to a cafeteria diet and
taurine supplementation during pre-gestation, gestation and
lactation resulted in different body weights and plasma
adiponectin levels. Future studies will continue to examine
the influence of maternal cafeteria diet and taurine supple-
mentation on physiological and metabolic changes and
maternal health.
Disclosure of Interest: None declared.
SUN-P239
EFFECTS OF DIETING ON INTRA-ABDOMINAL FATNESS AND
WAIST CIRCUMFERENCE
A. Ozdemir1 *, D. Dikmen1. 1Nutrition and Dietetics, Hacettepe
University, Ankara, Turkey
Rationale: There is an evidence that abdominal obesity is
associated with increased risk of morbidity and mortality. Waist
circumference and waist–hip ratio are abdominal adiposity
indicators (1). This study was planned with the object of
examining and comparing the changes that emerge in waist
circumference, waist hip ratio, intra-abdominal fat mass and
body compositions of the individuals who follow weight-loss
diets.
Methods: This study carried out with 26 overweight/obese
subjects. They were followed with weight-loss diets calculated
by specialized dietitians using Harris-Benedict formula includ-
ing their basal metabolic rates. Body composition analyses
examined with BIA, intra-abdominal fat percentage was
analyzed with VISCAN. All the individuals’ anthropometric
measurements were assessed once in a month who followed
their diet program for 3 months.
Results: The mean age of subjects was 47,2 ± 10,71 and mean
body mass index (BMI) was 32,8 ± 4,49 kg/m2. Of participants,
47,2% were men and 57,5% were women. Mean waist
circumference was decreased from 108 ± 7,42 cm to 100,3 ±
9,87 cm, and from 107,1 ± 11,89 cm to 98,7 ± 9,71 cm, respect-
ively in men and women ( p < 0.05). Intra-abdominal fat
percentages and body fat percentages were decreased from
43,2 ± 6.2% to 42,4 ± 6,39% and from 35,8 ± 8,28% to 34,9 ±
8,61%, respectively ( p < 0.05). A significant decrease was seen
waist circumference (cm), waist/hip ratio, intra-abdominal fat
percentages, between beginning, 1st month, and 3rd month
( p < 0.05). There was a significant correlation between waist
circumference and intra-abdominal fat mass ( p < 0.05).
Conclusion: The results obtained from this study show that
there were significant changes in some anthropometric
measurements and body composition with weight loss diets.
Reference
Waist circumference and waist-hip ratio. (2008). Report of a WHO
Expert Consultation. Geneva: World Health Organization, 8–11.
Disclosure of Interest: None declared.
Obesity and the metabolic syndrome 1
SUN-P240
EVOLUTION OF BODY COMPOSITION WITH DIFFERENT
BARIATRIC PROCEDURES: SLEEVE GASTRECTOMY VS
BILIOPANCREATIC DIVERSION VS GASTRIC BYPASS
B. Pintor De La Maza1 *, M. D. Ballesteros-Pomar1,
A. Urioste-Fondo1, L. M. Gajete-Martín1, M. Alejo-Ramos1,
D. Barajas-Galindo1, P. Fernández-Martínez1,
A. Hernandez-Moreno1, L. González-Herráez1,
I. Cano-Rodríguez1. 1High Risk Obesity Unit, Complejo
Asistencial Universitario de León, León, Spain
Rationale: Bariatric surgery is an effective intervention
strategy in obesity, resulting in sustained weight loss which
might differ among elected procedures. The aim of this study
was to assess the evolution of body composition in patients that
underwent Sleeve gastrectomy (SG), Biliopancreatic diversion
(BPD) and Gastric Bypass (GB).
Methods: The study was performed between July 2015 and
February 2017. All patients that underwent bariatric surgery
were included. Body composition was determined with a
Bioelectrical Impedance Analyzer (BIA – Tanita MC780) before
surgery and 6 and 12 months after surgery. The statistical
analysis included ANOVA test.
Results: 24 patients with a mean age of 44.67 (10.39) were
included. 75% were female. Mean weight before surgery was
121.36 (22.60) kg. 8 patients underwent BDP, 12 SG and 4 GB. 6
months after surgery, weight loss among groups was 44.38
(12.94) kg in BDP vs 29.09 (7.45) kg in SG vs 35.12 (4.62) kg in GB
( p = 0.007). The fat mass loss after 6 months was 34.62 (9.66)
kg in BDP vs 21.35 (5.59) kg in SG vs 25.97 (4.65) kg in GB
( p = 0.002). No significant differences were found among
techniques 12 months after surgery.
Conclusion: The weight loss and fat mass loss is lower in those
patients that underwent SG than the other two techniques,
although long term studies are needed.
Disclosure of Interest: None declared.
SUN-P241
OBESITY IN POSTMENOPAUSAL WOMEN IN THE SOUTH OF
BRAZIL
C. W. Gallon1 *, K. G. Mendes1, H. Theodoro1, M. T. A. Olinto2,
E. M. F. E. Silva1. 1Universidade de Caxias do Sul, Caxias do Sul,
2
Unisinos, São Leopoldo, Brazil
Rationale: Obesity is a public health problem that affects
women in the climacteric. There is an increase in premeno-
pausal prevalence and is directly related to the occurrence of
hypertension, diabetes mellitus and cardiovascular diseases.
This study aims to evaluate the prevalence of obesity in
postmenopausal women treated at the Central Ambulatory of
the University of Caxias do Sul.
Methods: For this purpose, 201 women were interviewed from
January 2010 to April 2011, in the age group from 44 to 65
years. This study was approved by the Research Ethics
Committee of the University of Caxias do Sul (No. 124/08)
Results: Of the 201 women investigated, 50.7% were obese.
Statistically significant differences were found in the variables
schooling, abdominal obesity, LAP (Lipid Accumulation
Product), high blood glucose, low HDL and presence of
metabolic syndrome. Regarding schooling, it was observed
that the higher the level, the higher the percentage of
S143
eutrophic women ( p = 0.045). Among those with abdominal
obesity, it was observed that all obese women presented waist
circumference above 88 cm ( p < 0.001). A higher LAP was found
in those with overweight (22.1%) and obesity (36.6%), when
compared to eutrophic women (1.3%) ( p < 0.001). As for
glycemia above 100 mg/dL or use of hypoglycemic medication,
an increase was observed when compared to eutrophic,
overweight and obese (9.6%, 28.8%, 61.6%, respectively)
( p = 0.004). Regarding HDL, the trend was the same (9.4%,
33.0%, 57.5%) ( p = 0.001). Metabolic syndrome was present in
5.8% of the eutrophic, 26.4% of overweight and 67.8% of obese
women ( p = 0.001).
Conclusion: After the information collection and analysis of
the observed variables, it can be concluded that the majority of
postmenopausal women are obese, have low schooling, have
had more than three pregnancies, have abdominal obesity,
have elevated LAP and glycemia, metabolic syndrome and low
HDL cholesterol.
Disclosure of Interest: None declared.
SUN-P242
DEVELOPMENT OF A ROUX-EN-Y GASTRIC BYPASS MODEL IN
OBESE YUCATAN MINIPIGS: FEASIBILITY AND PRELIMINARY
RESULTS ON WEIGHT LOSS AND GLP-1 SECRETION
D. Bergeat1,2 *, Y. Gautier1, S. Blat1, S. Guerin1, K. Boudjema2,
D. Val-Laillet1, R. Thibault1,3. 1UR 1341 ADNC, NuMeCan, INRA,
St Gilles, 2Hepatobiliary and Digestive Surgery, 3Department of
Nutrition, CHU Rennes, Rennes, France
Rationale: Gut-brain axis is truly involved in the regulation of
food behavior after obesity surgery. To prepare an original study
aimed at identifying the intestinal phenotypes correlated with
neuro-behavioral patterns, we developed a model of Roux-en-Y
gastric-bypass (RYGBP) in obese minipigs
Methods: After a period of 6 weeks of an obesogenic diet, we
performed a RYGBP and a sham operation using obese Yucatan
minipigs (mean weight 82.6 kg ± 2.8). Postoperative feeding
protocol was the same between groups. To appreciate the
incretin effect, a meal test (with the equivalent of 1 g of
glucose per kg) was performed before surgery, at 1 week and 1
month after surgery. Plasma GLP1 concentrations were
evaluated before the meal test and at 15, 30, 60, 120, and
180 min after the meal test. Results were compared using a
two-way ANOVA, Bonferroni post-hoc test.
Results: Thirteen obese Yucatan mini pigs were operated, 7
RYGBP and 6 sham. We observed 1 brutal death by sepsis in the
RYGBP group at postoperative day 3 and 1 gastrojejunal
anastomosis stenosis limiting food intake. Otherwise the
postoperative outcome was uneventful. At 1 month, the
mean percentage of weight loss was higher in RYGBP group
compared to sham group (−15 ± 3 vs −12 ± 2%, P = 0.049). One
week after surgery, postprandial GLP1 concentrations (n = 4 in
each group) were dramatically increased at each point in the
RYGBP group (P < 0.01 for all), especially at 30 min
(29.85 ± 4.31 vs 6.67 ± 1.73 pM), and after 1 month at 15, 30,
60, and 120 min (P < 0.01) in the RYGBP group compared to the
sham group.
Conclusion: RYGBP induced a major increase in postprandial
GLP1 secretion, as observed in patients undergoing RYGBP.
These results validate our model of RYGBP in obese minipigs for
further studies on gut-brain axis.
S144
Disclosure of Interest: D. Bergeat Grant/Research Support from:
ESPEN fellowship grant 2015, Y. Gautier: None declared, S. Blat: None
declared, S. Guerin: None declared, K. Boudjema: None declared,
D. Val-Laillet: None declared, R. Thibault: None declared.
SUN-P243
HERBAL SUPPLEMENT USE FOR WEIGHT LOSS AMONG WOMEN
AGED BETWEEN 19 AND 64 YEARS
E. D. Ors1 *, Z. Goktas1. 1Nutrition and Dietetics, Hacettepe
University, Ankara, Turkey
Rationale: Weight loss therapies require a lifestyle change and
this might be challenging for some people. Hence, additional
treatment options like supplement use are considered. Global
use of herbal products among individuals who try to lose weight
is increasing. The purpose of this study is to evaluate herbal
supplement use for weight loss among women who aim to lose
weight.
Methods: A total of 565 women aged between 19 and 64 years
participated in the study and subjects were recruited from
several sports centers. All the subjects completed a seven part
questionnaire form which included 50 questions and a 24-hour
recall dietary and energy expenditure assessment form.
Questions intended to collect data about demographic
characteristics, nutritional habits, nutritional supplement use
for weight loss and physical activity levels. Anthropometric
measurements were collected using bioelectrical impedance
analysis. Statistical significance was set at p < 0.05.
Results: In this study 38.1% of the women used at least one
dietary supplement or herbal supplement in the last year for
various reasons. The most commonly used supplements were
vitamin B12 (32.6%), iron (7.30%) and vitamin D (20.9%). In the
last 12 months 43.5% of women (n = 246) used food or herbal
supplements for weight loss. The most commonly used weight
loss supplements were respectively green tea (58.9%) and
lemon (27.2%). In the study, 89.8% of individuals that were using
herbal supplements claimed no adverse effects. Subjects that
use supplements to lose weight had a greater total daily energy
expenditure than subjects that don’t use any supplement.
Conclusion: In this study we demonstrated a trend for herbal or
food supplement use among women who aim to lose weight. For
a healthy weight loss, it is necessary to develop healthy eating
habits, increase physical activity levels and ensure these habits
to become life style changes under the supervision of a
dietetics expert.
Disclosure of Interest: None declared.
SUN-P244
DIETARY BEHAVIOUR PATTERN AND PHYSICAL ACTIVITY IN
OVERWEIGHT AND OBESE EGYPTIAN MOTHERS:
RELATIONSHIPS WITH THEIR CHILDREN’S BODY MASS INDEX
E. R. Abdelhamid1 *. 1Child Health Department, National
Research Center, Cairo, Egypt
Rationale: Obesity and related morbidity increase in Egyptian
women and their children. A better understanding of dietary
and activity patterns is needed to reduce obesity prevalence.
The present study aimed to assess dietary patterns and physical
activity in Egyptian overweight and obese mothers and to
explore its relationships with their children’s body mass
index (BMI).
Poster
Methods: This descriptive case-control study was conducted at
the National Research Center. The study included a sample of
64 overweight and obese mothers and 75 children, compared
with apparently healthy non-obese mothers and their children
of matched age and social class. Tested questionnaires were
used to collect information of the studied subjects.
Results: A statistically significantly higher incidence of
unemployment, large family size was observed in overweight
& obese women compared to controls (P < 0.05). Those women
who consumed vegetables more than 3 times a week were less
likely to be overweight or obese (P < 0.05). No significant
association were detected between mothers’ physical activity,
dietary behaviour variables and children’s BMI except for
consuming beverages with added sugar (95%CI = 0.074–0.985, P
Conclusion: Improper dietary patterns, nonworking mothers,
and big family size are associated with obesity among Egyptian
women. Emphasis should be given to increasing physical
activity and encourage healthier diets among Egyptian
mothers and their children.
Disclosure of Interest: None declared.
SUN-P245
AVOIDANCE OF MICRONUTRIENT MALNUTRITION AFTER
BARIATRIC SURGERY – A SINGLE CENTER EXPERIENCE OF
PROTOCOL-BASED JOINT FOLLOW-UP PROGRAM
E. K.-W. Ng1 *, S. K. Wong1, S. Y. Liu1. 1Surgery, The Chinese
University of Hong Kong, New Territories, Hong Kong
Rationale: Bariatric surgery is increasingly accepted as a
treatment for morbid obesity and obese diabetes in Asia.
Prevalence of post-op micronutrients deficiency in Asian
patients remains unknown. We report our center’s experience
of protocol-based follow-up (FU) program in prevention of
micronutrients malabsorption after bariatric procedures.
Methods: Data were retrieved from our multidisciplinary
metabolic surgical clinic’s database. Patients having either
laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric
bypass (LGBP) with at least 2 yrs of FU data were reviewed.
LGBP patients were given regular daily multivitatmin, calcium,
vit D and also iron supplements, with B12 injection every 3
months. LSG patients were given oral multivitamin only. Blood
tests were taken 6-monthly.
Results: Between Nov 2008 and Oct 2014, 92 patients (M/F:35/
57) with LSG and 38 patients (M/F:19/19) with LGBP done had
complete sets of 2-year FU data. The two groups were
comparable in preop demographics. Both groups also had
comparable magnitude of postop % total wt loss by 2 years (LSG:
26.2% vs LGBP: 19.7%). Patients with known type II diabetes had
significant improvement in HbA1c. However, in both groups,
there was significant drop in Hb level (LSG: 16.9 g/dL to 13.0 g/
dL; LGBP: 16.0 g/dL to 12.8 g/dL) by 2 years. Despite
supplements given, % Fe-saturation dropped in the LGBP
group but not in the LSG group. There were also decrease in
serum vit B12 level but the magnitude was more marked in the
LGBP group (from 204 down to 125) than the LSG group.
Conclusion: With a structured protocol-based joint FU
program, no measurable micronutrients malnutrition was
seen after bariatric surgery. However, patients with bypass
procedures tend to have a lower trend in Fe saturation and B12
in blood. Long-term monitoring and substitution is recom-
mended for this group of patients.
Obesity and the metabolic syndrome 1
Disclosure of Interest: None declared.
SUN-P246
PREVALENCE OF METABOLIC SYNDROME IN CHILDREN WITH
OBESITY
F. Esfarjani1 *, F. Mohammadi1, M. Khalafi1, R. Roustaee1,
H. Alikhanian1, R. Kelishadi2. 1Department of Food and
Nutrition Policy and Planning Research, National Nutrition and
Food Technology Research Institute, Faculty of Nutrition
Sciences and Food Technology, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, 2Department of Pediatrics,
Child Growth and Development Research Center, and Faculty of
Medicine, Isfahan University of Medical Sciences, Isfahan,
Tehran, Islamic Republic of Iran
Rationale: Childhood obesity increases the risk of metabolic
syndrome (MetS) both in childhood and adulthood. The present
study was determined the prevalence of MetS and its potential
determinants in a representative sample of obese children.
Methods: This cross-sectional study was conducted among 150
obese children. Body mass index (BMI ≥ 95th percentile) with
seven years of age. They were randomly selected from 9 health
centers in 3 districts of the north Tehran. Trained nutritionists
completed a socio-demographic questionnaire by interviewing
parents, and conducted the physical examination. Mets was
defined based on modified ATP III criteria.
Results: The mean (SD) of weight, height, and BMI was 37.5
(6.3) kg, 127.2 (4.7) cm and 23.08 (2.9) kg/m2, respectively.
The prevalence of MetS was 13.4%, without significant
difference in terms of gender. The most common component
of MetS was abdominal obesity (79%). While 21.3% of children
did not have any component of MetS, 42% of them had at least
one component. Most children with MetS had a history of
breastfeeding for less than 6 months. Waist circumference,
systolic and diastolic blood pressure, fasting blood glucose, and
triglyceride levels were higher in Mets compared to controls
( p < 0.05). Logistic regression model revealed that children
with birth weight of ≤2,500 gr. were at higher risk of MetS than
children with a higher birth weight (OR = 4.3; 95%CI: 1.1–9.7).
Conclusion: Primordial prevention of childhood obesity,
screening the components of MetS among obese children and
assessing the clustering of risk factors is associated with an
increased risk of cardiovascular disease. Therefore, these
components should be considered as a health priority at
individual and public levels.
Disclosure of Interest: None declared.
SUN-P247
THE RELATIONS BETWEEN NUTRITIONAL STATUS, SLEEP
QUALITY AND BLOOD LIPID PROFILE OF SHIFT WORKERS
G. Cakmak1 *, M. Kizil1. 1Hacettepe University, Ankara, Turkey
Rationale: Several studies reported that shift working might
relate with metabolic syndrome, obesity and cardiovascular
diseases due to affect circadian rhythm. The aim of this study
was the find out the relations between shift working and
nutrition habits, some biochemical findings, physical activities
and sleep quality.
Methods: This study was conducted on 70 shift and 70 daytime
workers. Questionnaire was performed face to face to them in
order to find out demographical characteristics, nutrition
S145
habits, dietary record, physical activity level and sleep quality.
Individuals’ fasting blood glucose, LDL (low density lipopro-
tein), HDL (high density lipoprotein), triglycerides and blood
pressure findings were evaluated.
Results: Shift workers’ LDL values were determined higher
( p < 0.05) than daytime workers and metabolic syndrome was
more common in shift workers. Body mass index and waist
circumference values were also higher in the shift workers
( p < 0.05). According to sleep quality evaluation, shift workers
sleep quality was worse than daytime workers ( p < 0.05). In
relation of physical activity level, both groups (shift workers
and daytime workers) were inactive. Average values of energy,
carbohydrate, protein, fat, sodium, sucrose, saturated and
mono-unsaturated fatty acid and cholesterol intakes were
found higher in the shift workers ( p < 0.05) but calcium and
vitamin A intake were higher in the daytime workers ( p < 0.05).
Conclusion: In conclusion, shift workers’ shift hours should be
rearranged, they should educate about the healthy nutrition
and dietitians should determine their nutrition programs.
Disclosure of Interest: None declared.
SUN-P248
IS SLEEP QUALITY ASSOCIATED WITH OBESITY AND
DEPRESSION AMONG TURKISH ADOLESCENTS?
B. Öge Yılmaz1, B. Cicek2, G. Kaner3 *. 1Department of Obesity,
Diabetes and Metabolic Diseases, Republic of Turkey, Ministry
of Health, Ankara, 2Faculty of Health Sciences, Department of
Nutrition and Dietetics, Erciyes University, Kayseri, 3Faculty of
Health Sciences, Department of Nutrition and Dietetics, Izmir
Katip Celebi University, İzmir, Turkey
Rationale: As the importance of sleep to physical and
psychological health becomes increasingly clear, there is a
growing need to establish the mechanisms through which the
relationships operate. This study aimed to investigate the
relationship between sleep quality, obesity and depression
among adolescents aged 14–17 years in Turkey.
Methods: According to the data obtained from the Kayseri
Provincial Directorate for National Education, 67 high-schools
located in Kayseri city center were accepted. Twelve schools
were selected amongst the 67 high-schools using the random
cluster sampling method. A total of 1,072 adolescents aged 14–
17 years were recruited into the study. Sleep quality was
assessed by the Pittsburg Sleep Quality Index (PSQI). Depression
symptomatology was measured using the Child Depression
Scale (CDS). Body weight and height were measured and body
mass index (BMI, kg/m2) were calculated.
Results: Of the adolescents; 43.9% (n = 471) were boys and
56.1% (n = 601) girls and the mean age was 15.54 ± 1.08 years.
Mean body weight and BMI were significant among genders
( p < 0.001). Depression was higher among girls (9.8%) than boys
(5.7%) ( p < 0.05). According to CDS, in the depressed group
body weight and BMI values were higher than the non-
depressed group but the difference is not statistically
significant. A negative weak relationship was determined
between PSQI and CDS (n = 1,072, r = 0.131, p = 0.000).
Conclusion: This study supports a negative relationship
between sleep quality and depression. Although statistically
insignificant, this study also suggests a putative link between
weight status and sleep quality.
Disclosure of Interest: None declared.
S146
SUN-P249
THE RELATIONSHIP BETWEEN BODY MASS INDEX, ABDOMINAL
OBESITY, METABOLIC PARAMETERS AND DEPRESSION AMONG
REPRODUCTIVE AGED WOMEN
G. Kaner1 *, E. Bellikci Koyu1, N. Seremet Kürklü2,
K. Tel Adıgüzel3. 1Faculty of Health Sciences, Department of
Nutrition and Dietetics, Izmir Katip Celebi University, İzmir,
2
Department of Nutrition and Dietetics, Akdeniz University
Antalya School of Health, Antalya, 3Faculty of Health Sciences,
Department of Nutrition and Dietetics, Hacettepe University,
Ankara, Turkey
Rationale: Obesity has been widely regarded as a public health
concern because of its adverse impact on individuals’ health.
The aim of this study is to examine the relationship between
body mass index, abdominal obesity, metabolic parameters and
depression among reproductive aged women.
Methods: Two hundred seventy-one women who applied to the
diet polyclinic of a state hospital in Izmir were included.
Sociodemographic characteristics were gathered using a data
collection form. Biochemical findings were examined in fasting
blood samples and anthropometric measurements were taken.
Depressive symptoms of participants were measured with Beck
Depression Inventory.
Results: Mean score of participants for Beck Depression
Inventory was 17.8 ± 11.8. Body weight, body mass index and
waist circumference were higher in the group with high level of
depressive symptoms ( p < 0.05). Fasting blood glucose, fasting
insulin, HOMA-IR, triglyceride and LDL cholesterol were also
higher in the group with high level of depressive symptoms; but
only HOMA-IR and triglyceride differences were statistically
significant. Being overweight or obese was associated with
increased risk of high level of depressive symptoms (OR: 4.853,
95% CI: 2.646–8.903). Although, the ratio of having high level of
depressive symptoms was higher in women with abdominal
obesity (%50.3) comparing to women without abdominal
obesity (%39.5), the difference was not statistically significant
( p = 0.078).
Conclusion: In this study, it was determined that the level of
depressive symptoms was higher in overweight or obese women
than women with normal body weight. It may be useful to
monitor women who apply for weight control in terms of risk of
depression.
Disclosure of Interest: None declared.
SUN-P250
ASSOCIATION BETWEEN METABOLIC SYNDROME AND CHRONIC
INFLAMMATION MARKERS
G. Kaner1 *, N. Seremet Kürklü2. 1Faculty of Health Sciences,
Department of Nutrition and Dietetics, İzmir Katip Çelebi
University, İzmir, 2Department of Nutrition and Dietetics,
Akdeniz University, Antalya School of Health, Antalya, Turkey
Rationale: The increase in proinflammatory cytokines due to
visceral fat causes low grade-chronic inflammation in indivi-
duals with the metabolic syndrome. C-reactive protein (CRP),
white blood cell (WBC) and ferritin levels are associated with
chronic inflammation. From this point of view, this study was
conducted to evaluate the relationship between metabolic
syndrome and chronic inflammatory markers.
Poster
Methods: A total of 298 women who applied to endocrinology,
internal medicine or diet clinic and did not diagnose with
metabolic syndrome or did not have an infection history were
included in this study. Anthropometric measurements (waist
and hip circumference) and fasting blood samples (fasting
blood glucose, triglyceride, HDL cholesterol, CRP, WBC,
ferritin) were taken. Metabolic syndrome was assessed accord-
ing to the International Diabetes Federation (IDF) criteria.
Results: The prevalence of metabolic syndrome was deter-
mined 34.2%. The levels of WBC and CRP were statistically
higher in women with metabolic syndrome (7.4 ± 2.45 mm3 and
1.5 ± 3.94 mg/dL; respectively) than in women without meta-
bolic syndrome (6.7 ± 1.45 mm3 and 0.7 ± 2.25 mg/dL; respect-
ively) while ferritin levels were not different between groups
( p > 0.005). In addition, waist circumference, which is the
indicator of abdominal obesity, was found to be positively
correlated with WBC (r = 0.287, p = 0.000) and ferritin (0.140,
p = 0.016).
Conclusion: In this study, it was determined that the metabolic
syndrome and increased waist circumference were associated
with chronic inflammation markers; and chronic inflammation
markers could be used to assess metabolic syndrome.
Disclosure of Interest: None declared.
SUN-P251
DO SOLUBLE TRANSFERRIN RECEPTOR LEVELS INCREASE IN
METABOLIC SYNDROME?
G. Kaner1 *, N. Seremet Kürklü2. 1Faculty of Health Sciences,
Department of Nutrition and Dietetics, İzmir Katip Çelebi
University, İzmir, 2Department of Nutrition and Dietetics,
Akdeniz University, Antalya School of Health, Antalya, Turkey
Rationale: The level of soluble transferrin receptor (sTfR) is
indicative of the organism’s need for the iron. In iron
deficiency, the level of sTfR increase. Since the metabolic
syndrome (MetS) is a chronic inflammatory process, serum iron
deficiency, elevated ferritin and sTFR are expected in
individuals with MetS. The aim of this study was to determine
the levels of sTfR in individuals with MetS. In addition, the
other aim of this study was to determine the relationship
between visceral fat and sTfR, the most important determi-
nants of MetS.
Methods: A total of 204 women aged 20–49 years who applied
to the diet clinics were included in this study. Body weight,
height, and waist circumference (WC) were measured; Body
Mass Index (BMI) was calculated based on the following
formula: body weight (kg)/height (m2). Fasting blood
glucose, triglyceride, sTfR levels were determined as well as
systolic and diastolic blood pressures were measured. The
prevalence of MetS was assessed according to the US National
Cholesterol Education Programme Adult Treatment Panel III
(NCEP-ATPIII) and the International Diabetes Federation (IDF)
criteria.
Results: Mean age, body weight, BMI, and WC of women were
the 33.3 ± 7.75 year, 77.6 ± 16.4 kg, 29.8 ± 6.28 kg/m2, 94.6 ±
12.92 cm; respectively. According to NCEP-ATPIII and IDF
criteria, 45.6% and 36.3% of women diagnosed with MetS,
respectively. There were no significant differences between
the sTfR levels of in women with and without MetS according to
both criteria. Although statistically insignificant, a low level of
Obesity and the metabolic syndrome 1
positive correlation between WC and sTfR levels were found
(r = 0.101, p > 0.05).
Conclusion: The increase in visceral fat-related inflammation
was associated with MetS and sTfR levels, no relationship was
found between sTfR levels, MetS and WC in this study. Lack of a
relationship between these parameters in this study may be
due to the inadequate sample size of the study.
Disclosure of Interest: None declared.
SUN-P252
EVALUATING THE EFFECTS OF BODY COMPOSITION ON
METABOLIC PROFILE IN PATIENTS WITH SCHIZOPHRENIA
I. Türkoğlu1 *, E. Akal Yıldız2, S. M. Mercanlıgil2, G. Yoca3,
K. Yazıcı4. 1Department of Nutrition and Dietetics, Hacettepe
University Faculty of Health Sciences, Ankara, Turkey,
2
Department of Nutrition and Dietetics, East Mediterranean
University Faculty of Health Sciences, Famagusta, Cyprus,
3
Ministry of Health Erbaa Government Hospital, Tokat,
4
Department of Psychiatry, Hacettepe University Faculty of
Medicine, Ankara, Turkey
Rationale: Treatment with certain atypical antipsychotics
(AAP) may act an important role, carrying increased risk for
adiposity and metabolic abnormalities in patients with
schizophrenia. The aim of this study was to clarify the impact
of body composition on metabolic profile in patients with
schizophrenia treated with AAP and to compare it with healthy
controls.
Methods: The study was conducted on 148 individuals with
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
diagnosis of schizophrenia or schizoaffective disorder and 77
age, gender matched healthy controls. We examined the
detailed body composition and antropometric measurements
(height, weight, waist and hip circumference, fat percentage,
fat mass and fat-free mass) of people with schizophrenia and
healthy controls.
Results: The patients and healthy controls were similar in age,
gender. Both in male and female, the mean body mass index
was not significantly different between groups ( p > 0.05). The
prevalence of metabolic syndrome was 54.5% in patients and
24.7% in healthy controls according to IDF criteria, respectively
( p < 0.01). The waist circumference of the patient group
(respectively, male 106.9 ± 10.9 cm, female 100.5 ± 12.9 cm)
was significantly higher than healthy controls (respectively,
male 94.7 ± 9.1 cm, female 91.6 ± 13.7 cm) ( p < 0.01). Also
women with schizophrenia had signifantly higher body fat
percentage, body fat mass and fat mass index than healthy
controls ( p < 0.05). When we examine individuals with MetS,
waist circumference of patient group (both in male and
female), was significantly higher than healthy controls
( p < 0.01).
Conclusion: Individuals with schizophrenia have metabolically
unfavorable body composition, comprising abdominal obesity,
high fat percentage. Fat mass relative to BMI was increased in
schizophrenia patients receiving AAP. This may lead to
increased risk of metabolic and cardiovascular diseases.
Disclosure of Interest: None declared.
S147
SUN-P253
PREVALENCE OF AND FACTORS ASSOCIATED WITH CHILDHOOD
OVERWEIGHT AND OBESITY IN PUBLIC SCHOOLS IN EL
SALVADOR. A CASE-CONTROLLED STUDY
J. W. Pena1 *, A. Oliva1. 1Medical Speciality, Universidad de El
Salvador, San Salvador, El Salvador
Rationale: The aim of this study was to assess the prevalence
and the factors associated with overweight and obesity among
children aged 5–9 years old in four urban public schools in El
Salvador.
Methods: A two phases cross-sectional study was conducted
from april to august, 2016. During the first phase, anthropo-
metric data was collected of 336 children aged 5–9 years, from
Suchitoto, El Salvador, and the corresponding body mass index
was calculated. The prevalence of overweight and obesity was
reported as percentage. During the second phase, 91 children
were identified as overweight or obese. Controls were matched
by age and gender. A personal interview was performed with
the parents of each participant to obtain background data. The
chi-square test was used to identify factors associated with
overweight and obesity.
Results: Childhood overweight and obesity prevalence was
34.5% (13.2% and 21.3%, respectively). The principal risk
factors found were maternal overweight or obesity at preg-
nancy onset (adjusted odds ratio [aOR] = 17.1, 95% confidence
interval: 4.5–110), high birth weight (aOR = 5.0, 95% IC: 1.1–
34.6) and a leisure time of more than two hours (aOR = 4.6, 95%
IC: 2.3–9.6). A protective factor was found to be a basic
education status of the mother (aOR = 0.43, IC = 0.2–0.9).
Conclusion: Childhood overweight and obesity have
significant prevalence in El Salvador, with every third child
being affected. This conditions are multifactorial. Familiar,
perinatal and posnatal history and current habits, as maternal
overweight or obesity at the pregnancy onset, and first degree
of consanguinity with overweight or obesity or with a chronic
disease and leisure time are significant factors associated with
childhood overweight and obesity. One protective factor was
found, the basic education status of the mother. Multicentric
studies are needed to confirm the findings.
Disclosure of Interest: None declared.
SUN-P254
OBESITY IS QUITE PREVALENT IN PATIENTS WITH
GASTROPARESIS
L. Maric1 *, S. Rodriguez1, A. Alvarez1, A. Cabrera2, F. Martinez3,
A. Schneider1, A. Ukleja1. 1Gastroenterology and Hepatology,
2
Internal Medicine, 3Radiology, Cleveland Clinic Florida,
Sunrise, United States
Rationale: Gastroparesis (GP) is a chronic disorder of gastric
motility defined as delayed gastric emptying of a solid meal in
the absence of mechanical obstruction. Clinical characteristics
of GP include early satiety, nausea, vomiting, upper abdominal
pain and bloating.
Methods: This was an IRB approved retrospective chart review
of 260 pts conducted at a tertiary center who underwent GES
from Jan to Dec 2015. 88 pts were diagnosed with GP using a 4-
hr gastric emptying scintigraphy, and were included in final
analysis. Data collected included pts age, sex, race, symptoms,
S148
etiology of gastroparesis, BMI, presence of other gastrointes-
tinal conditions, history of gastric surgery and narcotic use.
Results:
BMI GP: Mild Moderate Severe
Low 4 0 4
Normal 18 7 4
Overweight 14 4 7
Obesity (>30) 14 5 7
88 out of 260 pts met the inclusion criteria with presence
of delayed gastric emptying on GES. 82% of pts were Non-
Hispanic with mean age at diagnosis of 54. Mean BMI was
determined to be 26.8. In 88 patients with GP, nausea was
present in 63%, vomiting (42%), abd pain (55%) and bloating
(48%). The etiology of GP was idiopathic in 73% and diabetic in
20%. Regarding the BMI, 8 had low BMI, 29 had normal BMI (18.5–
24.9), 25 were overweight (25–29.9) and 26 were obese
(>/=30).
Conclusion: Based on our study population, majority of
patients were non-Hispanic females. The most common
etiology of GP is idiopathic. 58% of the patients with diagnosis
of GP were found to have BMI above normal, and 30% were
obese. There was a direct correlation between BMI >25 and
diagnosis of GP not only in diabetic group of patients, but also
in idiopathic and post-surgical patient population. Regarding
the severity of GP and BMI, 56% of patients with above normal
BMI were found to have mild or moderate GP, and 64% of
patients had severe GP. Despite the common concern, only 20%
of patients in our study population were on chronic narcotics.
Disclosure of Interest: None declared.
Paediatrics 1
SUN-P255
7TH PAEDIATRIC NUTRITION WEEK: 2016’s EDITION
A. De Luca1 *, C. Guidon1, D. Guimber2, N. Peretti3,
H. Piloquet4, R. Hankard1, on behalf of The Pediatric
Nutritional Assessment Network (www.epinut.fr). 1Unité
Mobile de Nutrition, CHU TOURS, INSERM U1069, Tours,
2
Paediatrics, CHU, Lille, 3Paediatrics, CHU, Lyon, 4CHU,
Nantes, France
Rationale: For 30 years, the prevalence of protein-energy
malnutrition (PEM) remains around 10% in Paediatrics wards.
Our aim was to assess the evolution of PEM frequency in our 7th
annual survey and to describe the role of the nursing staff in its
management.
Methods: This two-week observational cross-sectional survey
included patients under 18 admitted in participating centres.
All children were weighed and measured at admission. Children
below the 3rd centile of body mass index for age and sex had a
full diagnostic procedure, according to the guidelines of the
French Society of Paediatrics. Diagnoses and nutritional
supports were collected. Data were recorded on the e-Pinut
internet tool (www.epinut.fr). The role of caregivers in the
care of PEM was recorded by questionnaire for malnourished
children.
Poster
Results: Six countries participated, including 58 centres.
Among 1,926 observations collected, 1,781 were analysed
(mean age: 6.1 ± 5.3 years). A weight-for-height z-score
(Z-WFH) was <-2SD in 8% of cases: Ivory Coast 40% (n = 20),
Democratic Republic of Congo 18% (n = 84), France 8% (n =
1,583), Algeria 7% (n = 28), Gabon 6% (n = 17) and Belgium 5%
(n = 63). Nutritional support was present in 26% of cases. Fifteen
% of malnourished children had no nutritional support. Twenty-
one centres returned 147 questionnaires for the role of
caregivers. Child care assistants (CGAs) and nurses had a
major role in anthropometric measurements (85%), meal
(66%) and nutritional support delivery (53%). Dieticians had
a central role in nutritional plan (42%), dietary counselling
(50%) and explanations of nutritional support (57%). Nursing
care was perceived as increasing care in 41% of cases, including
for nurses (19%) and CGAs (10%), but only 2% of parents.
Conclusion: PEM frequency in hospitalized children appears to
decrease in this survey compared to previous editions. All
caregivers are involved in the management of PEM with a
pivotal role of nurses, CGAs, and dieticians.
Disclosure of Interest: A. De Luca Grant/Research Support from:
Nutricia Nutrition Clinique France, C. Guidon: None declared,
D. Guimber: None declared, N. Peretti: None declared, H. Piloquet:
None declared, R. Hankard: None declared.
SUN-P256
LIPID AND FATTY ACID INTAKE IS LINKED TO
ANTHROPOMETRIC PARAMETERS AT DIFFERENT MEALTIMES
IN CHILDREN
C. Mayorga-Mazón1,2 *, L. Ligerini1, C. Menendez1,
A. Monzón1, M. Guerendiain1,3. 1Metabolism and Nutrition
Disorders Research Group, 2School of Nursing, 3School
of Medicine, National University of Chimborazo,
Riobamba, Ecuador
Rationale: In childhood, the organism needs the contribution
of fatty acids for growth and developed, which become vital at
this physiological stage. Children living in Andean region of
Ecuador have greater nutritional vulnerability. For this reason,
our objective was to evaluate the relationship between lipid
and fatty acid intake and anthropometric parameters at
different mealtimes in children of highlands.
Methods: A cross-sectional descriptive study was developed in
98 children (5–11 years, 53.1% female) from San Juan,
Chimborazo, Ecuador (EVANES project participants). Lipid and
fatty acid (FA) intake was calculated at each mealtime
(breakfast, mid-morning collation, lunch, mid-afternoon col-
lation and dinner) from the data of nutritional survey. Weight
and height were measured, and the body mass index (BMI) and
standard deviation score of height and BMI were determined.
Results: Means of BMI, height, daily intake of total lipids and
saturated, monounsaturated and polyunsaturated FA were
16.74 ± 1.88 Kg/m2, 117.59 ± 12.22 cm, 16.45 ± 37.17 g, 18.17 ±
27.47 g, 18.64 ± 9.84 g and 9.97 ± 2.94 g, respectively. An
inverse relationship between total fat intake and weight,
height and BMI at mid-morning collation was observed, while
monounsaturated and polyunsaturated FA were negatively
related to BMI and standard deviation score-BMI, and weight
and BMI, respectively. A positive association was found
between saturated FA and BMI at lunch. Regarding dinner,
total fat was associated with weight and BMI.
Paediatrics 1
Conclusion: The relationship between total fat intake and
anthropometric parameters differs according to the mealtime.
At mid-morning collation, children with poorer nutritional
status consume more fats, but, at dinner, those with better
weight and BMI intake more lipids. Monounsaturated and
polyunsaturated FA are inversely related to anthropometry,
and saturated FA positively.
Disclosure of Interest: None declared.
SUN-P257
EVALUATION OF EDUCATIONAL EFFICIENCY BASED ON OREM’s
SELF-CARE THEORY GIVEN TO PARENTS OF CHILDREN WITH
GASTROSTOMY
D. Suluhan1 *, D. Yildiz2, B. Eren Fidanci2, I. Sürer3. 1Pediatric
Hospital, Gulhane Reserch and Trainig Hospital, 2Pediatric
Nursing, Health Sciences University, 3Department of
Pediatric Surgery, Gulhane Reserch and Trainig Hospital,
Ankara, Turkey
Rationale: This study was aimed to determinete of the effect
of based on Orem’s Self Care Theory educating on satisfaction
of gastrostomy feeding, quality of life, caregiver burden, state-
trait anxiety and complication rates regarding parents of
children with gastrostomy.
Methods: The study was conducted between January and July
2015 at GMMA Research and Training Hospital, Ankara
Hematology Oncology Children’s Hospital, Sami Ulus
Obstetrics, Children Health and Diseases Training and
Research Hospital. Between these dates, 78 mothers whom
have children with gastrostomy were included in the study.
Data were collected by Child and Parent Data Form,
Complication Checklist, Satisfaction of Gastrostomy Feeding
Scale, Caregiver Burden Scale, State-Trait Anxiety Scale,
Quality of Life Scale and Practice Check List. IBM Statistical
Package for Social Sciences 15.0 (SPSS) package program was
used for the statistical analysis of the data.
Results: All primary caregiver parents are mothers. 65.4% of
the mothers are between the ages of 21–30 and 43% of them are
primary school graduates. Mean score of Caregiver Burden
Scale is 47.52 ± 14.88 before the education and 35.07 ± 14.25
after the education ( p < 0.001). Mean score of Satisfaction of
Gastrostomy Feeding Scale is 18.48 ± 3.36 at the end of first
month after the training and 24.61 ± 2.94 at the end of third
months after the education ( p < 0.001). Mean score of State-
Trait Scale is 49.59 ± 3.16 before education and 44.20 ± 4.55
after education ( p < 0.001). After the education, it is deter-
mined other sub-dimensions of Quality of Life Scale mean score
increase except physical functioning ( p = 0.278) and pain
( p = 0.071) sub-dimensions compared to the before education.
Conclusion: As a result, after education which based on Orem’s
Self-Care Theory given to parents of children with gastrostomy,
it was found that primer caregivers’ outcomes were effected
positively.
Disclosure of Interest: D. Suluhan Grant/Research Support from: THE
SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY,
D. Yildiz: None declared, B. Eren Fidanci: None declared, I. Sürer:
None declared.
S149
SUN-P258
DETERMINATION OF KNOWLEDGE AND ATTITUDES OF
PEDIATRIC NURSES WORKING IN ATRAINING HOSPITAL ABOUT
PARENTERAL NUTRITION
D. Yildiz1 *, D. Suluhan1, S. Kiliç1. 1Gulhane Science Health
University, Ankara, Turkey
Rationale: Parenteral nutrition (PN) represents an alternative
or additional approach when other routes are not succeeding
(not necessarily having failed completely) or when it is not
possible or would be unsafe to use other routes. The main goal
of PN is to deliver a nutrient mixture closely related to
requirements safely and to avoid complications.
Methods: The study was carried outat the Department of
Pediatric Surgery and Department of Pediatrics between May 5
and June 01, 2012. The population of the study was consisted of
33 volunteered pediatric nurses. A quastionnaire was devel-
oped by the researchers.
Results: The score of nurses’ knowledge were minimum 48.75,
maximum 81.25 and median 61.75. Nurses knowledges were
25–60 (6.1%), 50.1–60 (24.3%), 60.1–70 (60.6%) and 70.1–80
(6%). The percent of nurses that scored over 80.1 was 3%. When
the education level was compared, it was found that there was
statistically significant diffirence between graduate and
undergraduate pediatric nurses’ score
Conclusion: It is recommended to plan in-service training for
pediatric nurses in order to ensure the desired level of
knowledge and skill and parenteral nutrition practices in safe
manner.
Reference
Singer P, et al., ESPEN Guidelines on Parenteral Nutrition: Intensive
care, Clinical Nutrition 28 (2009) 387–400.
Disclosure of Interest: None declared.
SUN-P259
EXTRAUTERINE GROWTH RETARDATION IN VERY LOW BIRTH
WEIGHT INFANTS AFTER CSPEN GUIDELINES FOR NUTRITION
SUPPORT IN NICU
H. Shan1 *, L. Hong1. 1Shanghai Children’s Medical Center,
Shanghai, China
Rationale: Extrauterine growth retardation (EUGR) in very low
birth weight (VLBW) infants indicates that the nutrient
requirements have not been adequately met intrauterine
growth. The aim of this study is to describe the growth and
nutritional practices in VLBW infants during NICU after CSPEN
guidelines for nutrition support in neonates (2013), and
compare the incidences of EUGR at discharge.
Methods: We retrospectively studied 227 VLBW infants (115
boys and 112 girls) from Shanghai Children’s Medical Center in
Shanghai from January 1, 2014 to December 31, 2016. When
admission, these infants were grouped small gestation age
(SGA) and appropriate gestation age (AGA). Growth retardation
was defined according to weight or head circumference
(HC) ≤10th percentile of the growth value expected based
on estimated postmenstrual age by Fenton Preterm Growth
Chart (2003). Nutritional practices were analyzed between
AGA and SGA.
Results: At discharge, the incidences of EUGR are 65.2% by
weight and 39.6% by HC. SGA had a significantly higher rate of
EUGR compared with AGA (97.8% vs 55.8% by weigh, p < 0.05;
S150
69.7% vs 32.0% by HC, p < 0.05). By brief parenteral nutrition
analysis, there were no significances of energy, glucose, amino
acid and lipid. There is significance of PN duration and the
use of PICC between AGA and SGA (31.4 VS 19.9, p < 0.05; 47.5%
VS 32.6%, p < 0.05). At the end of PN, there is significance
of calories percent in EN between AGA and SGA (67.5% VS
61.7%, p < 0.05). Meanwhile, Days to reach full feeds shows a
significance between the two groups (23.6 VS 15.0, p < 0.05).
Conclusion: The incidence of EUGR might be decreased after
CSPEN guidelines for nutrition support in neonates (2013). But
there is higher incidence of EUGR in AGA group, and SGA group
still shows growth retardation. It is crucial to determine the
optimal enteral nutrition for VLBW infants.
Disclosure of Interest: None declared.
SUN-P260
TOTAL INTELLIGENCE QUOTIENT IS ASSOCIATED WITH
MACRONUTRIENT AND ENERGY INTAKE IN PRESCHOOL AND
SCHOOL CHILDREN
I. Cando1,2, C. Mayorga-Mazón2,3, M. Guerendiain2,4 *. 1School
of Clinical Psychology, 2Metabolism and Nutrition Disorders
research group, 3School of Nursing, 4School of Medicine,
National University of Chimborazo, Riobamba, Ecuador
Rationale: Childhood is a critical period for brain development,
which may be affected by the nutrition. In Ecuador, especially
in rural and indigenous communities, children are more
vulnerable to food deficits. Therefore, our objective was to
explore the relationship between total intellectual quotient
and energy and macronutrient intake in preschool and school
children at different mealtimes.
Methods: Sixty-two schoolchildren (5–13 years), EVANES
project participants, were randomly selected. Total intelli-
gence quotient (IQ) was evaluated using Wechsler Preschool
and Primary Scale of Intelligence (WPPSI) and Wechsler
Intelligence Scale for Children (WISC), and was divided into
quartiles. To know the dietary intake a nutritional survey was
applied. Energy and macronutrients ( proteins, carbohydrates,
lipids and saturated, monounsaturated and polyunsaturated
fatty acids) were determined at different mealtimes (break-
fast, mid-morning collation, lunch, mid-afternoon collation
and dinner).
Results: The means of total IQ, energy, protein, carbohydrates,
lipids, saturated, monounsaturated and polyunsaturated fatty
acids were 80.82 ± 11.74 score, 206.80 ± 211.15 g, 4.58 ± 6.11 g,
33.39 ± 33.52 g, 6.52 ± 7.82 g, 1.08 ± 1.82 g, 1.28 ± 1.62 g and
0.90 ± 1.13 g, respectively. When we analyzed the relationship
between dietary intake and IQ, only at mid-morning collation
was found statistically significant associations. Thus, energy,
proteins, carbohydrates and total lipids were directly related
to total IQ. On the other hand, caloric intake was higher in Q4 of
total IQ than Q1, and total fat consumption was greater in Q3
than Q1.
Conclusion: The associations between variables were found
only at mid-morning collation, which is provided at school.
Children with higher energy and macronutrient intake have
better total intelligence quotient.
Disclosure of Interest: None declared.
Poster
SUN-P261
HOME PARENTERAL NUTRITION FOR PAEDIATRIC PATIENTS:
SAFETY, EFFECTIVENESS AND OUTCOME WHEN USING
STANDARD AIO ADMIXTURES
J. De Cloet1 *, E. Oudaert1, A. Somers1, S. Commeyne1,
M. Van Winckel2. 1Pharmacy Department, 2Paediatric
Gastroenterology Department, University Hospital Ghent,
Ghent, Belgium
Rationale: Since decades home parenteral nutrition (PN) for
patients suffering from intestinal failure is seen as the best
option to reduce hospital costs and to improve the quality of
life. Based on the ESPGHAN/ESPEN guidelines on PN for
paediatric patients, standard all-in-one PN admixtures
(STAIO) for 4 different weight categories were developed in
2008 at the University Hospital of Ghent: 3–10 kg (P1), 11–20 kg
(P2), 21–30 kg (P3) and >31 kg (P4). We aimed to evaluated the
effectiveness and safety of these STAIO in the home care
setting.
Methods: A single centre retrospective cohort study was
performed which included all patients <18 years that were
discharged on HPN sinds 2000. Children receiving individually
compounded admixtures (ICA; cohort 1) and children receiving
STAIO (cohort 2) were compared in terms of effectiveness and
complications of HPN. Data collected were: age at HPN onset,
duration, frequency and reason for HPN discontinuation,
composition of PN admixture, length and weight, catheter
related infections and occlusions and metabolic complications.
Results: The total cohort consists of 34 patients: 13 received
ICA, 18 received STAIO and 3 received both. Growth in terms of
weight and length were statistically significant in both cohorts.
After the implementation of the STAIO, the incidence of
catheter related bloodstream infections decreased from 2.39
to 1.16 episodes per 1000 HPN days and the incidence of
catheter occlusions from 0.65 to 0.24 events per 1000 HPN
days. A lower incidence of electrolyte (Na+, K+, Ca2+, Mg2+)
disturbances was reported for cohort 2. Abnormal liver function
tests were reported for 13 patients in cohort 2 with only 1
patient suffering from PN associated liver disease.
Conclusion: According to the findings in this study, we can
conclude that the STAIO are effective and safe for routine use in
a population of paediatric patients receiving HPN.
Disclosure of Interest: None declared.
SUN-P262
ANALYSIS OF FACTORS CONDUCIVE TO WEANING OFF HOME
PARENTERAL NUTRITION PROGRAM IN CHILDREN IN 2014–
2016
K. Tobota1 *, K. Popińska1, M. Danko1, K. Olszewska1,
M. Sibilska1, J. Zydak1, J. Ksiazyk1. 1Pediatrics Nutrition and
Metabolic Disorders, The Children’s Memorial Health
Institute, Warsaw, Poland
Rationale: There are around 125–130 patients every year on
Home Parenteral Nutrition (HPN) program in Children’s
Memorial Health Institute in Warsaw. 49 of them have been
weaned off the program due to distinct factors in 2014–2016.
Methods: Retrospective analysis of factors to weaned off HPN
in our hospital in years 2014–2016 including indications and
duration of HPN and nutritional status at the end of the
procedure.
Perioperative care 1
Results: At the beginning of HPN the age of patients was
between 2 and 221 month (range 6). At the end of the
procedure the age was between 6 and 268 (range 41). Duration
of HPN was between 0,5 and 221 months, range 53. Most of the
patients (37) was qualified for HPN because of partial resection
of small bowel. Second reason were neuromuscular bowel
diseases (6), then Crohn disease (2) and other factors (4). The
reasons of resections of small bowel were: intestinal torsion–6,
bowel obstruction-6, necrotizing enterocolitis (NEC)-4, mes-
enteric torsion-4, congenital gastroschisis-4, Pagoda’s syn-
drome-3, intestinal atresia - 3 and others-7. Most of the
patients (37) had preserved the ileocecal valve. From 10
patients who during parenteral nutrition have done intestinal
anastomosis half of them weaned off HPN in the first year after
the procedure, the rest-between 2 and 6 years. Patients after
congenital gastroschisis despite small resections of short
bowel, needed long-term parenteral nutrition (range 30
months). From 49 analyzed patients at the end of HPN 34
achieved regular weight and height according to WHO growth
charts.
Conclusion: The most frequent indication for HPN was
resection of small bowel. Essential factors to weaned off
parenteral nutrition were: length of small bowel, presence of
ileocecal valve and intestinal anastomosis. Nutritional status at
the end of HPN of most of the patients was satisfying.
Disclosure of Interest: None declared.
SUN-P263
HANDGRIP FORCE IN CHILDREN AND ADOLESCENTS WITH
CYSTIC FIBROSIS: IMPACT OF NUTRITIONAL AND
PULMONARY STATUS
K. Huysentruyt1 *, B. Hauser1, E. De Wachter2, A. Malfroot2,
K. Van De Maele3, I. Gies3, J. De Schepper3. 1Pediatric
Gastroenterology, 2Pediatric Pneumology, 3Pediatric
Endocrinology, Universitair Ziekenhuis Brussel, Vrije
Universiteit Brussel (VUB), Brussel, Belgium
Rationale: To analyze the hand grip strength (HGS) in relation
to nutritional and pulmonary status in children and adolescents
with cystic fibrosis (CF).
Methods: Hand grip data of CF children (aged 5–15 years)
having a body composition and lung function measurement at a
yearly follow up were analyzed. Body fat percentage (FM%)
calculated from skin fold measurements using the method of
Slaughter, was expressed as centile from the NHANES IV
database (FM% centile). Z-scores for weight (WFA), height
(HFA), body mass index (BMI) and mid-upper arm circumference
(MUAC) were calculated using Belgian reference data. HGS was
expressed as a percentage of the mean value of Belgian
reference data for the according age (%HGS). Forced vital
capacity (FVC) and forced expiratory volumes in one second
(FEV1) were expressed as % for age and body height.
Results: HGS was assessed 269 times in 60 (24 female) patients
(6 (10.3%) pancreas sufficient). Their mean (95% CI) WFA, HFA,
BMI and MUAC z-scores were −0.60 (−0.71;−0.48), −0.38
(−0.49;−0.26), −0.58 (−0.70;−0.45) and −0.59 (−0.70;−0.47)
and their median (Q1;Q3) FM% centile and FEV1 were 50 (25;50)
and 97% (84.8%; 105.7). Median (Q1;Q3) %HGS was 72.4%
(58.7%;85.4%). %HGS was not different according to sex
( p = 0.696) and pancreatic involvement ( p = 0.561). %HGS
correlated significantly ( p < 0.001) with WFA (r = 0.517), HFA
S151
(r = 0.459), BMI (r = 0.392) and MUAC (r = 0.402) and FEV1
(r = 0.325), but not with FM% centile (ρ = 0.10; p = 0.873).
Stepwise linear regression showed that %HGF was significantly
(F = 35.6, p < 0.001; r2 = 0.34) predicted by HFA (β = 0.368), FVC
(β = 0.181), age (β = 0.145) and BMI (β = 0.236).
Conclusion: CF children and adolescents have a lower handgrip
force in accordance with their nutritional status assessed by
standard anthropometry, irrespective of their pulmonary
status.
Disclosure of Interest: None declared.
Perioperative care 1
SUN-P264
THE IMPACT OF PREOPERATIVE EXCLUSIVE ENTERAL
NUTRITION IN MALNOURISHED PATIENTS WITH CROHN’s
DISEASE
A. S. Ferreira1 *, M. P. S. Costa1, C. Palmela2, S. Velho1,
J. Torres2, S. Ouro2, G. Luisa2, M. Cravo2. 1Nutrition, 2Hospital
Beatriz Angelo, Atouguia da Baleia, Portugal
Rationale: Our aim was to evaluate the impact of exclusive
enteral nutrition (EEN) in undernourished patients with
stricturing or penetrating CD and surgical indication.
Methods: Prospective study including CD patients with surgical
indication admitted at our institution between January 2016
and March 2017. Patients with BMI <18.5 kg/m2, weight
loss > 10% and/or serum albumin <3 g/dL received EEN supple-
mented with TGF beta for at least 2 weeks. Clinical (Harvey
Bradshaw- Index -HBI) and laboratorial parameters were
evaluated before and after EEN support. Surgical outcomes
were compared with patients with adequate nutritional status
who went for direct surgery.
Results: 20 patients were included, mean age of 43.8 ± 17.3
years. Of these, 7 underwent direct surgery and 13 performed
EEN, with compliance (higher than 75% of prescribed) in 85% of
patients (n = 11). Mean preoperative EEN duration was
43.4 ± 20.4 days. In the EEN group, we observed a significant
decrease in HBI mean value (9 vs 4, P < 0.001), CRP (12.2 vs
0.7 mg/dL, P = 0.003) and faecal calprotectin values (1003.1 vs
679, 3 μg/g p = 0.215); also, a significant increase in hemoglo-
bin (12.5 vs 13.5 g/dL, P = 0.061) and albumin (3.1 vs 4.1 g/dL,
P = 0.002) mean values was observed. A positive correlation
between duration of EEN and HBI decrease (r = 0.809, P = 0.003)
was observed. For fecal calprotectin decrease (r = 0.498,
P = 0.255), as well as increase in hemoglobin (r = 0.455,
P = 0.160) and albumin values (r = 0.489, P = 0.219) there was
a positive but non-significant correlation. Incidence of post-
operative complications (25% vs 37.5%, P = 1.000) and the
postoperative hospital stay (8.0 ± 5.4 vs. 8.1 ± 4.4 days,
P = 0.832) were similar in both groups.
Conclusion: Preoperative EEN in undernourished patients with
Crohn’s disease, decreased disease activity, possibly contrib-
uting for a better postoperative outcome.
Disclosure of Interest: None declared.
S152
SUN-P266
NUTRITIONAL STATUS OF COLORECTAL CANCER PATIENTS IN
KHOO TECK PUAT HOSPITAL, SINGAPORE
C. H. Toh1 *, H. Cheng1, K. Y. Tan2, M. Ho1. 1Nutrition &
Dietetics, 2Department of Surgery, Khoo Teck Puat Hospital,
Singapore, Singapore
Rationale: The aims of the study:
1. To study the prevalence of malnutrition in patients with
colorectal cancer who underwent surgery in KTPH,
Singapore;
2. To explore the validity of albumin, prealbumin and
Malnutrition Universal Screening Tool (MUST) in detecting
malnutrition in this population;
3. To investigate the effectivenss of a 2 week pre-operation
nutrition optimization in this patient population.
Methods: 36 colorectal cancer patients with a mean age of 68.3
years (±10.6) were recruited in this study. The mean BMI was
23.54 kg/m2 (±3.98). An objective assessment of nutritional
status was undertaken for all patients 2 weeks prior to surgery.
SGA and MUST were used to assess patients’ nutritional status.
Weight, height and BMI were obtained. Blood samples including
albumin and prealbumin were collected. BIA was performed to
assess patients’ muscle mass. For malnourished patients, a 2
week nutrition optimization (diet education + additional
600 kcal ONS) was provided. Above measurements were
repeated 1 day before or on the day of surgery for all patients.
Results: 16 (44%) patients were found to be malnourished by
using SGA. The mean body weight, peralbumin and albumin
level of these patients were 59.8 kg (±6.4), 16.1 d/L (±6.8) and
35.0 d/L (±4.9). The sensitivity of albumin, peralbumin and
MUST to detect malnutrition are 56%, 75% and 75% respectively,
whereas the specificity of these markers are 95%, 85% and 95%
respectively. After 2 weeks of nutrition optimization, patient’s
muscle mass and pre-albumin incresaed significantly by 0.9 kg
(±0.2) and 5.9 d/L (±1.4) respectively (P < 0.05).
Conclusion: 44% of colorectal cancer patients who underwent
colorectal surgery were malnourished. A 2 week nutrition
optimization intervention was found to be effective in
improving nutritional status of these patients. Prealbumin
and MUST can be used to identify malnutrition in these
patients.
Disclosure of Interest: None declared.
SUN-P267
NUTRICATT PROTOCOL: A NEW ITEM IN ERAS PROGRAM FOR
COLORECTAL CANCER SURGERY?
E. Rinninella1 *, M. Cintoni1, R. Persiani2, D. D’ugo2, A. Biondi2,
F. Pennestrì2, F. Scialanga1, L. Basso1, S. Leone1,
G. A. D. Miggiano1, A. Gasbarrini1, M. C. Mele1. 1Clinical
Nutrition, Gastroenterology Area, 2Abdominal and General
Surgery, Fondazione Policlinico Agostino Gemelli Roma, Rome,
Italy
Rationale: Nutritional support is considered a need in elective
gastrointestinal surgery. ERAS protocols are spreading in large
volume centers to enhance recovery after surgery (1,2).
Methods: In an ERAS program context, we developed a specific
nutritional protocol for elective patients awaiting surgery for
colon rectal cancer (NutriCatt). Clinical evaluation, nutri-
tional advices and a personalized diet were performed three
Poster
weeks before surgery. An early oral diet was given from one day
after surgery and continued until one month later.
Anthropometrics data, lab test and BIA Phase Angle (PhA)
were collected on several steps, from preadmission (3 weeks
before surgery), admission, after surgery, dimission and 1 month
after dimission. Mean lenght of hospital stay (LOS) was
registered. Data were compared using paired T-test and ANOVA
test. A p < 0.05 was considered statistically significant. Results
are expressed in mean and standard deviation and numbers.
Results: From February to September 2016, 100 consecutive
patients were enrolled. 55 were male, 45 female. Mean age was
67.8 (±12.4). At preadmission, mean weight, BMI and PhA were
71.4 (±15.3), 26.9 (±4.5), 5 (±0.86) respectively. At hospital
admission, no statistically differences were noted in the overall
population compared to preadmission data. However in >68
years old patients mean PhA significantly increased from 4.6 to
4.8 (±0.8) ( p = 0.02). Mean LOS was 5 (±3,6) days.
Conclusion: A personalized diet, started 3 weeks before
surgery is effective in improving nutritional status in more
frail and older patients waiting for colorectal cancer surgery
and may contribute to lower LOS.
References
1. Scott MJ, et al. ERAS® for gastrointestinal surgery, part 1:
pathophysiological considerations. Acta Anaesthesiol Scand.
2015;59:1212–31.
2. Gustafsson UO, et al. Guidelines for perioperative care in elective
colonic surgery: ERAS® Society recommendations. Clin Nutr.
2012;31:783–800.
Disclosure of Interest: None declared.
SUN-P268
AN EARLY NURSING NUTRITION INTERVENTION FOR
UNDERNOURISHED OUTPATIENTS PLANNED FOR SURGERY
H. V. Noort1 *, R. Ettema2, M. Heinen1, G. Huisman - de Waal1,
on behalf of the Basic Care Revisited Research Group. 1IQ
Healthcare, Radboud UMC, Nijmegen, 2Instituut voor
Verpleegkundige Studies, Hogeschool Urecht, Utrecht,
Netherlands
Rationale: Undernutrition among patients planned for surgery
influences outcomes, e.g. higher complication rates, longer
length of hospital stay (LoS) and increased mortality. The aim of
this study was to evaluate the feasibility and effectiveness of an
early nursing nutrition intervention (NNI) in outpatients
planned for surgery.
Methods: The NNI was performed in a multicentre pilot RCT.
Patients at risk for undernutrition, who received surgery
between June 2015 and September 2016, were randomly
assigned to receive either the NNI (nutritional advice, food
diary, counselling and telephone follow up before hospitalisa-
tion) or usual care. The outcome variables nutritional intake,
weight, and LoS were assessed by food diaries and medical file
analysis. Feasibility was assessed with nurses’ adherence to the
study protocol, and patients’ motivation to improve their
nutritional intake.
Results: From two anaesthesia outpatient clinics, 143 patients
participated in the study analysis. Nutritional intake was
significantly higher in the intervention group (IG). No differ-
ences in weight and LoS were found (Table 1). Counselling was
completed in 50% of the contacts. 83% of patients received the
two contacts as planned. 67% and 56% patients in the IG and
Perioperative care 1
control group were very motivated to increase their nutritional
intake (P = 0,036).
Conclusion: The NNI did improve nutritional intake and it is an
effective tool to decrease undernutrition in patients planned
for surgery. The NNI is feasible in patients planned for surgery,
but the intervention performance needs improvement.
Table 1: Outcomes for intervention and control group.
Control group Intervention Independent Sample
N = 73 group N = 60 T-Test (p-value)
Energy Intake in
Kcal/day
Mean (SD) 1,499 (665) 2,368 (865) 0.000
Protein intake
in gram/day
Mean (SD) 57 (28) 93 (31) 0.000
Length of stay
Mean (SD) 5.2 (8.9) 5.2 (5.8) 0.963
Change in Weight
in kg
Mean (SD) −0.5 (2.6) −0.3 (2.6) 0.754
Disclosure of Interest: None declared.
SUN-P269
ENHANCED RECOVERY PROGRAMS AFTER THORACIC
ESOPHAGEAL CANCER SURGERY FOR HIGH RISK PATIENTS
H. Sato1 *, Y. Miyawaki1, M. Aikawa1, K. Okamoto1,
S. Sakuramoto1, S. Yamaguchi1, I. Koyama1. 1Gastrointestinal
Surgery, Saitama International Medical Center, Saitama
Medical University, Hidaka-shi, Saitama, Japan
Rationale: Data on enhanced recovery programs after
thoracic esophageal cancer surgery for high risk patients
are sparse. The aim of this study was to evaluate the impact
of an enhanced recovery after surgery (ERAS) program in
patients with high risk who underwent a transthoracic
esophagectomy.
Methods: 33 patients who underwent a transthoracic esopha-
gectomy were put enrolled into ERAS program for high risk
patients (Group H). This group was then compared with a group
of 99 patients who had a standard risk (Group S). The outcome
measures comprised the morbidity rate, the average post-
operative days when the patients started walking and enteral
nutrition, postoperative pneumonia, anastomotic leak, and
length of postoperative hospital stay and readmission rates
within 30 days. This was a retrospective study.
Results: The morbidity, anastomotic leak, postoperative
pneumonia and readmission rates were 52%, 21%, 9% and 0%,
and 39%, 13%, 6% and 1%, in Groups H and S, respectively
( p < 0.01, n.s, n.s, and n.s). The average postoperative days
when the patients started walking and enteral nutrition in
Groups H and S were 1.0, 1.4 and 1.2, 1.0 days, respectively
( p < 0.01, and n.s). The length of postoperative hospital stay
was reduced in Group S in comparison to that in Group H
(average 21.7 versus 32.3 days; p < 0.01).
Conclusion: Groups H was inferior in starting walking, hospital
stay and mortality rate, compared with group S. However, there
were no statistical differences in morbidity rates including
postoperative pneumonia. Even in high risk patients, an ERAS
protocol is managed safely and is effective for the prevention of
postoperative complications.
Disclosure of Interest: None declared.
S153
SUN-P270
IMPACT OF SARCOPENIA ON PREOPERATIVE PULMONARY
FUNCTION IN HEPATO-BILLIARY PANCREATIC CANCER
H. Shirai1 *, T. Kaido1, S. Okumura1, S. Yao1, A. Kobayashi1,
Y. Hamaguchi1, S. Yagi1, N. Kamo1, H. Okajima1, S. Uemoto1.
1
Division of Hepato-Biliary-Pancreatic Surgery and
Transplantation, Department of Surgery, Kyoto University,
Kyoto, Japan
Rationale: The impact of sarcopenia on preoperative pulmon-
ary function in hepato-billiary pancreatic (HBP) cancer patients
remains unclear.
Methods: This study comprised 461 patients with hepatocel-
lular carcinoma (HCC), 180 patients with bile duct cancer (BDC)
and 297 patients with pancreatic cancer who underwent
resection between 2003 and 2015. Using preoperative CT
imaging at the L3 level, the quantity and quality of skeletal
muscle were evaluated by psoas muscle mass index (PMI) and
intramuscular adipose tissue content (IMAC), respectively. (1)
The correlation between preoperative pulmonary function and
sarcopenic factors. (2) Preoperative pulmonary function
according to preoperative sarcopenia status based on the sex-
cut-off values for PMI and IMAC.
Results: (1) In males, PMI was significantly correlated with
preoperative VC and FEV1.0 in HCC patients, VC and FEV1.0 in
BDC patients, and %VC, VC, and FEV1.0 in pancreatic cancer
patients. IMAC was significantly correlated with preoperative
VC and FEV1.0 in HCC patients, %VC, VC and FEV1.0 in BDC
patients, and FEV1.0% and FEV1.0 in pancreatic cancer
patients. In females, IMAC was significantly correlated with
preoperative VC and FEV1.0 in HCC patients and VC and FEV1.0
in pancreatic cancer patients.
(2) In males, preoperative %VC, VC, FEV1.0 in HCC patients, VC
and FEV1.0 in BDC patients and %VC, VC in pancreatic cancer
patients were significantly lower in the preoperative sarcope-
nia group than in the normal group. In females, preoperative
pulmonary function had no significant difference between the
two groups.
Conclusion: Preoperative sarcopenia has a strong negative
impact on pulmonary function in HBP cancer patients.
Disclosure of Interest: None declared.
SUN-P271
PERCUTANEOUS ENDOSCOPIC DERIVATION STOMA (PEDS) VS
VACUUM THERAPY IN ENTERO-ATMOSPHERIC FISTULA
PATIENTS
J. Sobocki1 *. 1Department of General Surgery and Clinical
Nutrition, Medical Universty of Warsaw, Warsaw, Poland
Rationale: Patients with entero-atmospheric fistula (EAF) are
characterized with high nutritional loses from fistula, long
hospital stay and high mortality.
The aim of the study was to evaluate effects of percutaneous
endoscopic derivation stoma (PEDS) vs vacuum therapy with
regard to nutritional improvement and time to hospital
discharge.
Methods: Twenty patients with EAF were included into the
study and divided into two groups: A- PEDS and B – vacuum. All
patients were fed totally parenteraly. The following para-
meters were evaluated: time to patient mobilization, vigour
improvement in one week time (self estimation scale −3 to +3),
S154
number of stoma bag/dressing replacement per day, weight
gain in 4 weeks, time to discharge from hospital. PEDS is a
percutaneously introduced catheter to the small bowel, placed
proximally to fistula with endoscopic assistance and accom-
panied with fistula closure by running suture.
Results:
A B
Avr. age 61,5 58,0
Avr. area of EAF (cm2) 381 320
Time to total patient mobilization (days) 3 22
Vigour improvement in one week time +2 −1
(self estimation)
Number of stoma bag/dressing replacement 1 2,2
per day
Weight gain in 4 weeks 2,1 −0,5
Albumine (at admission/after 4 weeks) mg% 1,7/2,4 1,9/2,1
Time to discharge 41 118
Time to reconstructive surgery (months) 10,5 15,1
The following complications were observed: PEDS – one
bleeding from suture site of the fistula, one suture leak, both
successfully treated with another suture placement. Vac-
therapy- bleeding from area covered by sponge (two pts), air
leak requiring replacement of dressing (3 pts several times, 6
pts at least 3 times).
Conclusion: PEDS facilitates mobilization of patients, stoma
care and weight gain, shortens time to discharge from hospital
and definitive reconstructive surgery.
Disclosure of Interest: None declared.
SUN-P272
ASSESSMENT OF THE IMPLEMENTATION OF THE PERI-
OPERATIVE NUTRITION ERAS GUIDELINES IN ELECTIVE
COLORECTAL SURGERY PATIENTS IN A TERTIARY HOSPITAL IN
SOUTH AFRICA
J. Visser1 *, J. Kotlowitz1, J. Kriel2, N. Ahmed3. 1Human
Nutrition, Stellenbosch University, Tygerberg, 2Fresenius-
Kabi, Cape Town, 3Tygerberg Academic Hospital, Tygerberg,
South Africa
Rationale: Implementation of the ERAS guidelines in South
Africa is yet to be studied and has the potential to lower costs
for the public health system. Understanding the current
practices and barriers to implementation will allow for
targeted strategies for effective implementation.
Methods: An observational descriptive cohort study was
conducted. Thirty colorectal surgery patients were observed
via the use of an observational checklist and an interviewer-
administered questionnaire. Knowledge, attitudes, practices
and barriers to implementation were assessed via a self-
administered questionnaire to 58 Health Care Professionals
(HCP’s).
Results: Seventy percent of patients were weighed on
admission. Patients were fasted pre-operatively from solids
and liquids for a mean of 19.5 hours (SD 13.2) and 14.92 hours
(SD 7.8) respectively. Pre-operative carbohydrate loading
drinks were not received by any patients. Patients were
fasted for a mean of 13.64 hours (SD 8.6) post-operatively.
The mean knowledge score of HCP’s was 36% (SD 27.7). Seventy
three percent of nurses reported weighing patients on
admission and 71% of HCP’s reported not ordering a
Poster
pre-operative carbohydrate drink. HCP’s reported advising
pre-operative fasting from solids and liquids for a mean of 9.59
hours (SD 5.69) and 4.30 hours (SD 4.31), respectively. Seventy
five percent of HCP’s reported advising post-operative fasting
according to ERAS guidelines. Lack of co-operation of the
multidisciplinary team, resistance to change and the lack of a
formal ERAS policy were identified as major barriers to
implementation.
Conclusion: Implementation of the ERAS guidelines was found
to be lacking. This study highlights the need for implementa-
tion of ERAS guidelines in South Africa and will assist in
developing targeted strategies for successful implementation.
Disclosure of Interest: J. Visser: None declared, J. Kotlowitz: None
declared, J. Kriel Other: Janine Kriel is employed by Fresenius Kabi
South Africa as a clinical nutrition sales representative. She is not
working in a management position and her current position had no
impact on this descriptive observational study. The research project
was conceptualised with the rest of the authors while Janine was a
clinical dietitian at Tygerberg Hospital., N. Ahmed: None declared.
SUN-P273
THE EFFECTS OF ORAL ADMINISTRATION OF CYSTINE/
THEANINE DURING THE PERIOPERATIVE PERIOD IN PATIENTS
UNDERGOING LAPAROSCOPIC COLORECTAL SURGERY: A
PILOT STUDY
K. Hiyama1 *, H. Terashima2, H. Tsukizaki1, Y. Sumi1, Y. Nakano1,
F. Imamura1, M. Kamiga1. 1Surgery, Hitachi Ltd, Hitachinaka
General Hospital, 2Hitachinaka Medical Education and
Research Center, University of Tsukuba Hospital,
Hitachinaka, Japan
Rationale: Cystine and Theanine (CT) are known to have
immunomodulatory effects such as attenuating inflammation.1
The aim of this study was to examine whether perioperative
supplementation with CT can achieve more prompt recovery in
the setting of minimally invasive surgery.
Methods: Until December 2016, 25 colon cancer patients aged
75 or younger, who had no other abdominal surgical history than
appendectomy, were randomly assigned to two groups: CT
group (13 patients) and control group (12 patients). In CT
group, patients received CT supplement (Cystine & Theanine,
Ajinomoto Co.) containing Cystine 700 mg and Theanine
280 mg for continuous 10 days (5 days before to 5 days after
surgery). All procedures were planned through laparoscopic
surgery. The postoperative data such as serum C-reactive
protein (CRP) levels, appetite, bowel motility and fluid therapy
were recorded for each patient of two groups.
Results: All of CT group could complete CT supplementation
without side effects such as GI discomfort. There were no
significant differences in patient characteristics. No significant
differences in CRP levels on POD1/3 could be seen. There were
also no significant differences in bowel motility such as time to
first flatus and defecation. CT group had significantly higher
appetite scores on POD1 (P = 0.022), leading to a significant
reduction in the total volume of infusion (P = 0.044).
Conclusion: Despite the fact that anti-inflammatory proper-
ties could not be detected in terms of CRP and bowel motility,
perioperative CT supplementation might prevent post-
operative loss of appetite and thereby ensure effectively
reducing fluid administration, suggesting the clinical benefit in
accelerating nutritional independence by mouth.
Protein and amino acid metabolism 1
Reference
1. Kurihara S, et al., Cystine and theanine: amino acids as oral
immunomodulative nutrients, SpringerPlus 2013;2:635.
Disclosure of Interest: None declared.
SUN-P274
ENHANCED RECOVERY AFTER SURGERY BY PERIOPERATIVE
SUPPORT CENTER -REALIZATION OF EARLY DRINKING,
EATING, MOBILIZING (DREAM) AND STUDY OF RECOVERY
SURVEY-
K. Ushigome1, H. Taniguchi1 *, M. Takenouchi1. 1saiseikai
Yokohamashi Tobu Hospital, Yokohama-City, Kanagawa, Japan
Rationale: Tobu Hospital Perioperative Support Center (TOPS)
has provided medical care team focusing on nutrition and pain
management that achieves early postoperative drinking,
eating, and mobilizing (DREAM).
Methods: The study was a prospective controlled interven-
tional study. We investigated the TOPS support intervention
effects by evaluating recovery outcomes of patients undergoing
gastrointestinal surgery by using the Japanese version of the
quality of recovery score (QoR-40J). The subjects included 28
patients before the intervention, and 30 patients after the
intervention. In addition, the TOPS support intervention
effects on POD1 were evaluated retrospectively using the
numerical rating scale (NRS). The subjects were patients
undergoing gastrointestinal surgery. A logistic regression
analysis was performed in 77 patients who received pre-
intervention (group A), 164 patients who received post-
intervention(group B), and 38 patients with a pain treatment
protocol(group C).
Results: Regarding results of QoR-40J in the long-stay group,
post-intervention ‘pain’ scores were significantly better than
pre-intervention ‘pain’ scores (P < 0.05). In group L, post-
intervention ‘emotional condition’ scores on POD1 tended to be
better than pre-intervention ‘emotional condition’ scores on
POD1. Among patients with an NRS score of <3, NRS score
decreased in the following group order: A > B > C. The number
of patients with an NRS score of 0 in group C was higher than
that in groups A and B.
Conclusion: In groupL, recovery rates of ‘pain’ and ‘emotional
condition’ on POD1 and ‘total score’ on POD1 and 3 were
significantly higher, showing the effect of the TOPSsupport
intervention. Thus, the support intervention at the TOPS
improves the recovery rate of postoperative patients.
Disclosure of Interest: None declared.
SUN-P275
THE INCIDENCE-RATE OF REFEEDING LIKE SYNDROME (RLS)
AND THE RELATION TO SODIUM BALANCE IN PATIENTS
ADMITTED FOR ACUTE G-I SURGERY
K. K. Mikkelsen1 *, M. Djurhuus1, V. A. Lin2, T. Boel2,
A. W. Volby3, J. R. Andersen1. 1Department of Nutrition,
Exercise and Sports, University of Copenhagen, 2Section for
Acute Surgery D 105, Department of Gastroenterology, Herlev
Hospital, Copenhagen, 3Department of Surgery, Holbæk
Hospital, Holbæk, Denmark
Rationale: The incidence rate of refeeding syndrome (RFS),
which is characterised by acute electrolyte and water
S155
disturbances and associated metabolic abnormalities, is
unknown among acute gastrosurgical patients without pre-
ceeding periods with semi-starvation. Both RFS and refeeding
phenomenon (RFF), characterised by a drop in plasma
phosphate, is observed among this group of patients, where
symptoms have been oedema and hypotension. This study seeks
to enlighten the undescribed condition, here named refeeding-
like syndrome (RLS). We wanted to establish the incidence rate
of RLS and determine, if a dose-response relationship exists
between RLS and a positive sodium balance in acute gastro-
surgical patients.
Methods: The incidence rate was observed by the means of a
prospective cohort study. The hypothesis regarding a dose-
response relationship was investigated by dividing the partici-
pants into three groups based on their sodium balance.
Results: A significant positive correlation between develop-
ment of RLS and the degree of a positive sodium balance was
found, both when dividing the groups by the cumulated and
mean sodium balances. The incidence rate of RLS was 1/3,45
person-days. The highest rate (1/1,00 person-days) was
observed in participants (N = 6) with positive balances within
the interval of [330,54–559,95] mmol/day. Determination of
the threshold for this relationship is affected by a low number
of participants in the group with the most positive balances.
The results can therefore be associated with type-2 error. It was
not possible to detect an association between low sodium fluid
therapy during operation and the development of RLS.
Conclusion: The existence of a dose-response relationship
between a positive sodium balance and the development of RLS
is possible. Further investigation is needed to determine if a
causal-relation exists.
Disclosure of Interest: None declared.
Protein and amino acid metabolism 1
SUN-P276
PROTEIN RESTRICTED DIET DURING GESTATION AND/OR
LACTATION IN MICE AFFECTS ORGANs’ 15N NIA IN THE
OFFSPRING: EFFECT OF DIET 15N CONTENT AND GROWTH
K. Bernardo1, C. Jousse2,3, P. Fafournoux2,3, R. Robins4,5,
R. Hankard1,6, A. De Luca1 *. 1Unité Mobile de Nutrition, CHU
TOURS, INSERM U1069, Tours, 2University, 3INRA UMR 1019,
Clermont-Ferrand, 4University, 5CEISAM, CNRS UMR 6230,
Nantes, 6University, Tours, France
Rationale: This study aimed at measuring the effect of 15N NIA
of normal to restricted protein diets given during gestation
and/or lactation and growth on organs’ 15N NIA in dams and the
offspring.
Methods: Female mice were fed normal diet (ND) containing
22% protein or isocaloric low protein diet (LPD) 10% protein
throughout gestation. At birth litters were equalized and dam’s
diet either maintained (ND-ND or LPD-LPD) or switched to the
other diet (ND-LPD or LPD-ND) until weaning at d30. All animals
were fed standard chow thereafter (A03). Offspring were
sacrificed at d1, d11, d3, d60, d480 and dams at d1. Growth was
modeled as an exponential function on the group followed up
until d480. Fur, liver and muscle were sampled at sacrifice and
analyzed for bulk 15N NIA using irm-MS coupled with elemental
analyzer after combustion. We used two-way ANOVA to test for
S156
fixed effect and interactions between fixed effects and random
element. Post-hoc tests were performed using Tukey test for
more than two groups.
Results: Higher 15N NIA in the diet resulted in higher organ 15N
NIA. Switching from one diet to another changed 15N NIA in each
organ. Although dam and offspring shared the same isotopic
environment during gestation 15N NIA at d1 was higher in dams.
Growth rate did not differ between groups and decreased from
m1 to m5. 15N NIA differed between organs and was affected by
growth and gestation/lactation.
Conclusion: Diet 15N NIA is a major determinant of organs’ 15N
NIA. 15N NIA depended on organ and age i.e. growth suggesting
an effect of metabolism and/or dilution space. Post-natal NP
regimen of lactating dams could reverse the effect of a protein-
restricted diet during gestation on the offspring growth.
Measuring 15N NIA in various matrices may open a field of
application particularly useful in the pre- and post-natal origins
of health and disease.
Disclosure of Interest: None declared.
SUN-P277
METABOLIC PHENOTYPING TO PROVIDE INSIGHT IN
MECHANISMS UNDERLYING MUSCLE WEAKNESS AND WASTING
IN PATIENTS WITH CANCER
B. S. Van Der Meij1,2,3 *, N. E. Deutz1, R. E. Rodriguez4,
F. Koeman1, T. C. Smit1, M. P. Engelen5. 1Center for
Translational Research in Aging and Longevity, Texas A&M
University, College Station, United States, 2Faculty of Health
Sciences and Medicine, Bond University, Gold Coast, 3Nutrition
and Dietetics, Mater Group, Brisbane, Australia, 4Division of
Hematology/Oncology, Scott and White Memorial Hospital,
College Station, United States, 5Center for Translational
Research in Aging and Longevity, Texas A&M University, College
Station, Australia
Rationale: Cancer is characterized by low plasma concentra-
tions of arginine (ARG), glutamine (GLN) and citrulline (CIT).
This study investigates the relationship between glutamine-
related metabolism and muscle strength in patients with
advanced cancer using metabolic phenotyping.
Methods: In 16 patients with solid tumours (C) and 16 age- and
gender-matched healthy controls (H), fasted plasma amino acid
concentrations and whole body ARG, GLN, CIT and GLU rates of
appearance (Ra) were assessed by pulse IV administration of L-
[Guanidino-15N2]-Arginine, L-[5–15N]-glutamine, L-[ureido-
13C-2H2]-Citrulline, L-[1,2–13C2]Glutamate and 2H3-Leucine
(LEU), and clearance rates calculated. Handgrip, inspiratory
and leg muscle strength and physical function (EORTC-QLQc30
questionnaire) were assessed, and amino acid concentrations
and isotope enrichments by LC-MS/MS. Statistics was done by
unpaired t-tests and spearman correlation tests.
Results: Ra and clearance rate of GLN were higher in C than in H
(Ra GLN: 491.4 ± 32.0 vs. 325.2 ± 51.5 μmol/kg ffm/h, p =
0.008, clearance GLN 1.13 ± 0.08 vs 0.70 ± 0.09, p < 0.001) as
well as that of the GLN related amino acids ARG, CIT and LEU
( p < 0.05). The conversion of ARG to CIT (marker of NO
synthesis), CIT to ARG (de novo ARG production) and GLU to
GLN (marker of muscle GLN production) were also higher in C
(P ≤ 0.01) and negatively correlated to FFMi (r < −0.5,
P < 0.05). Plasma BCAA was positively correlated to handgrip
and inspiratory muscle strength, and physical function (R > 0.4,
Poster
P < 0.05). RaCIT was negatively related to leg extension
strength (r = −0.7, P < 0.01).
Conclusion: Metabolic phenotyping using novel tracer pulse
methodology showed that disturbances in glutamine related
metabolism are associated with muscle wasting and weakness
in patients with cancer.
Disclosure of Interest: B. Van Der Meij Grant/Research Support from:
ESPEN Research Fellowship, N. Deutz: None declared, R. Rodriguez:
None declared, F. Koeman: None declared, T. Smit: None declared,
M. Engelen: None declared.
SUN-P278
PROGESTERONE-REGULATED ARGININE DECLINE AT LUTEAL
PHASE OF THE MENSTRUAL CYCLE AND ASSOCIATIONS WITH
RELATED AMINO ACIDS AND DERIVATIVES AND NUCLEAR
FACTOR KAPPA B P65 ACTIVATION
B. M. Winklhofer-Roob1 *, G. Faustmann1,2, A. Meinitzer3,
C. Magnes4, B. Tiran3, B. Obermayer-Pietsch5, H.-J. Gruber3,
J. Ribalta6, E. Rock7, J. M. Roob2. 1Human Nutrition &
Metabolism Research and Training Center, Institute of
Molecular Biosciences, Karl Franzens University of Graz,
2
Clinical Division of Nephrology, Department of Internal
Medicine, 3Clinical Institute of Medical and Chemical
Laboratory Diagnostics, Medical University of Graz, 4HEALTH,
Institute of Biomedicine and Health Sciences, Joanneum
Research, Forschungsgesellschaft m.b.H., 5Clinical Division of
Endocrinology, Department of Internal Medicine, Medical
University of Graz, Graz, Austria, 6Unitat de Recerca de Lipids I
Arteriosclerosi, Facultat de Medicina, Universitat Rovira I
Virgili, Tarragona, Spain, 7Unité de Nutrition Humaine, Centre
Auvergne Rhône-Alpes, Institut National de la Recherche
Agronomique, Clermont-Ferrand, France
Rationale: Given their role in female reproduction, the effects
of progesterone on arginine (Arg) and related amino acids as
well as polyamines and NF-κB p65 activation were studied
across the menstrual cycle.
Methods: Plasma Arg, ornithine (Orn), citrulline (Cit), lysine
(Lys), homoarginine (hArg), asymmetric dimethylarginine
(ADMA), putrescine (Put), spermidine (Spmd), spermine
(Spm), and N-acetyl-putrescine (AcPut) were determined, as
were NF-κB p65 activation in peripheral blood mononuclear
cells and serum progesterone in 28 women at early (T1) and late
follicular (T2) and mid (T3) and late (T4) luteal phase.
Results: (a) Increase from T1 and T2 to T3 and T4 in
progesterone and decrease in Arg (−20%; to ∼10th percentile
of men), Orn, Cit and Lys, as well as hArg and ADMA; (b) Inverse
regressions on progesterone of Arg, Orn, Cit and Lys, as well as
of ratios Arg to ADMA and Orn to Put, Spmd, Spm, and AcPut,
resp; (c) Inverse regressions on changes in progesterone of
changes T3-T2 in Arg, Orn, Cit and ADMA, and changes T3-T2 in
ratios Arg to ADMA, Arg to Cit and Orn to Put, Spmd and Spm,
resp. At T3, positive relations of Orn, Cit and Lys with Arg, and
of hArg with both Arg and Lys. Positive relations of changes (T3-
T2) in Arg with changes in Orn, Cit and ADMA; (d) Positive
relation of NF-κB p65 activation with Arg at T2. All results
P < 0.001 or P < 0.01.
Conclusion: These data provide strong evidence of a physio-
logical regulatory node aimed at preparing for successful
pregnancy, including progesterone-regulated luteal phase-
specific declines in Arg and related amino acids, and linking
Protein and amino acid metabolism 1 S157

reduced Arg at luteal phase to the role of NF-κB p65 in the
TH1-TH2 immune response shift required for materno-fetal
immune tolerance. For the first time, longitudinal changes
were shown for hArg and ADMA, which were closely related to
(changes in) Arg.
Disclosure of Interest: None declared.
SUN-P280
REALLOCATION OF ENERGY FLUX TO PROTEIN SYNTHESIS BY
CITRULLINE IN MUSCLE CELLS
A. Goron1, S. Blanchet2, E. Fontaine1, C. Moinard1 *. 1LBFA,
INSERM U1055, Université Grenoble Alpes, 2Institute for
Advanced Biosciences, Grenoble, France

SUN-P279 Rationale: Citrulline (CIT) is known to stimulate muscle protein

MODULATION OF MUSCLE PROTEIN SYNTHESIS BY AMINO synthesis. However, protein synthesis has an important energy
ACIDS: CONSEQUENCES ON THE SECRETOME – A PRELIMINARY cost and the regulation of energy metabolism by CIT is not
IN VITRO STUDY known. Thus, we proposed to determine the CIT effect on
protein synthesis and on the energy metabolism.
C. Breuillard1 *, A. Goron1, V. Cunin2, S. Bourgoin-Voillard2, Methods: Myotubes derived from primary culture of mouse
M. Sève2, C. Moinard1. 1Laboratory of Fundamental and myoblasts were used. Cells were incubated in a complete DMEM
Applied Bioenergetics, INSERM U1055, 2Laboratory of medium (Ctrl+) or in a DMEM medium without amino acid nor
Fundamental and Applied Bioenergetics, INSERM U1055, serum for 16 h (in order to decrease protein synthesis) followed
Proteomic plateform PROMETHEE, Grenoble Alpes University, by an incubation for 2 h without (Ctrl−) or with CIT (5 mM) (CIT)
Grenoble, France (n = 8/group). Then, cells were lysed in order to measure
protein synthesis by SUnSET method, or cells were used to
Rationale: Recently, a new view has emerged regarding muscle
measure the respiration by oxygraphy (using Seahorse) at the
functions, in particular its capacity to secrete proteins.
basal state and after inhibitors addition (cycloheximide (40 μM)
However, its nutritional regulation is largely unknown. Since
for protein synthesis, ouabaïne (300 μM) for Na+/K+ pumps or
amino acids (AA) are major regulator of muscle function, we
actinomycine D (10 μM) for DNA/RNA synthesis). This approach
propose to investigate the in vitro effect of hyperaminoacide-
allows to evaluate the energy part of these energy-consuming
mia (HAA) or specific AA (citrulline -Cit- or leucine -Leu-) on
processes.
muscle protein synthesis (MPS) and on the modulation of
Results:
muscle secretome.
Methods: Myotubes stemming from mouse primary culture of
Ctrl+ Ctrl- CIT
myoblasts were incubated in DMEM without serum (DMEM+) or
without serum and AA (DMEM−)±5 mM Cit (CIT) or 5 mM Leu Protein synthesis (A.U.) 100 ± 3a 65 ± 3b 88 ± 4c
Respiration allocated to protein 41 ± 1a 36 ± 1b 46 ± 2c
(LEU) for 14 h (n = 6). Culture media were pooled to analyze synthesis (%)
secretome by a proteomic approach (using an iTRAQ labeling Respiration allocated to Na+/K+ 15 ± 1a 17 ± 1a 15 ± 1a
and LC-MALDI-MS/MS analysis) and cells were lysed to evaluate pumps
MPS with SUnSET method. Respiration allocated to DNA/RNA 13 ± 1a 16 ± 1a 14 ± 1a
synthesis
Results: HAA, Leu or Cit addition stimulated the MPS compared Estimation of remaining 31 ± 2a 31 ± 1a 25 ± 2b
to control without AA (DMEM+: 154 ± 4, CIT: 136 ± 7, LEU: respiration allocated to others
131 ± 4 vs DMEM−: 100 ± 5, UA; p < 0.05). Concerning the energy expenditures (%)
secretome, HAA was able to mostly upregulate proteins Anova + bonferroni test. Values with different superscript letters are significantly
involved in cell development and angiogenesis (i.e. Sema3c, different (p < 0.05).
Sema3d, Follistatin-related protein 1, Angiopoietin-like 2,…)
whereas it downregulated proteins involved in calcium homeo- Conclusion: CITenhances muscle protein synthesis (+36%) via a
stasis (i.e. FKBP1A, Metastasin, Phosphohistidine phosphatase reallocation of energy flux to protein synthesis (+27%).
1,…). The modulation of secretome by Leu is widely different Disclosure of Interest: A. Goron: None declared, S. Blanchet: None
since mostly downregulated proteins are related to cytoskel- declared, E. Fontaine: None declared, C. Moinard Shareholder of:
eton (i.e. cofilin-2, Calponin-3,…). Finally, the modulation of Citrage.
secretome by Cit is more complex to interpret but it seems that
modulated proteins by Cit are involved in the cardiovascular
SUN-P281
homeostasis (i.e. Calumenin, Cystatin C,…).
PLASMA AMINO ACID PROFILE IN OBESE PATIENTS WITH
Conclusion: In conclusion, besides the positive effect of HAA or
PURINE METABOLISM DISORDERS
specific AA on the protein synthesis in muscle cells, this
preliminary work demonstrates that muscle secretome is E. Livantsova1,2 *, E. Saginova1, T. Krasnova1, A. Starodubova2,3,
modulated from different ways and underlines the complexity S. Kosyura2,3. 1M.V. Lomonosov Moscow State University,
2
of the regulation of protein homeostasis by nutrients. Federal Research Centre of Nutrition, Biotechnology and Food
Safety, 3N. I. Pirogov Russian National Research Medical
Disclosure of Interest: C. Breuillard Shareholder of: Citrage Company,
University, Moscow, Russian Federation
A. Goron: None declared, V. Cunin: None declared, S. Bourgoin-Voillard:
None declared, M. Sève: None declared, C. Moinard Shareholder of:
Rationale: The amino acids play an important role in the
Citrage Company.
formation of metabolic status because they tightly link all
metabolic pathways. The disturbances of uric acid metabolism
are probably associated with changes in plasma amino acid
profile.
Methods: The study included 59 patients (25 male and 34
female); the median age is 52 years [36; 60]. The number of
S158
obese patients was 38 (64%) (body mass index (BMI) >30 kg/m2).
The control group consists of subjects with a normal BMI (36%).
Hyperuricemia was detected in 20 (34%), of which 16 (80%) had
obesity. We evaluated the results of biochemical tests and
anthropometry. The analysis of amino acid blood composition
was performed using HPLC-MS.
Results: A statistically significant positive correlation was
observed between serum uric acid level and concentrations of
three amino acids: glutamic acid (r = 0.416; p < 0.01), leucine
and isoleucine (r = 0.318; p < 0.05). In the group of obese
patients, there were no relationships between BMI and
concentration of any amino acid. In contrast, the control
group demonstrated a highly significant positive correlation
BMI with concentration of alanine (r = 0.482; p = 0.027) and
glutamic acid (r = 0.521; p = 0.015). Most of the amino acids
(alanine, glutamic acid, leucine, and isoleucine) showed a
statistically significant or close to significant correlation with
the level of uric acid in obese patients. Thus, an increase in
body weight in the normal range is associated with alteration of
the amino acid profile.
Conclusion: Our study showed that purine metabolism dis-
orders in obese patients are associated with the metabolism of
leucine/isoleucine and glutamic acid. The findings suggest the
importance of amino acid metabolism in a variety of metabolic
conditions and can be used in further studies of the mechanism
of hyperuricemia and worsening of other metabolic disorders in
obese patients.
Disclosure of Interest: None declared.
SUN-P282
SENSITIVITY OF A 13C-PROTEIN OXIDATION BREATH TEST
INVESTIGATED WITH A PROTEIN RESTRICTED DIET IN
HEALTHY SUBJECTS
G. A. R. Reckman1,2 *, G. J. Navis1, C. P. van der Schans2,3,
R. J. Vonk4, H. Jager-Wittenaar2,5. 1Internal Medicine, Division
of Nephrology, University of Groningen, University Medical
Center Groningen, 2Research Group Healthy Ageing, Allied
Health Care and Nursing, Hanze University of Applied Sciences,
3
Rehabilitation and Health Psychology, 4Center for Medical
Biomics, 5Maxillofacial Surgery, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Rationale: Disturbed protein metabolism may result in
malnutrition. A non-invasive low cost clinical tool to measure
protein metabolism is lacking. Explorative research (n = 1) with
a newly developed non-invasive 13C-protein breath test
suggested a decrease in protein oxidation after a protein
restricted diet. Now, we aimed to test the effect of protein
restriction in more subjects, to assess sensitivity of the test.
Methods: In this exploratory study, 14 healthy male subjects
(23 ± 3 y) participated. Habitual intake was assessed by a 4-day
food diary. Next, subjects were instructed to use a 4-day
isocaloric protein restricted diet (0.25 g protein/kg bw/day).
After an overnight fast, a 30 g naturally enriched 13C-milk
protein test drink was consumed, followed by collection of
breath samples up to 330 min. Protein oxidation was analyzed
by Isotope Ratio Mass Spectrometry. 24-h urine was collected
on day 4 of the habitual diet, and on every day of the 4-day
protein restricted diet, to assess actual change in protein
intake.
Poster
Results: After the protein restricted diet, 30.2% ± 7.7 of the
30 g 13C-milk protein was oxidized over 330 min, compared to
30.6%±6.2 (NS) after the subject’s habitual diet (1.4 ± 0.3 g
protein/kg bw/day). Within subjects, both increase and
decrease in oxidation was found. During the 4-day protein
restricted diet, urinary urea:creatinine ratio decreased by
56% ± 10, consistent with a reduction in protein intake of 44% ±
15 (g/day) and 53%±12 (g/kg bw/day), based on urea and food
diary, respectively.
Conclusion: The breath test shows variation within subjects
and between diets, which could be related to the sensitivity of
the test. We cannot explain the variation by the measured
variables. Alternatively, our results may implicate that in some
of our subjects, protein intake did not sufficiently decrease to
levels that could alter protein metabolism.
Disclosure of Interest: G. Reckman: None declared, G. Navis: None
declared, C. van der Schans: None declared, R. Vonk Other: In kind
contribution of 13C-milk protein, H. Jager-Wittenaar: None declared.
SUN-P283
LEUCINE-ENRICHED WHEY PROTEIN MEDICAL NUTRITION
DRINKS IN POWDER AND LIQUID FORMAT RESULT IN HIGHER
POSTPRANDIAL SERUM AMINO ACID LEVELS COMPARED TO
STANDARD CASEIN-DOMINANT MEDICAL NUTRITION DRINKS
J. P. Van Wijngaarden1 *, S. Verlaan1, Y. C. Luiking1. 1Nutricia
Research, Nutricia Advanced Medical Nutrition, Utrecht,
Netherlands
Rationale: To adequately stimulate muscle protein synthesis
(MPS) in older people it is suggested that higher postprandial
blood levels of leucine (Leu) and essential amino acids (EAA)
are needed. Therefore, a Leu-enriched whey protein medical
nutrition (MN) drink was developed, in powder and in liquid
format. This study evaluated the bio-equivalence of these
formats on postprandial serum levels of Leu and EAA, and
evaluated superiority on serum levels of Leu and EAA compared
to standard MN drinks.
Methods: 12 healthy older subjects (65–75 y) participated in
this randomized, single blind cross-over study. On 4 occasions
subjects consumed: a Leu-enriched whey protein MN drink
(150 kcal, 21 g protein) in powder (150 ml; WHEY-P) or liquid
format (200 ml; WHEY-L), a casein-protein MN drink (300 kcal,
18 g protein, 125 ml; CAS) or a mixed-protein casein-dominant
MN drink (300 kcal, 18 g protein, 200 ml; MIX). Blood samples
were taken right before and at 15–30 min intervals until 4 h
after product intake, and were analysed for serum AA levels.
Bio-equivalence was tested as the 90%CI for the ratio of group
averages vs. pre-specified bio-equivalence limits (0.7–1.43).
Superiority was tested by ANOVA. Data are shown as mean ± SD.
Results: WHEY-P and WHEY-L were bio-equivalent in max Leu
concentration (Cmax; 469 ± 52 and 390 ± 51 μmol/L, resp), EAA
Cmax and iAUC of Leu and EAA. Leu Cmax was higher for WHEY-P
and WHEY-L vs CAS and MIX (197 ± 19 and 216 ± 28 μmol/L, resp;
p < 0.001). Similar differences were observed for EAA Cmax and
iAUC of Leu and EAA ( p < 0.001).
Conclusion: The Leu-enriched whey protein MN drinks in
powder and liquid format are bio-equivalent for postprandial
AA response, and result in higher serum levels of Leu and EAA
than standard casein-dominant MN drinks. Therefore, these
products seem preferable to provoke MPS in older adults.
Qualitative design studies
Disclosure of Interest: J. Van Wijngaarden Other: Employee of Nutricia
Research, S. Verlaan Other: Employee of Nutricia Research, Y. Luiking
Other: Employee of Nutricia Research.
SUN-P284
HIGHER PROTEIN INTAKE IS ASSOCIATED WITH LESS INJURIES
IN FRESHMAN ROWERS DURING COMPETITION SEASON: A
PILOT STUDY
J. V. D. Helder1 *, M. Tieland1, D. Diemer1, J. Jansen1,
J. Stubbe1, P. Weijs1,2. 1Faculty of Sports and Nutrition,
Amsterdam University of Applied Sciences, 2Nutrition &
Dietetics, Internal Medicine, VU University Medical Center,
Amsterdam, Netherlands
Rationale: Freshman rowers have an increased risk for injuries,
especially during high training load. Dietary protein may
stimulate recovery and therefore may reduce the risk for injuries
during extensive training periods. In this pilot, we studied the
association between protein intake and the incidence of injuries
in freshman rowers during competition season.
Methods: Freshman rowers (n = 28) were included from four
boats: 2 coxed eights (8+), 1 coxed four (4+) and 1 coxed quad
(4x+). Clarsen injury questionnaire (1) and 3-day food record
were performed at start and after 8 weeks of competition.
Correlation between protein intake and injury incidence was
analyzed with chi-square test.
Results: For 22 out of 28 included freshman rowers data
collection was complete for analysis (mean age 21 ± 2 years). In
total, 64% (14/22) of the athletes reported an injury and in
total 20 injuries were reported. Next to this reported injuries
27% (6/22) of the athletes had to interrupt rowing because of
the injury (mainly airway/flue). Chi-square test showed
significant correlations with injury for protein intake lower
than 1.2 g/kg/day ( p = 0.04), protein intake lower than 1.6 g/
kg/day ( p = 0.05), and less than 20 energy% protein ( p = 0.02).
Injured Non-injured Chi-Square
(n = 14) (n = 8) test
<1.6 g protein/kg/day 57% (8) 13% (1) 0.04
<1.2 g protein/kg/day 36% (5) 0% (0) 0.05
<20 energy % as protein 86% (12) 38% (3) 0.02
<30 g protein per meal 64% (9) 25% (2) 0.08
Conclusion: Freshmen rowers are prone to injuries early during
the competition season. Dietary protein intake is associated
with less injuries in freshman rowers. Further research needs to
be conducted to investigate the role of protein intake on
injuries in freshman rowers or other sports with related high
training load.
Reference
1. Clarsen et al. British Journal of Sports Medicine. 2013;47
(8):495–502.
Disclosure of Interest: None declared.
S159
Qualitative design studies
SUN-P286
INFANT FEEDING CHOICES: A QUANTITATIVE AND
QUALITATIVE EVALUATION OF EXPECTANT PARTICIPANT’S
INTENTIONS OF FEEDING IN THE COMMUNITY HEALTHCARE
ORGANISATION 1 (CHO 1) IN IRELAND
C. Bradshaw1 *, A. Breen1, L. Doherty2, R. Lennon3, R. Lydon4,
E. Mooney4, C. Moriarty5, L. Martin6, A. Mc Cloat4,
L. Stoddard5, M. Mc Loone1, G. McMonagle1. 1Science, Sligo
Institute of Technology, Sligo, 2Health Promotion, Letterkenny
University Hospital, Letterkenny, 3Health Science, Sligo
UniversityHospital, 4Home Economics, St Angelas NUIG,
5
Public Health, 6Health Promotion, Sligo UniversityHospital,
Sligo, Ireland
Rationale: The National Maternity Strategy in Ireland reports1 i
‘a health and wellbeing approach is adopted to ensure that
babies get the best start in life’. Breastfeeding (BF), rates in
Ireland remain the lowest in the Organisation for Economic Co-
operation and Development (OECD).2 CHO1,(North West)an
area with low rates of BF.3 This study looks at thoughts/
attitudes/opinions of expectant women (n = 312) in the CH01.
Methods: Ethical clearance was obtained from the 3
hospitals. Data was collected by a self-administered question-
naire with open/closed questions and distributed to consenting
women at the first appointment with obstetrics.
Results: Quantitative: n = 293 valid, 146 (49.8%) intend to BF,
81 (27.6%) intend to formula feed, 35 (11.9%) to use a mixture
and 31(10.7%) undecided. Qualitative: four themes emerged
Lived Experience, Motivation, Knowledge, and Environment
from codes. The women who intended to BF, 77 best for baby/
42 health benefits 37 cost/29 bonding/20 natural the con-
straints, 22 tried previously/15 said both parents can formula/
8 social concerns about BF.
Conclusion: CH01 Participants’ paradigm on infant feeding is
analyzed, areas to improve, are identified as create awareness,
increase knowledge and ultimately increase BF.
References
1. DoH (2016) Creating a Better Future Together; National Maternity
Strategy 2016–2026. Dublin: Healthy Ireland, Department of Health
& Patient Safety First.
2. OECD (2009) Family Database C01.5: Breastfeeding Rates [online]
Updated 1/10/2009. Available: http://http://www.oecd.org/els/
family/database [accessed 27 Nov 2016]
3. Health Information and Research Division, ESRI (2011) Perinatal
Statistics Report 2000. Dublin
Disclosure of Interest: None declared.
SUN-P287
WOMEN’S BEHAVIORS AND VIEWS ON HOME FOOD SAFETY
IN TEHRAN: A QUALITATIVE STUDY
F. Esfarjani1 *, R. Khaksar2, H. Hosseini3, F. Mohammadi1,
R. Roustaee1, H. Alikhanian1. 1Department of Food and
Nutrition Policy and Planning Research, National Nutrition and
Food Technology Research Institute, Faculty of Nutrition
Sciences and Food Technology, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, 2Department of Food Science
and Technology, National Nutrition and Food Technology
Research Institute, Faculty of Nutrition Sciences and Food
Technology, Shahid Beheshti University of Medical Sciences,
S160
Tehran, Iran, 3Department of Food Science and Technology,
National Nutrition and Food Technology Research Institute,
Faculty of Nutrition Sciences and Food Technology, Shahid
Beheshti University of Medical Sciences, Tehran, Islamic
Republic of Iran
Rationale: The aim of this study was to explore food safety
knowledge and behavior of housewives in the city of Tehran,
Iran.
Methods: In this qualitative study twelve Focus Group
Discussions by directed content analysis method (n = 96),
were conducted among women who were responsible for food
handling in their households, in 10 health centers. Each session
was held with 7–10 participants and their voices were recorded.
The final transcripts were read to obtain categories until
developing themes by using constant comparison method.
Results: Three categories in nine themes were emerged as
follows: Personal hygiene and poisoning (1) Washing hands as
priority in personal hygiene. Food safety, preparation and
storage (2) Inadequate knowledge about proper time for boiling
raw milk, (3) Lack of awareness about temperature of
refrigerator, (4) Incorrect storage of food in the refrigerator,
(5) Storage of unwashed and unpacked eggs, fresh fruits and
vegetables in the refrigerator, (6) Thawing frozen raw meat and
chicken at room temperature, (7) Incorrect separation and
sanitization of cutting boards for fresh vegetables, raw
meat, chicken, (8) Inappropriate washing of fresh leafy
vegetables. Safety of cooked foods (9) Improper reheating of
leftover foods.
Conclusion: The findings of this study illustrated that there was
lack of knowledge about food safety. It was evident that the
majority of the participants were not familiar with practices to
prevent cross contamination and food handling. Therefore
home food safety education should be conducted for
housewives.
Disclosure of Interest: None declared.
SUN-P288
‘AN ORCHESTRA WITHOUT A CONDUCTOR’: A QUALITATIVE
EXPLORATION OF THE JOURNEY FROM SYMPTOM ONSET TO
DIAGNOSIS IN PEOPLE WITH GASTROINTESTINAL
DYSMOTILITY
K. Twist1, J. Ablett2 *, A. Wearden1, P. Paine2, D. Vasant2,
S. Lal2, S. Peters1. 1University of Manchester, Manchester,
2
Salford Royal Foundation Trust, Salford, United Kingdom
Rationale: Gastrointestinal dysmotility (GID) is a relatively rare
spectrum of disorders where disruption to complex enteric
neuromuscular co-ordination leads to intractable gastrointes-
tinal symptoms, malnutrition and is a recognised cause of
chronic intestinal failure. To date, no study has provided an in-
depth account of the experiences of patients with GID and their
psychosocial needs. This study aimed to explore patient’s
experiences from symptom onset and the process of seeking
and receiving a diagnosis. It specifically explored the psycho-
logical impact of this process and the impact on personal and
professional relationships.
Methods: Participants (n = 20, mean age = 47.6, female n = 16,
Parenteral Nutrition = 13) were recruited from a UK centre with
tertiary Neurogastroenterology and Intestinal Failure services.
A qualitative explorative design with semi-structured in-depth
Poster
interviews was used. Data was analysed using thematic
analysis.
Results: Many participants experienced a significant delay in
obtaining a diagnosis and discussed the impact that ‘feeling
delegitimised’ and the ‘lack of coherent understanding of GID’
had on their relationships and mental health. Participants
reported having their mental health questioned and felt they
had to fight to prove their symptoms had a physical origin to
receive appropriate treatment. Although a diagnosis helped
legitimise symptoms, participants stated that GID was gener-
ally misunderstood by them, family and non-specialist health
professionals.
Conclusion: Symptoms of GID reported by patients are vast and
debilitating, compounded with a delay in validating symptoms
and lack of coherent understanding. More knowledge of GID is
needed for health professionals to speed up diagnosis and offer
more coherent information. The psychological impact of a GID
diagnosis should be acknowledged early to help facilitate
adjustment.
Disclosure of Interest: None declared.
SUN-P289
UNDERSTANDING BEHAVIORAL MECHANISMS FOR PHYSICAL
ACTIVITY IN HEAD AND NECK CANCER PATIENTS: A
QUALITATIVE STUDY
M. J. Sealy1,2 *, M. M. Stuiver3,4,5, J. Midtgaard6,7,
C. P. van der Schans1,8, J. L. Roodenburg2,
H. Jager-Wittenaar1,2. 1Research Group Healthy Ageing, Allied
Health Care and Nursing, Hanze University of Applied Sciences,
2
Department of Maxillofacial Surgery, University Medical
Center Groningen, University of Groningen, Groningen,
3
ACHIEVE, Faculty of Health, Amsterdam University of Applied
Sciences, 4Department of Physiotherapy and Department of
Head and Neck Surgery and Oncology, Netherlands Cancer
Institute, 5Department of Clinical Epidemiology, Biostatistics
and Bioinformatics, Academic Medical Center, Amsterdam,
Netherlands, 6University Hospitals Centre for Health Research,
Copenhagen University Hospital, 7Department of Public
Health, Section of Social Medicine, University of Copenhagen,
Copenhagen, Denmark, 8Department of Rehabilitation
Medicine and Department of Health Psychology Research,
University Medical Center Groningen, University of Groningen,
Groningen, Netherlands
Rationale: Head and neck cancer (HNC) patients often have
adverse changes in body composition. Loss of muscle mass and
strength frequently occur, even when dietary intake is
adequate. Nascent evidence suggests that a healthy lifestyle,
including adequate physical activity (PA) and diet, may prevent
muscle wasting. HNC patients often show suboptimal health
behavior pre-diagnosis, and additional barriers to PA can arise
from cancer treatment. Better understanding of the behavioral
mechanisms of PA in this mostly sedentary group is needed to
design effective individualized PA-supporting interventions.
This qualitative study explored the perspective of HNC
patients on PA.
Methods: We conducted 9 semi-structured interviews in HNC
patients, 6–8 weeks after treatment (surgery +/−(chemo)
radiation). The interviews were guided by the Theory of
Planned Behavior (TPB) key concepts, including: attitude;
social norm (with emphasis on role of healthcare
Qualitative design studies
professionals); self-efficacy; intention; barriers/facilitators,
knowledge/skills; and current PA behaviour. Interviews were
analysed by directed content analysis.
Results: Important themes identified for PA were: physical
barriers, health as stimulus, role of habits, and lack of interest.
While all themes could be fitted within the key concepts of TBP,
there was little interaction between intention and other
concepts. In fact, PA intention was not an explicit consideration
for most patients.
Conclusion: HNC patients perceived physical barriers, health,
habits, and lack of interest as important themes with regard to
PA. Our tentative results suggest that the TPB may not be the
most appropriate model for explaining PA in HNC patients. For
future research aiming to understand PA in HNC patients,
theories less focused on rational reasoning and more on
autonomy, such as Self Determination Theory, may be better
suited.
Disclosure of Interest: None declared.
SUN-P290
NUTRITION-RELATED ORDER-WRITING PRIVILEGES OF
DIETITIANS IMPROVES THE TIMELINESS OF PATIENTS
RECEIVING APPROPRIATE NUTRITION PRESCRIPTIONS IN
ACUTE HOSPITALS
Y. P. Lim1, E. Low1, R. J. Zhang1 *. 1Nutrition and Dietetics, Tan
Tock Seng Hospital, Singapore, Singapore
Rationale: Malnutrition is prevalent in acute hospitals and
patients are at risk of developing poor nutrition during
hospitalization. The prescription of oral nutrition supplements
(ONS) is an evidence-based nutrition intervention to manage
malnutrition in hospitalized patients. The project aimed to
evaluate the timeliness and accuracy of ONS prescriptions
received by patients before and after granting nutrition-
related order-writing privileges to dietitians in an acute
hospital in Singapore.
Methods: Dietitians provide recommendations on nutrition
prescription upon patient consultation; following which,
doctors will transcribe the prescriptions in an electronic
order system. Nurses then follow-up on the orders by
scheduling and serving ONS. To avoid unnecessary delay
between dietitians’ recommendations and patients receiving
ONS, ordering privileges were granted to dietitians to input
nutrition orders directly in the electronic system. Chart audits
were completed in 2014 and 2016 to compare the orders for
ONS, including its timeliness, accuracy before and after
implementation of dietitians’ order-writing privileges.
Results: Following dietitians’ direct access to the order system,
there was a 2.5 fold increase (40%, n = 30–98.1%, n = 53) in ONS
prescriptions transcribed based on dietitians recommenda-
tions. The average duration between dietitian recommenda-
tions and the order of ONS in the electronic system, decreased
10-fold, from 4.1 (0.17–13) days to 0.4 (0–6) days. 86.5% (n = 52)
of dietitians recommended prescriptions were transcribed into
the system within the same day.
Conclusion: Granting order-writing privileges to dietitians
improves the timeliness and accuracy of nutrition interventions
received by hospitalised patients who benefit from early and
appropriate nutrition care.
Disclosure of Interest: None declared.
S161
SUN-P291
ENTERAL NUTRITIONAL SUPPORT IN OUR HOSPITAL- ONE DAY
FOTOGRAPHY
S. Amálio1, S. Pina1 *, M. Figueiras1, P. Cabrita1,
H. Carrasqueira1, A. Lopes1. 1Medicina Interna 1, Centro
Hospitalar Do Algarve-Unidade Faro, Faro, Portugal
Rationale: Enteral nutritional support plays a very significant
part in the management of patients with poor voluntary oral
intake, chronic neurological or mechanical dysphagia Nasal
tubes should be used for short-term enteral feeding (4–6 weeks).
ESPEN Guidelines for enteral nutrition in dementia do no
recommend enteral nutrition in patients with severe dementia.
Methods: At 4th October of 2016 all patients hospitalized with
an enteric tube were registered. Patients in the Intensive care
Unit and Emergency department (ER) were excluded. For all of
them demographic data, clinical data and data refering to de
enteric tube were collected. The MDS Cognitive Performance
Scale was apllied to all.
Results: Observational, descriptive, prospective Study. 52
patients (30 men and 22 women) were identified on enteral
feeding (1 nasojejunal tube, 2 PEG and 48 naso gastric tubes).
37 patients (71,1%) were admited in an Internal Medicine
department and all except one was admitted through the ER.
The most important primary diagnosis was pneumoniae (28,8%)
followed by ischemic stroke (11,5%). Dehydration, elevated
sodium and dementia were the most reported secondary
diagnosis. Dysphagia was the main cause of intubation. More
than 50% ofthe analyzed patients had severe dementia at the
admition by de MDS Cognitive Performance Scale and in more
than 70% of these a nasogastric tube was introduced during the
hospital stay. In many of these patients the nasogastric tube was
a long term solution for enteral nutrition. All the nasogastric
tubes were of polyurethane material. The main complications
reported were hyperglicemia and diarrhea.
Conclusion: With these study we were able to identify mistakes
associated with enteral feeding in our hospital. As consequence
a protocol for enteral nutrition in dementia was elaborated.
Disclosure of Interest: None declared.
SUN-P292
COUNSELLING CLIENTS WITH CHRONIC DISEASES – ISSUES OF
DIET MAINTENANCE
T. Tran1 *, S. T. Kristensen1. 1Department of Nutrition and
Midwifery, Methropolitan University College, Copenhagen,
Denmark
Rationale: Diet compliance is a critical component in the
management of chronic diseases. This study examines main-
tenance in healthy eating habits and how this is experienced to
be affected by psychosocial and environmental issues.
Methods: 20 clients having or being at risk of developing type 2
diabetes and/or cardiovascular diseases were recruited. 10
men and 8 women (age: 66 ± 11.9 years) completed the study
and received in average 2–3 counselling sessions using
Motivational interviewing (MI) by dieticians. A food frequency
questionnaire was answered 4 times. The qualitative data
consisted of observations of 18 counselling sessions, semi-
structured interviews with 8 of the clients and 1 semi-
structured interview with 2 dieticians.
S162
Results: At baseline the intake of breakfast rich in dietary fibre
5–7 times/week was seen in 56% of the clients and increased to
67% at 1. follow-up ( p > 0.05). The daily intake of at least 2
slices of fibre rich bread increased from 56% to 67% ( p > 0.05).
The daily intake of fish for lunch increased from 17% to 39%.
However, the intake of fish for dinner did not change ( p > 0.05).
The daily intake of at least 3 portions of vegetables increased
from 0% to 6% while the corresponding intake of fruits
decreased from 28% to 22%. At 3. follow-up the intakes of
fibre and fish were normalised to baseline values, the intake of
vegetables remained at 6% and the intake of fruits increased to
33% ( p > 0.05).
The qualitative data showed that both individual and structural
eating issues affected clients’ maintenance in healthy eating
habits and that MI was difficult to align with the complexity of
food and eating practices.
Conclusion: Maintenance in diet compliance is a critical issue in
dietary counselling and the complexity of food and eating habits
needs to be taken further into account. A narrative approach is
suggested as a more context sensitive approach. How this can be
done will be examined in another part of this study.
Disclosure of Interest: None declared.
SUN-P293
MAKING A DIFFERENCE IN NUTRITION CARE FOR
HOSPITALISED PATIENTS: AN INTER-PROFESSIONAL
COLLABORATIVE MODEL
Y. P. Lim1 *, E. Low1, L. Ho2, J. Uthirapathy2, H. Tan2, W. S. Teo3,
C. Lim4, E. Kong5, J. L. Baldevarona6, T. L. Tan7. 1Nutrition and
Dietetics, 2Nursing Service, 3Speech Therapy, 4Hospitality and
Environmental Services, 5Occupational Therapy, 6Geriatric
Medicine, 7General Medicine, Tan Tock Seng Hospital,
Singapore, Singapore
Rationale: Patients are at risk of developing poor nutrition
during hospitalisation due to multiple challenges. It is critical
that a systematic and coordinated approach is developed to
ensure safe and optimal nutrition care delivery within a
healthcare facility. This project aimed to describe the inter-
professional collaborative model utilised to implement
improvement initiatives and the outcomes achieved within an
acute hospital in Singapore.
Methods: A nutrition committee comprising doctor, nurses,
speech therapist, occupational therapist, dietitians and cater-
ing staff was formed in 2015. It aimed to drive nutrition as one
of the key priorities in patient care, influence optimal nutrition
care culture within the institution, plan and implement
strategies in an inter-professional approach, and monitor
nutrition-related quality indicators.
Results: Seven nutrition quality statements were developed:
nutrition screening, nutrition care plan, feeding support,
feeding environment, availability of meals and snacks, pres-
entation of meals, and monitoring and review. Based on these
quality statements, improvement initiatives implemented
included granting nurses ordering privileges to refer nutritional
at risk patients to dietitian (referral of nutritional at risk
patients to dietitian increased from 27% to 65%); granting
dietitians nutrition ordering privileges (appropriate nutrition
orders increased from 40% to 98%); improving serving compli-
ance of oral nutrition supplements (21% to 87%); enhancing
enteral feeds grade-up protocol (target feeds achieved within 3
Poster
days increased from 33% to 81%); enhancing meal provision to
malnourished patients and meal tray tagging.
Conclusion: The inter-professional collaborative model is
impactful in influencing and effecting changes within the
hospital resulting in improvements achieved in key areas
identified in the seven nutrition quality statements.
Disclosure of Interest: None declared.
Vitamins, antioxidants and minerals 1
SUN-P294
VITAMIN D STATUS OF HOSPITALISED PATIENTS RECEIVING
NUTRITIONAL SUPPORT
A. E. Woollacott1 *, B. Lai1, P. Nair2, V. Flood3. 1Dietetics
Department, St Vincent’s Private Hospital, 2Intensive Care
Unit, St Vincent’s Hospital, 3Faculty of Health Sciences,
University of Sydney, Sydney, Australia
Rationale: The importance of vitamin D (VD) beyond its role in
musculoskeletal health, particularly for immunity, is well-
recognised. VD deficiency is common in Australia with the
Australian Health Survey reporting a 23% prevalence. VD
deficiency is associated with poorer intensive care and surgical
outcomes, greater risk of falls and hospital acquired infections
(HAI). The aim of the study was to prospectively identify the risk
of VD deficiency in hospitalised patients receiving nutritional
support.
Methods: Serial patients were studied over a 1-year period in a
private hospital. Demographic data, BMI, sun exposure, prior
VD supplementation and skin colour were collected. VD levels
were measured in patients at risk. Information on falls risk, HAI,
intravenous antibiotics, surgery and an intensive care stay were
collected in patients with a VD level.
Results: Of 392 patients studied, 185 (47.2%) were male. The
mean (SD) age was 73.9 (15.5) years with a median (IQR) length
of stay of 16 (10–24) days. 165 (42.1%) patients had prior
vitamin D3 supplementation (≥1,000 IU/day). 109 (27.8%)
patients were at risk for VD deficiency. In those, the mean
(SD) 25-hydroxy-vitamin-D was 44.5 (20.6)nmol/L with 99
(90.8%) having insufficient (<75 nmol/L) and 69 (63.3%) having
deficient (<50 nmol/L) levels. A quarter of all patients had
insufficient or deficient levels and of these 50.5% had a falls
risk, 28.3% had a HAI, 52.2% required intravenous antibiotics,
24.2% had an intensive care stay and 48.5% underwent surgery.
Conclusion: Given high incidence of falls risk and morbidity in
those patients with low VD levels it would seem prudent for
dietitians to conduct VD risk assessment on all referred patients.
Disclosure of Interest: None declared.
SUN-P295
VITAMIN D TESTING AND SUPPLEMENTATION IN CLINICAL
PRACTICE: A CROSS-SECTIONAL STUDY AMONG LEBANESE
PHYSICIANS IN A MIDDLE EASTERN URBAN SETTING
A. Aoun1 *, T. Karimeh1, N. El Gerges1, C. Obeid1, A. Wehbe2,
S. Hlais2. 1Notre Dame University, Louaize, Zouk Mosbeh,
2
Saint Joseph University, Beirut, Lebanon
Rationale: This observational cross-sectional study evaluated
the knowledge and practice of Vitamin D (VitD) measurement
and supplementation among physicians in North Lebanon.
Vitamins, antioxidants and minerals 1
Methods: A convenience sample of physicians, working at
hospitals and private clinics in North Lebanon, was recruited
during February and March 2016. Data was collected from a
face-to-face interview performed by a trained local dietician. A
total of 270 physicians (231 men and 39 women) were included
in the analysis. Informed consent form was signed by all
physicians prior to participation.
Results: The knowledge and practice were very diverse among
physicians. Only 23 (8.5%) were able to identify good
nutritional sources of VitD. Fifty one (18.9%) physicians never
measure VitD and 107 (39.6%) measure it in all patients.
Moreover, 265 (98.1%) physicians do not recommend any
specific method of testing and 253 (93.7%) rely on the different
cut-off levels of VitD set by the laboratories. Respectively, 162
(60%) and 174 (64.4%) ignore the approximate cost of the test
and supplementation. Additionally, 28 (10.4%) physicians
prescribe VitD supplements without diagnostic testing and
254 (94.1%) consider that VitD supplementation does not have
any side effects. Finally, 243 (90%) believe that physicians are
over-prescribing VitD supplements.
Conclusion: Confusion among physicians regarding when and
how to diagnose and treat VitD deficiency is apparent. Local
and international guidelines are urgently needed to regulate
VitD testing and supplementation.
Disclosure of Interest: None declared.
SUN-P296
HYPOVITAMINOSIS D IN DYSPHAGIC PATIENTS THAT
UNDERWENT ENDOSCOPIC GASTROSTOMY
C. Santos1 *, A. Barata1, G. Nunes1, J. Fonseca1. 1Hospital
Garcia de Orta, Almada, Portugal
Rationale: Vitamin D deficiency is a major public health
problem and increased risk to develop vitamin D deficiency
comprise insufficient sunlight and reduced alimentary intake.
Dysphagic endoscopic gastrostomy (PEG) candidates may be at
risk due to low dietary intake and reduced motility, with
limited sun exposure. This study aimed to determine the
prevalence of hypovitaminosis D in dysphagic patients that
were proposed and underwent gastrostomy and to assess
potential relationships between vitamin D levels, age, gender
and underlying diseases.
Methods: Prospective observational study during a 4 weeks’
period after gastrostomy. Data was collected at initial PEG
procedure (T0) and after 4 weeks (T1). Initial evaluation
included: age, gender, disorder causing dysphagia,
Neurological Dysphagia (ND) or Head and Neck Cancer (HNC),
albumin, transferrin, Vitamin D. At T1, a blood sample was
collected for Vitamin D, albumin and transferrin. Patients were
fed with homemade meals.
Results: We initially evaluated 200 patients (118 males), 21–95
years: HNC-57, ND-143. Initial low Vitamin D in 181; low
albumin in 96, low transferrin in 121. Protein levels increase T0-
T1, most patients reaching normal values. Vitamin D has a
slower evolution, most patients still displaying low Vitamin D at
T1. Nevertheless, there were significant differences between
the 2 moments for vitamin D ( p = 0.000), as for albumin
( p = 0.000) and transferrin ( p = 0.014). No associations were
found between Vitamin D, age, gender or underlying disease.
S163
Conclusion: The large majority of dysphagic patients proposed
to PEG exhibit vitamin D deficiency. Underlying diseases, age,
gender did not significantly influence the prevalence of
vitamin D deficiency. Homemade meals were insufficient to
normalize serum vitamin D in most patients. More researches is
needed to prepare guidelines for vitamin D supplementation in
PEG patients.
Disclosure of Interest: None declared.
SUN-P297
THE ROLE OF CALCIUM, IRON, MAGNESIUM, PHOSPHORUS,
POTASSIUM, SELENIUM, SODIUM, AND ZINC ON MUSCLE MASS,
MUSCLE STRENGTH, AND PHYSICAL PERFORMANCE IN OLDER
ADULTS: A SYSTEMATIC REVIEW
C. van Dronkelaar1 *, A. van Velzen1, M. Abdelrazek1,
A. van der Steen1, P. J. Weijs1,2, M. Tieland1. 1Faculty of Sports
and Nutrition, Amsterdam University of Applied Sciences,
2
Department of Nutrition and Dietetics, VU University Medical
Center, Amsterdam, Netherlands
Rationale: Minerals may contribute to prevent and treat
sarcopenia, the age-related loss of muscle mass, muscle
strength, and physical performance. The aim of this systematic
review is to evaluate the role of calcium, iron, magnesium,
phosphorus, potassium, selenium, sodium, and zinc on muscle
mass, muscle strength, and physical performance in older
adults.
Methods: A systematic search was conducted between March
2016 and July 2016, in the PubMed database using pre-defined
search terms. Articles on the role of dietary mineral intake or
mineral serum concentrations on muscle mass, muscle
strength, physical performance, and the prevalence of
sarcopenia in healthy or frail older adults (average age ≥ 65
years) were selected. Meta-analyses statistic will be performed
when possible.
Results: From the 3,346 articles found, ten studies met the
inclusion criteria. Observational studies showed that serum
selenium and calcium intake were significantly associated with
muscle mass. Magnesium, based on one randomized controlled
trial, selenium, iron, and zinc intake were significantly and
positively associated with physical performance in older adults.
Magnesium, selenium, calcium, and phosphorus intake were
associated with the prevalence of sarcopenia. No studies on the
role of sodium or potassium on muscle mass, muscle strength,
or physical performance were found. Meta-analysis was not
possible.
Conclusion: Minerals may be important nutrients to prevent
and treat sarcopenia. Particularly, magnesium, selenium, and
calcium seem to be most promising. Most of the included
studies, however, were observational studies. Therefore, more
randomized controlled trials are needed to elucidate the
potential benefits of mineral intake to prevent and treat
sarcopenia and support healthy aging.
Disclosure of Interest: None declared.
S164
SUN-P298
EFFECT OF ISOLATED OR COMBINED PARENTERAL INFUSION
OF FISH OIL EMULSION AND GLUTAMINE ON THE TISSUE
ANTIOXIDANT POTENTIAL OF RATS SUBMITTED TO ACUTE
PANCREATITIS MODEL
R. S. Oliveira Filho1, P. C. Garla1, R. S. M. D. M. Torrinhas1,
R. A. Garib1, A. Tesser1, F. G. G. Aprobato1, É. M. Tamanaha1,
M. S. Antunes1, D. L. Waitzberg1 *. 1Department of
Gastroenterology, LIM 35, Faculdade de Medicina da
Universidade de São Paulo, São Paulo, Brazil
Rationale: Experimental acute pancreatitis (AP) is a well-
established oxidative stress model.1 Evidence suggests that fish
oil (FO) and glutamine (GLN) can improve oxidative stress.2,3
The present study aimed to evaluate the tissue antioxidant
response to isolated or combined parenteral infusion(PI) of FO
and GLN prior the induction of experimental AP.
Methods: After central venous catheterization, isogenic rats
received PI of FO10% (n = 2), GLN20% (n = 2), FO10%+GLN20%
(n = 2) or not received PI (SHAM;n = 2) for 48 h. After this
period, the animals were submitted to the induction of AP.
After 12 h of AP induction, the rats were euthanized for lung
and spleen collection and subsequent analysis of antioxidant
enzymes glutathione peroxidase (Gpx) and superoxide dismu-
tase (SOD) by immunohistochemistry. The intensity of these
enzymes cell marking was determined according to the
following classification: 0-negative, 1-weak (<35%), 2-inter-
mediate (35–75%) and 3-strong (>75%). The genetic similarity of
the animals and the high specificity of the immunohistochem-
istry technique allowed these analyzes to be explored in a small
sample of animals.
Results: In the lung tissue, the Gpx cell marking showed
intensities 3 in the FO group, 2 in the FO + GLN and 1 in the GLN
and SHAM groups (FOvsGLN;SHAM p < 0,05); while SOD pre-
sented intensities 1 in the FO, GLN and SHAM groups and 0 in the
FO + GLN. At the spleen, Gpx cell marking presented intensities
3 in the FO and FO + GN groups and 1 in the GLN and SHAM
groups (FO;FO + GLNvsGLN;SHAMp < 0,05); while SOD pre-
sented intensities 2 in the FO and FO + GLN groups and 1 in
the GLN and SHAM groups.
Conclusion: The previous PI of FO, but not GLN, improved the
tissue antioxidant potential. This effect was partially lost when
FO + GLN was infused.
References
1. Armstrong JA, et al. Free Radic Res. 2013.
2. Manzanares W, et al. Crit Care. 2015.
3. Wischmeyer PE, et al. Crit Care. 2014.
Disclosure of Interest: None declared.
SUN-P299
ASSESSMENT OF VITAMIN D LEVEL IN AUTOIMMUNE THYROID
DISEASE IN TURKISH POPULATION
B. P. Sarer-Yurekli1, E. Bellikci-Koyu2 *, H. Ozisik1, D. Ongan2,
G. Ozgen1. 1Endocrinology and Metabolism, Ege Unversity,
Faculty of Medicine, 2Nutrition and Dietetics, Izmir Katip
Celebi University, Faculty of Health Sciences, Izmir, Turkey
Rationale: It has been reported that vitamin D is an
immunomodulatory factor beyond its role in the calcium-
phosphorus homeostasis. The aim of this study was to assess
Poster
vitamin D serum levels in autoimmune thyroid disease in Turkish
population.
Methods: The subjects with Hashimato thyroiditis (HT) (n = 67,
mean age 45.1 ± 10.9, female/male-61/6), control subjects
matched with age and sex (n = 29, mean age 42.1 ± 15.7,
female/male-26/3) and only 6 patients with Graves’ disease
(mean age 42.5 ± 13.3, female/male-5/1) were recruited for
the study during October–November 2016. Thyroid function
tests, thyroid antibodies (AntiTg, AntiTPO, TSHRAb), ultra-
sound features, demographic and antropometric variables
were recorded.
Results: The mean vitamin D level was 53.1 ± 24.7 and
54.1 ± 19.8 nmol/L in the HT and control groups, respectively
( p = 0.482). Vitamin D deficiency (≤50 nmol/L) was present in
48% of the whole study group. Vitamin D deficiency was not
significantly different in HTand control group (48.7% vs. 37.9%,
p = 0.254). All 6 Graves’ patients had vitamin D deficiency
which was 42.5 ± 13.3 nmol/L. Vitamin D insufficiency
(between 51 and 74 nmol/L) was not significantly different
between HT and control groups (68.6% vs. 66.7%, p = 0.88,
respectively). There was no correlation between vitamin D
level and thyroid antibodies (AntiTg and AntiTPO). Vitamin D
levels were significantly higher in subjects with L-thyroxine
replacement compared to those who were not taking replace-
ment in HT group (58.7 vs. 46.0, p = 0.03, respectively).
Conclusion: Vitamin D level was not different significantly
between HTand control groups. It was significantly higher in HT
subjects with thyroid hormone replacement. Vitamin D could
be taking role in the development of autoimmune process.
Besides, vitamin D deficiency could occur as a consequence of
the disease process. Further studies are needed to enlighten
the relationship between HT and vitamin D.
Disclosure of Interest: None declared.
SUN-P300
KIWIFRUIT FAVORABLY AFFECTS PARAOXONASE 1 ACTIVITY
AND PREVENTS LIPID PEROXIDATION IN HIGH FAT DIET FED
HAMSTERS
H. Tayebinia1 *, N. Rezaei1, I. Khodadadi Kholan1,
S. Moradkhani1, E. Abbasi1, M. Saidijam1. 1Hamadan University
of Medical Sciences, Hamadan, Islamic Republic of Iran
Rationale: Kiwifruit with high content of antioxidants improves
serum HDL-cholesterol (HDL-C) level and shows beneficial
effects on human health. The aim of this study was to
investigate the effects of kiwifruit on the activity and the
gene expression level of paraoxonase 1 (PON1), the main
antioxidant enzyme of HDL, in high fat diet (HFD) fed hamsters.
Methods: Forty two male Syrian hamsters were divided into six
groups and fed control diet, control diet with kiwi (1.86 or
3.73 g/kg), or HFD (15% butter fat + 0.05% cholesterol) with or
without kiwi for 8 weeks. Serum lipids profile and the
arylesterase and paraoxonase activities of PON1 were mea-
sured by spectrophotometry whereas serum malondialdehyde
(MDA) and oxidized LDL (ox-LDL) were determined by fluor-
ometry and ELISA, respectively. Liver gene expression level of
PON1 was assessed by real time quantitative PCR. Results were
analyzed by one-way ANOVA followed by post hoc Tukey test and
statistical significance was set at p < 0.05.
Results: A significant increase in HDL-C and decrease in LDL-C
as well as a remarkable reduction in ox-LDL and MDA were
Vitamins, antioxidants and minerals 1
observed after consumption of kiwi in HFD-fed hamsters.
Paraoxonase activity of PON1 significantly increased and
arylesterase activity almost tripled after consumption of kiwi
in treated groups compared with untreated hamsters. Kiwi
supplementation also significantly reduced PON1 gene expres-
sion level in the liver.
Conclusion: Our data suggest that in HFD-received hamsters,
kiwifruit supplementation improved lipid profile and prevented
lipid induced oxidative stress probably through increasing
arylesterase and paraoxonase activities of PON1. Increased
PON1 activity accompanied with decreased its gene expression
level might suggest that incline in PON1 activity down-regulate
the gene expression through a negative feedback control
pathway.
Disclosure of Interest: None declared.
SUN-P301
INVESTIGATION ON THE EFFECT OF AMINOLEVULINIC ACID ON
INTESTINAL ENVIRONMENT OF AGING MICE
H. Akatsu1,2 *, S. Arai2,3, T. Tanaka4, A. Kamiya4, K. Arakawa1,
Y. Masaki1, H. Tanaka1, T. Kanematsu1, H. Ohara1, K. Inoue5,
J.-Z. Xia3, M. Maruyama2. 1Department of Community-Based
Medical Education, Nagoya City University, Nagoya,
2
Department of Mechanism of Aging, Research Institute,
National Center for Geriarics and Gerontology, Ohbu,
3
Morinaga Milk Industry Co., Ltd., Zama, 4SBI Pharmaceuticals
Co., Ltd., Tokyo, 5College of Pharmaceutical Sciences,
Ritsumeikan University, Kusatsu, Japan
Rationale: With aging, oxidative stress accumulates and
potential of biodefence and immunity are decreased.
Aminolevulinic acid is indispensable as a raw material of
home for respiratory chain and oxygen transport. However, it is
relatively insufficient due to aging, although it is a natural
amino acid synthesized in vivo. Recently, it became possible to
obtain and ingest it as a supplemental material. There are
accumulated data that indicated the effects in impaired
glucose tolerance or so. The effect of oral ingestion on the
intestinal environment is not well known.
Methods: 19-month-old C57BL/6 mice were fed for 6 weeks
with food supplemented with ALA as a conventional diet. As
non-aging controls, young mice at 6 weeks were performed for
the similar intervention. Furthermore, as a positive controls,
young and aged mice fed conventional diet and given special
water with oligosaccharide were included. Each group con-
tained 3 mice. Food and water intake, weight, and fecal flush
were carried out every week. For feces, gene extraction was
carried out and the bacterial DNA sequencing was performed
comprehensively with the next generation sequencer for
analysis of microbiota composition.
Results: In the positive control groups given oligosaccharide-
containing water, young group took much more the water than
regular water group but result of aged mice was opposite. On
the other hand, the influence of ALA intervention was not
observed for both young and aged mice. There was no special
effect on the microbiota composition by ALA intervention.
Conclusion: No obvious effect was observed for ALA intake in
the study. This may be owing to the intensive individual variety
of the mice and short administration period. We are considering
future research with increasing number of animals and long-
term intervention.
S165
Disclosure of Interest: H. Akatsu Grant/Research Support from:
research support, S. Arai: None declared, T. Tanaka: None declared,
A. Kamiya: None declared, K. Arakawa: None declared, Y. Masaki: None
declared, H. Tanaka: None declared, T. Kanematsu: None declared,
H. Ohara: None declared, K. Inoue: None declared, J.-Z. Xia: None
declared, M. Maruyama: None declared.
SUN-P302
EVALUATING THE EFFECTS OF DIETARY FATTY ACID AND
ANTIOXIDANT VITAMIN INTAKE ON METABOLIC PROFILE IN
PATIENTS WITH SCHIZOPHRENIA
I. Türkoğlu1 *, E. Akal Yıldız2, S. M. Mercanlıgil2, G. Yoca3,
K. Yazıcı4. 1Department of Nutrition and Dietetics, Hacettepe
University Faculty of Health Sciences, Ankara, Turkey,
2
Department of Nutrition and Dietetics, East Mediterranean
University Faculty of Health Sciences, Famagusta, Cyprus,
3
Ministry of Health Erbaa Government Hospital, Tokat,
4
Department of Psychiatry, Hacettepe University Faculty of
Medicine, Ankara, Turkey
Rationale: Esseantial fatty acid deficiencies in cellular
membranes have been observed in schizophrenia. There are
few studies in schizophrenia patients whether intake of dietary
fatty acids and antioxidant vitamins is inadequate and
contributes observed deficits. The aim of the study was to
assess fatty acids and antioxidant vitamins intake and to
evaluate effects of these nutrients on metabolic profile in
patients with schizophrenia.
Methods: The study was conducted on 148 individuals with
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
diagnosis of schizophrenia or schizoaffective disorder and 77
age, gender matched healthy controls. Sociodemographic and
medical data were obtained through interviews and question-
naires. Food and beverage intake was recorded by using a 24-
hour dietary record.
Results: The patients and healthy controls were similar in age,
gender and there is no statistical difference on body mass index
between the groups ( p > 0.05). Total fat and saturated fatty
acid intake was significantly higher in schizophrenia patients
than in controls ( p < 0.05). There is no differences were found
in omega-6/omega-3 ratio between the groups ( p > 0.05).
Beta-carotene and C intakes were significantly lower in
schizophrenia patients than in controls ( p < 0.05). When we
examine individuals with MetS total fat intake and saturated fat
intake of women with schizophrenia were significantly higher
than healthy controls ( p < 0.01). No differences in antioxidant
vitamins intake were found between the groups who had MetS.
Conclusion: It is needed the development of special dietary
interventions for schizophrenia patients as increased intake of
dietary fat and low antioxidant vitamin intake may contribute
to the development of metabolic side effects of antipsychotic
treatment.
Disclosure of Interest: None declared.
S166
SUN-P303
THE RELATION BETWEEN TRACE ELEMENTS LEVELS, TIME
COURSE AND CLINICAL OUTCOMES IN CRITICALLY ILL
SURGICAL PATIENTS
J. Yang1 *, S. K. Hong2. 1Department of Pharmacy, Asan Medical
Center, 2Department of Surgery, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Republic of
Korea
Rationale: This study aimed to determine trace elements
levels, time course and relation to clinical outcomes in
critically ill surgical patients.
Methods: We reviewed retrospectively patients’ electronic
medical records that were admitted to an adult surgical
intensive care unit (ICU) from January 2016 through December
2016 and managed for more than 7 days. We analyzed whole
blood selenium level, serum zinc level, serum copper level at
interval of week during the ICU stay and investigated length of
stay (LOS) in the ICU, LOS in the hospital, and 90-day mortality.
Data were analyzed using SPSS 21.
Results: A total of 87 patients were evaluated and selenium,
zinc, copper levels were collected 152, 154 and 154 respectively
at ICU day 1∼28. Overall, mean selenium level was 10.5 ± 4.1
(range, 6–45) mcg/dL and mean zinc level was 68.0 ± 25.9 (16–
169) mcg/dL, and mean copper level was 78.7 ± 34.5 (13–159.7)
mcg/dL. No selenium levels were below normal range. But, the
zinc and copper levels were below in 51.9% and 42.9%
respectively. The zinc levels were steadily increased during
the ICU stay (R2 = 0.21, p < 0.001). In subgroup, patients with
continuous renal replacement therapy (CRRT) had correlation
(R2 = 0.36, P < 0.001). Fourth zinc levels were higher in the
nonsurvivor group (114.9 ± 41.2 mcg/dL) than in the survivor
group (80.8 ± 19.8 mcg/dL, p = 0.022). Second copper levels
were inversely correlated with LOS in the hospital in the survivor
group (R2 = 0.11, p = 0.037). Other levels were not correlated
with LOS in the ICU and hospital and 90-day mortality.
Conclusion: There was no selenium deficiency in surgical ICU
patients within 4 weeks after ICU admission. Whole blood
selenium level was no different over time and was not
correlated with clinical outcomes. Serum zinc level has steadily
increased during the ICU stay in patients with CRRT and was
higher in the nonsurvivor.
Disclosure of Interest: None declared.
Late Breaking Abstract 1
SUN-LB304
ASSOCIATIONS BETWEEN PHYSICAL ACTIVITY, DEPRESSION
AND COGNITIVE FUNCTION
A. Ilhan1 *, P. Bilgic1, M. Varli2. 1Hacettepe University Faculty of
Health Sciences Department of Nutrition and Dietetics,
2
Department of Internal Medicine, Ankara University, Faculty
of Medicine, Ankara, Turkey
Rationale: The burden of dementia among older individuals is
an important public health problem, considering the increasing
number of elderly population in Turkey. The prevalence of
depression has also grown in Turkish older adults. Therefore, the
aim of this study was to investigate the relationship between
physical activity level, depression and cognitive function in
community-dwelling older adults living in Ankara, Turkey.
Poster
Methods: A sample of 200 functionally independent patients
(111 women and 89 men) aged 65 years or older (mean age:
74.97 ± 7.44) was selected from Medicine Faculty of Ankara
University. Standardized Mini Mental State Examination (S-
MMSE) was used to evaluate cognitive function, Geriatric
Depression Scale (GDS) to assess depression status for all
patients. 24-hours physical activity records were obtained to
assess physical activity level (PAL). Patients with advanced
visual and auditory impairment, delirium, cancer and disabled
were excluded.
Results: Thirty eight of two hundred (%19) patients were
diagnosed with dementia. Those with dementia and without
dementia were divided into two groups. The dementia group’s
mean scores of S-MMSE, GDS and PAL were 17.63 ± 3.93, 8.81±.41
and 1.2 ± 0.14, respectively. Non-demented group’s mean scores
of S-MMSE and GDS were 25.61 ± 3.43, 5.37 ± 2.9 and 1.49 ± 0.26,
respectively. In all groups; S-MMSE, GDS and PAL scores of men
were significantly higher than women (p < 0.05). When we
analyzed the relationship between S-MMSE values and the results
of the PAL and GDS, we found significant positive correlation for
S-MMSE versus PAL (n = 200, r = 0.56, p < 0.001) and negative
correlation S-MMSE versus GDS (n = 200, r = −0.55, p < 0.001).
Conclusion: The study revealed that the cognitive impairment
was significantly associate with depression. This may be due to
the association between depression and physical disability or
depression may have been reduced their active lifestyles.
Disclosure of Interest: None declared.
SUN-LB305
THE EFFECT OF NUTRITIONAL INTERVENTION IN OLDER
ADULTS ON HANDGRIP STRENGTH AND MORTALITY: RESULTS
FROM 9 POOLED RCTS
J. I. Van Zwienen-Pot1 *, I. Reinders2, C. P. de Groot3,
A. M. Beck4, I. Feldblum5, I. Jobse6, F. Neelemaat1,
M. A. de van der Schueren1,7, D. R. Shahar5, E. T. Smeets3,
M. Tieland3, H. A. Wijnhoven2, D. Volkert6, M. Visser1,2.
1
Department of Internal Medicine, Nutrition and Dietetics, VU
University Medical Center, 2Department of Health Sciences,
Faculty of Earth and Life Sciences, Vrije Universiteit,
Amsterdam, 3Division of Human Nutrition, Wageningen
University, Wageningen, Netherlands, 4Clinical Nutrition
Research Unit, Herlev University Hospital, Gentofte, Denmark,
5
Daniel Abraham International Center for Health and Disease
Department of Public Health, Faculty of Health Sciences, Ben-
Gurion University, Beer-Sheva, Israel, 6Institute for
Biomedicine of Aging, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Nuremberg, Germany, 7HAN University of
Applied Sciences, Nijmegen, Netherlands
Rationale: Nutritional intervention studies in older malnour-
ished adults or at risk of malnutrition focus on improving
nutritional status through increasing energy and protein intake.
While this often results in weight gain, limited information is
available on the effect on clinical outcomes such as handgrip
strength (HGS) and mortality.
Methods: Individual patient data from 1,263 participants from
9 nutritional intervention RCTs were pooled (4 hospital setting,
3 community dwelling, 2 institutionalized). Intervention
consisted of ONS, dietary counselling or both. HGS change
was measured in 7 RCTs (N = 676: 308 control) and mortality in 6
RCTs (N = 793: 426 control). A ≥3 kg increase in HGS was
Late Breaking Abstract 1
considered clinically relevant. Logistic generalized estimating
equations analyses were used to test intervention effect.
Results: Mean baseline age of those with measured HGS was 80
(SD8) years and 64% was female. In the intervention group, 26%
had a relevant HGS increase versus 24% in controls ( p = 0.59).
Overall, GEE showed no treatment effect on HGS (OR 1.15 95%
CI 0.81–1.62). However, interaction was found between setting
and treatment ( p = 0.076): a stronger effect on HGS was
observed for hospital patients versus other settings. For the 793
participants with mortality data mean age was 79 (9) years and
65% women. In the intervention group, 8% died versus 12% in
controls ( p = 0.08). Overall, no treatment effect was observed
(OR 0.65 95% CI 0.36–1.16). However, interaction was found
between treatment and sex ( p = 0.07) and setting ( p = 0.02):
effect on mortality was greater for women versus men and for
institutionalized participants versus other settings.
Conclusion: This pooled analysis showed that nutritional
intervention in older persons has no overall effect on handgrip
strength and mortality. However, positive effects were
observed in specific subgroups.
Disclosure of Interest: None declared.
SUN-LB306
POTENTIALLY MODIFIABLE DETERMINANTS OF
MALNUTRITION IN OLDER ADULTS: A SYSTEMATIC REVIEW
M. O’keeffe1 *, M. Kelly1, E. O’herlihy2, P. O’toole2, P. Kearney2,
S. Timmons2, C. Stanton2, Y. Rolland3, C. Sulmont Rosse4,
I. Maitre5, H. Boeing6, M. Stelmach6, G. Nagel7, M. Wolters8,
A. Hebestreit8, L. De Groot9, R. Teh10, M. Agnes Peyron11,
D. Dardevet11, I. Papet11, M. Streicher12, G. Torbahn12,
E. Kiesswetter12, M. Visser13, D. Volkert12, E. O’connor14,
on behalf of MaNuEL. 1Biological Sciences, University of
Limerick, Limerick, 2University College Cork, Cork, Ireland,
3
Gerontopole Toulouse, Toulouse, 4INRA au Centre des Sciences
du Goût et de l’Alimentation, Dijon, 5School of Agricultural
Studies (ESA) Angers, Angers, France, 6German Institute for
Nutrition Potsdam-Rehbruecke, Potsdam, 7Ulm University,
Ulm, 8Leipniz Institute for Prevention Research and
Epidemiology, BIPS GmbH, Bremen, Germany, 9Wageningen
University Research Centre, Wageningen, Netherlands,
10
University of Auckland, Auckland, New Zealand, 11INRA
Clermont, Lyon, France, 12Friedrich-Alexander-Universität
Erlangen-Nürnberg, Nürnberg, Germany, 13VU University
Amsterdam, Amsterdam, Netherlands, 14University of
Limerick, Limerick, Ireland
Rationale: Malnutrition is widespread among older adults
worldwide. To develop effective prevention strategies, evi-
dence-based knowledge is needed on the modifiable determi-
nants of malnutrition in this population. Many cross-sectional
studies and narrative reviews exist, but systematic reviews of
prospective studies are lacking. Identifying the potentially
modifiable determinants of malnutrition could inform screen-
ing tool/clinical prediction rule development and the forma-
tion of preventative interventions.
Methods: A systematic review was performed in accordance
with the PRISMA statement. It was registered on PROSPERO.
Eight electronic databases were searched using an agreed
range of keywords by two independent reviewers. Prospective
studies with at least one determinant measured at baseline and
malnutrition as outcome at follow-up were included. Study
S167
participants were required to be over 65 years of age to be
eligible. Study quality was assessed using Newcastle Ottawa
Scale by two independent reviewers. A meta-analysis was not
conducted due to study heterogeneity.
Results: 24 prospective cohort studies were included. The
majority of studies failed to control for confounders limiting
the generalisability of these study results. The studies that did
control for confounders displayed that frailty, polypharmacy,
poor self reported general health, cognitive decline, dementia,
eating dependencies, loss of interest in life, poor appetite
and impaired swallowing were significant predictors of
malnutrition.
Conclusion: This is the first systematic review to investigate
the potentially modifiable determinants of malnutrition in
older adults. Targetting the modifiable factors identified in the
results will inform better screening tools for malnutrition and
the development of more interventions for the effective
treatment and prevention of malnutrition in older adults.
References: Not published yet.
Disclosure of Interest: None declared.
SUN-LB307
ABDOMINAL ULTRASOUND FINDINGS OF GASTROINTESTINAL
MOTILITY ARE EFFECTIVE IN PREDICTING THE RISK OF FEVER
DUE TO RESPIRATORY INFECTIONS IN PATIENTS WITH FEEDING
TUBES
M. Ishii1 *, Y. Yamaguchi1, S. Osumi2, Y. Tanaka2, S. Ogawa1,
M. Akishita1. 1The Department of Geriatric Medicine, The
University of Tokyo, Tokyo, 2Okamoto-Ishii Hospital,
Yaizu, Japan
Rationale: Decreased gastrointestinal motility including gas-
troesophageal reflux is one of the causes of the aspiration
pneumonia in elderly patients with feeding tubes.
Methods: We studied 33 patients with feeding tubes who were
admitted to the long-term care hospital for more than 90 days.
The febrile days of 37.5°C or greater in each patient were
counted during the past 90-day records. Fever due to
respiratory infections was determined by excluding the fevers
diagnosed as resulting from other causes. The cross-sectional
area of and proximal stomach and the antrum were measured
by ultrasonography before and after administration of liquid
diet (1 kcal/ml, 400 ml/hr, 400 ml × 3/day). We evaluated the
function of gastric discharge and dilatation at 1-min and 30-min
intervals after the administration.
Results: We evaluated the relationships between gastrointes-
tinal motility and febrile days for the screening of respiratory
infections in patients with feeding tubes. In the multivariate
analysis the febrile days were associated with the decreased
motility of the discharge in the antrum of stomach at 30-min
intervals after the administration ( p < 0.05). The logistic
regression analysis showed that decreased motility of the
dilatation in the proximal stomach was associated with a
history of lower respiratory infections ( p < 0.05).
Conclusion: Decreased gastrointestinal motility is one of the
causes of fever due to aspiration in the elderly patients with
feeding tubes. The findings of decreased gastrointestinal
motility in the abdominal ultrasound examination are effective
in predicting the risk of fever due to respiratory infections in
the elderly patients.
Disclosure of Interest: None declared.
S168
SUN-LB308
THE COST OF SARCOPENIA RELATED HOSPITALIZATIONS IN
OLDER ADULTS
S. Goates1 *, K. Du2, S. Pereira3, M. E. Arensberg3, T. Gaillard4.
1
Abbott Laboratories, Columbus, 2Abbott Laboratories,
Urbana-Champaign, 3Abbott Laboratories, Columbus,
4
University of Cincinnati, Cincinnati, United States
Rationale: There are few estimates of the cost burden of
sarcopenia in older aduts, and none that use the modern
definition incorporating both low lean body mass and func-
tional limitation. Our objective is to provide an updated
estimate of the cost burden of sarcopenia related hospitaliza-
tions in American adults age 65 and older.
Methods: We used the National Health and Nutrition
Examination Survey (NHANES) from 1999–2004 to identify
sarcopenic individuals – those with low appendicular lean
mass adjusted for body mass index (<0.789 kg/m2 for men;
<0.512 kg/m2 for women) who report functional limitation.
The annual cost of hospitalization was imputed using episode
cost data from the Health Care Utilization Project 2014, based
on age, race, gender and number of hospitalizations. The
impact of sarcopenia on annual hospitalization costs was
estimated using two-part multivariate regression. Population
total costs were estimated for race-gender subgroups using
population counts from the US Census 2014, the subgroup
prevalence of sarcopenia estimated from NHANES, and
marginal costs estimates of sarcopenia. Confidence intervals
were estimated by simulation.
Results: The total cost of sarcopenia-related hospitalizations in
the United States for this population is $18.4 billion annually
(95% CI: $7.5 billion, $28.5 billion). The estimated burden for
women is greater than for men ($10.4 billion vs. $8.0 billion; p-
value = 0.09), and the cost per person varies significantly by
race ( p < 0.01): $322 for Whites (CI: $131, $503); $140 for
Blacks (CI: $46,$261); $741 for Hispanics (CI:$280, $1161) and
$697 for Other (CI: $157,$1445).
Conclusion: Sarcopenia increases hospitalization and imposes
a heavy burden on health care spending for the elderly. These
findings emphasize the need for early identification and
treatment in at-risk older adults to reduce hospitalization.
Disclosure of Interest: S. Goates Shareholder at: Shareholder of Abbott
Nutrition, Other: Employee of Abbott Nutrition, K. Du Other: Employee
of Abbott Nutrition, S. Pereira Shareholder at: Shareholder of Abbott
Nutrition, Other: Employee of Abbott Nutrition, M. E. Arensberg
Shareholder at: Shareholder of Abbott Nutrition, Other: Employee of
Abbott Nutrition, T. Gaillard: None declared.
SUN-LB309
ASSOCIATION BETWEEN MALNUTRITION AND HOSPITAL COST
AMONG COMMUNITY-DWELLING OLDER CHINESE ADULTS
S. Goates1,2 *, Y. Zhang3, L. Fan4, S. Li5, L. Claytor6,
J. Partridge1, S. Sulo7. 1Abbott Laboratories, Columbus, United
States, 2Abbott Laboratories, Columbus, United States,
3
National Health Development Research Center, Beijing,
China, 4Abbott Laboratories, Urbana-Champaign, United
States, 5Abbott Laboratories, Shanghai, China, 6Abbott
Laboratories, Singapore, Singapore, 7Abbott Laboratories,
Chicago, United States
Rationale: China has a large and growing elderly population.
However, research on the association between malnutrition
Poster
and healthcare costs in the community setting in China is
limited. This paper aims to study the association between
malnutrition and hospital costs among community-dwelling
older Chinese adults.
Methods: A sample of 7,768 adults aged 60 years or older from
the 2013 China Health and Retirement Longitudinal Study were
included in the analysis. Handgrip strength, body mass index
and weight loss were used as indicators of malnutrition status.
Negative binomial regressions were employed to analyze the
associations between malnutrition and the number of hospital
admissions and outpatient visits. A two-part model was used to
analyze the impact of malnutrition on hospital cost. The first
part studied the impact of malnutrition on the use of inpatient
and outpatient services, and the second part investigated the
impact of malnutrition on inpatient and outpatient cost,
conditional on using medical services. Analysis controlled for
socio-demographics, health status, health insurance, and
quality of healthcare.
Results: Malnutrition was associated with 32% more hospital
admissions and 31% higher inpatient cost per year; 17% more
outpatient visits, and 9% more outpatient cost per month (all
p < 0.01). In total, malnutrition was associated with ¥32.37
($4.62) billion and ¥13.47 ($1.92) billion additional inpatient
and outpatient costs every year (all p < 0.01) in China.
Conclusion: Malnutrition was associated with significantly
more hospital admissions, higher hospital outpatient visits
and associated costs. These results suggest that malnutrition is
an independent predictor of hospital cost and healthcare
resource utilization, thus highlighting the importance of
malnutrition screening, identification, and treatment for
older Chinese adults living in the community.
Disclosure of Interest: S. Goates: None declared, Y. Zhang: None
declared, L. Fan Other: Employee of Abbott Nutrition, S. Li Shareholder
at: Abbott Nutrition, Other: Employee of Abbott Nutrition, L. Claytor
Shareholder at: Abbott Nutrition, Other: Employee of Abbott Nutrition,
J. Partridge Shareholder at: Abbott Nutrition, Other: Employee of
Abbott Nutrition, S. Sulo Shareholder at: Abbott Nutrition, Other:
Employee of Abbott Nutrition.
SUN-LB310
EFFICACY OF ACTIVE HEXOSE CORRELATED COMPOUND
AGAINST NASOPHARYNGEAL COMPLAINTS: A RANDOMIZED,
DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
T. Hisajima1,2,3 *, H. Waki1,3, A. Sato4, T. Miura4, T. Suzuki2,
Y. Tanaka2, K. Tamai2, K. Uebaba1,2,3, K. Imai1,2,3. 1Research
Institute of Oriental Medicine, 2Graduate School of Health
Science, 3Faculty of Health Care, Teikyo Heisei University,
Tokyo, 4Amino Up Chemical Co., Ltd., Sapporo, Japan
Rationale: The aim of this study was to investigate the
potential of active hexose correlated compound (AHCC) on
nose symptom affected by autonomic nervous system (ANS)
activity.
Methods: The randomized, double-blind, placebo-controlled,
cross-over trial was conducted on 18 adult subjects. AHCC (3 g/
day) or placebo was scheduled, each of 14 days, with a 14-days
wash-out. The degree of a runny nose was evaluated
subjectively by Wisconsin Upper Respiratory Symptom Survey-
21 (WURSS-21). Low-frequency (LF) and high-frequency (HF)
components of heart rate (HR) variability were measured
during sitting rest as markers of ANS function. LF/HF ratio and
HF were used for the index of the activity level of the
Late Breaking Abstract 1
sympathetic nerve and the parasympathetic nerve, respect-
ively. The data were analyzed statistically by paired and
unpaired t-test.
Results: From Day1 through Day14, the amount of changes in
sneezing, runny nose, nasal congestion, and postnasal drip in
the placebo group were 0.67 ± 1.87, 0.83 ± 2.17, 0.42 ± 2.61,
and 0.67 ± 1.78, respectively, showing an increase in all
participants, whereas in the AHCC group these were
−0.42 ± 1.08, −0.58 ± 1.88, −0.58 ± 1.88, and −0.92 ± 1.62,
respectively, showing a decrease in all participants, especially
decreases in the nasal congestion ( p < 0.05) and postnasal drip
( p = 0.08) conditions. In addition, with respect to postnasal
drip, the AHCC group showed a significant difference ( p < 0.05)
compared to the placebo group. In comparison between Day1
and Day14, in the AHCC group, HR increase ( p = 0.01) and HF
suppression ( p = 0.08) were confirmed, whereas in the placebo
group, no significant changes were observed. From Day1
through Day14, in the AHCC group, there was a significant
difference ( p = 0.04) between groups, along with an increase in
the sIgA amount ( p = 0.08) in the saliva.
Conclusion: These data indicated that AHCC was effective in
improving nasal congestion and postnasal drip symptoms.
Disclosure of Interest: None declared.
SUN-LB311
FTO RS9939609 POLYMORPHISM IN NON ALCOHOLIC FATTY
LIVER DISEASE – FREQUENCY AND CHARACTERISTICS OF RISK
GENOTYPES
A. C. Tierney1 *, E. George1, A. Reddy1, M. Ryan2, S. Sood3,
A. Nicoll4, S. Roberts5. 1La Trobe University, 2St Vincent’s
Hospital, 3Royal Melbourne Hospital, 4Eastern Health, 5Alfred
Health, Melbourne, Australia
Rationale: The Fat Mass and Obesity-Associated Protein (FTO)
gene rs9939609 single nucleotide polymorphism (SNP) has been
associated with metabolic diseases in the general population.
As such, it may also play a role in the development and
progression of Non Alcoholic Fatty Liver Disease (NAFLD). The
aim of this study was to examine the prevalence of the
rs9939609 FTO polymorphism in a NAFLD cohort and describe
the metabolic and liver factors in the risk allele A groups.
Methods: A cross-sectional study in 28 patients with diagnosed
NAFLD. FTO rs9939609 polymorphism was genotyped by
Fitgenes Limited. Anthropometric, biochemical and metabolic
risk factors were assessed. Patients underwent transient
elastography, Fibroscan™ to determine liver stiffness measures
and Magnetic Resonance Spectroscopy for intrahepatic lipid
content.
Results: Ten percent of patients with NAFLD in this cohort were
carriers of the rs9939609 AA genotype, 53.6% were AT carriers
and 35.7% were homozygote TTcarriers. Patients with the risk A
allele had a significantly higher waist-to-hip ratio compared to
the non-risk TT genotype group (1.0 (0.1) vs 0.9 (0.04),
respectively, p = 0.04) and neck circumference (41 cm (4.1) v
37 cm (3.3), respectively, p = 0.02). The AA group had
significantly higher ALT levels (88.3 U/L (43)) compared to
the AT (55.4 U/L (21.6)) and the TT (42.2 U/L (23.6)) groups,
p = 0.04. AST values were also significantly higher (AA 60 U/L
(27), AT 35 U/L (12.6) and TT 27 U/L (10.5), p = 0.004). HDL
cholesterol was significantly lower in the risk allele groups (AA
1.0 mmol/L (0.26), AT 1.1 mmol/L (0.23) TT 1.37 mmol/L
S169
(0.27), p = 0.04). Circulating insulin levels were significantly
higher in the risk allele groups compared to the TT genotype
(21.9 mIU/L (12.8) vs 14.2 mIU/L (4.3), p = 0.04). Liver
stiffness measures did not differ between the groups, although
liver fat was notably higher in the risk allele groups compared
to the TT genotype (13.7% (10.5) vs 8.8% (8.7) ns).
Conclusion: Patients with NAFLD carrying the unfavourable
AA/AT genotype of rs9939609 polymorphism had a more
unfavourable anthropometric, biochemical, liver stiffness
measure and hepatic steatosis phenotype. Larger numbers
are needed to determine true prevalence rates and associated
metabolic features.
Disclosure of Interest: None declared.
SUN-LB312
BODY COMPOSITION SIGNIFICANTLY INFLUENCES ENERGY
EXPENDITURE IN CIRRHOSIS
J. K. Heyman1 *, G. W. McCaughan2, K. Liu2, B. Rijksen3.
1
Nutrition and Dietetics, 2Liver Transplant, Royal Prince Alfred
Hospital, Sydney, Australia, 3Radiation Oncology, The
Netherlands Cancer Institute, Amsterdam, Netherlands
Rationale: ESPEN guidelines recommend measuring energy
expenditure in cirrhosis. We conducted a retrospective analysis
of our indirect calorimetry results in our cohort of adults with
cirrhosis (2003–2017) to determine the normal energy expend-
iture range and to identify the influence of energy expenditure
on nutrition.
Methods: 209 adults with cirrhosis [155 male: 54 female, mean
age (range) 52.7 (17–75) years], who consented to have indirect
calorimetry were included. Skin fold anthropometry measures
were done on each participant as part of their nutritional
assessment and compared to normal values to determine body
composition. Our results were normally distributed and
analysed using ANOVA and chi-square in statistical software
(SPSS).
Results: 105 adults in our normal range for energy expenditure
(25th–75th %tile) utilised 1,461.8–1,909.8 kcal/day at rest. The
majority of the 52 adults with faster than normal energy
expenditure (>75th %tile) 41/52(78.8%) had muscle mass in or
above the normal range and 44/52 (84.6%) had fat stores in or
above the normal range for age and gender. The majority of the
52 adults with slower than normal energy expenditure (<25th %
tile) 31/52(59.6%) had less than normal muscle mass and 35/52
(67.3%) had less than normal fat stores for age and gender.
These differences in body composition were highly significant
( p < 0.002).
Conclusion: In our cohort body composition significantly
influences energy expenditure in cirrhosis while other factors
such as disease severity, diagnostic group and ethnicity do not.
Hypermetabolic adults with cirrhosis are usually described in
the literature as malnourished as their nutritional require-
ments are high and difficult to meet. However our data indicate
that these patients have well maintained muscle and fat stores.
Early nutrition assessment including measuring energy expend-
iture and nutritional intervention may assist in providing
nutritional requirements in cirrhosis.
Disclosure of Interest: None declared.
S170
SUN-LB313
CORRELATION BETWEEN MUSCLE STRENGTH AND PROGNOSIS
IN CHRONIC LIVER DISEASE PATIENTS
M. Shiraki1 *, T. Hanai1, M. Shimizu1. 1Department of Internal
Medicine, Gifu University School of Medicine, 1–1 Yanagido,
Gifu, Japan
Rationale: In recent years reported associations between
various diseases and sarcopenia have attracted attention. In
chronic liver disease patients, there are a lot of articles about
the quantity of muscle, but there are few articles about the
quality of muscle. We investigated muscle strength, prognosis,
and associated factors in chronic liver disease patients.
Methods: The subjects were 263 chronic liver disease patients
(men:women, 153:110; age 71 (19–89) years; chronic hepatitis:
cirrhosis, 79:174; Child-Pugh classification A:B:C, 96:57:21;
hepatocellular carcinoma yes:no, 152:111; etiology HBV:HCV:
alcohol:others, 35:159:22:47; observation period 695 (1–1603)
days). Sarcopenia was diagnosed using the Assessment Criteria
for Sarcopenia in Liver Disease 2016 of the Japan Society of
Hepatology.
Results: 1. The frequency of sarcopenia complications was
15.0% in all subjects, with muscle weakness in 27.6% and
reduced muscle mass in 46.7%. 2. Grip strength was 33.0 (12.0–
59.8) kg in men and 19.1 (8.3–28.6) kg in women. 3. A
significant relationship was observed between muscle strength
and prognosis. 4. Using survival prognosis as the outcome, the
optimal cut-off values calculated using receiver–operating
characteristic curves were 28.9 kg for men (area under the
ROC curve [AUC], 0.78; sensitivity, 82%; specificity, 70%) and
17.6 kg for women (AUC, 0.65; sensitivity, 63%; specificity,
67%). 5. Muscle strength was significantly related to sex, age,
clinical condition, albumin level, branched chain amino acid
level, and zinc level. In multivariate analysis, muscle strength
was significantly related to age (odds ratio (OR) 1.08 (1.03–
1.11) P < 0.01), branched chain amino acids level (OR 0.99
(0.99–0.999) P = 0.03), and zinc level (OR 0.98 (0.95–0.99)
P = 0.04).
Conclusion: The frequency of sarcopenia complications was
15.0%, with muscle weakness in 27.6%and reduced muscle mass
in 46.7%. A significant relationship was observed between
muscle strength and prognosis. There was significant correl-
ation between muscle strength and serum branched chain
amino acids and zinc concentrations. These findings suggest
that nutritional intervention with branched chain amino acids
and zinc would be effective the treatment of muscle weakness
or the prognosis in chronic liver disease patients.
Disclosure of Interest: None declared.
SUN-LB314
ALBUMIN COPPER BINDING ASSAY AS A PREDICTOR OF
ANASTOMOSIS DEHISCENCE IN PATIENTS AFTER COLORECTAL
SURGERY
R. Hyspler1 *, A. Ticha1, L. Zaloudkova2, I. Svobodova1,
M. Kaska3, Z. Zadák1. 1Department of Research and
Development, 2Department of Clinical Chemistry,
3
Department of Surgery, University Hospital Hradec Kralove,
Hradec Kralove, Czech Republic
Rationale: Dehiscence of anastomosis is an infrequent but
serious complication of colorectal surgery and a difficult task
Poster
for intensive postoperative care. Until recently a suitable
biochemical marker to identify high risk patients has not been
available. Now the Albumin Copper Binding Assay (ACuB Assay)
has been developed to improve the detection of ischemia-
modified albumin (IMA), traditionally detected by cobalt
binding assay. The aim of the presented work was to test the
ability of the assay to predict the development of dehiscence.
Methods: Patients (n = 117) suffering from colorectal cancer
and undergoing surgery were enrolled in the study. In 5
patients, dehiscence of anastomosis developed (4.3%). Blood
samples were drawn prior to and 2 hours after the surgery. The
Albumin Copper Binding Assay was performed to detect IMA
using copper(II) ions and the fluorescent dye lucifer yellow. The
results are expressed as the pre- and post-operative difference
in fluorescence units (FU) per g of albumin (mean±SD). These
values correlate with usually increased concentration of
ischaemia-modified albumin postoperatively, due to tissue
ischemia.
Results: Patients suffering from dehiscence (365 ± 159 FU/g)
had a significantly higher concentration of ischemia-modified
albumin compared to controls (97 ± 240 FU/g, p = 0.017). Using
a cut-off value of 270 FU/g for discriminating positive vs.
negative results, the diagnostic sensitivity was 100%, specifi-
city 80% and efficiency 81%. The negative predictive value was
100% and positive predictive value 20%.
Conclusion: This recently developed method offers new
diagnostic help in postoperative intensive care. In particular,
the high negative predictive value may help to exclude patients
not threatened by dehiscence of anastomosis. Possible analyt-
ical improvements of this promising assay may even improve its
diagnostic efficiency.
Supported by grant of Ministry of Commerce No FV 10454,
Czech Republic.
Disclosure of Interest: None declared.
SUN-LB315
CURCUMIN PROTECTS LIVER INFLAMMATION BY SUPPRESSING
INOS INDUCTION IN RAT HEPATOCYTES
R. Nakatake1 *, H. Hishikawa1, H. Matushima1, Y. Nakamura1,
M. Ishizaki1, K. Matsui1, M. Kaibori1, M. Nishizawa2,
T. Okumura1,3, A.-H. Kwon1. 1Surgery, Kansai Medical Universiy,
Osaka, 2Biomedical Sciences, College of Life Sciences,
3
Research Organization of Science and Technology,
Ritsumeikan University, Shiga, Japan
Rationale: Curcumin has a variety of beneficial effects on
organ metabolism. However, there is little evidence that
curcumin affects inflammatory mediators, such as tumor
necrosis factor (TNF)-α and nitric oxide (NO). In inflamed
liver, proinflammatory cytokines stimulate liver cells, followed
by induction of inducible NO synthase (iNOS). Excessive NO
produced by iNOS is one of the factors in liver injury. Therefore,
inhibiting iNOS induction for preventing liver injury is import-
ant. This study aimed to investigate liver protective effects
of curcumin by examining interleukin (IL)-1β-stimulated
hepatocytes.
Methods: Hepatocytes were isolated from rats (Wistar male,
200 g) and cultured. Cells were treated with IL-1β (1 nM) in the
presence or absence of curcumin (5–25 μM). Induction of NO
production and iNOS, and the signaling pathway of iNOS were
analyzed.
Late Breaking Abstract 1
Results: Simultaneous addition of IL-1β and curcumin
decreased expression levels of iNOS protein and mRNA,
resulting in inhibition of NO production. Curcumin also
reduced mRNA expression of TNF-α and IL-6. Curcumin
inhibited two essential signaling pathways for iNOS induction,
NF-κB activation and type I IL-1 receptor upregulation.
Transfection experiments showed that curcumin reduced iNOS
mRNA levels at the promoter activation and mRNA stabilization
steps. Delayed administration of curcumin after IL-1β addition
also inhibited iNOS induction.
Conclusion: Curcumin affects induction of inflammatory
mediators, such as iNOS and TNF-α, in part through inhibition
of NF-κB activation in hepatocytes. Curcumin may have
therapeutic potential for organ injuries, including the liver.
Disclosure of Interest: None declared.
SUN-LB316
INFLUENCES OF AGING ON THE PHAGOCYTIC ACTIVITY OF
KUPFFER CELLS IN MICE
S. Murakoshi1 *, K. Fukatsu1, M. Noguchi1, T. Watanabe2,
K. Higashizono3, A. Watkins1, H. Yasuhara1. 1Surgical Center,
The University of Tokyo Hospital, Tokyo, 2Surgery, National
Defense Medical College, Tokorozawa, 3Gastrointestinal
Surgery, The University of Tokyo Hospital, Tokyo, Japan
Rationale: The hepatic immunity generally declines with
aging. Clinically, the consequences of impaired hepatic
immune function in the elderly include an increased suscep-
tibility to infections. Kupffer cells (resident hepatic macro-
phages) are important in the elimination of pathogens.
However, the changes in the function of Kupffer cells
associated with aging remains unclear. In the present study,
we examined how aging would affects phagocytic activity of
Kupffer cells in mice.
Methods: We examined Kupffer cells of young adult (6 weeks
old, n = 7) and aged (65–70 weeks old, n = 7) ICR mice. Whole
liver was harvested and hepatic mononuclear cells (including
Kupffer cells) were isolated. Hepatic mononuclear cells and
microspheres were incubated with or without lipopolysacchar-
ide (LPS) in vitro. Microsphere phagocytosis by Kupffer cells was
evaluated using flowcytometry. We also counted the number of
Kupffer cells isolated.
Results: Kupffer cells’ numbers were not significantly different
between young adult and aged groups. Without LPS stimula-
tion, there were no significant differences in the positive ratios
of microsphere phagocytosis by Kupffer cells between the 2
groups. However, with LPS stimulation, those of microsphere
phagocytosis was significantly less in the aged than in the young
adult group.
Table: Kupffer cells’ numbers and positive ratios of microsphere phagocytosis.
Young adult group
Kupffer cells’ numbers/liver 1 g (1 × 106) 1.28 ± 0.22
Microsphere phagocytosis without LPS (%) 56.1 ± 7.6
Microsphere phagocytosis with LPS (%) 79.7 ± 2.7
*p < 0.01 vs. Young adult group, Mann-Whitney’s U test, means ± SE.
Conclusion: Aging induced-reduction of phagocytic activity of
Kupffer cells might lead to impaired hepatic immunity in
inflammatory condition.
Disclosure of Interest: None declared.
S171
SUN-LB317
THE APPLICATION OF ONODERA PROGNOSTIC NUTRITIONAL
INDEX AND NEUTROPHIL-LYMPHOCYTE-RATIO IN RISK
EVALUATION OF POSTOPERATIVE COMPLICATION AND
PREDICTING THE PROGNOSIS OF GASTRIC CANCER PATIENTS
ACCEPTED GASTRECTOMY
D. Liu1 *, W. Kang1. 1General Surgery Ward 3, Peking Union
Medical College Hospital, Beijing, China
Rationale: To investigate the application of Onodera prognostic
nutritional index and Neutrophil-Lymphocyte ratio in risk
evaluation of postoperative complication and predicting the
outcomes of gastric cancer patients accepted gastrectomy.
Methods: Clinical data of 877 patients with pathologically
proved gastric cancer who had undergone gastrectomy in
Beijing Peking Union Medical College Hospital between October
2006 and March 2011 were extracted and analyzed retrospect-
ively. The distributions of OPNI and NLR in clinical features
were analysed. The Receiver Operating Characteristic (ROC)
curve and Youden index were used to determine the cutoff
values for OPNI and NLR, which had the best sensitivity and
specificity. We analyzed the correlation between OPNI and
NLR. Logistic regression model was used to investigate the
application of OPNI and NLR in risk evaluation of postoperative
complications. The Cox proportional hazard model was used to
explore the influencing factors of predicting the outcomes.
Results: The mean OPNI was 46.54 ± 7.08, and the mean NLR
was 2.96 ± 1.81. On the basis of the complications, the optimal
cutoff value of the OPNI was set at 40. 9, and the NLR was set at
4.13. Logistic regression analysis model showed that preopera-
tive prealbumin, low OPNI and surgical procedure were
independent risk factors. On the basis of five years survival
rate, the optimal cutoff value of the OPNI was set at 42.98, and
the NLR was set at 3.74. Kaplan Meier - method was used to
construct survival curves. Using the COX proportional hazards
model on the postoperative outcomes of patients with gastric
cancer factor of single factor analysis and multifactor analysis.
The multivariate analyses showed that depth of invasion,
lymph node metastasis, preoperative OPNI value and preopera-
tive NLR value were independent factors in predicting overall
survival rate of patients who underwent gastrectomy.
Conclusion: Onodera Prognostic Nutritional Index and
Neutrophil-Lymphocyte-Ratio were important reference
values in risk evaluation of postoperative complication and
predicting the outcomes of gastric cancer patients accepted
gastrectomy. Patients whose OPNI was less, NLR was higher
were at higher risk of postoperative complications and poorer
prognosis.
Disclosure of Interest: None declared.
SUN-LB318
Aged group CHANGES IN SMELL, TASTE AND FOOD PREFERENCES IN
1.28 ± 0.17 COLORECTAL CANCER PATIENTS
59.1 ± 2.7 E. M. Postma1,2 *, S. Boesveldt2, D. E. Kok2, E. Kampman2. 1Top
63.9 ± 3.6*
Institute Food and Nutrition, 2Division of Human Nutrition,
Wageningen University & Research, Wageningen, Netherlands
Rationale: Changes in smell and taste are common side effects
of chemotherapy in patients and might affect dietary habits,
nutritional status and quality of life, although changes vary in
prevalence, duration and severity. Therefore, this study
S172
investigated occurrence and duration of chemosensory changes
and food preferences in colorectal cancer patients.
Methods: Smell and taste function and food preferences were
assessed among colorectal cancer patients undergoing chemo-
therapy at 6, 12 or 24 months after diagnosis as part of an
ongoing cohort study among newly diagnosed colorectal cancer
patients. Sniffin’ Sticks and Taste Strips were used to
objectively measure smell and taste function. Perceived
alterations in smell, taste and appetite were measured with
the Appetite, Hunger and Sensory Perception questionnaire
(AHSP). Food preferences were measured using the
Macronutrient and Taste Preference Ranking Task (MTPRT) (1).
Results: Preliminary results (n = 13) from patients at 12 and 24
months after diagnosis show on average normal smell
(30.5 ± 4.1 out of 48) and taste function (11.4 ± 3.55 out of
16), with no differences between time points. Within the
MTPRT, preference was highest for high-protein foods
(3.0 ± 0.63 out of 4) and lowest for high-carbohydrate foods
(1.9 ± 0.34 out of 4). No differences in AHSP scores were found
between time points. Mean scores did indicate better self-
reported smell and taste function and appetite at measured
time points compared to the time before onset of the disease.
Conclusion: These results from a small sample suggest no
changes in smell and taste at 12 and 24 months after diagnosis.
However, results from the AHSP point towards changes in self-
reported smell and taste function. Changes in smell and taste
during treatment might distort recalling the sense of smell and
taste before treatment, which may affect self-reported smell
and taste function after treatment. Further research will
therefore include a larger group of patients (n = 60) and
prospective measurements before, during and shortly after
chemotherapy.
Reference
1. de Bruijn SE, et al. The reliability and validity of the Macronutrient
and Taste Preference Ranking Task: A new method to measure food
preferences. Food Quality and Preference, 2017. 57:32–40.
Disclosure of Interest: None declared.
SUN-LB319
CALORIC RESTRICTION IN BREAST CANCER WOMEN
UNDERGOING TO NEOADJUVANT CHEMOTHERAPY: SAFETY,
FEASIBILITY AND EFFICACY PRELIMINARY DATA
E. Finocchiaro1 *, A. De Francesco2, A. Collo1, I. Castellano3.
1
Department of Clinical Nutrition Molinette Hospital,
2
Department of Clinical Nutriton Molinette Hospital,
3
Department Pathology, Turin, Italy
Rationale: Unlike the physiological counterpart, cancer cells
exploit aerobic glycolysis to maintain their high proliferation
rate (Warburg effect). Caloric restriction (CR) could enhance
oxidative stress in cancer cells, favoring apoptosis, reducing
proliferation and angiogenesis through molecular targets as
IGF-1/Akt mTOR and AMP-K.
Methods: Trial involving breast cancer patients eligible to
neoadjuvant chemotherapy (CT), at the enrollment (T0)
randomized to CR (CRA) or standard diet arm (SDA) according
to the receptorial status (EgR, PgR, Ki67, cerb b2). CR: caloric
intake reduced by 50% of total energy expenditure (TEE) in the
48 hours before and in the CT day; by 30% in the other days.
After 6 months (T2) patients undergo to surgery. Endpoints:
safety, feasibility, tumor cells reduction. Nutritional
Poster
assessment: anthropometric parameters, food history (once a
month); bioimpedentiometry, blood biochemistry (T0, T2).
Adherence: excess <15% in prescribed kcal in almost 2/3 of
controls. Pathological response: by pathological examination
according to Pinder classification.
Results: 12 women enrolled, 8 reached T2 (4 CRA, 4 SDA).
Safety: no major adverse events. Median body weight varia-
tions (T2 vs T0): body weight −2,0 kg (−6; 1.7), −3.42%
(−10.91; 2.69); phase angle −0.2° (−0.7; 0.1), −3.34% (−17.5;
2,22); fatty free mass 1.65 kg (0,7; 1.9), 3.59% (1.85; 4.39);
fatty mass −3.05 (−6.7; −0.1) kg, −23.72% (−39.18; −0.7);
total proteins −0.6 g/dl (−0.9; 0.1), −8.11% (−12.5; 1.59).
Adherence: 80% for 50% TEE diet, 60% for 70% TEE diet.
Efficacy: residual disease 0 or <50% of initial value: 100% (3/4)
in CRA, 25% (1/4) in SDA; residual disease >50% or progression:
0% in SDA, 75% (3/4) in SDA.
Conclusion: Although the limited sample size, our data
indicate CR as a safe treatment, potentially successful to
enhance standard neoadjuvant CT response rates.
References
1. Mattison JA, Roth GS, Beasley TM, Tilmont EM, Handy AM,
Herbert RL, Longo DL, et al. Impact of caloric restriction on
health and survival in rhesus monkeys from the NIA study. Nature.
2012;489(7415):318–21.
2. Brandhorst S1, Longo DL, et al. Fasting and Caloric Restriction in
Cancer Prevention and Treatment. Recent Result Cancer Results
2016;2017–214.
Disclosure of Interest: None declared.
SUN-LB320
THE IMPACT OF ENHANCED RECOVERY AFTER SURGERY ON
NUTRITION CARE
L. M. Gramlich1 *, L. Martin2, M. Atkins3, M. Gillam3,
C. Sheppard4, S. Buhler3, C. Basualdo Hammond3, G. Nelson5.
1
University of Alberta, 2University of Alberta, 3Nutrition
Services, Alberta Health Services, 446 St Georges Crt,
University of Alberta, Edmonton, 5Surgery, Alberta Health
Services, Calgary, Canada
Rationale: Enhanced Recovery After Surgery (ERAS) is a
multimodal evidenced based care pathway designed to
optimize recovery. ERAS implementation was phased in for
elective colorectal surgical patients at 6 hospitals in Alberta,
Canada from 2013 to present. This study describes changes in
nutrition care with ERAS in Alberta Health Services.
Methods: ERAS care pathway data was collected at 6 hospitals
between 2013 and 2017. Data collection began prior to ERAS
implementation (Pre-ERAS group, N = 476) and was compared
with that after ERAS implementation (ERAS group, N = 3,496).
Data for nutrition care elements were analyzed for compliance
and completeness. Nutrition care elements included screening
for malnutrition, carbohydrate loading (yes/no) and assess-
ment of early oral intake: days to patient tolerated solid food,
and the energy (kcal) intake from ONS on post-operative days
(POD) 0–3. Comparisons between Pre-ERAS and ERAS groups
were made to determine if improvements in nutrition care
occurred.
Results: A total of 3,972 patients were included, 56% were male
with an average age of 61.0 ± 14.2 years, and a mean BMI of
28.2 ± 6.2. Compliance with malnutrition screening improved
with ERAS (74% vs. 9% Pre-ERAS, P < 0.001). 19% of patients
Late Breaking Abstract 1
were not assessed, and 6% were missing data. Adoption of
carbohydrate loading improved with ERAS (63% vs. 3% Pre-ERAS,
P < 0.001). Days to tolerating solid food was significantly
shorter in the ERAS group compared to pre-ERAS (2.9 days vs.
5.9 p < 0.001). Compliance to ONS energy intake (kcal) from
ONS was lower than the targets in the ERAS group (20% POD 0,
30% POD1, 12% POD 2, 13% POD3) but was improved compared
to the Pre-ERAS group (0–0.4% POD0 to POD3).
Conclusion: ERAS implementation resulted in improved com-
pliance to nutrition care for elective colorectal surgical
patients. Gaps exist after ERAS implementation including
poor compliance and documentation with regard to early ONS
consumption.
References
Nelson G, et al. (2016). Implementation of enhanced recovery after
surgery (ERAS) across a provincial healthcare system: The ERAS
Alberta colorectal surgery experience. World Journal of Surgery;
Gramlich LM et al. Implementation of Enhanced Recovery After
Surgery: A Strategy to Transform Surgical Care Across a Health
System. Implementation Science. 2017.
Disclosure of Interest: None declared.
SUN-LB321
INCIDENCE OF REFEEDING SYNDROME IN ONCOLOGIC
PATIENTS
L. P. Moreira Carrasco1 *, M. G. Contreras1, F. Silva1, J. Gelvez2.
1
Fundacion Arturo Lopez Perez, 2MEDKIN, Santiago, Chile
Rationale: Refeeding syndrome is defined by a potentially fatal
shift of fluids and electrolytes. This may occur after reintro-
ducing nutrition in a malnourished patient. Due to a pro-
inflammatory state and an elevated metabolic rate, oncology
patients are at increased risk of refeeding syndrome. In Chile
the number of oncologic patients that develop this syndrome
has yet not been described
Methods: All patients admitted to the critical care unit of
the Arturo López Pérez Institute between March and May
of 2017 were included. The National Institute for Health
and Care Excellence (NICE) criteria were applied to categorize
risk of RFS. Hypophosphatemia was considered the main
indicator for the presence of this syndrome, according to
Marik et al. definition (drop of phosphorus >0,5 mg/dL to
<2,0 mg/dL). To classify patients nutritionally we used the
Subjective Global Assessment (SGA) tool. Categorical variables
were summarized through frequencies and percentages;
continuous variables were summarized by mean, standard
deviation and range.
Results: 59 patients were included, 34 of them were women
(58%). Mean age was 61 years. 6 patients were well nourished,
36 were moderated malnourished and 17 were severe mal-
nourished (A, B and C category of SGA respectively). According
to NICE criteria, 20 patients were considered at high risk and 9
at very high risk of developing RFS. 18 patients (30,5%)
developed RFS, 9 were at low risk, 6 at high risk and 3 at very
high risk according to NICE criteria. SGA and NICE classifica-
tions were not associated with RFS ( p > 0.05). No other
electrolyte disturbances were identified.
Conclusion: This is the first study in Chile that provides the
incidence of RFS in oncologic patients. The incidence of RFS
varies widely depending on the used definition. Studies with an
increased number of patients are required. It is crucial to have
S173
a clear and standardized definition of RFS in oncologic
population.
Disclosure of Interest: None declared.
SUN-LB322
GLASGOW PROGNOSTIC SCORE AS A USEFUL PROGNOSTIC
FACTOR AFTER PANCREATICODUODENECTOMY FOR
PANCREATIC CANCER
M. Ogiku1 *, Y. Ikematsu1, T. Ogasawara2. 1Digestive Surgery,
2
Respiratory Medicine, Hamamatsu Medical Center,
Hamamatsu, Japan
Rationale: Several previous studies have revealed that the
Glasgow Prognostic Score (GPS) is a useful scoring system to
predict the prognosis of patients with various kinds of advanced
cancers. The aim of the present study was to assess the value of
the GPS as a prognostic tool in pancreatic cancer patients after
pancreaticoduodenectomy.
Methods: 43 consecutive patients, who underwent standard PD
or pylorus-preserving pancreatoduodenectomy (PpPD) at
Hamamatsu Medical Center between January 2005 and
December 2016, were analyzed retrospectively. GPS were
evaluated by biochemical test within 7 days before surgery.
Results: The median survival time in patients with a GPS of 0
and 1 was 1,139 and 316 days, respectively (only one patient
with a GPS of 2). Patients with a GPS of 0 had significantly
better survival than patients with a GPS of 1 (P = 0.0382).
Multivariate analysis revealed that GPS (Hazard ratio (HR)
2.247; P = 0.01) and recurrence (HR 15.5; P < 0.001) were
independent factors for poor prognosis. But GPS were not
associated with the recurrence rate (P = 0.71).
Conclusion: The present study suggests that GPS predicts
overall survival in pancreatic cancer patients after
pancreaticoduodenectomy.
Disclosure of Interest: None declared.
SUN-LB323
COMPLETELY LAPAROSCOPIC FEEDING JEJUNOSTOMY – OWN
SURGICAL TECHNIQUE MODIFICATION AND RESULTS OF A
PILOT GROUP
P. Kabata1 *, M. Bobowicz1, M. Swierblewski1, J. Jaskiewicz1.
1
Department of Surgical Oncology, Medical University of
Gdańsk, Gdańsk, Poland
Rationale: Jejunostomy is a commonly used enteral feeding
access in patients with obstructing upper gastrointestinal tract
disorders. Jejunum is hardly accessible with endoscopic or
percutaneous approach thus minilaparotomy is required to
facilitate it. Minimally invasive approach enables better
postoperative performance and faster recovery. We would like
to present our completely laparoscopic modification of surgical
technique and results of a pilot group.
Methods: All consecutive patients qualified for jejunostomy
placement were screened for feasibility. Patients with
history of major abdominal surgery and other significant
contraindications for laparoscopy were disqualified. All proce-
dures were performed with 12CH needle-jejunostomy and
fixed to abdominal wall with …diamond-technique” described
later.
Results: Over the period of October 2016 till March 2017, we
qualified 10 patients into the pilot study group. There were 4
S174
female and 6 male patients with the mean age of 60.9 years
(range 51–76). Majority suffered from dysphagia or aphagia due
to the neoplasms of oesophagus (N = 3), stomach (N = 3), tongue
(N = 2), piriform sinus (N = 1) or oesophago-tracheal fistula
(N = 1). Operating time decreased from the initial 196 min to
55 min in the last patient with the mean duration of 125,4 min.
Patients can be discharged as soon as they tolerate enteral
feeding. There were no complications but one patient
deceased due to the disseminated disease. In one patient the
jejunostomy tube was inserted proximally that required
readjustment over the guide wire. Two patients removed
their catheters accidentally and required further surgery to
re-establish enteral feeding.
Conclusion: Laparoscopic feeding jejunostomy is a safe and
effective procedure that enables fast recovery.
Disclosure of Interest: None declared.
SUN-LB324
BODY WEIGHT AND HAND GRIP STRENGTH DURING CURATIVE
RADIOTHERAPY: IS THERE A GREATER DECLINE IN OLDER
HEAD AND NECK CANCER PATIENTS?
S. Lichthart1,2 *, L. van Miert3, M. Kennis3, E. Leistra2,
R. Poorter4, S. Beijer1. 1Department of Research, Netherlands
Comprehensive Cancer Organisation, Utrecht, 2Health
Sciences, Vrije Universiteit, Amsterdam, 3Nutrition and
Dietetics, 4Radiation Oncology, Institute Verbeeten, Tilburg,
Netherlands
Rationale: Malnutrition is a common problem in head and neck
cancer (HNC) patients undergoing radiotherapy (RT). However,
less is known if deterioration of nutritional status is worse in
older patients. Therefore, this study assessed if changes in
body weight (BW) and hand grip strength (HGS) during curative
RT differs between younger (<65 years) and older (≥65 years)
HNC patients.
Methods: Newly diagnosed HNC patients undergoing RT
between 2008 and 2012 were included. BW and HGS data,
clinical and personal factors were retrieved from medical and
dietetic records and combined with tumour specific informa-
tion from the Netherlands Cancer Registry. Independent t-tests
(<65 years vs. ≥ 65 years), uni- and multivariable analyses (BW
or HGS as continuous variable) were performed to assess the
association between personal and clinical factors and percent-
age change in BW and HGS during RT.
Results: 227 HNC patients were included (♂ 67.4%; mean age
64.3 ± 11.3). Results showed a significant decrease in BW in HNC
patient during RT but no significant difference in percentage
BW change between HNC patients <65 years and ≥ 65 years.
During RT, HGS significantly increased in men <65 years (1.29 kg±
4.62; p = 0.02) and significantly decreased in women ≥ 65 years
(−1.06 kg ± 2.09; p = 0.01). Leading to a borderline significant
difference in percentage change in HGS between HNC patients
<65 years (2.36 ± 10.26) and ≥ 65 years (−0.26 ± 10.01; p =
0.05). Multivariable regression analyses confirmed the signifi-
cant association between age and percentage change in HGS
during RT.
Conclusion: HNC patients undergoing RT significantly
decreased in BW independent of age. In contrast, percentage
change in HGS was significantly different between younger and
older HNC patients. More research is necessary to investigate
the causes for weight loss despite adequate nutritional support
Poster
and the difference in change in HGS between younger men and
older women.
Disclosure of Interest: None declared.
SUN-LB325
PROGNOSTIC SIGNIFICANCE OF PERIOPERATIVE NUTRITIONAL
PARAMETERS IN PATIENTS WITH GASTRIC CANCER
S. E. Oh1 *, M. G. Choi1, J. Y. An1, J. H. Lee1, T. S. Sohn1,
J. M. Bae1, S. Kim1, J. M. Seo1. 1Surgery, Samsung Medical
Center, Seoul, Republic of Korea
Rationale: It has been suggested that nutritional status is
associated with survival outcomes in cancer patients. The aim
of the current study is to evaluate the prognostic significance of
various nutritional parameters during the perioperative period
in patients with gastric cancer.
Methods: This study enrolled patients with gastric cancer, who
underwent D2 gastrectomy at the Department of Surgery,
Samsung Medical Center, in 2008. The prognostic significance
of nutritional parameters was analyzed, along with other
clinical- and pathological variables, preoperatively and post-
operatively at 3, 6, and 12 months.
Results: The total number of patients was 1,424. The mean
values of nutritional parameters, weight, body mass index
(BMI), albumin, hemoglobin, total cholesterol, total lympho-
cyte count (TLC), and prognostic nutritional index (PNI) score,
all decreased significantly over time after surgery.
Preoperatively, low BMI (<18.5 kg/m2) and low TLC level
(<1,000 per mm3) were revealed as independent prognostic
factors in the multivariate analysis. Low preoperative TLC
level and decline in PNI (ΔPNI < −2.2) 3 months postopera-
tively, decline in PNI (ΔPNI < −2.3) and low preoperative BMI 6
months postoperatively, and low preoperative BMI 12 months
postoperatively were independent nutritional prognostic
indicators.
Conclusion: The nutritional parameters of preoperative BMI,
preoperative TLC level, and postoperative change in PNI were
identified as independent nutritional prognostic factors in
patients with gastric cancer. Our results imply prognostic
benefit from careful nutritional support for patients with poor
nutritional parameters.
Disclosure of Interest: None declared.
SUN-LB326
OVERWEIGHT, OBESITY AND RISK OF LEUKEMIA IN ADULTS: A
META-ANALYSIS OF COHORT STUDIES
T. Psaltopoulou1 *, I. Ntanasis-Stathopoulos1, I.-G. Tzanninis1,
I. N. Sergentanis2, A. Karadimitris3, T. N. Sergentanis1.
1
Department of Hygiene, Epidemiology and Medical Statistics,
Medical School, National University of Athens, Athens, Greece,
2
Department of Psychiatry, University Hospital of Geneva
(HUG), Geneva, Switzerland, 3Faculty of Medicine, Imperial
College London, London, United Kingdom
Rationale: This meta-analysis aims to evaluate the association
between overweight, obesity and the risk of leukemia in adults,
assessing separately men and women.
Methods: The eligible studies were identified in PubMed using a
predefined search algorithm; there were no language restric-
tions and the end-of-search date was May 31, 2016. Two authors
independently performed the selection of studies and data
Late Breaking Abstract 1
abstraction. Overweight and obesity were defined as Body Mass
Index 25.0–29.9, and >30 kg/m2, respectively. The pooled
relative risk (RR) estimates were calculated using random
effects (DerSimonian-Laird) models, separately by gender.
Analysis was performed with STATA/SE 13 statistical software;
this study received a grant funded by Wereld Kanker Onderzoek
Fonds (WCRF NL) and administered by WCRF International as
part of the WCRF International program.
Results: In men, obesity was associated with increased
leukemia risk ( pooled RR = 1.37, 95%CI: 1.19–1.59, 10 studies),
whereas no association was observed regarding overweight
( pooled RR = 1.05, 95%CI: 0.95–1.17, nine studies). In women,
obesity ( pooled RR = 1.36, 95%CI: 1.12–1.66, eight studies) and
overweight ( pooled RR = 1.28, 95%CI: 1.09–1.52, six studies)
were associated with increased leukemia risk. Obesity was also
associated with acute myeloid leukemia risk in both sexes.
Conclusion: Obesity is a risk factor for leukemia in both sexes;
further studies are needed for the evaluation of associations
regarding leukemia subtypes.
Disclosure of Interest: None declared.
SUN-LB327
A COMPARISON OF THE POSTOPERATIVE NUTRITIONAL STATUS
OF THREE RECONSTRUCTION METHODS AFTER DISTAL
GASTRECTOMY IN GASTRIC CANCER PATIENTS
Y. N. Kim1 *, J. Y. An1, on behalf of Department of Surgery,
Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, Republic of Korea. 1Department of Surgery,
Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, Republic of Korea
Rationale: The aim of this study was to compare the
postoperative nutritional status of Billroth I (BI), Billroth II
(BII), Roux-en-Y (RY) reconstruction after distal gastrectomy in
gastric cancer patients.
Methods: We retrospectively reviewed data from 1,305 gastric
cancer patients who underwent distal gastrectomy at two
hospitals from January 2011 to December 2014. From this data,
we analyzed clinicopathologic characteristics, PNI, NRI, and
nutritional status through hematologic test for each patient.
Patients were divided into three groups according to the
reconstruction methods: Billroth I, Billroth II, and Roux-en-Y.
We compared the nutritional status according to reconstruction
methods by measuring weight change, hematologic data
including hemoglobin, albumin, cholesterol, total lymphocyte
count, total protein, and transferrin.
Results: Comparison of the nutritional parameters including
Hb, albumin, protein, total lymphocyte count, transferrin
between Billroth I, Billroth II, and Roux-en-Y revealed that
there were no significant difference, but there were a
significant decrease in weight loss rate, BMI and serum
cholesterol change 12 months postoperatively. Although there
were weight loss, BMI and cholesterol decline in three groups,
weight loss rate was significantly lowest 12 months after
surgery in BI reconstruction (vs other two group) ( p < 0.001).
Assessment index of nutritional status between three groups
was not statistically significant differences 12 months after
surgery, but there was significant difference in BMI and
cholesterol decline between BII and RY reconstruction group.
In multivariate analysis, reconstruction type was associated
with weight, BMI, cholesterol change.
S175
Conclusion: RY reconstruction was beneficial for obese patient
of early gastric cancer than BII and BI as there was the reduction
of BMI and total cholesterol except for reduction of other
nutritional parameters. Further prospective studies are needed
to confirm the reconstruction type after distal gastrectomy by
considering the existence of obesity.
Disclosure of Interest: None declared.
SUN-LB328
LOW VOLUME ENERGY DENSE ORAL NUTRITIONAL
SUPPLEMENTS IMPROVE MICRONUTRIENT INTAKES IN FREE
LIVING MALNOURISHED OLDER PEOPLE – A RANDOMISED
TRIAL
A. L. Cawood1 *, T. R. Smith2, N. Guildford3, C. Wood3,
K. Ashbolt3, E. R. Walters3, R. J. Stratton1. 1Faculty of
Medicine, University of Southampton, 2Department of
Gastroenterology, 3Department of Dietetics and Speech and
Language Therapy, University Hospital Southampton NHS
Foundation Trust, Southampton, United Kingdom
Rationale: We have previously shown that low volume energy
dense oral nutritional supplements (ONS) significantly increase
intakes of energy and protein with little suppression of food
intake (1), but the effect on micronutrients requires furthur
investigation.
Methods: 308 older people (>50 y) recruited through GPs (age
71.5 ± 10.7 y; BMI 19.4 ± 2.5 kg/m2, Charleston Comorbidity
Index (CCI) 1.02 ± 0.93, 67% female) at risk of malnutrition
(‘MUST’) were randomised to low volume ONS (Fortisip
Compact range, Nutricia; 2.4 kcal/ml) plus dietary advice
(DA) (as a diet sheet) (n154; ONS group) or DA alone (n154; DA
group) for 12 wks. At baseline, 4, 8, 12 wks, food and total
intake were measured, micronutrient intakes analysed and
compared to EFSA reference values where available.
Percentage difference between groups over 12 wks for 25
micronutrients was calculated (trace elements (n7), minerals
(n5), vitamins (n13)), along with the extent to which ONS
intake was additive to the diet (2). Intention to treat analysis
was undertaken (controlled for baseline, age, sex, ‘MUST’,
CCI), results presented as mean ± SE.
Results: Total micronutrient intake was significantly higher in
the ONS group compared to the DA group (for all except
sodium, chloride, vitamin B12). Overall 92 ± 4% of the ingested
ONS was additive to food intake with no difference in intakes of
micronutrients from food between groups (−1 ± 1%; NS). Total
intake in the ONS group exceeded that of DA group by 40 ± 5%
overall (46 ± 7% vitamins, 43 ± 8% trace elements, 19 ± 7%
minerals). Over 12 wks, 86% of micronutrients (18/21) met
EFSA values in the ONS group compared to 43% in the DA group
(9/21) ( p = 0.004).
Conclusion: This large randomised trial shows that malnour-
ished free living older people are unable to achieve adequate
micronutrient intakes from food alone, and the addition of low
volume energy dense ONS is effective at significantly improving
intakes, helping them to meet recommended reference
intakes.
References
1. Smith TR, et al., Clin Nutr Supp (in press).
2. Stratton & Elia 1999. Clin Nutr 18, 29–84.
S176
Disclosure of Interest: A. Cawood Other: Nutricia Ltd, T. Smith: None
declared, N. Guildford: None declared, C. Wood: None declared,
K. Ashbolt: None declared, E. Walters: None declared, R. Stratton Other:
Nutricia Ltd.
SUN-LB329
LIQUID CARBOHYDRATE CONTENT OF MEALS IS A MAJOR
DETERMINANT OF GASTRIC EMPTYING RATE
E. Charidemou1 *, X. Li1, B. McNally1, M. Harvey2, E. Orford2,
S. Wassell2, M. Venables2, T. Ashmore1, J. L. Griffin1.
1
Department of Biochemistry, University of Cambridge, 2MRC
Elsie Widdowson Laboratory, Cambridge, United Kingdom
Rationale: The transition to energy-dense, Western-style diets
of low satiety value has led to a growing prevalence of obesity
and Type 2 diabetes mellitus (T2DM). Around 50–75% of
diabetics suffer from dyslipidaemia and 30–50% experience
delayed gastric emptying (GE), the rate at which chyme leaves
the stomach to enter the duodenum. We aimed to define, using
stable isotope techniques in healthy humans, how solid/liquid
ratios of meals and macronutrient composition affects GE and
lipid metabolism via blood lipid profiling.
Methods: We determined GE rate and blood lipid profile in four
subjects to date. After a 12-hour fast, subjects consumed one
of five randomised meals containing egg yolk labelled with 13C-
octanoic acid, during visits separated by two-weeks. A
standardised 2 MJ meal (S), low in liquid carbohydrate (CHO),
was modified to contain purely liquid CHO (MS). The MS meal
was further altered to provide isoenergetic meals high in fat
(HF), protein (HP) and CHO (HC). Isotope ratio mass spectrom-
etry determined 13C-enrichment in breath exhalates and
resulting blood lipid profiles were determined by liquid
chromatography-mass spectrometry.
Results: Our results demonstrated that macronutrient com-
position does not greatly affect GE rate or blood lipid profile.
However, increasing liquid CHO delays GE. Blood lipidomics
showed that HP increased triglycerides (TGs) comprising 14:0,
16:0, 16:1, 18:0 and 18:1 fatty acids, associated with de novo
lipogenesis (DNL).
Conclusion: Increased DNL predisposes individuals to IR and is
linked to T2DM. Conceivably, early delivery of CHO to the
duodenum, sensed in the small intestine, may delay emptying
of the solid portion. Increased TGs indicative of DNL, which
normally occurs during an over-abundance of supply, were
detected after the HP meal, though the meals were isoener-
getic. Moreover, this followed a 12-hour fast, which typically
supresses DNL, and may therefore have general implications for
high-protein diets.
Disclosure of Interest: None declared.
SUN-LB330
NUTRITIONAL CARE PLAN TO PREVENT HYPOGLYCEMIA
DURING ADMISSION – RESULTS FROM THE MENU PROJECT
E. Leibovitz1 *, F. Moore2, R. Dobinsky2, M. Boaz3. 1Internal
Medicine, Yoseftal Hospital, Eilat, 2Internal Medicine, Wolfson
Medical Center, Holon, 3Department of Nutrition Sciences,
Ariel University, Ariel, Israel
Rationale: We studied the effect of a nutritional care plan on
the rate of hypoglyemia among diabetes patients admitted to
internal medicine departments.
Poster
Methods: For this analysis we included all diabetes patients
admitted to internal medicine unit ‘E’ at Wolfson Medical
Center between June 1, 2016–April 30, 2017. The previously
reported Measuring Nutrition Risk in Hospitalized Patients,
(MENU) nutrition care plan calls for prescribing one portion
of oral nutritional supplements (ONS) or 500 ml IV 5%
dextrose (for fasting or non-compliance patients) during
the morning hours for hypoalbuminemic (below 3.5 g/dL)
diabetes patients. Consumption of the ONS was verified
during the morning rounds. All glucose measurements were
recorded automatically in the patients’ electronic medical
records. A logistic regression model was used to evaluate the
effect of the nutrition support on the occurrence of
hypoglycemia. We included age, sex, serum albumin, day
of inclusion to the protocol and percent of protocol
adherence as covariates.
Results: During the study acquisition period, there were 232
diabetes patients who were candidates for the MENU
nutrition care plan. Of these patients, 3 were omitted from
the analysis because of incomplete records. Of the 229
patients included in the analysis (mean age 77.2 ± 12.1 years,
64.2% female, mean albumin 3.13 ± 0.31 g/dL), 27.9% had at
least one documented hypoglycemic event during the
hospitalization. The average day of enrolment with the
MENU nutrition care plan was 4.6 ± 5.5 days. The logistic
regression model of hypoglycemia indicated that age (OR
1.036, 95% CI 1.007–1.066, p = 0.015) and day of hospitaliza-
tion on which the patient was included in the study (OR 1.112
95% CI 1.045–1.183, p = 0.001) increased risk of hypogly-
cemia. Participating in the MENU nutrition care plan
significantly reduced risk of hypoglycemia: OR 0.357, 95% CI
0.156–0.814, p = 0.014. Age and serum albumin were not
significantly associated with hypoglycemia risk.
Conclusion: Oral nutritional supplement reduces hypogly-
cemia risk among diabetes in-patients with hypoalbuminemia.
Disclosure of Interest: E. Leibovitz Grant/Research Support from:
Abbott Israel, F. Moore: None declared, R. Dobinsky: None declared,
M. Boaz: None declared.
SUN-LB331
COMPARISON OF ANTHROPOMETRIC AND BIOCHEMICAL DATA
CHANGE RESPONSES TO BREAD, WHITE RICE AND
GERMINATED BROWN RICE IN PRE-DIABETIC ADULTS: CROSS-
OVER STUDY
H. W. Baik1 *. 1Bundang Jesaeng General Hospital, GyeongGi-
Do, Republic of Korea
Rationale: Germinated brown rice, it is rich in dietary fiber,
vitamins and minerals, and contains functional materials such
as γ-Aminobutyric acid (GABA). Germinated brown rice was
found to be effective in improving fasting blood glucose in
animal experiments in diabetic rats. We investigated the
difference of blood glucose and insulin concentration according
to the types (bread, white rice, brown rice, germinated brown
rice) consumed mainly by Koreans. This is a preliminary study
showed the possibility of the improvement of blood sugar by
ingestion of germinated brown rice. Therefore, we investigated
whether germinated brown rice helps blood glucose control in
pre-diabetic adults.
Methods: The subjects were selected from those who were
between 19 and 64 years of age with pre-diabetes (fasting
Late Breaking Abstract 1
glucose 100 to 125 mg/dL). Those who were taking diabetic
medication and dyslipidemic medication and those with severe
disease were excluded. The subjects consume bread or white
rice or germinated brown rice three times per day for one
month. Blood tests and body composition tests are conducted
before and after meals according to each intervention method.
The wash-out period was maintained for more than 2 weeks to
minimize the carry-over effect of the experiment.
Results: The mean age was 38.6 ± 7.9 years and the mean BMI
was 25.7 ± 3.2 kg/m2 in 44 prediabetic adults (germinated
brown rice; n = 16, white rice; n = 14, bread; n = 11). There was
no significant difference in the anthropometric and biochem-
ical data of one month after ingestion of bread, white rice and
germinated brown rice. However, groups of germinated brown
rice and white rice showed a tendency to decrease in weight
loss, waist circumference, and lipid blood test compared to
bread.
Conclusion: Although research is still under way and there are
not many subjects, there is no significant effect of germination
brown rice, white rice, and bread intake. It is the first
meaningful study to test people with diabetes and the results
of the study are expected in the future.
Disclosure of Interest: None declared.
SUN-LB332
ALBUMIN, MICRONUTRIENTS STATUS AND PROGNOSIS IN ALS
PATIENTS
I. Breton1 *, C. Velasco1, M. Camblor1, C. Cuerda1, M. Motilla1,
Y. Olmedilla1, R. Jimenez2, I. Catalina2, R. Barahona2,
J. L. Muñoz-Blanco2, P. Garcia-Peris1. 1Nutrition Unit,
2
Neurology Unit, Hospital Gregorio Marañón, Madrid, Spain
Rationale: Malnutrition leads to a worse prognosis in ALS
patients. The effect of albumin and micronutrient status is not
well known. The aim of this study is to evaluate the relationship
between albumin and micronutrient status and survival in ALS
patients.
Methods: Retrospective study in an ALS population. Clinical,
anthropometric and biochemical data (albumin, prealbumin,
ferritin, Zn, Cu, folate, vit B12, A E, D) were analysed at first
evaluation in a multidisciplinary clinic. Survival time was
calculated to death or to Dec 2016. Statistical analysis (SPSS
21.0) incudes a descriptive study, Pearson’s correlation and
Kaplan-Meier test. Sig p < 0,05.
Results: Two hundred and ten ALS patients (120 male, 68,8%
spinal onset) were evaluated. Mean age was 62,1 ± 13,7, BMI
25,7 ± 4,2 kg/m2 and mean time of follow-up of 33,4 ± 28 m.
% of patients
Prealbumin < 20 mg/dl 17,1
vit D < 30 ng/ml <20 ng/ml) 87 (62,8)
Zn < 70 μg/dl 33
Cu < 80 μg/dl 11,2
Ferritin < 30 μg/dl (>300 μg/dl) 12 (20)
Rest of biochemical data were normal in >95 of patients.
Patients with albumin and prealbumin above median (4,4 g/dl
and 25 mg/dl respectively) had a longer survival (P = 0,008 and
0,046). Vit D < 20 ng/ml was associated with a higher mortality
( p = 0,047). A negative correlation was observed between Cu
S177
and survival (r = −0,24 p = 0,018); those patients with Cu > p75
of population had a higher mortality ( p = 0,031). Patients with
ferritin > 300 mg/dl had a higher mortality than those with
ferritin < 30 ng/dl (( p = 0,005). We found no relationship
between Zn, folate, vit B12, A, E and survival.
Conclusion: In this series of ALS patients, those with higher
serum albumin and prealbumin levels at first evaluation had a
longer survival. A decrease in vit D and an increase in ferritin
and Cu plasma levels were associated with a worse prognosis.
Further studies are needed to confirm these data.
Disclosure of Interest: None declared.
SUN-LB333
INTESTINAL PRODUCTION OF HYDROGEN WITH FRUCTOSE
SOLUTION IN RUNNERS AND PERSONS WITH NON-ALCOHOLIC
FATTY LIVER DISEASE A PILOT STUDY
J. M. F. Sicchieri1,2 *, G. Junqueira1, C. S. Manca1,
A. D. L. C. Martinelli3, A. M. Navarro1, R. B. Oliveira4.
1
Department of Internal Medicine, Division of Nutrition and
Metabolism, University Hospital, Faculty of Medicine of
Ribeirão Preto, University of São Paulo, Brazil, 2Division of
Nutrition and Metabolism, Department of Internal Medicine,
University Hospital, Faculty of Medicine of Ribeirão Preto,
University of São Paulo, Brazil, 3Department of Internal
Medicine, Division of Gastroenterology, University Hospital,
Faculty of Medicine of Ribeirão Preto, University of São Paulo,
Brazil, 4Department of Internal Medicine, Division of
Gastroenterology, Ribeirao Preto, Brazil
Rationale: The increase in the intake of fructose in the
Western diet and its repercussion have raised interest of
researchers in the field. To assess gastrointestinal symptoms
and hydrogen production after the ingestion of a fructose
solution.
Methods: Hydrogen test (H2 test) was performed after the
ingestion of a solution with 50 g fructose along with the
application of a questionnaire to evaluate the consumption of
dietary sources of fructose and gastrointestinal symptoms
during the H2 test in three groups: Athletes group (AG), with
eight athletes; control group (CG), with eight healthy subjects;
and non-alcoholic fatty liver disease group (NAFLDG), with
nine subjects with the disease. Statistical analysis was
performed with analysis of variance (ANOVA) at a p ≥ 0.05
significance level.
Results: The AG was the largest H2 producer followed by the CG
with significant difference between the AG and NAFLDG
( p ≤ 0.05). Fruits in natura were the most commonly men-
tioned dietary source of fructose. Most participants remained
asymptomatic during the experiment.
Conclusion: This pilot study points out that hydrogen produc-
tion is higher in the AG and CG. Further studies are required to
better explain the contribution of factors such as diet and
lifestyle on hydrogen production.
Disclosure of Interest: None declared.
S178
SUN-LB334
EVALUATION OF ADIPOSITY AND INFLAMMATION IN RATS
OFFSPRING SUBJECTED TO FEED RESTRICTION DURING
PREGNANCY
S. Andreotti1, G. Boltes Reis1, F. D. F. Silva1, A. C. M. Komino1,
N. L. Gil2, A. P. A. Ramos2, F. B. Lima1, R. G. Landgraf2,
M. A. Landgraf3 *. 1Physiology, University of São Paulo, São
Paulo, 2Pharmaceutical Sciences, Federal University of São
Paulo, Diadema, 3Pharmacology, University of São Paulo, São
Paulo, Brazil
Rationale: We have investigated the repercussions in the
adipose tissue development in adult (12-week old) rats
submitted to in utero undernourishment, which causes small
birth weight and hypercorticosteronemia.
Methods: Females Wistar rats (12–16 weeks old) in estrus were
mated and, after confirmed the presence of spermatozoa in
vaginal swab, were divided into two groups: G1 – fed with
normal diet (commercial pellets) and water ad libitum; G2 –
50% food restriction and free water access. Offspring G1 of
normal birth weight (NBW) and offspring G2 of low birth weight
(LBW). These rats were euthanized, their perivascular fat pads
were weighted and inflammatory parameters were measured.
Results: Body weight (g) at 12 weeks old: NBW = 323,6 ± 6,4
vs. LBW = 364,4 ± 6,5* ( p = 0,0002). Perivascular fat pad (g):
NBW = 2,364 ± 0,2 vs. LBW = 1,811 ± 0,1*(p = 0,0356). Adipocyte
volume ( pL): NBW = 118,4 ± 8,1 vs. LBW = 167,1 ± 9,6. The
secretion of cytokines by adipocytes (TNFa, IL1β, IL6 and IL10)
are significantly higher in LBW animals, when compared to NBW
animals.
Conclusion: Adult rats that presented low birth weight, in
consequence to maternal undernourishment during all preg-
nancy, developed alterations in their adiposity, increasing
proinflammatory cytokine levels.
Supported by FAPESP- 2014/15210-3, 2012/51104-8, 2010/
01404-0 and CNPq
Disclosure of Interest: None declared.
SUN-LB335
DETECTION OF SARCOPENIA IN PATIENTS WITH RHEUMATOID
ARTHRITIS
M. Sebe1 *, R. Tsutsumi1, M. Chikugo1, J. Kishi2, M. Iuchi1,
M. Kuroda1, N. Harada1, Y. Nakaya1, Y. Tsutsumi3, Y. Nishioka2,
H. Sakaue1. 1Nutrition and Metabolism, 2Respiratory Medicine
and Rheumatology, 3Anesthesiology, Biomedical Sciences,
Tokushima University, Tokushima, Japan
Rationale: Sarcopenia is defined as a decrease in muscle mass
and function and is one of the determinants of age-related
disability and mortality. Differentiating sarcopenia from loss of
muscle mass due to pain, limb deformity and impairment in
physical function in patients with rheumatoid arthritis is a
difficult yet clinically important issue due the negative effects
of decreased muscle mass and function on quality of life. The
aims of our study were to determine the prevalence of
sarcopenia in patients with rheumatoid arthritis and to
evaluate the association between sarcopenia and inflammation
and disability scores in patients with rheumatoid arthritis.
Methods: The study group was formed of 278 patients with
rheumatoid arthritis (61 men and 217 women). The identifica-
tion of sarcopenia was based on muscle mass, quantified using
Poster
bioelectric impedance analysis, handgrip strength and isomet-
ric knee flexion/extension strength. Serum level of C-reactive
protein and the Disease Activity and Disability (DAS-28) score
were quantified. Measured outcomes were compared among
patients with and without sarcopenia. Statistical analysis was
performed using Graph Pad Prism 5.0 (San Diego, CA).
Results: Sarcopenia was identified in 35.8% of females and
33.3% of males in our study group, with no effect of disease
duration. DAS-28 scores, however, were higher among patients
with sarcopenia, compared to those without sarcopenia
(P < 0.05). Although a higher than normal body fat percentage
was identified in all patients, BMI was lower for patients with
sarcopenia (20.0 kg/m2) than in patients without sarcopenia
(23.4 kg/m2; P < 0.05).
Conclusion: Sarcopenia was identified in 35% of patients with
RA, and was associated with a higher body fat percentage as
muscle mass decreased. Therefore, the prevalence of sarco-
penia is high among patients with RA.
Disclosure of Interest: None declared.
SUN-LB336
PREVALENCE OF DYSPHAGIA IN A COHORT OF PATIENTS WITH
STEINERT DISEASE
P. Díaz Guardiola1 *, J. Olivar Roldán2, S. Azriel Mira1,
J. García de Gregorio3, C. Martín González3,
C. Casanova Rodriguez4, R. Moreno Zabaleta5,
G. Gutierrez Gutierrez6. 1Endocrinology and Nutrition
Department, Hospital Universitario Infanta Sofia,
2
Endocrinology and Nutrition Department, Horpital
Universitario Infanta Sofía, 3Otolaryngology Department,
4
Cardiology Department, 5Neumology Department,
6
Neurology Department, Hospital Universitario Infanta Sofia,
Madrid, Spain
Rationale: Myotonic dystrophy type 1 or Steinert disease is a
muscular dystrophy frequently seen in adults. It is an inherited
autosomal-dominant disease affecting multiple systems inclu-
sive of cardiac, ocular, pulmonary, digestive and endocrine
alterations.
It frequently affects smooth muscle tissue so many of these
patients present signs of dysphagia, which can lead to
malnutrition and repeated respiratory infections subsequently
increasing risk of morbidity & mortality.
Objective: To understand the prevalence of dysphagia within a
cohort of patients with Steinert Disease.
Methods: A retrospective and descriptive study of patients with
Steinert Disease diagnosis followed in the Neuromuscular
Pathology Unit which screened dysphagia utilising the Eating
Assessment Tool-10 (EAT-10). The patients with suspected
dysphagia were referred to Nutrition and Otolaryngology.
Volume viscosity swallow test (V-VST) or swallowing fibroendo-
scopy was performed in cases with positive EAT-10.
Results: Of the 55 patients who attended the Neuromuscular
Disease Consultation, 27 were women and 28 men, with an
average age of 46.14 ± 14.3 years. Fifty patients were screened
with dysphagia (EAT-10), 23 of which were positive (46%). In
these patients, the study was extended by performing
swallowing fibroendoscopy or V-VST. 21 patients were diag-
nosed with dysphagia (38% of patients), more than half of which
(13 patients, 61%) had problems with solids and 4 with liquids
(19%), 2 with mixed (9%) and 2 with both textures (9%).
Critical Care 2
In addition to this, 13% of the evaluated patients (7) presented
malnutrition, all of them of caloric type
Conclusion: Dysphagia is very common in patients with
Steinert’s disease therefore, it is essential to take it into
account and perform screenings in all of them, since its early
detection can avoid the risk of increased morbidity and
mortality associated with dysphagia: respiratory infections,
malnutrition and death.
Disclosure of Interest: None declared.
SUN-LB337
LUNG ENDOTHELIAL CELLS FROM INTRAUTERINE
MALNUTRITION-INDUCED LOW-BIRTH-WEIGHT RATS FAIL TO
EXPRESS THE LEPTIN RECEPTOR (OBRB) AND
DOWNREGULATE INFLAMMATORY RESPONSES
A. M. Balbino1, M. M. Silva1, G. A. Azevedo1, N. L. Gil1,
M. A. Landgraf2, R. G. Landgraf1 *. 1Pharmaceuticals Science,
Federal University of São Paulo, Diadema, 2Pharmacology,
University of São Paulo, São Paulo, Brazil
Rationale: We evaluated the expression of the long-form leptin
receptor (ObRb) in lung endothelial cells from Low birth weight
(LBW) rats and examined its role in the production of
inflammatory mediators.
Methods: Lung endothelial cells were obtained from LBW or
normal-birth-weight (NBW) rats. These cells were stimulated
with leptin (10 ng/mL), LPS (1 μg/mL) or leptin plus LPS. Six
hours after stimulation, the production of inflammatory
mediators (PGE2, LTB4, IL-1β and IL-6) and the expression of
leptin receptor (ObRb) were examined.
Results: Western blot assay showed that the expression of long-
form leptin receptor was decreased (63%) in primary cultures of
endothelial cells derived from LBW rats. Leptin alone did not
induce any alteration of the levels of inflammatory mediators
evaluated, whereas LPS increased the levels of PGE2, LTB4, IL-
1β and IL-6. Only in endothelial cells from NBW rats did leptin
enhance the production of lipid mediators in response to LPS.
The production of IL-1β and IL-6 was increased in NBW rat cells
after exposure to LPS.
Conclusion: These results suggest that low birth weight
induced by intrauterine malnutrition does not induce leptin
receptor expression and downregulates inflammatory mediator
production in primary cultures of pulmonary endothelial cells
stimulated LPS.
Disclosure of Interest: None declared.
SUN-LB338
LIFELONG FOOD ALLERGIES CAN LEAD TO POOR
NUTRITIONAL STATUS
T. Sinai1 *, R. Amizur-Levi1, A. Elizur2, M. R. Goldberg2,
L. Nachshon2, Y. Katz2, E. Monsonego-Ornan1. 1The School of
Nutritional Sciences, The Hebrew University of Jerusalem,
Rehovot, 2Allergy and Immunology Institute, Assaf-Harofeh
Medical Center, Zerifin, Israel
Rationale: Food avoidance diets restrict the variety of foods
that can be eaten and impact overall dietary consumption. This
study investigated dietary intake and anthropometric measure-
ments in young adults with IgE-mediated Cow-Milk Allergy
(IgE-CMA).
S179
Methods: Weight, height, BMI and dietary intake was evaluated
in 69 IgE-CMA patients (44% males) and 31 volunteers without
food allergies (control group, 45% males) aged ∼20 years.
Anthropometric data were compared to the general population
and presented as z-scores using CDC growth charts. Nutritional
assessment was based on 24-hour-dietary-recall and presented
as percent of recommended values (DRIs). Analyses were done
using T-Test for continuous variables and Chi-Square tests for
categorical data.
Results: Low nutrient consumption was noted in CMA patients
(Table 1), 17 (25%) consumed less than the minimum daily
recommendation for protein vs. 1 (0.03%) in controls, p < 0.01.
Height-z-score were significantly reduced in CMA patients
compared to both general population (−0.6 ± 0.9 vs.0, p <
0.0001) and controls (vs. 0.07 ± 0.6, p < 0.001). Twenty CMA
patients (29%) had additional food allergies to nuts, eggs, fish
and/or meat. Of these 20 participants many had significantly
reduced BMI (−0.6 ± 1.0 vs. 0.1 ± 0.8, p = 0.03) and were more
likely to consume <80% of energy recommendations.
Table 1: Nutritional data of participants [%DRI, Mean ± SD].
Nutrient IgE-CMA Control Nutrient IgE-CMA Control
Calcium **33 ± 24 87 ± 42 Phosphorus **118 ± 66 190 ± 80
Magnesium *72 ± 30 91 ± 35 Vitamin A *43 ± 39 77 ± 70
Potassium *48 ± 19 58 ± 22 Riboflavin **110 ± 64 166 ± 78
Zinc *87 ± 45 110 ± 37 Vitamin B12 **146 ± 104 201 ± 134
*p < 0.05, **p < 0.001. No significant differences were found between groups in
energy, protein, fat, carbohydrates or in other micronutrients.
Conclusion: Individuals with CMA are at risk for inadequate
nutritional intake and short stature. Growth monitoring and
appropriate dietary interventions from childhood is
recommended.
Disclosure of Interest: None declared.
Critical Care 2
MON-P001
INDIRECT CALORIMETRY VS METABOLIC LIMITS TRACING FOR
EFFECTIVE PARENTERAL NUTRITION IN ICU PATIENT
J. Sobocki1 *. 1Department of Surgery and Clinical Nutrition,
Medical University of Warsaw, Warsaw, Poland
Rationale: Estimation of nutritional needs for ICU patients is
difficult. Nutritional needs and metabolic limits changes day by
day and hour by hour. Overnutrition and undernutrition are
both harmful. The aim of the study was to evaluate accuracy of
IC measurement in prediction of patients needs, compared to
metabolic limits tracing technique.
Methods: 20 patients on surgical ICU were included into the
study. Indirect Calorimetry (IC, Cosmed) was measured for 5
days in each patient (100 patient-days measurements) accord-
ing to standardized technique. Results were compared to
metabolic limits tracing technique. TPN was administered
according to IC measurements.
Results: IC overestimated (defined as >10% calories over
metabolic limit) in 85 measurements (85%). In two thirds
overestimation was more than 20% and maximal was more than
40%. IC was accurate (+/−10%) in 10 measurements (10%).
Underestimation (>10% of calories deficit) was rare, but has
S180
happened in 5 days (5%). The former was observed in patients
recovering from critical illness.
Conclusion: IC overestimates (total energy expenditure often
overcomes metabolic limits) or underestimates nutritional
needs (when patient is undernourished). Only 10% of measure-
ments IC estimation was adequate. However IC is useful tool in
ICU, it should be used with caution.
Disclosure of Interest: None declared.
MON-P002
CO2 REMOVAL BY CVVH CAN BE CALCULATED
J. Jonckheer1 *, A. Debain2, W. Moeyerson1, P. Honore1,
E. De Waele1. 1Intensive Care, 2Internal Medecine, University
Hospital of Brussels, Jette, Belgium
Rationale: Nutrition is a cornerstone in the care of critical ill
patients. Calculating the individual caloric need with the use of
formula has been shown by large trials to be inaccurate. The
golden standard is Indirect Calorimetry and measures carbon
dioxide (CO2) production (V̇ CO2) and oxygen (O2) consumption
(V̇ O2). By using the Weir formula, Energy Expenditure can be
calculated. The use of IC is contraindicated during continuous
renal replacement therapy (CRRT) because of the potential loss
of CO2 and isoforms in the dialysate. We aimed to find a way
to predict the tCO2 (total CO2 content) and tO2 (total O2
content) exchange in the CRRT machine to enable the use of IC
during CRRT.
Methods: In 6 patients treated with continuous veno-venous
hemofiltration (CVVH) with trisodium citrate, tCO2 and other
components of the blood and dialysate were measured on
different sample points of the CVVH circuit using a blood gas
analyzer. Citrate was stopped and replaced by an infusion of
Natrium Chloride 0,9% at the same flow to evaluate its effect on
tCO2 and tO2 exchange.
Results: 23% of tCO2 was removed from the blood passing
through the CVVH machine when replacement fluid without
bicarbonate was used. This was independent of predilution
fluid used. The change in O2 was not significant (<0,5% of
average V̇ O2).
Using a blood gas analyzer, tCO2 in dialysate correlated with
tCO2 extraction due to the CVVH filter. A formula to calculate
the tCO2 exchange in the CVVH machine could be derived
which uses the settings of the machine and either blood
obtained in the arterial CVVH circuit or tCO2 in the dialysate.
Conclusion: CO2 exchange due to CVVH can be calculated using
our formula. A blood gas analyzer can be used to assess the
tCO2 extraction in the dialysate, although it wasn’t validated
for it. Both findings should enable and facilitate the use of
IC during CVVH if a correction factor is used for the
measured V̇ CO2.
Disclosure of Interest: None declared.
Poster
MON-P003
CRITICAL ILLNESS REDUCES SELF-REPORTED APPETITE AND
ORAL INTAKE BUT NOTACTUAL INTAKE ATAWEIGHED MEAL 3-
MONTHS POST-DISCHARGE
L. Chapple1,1,2 *, L. Weinel3, Y. Ali Abdelhamid1,3, M. Summers3,
T. Nguyen1, P. Kar1, M. Chapman1,2,3, A. Deane1,2,3. 1Discipline
of Acute Care Medicine, University of Adelaide, 2National
Health and Medical Research Council of Australia Centre of
Research Excellence in Nutritional Physiology, 3Intensive Care
Unit, Royal Adelaide Hospital, Adelaide, Australia
Rationale: Oral intake is inadequate early after ICU discharge
yet appetite and intake in survivors after hospital discharge is
unknown. The aim of this study was to assess whether ICU
survivors have reduced appetite and dietary intake 3-months
after ICU discharge compared to in health.
Methods: Adult ICU survivors were assessed 3-months after ICU
discharge and compared to healthy subjects. Following an
overnight fast, all participants consumed a standardised
carbohydrate drink. Intake was assessed by 24-hour recall of
the preceding day (conducted by a dietitian) and a standard
weighed buffet meal 4-hours post-drink. Appetite was assessed
pre-drink (fasting) and pre- and post-buffet using visual
analogue scales.
Results: Fifty-one ICU survivors (42% male; 70 ± 9 y; BMI
28 ± 6 kg/m2) and 25 healthy subjects (60% male; 67 ± 12 y;
BMI 27 ± 4 kg/m2) were evaluated. From the 24-hour recall ICU
survivors consumed less fat (ICU 74 (48): health 104 (70) g;
p = 0.032) and energy (ICU 7740 (2899): health 9578 (3487) kJ;
p = 0.018) than healthy subjects. Fasting and pre-meal, ICU
survivors had less preference for fat than healthy subjects
( p = 0.033; 0.006). Oral intake from the weighed buffet was
comparable between ICU survivors and healthy subjects
(Table 1). Post-meal, ICU survivors had greater hunger ratings
( p = 0.042) and less appetite satisfaction ( p = 0.019).
Table 1: Intake from buffet, mean (SD).
ICU Health p
Energy, kJ 2751 (1260) 3077 (1359) 0.304
Protein, g 37 (19) 40 (17) 0.574
Fat, g 23 (12) 26 (13) 0.346
Carbohydrates, g 69 (35) 79 (42) 0.298
Conclusion: ICU survivors reported less preference for fat and
less fat and energy consumption than healthy subjects. Intake
from a weighed meal was comparable, yet ICU survivors had
greater hunger ratings and less appetite satisfaction after the
meal, suggesting other factors may influence intake.
Disclosure of Interest: None declared.
MON-P004
DETECTING MALNUTRITION IN THE CRITICALLY ILL USING
DIFFERENT ASSESSMENT TOOLS
M. T. Al Kalaldeh1 *. 1Faculty of Nursing, Al-Zaytoonah
University of Jordan, Amman, Jordan
Rationale: Proper nutritional assessment is strongly associated
with nutritional failure and mortality in the critically ill (1).
There is a little consensus on the appropriateness of using such
nutritional in the intensive care (2). This study aimed to
assesses using diffrent measurement in predicting nutritional
status in the ICU.
Critical Care 2
Methods: This cross-sectional observational study included
critically ill patients who were fed enterally and mechanically
ventilated. Patients were assessed using Malnutrition Universal
Screening Tool (MUST), Phase Angel (PA) by Bioelectrical
Impedance Analysis (BIA), and Acute Physiology and Chronic
Health Evaluation II (APACHE II).
Results: 122 patients were examined. The duration of intensive
care admission was 6.25 (IQR 4.3–8.7). 78 (63.9%) of patients
were acute emergency cases while 39 (32.0%) were chronic
medical cases and 5 (4.1%) were other medical diagnosis. Mean
of APACHE II score was 17.93 (SD 7.3). Based on this, 89 patients
(73.0%) were found with low PA and the other was found
normal. While MUST was ranged from 0 (Low risk) to 2 (high
risk), 63 patients (51.6%) were at low risk, 27 (22.1%) were at
moderate risk, and 32 (26.3%) were at high risk. Correlation
revealed low significant correlation between MUST and both PA
and APACHE II (R = 0.41 and 0.57; p = 0.035 and 0.006,
respectively). However, high correlation was found between
PA and APACHE II (r = 0.89, p < 0.001).
Conclusion: The reliance on one tool for nutritional assessment
would under-diagnose nutritional status in the critically ill.
References
1. Feldblum I, German L, Bilenko NAS, Enten R, Greenberg D, et al.
Nutritional risk and health care use before and after an acute
hospitalization among the elderly. Nutrition. 2009;25:415–20.
2. Heyland DK, Stephens KE, Day AG, McClave SA. The success of
enteral nutrition and ICU-acquired infections: A multicenter
observational study. Clinical Nutrition. 2011;30(2):148–55.
Disclosure of Interest: None declared.
MON-P005
DIABETES SPECIFIC ENTERAL FORMULAS IN ICU
M. Castro1 *, L. M. Horie1, K. S. Kawamura2, F. Rascov2,
D. Toledo3. 1Gastroenterology, Faculdade de Medicina da USP,
Sao Paulo, 2Nutrition, Pronto Socorro Central, Sao Bernardo,
3
Nutrition, Hospital Albert Einstein, Sao Paulo, Brazil
Rationale: Although standard enteral nutrition is universally
accepted, the use of disease-specific formulas for hypergly-
cemic patients is still controversial. This study compares three
differents high-protein diabetes-specific formulas to verify the
improvement of glycemic control and tolerability.
Methods: This was a prospective, open-label, randomized
study. The patient groups established according to the high-
protein formula received were: group A, Glucerna 1.5 (Abbott),
B, Diason 1.5 (Nutricia); group C, Novasource GC 1.5 (Nestle).
Inclusion criteria were: expected enteral nutrition ≥5 days,
baseline glucose >180 mg/dL in the first 48 h. The targeted
glucose level was 110–150 mg/dL. Glycemic variability was
calculated as the standard deviation, glycemic lability index
and coefficient of variation. We collected daily gastrintestinal
events (diarrhea and vomiting).
Results: A total of 64 patients were consecutively enrolled (A
20, B 24 and C 18). There were no difference in glucose control
between the tthree groups (233 ± 58 vs. 224 ± 46 vs 233 ± 58 IU/
day, p > 0.05). Gastrintestinal events were not different
between the groups.
Conclusion: In these study, the three diabetes-specific
formulas had the same effect in glucose control and gastrin-
testinal events.
Disclosure of Interest: None declared.
S181
MON-P006
MINIMALLY INVASIVE TREATMENT OF ABDOMINAL
COMPARTMENT SYNDROME DURING ACUTE PANCREATITIS
REDUCES INTOLERANCE OF TUBE FEEDING
M. Bezmarevic1 *, M. Panisic1, A. Popadic2, D. Mirkovic1. 1Clinic
for General Surgery, 2Clinic of Anesthesiology and Intensive
Care, Military Medical Academy, Belgrade, Serbia
Rationale: Intolerance of tube feeding (TF) is associate with
abdominal compartment syndrome (ACS) and in patients with
open abdomen (OA). To compare effects of decompressive
laparotomy with temporary abdominal closure (OA) and
percutaneous puncture with placement of abdominal catheter
(PP) in patients with ACS during severe acute pancreatitis (SAP)
regarding tolerance of TF.
Methods: Prospective study included 15 patients divided into
two groups (8-OA and 7-PP group). APACHE 2 score, intra-
abdominal pressure (IAP) and tolerance of TF were assessed
before and after procedures and comparison between two
groups were assessed.
Results: Before the procedure APACHE 2 score was 19.5 ± 2.7 in
OA group and 19.7 ± 3.9 in PP group ( p = 0.9). Before the
procedure IAP was 22 ± 1.4 mmHg in OA group and 23 ± 2.2
mmHg in PP group ( p = 0.14). Intolerance of TF was present in
all patients in both groups before procedure. After the
procedure APACHE 2 score was 15.7 ± 3.1 in OA group and
before 17.3 ± 5.7 in PP group ( p = 0.52). After the procedures
IAP was 10 ± 2.1 mmHg in OA group and 14 ± 3.2 mmHg in PP
group. After the procedure intolerance of TF was present in 6
(75%) patients in OA group and in one (14%) patient in PP group
( p = 0.001). There was significant difference in APACHE 2 score
( p = 0.001) and IAP ( p < 0.001) before and after procedures, but
no significant difference in APACHE 2 score ( p = 0.394) and IAP
( p = 0.144) changes between groups. The significant difference
was found between number of patients who did not tolerate TF
in PP group before and after procedure ( p < 0.001), but no
differences between those patients in OA group ( p = 0.19).
Conclusion: Intolerance of TF is present in patients with ACS in
SAP. Minimally invasive treatment and decompressive laparot-
omy have an immediate effect on organ function. Minimally
invasive treatment of ACS reduce intolerance of TF more than
decompressive laparotomy in patients with SAP.
Disclosure of Interest: None declared.
MON-P007
EVALUATION OF PROTEIN INTAKE WITH TOTAL PARENTERAL
NUTRITION (TPN) IN A CLINICAL SETTING
M. A. Van Kralingen1 *, S. Leij - Halfwerk1, J. van der Linde2,
M. Mensink2. 1Hogeschool van Arnhem en Nijmegen, Nijmegen,
2
Rijnstate Hospital, Arnhem, Netherlands
Rationale: Sufficient protein intake in patients receiving total
parenteral nutrition (TPN) is important for recovery and
reducing mortality risk. As it is suspected that protein intake
in these patients is below their protein requirements the goal of
this study was to evaluate protein intake in patients receiving
TPN in a clinical setting.
Methods: Protein intake (g/kg body weight) and energy intake
were retrospectively collected from patient records of all
patients receiving TPN in all hospital wards of Rijnstate
Hospital in Arnhem, the Netherlands, between July and
S182
December 2016, and compared with their individual protein
and energy requirements. For protein requirement, 1.2 g/kg –
according to the ESPEN and ASPEN guidelines– and 1.5 g/kg –
taking into account disease-related stress factors– were
used. Energy requirement was estimated with Harris &
Benedict + 30%. In overweight patients requirements were
recalculated to BMI 27 kg/m2. Patients with enteral nutritional
intake were excluded.
Results: A total of 52 patients were enrolled in this study. The
mean protein intake was 1.4 g/kg (SD ± 0.2 g/kg) which was
significantly higher than 1.2 g/kg (t-test, p < 0.0005), but
lower than 1.5 g/kg (t-test, p = 0,018). Three patients (6%)
received less than 1.2 g protein/kg (0.8 g/kg to 1.1 g/kg),
whereas 16 patients (31%) received more than 1.5 g/kg
(1.6 g/kg to 2.5 g/kg). The mean energy intake was
1,930 kcal (SD ± 300 kcal), which is 99% of mean energy
requirement (SD ± 11%, 1,973 kcal±301 kcal).
Conclusion: Most patients received sufficient protein with TPN
per the minimum requirement of 1.2 g protein/kg. However, to
reach the requirement of 1.5 g protein/kg in a clinical setting
an amino acid supplement may be indicated to avoid caloric
overfeeding.
References
1. ASPEN Guidelines for Provision and Assessment of Nutrition Support
Therapy in the Adult Critically Ill Patient 2016.
2. ESPEN Guidelines on Enteral Nutrition: Intensive Care 2006.
Disclosure of Interest: None declared.
MON-P008
SUBSTRATE UTILIZATION AND ADMINISTRATION IN CRITICALLY
ILL PATIENTS WITH ACUTE KIDNEY INJURY: A PROSPECTIVE
MULTICENTER STUDY
M. Hellerman1 *, A. Sabatino2, M. Theilla1, I. Kagan1,
E. Fiaccadori2, P. Singer1. 1Intensive Care Unit, Rabin Medical
Center, Petah Tikva, Israel, 2Intensive Care Unit, Parma
Hospital, Parma, Italy
Rationale: The objective of our study is to evaluate the
adequacy of nutritional support in intensive care unit (ICU)
patients with acute kidney injury (AKI). This was achieved by
comparing administered amount of carbohydrates and lipids to
substrate utilization calculated from indirect calorimetry
measurements.
Methods: A prospective multi-center study, (Rabin Medical
Center ICU, Israel and the Renal ICU Parma Hospital, Italy)
included adult ICU patients with AKI (based on KDIGO criteria)
receiving enteral and/or parenteral nutrition. Resting energy
expenditure (REE) was measured by indirect calorimetry
(Deltatrac II, Datex GE), nitrogen excretion was measured
using urinary urea nitrogen and changes in plasma BUN. Fat and
carbohydrate oxidation were derived from Weir formulas and
compared to daily prescribed and administered fat and
carbohydrates. Study was approved by the institutional
review board. Wilcoxon Signed Ranks Test was used for
statistical analysis.
Results: Lipid expenditure was derived from 86 measurements
yielding a mean REE of 1,755 cal/24 h (Standard deviation (SD)
406) and an N2 excretion of 12.6 g/24 h (SD 7.4). Mean lipid
oxidation was 114 ± g/24 h (SD 66.8), while prescribed lipids
were 6 ± g/24 h (SD 32; p < 0.001). Carbohydrate expenditure
was derived from 75 measurements yielding a mean REE of
Poster
1,703 cal/24 h (SD 405) and N2 excretion of 11.2 g/24 h (SD
6.6). Mean carbohydrate oxidation was 161 ± g/24 h (SD 176),
much lower than prescribed carbohydrates 191 ± g/24 h (SD 76;
p < 0.001). Amount of carbohydrates and fat administered
correlated to prescribed amount (r = 0.825 and 0.887
respectively).
Conclusion: Substrate utilization is not in relation with
substrate administration in artificially fed critically ill patients
suffering from AKI. Standard nutrition, based on commercial
formulas, should be challenged with a guided nutritional
approach based on substrate utilization.
Disclosure of Interest: None declared.
MON-P009
CAN WE USE PREALBUMIN AS A MARKER FOR NUTRITIONAL
STATUS IN CRITICALLY ILL SURGICAL PATIENTS?
N.-J. Choi1 *, J. H. Jung2. 1Trauma and Surgical Critical Care,
2
Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Republic of Korea
Rationale: Serum prealbumin (PAB) is used as a nutrition
indicator because it reflects the short-term nutritional status
with a short half-life. However, PAB is influenced by not only
nutrition therapy, but also other several factors.
The purpose of this study was to evaluate the correlation
between PAB and CRP and compare with correlation between
PAB and nutritional intake in critically ill surgical patients.
Methods: This retrospective cohort study included the
patients (n = 67) who had been admitted to the surgical
intensive care unit (SICU) for more than 7 days in 2015 and
checked the level of PAB sequentially two more times.
Electronic medical records were reviewed the patient
characteristics, nutritional status, PAB, CRP and the amount
of nutritional intake. Statistical analysis was performed using
Pearson’s correlation coefficient, independent t-test methods
of SPSS 21.0 program.
Results: The PAB measured just after SICU admission demon-
strated no relation with nutritional status (adequate (n = 29),
9.8 ± 5.2 mg/dL vs. malnutrition (n = 38) 10.5 ± 6.3 mg/dL,
p = 0.607). In addition, PAB sequentially measured (on ICU
14th day) showed no correlation with the amount of caloric
intake (≥25 kcal/kg/day (n = 24) 13.4 ± 6.4 mg/dL vs. <25 kcal/
kg/day (n = 43) 11.2 ± 5.5 mg/dL, p = 0.149). The change of PAB
showed correlation with not the amount of nutrition intake
(r = 0.129, p = 0.296), but the level of CRP (r = −0.508,
p = 0.000).
Conclusion: In acute phase of critically ill surgical patients, the
level of PAB showed a strong correlation with CRP level, rather
than the amount of nutritional intake. Therefore, we should be
careful to interpret PAB of critically ill surgical patients.
Disclosure of Interest: None declared.
MON-P010
ELEMENTAL VERSUS POLYMERIC ENTERAL NUTRITION IN ICU
PATIENTS: WHAT IS PREFERRED?
N. Kazeminia1 *, M. Sistanizad1. 1Clinical Pharmacy, School of
Pharmacy, Tehran, Islamic Republic of Iran
Rationale: Selection of enteral nutrition (EN) formula in ICU
patients has become an important topic recently due to its
impact hospital expenditure as well as patient’s metabolic
Critical Care 2
balance. Semi-elemental and polymeric are two types of EN
product which is widely used in hospitals with manufacturer
reports of semi-elemental product preference in critically ill
patients. This study was designed to compare these two EN
products (semi elemental vs polymeric) in ICU patients.
Methods: Fifty patients who received EN within the first 48
hours of ICU admission divided into two groups of semi-
elemental and polymeric, 25 patients in each. Patient’s
laboratory data was noted for seven concomitant days.
Moreover, six-hours urine was collected for each patient to
calculate nitrogen balance, while albumin level was recorded in
days 1, 4 and 7. Results of enteral feeding with these two formula
were subsequently assessed and analyzed using SPSS software.
Results: Tolerance of nutrition and reported serum level of
Creatinine, K, Na and Urea had not significant difference in the
two groups in these 7 days period. The mean nitrogen balance
was more negative in polymeric group (−5.46 ± 8.97 vs
3.41 ± 9.38, p-value: 0.367) and sepsis incidence was detected
in 64% and 60% of polymeric and semi-elemental groups
respectively ( p-value: 0.771). The mean serum albumin value
was 0.04 lower in polymeric group with 0.88 of increase in mean
number of albumin vial usage ( p-value: 0.835 and 0.728).
Nitrogen balance had no correlation with 28-days mortality ( p-
value: 0.917), ICU mortality ( p-value: 0.717) and incidence of
sepsis ( p-value: 0.515).
Conclusion: According to the results of this study, no significant
difference between polymeric and semi-elemental EN was seen
in ICU patients. Therefore, contrary to the claims of the
manufacturer, semi-elemental products with hydrolyzed
protein content are not preferred in critically ill patients.
Disclosure of Interest: None declared.
MON-P011
TRACE ELEMENT REPLETION FOLLOWING SEVERE BURN
INJURY: A 16-YEAR RETROSPECTIVE COHORT STUDY
O. Pantet1 *, P. Stoecklin2, M. Charrière1, A. Vernay3,
M. M. Berger1. 1Intensive Care and Burn Center, CHUV,
Lausanne, 2Intensive Care Medicine, Inselspital, Bern,
3
Computer Sciences, CHUV, Lausanne, Switzerland
Rationale: Trace elements (TE) repletion has been shown to be
beneficial in burn patients who suffer from large exudative
losses of Cu, Se and Zn. Aim of the study was to check if our
repletion protocols were appropriate to normalize TE plasmatic
levels of our burn patients over a period of 16 years.
Methods: Inclusion criteria were: burn injury requiring an ICU
stay >7 days. The cohort was divided into 4 groups according to
the period defined by changes in our management protocol.
Period 1 (P1): 1999–2000, P2: 2001–2005, P3: 2006–2010, P4:
2011–2015. Changes were mainly increasing TE repletion doses
and better compliance with the repletion protocol.
Table 1: (abstract: MON-P011).
Variable All periods Period 1 (99–01)
Nr of patients 253 32
Daily Cu intake (mg) 2.5 (3.4) 2.7 (3.4)
Cu level (mg/l)∗ (12.5–23.6) 14.2 (11.7) 8.3∗ (5.2)
Daily Se intake (μg)∗ 334 (484) 300∗ (374)
Se level (μg/l)∗ (750–1,500) 1,233 (769) 530∗ (430)
Daily Zn intake (mg)∗ 33 (48) 27∗ (35)
Zn level (mg/l)∗ (10.1–17) 12.3 (5.8) 6.7∗ (3.9)
S183
Demographic data, daily TE intakes and weekly TE plasma
levels were retrospectively retrieved for the first 21 days. Data
is expressed as median and (IQR).
Results: 253 patients aged 43 (32) years, burned on 25 (24)%
body surface area were included (no difference between
periods). Daily Cu, Se and Zn intakes increased significantly
between 1999 and 2015, allowing normalization of plasma Cu
(19 mg/l) and Zn (12 mg/l) levels during P4. Median plasma Se
levels were elevated during P4, flirting with the maximal range
(1,404 μg/l).
Conclusion: The study shows that our supplementation
protocol normalizes Cu and Zinc levels, but Se doses seem
too high, suggesting a reduction of the dose.
Disclosure of Interest: None declared.
MON-P012
VALIDATION OF PREDICTIVE EQUATIONS TO ESTIMATE
RESTING ENERGY EXPENDITURE IN CRITICALLY ILL PATIENTS
O. Zusman1,2, I. Kagan2,3, M. Theilla3,4 *, I. Bendavid2,3,
J. Cohen2,3, P. Singer2,3. 1Department of Cardiology, Rabin
Medical Center, Petach Tiqva, 2Faculty of Medicine, Tel Aviv
University, Tel Aviv, 3Department of General Intensive Care and
Institute for Nutrition Research, Rabin Medical Center, Petach
Tiqva, 4Faculty of Nursing, Steyer School of Health Professions,
Tel Aviv University, Tel Aviv, Israel
Rationale: Although measuring resting energy expenditure
(REE) via indirect calorimetry (IC) is the gold standard
recommended by guidelines, technical difficulties hinder its
use, and predictive equations are largely used in place. We
sought to validate commonly used equations using a large
cohort of patients.
Methods: Patients were hospitalized from 2003–2015 at a 16-
bed ICU at a university affiliated, tertiary care hospital. Data
was drawn from a computerized system and included the IC REE
as well as other variables required by equations. Measurements
were restricted to up to 5 REE per patient to avoid bias.
Equation performance was assessed by comparing means,
standard deviations, correlation, concordance, and agree-
ment, which was defined as a measurement within 85% and
115% of measured REE.
Results: A total of 3,573 REE measurements in 1,098 patients
were included. Median age was 64 (interquartile range, IQR
27), 65% were male, and 91% were ventilated. A total of 562
patients had more than 2 REE measurements. For these
patients, the mean difference between maximum and
minimum measured REE was 500 kcal. The performance of
predictive equations is presented in Table 1. Equation
performance varied according to parameter, but none
reached more than 50% agreement with measured REE.
Period 2 (02–05) Period 3 (06–10) Period 4 (11–15) P-value
57 85 79
2.0∗ (3.0) 2.2 (3.0) 3.3∗ (4.2) <0.001
11.7 (16.4) 17.6 (9.3) 19.3∗ (8.7) <0.001
323 (397) 392∗ (540) 292 (647) <0.001
1,053 (540) 1,461∗ (683) 1,404 (538) <0.001
30 (37) 45 (50) 40∗ (61) <0.001
13 (7) 13.2∗ (5.6) 11.5 (4.2) <0.001
S184 Poster

Table 1: (abstract: MON-P012).

Mean Standard % % Correlation Concordance Agreement
Difference Deviation Error Difference

Faisy 10.19 455.58 0.21 0.13 0.49 0.57 0.5

Harrison-Benedict 94.9 446.5 0.21 0.13 0.54 0.59 0.5
Ireton-Jones 26.81 461.16 0.2 0.13 0.46 0.52 0.49
Jolliet 99.26 542.04 0.24 0.14 0.51 0.62 0.44
Mifflin-St. Jeor −438.39 431.97 0.24 0.17 0.54 0.35 0.3
Penn State −206.7 453.29 0.2 0.14 0.51 0.54 0.44
25 kcal/kg 47.08 557.74 0.24 0.15 0.36 0.52 0.42

Conclusion: This is the largest study comparing predictive MON-P014

equations to resting energy expenditure measured by indirect
calorimetry. Due to low performance, predictive equations
cannot be used in place of indirect calorimetry to estimate REE.
Disclosure of Interest: None declared.
MON-P013
EARLY ADMINISTRATION OF PROTEIN IN CRITICALLY ILL
PATIENTS IMPROVES SURVIVAL: A LARGE RETROSPECTIVE
COHORT STUDY
O. Zusman1,2, I. Kagan1,3, M. Theilla3,4 *, I. Bendavid1,3,
J. Cohen1,3, P. Singer1,3. 1Faculty of Medicine, Tel Aviv
University, Tel Aviv, 2Cardiology, 3Department of General
Intensive Care and Institute for Nutrition Research, Rabin
Medical Center, Petach Tiqva, 4Nursing Department, Steyer
School of Health Professions, Sackler School of Medicine, Tel
Aviv University, Tel Aviv, Israel
Rationale: The issue of timing of nutrition provision in critically
ill patients is under debate in the literature. While protein is
recognized as a valuable macronutrient in this patient
population, it is currently not known whether early adminis-
tration of protein improves patient outcomes.
Methods: Included patients were hospitalized from 2003 to
2015 at a 16-bed ICU at a university affiliated, tertiary care
hospital, who stayed at least 4 days in the unit. Data was drawn
from a computerized system and included the demographic
data, as well as SOFA score, need for parenteral nutrition, and
amount of protein per day. Patients that received mean daily
protein of more than 0.7 gr/kg/d in the first 3 days were
included in the early group, and those that received less in the
first days, were included in the late-protein group.
Results: A total of 2,253 patients were included, of which 1,040
were in the early group, and 1,213 in the late group. Age and
sex were similar, with higher SOFA score and parenteral
nutrition in the late group. After 60-days, 371 (36%) in the
early group, and 517 (43%) in the late-adequate group had died
( p < 0.001 for difference). In multivariable Cox regression
analysis, while controlling for age, sex, weight, parenteral
nutrition, mean delivered calories, and mean daily protein
received after the first 3 days, administration of vasopressors,
and total hospital stay, early protein was associated with
increased survival (HR 0.84, 95% CI 0.72–0.98, p = 0.01)
Conclusion: Results of this study suggest that early delivery of
protein is associated with increased survival. RCTs are needed
to validate this result.
Disclosure of Interest: O. Zusman: None declared, I. Kagan: None
declared, M. Theilla: None declared, I. Bendavid: None declared,
J. Cohen: None declared, P. Singer Grant/Research Support from:
Unrestricted grant from Fresenius.
PHOSPHATE DEFICIENCY IN SEVERE DIABETIC
KETOACIDOSIS
P. Tesinsky1 *, A. Haken2, J. Gojda1. 1ICU, Dept. of Medicine 2,
Charles University Hospital, 23rd Faculty of Medicine, Prague,
Czech Republic
Rationale: Severe diabetic ketoacidosis (DKA) is often accom-
panied by hypophosphataemia. Clinical manifestations include
weakness, changes of state of consciousness, and muscle
fatigue. The aim of this prospective study was to identify the
presence of hypophosphataemia in severe diabetic ketoacidosis
and to compare patients’ metabolic state with specific clinical
manifestation.
Methods: Patients with severe hypophosphataemia during
treatment of DKA were monitored within a period of 48 hours
after admission. Following parameters were evaluated at times
0, 12, 24, and 48 hours: pH, bicarbonate, glycaemia, potassium
(K), phosphate (P), CRP, and urinary ketones. Simultaneously,
cumulative doses of insulin, energy, fluids, K, and P were
calculated.
Results: Out of 3,595 patients admitted to the tertiary hospital
medical ICU between January 1, 2012, and December 31, 2016,
114 patients had a diagnosis of DKA (3.17%), while 48 patients
from this group (42.1%) had evidence of severe hypopho-
sphataemia (less than 0.35 mmol/L) during the treatment. Out
of these, 10 patients required temporary ventilatory support.
The total dosage of insulin within the first 24 hours was
significantly lower in these patients (60 IU) in comparison to
the mean value of the whole study group (163 IU).
Furthermore, only 200 kcal were delivered to these patients
within the first 24 hours (compared to 1,956 kcal in the whole
group), 4,050 ml fluids (6,437 ml), 60 mmol K (108 mmol), and
0 mmol P (49 mmol). The clinical symptomatology resumed
completely in all patients within the next 24 hours after
suplementation of fluid, energy, K, and P.
Conclusion: Although phosphate supplementation is not
routinely recommended during treatment of diabetic ketoaci-
dosis, we should be aware of danger of hypophosphataemia.
Therefore, monitoring of serum phosphate level and its
repletion if necessary should be considered.
Disclosure of Interest: None declared.
Critical Care 2
MON-P015
NUTRITION RISK IN CRITICALLY ILL PATIENTS AND
OUTCOME; NUTRIC SCORE, MUST AND SERUM ALBUMIN
COMPARISON
R. Carvalho1 *, M. Henriques2, L. Esteves3, R. César1, H. Costa2.
1
Endocrinology and Nutrition Service, 2Intensive Care Service,
3
Genetics and Molecular Pathology Unit, Divino Espirito Santo
Hospital, Ponta Delgada, Portugal
Rationale: Critical illness is associated with a rapid deterior-
ation in nutritional status, even in patients admitted to the
Intensive Care Unit (ICU) well nourished. Several tools assess
nutrition risk but most consider all ICU patients at high risk.
Nutric score (NS) is a novel screening tool designed to better
identify ICU patients at risk of developing malnutrition. The
objective of the study was to compare the correlation of NS,
Malnutrition Universal Screening Tool (MUST) and serum
albumin (SA) with the outcome, measured in ICU-LOS and 28
day mortality.
Methods: A retrospective, observational study, of all patients
stayed in ICU >72 hours within a 6 month period. Data was
collected for inclusion in the scores: age, baseline MUST,
baseline APACHE II, baseline SOFA, number of comorbidities,
days from hospital admission to ICU admission, Body Mass
Index <20 and SA. Outcomes were collected until day 28
and included ICU-LOS and 28-day mortality. Statistical analysis
was done with Studentst-test or Mann-Whitney test for
continuous variables and Fisher’s exact tests for categorical
variables and considered to be significant for p-values less
than 0.05. All analysis were performed with SPSS 21.0
software.
Results: 70 patients were eligible for the study, mean age
65.9 ± 9 y, males 55.7%, BMI 27.8 ± 6.6, LOS-ICU 12.1 ± 9.3 days.
At 28 day 11 patients (15.7%) died. In NS, 5 (7.1%) and 6 (8.5%)
patients died in the low and high risk score respectively; in
MUST 1 (1.4%) and 10 (14.3%) patients died in the low and high
risk scores respectively and in SA 3 (4.3%) and 8 (11.4%) patients
died in the moderate or severe depleted scores. The
differences were not statistically different for 28 day mortality
or ICU-LOS in NS, MUST and SA scoring systems.
Conclusion: We did not found a statistical difference between
survivors and non-survivors and between ICU-LOS in NS, MUST
and SA nutrition risk screening tools.
Disclosure of Interest: None declared.
MON-P016
ESTABLISHMENT OF INTESTINAL MICROBIOTA IN SURGICAL
NEWBORNS WITH INTESTINAL FAILURE
R. Feferbaum1 *, on behalf of Luana Moreira2, A. M. Matuhara1,
M. E. J. Rivero1, C. R. Taddei2. 1Pediatrics, Instituto da Criança
do HC Faculdade De Medicina Da Universidade De São Paulo,
Sao Paulo, Brazil
Rationale: Intestinal microbiota in the neonate is highly
susceptible to perturbations of the luminal environment. due
to prolonged antibiotic treatments, delayed enteral feeding
and TPN.
Methods: Analyse fecal microbiota of 20 surgical neonates with
intestinal wall failure due gastrosquisis and onphalocoele.
Fecal sample were collected from all newborns weekly since
S185
their born and consequently admittance until their discard of
NICU and store at −80C until experiments. The fecal microbiota
composition was evaluated using MiSeq sequencing approach
and qPCR.
Results: The results show a lower diversity in fecal microbiota
composition, with a predominance of members of the Phylum
Firmicutes and Proteobacteria. The value of total bacteria
found in those newborns was significant lower than those found
for healthy newborns, found in previous reports. The younger
the newborn, lower is the value of total bacteria in their
intestinal microbiota. The evaluation of the intestinal colon-
ization shows an increase in diversity in the last weeks of
permanence in the unit care. However, the newborns showed
high relative abundance of Enterobacteria, Staphylococcus and
Streptococcus in the last weeks of permanence in the unit.
Many of them are colonized by pathogenic bacteria, like
Pseudomonas and Stenotrophomonas. There was a positive
association between reduction of the diversity and occurrence
of sepsis. The qPCR results showed a reduced colonization by
Lactobacillus and Bifidobacterium.
Conclusion: Conclusion: These results suggested that the
absence of feeding andTPN may disturb the establishment of
intestinal microbiota, favoring pathogenic bacteria and conse-
quent clinical intercurrents occurrence, such sepsis. These
findings may contribute to the understanding of how intestinal
microbiota develops in critical newborn. Financial support:
FAPESP N. 2015/13–59–9.
Disclosure of Interest: None declared.
MON-P017
THE IMPACT OF PERIOPERATIVE NUTRITIONAL SUPPORT
WITH THE USE OF NUTRIDRINK COMPACT WITH DIETARY
FIBERS ON THE INCIDENCE OF INFECTIOUS COMPLICATIONS
AFTER PANCREATODUODENAL RESECTION
S. Bobovnick1 *. 1ICU, Municipal Clinical Hospital named after
E.E.Volosevich, Arkhangelsk, Russian Federation
Rationale: Perioperative nutritional support for patients after
surgery for chronic pancreatitis is a difficult problem due to
severity of desease and major intraabdominal trauma
Methods: 10 days before surgery patients in Group I received
daily 125 ml/day of Nutridrink Compact with dietary fibers.
In the postoperative period they received the tube feeding
with Nutrisone at the rate of 25 kcal/kg/day and 1.5 g/kg/
day of protein in combination with Nutridrink Compact MF at
the rate of 125 ml/day 24 h after pancreatoduodenal
resection. Patients in Group II received tube feeding with
Nutrisone at the rate of 25 kcal/kg/day and 1.5 g/kg/day of
protein 24 h. Tubes were installed intraoperatively at the
back of anastomosis zone. The period of duration of tube
feeding in both groups during the postoperative period was 7
days.
Results: Decrease in the number of infectious complications in
main group (2 patients, 9.5%) as compared to the control (6
patients, 28.6%, p = 0.02). Decrease in antibacterial therapy
duration has been observed(only 2 patients from Group I
underwent an average course of antibacterial therapy within
9.2 days as compared to 6 patients from Group II within 13.7
days). Significant reduction in postoperative plenghts of stay
(Group I – 11.1 days, Group II 22.9 days, p = 0.01). In Group II, 2
S186
patients died from purulent-septic complications. More pro-
nounced depletion of visceral pool of total protein, albumin
and transferrin has been observed in Group II on the 10th day of
the postoperative period.
Conclusion: Nutritional support with the use Nutridrink
Compact MF during the perioperative period leads to reduction
of complications, improvement of visceral protein status
and a significant reduction of infectious complications in the
postoperative period in patients undergoing surgery for chronic
calculous pancreatitis.
Disclosure of Interest: None declared.
MON-P018
JUSTIFICATION FOR INCLUSION OF SEMI-ELEMENTAL
FEEDS INTO THE COMPOSITION OF EARLY ENTERAL
NUTRITION
V. Fisher1 *. 1Deputy Chief Regional Clinical Hospital, PhD,
Ass Professor of the Department of Anesthesiology
and Reanimation of the Stavropol Medical University,
Stavropol Medical University, Stavropol,
Russian Federation
Rationale: Still some issues remain disputable concerning
the composition of the feeds for early EN and the periods for
their prescription after surgery. This situation prompted the
study as to the efficiency of the use of semi-elemental feeds for
enteral nutrition during the first day after surgical
interventions.
Methods: 20 patients after reconstructive surgeries related
to elimination of operational stomas of the large intestine. 10
patients as a control group, 10 patients as a main group. During
the 24 h after the surgery the patients of the control group
received 1,000 ml of glucose-electrolyte solution, while the
patients of the main group received 500 ml of glucose-
electrolyte solution and 500 ml of semi-elemental tube feed
(Nutrison Advanced Peptisorb). The groups were randomized as
to the volume of surgical intervention, the initial degree of
nutritional insufficiency. Significant comorbidity was the
criterion for exclusion.
Results: Anastomosis leakeage was observed in two patients of
the control group (20%) and only in one patient in main group
(10%, p < 0.005). The number of postoperative wound abscesses
was the same in both groups. By the 3rd day of the
postoperative period the amount of albumin from the initial
level was 90% in the patients of control group and 93% in the
main group ( p < 0.005). It should be noted that by the third day
of the postoperative period the function of gastrointestinal
tract was restored, which allowed to perform complete enteral
nutrition in 70% of the persons in the control group and in 80% of
the pts in main group ( p < 0.005).
Conclusion: Study demonstrate the benefits of semi-elemental
feeds for EN during the first 24 h after surgery on the large
intestine. it leads to earlier restoration of the intestinal tract
function, normalizes protein metabolism, as well as reducing
the risk of infectious complications and frequency of anasto-
mosis leakeage.
Disclosure of Interest: None declared.
Poster
MON-P019
THE EFFECT OF FLUID INTAKE ON FLUID BALANCE AND
PROGNOSIS IN POLYTRAUMA PATIENTS IN ICU
V. Joskova1,2 *, A. Patkova1,2, E. Havel3, M. Kovarik1,2,
Z. Zadak1, M. Hronek1,2. 1Department of Research and
Development, University Hospital in Hradec Kralove,
2
Department of Biological and Medical Sciences, Faculty of
Pharmacy in Hradec Kralove, Charles University, 3Department
of Surgery, University Hospital in Hradec Kralove, Hradec
Kralove, Czech Republic
Rationale: The aim of this study was to evaluate the changes in
volume and distribution of body fluids with their effect on
clinical outcomes in polytrauma patients, because it is not well
known.
Methods: The study included 30 polytrauma patients (22 men
and 8 women) with mean age 43.33 ± 16.79 years. During the
whole hospitalization fluid balances were recorded from
hospital documentation. On selected days (minimum day 2;
maximum day 65; in total 130 examinations), body fluids were
examined by bioelectrical impedance spectroscopy (BCM
monitor, Fresenius, Germany) and metabolism was character-
ized by the indirect calorimetry (Vmax Series, V6200 Autobox,
SensorMedics Corporation, California, USA). Graph-Pad Prism6
(GraphPad Software, La Jolla, CA, USA) and Excel 2016
(Microsoft, Redmont, WA, USA) were used for statistical
analyses.
Results: According to patient’s fluid balances, examinations
were divided into three periods of ICU hospitalization (day 1–
3, day 4–10 and day 11 and more). Mean total body water
(TBW) (51.72; 50.40; 48.25 l) and extracellular water (ECW)
(27.17; 26.67; 23.70 l) was decreasing, but mean intracellu-
lar water (ICW) remained unchanged (24.57; 24.70; 24.54 l).
In the period between day 4 and 10, higher fluid intake
correlated with higher excess fluid in extracellular water
(OH) ( p = 7*10−5; r = 0.570), ECW ( p = 0,005; r = 0.424) and
ratio between ECW/ICW ( p = 9*10−5; r = 0.562). Patients with
higher values of mentioned parameters showed longer
duration of mechanical ventilation and length of ICU stay.
Fluid balance was influenced by fluid intake according to
derived equations.
Conclusion: Changes in fluid volumes seem to be an indirect
prognostic marker in polytrauma patients. Derived equations
can be applied in clinical practice for optimization of the
appropriate fluid intake that can contribute to reduce the
duration of mechanical ventilation and the length of ICU stay.
Disclosure of Interest: None declared.
MON-P020
EARLY HIGH PROTEIN INTAKE WITHOUT ENERGY
OVERFEEDING IN CRITICALLY ILL PATIENTS
W. G. Looijaard1 *, N. Denneman1, B. Broens1, P. J. Weijs1,2,
H. M. Oudemans-van Straaten1. 1Department of Adult
Intensive Care Medicine, 2Department of Nutrition and
Dietetics, VU University Medical Center, Amsterdam,
Netherlands
Rationale: Early high protein (≥1.2 g/kg/day) and no energy
overfeeding were associated with lower mortality in a
retrospective cohort of non-septic intensive care (ICU)
patients.1 Reaching protein targets without overfeeding
Critical Care 2
energy is challenging with traditional enteral formulas. This
prospective pilot study aimed to determine the feasibility of
reaching a protein target of ≥1.2 g/kg ideal body weight (IBW)/
day after 96 h of ICU admission using a new high protein-to-
energy ratio enteral nutrition (EN) formula.
Methods: Adult non-septic, ventilated ICU patients were fed for
96 h with the new formula (Fresubin® Intensive, Fresenius Kabi)
containing 82 g hydrolysed whey protein/1,000 kcal. EN started
<24 h of admission. Feeding target was 90% of energy
expenditure measured daily by indirect calorimetry or VCO2.2
Primary endpoint was % of patients reaching the protein target
(≥1.2 g/kg IBW) after 96 h. Secondary endpoints included
protein intake after 48 h and GI tolerance. Data in median [IQR].
Results: 26 patients were included (18M, 8F), age 60 [43–66],
APACHE II 21 [19–23], BMI 26 [23–30] kg/m2. 20/26 patients
received the study formula for 96 h (2 died, 4 started oral
intake). The protein target was reached by 22/26 patients
(85%) after 48 h and by 19/20 (95%) after 96 h. GI tolerance was
good, no diarrhoea, 1 patient vomited once. In 1 patient plasma
urea rose unrelated to renal failure (25 mmol/L).
48 hours (n = 26) 96 hours (n = 20)
Energy intake (% of 85 [75–92] 95 [79–99]
energy expenditure)
Patients receiving ≥1.2 g/ 22/26 (85%) 19/20 (95%)
kg IBW protein
Protein intake (g/kg IBW) 1.65 [1.28–1.82] 1.89 [1.56–2.33]
Protein intake (g/kg 1.41 [1.26–1.57] 1.63 [1.41–1.86]
actual BW)
Conclusion: This high-protein EN formula containing hydro-
lysed whey protein is well tolerated and enables clinicians to
achieve a high protein target early during ICU stay, without
exceeding the defined energy target.
References
1. PMID 25499096
2. PMID 26494245
Disclosure of Interest: W. Looijaard: None declared, N. Denneman:
None declared, B. Broens: None declared, P. Weijs Speaker Bureau of:
Fresenius Kabi, H. Oudemans-van Straaten Grant/Research Support
from: this investigator-initiated study was fully supported by Fresenius
Kabi.
MON-P021
STEPWISE INCREASE IN PROTEIN DELIVERY IN THE FIRST 14
DAYS OF ADMISSION IS ASSOCIATED WITH IMPROVED 6-MONTH
OUTCOME IN SARCOPENIC CRITICALLY ILL PATIENTS
W. G. Looijaard1 *, I. Dekker2, S. Stapel1, H. Oudemans1,
P. J. Weijs1,2,3. 1Intensive Care Medicine, 2Nutrition and
Dietetics, VU University Medical Center, 3Nutrition and
Dietetics, Amsterdam University of Applied Sciences,
Amsterdam, Netherlands
Rationale: There is no consensus on nutritional goals in critical
care. ESPEN and ASPEN guidelines agree that protein delivery
should be >1.2 g/kg/d, however the trajectory is still unclear.
Aim was to determine which protein trajectory was associated
with lowest 6-m mortality in sarcopenic ICU patients.
Methods: Sarcopenic ICU patients with abdominal CT-scan at
admission (+/−4 d) and with nutritional intake registered for
up to 14 d were retrospectively included. Sarcopenia was
defined as muscle area <110 m2 (F) and 170 m2 (M). Cox
S187
regression analysis was used to relate protein delivery (g/kg)
during days 1–3, 4–7, and 8–14 of ICU admission to 6 m
mortality in sarcopenic patients, with adjustments for energy
intake-expenditure ratio, and APACHE II score. A range of
protein delivery levels was tested and the optimum level was
selected based on HR and p-value. Protein target was >1.2 g/
kg/day.
Results: 199 sarcopenic patients (137 male) were included, age
62 ± 17 y, APACHE II score 25 ± 8. Mean energy delivery was
1,470 and 1,928 kcal/d in week 1 and 2, respectively. Mean
protein delivery during the first 14 days in the ICU increased
from 0.5 to 1.2 g/kg. Cox regression indicated >0.8 g/kg on
days 1–3, >1.3 g/kg on days 4–7, and >1.65 g/kg on days 8–14 as
optimal. For days 8–14 higher levels were not available for
evaluation.
Day 1–3 Day 4–7 Day 8–14
Protein delivery, g/kg/d 0.47 ± 0.32 1.11 ± 0.32 1.20 ± 0.28
Optimal protein delivery, >0.8 (42/199) >1.3 (55/199) >1.65 (8/199)
g/kg/d (# pats)
Adjusted mortality risk HR 0.43; CI HR 0.53; CI HR 0.12; CI
with optimal protein 0.21–0.86; 0.30–0.94; 0.03–1.52;
delivery p = 0.016 p = 0.031 p = 0.118
Conclusion: The optimal protein intake of sarcopenic ICU
patients increased during admission from 0.8 g/kg/day during
days 1–3 to 1.3 g/kg/day during days 4–7, and higher than
1.65 g/kg/day during the second week.
Disclosure of Interest: None declared.
MON-P022
GUT MICROBIOTA TRAJECTORY IN PATIENTS WITH SEVERE
BURN: A TIME SERIES STUDY
X. Wang1 *, J. Yang1, F. Tian1, L. Zhang1, Q. Lei2, T. Jiang3,
J. Zhou4, S. Yuan4, J. Li1. 1Department of general sugery,
Jinling Hospital, Nanjing, 2Department of general sugery, The
First People’s Hospital of Foshan, Foshan, 3Department of
Gynecology, Obstetrics and Gynecology Hospital of Fudan
University, Shanghai, 4Department of Burn, Jinling Hospital,
Nanjing, China
Rationale: Severe burn is a complicated lesion that greatly
impacts the physiological functionality of human body. Sepsis is
the leading cause of death in patients with severe burn due to
increased intestinal permeability, altered gut microbiomes and
bacterial translocation. Recent studies have indicated that gut
microbiota is closely associated with burn injury. However, few
time series experiments was designed to study the post-burn
dynamic change of gut microbiome and its association with
enteral nutrition.
Methods: Seven severely burned patients who suffered from a
severe metal dust explosion injury were recruited in this study.
The dynamic changes of gut microbiome of fecal samples at six
time points (1–3 days, 2, 3, 4, 5 and 6 weeks after severe burn)
were detected by using 16S ribosomal RNA pyrosequencing
technology.
Results: Following the post-burn temporal order, gut micro-
biota dysbiosis was detected in the gut microbiome after severe
burn, and then it was gradually resolved. The bio-diversity of
gut bacteria was initially decreased, and then returned to
normal level. In addition, at the early stage (from 2 to 4 weeks),
S188
the majority of those patients’ gut microbiome was a pathogen
genus, Enterococcus and Escherichia; while at the end of this
study, the majority was a beneficial genus, Bacteroides.
Conclusion: Severe burn injury can cause a dramatic dysbiosis
of gut microbiota. A trend of enriched beneficial bacteria and
diminished pathogen bacteria may serve as prognosis micro-
biome biomarkers of severe burn patients.
Disclosure of Interest: None declared.
MON-P023
FISH OIL-SUPPLEMENT PARENTERAL NUTRITION MODULATE
IMMUNITY AND REDUCE INFLAMMATION VIA SUPPRESS THE
TLR-4 SIGNALING PATHWAYS IN RATS WITH ABDOMINAL SEPSIS
Y. Zhou1 *, S. Cao1. 1General Surgery, Affiliated Hospital of
Qingdao University, Qingdao, China
Rationale: The study researched the mechanisms of fish oil-
supplement parenteral nutrition modulate immunity and
reduce inflammation in rats with abdominal sepsis.
Methods: 36 adult male Sprague-Dawley rats were randomly
assigned to receive standard chow and water (Sham group,
n = 9) or normal saline (NS group n = 9) or total parenteral
nutrition (TPN) containing a standard soybean oil emulsion (SO
group n = 9) or FO-supplemented TPN (FO group n = 9) at the
onset of sepsis for 5 days. The dry/wet weight ratio of lung,
intestinal mucosa scores, plasma cytokines and TLR-4, MYD88,
phosphorylation NF-κB( p65), NF-κB ( p65) expression in spleen
mononuclear cells, occludin expression in intestinal tissue were
determined.
Results: Compared with the NS and SO group, Fish oil–
supplemented TPN can decrease the dry/wet weight ratio of
lung; improve the intestinal mucosal damage score; suppressed
TLR4 activation in spleen monocytes; up-regulate the expres-
sion of the occludin mRNA and protein in intestinal tissue;
reduced proinflammatory cytokines production.
Conclusion: In this study, we observed that fish oil-supplement
parenteral nutrition modulate immunity and reduce inflamma-
tion via suppress the TLR-4 signaling pathways, namely
alleviated ALI, protected the integrity of intestinal tissue,
reduce the production of proinflammatory cytokines.
Disclosure of Interest: None declared.
MON-P024
THE EFFECT OF EARLY OR LATE PARENTERAL NUTRITION
SUPPORT ON THE CLINICAL OUTCOME IN THE PATIENTS WITH
ACUTE SURGICAL ABDOMEN
Y.-P. Hsu1 *. 1Trauma and Emergency Division, Surgical
Department, Chang-Gung Memorial Hospital, Linko Branch,
Kaisan, Taiwan, Province of China
Rationale: The early supplemented parenteral nutritional
(sPN) for critically ill patients is still controversial (1). It is
wondering if the sPN is helpful for the critical patients with
acute surgical abdomen.
Methods: In this retrospective study, we reviewed the patients
who underwent operation due to acute surgical abdomen and
were admitted to surgical Intensive Care Unit (SICU). Early sPN
is defined as administration of sPN within 72 hours after SICU
admission, and late sPN is beyond this time point.
Results: From January 1, 2016 to December 31, 2016, we
totally collected 887 patients undergoing emergent operation
Poster
for acute abdomen, in whom 98 patients needed to be admitted
to SICU due to immediate or potential life threatening
conditions. There were 4 patients below 18 years of age, 12
patients without PN administration and 13 patients with
transfer to ward within 3 days and 4 patients expired within
one week of admission. There were total 65 patients eligible for
this study. There were 24 patients with early sPN and 41
patients with late sPN. The age, sex, SICU stay, ventilator days,
hospital stay, intra-abdominal abscess rate and mortality rate
were not statistically significant; however, the infection rate
for patients with early sPN was higher than that of late sPN (8/
24 = 33% vs. 6/41 = 15%, p = 0.02).
Conclusion: For critically ill patients with acute surgical
abdomen, early sPN is not recommended due to higher post-
operative wound infection rate.
Reference
Disclosure of Interest: None declared.
MON-P025
ASSOCIATION BETWEEN HEART RATE VARIABILITY MEASURES
AND ENERGY HOMEOSTASIS IN PATIENTS WITH VEGETATIVE
STATUS: A PROSPECTIVE CLINICAL COHORT PILOT STUDY
Y. Kiryachkov1 *, I. Shelkunova1 on behalf of I.G. Shelkunova, D.
L. Kolesov, V.V. Danilec. 1FSCC for Intensive Care Units and
Rehabilitation, Moscow, Russian Federation
Rationale: The aim of the study was to study the relationship
between the parameters of the functional state of the
autonomic nervous system and the nutritional status of
patients.
Methods: 11 patients were examined. The average age of
46 ± 17.7, men – 6, women – 5. The reasons for the development
of the vegetative state were: the consequences of traumatic
brain injury in – 4 patients; Anoxic brain damage – 4 patients;
Consequences of development of acute cerebrovascular acci-
dent – 3 patients. The Institutional Clinical Ethics Committee
has approved this study. Heart rate variability (Standard
deviation of all NN Intervals – SDNN, pNN50% percentage of
differences between adjacent NN intervals that are greater than
50 msec; square root of the mean of the squares of differences
between adjacent NN intervals – RMSSD) is analyzed a
computerized beat-to-beat heart rate. 5 minutes of cardio
intervals were used. 2. Plasma concentration of albumin,
prealbumin, transferrin, is analyzed using routine
technique. 3. The anthropometric measurements (BMI) and
total Lymphocyte count was also determined. All parameters
were registered at the time of admission of patients to the clinic.
Results: All patients in the vegetative state have a hyperadre-
nergic status: SDNN – 11,2 ± 2,81 msec; rMSSD – 2,45 ± 0,8 msec;
pNN50% – 0. In all patients in the hyperadrenergic status, the
states of reduced nutrition: serum albumin 2,7 ± 0,08 mg/dl;
prealbumin 13 ± 1,7 mg/dl; transferrin 164,1 ± 10,6 mg/dl; total
Lymphocyte count 1,430 ± 70/mm3; BMI 17,54 ± 1,27 kg/m2.
Conclusion: Between the parameters of reduced nutrition and
the parameters of functional activity of the autonomic nervous
system, a reliable interrelation. Imbalance of the autonomic
nervous system leads to a deterioration in the status of
nutrition in patients with brain damage.
Disclosure of Interest: None declared.
Geriatrics 2
MON-P026
EARLY EVALUATION OF THE SWALLOWING FUNCTION CAN
SHORTEN HOSPITALISATION PERIOD FOR PATIENTS WITH
ACUTE CEREBRAL INFARCTION: A HISTORICAL CONTROL
STUDY
Y. Ogawa1 *, A. Naganuma1,2, M. Inagawa1, T. Iida3, M. Kimura4,
A. Kumakura1, T. Yoshida1, H. Nakamura1, A. Moroboshi1,
R. Ueda1, Y. Kawahara1, S. Sekine1, Y. Shiozawa1, Y. Koyama1,
H. Funakoshi1, H. Tanaka1, M. Kanai1, K. Ishiguro1, T. Ogawa1,
H. Ishihara2. 1Nutrition Support Team, 2Department of
Gastroenterology, Takasaki General Medical Center, National
Hospital Organization, Takasaki, Gunma, 3Department of Oral
Science, Graduate School of Dentistry, Kanagawa Dental
University, Yokosuka, Kanagawa, 4Department of Dysphagia
Rehabilitation, Nihon University School of Dentistry, Chiyoda-
ku, Tokyo, Japan
Rationale: Since April 2016, we evaluated the swallowing
function in patients with acute cerebral infarction (CI),
using videoendoscopic examination (VE) within 48 hours of
hospitalisation. Our aim was to verify whether early evalu-
ation of the swallowing function by VE is useful in clinical
practice.
Methods: Two groups were included: a control (C) group of 35
patients with CI who were treated with a conventional
method from January to March 2016 and an early VE (V)
group of 41 patients with CI who were evaluated using VE
within 48 hours of hospitalisation from January to March
2017. The following items were compared: the hospitalisation
period, the amount of energy administered 2 days after
hospitalisation, and the improvement ratio of the dysphagia
severity scale (DSS; DSS at discharge/DSS at hospitalisation).
To compare the characteristics of both the groups, Student t-
test was performed. Pearson’s correlation coefficient was
performed to analyse the variables related to the hospital-
isation period.
Results: The patients characteristics (C vs. V group) were as
follows: mean age, 76.9 ± 10.1 vs. 76.4 ± 10.4 years; and mean
body mass index, 21.5 ± 4.5 vs. 21.7 ± 3.9 kg/m2, respectively.
The results (C vs. V group) were as follows: the mean
hospitalisation period was 32.2 ± 17.2 vs. 22.4 ± 11.4 days (p =
0.004), the amount of energy administered 2 days after
hospitalisation was 17.6 ± 12.9 vs. 23.1 ± 7.6 kcal/kg/day (p =
0.025), and the improvement ratio of DSS was 1.37 ± 0.75 vs.
1.64 ± 1.07 (p = 0.222). A negative correlation was observed
between the hospitalisation period and amount of energy
administered 2 days after hospitalisation (r = −0.4295, p = 0.002).
Conclusion: To our knowledge, this is the first study that shows
early nutritional intervention using VE within 48 hours of
hospitalisation shortens the hospitalisation period in patients
with acute CI.
Disclosure of Interest: None declared.
S189
Geriatrics 2
MON-P027
THE DETERMINANTS OF MALNUTRITION IN THE IRISH
ELDERLY POPULATION BASED ON SEX: PRELIMINARY RESULTS
FROM THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)
L. A. Bardon1,2 *, M. Streicher3, C. A. Corish2,4, M. Clarke1,2,
L. C. Power2,4, D. Volkert3, E. R. Gibney1,2, on behalf of the
MaNuEL Consortium. 1School of Agriculture and Food Science,
2
UCD Institute of Food and Health, University College Dublin,
Dublin, Ireland, 3Institute for Biomedicine of Aging, Friedrich-
Alexander-Universität Erlangen-Nürnberg, Nuremberg,
Germany, 4School of Public Health, Physiotherapy and Sports
Science, University College Dublin, Dublin, Ireland
Rationale: Malnutrition detrimentally affects health, quality
of life and disease outcome; therefore, the determinants of
malnutrition should be established. The Malnutrition in the
Elderly (MaNuEL) project is conducting analysis of longitu-
dinal European datasets to determine the predictors of
malnutrition in older, community-dwelling people. The aim
of this research was to assess the factors associated with
developing malnutrition from baseline to 2-y follow-up in
males and females.
Methods: Data were analysed for a sub-cohort (n = 1,841) of
TILDA participants using binary univariate regression analysis
with malnutrition as the dependent variable (defined as
BMI < 20 kg/m2/weight loss (WL) ≥10% over 2-y). Exclusion
criteria included being <65 y, BMI/WL data unavailable at
baseline and/or follow-up, and presence of malnutrition at
baseline (BMI < 20 or WL > 4.5 kg in the last year).
Results: Approximately half the cohort was female (50.2%).
The mean age was 71.7 ± 5.03 y in females and 71.7 ± 4.96 y in
males. Factors associated ( p < 0.05) with malnutrition in both
genders were polypharmacy (≥5 drugs/day) [OR (95% CI) males,
females] [1.93 (1.25–2.97), 1.7 (1.13–2.56)], reported walking
difficulties [2.49 (1.29–4.78), 2.32 (1.3–4.15)] and problems
climbing stairs [2.61 (1.7–4.0)]. Being unmarried, reporting low
physical activity, recent hospital admission, fair/poor self-rated
health and falling during the follow-up period were associated
with nutritional risk at 2-y follow-up in males. For females, older
age, receiving social support and cognitive impairment were
associated with nutritional risk at 2-y follow-up.
Conclusion: Risk of malnutrition is influenced by a range of
determinants which differ according to sex. Future work will
include multivariate regression analysis to establish the
strongest independent determinants of malnutrition in older
Irish people.
Disclosure of Interest: None declared.
MON-P028
STAFF ATTITUDES TOWARDS NUTRITIONAL CARE FOR
ELDERLY IN NURSING HOMES IN ITALY: A MULTICENTER
SURVEY
A. Castaldo1, E. Zanetti2, M. Lusignani3, M. C. Gugiari1,
A. Nobili4, M. Zani5, A. Verardi6, M. Magri7, A. Ianes8,
G. Ardoino8, L. Bonetti9 *. 1Education, Provincia Religiosa di
S. Marziano di Don Orione, Piccolo Cottolengo, Milan,
2
Research, Gruppo di Ricerca Geriatrica, Brescia, 3Nursing
Bachelor, University of Milan, 4Quality, Mario Negri, Milan,
S190 Poster
5
Nursing home, Le Rondini, Brescia, 6Nutrition-Audit, Health Results: Total 3,731 people older than 60 years old were
Agency, 7Research, Nurse Council, 8Medical Direction, Korian analyzed and there were 94 GPT. Table 1 showed that GPTwere
Group, Milan, Italy, 9Istituto oncologico della Svizzera italiana, statistically associated with more hypercholesterolemia
Ente Ospedaliero Cantonale Canton Ticino, Bellinzona, (27.37% vs. 39.36%, p = 0.0372). Also GPT showed tendency to
Switzerland gain weight for a year less underweight, more obesity and higher
HbA1c. However they could not show statistical difference.
Rationale: Nutritional care is often neglected and under- Conclusion: GPT showed more incidence of hypercholesterol-
estimated by health professionals (HPs) and nurse aides. This emia. More attention might be required to yield better long-
can lead to malnourished patients or patients at risk of term prognosis and increase life quality of GPT. Further
malnutrition to not be identified and receive adequate care. evaluation to GPT is needed.
It was important to understand the areas of nutritional care in
Table 1: Analysis of nutritional parameters.
which HPs show negative attitudes to prevent malnutrition and
improve overall quality of care. The aim was to assess staff Non-GPT GPT P-value
attitudes towards nutritional care in Nursing Homes (NHs). HbA1c
Methods: This is a multicentre survey, involving physicians, ≥6.5 733 (20.99) 28 (28.08) 0.1681
<6.5 2,904 (79.01) 66 (71.92)
registered nurses and nurse aides, working in 29 NHs in Italy. We
Hypercholesterolemia
used ‘The Staff Attitudes to Nutritional Nurses Care Geriatric No 2,642 (72.63) 59 (60.64) 0.0372
Scale’ to assess attitudes (Bonetti et al. 2013). We compared Yes 995 (27.37) 35 (39.36)
attitudes between HPs and nurse aides using the Kruskal Wallis. Weight change (for a year)
None 2,628 (72.55) 56 (61.53) 0.0958
Results: 1,015 questionnaires were submitted, 204 were Decrease 588 (15.68) 22 (21.19)
nurses, 36 physicians and 712 nurse aides. 20% showed negative Increase 421 (11.77) 16 (17.28)
attitudes, 50% neutral and 30% positive. Nurse aides showed Obesity
Normal 2,205 (60.53) 57 (57.70) 0.5873
worse attitudes compared to health professionals. Differences Underweight 82 (2.16) 1 (0.91)
were found between those who attended education on Obesity 1350 (37.31) 36 (41.39)
nutritional care and those who didn’t. The areas in which HPs
showed the worst attitudes were ‘Norms’ and ‘Assessment’ and GPT geriatric patients after trauma associated admission.
Data are presented as number (percentage).
they showed the best attitudes in ‘Individualization’ and
‘Intervention’.
Conclusion: The study showed a low positive staff attitude Disclosure of Interest: M. Kim Grant/Research Support from: The
statistical consultation was supported by a grant of the Korea Health
towards nutritional care for the elderly. The fact that nurse
Technology R&D Project through the Korea Health Industry
aides showed the worse attitudes is important information as Development Institute (KHIDI), funded by the Ministry of Health &
they usually assist patients with meals and monitor food intake. Welfare, Republic of Korea (grant number : HI14C1062), H. J. Cho: None
It is therefore necessary to improve knowledge on the declared, T. H. Hong: None declared, J. I. Lee: None declared, J. Kim:
importance of nutritional care in HPs to prevent malnutrition None declared, S. Baek: None declared, A. Lee: None declared,
and its negative effects in elderly living in NH. S. Y. Kwon: None declared.
References
Bonetti L, Bagnasco A, Aleo G, Sasso L. Validation of the Staff MON-P030
Attitudes to Nutritional Nursing Care Geriatric scale in Italian. Int
RISK FACTORS OF REFEEDING SYNDROME AND MALNUTRITION
Nurs Rev. 2013;60(3):389–96.
SCREENING IN OLDER HOSPITALIZED PATIENTS
Disclosure of Interest: None declared.
M. Pourhassan1 *, I. Cuvelier2, I. Gehrke3, C. Marburger4,
M. K. Modreker5, D. Volkert6, H.-P. Willschrei7, R. Wirth8.
MON-P029 1
Department of Geriatric Medicine, Marien Hospital Herne,
GERIATRIC PATIENTS AFTER TRAUMA ASSOCIATED ADMISSION Ruhr-University Bochum, Herne, 2Geriatric Center, Karlstruhe,
ARE EASY TO HAVE HYPERCHOLESTEROLEMIA 3
Department of Internal Medicine IV, Donaueschingen,
M. Kim1 *, H. J. Cho1, T. H. Hong1, J. I. Lee2, J. Kim3, S. Baek3, 4
Department of Geriatric Rehabilitation, Christophsbad Clinic,
A. Lee3, S. Y. Kwon4. 1Department of Trauma Surgery, Göppingen, 5Department of Geriatric, Sana Hanse-Clinic,
2
Department of Surgery, 3Nutritional Support Team, Wismar, 6Friedrich-Alexander-Universität Erlangen-Nürnberg,
Uijeongbu St. Mary’s Hospital, 4Nutritional Support Institute for Biomedicine of Aging, Nuremberg, 7Department
Team, Uijeongbu St.Mary’s Hospital, Uijeongbu-si, of Internal Medicine, Malteser Hospital St. Josefshospital,
Republic of Korea Uerdingen, 8Department of Geriatric Medicine, Marien
Hospital Herne, University Hospital Ruhr-University Bochum,
Rationale: There are many geriatric patients after trauma, Herne, Germany
however, analysis about their long-term prognosis is lacking.
This study was planned to analyze nutritional state in geriatric Rationale: The incidence of refeeding syndrome (RFS) in elderly
patients after trauma associated admission. (GPT) patients is not well-known. The aims of the study were (i) to
Methods: Data was collected from Korean national health and determine the prevalence of known risk factors for RFS and (ii)
nutrition examination survey conducted from 2013 to 2015. The to compare the prevalence and severity of malnutrition with the
elderly older than 60 years old were gathered and divided prevalence of known risk factors of RFS in older individuals.
according to trauma associated admission within a year. Their Methods: This cross-sectional multicenter-study investigated
nutritional parameters were analyzed. We performed Chi 342 older participants who were consecutively admitted to an
square for qualitative comparison and independent t-test for acute geriatric hospital ward. The National Institute for Health
quantitative comparison. and Clinical Excellence (NICE) criteria applied for determining
Geriatrics 2
patients at risk of RFS. Malnutrition screening was conducted
using Nutritional Risk Screening (NRS), Malnutrition Universal
Screening Tool (MUST) and Mini Nutritional Assessment-Short
Form (MNA-SF). Blood samples were analyzed according to
standard procedures.
Results: Of 342 older participants (mean age 83.1 ± 6.8, BMI
ranged 14.7–43.6 kg/m2), 239 (69.9%) were considered to be at
risk of RFS. More participants were assessed at risk of
malnutrition using NRS (74.0%) compared to MUST (49.7%)
and MNA-SF (56.8%). Based on NRS, 75.9% of patients at risk of
malnutrition are at risk of RFS whereas according to MUST and
MNA-SF, 85.9% and 69.1% of patients at risk of malnutrition are
exposed to high risk of RFS, respectively. The prevalence of risk
of RFS is increased with higher score of NRS and MUSTand lower
score of MNA-SF.
Conclusion: Almost all geriatric hospitalized patients with risk
of malnutrition demonstrated risk of RFS and should therefore
be regarded at risk for RFS. A special screening for risk factors
of RFS in addition to malnutrition screening appears to be non-
essential among this population. Nevertheless, in patients
undergoing nutritional therapy, monitoring and if necessary
supplementation of electrolytes is mandatory during the
refeeding period.
Disclosure of Interest: None declared.
MON-P031
DISTRIBUTION OF PROTEIN CONSUMPTION IN HOSPITALIZED,
MALNOURISHED, OLDER PATIENTS
M. E. G. Weijzen1 *, I. W. K. Kouw1, P. Geerlings2,
L. J. C. van Loon1. 1NUTRIM School of Nutrition and
Translational Research in Metabolism, 2Department of
Dietetics, Maastricht University Medical Centre, Maastricht,
Netherlands
Rationale: Protein-dense foods and/or protein supplemen-
tation are required to increase protein intake and, as such,
attenuate the loss of skeletal muscle mass during hospitali-
zation in older patients. We recently showed that
patients admitted for elective surgery consumed 0.53 ± 0.02 g
protein · kg−1 · d−1 during hospitalization. In the present study
we assessed actual food and snack consumption and recorded
supplement use in a variety of malnourished patients during
hospitalization.
Methods: In this observational study, n = 100 patients will be
monitored during hospitalization. Food provided by hospital
meals, snacks and supplements, and actual food consumed by
patients was weighed and recorded. Data were analyzed using
paired Students t-tests and repeated measures ANOVA.
Results: Preliminary results (n = 46; age 72 ± 2 y; hospital stay
17 ± 2 d) show that malnourished patients consume 5.3 ± 0.3
MJ · d−1, with 15, 52, and 32 En% provided as protein,
carbohydrate, and fat, respectively. The amount of protein
consumed (without supplementation) averaged 0.62 ± 0.04 g ·
kg−1 · d−1. Protein supplementation was provided in 67% of the
patients (n = 31) and increased protein intake from 0.65 ± 0.05
to 0.82 ± 0.07 g · kg−1 · d−1. Protein intake was 12 ± 1, 12 ± 1,
and 14 ± 1 g at breakfast, lunch, and dinner, respectively.
Protein supplementation, provided in between meals,
increased protein consumption with 4 ± 1 g in the morning,
3 ± 1 g in the afternoon, and 3 ± 1 g in the evening.
S191
Conclusion: Protein consumption in hospitalized, malnour-
ished, older patients averages 0.62 g · kg−1 · d−1, remaining
well below minimal protein intake requirements. Protein
supplementation increases daily protein intake towards
0.8 g · kg−1 · d−1, but the protein content of the main meals
remains far less than 20 g. Provision of more protein-dense
foods or protein supplementation is warranted to attenuate
skeletal muscle loss during hospitalization.
Disclosure of Interest: None declared.
MON-P032
EATING DIFFICULTIES IN ACUTE GERIATRIC PATIENTS ARE
ASSOCIATED WITH POOR NUTRITIONAL STATUS AND REDUCED
ACTIVITIES OF DAILY LIVING
M. M. Nielsen1 *, T. Maribo2,3, D. Melgaard4. 1Department of
Public Health, Aarhus University, Student cand.scient.san,
2
Department of Public Health, Section of Clinical Social
Medicine and Rehabilitation, Aarhus University, 3DEFAKTUM,
Central Denmark Region, Aarhus, 4Center for Clinical
Research, North Denmark Regional Hospital, Hjørring,
Denmark
Rationale: Eating difficulties in acute geriatric patients are
associated with poor nutritional status and limitations in
activities of daily living. The aim of this study was to test the
association between eating difficulties and nutritional status
and activity of daily living in a geriatric population.
Methods: A cross-sectional study conducted between March
and September 2016. Eating difficulties were assessed using
the Minimal Eating Observational Form (MEOF-II), including
observations related to ingestion, deglutition and energy/
appetite. Eating difficulties were determined on the basis of
one or more components of the MEOF-II. Poor nutritional status
was defined as age-specific low body mass index (BMI), <20 kg/
m2 if <70 years, or <22 kg/m2 if ≥70 years. Activity of daily
living was assessed using the Barthel Index and defined as low
(<50) or high (50–100).
Results: 297 acute geriatric patients were included; mean age
was 83.0 (±7.7) years and 56.2% were female. The prevalence
of eating difficulties was 54.9%. Mean BMI was 26.1 (±5.6) and
median Barthel Index was 47 (30;58).
No eating Eating
difficulties difficulties
Age* 82.4 (±7.5) 83.5 (±7.9) p = 0.871
BMI* 27.6 (±5.3) 24.7 (±5.6) p < 0.001
Barthel-100** 51.0 (39;74) 42.5 (23;52) p < 0.001
*Mean (SD), **Median (IQR).
Patients with normal/high BMI had a risk reduction of 37% in
eating difficulties, compared to patients with age-specific low
BMI ( p = 0.003). Patients with a high activity of daily living had a
risk reduction of 39% in eating difficulties, compared to
patients with low activity of daily living ( p < 0.001).
Conclusion: Eating difficulties are highly prevalent in geriatric
patients and associated with poor nutritional status and
reduced activities in daily living. Identification of eating
difficulties may be important to preserve nutritional status
and functioning in the geriatric population.
Disclosure of Interest: None declared.
S192
MON-P033
SIPPING IN PATIENTS OF ELDERLY AGE WITH HIP FRACTURE
N. Andreeva1 *. 1Department of Resuscitation, Anesthesiology,
Intensive Care and Emergency Medical Care, FGBOU VO
TGMU (Pacific State Medical University), Vladivistok, Russian
Federation
Rationale: 52% of patients admitted to in-patient departments
with cervical hip fractures have Nutritional deficiency (ND),
which is left undetected in most cases. Moreover, delay in
surgery delay for up to 1.5 weeks, the presence of concomitant
chronic diseases promotes deterioration of prognosis as to
successful osteosynthesis and rehabilitation in patients during
post-surgery period. Therefore, adding of enteral nutritional
mixtures (ENM) in the form of sipping to standard hospital diet
is an important asset in terms of preparation of these patients
for surgeries.
Methods: The efficiency of additional sipping nutrition by
way of hyper caloric ENM in patients of elderly age with cervical
hip fractures was evaluated for 4 weeks during post-surgical
period, with due regard to screening as to nutritional
deficiency. A nutritional mini-questionnaire was used to
reveal the degree of protein and energy deficiency, in which
general and subjective factors, BMI, anthropometric measure-
ments, issues of dietary behavior, as well as biochemical
markers, were reflected.
Results: It was shown that the use of Forticare (hyper caloric
nutritional mixture) at a dose of 600 kcal a day helps to
normalize the indicators of absolute lymphocyte count and
albumin level, provide the average body mass gain of 700–800 g
already by Day 7–8 after the beginning of treatment in 83.3%
patients with mild and moderate ND degree. It also allows to
reduce the incidence of infectious complications by 16% and
minimize the development of multiple organ failure syndrome
during post-surgery period.
Conclusion: Sipping as an additional caloric and protein
equivalent during post-surgical period leads to quicker
rehabilitation, increases the number of favorable treatment
outcomes and helps to decrease mortality in patients of elderly
age with cervical hip fractures.
Disclosure of Interest: None declared.
MON-P034
ADHERENCE TO THE MEDITERRANEAN DIET AND RISK OF
DEPRESSION IN ELDERLY
N. Seremet Kurklu1 *, G. Kaner2, H. Kamarli Altun1,
E. Guven Sade3. 1Department of Nutrition and Dietetics,
Akdeniz University, Antalya School of Health, Antalya,
2
Department of Nutrition and Dietetics, İzmir Katip Çelebi
University, Faculty of Health Sciences, İzmir, 3Family Medicine,
Mersin, Turkey
Rationale: The Mediterranean diet (MD) is a dietary pattern
characterized by high fruits, vegetables, legumes, cereals,
olive oil, and fish consumption, a low meat and dairy products
consumption. Because of this, the adherence to a
Mediterrnaean Dietary Pattern could prevent depression. We
aimed to assess the relationship between MD and the risk of
depression among elderly who live in the Mediterranean region
of Turkey.
Poster
Methods: A total of 75 elderly (men = 38, women = 37) who did
not diagnose with depression were included in this study. To
calculate MDS, food frequency questionnaire were used which
includes 11 main components of the MD. According to the
consumption frequency, (no consumption, rare, frequent, very
frequent, weekly and daily) items are scored between 0 and
5. The total score was ranging from 0 to 55. MDS scores were
divided into the tertiles, scores between 0 and 28 were
considered as low, 29 to 30 as average and 31 to 55 as high.
Depression was assessed with the Geriatric Depression Scale
(GDS). According to GDS, a score of 0–10 is normal, 11–13
probable depression, ≥14 is depression.
Results: Mean age, MDS and GDS scores of individuals were
68.7 ± 4.78, 29.9 ± 3.15 and, 11.5 ± 3.31, respectively.
Approximately half of the individuals (45.3%) were not in
depression while 21.3% were depressed. According to 1 to 3
tertiles, scores were 11.5 ± 3.92, 10.9 ± 3.03 and, 12.2 ± 3.16,
respectively. In addition, scores differences between groups
were insignificant ( p > 0.05). Although statistically insignifi-
cant, a negative relationship was found between MDS and GDS
score (r = −0.16, p = 0.894).
Conclusion: Depression was detected approximately one out of
the four elderly. Although the protective effect of the MD on
depression is known, we thought that the lack of a relationship
between MDS and GDS in this study is due to the inadequate
sample size of the study.
Disclosure of Interest: None declared.
MON-P035
FACTORS ASSOCIATED WITH SERUM 25-HYDROXYVITAMIND3
LEVELS IN FREE-LIVING MODERATE ALZHEIMER’S DISEASE
PATIENTS
O. L. Vicente De Sousa1 *, R. S. Guerra2, A. S. Sousa3,
T. F. Amaral2. 1Geriatric Unit, Hospital Magalhães Lemos E.P.E.,
2
UISPA-LAETA/INEGI, Faculdade de Engenharia, Universidade
do Porto, 3Faculdade de Ciências da Nutrição e Alimentação,
Universidade do Porto, Porto, Portugal
Rationale: Hypovitaminosis D has been associated with
cognitive decline among older adults. The relationship
between serum 25(OH)D3, functional status and caregivers
burden disease in free-living Alzheimer`s disease (AD) remains
to be studied. This study aims to explore the factors associated
with 25(OH)D3 status among free-living moderate AD patients.
Methods: A cross-sectional study was conducted in 79 free-
living moderate AD patients [32 men/47 women; mean(SD)
age = 78.2(6.6)years], not taking Vitamin D supplements.
Serum 25(OH)D3 was determined. MNA® score, bioimpedance
analysis, functional status indicators, including gait speed,
handgrip strength (HGS), and Barthel index were evaluated.
Cognitive function was assessed with MMSE score. Caregiver
burden disease was assessed using Zarit’s scale. Multivariable
linear regression analyses were conducted and b and 95%
confidence intervals (95%CI) were determined.
Results: Fourteen patients (50.6%) were undernourished
(MNA®≤17) and 39(49.3%) were nutritionally-at-risk
(MNA®score 17.1–23.4). Mean(SD) 25(OH)D3 levels were 15.8
(6.4) ng/mL. Among undernourished AD patients, 2 (50%) had
severe 25(OH)D3 deficiency (≤10 ng/mL), 34 (52.3%) defi-
ciency (>10 ≤ 30 ng/mL) and 4(40%) normal levels. For the
patients at undernutrition risk, 2(50.0%) were classified as
Geriatrics 2
presenting severe 25(OH)D3 deficiency, 31 (47.7%) deficiency
and 6(60%) normal levels. Factors associated with serum 25
(OH)D3 were HGS(b = 0.319,95%CI 0.095–0.544), MMSE [b=
−0.307,95%CI −0.528-(0.086)], Barthel index (b = 0.232,95%CI
0.005–0.459) and higher caregivers-Zarit burden disease score
(b = 0.250, 95%CI 0.045–0.456), R2 = 0.237.
Conclusion: A high proportion of free-living AD patients had 25
(OH)D3 insufficiency. Higher HGS values, low MMSE score,
independence and higher cargivers-Zarit burden disease score
were positively associated with 25(OH)D3.
Disclosure of Interest: None declared.
MON-P036
EVIDENCE ON HOME ENTERAL NUTRITION IN DEMENTIA
P. Orlandoni1 *, N. Jukic Peladic2, C. Venturini1, M. di Rosa3,
C. Cola2, D. Sparvoli2, N. Giorgini2, R. Basile3, D. Fagnani2.
1
Nutrizione Clinica, 2Vivisol Srl, 3INRCA, Ancona, Italy
Rationale: There is a still open debate within the scientific
community about the advisability of artificial nutrition (AN) by
Percutaneous Endoscopic Gastrostomy (PEG) in elderly
patients ( pts) with advanced dementia (D). It is argues that
AN does not improve the outcomes of these pts when
compared to orally fed pts. In Italy, the AN is administered
only when pts cannot be fed by mouth. Therefore, we
compared the outcomes of pts with D, who were tube fed by
PEG and by nasogastric tube (NGT), with the outcomes of non
demented (ND) tube fed pts.
Methods: We performed a retrospective observational study on
585 pts (85,6 ± 6,9 years), treated with Home Enteral Nutrition
(HEN) from 2010 to 2015 by Clinical Nutrition Unit of an Italian
research geriatric hospital (INRCA, Ancona). Incidence rates of
mechanical, gastrointestinal and metabolic complications and
survival – were compared between pts with severe D and ND
pts. The mortality risk factors were evaluated by Cox
proportional hazards model.
Results: The incidence rates of complications did not differ
between D and ND pts (mechanical: 1,35/1000 days in ND vs.
1,45/1000 days in D ( p = 0,270), gastrointestinal: 1,30/1000
days in ND vs. 1,35/1000 days in D ( p = 0,984), metabolic: 0,36/
1000 days in ND vs. 0,35/1000 days in D ( p = 0,252)). Neither
the median survival differed significantly between D and ND
(193 days in ND vs. 192 days in D, ( p > 0.05). Female gender,
advanced age, NGT, Diabetes Mellitus and Chronic Renal failure
were identified as survival risk factors, high values of Geriatric
Nutritional Risk Index as a protective factor.
Conclusion: Given that there are no significant differences in
complications of the HEN therapy and survival among D and
ND pts, the AN shouldn’t be contraindicated a priori in pts
with severe D. Regular follow up is mandatory to guarantee
the adherence of the therapy to its initial aims and to
assure that a principle of beneficence and non-maleficence is
respected.
Disclosure of Interest: None declared.
S193
MON-P037
CAN FORTIFIED FOODS AND SNACKS INCREASE THE ENERGY
AND PROTEIN INTAKE OF HOSPITALISED OLDER PATIENTS? A
SYSTEMATIC REVIEW
S. Mills1 *, C. R. Wilcox1, K. Ibrahim1,2, H. C. Roberts1,2.
1
Department of Academic Geriatric Medicine, University
Hospital Southamption Mailpoint 807, 2National Institute for
Health Research Collaboration for Leadership in 13 Applied
Health Research and Care (NIHR CLAHRC) Wessex, University of
Southampton, Southampton, United Kingdom
Rationale: Malnutrition is a significant problem amongst
hospitalised older people. The purpose of this review was to
summarise the evidence for the use of energy and protein
dense meals (via fortification) or snacks (supplementation) to
increase the dietary energy and protein intake of older people
in hospital or rehabilitation facilities.
Methods: A literature search was conducted through PubMed,
EMBASE, CINAHL and the Cochrane Database of Systematic
Reviews for studies published between May 1996 and May 2016
that assessed energy and/or protein intake of patients (mean
age >60) in hospitals or rehabilitation centres.
Results: Ten relevant articles were identified, containing 546
patients (mean age 60–83 years). Four articles demonstrated
significantly increased energy intake, and five articles showed
significant increased protein intake. Fortification with dairy
products was associated with a significantly increased energy
intake, whereas fortification involving mainly protein was
associated with improved protein intake. Two articles found
ONS to be superior to fortification, however the quality of the
comparisons was very poor. Four articles assessed compliance
with enriched products and reported good tolerance. Two
articles performed cost-analysis and found that fortification
was cost-effective.
Conclusion: Despite a paucity of strong evidence, we suggest
that an effective combination of energy and protein fortifica-
tion may be a relatively simple, well-tolerated and economical
approach to help older people meet their nutritional needs.
Larger trials over longer periods are required to definitively
establish the impact of fortified food on nutritional intake
and functional outcomes in comparison to ONS and usual
nutritional care
Disclosure of Interest: None declared.
MON-P038
RELATIONSHIP BETWEEN THE RISK OF DYSPHAGIA AND
FUNCTIONAL OUTCOMES IN OLDER COMMUNITY-DWELLERS
S. Tagliaferri1 *, L. Gionti2, F. Lauretani2, A. Ticinesi1,
T. Meschi1, M. G. Maggio1. 1Medicine and Surgery, University of
Parma, 2Frailty and Multimorbity Lab Geriatric Clinic Unit,
University Hospital of Parma, Parma, Italy
Rationale: Oropharyngeal dysphagia (OD) is a swallowing
disorder highly prevalent in older community-dwellers,
increasing the risk of malnutrition and aspiration pneumonia.
However, it is frequently underdiagnosed and its association
with functional performance is still unclear.
Methods: With a cross-sectional study design, we enrolled 228
older (mean age 81) community-dwellers evaluated at the
Frailty-Multimorbidity Lab Geriatric Clinic Unit of Parma
University-Hospital. Subjective dysphagia was assessed with
S194
10-item Eating Assessment Tool (EAT-10). Nutritional screening
was performed calculating BMI and Mini-Nutritional
Assessment-Short Form (MNA-SF) score. Physical and muscle
performance was assessed with Short-Physical Performance
Battery (SPPB) test and handgrip strength. Cognitive perform-
ance was screened with Mini-Mental State Examination (MMSE)
test. The relationship between EAT-10 and nutritional, phys-
ical, cognitive and motor performance was estimated through
univariate analysis in sex- and age-adjusted and multivariate
linear regression model. A logistic regression analysis was run to
identify the most predictive factor of dysphagia risk.
Results: In the univariate models, EAT-10 score was sig-
nificantly and negatively correlated with SPPB score
(β = −0.18 ± 0.04, p < 0.0001), handgrip strength (β = −0.35 ±
0.11, p = 0.001) and MNA-SF (β = −0.43 ± 0.07, p < 0.0001). In
the multivariate model, EAT-10 score confirmed as significantly
associated with SPPB (β = −0.29 ± 0.10, p = 0.003) and handgrip
strength (β = −0.12 ± 0.05, p = 0.02), but not with MNA-SF. In
logistic regression analysis, SPPB was the only factor signifi-
cantly associated with EAT-10 score (OR = 0.82, 95%IC = 0.70–
0.96).
Conclusion: In older outpatients, the risk of dysphagia was
significantly correlated with physical performance and muscle
strength. The screening of OD should be implemented in the
geriatric setting.
Disclosure of Interest: None declared.
MON-P039
METHOD FOR ASSESSMENT OF DIETARY INTAKE IN ELDERLY
PEOPLE. A COMPARISON OF 3-DAY FOOD DIARY AND 24-HOUR
DIETARY RECALL
S. Engelheart1 *, R. Brummer1, O. Ljungqvist1,
H. Bertéus Forslund2. 1School of Medical Sciences, Örebro
University, Örebro, 2Institute of Medicine, Sahlgrenska
Academy, University of Gothenburg, Göteborg, Sweden
Rationale: Dietary assessment in elderly people in need of
home health care, is complicated by functional and cognitive
disabilities. It is important to elaborate an accurate method, to
be used as a base for nutritional treatment. The aim of the
study was to compare two different methods for assessment of
dietary intake and to study the differences in outcome.
Methods: Dietary intake was assessed by 3-day Food Diary (FD)
and by 24-hour Dietary Recall (24 h) in elderly people in need of
home health care. A study population comprising 64 elderly
people, and 42 (29 females and 13 males), age 82.2 years
(range 67–94), had assessed the dietary intake by both
methods, and was included. Differences between methods
were assessed by parametric statistics, simple regression and
Bland-Altman plots.
Results: The mean energy intake according to FD (1,607 kcal/
day, SD 448 kcal, range 800–2,900 kcal) did not differ signifi-
cantly ( p = 0.18) from 24 h (1,524 kcal/day, SD 394 kcal, range
800–2,500 kcal), and a positive association was observed ( p <
0.001, R2 = 68.8%). The mean difference was 83 kcal (limits of
agreement -655–821), with no proportional bias ( p = 0.34),
showing that mean energy intake according to 24 h was slightly
lower.
The mean protein intake according to FD (61.7 g/day, SD 17 g,
range 28–116 g) did not differed significantly ( p = 0.68) from
24 h (59.9 g/day, SD 19 g, range 29–114 kcal). A possible
Poster
positive association was observed ( p = 0.002, R2 = 44.7%). The
mean difference was 1.24 g (limits of agreement -4.6–37.0),
with no proportional bias ( p = 0.61), also showing that mean
protein intake according to 24 h was slightly lower.
Conclusion: Our results showed that these two methods of
dietary intake assessment provided similar results in elderly
people. The intake of energy and protein, assessed by 24-hour
Dietary Recall was, as expected, slightly lower than assessed by
3-day Food Diary.
Disclosure of Interest: None declared.
MON-P040
ASSESSMENT OF BODY COMPOSITION IN ELDERLY PEOPLE. A
COMPARISON OF THREE METHODS
S. Engelheart1 *, H. Bertéus Forslund2, O. Ljungqvist1,
R. Brummer1. 1School of Medical Sciences, Örebro University,
Örebro, 2Institute of Medicine, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
Rationale: The importance of maintaining muscle mass in old
age is well known, but the most adequate method to use,
assessing body composition in elderly people in need of home
health care, is not. Dual-energy X-ray Absorptiometry (DXA) is
considered a reference method, but has disadvantages that it
cannot be used at home or at local primary care centers. The
aim of the study was to compare DXA to two ambulatory
methods for assessment of the body composition and to study
the differences in outcome.
Methods: Body composition was assessed in a 2-compartment-
modell (body fat and fat-free mass): (1) DXA (n = 23), (2) BIA
(n = 53), Bioelectrical Impedance assessment and (3) skinfold
measurement (n = 50) at four locations (biceps, triceps,
subscapularis and crista iliaca). A sample of 58 elderly people
(20 females and 38 males), age 81.4 years (range 65–97), in
need of home health care was included. Differences in methods
were assessed by parametric statistics, simple regression and
Bland-Altman plots.
Results: In men, mean body fat mass was 31.5 kg (DXA), 28.4 kg
(BIA) and 19.4 kg (skinfold), respectively. In women the body fat
mass was 23.9 kg (DXA), 29.5 kg (BIA) and 21.7 kg (skinfold),
respectively. There was no significant differences according
to sex.
Results by DXA did not differ significantly from BIA (P = 0.05) or
skinfolds ( p = 0.12), but the results by BIA differed significantly
( p < 0.001) to skinfold. A positive association was observed in
DXA vs. skinfold ( p = 0.001) and a non-significant ( p = 0.6)
negative association was observed in DXA vs. BIA. For mean
difference and limits of agreement, in the Bland Altman plot,
see Table.
Mean Limits of
difference agreement
Body fat mass DXA vs BIA −2.8 kg −15.1 to 9.48
DXA vs skinfold 1.8 kg −7,9 to 11.4
BIA vs skinfold 4.5 kg −4.5 to 13.6
Conclusion: Our results showed that the two ambulatory
methods gave similar results as DXA in elderly people, but the
two ambulatory methods (BIA vs skinfold) did not.
Disclosure of Interest: None declared.
Geriatrics 2
MON-P041
HANDGRIP STRENGTH IS LESS SIGNIFICANTLY ASSOCIATED
WITH GERIATRIC DOMAINS COMPARED TO QUADRICEPS
STRENGTH AMONG GERIATRIC OUTPATIENTS
S. S. Y. Yeung1,2 *, E. M. Reijnierse1, M. C. Trappenburg3,4,
C. G. M. Meskers2,5, A. B. Maier1,2. 1Medicine and Aged Care,
University of Melbourne, Melbourne, Australia, 2Human
Movement Sciences, MOVE Research Institute Amsterdam,
Vrije Universiteit, 3Internal Medicine, Section of Gerontology
and Geriatrics, VU University Medical Center, Amsterdam,
4
Internal Medicine, Amstelland Hospital, Amstelveen,
5
Rehabilitation Medicine, VU University Medical Center,
Amsterdam, Netherlands
Rationale: Decline in muscle strength is a well-known
consequence of the ageing process and muscle strength
measurements are therefore usually part of a Comprehensive
Geriatric Assessment (CGA). Whether handgrip strength
(HGS) as a proxy for overall muscle strength suffices, or
quadriceps strength (QS) should be measured in addition, is
unknown. The aim of this study was to examine the relation of
both HGS and QS to different domains of the CGA in geriatric
outpatients.
Methods: 163 older adults referred due to mobility problems to
a geriatric outpatient clinic in the Netherlands were included in
the present study. CGA included questionnaires and measure-
ments of physical (Timed Up & Go (TUG) and Short Physical
Performance Battery (SPPB)), functional (activities of daily
living (ADL)), psychological (Hospital Anxiety and Depression
Scale (HADS)) and cognitive (Mini-mental state examination
(MMSE)) domains. Standardized HGS and QS were defined as
dependent variables and domains of CGA were defined as
independent variables. Linear regression analyses were applied
to examine the association of HGS and QS with different
domains of CGA adjusted for age and gender and presented as
beta and 95% confidence interval (CI).
Results: HGS and QS were both significantly related to physical,
functional, psychological and cognitive domains of the CGA.
However, HGS was less related to physical and psychological
domains of the CGA compared to QS (TUG: −0.16 (−0.03;
−0.01) vs. −0.37 (−0.06; −0.03); SPPB: 0.20 (0.03; 0.10) vs.
0.38 (0.09; 0.17)); HADS depression: −0.18 (−0.08; −0.01 vs.
−0.33 (−0.13; −0.05)).
Conclusion: In geriatric outpatients, both HGS and QS were
associated with all domains of the CGA but HGS was less related
to physical and psychological domains compared to QS.
Measuring QS in the Comprehensive Geriatric Assessment may
be of additional value.
Disclosure of Interest: None declared.
MON-P042
THE RELATIONSHIP BETWEEN FRAILTY AND
OSTEOSARCOPENIA IN GERIATRIC PATIENTS
S. Kaya1, O. Deniz1 *, H. Dogan Varan1, M. C. Kizilarslanoğlu1,
B. Goker1. 1Department of Geriatrics, Gazi University,
Ankara, Turkey
Rationale: Osteosarcopenia is defined as the presence of both
sarcopenia and osteoporosis in elderly patients and its
association with frailty has not been well described. We
S195
designed a study to show the association between frailty and
osteosarcopenia in the elderly patients.
Methods: One hundred elderly patients who had bone mineral
density available, performed as part of the routine geriatric
assessment, were enrolled in the study. Osteosarcopenia was
considered when both sarcopenia and osteoporosis were
present. Frailty status of the patients were evaluated
according to the Fried’s Frailty Index, including five domains:
weight loss, weakness, exhaustion, low activity and slow
walking speed.
Results: The median age of the one hundred patients was 75
years (min-max: 65–90) and 51.0% were male. Frailty status of
the patients was as follows: 21% frail, 44% pre-frail and 35%
robust. Frailty was more common in osteosarcopenic patients
compared to ‘sarcopenic and non-osteoporotic’ and non-
sarcopenic groups (66.7%, 27.3% and 13.0%, respectively)
( p < 0.001). Osteosarcopenia was found to be associated with
frailty in univariate analysis (OR: 11.5, p < 0.001). Low handgrip
strength and calf circumferences, higher age, slow walking
speed, lower body mass index (BMI), frailty, decreased scores of
basic and instrumental activities of daily living (ADL), clock
drawing test, mini-mental state examination and mini-nutri-
tional assessment-short from (MNA-SF) were shown to be
associated with osteosarcopenia ( p < 0.05, for all parameters).
In multivariate analysis, age (OR: 1,395, p = 0,023), instrumen-
tal ADL (OR: 0.550, p = 0.042), female gender (OR: 43.203,
p = 0.012) and BMI (OR: 0.507, p = 0.004) were detected to be
independently associated factors with osteosarcopenia.
Conclusion: Our results suggest that frailty rate in osteosarco-
penic patients may be higher than those who are sarcopenic-
non-osteoporotic and non-sarcopenic
Disclosure of Interest: None declared.
MON-P043
THE SEVERITY OF COMMUNITY ACQUIRED PNEUMONIA IS
STRONGLY ASSOCATED WITH SERUM ALBUMIN
T. Shimizu1 *, T. Namikawa2, K. Banba3, T. Nishikimi4.
1
Department of Cerebrovascular Diseases, Wakakusa-Tatsuma
Rehabilitation Hospital, Daito, 2Department of Rehabilitation,
Suita Tokushuen, Suita, 3Department of Rehabilitation,
Matsubara Tokushukai Hospital, Matsubara, 4Department of
Medicine, Wakakusa-Tatsuma Rehabilitation Hospital,
Daito, Japan
Rationale: Community acquired pneumonia (CAP) in the
elderly people may be occurred by the micro-aspiration of
saliva. The reduction of immunity derived from the poor
nutritional status may also be involved. Then in this study, the
association of CAP with nutritional status was investigated.
Methods: Twenty one cases with CAP were subjected (averaged
age was eighty four years). There were eight males and thirteen
females. Their nutritional status was evaluated by serum
albumin, transferrin and transthyretin. The severity of CAP was
judged by the size of pneumonia lesion in the chest X-ray
images. When the pneumonia lesion expands to less than one
third of unilateral lung, the severity is low and to more than one
third of unilateral lung, it is high. The association between the
severity and nutritional status was investigated. Nutritional
status was evaluated by serum proteins such as albumin as a
static factor and rapid turnover proteins such as transferrin
(TRF) and transthyretin (TTR).
S196
Results: There were nine cases in low severity group (Group A)
and twelve cases in high severity group (Group B). The mean
age was 85 ± 8 years in Group A and 81 ± 12 years in Group B (ns),
the white blood cell counts (WBC) was 10,633 ± 5,407/mm3 and
13,367 ± 7,211/mm3 (ns, not significant), and C-reactive
peptide (CRP) was 12.2 ± 11.3 mg/dl and 15.1 ± 9.0 mg/dl
(ns), respectively. In the investigation of association between
the pneumonia severity and nutrition, albumin was 3.61 ± 0.53
g/dl in Group A and 3.12 ± 0.73 g/dl in Group B ( p = 0.0365),
transferrin (TRF) was 167.4 ± 45.6 mg/dl and 171.9 ± 51.6
mg/dl (ns), transthyretin (TTR) was 10.54 ± 4.67 mg/dl and
10.49 ± 4.63 mg/dl (ns), respectively.
Conclusion: The pneumonia severity in CAP was significantly
associated with albumin but TRF or TTR. Moreover it is not
associated with WBC or CRP either. The pneumonia severity
appears to depend on the usual nutritional status prior to
admission reflected by albumin.
Disclosure of Interest: None declared.
MON-P044
EARLY RESUMPTION OF ORAL INTAKE AND ENTERAL
NUTRITION CONTRIBUTE TO THE CONTINUATION OF ORAL
INTAKE IN PATIENTS WITH NURSING AND HEALTHCARE-
ASSOCIATED PNEUMONIA
T. Ogasawara1 *, M. Oogiku2, Y. Ikematsu2. 1Respiratory
Medicine, 2Surgery, Hamamatsu Medical Center,
Hamamatsu, Japan
Rationale: Nursing and healthcare-associated pneumonia
(NHCAP), proposed by the Japan Respiratory Society, is made
mostly of aspiration pneumonia in elderly patients. The aim
was to evaluate whether an early resumption of oral intake and
aggressive enteral nutrition provide palliation of swallowing
difficulty in patients with NHCAP.
Methods: In this retrospective study, 166 patients (median 85
years old) with NHCAP, who participated in 2 prospective studies
about a choice and duration of antibiotics therapy conducted in
our hospital, were included. Early resumption of oral intake and
enteral nutrition (EOE) were defined as an initiation within 2
days of hospitalization. The prognostic factor for the continu-
ation of oral intake was analyzed by logistic regression model.
Propensity scores were calculated from baseline data, risk
factors and comorbidities, resulting in 35 pairs.
Results: Among the patients, 116 (69.9%) had aspiration
pneumonia. Eighty one patients (48.8%) received EOE (oral
intake = 68, enteral nutrition = 13) and 80 patients (48.2%)
could continue oral intake at the time of discharge. A
univariate analysis showed a significant association between
the continuation of oral intake and EOE (odds ratio [OR] = 5.1,
95% confidence interval [CI]: 2.6–9.8), low body mass index
(<17 kg/m2) (OR = 0.38, 95%CI: 0.20–0.72) or severity of
pneumonia (A-DROP <3) (OR = 4.2, 95%CI: 2.2–8.0) upon
admission. Among patients received enteral feeding as the
first nutritional therapy, early enteral nutrition slightly
increased the number of patients who could be ingested
orally (15% vs. 0%, P = 0.09). After propensity adjustment, EOE
(OR = 3.24, 95%CI: 1.22–8.63, P = 0.02) was an independent
prognostic factor for the continuation of oral intake.
Conclusion: EOE strategy may provide palliation of swallowing
difficulty in elderly patients with NHCAP.
Disclosure of Interest: None declared.
Poster
MON-P045
FUNCTIONAL TEETH AMELIORATE NUTRITIONAL STATUS AND
SELF-CARE ACTIVITY IN ELDERLY PEOPLE
T. Namikawa1 *, T. Shimizu2. 1Department of Rehabilitation,
Suita Tokushuen Geriatric Health Service Facility, Suita,
2
Depart of Medicine, Maki Hospital, Osaka, Japan
Rationale: Good oral function is essential to live in a healthy
life especially for the old. The significance of residual teeth in
nutritional status and self-care activity in elderly people was
investigated. Then it was also investigated how the functional
teeth(FT) supported by denture, worked to ameliorate
nutritional status and self-care activity.
Methods: 89 elderly people (23 males, 66 females, mean age,
84 ± 4 years) who are admitted to a geriatric health care
services facility in a stable state were subjected. The
association of residual teeth and nutritional status evaluated
by albumin(alb) and self-care activity evaluated by Barthel
Index (BI) was investigated. Then the significance of FT
supported by denture was also examined.
Results: The subjects were classified into 2 groups according to
the number of residual teeth. The number of the teeth in Group
A was 0–19 (n = 70), and that in Group B was more than 20
(n = 29). Alb was 3.45 ± 0.53 g/dl in Group A and 3.55 ± 0.55 g/
dl in Group B (ns). BI was 49.3 ± 29.5 in Group A and 45.0 ± 31.1
in Group B (ns). In the investigation of effects of FT, the
subjects were also divided into 3 groups according to the
number of FT. The number of the FTwas 0–19 in Group C (n = 29),
more than 20 in Group D (n = 60) and 28 in Group E (n = 26). Alb
was 3.36 ± 0.44 g/dl in Group C and 3.53 + 0.57 g/dl in Group D
(ns). BI was 36.6 ± 31.9 in Group C and 54.1 ± 27.2 in Group D
( p = 0.0084). In Group E, alb was 3.59 ± 0.56 and BI was
58.8 ± 27.2. These data in Group E were significantly bigger
than those of Group C ( p = 0.0398, p = 0.00223 respectively).
Conclusion: The number of FTwas significantly associated with
BI. Especially the FT with 28 teeth showed a better nutritional
status and BI. The study shows that the oral FT supported by
twenty eight residual teeth or total denture works very well to
maintain good nutrition and self-care activity in the elderly
people.
Disclosure of Interest: None declared.
MON-P046
DIFFERENCES IN HEIGHT- AND WEIGHT-ADJUSTED SKELETAL
MUSCLE MASS INDICES AS SARCOPENIA SCREENING TOOLS IN
GERIATRIC POPULATIONS
V. Biesinger1, A. Hendricks1 *, A. Gonzalez Granda1, M. Basrai1,
L. Stollhof2, U. C. Liener3, A. K. Nussler2, S. C. Bischoff1.
1
Nutritional Medicine, University of Hohenheim, Stuttgart,
2
BG Trauma Center, Siegfried Weller Institut, Tübingen,
3
Department of Orthopedics and Trauma Surgery, Vinzenz von
Paul Kliniken gGmbH Marienhospital, Stuttgart, Germany
Rationale: Literature suggests different screening tools for
sarcopenia in clinical practice, some include only bioimpe-
dance analysis (BIA), others amend physical performance and
muscle strength. We aim to find appropriate methods for a
geriatric surgery population, since benchmarks are rare.
Methods: Our cohort comprises 45.8% hospitalized and 54.2%
obesity therapy patients (n = 2,864; 70% female; mean age 50
years; mean BMI 32 kg/m2), and a subgroup of geriatric surgery
Geriatrics 2
patients (n = 44; mean age 82 years; BMI 24 kg/m2). We
analysed height-adjusted (recommended in lean subjects)
and weight-adjusted (recommended in obesity) skeletal
muscle mass indices hSMI and wSMI, derived from BIA data
sets from clinical trials. If applicable the geriatric cohort was
categorized into EWGSOP criteria grades ‘presarcopenia’,
‘sarcopenia’ and ‘severe sarcopenia’ (n = 30).
Results: In total 7.6% are diagnosed sarcopenic by hSMI
definition respectively 45.4% by wSMI, and only in 2.7% both
indices are consistent. When adjusted for BMI, hSMI defines
7.3% lean and 0.3% obese subjects as sarcopenic. Contrary,
wSMI attests sarcopenia in 4.4% and 41% of the lean and obese
subjects, respectively. In the geriatric subgroup the hSMI leads
to sarcopenia in 34.1% respectively 25% by wSMI, while 13.6%
match. According to EWGSOP criteria in the geriatric study
group 30% show severe sarcopenia and 10% either impaired
physical performance or reduced muscle strength (sarcopenia),
which resembles hSMI results.
Conclusion: Considerably divergent results are derived from
different sarcopenia screening tools. Adjustment by height and
not weight seems reliable not only in lean but also in elderly
subjects. In our geriatric population the BIA generated hSMI
seems sufficient if physical performance and muscle strength
are not feasible. Further investigation with dual X-ray
absorptiometry is needed.
Disclosure of Interest: None declared.
MON-P047
ASSOCIATION OF MORTALITY AND PHASE ANGLE MEASURED
BY DIFFERENT BIOELECTRICAL IMPEDANCE ANALYSIS (BIA)
DEVICES
V. L. Karsegard1 *, C. E. Graf2, F. R. Herrmann3, A. Spörri4,
L. Genton1. 1Clinical Nutrition, 2Dept. Internal Medicine,
Rehabilitation and Geriatrics, 3Rehabilitation and Palliative
Care, University Hospitals of Geneva, Geneva, 4Social and
Preventive Medicine, University of Bern, Bern, Switzerland
Rationale: A high phase angle measured by the Nutriguard®
bioelectrical impedance analysis device is associated with a
reduced mortality risk in older people. This retrospective study
aims to analyze whether this association persists with the other
devices that have been used in our hospital.
Methods: This study encompasses all people 65 yrs and older
who underwent a phase angle measurement between 1990 and
2011 at the Geneva University Hospitals, with the RJL-101®
(RJL Systems), Xitron 4000B® (Xitron Technologies), Eugedia®
(Eugédia-Spengler) and Bio-Z® (Spengler). Diseases at the time
of phase angle measurement were reported in the form of the
Cumulative Illness Rating Scale. Date of death was retrieved
until December 2012. Phase angle values were categorized into
sex- and device-specific quartiles, where quartile 1 represents
the lowest quartile and reference value. Cox regressions were
performed to evaluate the association between phase angle
quartiles and mortality.
Results: We considered 1,878 people (969 women), of whom
1,151 had died. In univariate sex-specific Cox regressions, the
death risk decreased progressively as the phase angle quartile
measured by the Bio-Z® or RJL-101® increased. The HR (95% CI)
in quartile 4 was 0.36 (0.26, 0.50) and 0.38 (0.29, 052) in
S197
women and men measured with the Bio-Z® (both p < 0.001),
and 0.23 (0.14, 0.39) and 0.19 (0.10, 0.36) in women and men
measured with the RJL-101® (both p < 0.001). The association
between phase angle and mortality persisted when adjusted
for age, body mass index or co-morbidities. The small number
of deaths in people who underwent a measurement by Eugedia®
(n = 93) or Xitron4000B® (n = 56) did not allow performing
multivariate Cox regressions.
Conclusion: Phase angle quartiles are associated with mortal-
ity in people aged >65 years when using the RJL-101® or Bio-Z
device®.
Disclosure of Interest: None declared.
MON-P048
HYDRATION ON PATIENTS IN A HOME CARE PROGRAM (HCP)
WITH OROFARINGEA DYSPHAGIA
V. Aviles1 *, L. Andurell1, H. Segurola1, R. Lorite1, G. Cárdenas1,
A. Sancho1, N. Garcia1, M. Comas1, R. Burgos1. 1Nutritional
Support Unit, University Hospital Vall d’Hebron,
Barcelona, Spain
Rationale: Patients suffering from oropharyngeal dysphagia
(OFD) often fail to achieve their nutritional and water
requirements. Thickeners palatability is a factor that condi-
tions the water intake, especially if the texture is very thick.
Dehydration can be a cause of hospitalization and confers a
worse prognosis.
Objectives: To rate the nutritional and hydration status of
patients in the HCP program affected by OFD that requires fluid
thickening.
Methods: A prospective, descriptive study of HCP patients
included in a home nutrition program in the period of July 2015
to September 2016. The tracing was carried out by telephone
consultation, doing a 24 hour reminder, anthropometry and
water records. Nutritional advice was offered in case of low
intake, as well as strategies to improve water intake.
Results: 66 patients, 39 women, age 84.2 ± 7.76 R(59–98). 28
patients with dementia (13 Alzheimer’s), 11 Parkinson’s, 15
cognitive and functional deterioration, 10 strokes, 1 neopla-
sia,1 COPD. BMI: 26.29 ± 5.26 R (14.84–42.43) 30% presented
weight loss, of which 70% were dementias. In 41 patients (62%)
the diet was in pureé texture(TXT) and 25 (38%) in the form of
easy mastication (smooth and easy to chew)or regular texture.
All of them used thickeners for liquids: nectar texture 29%,
honey 41% and pudding 30%.
Water registry: nectar texture 1,014.5 ml±441.8 R (425–2,125),
honey 927.8 ml±380.3 R (425–2,000), pudding 781.3 ml±292.2 R
(200–1,500). P 0.025 between nectar and pudding, p 0.065
between honey and pudding. Patients with TXT diet had to
thicken the liquids to honey texture by 49%, 39% to pudding and
to the non-TXT diet by 52% in nectar.
Conclusion: Patients who need to thicken liquids have a lower
water intake when the liquid texture is pudding. The honey
texture is the most used. It is necessary to determine the
minimum safe viscosity to favor ingestion and hydration, as well
as the use of more palatable thickeners.
Disclosure of Interest: None declared.
S198
MON-P049
A RANDOMIZED-CONTROLLED TRIAL OF LEUCINE-ENRICHED
AMINO-ACID MIXTURES ON MUSCLE MASS, STRENGTH, AND
PHYSICAL PERFORMANCE IN POST-STROKE PATIENTS WITH
SARCOPENIA
Y. Yoshimura1 *, T. Bise2, S. Shimazu3, A. Shiraishi4.
1
Rehabilitation Medicine, 2Rehabilitation, 3Nutritional
Management, 4Dental Office, Kumamoto Rehabilitation
Hospital, Kumamoto, Japan
Rationale: Sarcopenia is associated with lower physical
performance in stroke patients. The aim of the study is to
evaluate the effectiveness of nutritional intervention in
improving physical function in stroke patients with sarcopenia,
where the evidence is still limited.
Methods: A total of twenty six post-stroke patients with
sarcopenia were included and randomly allocated to either
convalescent stroke rehabilitation with or without a blend of
essential amino acids containing 40% leucine, AminoL40, to
consume once daily for 2 months of intervention. Sarcopenia
was defined as a loss of skeletal muscle mass index (SMI) with
BIA and decreased muscle strength as measured by handgrip
strength (HG); cut-off values were adopted from the AWGS.
Functional Independence Measure (FIM), SMI, and HG were
assessed at baseline, and after two months of intervention.
ANCOVAwith baseline values of age, sex and NIHSS as covariates
were used to analyze between-group differences.
Results: FIM improved in both groups without significant
between-group differences. The intervention group improved
more in SMI and HG compared with the control group, between-
group effect of SMI (0.25 kg/m2, 95%CI: 0.11–0.40, p = 0.04)
and HG (0.81 kg, 95%CI: 0.46–1.10, p = 0.03), respectively.
Conclusion: This two months intervention of leucine-enriched
amino-acid oral nutritional supplement added to convalescent
stroke rehabilitation resulted in improvements in muscle mass
and strength among post-stroke patients with sarcopenia. This
study shows proof-of-principle that specific nutritional supple-
mentation might benefit sarcopenic patients, especially
relevant for those with disabilities due to stroke. Further
trials are needed to investigate the role of a specific nutritional
supplement as part of a multimodal approach to improve
physical performance among stroke patients with sarcopenia.
Disclosure of Interest: None declared.
MON-P050
THE PREVALENCE OF SARCOPENIA IN NURSING HOME FOR
THE ELDERLY
Z. Sundov1 *, Z. Kolak2,3, A. Šundov4. 1Gastroenterology,
Clinical Hospital Split, 2Home for the Retired and Elderly
Persons, Split, Croatia, 3Gastroenterology, Home for the
Retired and Elderly Persons, 4Hercegovačka 83, Community
Health Center Split, Split, Croatia
Rationale: Sarcopenia, or the decline of skeletal muscle tissue
with age, is one of the most important causes of functional
decline and loss of independence in older adults. Sarcopenia is
defined by both loss of muscle mass and loss of muscle function
or strength.
Methods: The study on the prevalence of sarcopenia was
carried out in nursing home for the elderly in Split, Croatia.
Muscle mass is measured by the bioelectrical impedance (BIA).
Poster
Muscle mass is converted to the muscle mass index (SMI). For
the lower limit value of reduced muscle mass the values
indicated in the recommendations EWGSOP (media <8.87 and
6.42 kg/m2 in man and woman). Muscle strength is determined
by the power of distress using hand-held dynamometer.
Decreased muscle strength is defined as less than 30 kg for
men and 20 kg in women. Physical endurance test measured the
walking speed of a length of 4 m. The values of less than 0.8 m/
s to identify persons with reduced physical endurance.
Results: One hundred participants (21 men and 79 women)
between the ages of 67 and 96 years (mean 80,7) was in a study
of prevalence of sarcopenia. Mean Body Mass Index was
26,21 kg/m2 (BMI 20–25 kg/m2), 9.17 was index of muscle
mass (SMI < 8.87 and 6.42 kg/m2, a man and a woman), 17/21
men and 73/79 had low muscle strength (less than 30 kg for
men and 20 kg in women), 30/100 low usual gait speed (less than
0.8 m/s), 4/100 had sarcopenia and 1 of 4 had severe sarcopenia.
After 6 months follow-up examination 3/100 patients have died,
18/100 patients had falls, 3/18 had fractures.
Conclusion: Sarcopenia is a common condition in older adults
that contributes to functional decline, disability, frailty, and
falls. The risk of identification sarcopenia will greatly facilitate
the intervention, any pharmaceutical agents that act on
different biological pathways, with adequate nutrition and
targeted exercises remain the gold standard for therapy.
Disclosure of Interest: None declared.
Hormones, mediators and immunity
MON-P051
ASSOCIATION OF TUMOR GROWTH FACTOR-Β AND
INTERFERON-Γ SERUM LEVELS WITH INSULIN RESISTANCE IN
NORMAL PREGNANCY
A. Sotoodeh Jahromi1 *. 1Jahrom University of Medical
Sciences, Jahrom, Islamic Republic of Iran
Rationale: Pregnancy is related to change in glucose metab-
olism and insulin production. The aim of our study was to
determine the association of serum IFN-γ and TGF-β levels with
insulin resistance during normal pregnancy.
Methods: This cross sectional study was carried out on 97
healthy pregnant (in different trimesters) and 28 healthy non-
pregnant women. Serum TGF-β and IFN-γ level were measured
by ELISA method.
Results: Pregnant women had high level TGF-β and low level
IFN-γ as compared non-pregnant women. Maternal serum TGF-
β concentration significantly increased in third trimester as
compared first and second trimester of pregnancy. Maternal
serum IFN-γ concentration significantly decreased in third
trimester as compared first and second trimester of pregnancy.
Pregnant women exhibited higher score of HOMA IR as
compared non-pregnant women. There were association
between gestational age with body mass index (r = 0.28,
P = 0.005), TGF-β (r = 0.45, P < 0.001) and IFN-γ (r = −0.50,
P < 0.001). There was significant association between Insulin
resistance and TGF-β (r = 0.17, p = 0.05).
Conclusion: Our findings suggest that changes in maternal
cytokine level in healthy pregnant women were anti-inflam-
matory. Furthermore, Tumor Growth Factor-β appears has a
role in induction insulin resistance in healthy pregnant women.
Hormones, mediators and immunity
However, further studies needed to evaluate role of different
cytokines on insulin resistance in normal pregnancy.
Disclosure of Interest: None declared.
MON-P052
A RANDOMISED CONTROLLED TRIAL INVESTIGATING THE
EFFECTS OF PARENTERAL FISH OIL ON PRO-INFLAMMATORY
RESOLVIN & PROTECTIN PROFILE IN CRITICALLY ILL PATIENTS
WITH SEPSIS
D. K. Bilku1 *, T. Hall1, D. Al-Leswas1, C. Horst1, J. Cooke1,
M. Metcalfe1, A. Dennison1. 1University Hospitals of Leicester
NHS Trust, Leicester, United Kingdom
Rationale: Severe sepsis in Intensive Care Unit (ICU) is
associated with high mortality (40%) due to inappropriate
inflammation and immunosuppression. Omega-3 (ω-3) has
shown to attenuate uncontrolled inflammation and produce
clinical benefit. This trial explores the role of omega-3 in sepsis.
Methods: 20 patients with abdominal sepsis were selected
from a randomised trial of 60 consecutive septic patients in
ICU. Of these 10 received parenteral ω-3 (Fish oil, FO group)
and 10 received standard medical therapy (control, C group).
The primary outcome was effect of ω-3 on pro-inflammatory
resolvins and protectins. The secondary outcome was to assess
effect of omega-3 on organ dysfunction measured using
maximum Sequential Organ Failure Assessment (max-SOFA)
score and delta-SOFA score. Analysis was performed using
mixed linear regression.
Results: Omega-3 significantly decreased PGE2 (0.001) and
TXB2 (0.02) over time in the FO group. Also, the concentration
of other pro-inflammatory markers i.e. 5-HETE, 12-HETE, 15-
HETE, LTB4, PGF2α were higher in the C-group as compared to
the FO-group. Linear regression showed a significant associ-
ation between FO, max-SOFA and delta-SOFA scores in these
patients. The max-SOFA and delta-SOFA scores in FO group were
significantly lower than C-group.
Conclusion: A significant decrease was detected in PGE2 and
TXB2 concentration in the ω-3 group. Fish oil improved organ
dysfunction in sepsis thus influencing clinical outcome.
Disclosure of Interest: None declared.
MON-P053
OMEGA-3 SIGNIFICANTLY IMPROVED ORGAN DYSFUNCTION IN
CRITICALLY ILL SEPTIC PATIENTS – RESULTS OF A RANDOMISED
CONTROLLED TRIAL
D. K. Bilku1,1 *, T. Hall1, D. Al-Leswas1, C. Horst1, J. Cooke1,
M. Metcalfe1, A. Dennison1. 1University Hospitals of Leicester
NHS Trust, Leicester, United Kingdom
Rationale: Inappropriate inflammation and immunosuppres-
sion causes high mortality (40%) in septic patients on Intensive
Care Unit (ICU). Omega-3 (ω-3) has demonstrated to attenuate
uncontrolled inflammation and produce clinical benefit. This
trial explores the effect of omega-3 in sepsis.
Methods: A sub-group of 20 patients with abdominal sepsis
were selected from a randomised trial of 60 consecutive septic
patients in ICU. Of these 10 received parenteral ω-3 (Fish oil,
FO group) and 10 received standard medical therapy (control, C
group). The primary outcome was effect of ω-3 on anti-
inflammatory resolvins and protectins. The secondary outcome
was to analyse the effect of ω-3 on organ dysfunction measured
S199
using maximum Sequential Organ Failure Assessment (max-
SOFA) and delta-SOFA score. Analysis was performed using
mixed linear regression.
Results: Concentration of 4 HDHA (0.01) and 17 HDHA (0.01)
was significantly higher in the FO group. Analysis demonstrated
that concentration of other anti-inflammatory markers i.e.
LXA4, PGD2, Hipoxillin, 14 HDHA, 12 HEPE, 13 HODE, 15 HEPE,
18 HEPE was higher in the FO group. Linear regression showed a
significant association between FO, max-SOFA and delta-SOFA
scores in these patients. The max-SOFA and delta-SOFA scores
in FO group were significantly lower than C-group.
Conclusion: 4 HDHA and 17 HDHA were significantly higher in
the FO group. Fish oil improved organ dysfunction in these
critically ill septic patients.
Disclosure of Interest: None declared.
MON-P054
EFFECT OF PARENTERAL OMEGA-3 ON MORTALITY AND
COMPLEMENT-3 LEVELS IN SEPTIC PATIENTS
D. K. Bilku1,1 *, J. Zimmer1, C. M. Stover1, T. Hall1, W. Cheung1,
C. Horst1, A. R. Dennison1. 1University Hospitals of Leicester
NHS Trust, Leicester, United Kingdom
Rationale: To correlate mortality, the effect of parenteral
omega-3 fish oil and serum complement 3 (C3) levels in septic
patients on the Intensive Care Unit (ICU).
Methods: As part of a randomised clinical trial investigating the
effects of parenteral omega-3, 20 septic patients were studied.
Levels of C3 were measured by ELISA and correlated with a
number of important clinical parameters.
Results: Levels of C3 were measured at two time points. Time
point 1 (t1) is day 0 and time point 2 (t2) is the last day of stay on
ICU. All patients were found to be C3 depleted (<750 mcg/ml at
baseline). They were divided into two groups, group1 (N = 8)
were patients with lower C3 at t2, group 2 (N = 12) were
patients with stable or higher C3 at t2. The two groups were
compared with regards to type of organism, mortality and
effect of omega-3 on mortality.
Conclusion: In group1, the majority of the sepsis was due to a
gram negative organism whereas in group 2 it was due to a gram
positive organism. In group 1, there were 3 deaths (50%) all of
which were controls and had progressive depletion of C3. There
were no deaths (0%) in the omega-3 sub-group. In group 2, 6/7
patients receiving omega-3 survived (12% mortality) while 3/4
control patients survived (25% mortality). We conclude that
parenteral omega-3 reduces mortality by up to 50%. Progressive
depletion of C3 is associated with poor outcome and may be
used as a marker for clinical outcome.
Disclosure of Interest: None declared.
MON-P055
CORE TEMPERATURE AND DIETARY PATTERNS
K. Kimura1 *, D. Akiyama1, G. Hagiwara2. 1Department of
Health and Sports Management, Japan University of
Economics, Dazaifu-City, 2National Institute of Fitness and
Sports in Kanoya, Kanoya-City, Japan
Rationale: For humans, maintaining a core temperature of
37.0°C is important, but reports in recent years show a
declining trend in body temperature. The aim of this study
S200
was to investigate the relationship between tympanic tem-
perature and dietary patterns.
Methods: Subjects were 34 healthy female students (18.2 ± 0.4
years). The subjects measured their tympanic temperature
upon waking using an infrared thermometer for two consecu-
tive days. The dietary patterns survey used a questionnaire
format asking about the average meal content consumed per
week over the last 1–2 months, and the meal consumption,
including nutritional content and other factors, were analyzed
using analysis software. The Pearson correlation coefficient
was used for correlation relationships between items. Also,
comparison of the two groups with tympanic temperature
readings of 36.5°C or more and less than 36.5°C was conducted,
and when there was no significant difference identified with
Levene testing for equal variances based on testing of
applicable differences, t-test was implemented, while when
significant differences were identified, Welch testing was
implemented. A significance level of P < 0.05 was used.
Results: 17 subjects had waking tympanic temperature of 36.5°
C or more, and 17 subjects had temperatures of less than 36.5°C.
No correlation was identified between nutrition and tympanic
temperature in either group. Also, no significant differences
in diet were identified between the two groups. Among the
subjects with temperatures of 36.5°C or more, the ratio of
total caloric intake made up of fat was significantly higher
(34 ± 5% and 31 ± 3%, P < 0.05), and the ratio of carbohydrate
was significantly lower (50 ± 7% and 54 ± 5%, P < 0.05).
Conclusion: We compared dietary content on either side of
36.5°C, the ratio of total caloric intake made up of fat was
significantly higher for subjects with temperature of 36.5°C or
more, and the ratio of carbohydrate was significantly lower for
these subjects as well.
Disclosure of Interest: None declared.
MON-P056
THE RELATIONSHIP OF THE SERUM IRISIN LEVELS AND
ANTHROPOMETRIC MEASUREMENTS OF OBESE AND NON-
OBESECHILDREN
K. Esin1 *, N. Şanlıer1, E. Adal2, S. Batırel3, G. Ülfer4, P. Yiğit5.
1
Nutrition and Dietetics, Gazi University, Ankara, 2Pediatric
Endocrinology and Metabolism, Istanbul Medipol University,
3
Department of Biochemistry, Marmara University,
4
Department of Biochemistry, 5Department of Biostatistics and
Medical Informatics, Istanbul Medipol University, Istanbul,
Turkey
Rationale: Irisin is a newly discovered muscle derived hormone
which has increasing effect on energy expenditure in the body.
The aim of this study was to compare the serum irisin level and
the anthropometric measurements and biochemical para-
meters of the obese and non-obese children. Irisin is a newly
discovered muscle derived hormone which has increasing
effect on energy expenditure in the body. The aim of this
study was to compare the serum irisin level and the
anthropometric measurements and biochemical parameters
of the obese and non-obese children.
Methods: The study was conducted on a total number of 80
children, 44 of those were obese (Body Mass Index ≥ 97.
percentile) and 36 were non-obese. The anthropometric
measurements and body compositions of the children were
recorded and hormone (irisin, leptin, adiponectin) analyses
Poster
were conducted with serum 25 hydroxy vitamin D and some
biochemical tests.
Results: The body compositions and anthropometric measure-
ments were found to be significantly higher in obese children
( p < 0.05). The fasting blood glucose, insulin, HOMA-IR and
leptin levels in obese children and the HDL cholesterol and
adiponectin levels in the non-obese children were found
significantly higher ( p < 0.05). The serum vitamin D level of
both the obese children and non-obese children were
adequate, the leptin levels in the obese children were higher
and the adiponectin levels were lower than non-obese children.
No significant differences were found in serum irisin level, the
level of vitamin D, the insulin resistance, anthropometric and
biochemical measurements.
Conclusion: Several studies conducted in adults linked the
irisin level to obesity. However, in this study no difference
between the results of irisin level of children was assumed due
to the unmatured muscle tissue of the children compared with
the adult muscle tissue.
Disclosure of Interest: None declared.
MON-P057
CORRELATION BETWEEN BMI AND TLR4 AND OB-R
EXPRESSION ON MONOCYTES IN PATIENTS WITH EATING
DISORDERS
L. E. Belmonte1,2,3,4, M. P. Tavolacci4, M. Galmiche1,2,5,
N. Achamrah1,2,3, A. Rimbert3, J. Delay3, C. Bole-Feysot1,2,
C. Guérin1,2, S. Grigioni3, V. Folope3, A. Petit3, M. Coëffier1,2,3,
P. Déchelotte1,2,3 *. 1Normandie Univ, URN, INSERM UMR 1073,
2
Institut de Recherche et d’Innovation Biomédicale (IRIB),
Universite de Rouen, 3Département de Nutrition, 4CIC-CRB
1404, CHU de Rouen, 5Societé TargEDys, Rouen, France
Rationale: Eating disorders like Anorexia Nervosa, Bulimia and
Binge Eating have been associated with low-grade inflamma-
tion. TLRs and ObR activation on monocytes contribute to the
regulation of inflammatory mediators; however, there is a
paucity of data examining its potential involvement in eating
disorders. We thus explored TLR2, TLR4 and Ob-R expression on
monocytes in a cohort of patients with disturbed eating
behavior.
Methods: Eighty seven patients fulfilling the DSM-V criteria
were included. Patients were classified into 5 groups according
to baseline BMI: <18,5, n = 16; 18, 5–24,9, n = 10; 25–34,9,
n = 16; 35–39,9, n = 25 et ≥40, n = 20. Peripheral blood was
collected into EDTA tubes. TLR2, TLR4 and Ob-R expression
were assessed by flow cytometry. CD14 and CD11b antibodies
were used to identify peripheral monocytes. Results are
expressed as mean fluorescence intensity. Results (mean
±SEM) were compared by ANOVA and correlations were
analyzed by Spearman or Pearson tests.
Results: TLR4 expression in monocytes was significantly
different between the 5 groups BMI (*p = 0,008). In particular,
TLR4 was higher in patients with BMI < 18.5 than in patients
with BMI > 40 (36.9 ± 8 vs 14.9 ± 2, p < 0.05). Additionally, a
negative correlation was observed between TLR4 expression
and BMI (*p = 0.0015). By contrast, TLR2 expression in
peripheral monocytes was not different between groups
( p > 0.05). Finally, Ob-R was also differentially expressed in
monocytes of patients according to their BMI. Specifically, Ob-R
Hormones, mediators and immunity
expression was greater in BMI < 18.5 than in BMI > 40 (49.6 ± 16
vs 13.6 ± 1.7, p < 0.05).
Conclusion: These results show a differential expression of two
receptors of inflammation, TLR4 and Ob-R, at cell surface of
monocytes according to BMI. Additional studies are necessary
to determine both the molecular mechanisms responsible for
divergent expression and the role of these inflammatory
receptors in the regulation of eating disorders.
Disclosure of Interest: L. Belmonte: None declared, M. Tavolacci: None
declared, M. Galmiche Other: employee TarGEdys, N. Achamrah: None
declared, A. Rimbert: None declared, J. Delay: None declared, C. Bole-
Feysot: None declared, C. Guérin: None declared, S. Grigioni: None
declared, V. Folope: None declared, A. Petit: None declared,
M. Coëffier: None declared, P. Déchelotte: None declared.
MON-P058
DOES RESTORATION OF PEYER’S PATCH LYMPHOCYTE
NUMBER BY COMBINING FISH AND SOYBEAN OIL IN
PARENTERAL NUTRITION ALSO IMPROVE THE GUT
MORPHOLOGY AND IMMUNOGLOBULIN A LEVEL?
M. Noguchi1 *, K. Fukatsu1, S. Murakoshi1, T. Watanabe2, M. Ri3,
K. Higashizono3, A. Watokins4, T. Moriya2, H. Yasuhara1.
1
Surgical Center, The University of Tokyo Hospital, Tokyo,
2
Department of Surgery, National Defense Medical College,
Tokorozawa, 3Department of Gastrointestinal Surgery,
4
Department of Surgery, The University of Tokyo Hospital,
Tokyo, Japan
Rationale: Lack of enteral nutrition causes atrophy of gut
associated lymphoid tissue and gut morphology, and reduces
mucosal IgA levels in small intestine.
Our previous study demonstrated parenteral nutrition (PN)
containing both fish (FO) and soybean oil (SO) at a 1:2 ratio to
restore Peyer’s patch (PP), an inductive site of gut mucosal
immunity, lymphocyte numbers in mice. However, whether
such PP recovery improves gut morphology and IgA levels
remains unclear.
Herein, we examined effects of the PN formula with various fat
to total energy ratio on intestinal morphology and IgA levels in
mice.
Methods: Male ICR mice (n = 81) were randomized to chow, fat-
free, 10%, 20%, 30% and 40% PN groups. The latter 4 groups
received 33% of fat energy from FO and 67% from SO, but the fat
to total energy ratios differed (10–40%) among these groups.
After 5 days of feeding, the mice were killed and the entire
small intestine was harvested. Villous heights in the jejunum
and ileum were evaluated with HE staining. IgA levels of small
intestinal washings were measured using ELISA.
Results: In the jejunum, villous height was lower in the fat-free
PN than in the chow group and 10–40%PN groups, without
significant differences among 10–40%PN and chow groups. The
chow group showed higher gut IgA levels than any of the PN
groups (Table).
Conclusion: Though PN containing FO and SO at a 1:2 ratio with
10–40% fat to total energy ratio equally improves PN-induced
mucosal atrophy in jejunum, this recovery apparently does not
raise gut IgA levels.
S201
Table: Villous heights of jejunum and ileum, Intestinal IgA level.
Jejunum Ileum IgA (μg/
(μm) (μm) ml)
CHOW 436 ± 14* 220 ± 11 51.8 ± 12.3
fat free PN 363 ± 9 200 ± 6 24.6 ± 3.7†
10%PN 452 ± 14* 235 ± 13 25.3 ± 2.6†
20%PN 452 ± 14* 229 ± 11 28.7 ± 4.6†
30%PN 443 ± 13* 216 ± 10 29.0 ± 6.2†
40%PN 441 ± 15* 225 ± 12 32.0 ± 4.5†
means±SE, *p < 0.05 vs. Fat free PN, †p < 0.05 vs. CHOW, ANOVA.
Disclosure of Interest: None declared.
MON-P059
INSULIN RESISTANCE AND SERUM LEVELS OF INTERLEUKIN-17
AND INTERLEUKIN-18 IN NORMAL PREGNANCY
S. Sobhanian1 *, A. Sotoodeh Jahromi1. 1Jahrom University of
Medical Sciences, Jahrom, Islamic Republic of Iran
Rationale: Pregnancy is associated with insulin resistance
and glucose metabolism disorders. There is an oncoming
augmentation in maternal insulin secretary response to
glucose and a variety of other stimuli during the course of
gestation.
Methods: This descriptive cross sectional study was carried out
on 97 healthy pregnant women including 32, 25, and 40
individuals in the first, second, and third trimesters, respect-
ively, and on 28 healthy non pregnant women between the
autumn of 2012 and the spring of 2013. We analyzed the serum
concentrations of IL-17 and IL-18 by using the enzyme linked
immunosorbent assay (ELISA). Insulin resistance was measured
by homeostasis model assessment of insulin resistance
equation.
Results: No significant differences between the demographic
data of the pregnant and non pregnant groups were observed.
Insulin resistant in pregnant women was significantly higher
than the controls ( p = 0.006). Serum IL-17 concentration was
significantly different in non pregnant women and pregnant
women in all gestational ages ( p < 0.05). Serum IL-18 level was
significantly lower in subjects with first, second, and third
trimesters of pregnancy in compared to non pregnant women
( p < 0.05). No significant correlations were found between
serum IL-17 and IL-18 levels with insulin resistance (r = 0.08,
p = 0.34 vs. r = 0.01, p = 0.91, respectively).
Conclusion: Our data suggested that IL-17 and IL-18 do not
appear to attribute greatly to pregnancy deduced insulin
resistance during normal pregnancy.
Disclosure of Interest: None declared.
MON-P060
THE OPTIMAL TIME OF GLP-2 INTERVENE FOR EARLY
INTESTINAL REHABILITATION IN A RAT MODEL OF MASSIVE
BOWEL RESECTION
Y. Li1 *, Z. Cai2. 1Department of Surgery, Shanghai Ninth
People’s Hospital, Shanghai Jiaotong Univesity School of
Medicine, Shanghai, 2Department of Surgery, Jinling Hospital,
Nanjing University School of Medicine, Nanjing, China
Rationale: To explore the optimal time of GLP-2 intervene for
early intestinal rehabilitation in a rat model of massive bowel
resection.
S202
Methods: The rats underwent massive bowel resection(80%
small bowel resection) were divided into two groups: glucagon-
like peptide-2(GLP-2)and saline were given introperitoneal
injection for 3 days at different time points following by MBR,
respectively. The expression of apoptosis was detected by
Western Blotting by detecting the apoptosis-related protein
PARP and Caspase 8.
Results: The number of autophagic body was significantly
reduced after the treatment of GLP-2 at postoperative 24
hours. The expression of autophagy marker including LC3, Atg5
and Beclin-1 was heavily reduced after the treatment of GLP-2
at postoperative 24 hours on the level of mRNA. Among them,
the level of Beclin-1 was the most significantly reduced. While
the expression of P62 significantly increased after the
treatment at this time point. The rate of transition from LC3 I
to LC3 II and the expression of LC3 II were reduced significantly
after the treatment of GLP-2 at postoperative 24 hours.
Meanwhile, the levels of Atg5 and Beclin-1 were also reduced
at this time point. However, the levels of P62 decreased
significantly after the treatment. The expression of autophagy
increased significantly after the treatment of GLP-2 at
postoperative 72 hours.
Conclusion: The intervene of GLP-2 initiated at postoperative
24 hours is the optimal time for early intestinal rehabilitation a
rat model of massive bowel resection.
Disclosure of Interest: None declared.
MON-P061
GLUCAGON-LIKE PEPTIDE-2 MODULATES THE EFFECTS OF
AUTOPHAGY ON INTESTINAL ADAPTION IN A RAT MODEL OF
SHORT BOWEL SYNDROME
Y. Li1 *, Z. Cai2. 1Department of Surgery, Shanghai Ninth
People’s Hospital, Shanghai Jiaotong Univesity School of
Medicine, Shanghai, 2Department of Surgery, Jinling Hospital,
Nanjing University School of Medicine, Nanjing, China
Rationale: To explore the molecular mechamism of glucagon-
like peptide-2 modulating the effects of autophagy on
intestinal adaption in a rat model of short bowel syndrome.
Methods: The rats was underwent massive bowel resection
(80% small bowel resection) to imitate the clinical condition of
SBS caused by IRI. The expression of autophagy at different
time points postoperatively through combined methods of
electron microscopy (EM), polymerase chain reaction (PCR)
and Western Blotting, and a variety of autophagy markers
including LC3, p62, Atg5 and Beclin-1 were observed, the
expression of apoptosis through the method of Western Blotting
by detecting the apoptosis-related protein PARP and Caspase 8
was analysed.
Results: The number of autophagic body within 24 hours after
MBR was greater than the sham-operated group, and the
number decreased significantly at postoperative 72 hours. The
expression of autophagy marker including LC3, Atg5 and Beclin-
1 were significantly increased within postoperative 24 hours on
the level of mRNA. Among them, the expression of Beclin-1
increased most significantly. These markers gradually
decreased at postoperative 72 hours. Besides, the expression
of P62 decreased within postoperative 24 hours, while
significantly increased at postoperative 72 hours in the
experimental groups compared with the sham-operated
group. The expression of apoptosis related protein PARP and
Poster
Caspase 8 significantly increased after postoperative 72 hours,
while didn’t change much at postoperative 24 hours.
Conclusion: The expression of autophagy and apoptosis was
presumed to be stabilized at a basal level after postoperative
72 hours. The increased apoptosis and decreased autophagy
may increase self-renewal of enterocytes and promote the
process of intestinal adaptation
Disclosure of Interest: None declared.
Liver and gastrointestinal tract 2
MON-P062
PREVALENCE OF INTESTINAL FAILURE ASSOCIATED LIVER
DISEASE (IFALD) IN ADULTS ACCORDING TO DIFFERENT
INDICES
A. S. Sasdelli1, F. Agostini1, C. Pazzeschi1, M. Guidetti1,
L. Pironi1 *. 1Center for Chronic Intestinal Failure, University of
Bologna, Bologna, Italy
Rationale: A comprehensive and unique definition of IFALD is
not yet available. The aim of this study was to assess the
prevalence of IFALD according to indirect biochemical and
instrumental indices of liver disease.
Methods: Cross sectional study carried out in a single medical
center, on adult outpatients on Home Parenteral Nutrition
(HPN) for Chronic Intestinal failure (CIF) due to benign disease,
with no liver disease due to a known cause. The followings were
collected: anagraphic and anthropometric data, CIF mechan-
ism, underlying disease, HPN characteristics, biochemistry and
liver ultrasound (US). Criteria for IFALD diagnosis: ‘general
criteria’: alkaline phosphatase and gamma-glutamyl transfer-
ase >1.5 ULN plus US signs of liver steatosis; cholestasis: direct
bilirubin >0.3 mg/dL; steatosis at biochemistry: AST/ALT ratio
(AAR) <1; steatosis at US; indices of fibrosis (APRI, Forns, NFS,
FIB-4). Statistic: median, chi-squared test.
Results: A total of 117 patients were included (M 44%, age
52 yrs). Prevalence (%) of IFALD according to the individual
index: ‘general criteria’, 7; cholestasis, 27; steatosis-AAR, 51;
steatosis-US, 44; fibrosis: APRI, 10; Forns, 24; NFS, 3; FIB-4, 20.
Patients with all positive indices, 0; patients with no positive
index, 15. Prevalence of positive APRI (P < 0.01) or FIB-4
(P < 0.03) was greater in females; positivity of Forns (P < 0.001),
NFS (P < 0.001) and FIB4 (P < 0.002) increased with age
category; prevalence of cholestasis was greater in patients
with jejunostomy or entero-cutaneous fistulas (P < 0.05).
Conclusion: In adults, indirect indices of liver disease indicate
that IFALD is mainly represented by liver steatosis, whereas
cholestasis and hepatic fibrosis may affect about one fourth of
patients. Sex, age and CIF mechanism might play a role in the
positivity of IFALD indices.
Disclosure of Interest: None declared.
MON-P063
ASSOCIATION BETWEEN PRESARCOPENIA, SARCOPENIA AND
BONE MINERAL DENSITY IN PATIENTS WITH CHRONIC
HEPATITIS C
T. Bering1, K. G. D. Diniz1, M. P. P. Coelho1, D. A. Vieira1,
M. M. S. Soares2, A. M. Kakehasi3, M. I. T. D. Correia4,
R. T. Teixeira1, D. M. M. Queiroz5, G. A. Rocha5, L. D. Silva1,2 *.
1
Outpatient Clinic of Viral Hepatitis, Instituto Alfa de
Liver and gastrointestinal tract 2
Gastroenterologia, 2Internal Medicine, 3Locomotor System
Department, 4Department of Surgery, 5Laboratory of Research
in Bacteriology, Faculdade de Medicina, Universidade Federal
de Minas Gerais, Belo Horizonte, Brazil
Rationale: Although low skeletal muscle mass (MM) has been
considered a predictor of bone mineral density (BMD), their
association in chronic hepatitis C(CHC) is not fully understood.
Thus, we evaluated the prevalence of low BMD and sarcopenia
among CHC patients. The association between BMD, body
composition, muscle strength (MS) and nutritional status was
also investigated.
Methods: 104 subjects [mean age, 50.5 ± 11.3 yrs.; 75.0%
males; 67.3% non-cirrhotic and 32.7% with compensated
cirrhosis], prospectively, underwent scanning of the lean
tissue, appendicular skeletal muscle mass (ASM), fat mass
(FM), lumbar spine, hip, femoral, neck and whole-body BMD by
dual-energy X-ray absorptiometry(DXA). MS was assessed by
dynamometry. Sarcopenia was defined by the presence of both
low ASM/height2 (ASMI) and low MS(EWGSOP criteria). Low BMD
and nutritional status were evaluated, respectively, according
to WHO criteria and Controlling Nutritional Status score.
Results: Low BMD, low MS, presarcopenia (low MM) and
sarcopenia were found in 34.6%, 27.9%, 14.4% and 8.7%
patients, respectively. In multivariate analysis, ASMI was an
independent predictor of BMD. Neither FM nor body mass index
(BMI) was associated with BMD. Sarcopenia was independently
associated with BMD and malnutrition. 88.9% of sarcopenic
individuals had normal BMI. Positive correlation was found
between mid-arm muscle circumference (MAMC) and ASMI.
When ASMI was replaced by MAMC in the evaluation of MM, we
found a moderate and substantial agreement between MAMC
and ASMI in the evaluation of presarcopenia and sarcopenia,
respectively.
Conclusion: To the best of our knowledge, this is the first study
to demonstrate that ASM is an independent predictor of BMD in
CHC patients. MAMC coupled with handgrip strength testing
should be incorporated into routine clinical practice to detect
presarcopenia and sarcopenia, which might go underdiagnosed
when only BMI is used.
Disclosure of Interest: None declared.
MON-P064
DIET INFLUENCE ON THE INTESTINAL MICROBIOTA IN
PATIENTS WITH SHORT BOWEL SYNDROME
I. Higuera Pulgar1, P. García Peris2, I. Bretón Lesmes2,
M. Camblor Álvarez2, M. C. Collado Amores3,
M. L. Carrascal Fabián2, L. Arhip2, M. L. Motilla de la Cámara2,
M. C. Cuerda Compés2 *. 1Universidad Complutense de Madrid,
2
Hospital General Universitario Gregorio Marañón, Madrid,
3
Instituto de Agroquímica y Tecnología de Alimentos de
Valencia, Valencia, Spain
Rationale: In addition to developing different functions in the
body, intestinal microbiota could have a potential effect on
controlling food intake. Since the diet is a modifying factor of
the microbiota, the study of its influence on microbiota in
patients with short bowel syndrome (SBS) could make us
understand the dysbiosis and the development of hyperphagia
in these patients.
S203
Methods: This is a multicenter observational study in patients
with SBS >18 years. We studied microbiota at phylum-level by
16S rRNA sequencing and hyperphagia (energy intake > 1,5
times the REE) measured by indirect calorimetry (Fitmate GS®,
COSMED®) and 7-day food record. Variables were expressed as
frequencies and median [interquartile range]. Spearman
correlation by IBM-SPSS Statistics21® was carried out.
Results: Twenty patients were included (68 [59–76] years, 75%
women). The oral energy intake was 2,287 [1,643–2,887] kcal,
39 [24–49] kcal/kg/day, which were distributed as follows:
46 [39–52] % carbohydrates, 16 [14–18] % proteins (0,72
[0,59–1,07] g/kg/day) and 35 [31–41] % lipids. 65% of the
sample did not cover orally the minimum recommended
amount of protein (0,8 g/kg/day), this patients having a
significant increase in Bacteroidetes ( p = 0,017). 50% of the
patients did not meet the recommended amount of dietary
fibre (22,3 [8,3–32,4] g) (women: 22 g/day, men: 30 g/day).
This was correlated with a lower presence of Actinobacteria
( p = 0,03), but with an increase of Proteobacteria ( p = 0,011).
The presence of hyperphagia (57,9%) did not correlate with
none of the phylums.
Conclusion: The low protein intake appears to increase the
Bacteroidetes and the insufficient fibre intake decreases the
Actinobacteria, while the Proteobacteria increases in patients
with SBS. The hyperphagia has not been linked to changes in
the microbiota at the phylum-level.
Disclosure of Interest: None declared.
MON-P065
STUDY OF INTESTINAL MICROBIOTA IN PATIENTS WITH SHORT
BOWEL SYNDROME
I. Higuera Pulgar1, P. García Peris2, I. Bretón Lesmes2,
M. Camblor Álvarez2, M. C. Collado Amores3, C. Gil Martínez4,
P. Matía Martin5, L. Arhip2, M. C. Cuerda Compés2 *.
1
Universidad Complutense de Madrid, 2Hospital General
Universitario Gregorio Marañón, Madrid, 3Instituto de
Agroquímica y Tecnología de Alimentos de Valencia, Valencia,
4
Hospital Universitario de la Defensa Gómez Ulla, 5Hospital
Universitario Clínico San Carlos, Madrid, Spain
Rationale: The differences between patients with short bowel
syndrome (SBS) with and without colon, as well as with and
without intestinal failure (IF) have not yet been fully
characterized.
Methods: This is a multicenter observational cross-sectional
study in patients >18 years, including 4 SBS groups (with and
without IF, with and without colon) and 1 control group. We
studied microbiota at phylum, family and genus level by 16S
rRNA sequencing. Variables were expressed as frequencies and
median [interquartile range]. Calypso 7.0 software (http://
cgenome.net/calypso/), T-test, one-way ANOVA, Bray-Curtis
and Shannon Index were used used for statistical analysis.
Results: Twenty patients (age 68 [59–76] years, 75% women)
and 20 controls (age 44,5 [40–51] years, 55% women) were
included, with significant differences in age ( p < 0.0001). The
patients with SBS had a higher relative abundance of
Verrucomicrobia ( p = 0,024) and Fusobacteria ( p = 0,048) and
a decrease in Bacteroidetes ( p = 0,019), compared to healthy
subjects. In SBS patients, the absence of colon decreased
Enterobacteriaceae ( p = 0,047) and Veillonela ( p = 0,047). The
presence of IF resulted in decreased bacterial diversity in
S204 Poster

patients with colon ( p = 0,015), with lessen Blautia ( p = 0,017), MON-P067

Veillonela ( p = 0,043) and Coprococcus ( p = 0,043). Bray-Curtis PARENTERAL NUTRITION WITH OMEGA-3 FATTY ACIDS
Index was 16% for the presence or absence of colon and 17% for RESULTS IN HIGH ENDOGENOUS EPA/DHA LEVELS IN SHORT
the presence or absence of IF. BOWEL SYNDROME PATIENTS
Conclusion: The microbiota of patients with SBS is different M. Karber1,2,3 *, S. Pevny1, D. Thurmann1, W.-H. Schunck2,
compared to healthy subjects. In addition, the dysbioses that K.-H. Weylandt1, U.-F. Pape1. 1Department of
are produced depend on the presence or not of colon in Gastroenterology, Hepatology and Endocrinology, Charité –
continuity, as well as the development or not of IF. Universitätsmedizin Berlin, 2Max Delbrück Center for
Disclosure of Interest: None declared. Molecular Medicine in the Helmholtz Association (MDC),
3
Berlin Institute of Health, Berlin, Germany
MON-P066
SMOF LIPID USE IN PATIENTS WITH INTRALIPID INTOLERANCE Rationale: Long-term parenteral nutrition (PN) of short bowel
syndrome patients (SBS-P) bears an increased risk of intestinal
M. Mundi1 *, J. Carnell2, M. McMahon2, R. Hurt2. 1Division of failure associated liver disease (IFALD). The antiinflammatory
Endocrinology, 2Mayo Clinic, Rochester, United States properties of long-chain omega-3 polyunsaturated fatty acids
(n-3 PUFA) attracted attention for preventing IFALD. However,
Rationale: Smoflipid has recently been approved for use in US
the relative impact and mechanisms of this approach have not
but literature has been limited to short term studies with
been fully established, as required for recommending general
duration of 14–28 days. Long-term studies are necessary in the
use of n-3 PUFA containing PN in SBS-P.
Home Parenteral Nutrition (HPN) population.
Methods: A prospective pilot study was performed in adult
Methods: Intralipid intolerant patients were transitioned to
IFALD-free SBS-P to investigate the effects of n-3 PUFAs on
Smoflipid with primary aim of increasing % calories from lipids
endogenous fatty acid (FA) profiles, inflammatory markers, and
without further elevation in liver function studies.
liver function tests. 8 SBS-P (mean age 50 ± 24 years;
Results: As of this analysis, 7 patients (3 female and 4 male)
pretreated with PN containing n-3 PUFA) received n-3 PUFA-
were placed on Smoflipid with duration of use of 83 ± 7.2 days.
free Lipovenös® MCT 20% during an 8- week washout, followed
Patients were on HPN for 10.9 ± 9.4 years with most common
by 8 weeks PN, wherein 25% of fat was replaced by n-3 PUFA-
indication of short bowel syndrome/malnutrition (n = 5) and
rich Omegaven®. 1,538 ± 275 kcal per infusion were applied on
motility disorder (n = 2). Most common reason for Intralipid
5.3 ± 1.4 days/week. Blood samples were taken every 4 weeks.
intolerance was IFALD (n = 7) with one patient also developing
The FA profile of erythrocytes yielded the HS-Omega-3 Index®
recurrent pancreatitis.
(n-3 index = (EPA + DHA)/total FA)).
Use of Smoflipid allowed an increase in total calories provided
Results: At baseline SBS-P demonstrated an n-3 index of
with an overall increase in the % calories from lipids from
12 ± 1.8, which declined continuously to 9 ± 0.8 during wash-
8.2 ± 7.2% to 12.4 ± 8.6%, while decreasing the % calories from
out. Subsequent re-supplementation resulted in significantly
dextrose from 64.8 ± 8.3% to 60.9 ± 7.2%. Despite increase in
increased n-3 PUFAs and decreased saturated and n-6 FA leading
lipid calories, liver studies revealed a trend towards improve-
to a raised the n-3 index of 13 ± 1.1. SBS-P simultaneously had
ment with total bilirubin decreasing from 1.3 ± 0.5 to 1.1 ± 0.6.
stable laboratory parameters and a clinically stable course.
Conclusion: A high baseline n-3-index did exclude n-3 PUFA
Baseline Week 8 P-value deficiency on pre-study PN; a specific reduction of n-3 PUFA on
wash-out and reversible increase on re-supplementation could
Age (years) 47.8 ± 13.9
Years on HPN 10.9 ± 9.4 be demonstrated and was associated with clinical and
BMI (kg/m2) 23.8 ± 4.8 paraclinical stability indicating exceptionally effective n-3
Total Calories per day 1,664.6 ± 516.3 1,702.5 ± 470.0 0.65 PUFA supplementation. Thus, n-3 PUFA-rich PN results in
% of Harris Benedict 108.3 ± 27.6 112.7 ± 34.7 0.40
Amino Acids (g/day) 112.3 ± 47.5 112.3 ± 47.5
extraordinarily high endogenous EPA/DHA levels compared to
Dextrose (g/day) 331.6 ± 83.7 298.7 ± 67.1 0.33 oral supplementation (n-3 indices 4 to 8).
Lipids (g/week) 109.3 ± 105.9 166.4 ± 145.3 0.13
Disclosure of Interest: None declared.
% Calories from Amino 27 ± 5.2 26.7 ± 7.2 0.77
Acid
% Calories from Dextrose 64.8 ± 8.3 60.9 ± 7.2 0.017 MON-P068
% Calories from Lipids 8.2 ± 7.2 12.4 ± 8.6 0.05
Alk Phos 237.6 ± 266.9 211.7 ± 193 0.37 INDIVIDUALIZED 6-MONTHS CONTROLLED AND
AST 57.0 ± 30.1 39.8 ± 12.9 0.20 MOTIVATIONAL PROGRAM CHANGING EATING BEHAVIOR
ALT 66.9 ± 14.7 57.2 ± 17.9 0.47 REDUCE WEIGHT AND LEVELS OF NON-INVASIVE BIOMARKER
Total Bilirubin 1.3 ± 0.5 1.1 ± 0.6 0.02
OF LIVER APOPTOSIS IN PATIENTS WITH NONALCOHOLIC
FATTY LIVER DISEASE
Conclusion: Smoflipid is a viable alternative to Intralipid in
N. Dynnyk1 *. 1Internal Medicine 3, Bogomolets National
patients with IFALD allowing increase in calories provided from
Medical University, Kyiv, Ukraine
lipids with improvement in some LFTs.
Disclosure of Interest: M. Mundi: None declared, J. Carnell: None Rationale: Lifestyle modification and weight loss above 7–10%
declared, M. McMahon: None declared, R. Hurt Consultant for: Nestle. is the effectiveness treatment of NAFLD. But still there is a gap
how to increase patient adherence for changing eating
behavior and effect of weight loss. According to this we have
created motivational and controlled programm for changing
eating behavior and investigate it´s role in weight loss in
Liver and gastrointestinal tract 2
patients with NAFLD. Also we discover how this program can
improve hepatic apoptosis as a main predictor of Nonalcoholic
fatty liver disease progression, which can be measured by
biomarker cytokeratin 18.
Methods: 58 patients with NAFLD were randomized in a two
groups. All of them had diagnosed NAFLD. We described
importance of weight loss for the improving NAFLD. We gave
diet recommendations which consists of reducing portions of
food, avoiding drinking soda water, reducing carbohydrates
intake and increasing fiber intake. For better diet adherence
every day first group were writing food diaries. Each person
from first group had 8 personalised sessions with doctor during
6 months. On each sessions patients were measured of weight,
waist circumference and fat percentage measured by bioelec-
tric impedancemetry. To those from control group were just
given general recommendations of changing eating behavior
without controlled sessions with doctor during 6 months.
Results: We observed significant decreasing in weight loss
( p < 0,01), cytokeratin18 fragments M30 ( p < 0,01), Fatty liver
index, Visceral adiposity index and Fat contain measured by
bioelectric impedancemetry.
Conclusion: Individualized controlled and motivational
program of changing eating behavior leads to weight loss and
improves steatosis and Cytokeratin 18 levels in patients with
NAFLD during 6 months.
Disclosure of Interest: None declared.
MON-P069
LIPID, FETUIN-A AND MACROPHAGE ZONATION IN HIGH FAT
DIET FOZ-FOZ MICE WITH NON-ALCOHOLIC STEATOHEPATITIS
N. Lanthier1,2 *, Q. Etienne1, V. Lebrun1, L. Poekes1,
Y. Horsmans1,2, I. A. Leclercq1. 1Laboratory of
Gastroenterology and Hepatology, Institut de Recherche
Expérimentale et Clinique, Université catholique de Louvain,
2
Service d’Hépato-Gastro-Entérologie, Cliniques
universitaires Saint-Luc, Brussels, Belgium
Rationale: Innate immunity and insulin resistance constitute
potential mechanisms underlying non-alcoholic steatohepatitis
(NASH) progression. Here, we explore the effect of a high fat
diet (HFD) on a liver-derived protein increased in diabetic
patients called fetuin-A and its relation with the development
of steatosis, cell injury and liver macrophage activation in a
mouse model of obesity and NASH.
Methods: Male foz/foz mice were fed a normal diet (ND) or a
HFD for 12 (long term HFD or LHFD) or 30 weeks (very long term
HFD or VLHFD) to induce early or definite fibrosing NASH,
respectively.
Results: Compared to ND-fed foz/foz mice, HFD-fed foz/foz
mice developed obesity, insulin resistance and either steatosis
(LHFD) or steatohepatitis with steatosis, hepatocyte balloon-
ing, inflammation and fibrosis (VLHFD).
In ND fed mice, fetuin-A staining was positive in the cytoplasm of
zone 3 centrilobular hepatocytes while F4/80+ Kupffer cells
were located in the sinusoids of the intermediate lobular zone 2.
In LHFD fed mice, lipid deposition occurred in the zone 3
centrilobular hepatocytes. Liver m-RNA expression showed a
2-fold increased level of F4/80+ macrophage mRNA compared
to ND.
In VLHD, a loss of zonation of liver steatosis with the presence
of fat loaded hepatocytes in all liver lobular zones was
S205
observed. Fetuin-A was highest in periportal fat-ladden
hepatocytes and next to inflammatory infiltrates. There was
a 4-fold F4/80 mRNA increased level upon VLHFD compared to
ND. Interestingly, F4/80+ cells from lipogranuloma were
positive for fetuin-A protein staining.
Conclusion: Lipid deposition, macrophage infiltration and
fetuin-A production may be important factors in the liver
tissue remodeling observed during NASH development.
Disclosure of Interest: None declared.
MON-P070
EFFECTS OF REDUCED SATURATED FATTY ACID ON BODY
COMPOSITION IN PATIENTS WITH NON-ALCOHOLIC FATTY
LIVER DISEASE (NAFLD)
N. B. Erdem1 *, Z. Goktas1. 1Nutrition and Dietetics, Hacettepe
University, Ankara, Turkey
Rationale: Lifestyle changes including dietary patterns repre-
sents the main target for the prevention and treatment of
nonalcoholic fatty liver disease (NAFLD). Saturated fatty acids
(SFA) have unfavorable effects on lipid and glucose metabolism
which might worsen the progression of NAFLD. The aim of this
study to determine the effects of reduced saturated fatty acid
diet (7%) on anthropometric measurements of individuals with
non-alcoholic fatty liver disease.
Methods: A total of 23 adults aged between 19 and 65 years
participated in the study. Subjects were randomly divided into
two groups. Both groups followed a diet treatment for three
months; group 1 with 7% saturated fatty acid (n = 11) and group
2 with 12% saturated fatty acid (n = 12). Participants visited at
baseline, 1st month and 3rd month. Data collected during each
visit included height, weight, waist, hip, neck circumferences,
body fat composition, body muscle composition and intra
abdominal fat. Body fat and muscle compositions were
collected using bioelectrical impedance analysis. Intra abdom-
inal fat was measured via VISCAN.
Results: A total of 12 female and 11 male subjects participated
in the study. In both groups, weight significantly decreased;
from 86.1 to 81.2 in 7% SFA group and from 76.8 to 74.0 in 12%
SFA group ( p < 0.05). Moreover; waist circumferences, intra-
abdominal fat and Body Mass Index (BMI) changes were
significant in both groups ( p < 0.05). For 7% SFA group waist
hip ratio change wasn’t significant ( p > 0.05) however, it was
significantly changed for 12% SFA group ( p < 0.05).
Conclusion: Within each group there was significant decrease
in terms of anthropometric measurements such as weight, BMI,
waist circumference, intra abdominal fat. However there were
no significant differences in anthropometric measurements
between different SFA groups.
Disclosure of Interest: None declared.
MON-P071
INCREASE IN BMI AFTER INTESTINAL TRANSPLANTATION (ITX)
IN ADULTS WITHOUT TOTAL PARENTERAL NUTRITION (TPN)
S. Tabak1 *, H. Noordhoff1, H. D. Bats1, F. V. D. Heide1,
G. Dijkstra1. 1Gastroenterology and Hepatology, UMCG,
Groningen, Netherlands
Rationale: Is intestinal transplantation (ITx) a succesful
treatment of chronic intestinal failure to increase BMI
S206
without TPN; results of 10 adult transplantations of the
University Medical Centre Groningen.
Methods: Retrospective observational study from September
2001 to March 2017.
Results: The University Medical Center Groningen (UMCG) is
the only intestinal transplant (ITx) center in the Netherlands.
In the last 15 years, only 11 intestinal transplants were needed
in adult patients with chronic intestinal failure. Ten patients (2
male and 8 female, aged 24–55 years, median 42) were
transplanted between September 2001 till March 2017, with a
follow up period of 8–165 months (median 17). All patients had
a regular diet, before ITx. Indications for ITx were line
occlusion and infection (9), a perceived poor quality of life
(2). Patients were dependent of TPN before ITx during 9 and
164 months (median 74). Body weight before ITx was ranged
from 46 to 75 kg (median 57), the Body Mass Index (BMI) was
ranged from 15,5 to 23,1, median 20,7. Body weight after ITx at
the end of follow up was ranged from 49 to 98 kg (median 60,5)
and the BMI after ITx was ranged from 17,4 to 39,3 (median
21,5). In 4 patients bodyweight was increased with 6–41 kg
(median 16), the bodyweight of one patient remained the
same, for one patient the bodyweight decreased with 15 kg
(BMI 17,4). At the end of follow up, the graft of 6 patients was
intact, 2 patients died, in 2 patients the graft had to be
removed because of rejection. All patients were able to eat a
regular diet at hospital discharge, only 1 of them needed
additionally TPN.
Conclusion: After intestinal transplantation, in 67% of the
patients the BMI increases with a regular diet and without TPN.
Disclosure of Interest: None declared.
MON-P072
VISCERAL ADIPOSITY AND SARCOPENIC OBESITY ARE CLOSELY
ASSOCIATED WITH MORTALITY AND RECURRENCE AFTER
PANCREATIC CANCER RESECTION: USEFULNESS OF BODY
COMPOSITION ANALYSIS
S. Okumura1 *, T. Kaido1, Y. Hamaguchi1, A. Kobayashi1,
H. Shirai1, S. Yao1, S. Yagi1, N. Kamo1, K. Takaori1, S. Uemoto1.
1
Division of Hepato-Biliary-Pancreatic Surgery and
Transplantation, Kyoto University, Kyoto, Japan
Rationale: Sarcopenia and muscle steatosis, characterized as
the decrease in muscle mass and function, have been identified
as poor prognostic factors for pancreatic cancer. However, the
significance of visceral adiposity and sarcopenic obesity on
outcomes after the resection of pancreatic cancer remains
unclear.
Methods: A retrospective analysis of 301 patients who
underwent resection for localized pancreatic cancer between
2004 and 2015 was performed. Visceral adiposity [visceral to
subcutaneous adipose tissue area ratio (VSR)] was measured on
preoperative computed tomography images, together with
visceral fat area (VFA), skeletal muscle index (SMI) and muscle
attenuation (MA). The impacts of these body composition
parameters on outcomes after pancreatic resection were
analyzed.
Results: The overall survival (OS) and recurrence-free survival
(RFS) rates were significantly lower in patients with high VSR
than those in patients with low VSR (P = 0.001, P = 0.007,
respectively). There were no differences in OS and RFS
between high VFA and low VFA group, however, when analyzed
Poster
together with sarcopenic factors, OS and RFS rates of the
patients with sarcopenic obesity were significantly lower
compared with those of the others. Multivariate analyses
revealed that high VSR (visceral adiposity) was an independent
risk factor for mortality [Hazard ratio (HR) = 1.576, P = 0.009]
and recurrence (HR = 1.405, P = 0.026) together with low SMI
(sarcopenia), low MA (muscle steatosis), high CA19–9, micro-
vascular invasion, and nodal metastasis.
Conclusion: Visceral adiposity and sarcopenic obesity were
closely associated with mortality and recurrence after the
resection of pancreatic cancer.
Disclosure of Interest: None declared.
MON-P073
TREATMENT WITH TEDUGLUTIDE IN PATIENTS WITH SHORT
BOWEL SYNDROME: PARENTERAL SUPPORT AND
BIOELECTRICAL IMPEDANCE ANALYSIS IN CLINICAL ROUTINE
S. Pevny1, S. Maasberg1, M. Karber1 *, B. Knappe-Drzikova1,
D. Thurmann1, A. Pascher2, U.-F. Pape1. 1Department of
Gastroenterology, Hepatology and Endocrinology, 2Department
of General, Visceral and Transplantation Surgery, Charité
University Medicine Berlin, Berlin, Germany
Rationale: Teduglutide (TED), an analogue of the gastrointes-
tinal hormone glucagon like peptide-2 (GLP-2) that promotes
regeneration of the intestinal mucosa, is effective for
enhancing intestinal adaption in patients ( pts) with short
bowel syndrome (SBS) and chronic intestinal failure. Data of
clinical routine treatment are not available yet.
Methods: Center based prospectively collected clinical and
paraclinical data of pts with benign SBS were analyzed
retrospectively from a single university hospital. Within a
subcohort, nutritional status was assessed in clinical routine by
bioelectrical impedance analysis (BIA).
Results: In total, 24 pts with heterogeneous bowel anatomy
were treated since Oct. 2014. Three month after initiation of
TED treatment pts showed a 2,679 ml (17%) reduction in
intravenous fluid (IVF) requirements (n = 17; p = 0.007) and a
1,522 kcal (17%) reduction in intravenous energy requirement
(n = 17; p = 0.007) per week. After one year, the difference of
reduction approximately doubled (n = 9; p = 0,001 and p = 0,005
resp.) accompanied by a significant reduction in parenteral
nutrition (PN) of 1.9 days/week ( p = 0,01) and no reduction in
IVF days/week. Three out of 20 pts (15%) who are currently
on TED were weaned off PN after a mean treatment of 25
weeks (SD: 12 wks.), two continuing on IVF. Analysis of BIA
parameters revealed stability in body mass index, phase angle
α, body cell mass, and intra- or extracellular water albeit
reduction in parenteral support after 24 (n = 9) and 45 (n = 7)
weeks on TED.
Conclusion: The gradual reduction of IVF and PN support
in TED-treated SBS demonstrates a beneficial effect at no
cost of body composition suggesting stability of nutritional
status with improved intestinal function. Applying BIA for
monitoring body composition as a surrogate of nutritional
status in clinical routine can guide decision making in IVF/PN
management.
Disclosure of Interest: S. Pevny: None declared, S. Maasberg: None
declared, M. Karber: None declared, B. Knappe-Drzikova: None
declared, D. Thurmann: None declared, A. Pascher: None declared,
U.-F. Pape Grant/Research Support from: Shire, Speaker Bureau of: Shire.
Liver and gastrointestinal tract 2
MON-P074
PARENTERAL OLIVE OIL IMPROVES LIVER FUNCTION IN
INTESTINAL FAILURE PATIENTS: RANDOMIZED, CONTROLLED
CLINICAL TRIAL
S. Klek1 *, K. Szczepanek2, L. Scislo3, E. Walewska4, M. Pietka2,
M. Pisarska5, M. Pedziwiatr6. 1General and Oncology Surgery
Unit with Intestinal Failure Center, 215 Tyniecka Street,
Stanley Dudrick’s Memorial Hospital, Skawina, 3Department of
Clinical Nursing, 42Department of Clinical Nursing, 52nd Dept
of Surgery, 62nd Dept of Surgey, Jagiellonian University,
Krakow, Poland
Rationale: Intravenous lipid emulsion (IVLE) is the essential
component of parenteral nutrition (PN), but also one the key
risk factors for the intestinal failure related liver disease
(IFALD). There is a variety of IVLE commercially available, of
various generations, from long-chained triglycerides to multi-
IVLE solution. A comprehensive research comparing long term
hepatic effect of IVES, has never been done, hence it became
the aim of the study
Methods: A randomized, controlled clinical trial was per-
formed at the Intestinal Failure Center, between January, the
1st 2010 and December, the 31st, 2015. Sixty-seven patients (37
F, 30 M, mean age 53.9) receiving home parenteral nutrition
(HPN) due to stable chronic intestinal failure (CIF), were
randomized to receive one the following lipid emulsions for 12
months: long-chained triglycerides (LCT), medium/long-
chained triglycerides (MCT/LCT), olive oil/LCT (OO/OCT) and
SMOFlipid. Liver function was assessed clinically and with
biochemical parameters: SGOT, SGTP, GGPT, serum bilirubin
Results: The most common reason for CIF was short bowel due
to mesenteric ischaemia, then Crohn’s disease, surgical
complications and radiation enteritis. The omega-9 based
lipid emulsion proved to be the only one capable of reducing
the bilirubin concentration (28.1 ± 25.3 at the beginning vs
11.1 ± 4.5 at the end, p = 0.0023) as well as GGTP (222.5 ± 205.8
vs 146.6 ± 197.7, p = 0.0079). No other lipid emulsion exerted
such an effect.
Conclusion: The omega-9-IVLE were the only emulsions, which
demonstrated hepato-protective effect. It may suggest the it
should become an obligatory IVLE for long-term PN patients.
Disclosure of Interest: None declared.
MON-P075
INFLUENCE OF DIFFERENT LIPID EMULSIONS ON LIVER
PARAMETERS IN PATIENTS ON LONG-TERM PARENTERAL
NUTRTION
S. Osowska1 *, M. Kunecki2, M. Omidi1, J. Tokarczyk2,
K. Majewska1, J. Sobocki1. 1Warsaw Medical University,
Warsaw, 2Pirogow Hospital, Łódz,́ Poland
Rationale: The aim of this pilot study was to examine how a
change of lipid emulsion (LE) influences liver parameters in
patients on long-term parenteral nutrition (PN).
Methods: We obtained blood samples from 38 adult patients
with intestinal failure on long-term (>2 years) PN from two PN
centres in Poland (Warsaw and Łódz)́ . Patients with ongoing
acute infections were excluded from the study. The PN regimen
of 15 patients changed from Intralipid to Smoflipid (IS group)
and of 23 patients from Intralipid to Clinoleic (IC group). The
patients were on the changed PN regimen for 2 months. Liver
S207
parameters (bilirubin, triglycerides, cholesterol, ALT, AST,
GGT) were analysed before and after the change of LE.
Statistical analysis was performed using Student’s t-test and
Mann-Whitney test. A p-value <0.05 was considered to indicate
statistical significance.
Results: There were no statistically significant differences in
any of the examined parameters before and after change of LE.
However, in both groups there were patients with a high level of
GGT at the beginning of the experiment (twice the norm and
above). In the IS group there were 6 such patients before
changing to Smoflipid and the change of LE from Intralipid to
Smoflipid resulted in the decrease of GGT in 5 patients. The
decrease was up to 60%. In the IC group there were 10 patients
with high GGT before changing to Clinoleic. The change from
Intralipid to Clinoleic decreased GGT in 6 patients and
increased it in 4. Because of the small number of patients we
did not statistically analyse these data.
Conclusion: A change of LE may influence patients with liver
problems, characterised by high GGT. Smoflipid seems to be
effective at improving GGT. A future study should focus on long-
term PN patients with liver problems.
Disclosure of Interest: None declared.
MON-P076
LOW FODMAP DIET IMPROVES SYMPTOMS AND QUALITY OF
LIFE IN PATIENTS WITH RADIATION INDUCED SMALL BOWEL
DISEASE: A PILOT STUDY
T. Larsen1 *, T. Hausken1,2, S. O. Ystad1,3, N. Hovdenak1,2,
G. A. Lied1,2. 1Department of Clinical Medicine, Center for
Nutrition, University of Bergen, 2Section of Gastroenterology,
Department of Medicine, 3National Centre of Functional
Gastrointestinal Disorders, Haukeland University Hospital,
Bergen, Norway
Rationale: Patients suffering chronic radiation induced small
bowel disease (RISBD) after cancer treatment have similar
symptoms as IBS (irritable bowel syndrome) patients despite
dissimilar pathological origin. The low FODMAP (fermentable
oligo-, di-, monosaccharides and polyols) diet (LFD) is a
widespread management strategy for IBS. The aim of this
study was to investigate the effects of LFD on symptoms and
health related quality of life (HRQOL) for RISBD patients.
Methods: In an open pilot study, eleven patients with RISBD-
related IBS symptoms were instructed to follow LFD throughout
a 4-week intervention period. IBS Severity Scoring System (IBS-
SSS) and IBS Symptom Questionnaire (IBS-SQ) were used to
assess symptoms. An ad hoc questionnaire measured grade of
damage and typical RISBD complaints. Short Form Nepean
Dyspepsia Index (SF-NDI) and 12-item Short Form Health Survey
(SF-12) were used to evaluate HRQOL. Baseline FODMAP intake,
additional dietary changes and adherence to the diet were
estimated from a 3-day food record. All forms were filled at
baseline and at 4 weeks.
Results: FODMAP intake was successfully reduced, and add-
itional dietary changes were reduced intake of energy,
carbohydrates and fiber. The adherence to the diet was high
(mean 94.8%). IBS symptoms improved significantly based on
mean total score of IBS-SSS and IBS-SQ, which changed
respectively from 310.2 to 171.4 ( p = 0.001) and 27.4 to 15.7
( p = 0.002). HRQOL improved based on SF-NDI (30.5 ± 9.4 to
S208
18.3 ± 8.2, p = 0.001) and based on the mental ( p = 0.047) and
the physical ( p = 0.134) component score of SF-12.
Conclusion: The low FODMAP diet seems effective in alleviat-
ing IBS symptoms, and improving HRQOL in RISPBD patients.
High compliance to LFD is possible with adequate and
continuous diet counseling. Further research should be
conducted to enable implementation of LFD as a future
management strategy for RISBD.
Disclosure of Interest: None declared.
MON-P077
THE NEUTROPHIL-TO-LYMPHOCYTE RATIO PREDICTS
MALIGNANT POTENTIAL IN PANCREATIC NEUROENDOCRINE
NEOPLASMS
Y. Zhang1 *, H. Wu1. 1Pancreatic Surgery, Union Hospital,
Wuhan, China
Rationale: Accurately identifying malignant components in
patients with pancreatic neuroendocrine neoplasms (PanNEN)
remains challenging. Neutrophil-to-lymphocyte ratio (NLR) is a
marker of poor prognosis in oncological patients. Our aim was
to evaluate whether NLR was predictive of pancreatic
neuroendocrine carcinoma (PanNEC) in PanNEN.
Methods: A total of 146 patients with PanNEN who underwent
surgery in Union Hospital (Wuhan, China) from 2005 to 2016
were included. The association between the presence of
malignant components and preoperative NLR was analyzed.
Results: Compared to patients with pancreatic neuroendocrine
tumor (PanNET) (n = 119), patients with PanNEC (n = 27)
showed higher value of preoperative NLR (2.04 [1.50–2.79] vs.
2.92 [1.81–3.79]; P = 0.003). After multivariate analysis, NLR
value >2.47 (hazard ratio [HR] 4.45, 95% confident interval [CI]:
1.61–12.34; p = 0.004), CA19–9 > 37 IU/ml (HR 3.81, 95% CI:
1.01–14.43; p = 0.048), and tumor diameter > 3 cm (HR 7.35,
95% CI: 2.45–11.95; p < 0.001) and were identified as an
independent prognostic factor. NLR > 2.47 shows a high
specificity of 71.4% and high negative predictive value of 91.4%.
Conclusion: Preoperative NLR is a useful predictor for
diagnosing PanNEC in patients with PanNEN.
Disclosure of Interest: None declared.
Nutrition and cancer 2
MON-P078
DO NUTRITIONAL INTAKES AFFECT ON BODY MASS INDEX IN
SURVIVORS OF ACUTE LYMPHOBLASTIC LEUKEMIA CHILDREN?
K. Tel Adıgüzel1 *, O. Gürsel2, H. Gokmen Ozel1. 1Nutrition and
Dietetics, Facuty of Health Sciences, Hacettepe University,
2 between Group A and B. WHO BMIZ scores were used to classify
Pediatric Heamotology, Gülhane Education and Research
Hospital, Ankara, Turkey
Rationale: Survivors of pediatric acute lymphoblastic leukemia
(ALL) are at risk becoming overweight or obese after the
treatment. ALL survivors, may have a poor adherence to the
dietary guildelines. The aim of this study was to evaluate
energy and macronutrient intakes in survivors of pediatric ALL.
Methods: A total of 17 survivors of ALL aged 4–13 years (10
boys, 7 girls) were included. The mean age at enrollment (±SD)
was 9.0 ± 3.1 yrs. The mean survival time after cancer
treatment was 21.9 months (6–48 months). Body weight and
Poster
height were measured. BMI Z-scores were calculated.
Participants were classified as normal weight, overweight or
obese at their last visit according to WHO BMI Z scores
classification [normal: +1 to −1 standard deviation (SD),
overweight and obese: >1 SD]. Energy and macronutrients
intakes were analyzed from a parent-reported 3 days food
record. The percentage of energy intakes were expressed in
relative to the Turkey Dietary Guidelines. Mean percentage of
energy from protein, carbohydrate and fat was calculated.
Results: 52.9% of the survivors were overweight or obese.
The percentage of mean energy intake in relative to the
guideline was 103.9% ± 19.3% for normal BMI patients and
107.4% ± 26.9% for overweight-obese patients ( p > 0.05). Mean
percentage of energy from protein were not different in
overweight-obese patients (14.8% ± 1.7%) vs normal BMI
patients (14.9% ± 1.5%). Whereas mean percentage of energy
from carbohydrates were higher in overweight-obese group
(48.1% ± 4.4% vs 43.3% ± 4.0%) ( p < 0.05), mean percentage of
energy from fats (42.3% ± 3.1% vs 36.8% ± 4.5%) ( p < 0.01) were
higher in normal BMI group.
Conclusion: The results of this study showed that eating habits
play an important role in obesity development in the survivors
of pediatric ALL. Interventions are needed to address weight
control after the treatment, particularly for patients who are
overweight or obese.
Disclosure of Interest: None declared.
MON-P079
IS OVERWEIGHT AND OBESITY HIGHER IN SURVIVORS OF
ACUTE LYMPHOBLASTIC LEUKEMIA CHILDREN?
K. Tel Adıgüzel1 *, O. Gürsel2, H. Gokmen Ozel1. 1Nutrition and
Dietetics Department, Faculty of Health Sciences, Hacettepe
University, 2Pediatric Heamotology Department, Gülhane
Education and Research Hospital, Ankara, Turkey
Rationale: A high prevalence of obesity has been increased in
childhood cancers survivors. In particular, survivors of pediatric
acute lymphoblastic leukemia have been found to be at risk of
becoming overweight or obese. The aim of this study was to
evaluate overweight and obesity in acute lymphoblastic
leukemia (ALL) and survivors of leukemia children.
Methods: Nine children (5 boys, 4 girls) aged 4–12 years with
acute lymphoblastic leukemia (Group A) and 17 survivors of
leukemia (Group B) (10 boys, 7 girls, aged 4–13 years) were
included. Mean age of children (±SD) was 9.3 ± 2.7 years in
Group A and 9.0 ± 3.1 years in Group B. The mean survival time
after cancer treatment was 21.9 months (6–48 months) in Group
B. Body weight and height were measured. BMI Z-scores were
calculated using WHO Anhtro Plus programme and compared
into: overweight and obese: >1 standard deviation (SD).
Results: Types of leukemia were pre-B ALL (55.6%), B-ALL
(44.4%) in Group A and pre-B ALL (82.4%), B-ALL (5.9%) and
T-ALL (11.8%) in Group B. Whereas there were no overweight
and obese patients in Group A, 35.3% and 17.6% of children
were overweight and obese in Group B, respectively. BMI Z-
scores were significantly higher in Group B (1.01 ± 1.24) than
Group A (−0.24 ± 1.16) ( p < 0.01).
Conclusion: The results of this study showed that acute period
of leukemia effects BMI negatively and survivors of acute
Nutrition and cancer 2
lymphoblastic leukemia are at increased risk for several
cardiometabolic complications such as overweight and
obesity. Since nutrition plays an important role in the etiology
of overweight and obesity, energy and nutreint intakes of these
children should be evaluated regularly. Healthy dietary
recommendations may decrease risk of weight gain and
subsequent risk of cardiometabolic complications after
cancer treatment.
Disclosure of Interest: None declared.
MON-P080
IS ENERGY AND MACRONUTRIENTS INTAKE DIFFERENT
BETWEEN CHILDREN WITH ACUTE LYMPHOBLASTIC
LEUKEMIA AND SURVIVORS OF LEUKEMIA WHOSE BODY
WEIGHT NORMAL?
K. Tel Adıgüzel1 *, O. Gürsel2, H. Gokmen Ozel1. 1Nutrition and
Dietetics Department, Faculty of Health Sciences, Hacettepe
University, 2Pediatric Heamotology Department, Gülhane
Education and Research Hospital, Ankara, Turkey
Rationale: Survivors of pediatric cancer have been found to
be at risk of becoming overweight or obese. Poor diet may
increase the risk that childhood cancer survivors will suffer
from chronic disease. The aim of this study was to evaluate
energy and macronutrient intakes in acute lymphoblastic
leukemia (ALL) and survivors of leukemia whose body weight
normal.
Methods: Eight children (4 boys, 4 girls) aged 4–12 years with
ALL and 8 survivors of ALL (4 boys, 4 girls, aged 4–13 years)
whose body weight normal were included. The mean survival
time after the treatment was 21.9 months (6–48 months). Body
weight and height were measured. WHO BMIZ scores were used
to classify into: normal: +1 to −1 standard deviation (SD).
Energy and macronutrients intakes were analyzed from a
parent-reported 3 days food record. The percentage of energy
intakes were expressed in relative to the Turkey Dietary
Guidelines. Mean percentage of energy from protein, carbo-
hydrate and fat was calculated.
Results: The mean energy intake percentage in relative to the
National Gudelines was higher in survivors of ALL (103.9% ±
19.3%) than ALL patients (73.9% ± 21.9%) ( p < 0.05). Mean
percentage of energy from protein were not different in ALL
patients (15.5% ± 1.2%) compared to survivors (14.8% ± 1.7%).
Mean percentage of energy from carbohydrates were higher in
ALL patients (51.4% ± 2.8% vs 43.3% ± 4.0%) ( p < 0.001) and
mean percentage of energy from fats were higher in survivors
of ALL (42.3% ± 3.1% vs 33.1% ± 2.6%) ( p < 0.001).
Conclusion: The results of this study showed that energy and
fat intakes were higher among survivors of ALL patients whose
body weight normal. Survivors of ALL may be more susceptible
to overweight and obesity caused by poor nutrition.
Prospective intervention trials are needed to establish
dietary guidelines for preventing obesity, among survivors of
childhood cancers.
Disclosure of Interest: None declared.
S209
MON-P081
PHASE ANGLE AND BODY COMPOSITION IN PATIENTS WITH
LOCALLY ADVANCED CERVICAL CANCER IB2-IVA WITH OR
WITHOUT COMORBIDITIES
L. Flores-Cisneros1,2 *, V. Casique-Pérez1,
U. Velázquez-Morales1, L. Castillo-Martínez2, L. Cetina-Pérez1,
R. Jiménez-Lima1, D. Castro-Eguiluz1, M. Sánchez-López1.
1
Instituto Nacional de Cancerología, 2Instituto Nacional de
Ciencias Medicas y Nutricion ‘Salvador Zubiran’, MEXICO CITY,
Mexico
Rationale: Patients with cancer have a greatest risk for
developing malnutrition. A clinical manifestation can include
skeletal muscle wasting, anemia, anorexia and altered immune
function. Comorbidities can condition a worse malnutrition
status. The phase angle (PA) and body composition are
techniques which permit identify malnutrition. However PA it
has been associated as a good prognosis indicator in these
patients.
Objective: To evaluate the body composition and phase angle
in patients with cervical cancer and comorbidities.
Methods: Cross-sectional study was performed in twenty
subjects with locally advanced cervical cancer IB2 – IVA older
than 18 years old were included. Chronic kidney disease, lupus,
HIV was excluded. Chi-square and t-test for independent
samples were performed in order to contrast the differences
between the groups without and with comorbidities (diabetes
type II, systemic hypertension and geriatrics). Lineal regression
was performed to evaluate the PA between groups adjusted by
confounding variables.
Results: 20 subjects were evaluated (10 without comorbidities
and 10 with comorbidities). Patients with comorbidities
presented higher age (62 ± 10.6 vs 38.5 ± 9.6, p < 0.001), less
mid-upper arm circumference (27.7 ± 2.5 vs 30.7 ± 2.3, p =
0.08) lean body mass (54.2 ± 12.3 vs 63.7 ± 3.9%, p = 0.08), third
space (0.47 ± 0.5 vs −0.56 ± 0.64, p = 0.013) and phase angle
(5.2 ± 0.96 vs 6.2 ± 0.85) p = 0.026 than subjects without
comorbidities. Patients with comorbidities had −1.10 less PA
[β: −1.10; 95% CI: −2.173 to −0.0324, p = 0.044] compared with
no comorbidities patients adjusted by age.
Conclusion: Patients with cervical cancer and comorbidities
present a deteriorated body composition and phase angle,
which could have negative implications in diagnosis and
clinical stage.
Disclosure of Interest: None declared.
MON-P082
MUSCLE MASS LOSS (MML) ASSESSED BY ABDOMINAL CT
AFFECTS LONG-TERM SURVIVAL AFTER LIVER RESECTION FOR
INTRA HEPATIC CHOLANGIOCARCINOMA (ICC)
L. Lacaze1 *, D. Bergeat2, E. Bardou-Jacquet3, A. Merdrignac1,
P. Meurice4, D. Val-Laillet4, K. Boudjema1, R. Thibault5.
1
Digestive and Hepatobiliary Surgery, University hospital,
2
Digestive and Hepatobiliary Surgery, University Hospital,
3
Hepatology, University Hospital, Rennes, 4INRA, Saint Gilles,
5
Nutrition, University Hospital, Rennes, France
Rationale: MML was identified to be independently associated
with poor prognosis in colorectal liver metastases and
hepatocellular carcinoma. This has never been studied after
S210
liver resection for ICC. Measuring the two psoas areas (PA) on
computed tomography (CT) is a simple tool to evaluate MML.
Aim: To evaluate the prevalence of MML in patients who
underwent liver resection for ICC and to assess the prognostic
impact on patients’ survival.
Methods: All consecutive patients who underwent liver
resection for ICC between 2004 and 2016 and who had available
preoperative CT were included. PA measurement was per-
formed at the transversal level of the third lumbar vertebra by
one single non-radiologist operator with the ImageJ software
with a threshold range between −29 and +150 Hounsfield units
corresponding to muscle density. Univariate and multivariate
analysis for disease-free survival were realized using the Cox
model.
Results: 102 patients were included. 37% MML, 74% men,
median age 67 yrs, 82% ASA score greater than or equal to
2. Median PA was 1,166.2 mm2 in MML group and 2,132.7 mm2 in
normal muscle mass group. The median body mass index (BMI)
was 25.3 kg/m2 (IQ = 23.5–28.4). On multivariate analysis, MML
was found to be an independent predictor of disease-free
survival (DFS) (Hazard ratio (HR) = 0.99 [95% confidence interval
(CI), 0.999–1.000], p = 0.038), metastatic lymph node (HR =
2.359 [1.186–4.691], p = 0.021), chemotherapy (HR = 2.445
[1.173–5.094], p = 0.017), tumor size (HR = 1.106 [1.024–
1.193], p = 0.01), BMI (HR = 1.093 [1.013–1.180], p = 0.021)
were also found to be associated with a poor DFS.
Conclusion: MML is an independent prognostic factor of poor
DFS in European patients with resectable ICC. This could be
used to select patients and to implement adapted nutritional
management before surgery.
Disclosure of Interest: None declared.
MON-P083
INTERNATIONAL NUTRITION AUDIT IN FOREGUT TUMORS
(INFORM): A LOOK AT CANADIAN PATIENT EXPERIENCES
L. Gramlich1 *, R. Dhaliwal2, on behalf of the INFORM Study
Investigators. 1Medicine, 2University of Alberta, Alberta
Health Services, Edmonton, Canada
Rationale: Patients with foregut tumors are at high risk of
malnutrition due to the complex nature of their disease and
lengthy treatment. This paper describes nutrition practices and
patient generated experiences in head/neck (HN) and esopha-
geal (E) cancer (CA) patients upon presentation to Canadian
settings.
Methods: In a multicenter prospective audit, consenting adult
patients with curative HN or E CA were enrolled from 6 cancer
care settings in Canada. Patients were followed by the
registered dietitian from presentation to the cancer care
setting (baseline) to a maximum of 6 months. Baseline patient
characteristics, nutrition practices, patient generated subject-
ive global assessment (PG-SGA) and satisfaction with care
(CANHELP lite) are reported.
Results: Preliminary: A total of 71 patients were enrolled (42
HN, 29 E CA), average recruitment of 2.2 patients per week.
Average age was 62.3 yrs, BMI 28.4 and 77% were males. Thirty-
seven % patients were assessed by a dietitian within 1 month of
diagnosis. According to the baseline PGSGA, 34% patients
reported a decrease in weight within the last 2 weeks and 46%
reported a reduced oral intake within the last month.
Symptoms most likely to result in reduced intake were
Poster
swallowing problems followed by pain, fatigue, lack of
appetite, constipation and dry mouth. Enteral/parenteral
nutrition was received by 6% of patients within the last
month. More than 90% indicated that they were completely or
very satisfied with care they received.
Conclusion: Patients with HN or E CA present to Canadian
cancer settings with weight loss and reduced oral intake
however a minority receive artificial nutrition prior to
admission. Patients appear to be highly satisfied with the
quality of care they receive at the onset of diagnosis. Follow up
data and inclusion of international settings will further
illuminate nutrition practices, outcomes and experiences of
this high-risk population.
Disclosure of Interest: L. Gramlich Grant/Research Support from:
Fresenius-Kabi, Nutricia, Baxter, R. Dhaliwal Other: Nestle, Baxter.
MON-P084
CLINICAL OUTCOME AND QUALITY OF LIFE IN PATIENTS WITH
ADVANCED CANCER RECEIVING HOME PARENTERAL
NUTRITION
L. C. Sun1,2 *, Y.-L. Shih1,2, J.-Y. Wang2,3,4. 1Division of Nursing,
2
Nutrition Support Team, 3Division of Colorectal surgery,
Departments of Surgery, 4Department of Surgery, Faculty of
Medicine, College of Medicine, Kaohsiung Medical University
Hospital, Kaohsiung, Taiwan, Province of China
Rationale: Parenteral nutrition (PN) is indicated in advanced
cancer patients with poor gastrointestinal function and
inadequate enteral nutrition. When patients need PN supply
outside the hospital, home PN (HPN) should be continued for
nutrition support. The study investigated the survival time,
quality of life (QoL), nutritional outcome of advanced cancer
patients receiving HPN.
Methods: Fifty-four advanced cancer patients receiving HPN
were enrolled during December 2014 and January 2017. QoL
and nutritional status were measured at baseline and each
month visit using EORTC QLQ-C 30 and laboratory data. Qol and
nutritional status were analyzed in five different time at after
1, 2, 3, 4 or 5 months. Overall survival (OS) was defined as the
time interval between the dates of HPN start till the death or
the last visit, and was also compared.
Results: There were 31 (57.4%) males and 23 (42.6%) females.
Thirsty-one patients (57.4%) were stomach cancer and 20 (37%)
were colorectal cancer and 3 (5.6%) were other malignancy.
After one month of HPN (n = 38) there was a significant worse in
role of function (P = 0.002); while after 2 month of HPN (n = 21)
there was a significant worse in physical function (P = 0.014).
However, after 4 and 5 months of HPN there was a significant
improvement in body weight (BW) and body mass index (BMI)
(both P < 0.05). After 5 months of HPN, there were a significant
improvement in fatigue (P = 0.015). The median duration of
HPN was 3.9 months (range 1–23). Meanwhile, HPN patients
administrated for at least 1 month had a significantly better OS
than those with less than 1 month (P = 0.016).
Conclusion: HPN revealed the improvement in QoL, OS and
nutritional status, and the obvious benefit was observed in
patients after 4 months of HPN, although patients receiving
HPN after 1 and 2 months revealed the prominent worse in role
and physical function, respectively.
Disclosure of Interest: None declared.
Nutrition and cancer 2
MON-P085
NUTRITIONAL CHANGES IN PATIENTS WITH LOCALLY
ADVANCED HEAD AND NECK CANCER DURING TREATMENT
L. Arribas1,2,3 *, L. Hurtós4, M. Taberna2,3,5,6, I. Peiró4,
E. Vilajosana2,5, A. Lozano2,7, R. Mesia2,5, N. Virgili8. 1Clinical
Nutrition Unit, Catalan Institute of Oncology (ICO), IDIBELL,
L’Hospitalet de Llobregat, Barcelona, 2Head and Neck Unit,
Bellvitge University Hospital-, Catalan Institute of Oncology
(ICO), L’Hospitalet de Llobregat, Barcelona, 3University of
Barcelona, Barcelona, 4Clinical Nutrition Unit, 5Medical
Oncology Department, 6Cancer Epidemiology Research
Program, 7Radiation Oncology Department, Catalan Institute
of Oncology (ICO), IDIBELL, 8Nutrition and Dietetics Unit,
Nutrition and Endocrinology Department, Bellvitge University
Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
Rationale: The purpose of the study is to evaluate changes in
body composition and nutritional status that occur throughout
the oncological treatment.
Methods: A prospective cohort observational study in patients
diagnosed with head and neck squamous cell carcinoma
(HNSCC) that underwent treatment with induction chemother-
apy (iCT) followed by chemoradiotherapy or bioradiotherapy
were invited to participate. All patients had dietetic counseling
from the diagnosis and a close monitoring throughout the
treatment implementing nutritional support as needed.
Results: From June 2011 until October 2012, 20 patients were
included. Nutritional and anthropometric parameters were
collected at diagnosis, post iCT, after RT, 1 and 3 months post
radiotherapy. According to Patient Generated Subjective
Global Assessment, 30% were malnourished at diagnosis.
After iCT there was an increase in weight, body mass index
(BMI) and fat free mass (FFM) with almost complete improve-
ment in dysphagia and odynophagia. Nevertheless a significant
nutritional deterioration ( p = 0.0022) occurred at the end of
radiotherapy with 95% of patients becoming severe or
moderate malnourished. Nutritional parameters such as
weight, BMI and hand grip strength also decrease significantly
during treatment.
Conclusion: Despite an intensive nutritional support from the
diagnosis throughout the oncological treatment in advanced
HNSCC cancer patients, nutritional status deteriorates during
RT. Our findings suggest that iCT may help improve nutritional
status by ameliorating the symptoms that limit the oral intake.
This improvement in the nutritional status could contribute to
minimize further deterioration. Further investigations are
needed involving novel approaches to avoid nutritional
deterioration.
Disclosure of Interest: None declared.
MON-P086
RISK OF MUCOSITIS IN HDT PRIOR TO STEM CELL
TRANSPLANTATION
L. Drustrup1, M. Holst2 *. 1Department of Clinical Medicine,
Aalborg University, 2Center for Nutrition and Bowel Disease,
Aalborg University Hospital, Aalborg, Denmark
Rationale: Mucositis is one of the most significant side effects
reported in patients receiving high-dose chemotherapy (HDT)
prior to stem cell transplantation due to hematology disease.
Mucositis induces pain, diarrhea and reduced food intake in
S211
different degrees. This study investigated incidence of muco-
sitis, nutritional risk (NRS) and artificial nutritional therapy.
Methods: A retrospective observational cohort included all
adult patients treated with HDT prior to stem cell transplant-
ation due to lymphoma or multiple myeloma at Aalborg
University Hospital during 20 months. Data was extracted
from patient records, and followed patients during the 21-day
treatment. Statistics: Comparisons; student’s t-test, Mann-
Whitney, or X 2 test. Environmental risk factors by Cox
proportional hazards.
Results: A high incidence of mucositis was seen, with highest
occurrence in the BEAM population ( p = 0.02). The prevalence
of nutritional risk increased during treatment in both groups
( p = 0.47), and 41% were treated with EN or PN. An elevation of
sodium ( p = 0.00) as well as potassium (K) ( p = 0.02) before
upstart of treatment, increased duration of mucositis and
elevation of sodium (Na) (=0.03) decrease in time to mucositis.
All HDT BEAM Melphalan
population cohort cohort
N= (%Female) 66(35) 23(43) 43(30)
Mucositis N(%) Yes 48(73) 21(91) 27(63)
NRS risk prior to 32(48) 9(39) 23(47)
treatment N(%)
NRS risk during 61(92) 22(96%) 39(91%)
treatment N(%)
Conclusion: Mucositis and nutritional risk is common in HDT,
with high prevalence of need for EN/PN. Attention should be
given to prevention and timing of nutritional therapy, as well as
studies looking into K and Na.
Disclosure of Interest: None declared.
MON-P087
HIGH-RADIODENSITY SKELETAL INDEX AS PREDICTOR OF
EARLY MORTALITY IN OVARIAN ADENOCARCINOMA
K. D. A. Bruno1, N. S. de Paula1, M. A. Aredes1, G. V. Chaves1 *.
1
Nutrition and Dietetics, Brazilian National Cancer Institute –
INCA, Rio de Janeiro, Brazil
Rationale: This study aimed to determine the prognostic value
of the quantitative and qualitative parameters of the skeletal
muscle (SM) in patients with ovarian adenocarcinoma.
Methods: In a retrospective cohort, we included patients with
ovarian adenocarcinoma, enrolled between 2008 and 2015,
who had a CT scan (CT) available within 45 days before any
cancer treatment. Sociodemographic and clinical data were
collected, as well as one-year survival. CT images at the third
lumbar vertebra (L3) were used to assess overall skeletal
muscle index (SMI) using the standard range −29 to +150
Hounsfield Units (HU), which was afterwards divided into sub-
ranges of radiation attenuation: low-radiodensity skeletal
muscle index (LRSMI, in the range −29 to + 29 HU) representing
SM area with increased intramyocellular triglycerides, and the
high-radiodensity skeletal muscle index (HRSMI, in the range
+30 to +150 HU), representing the area with low fat infiltration.
Sarcopenia was defined when SMI was ≤38.9 cm2/m2. Kaplan-
Meier method and Cox Regression evaluated one-year survival.
All statistical analysis were considered statistically significant
when p < 0.05.
S212
Results: Sarcopenia was found in 34.5% of the 139 eligible
patients, although it was not associated to one-year mortality.
Patients in the lower quartile of the HRSMI had a shorter
survival time, compared to patients in the upper quartiles
( p = 0.014). In multiple cox regression, HRSMI was the only
independent predictor of shorter survival (HR: 2.852; CI: 1.17–
6.95; p = 0.021).
Conclusion: These results indicate that SM quality, specifically
the amount of HRSMI, directly implies in poor prognosis of
patients with ovarian adenocarcinoma. More studies are
needed to understand the role of the HRSMI in cancer
outcomes.
Disclosure of Interest: None declared.
MON-P088
EFFECTS OF SUPPLEMENTATION WITH OMEGA-3 ON BODY
COMPOSITION AND FUNCTIONAL CAPACITY IN PATIENTS WITH
CERVICAL CANCER IN CHEMORADIOTHERAPY: PRELIMINARY
RESULTS
M. A. Aredes1, A. O. da Camara1, N. S. de Paula1, G. V. Chaves1 *.
1
Nutrition and Dietetics, Brazilian National Cancer Institute –
INCA, Rio de Janeiro, Brazil
Rationale: We aimed to evaluate the effect of omega-3
supplementation on body composition, with emphasis on
skeletal muscle quality, and functional capacity in cervical
cancer patients undergoing chemoradiotherapy.
Methods: Randomized controlled trial, triple blinded.
Patients were randomly assigned (2:1) at enrolment to the
control group (CG) or intervention group (IG). CG received olive
oil and IG fish oil (2g eicoisapentaenoic acid). Data collection
occurred the day before the treatment and the other after 45
days. Patients were assessed for weight, body composition, and
functional capacity by handgrip strength and 30 second chair
test. CT images were used to assess skeletal muscle para-
meters. Skeletal muscle index (SMI) was calculated in the range
−29 + 150 Hounsfield Units (HU) and reduced muscle attenu-
ation area (range −29 + 29HU) was classified as low-radio-
density skeletal muscle index (LRSMI), representing the SM area
with high intramuscular fat infiltration. A moderate and severe
loss was considered when a reduction of 5–9,9% and ≥10%
occurred, respectively.
Results: We included 24 patients in this prelimiray results, 16 in
the GC and 8 in IG. All groups experienced median weight and
SMI losses whereas with no statistical difference. The other
parameters evaluated also did not present statistical differ-
ence between the groups, although the IG showed a slight
Table 1: (abstract: MON-P089).
Pre-HSCT D+7
HB(kcal) 1448[1288–1630] 1390[1277–1613]
IC(kcal) 1482[1349–1610] 1557[1344–1740]
IC(kcal/kg) 20,3[16,9–23,6] 21,2[19,4–25,3]
Bland-Altman
Mean 7,1 −83,3
Mean±2SD (−397,3/411,5) (−481,3/314,7)
Confidence (−73,8/88) (−170,5/3,9)
Interval95%
Poster
improvement in strength when evaluated by the 30 second
chair test. Approximately 75% and 71% of the patients who
experienced moderated and severe SMI loss were allocated in
CG. Conversely, 73.3% of the patients that experienced
intramuscular fat gain (in terms of LRSMI) were in the CG.
Conclusion: Despite not having an effect on preventing SMI
loss, omega-3 seems to prevent the intramuscular fat infiltra-
tion in the SM, resulting in preservation of SM quality after
cancer treatment.
Disclosure of Interest: None declared.
MON-P089
RESTING ENERGY EXPENDITURE IN ONCO-HEMATOLOGICAL
PATIENTS DURING HEMATOPOIETIC STEM CELL
TRANSPLANTATION
M. Motilla De La Cámara1 *, L. Arhip1, I. Bretón Lesmes1,
M. Camblor Alvarez1, V. Velasco Gimeno1,
M. L. Carrascal Fabian1, A. Morales Cerchiaro1, G. Feo Ortega1,
M. Kwon2, P. García Peris1, C. Cuerda Compés1. 1Nutrition Unit,
2
Hematology Service, Hospital General Universitario Gregorio
Marañón, Madrid, Spain
Rationale: There are few studies evaluating resting energy
expenditure (REE) measured by indirect calorimetry (IC) in
adult patients during hematopoietic stem cell transplantation
(HSCT). The aims of the study were: measure REE by IC and
compare it with the Harris-Benedict Equation (HBE) and
contrast the individual energy requirements to ESPEN 2016
guidelines for cancer patients.
Methods: This is a prospective observational study in HSCT
patients. Age, sex, and BMI were collected. REE was measured
pre-HSCT, at D + 7 and D + 14, at discharge and post-discharge
after overnight fast by Fitmate®Cosmed and HBE. Results are
expressed as median [interquartile range]. Non-parametric
tests from IBM-SPSS Statistics21® and Bland-Altman were used.
Results: Twenty-five patients (10 men) aged 50[44–63] years
were studied. 64% of the patients had an allogeneic HSCT. The
hospital stay was 33[30–44] days. The BMI decreased during
HSCT ( p < 0.001). Table 1 shows REE changes. There were no
differences in measured REE according to the type of
transplant.
Conclusion: We did not find significant changes in measured
REE during HSCT. There is a low concordance between
measured REE and HBE in onco-hematologic patients during
HSCT. Individual energy requirements are lower than the ESPEN
guidelines.
Disclosure of Interest: None declared.
D + 14 Discharge Post-Discharge p
1389[1271–1613] 1353[1270–1641] 1390[1278–1672] <0,001
1644[1412–1949] 1364[1228–1681] 1453[1122–1563] 0,471
22,6[20,2–24] 21,9[19,2–22,7] 20,2[17,1–24,7] 0,376
−163,5 −6,2 32,2
(−541,4/214,4) (−256,9/244,5) (−300,7/397,3)
(−253,3/−73,7) (−77,1/64,8) (−52,2/116,5)
Nutrition and cancer 2
MON-P090
FTO GENE AFFECTS OBESITY AND BREAST CANCER THROUGH
SIMILAR MECHANISMS: A NEW INSIGHT INTO THE MOLECULAR
THERAPEUTIC TARGETS
M. Gholamalizadeh1 *, S. Doaei1. 1Medical University of Shahid
Beheshti, Tehran, Islamic Republic of Iran
Rationale: The fat mass and obesity-related (FTO) gene is
known to be associated with risk of obesity. Some recent studies
have shown that the FTO polymorphisms are linked with breast
cancer. This review focused on the possible mechanisms of the
effects of the FTO on obesity and breast cancer.
Methods: All articles published in English from June 1990 to
January 2017 were studied. The search terms used were FTO
gene, FTO polymorphism, breast cancer and obesity. Inclusion
criteria consisted of assessment of the relationship between
FTO polymorphisms and/or FTO expression level with obesity
and/or breast cancer as a primary outcome.
Results: The risk of both obesity and breast cancer is affected
by the FTO genotype. Some FTO polymorphisms exert their
effects through effect on IRX3 gene expression level. On the
other hand, the FTO gene expression level is closely related to
mTOR signaling pathway activation and its ultimate effects on
obesity and breast cancer. Obesity and breast cancer might
have similar genetics origins.
Conclusion: The FTO gene is a possible mediator between
obesity and breast cancer. If this result is correct then, it will be
interesting to examine the FTO gene as a molecular therapeu-
tics target.
Disclosure of Interest: None declared.
MON-P091
LONG TERM WEIGHT LOSS AFTER ESOPHAGEAL, PANCREATIC,
AND GASTRIC CANCER RESECTION
M. E. Cook1 *, L. B. Skadhauge1, A. E. Bilgrau2, M. Holst1,
H. H. Rasmussen1. 1Center for Nutrition and Bowel Diseases,
Aalborg University Hospital, 2Department of Mathematical
Sciences, Aalborg University, Aalborg, Denmark
Rationale: Malnutrition is a serious issue among patients with
esophageal, pancreatic, and gastric cancer in the pre- and
postoperative period. The aim was to describe weight loss and
risk factors affecting nutritional intake during treatment.
Methods: All data relating to nutritional status were recorded,
including symptoms such as nausea, loss of appetite and other
risk factors that could prevent a sufficient nutritional intake.
Data were collected by retrospectively reviewing 30 medical
records in three upper gastrointestinal (GI) cancers (10 in each
group) and were obtained at time of diagnosis, preoperatively,
on discharge, and after 1, 3, and 6 months.
Results: The average weight loss was −11.0 kg (−13.8%, SD
7.7 kg) with pain, nausea, and dysphagia being the most
frequent preoperative risk factors. Postoperatively, nausea,
loss of appetite, and pain were most frequent. The weight losses
were similar for each cancer site with an average of −12.1 kg
(−14.6%, SD 5.7 kg), −10.7 kg (−13.5%, SD 10.0 kg), and
−10.2 kg (−12.7%, SD 7.8 kg) for esophageal, pancreatic, and
gastric cancer, respectively. The most frequent preoperative
risk factors for esophageal cancer were dysphagia (n = 6), pain
(n = 5), and vomiting (n = 3). Postoperatively, this group suffered
from loss of appetite (n = 6), early satiety (n = 6), and oral fungal
S213
infection (n = 6). In pancreatic cancers, the most frequent
preoperative risk factors were pain (n = 8), diarrhea (n = 3), and
nausea (n = 3). Postoperatively, this group mainly suffered from
loss of appetite (n = 4), pain (n = 4), and nausea (n = 3). In gastric
cancer, frequent preoperative risk factors were nausea (n = 5),
pain (n = 4) and oral fungal infections (n = 3). Post surgery they
reported nausea (n = 5), pain (n = 5) and fatigue (n = 5).
Conclusion: Upper GI cancer patients receiving surgical
treatment experience major weight loss due to substantial
and to some extent varying nutritional risk factors throughout
the treatments.
Disclosure of Interest: None declared.
MON-P092
CHANGES OF INTESTINAL PEPT1 EXPRESSION IN GASTRIC
CANCER PATIENTS UNDER MALNUTRITION CONDITIONS
M. Wang1 *. 1Department of General Surgery, Nanjing Drum
Tower Hospital, Nanjing, China
Rationale: Malnutrition is common in gastric cancer patients.
The peptide transport and uptake processes depend on the
intestinal peptide transporter 1(PEPT1). However, little is
known about the intestinal PEPT1 in gastric cancer patients.
Methods: Total 60 gastric cancer patients were included and
divided into two groups according to NRS2002 scores. group1:
NRS score ≥ 3, group2: NRS score <3. Intestinal morphology in
two groups was observed. The expression of intestinal PEPT1
protein was detected by western Blot. The concentration of
serum cytokines in gastric cancer patients were determined by
ELISA. The expression of PEPT1 at different concentration of
cytokine treatment was detected in Caco-2 cell lines.
Results: The expression of intestinal PEPT1 in NRS score ≥ 3
group was significantly higher than in NRS score <3 group
(P < 0.05). Serum concentration of TNF-α in the NRS score ≥ 3
group was significantly higher than NRS score <3 group
(P < 0.05. With TNF-α (50 ng/ml) short treatment (24 h) for
Caco-2 cells, PEPT1 expression increased significantly com-
pared with control.
Conclusion: Malnutrition high risk (NRS score ≥ 3) in gastric
cancer patients was associated with increased expression of
intestinal PEPT1 protein, the mechanism was probably attrib-
uted to the regulation of TNF-α.
Disclosure of Interest: None declared.
MON-P093
PREOPERATIVE NUTRITION REGIME FOR PREVENTION OF
REFEEDING SYNDROME IN SURGICAL HEAD AND NECK CANCER
PATIENTS
M. O. Holm1 *, M. S. Abilashan1, I. Wessel2, J. R. Andersen1.
1
Department of Nutrition, Exercise and Sports, University of
Copenhagen, 2Department of Otorhinolaryngology, Head and
Neck Surgery & Audiology, Rigshospitale 5t, Copenhagen,
Denmark
Rationale: Refeeding syndrome (RS) is observed in malnour-
ished individuals who are refed after prolonged semi-starvation
experienced by 30–50% of head and neck cancer (HNC) patients
most frequently caused by pain, dysphagia, tumour localiza-
tion, and loss of appetite. A previous study in the same kind a of
patients resulted in a 20% incidence-rate of RS.
S214
Methods: A randomized, controlled, non-blinded study in HNC
patients recruited 5–14 days prior to surgery. Nineteen in the
intervention group, 20 in the control group. The intervention
group received supplements to habitual dietary intake rich in
protein and low in sodium and had individual dietary advice
with a goal of 1.5 g/kg protein and no additional sodium in the
food. The control group was treated according to the
department’s standard. Blood tests, weight, bio-impedance,
hand grip strength, fitness tests and questionnaires about
dysphagia, quality of life related to dysphagia, and Activities of
Daily Living were collected pre and postoperatively. Patients
were followed-up daily for seven days, and 30 days’
postoperatively.
Results: Seven percent of the intervention group and 40% of the
control group developed RS postoperatively. RF developed in
86% of the intervention group and 93% in the control group. The
difference was not statistically significant. The intervention
group had a significant increase in preoperative protein intake
compared to estimated needs (110%) compared to the control
group (71%). There was no significant difference in pre and
postoperative sodium intake or postoperative energy intake
between groups.
Conclusion: The compliance to advices on sodium reduction
was poor in the intervention group, which is the probable
explaination for the lack of a significant reduction in incidence
of RS between groups. Accordingly, it was not possible to
conclude, whether such a preoperative dietary regime can be
recommended in HNC patients.
Disclosure of Interest: None declared.
MON-P094
HIGH PREVALENCE OF VITAMIN D DEFICIENCY IN HEAD AND
NECK CANCER PATIENTS
G. Allo Miguel1, A. Ruiz Alonso2, M. Sierra Bracamonte1,
M. León Sanz1 *. 1Endocrinology and Nutrition, 2Radiotherapy,
12 de Octubre University Hospital, Madrid, Spain
Rationale: Vitamin D [25(OH)D] deficiency is a common finding
in oncology patients. However, just one study has evaluated the
incidence of 25(OH)D deficiency in head and neck cancer
patients. So, the aim of this study is to evaluate 25(OH)D level
in a cohort of patients with head and neck cell cancer and its
relation with inflammatory markers.
Methods: 38 patients with new diagnosis of head and neck
cancer were included. None of the patients suffered of
metabolic bone diseases or were taking drugs (calcium and
vitamin D included) that interfere with bone metabolism.
Serum 25(OH)D, fibrinogen, C-reactive protein (CRP) were
measured. Statistical analysis: Data are presented as mean
(std). Student t-test was used to compare inflammatory
markers between the groups with: 25(OH)D deficiency
(<20 ng/ml), insufficiency (≥20-<30 ng/ml) and sufficiency
(≥30 ng/ml). Significance level was 0.05.
Results: 34/4 (male/female) patients were included. Baseline
characteristics: age: 61.6 ± 10.4; IMC: 28.89 ± 6.23; 25(OH)D
17.26 ± 8.19; CRP:1.45 ± 2.15; fibrinogen: 552.92 ± 159.02.
47,4% of the patients were at nutritional risk at diagnosis. 25
(OH)D level was low in 94,4% of the patients: 27 patients showed
25(OH)D deficiency (13.36 ± 3.67) and 9 patients insufficiency
(23.66 ± 2.62). Only 2 patients showed 25(OH)D sufficiency. 25
(OH)D showed no significant correlation with any of the
Poster
inflammatory markers. Those were higher in the 25(OH)D
deficiency group (compared to the insufficiency group) but
the results were no significant: CRP (0.75 ± 3.6 and 0.63 ± 2.90:
p = 0,56); fibrinogen (606 ± 202.65 and 529.29 ± 115.147:
p = 0.46).
Conclusion: Our results show that low 25(OH)D (specially
deficiency) is a frequent finding in head and neck cancer
patients. We also found non-significant higher levels of
inflammatory markers in the deficient group. Based on these,
we recommend screen and avoid 25(OH)D deficiency in head
and neck cancer patients with proper supplementation.
Disclosure of Interest: None declared.
MON-P095
THE EFFECT OF FISH OIL-SUPPLEMENTED GEMCITABINE
TREATMENT ON LEUKOTRIENE B4 LEVELS IN PANCREATIC
CANCER
N. Martin1,2 *, J. Isherwood3, M. Madden2, V. Narayanan2,
N. Mustafa2, C. Bhangal2, S. Farah2, S. E. Jones2, F. Runau3,
A. Arshad3, W. Y. Chung3, A. R. Dennison3. 1Infection, Immunity
and Inflammation, University of Leicester, 2Health and Life
Sciences, De Montfort University, 3Hepato-Pancreato-Biliary
Unit, University Hospitals of Leicester, Leicester,
United Kingdom
Rationale: Pancreatic cancer (PC) is the 5th leading cause of
cancer death in Western Europe. The immune-mediators such
as Leukotriene B4 (LTB4) in the tumour microenvironment
might contribute to the growth and spread of PC. The aim of
this study is to determine the potential anti-inflammatory
effects of omega-3 fatty acids in patients being treated for PC.
Methods: Blood samples were taken from PC patients
undergoing Gemcitabine treatment (n = 8, CON) and from
patients undergoing Gemcitabine treatment supplemented
(n = 17, O-3) with omega-3 fatty acids, for up to a maximum
of 6 months where possible. Plasma was isolated from blood
and stored at −80°C until analysis for baseline LTB4 levels
(baseline). A further aliquot of blood was incubated with
Zymosan for 30 min at RT then 30 min at 37°C, plasma was
collected and stored until analysis (stimulated). All samples
were analysed using human LTB4 commercial ELISA kits
according to the manufacturers’ instructions (Invitrogen, USA
and R&D Systems, UK).
Results: There was a reduction in plasma LTB4 levels in O-3
patients (CON 3.5 ± 0.3 (mean±SEM) ng/ml vs O-3 2.8 ± 0.1 ng/
ml, p = 0.02), and the stimulated levels in O-3 patients were
significantly reduced ( p < 0.05). There was a significant
reduction in LTB4 levels of stimulated high Progression Free
Survival (PFS) O-3 patients (O-3 low PFS 4.5 ± 0.3 ng/ml vs O-3
high PFS 3.6 ± 1.1 ng/ml, p = 0.01) and in patients at later TNM
stage (O-3 stage 3 4.8 ± 0.2 ng/ml vs stage 4 2.9 ± 0.2 ng/ml,
p < 0.0001).
Conclusion: Our results show that although the baseline LTB4 is
unaffected by omega-3 supplementation, the stimulated
leukocyte response is reduced and is associated with increased
patient PFS and later disease stage. These data indicate that
omega-3 supplementation affects an anti-inflammatory profile
in these patients, being more effective at later disease stages
and may improve survival.
Disclosure of Interest: None declared.
Nutrition and cancer 2
MON-P096
BIOCHEMICAL MEASUREMENTS AS A PREDICTOR OF SURVIVAL
IN PATIENTS WITH INCURABLE CANCERS RECEIVING HOME
PARENTERAL NUTRITION (HPN)
N. Keane1 *, K. Fragkos2, P. S. Patel1, K. Murray2, S. Obbard2,
S. Ajibodu3, S. O’callaghan3, H. Kwok2, E. Paulon2,
J. Barragry2, S. Mehta2, S. Di Caro2, F. Rahman2. 1Dietetics,
2
GI Services, 3Pharmacy, University College London Hospital,
London, United Kingdom
Rationale: To identify factors like biochemical measurements
that may affect prognosis in HPN patients with incurable
cancer.
Methods: Data was collected retrospectively for all patients
receiving HPN between 01/01/2006 and 15/10/2016.
Demographic, biochemical and medical factors, Karnofsky
Performance Status (KPS) and Glasgow Prognostic Score (GPS)
were recorded. Univariate and multivariate analyses were
performed including Kaplan-Meier curves, Cox Regression and
correlation analyses.
Results: 66 HPN patients (43 female, mean age 57 years) with
incurable cancers were identified. On discharge, mean CRP was
high at 46 mg/L (SD = 48.3) and albumin borderline low at
32.2 g/L (SD = 6). Mean haemoglobin was slightly below normal
(101.6 g/L, SD = 15) and mean values of electrolytes were
within normal values. The only significant predictors of survival
were CRP [(HR = 1.01 (95% CI 1.004–1.015, p = 0.001)] and WCC
[HR = 1.06 (95% CI 1.01–1.10, p = 0.011)], with higher levels of
markers of inflammation being correlated with higher inci-
dence of deaths. Sodium predicted survival (overall and 6-
month) with borderline significance [those with sodium
≥ 135 mmol/L showing 38% less incidence of deaths compared
to sodium <135 mmol/L]. Higher levels of albumin were
associated with an improved survival [HR = 0.96 (95% CI 0.91–
1.00, p = 0.052)] with a borderline statistical significance.
These results are aligned with the findings of the correlation
between survival and GPS which encompass both CRP and
albumin.
Conclusion: Our study supports that a systemic inflammatory
status, as assessed with higher GPS, CRP, and WCC is associated
with a worse performance status (i.e. lower KPS and prognosis).
Possible timely referral for nutrition support may be required as
patients with earlier stage disease will likely have better GPS
and KPS scores which is associated with improved overall
survival.
Disclosure of Interest: None declared.
MON-P097
ANTHROPOMETRIC MEASUREMENTS AS A PREDICTOR OF
SURVIVAL IN PATIENTS WITH INCURABLE CANCERS RECEIVING
HOME PARENTERAL NUTRITION (HPN)
N. Keane1 *, K. Fragkos2, P. S. Patel1, K. Murray2, S. Obbard2,
S. Ajibodu3, S. O’callaghan3, H. Kwok2, E. Paulon2,
J. Barragry2, S. Mehta2, S. Di Caro2, F. Rahman2. 1Dietetics, 2GI
Services, 3Pharmacy, University College London Hospital,
London, United Kingdom
Rationale: To identify factors like anthropometry that may
affect prognosis in HPN patients with incurable cancer.
Methods: Data was collected retrospectively for all patients
receiving HPN between 01/01/2006 and 15/10/2016.
S215
Univariate and multivariate analyses were performed including
Kaplan-Meier curves, Cox Regression and correlation analyses.
Results: 71 HPN patients with incurable cancers (49
females, 22 males) with mean age 56.8 years (SD = 11.9). The
malignancy types were gynaecological (33.8%), upper gastro-
intestinal (25.4%), lower gastrointestinal (18.3%), hepato-
pancreatic-biliary (7%), haematological (5.6%) and others
(9.9%). Most patients had metastatic disease (81.7%) and had
undergone prior surgery for their malignancy (74.3%), or
chemotherapy before and/or during PN administration
(88.6%). The majority of patients also had radiotherapy
(31.4%). The mean BMI upon starting HPN was 19.9 kg/m2
(SD = 4.13), with 58.1% of patients presenting with a weight loss
of more than 10%, and, 11.3% with more than 30%. Therefore,
87% patients were in a state of cancer cachexia. The mean
weight upon starting HPN was 55.3 kg (SD = 11.5), while in the
outpatient setting between 0–3 months and 3–6 months, mean
weight was 54.5 kg (SD = 9) and 58.6 kg (SD = 11.3) respectively,
indicating a relative increase. None of the weight, height, BMI
and presence of cancer cachexia variables significantly
predicted survival.
Conclusion: Several studies1 have examined anthropometrics
as predictors of survival in patients with advanced cancer on
HPN, although this study failed to observe any associations
amongst BMI, height and weight with survival.
Reference
1. Bozzetti F, Santarpia L, Pironi L, et al. The prognosis of incurable
cachectic cancer patients on home parenteral nutrition: A multi-
centre observational study with prospective follow-up of 414
patients. Annals of Oncology 25:487–493, 2014.
Disclosure of Interest: None declared.
MON-P098
RISK OF MALNUTRITION ASSOCIATED WITH
GASTROINTESTINAL SIGNS AND SYMPTOMS AND THE
LOCATION OF THE DISEASE: RESULTS OF BRAZILIAN
RESEARCH ON NUTRITION ONCOLOGY
N. B. de Pinho1 *, C. Saunders2, R. B. Martucci1,3,
V. D. Rodrigues1, C. A. D’almeida1, L. C. S. Thuler4,
W. A. F. Peres2. 1Nutrition and Dietetic Service, National
Cancer Institute, 2Nutrition and Dietetic, Universidade
Federal do Rio de Janeiro, 3Applied Nutrition, Universidade do
Estado do Rio de Janeiro, 4Research Center, National Cancer
Institute, Rio de Janeiro, Brazil
Rationale: Nutritional Patient-Generated Subjective Global
Assessment (PG-SGA) plays an important role in the diagnosis of
malnutrition in cancer patients. The objective was to evaluate
the prevalence of malnutrition and its association with tumor
location and nutritional impact signs and symptoms at the time
of hospital admission in all regions of Brazil.
Methods: Multicenter, cross-sectional study, included 45
hospitals. 4,783 nutritional status of adult and elderly patients,
of both genders, was assessed at the time of hospital admission
using PG-SGA. The association between the independent
variables (signs and symptoms of nutritional impact and
tumor location) and the nutritional status classification was
evaluated in three levels: A (well nourished), B (moderately
malnourished or nutritional risk) and C (severe malnourished),
using the ordinal polytomic regression with proportional odds
model.
S216
Results: The overall prevalence of malnutrition (B (n = 1,601)
= 33.5% + C (n = 564) = 11.8%) was 45.3%. The prevalence of
malnutrition was 74.5% (B = 44.3% and C = 31.2%) in patients
with upper abdominal tract tumors and 64.0% (B = 39.7% and
C = 24.1%) in patients with head and neck tumors. The presence
of more than 3 symptoms considerably increased the odds ratio
for malnutrition (OR = 27.3, 95% CI: 22.9–32.6; p < 0.001).
Dysphagia (OR = 4.05, 95%: 3.25–5.05; <0.001) and anorexia
(OR = 3.38, 95% CI: 2.91–3.93; p <0.001), among the signs and
symptoms, were those with the highest risk for malnutrition.
Conclusion: Nutritional impact signs and symptoms, such as
anorexia and dysphagia, and upper abdominal tract (OR: 5,53,
IC: 4,09–7,5; p < 0,001) and head and neck tumors (OR: 4,54, IC:
3,29–6,26; p < 0,001) presented the highest risk for malnutri-
tion in oncology patients at the time of hospital admission.
Disclosure of Interest: None declared.
MON-P099
PREDICTING ENERGY EXPENDITURE IN CANCER: IMPACT OF
BODY COMPOSITION, TUMOUR STAGE AND INFLAMMATION
O. Wallengren1 *, I. Bosaeus1. 1Clinical Nutrition Unit,
Sahlgrenska University Hospital, Gothenburg, Sweden
Rationale: Resting energy expenditure (REE) tends to be higher
in cancer patients but variation is considerable. We explored if
REE prediction in cancer patients could be improved compared
to the Harris-Benedict equation (HB) with a cancer specific
prediction using sex, age, height and body weight, also
considering body composition (BC), tumour stage and levels
of inflammation.
Methods: REE was measured by indirect calorimetry in 390
patients with advanced cancer (stage III and IV). Body
composition was measured by DXA (fat free mass; FFM and
fat mass; FM) and inflammation by 4-levels of C-reactive
protein (CRP <10, 10–24, 25–100 and >100 mg/L). Regression
with leave-one-out cross-validation was used and prediction
accuracy are expressed as coefficient of variation of root mean
squared prediction error, (CV(RMSE); %).
Results: The HB equation explained 62% of the variance (R 2,
P < 0.001) with mean bias of –156 ± 167 kcal (P < 0.001) and CV
(RMSE) of 15%. The sex, age, height and weight model had
R 2 = 64% and CV(RMSE) of 11%. With addition of CRP and stage
R 2 was 70% and CV(RMSE) 10%. The BC model (age, FFM and FM)
had R 2 = 66% and CV(RMSE) of 11%. With addition of CRP and
stage R 2 was 72% and CV(RMSE) 10% (P for all models <0.001).
There was no difference in REE between sexes when adjusting
for BC (P = 0.3). REE was increased with inflammation by 3, 6
and 15% (52, 95 and 218 kcal respectively, P < 0.01) for each
level of CRP > 10 mg/L. There was a difference in REE of 2%
(37 kcal, P = 0.02) between tumour stages.
Conclusion: Prediction of REE from sex, age, height and weight
improved prediction compared to the Harris-Benedict equa-
tion. Considering body composition added little improvement.
Tumour stage and inflammation was associated with increased
REE and should be considered when developing REE estimation
equations for cancer patients.
Disclosure of Interest: None declared.
Poster
MON-P100
METABOLIC DISORDERS IN PATIENTS WITH ADVANCED
GASTRIC CANCER BEFORE ANTITUMOR CHEMOTHERAPY
O. Obukhova1 *, S. Kashiya1, I. Kurmukov1. 1Medical ICU, N.N.
Blokhin Russian Cancer Research Center, Moscow, Russian
Federation
Rationale: Gastric cancer is associated with the development
of cachexia, which can affect survival in chemotherapy. We
diagnosed cancer cachexia in the presence of two factors: the
body weight loss ≥10% and the level of C-reactive protein (CRP)
≥10 mg/l. Our goal was to study the consumption of protein and
energy, as well as assess water/electrolyte disorders in patients
with advanced or metastatic gastric cancer before the onset of
antitumor chemotherapy.
Methods: 56 patients with locally advanced or metastatic
gastric cancer (30 males, age 33–76 years) were consecutively
enrolled. Patients were questioned about their diet (data on all
food and drink consumed over 3 days was recorded). Energy,
protein and fluid intake was calculated. Body mass index (BMI),
azotemia, serum glucose, total protein, albumin, liver function
tests, electrolytes, CRP were measured. The data were
analyzed by SPSS13.0 software. The results were expressed as
mean ± SD.
Results: The energy intake made 23.4 ± 3.1 kcal/kg, the
protein intake was 0.74 ± 0.17 g/kg per day, the liquid intake
equaled 17.4 ± 1.7 ml/kg per day. The weight loss over last six
months was 15.1 ± 3.3%. The BMI was 19.3 ± 1.2 kg/m2, the CRP
was 20.1 ± 2.2 mg/l. The concentrations of sodium, potassium,
ionized calcium were decreased (128.1 ± 2.2 mmol/l, 3.2 ± 0.4
mmol/l, 1.09 ± 0.5 mmol/l, respectively).
Conclusion: Thus, in patients with inoperable gastric cancer
against the background of cachexia, the intake of energy,
protein and liquid with food is significantly reduced, which
leads to the development of electrolyte disorders (in particu-
lar, severe hyponatremia, hypocalcemia) requiring medical
correction.
Disclosure of Interest: None declared.
MON-P101
CANCER CACHEXIA: HOW ACCURATE IS THE ONCOLOGISTS’
CLINICAL ASSESSMENT?
Q. van Bokhorst1, A. Van Der Werf1 *, H. Verheul2,
M. de van der Schueren1, J. Langius1. 1Nutrition and Dietetics,
2
Oncology, VUmc, Amsterdam, Netherlands
Rationale: Despite its high prevalence, cancer cachexia
often remains under-recognized in clinical practice. In this
study, we aimed to investigate cancer cachexia proportions
according to both the judgement of the treating oncologists
and objective assessment methods by body composition
analyses.
Methods: Patients with metastasized colorectal cancer (n = 47)
were clinically and objectively assessed for cancer cachexia
before the start of first line chemotherapy. Assessment on the
basis of clinical presentation was performed by the treating
oncologists. For objective assessment, the international
diagnostic criteria by Fearon et al. (2011]) were used: weight
loss >5% or weight loss >2% combined with BMI < 20 or (CT
determined) low muscle mass. A McNemar’s test was
Nutrition and cancer 2
performed to examine whether proportions of cancer cachexia
were similar according to the two diagnostic approaches.
Results: Proportions of cancer cachexia differed significantly
between the two assessment methods ( p < 0.001). Cachexia
was present in 3 patients (6%) according to the oncologists
and in 22 patients (47%) according to objective assessment. Of
the 22 objectively cachectic patients, 1 was also clinically
recognized, while the other 21 cachectic patients were non-
cachectic according to the oncologists (false negative rate of
95%). The small number of clinically cachectic patients
hindered further statistical analyses.
Conclusion: Cancer cachexia is severely under-recognized by
the oncologists. Although there are indications of factors
contributing to this under-recognition (e.g. high BMI masking
low muscle mass), further research should be done to
investigate whether accuracy of clinical assessment can be
improved. Furthermore, it should be studied which of the
assessment methods is most predictive for clinical outcomes
and whether cachexia treatment is effective in these patients.
For now, objective approach is recommended in cancer
cachexia assessment.
Disclosure of Interest: None declared.
MON-P102
DIETETIC COUNSELING IN A NUTRITION TEAM IMPROVES
NUTRITIONAL STATUS FOR PATIENTS WITH UPPER
GASTROINTESTINAL CANCER DURING PALLIATIVE
CHEMOTHERAPY
R. E. Nielsen1 *, T. Beermann1, A. Carus2, M. E. Cook1.
1
Department of Gastroenterology, 2Department of Oncology,
Aalbrog University Hospital, Aalborg, Denmark
Rationale: Patients with upper gastrointestinal cancer (UGIC)
in palliative care often suffer from unintended weight loss. The
aim of this study is to evaluate the effect of dietetic counseling
by a registered dietitian and care by a nurse specialized in
unintended weight loss.
Methods: Patients with UGIC receiving palliative chemother-
apy at Aalborg University Hospital and considered of nutritional
risk by NRS-2002, were during medical counseling screened for
nutritional problems using a modified PG-SGA questionnaire. A
patient with a score ≥7 on a scale from zero to 10 was referred
to the nutrition team. Patients received dietetic advice on how
to obtain the required amount of energy and protein, using
regular foods, enteral and/or parenteral nutrition as required.
The nursing counseling included advice for gastro-intestinal
problems, fatigue and nausea.
Results: 32 patients (17 M/15 W, average BMI: 21,7 and age:
65.9 years) with UGIC (16 pancreatic, 10 cardia, 3 oesophagus,
2 ventricular and 1 appendix) were referred to the nutrition
team during a period of 6 months. 30 patients had weight loss
before referral to the nutrition team (average −13.9 kg, range:
−3 to −31.4). At the following counseling weight loss had
diminished significantly (−0.5 kg (n = 22) p < 0.001), was almost
unchanged for the 2nd follow-up (−0.8 kg, n = 17) and
stabilized at 3rd follow-up (0.0 kg, n = 9).
Conclusion: Dietetic counseling as part of a specialized
nutrition team stopped unintended weight loss for patients
with upper gastrointestinal cancer receiving palliative chemo-
therapy during active treatment period. However, more and
more patients were lost to follow-up counseling caused by
S217
disease progression, whereas chemotherapy was stopped and
patients received home palliative care.
Disclosure of Interest: None declared.
MON-P103
CHARACTERISTICS OF HOME ENTERALLY TUBE FED PATIENTS
WITH HEAD AND NECK CANCER IN THE UK
R. H. Evill1 *, T. R. Smith2, R. J. Stratton2, on behalf of the BANS
Committee, British Association for Parenteral and Enteral
Nutrition (BAPEN). 1on behalf of BANS, 2BANS, BAPEN,
Redditch, United Kingdom
Rationale: The use of home enteral tube feeding (HETF) in
patients with head and neck cancer is growing1 but there has
been little recent exploration nationally of this patient group
and their outcomes in the UK.
Methods: The British Artificial Nutrition Survey (BANS) of
BAPEN investigated the use of HETF in head and neck cancer
patients, to assess patient characteristics and outcomes. As
part of the ongoing survey (www.e-bans.com), 117 reporting
centres from across the UK (6,270 adult patients; point
prevalence December 2015) provided fully anonymised data
for head and neck cancer patients on: age; ability to manage;
activity level; reason, route and location for feeding. Patient
outcomes after 1 year of HETF were reported.
Results: The proportion of adult patients receiving HETF with
cancer was 26% (1638/6270) and most (83%, n 1353) had head
and neck cancer (an increase of 12% since 2010). Most (70%)
patients receiving HETF with head and neck cancer were aged
≤70 y and were tube fed primarily because of a swallowing
disorder (69%), disease-related malnutrition (19%) or GI
obstruction (3%), typically (85%) by gastrostomy. Most patients
lived in their own home (96%) and were independent (75%),
with only 4% requiring total help to manage and 20% some help.
The majority of patients had full normal activity (73%), 25% had
limited activity, and <2% were housebound or bedbound. After
1 year, 61% continued with HETF, almost a quarter (24%)
returned to oral feeding alone, 14% had died, 0% were
hospitalised and <1% withdrew or refused HETF.
Conclusion: This survey suggests patients with head and neck
cancer receiving HETF are a relatively independent and active
patient group living at home. Further work is required to assess
the optimal way of providing HETF to support this patient
group.
Reference
1. Smith T. et al. Annual BANS report 2011. Artificial nutrition support
in the UK 2000–2010. BAPEN, 2011 (www.BAPEN.org.uk)
Disclosure of Interest: None declared.
MON-P104
DEVELOPMENT OF ORAL MUCOSITIS AFFECTS ENERGY AND
MACRONUTRIENT INTAKES IN HOSPITALIZED PEDIATRIC
ONCOLOGY PATIENTS
S. Öztürk1 *, H. Susam Şen2, C. Akyüz2, H. Gokmen Ozel1.
1
Nutrition and Dietetics, Faculty of Health Sciences, 2Pediatric
Oncology Department, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
Rationale: Oral mucositis (OM) is a very common, potentially
severe side effect, caused by treatment with radiotherapy or
S218
chemotherapy (CT) for cancer. Patients with OM often
experience intense pain, leading to difficulty with eating and
speech. The aim of this study was to evaluate the effects of OM
development on energy and macronutrient intakes in hospita-
lized pediatric oncology patients treated with CT.
Methods: Thirteen hospitalized pediatric oncology patients (8
boys, 5 girls) aged between 3 and 15 years developed OM were
included. Five patients had lymphomas and eight patients had
solid tumors. Mean age of children (±SD) at enrollment was
7.5 ± 4.1 years. Mean cycles of chemotherapy was 5.0 ± 4.1
(between 1 and 12). Energy and macronutrient intakes were
analyzed from a 24-hour dietary recall before CT, on the last
day of CTand after OM development. The percentage of energy
intakes were expressed in relative to the Turkey Dietary
Guidelines. Mean percentage of energy from protein, carbo-
hydrate and fat was calculated.
Results: The mean energy intake percentage in relative to
the National Gudelines was higher before CT (88.7% ± 33.6%)
and on the last day of CT (59.2% ± 30.8%) than after OM
development (17.2% ± 22.6%) ( p < 0.001). It was found that
five patients (38.5%) did not consume any food or drink on the
dietary recall day after the development of OM period. Mean
percentage of energy from protein (before CT = 14 ± 2.7%, last
day CT = 12.2 ± 3.4%, OM = 12.1 ± 3.1%), carbohydrate (before
CT = 43.9 ± 7.0%, last day CT = 46.2 ± 6.8%, OM = 44.7 ±
5.2%) and fats (before CT = 41.0 ± 5.6%, last day CT = 40.5 ±
5.9%, OM = 43.2 ± 8.2%) did not change significantly during the
course of OM.
Conclusion: It was found that energy intake of the patients was
the lowest after OM development. Regular dietary counseling
during the course of OM appears to maintain or to improve
nutritional status.
Disclosure of Interest: None declared.
MON-P105
CHANGES IN NUTRITION STATUS DURING THE COURSE OF
CHEMOTHERAPY IN HOSPITALIZED PEDIATRIC ONCOLOGY
PATIENTS
S. Öztürk1 *, H. Susam Şen2, C. Akyüz2, H. Gokmen Ozel1.
1
Nutrition and Dietetics, Faculty of Health Sciences, 2Pediatric
Oncology Department, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
Rationale: Deterioration in nutritional status during cancer
treatment has been increasingly noted. The aim of this study
was to evaluate changes in energy and macronutrients intakes
and anthropometric measurements during chemotherapy (CT)
in pediatric oncology patients.
Methods: Sixty hospitalized pediatric oncology patients (33
boys, 27 girls) aged between 2 and 17 years treated with CT
were included. Thirteen patients had lymphomas and 47
patients had solid tumors. Mean age of children (±SD) at
enrollment was 8.8 ± 5.1 years. Mean cycles of chemotherapy
was 4.1 ± 3.2 (between 1 and 13). Body mass index (BMI) Z
scores were calculated using WHO Standards. Energy and
macronutrient intakes were analyzed from a 24-hour dietary
recall before and on the last day of CT. The percentage of
energy intakes were expressed in relative to the Turkey Dietary
Guidelines. Mean percentage of energy from protein, carbo-
hydrate and fat was calculated.
Poster
Results: Mean BMI Z score was significantly lower on the last day
of CT (−0.20 ± 2.09) than before CT (0.05 ± 1.99) ( p < 0.001).
The mean energy intake percentage in relative to the National
Gudelines was lower in the last day of CT (46.4%±25.3%) than
before CT (85.5%±29.5%) ( p < 0.001). It was found that
two patients (3.3%) did not consume any food or drink on the
dietary recall day during the last day of CT. Mean percentage of
energy from protein (before CT = 14.3 ± 2.67% vs last day
CT = 13.6 ± 3.5%), carbohydrate (before CT = 42.0 ± 7.7% vs last
day CT = 44.6 ± 9.7%) and fats (before CT = 42.5 ± 7.3% vs last
day CT = 40.7 ± 8.6%) did not change significantly during the
course of CT.
Conclusion: Energy intakes and BMI Z scores varied in the cycle
of chemotherapy, with the lowest intake and BMI Z scores on
the last day of CT. Further studies evaluating dietary intake and
antropometrc measurements in patients undergoing CT should
include in the protocol the exact time point of dietary
assessment.
Disclosure of Interest: None declared.
MON-P107
THE IMPACT OF PREOPERATIVE NUTRITIONAL RISK
SCREENING 2002 SCORE ON SURVIVAL IN PATIENTS
UNDERGOING CYTOREDUCTICE SURGERY AND HYPERTERMIC
INTRAPERITONEAL CHEMOTHERAPY
S. Demiral Sezer1 *, T. Ö. Sezer2, O. Firat2, S. Ersin2. 1Internal
Medicine, Tepecik Training and Research Hospital, 2General
Surgery, Ege University School of Medicine, Izmır, Turkey
Rationale:
The Nutritional Risk Screening 2002 (NRS 2002) defines
nutritional and functional status of patients with the aim of
identifying who could benefit from a nutritional intervention.
However impact of NRS 2002 scores after Cytoreductice Surgery
and hypertermic intraperitoneal chemotherapy is unclear
(CRS + HIPEC).
Methods: This study evaluated preoperative NRS 2002 score in
30 patients undergoing CRS+ HIPEC at our institution between
March 2016 and January 2017 retrospectively. Patients demo-
grafic data, postoperative complications, lenght of hospital
stay, shortterm survival were analyzed.
Results: Weight loss in last 3 months had a longer postoperative
hospital stay. A statistically significant relationship with NRS
2002 score higher than 3 had a longer hospital stay and
postoperative complications ( p < 0.01). Shortterm survival was
higher at NRS2002 score higher than 3 but not significant.
Conclusion: Malnutrition is highly prevalent among patients
hospitalized in advanced cancer patients, and it affects the
length of hospitalization, postoperative complications and
early survival. NRS 2002 score was easy to predict postoperative
morbidity.
Disclosure of Interest: None declared.
Nutrition and cancer 2
MON-P108
NUTRITIONAL PREDICTORS FOR POSTOPERATIVE LONG-TERM
OUTCOME OF GASTRIC CANCER PATIENTS TREATED WITH
POSTOPERATIVE CHEMOTHERAPY
S. Y. Yu1 *, T. S. Sohn2, J. M. Bae2, S. Kim2, Y. J. Kim1, Y. Y. Cho1,
M. Y. Rha1, M. G. Choi2. 1Department of Dietetics, 2Department
of Surgery, Samsung Medcal Center, Seoul, Republic of Korea
Rationale: The impact of pre- and post-operative nutritional
status on long term outcomes for gastric cancer patients
treated with postoperative chemotherapy was investigated.
Methods: We retrospectively reviewed 293 gastric cancer
patients who underwent surgical resection treated with
postoperative chemotherapy from January 2008 to October
2008. Median follow-up duration was 67.2 months (range 6–84).
At admission, and one month after surgery, the patients were
assessed on nutritional risk index (NRI), anthropometric
measurement and laboratory data. The NRI was calculated as
follows: NRI = [1.519 × serum albumin (g/L) + 0.417 − ( present
weight/usual weight × 100). Nutritional risk was defined as
three grades: (1) severely malnourished (NRI ≤ 83.5); (2)
moderately malnourished (NRI 83.5–97.5), or (3) well nourished
(NRI ≥ 97.5).
Results: The 5-year survival rates in patients with preoperative
NRI score 1, 2, and 3 were 33.3%, 73.8% and 79.5%. Overall
survival rates were significantly lower in preoperative severely
malnourished patients (NRI ≤ 83.5) (P = 0.018) and patients
whose preoperative body weight loss was ≥5% (P < 0.001).
Multivariate analysis of overall survival indicated that TNM
stage (P = 0.001), venous invasion (P = 0.003), preoperative
bodyweight loss (P = 0.002), and preoperative NRI score
(P = 0.025) were independent prognostic factors. The post-
operative nutritional status (nutritional status at one month
after surgery) was not independent prognostic factor.
Conclusion: The preoperative NRI score and preoperative body
weight loss were a useful predictor for the long-term outcome
of gastric cancer patients treated with postoperative
chemotherapy.
Disclosure of Interest: None declared.
MON-P109
BODY COMPOSITION AS A PREDICTOR OF MORBIDITY AND
MORTALITY IN SURGICAL PATIENTS WITH BILE DUCT AND
PANCREATIC CARCINOMA
S. Velho1 *, M. C. Santos2, C. Cunha3, F. Costa4, L. Agostinho5,
R. Cruz5, R. Roque3, P. Oliveira3, J. R. D. Andrade6, C. Ferreira6,
R. Maio3, V. Baracos7, M. Cravo2. 1Dietetics and Nutrition,
2
Gastroenterology, 3Surgery, Hospital Beatriz Ângelo,
4
Oncology Manager, Luz Saúde, 5Radiology, Hospital Beatriz
Ângelo, Loures, 6Surgery, Hospital da Luz, Lisboa, Portugal,
7
Oncology, University of Alberta, Alberta, Canada
Rationale: To assess the association between body composition
measurements and post-op complications and 90 days
mortality.
Methods: Retrospective study in patients ( pts) with pancre-
atic, ampullary or bile duct carcinoma that underwent surgery
between March 2012 and October 2016. Body composition
(skeletal muscle, visceral fat and subcutaneous fat area) was
assessed with routine diagnostic Computed Tomography scan;
images were acquired at the 3rd lumbar vertebrae. Post-op
S219
complications were classified according to Clavien Dindo [Minor
(grade I–IIIa) and Major(grade IIIb–V)].
Results: 59 pts were enrolled, 11 were excluded due to
unavailable CT scan. 48 pts were included, mean age of
70,9 ± 8,5 years, 28 males. 25% of pts had major post-op
complications and 90 day mortality was 8,3%. On simple logistic
regression skeletal muscle area (OR 0,97; P = 0,09) and index
(OR 0,91; P = 0,09) had a trend for a protective effect of major
complications. On multiple logistic regression both skeletal
muscle index (OR 0,89; P = 0,05) and surgery duration (OR 1,01;
P = 0,07) were associated with major complications. ROC curve
analysis of the later model showed an adequate ability of major
post-op complications discrimination (AUC = 0,736). On simple
logistic regression surgery duration (OR 1,02; P = 0,05), visceral
fat area and index were associated with a higher 90 d mortality
(OR 1.02; P = 0,02 and OR 1,05; P = 0,04, respectively), whereas
muscle radiation attenuation had a protective effect (OR 0,88;
P = 0,05).
Conclusion: Lower skeletal muscle and muscle radiation
attenuation, as well as higher visceral fat and surgery duration
are associated with worse clinical outcomes namely major post
op complications and 90 day mortality.
Disclosure of Interest: None declared.
MON-P110
THE IMPACT OF PROGNOSTIC NUTRITIONAL INDEX (PNI) ON
THE SURVIVAL OF PATIENTS WITH ADVANCED
HEPATOCELLULAR CARCINOMA TREATED WITH SORAFENIB: A
MULTICENTER STUDY
T. Hatanaka1,2 *, A. Naganuma1, D. Uehara3, T. Nagashima4,
T. Ueno5, M. Namikawa6, S. Saito7, K. Hosonuma8, T. Ohyama2,
H. Suzuki9, H. Takagi10, K. Sato11, S. Kakizaki11. 1Department of
Gastroenterology, Takasaki General Medical Center, National
Hospital Organization, Takasaki, 2Department of
Gastroenterology, Saiseikai Maebashi Hospital, 3Department
of Medicine and Molecular Science, Gunma University
Graduate School of Medicine, Maebashi, 4Department of
Gastroenterology, Shibukawa Medical Center, National
Hospital Organization, Shibukawa, 5Department of Internal
Medicine, Isesaki Municipal Hospital, Isesaki, 6Department of
Internal Medicine, Kiryu Kosei General Hospital, Kiryu,
7
Department of Gastroenterology, Tomioka General Hospital,
Tomioka, 8Department of Internal Medicine, Toho Hospital,
Midori, 9Department of Internal Medicine, Haramachi Red
Cross Hospital, Agatsuma, 10Department of Gastroenterology
and Hepatology, Kusunoki Hospital, Fujioka, 11Department of
Gastroenterology and Hepatology, Gunma University Hospital,
Maebashi, Japan
Rationale: This study aimed to investigate the impact of
prognostic nutritional index (PNI) on the survival of patients
with advanced hepatocellular carcinoma (HCC) treated with
sorafenib.
Methods: A total of 110 advanced HCC patients from May 2009
to December 2015 at Takasaki General Medical Center and our
affiliated hospitals were included in this retrospective multi-
center cohort study. PNI was calculated as follows: 10 × serum
albumin (g/dl) + 0.005 × total lymphocyte count ( per mm3).
The patients were divided into two groups according to the cut
off value of PNI that was calculated by a ROC curve analysis.
S220
Results: The optimal cut off value of PNI was set at 46.5. The
patients’ characteristics between PNI-high group (>46.5,
n = 26) and PNI-low group (<46.5, n = 84) were not statistically
significant. The median age was 71 (interquartile range [IQR];
64–76) years in PNI-high group and 71 (IQR: 64–76) years in PNI-
low group. Child-Pugh Class (A/B) in PNI-high group and PNI-low
group were 25 (96.2%)/1 (3.8%) and 76 (90.5%)/8 (9.5%),
respectively. Barcelona Clinic Liver Cancer (BCLC) stage (B/C)
was 9 (34.6%)/17 (65.4%) in PNI-high group and 28 (33.3%)/56
(66.7%) in PNI-low group. α-fetoprotein (AFP) were 45 (IQR; 10–
1703) ng/ml in PNI-high group and 137 (IQR; 17–798) ng/ml in
PNI-low group. One-year survival rates were 80.0(CI: 64.3–95.7)
% in PNI-high group and 48.7(CI: 37.7–59.7) % in PNI-low group,
respectively. Cumulative survival rate in PNI-high group was
significantly better than that in PNI-low group (P = 0.023). A
multivariate analysis showed that an AFP > 120 ng/ml (Hazard
ratio [HR] 2.04; 95%CI 1.32–3.05, P < 0.001) and PNI-high group
(HR 0.59; 95%CI 0.35–0.995, P < 0.048) were independent
factors associated with overall survival.
Conclusion: PNI is a simple and useful marker to predict the
survival of patients with HCC treated with sorafenib.
Disclosure of Interest: None declared.
MON-P111
SARCOPENIA IS ASSOCIATED WITH POORER COMPLIANCE
WITH ADJUVANT CHEMOTHERAPY IN GASTRIC CANCER
PATIENTS
T. Nishigori1 *, S. Tsunoda1, K. Obama1, T. Watanabe1,
S. Hisamori1, K. Hashimoto1, Y. Sakai1. 1Department of Surgery,
Kyoto University, Kyoto, Japan
Rationale: S-1 Adjuvant chemotherapy (AC) has been shown to
improve the prognosis after the curative resection of advanced
gastric cancer (GC), but it is associated with poor compliance.
Recently, sarcopenia has been reported to be associated with
higher chemotherapy toxicity in several types of cancers. The
aim of this study was to investigate the impact of sarcopenia on
the continuation of AC after gastrectomy.
Methods: Patients who received S-1 AC following curative
gastrectomy for Stage II/III GC at Kyoto University Hospital
between 2005 and 2015 were retrospectively investigated.
Imaging at L3 level of preoperative CT scan was used to analyze
skeletal muscle mass. Sarcopenia was defined based on the cut-
off values reported by Martin et al.1 The proportions of patients
who discontinued AC within one year (except for recurrence)
were compared between patients with and without sarcopenia.
Results: Among 149 eligible patients, 60 (40%) had sarcopenia.
In patients with and without sarcopenia, 21 (35%) and 13 (15%)
discontinued S-1 AC within one year, respectively (P = 0.004).
Multivariate logistic regression analysis, adjusting for age,
stage, creatinine clearance, and body weight loss after surgery,
demonstrated that sarcopenia (OR 2.91, 95% CI 1.26–6.70,
P = 0.012) and age ≥ 65 (OR 3.58, 95% CI 1.29–9.95, P = 0.015)
were independent predictors of poorer compliance with AC.
Conclusion: In patients with GC, sarcopenia is associated with
poorer compliance with S-1 AC. Further studies are needed to
elucidate the effect of perioperative nutrition and physical
activity programs on AC compliance after gastrectomy.
Reference
1. Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT,
McCargar LJ, et al. Cancer cachexia in the age of obesity: skeletal
Poster
muscle depletion is a powerful prognostic factor, independent of
body mass index. J Clin Oncol. 2013;31(12):1539–47.
Disclosure of Interest: None declared.
MON-P112
CUT-OFF VALUES FOR THE FAACT-A/CS AND THE VAS FOR
APPETITE FOR THE ASSESSMENT OF ANOREXIA IN CANCER
PATIENTS
T. J. E. van Elsacker1, S. Van Den Berghe1, M. De Groot1,
J. A. E. Langius1 *. 1Nutrition and Dietetics, The Hague
University of Applied Sciences, The Hague, Netherlands
Rationale: The Anorexia/Cachexia Subscale of the Functional
Assessment of Anorexia/Cachexia Therapy questionnaire
(FAACT) and the visual analog scale for appetite (VAS) are
diagnostic tools used to assess anorexia in cancer patients.
Several different cut-off values for anorexia are proposed for
the FAACT (≤24, ≤30 and ≤37) and the VAS (<50 and <70). As no
normative data in a healthy population currently exist, this
study aimed to obtain cut-off values for the FAACT and the VAS
for the assessment of anorexia in patients with cancer, based on
the scores of the healthy adult Dutch population.
Methods: The FAACT and the VAS were both assessed among
healthy, independent living men and women aged 18–75 years.
Participants were excluded when using any medication affect-
ing appetite. To examine if age- or gender-specific reference
values were required, the correlation between age and
appetite and between sex and appetite was investigated by,
respectively, the Spearman’s correlation coefficient rho and
Eta. The cut-off values for the FAACTand the VAS were based on
the 10th percentile of the scores of the healthy population.
Results: A total of 280 participants (38.6 ± 17.4 years; 44%
male) were included for data analyses. The median anorexia
score was 40 (IQR 36–42) points on the FAACTand 83 (IQR 69–92)
points on the VAS. No correlation was found between age and
sex and the scores on the FAACT (rho = 0.029; p = 0.624 and
Eta = 0.231) and the VAS (rho = 0.117; p = 0.051 and
Eta = 0.106). Based on the 10th percentile of the total
population, the optimal cut-off value for the FAACT was ≤33
and for the VAS ≤ 54.
Conclusion: For the assessment of anorexia in cancer patients,
cut-off values of ≤33 for the FAACT and ≤54 for the VAS are
suggested. These cut-off values differ from previously pro-
posed cut-off values. Further research is needed to validate
these cut-off values in cancer patients.
Disclosure of Interest: None declared.
MON-P113
EGCG INDUCED MIRNA-MEDIATED REGULATION IN NON-SMALL
CELL LUNG CANCERS (NSCLCS)-NGS APPROACH
V. Bhardwaj1 *, N. Ramesh1, A. K. A. Mandal1. 1Biotechnology,
VIT University, Vellore, India
Rationale: Non-small cell lung cancers (NSCLCs) is a group of
distinct diseases with cellular and genetic heterogeneity with
three known forms adenocarcinoma, squamous cell carcinoma
and large cell carcinoma. Modulation of miRNAs expression
profiles are known to be predictor in NSCLCs. Hence, the
current study was undertaken to investigate the modulatory
effect of EGCG on cellular miRNA expression and cell cycle
proliferation in NSCLCs (A549).
Nutrition and cancer 2
Methods: A549 cells were treated with 40 and 100 μM EGCG.
Next generation sequencing technology (NGS) was employed to
study the differential expression of novel and known miRNAs.
The data generated was analysed with computational approach
to study and correlate the expression profiles of both known and
novel miRNAs. Flow cytometry analysis was also carried out to
better understand the role of EGCG in cell cycle proliferation.
Results: Studies with significantly expressed known miRNAs
showed noteworthy difference in control and EGCG treated
samples, which was evident from the generated heat maps. In
case of novel miRNAs, the differential expression levels were
estimated by counting the number of times the miRNA
sequences are repeated in the given dataset. Together the
analysis of these microRNA profiles revealed log 2 fold
modulation in expression levels. 667 (control), 661 (40 μM
EGCG) and 663 (100 μM EGCG) known mature miRNAs and 157
(control), 282 (40 μM EGCG) and 165 (100 μM EGCG) novel
mature miRNAs were reported. Gene-annotation analysis
(DAVID and PANTHER) of the top 50 miRNAs treated with
EGCG showed to regulate networks associated with WNT, AKT/
PI3K pathways and cell cycle. Flow cytometric analysis further
confirmed EGCG’s role in cell cycle proliferation.
Conclusion: In conclusion, the analysis demonstrates that
EGCG is actively involved in miRNA modulation in NSCLCs,
which further attests to its chemoprotective role.
Disclosure of Interest: None declared.
MON-P114
EARLY ENTERAL FEEDING VIA FEEDING JEJUNOSTOMY IN
GASTRIC CANCER PATIENTS AFTER RADICAL RESECTION
W.-C. Su1 *, H.-L. Tsai1, J.-Y. Wang1. 1Division of Colorectal
Surgery (Department of Surgery), Kaohsiung Medical
University Hospital, Kaohsiung, Taiwan, Province of China
Rationale: Introducing early enteral nutrition (EEN) in gastric
cancer (GC) patients has conventionally been challenging by
oral feeding. The aim of this study was to assess the clinical
outcomes of feeding jejunostomy (FJ) in GC patients undergo-
ing radical resection in one single institution in Taiwan.
Methods: This study recruited 198 patients diagnosed with GC
who had radical resection and FJ from May 2010 to January
2017. All medical records from 198 GC patients were
retrospectively analysed. Early enteral feeding was admini-
strated within 48 hours after radical resection. The outcome
was evaluated based on postoperative complications, anasto-
motic leak rate, and length of hospitalization.
Results: FJ was performed in 118 males (59.6%) and 80 females
(40.4%) operated for GC with a mean age of 66.2 (28–92) years.
Among 198 patients, 38.9% were stage I, 21.2% were stage II,
33.9% were stage III and 6.0% were stage IV in 6.0%. Total
gastrectomy (TG) was performed in 33 (16.7%) patients and 165
(83.3%) underwent subtotal gastrectomy (STG). The mean
operative time for TG and STG were 305.4 ± 64.3 (min) and
248.5 ± 69.8 (min) respectively. In terms of operative blood
loss, the mean TG and STG were 173.6 ± 262.2 (mL) and
107.3 ± 114.2 (mL) accordingly. Mean postoperative hospital
stay for TG patients was 14.9 ± 9.2 days whereas for STG
patients was 14.4 ± 12.7 days. The incidence of postoperative
complications was 24.2% but none of these cases were due to FJ
itself. Prolong ileus incidence was merely 2.5% and this further
supports feasibility of FJ.
S221
Conclusion: We believe introducing EEN as suggested by ESPEN
guidelines is advantageous. In our 198 GC patients, EEN was
successfully implemented via FJ. Enteral therapy via feeding
jejunal tube is highly feasible and thereby may be routinely
performed in GC patients for early enteral feeding.
Disclosure of Interest: None declared.
MON-P115
COULD SARCOPENIC OBESITY SERVE AS AN INDEPENDENT
RISK FACTOR FOR POSTOPERATIVE SHORT-TERM OUTCOMES
AFTER RADICAL RESECTION FOR GASTRIC CANCER? A SINGLE
TEACHING HOSPITAL PILOT RETROSPECTIVE STUDY
Y. Zhou1 *, L. Wang2, S. cao1. 1General Surgery, 2Affiliated
Hospital of Qingdao University, Qingdao, China
Rationale: The aim of this study was to investigate the impact
of CT-assessed SO on short-term outcomes after radical
resection for gastric cancer.
Methods: We retrospectively analyzed a consecutive patient
who underwent radical gastrectomy for gastric cancer. Skeletal
muscle area and adipose tissue area were measured using CT
scan at the level of the third lumbar vertebra (L3) where both
transverse processes were visible within 1 week before surgery.
Perioperative data, and short-term outcomes were recorded
prospectively.
Results: When compared with patients in non-SO group,
patients in SO group had higher perinephric fat thickness
(1.41 vs. 0.86, p < 0.001), subcutaneous adipose tissue area
(156.16 vs. 111.95, p < 0.001), inter-muscle adipose tissue area
(13.40 vs. 8.03, p < 0.001), visceral adipose tissue area (162.20
vs. 109.82, p < 0.001) and total adipose tissue area (331.76 vs.
226.65, p < 0.001). Comparing with non-SO patients, SO
patients had a higher risk in major postoperative complications
(42.2% vs. 16.8%, p < 0.001), longer postoperative hospital stay
(9.00 vs. 8.00, p = 0.007), and higher hospital costs (14688 vs.
13693, p = 0.011). Multivariable analysis after controlling for
potential confounders revealed that sarcopenic obesity (OR
2.935, 95% CI 1.121–7.682, p = 0.028), diabetes (OR 4.146, 95%
CI 1.033–16.639, p = 0.045) and hypoalbuminemia (OR 2.030,
95% CI 0.985–4.181, p = 0.055) were independent risk factors
for major postoperative complications.
Conclusion: This study suggests that sarcopenic obesity could
serve as an independent risk factor for postoperative short-
term outcomes, at least in patients with gastric cancer who
undergo radical gastrectomy.
Disclosure of Interest: None declared.
MON-P116
PI3KINASE-AKT-MTOR PATHWAYAND GLUTAMINE METABOLISM
IN OVARIAN CANCER
Z. Ajgal1,2 *, S. Le Plenier2, S. Ricci3, N. Neveu2,3,
J. Alexandre1, F. Goldwasser1, J.-P. De Bandt2,3, L. Cynober2,3,
M.-C. Blanc2,3. 1Medical Oncology, Hôpital Cochin, 2EA4466,
Université Paris Descartes, 3Biochemistry, Hôpital Cochin,
Paris, France
Rationale: PI3Kinase-AKT-mTOR is a frequently mutated
signaling pathway in ovarian cancer and can be activated by
glutamine (Gln) and its metabolites. Conversely mTORC1
regulates glutaminolysis. Combining inhibition of mTORC1 and
S222
glutaminolysis could have a synergistic effect on the inhibition
of tumor growth.
Methods: Three human ovarian cancer cell lines, OVCAR3 (high
grade serous), ES2 and TOV21G (clear cells), were cultured in
RPMI-15% FBS with 0, 2 or 4 mM Gln. Cells were incubated with 1
to 10 nM Rapamycin (Rapa), a selective mTORC1 inhibitor, for 24
or 4 8h. Cell proliferation was assessed by BrdU incorporation
(ELISA). Expression and activation of signaling proteins (S6K1,
Akt, Erk, c-myc, HIF1α IκB) was measured by western blot.
Results as mean ± SD; Mann Withney test was used for comparison
Results: Rapa 10 nM had a moderate antiproliferative effect
after a 24 or 48 h incubation. No synergistic effect with Gln
deprivation was found.
Cell proliferation (Optic Density)
48 h Rapa 0nM 48 H Rapa 10 nM
Gln 0 mM Gln 2 mM p Gln 0 mM Gln 2 mM
TOV21 G 1,13 ± 0,09 1,20 ± 0,12 0,1 0,86 ± 0,04 0,80 ± 0,08
OVCAR3 0,59 ± 0,05 0,66 ± 0,05 0,7 0,65 ± 0,04 0,48 ± 0,08
ES2 0,79 ± 0,06 0,55 ± 0,08 1 0,60 ± 0,1 0,32 ± 0,03
Phospho-AKT is detected in all experimental conditions
indicating upstream activation of the pathway despite S6K1
inhibition by Rapa. Phospho-Erk increased in OVCAR3 after
addition of Rapa but was constitutively present in TOV21G and
ES2: activation of MAPKinase signaling could be another
pathway of resistance. Depletion of Gln inhibited expression
of HIF1α. HIF1α/GAPDH ratio was 0 (TOV21G), 0.3 (OVCAR3) and
0.07 (ES2) in 0mM Gln condition versus 1.5 (TOV21G), 3.8
(OVCAR3) and 2.2 (ES2) in standard condition.
Conclusion: Gln depletion alone or in combination with Rapa
has a moderate impact on proliferation but contributes to the
regulation of signaling pathway like HIF1α known to be involved
in VEGF production, invasiveness and chemoresistance.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 2
MON-P118
THE EFFECT OF ENTERAL NUTRITION SUPPORT THERAPY
THROUGH PEG/J IN PATIENTS WITH GASTROPTOSIS AND
SEVERELY MALNUTRITION
L. Zhang1 *, X. Gao1, X. Wang1, J. Li1. 1Research Institute of
General Surgery, Jinling Hospital, Medical School of Nanjing
University, Nanjing, China
Rationale: To investigate the significance, effects and precau-
tions of enteral nutrition support therapy through PEG/J in
patients with gastroptosis and severely malnutrition.
Methods: Clinical date of 11 gastroptosis patients with severely
malnutrition who were treated with enteral nutrition support
therapy through PEG/J were retrospectively summarized. They
were followed up more than 6monthes and all the patients are
alive till now. The cost of hospitalization, the enteral nutrition
duration and de current nutritional status of these patients
were analyzed.
Results: After treatment, the nutrition status of all the 11
patients were improved. The body weight of 7 cases returned to
normal and abdominal distension symptoms disappeared, who
Poster
had been successfully removed the PEG/J and completely
weaned off enteral nutrition. 4 cases of gastroptosis were
successfully treated. The enteral nutrition duration was
(158.57 ± 19.36) days and the cost of hospitalization was
(47.0 ± 16.0) thousand yuan. As for the patients’ nutritional
index, mean BMI, body weight gain, blood hemoglobin,
serum albumin level and serum prealbumin level were
(19.70 ± 1.50) kg/m2, (9.54 ± 5.08) kg, (129.14 ± 14.94) g/L,
(43.96 ± 2.56) g/L, (279.38 ± 78.20) g/L respectively.
Conclusion: Enteral nutrition through PEG/J is a clinical valid
treatment in gastroptosis patients with severely malnutrition
and could significantly improve the nutritional status and
abdominal distension symptoms.
Disclosure of Interest: None declared.
MON-P119
COEXISTENCE OF MALNUTRITION, FRAILTY, PHYSICAL
p
FRAILTY, AND DISABILITY IN PATIENTS WITH COPD AT THE
0,3 START OF A PULMONARY REHABILITATION PROGRAM
0,03
0,03 L. ter Beek1,2,3 *, H. van der Vaart2, J. B. Wempe2,
F. D. Ottery1,4, J. L. Roodenburg3, C. P. van der Schans1,5,6,
H. Jager-Wittenaar1,3. 1Research Group Healthy Ageing, Allied
Health Care and Nursing, Hanze University of Applied Sciences,
Groningen, 2Department of Pulmonary Diseases and
Tuberculosis, Center for Rehabilitation, University of
Groningen, University Medical Center Groningen, Haren,
Groningen, 3Department of Maxillofacial Surgery, University of
Groningen, University Medical Center Groningen, Groningen,
Netherlands, 4Ottery & Associates, Vernon Hills (Chicago),
United States, 5Department of Rehabilitation Medicine,
6
Department of Health Psychology Research, University of
Groningen, University Medical Center Groningen, Groningen,
Netherlands
Rationale: Malnutrition, frailty, physical frailty, and disability
seem to be ‘overlapping’ conditions, since all are to a certain
extent defined by a decrease in muscle mass and/or strength,
level of activity, and functional performance. However, it is
unclear to what extent these conditions coexist in patients with
chronic disease. We therefore aimed to determine the
coexistence of malnutrition, frailty, physical frailty and
disability in patients with chronic obstructive pulmonary
disease (COPD) that started a pulmonary rehabilitation
program.
Methods: In 47 patients with COPD (47% male, mean age
60.2 ± 9.6 years, mean BMI 24.0 ± 4.6, median FEV1% pred 33
[IQR: 25–43]), malnutrition was assessed by the Scored Patient-
Generated Subjective Global Assessment. Patients were cate-
gorized as well nourished (PG-SGA A), moderate/suspected
malnutrition (PG-SGA B), or severe malnutrition (PG-SGA C).
Frailty was assessed by the Evaluative Frailty Index for Physical
activity, and physical frailty was assessed by Fried’s criteria.
Disability was measured by the WHO Disability Assessment
Schedule 2.0.
Results: Of all patients, 40% percent (19/47) were categorized
as malnourished (B or C). Eighty-five percent (40/47) were
frail, 17% (8/47) were physically frail, 75% (35/47) were
physically pre-frail, and 30% (14/47) were disabled. The
coexistence of malnutrition and disability is limited (15%). Of
physically frail patients, 75% were malnourished and 44% of
frail patients were malnourished. In three patients all four
Nutrition and chronic diseases 2
conditions coexisted. Six patients were neither malnourished,
frail, physically frail or disabled.
Conclusion: Most COPD patients starting pulmonary rehabili-
tation are frail, but only a minority is physically frail. Almost all
malnourished patients are frail (95%) but not all frail patients
are malnourished (45%).
Disclosure of Interest: L. ter Beek: None declared, H. van der Vaart
Other: Personal fee from Vertex, outside the submitted work,
J. Wempe: None declared, F. Ottery Other: Developer of the PG-SGA,
co-developer of the PG-SGA based Pt-Global app, J. Roodenburg: None
declared, C. van der Schans: None declared, H. Jager-Wittenaar Other:
Co-developer of the PG-SGA based Pt-Global app.
MON-P120
RADIOLOGICAL PERCUTANEOUS GASTROSTOMY (GRP) AND
ITS IMPACT ON NUTRITIONAL STATUS IN PATIENTS WITH
AMYOTROPHIC LATERAL SCLEROSIS (ALS).
M. Virgili-Casas1 *, A. Prats2, I. Jimenez3, E. Romero4,
V. Herrera5, B. Andres6, M. Montserrat7, R. Lopez-Urdiales8,
M. Povedano9. 1Clinical Nutrition and Dietetics Unit,
Endocrinology and Nutrition Department, Multidiscilplinary
Unit Motor Neuron Disease, Hospital Universitari Bellvitge,
IDIBELL, L’Hospitalet de Llobregat, Barcelona, 2Clinical
Nutrition and Dietetics, Endocrinology and Nutrition
Department, Multidisciplinary Unit Motor Neuron Disease,
Hospital Universitari Bellvitge, IDIBELL, L’Hospitalet de
Llobregat, 3Clinical Nutrition and Dietetics Unit,
Endocrinology and Nutrition Department, Multidisciplinary
Unit Motor Neuron Disease, Hospital Universitari de Bellvitge,
IDIBELL, L’Hopsitalet de Llobregat, Barcelona, 4Clinical
Nutrition and Dietetics Unit. Endocrinology and Nutrition
Department, Multidisciplinary Unit Motor Neuron Disease,
Hospital Universitari Bellvitge. IDIBELL, L’Hospitalet de
Llobregat, Barcelona, 5Clinical Nutrition and Dietetics Unit,
Endocrinology and Nutrition Department.Multidisciplinary
Unit Motor Neuron Disease, 6Multidisciplinary Unit Motor
Neuron Disease, 7Clinical Nutrition and Dietetics Unit,
Endocrinology and Nutrition Department, 8Clinical Nutritition
and Dietetics Unit, Hospital Universitari Bellvitge,
9
Multidisciplinary Unit of Motor Neuron Disease, Hospital
Universitari Bellvitge, IDIBELL, L’Hospitalet de
Llobregat, Spain
Rationale: ALS is a neurodegenerative disease that leads to a
state of malnutrition. It is associated with hypermetabolism
and/or dysphagia, so the placement of a Percutaneous
Gastrostomy (PG) is indicated to correct this situation. To
describe the therapeutic indication of RPG, and to monitor
weight evolution and the impact of the delay between indica-
tion and RPG placement on the nutritional status of the patient.
Methods: A retrospective and descriptive study has been
held in the Multidisciplinary Motor Neuron Disease Unit
(MMNDU) of Bellvitge University Hospital with ALS patients
who underwent RPG between Jan 2012 and Dec 2015. Six
months after RPG placement, clinical and nutritional follow up
is described.
Results: 87 patients (54% men), age at diagnosis 63 years.
Spinal onset 57%, bulbar onset 41%, respiratory onset 1%. The
mean vital capacity (FVC) at the time of diagnosis was
73% ± 19% decreasing to 55% ± 18% at the RPG placement. 61%
S223
received noninvasive mechanical ventilation. The indication
was 73.6% for dysphagia and 26.4% for respiratory. The weight
evolution from the first visit to the RPG indication was
distributed into 4 groups, depending on weight loss: (a)
39.1%, no weight loss, (b) 29.9%, weight loss <5%, (c) 24.1%,
weight loss 5–10% and (d) 6.9%, weight loss > 10%. There is a
significant positive correlation between placement acceptance
delay and weight loss ( p = 0.003) with an average delay of 5.4,
1.9, 5.09 and 5.9 months respectively. During the follow-up, 36
(41%) patients died. The weight remained stable in all groups
during the 6 months after RPG.
Conclusion: The most common indication for RPG in ALS
patients is dysphagia, and its placement helps to maintain
nutritional status, avoiding weight loss. Further delay in
gastrostomy placement is associated with increased weight
loss. More studies are needed to give greater robustness to the
results obtained.
Disclosure of Interest: None declared.
MON-P121
ASSOCIATION OF THE DIETARY AND LIFESTYLE FACTORS WITH
THE LONG-TERM CARDIOVASCULAR RISK IN THE URBAN SAUDI
POPULATION DURING EARLY ADULTHOOD
A. M. Almajwal1, M. M. A. Abulmeaty1,2 *, M. F. Elsadek1,
D. Aldisi1, M. Alquraishii1, S. Razak1, N. K. Almadani1,
H. M. Hassan1, on behalf of the Deanship of Scientific Research
at King Saudi University, the research group project no RGP-
VPP-193. 1Clinical Nutrition Program, Community Health
Sciences, King Saud University, Riyadh, Saudi Arabia, 2Medical
Physiology, Obesity Research and Management Unit, Zagazig
University, Zagazig, Egypt
Rationale: Is the long-term risk of the cardiovascular
disease (CVD) among urban Saudi population during the early
adulthood determined by certain dietary and lifestyle
parameters?
Methods: A total of 371 subjects (163 men), 18–46 y old were
enrolled in a cross-sectional study. The simple lifestyle
indicator questionnaire1 was used and we investigated certain
factors such as consumption of vegetables, fruits & fishes,
following a dietary regimen (which included variety & calorie
control), salt addition, physical activity, smoking, and cola
drinking. Fasting glucose and lipid panel were analyzed, and
blood pressure was recorded in the sitting position. Lifelong
American college of cardiology/American heart association
(lifetime ASCVD)2 was calculated. Multiple logistic regression
was used to test determinants of lifetime ASCVD.
Results: Among Saudi young women, following a dietary regimen
and having no family history of cardiovascular disease reduce the
risk of lifetime ASCVD by about 89% and 80% {odds ratio (95%
CI) = 0.11 (0.02–0.52) and 0.20 (0.05–0.82), respectively,
P < 0.05}. Among men group no significant predictors were
found, however, the high-risk quartile was more smoker
(X 2 = 5.76, df 1 & P < 0.05), more cola drinker, added more table
salt, and had a family history of cardiovascular disease (P > 0.05).
Conclusion: In women, following a dietary regimen is the main
protector of ASCVD. In men, no determinants were significantly
reported however, smoking and salt addition were associated
with the high-risk quartile.
S224
References
1. Godwin et al. Testing the Simple Lifestyle Indicator Questionnaire
Initial psychometric study. Can Fam Physician 2008;54:76–77.
2. Goff et al. 2013 ACC/AHA guideline on the assessment of
cardiovascular risk: a report of the American College of
Cardiology/American Heart Association Task Force on Practice
Guidelines. Circulation. 2014;129 (25 suppl 2):S49–S73.
Disclosure of Interest: None declared.
MON-P122
DOCOHEXANOIC ACID IMPROVES INFLAMMATORY PROFILE
AND ANEMIA IN HEMODIALYSIS PATIENTS
M. Ruperto1 *, M. Fernández-Lucas2, L. Blanco2, E. Casillas2,
J. L. Teruel2, F. Liaño2. 1Human Nutrition and Dietetics,
Universidad Alfonso X el Sabio, 2Nephrology, Hospital Ramon y
Cajal, Madrid, Spain
Rationale: Docohexanoic acid (DHA), a dietary n-3 polyunsat-
urated fatty acid(PUFA n-3), have shown reduce all-cause
mortality in hemodialysis patients (HD). This study aimed
to evaluate whether DHA-supplementation modified inflam-
matory profile and modulated response to erythropoiesis-
stimulating-agents in HD.
Methods: Parallel-controlled clinical trial in 42 HD patients
(men: 69%; aged:66.7 ± 15.5;DM:19%), randomized into 2
groups: intervention group (DHA, n = 21) and, control group
(Control, n = 21). Administration of DHA supplementation
(645 mg DHA/3 times per week, post-HD) for 2 months of
follow-up. Assessment intra and inter-groups at baseline(0) and
post-intervention(1) of clinical, biochemical and nutrition-
inflammatory parameters. Inflammation measured by C-react-
ive protein(CRP), anemia control through weekly dose of
erythropoietin (Epo) and erythropoiesis -responsiveness
index (ERI).
Results: The DHA supplemented group(0–1), significantly
improved hemoglobin concentrations (Hb) (Hb0: 10.87 ± 1.65
vs. Hb1: 11.7 ± 1.15; p = 0.019), associated with lower Epo
doses (Epo0: 13312.5 ± 8.219,6 vs. Epo1: 8687.5 ± 6680.5;
p = 0.022) and ERI (IRE0: 22.25 ± 13.77 vs. IRE1:12.28.±8.96;
p = 0.005); whereas in the control group there were not found
differences in the Epo requirements(Epo0:7850 ± 6002.4 vs.
Epo1: 9000. ± 7732; p = 0.22) and ERI (ERI0:14.7 ± 13.7 vs.
ERI1:16.4. ± 14.9;p = 0.32) in the control group. High mean
values of CRP (inter and intra-groups) in the control group
(Control, CRP(0–1):18.79 ± 4.4–28.23 ± 15.4; p = 0,018), com-
pared with DHA group (DHA, PCR(0–1):18.79 ± 4.4–13.15 ± 3.5;
p = 0,018) were found. No significant changes in lipid profile
were observed. Adverse effects with DHA supplementation
were not found.
Conclusion: DHA supplementation post-HD enhances the
inflammation and the control of anemia in HD patients.
Further studies are required to evaluate longitudinally the
effect of DHA in inflammatory biomarkers for the control of
anemia.
Disclosure of Interest: None declared.
Poster
MON-P123
STUDY OF THE DIAGNOSTIC VALUE OF THE GERIATRIC
NUTRITIONAL RISK INDEX (GNRI) IN PATIENTS ON
HEMODIALYSIS: INFLUENCE OF AGE
M. C. Terroba Larumbe1 *, C. Crespo Soto1,
M. Gonzalez Sagrado2, J. M. Monfá Bosch3, G. Cabezas García1,
M. Ventosa Viña1, L. Cuellar Olmedo1, M. Chimeno Viñas1,
G. Gallego Herreros1. 1Endocrinology and Nutrition, 2Research
Support Unit, 3Nephrology, Hospital Universitario Río Hortega,
Valladolid, Spain
Rationale: To determine the sensitivity and specificity of
the GNRI, proposed as a nutritional screening method in
patients on hemodialysis, applying different cutoff points, and
taking as reference the protein energy wasting (PEW)
syndrome.
Methods: 53 patients were evaluated (35 men, 18 women),
mean age 68.3+/−13.5 years, 28 under 70 and 25 over 70 years
old, median time on hemodialysis 34 months (range 7.4–80.9).
The prevalence of malnutrition was established according
to the International Society of Renal Nutrition and Metabolism
(ISRNM) criteria to diagnose PEW syndrome and with the
formula: IRNG = [14.89 × albumin (g/dl)] + [41.7 × (weight/
ideal weight)], applying different cutoff points. The analysis
was performed globally and separating patients according
to age.
Results: The table includes the prevalence of malnutrition in
frequency and percentage, applying PEW and GNRI, and the
sensitivity and specificity of GNRI. 19 patients (35.8%) were
diagnosed as PEW; 11 (39.3%) of them < 70 and 8 (32%) > 70.
Considering the GNRI < 92 diagnosis overall, sensitivity (S) was
42.1 and specificity (Sp) 85.3, being 50 and 70.6 respectively in
those aged >70. Applying GNRI < 100 overall, sensitivity was 84.2
and specificity 55.9 [ positive predictive value (PPV) 51.6,
negative predictive value (NPV) 86.4]; in those aged > 70
the sensitivity was 100 and the specificity was 41.2 [PPV 44.4,
NPV 100].
Group PEW GNRI < 92 GNRI < 100
Global 19 (35,8%) 13 (24,5%) S42.1 Sp85.3 31 (58,5%) S84.2 Sp55.9
Age < 70 11 (39,3%) 4 (14,3%) S36.4 Sp100 13 (46,4%) S72.7 Sp70.6
Age > 70 8 (32%) 9 (36%) S50 Sp70.6 18 (72%) S100 Sp41.2
Conclusion: Although the GNRI < 92 has been postulated as a
simple and valid marker of malnutrition in hemodialysis
patients, in our study it showed a low sensitivity in the global
patient population. Applying the GNRI < 100 could be useful for
those over 70 years old.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 2
MON-P124
VALUE OF THE PROTEIN CATABOLIC RATE (PCR) AS AN
INDICATOR OF PROTEIN INTAKE IN HEMODIALYSIS PATIENTS
(HDP) AND ITS ASSOCIATION WITH ANTHROPOMETRIC AND
BIOCHEMICAL PARAMETERS. INFLUENCE OF INFLAMMATION.
M. C. Terroba Larumbe1 *, C. Crespo Soto1,
M. Gonzalez Sagrado2, R. Conde Vicente2, G. Cabezas Garcia1,
A. Quintano Pindado3, M. Ventosa Viña1, G. Gallego Herreros1,
L. Cuellar Olmedo1. 1Endocrinology and Nutrition, 2Research
Support Unit, 3Nephrology, Hospital Universitario Río Hortega,
Valladolid, Spain
Rationale: Low protein intake is associated with higher
mortality in HDP and should be monitored by a dietary survey
or by measuring the PCR adjusted for body weight (nPCR)
expressed in g/kg/day, indicative of protein intake in stable
patients. The aim of this study is to evaluate the achievement
of the objective of protein intake > 1.2 g/kg/d in our patients
using both methods and the correlation between nPCR,
nutritional and inflammatory parameters.
Methods: 29 patients were evaluated (21 men, 8 women),
mean age 68.7+/−12.9 years, applying a food survey, mid arm
muscle circumference (MAMC), body mass index (BMI), albumin
and C-reactive protein (CRP). Presence of inflammation is
recognized if CRP > 3 mg/L.
Results: Mean nPCR:1.2 g/kg/d; Median:1.13 (Q1 0.96 Q3
1.35); 14 of the 29 patients (48.3%) showed inflammation. The
protein intake objective was reached in 12 cases (41.4%)
according to nPCR and in 17(58,7%) according to the survey.
Overall nPCR was not associated with protein intake according
to the survey or with CRP but we found a significant association
between nPCR and albumin(r = 0.479; p = 0.009). When inflam-
mation is not present nPCR was not correlated with the survey
but the mean value was higher in patients who met survey
targets than those who did not (1.15 versus 0.8 mg/kg/d). nPCR
was not associated with albumin, MAMC or BMI. When
inflammation is present, nPCR showed a non-significant
negative association with the protein intake surveys, signifi-
cant correlation with albumin(r = 0.566, p = 0.035) and non-
significant association with MACM and BMI.
Conclusion: In our study, nPCR was associated with albumin, a
marker of mortality in HDP but it was not useful as an indicator
of protein intake, especially in hypercatabolic patients.
Despite nutritional intervention it is difficult to meet the
intake goals.
Disclosure of Interest: None declared.
MON-P125
CHANGES IN THE NUTRITIONAL PARAMETERS OF PATIENTS IN
MAINTENANCE HEMODIALYSIS (MHD) DIAGNOSED WITH
PROTEIN ENERGY WASTING (PEW) SYNDROME WITH A
SPECIFIC ORAL SUPPLEMENT (OS)
M. C. Terroba Larumbe1 *, C. Crespo Soto1,
M. Gonzalez Sagrado2, B. Gomez Giralda3, L. Cuellar Olmedo1,
M. Ventosa Viña1, F. Nuñez Ortega1, A. Barrera Rebollo4,
G. Gallego Herreros1. 1Endocrinology and Nutrition, 2Research
Support Unit, 3Nephrology, 4Surgery, Hospital Universitario Río
Hortega, Valladolid, Spain
Rationale: Oral supplements improve nutritional parameters
and reduce mortality in MHD patients. However, there are not
S225
many studies that analyze separately the effect on the
malnourished. Furthermore the definition of malnutrition
varies widely among them so there is little data regarding OS
use in patients with PEW syndrome.
Methods: 43 patients were evaluated (31 men, 12 women),
mean age 68.2+/−13.7 years, carrying out food survey,
anthropometry, bioimpedance and biochemistry at the base-
line and after 7.6+/−0.4 months. The presence of PEW was
defined according to the International Renal Society of
Nutrition and Metabolism (ISRNM) criteria. PEW patients at
baseline took a specific OS (Nepro® HP), 1 bottle daily (220 ml,
396 kcal, 17.8 g of protein with lower concentrations of
carbohydrates, sodium, potassium and phosphorus than stand-
ard OS). Non-PEW patients received routine care.
Results: 16 patients were diagnosed as PEW at baseline and
received OS. After follow-up, non-PEW patients who did not
take the supplement had a significant decrease in mid arm
muscle circumference (MAMC) ( p = 0.001) and body mass index
(BMI) ( p = 0.033) while PEW patients did not show significant
changes. Analyzing the percentage of patients who met the
dietary intake goals: in non-PEW patients, caloric intake
dropped from 46.2% to 40.7% and protein intake increased
from 84.6% to 92.6% while in PEW patients, caloric intake
increased significantly from 37.5% to 87.5% ( p = 0.003) and
protein intake increased from 81.2% to 100%.
Conclusion: The use of specific OS in our PEW patients
favored the achievement of the dietary intake goals, signifi-
cantly in the case of energy, although significant improvements
were not produce in the anthropometric parameters. The use
of OS in non-PEW patients could prevent nutritional
deterioration.
Disclosure of Interest: None declared.
MON-P126
CONTROLLED RANDOMIZED STUDY IN ANOREXIC
HEMODIALYSIS PATIENTS TREATED WITH MEGESTROL ACETATE
COMPARED WITH PLACEBO.
M. Fernández-Lucas1, M. D. M. Ruperto Lope2 *, M. Diaz1,
N. Rodríguez-Mendiola1, G. Ruíz-Roso1, J. L. Teruel1, F. Liaño1.
1
Nephrology, Hospital Ramon y Cajal, 2Human Nutrition and
Dietetics, Universidad Alfonso X EL Sabio, Madrid, Spain
Rationale: Uremic anorexia is a frequent nutritional disorder in
hemodialysis patients (HD). This study aimed to analyse the
effect of megestrol acetate on uremic anorexia vs. placebo in
HD patients.
Methods: A sample of 19 HD patients (men: 44,4%, age: r: 40–80
years) were enrolled in a randomized –controlled study for 1
year follow–up in a HD unit. Uremic anorexia by Likert scale was
evaluated. The sample was randomized into two groups: G1,
intervention group: 160 mg/ day of megestrol acetate (n = 10)
and placebo group (n = 9). A dose of 160 mg/day of megestrol
acetate was provided during 3 months of follow-up.
Anthropometric measures, biochemical parameters and body
composition analysis by bioelectrical bioimpedance (EFG,
Akern, SRL), on baseline (V0) and post-intervention period
(V1) were performed.
Results: At baseline, no differences between groups on age,
time on HD, serum albumin and Kt/Vsp were found. At 3
months, 90% of intervention group vs. 44.4% of placebo group
had better perception of appetite. Higher significant body
S226 Poster

weight, serum creatinine and serum albumin were only found in higher BMI, Fat-Free mass, Total Fat mass, and Total muscle
intervention group (at least, p < 0.05). No adverse effects were mass are associated with slight decrease in the risk of
found with administration of megestrol acetate. osteoporosis.
Conclusion: The administration of megestrol acetate improve Conclusion: BMI and Fat Free Mass evaluated by by bioelec-
nutritional status being associated significantly with weight trical impedance analysis are associated with osteoporosis risk,
gained and higher serum albumin and creatinine concentra- which is in line with previous studies.
tions in anorexic HD patients. Further longitudinal studies are Disclosure of Interest: None declared.
required to evaluate uremic anorexia in HD patients.
Disclosure of Interest: None declared. MON-P128
A PILOT STUDY: THE DIFFERENCE OF BODY FAT COMPOSTION
MON-P127 IN CHRONIC KIDNEY DISEASE PATIENT ON HEMODIALYSIS WITH
ANTHROPOMETRIC AND BIOIMPEDANCE PARAMETERS AND AND WITHOUT TYPE 2 DIABETES MELLITUS IN ATMA JAYA
THEIR ASSOCIATION WITH OSTEOPOROSIS. A CASE CONTROL HOSPITAL
STUDY M. R. Iryaningrum1 *, L. Luse1, V. Visakha1, F. Chriestya1,
M. J. Martínez-Ramírez1*, C. Montes Castillo2, Y. Maslim1. 1Internal Medicine, School of Medicine Atma Jaya
C. Tenorio Jiménez3, M. Garrido Martínez3, Catholic University of Indonesia, Jakarta, Indonesia
A. D. Delgado-Martínez4, M. de Damas Medina3,
M. Serrano Quero3, M. Delgado-Rodríguez5. 1Endocrinology and Rationale: Chronic kidney disease (CKD) is a common
Nutrition, Hospital of Jaén. University of Jaén, Jaén, comorbidity in patients with type 2 Diabetes Mellitus (T2DM).
2
Endocrinology and Nutrition, La Paz Hospital, Madrid, About 50% patients with T2DM globally estimated have CKD.
3
Endocrinology and Nutrition, Hospital of Jaén, 4Traumatology Visceral or central obesity, as evidenced by waist-hip ratio
and Orthopaedic Surgery, Hospital of Jaén. University of Jaén, (WHR), is very common in T2DM and increase cardiovascular
5
Public Health and Epidemiology, University of Jaén, Jaén, Spain morbidity and mortality. WHR is used as an indirect measure of
body fat composition. The aim of the study is to know body fat
Rationale: Low body weight is one of the main factors for composition in CKD patient on hemodialysis (HD) with and
osteoporosis. Specifically loss of muscle has been associated without T2DM.
with an increase in fracture risk. Our aim was to assess the Methods: A pilot study that using simple random sampling was
association between anthropometric and bioimpedance ana- done to CKD patients on HD who came to HD unit in Atma Jaya
lysis parameters and the presence of osteoporosis. Hospital from January to March 2017. We made two group of
Methods: Case-control study. Fifty eight cases and 58 controls patients consisted of 12 patients with T2DM and 29 patients
matched for age (±1 year) and sex. Cases were patients without T2DM. Those patients underwent anthropometric
diagnosed with osteoporosis using Dual-energy X-ray absorpti- measurement, such as body mass index (BMI), WHR, and skin-
ometry (DXA). Controls were healthy individuals without fold test, to assess body fat composition.
osteoporosis (DXA performed) and no history of fractures. Results: There were 23 (56,1%) male and 18 (43,9%) female
Anthropometric parameters (weight, height, BMI) and evalu- patients participated in this study. The median age among
ation of body compartments by bioelectrical impedance patients was 50 (25–68) years. BMI, WHR, and skin-fold calipers
analysis were performed in both groups. Statistical analysis: in CKD patients on HD with and without T2DM, sequentially, was
T-test for comparison of means and Multivariate linear 24,87 ± 4,5 and 21,51 ± 3,07; 0,97 ± 0,07 and 0,91 ± 0,07;
regression models. 2,23 ± 1 and 1,31 ± 0,65. There are significant differences in
body fat composition between diabetic and non-diabetic
Table 1: Mean Differences between Cases and Controls.
patients in all of the anthropometric measurement.
Anthropometric parameters Conclusion: There are differences of body fat composition in
Variable p-value
CKD patient on HD with and without type 2 DM. Future research
Weight (Kg) Controls 74.88 (1.72) 0.00 with larger sample and laboratory measurement is needed to
Cases 64.01 (1.65) determine the significant differences.
Height (cm) Controls 157.98 (0.76) 0.15
Cases 156.18 (0.99) Disclosure of Interest: None declared.
BMI (Kg/m2) Controls 30.05 (0.70) 0.00
Cases 26.26 (0.61)
MON-P129
Bioelectrical impedance analysis
Variable Mean (±EEM) p-value RELATION BETWEEN OMEGA-6 INTAKE AND CYTOKINES
Fat (%) Controls 35.40 (1.15) 0.07
CONCENTRATION IN WOMEN WITH RHEUMATOID ARTHRITIS.
Cases 32.53 (1.10) M. Lozada-Mellado1 *, M. Ogata-Medel1, L. Llorente2,
Total Body water (Kg) Controls 45.55 (0.73) 0.08
A. Hinojosa-Azaola2, J. A. Pineda-Juárez1,
Cases 47.37 (0.72)
Fat Free Mass (Kg) Controls 47,30 (1.14) 0.01 J. M. García-Morales1, A. Rojas-Mandujano1,
Cases 43.26 (1.10) L. Castillo-Martínez1, J. Alcocer-Varela2. 1Nutrición clínica,
Total Muscle Mass (Kg) Controls 44.84 (1.03) 0.01 2
Reumatología, Instituto Nacional De Ciencias Médicas Y
Cases 40.28 (1.38)
Total Fat Mass (Kg) Controls 27.18 (1.58) 0.00 Nutrición Salvador Zubiran, Ciudad de México, Mexico
Cases 21.60 (1.26)
Rationale: Polyunsaturated Fatty Acids (PUFAs) are associated
Results: We observed a significant difference between cases with inflammation. While Omega-3 PUFAs have emerged as
and controls in weight, BMI, Fat Free mass, Total Fat mass, and anti-inflammatory, the role of Omega-6 PUFAs is yet to be
Total Muscle mass (Table 1). Multivariate analysis showed that established in rheumatoid arthritis (RA).
Nutrition and chronic diseases 2
Methods: Women with RA global functional status I-III were
included, cytokines levels were determined by the Luminex
method, the intake of Omega-6 PUFAs was obtained by 24-hour
dietary recall which was divided in terciles of consumption (low
<4.1 gr, intermediate 4.1–14.0 gr, and high intake ≤ 15.0 gr),
and the difference between terciles was obtained by ANOVA.
Results: Fifty women were included with median age of 47
(P25th 37.5 – P75th 55) years, mean DAS28 score 2.5 ± 1.1, and
median disease duration 9 (P25th 5 – P75th 19) years. It was
observed that the group of lower intake of Omega-6 PUFAs had
higher concentration of proinflammatory cytokines compared
with intermediate and high intake, independently of other
variables associated with inflammation: EGF p= 0.003 151.96
(P25th 54.15- Pth75 202.22) vs 60.93 (P25th 30.4 - P75th
119.8), IL12 p= 0.05 76.84 (P25th 2.1 - P75th356.7) vs 20.17
(P25th 0 P75th 67.25), IL13 p= 0.001 91.98 (P25th 0 – P75th
319.8) vs 0.28 (P25th 0 – P75th 6.5), IL5 p= 0.014 11.98 (P25th
0.1 – P75th 72.0) vs 3.29 (P25th 0.62 – P75th 9.0), IL8 p = 0.002
40.31 (P25th 40.31 – P75th 138.32) vs 15.84 (P25th 9.7 – P75th
23.6), TNFβ p= 0.001 278.11 (P25th 16.3 – P75th 706.49) vs
12.45 (P25th 0 – P75th 98.69).
Conclusion: The high intake of Omega-6 PUFAs was associated
with the decrease serum levels of proinflammatory cytokines.
Disclosure of Interest: None declared.
MON-P130
Β-HYDROXY-Β-METHYLBUTYRATE (HMB) PLASMA LEVELS
ARE STRONGLY RELATED TO MUSCLE MASS AND STRENGTH IN
PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
M. P. Engelen1 *, D. K. Walker1, A. Wierzchowska-Mcnew1,
M. S. Jeon1, N. E. Deutz1. 1Center for Translational Research in
Aging and Longevity, Dept. Health and Kinesiology, Texas A&M
University, College Station, United States
Rationale: β-hydroxy-β-methylbutyrate (HMB), a product of
leucine (LEU) oxidation, is known for its anti-catabolic
properties. Chronic Obstructive Pulmonary Disease (COPD) is
often associated with muscle loss and dysfunction but the role
of HMB remains unclear. This study investigates the relationship
between HMB metabolism, muscle strength and mass in normal
weight COPD patients.
Methods: In 22 patients with moderate to severe COPD (GOLD
II-IV) and 13 age-matched healthy control subjects, fasted
plasma HMB, branched chain amino acid (BCAA) and keto acid
(BCKA) concentrations, and rate of appearance (Ra) of LEU
were measured after pulse IV administration of 2H3-LEU, and
absolute synthesis rate of HMB from Leucine (ASR LEU > HMB)
was calculated. Appendicular skeletal muscle mass index
(ASMI) was measured by Dual-energy X-ray absorptiometry,
and respiratory-, handgrip-, and leg muscle strength by mouth
pressures, handgrip- and one leg dynamometry, respectively.
We measured plasma concentrations and enrichments by GC-
and LC-MS/MS. Statistics by unpaired t-tests and spearman
correlation tests.
Results: The COPD patients were characterized by reduced
(upper and lower) limb and inspiratory mouth pressure
( p < 0.01), and increased Ra LEU ( p < 0.001) as compared to
the healthy control group, and comparable values for ASMI,
plasma HMB, BCAA and BCKA concentrations, and ASR
LEU > HMB. Significant relationships were found in COPD
patients between plasma HMB and ASMI (r:0.77, p < 0.001),
S227
handgrip strength (r:0.62, p < 0.01), leg strength (r:0.66,
p < 0.01), inspiratory- (r:0.52, p < 0.05) and expiratory mouth
pressures (r:0.64, p < 0.01). ASR LEU > HMB was correlated with
plasma HMB (r:0.53, p < 0.05) and BCKA concentrations (r:0.51,
p < 0.05), and handgrip strength (r:0.73, p < 0.001).
Conclusion: Muscle weakness is associated with reduced HMB
concentration and production in patients with COPD.
Disclosure of Interest: None declared.
MON-P131
TASTE RECEPTOR POLYMORPHISMS AND OBESITY: IS THERE
A LINK?
M. Taus1 *, A. Vignini2, F. Borroni2, S. Pugnaloni2,
J. Sabbatinelli2, M. Fabri3, M. Emanuelli2, D. Fumelli1,
M. Cecati2, G. Nicolai1, D. Busni1, A. Nicolai1, L. Mazzanti2.
1
Unità di Dietetica e Nutrizione Clinica, Azienda Ospedaliera
Universitaria di Ancona, 2Dipartimento di Scienze Cliniche
Specialistiche ed Odontostomatologiche-Sezione di
Biochimica, Biologia e Fisica, Facoltà di Medicina e Chirurgia,
3
Dipartimento di Medicina Sperimentale e Clinica, Sezione di
Neuroscienze e Biologia Cellulare, Facoltà di Medicina e
Chirurgia, Università Politecnica delle Marche, Ancona, Italy
Rationale: Taste sensitivity plays an important role in
individual food preferences and dietary habits and its
changes is positively correlated with Body Mass Index (BMI)
increase. The aim of this study was to investigate the genetic
polymorphisms of taste receptors in obese and control patients
since their modifications could lead to prefere high-calorie
foods that promote the onset of obesity.
Methods: In 78 overweight-obese patients (BMI ≥ 25 kg/m2)
and 31 normoweight healty patients (BMI < 25 kg/m2), we
investigated 4 different polymorphisms: TAS2R38 A49P
(rs713598) and TASR38 V462A (rs1726866) located at TAS2R38
gene (NM_176817.4) which codifies for the bitter taste
receptor; and TAS1R3 C-1572T (rs307355) and TAS1R3 G-
1266A (rs35744813) located at TAS1R3 gene (NM_152228.2)
which codifies for the sweet taste receptor. These 4 investi-
gated polymorphisms differ at three nucleotide positions
resulting in amino acid changes in the protein.
Results: The frequency of the mutations for TAS1R3 C-1572T
and TAS1R3 G-1266A is extremely low in pathological and
control samples; thus we aren′t able to formulate any
suggestion relative to alleles distribution. On the contrary,
preliminary data seem to show a different distribution for two
alleles involved in both of two polymorphisms TAS2R38 A49P
and TAS2R38 V462A between pathological and control groups.
Conclusion: Our data could support recent scientific advances
showing that single nucleotide polymorphisms are linked to
differences in taste perception and food preference. The
importance of genetic chemosensory variation and the
influence of gustatory functioning on eating behavior should
be investigated in each person since individual genotypic
variations results in specific phenotypes of food preference and
nutrient intake. In conclusion, our findings could provide
important insights for the design of new therapies for weight
loss and long-term weight maintenance.
Disclosure of Interest: None declared.
S228
MON-P132
EQ5D-3L INCLUDING VAS FOR MEASURING QUALITY OF LIFE
IN HPN PATIENTS
M. Holst1,2 *, L. Ryttergaard3, L. S. Frandsen2,
L. Vinter-Jensen2, H. H. Rasmussen1,2. 1Department of Health
Sciences, Aalborg University, 2Center for Nutrition and Bowel
Disease, Aalborg University Hospital, Aalborg,
3
Gastroenterology, Herlev Hospital, Copenhagen, Denmark
Rationale: According to literature, HPN patients experience
reduced quality of life (QOL). This study aimed to explore the
internal validity for measuring quality of life by EQ5D-3L
including VAS in a Danish population of HPN patients.
Methods: All patients receiving HPN for > one year (N = 88) at
Center for Nutrition and Bowel Disease, Aalborg University
Hospital, were included in the investigation of EQ-5D-3L
including the EQ VAS (visual analogue scale), which was sent
to patients by mail, with a reply envelope.
Results: A total of 50 (57%) patients mean age 63(SD 12.4)
responded. Of these, 68% were female. The majority were
cohabiting 31 (62%), 40% had a medium high education, and 53%
retired. Home care nurse was involved in 26 (53%) care around
HPN. Overall EQ5D VAS score for QOL was 58.73. a numerically
lower score was found in Female (56.44) than male (63.59).
Lowest VAS-QOL was found in patients aged 30–50 years
(Female: 48 and Male: 55). For the EQ5D dimensions, most
patients indicated ‘no problems’ to mobility, personal care and
anxiety/depression, while for usual activities 30% and pain/
discomfort, 36% reported ‘difficulties’. The mean value of EQ-
5D index score (0.694) was higher than the mean VAS score
(0.587); T = 5.172 and p < 0.001. Further studies may explain
the difference between the two parts of EQ5D-3L.
Conclusion: A significant difference was seen between the
EQ5D-QOL-measures, by index score and VAS. Decreased QOL in
HPN patients is seen especially in age below 50, and in
dimensions of usual activities and pain/discomfort.
Disclosure of Interest: None declared.
MON-P133
VİTAMİN D AND PSYCHOLOGİCAL STATUS İN DİALYSİS PATİENT
M. Aydin Cil1 *, K. Gokalp2, A. Yayla3. 1Nutrition and Dietetic,
Health Science Faculty, Ataturk University, 2Psychological,
3
Surgery, Nursing Faculty, Ataturk University, Erzurum, Turkey
Rationale: Psychological disorders are common problems
among end-stage renal disease patients. Vitamin D (VD) can
be essential for congitive functions. Especially depression is
associated with VD deficiency. The aims of this study was to
elucidate association between serum VD level and psycho-
logical status in dialyzed patients.
Methods: The study was carried out in a university hospital
dialysis center in Eastern Turkey. 25(OH) D levels measured in a
university hospital biochemical laboratuary. Psychological
status was evaluated by Brief Symptom Invantory.
Results: The study was conducted with 90 dialysis patient (59
hemodialysis, 31 continuous ambulatory peritoneal dialysis).
Mean age was 53.74 ± 14.83 (18–81) years, 61.6% of patients
were female, 38.4% of patients were male. Mean VD was
23.51 ± 29.50 ng/mL (3–118) and 63.2% of patients were levels
of VD<20 ng/mL, 8.9% of patients were levels of VD 20–30 ng/
mL, %27.8 of patients were levels of VD >30 ng/mL. Negatif
Poster
correlation was found between VD and psychological status in
dialysis patients ( p < 0.05). There was statistically significant
relation between VD and obsessive compulsive disorder,
depression, paranoid ideation scores ( p < 0.05). Patients who
low VD level has had high scores.
Conclusion: VD levels can be effective on psychological status
in dialysis patients. Vitamin D is essential for not only bone
health but also psychological wellness in these patients. While
clinicians will asses and therapy of dialysis patient’s psycho-
logical status should take into account patient’s vitamin D
status.
Disclosure of Interest: None declared.
MON-P134
MEGESTROL ACETATE INCREASE MUSCLE MASS IN
HEMODIALYSIS PATIENTS
M. Fernandez-Lucas1, M. D. M. Ruperto2 *, M. Díaz1,
N. Rodríguez-Mendiola1, G. Ruíz-Roso1, J. L. Teruel1, F. Liaño1.
1
Nephrolgy, Hospital Ramón Y Cajal, 2Nutrition, U. Alfonso X el
Sabio, Madrid, Spain
Rationale: Megestrol acetate is a stimulant-appetite with
potential effects in uremic anorexia in hemodialysis patients
(HD). The study aimed to assess the effect of megestrol acetate
on nutritional status and the body composition changes in
HD patients.
Methods: Descriptive-longitudinal-intervention study in 9
anorexic HD patients (men: 44,4%, age: r: 40–80 yr) assessed
by Likert scale. A dose of 160 mg/day of megestrol acetate was
provided during follow-up (2–12 months). Anthropometric
measures, biochemical parameters and body composition
analysis by bioelectrical bioimpedance (EFG, Akern, SRL), on
baseline (V0) and post-intervention period (V1) were
performed.
Results: Mean time of follow-up was 6.5 ± 3.8 months. Data
post-intervention compared with baseline showed significant
differences with dry weight (V1: 61.7 ± 13.7 vs. V0: 56.7 ± 11.2;
p= 0.009), intracellular body water (V1: 56.5 ± 5 vs. V0:
49.9 ± 5; p = 0.01), body cell mass (kg) (V1: 25 ± 7.5 vs. V0:
21.3 ± 6.1; p= 0.025), and muscle mass (V1: 30.8 ± 8.9 vs. V0:
26.7 ± 7.6; p= 0.033). No significant changes on fat mass were
found. Higher normalized nitrogen appearance (V1: 1.5 vs. V0:
0.97 g/kg /day; p < 0.05), as well as higher level of serum
albumin and s-creatinine (both, p < 0.05), were found in post-
intervention state. No changes in phosphatemia and dialysis
dose (sp Kt/Vurea) or adverse effects of megestrol acetate
were observed.
Conclusion: The administration of megestrol acetate improve
nutritional-hydration being associated significantly with
weight gained and higher body cell mass, muscle mass and
serum albumin in anorexic HD patients. Further longitudinal
studies are required to evaluate uremic anorexia in HD
patients.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 2
MON-P135
MONITORING OF NUTRITIONAL STATUS IN PATIENTS WITH A
PSYCHIATRIC DIAGNOSIS, COMPARED PARAMETER VALUES IN
THE GROUP OF PATIENTS WITH EATING DISORDERS
(ANOREXIA NERVOSA AND BULIMIA NERVOSA) AND WITHOUT
EATING DISORDERS
M. Navratilova1 *, J. Tůmová2, J. Jarkovský3. 1Department of
Psychiatry, 2Department of Clinical biochemistry, Medical
Faculty of Masaryk University and University Hospital Brno,
3
Institute of Biostatistics and Analyses, Medical Faculty of
Masaryk University Brno, Brno, Czech Republic
Rationale: The aim of our study was to monitor the nutritional
status and laboratory parameters in patients with a psychiatric
diagnosis and compare parameter values in the group of
patients with eating disorders and without eating
disorders (ED)
Methods: We observed a total of 338 patients with a psychiatric
dg 217 women, 121 men over a period of 1y from January to
December 2014. The average length of follow-up was
3.5 months, 122 patients with ED-32 with bulimia nervosa, 62
with anorexia nervosa, 28 with mixed form and 216 with other
psych. diagnoses:128 women, 88 men. The average age of
patients with ED was 26 y, women accounted 90.2%, males 9.8%
of the dataset, aged 14–38 y, average age with other psychiatric
diagnoses was 36 y, women 59%, men 41% of the dataset, aged
15–87 y. Patients were observed in long-term study.
We investigated the biochemical prm a total of 36 prm in serum
and 10 prm in urine for 24 hrs under metabolic screening.
The dataset were statistically evaluated.
Results: Statistically significant differences were found for
total bilirubin, GGT, ALP, total protein, glucose, albumin,
phosphorus, sodium, potassium, magnesium, iron, pancreatic
amylase, HDL-cholesterol, total T3, prealbumin, transferrin
and ferritin, but it did not response the severity of the clinical
condition. For the assessment of the clinical status these
differences between the two groups are insignificant.
Conclusion: We reaffirmed that it cannot reveal the dg of ED
using biochemical parameters, we observed small differences
in contrast to significant weight loss and very serious clinical
conditions (bradycardia, arrhythmia, hypotension, amenor-
rhea, osteopenia to osteoporosis, lanugo, impaired thermo-
regulation, trophic changes, changes in GIT, peripheral
cyanosis, colaps conditions, epiparoxysmy, immune
deficiencies).
Disclosure of Interest: None declared.
MON-P136
A PROTOCOL FOR MEDICATION RECONCILIATION IN PATIENTS
WITH FEEDING TUBE
M. G.-M. G.-M. Isabel1, M. Moreno Santa Maria1, E. Alvaro1,
L. Rey1, J. Abiés1 *, J. Arenas1. 1Hospital Costa Del Sol,
Marbella, Spain
Rationale: To describe the characteristics of a population of
patients with feeding tube who have been included in a
program for medication reconciliation and drug management
education provided by pharmacist. Secondarily, to analyze if
the recommendations are accepted by the doctor and the
medication is modified according to our indication
S229
Methods: The protocol contemplates to review home medica-
tion in all patients that at discharged incorporate a feeding
tube. Pharmacists list all medication by reconciliation protocol
and record it in patient history. These report includes
medication recommendation for feeding tube according to
bibliography. During 2016 for each patient was recorded:
demographic variables, type of feeding tube, conciliation to
hospital discharge or replacement of the device, causes of
feeding tube establishment, number of patients who needed
pharmacists’ intervention, and patient with pharmacists
intervention whose physician adapted treatment to their
recommendations.
Results: 116 patients were recruited, 61.8% women, mean age
76 ± 18 years. 62.9% PEG, 36.2% NGT, 0.86% nasojejunal tube.
58.6% was performed at the time of device placement, and
41.4% at subsequent insertions. [U1] [I2] Causes of feeding
tube: Dementia 18.96%; Ictus 29.31%; Neoplasms 18.11%,
Alzheimer’s 16.37%; Parkinson’s disease 5.18%; Other 12.06%.
After reviewing patient’s medication at discharged, 75% of
them required a reconciliation report. After physicians
prescriptions analysis, 45.9% of pharmacist’s recommendations
were accepted
Conclusion: Three quarters of patients require medication
modifications according to feeding tube characteristics. The
implementation of the protocol allows an early adaptation of
the medication and a periodic monitoring of the use of the
medication in half of patients
Disclosure of Interest: None declared.
MON-P137
EFFECT OF CITRULLINE SUPPLEMENTATION COMBINED TO
HIGH INTENSITY INTERVAL TRAINING ON FUNCTIONAL
CAPACITIES AND BODY COMPOSITION IN NON-OBESE OLDER
ADULTS.
M. Aubertin-Leheudre1,2 *, M. C. Dulac1, G. El Hajj Boutros3,
L. P. Carvalho3, V. Marcangeli3, P. Gaudreau4, J. A. Morais5,
G. Gouspillou3, P. Noirez6. 1Sciences of Physical Activity, UQAM,
2
Centre de Recherche de l’Institut Universitaire de Geriatrie
de Montreal (CRIUGM), 3UQAM, 4U de Montreal, 5McGill
University, Montreal, Canada, 6Paris Descartes University,
Paris, France
Rationale: Aging is associated with an increase in fat mass
(FM), a decrease in muscle mass (LBM) and strength leading to a
decline in functional capacity. In animal studies, citrulline
supplementation (CIT) induces an increase of LBM, a decrease
of FM and stimulates lipolysis. Our aim was to evaluate the
effect of CIT combined to high intensity interval training (HIIT)
on functional capacities and body composition in non-obese
older adults.
Methods: 44 non-obese (BMI < 30 kg/m2) and sedentary (<2 h of
structured exercise/week) older adults (>60 yrs) have been
recruited and double-blinded randomly assigned to 2 groups:
Placebo (PLA; n = 21) and CIT (n = 23).
All participants received 10 g of CIT supplementation/day and
followed a HIIT (30 min/session; cycle: 30 sec > 80% heart rate
(HR)+ 1:30 min at 65%HR) on elliptical during 12 weeks.
Body composition (LBM, FM: DXA); functional capacities
(unipodal balance; normal and fast timed up & go (nTUG;
fTUG); chair and step tests);handgrip stenght (HS) & aerobic
S230 Poster

capacities (6min-walk test; VO2 max) were measured pre and MON-P139
post-intervention. PATIENTS WITH SHORT BOWEL SYNDROME STRATIFIED BY
Results: At baseline, no difference was observed for age DIAGNOSIS: POST HOC ANALYSIS OF TEDUGLUTIDE ON FLUID
(67.9 ± 3.3 vs 67.5 ± 5.0 yrs), BMI (26.1 ± 2.2 vs 25.5 ± 2.4 kg/ COMPOSITE EFFECT
m2), total FM (24.04 ± 5.04 vs. 24.14 ± 5.28 kg) and LBM P. B. Jeppesen1 *, S. M. Gabe2, K. Iyer3, U.-F. Pape4,
(47.6 ± 9.9 vs. 44.1 ± 8.8 kg) or HS/body weight (0.46 ± 0.08 D. L. Seidner5, H.-M. Lee6, C. Olivier7. 1Rigshospitalet,
vs. 0.44 ± 0.010 kg/kg) between the PLA and CIT groups. Copenhagen, Denmark, 2St Mark’s Hospital, Northwick Park,
Using a General Linear Model repeated measured, we observed United Kingdom, 3Mount Sinai Medical Center, New York,
that the CIT group improved significantly more unipodal United States, 4Charité University Medicine, Berlin, Germany,
balance ( p = 0.020), nTUG ( p = 0.033), fTUG ( p = 0.0016), and 5
Vanderbilt University Medical Center, Nashville, 6Shire Human
total ( p = 0.033), trunk ( p = 0.042) and android ( p = 0.017) FM. Genetic Therapies, Inc., Lexington, United States, 7Shire
Conclusion: CIT supplementation combined to HIIT improves International GmbH, Zug, Switzerland
more efficiently functional capacities and body composition in
non-obese older adults. Further studies will be necessary to Rationale: Inflammatory bowel disease (IBD) and mesenteric
decipher the underlying mechanism of action of CIT in vascular (Vasc) disease are underlying conditions for short
association with exercise. bowel syndrome−intestinal failure (SBS−IF). Fluid balance,
Disclosure of Interest: None declared. urine production, and parenteral support (PS) volume are
variable among SBS−IF patients ( pts). This is a post hoc analysis
MON-P138 of teduglutide (TED) on fluid composite effect (FCE = sum of
PREVALANCE OF MALNUTRITION IN HOSPITALIZED CHILDREN urine volume output increase, oral fluid intake reduction, and
PS volume reduction) in pts stratified by diagnosis.
N. Urganci1 *. 1Pediatry, Nutricia, Istanbul, Turkey Methods: STEPS (NCT00798967; EudraCT2008-006193-15) was
a 24-wk, placebo (PBO)−controlled study of TED 0.05 mg/kg/
Rationale: This study aims to investigate the distribution of
day in SBS−IF pts. Three groups were evaluated: SBS−IBD, SBS
malnutrition and disease, detection of malnutrition preva-
−Vasc, and Other.
lance, effects of hospitalization on nutritional status.
Results: The SBS−IBD group included more pts with stoma (95%;
Methods: Four hundred children at the age of 1 month to 18
SBS−Vasc, 19%; Other, 41%) and fewer with colon-in-continuity
years who were hospitalized and followed at the inpatient
(11%; SBS−Vasc, 78%; Other, 62%). At Wk24 (Table), PS volume
pediatric clinics of Şişli Hamidiye Etfal Training and Research
reductions were significantly higher in SBS−IBD pts treated
Hospital in the period between August 2014 and May 2015, were
with TED vs PBO (P = 0.02) and vs TED pts in SBS−Vasc (P = 0.04)
included in the study. Within the first 48 hours after
and Other (P = 0.02) groups. Change in FCE was greater in SBS
hospitalization and discharged at the last 24 hours, body
−IBD pts treated with TED vs PBO (P < 0.02) and vs TED pts in SBS
weight, height was measured. The prevalence of malnutrition
−Vasc (P < 0.01) and Other (P = 0.05) groups.
during hospital admission and discharge of patients was
determined Table:
Results: Malnutrition was observed at 56.2%, 38.4%, 30%, 28.9% SBS–IBD SBS–Vasc Other
rates, in children having malignancy, neurological diseases,
Mean (SD), TED, PBO, TED, PBO, TED, PBO,
infection diseases, gastroenterological system diseases,
mL/day n = 11 n=8 n = 15 n = 17 n = 16 n = 18
respectively. 31.5% of all the subjects had acute malnutrition
at discharge. It is found an increased prevalance of malnutri- Baseline
PS 2268 (1480) 3088 (1156) 1827 (982) 1338 (731) 1399 (811) 1928 (855)
tion 2–6 years of age and 10–18 years of age at discharge. The Oral intake 2456 (1176) 1521 (532) 1780 (761) 1634 (536) 1600 (575) 1692 (708)
prevalance of malnutrition decreased in the 1 month-2 age Urine 1160 (160) 1302 (243) 1385 (252) 1389 (327) 1448 (114) 1387 (226)
group and 6–10 age group between admission and discharge. Change at Wk24
PS –1102 (654)* –357 (453)‡ –513 (539) –277 (428)§ –450 (280)# –363 (345)
Among the groups with high number of patients when evaluated Oral intake –220 (338)† 246 (608)‡ –24 (500) 188 (531)# 79 (611)# 254 (470)
according to hospitalization criteria, the highest malnutrition Urine 191 (180)† –138 (239)‡ 52 (286) 31 (243)# 222 (341)# 128 (466)
rate was found in malignity (56.2%), neurology (38.4%) and FCE –1437 (900)† 27 (818)‡ –588 (995) –147 (575)# –593 (444)# –237 (588)
infection (30%) groups. The lowest rate of malnutrition was
*n = 9; †n = 8; ‡n = 7; §n = 16; #n = 15.
found in allergy (0.002%), endocrine (0.002%), heart diseases
(0.002%) and metabolic diseases (0.002%) groups. Diseases with Conclusion: TED had the largest absolute effect on FCE in the
more patients in the group when assessed according to system SBS−IBD group; TED effect on FCE was not as major in SBS−Vasc
only the prevalence of malnutrition were decreased in the or Other pts at Wk24.
infection group at discharge.
Disclosure of Interest: P. Jeppesen Consultant for: Shire, Speaker
Conclusion: Hospitalization of children affects the nutritional Bureau of: Shire, S. Gabe Consultant for: Shire, K. Iyer Consultant for:
status adversely in general, and increases the high frequency of Shire, U.-F. Pape Grant / Research Support from: Shire, Consultant for:
malnutrition. That’s why calori calculation according to Shire, Speaker Bureau of: Shire, D. Seidner Consultant for: Shire, H.-M.
childrens’ age, diagnosis and needs should be evoluated and Lee Other: Employee for Shire, C. Olivier Other: Employee for Shire.
it’s important to prevent them from starving.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 2
MON-P140
PREVALENCE AND ASSOCIATED FACTORS OF LOW BONE
MINERAL DENSITY AND FRACTURES IN A LARGE COHORT OF
SEVERELY UNDERNOURISHED INPATIENTS WITH ANOREXIA
NERVOSA (AN)
P. Bemer1 *, H. Ohanyan1, N. Kayser1, M. Hanachi1,2,
J.-C. Melchior1,2. 1Clinical Nutrition Unit, Hôpital Raymond
Poincaré (APHP), Garches, 2Faculté de médecine, Université de
Versailles, Saint-Quentin-en-Yvelines, INSERM U1179,
Montigny-le-Bretonneux, France
Rationale: Anorexia nervosa (AN) is a psychiatric disorder with
potentially serious somatic consequences. Reduced bone
mineral density (BMD) is frequently observed in patients with
AN which expose them to high risk of fractures.
Methods: We aimed to study the prevalences of low BMD
and fractures in severely malnourished inpatients with AN
and their associations with clinical and biological parameters.
BMD was evaluated by using dual energy X-ray absorptiometry.
Results: We included 109 patients (105 F/4 M), age 30.8 ± 12.4,
BMI 12.9 ± 2, 67.9% AN restrictive type, 32.1% purging type.
Duration of illness and amenorrhea were respectively
11.4 ± 10.8 and 8.9 ± 9.4. Prevalence of reduced spine Zscore
under -2 SD was observed in 57 patients (52.3%). Eleven
patients (10.1%) had one or more fractures, including 8% of
vertebral fractures. Higher age and lower BMI were significantly
associated with lower spine Zscore (respectively p = 0.005,
p = 0.0003). Higher age was also associated with lower femoral
neck Zscore ( p = 0.0002), as well as alkaline phosphatase
( p = 0.04), duration of illness ( p = 0.003) and undergoing
neuroleptic treatment ( p = 0.001). Bone mineral density for
all body was significantly associated with an undergoing
treatment by proton pump inhibitors ( p = 0.01) and fractures
( p = 0.03). Fractures were significantly more frequent in older
patients ( p = 0.009) and associated with the duration of disease
( p = 0.02).
Conclusion: More than half of severely AN malnourished
inpatients have low BMD with high rate of fractures. Severity
of undernutrition and duration of disease are the most
important associated factors. These results highlight the
importance of rapid weight gain in this population. More
prospectives studies are needed to identifie patient profiles at
high risk of osteoporosis and fractures and to test preventive
and curative treatments.
Disclosure of Interest: None declared.
MON-P141
TREATMENT OF MALNUTRITION IN HOSPITALISED PATIENTS
WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD):
IS THERE OPPORTUNITY?
P. F. Collins1,2 *, A. S. Lackoff1, C. Hukins3. 1School of Exercise
and Nutrition Sciences, Faculty of Health, QUT, 2Department of
Nutrition and Dietetics, 3Department of Respiratory & Sleep
Medicine, Princess Alexandra Hospital, Brisbane, Australia
Rationale: Malnutrition in COPD presents both an economic
and operational burden to hospitals. This study aimed to
explore patterns of healthcare use and costs in relation to
malnutrition and admission type.
Methods: A prospective cohort observational study was
conducted in outpatients with COPD attending a large tertiary
S231
Australian hospital. Electronic hospital records and coding
were used to explore the influence of malnutrition on
healthcare use (length of hospital stay (LOS)), admission type
(respiratory or non-respiratory related) and costs (Australian
dollars (AUD$)).
Results: Of the 834 COPD patients observed, 286 were
hospitalised during follow-up (16% coded for malnutrition).
Malnourished patients hospitalised for non-respiratory related
reasons had significantly longer mean LOS (22.1 SD 21.1 d vs 9.8
SD 13.9 d; p < 0.001) at more than double the cost ($39,209 SD
$40,525 vs $18,857 SD $25,333; p < 0.001). Malnutrition in
respiratory-related admissions was related to significantly
longer mean LOS (14.0 SD 11.4 d vs 7.3 SD 8.9 d; p = 0.003) and
a trend for increased costs ($22,366 SD $17,544 vs $13,791 SD
$21,273; p = 0.083). This was similar at the respiratory ward
level with malnourished patients staying significantly longer
(15.3 SD 10.4 d vs 8.3 SD 9.1 d; p = 0.006). Importantly, 35% of
malnourished patients on the respiratory ward had an admission
≤1 week compared to 25.5% of the malnourished cohort as a
whole. This rose to 41% (LOS ≤ 1wk) of malnourished COPD
patients admitted for respiratory-related reasons across all
wards.
Conclusion: Malnutrition was associated with increased
healthcare use and costs but this varied considerably depend-
ing on the admission type and ward. While the acute setting is
an opportune time to identify malnutrition and start nutrition
support, the limited LOS highlights the need for robust
coordinated nutritional care post-discharge.
Disclosure of Interest: None declared.
MON-P142
VALIDATION OF PREDICTIVE EQUATIONS FOR RESTING
ENERGY EXPENDITURE IN ADULTS AND ELDERY NON-
CRITICALLY ILL PORTUGUESE PATIENTS
P. S. Barcellos1,2 *, N. Borges3, D. Torres2. 1Departamento de
Ciências Fisiológicas, UFMA, São Luís-MA, Brazil, 2Fcnaup,
Universidade Do Porto, Porto, Portugal, 3Fcnaup, Universidade
Do Porto, Porto
Rationale: Compare resting energy expenditure (REE) mea-
sured by indirect calorimetry (IC) and predicted by equation
values in adults and elderly non-critically ill patients and
analyze which was the best alternative.
Methods: Non-critical ill patients (180), with non-critically ill
diagnosis from Surgery unit at portuguese hospital were
evaluated from June 2015 to December 2016. Indirect
calorimeter was used to measure REE (Cosmed k4 b2) and
compared with energy expenditure formulas.
Results: Table 1. Resting energy expenditure mean measured
by indirect calorimetry and estimated by formulas in non-
critical ill patients in a Portuguese Hospital, 2016.
Conclusion: Resting energy expenditure measuared by iC shows
weak correlation with estimated energy by formulas (Harris-
Benedict, Ireton-Jones and MifflinSt. Jeor, 1991). Mean of
difference were differents both in adults and elderly people.
Results suggests these formulas there′s not accurate for this
population.
S232
Table 1:
GLOBAL (n = 180) ADULTS (n = 102) ELDERLY (n = 78)
REE (kcal) Mean SD r Mean SD r Mean SD
Indirect 1891,53 ±723,58 1 1928,33 ±661,76 1 1843,40 ±799,12 1
Calorimetry
Harris- 1414,38* ±229,12 0,33** 1501,44* ±237,79 0,35** 1300,53* ±157,16 0,35**
Benedict
Ireton-Jones 1535,98* ±378,02 0,23** 1747,29* ±316,28 0,21* 1259,64* ±253,91 0,32**
MifflinStJeor 1339,39* ±239,65 0,40** 1419,46* ±234,55 0,42** 1234,68* ±204,33 0,40**
1990
Friedman Test *p-value <0,05 r- Pearson correlation * < 0,05 and ** <0,01.
References
Harris JA. and Benedict FG. A biometric study of human basal
metabolism. Proceedings of the National Academy of Sciences of the
United States of America 1918;4: 370–373.
Ireton-Jones C, Jones JD. Improved equations for predicting energy
expenditure in patients: The Ireton-Jones equations. Nutr Clin Pract.
2002;17:29–31.
Mifflin MD, Stjeor ST and cols. A New Predictive Equation for Resting
Energy-Expenditure in Healthy-Individuals. AJCN. 1990;51(2):241–7.
Disclosure of Interest: None declared.
MON-P144
ENERGY INTAKE AND EXPENDITURE IN OBESE OLDER ADULTS
WITH AND WITHOUT TYPE 2 DIABETES
R. G. Memelink1 *, A. M. Verreijen1, J. De Vogel-Van den Bosch2,
P. J. Weijs1. 1Department of Nutrition and Dietetics, School of
Sports and Nutrition, Amsterdam University of Applied
Sciences, Amsterdam, 2Nutricia Advanced Medical Nutrition,
Nutricia Research, Utrecht, Netherlands
Rationale: Obesity is a risk factor for type 2 diabetes (DM2),
however not all obese people develop DM2. We explored
differences in energy intake and expenditure between obese
older adults with and without DM2.
Methods: Baseline data from 2 lifestyle interventions with a
total of 202 obese older adults were included in the analyses.
Obesity was defined as BMI > 30.0, or >27.0 with waist
circumference >88 (women) or >102 cm (men). DM2 was
confirmed by use of diabetes medication. Subjects were
between 55 and 85 years old and 45% was female. Energy
intake (EI) was measured by 3-day food diary and physical
activity level (PAL) by 3-day movement diary. Resting energy
expenditure (REE) was measured using indirect calorimetry and
total energy expenditure (TEE) was calculated as REE x PAL.
Between group differences were analysed with independent
samples T-tests.
Results: The obese group with DM2 (n = 117) had more males
(67.5% vs 37.6% p < 0.001) and similar BMI (33.3 vs 33.0 kg/m2)
compared to the group without DM2 (n = 85). Analyses of males
and females separately showed lower PAL in males with DM2 (vs
without DM2; 1.37 vs 1.45, p = 0.015), without differences in EI
(2055 vs 1953 kcal/d), REE (1970 vs 1929 kcal/d), and TEE
(2699 vs 2830 kcal/d). In females with DM2, both PAL (1.38 vs
1.47, p = 0.014) and EI (1543 vs 1839 kcal/d, p = 0.008) were
significantly lower, whereas REE (1592 vs 1598 kcal/d) and TEE
(2220 vs 2318 kcal/d) did not differ significantly from obese
females without DM2.
Conclusion: In both males and females, obese older adults with
type 2 diabetes showed similar resting and total energy
expenditure but lower physical activity level compared to
Poster
those without DM2. Females with DM2 showed lower energy
intake. On average, subjects seem to have a negative energy
balance, which is probably due to a combination of under-
r
reporting of intake and over-reporting of activity.
Disclosure of Interest: R. Memelink Grant / Research Support from:
Baseline data obtained from Nutricia Research co-funded trials,
A. Verreijen: None declared, J. De Vogel-Van den Bosch Other:
Employee Nutricia Research, P. Weijs: None declared.
MON-P145
THE EFFECT OF DIETARY NITRATE SUPPLEMENTATION ON
MECHANICAL EFFICIENCY AND CARDIOMETABOLIC RISK
PROFILE IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
R. J. H. C. G. Beijers1 *, S. Huysmans1, C. van de Bool1,
B. R. M. Kingma2, L. B. Verdijk2, L. J. C. van Loon2, S. J. Meex3,
H. R. Gosker1, A. M. W. J. Schols1. 1Department of Respiratory
Medicine, 2Department of Human Biology and Movement
Sciences, NUTRIM School of Nutrition and Translational
Research in Metabolism, Maastricht University Medical Centre+,
3
Department of Clinical Chemistry, Cardiovascular Research
Institue Maastricht (CARIM), Maastricht, Netherlands
Rationale: Many patients with COPD have a decreased
mechanical efficiency during exercise and are at increased
cardiometabolic risk. Dietary nitrate supplementation may
reduce oxygen requirements during submaximal exercise,
improve exercise performance and lower blood pressure. This
study determines the impact of acute and 7-days dietary
nitrate supplementation on mechanical efficiency and cardio-
metabolic risk profile in patients with COPD.
Methods: In a double-blind, randomized cross-over placebo-
controlled trial 18 COPD patients were included with moderate
airflow obstruction and exercise impairment, normal BMI
(25.9 ± 3.4 kg/m²) but high prevalence of abdominal obesity
(77.8%) and moderately decreased mechanical efficiency.
Subjects were randomly allocated to the treatment order of 7
days sodium nitrate ingestion (∼8 mmol per day) and 7 days
placebo (NaCl solution), separated by one week washout.
Before (day 1) and after (day 7) both intervention periods
mechanical efficiency during submaximal cycle ergometry,
plasma nitrate and nitrite levels, cardiac plasma markers (e.g.
high-sensitive troponin T (Hs-TNT), Nt-proBNP and creatinine
kinase (CK)) and blood pressure were measured.
Results: Plasma nitrate and nitrite concentrations increased
at day 1 (7-fold and 2-fold, respectively) and day 7 (8-fold and
2-fold, respectively) after sodium nitrate compared with
placebo ingestion. Systolic and diastolic blood pressure did
not change following nitrate ingestion. Furthermore, no
differences were observed in mechanical efficiency during
submaximal exercise and no changes were observed in Hs-TNT,
CK and Nt-proBNP concentrations between the nitrate and
placebo treatment.
Conclusion: Acute as well as 7-days of dietary nitrate
supplementation does not increase mechanical efficiency or
improve cardiometabolic risk profile in mild-to-moderate COPD
patients.
Disclosure of Interest: None declared.
Nutrition and chronic diseases 2
MON-P146
A POOR MUSCLE FUNCTION STATUS IS ASSOCIATED TO
MALNUTRITION RISK IN A COHORT OF CHRONIC HEART
FAILURE PATIENTS
S. Molinero Abad1, A. Mijan de la Torre1, M. Soto Celix2,
A. Riego Valledor1 *. 1Internal Medicine, Hospital Universitario
De Burgos, Burgos, Spain, 2Nutrition, Universidad Pontificia
Católica de Chile, Santiago de Chile, Chile
Rationale: Our previous studies have shown how Sarcopenia is a
prevalent syndrome in CHF patients with a lower survival. Now
we wanted to check if a malnutrition risk modifies survival in
this setting and his association with a poor muscle function.
Methods: Prospective cohort study (n = 103) patients with CHF
(NYHA III-IV) were consecutively selected. Nutrition risk
screening (NRS-2002), Mini-Nutritional assesment (MNA) and
Subjective global assessment (VGS) were performed. Muscle
function was measured by hand-grip dynamometry (kg) - lower
limit <20(f ); <30(m)-. Patients were followed-up and survival
rate (months) registered. Data (mean, IC 95%) were stat
analyzed by Kaplan-Meier and Log-Rank Tests. Statistical
significance was reached at p < 0.05.
Results: One-hundred three patients (50 f-82.5y; 53 m-82.5y)
were selected. Global prevalence of malnutrition was 69,9%
NRS-2002 (67,3% females/71,7% males); 83,3% MNA (83,7%
females/83%males) and 58,8% VGS (59,2% females/ 58,5%
males). Low muscle strength (Kg) was detected in 77,1% (37) of
women and 79,2% (42) of men with a mean of 14,9 ± 2,5 and
24.5 ± 5,5 respectively. Survival rate was not influenced by
gender ( p = 0.56), but was influenced by risk of malnutrition
( p= 0,017 NRS; p= 0.08 MNA; P= 0.005 VGS). An association
between muscle function and risk of malnutrition using the T-
Test (mean difference 3,45 Kg NRS ( p = 0.039); mean differ-
ence 5,33 Kg MNA ( p = 0.00,9); mean difference 4,085 Kg in
VGS ( p = 0,009)).
Conclusion:
1. A high prevalence of malnutrition has been shown in our
cohort of Severe CHF patients.
2. The risk of malnutrition is statistically associated with a
lower survival.
3. Muscle function decreases at risk of malnutrition
4. Further analysis to check if low muscle strength may
isolately influence to survival
Disclosure of Interest: None declared.
MON-P147
NUTRITIONAL STATUS IN COPD PATIENTS STAGED ACCORDING
TO THE 2015 GOLD STANDARDS: AN OBSERVATIONAL STUDY
S. Arinc1 *, M. Agca1, F. Yaman1. 1Department of Chest Disease,
Sureyyapasa Chest Disease and Thoracic Surgery Training and
Research Hospital, Istanbul, Turkey
Rationale: Nutritional status is one of the factors affecting
prognosis in chronic diseases. Nutrition support is an important
component of patient care. This study aimed to evaluate the
nutritional status of patients with the diagnosis of chronic
obstructive pulmonary disease (COPD).
Methods: This observational study included consecutive
patients who were admitted to the hospital and followed-up
with the diagnosis of COPD for at least 1 year. Patients having a
S233
respiratory disease other than COPD, those having a disease
that would lead to malnutrition, pregnant women, and those
who gave birth in the last 3 months were excluded. Body mass
index (BMI), fat-free body mass, findings of respiratory function
and handgrip strength tests, the Modified Medical Research
Council dyspnea score, and the GOLD 2015 stage were
recorded.
Results: The study included 241 COPD patients who had a GOLD
stage A (n = 54), B (n = 32), C (n = 61), or D (n = 94) COPD. There
was no difference among the stage groups regarding gender and
fat-free body mass. The BMI of the patients with stage D was
significantly lower than that of those with stage A. The rate of
weak patients (a BMI of <18.5) was 0% in the patients with stage
A and 5.3% in those with stage D. A decrease was observed in the
forced expiratory volume in one second (FEV1), which reflects
the respiratory muscle strength, with increasing disease stage.
The value of the handgrip test, which reflects the peripheral
muscle strength, was lower in the patients with stage D than in
those with stage A (Table 1).
Table 1: Findings of the patients with GOLD stage A and D COPD.
Stage A Median Stage D Median
(Q1-Q3) (Q1-Q3)
BMI, kg/m2 28.02 (24.8–32.31) 25.97 (22.30–29.79)
FEV1, % 61 (57–74) 33 (23–41)
Handgrip strength test, kg 29.92 (25.2–38.63) 24.58 (19.23–29.87)
Conclusion: The BMI was observed to be lower in the advanced
stage COPD patients, which resulted in a decrease in the muscle
strength.
Disclosure of Interest: S. Arinc Grant / Research Support from: Nutricia
Medical Nutrition, Turkey, M. Agca Grant / Research Support from:
Nutricia Medical Nutrition, Turkey, F. Yaman Grant/Research Support
from: Nutricia Medical Nutrition, Turkey.
MON-P148
DIETARY INTAKE OF PATIENTS WITH INFLAMMATORY BOWEL
DISEASE
S. Maissen1 *, D. Caviezel2, P. Hruz2, C. Kiss1. 1Dietetic Service;,
Endocrinology, Diabetology & Metabolism, 2Gastroenterology
& Hepatology, University Hospital Basel, Basel, Switzerland
Rationale: Inflammatory bowel disease (IBD) is a chronic
inflammatory condition of the gastro-intestinal tract which
may have a relevant impact on the dietary intake and
nutritional status of affected patients. Observations suggest
that the increased prevalence of malnutrition and nutritional
deficiencies have an unfavourable effect on disease outcome
(1). In the past few years biological therapies have been
introduced in the treatment of IBD. Since then only a few
studies report about the diet and nutritional status of these
patients.
To assess the nutritional status of IBD patients treated with
biologicals a comprehensive assessment was undertaken. In a
part of this study we assessed for eating habits.
Methods: In this descriptive, prospective single center study
156 adults with IBD were included. The IBD patients were
between 18–83 years (mean 41) and 50% were women. The
dietitian assessed dietary intake with a modified food
frequency questionnaire (2). The questionnaire contains 10
components and each component has a score ranging from 0 to
S234
2 with a max of 20. Higher values in the score indicate better
the adherence to the healthy eating guidelines.
Results: The mean score of the food questionnaire was 14.3
(range 9–18). Three quarters of IBD patients showed an
insufficient intake of vegetables and 35% eat only 0–1 fruit
portions. Only one of five uses recommended oils and more
than one third have a dietary calcium intake below 750 mg per
day. The majority has not been referred to a dietitian, although
more than half of them would be interested in dietary
counselling.
Conclusion: The results may provide a basis for an improved
dietary management of patients with IBD by a specialised
dietitian.
References
1. Forbes A, et al. Clinical Nutrition 2017;36:321–347.
2. Russell J, et al. Brit J Nutr. 2013;109:547–555.
Disclosure of Interest: None declared.
MON-P149
PATIENTS WITH INTESTINAL FAILURE (IF) RECEIVING HOME
PARENTERAL SUPPORT (HPS): EVALUATION OF A CATHETER-
SALVAGE-STRATEGY IN CASE OF CATHETER-RELATED
BLOODSTREAM INFECTIONS (CRBSIS)
S. Tribler1 *, C. F. Brandt1, K. A. Fuglsang1, M. Staun1,
P. Broebech1, C. E. Moser2, T. Scheike3, P. B. Jeppesen1.
1
Department of Medical Gastroenterology, 2Department of
Clinical Microbiology, Copenhagen University Hospital,
Rigshospitalet, 3Department of Biostatistics, Copenhagen
University, Copenhagen, Denmark
Rationale: Facing CRBSIs IF patients may require repetitive
replacement of their tunneled central venous catheter (CVC).
The catheter-salvage-strategy recommended by ESPEN is
evaluated.
Methods: In a retrospective analysis, based on the Copenhagen
IF database and the Microbiological Database, Rigshospitalet,
Denmark, we evaluated all CRBSIs from 2002–2016. Catheter
salvage was defined by successful antimicrobial treatment with
the CVC retained at discharge. CRBSI recurrence was defined by
the finding of the same microbial species and identical
antibiogram within 100 days. Hazard ratio was analysed with
Cox proportional hazard model.
Results: In 715 adult HPS patients, 2006 CVCs were inserted
covering 2014.3 CVC years with 1350 CRBSIs (1.83/1000 CVC
days) occurring in 357 patients (49.9%). CRBSI-related mortal-
ity (n = 5) was 0.007/1000 CVC days. The hazard risk ratio for a
new CRBSI was 0.82 (95% CI; 0.57–1.17) (P = .28) in a replaced
versus retained CVC when analysed on patients first CRBSI. In
744/1350 of CRBSIs (55.1%) the CVC was salvaged; Mono-
infections 577/913 (63.2%) and poly-infections 154/296
(52.0%). Salvage rates for Coagulase-negative staphylococci
(CNS) were 68.4% (350/512); Enterobacteriaceae 49% (269/
549) and Staphylococcus aureus 40.7% (46/113). The median
time to a CRBSI in a new CVC was 105 days (25–75th percentiles;
44–265) and 76 days (38–171) to next CRBSI in a previously
salvaged CVC (PWilcoxon=.004). Risk of CRBSI recurrence after a
CNS was 12.9%, for S. aureus 8.7% and for Enterobacteriaceae
16.7%.
Conclusion: A catheter-salvage-strategy in HPS patients is
safe, however it carries a risk of CRBSI recurrence. New CRBSIs
occur earlier in a salvaged CVC, but when evaluated according
Poster
to CVC management at first CRBSI we did not find significantly
increased risk of future CRBSIs.
Disclosure of Interest: None declared.
MON-P150
NUTRITIONAL SUPPORT IN MELAS SYNDROME. NOT ONLY
SCIENCE BUT ALSO ART.
V. Garcia Zafra1 *, P. Sanchez Sequero1, R. Cañas Angulo1,
A. Rubio Gambin1, A. M. García Cayuela1, M. Chiang Alvarez1,
T. Bernal Canales2, J. F. Sánchez Romera3, M. Ferrer Gomez3.
1
Endocrinology and Nutrition, Hospital General Universitario
Santa Lucia, Cartagena, 2Psychiatry, Hospital General
Universitario Reina Sofia, 3Endocrinology and Nutrition,
Hospital Clinico Universitario Virgen de la Arrixaca,
Murcia, Spain
Rationale: MELAS syndrome (MS) is a rare mythocondrial
disease, maybe due to an heterogeneous phenotype under-
diagnosed. Its complexity is related with the multiple organ
dysfunction. Most prevalent symptoms are lactic acidosis (97%),
seizures and stroke-like episodes (>90%), but also diabetes
mellitus (DM) (33%) and gastrointestinal manifestations (77%)
like gastric dismotility. The only available treatment is arginine
supplements (ARG) but vomits determine its bad accomplish-
ment. Related with DM, first line treatment is diet and
exercise, metformin is contraindicated for lactic acidosis risk.
There is a lack of evidence concerning the complex manage-
ment of nutritional support in these patients.
Methods: Here we report the case of a 29-year-old woman with
severe caloric undernutrition hospitalized for seizures, nausea
and vomits that debuted with DM after nutritional support.
Results: The patient had cognitive impairment due to a stroke-
like episode and could not eat or receive ARG. Enteral nutrition
(EN) was administrated throw nasogastric tube with continuous
regimen and a standard formula. This tube was also used to
administrate ARG. After one week on EN, glycemia was 401 mg/
dl. Lab test showed: insulin 252 mcUI/ml (2–25), C-peptide 7.1
ng/ml (1.1–4.4), HbA1c 7.8% and negative autoimmunity for
DM. Later, EN was changed to a specific diabetes formula and
the insulin needs were reduced and simplified. Finally the
patient was discharged with nocturnal EN cycle throw
gastrostomy, specific DM formula and 6 units of glargine insulin.
Conclusion: MS is a rare but also underdiagnosed disease.
Gastrointestinal symptons are frequent and determine nutri-
tional status as well as DM in which MET is contraindicated. In
this case nocturnal EN cycle provides a safe way to administrate
ARG, improve nutritional status and control hyperglycemia.
Disclosure of Interest: None declared.
MON-P151
EXAMINATION OF GLYCEMIC CONTROL INDEX IN DIABETIC
DIALYSIS PATIENTS UNDER ON-LINE HEMODIAFILTRATION
Y. Kitajima1 *, T. Hyodo2, Y. Sato3. 1Tokyo Healthcare University,
Tokyo, 2Eijin Clinic, Hiratsuka, 3Sato Junkankika Hospital,
Matsuyama, Japan
Rationale: Glycohemoglobin (HbA1c) of diabetic dialysis
patients has been reported to underestimate diurnal blood
sugar fluctuations as it is affected by red cell survival,
erythropoietin, etc. Therefore, it is recommended in Japan
that glycoalbumin (GA) should be used for glycemic control
Nutrition and chronic diseases 2
index of diabetic dialysis patients. However, recently in Japan,
on-line hemodiafiltration (o-HDF) with high albumin (Alb)
leakage has been widely used in dialysis treatment methods
due to the reimbursement in the national insurance system
since 2012. As GA is affected by albumin metabolism,
evaluation of GA values needs to be reexamined for diabetic
dialysis patients under o-HDF. In this study, we examined GA
values for different dialysis treatment methods.
Methods: The subjects were divided according to treatment
types: a hemodialysis (HD) group (23 diabetic dialysis patients)
and an o-HDF group (133 diabetic dialysis patients). We
examined the correlation of GA and HbA1c in comparison
with known correlation, and the amount of Alb removed in the
o-HDF group.
Results: A significant positive correlation was observed
between GA and HbA1c in the HD group (R2 = 0.809 and
p < 0.0001). Inaba et al. reported a similar result (r = 0.777 and
p < 0.001: J Am Soc Nephrol, 2007). However, the correlation in
the o-HDF group was lower than in the HD group (R2 = 0.316 and
p < 0.0001). In the o-HDF group, average of GA, HbAlc and Hb is
20.4 ± 4.7%, 6.0 ± 0.9% and 10.6 ± 1.0 g/dl.
Conclusion: It is possible that GAvalue is underestimated in the
o-HDF group due to the effect of Alb leakage. If Hb value is
stable by the therapy, HbA1c may be the golden standard of the
diabetic estimation even also in dialysis patients. For glycemic
control index of diabetic dialysis patients, GA and HbA1c need
to be used along with the dialysis treatment method.
Disclosure of Interest: None declared.
MON-P152
GLYCEMIC INDEX OF FREQUENTLY CONSUMED BREAD TYPES
USED FOR HEALTHY SUBJECTS AND PATIENTS WITH CHRONIC
DISEASES
Z. Büyüktuncer Demirel1 *, R. Ergun1, H. Köksel2,
H. Gokmen Ozel1. 1Nutrition and Dietetics, Faculty of Health
Sciences, 2Food Engineering, Hacettepe University, Ankara,
Turkey
Rationale: There is growing evidence that the type of
carbohydrate consumed is important in relation to chronic
diseases risk, and there is currently particular interest in the
role of low-glycaemic index (GI) foods. Bread is the staple food
in Turkish population. The aim of this study was to assess GI of
frequently consumed bread types used for both healthy
subjects and patients with chronic diseases.
Methods: Ten healthy volunteers aged 19–35 years were
included. Capillary blood glucose (BG) were measured after
12 hours starvation and at 15, 30, 45, 60, 90 and 120 minutes.
Each of the 10 subjects consumed portions of the ten types of
breads and the reference food (glucose powder), containing
50 g of available carbohydrate on separate mornings over a-
11-week period. GI were calculated using WHO incremental
area under the BG response curve.
Results: The lowest GI were found in village bread (VB) rich in
whole wheat (42 ± 4). The GI values of other bread types were
as follows: Stone mill (46 ± 5), wheat bran (51 ± 3), rye (52 ± 7),
ciabatta (54 ± 6), germ (54 ± 6), bagel (60.0 ± 3), white (65 ± 7),
pita (70 ± 8) and hazelnut (75 ± 9). BG after VB consumption
was significantly less than after hazelnut ( p < 0.01), pita and
white breads at 90 minutes ( p < 0.05).
S235
Conclusion: The WHO/FAO (Food and Agriculture organisation
of the UN) and some health agencies in Europe, Canada, and
Australia advocate consumption of a low-GI diet. Since low GI
breads may control postprandial BG and insulin responses
better, GI can be used to guide bread choices in both heathy
subjects and patients with chronic diseases.
Disclosure of Interest: None declared.
MON-P153
DOES DIFFERENT PREPERATION AND COOKING METHODS
IMPACT ON THE GLYCEMIC INDEX OF THE POTATO?
S. Çiftçi1, Z. Büyüktuncer Demirel1 *, H. Köksel2,
H. Gokmen Ozel1. 1Nutrition and Dietetics, Faculty of Health
Sciences, 2Food Engineering, Hacettepe University, Ankara,
Turkey
Rationale: Potato, staple food, is widely consumed in most
countries. Potato has a high glycemic index (GI) and the
preparation and cooking methods affect the GI of the potato.
The aim of this study was to determine the effect of different
preparation and cooking methods on GI of potato.
Methods: Ten healthy volunteers aged 19–35 yrs were included.
Each of the 10 subjects consumed potatoes which were
prepared and cooked using different 8 methods [boiled for
35 min (B35), boiled for 50 min (B50), boiled for 35 min and
then cooled for 24 hrs (B35C), boiled for 50 min and then
cooled for 24 hrs (B50C), peeled and fried for 8 min (PF),
unpeeled and fried for 8 min(UPF), peeled and baked for
30 min (PB) and unpeeled and baked for 30 min (UPB)]. The
reference foods (glucose powder and white bread) and
potatoes were consumed containing 25 g of available carbohy-
drate on separate mornings over a-10-week period. Capillary
duplicate blood glucose (BG) levels were measured after 12
hours starvation and at 15, 30, 45, 60, 90 and 120 minutes
after test and reference foods consumption. GI were calculated
using WHO incremental area under the BG response curve.
Results: The lowest GI were found in potatoes which were B35C
relative to glucose (65 ± 37) and white bread (83 ± 50). The GI
values of other preperation and cooking methods were as
follows relative to glucose: PF (76 ± 32), UPF (77 ± 31), B50C
(81 ± 51), UPB (91 ± 48), B35 (101 ± 32), B50 (100 ± 43) and
relative to white bread: PF (97 ± 35), UPF (101 ± 45), B50C
(102 ± 54), UPB (115 ± 52), B50 (131 ± 59) and B35 (133 ± 43).
The lowest GI were found in potatoes which were PB relative to
glucose (115 ± 56) and white bread (148 ± 63).
Conclusion: It has been suggested that foods with a GI are
detrimental to health. Frying method had relatively low GI
values, but it does not appear to be particularly healthy. Beside
of the GI knowledge, healthy eating habits should be taught to
the individuals by dietitians.
Disclosure of Interest: None declared.
S236
MON-P154
PHOSPHORUS NUTRITIONAL KNOWLEDGE IN DIALYSIS UNITS
IN GREECE
Z. Pafili1,2 *, M. Maridaki2. 1Department of Dietetics, Volos
General Hospital, Volos, 2School of Physical Education and
Sport Science, National and Kapodistrian University of Athens,
Athens, Greece
Rationale: In hemodialysis patients dietary phosphorus restric-
tion is an essential component of the effort to control serum
phosphorus. Despite dietary counceling, nutritional knowledge
of phosphorus has been found to be low in this population. Our
aim was to assess phosphorus nutritional knowledge in Greek
hemodialysis patients, renal nurses and nephrologists.
Methods: Phosphorus nutritional knowledge was evaluated
using the CKDKAT-N questionnaire in three hemodialysis units.
Sixty eight patients, 19 renal nurses and 11 nephrologists
completed the questionnaire which consisted of a phosphorus
section (15 questions) and a rest nutrient section (10 questions
for protein, sodium and potassium). Test questions assesed
knowledge of food nutrient content, nutrient health effects
and intake recommendations. To calculate total and partial
scores each correct answer got 1 point.
Results: Nephrologists had higher CKDKAT–N total and phos-
phorus knowledge scores compared with renal nurses and
patients (total: 19.1 ± 3.6 vs 14.1 ± 2.8 and 13.2 ± 2.8 respect-
ively, P < 0.01), ( phosphorus: 10.6 ± 2.7 vs 7.6 ± 2.2 P and
7.3 ± 2.0 respectively, P < 0.01). There were no differences in
total and phosphorus scores between nurses and patients.
Patients and nurses answered correctly a higher percentage of
phosphorus section questions compared with the rest section
questions (P < 0.001), whereas no such difference was found for
doctors.
Conclusion: Our results confirm those of previous studies that
hemodialysis patients as well as renal nurses have a low
knowledge level of phosphorus. Nutritional training of patients
and health professionals could increase knowledge and possibly
contribute to better biochemical profile of phosphorus in
patients.
Reference
1. Pollock JB, Jaffery JB. Knowledge of phosphorus compared with
other nutrients in maintenance dialysis patients. J Ren Nutr. 2007
Sep;17(5):323–8.
Disclosure of Interest: None declared.
Nutritional assessment 2
MON-P155
INFLUENCE OF NON-CLASSICAL MEDICAL CONDITIONS ON
CLINICAL COURSE OF PATIENTS WITH ANOREXIA NERVOSA
M. Cayon-Blanco1 *, C. Garcia-Figueras-Mateos2. 1Endocrinology
and Nutrition Unit, 2Internal Medicine, Hospital Sas De Jerez
De La Frontera, Jerez De La Frontera, Spain
Rationale: Anorexia nervosa (AN) is associated with numerous
and well-known concurrent medical complications. In addition
to these classical medical complications, other co-morbid
conditions are common. Also, patients with AN often require
admissions to non-psychiatric hospital wards due to medical
complications. Published data focused on both issues are
Poster
scarce. Our aims are to describe the prevalence of these co-
morbid conditions and their impact on patients with AN.
Methods: We conducted an observational, retrospective study
including patients with AN followed by our Nutrition Unit. Data
related to mental status and its treatment as well as data
related to medical conditions and admissions to conventional
medical wards were collected.
Results: Data from 50 patients were available for analysis. 58%
of the cohort suffered from other co-morbid conditions. 18% had
allergic diseases, 14% gastritis or gastroesophageal reflux
disease, 10% neurological diseases and 4% celiac disease. 18%
were admitted in a medical ward of our hospital. Electrolyte
imbalances followed by infectious diseases were the most
common causes of admission (55.5%, 22.2%, respectively).
Patients who required admission were more likely to have non-
classical co-morbidities (88.9% vs 11.1%; p = 0.04), longer time
of evolution of AN (16.1 ± 6.9 vs 4.7 ± 0.9 years; p = 0.01), higher
age at diagnosis (19.1 ± 5.2 vs 16.7 ± 5.5; p < 0.001) and were
taking a higher number of psychiatric drugs (3 ± 0.5 vs 1.2 ± 0.9;
p < 0.001). Body mass index was not significantly tied to a higher
rate of admissions.
Conclusion: Non-classical co-morbidities are frequent in
patients with AN. Thought we found that severity of mental
status has a strong influence on probability to be admitted by
clinical condition, some common clinical conditions in these
patients, such as gastrointestinal disorders, can promote that
probability irrespective of body mass index.
Disclosure of Interest: None declared.
MON-P156
INFLUENCE OF A NUTRITION SUPPORT TEAM IN NUTRITIONAL
CLINICAL PRACTICE: A SINGLE-CENTER DESCRIPTIVE
ANALYSYS.
M. Cayón-Blanco1 *, C. Garcia-Figueras Mateos2,
L. Garcia Garcia-Doncel1. 1Endocrinology and Nutrition Unit,
2
Internal Medicine Unit, Hospital Sas De Jerez De La Frontera,
Jerez De La Frontera, Spain
Rationale: With the development of specialized nutrition
support, an interdisciplinary approach was essential to
translating this medical breakthrough from the laboratory to
the bedside. Nutrition support teams (NST) were created to
optimize the effectiveness and safety of this therapy. In
hospitals that have incorporated NST to routine clinical
practice, patterns of nutritional support can change after its
incorporation. This study aims to analyze the interventions of a
NST over 2 years after its setting-up in our hospital.
Methods: Descriptive and prospective study including all
patients which nutrition support were directly supervised by
NST. To test potential changes in nutrition support patterns,
characteristics of the activity and prescriptions performed
by NST during first and second year were compared.
Patients were followed-up from first day of assesment to
discharge.
Results: During the second year after its implementation, NST
increased its activity by 13% (first year consultations: 10.7/
month; second year: 13.9/month). Most of requirements for
nutrition approach were made by medical departments (51.8%
at first year and 53.3% during second year; p > 0.05). During the
second year, parenteral nutrition use decreased by 9%
and enteral nutrition using feeding lines increased by 8.5%
Nutritional assessment 2
( p < 0.05). Mean follow-up days during hospital stay decreased
significantly in the second year (14.1 ± 1.9 vs 10.3 ± 4.9;
p = 0.02) due to shorter lengh of stay.
Conclusion: Implementation of NST in our hospital resulted in a
reduction of use of parenteral nutrition, increase of use of
enteral nutrition and a shorter lengh of hospital stay.
Disclosure of Interest: None declared.
MON-P158
IMPACT IN NUTRITIONAL STATUS AND DIET PROGRESSION
OF A NUTRITIONAL CONSULTATION AFTER STOMA
CONSTRUCTION
M. Moreno Santa Maria1,2, J. Abilés Osinaga1,2 *,
L. Rey Fernández1, C. Pérez Jiménez3, P. Utrilla Navarro2,4,
C. López Rodriguez1, L. Visiedo Rodas1,
J. J. Arenas Villafranca1,2. 1Pharmacy and Nutrition
Department, Hospital Costa del Sol, Marbella, 2Doctoral
Programme in Pharmacy, University of Granada, Granada,
3
Surgery Department, Hospital Costa del Sol, Marbella,
4
Pharmacology Department, University of Granada,
Granada, Spain
Rationale: In ostomized patients the oral diet reintroduction
should be performed progressively. In addition, malnutrition is
a long-term complication. Our objective is to evaluate the
impact of a nutritional consultation at dischargein theses
patiens.
Methods: A prospective study was performed. At discharge, the
patient has two appointment with dieticians for assessment
and diagnosis, a review of diet progression and nutritional
treatment. The patient’s weight was recorded and nutritional
profile was requested (albumin, prealbumin, transferrin,
cholesterol) at 7–10 days (visit1) and a month later (visit2).
Statistical analysis was performed.
Results: 37 patients were recruited, 66.9 ± 13.3years, 81%men.
Nutritional diagnosis at Visit1 was 37.8% good nutritional
status, 18.9% nutritional risk, 13.5% mild malnutrition*, 27%
moderate* and 2.7% severe*; At Visit2 was 64.3% good
nutritional status, 32.1% nutritional risk and 3.6 mild malnu-
trition* (*All protein-calorie). Weight’s difference between
Visit1 and Visit2 was + 2.4 ± 3.6 kg ( p = 0.001). The mean
nutritional parameters measured between Visit1 and Visit2
were respectively: Albumin 3.5 g/dL and 4.0 g/dL (+0.6 ± 0.5,
p = 0.001), PreAlbumin 20.0 mg/dL and 25 mg/dL (+4.9 ± 7.3,
p = 0.003), Cholesterol 155.9 mg/dL and 181.2 mg/dL
(+25.3 ± 36.0, p = 0.002), Transferrin 200.7 mg/dL and
254.9 mg/dL (+54.2 ± 39.6, p = 0.001), CRP 45.3 mg/L and
14.9 mg/L (-30.3 ± 41.0, p = 0.002). At Visit1 72.2% of the
patients tolerated soft diet, 22.2% complete, 2.8% astringent
and 2.8% low-residues; 40.5% required oral supplementation
(mean extra 870 kcal/patient). At Visit2 100% tolerated normal
diet requiring supplementation 29.7% (mean extra 440 kcal/
patient)
Conclusion: The nutritional consultation for ostomized
patients has allowed us to reach a good nutritional status in
the majority of the patients with a correct diet transition and
an optimization in the use of oral supplementation.
Disclosure of Interest: None declared.
S237
MON-P159
VALUATION OF MEDICAL NUTRITION
M. Nuijten1 *. 1Nutritioneconomics, A2M – Minerva, Jisp,
Netherlands
Rationale: Disease related malnutrition is a worldwide problem
in all health care settings with potentially serious clinical and
economic consequences. Many studies show that the use of
medical nutrition is a cost-effective treatment leading to cost
savings and a higher effectiveness. Therefore the price setting
of medical nutrition may be questioned.
Methods: We calculated the break-even price for medical
nutrition from various perspectives: (1) The incremental cost-
effectiveness threshold from the payer’s perspective based on
health economic concepts; (2) The Discounted Cash Flow
threshold from the perspective of the financial investor based
on business valuation theory. These methods are commonly
applied to pharmaceuticals for price setting and price
justification.
Results: The break-even price was at least 10 times higher than
the actual price of 2 euro per day in the most conservative
analysis. There was a huge variance in the outcomes based on
the underlying assumptions of the calculations in both the cost-
effectiveness and business valuation model. The incremental
cost-effectiveness ratio and cost of capital were the most
sensitive parameters in respectively the cost-effectiveness and
business valuation model.
Conclusion: The break-even price analyses show that the
prices for medical nutrition do not reflect the full value
from a society perspective, consisting of the payer and
financial investors. The willingness to pay for medical
nutrition seems inappropriately lower compared with phar-
maceuticals, which may question the use of different pricing
and reimbursement policies for medical nutrition and
pharmaceuticals.
Disclosure of Interest: None declared.
MON-P160
NUTRITIONAL RISK IS A UNKNOWN CONDITION IN
INSTITUTIONALIZED ELDERLY PEOPLE WITHOUT
FUNCTIONAL LIMITATIONS AND COGNITIVE IMPAIRMENT. ARE
REQUIRED PREVENTIVE STRATEGIES?
M. D. M. Ruperto Lopez1 *, C. Iglesias1. 1Human Nutrition and
Dietetics, Universidad Alfonso X el Sabio, Madrid, Spain
Rationale: Disease-related malnutrition (DRM) is a multifac-
torial condition in institutionalized eldest population. The aim
of the study was to analyse the nutritional risk and DRM in
elderly people without functional limitations and cognitive
impairment living in nursing homes.
Methods: Cross-sectional study in 189 elders (60% men, aged:
87.9 ± 9.2 years, and time of institutionalization: 20.1 ± 10.2
months). Demographic, clinical and nutritional indicators were
recorded. Nutritional screening by Mini-Nutritional Assessment
(MNA) and, anthropometric, biochemical parameters were
performed. Analysis of body composition by bioelectrical
impedance was used. Subjects were classified into three
groups (G): Well-nourished (MNA ≥ 24 points); At nutritional
risk (MNA 23,5–17 points) and DRE (<17 points). Statistical
analysis by SPSS v.20.
S238
Results: Nutritional risk and DRE were 52.9% and 10%,
respectively. MNA score showed significant differences
between groups with BMI, mid-arm muscle and calf circumfer-
ences, lean body mass and serum prealbumin (at least,
P < 0.05). MNA was directly correlated with % fat mass (r = 0.34;
p < 0.001), mid-arm muscle circumference (r = 0.28; p = 0.003)
and %lymphocytes (r = 0.31; p = 0.002), whereas an inverse
significant correlation with hand-grip strength (right hand)
(r = 0.84; p = 0.017) were found.
Conclusion: Elderly people without functional limitations and
cognitive impairment have also higher nutritional risk and/or
DRE. Periodic screening and assessment of nutritional status
prevents malnutrition and improve quality of live in elder
people. Further studies and new preventive strategies too
promove healthy ageing are required.
Disclosure of Interest: None declared.
MON-P161
ARE PATIENTS WITH NORMAL WEIGHT OR OVERWEIGHT AND
CONCOMITANT WEIGHT LOSS MISSED IN THE NEW ESPEN
DEFINITION FOR MALNUTRITION?
M. A. De Van Der Schueren1 *, M. de Smoker1, E. Leistra2,
H. M. Kruizenga1. 1Nutrition and Dietetics, Vu University
Medical Center, 2Health Sciences, Vrije Universiteit,
Amsterdam, Netherlands
Rationale: Concerns have been raised whether the new
ESPEN definition for malnutrition correctly classifies malnutri-
tion in patients with normal weight or overweight and
concomitant weight loss, as they do not necessarily meet
the criteria for low FFMI. The aim of this study is to assess
the association between critical weight loss and one-year
mortality in hospitalized patients, stratified by BMI and FFMI
subgroups
Methods: Included were 769 patients admitted to the VU
University Medical Center. Critical weight loss (CWL) was
defined as >5% weight loss in the previous month or >10% weight
loss in the previous six months. The association between CWL
and one-year mortality was analyzed with a priori stratification
by the ESPEN definition cut-off values: BMI ≥ 20.0 kg/m2 for
patients <70 years and ≥ 22.0 kg/m2 for patients ≥70 years,
FFMI ≥ 15 kg/m2 for females and ≥ 17 kg/m2 for males.
Mortality risks were calculated (HR, 95% CI)
Results: Overall, CWL was associated with an increased one-
year mortality rate compared to no-CWL. In BMI and FFMI
subcategories, CWL was predictive for mortality only in
patients with low FFMI (Table).
HR for one-year mortality
compared to patients with no CWL
CWL (all patients) 1.76 (1.26–2.45)
CWL + FFMI ≥ 15/17 1.37 (0.85–2.21)
CWL + FFMI <15/17 1.95 (1.20–3.17)
CWL + BMI ≥ 20 /22 1.75 (1.17–2.61)
CWL + BMI ≥ 20 /22 + FFMI ≥ 15/17 1.38 (0.84–2.27)
CWL + BMI ≥ 20 /22 + FFMI <15/17 2.69 (1.29–5.65)
Conclusion: Patients with critical weight loss have a higher
one-year mortality risk compared to patients with no critical
weight loss. FFMI seems to play a crucial role in this association,
as only patients with a FFMI below cut-off points had increased
Poster
mortality rates, compared to their counterparts with normal
FFMI
Disclosure of Interest: None declared.
MON-P162
COMPARATIVE ANALYSIS OF THE PREVALENCE OF IN-
HOSPITAL MALNUTRITION ACCORDING TO ASPEN-ADA 2010
AND ESPEN 2015 CONSENSUS
M. Millan-Lopez1 *, M. A. Reyes Lopez2. 1Nutrition, Instituto de
Salud del Estado de Mexico, Tenancingo, 2Nutrition, Instituto
Nacional de Perinatología, Mexico, Mexico
Rationale: In-hospital malnutrition is a problem that prevails.
In developed the prevalence of in-hospital malnutrition ranges
widely due to the absence of standardized diagnostic tools. In
the field of clinical nutrition, as far as we know, no existent
data compares the diagnosis potential of the ASPEN-ADA 2010
and ESPEN 2015 tools
This study is aimed to evaluate in-hospital malnutrition
prevalence by employing the underlying rationale of the
ASPEN-ADA-2010 and ESPEN-2015 tools.
Methods: A transversal study was conducted at the General
Hospital located at Tenancingo, Mexico, and divided into two
time periods; August 15th-26th of 2016 and March 6th–22th of
2017. To some extent, patients from the areas of internal
medicine, surgery, and traumatology were included to conduct
this study.
Results: The population sample comprehends one hundred
patients, with a mean age of 48 years. The in-hospital
malnutrition prevalence, rises higher with to ASPEN-ADA 2010
tool in comparison to the ESPEN 2015 tool (65% vs 22%, p
<0.001). Both tools, showed that the greatest frequency of In-
hospital malnutrition prevalence was present in internal
medicine patients (80% ASPEN-ADA 2010 and 25% ESPEN
2015). Consequently, the stratified analysis demonstrated
that in adults, (young 16–40 y, middle 41–60 y and older
>61 y), the in-hospital malnutrition prevalence was higher
according to the ASPEN-ADA 2010 tool than to ESPEN 2015 (50%
vs23%, 74%vs35%, and 77%vs7%, respectively).
Conclusion: The In-hospital malnutrition prevalence varia-
tions, highly depends on the tool used employed. ESPEN 2015
tool tends to underestimate the diagnosis. We consider that the
advantages of having an early diagnosis, favourably outweighs
the inconveniences of a higher In-hospital malnutrition
prevalence. We suggest the use of the ASPEN-ADA 2010 tool
as a means of monitoring and identifying in-hospital patients
with malnutrition.
Disclosure of Interest: None declared.
MON-P163
IN-HOSPITAL DESNUTRITION PREVALENCE AT GENERAL
HOSPITAL OF TENANCINGO, (MEXICO) ACCORDING ESPEN
2015 CONSENSUS
M. Millan-Lopez1 *, M. A. Reyes Lopez2. 1Nutrition, Instituto de
Salud del Estado de Mexico, Tenancingo, 2Nutrition, Instituto
Nacional de Perinatología, Mexico, Mexico
Rationale: Although in-Hospital malnutrition is a widely known
problem, its prevalence varies according the studied group and
the employed tool. The consequences of In-hospital malnutri-
tion ranges from a worst clinic prognosis until economics
Nutritional assessment 2
concerns, so its identification and treatment must be a priority.
The study aim was to identify the In-hospital malnutrition
prevalence according ESPEN 2015 tool.
Methods: A transversal study was conducted at the General
Hospital located at Tenancingo, Mexico in two periods; August
15th–26th of 2016 and March 6th–22th of 2017. To some extent,
patients from the areas of internal medicine, surgery and
traumatology were included to conduct this study.
Results: The population sample comprehends one hundred
patients, with a mean age of 48 years. According body mass
index (BMI) 52% had normal weight, 33% overweight, 8%
obesity and 7% underweight. The In-hospital malnutrition
prevalence was 22%. The internal medicine group was the
patients group with the highest In-hospital malnutrition
prevalence (25%), in contrast with the surgery and orthope-
dics and traumatology groups (19.4% and 12.5%, respect-
ively). The stratified analysis showed an In-hospital
malnutrition prevalence of 35% for adults, 23% for young
adults and 6.7% for older adults.
Conclusion: We found an in-hospital malnutrition prevalence
to similar reported for others authors. The In-hospital
malnutrition problem varies according de group of age and
the kind of pathology. It seems that ESPEN 2015 tool has a
diagnosis potential for identify malnutrition among internal
medicine patients and those between 41 and 59 years, although
it is necessary more studies for evaluate the confiability of
this diagnosis The In-hospital malnutrition consequences
impact clinical and economic fields, so its identification is a
priority.
Disclosure of Interest: None declared.
MON-P164
BODY COMPOSITION IS ASSOCIATED WITH MORTALITY IN
PATIENTS WITH INTESTINAL FAILURE ON LONG-TERM HOME
PARENTERAL NUTRITION
M. Køhler1 *, H. H. Rasmussen1,2, S. S. Olesen2,3. 1Center for
Nutrition and Bowel Disease, Aalborg University Hospital,
2
Clinical Institute, Aalborg University, 3Center for Pancreatic
Diseases, Aalborg University Hospital, Aalborg, Denmark
Rationale: Patients with intestinal failure type 3 (IF) are at risk
of altered body composition and impaired muscle function due
to malnutrition, malabsorption and immobilization, which may
negatively influence survival. The aim of this study was to
investigate the association between body composition, muscle
strength and mortality in IF patients on long-term parenteral
nutrition (HPN)
Methods: This was a prospective cohort study comprising 77
patients with IF on long-term HPN (>12 months). The primary
outcome was all-cause mortality. We recorded gender, age,
body mass index (BMI, kg/m2) and handgrip strength (HGS, kg).
Further, we recorded fat mass index (FMI, kg/m2), fat free mass
index (FFMI, kg/m2) and phase angle (PA, degrees) measured by
bioelectrical impedance analysis (BIA). HGS and BIA para-
meters were analysed for their association with mortality;
assessments variables were compared to normative data and
categorised into normal or abnormal.
Statistics: Kaplan-Meier curves and Cox proportional hazards
models. Significance level: p < 0.05
Results: Of the 77 patients (age 59 ± 15 years, BMI 20.0 ± 4.2
kg/m2, female 73%), 16 (20.8%) died during the follow-up
S239
period (median 24.3 months). The cumulative mortality rate
was 14.3% after two years. Fat free mass index (FFMI) below
normal (Hazard Ratio 3.9 [95% CI; 1.1–14.1]; P = 0.04) and
phase angle below normal (Hazard Ratio 5.3 [95% CI; 1.6–17.5];
P = 0.007) were identified as independent risk factors for
mortality
Conclusion: In this study, we found that phase angle (PA) and
fat free mass index (FFMI) predicted mortality in a cohort of
patients with intestinal failure on long-term parenteral
nutrition. We found a fourfold increased mortality in patients
with a low FFMI and a fivefold increased mortality in patients
with a low PA
Disclosure of Interest: None declared.
MON-P165
MALNUTRITION PREVALENCE IN PATIENTS ADMITTED IN A
GENERAL PSYCHIATRY WARD OF AN ACUTE CARE HOSPITAL
M. Comas1 *, H. Segurola1, V. Avilés1, M. Guerrero1, A. Sancho1,
G. Cárdenas1, M. Giribés1, B. Sarto1, C. Puiggrós1, R. Burgos1.
1
Nutritional Support Unit, University Hospital Vall d’Hebron,
Barcelona, Spain
Rationale: Disease-related malnutrition (DRM) is highly preva-
lent at hospital admission, and impacts negatively in the
evolution of the patient. There is not enough information
regarding the malnutrition prevalence in patients admitted for
psychiatric pathology, with the exception of units specialized in
eating disorders.
To determine the malnutrition prevalence in patients admitted
in a general psychiatry ward of an acute care hospital, which is
not a reference center for eating disorders.
Methods: Patients admitted in a psychiatric ward between
2013–2016 were included in the study. Nutritional risk (NR) was
evaluated by Nutritional Risk Screening 2002 (NRS-2002),
followed by full nutritional assessment (NA) of positive
screened patients.
Results: 216 psychiatric patients were screened with NRS-
2002, of which 31(14.4%) were detected as NR. Average age:
45 ± 15 years. Only 2 malnourished patients had eating disorder
among other diagnoses, and 7 had dependence on toxic
substances.
After NA 18(58%) were confirmed as malnourished. The mean
hospital stay was 13 ± 8.3 days, without any difference
according to nutritional status.
As a main dietary intervention, a personalized diet was
designed in 78% of the patients, and 17% needed an oral
nutritional supplementation. Only one case required enteral
nutrition.
71% of malnourished patients were discharged home, 23% to a
psychiatric convalescent facility. The mortality rate was 3%. Of
the patients screened as negative NR, 20% required a stay in the
convalescent center.
Conclusion: The DRM prevalence in a psychiatric ward is lower
than those described for the general hospital population,
probably related to the youngest and the lower comorbidities of
this group of patients. Among malnourished patients, the group
of patients with addictions to various substances is the most
prominent (22%).
Disclosure of Interest: None declared.
S240
MON-P166
DISEASE-RELATED MALNUTRITION AT ADMISSION IN A THIRD
LEVEL HOSPITAL: BEYOND 10000 SCREENED PATIENTS
M. Comas Martínez1 *, H. Segurola1, V. Avilés1, A. Sancho1,
G. Cárdenas1, B. Sarto1, M. Giribés1, M. Guerrero1,
C. Puiggrós1, R. Burgos1. 1Nutritional Support Unit, University
Hospital Vall d’Hebron, Barcelona, Spain
Rationale: Disease-related malnutrition (DRM) is highly preva-
lent at hospital admission, and impacts negatively in the
outcome of the patient.
To analyze the impact of malnutrition in the outcome of
patients admitted to a third level hospital after implementing a
nutritional risk screening method at hospital admission.
Methods: In 2013, a nutritional intervention protocol was
started, including detection of nutritional risk through
Nutritional Risk Screening 2002 (NRS-2002), followed by
nutritional evaluation and nutritional plan.
Results: Since 2013, 10089 patients have been screened, of
whom 23.8% presents risk of malnutrition at admission. After
nutritional assessment, 52% of the patients were identified as
malnourished and required nutritional intervention: diet
adaptation in 54.2%, 36.7% also needed oral nutritional
supplementation, 3.8% required enteral nutrition and 5.3%
parenteral nutrition.
The mean hospital stay was 16.64 days in malnourished
patients. Patients without nutritional risk had an average
hospital stay of 10.97 days. ( p < 0.0001)
Malnourished patients presented a high mortality rate (8.2% VS
2.7% in non-malnourished patients), and also a high need for a
convalescent center (13.45% VS 7.26% ( p < 0.0001))
Conclusion: The DRM prevalence is very similar to that
reported in literature, highlighting a greater mortality rate
and a higher need for a convalescent center. We need to
implement nutritional strategies to address DRM in the
community setting.
Disclosure of Interest: None declared.
MON-P167
INFLUENCE OF MALNUTRITION ON MORTALITY IN
HOSPITALIZED PATIENTS
M. Wäsch1, M. Plauth1 *. 1Dessau Community Hospital, Dessau-
Roßlau, Germany
Rationale: Hospital malnutrition is an often underestimated
problem in the Industrial countries causing increased morbidity
and mortality for patients as well as considerable additional
cost for the health care system. For the detection of the
malnutrition, various screening and assessment tools are
recommended. The aim of this study was to examine whether
hospital patients classified as malnourished according to either
SGA category B and C or phase angle (PA) <5th percentile had an
increased mortality risk according to the Pandora score.
Methods: Of 353/358 consecutive patients admitted to the
gastroenterology ward of Dessau community hospital in the
period 15.02–24.04.2016 were screened for malnutrition using
NRS-2002. 191/353 patients had a score of ≥ 3. In 150/191
patients the full data set including Pandora score, SGA
classification, PA from bioelectric impedance analysis was
available for analysis.
Poster
Results: Malnourished patients showed a significantly higher
mortality risk. Compared to 31 well nourished patients (SGA A)
119 malnourished patients (SGA B and C) showed a fourfold
higher 30-day mortality risk (9.4 8.7% vs. 2.3 2.3%; p < 0.001).
Using PA <5th percentile as criterion for malnutrition the
mortality risk was of the same magnitude in 103 patients and
significantly higher than in the well nourished group (9.8 9.1%
vs 3.8 3.9%; p < 0.001). Using either NRS ≥ 3 and SGA B and C or
NRS ≥ 3 and PA <5th percentile as criterion the prevalence of
malnutrition was 33% and 29% in excellent agreement with
published data.
Conclusion: SGA as a subjective and PA as an objective method
are equally well suited to identify patients at increased risk of
malnutrition related mortality.
Disclosure of Interest: None declared.
MON-P168
THE RELATIONSHIP BETWEEN DIET QUALITY AND LIFE
QUALITY IN ADULTS
M. A. Sahin1 *, Z. Buyuktuncer1. 1Nutrition and Dietetics,
Hacettepe University, Ankara, Turkey
Rationale: Diet quality has a potential to influence the quality
of life. However, little is known about the relationship between
diet quality and life quality. This study aimed to determine the
relationship between diet quality and life quality in an adult
population.
Methods: The study was conducted on 1,181 individuals, aged
19 to 65 years who were admitted to 19 Family Health Centers
in Edirne, Turkey. General characteristics, anthropometrical
measurements and physical activity data of individuals were
recorded. Food frequency questionnaire was used to determine
diet quality; and Short Form-36 life quality questionnaire was
used to determine the life quality. Healthy Eating Index-2005
(HEI-2005) scores of individuals were calculated, and then
classified into three groups: good (over 80 points), moderate
(between 51 and 80 points), and poor (50 and under points).
Short Form-36 life quality questionnaire was used to calculate
mental components score and physical components score.
Results: The mean of Healthy Eating Score was 58.3 for males,
63.8 for females. A strong relationship between diet quality
and life quality was shown in this study. The diet quality score
was significantly associated with mental components score
( p < 0.01). Moreover, individuals had low scores for consump-
tion of total vegetables, whole grains and dairy products, and
intake of sodium whereas high scores for consumption of total
grains, meats and legumes and intake of saturated fat.
Conclusion: Improving the life quality of populations is one of
the main goals of public health strategies. This study showed
that improving diet quality can help improving society’s life
quality. Encouraging people for increasing their vegetable,
grain and dairy consumption, and decreasing salt intake should
be prior foresight to improve diet quality of people living in
Edirne.
References:
Disclosure of Interest: None declared.
Nutritional assessment 2
MON-P169
VALIDATION OF THE MALNUTRITION UNIVERSAL SCREENING
TOOL (MUST) FOR THE MALNUTRITION IN TURKISH HOSPITAL
SETTINGS
F. Sümer1, B. Bolayır2, C. Balcı1, R. T. Doğrul1, G. S. Ayçiçek1,
C. Özsürekçi1, H. Çalışkan1, B. B. Yavuz1, M. Cankurtaran1,
M. Halil1 *. 1Department of Internal Medicine Division of
Geriatrics, Hacettepe University, 2Department of Internal
Medicine Division of Endocrinology and Metabolism, Gazi
University, Ankara, Turkey
Rationale: A variety of screening tools are used for the
determination of malnutrition, one of the most one is the
Malnutrition Universal Screening Tool (MUST). In this study, we
have investigated the validation of the MUST test in hospital
settings.
Methods: A total of 252 patients hospitalized in medical or
surgical wards were included for the study. All the patients
underwent comprehensive geriatric assessment. Nutritional
status of the patients was evaluated by two geriatricians
experienced in malnutrition. There was very good agreement
between them (kappa = 0.85). The patients were also eval-
uated by using MUST test for nutritional status by a different
clinician blinded to the decisions of the geriatricians for the
nutritional status of the patients. Nutritional status of the
patients according to the MUST and the geriatrician decision
was compared with Cohen’s kappa analysis. Also, the sensitivity
and specificity results of the MUST test for the malnutrition
were evaluated.
Results: The mean age of the patients was 59,55 ± 15,93 years
and 56% of them were female. The sensitivity, specificity,
positive predictive and negative predictive values of the MUST
test for detecting malnutrition in hospital settings were 73%,
92%, 85% and 85%, respectively. Test results were more sensitive
in patients under 65 age, but more specific in geriatric
population. When compared between medical and surgery
wards, test was both more sensitive (77%) and specific(96%) in
surgery ward.
Conclusion: This study showed that the Turkish version of the
MUST test is validated for inpatients.
Disclosure of Interest: None declared.
MON-P170
IS EXAMINATION PERIOD RELATED WITH INCREASED
CAFFEINE INTAKE AMONG UNIVERSITY STUDENTS? A CROSS
SECTIONAL STUDY
M. M. Tengilimoglu Metin1 *, D. Gumus1, S. Sevim1, G. G. Topal1,
M. Kizil1. 1Hacettepe University, Ankara, Turkey
Rationale: University students are exposed to stress due to
their daily academic load. Due to work and projects, university
students commonly have academic stress. Caffeinated stimu-
lants are broadly regarded as helping students stay focused and
alert to improve their academic performance, especially
examination period. Hence, the aim of this study was to
compare the non-examination and examination period caffeine
intake and depression
Methods: A cross-sectional study was conducted on 103 male
and 227 female university students aged 18–30 years. In non-
examination and examination period, caffeine intake data was
collected using caffeine consumption questionnaire and
S241
depression was determined by Beck Depression Scale. Beck
depression scores were classified as minimal, mild, moderate,
and several depression. The differences of caffeine intake and
Beck Depression Score in non-examination and examination
period were examined by paired t test
Results: Our subjects consisted of a total of 68.8% females and
31.2% males. The mean beck depression score of female and
male were found 12.0 ± 10.0, 8.6 ± 8.9 in the examination
period and were found 6.4 ± 6.4, 5.3 ± 5.1 in non-examination
period, respectively ( p < 0.01). For female and male, the
quantity of daily caffeine consumption was found 323.1 and
307.2 mg in examination period, respectively, however,
average daily caffeine consumption was found as 186.8 and
242.2 mg, respectively ( p < 0.05). Major contributors to
caffeine intake among students were black tea, Nescafe,
herbal tea, green tea, Turkish coffee, ice tea and milk with
chocolate, respectively. Caffeine consumption was shown to
have a positive relationship with beck depression score and
beck depression score was found to be higher in those with a
higher caffeine intake ( p < 0.01).
Conclusion: In examination period, university students tend to
increase their caffeine consumption in order to manage
academic stress.
Disclosure of Interest: None declared.
MON-P171
CHANGES IN SLEEP DURATION ASSOCIATED WITH
NUTRITIONAL STATUS AND APPETITE IN ELDERLY
N. Acar Tek1, M. S. Karacil Ermumcu1 *. 1Nutrition and
Dietetics, Gazi University Faculty of Health Sciences, Ankara,
Turkey
Rationale: The aim of the present study was to examine the
association between nutritional status with appetite and
changes in sleep duration in older adults.
Methods: This is a cross-sectional population-based study was
conducted at 142 men and 265 women totally 407 elderly
aged ≥ 60 years. Questionnaire including the demographic
characteristics, health information, sleep duration, Mini
Nutrition Assessment (MNA), Mini Nutrition Assessment-Short
Form (MNA-SF) and Simplified Nutritional Appetite
Questionnaire (SNAQ) was performed by face-to-face inter-
views. Statistical analysis was performed with version 16 SPSS.
Results: A total of 407 home dwelling elderly individuals were
interviewed (142 men and 265 women) with a mean age of men
and women 72.8 ± 6.67 years; 71.1 ± 6.41 years respectively
( p < 0.05). The mean night sleep duration (hour/day) of women
and men 7.9 ± 1.72 and 7.9 ± 1.72 hours respectively and the
mean daytime sleep duration (hour/day) of women and men
1.0 ± 1.19 and 0.9 ± 1.18 hours respectively. There isn’t any
significant differences between daytime and night sleep
duration between groups ( p > 0.05). When we determinated
the association between sleep duration with nutritional status
and appetite we found that there is negative correlation
between daytime sleep duration with MNA-SF (r:−0.236;
p:0.000), MNA (r:−0.250; p:0.000), and SNAQ (r:−0.133;
p:0.000), scores. But there is a positive association between
night sleep duration and MNA-SF (r:0.098; p:0.048) scores.
Conclusion: Better nutritional status and appetite was
associated with changes in sleep duration.
Disclosure of Interest: None declared.
S242
MON-P172
DETERMINANTS OF QUALITY OF LIFE IN FREE-LIVING
ELDERLY POPULATION: NUTRITIONAL STATUS AND APPETITE
N. Acar Tek1, M. S. Karacil Ermumcu1 *. 1Nutrition and
Dietetics, Gazi University Faculty of Health Sciences, Ankara,
Turkey
Rationale: The aim of the present study was to examine
nutritional risk factors such as poor appetite and malnutrition
affecting quality of life in elderly.
Methods: This is a cross-sectional population-based study
consisted of 407 (142 men and 265 women) elderly mean
aged 71.7 ± 6.54. Questionnaire including the demographic and
general characteristics, health information, nutrition beha-
viours, health related life quality scale (The Health Survey
Short Form-SF36), Mini Nutrition Assessment (MNA), Mini
Nutrition Assessment-Short Form (MNA-SF) and Simplified
Nutritional Appetite Questionnaire (SNAQ) was performed by
face-to-face interviews. Anthropometric measurements were
measured by well-trained investigators, using standard meas-
urement protocols. Daily food consumption was assessed using
24 hour dietary recall.
Results: Women obtained lower scores in the physical function-
ing, bodily pain, general health, vitality, role-emotional,
physical and mental component summary scales ( p < 0.05).
There isn’t any significant association between anthropometric
measurements, number of main meal/snack and consumption
of nutrients (except energy and fiber intake) with life quality of
elderly. But night sleep duration negatively correlated with
mental component summary scale scores and BMI negatively
correlated with physical component summary scale scores. A
one unit increase in the elderly’s SNAQ score caused a two unit
increase in the physical component summary scale And also a
one unit increase in the elderly’s SNAQ and MNA-SF score
caused 1.4 unit increase in the mental component summary
scale score.
Conclusion: Factors such as nutritional status and appetite
which affect life quality of elderly have to improve so these
factors will increase the quality of life in this group.
Disclosure of Interest: None declared.
MON-P173
EVALUATION OF MALNUTRITION ACCORDING TO DIFFERENT
CRITERIA IN HEMODIALYSIS PATIENTS
E. Koksal1, M. S. Karacil Ermumcu1 *, O. Kucukerdonmez2,
E. Karabudak1. 1Nutrition and Dietetics, Gazi University
Faculty of Health Sciences, Ankara, 2Nutrition and Dietetics,
Ege University Faculty of Health Sciences, İzmir, Turkey
Rationale: The aim of this study to evaluate malnutrition
according to malnutrition related parameters in hemodialysis
patients.
Methods: This cross-sectional clinical study was conducted on
eighty two patients applied to a special dialysis center. The
demographic parameters, antropometric measurements and
biochemical findings were taken for all participants. Body
weight, body mass index (BMI), energy intake (kkal/kg),
normalized protein nitrogen appearance (nPNA (g/kg/day)),
albumin (g/dL), blood urea nitrogen (BUN (mg/dL)), creatine
(mg/dL) and serum cholesterol (mg/dL) was used to determine
malnutrition in patients with their spesific cut off values.
Poster
Results: The mean age of the patients was 47.17 ± 10.61 years.
And 48.8% of the patients were men and 51.2% were females.
Prevalence of malnutrition was 8.5% according to body weight (<
%85 ideal body weight) and 92.7% with regard to energy intake
(<35 kkal/kg for <60 years and <30–35 kkal/kg for ≥60 years) and
54.90% for BMI (<23 kg/m2) and 46.3% according to creatine
(<10 mg/dL) and 35.4% with regard to cholesterol (<150 mg/dL).
There was not any malnourished individual according to BUN
(<60 mg/dL) and only one patient was malnutrition accordingly
nPNA (<1 g/kg/day) and two patients were malnutrition accord-
ing to albumin (<3.5 g/dL). And 20.7% of patients were
malnourished according to 4 or more of the malnutrition criteria.
Conclusion: The malnutrition prevalence of patients was found
very different according to the parameters related to malnu-
trition. Therefore it should be necessary to evaluate these
parameters together.
Disclosure of Interest: None declared.
MON-P174
RELATIONSHIP BETWEEN NUTRITION AND PSYCHOLOGICAL
STATUS İN DIALYSIS PATIENT
M. Aydin Cil1 *, K. Gokalp2, A. Yayla3, M. Tan4. 1Nutrition and
Dietetic, Health Science Faculty, Ataturk University,
2
Psychology, 3Surgery, 4Internal Medicine, Nursing Faculty,
Ataturk University, Erzurum, Turkey
Rationale: Psychological disorders like depression and anxiety
are most commonly comorbid diseases to end-stage renal
disease patients. Due to poor oral consumption depression is a
risk factor for malnutrition. The study aim was to asses the
relationship between nutritional and psychological status in
hemodialysis (HD) and continuous ambulatory peritoneal
dialysis (CAPD) patient.
Methods: This study was conducted in dialysis centers in
Erzurum in Turkey. We evaluated the nutrition status of dialysis
patient by antropometric measuruments (body mass index
(BMI), waist/hip ratio, triceps skinfold thickness (TSF)), serum
albumin and subjective global assesment (SGA). Brief Symptom
Inventory (BSI) was used to asses psychological status.
Results: Totally 177 patients (HD, CAPD) who fit inclusion
criteria were enrolled. Mean age was 51.70 ± 16.75 years and
47.5% of patients were male, 52.5% of patients were female.
While there was no statistically difference between psycho-
logical status and SGA in CAPD ( p > 0.05), statistical signifi-
cant difference between phobia, psychoticism scores and SGA
was observed in HD ( p < 0.05). Well- nourished patients had
lower scores than malnourished (SGA B-C). Negatif correl-
ation were found between TSF and psychological status both
two groups. In BSI, interpersonal sensitivity, depression,
anxiety, paranoid thought, hostility, psychoticism scores for
CAPD patients; obsessive compulsive disorder, anxiety and
phobia scores for HD was found higher in malnourished
patients ( p > 0.05). There was no statistically significant
relation between BKI, serum albumin, waist/hip ratio and
psychological status.
Conclusion: Psychological status was found independent
predictors of malnutrition in dialysis patients. Clinicians
should be evaluating patient′s psychological status while
assessing nutritional status of dialysis patients.
Disclosure of Interest: None declared.
Nutritional assessment 2
MON-P175
EFFECT OF ORAL NUTRITIONAL SUPPLEMENTATION ON THE
NUTRITIONAL STATUS AND QUALITY OF LIFE OF PATIENTS
WITH GASTROINTESTINAL CANCER AFTER SURGERY: A MULTI-
CENTER STUDY
X. Yang1, M. Zhu2 *, D. Xiu3, Y. Yang4, G. Yang5, W. Hu6, Z. Wang7,
H. Cui1, J. Wei1. 1Beijing Hospital, 2Beijing Hospital, 3Peking
University Third Hospital, Beijing, 4Xinhua Hospital Affiliated
to Shanghai Jiaotong University School of Medicine, Shanghai,
5
Nanfang Hospital Affiliated to Southern Medicine University,
Guangzhou, 6Ruijin Hospital Shanghai Jiaotong University
School of Medicine, 7Shanghai Sixth Hospital Affiliated to
Shanghai Jiaotong University School of Medicine, Shanghai,
China
Rationale: This study aims to evaluate the effect of oral
nutritional supplementation on the nutritional status and
quality of life of patients with gastrointestinal cancer.
Methods: A multi-center study was conducted on gastrointes-
tinal cancer patients who received surgical treatment from
2013 to 2015. All patients were screened using the Nutrition
Risk Screening 2002 (NRS 2002) to assess for nutritional risk.
Patients with nutritional risk were randomly divided into two
groups upon discharge: patients in study group, were given
dietary guidance and oral nutritional supplements (500 Kcal/
d, whole protein enteral nutrition); patients in control group
only received dietary guidance. Anthropometric measure-
ments, nutrition-related laboratory tests and gastrointestinal
function scores were also collected and compared.
Results: 55 in study group and 59 patients in control group
completed this study. Compared with baseline, the body weight
of patients in study group increased by 1.345 ± 0.531 Kg and
1.352 ± 0.729 Kg at 60 days and 90 days respectively, which was
significantly higher than control group (−1.012 ± 0.543 Kg, and
−1.597 ± 0.811 Kg at 60 days and 90 days after discharge;
P = 0.003 and 0.008). A similar situation was also observed for
BMI, which increased in patients in study group (60 days:
0.486 ± 0.215, 90 days: 0.539 ± 0.218), but decreased in control
group (60 days: −0.428 ± 0.221, 90 days: −0.44 ± 0.231)
(P < 0.01). There were no differences between groups for
other indicators between two groups.
Conclusion: Oral nutritional supplements might improve the
weight and BMI of patients with gastrointestinal cancer after
surgery. However, this has less impact on improving their
quality of life.
Disclosure of Interest: None declared.
MON-P176
NUTRITIONAL ASSESSMENT IN OBESITY PREVENTION
M. Stubelj1 *, M. Černelič Bizjak1, A. Petelin1,
Z. Jenko Pražnikar1. 1University of Primorska, Faculty of
Health Sciences, Izola, Slovenia
Rationale: Nutrition care process in obesity prevention is a
problem-solving method composed of assessments, diagnosis,
interventions, monitoring and evaluations. Nutrition assess-
ment is a systematic process of obtaining and interpreting data
in order to make decisions about the nature of nutritional
treating. It depends on practice settings and is an on-going,
dynamic process. Due to the large amount of data, it is difficult
to control.
S243
Methods: A qualitative multi-criteria method Decision Expert
(DEXi) was applied to create the model, tested on 20 women
and 13 men. Average women body mass index was 29,1 ± 2,7,
with 38,2% ± 3,1 of body fat; average men body mass index was
29,8 ± 2,8, with 24,2% ± 3,5 of body fat.
Results: We designed a multi-criteria decision model that
can be used as a decision support in selecting assessment
frequency, data collection with monitoring and evaluation. The
main criteria that is put on the top of DEXi model, tells us when
reassessment is required: in 1 week (very high health risk), in 2
weeks (high health risk), in 3 weeks (low health risk), 4 weeks
(very low health risk) or reassessment is not required (no risk).
The selected criteria that contribute to the value of the main
criteria are: energy intake, the adequacy of nutrients, dietary
habits, physical activity and health (e.g. biochemical determi-
nations: glucose, insulin, lipids and inflammatory markers). We
identified nine subjects with very high health risk, sixteen with
high health risk, seven with a low health risk, one with very
small health risk.
Conclusion: The decision-model, created according DEXi
method, was developed as a uniform system of decision-
making in the process of nutritional treatment in obesity
prevention. Using this model, we can reduce the time to make
decisions, evaluate the variants, understand the decisions, and
allow equal treatment of all subjects.
Disclosure of Interest: None declared.
MON-P177
VALIDATION AND RELIABILITY OF THE TURKISH VERSION OF
SUBJECTIVE GLOBAL ASSESSMENT TEST IN HOSPITALIZED
PATIENTS
C. Balci1, B. Bolayır2, F. Sümer1, R. T. Doğrul1, G. S. Ayçiçek1,
C. Özsürekci1, H. Çalışkan1, B. B. Yavuz1, M. Cankurtaran1 *,
M. Halil1. 1Department of Internal Medicine Division of
Geriatrics, Hacettepe University, 2Department of Internal
Medicine Division of Endocrinology and Metabolism, Gazi
University, Ankara, Turkey
Rationale: Malnutrition is a frequent occurrence in hospita-
lized patients. Although there are numureous screening tools
for malnutrition most of them has not been validated in our
country. In this study, the validity and reliability of the Turkish
version of the Subjective Global Assessment (SGA) test used to
assess malnutrition in hospitalized patients was evaluated.
Methods: A total of 231 patients 131 women (56.7%) and 100
men (43.3%) with an average age of 58,8 ± 16.2 were included in
the study. 109 (47.2%) and 122 (52.8%) of the patients were
followed at the medical and surgical wards, respectively. Two
geriatricians experienced in the field of malnutrition who were
unaware of the SGA results, interpreted the patients nutri-
tional status after the evaluation of several parameters such as
medical history including weight loss, appetite, anthropomet-
ric measurements, biochemical markers, bioimpedance ana-
lysis, hand grip strength and 3-day dietary records. Based on
these, the patients were divided into ‘at nutritional risk’ and
‘not at nutritional risk’ groups by specialists. Concordance
between the two clinicians’ clinical assessment was analyzed
by kappa statistics and excellent concordance was found
(kappa = 0.861), therefore the more experienced specialist’s
decisions was accepted as gold-standard. A third physician
performed SGA within 48 h of admission. At the end of the SGA
S244
evaluation patients with a category ‘A’ were classified as ‘non-
malnourished’ and those with categories ‘B and C’ were
classified as ‘malnourished’.
Results: In general, SGA was found to be 83% sensitive and 92%
specific compared to the clinician’s assessment of malnutri-
tion. The positive predictive value and the negative predictive
value were 86% and 90%, respectively.
Conclusion: The Turkish version of the SGA test in hospitalized
patients is a valid and reliable method for evaluating
malnutrition.
Disclosure of Interest: None declared.
MON-P178
LOW BIOIMPEDANCE PHASE ANGLE INDICATES MUSCLE
CATABOLISM AND LOSS OF MUSCLE AND COGNITIVE
FUNCTION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
N. Rotovnik Kozjek1,2 *, C. Lieben1, N. Deutz1, M. Engelen1.
1
Center for Translational Research in Aging & Longevity, Dept.
Health and Kinesiology, Texas A&M University, College Station,
United States, 2Clinical Nutrition Unit, Institute of Oncology,
Ljubljana, Slovenia
Rationale: Phase angle (PA) is a parameter of bioelectrical
impedance analysis (BIA) and a low value has been used as an
indirect marker of fat-free mass loss, impaired cell function
and poor disease prognosis in chronic obstructive pulmonary
disease (COPD). We examined whether low PA in COPD is
associated with skeletal muscle and cognitive dysfunction,
muscle loss, and enhanced muscle myofibrillar protein break-
down (MPB) rate.
Methods: In 21 normal weight COPD patients (GOLD II-IV, 10
with normal PA (≥5) (NPA) and 11 with low PA (<5) (LPA)) and 13
healthy age-matched controls, body composition, and inspira-
tory, hand, and leg muscle strength were assessed by dual-
energy X-ray absorptiometry, mouth pressure, handgrip and
one leg dynamometry, respectively. Physical activity was
assessed by PASE Questionnaire, and PA at 50 Hz by BIA.
Cognitive function was measured with Trail Making Test (TMT),
and whole body MPB by pulse iv administration of L-(2H3)tau-
methylhistidine stable tracer. Statistics by one-way analysis of
variance and significance was set at p < 0.05.
Results: Body composition was not different between the 3
groups, and severity of airflow obstruction comparable in
the COPD subgroups. The LPA COPD group had lower values
for inspiratory, handgrip and leg strength, and physical
activity ( p < 0.01), higher TMT response and interference
time ( p < 0.05) than the control group. Furthermore, the LPA
COPD had lower values for handgrip and leg strength, and
higher TMT interference ( p < 0.05) than the NPA group. MPB
was higher in the LPA COPD group compared to the control
group (0.48 ± 0.33 vs 0.20 ± 0.09 μmol/kg ffm/h, p < 0.01) but
not to the NPA group (0.32 ± 0.21 umol/kg ffm/h, p = 0.11).
Conclusion: Low phase angle reflects presence of muscle
weakness, deficits in psychomotor speed and cognitive
flexibility, and myofibrillar protein breakdown in normal
weight COPD patients.
Disclosure of Interest: None declared.
Poster
MON-P179
THE RESEARCH BETWEEN THE DATA OF CALF
CIRCUMFERENTIAL MEASUREMENT IN MINI NUTRITIONAL
ASSESSMENT SHORT FORM (MNA-SF) AND THE DATA OF PHASE
ANGLE FOR BED BOUNDED PATIENTS―THE 7TH REPORT
AFTER COPENHAGEN
N. Katsura1 *. 1Surgery, Miyazu Takeda Hospital, Kyoto, Japan
Rationale: One of the advantage of Mini Nutritional
Assessment-Short Form (MNA-SF) is that it does not need to
measure body weight of patients. Body mass index(BMI) can be
exchanged to calf Circumference (CC) measurement. However,
current cut off point, 31 cm is adequate for standing or sitting
position. In the ESPEN in Leipzig, we reported the new cut-off
point, 29 cm for supine position. This time we examined the
relevance between the discrepancy of CC at supine position and
sitting position with phase angle measurment to check
nutritional situation of bed-bounded patients.
Methods: 45 patients, 21 male, 24 female, mean age 83.1
(70–98 years old), were examined with both 29 cm and 31 cm of
CC measurement of MNA-SF and phase angle data with Bio
Impedance Analyzer (BIA). As the results, a coefficient of
correlation was calculated.
Results: A coefficient of correlation of 45 patients between the
gap of the data of supine position and sitting position and phase
angle is 0.7506, showing strong coefficient.
Conclusion: Strong correlation between the gap of CC and
phase angle was admitted. We should use our new cut-off point,
29 cm, with MNA-SF to the patients who show the normal phase
angle data.
References: no reference
Disclosure of Interest: None declared.
MON-P180
COMPARISON OF BODY COMPOSITION ASSESSMENT BY BIA
AND DEXA ACCORDING TO THE BODY MASS INDEX: A
RETROSPECTIVE STUDY ON 3655 MEASURES
N. Achamrah1,2, G. Colange2, J. Delay2, A. Rimbert1,2,
V. Folope1,2, A. Petit1,2, S. Grigioni1,2, P. Déchelotte1,2 *,
M. Coëffier1,2. 1INSERM UMR 1073, Normandie Univ, 2Nutrition,
Rouen Hospital Center, Rouen, France
Rationale: Body composition (BC) assessment is used in clinical
practice for nutritional evaluation and monitoring. The
standard method, dual-energy X-ray absorptiometry (DEXA),
is hardly feasible in routine clinical practice contrary to
Bioelectrical Impedance Analysis (BIA) method. We aimed to
compare BC assessment by DEXA and BIA according to the body
mass index (BMI) in a large cohort.
Methods: We analysed DEXA and BIA measures in patients
followed in a Nutrition Unit from 2010 to 2016. BC was assessed
under standardized conditions by DEXA (Lunar Prodigy
Advance) and BIA (Bodystat QuadScan 4000, Manufacturer’s
equation). Bland-Altman test was performed for each class of
BMI. Fat mass (FM) and fat free mass (FFM) values were
compared using Kruskal-Wallis test.
Results: FM and FFM differences are indicated in Table 1. BC
values were very closed for BMI between 16 and 18,5
(difference <1 kg). For BMI >18,5 and BMI <40, BIA over-
estimated FFM from 2,51 to 5,67 kg, and underestimated FM
from 3,38 to 8,28 kg compared with DEXA method. For
Nutritional assessment 2 S245

Table 1: (abstract: MON-P180). Values without a common letter differ significantly (p < 0.05).
BMI < 16 16 ≤ BMI < 18.5 18.5 ≤ BMI < 25 25 ≤ BMI < 30 30 ≤ BMI < 35 35 ≤ BMI < 40 BMI > 40
2 a b c d e f g
BMI(kg/m ) 14,67 ± 0,09 17,17 ± 0,05 21,26 ± 0,12 28,03 ± 0,08 32,69 ± 0,05 37,44 ± 0,05 44,25 ± 0,12
a a b c d c c
Age 32,0 ± 1.1 32,5 ± 1,0 33,4 ± 0,98 45,1 ± 0,8 48,5 ± 0,5 45,9 ± 0,5 45,1 ± 0,5
a a b c c d d
Δ FM(BIA-DEXA; kg) −2,57 ± 0,26 −0,86 ± 0,22 2,51 ± 0,23 5,67 ± 0,21 5,42 ± 0,14 4,02 ± 0,15 0,62 ± 0,18
a a b c c c d
Δ FFM (BIA-DEXA; kg) 2,25 ± 0,27 0,64 ± 0,22 −3,38 ± 0,26 −7,18 ± 0,23 −7,74 ± 0,15 −8,28 ± 0,17 −5,87 ± 0,18

BMI ≥ 40, differences vary with BMI. For BMI <16, BIA under-
estimated FFM by 2,25 kg, and overestimated FM by 2,57 kg.
Conclusion: BIA provides a suitable assessment of BC for BMI
between 16 and 18,5. For BMI <16, further analyses are needed,
in a larger number of patients. For BMI >18,5 and BMI <40,
adjustments have to be made according to the BMI class.
Disclosure of Interest: None declared.
MON-P181
NUTRITIONAL RISK ASSESSMENT OF THE PATİENTS WITH
INFLAMMATORY BOWEL DİSEASE
N. G. Ünal1 *, N. ORUÇ1, A. Ö. Özütemiz1. 1Gastroenterology,
Ege University Faculty of Medicine, İzmir, Turkey
Rationale: Inflammatory bowel disease (IBD) is chronic
inflammatory disease of the digestive tract. IBD patients tend
to have nutritional deficiency cause of active course of disease
and also to avoid nutrition-releated bowel symptoms.
Nutritional factors play a key role fort the patients outcome.
This study aimed to determine nutritional ris assessment of the
IBD patients.
Methods: A total 318 IBD outpatients were enrolled to the
study between december 2015-december 2016. Data of the
patients and mini nutritional assessment form (MNA)1 were
evaluated retrospectively. According to the MNA form, the
total scores of the patients were classified into 3 groups;<17 is
defined as malnutrition, 17–23,5 at the risk of malnutrition and
24–30 as normal nutritional status. BMI were calculated
according to WHO criteria as followed; <18,5 kg/m2 under-
weight, 18,5–25 normal range, 25–30 overweight and ≥ 30
obese.2
Results: A total 200(63%) of the patients were ulcerative
colitis, 118(37%) were Crohn’s disease. Mean age was 45,7 years
(18–83), 174(55%) of the patients were men, 25(8%) of the
patients were underweight, 146(46,4%) normal, 110(34,6)
overweight and 37(%12) obese. MNA score showed 59(18,5%)
were malnourished, 105(33%) were at risk of malnutrition and
154(48,5) were normal nutritional status.
Conclusion: Data of this study showed that 8% of IBD patients
are underweight according to the BMI. But MNA scores revealed
that at least 50% of patients are malnourished or at the risk of
malnutrition. MNA can be used as a tool for the assessment of
the nutritional risk in IBD outpatient.
References
1. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening
for Undernutrition in Geriatric Practice: Developing the Short-Form
Mini Nutritional Assessment (MNA-SF). J. Geront. 2001; 56A:
M366–377
2. WHO expert consultation. Appropriate body-mass index for Asian
populations and its implications for policy and intervention
strategies. The Lancet, 2004; 157–163.
Disclosure of Interest: None declared.
MON-P182
THE DIFFERENCE RELIABILITY BETWEEN NUTRITIONAL
ASSESSMENT PARAMETERS FOR DETECTING MALNUTRITION
IN TYPE 2 DIABETES MELLITUS OUTPATIENTS WITH ACTIVE
TUBERCULOSIS
N. N. M. Soetedjo1 *, D. F. Abdullah2, P. Santoso3, H. Permana1.
1
Endocrinology and Metabolism DIvision, Internal Medicine
Department, 2Internal Medicine Department, 3Pulmonology
Division, Internal Medicine Department, Padjadjaran
University, Bandung, Indonesia
Rationale: Diabetes Mellitus (DM) and Tuberculosis (TB) are
both have strong correlations with malnutrition, but there is no
currently simple, easy and inexpensive method for assessment
of nutritional status in detecting malnutrition especially in
type 2 diabetes mellitus (T2DM) outpatients with active TB.
The aim of this study is to evaluate the difference agreement
between malnutrition parameters based on Body Mass
Index (BMI), Subjective Global Assessment (SGA), and Total
Lymphocyte Count (TLC) with serum albumin as gold standard
in T2DM with active TB.
Methods: This study was a cross-sectional study in type 2
Diabetes Mellitus outpatients with active Tuberculosis between
February 2014 until November 2015 who come to Endocrinology
and Pulmonology Outpatient Clinics, Hasan Sadikin General
Hospital, Bandung, Indonesia. Non Parametric Kappa Formula
were using to measure the difference reliability between BMI,
SGA and TLC with serum albumin as gold standard.
Results: At the end of this study there were 64 T2DM
outpatients with active TB, 34 (53,1%) were male. The mean
aged was 52 ± 11 years old. Malnutrition prevalence was 31,3%
based on serum albumin; 39,1% based on SGA; 29,7% based on
TLC and 21,9% based on BMI. The reability test showed that BMI
and TLC had slight reliability (k = 0,208, p 0,087; k = 0,078,
p = 0,531) while SGA has good reliability with serum albumin as
gold standard (k= 0,830, p < 0,001).
Conclusion: As conclusion SGA compared to BMI and TLC
showed good reliability with albumin value in detecting
malnutrition in type 2 diabetes mellitus outpatients with
active tuberculosis.
Disclosure of Interest: None declared.
MON-P183
EVALUATION OF NUTRITIONAL STATUS AND SOCIAL
CONDITIONS OF STREET CHILDREN: KAYSERI PROVINCE FROM
TURKEY
G. Kaner1, N. İnanç2 *, G. Ünal2, E. Sivri2, N. Seremet Kürklü3.
1
Faculty of Health Sciences, Department of Nutrition and
Dietetics, Izmir Katip Celebi University, Izmir, 2Faculty of
S246
Health Sciences, Department of Nutrition and Dietetics, Nuh
Naci Yazgan University, Kayseri, 3Department of Nutrition and
Dietetics, Akdeniz University, Antalya School of Health,
Antalya, Turkey
Rationale: The number of children who work on the streets of
Turkey has prominently increased. They become vulnerable to
malnutrition. We aimed to evaluate the nutritional status and
social conditions of a group of street children in Central
Anatolia.
Methods: A general questionnaire was applied to 75 children
via a face-to-face interview. Body weight and height were
measured and BMI was calculated. Children were distributed
according to the height for age and weight for height by using
WHO 2007 references.
Results: The majority of the children were boys. Approximately
half of the children were attending primary school and also
working on the street whereas 29.3% dropped out of school. The
incidence of working on the street was higher in 7–9 and 10–12
age groups and that half of the children were selling tissues,
gums and flowers on the street. It was seen that 37.3% of the
children working on the street were having 2 main meals, while
56.0% were having 3; that the majority of them were skipping
meals. Majority of boys (87.3%) and girls (75.0%) cannot receive
the daily energy they need. One fourth of the boys (25.4%) and
one third of the girls (33.3%) cannot intake enough protein.
Most of the boys cannot consume sufficient fiber (79.4%),
vitamin C (69.8%) and phosphor (65.1%). Almost all the boys
(98.4%) and all of the girls (100.0%) can not receive enough
calcium. Almost half of the boys (47.6%) and the majority of the
girls (75.0%) cannot gain enough iron. More than half of the
children (54.7%) were normal weight; while 36.0% of them were
overweight according to their body mass index for age.
According to their height for age, 70.7% of children were
normal and 12.0% were stunted.
Conclusion: The children who are put to work in the streets do
not have a balanced diet. This subject is in need of extensive
studies with control groups including all the cities in Turkey.
Disclosure of Interest: None declared.
MON-P184
ASSESSMENT OF NUTRITION STATUS OF ELITE TURKISH
ADOLESCENT FOOTBALL PLAYERS
N. Ersoy1 *, G. Ersoy2. 1Nutrition and Dietetic, Hacettepe
University, Ankara, 2Nutrition and Dietetic, İstanbul Aydın
Üniversitesi, İstanbul, Turkey
Rationale: Meeting energy and nutrient requirements of
adolescent athletes is not only important for sports perform-
ance but also for their health. By considering that they are on
the way of starting professional life, determination of their
nutrition status is very important.
Methods: 26 young athletes, who are on the way of becoming
professional athletes, are participated to this study. All
measurements (anthropometric measurements, food consump-
tion records and fluid consumption amount) were taken during
three consecutive days before an important competitive soccer
match. The study was approved by the Clinical Research Ethical
Advisory Committee No. 1 in Ankara. Descriptive statistics on
personal characteristics, and food consumption variables was
calculated.
Poster
Results: Physical characteristics of the players were: age
15 ± 1.2 years, height 175.2 ± 6.8 cm, weight 67.3 ± 5.9 kg, BMI
21.9 ± 1.3 kg/m2 and body fat percentages % 6.2 ± 1.7. When
their food consumption is examined, it’s seen that their daily
energy intake is 3225 ± 692 kcal and their energy consumption
is 3322 ± 240 kcal. Carbohydrate, protein, fat percentage of
the energy intake was found as %53,6, %16,2 and %30.2
respectively. Daily fluid consumption of athletes found to be
2780 ± 567 mL. During the training, athletes only consumed
water and amount of water consumed is 908.6 ± 332.7 mL.
When nutrient intake of players are examined based on RDA
(Recommended Daily Allowance), it has been seen that %92,3
of them do not consume D vitamin adequately and %50 of them
do not consume calcium adequately.
Conclusion: To summarize, inadequacies are determined in
food and fluid intakes of adolescent athletes. As they are in
developmental period, they must increase their calcium intake.
Considering that fact that the adolescent athletes may transfer
their wrong nutrition habits to their professional life, they need
professional assistance in nutrition and hydration status.
Disclosure of Interest: None declared.
MON-P185
ASSESSMENT OF NUTRITION KNOWLEDGE AND FOOD INTAKES
OF WHEELCHAIR WOMAN NATIONAL BASKETBALL TEAM
N. Ersoy1 *, G. Ersoy2. 1Nutrition and Dietetic, Hacettepe
University, Ankara, 2Nutrition and Dietetic, İstanbul Aydın
University, İstanbul, Turkey
Rationale: In this study, determination of nutrition knowledge
and food intakes of disabled athletes are aimed.
Methods: This study was made by 22 players of Wheelchair
Woman National Basketball Team between 14–17 January 2013
(during camp period) in Ankara. Players voluntarily partici-
pated to the study and nutrition knowledge level questionnaire
and food intake records of the players for the past 24 hours have
been taken. All subjects gave their written informed consent to
participation. Descriptive statistics on personal character-
istics, and food consumption variables was calculated.
Results: Average age of the basketball players were 25,5 ± 7,2
years and daily energy intake was 2868 ± 524 kcal, energy
consumption is 3407 ± 662 kcal. Carbohydrate, protein, fat
percentage of the energy was found as %42.7 ± 8.84, %
13.3 ± 1.96, %44.0 ± 8.07 respectively. %72.7 of the participants
had stated that their nutrition knowledge level was good but
they only answered %29 of the questions correctly. It has been
seen that the players are commonly uninformed about
nutrients, fluid intake and principals of sports nutrition. %
18,2 of the players with healthy nutrition information said that
they gained the source of these information from dieticians.
When nutrient intake of players are examined based on RDA
(Recommended Daily Allowance), it has been seen that intake
of vitamin B1, folic acid, iron, magnesium and fibre are
inadequate.
Conclusion: Nutrition information (especially in the field of
sports nutrition) of disables athletes is inadequate. Reference
values have to be created for putting emphasis on nutrition
status of disabled athletes, for developing strategies for
nutrition status and food consumption requirements.
Nutritional assessment 2
Reference
Guidetti L, Franciosi E, Emerenziani GP, Gallotta MC, Baldari C.
(2009) Assessing Basketball Ability in Players with Mental
Retardation. Br J Sports Med;43:208–212.
Disclosure of Interest: None declared.
MON-P186
ASSESSMENT OF ADOLESCENCE SWIMMERS’ NUTRITION
STATUS
N. Ersoy1 *, T. Özgürtaş2. 1Nutrition and Dietetic, Hacettepe
University, 2Medicine, Sağlık Bilimleri University, Ankara,
Turkey
Rationale: To assess nutrition status in adolescence swimmers
and to evaluate food consumption. At the same time,
anthropometric measurements of adolescence swimmers
were got and this measurements were evaluated according to
reference data.
Methods: In total 19 swimmers aged 11–13 years, were included
in this study. Three days food consumption records and some
anthropometric measurement (weight and height) were
assessed. The study was approved by the Clinical Research
Ethical Advisory Committee in Ankara (with the resolution
dated 24.07.2013 and numbered B.10.4.İSM.4.06.68.49), and
all subjects gave their written informed consent to participa-
tion. Descriptive statistics on personal characteristics, and
food consumption variables was calculated.
Results: The mean weight and height of swimmers were
45.3 ± 8.7 kg and 153.0 ± 6.3 cm, respectively. Carbohydrate,
protein, fat percentage of the daily energy intake was found as
38.6 ± 5.3%, 16.8 ± 2.8% and 44.7 ± 5.0 respectively. Daily
calcium intake was 801.3 ± 241.0 mg and only 7 swimmers
(37%) met the daily calcium requirement.
Conclusion: Carbohydrate and fat intake of swimmers were
unbalanced. Carbohydrate intake was below the recommended
value, and fat intake was over the recommended value. At the
same time, calcium intake is also very low. It should not be
forgotten that swimming sports can be risky in terms of vitamin
D deficiency because they are made in closed area in Turkey. It
should be noted that these athletes may be at risk for
developing some diseases, especially bone health, if their
calcium and vitamin D needs cannot be met due to their age of
development.
Disclosure of Interest: None declared.
MON-P187
TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE
SCORED PATIENT-GENERATED SUBJECTIVE GLOBAL
ASSESSMENT (PG-SGA) TO THE THAI SETTING
N. Nitichai1 *, J. Angkatavanich1, N. Somlaw2, B. Sirichindakul3,
K. Chittawatanarat4, N. Voravud2, H. Jager-Wittenaar5,6,
F. D. Ottery6,7, on behalf of PG-SGA/Pt-Global Platform Team.
1
Department of Nutrition and Dietetics, Faculty of Allied
Health Sciences, Chulalongkorn University, 2Department of
Medicine, 3Department of Surgery, Faculty of Medicine,
Chulalongkorn University and King Chulalongkorn Memorial
Hospital, Bangkok, 4Department of Surgery, Faculty of
Medicine, Chiangmai University, Chiangmai, Thailand,
5 Rationale: The European Society of Clinical Nutrition and
Department of Oral and Maxillofacial Surgery, University of
Groningen, University Medical Center Groningen, 6Research
S247
Group Healthy Ageing, Allied Health Care and Nursing, Hanze
University of Applied Sciences, Groningen, Netherlands,
7
Ottery & Associates, LLC., Oncology Care Consultants, Vernon
Hills (Chicago area), United States
Rationale: The Scored Patient-Generated Subjective Global
Assessment (PG-SGA) is a multidimensional tool to assess
malnutrition and risk factors. We aimed to translate and cross-
culturally adapt the original PG-SGA for the Thai setting and
test its linguistic validity and intra-rater reliability in cancer
patients.
Methods: The Thai version of the PG-SGA was developed
according to the Principles of Good Practice for the Translation
and Cultural Adaptation Process for the Patient Reported
Outcomes by the International Society for Pharmacoeconomics
and Outcomes Research (ISPOR). In 50 cancer patients and 50
healthcare professionals, linguistic validity of the Thai PG-SGA
was assessed by Scale Comprehensibility Index (S-CI) and Scale
Difficulty Index (S-DI)), using a 4-point scale. Relevance was
assessed in professionals only, by Scale Content Validity Index
(S-CVI). In addition, intra-rater reliability (test-retest within 72
hours of admission; Intraclass Correlation Coefficient (ICC) and
weighted kappa (κ)) were assessed.
Results: The Thai PG-SGA showed excellent comprehensi-
bility (S-CI = 0.99) and difficulty (S-DI = 0.95) as perceived by
patients. It also showed excellent comprehensibility
(S-CI= 0.92) and borderline acceptable difficulty (S-DI = 0.79)
as perceived by professionals. Relevance of the Thai PG-SGA in
assessing malnutrition was considered excellent (S-CVI = 0.95).
Agreement between numerical scores was good to excellent
(ICC = 0.95) and agreement between PG-SGA categories was
very good (weighted κ=0.95).
Conclusion: The Thai version of the PG-SGA was considered
very easy to complete by patients. Professionals evaluated it as
very comprehensible, relevant, and borderline acceptable in
difficulty to complete. It is a reliable tool for assessment of
malnutrition and risk factors in cancer patients.
Disclosure of Interest: N. Nitichai Grant/Research Support from:
The 90th Anniversary of Chulalongkorn University Scholarship, J.
Angkatavanich Grant/Research Support from: The 90th Anniversary of
Chulalongkorn University Scholarship, N. Somlaw: None declared,
B. Sirichindakul: None declared, K. Chittawatanarat: None declared,
N. Voravud: None declared, H. Jager-Wittenaar Other: Co-developer of
the PG-SGA based Pt-Global app, F. Ottery Other: Copyright holder of
the Patient-Generated Subjective Global Assessment (PG-SGA), co-
owner and co-developer of the PG-SGA based Pt-Global app.
MON-P188
RELATIONSHIP BETWEEN SKELETAL MUSCLE MASS AND EACH
NUTRITIONAL INDEX OF HEART FAILURE PATIENTS: DOES BMI
AND BIOCHEMICAL INDICATORS REFLECT SKELETAL
MUSCLE MASS?
N. Suzuki1 *, K. Kida2, S. Doi1, C. Ito2, K. Ashikaga2, H. Matsuda1,
K. Suzuki2, T. Harada2, Y. J. Akashi2. 1Division of Cardiology,
Department of Internal Medicine, ST. Marianna University
School of Medicine Yokohama City Seibu Hospital, Yokohama,
2
Division of Cardiology, Department of Internal Medicine, ST.
Marianna University School of Medicine, Kawasaki, Japan
Metabolism (ESPEN) Consensus Statement recommends diag-
nosis of malnutrition using several malnutrition screening tools
S248
and physical measurement, other than biochemical indicators.
Also, body mass index is cited as an index to recognize
significant correlation with skeletal muscle mass. However,
body weight changes due to edema are often observed in
chronic heart failure (CHF) patients.
Methods: Totally 45 outpatients with CHF were enrolled. Total
skeletal muscle mass was measured at the level of the third
lumbar vertebra using available preoperative computed tom-
ography images (Cutoff value: male 36.2 cm2/m2, female
29.6 cm2/m2). It was investigated on the relationship
between skeletal muscle mass and each nutritional indicator.
Results: The mean age was 75.6 ± 6.4 years old and left
ventricular ejection fraction was 44.3 ± 18.9%. Of the study
patients, 53.3% patients were male, 26.7% patients had
ischemic heart failure, 57.8% patients had New York Heart
Association (NYHA) classification ≥2, and 68.9% patients had
Mini Nutritional Assessment Short Form (MNA-SF) score ≤11.
Correlation between skeletal muscle mass and each index was
body mass index (BMI; r = 0.63, p < 0.01), Geriatric Nutritional
Risk Index (GNRI; r = 0.51, p < 0.01), MNA-SF (r = 0.37, p = 0.03)
and serum albumin value (Alb; r = −0.10, p = 0.59). In addition,
the predictive ability of skeletal muscle mass reduction by area
under the receiver operating characteristic Curve (AUC) was
BMI: 0.79, MNA-SF: 0.74, GNRI: 0.70, and Alb: 0.59.
Conclusion: Because Alb was affected by inflammation and
body congestion, there was no correlation between skeletal
muscle mass. On the other hand, BMI and MNA – SF, GMRI
including BMI in the evaluation items also showed correlation
with skeletal muscle mass in CHF, and these possibilities may
reflect skeletal muscle mass.
Disclosure of Interest: None declared.
MON-P189
CHANGE IN HANDGRIP STRENGTH AND FAT-FREE MASS
DURING NUTRITIONAL INTERVENTION AND FOLLOW-UP IN
MALNOURISHED HOSPITALIZED PATIENTS
P. L. M. Lakenman1, C. Oudshoorn2 *. 1Department Nutrition
and Dietetics, Internal Medicine, 2Department Internal
Medicine, Erasmus MC, University Medical Center, Rotterdam,
Netherlands
Rationale: Malnutrition is frequently observed in Dutch
Hospitals. According to the Dutch Dietetic Guidelines, mea-
surements of handgrip strength (HGS) and fat-free mass (FFM)
should be part of assessment of the nutritional status. It
remains unknown how often HGS and FFM should be measured
during follow-up. The aim of this study was to examine the
change in HGS and FFM during nutritional intervention and
follow-up in hospitalized patients.
Methods: All patients admitted to the departments of internal
medicine and surgery who were diagnosed as malnourished
according to the Malnutrition Universal Screening Tool (MUST,
score ≥ 2) in the period January-March 2017 in the Erasmus MC
were included. Nutritional assessment (NA) took place at
admission, 5 days after the day of admission and after longer
follow-up period on indication. NA was assessed by: body
weight (kg), weight loss prior to admission (WL, kg), FFM (kg/
m2), fat-free mass index (FFMI, kg/m2), HGS (kg) and protein
intake (weight X 1.2–1.5 g, as percentage of requirement).
Non-parametric tests were performed to examine the differ-
ences of HGS and FFM during follow-up.
Poster
Results: A total of 81 patients (53% male; mean age 59 (±13)
years) were included. At baseline, mean body mass index was
21.5 (±17.3) kg/m2, mean WL prior to admission was 8 kg
(10%). In 23 (51%) patients the HGS and in 30 (76%) patients
the FFMI were below the 10th percentile of the reference
values at baseline. Mean HGS at admission was 26 (±9.4) kg
and mean FFM was 46.5 (±9.4) kg. During follow-up there
were no significant changes in HGS (P = 0.36) and FFM
(P = 0.88).
Conclusion: In this study there were no changes observed in
HGS and FFM during nutritional intervention and follow-up in
newly admitted malnourished hospitalized patients. The
added value of HGS and FFM measurements in nutritional
intervention and follow-up needs to be assessed in further
studies.
Disclosure of Interest: None declared.
MON-P190
REFERENCE VALUES FOR HANDGRIP STRENGTH CORRECTED
FOR ARM MUSCLE AREA DIFFER BETWEEN GENDERS.
P. Reijven1 *, P. Geerlings1. 1Dietetics, Mumc Maastricht,
Maastricht, Netherlands
Rationale: A low handgrip strength (HGS) is an indication for
loss of skeletal muscle and/or overall physical condition of
patients and is an independent predictor for complications and
mortality. Reference values are not specified for frame size,
height or muscle mass. This might lead to misinterpretations of
measured values. We therefore constructed reference values
corrected for mid arm muscle area (MAMA).
Methods: In 1273 (913 females; 360 males) healthy volunteers
(age 20–80 years) HGS, midarm circumference and triceps
skinfold were measured. MAMA was calculated and HGS was
corrected for MAMA. Age and gender specific percentiles were
calculated. Data of men and women were compared by
student T-tests.
Results: In all age categories absolute HGS was higher in males
than in females (P < 0,001). However, HGS/cm2 MAMA was not
different between genders and stable until the age of 50 years.
In females the P50 percentile showed a decline of 30% from age
30 to 70 years, while in males this decline was only 18%.
Table 1: P50 values HGS/MAMA (kg/cm2) from age 40 to 79 years.
Age (years) 40–49 50–59 60–69 70–79
Males 0,922 0,901 0,846* 0,755*
Females 0,913 0,800 0,696 0,677
*significantly different from females (P < 0,001).
Conclusion: in healthy persons the HGS corrected for MAMA is
constant until the age of 50 years and not different between
genders. Above 50 years the corrected HGS declines gradually,
especially in women. HGS/MAMA might be a simple screening
tool for muscle quality and/or overall physical capacity. The
difference between genders during ageing might indicate
differences in muscle metabolism.
Disclosure of Interest: None declared.
Nutritional assessment 2
MON-P191
A SHORT NUTRITIONAL ASSESSMENT PROCEDURE (SNAP)
IDENTIFIES PATIENTS WITH NORMAL BMI AS MALNOURISHED.
P. Reijven1 *, L. Sundaram1, A. Vroomen1, J. Brouns1,
P. Geerlings1. 1Dietetics, MUMC Maastricht, Maastricht,
Netherlands
Rationale: In a recent ESPEN consensus statement disease
related malnutrition (DRM) was defined as a low BMI (<18,5) or
a substantial weight loss combined with a low BMI or low FFMI.
This definition excludes the need for body composition and
function measurements. Especially in patients with liver or
renal disease this might lead to wrong conclusions. Aim of the
study was to compare BMI with mid arm muscle and fat area and
handgrip strength (HGS) in patients with renal or liver disease.
Methods: in 32 patients with liver disease (15 males, 17
females, mean age 58 years (SD = 9))and 44 patients on renal
dialysis (30 males, 14 females, mean age 70 years (SD 12)) we
measured weight, height, midarm circumference, triceps
skinfold and HGS and calculated BMI, mid arm muscle area
(MAMA) and mid arm fat area (MAFA). Values were compared
with gender and age specific reference values ( percentiles).
Results: BMI below 18,5 kg/m2 was measured in two dialysis
patients, both patients scored below P5 for MAMA, MAFA and
HGS. All other patients had BMI values above 20. Despite the
absence of underweight a substantial numbers of patients
scored low for MAMA, MAFA and HGS (see Table 1).
Table 1: Percentage of patients with values < P5 or between P5 and P15 for MAMA,
MAFA and HGS.
Patients MAMA MAFA
<P5 P5-P15 <P5 P5-P15 <P5
Liver dis.(N = 32) 9 22 12 12 28
Dialysis (N = 44) 20 11 14 7 45
Conclusion: BMI is unable to identify malnourished patients
with compromised body composition and low muscle strength.
Overhydration, ascites and (abdominal) fat mass can mask the
loss of skeletal muscle mass. Simple anthropometric measures
might be useful in daily practice to monitor nutritional status of
chronically ill patients when a detailed nutritional assessment
is not possible.
Disclosure of Interest: None declared.
MON-P192
USING QUALITY IMPROVEMENT METHODOLOGIES TO
OPTIMISE NUTRITION CARE FOR ALL PATIENTS ADMITTED TO
AN ACUTE NEUROSURGICAL WARD IN BEAUMONT HOSPITAL
P. O’connor1, K. Cullen1 *, E. Bradley2. 1Department of
Nutrition & Dietetics, 2Department of Nursing, Beaumont
Hospital, Dublin 9, Ireland
Rationale: Malnutrition can be both a cause and a conse-
quence of disease, and can lead to worse health and clinical
outcomes in all social and healthcare settings. Previous audits
showed that on average 28% of patients admitted to our
hospital are at risk of malnutrition1. To ensure patients receive
the right intervention at the right time we need systems in
place to firstly identify patients at risk of malnutrition and also
prevent patients from becoming malnourished during
admission.
S249
We proposed using Quality Improvement Methodologies to
improve the standard of nutritional care being provided to all
patients admitted to an acute Neurosurgical Ward.
Methods: The Model for Improvement (MFI) framework2 was
used in conjunction with the “Plan, Do, Study, Act (PDSA)
cycle”. A number of baseline audits were completed (rates of
screening, weight on admission audit, mealtime audits). A
number of PDSA cycles were completed including:
• Nutrition education
• Admission Pack Flowsheets
• Self Auditing process
• Using red mats to highlight patients requiring assistance
Results: Over an eight week period, the team achieved a
sustained compliance rate of 80% for malnutrition screening
(from baseline of 0%). There was also an improvement with
mealtime assistance observed, with 100% of patients receiving
timely assistance post intervention (compared to 72% at
baseline).
Conclusion: A significant improvement in optimising the
nutritional care for patients was achieved using the MFI and
PDSA cycles. Patients at risk of malnutrition were identified at
an earlier stage of their admission journey resulting in earlier
dietary intervention. A secondary outcome of this project has
been the change in mindset and culture within the
organisation.
References
1. http://www.bapen.org.uk/pdfs/nsw/nsw-2011-report.pdf
2. Langley et al. 2009. The Improvement guide. Jossey-Bass: A Wiley
HGS imprint (USA)
Disclosure of Interest: None declared.
P5-P15
31
9 MON-P193
MALNUTRITION HAS NEGATIVE EFFECTS ON POSTOPERATIVE
COMPLICATIONS, LENGTH OF STAY AND READMISSIONS AT
SURGICAL PATIENTS
P. Sarkut1 *, S. Kilicturgay2, E. S. Kerim3, O. Sütcüoglu4,
G. Dundar5, I. Tirnova1. 1Department of General Surgery,
Uludag University, 2Department of General Surgery, WM
Medical Park Hospital, Bursa, 3Department of General Surgery,
Tepecik Training and Research Hospital, Izmir, 4Department of
Internal Medicine, Gazi University, 5Department of
Otolaryngology, Hacettepe University, ankara, Turkey
Rationale: We investigated the effects of malnutrition and
nutritional supporting on postoperative complications, length
of hospitalisation and readmissions of postoperative 30th and
90th days in this trial.
Methods: The data is collected from the surgical patients as
prospectively between March 2013 and March 2014. Patients’
data as age, gender, body mass index (BMI), loss of wiegth (%10
in 6 months), nutritonal support status, nutritonal support
timing, lenght of stay (LOS), postoperative complications and
readmissions of postoperative 30th and 90th days. Patients with
BMI < 18.5 and/or weigth loss are assumed as malnourished
patient. Malnourished patients are divided in four groups; no
malnutrition support (N), preoperative nutritional support
(PrN), postoperative support (PsN)and both preoperative and
postoperative nutritional support (PerN).
Results: 1,325 women (%58,2) and 951 men (%41,8), 2,276
patients evaluated totally. Malnutrition was detected at 185
S250
patients (%8,1). İnfectious complications had seen in %4,9 of
malnutriated patient while others suffered from infectious
complications at %2,2 rate ( p = 0,037). Similarly malnourished
patients had significantly longer hospital stay ( p < 0,005). The
readmission rate was %13 at malnourished patients, while
others’ rate was %6,5 at postoperative 30th day ( p = 0,001).
Postoperative 90th day readmission rates were %4,9 and %1,4
respectively( p = 0,002). By the way there were no significant
difference between the groups on gastrointestinal complica-
tions ( p = 0,197) and other complications ( p = 0,045).
Conclusion: BMI is detected as unsatisyfing on evaluation of
malnutrition. Malnutrition is a significant risk factor of LOS,
infectous complications and readmissions. It seems to nutri-
tional supporting has an impact on infectious complications on
readmission althougt it has no effect at early stage.
Disclosure of Interest: None declared.
MON-P194
A SHORT NUTRITIONAL ASSESSMENT PROCEDURE (SNAP)
FOR ROUTINE DIETETIC PRACTICE.
P. Reijven1 *, L. Sundaram1, A. Vroomen1, J. Brouns1,
P. Geerlings1. 1Dietetics, MUMC Maastricht, Maastricht,
Netherlands
Rationale: Screening for malnutrition is introduced in most
hospitals. However a full nutritional assessment in positively
screened patients is not a routine procedure. We propose a
simple, quick and cheap method that can be used in health
care centers. Aim of the study was to compare SNAP outcomes
with body composition measured by bioelectrical impedance
analysis (BIA).
Methods: In patients referred by medical specialists for a full
nutritional assessment, fat free mass index (FFMI) and fat mass
index (FMI) measured with BIA (using the Geneva equation)
were compared with SNAP outcomes of mid arm muscle area
(MAMA), mid arm fat area (MAFA) and handgrip strength (HGS).
Patients with neurological or muscular diseases were excluded.
The SNAP consists of anthropometric measurements: height,
weight, circumference of mid upper arm, triceps skin fold and
HGS. Together with date of birth, gender and usual weight
these data are used in a spreadsheet. The patients age, weight,
weight loss, MAMA, MAFA are calculated and results of BMI,
frame size, MAC, MAMA, MAFA and HGS are immediately
available. Gender and age specific reference values are used
for presenting results in percentiles categories.
Results: 42 patients were included (mean age 50 years, SD = 18
years). Mean BMI was 23,2 kg/m2 (SD = 6,3), 13 patients (31%)
had BMI < 18,5 kg/m2. HGS was below P15 is 29 (69%) patients.
Of the patients with normal BMI (>18,5) (n = 29) 41% had MAMA
below P15 and 72% had HGS below P15. VVMbia correlated with
MAMA (R = 0,73, P < 0,01), VMbia correlated with MAFA
(R = 0,73, P < 0,01). The sensitivity and specificity of MAMA
for identifying patients with a low FFMI (males: < 17,4 kg/m2;
females: <15,0 kg/m2) were 64% and 75% respectively.
Conclusion: When a full nutritional assessment is not possible,
SNAP can help dieticians to identify and monitor patients with a
low FFMI and low muscle strength.
Disclosure of Interest: None declared.
Poster
MON-P195
DIAGNOSTIC ACCURACY OF ESPEN DIAGNOSTIC CRITERIA FOR
MALNUTRITION IN SELECTED CLINICAL POPULATIONS
P. Dewansingh1,2 *, L. ter Beek1,3,4, M. Euwes5, G. van der Sluis6,
F. D. Ottery1,7, C. P. van der Schans1,8,9,10,
H. Jager-Wittenaar1,11. 1Research Group Healthy Ageing,
Allied Health Care and Nursing, Hanze University of Applied
Sciences, Groningen, 2Nutrition and Dietetics, Nij Smellinghe
Hospital, Drachten, 3Department of Pulmonary Diseases and
Tuberculosis, Center for Rehabilitation, 4Department of
Maxillofacial Surgery, University of Groningen, University
Medical Center Groningen, Groningen, 5General Health Care,
6
Department of Physical Therapy, Nij Smellinghe Hospital,
Drachten, Netherlands, 7Ottery & Associates, Vernon Hills
(Chicago), United States, 8Faculty of Medical Sciences, 9Dept.
of Rehabilitation Medicine, 10Dept. of Health Psychology
Research, 11Dept. of Maxillofacial Surgery, University of
Groningen, University Medical Center Groningen, Groningen,
Netherlands
Rationale: We aimed to assess diagnostic accuracy of ESPEN’s
Diagnostic Criteria for malnutrition (EDC), as compared to the
Patient-Generated Subjective Global Assessment (PG-SGA) in
selected clinical populations.
Methods: In two hospitals, in 174 patients (67.5 ± 10.3 yrs;
COPD: n = 116; colon/rectum cancer: n = 21; orthopedic:
n = 37) malnutrition was assessed by EDC and PG–SGA.
According to EDC, malnutrition was defined as having at least
one of the following criteria: 1) BMI < 18.5 kg/m2; 2)
combination of unintentional weight loss (>10% of habitual
weight indefinite of time, or >5% over 3 months) and low BMI
(<20 or <22 kg/m2 in subjects younger and older than 70 yrs,
respectively) and/or a low fat-free mass index (FFMI) by
bio-electrical impedance (<15 [female] and <17 kg/m2
[male]). As reference, malnutrition was defined as PG-SGA
Stage B (moderately/suspected malnutrition) or Stage C
(severely malnourished). Diagnostic accuracy was assessed by
sensitivity, specificity, positive and negative predictive value,
and ROC curve.
Results: According to EDC and PG-SGA, 6.9% and 31% were
malnourished, respectively. For COPD, colon/rectum cancer,
and orthopedic patients, prevalence was 9.5% and 39.7%, 4.8%
and 19%, and 0% and 10.8% respectively. Overall sensitivity,
specificity, positive and negative predictive value were 0.15,
0.97, 0.85 and 0.03, respectively. The area under the ROC curve
(AUC) was 0.56 ( p = 0.23) for the total population. For COPD,
colon/rectum cancer, and orthopedic patients AUC was 0.55
( p = 0.39), 0.63 ( p = 0.45), and 0.50 ( p = 1.00), respectively.
Conclusion: In COPD, rectum-/colon cancer, and orthopedic
patients, diagnostic accuracy of EDC as compared to the PG-
SGA is low, especially sensitivity and negative predictive value.
Consequently, using EDC in these populations is likely to result
in underrecognition of malnutrition, which may hinder timely
and adequate treatment of malnutrition.
Disclosure of Interest: P. Dewansingh: None declared, L. ter Beek:
None declared, M. Euwes: None declared, G. van der Sluis: None
declared, F. Ottery Other: Developer of the PG-SGA, co-developer of
the PG-SGA based Pt-Global app, C. van der Schans: None
declared, H. Jager-Wittenaar Other: Co-developer of the PG-SGA
based Pt-Global app.
Nutritional assessment 2
MON-P196
‘lET THEM EAT CAKE’: A RETROSPECTIVE SERVICE
EVALUATION OF FOCUS ON UNDERNUTRITION IN CARE HOMES
R. Masters1 *. 1Nutrition and Dietetics, County Durham and
Darlington NHS Trust, NHS, Bishop Auckland, United Kingdom
Rationale: Undernutrition is a cause of poor health in older
people, affecting 35% of residents in care homes1. Focus on
Undernutrition (FoU), delivered by dietetic assistants (DA) uses
multifaceted approaches to undernutrition management. The
study aims to evaluate FoU’s impact on undernutrition outcome
measures in care homes; including weight change in residents
‘at risk’ of undernutrition, prevalence of undernutrition and
pressure ulcers (PU).
Methods: A retrospective pragmatic service evaluation using
pseudonymised data collected over 13 years on weight,
undernutrition risk and PU from long-stay residents’ notes
before and six months after training.
Results: Analysis on 104 homes, 4315 residents (71.3% female;
mean stay 10.8 (1–278) months) in County Durham. Following
FoU a significant difference was identified for:
• Improved rate of weight change for ‘at risk’ residents
( p < 0.001). Undernutrition risk significantly influenced
weight change (low:B1.04 kg, E0.01 kg; moderate: B−
1.79 kg, E−0.38 kg; high:B−0.83 kg, E1.00 kg, Bp < 0.001,
E
p = 0.001)
• Reduced undernutrition prevalence ( p < 0.001) from 32.7%
to 29.1% residents ‘at risk’ (moderate:B13.1%, E8.9%;
high:B19.6%, E15.9%). Nutrition screening significantly
improved (B76.3%, E98.7%, p < 0.001)
• Reduced prevalence PU (51%, p < 0.001). PU prevalence
significantly increased with undernutrition severity at
baseline ( p < 0.001), but not following FoU ( p = 0.233)
(low: B5%, E2.3%; moderate:B6.9%, E1.6%; high:B10.5%,
E
3.9%). Odds of developing PU reduced 53% (OR:0.47)
B
:baseline; E:evaluation;OR:odds ratio
Conclusion: These results demonstrate DAs delivering FoU
significantly improves weight, undernutrition and PU preva-
lence in care homes. Indicating FoU is an effective model for
improving undernutrition outcomes, with the potential of
reducing possible harm, such as PU in care homes.
Reference
1. Russell C & Elia M. (2015) Nutrition Screening Survey in care homes
in England. BAPEN.
Disclosure of Interest: None declared.
MON-P197
A NEW DISEASE SPECIFIC NUTRITIONAL SCREENING TOOL FOR
INPATIENTS WITH HEART FAILURE
R. Jones1 *, H. Jackson1. 1Nutrition and Dietetics, St Georges
Hospital, London, United Kingdom
Rationale: Malnutrition contributes to poor outcomes in
patients with Heart Failure (HF) (1) and is highly prevalent at
75–90% (2). Patients should be screened for malnutrition on
admission to hospital (3). The commonly used Malnutrition
Universal Screening Tool (MUST) may not be reliable in HF
patients with oedema. There is no consensus for an alternative
nutritional screening tool (NST). A HF inpatient NST (HFiNUT)
was designed. This pilot study aimed to assess the HFiNUT and
S251
MUST in comparison with subjective global assessment (SGA),
as the reference standard of nutritional status.
Methods: Inpatient admissions to the HF Unit were nutrition-
ally screened using the MUSTand HFiNUT. A SGA was completed
by an experienced dietitian, blinded to the NST results. Each
NST was used to categorise patients by malnutrition risk and
compared with nutritional status indicated by SGA.
Results: 40 inpatients (23 male), average age 73 years (28–95
years) were assessed. Ethnicity in 63% of the participants was
White, 23% were Asian and 5% Black.
68% of the participants were malnourished by SGA. 15% were at
nutritional risk using MUST (Score ≥1) and using HFiNUT 90%
(Score ≥1). MUST identified 8% for dietetic referral and
HFiNUT 70%.
The sensitivity of HFiNUT was 85% and MUST was 11% when
identifying patients for referral to a dietitian. MUST had 24
false negative results (89%) compared with the HFiNUT 5 results
(15%). The specificity of MUST was 100% vs HFiNUT 62%.
Conclusion: This study supports previous findings of high rates
of malnutrition in HF patients. Replacement of MUST with
HFiNUTwould increase the proportion of malnourished patients
identified and referred for dietetic intervention. Further work
is required to determine if these results are reproducible in
larger patient numbers.
References
1. Sze S, et al. (2017) Clin Res Cardiol 15,1082–1085.
2. Lin H, et al. Heart Fail Rev (2016) 21:549. doi: 10.1007/s10741-016-
9540-0.
3. NICE (2006) CG32.
Disclosure of Interest: None declared.
MON-P198
HOSPITAL MALNUTRITION ON THE AFRICAN CONTINENT:
WE HAVE A PROBLEM
R. Blaauw1 *, E. Achar1, R. Dolman2, J. Harbron3, M. Moens1,
F. Munyi1, D. Nel4, D. Nyatefe2, J. Visser1. 1Division of Human
Nutrition, Stellenbosch University, Cape Town, 2Centre of
Excellence for Nutrition, North-West University,
Potchefstroom Campus, Potchefstroom, 3Division of Human
Nutrition, University of Cape Town, 4Centre for Statistical
Consultation, Stellenbosch University, Cape Town, South Africa
Rationale: Globally prevalence of malnutrition on admission to
hospital varies between 15% and 60%. However, data regarding
Africa is lacking. This study aimed to determine the prevalence
of risk for malnutrition on admission and discharge and the
association with selected indicators.
Methods: In this multi-centre analytical cohort study, adult
patients from hospitals in South Africa, Kenya and Ghana were
screened on admission and discharge and contacted 3 months
post-discharge. Relevant morbidity and mortality outcomes
were assessed. At-risk for malnutrition was indicated if NRS-
2002 score ≥ 3. Summary statistics, analysis of variance and
non-parametric methods were used. Statistical significance
was 5%.
Results: 2126 Adult patients (44.9 ± 15.9 years old, 52.2%
female) were screened on admission. 72.6% were at risk of
malnutrition, with a higher prevalence for patients in
Kenya and Ghana (74.6%) versus those from South Africa
(69.8%) (Chi2 = 4.85,p = 0.028). Discharge risk of malnutrition
was 75% (n = 557). Mean length of stay (LOS) was 6.6 ± 6.3 days.
S252
During hospitalization, only 18.8% of patients were referred for
nutrition support; 23.5% lost ≥5% body weight and discharge
BMI (23.11 ± 8.56 kg/m2) was significantly lower than admis-
sion BMI (24.32 ± 0.31 kg/m2)( p < 0.001). Admission nutrition
risk was associated with increased mortality (Chi2 = 17.24,
p = 0.001); older age in men ( p = 0.008); longer LOS ( p = 0.001)
and increased 3-month re-admission rates (Chi2 = 4.25;
p = 0.039). The latter was also significantly associated with a
greater percentage weight loss prior to admission ( p = 0.002),
as well as a lower BMI on discharge ( p = 0.008).
Conclusion: Nearly two-thirds of all patients were at-risk of
malnutrition on admission. This was associated with longer
LOS, greater hospital mortality and increased 3-month re-
admission rates. Routine screening practices with appropriate
nutrition support action should be implemented as a matter of
urgency.
Disclosure of Interest: None declared.
MON-P199
NECK CIRCUMFERENCE: IS THERE CORRELATION WITH THE
ARM MUSCULAR AREA IN CHILDREN AND ADOLESCENTS WITH
MALIGNANT NEOPLASMS?
R. D. L. Ferretti1 *, P. S. Maia-Lemos2, K. J. T. Guedes1,
E. M. M. Caran1. 1Pediatrics, Federal University of Sao Paulo,
Sao Paulo, 2Federal University of Sao Paulo, Sao Paulo, Brazil
Rationale: Patients with malignant neoplasms may present
malnutrition early, and this finding may be underestimated
when only the Body Mass Index is considered due to the various
metabolic changes, hydration status, and the side effects
caused by antineoplastic therapy, however, anthropometric
indicators can identify changes in nutritional status. Neck
circumference (NC) is a measure of easy gauging and
applicability in clinical practice, in addition to reflecting
deposits of upper body subcutaneous fat, therefore the main
objective of this study was to verify if there is a correlation
between NC and Arm Muscular Area (AMA).
Methods: A cross-sectional study that assessed children and
adolescents from 0 to 20 years old with malignant neoplasms at
a Pediatric Oncology Specialized Institute between October
2015 and March 2017. Measurements of NC were evaluated,
besides middle upper arm circumference and triceps skinfold
(to calculate AMA). Student’s t-test for independent samples,
and Pearson’s correlation between NC and AMA were per-
formed, with significance level p < 0.05.
Results: Among the 1656 assessments, 56.9% (n = 943) were
male. The mean age, for male and female were 9.0 ± 5.8 and
8.5 ± 5.4, respectively. Considering the groups of solid tumors
(n = 1364) and hematological tumors (n = 292), there was a
significant difference between the means for NC ( p = 0.016)
and AMA ( p = 0.004), being higher for the group of hemato-
logical tumors. The correlation between NC and AMA was
positive and very strong for male and female (r = 0.9 vs r = 0.8;
p = 0,000) respectively.
Conclusion: It is concluded that there is a very strong
correlation between NC and AMA for both sexes, and this
outcome was higher for males. Thus, NC measurement is a good
indicator to identify changes in the nutritional status of
children and adolescents with malignant neoplasms.
Disclosure of Interest: None declared.
Poster
MON-P200
IS CALF CIRCUMFERENCE A GOOD INDICATOR OF MUSCLE
MASS DEPLETION IN CHILDREN AND ADOLESCENTS WITH
MALIGNANT NEOPLASMS?
R. D. L. Ferretti1 *, P. S. Maia-Lemos1, K. J. T. Guedes1,
E. M. M. Caran1. 1Pediatrics, Federal University of Sao Paulo,
Sao Paulo, Brazil
Rationale: Children and adolescents with malignant neoplasms
may present malnutrition, but this finding may be under-
estimated when considering General Adiposity Indexes, such as
the Body Mass Index (BMI). Anthropometric measures are able
of early detection of malnutrition, specifically muscle mass
depletion, such as calf circumference (CC). The main objective
of this study is to verify if there is a correlation between the
measurement CC and arm muscle area (AMA), skinfold Triceps
(ST), and Body Mass Index (BMI).
Methods: A cross-sectional study evaluated children and
adolescents from 0 to 20 years of age with malignant neoplasms
at a Pediatric Oncology Specialized Institute between October
2015 and August 2016. Measurements of CC were evaluated
and, for AMA calculation, middle upper arm circumference
(MUAC) and ST were evaluated. The values of weight and
length/height were obtained for the calculation of BMI. All
measurements were performed by trained evaluators, follow-
ing anthropometric techniques standardized by the literature.
Correlation between CC and other variables (AMA, BMI and ST)
was performed through the Pearson correlation, with signifi-
cance value p < 0,05.
Results: Among the 1535 assessment, 54,72% (n = 840) were
male. The mean age was 9.92 (±7.47). The correlation between
CC and the other independent variables (AMA, BMI CC), were
positive and very strong between CC and AMA (r = 0.87), CC and
BMI (r = 0.80) and strong between CC and ST (r = 0.74); p < 0,05.
Conclusion: It is concluded that the calf circumference,
besides being an easy and low cost measure to be used in
clinical practice, has a very strong correlation with AMA, which
also reflects muscle mass stores, being a good indicator for
monitoring the nutritional status of children and adolescents
with malignant neoplasms.
Disclosure of Interest: None declared.
MON-P201
THE IDENTIFICATION AND CLASSIFICATION OF THE
NUTRITIONAL RISK RESULTING FROM AN UNDER-RESOURCED
DIETETIC SERVICE
R. Hannon1, S. Mcmahon1, O. Smith1, M. O’donoghue1,
D. Walsh1, B. Moore1, E. Sweeney1, C. White1, K. Mcelligott1,
E. Duignan1, L. Masterson1, G. Marrinan1, M. Lyons1,
M. Hannon1 *, N. Hastings1, N. Brosnan1, R. Clynes1,
S. Cunneen1, C. O’hanlon1. 1Beaumont Hospital, Dublin 9,
Ireland
Rationale: In 2016, our Nutrition and Dietetics Department
experienced severe deficits in staffing. At its worst, the staffing
deficit for the department was equivalent to 5.5 WTE (22.6%).
The aim of this audit was to analyse and categorise the
nutritional risk to inpatients resulting from an under-resourced
dietetic service.
Nutritional assessment 2
Methods: In order to ensure patient safety, outpatient services
were curtailed, day ward service was reduced and inpatient
referrals received from under-resourced areas were initially
screened and those not requiring enteral or parenteral
nutrition were placed on a waiting list. Subsequently, an
audit tool was devised and medical charts were retrospectively
reviewed to analyse the nutritional parameters and assess the
level of risk to waiting list patients resulting from the absence
of dietetic intervention. The Health Service Executive (HSE)
Risk Assessment Tool was completed on each patient as a means
of risk analysis and categorisation.
Results: Ninety nine patients were referred, of these 11 were
seen within the department priority codes, 1 was not admitted
and no data was available for 2 due to missing medical charts.
Data was collected on the remaining 85 patients. Eighty five
percent (n = 72) had two or more nutrition related risk factors.
Seventy five patients had a documented weight, however, only
25% (n= 21) had an initial Malnutrition Universal Screening Tool
(MUST) score completed. At least 36 patients were deemed at
risk of refeeding syndrome.
Scoring of the HSE Risk Assessment Tools revealed that 75%
(n = 64) were classified in the red risk category (moderate to
extreme) as a result of malnutrition, refeeding syndrome risk or
poor wound healing.
Conclusion: Significant dietetic staffing deficits resulted in
suboptimal nutritional management and moderate to extreme
malnutrition risk in 75% of this patient cohort.
Disclosure of Interest: None declared.
MON-P202
ULTRASOUND: A NEW STRATEGY TO EVALUATE BODY
COMPOSITION IN CROHN’S PATIENTS UNDERGOING
HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT)
A. Z. Pereira1, S. E. A. Gonçalves1 *, B. L. de Sá2, M. Cocco3,
A. A. F. Ribeiro1, N. Hamerschlak1. 1Oncology and Hematology,
2
Clinical Nutrition, 3Physiotherapy, Hospital Israelita Albert
Einstein, S.Paulo, Brazil
Rationale: Crohn disease is a chronic inflammatory disorder of
the gastrointestinal tract with a strong polygenic immune
component. In refractory cases, autologous HSCT can decrease
disease activity and mucosal healing and improve quality
of life. Reduced muscular mass and excess visceral fat in
patients undergoing HSCT are associated with higher
mortality, longer hospitalization, longer use of immunosup-
pressive drugs, graft-versus-host disease, shorter disease-free
interval after the HSCT and comorbidities leading to shorter
survival time.
Objectives: To evaluate muscle thickness and visceral fat
by US.
Methods: We evaluated 5 HSCT patients (≥18years) at Hospital
Israelita Albert Einstein, São Paulo, Brazil, on their first day of
hospitalization, before HSCT and after the engraftment. The
thickness of the right femoral quadriceps muscle (RFQ),
measured at 6 cm from the top edge of the patella was
measured using US in B-mode. The VF was measured in the
abdominal region, by the thickness of the fat layer between the
linea alba and the anterior wall of the aorta.
Results: Most patients were men (75%) with a mean age of 35
years (±14 years). Most patients were undernutrition, with body
S253
mass index (BMI) of 21 kg/m2 (±2,5 kg/m2). The average time
EN was 11 days (±1 days). In the baseline, RFQ was 1.5 cm
(±0.2 cm) and the VF was 4,2 cm (±1.3 cm). After engrafment,
RFQ was 1.3 cm (±0.2 cm) and the VF was 4,2 cm (±1.2 cm).
There wasn’t significant difference between baseline and
after engraftment, although RFQ had reduced in all patients.
Conclusion: In this cohort of patients we found reduced
muscle thickness after engraftment and VF didn’t have any
alterations. The US was a practical, economical and effective
method to evaluate these patients.
Disclosure of Interest: None declared.
MON-P203
TRANSTHYRETIN FOR ROUTINE ASSESSMENT OF
MALNUTRITION: AN INTERNATIONAL SURVEY OF EXPERTS IN
THE FIELD
S. Dellière1, N. Neveux1,2, J.-P. De Bandt1,2, L. Cynober1,2 *
1
Service de Biochimie, Hôpitaux Cochin et Hôtel-Dieu, GH
HUPC, APHP, 2Laboratoire de biologie de la Nutrition EA4466
PRETRAM, Université Paris Descartes, Paris, France
Rationale: Transthyretin (TTR) is suitable for assessing malnu-
trition.1 However, its sensitivity to inflammation and the
frequent confusion in terms of its use as a marker of diagnosis,
prognosis or of the effectiveness of refeeding, do not favor its
use. Moreover, no ESPEN/ASPEN recommendations exist con-
cerning its use and cut-off values. Our aim was to evaluate the
overall perception of the value of this parameter and its
utilization worldwide.
Methods: A panel of international experts in the field were
asked about the use of transthyretin in clinical practice in their
country, existing guidelines by local health authorities and the
cut-off values used to define malnutrition.
Results: A total of 28 experts (surgery [8], nutrition [6], critical
care [4], geriatrics [4], biology [3], pediatrics [1], internal
medicine [1], gastroenterology [1]) from 15 countries partici-
pated. TTR appears in national guidelines in Italy, Poland and
France with cut-off values for defining mild/moderate/severe
malnutrition: 0.22/0.17/0.10 g/L, 0.20/0.10/0.05 g/L and no/
0.11/0.05 g/L. TTR is rarely used for routine practice in the UK
and Sweden where assessment is centralized in a few
laboratories. Argentina, Brazil, Chile, Canada, Israel, Japan,
the Netherlands, Switzerland and USA do not use or no longer
use TTR, either for lack of evidence of its usefulness or for
financial reasons.
Conclusion: Although often used for research purposes, TTR is
not used in clinical practice in most countries. Given the
difficulty of finding a consensus tool for the diagnosis of
malnutrition, such a simple and inexpensive marker should be
considered. However, additional studies are required to define
and settle international guidelines for the use of TTR and its
associated cut-off values.
Reference
1. Clin Nutr, 2017; 36: 364–370.
Disclosure of Interest: None declared.
S254
MON-P204
DOES EXAMINATION PERIOD ALTER FOOD CHOICES OF
UNIVERSITY STUDENTS?
S. Sevim1 *, M. M. Tengilimoglu Metin1, D. Gumus1, G. G. Topal1,
M. Kizil1. 1Department of Nutrition and Dietetics, Faculty of
Health Sciences, Ankara, Turkey
Rationale: University students experience high level of stress
due to academic workload and time management. It is thought
that some physiological and psychological mechanisms under-
lying the mood and emotional states of humans, such as stress,
influence the choice of food. The aim of study was to compare
the food choices of university students in exam period and non-
exam period.
Methods: This cross-sectional study was carried out on 103
male and 227 female university students aged 18–30 years. In
exam and non-exam period, food choice data was collected
using the Food Choice Questionnaire (FCQ) and depression
score was determined by beck depression scale. The Food
Choice Questionnaire is consist of 9 subset (health, mood,
convenience, sensory appeal, natural content, price, weight
control, familiarity, ethical concern) and 36 items and
participants responded to each item using a 7-point bipolar
scale (1 = disagree strongly, 7 = agree strongly).
Results: According to the beck depression score, 22.1% of the
students stated that they were depressed in non-exam
period, while 45.2% of the students stated that they were
depressed in exam period. The mean mood score of students is
higher in exam period (5.5) than in non-exam period (5.2).
Students told that be inclined to food which helps cope with
stress and life, helps relax, keeps awake/alert, cheers up,
makes feel good.
Conclusion: In exam period, mood of students affects their
food choice. Students tend to prefer food which improves mood
when they are under stress.
Disclosure of Interest: None declared.
MON-P206
MONITORING FOOD INTAKE OF PATIENTS AT RISK FOR
MALNUTRITION IN AN INTERNAL MEDICINE DEPARTMENT –
ARE WE DOING ENOUGH?
S. Ilovaisky1 *, I. Papier2, Z. Zaltz1, M. Shiloah2, G. Hyams2,
A. Raz1, I. Chermesh3. 1Internal Medicine A, 2Nursing
Administration, 3Gastroenterology Department, Rambam
Health Care Campus, Haifa, Israel
Rationale: There is a clear correlation between nutritional
intake during hospitalization, nutritional status, and outcome.
Documentation of oral intake is of great importance and should
allow identification of patients in need of artificial nutritional
treatment.
Methods: Patients hospitalized in an internal medicine
department for more than three days, that were defined at
risk for malnutrition (MUST >/= 2) were included in the study.
Medical files were reviewed. Documentation of food intake for
the first three days was drawn from the nurses’ follow-up. Data,
including demographic, performance status, the presence of a
feeding tube, orders for medical nutrition, nutritional recom-
mendations of discharge and whether dietician counseling was
given – were retrieved. Statistical analysis was performed.
Poster
Results: Study population included 80 patients (MUST >/= 2),
51% males, age 75 +/− 12.7 years, 55% bedridden, 11% were fed
through feeding tube, 32% had pressure ulcers in admission. No
reference was made regarding food intake in 381 (53%) of 720
meals. In 8% of the patients none of the meals were
documented, only 17% of these patients were given artificial
nutrition, whereas 49% of patients with at least one meal
documented received artificial nutrition ( p = NS). Lunch was
significantly less documented (16%) than breakfast (47%) or
dinner (52%) ( p < 0.0001).
Conclusion: When patients’ intake is not documented,
artificial nutrition is given less frequently. Monitoring of oral
intake allows identification of patients in need of artificial
nutrition. Nurses clearly find it less convenient to document
lunch. A larger study is needed to provide information which
meal is preferably documented and count of how many meals
are needed to decide about a patient’s need for artificial
nutrition.
Disclosure of Interest: None declared.
MON-P207
THE APPROPRIATE NUTRITIONAL ASSESSMENT TO PREDICT
FUNCTIONAL OUTCOME WITH HIP FRACTURE PATIENTS
DURING ACUTE PHASE – THE COMPARISON OF MNA-SF, MUST,
NRS-2002 AND GNRI
T. Inoue1,2 *, T. Kakehi1, M. Kakiuchi1, T. Tanaka1.
1
Rehabilitation, Nishi-Kobe Medical Center,
2
Community Health Science, Kobe University Graduate
School, Kobe, Japan
Rationale: Malnutrition is common in patients with hip fracture
but no study has examined about ‘best screening tool’ for
predicting functional outcomes. The aim of the present study
was to examine the optimal nutritional screening tool for
predicting functional outcomes from 4 nutritional screening
tools.
Methods: Mini Nutritional Assessment Short-form (MNA-SF),
Malnutrition Universal Screening Tool (MUST), Nutritional Risk
Score (NRS-2002), Geriatric Nutritional Risk Index (GNRI) were
administered to 205 operated hip fracture patients. Functional
outcomes were evaluated using a functional independent
measurement instrument (FIM) and 10 m walking speed. We
evaluated discharge motor-FIM score and absolute functional
gain on the motor-FIM score (discharge motor FIM score –
baseline motor FIM score).
Results: Two hundred and fifty patients were included. Mean
age was 83.5 ± 7.0 years and female accounted for 82.0%.
According to MNA-SF, 27.3% were well-nourished, 50.2% were at
risk of malnutrition, 22.4% were malnourished. When evalu-
ated by MUST, 47.3% were low risk, 20.5% were medium risk,
and 66 32.2% were high risk. Based on NRS-2002, 43.4% were
well-nourished, 33.7% were nutritionally at risk, 22.9% were
medium risk. According to GNRI, 21.5% were low risk, 36.1%
were medium risk, 42.4% were high risk. Multiple regression
analysis showed that significant relationships were found
between MNA-SF and each functional outcomes. According to
NRS-2002, the patients with risk group were significant poor
functional recovery compared with low risk (<0.05). Based on
GNRI, patients with major risk needed more time compared
with low risk for 10 m walking speed (<0.01).
Nutritional assessment 2 S255

Conclusion: MNA-SF was only nutritional screening tool MON-P209

which showed significant relationships to each functional BODY COMPOSITION, PROTEIN INTAKE AND PHYSICAL
outcomes. FUNCTION IN ADULT PATIENTS WITH MITOCHONDRIAL
Disclosure of Interest: None declared. DISEASE
V. Bordier1 *, H. Zweers2, S. Leij3, D. Maas2, S. Knuijt2,
MON-P208 G. Wanten2, M. Janssen2. 1Human Nutrition Laboratory, ETHZ,
BIOELECTRICAL IMPEDANCE ANALYSIS DERIVED PHASE Zurich, Switzerland, 2Radboud Center for Mitochondrial
ANGLE AS A TOOL FOR DETECTING MALNUTRITION IN Medicine, Radboud University Medical Center, 3Nutrition and
HOSPITAL IN-PATIENTS Dietetics, HAN University of Applied Sciences, Nijmegen,
Netherlands
T. Thomas1 *, E. Player2, W. Y. Chan3, L. Alexandre4, A. Forbes4
1
Queen Elizabeth Hospital, Birmingham, 2NHS, Norwich, 3NHS, Rationale: Low physical functioning of patients with mito-
London, 4University of East Anglia, Norwich, United Kingdom chondrial disease (MD) may be due to a diminished fat free
mass. In this case, improving body composition through a
Rationale: We assessed whether bioelectrical impedance
nutritional intervention might be a promising strategy. The aim
analysis (BIA) derived phase angle (PA), plasma markers such
of this study was to analyze body composition, nutritional
as citrulline and pre-albumin could aid nutrition assessment
intake and physical function, as well as their interrelations in
and if current starving and resting protocols are required for
MD patients.
BIA.
Methods: In 37 MD patients, body composition was assessed by
Methods: 80 adult in-patients were recruited over a 40 week
Dual-energy X-rays absorptiometry. Physical functioning was
period. The Malnutrition Universal Screening Tool (MUST) and
measured by means of the hand grip strength test (HGS),
Subjective Global Assessment (SGA) were performed. Serum
6-minutes walking test (6MWT), 30-seconds sit-to-stand test
was analysed for citrulline and pre-albumin. Bodystat 4000
(30SCT), and 6-minutes mastication test (6MMT). Protein
analyser assessed PA in 3 different metabolic states: rested and
intake and needs were assessed by a dietician.
fasted, post-exercise and post food, and exercise. The
Results: Thirty-seven genetically proven MD patients (aged
reference standard for malnutrition was determined using
42 ± 12 yrs, 40% men) were studied, of whom 78% had the
SGA. Statistical analysis included paired t test and logistical
m3243A > G mutation. Although only 5% of the MD patients had
regression.
a BMI < 18.5 kg/m2, 62% had a low fat free mass index (FFMI)
Results: Total study size was 80 patients; 47(59%) male (20–86
and 49% did not meet their protein requirements. Decreased
years) and 33(41%) female (18–87 years). 66 patients com-
physical function, as evidenced by low HGS, was observed in
pleted all arms of the study; 14 patients did not consent to
43%, walking less than the predicted distance was found in
blood test arm.
100%, low 30SCT results in 86% and diminished chewing
1. SGA and PA identified 47 (59%) and 50 (63%) patients with
endurance in 48%.
malnutrition compared to 9(11%) by MUST
Low protein intake was associated with low HGS performance
2. SGA and PA identified 15(19%) and 10(13%) patients with
(r = 0.501, p < 0.01) and low 6MMT (r = 0.645, p < 0.01), but
severe malnutrition compared to 2(0.03%) by MUST
neither with the 6MWT (r = 0.216) nor the 30SCT (r = 0.371).
3. Compared to SGA, PA had sensitivity of 91%(95% CI
FFMI did not correlate with any of the function tests, nor with
80% > 98%) and specificity of 36%(95% CI 11% > 69%).
protein intake.
Positive predictive value was 86%(95% CI 80% > 91%).
Conclusion: Although the majority of these patients had
Negative predictive value was 50%(95% CI 23% > 77%)
altered body composition, decreased physical function and
4. There were no food or exercise related difference in PA
low protein intake, diminished fat free mass was not related to
( p = 0.1837; p = 0.1344 respectively)
physical function. Therefore, the true association between
5. Pre-albumin co-related with SGA ( p = 0.003), citrulline did
body composition and performance still needs clarification.
not ( p = 0.348)
However, as protein intake relates with physical functioning,
Conclusion: BIA-derived PA is an objective measurement apt supporting protein intake in MD patients seems of great
for nutritional assessment. It is sensitive for detecting importance in clinical care.
malnutrition. It has a highly significant association with SGA. Disclosure of Interest: None declared.
Current fasting and resting protocols surrounding its use are
invalid. Pre-albumin is a useful biomarker in nutritional
MON-P210
assessment.
NOVEL HOSPITAL MEAL SERVICE REDUCES FOOD WASTE
Reference WHILE IMPROVING NUTRITIONAL INTAKE OF PATIENTS
1. BAPEN The cost of malnutrition in England and potential cost savings V. E. Ijmker-Hemink1 *, D. N. Dijxhoorn1, M. G. A. van den Berg1,
from nutritional interventions Accessed:20/02/2017. G. J. A. Wanten1. 1Gastroenterology and Hepatology,
Disclosure of Interest: None declared. Radboudumc, Nijmegen, Netherlands

Rationale: Food wastage heavily compromises hospital

resources. Therefore, we investigated whether FoodforCare
(FfC), a novel meal service comprising 6–7 small protein-rich
meals per day provided directly at the bedside following
proactive advise from a nutritional assistant, can reduce food
waste compared to a traditional 3-meals per day service (TMS).
S256
Methods: This study was part of a clinical study where patients
who were admitted for at least one day to a medical
(Gastroenterology) or surgical (Orthopedics, Gynaecology,
Urology) ward were offered TMS (n = 326, mean age 58 ± 17 yrs)
or FfC meal service (n = 311, mean age 60 ± 16 yrs). Food waste,
i.e. all left over products from meals used on one day, was
calculated using weighed food records. Furthermore, we
determined food waste for each meal separately. Differences
in median waste between the groups were tested using the
Mann-Whitney U test. Results are displayed as median [IQR]
unless stated otherwise.
Results: The amount of food handed out by FfC was
significantly higher than by the TMS (mean weight ± SD;
945.2 ± 267.5 grams vs. 863.8 ± 303.4 grams, p < 0.05). In
total, FfC showed a significantly lower percentage of waste
than the TMS (7.7% [22.0] vs. 14.1% [27.9], p < 0.05). The
percentage of food wasted per meal was significantly lower
with FfC at lunch (0.0% [11.2] vs. 1.5% [11.7], p < 0.05) and
dinner (1.9% [31.8] vs. 14.4% [39.2], p < 0.05).
Conclusion: FfC reduced overall daily food waste as well as at
specific moments, i.e. during lunch and dinner. Furthermore,
the amount of food handed out was higher indicating that
nutritional intake improved. These findings are in line with the
increased energy and protein intake shown in other results of
this project. As such, this novel meal service holds promise as a
concept that will further improve the quality of care for these
patients.
Disclosure of Interest: None declared.
MON-P211
DIETARY ENERGY AND NUTRIENT INTAKES ARE SIMILAR
AMONG DIFFERENT PHYSICAL ACTIVITY LEVELS IN ADULTS
E. Karabudak1, Y. Ertaş1 *, A. Karaca2. 1Nutrition and Dietetics,
Gazi University, 2Faculty of Sport Sciences, Hacettepe
University, Ankara, Turkey
Rationale: Level of physical activity in leisure time could be a
demonstration of healthy lifestyle for individuals’ daily life and
dietary intakes could be shaped according to their activity
levels. In this study, we aimed to evaluate physical activity
levels of healthy adults and determine their dietary energy,
nutrient intakes and supplementation status according to
different activity categories.
Methods: This study was conducted on 381 male and 391
female adults aged 19–67 years. Physical activity levels were
determined via ‘Physical Activity Assessment Questionnaire
(PAAQ)’ as total metabolic expenditure units (METs) and
divided into three categories: sedentary (≤1.4 MET), moder-
ately active (1.41–1.75 MET) and active (>1.75 MET). Twenty-
four hour dietary recall was obtained from all participants.
Dietary energy and nutrient intakes were evaluated via
Nutrition Information System for Turkey (BeBiS).
Supplementation status of the individuals were questioned.
Appropriate statistical analysis were performed.
Results: Mean age of male and female participants was
37.8 ± 12.61 and 34.8 ± 11.51 years respectively. From seden-
tary to active group, there was a decreasing trend for mean
dietary energy intake in both genders; however, it was not
statistically significant ( p > 0.05). Similarly, differences in
mean dietary macro- and micronutrient intakes were not
statistically significant among physical activity level categories
Poster
( p > 0.05). On the other hand, supplementation usage is
increasing in male participants as the level of activity increases
(none of sedentary, 6.2% of moderately active, 6.7% of active
males) was found (chi-square = 6.292, p < 0.05).
Conclusion: Individuals’ dietary energy and nutrient intakes
were not different according to their activity level. However, it
was determined that active male individuals pay more
attention to use supplementation regularly.
Disclosure of Interest: None declared.
MON-P212
CONSUMPTION DIFFERENCES OF FOODS AND BEVERAGES IN
DIFFERENT SPORT ACTIVITY LEVELS IN ADULTS
Y. Ertaş1 *, E. Karabudak1, A. Karaca2. 1Nutrition and Dietetics,
Gazi University, 2Faculty of Sport Sciences, Hacettepe
University, Ankara, Turkey
Rationale: Having higher physical activity level and doing sport
regularly could be associated with healthy dietary chooses. In
order to understand this, we aimed to evaluate participants’
consumptions of food groups according to different sport
activity levels in this study.
Methods: This study was conducted on 772 adults (381 male
and 391 female) adults. Sport activity levels were determined
via ‘Physical Activity Assessment Questionnaire (PAAQ)’ (1) as
metabolic expenditure units (METs) and divided into three
categories (2): inactive (≤3 MET), moderately active (3–6 MET)
and active (>6 MET). Twenty-four hour dietary recall were
obtained from the individuals. Consumption amounts of various
foods and beverages (milk, cheese, egg, bread, grains,
vegetables, fruits, meat, poultry, fish, legumes, nuts/seeds,
honey/jam, tea, coffee, soft drinks) were evaluated via
Nutrition Information System for Turkey (BeBiS).
Results: Mean age of participants was 36.3 ± 12.15 years.
According to sport METs; inactive, moderately active and active
males were 36.5%, 33.6% and 29.9% for males and 40.2%, 51.2%
and 8.7% for females respectively. In males, consumption
amounts of fruit, cheese, tea and soft drinks; in females,
consumption amounts of bread, egg, nuts/seeds, honey/jam,
tea and soft drinks were statistically significant in METs groups
( p < 0.05). All these food and beverage groups except egg
consumption of females were statistically lower in active group
than the other groups were found in both gender ( p < 0.05). Egg
consumption of active females were higher than the other
female activity groups ( p < 0.05).
Conclusion: Active male and females have shown different
patterns in terms of food consumptions; but similar in terms of
beverages. Furthermore, active female adults chose to
decrease particularly high energy density foods. However, it
could not be observed such pattern in males.
Disclosure of Interest: None declared.
MON-P213
INCREASE IN EATING DISORDER SCORES ARE RELATED WITH
POOR DIET QUALITY IN FEMALES
M. Gezmen-KARADAĞ 1, H. Yildiran1, Y. ERTAŞ1 *. 1Nutrition and
Dietetics, Gazi University, Ankara, Turkey
Rationale: Eating disorders could affect diet quality. Diet
quality of individuals who have eating disorders is expected to
be lower and consumption of certain foods would be decreased.
Nutritional assessment 2
In this study we aimed to determine the associations between
dietary component scores of Healthy Eating Index (HEI) with
eating disorder risk scores in female adults.
Methods: This study was consisted of 275 female adults aged
18–50 years. Eating disorder risk was determined with Eating
Attitude Test (EAT-40) test. HEI-2010 dietary components (total
fruit, whole fruit, total vegetables, greens and beans, whole
grains, dairy products, total protein foods, seafood, fatty acids,
refined grains, sodium, empty calories) and total HEI score
were calculated from twenty-four hour food consumption
recall data. Correlations between eating disorder scores and
HEI scores were given.
Results: Eating disorder frequency of participants were
determined as 4.3%. Mean HEI score and EAT-40 score were
respectively 64.7 ± 10.27 and 43.5 ± 13.79 in females with
eating disorders and 64.2 ± 9.48 and 12.3 ± 5.49 in females with
not having eating disorders. Negative correlations were
determined between total HEI scores (r = −0.497, p = 0.05),
fruit score (r = −0.659, p = 0.005) and refined grains (r =
−0.536, p = 0.032) in females with eating disorder.
Conclusion: Diet quality decreased as eating disorder scores
increased in female adults with eating disorder. Furthermore,
the decreases were mediated with decreases in fruit scores and
increases in refined grain scores.
Disclosure of Interest: None declared.
MON-P214
DIET QUALITY IS RELATED WITH DECREASED ENERGY AND FAT
INTAKE IN ADULTS
Y. Ertaş1 *, M. Gezmen-Karadağ1. 1Nutrition and Dietetics, Gazi
University, Ankara, Turkey
Rationale: Healthy eating index is a valid tool in order to
determine individuals’ diet quality and it could be a demon-
stration of nutrient sufficiency. In this study assessment of the
associations between HEI scores with dietary energy and macro
nutrient intakes in adults.
Methods: This study was consisted of totally 750 (275 males and
275 females) adults aged 18–50 years. Daily dietary energy and
macro nutrient intakes calculated from 24 hour food recall data
by a nutrition information system for Turkey called BeBiS®.
Diet quality was assessed with HEI-2010. Correlations between
dietary energy and macro nutrients with HEI scores were given.
Results: Mean ages of participants’ were 25.9 ± 6.60 years in
males and 25.6 ± 6.82 years in females. For males, negative
correlations were shown between HEI scores and dietary energy
(r = −0.173, p = 0.001), fat intake (r = −0.192, p < 0.001) and
saturated fatty acids intake (r = −0.228, p < 0.001). For
females, negative correlations were determined between
dietary energy (r = −0.154, p = 0.003), fat intake (r = −0.196,
p < 0.001), saturated fatty acid intake (r = −0.242, p < 0.001)
and monounsaturated fatty acid intake (r = −0.145, p = 0.005).
Conclusion: In conclusion, as diet quality increase, daily
dietary energy, total fat and especially saturated fatty acids
decreased. It would be indicative of maintaining ideal body
weight and composition.
Disclosure of Interest: None declared.
S257
MON-P215
ORTHOREXIC FEMALES PAY ATTENTION TO SODIUM INTAKES
AND CONSUMPTION OF WHOLE GRAINS
M. Gezmen-Karadağ1, Y. Ertaş1 *. 1Nutrition and Dietetics, Gazi
University, Ankara, Turkey
Rationale: Diet quality indexes are related with various chronic
diseases and could allow the evaluation of food groups as their
components. In this study we aimed to determine the
associations between dietary component scores of Healthy
Eating Index (HEI) with orthorexia nervosa risk scores in adults.
Methods: This study was conducted with 375 male and 375
female subjects. Twenty-four hour food consumption recall was
obtained of individuals. Scores of HEI-2010 dietary components
(total fruit, whole fruit, total vegetables, greens and beans,
whole grains, dairy products, total protein foods, seafood,
fatty acids, refined grains, sodium, empty calories) and total
HEI score were calculated. Orthorexia nervosa risk was
determined via ORTO-15 test. Correlations were assessed
with SPSS 15 statistical programme.
Results: Mean age of male and female participants was
25.9 ± 6.60 and 25.6 ± 6.82 years respectively. Mean total HEI
score and ORTO-15 score were respectively; 64.9 ± 8.92 and
38.9 ± 3.31 in males and 64.2 ± 9.50 and 39.2 ± 3.25 in females.
Whole grain scores (r = 0.209, p = 0.004) and sodium scores
(r = 0.145, p = 0.049) components of HEI were significantly
positive correlated in orthorexic females. There were no
statistically significant correlation was found in males ( p > 0.05).
Conclusion: Increase in consumption of whole grains and
decrease in sodium intakes were observed in orthorexic
females. It could be concluded that women who tend to
orthorexia pay attention to consumption of whole grains and
reduction of sodium intake.
Disclosure of Interest: None declared.
MON-P216
TELEVISION VIEWING PERIOD AND DIET QUALITY AMONG
ADOLESCENTS
K. Isgin1, E. Bellikci Koyu2 *, A. Akyol Mutlu1, R. Nergiz Unal1,
A. Ayaz1, Z. Buyuktuncer1. 1Department of Nutrition and
Dietetics, Hacettepe University, Ankara, 2Department of
Nutrition and Dietetics, İzmir Katip Celebi University,
İzmir, Turkey
Rationale: An association between watching television (TV)
and obesity was reported. However, little is known about diet
quality of people who have long TV viewing period. This study
aimed to compare diet quality of adolescents according to TV
viewing period. This study aimed to determine the relationship
between TV viewing period and total diet quality beyond
specific food preferences in adolescents.
Methods: A cross-sectional study was performed with 1371
adolescents aged 11–16 years in Ankara, Turkey. General
characteristics and TV viewing periods of adolescents were
recorded. TV viewing period was classified according to
recommendation to adolescents of American Academy of
Pediatrics (≤120 and >120 minutes/day). Dietary intake was
assessed using food frequency questionnaire and diet quality
was estimated using Healthy Eating Index-2010 (HEI-2010). A
maximum score of index is 100 points; and 0–50 points is
categorized as ‘poor’, 51–100 points is ‘needs improvement/
S258
good’. Total score and subscale scores of HEI were analysed
according to TV viewing period.
Results: Mean HEI score was 54.4 ± 8.95 points in all group. Long
TV watchers had a lower mean HEI score (53.7 ± 8.86) than short
TV watchers (54.9 ± 8.99) ( p = 0.020). Furthermore, poor diet
quality was 38.1% in the participants with long TV viewing period
whereas it was 36.1% in participants with short TV viewing
period ( p = 0.026). The difference in diet quality between TV
viewing groups arisen from lower consumption of dairy products,
total vegetables and greens and beans groups. These food
items were consumed in larger amounts by adolescents watch-
ing TV less than 120 minutes ( p < 0.05, for each).
Conclusion: Diet quality was decreased by increasing TV
viewing period. Adolescents watching TV more than 120
minutes had significantly lower diet quality and this signifi-
cance was due to the differences consumption of dairy
products, vegetable and greens and beans.
Disclosure of Interest: None declared.
MON-P217
ULNA LENGTH TO PREDICT HEIGHT IN GREEK PATIENTS
Z. Pafili1 *, A. Lioupis2. 1Department of Dietetics, 2General
Surgery Clinic, Volos General Hospital, Volos, Greece
Rationale: Height measurement is essential for BMI calculation
and patient stratification for malnutrition risk in the hospital
setting. For ambulatory patients height cannot be directly
measured but can be estimated from ulna length using the
MUST equations. The aim of this study was to evaluate the
accuracy of the published MUSTequations for predicting height
from ulna length in Greek adult patients.
Methods: The study population consisted of all patients >21
years admitted in a general surgery clinic during a month in
whom ulna length and standing height could be measured.
Ninety patients aged 21.6–85.2 years (37 male and 53 female)
were included in the study. Height was predicted from ulna
length using the MUST equations, and predicted values were
compared with measured ones.
Results: Patients were categorised according to sex and age
(<65years or ≥ 65 years) to 4 groups. There was a significant
difference between mean measured and mean predicted
height using the MUST equations for both male (172.5 cm vs
176.0 cm, p < 0.001 and 167.0 cm vs 169.8 cm, p < 0.02, for
men <65 (N = 16) and ≥ 65 years (N = 21) respectively) and
female patients (159.9 cm vs 162.4 cm, p < 0.01 and 151.3 cm
vs 155.8 cm, p < 0.01, for women < 65 (N = 30) and ≥ 65 years
(N = 23) respectively). Ulna length and measured height were
significantly correlated in men (r = 0.89, 0 < 0.01 and r = 0.68,
p < 0.01 for men <65 years and ≥65 years respectively). In
females ulna length and height were corellated only in patients
<65 years (r = 0.41, p < 0.05).
Conclusion: The MUST equations for predicting height from
ulna length should be used with extra caution in Greek
patients, especially older ones, since they tend to singificantly
overestimate height, which could lead to errors in BMI
calculation and malnutrition risk assessment.
Reference
Elia M. Screening for malnutrition: A multidisciplinary responsibility.
Development and Use of the Malnutrition Universal Screening Tool
(‘MUST’) for adults. Redditch: BAPEN; 2003.
Disclosure of Interest: None declared.
Poster
MON-P218
EFFECT OF DIFFERENT MIS CUT OFF SCORES FOR
IDENTIFICATION OF MALNUTRITION – INFLAMMATION
PREVALENCE IN HEMODIALYSIS PATIENTS
Z. Pafili1,2 *, M. Maridaki1. 1School of Physical Education and
Sport Science, National and Kapodistrian University of Athens,
Athens, 2Department of Dietetics, Volos General Hospital,
Volos, Greece
Rationale: Malnutrition inflammation score (MIS) is a simple
tool to assess the presence of malnutrition related to
inflammation, and is associated with mortality in patients on
maintainance hemodialysis. Total score ranges from 0 to 30 and
even though higher scores denote greater risk there is no
universal cut off point for patient stratification. The aim of this
study was to assess the differences in patient classification into
high and low risk using the different proposed MIS score cut off
points of >4, >7 and >10.
Methods: All stable hemodialysis patients who aggreed to take
part in the study from 3 hospital dialysis units in Greece were
included, totalling 67 patients (52.7 ± 14.5 years, 24.4 ± 4.1
kg/m2, 6.3 ± 5.9 years in dialysis, serum albumin 4.2 ± 0.3 mg/
dL). MIS and SGAwere used to assess patients nutritional status.
Results: Average patient MIS score was 5.2 ± 2.8 (median 5.0).
According to SGA 29% of patients were classified as mildy to
moderately malnourished (scores B and C). A significantly
greater percentage of patients were classified as in risk of
malnutrition when an MIS cutoff score of 4 was used (54%)
compared with cutoff scores >7 (18%) and >10 (3%) ( p < 0.01),
with no significant difference between the two later cutoff
scores. MIS score was significantly positively correlated with
SGA (r = 0.69, p < 0.01) whereas no correlation between MIS
score and patient age, BMI, dialysis duration and serum albumin
was found.
Conclusion: The lack of a universal MIS score cutoff point
makes the identification of hemodialysis patients who would
benefit more from targeted medical and nutritional interven-
tions challenging.
Reference
Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A
malnutrition-inflammation score is correlated with morbidity and
mortality in maintenance hemodialysis patients. Am J Kidney Dis.
2001 Dec;38(6):1251–63.
Disclosure of Interest: None declared.
MON-P219
MALNUTRITION SCREENING AND NUTRITIONAL INDICES IN
THE SURGICAL WARD
Z. Pafili1 *, C. Psachoula1, M. Alexiadi1, C. Kalesopoulou1,
A. Lioupis2. 1Department of Dietetics, 2General Surgery Clinic,
Volos General Hospital, Volos, Greece
Rationale: Surgical patients are considered in high malnutri-
tion risk, and even though there are many validated tools to
assess risk, older indices such as albumin and total lymphocyte
count depletion are still used to identify malnourished
patients. The aim of this study was to assess malnutrition risk
in a surgical ward using NRS-2002, albumin and total
lymphocyte count.
Methods: Study population consisted of all adult patients
admitted in the general surgery clinic of a peripheral hospital in
Nutritional epidemiology 2 S259

Greece during 30 consecutive days. 195 patients (60.6 ± 18.8 digestive system. 81.2% of all cases received oral nutritional
years), 53% of which were ≥ 65 years were included. NRS-2002 supplement (ONS), 17.3% enteral nutrition (EN) and 1.5%
was used to assess malnutrition risk in all patients and serum parenteral nutrition (PN). The mean treatment duration of ONS
albumin (where available) and total lymphocyte counts were were 209 ± 352 days, 390 ± 546 days for EN and 260 ± 457 days
recorded. for PN. The 20–39 years old patients with EN treatment duration
Results: BMI could be calculated or estimated using MUST of 892 ± 793 days differed significantly from the average
guidelines in 93.3% of the patients. According to NRS-2002 ( p < 0.001).
score 13.8% (27) of the patients were at nutritional risk (score Conclusion: By now, a large number of patients receive HAN
≥3). Of the 27 patients at nutrition risk 11 were diagnosed and tumor patients are the largest patient group. ONS were
as malnourished according to the ESPEN criteria, while in 3 used more frequently and often for short treatment period. In
patients no diagnosis could be made due to lack of BMI data. contrast, EN was used more rarely, but on average for a longer
Albumin values were obtained for 90 patients (including 23 of period especially in younger patients.
the patients at risk). Values ≤3.5 mg/dL were found in 43% of the Reference
patients with NRS score ≥3 and in 16% of patients with NRS score
1. Shaw SA, Rühlin M, Wagener N, Stanga Z, Meier R, Ballmer PE.
<3. Mean serum albumin differed significantly between patients
Home Artificial Nutrition in Switzerland: An Epidemiological Survey
with NRS score ≥3 and those with NRS score <3 (3.6 ± 0.7 vs from 2005 to 2009. Ann Nutr Metab 2013;62:205–11.
4.0 ± 0.6 mg/dL respectively, p < 0.001). Total lympocyte count
depletion (≤2000 cells/mm3) was evident in 68% of all patients, Disclosure of Interest: None declared.
with no significant difference in TLC depletion severity between
the patients with NRS score ≥3 or <3. No significant correlation MON-P221
was found for NRS-2002 score and albumin or TLC. PREVALENCE OF HOME PARENTERAL AND ENTERAL
Conclusion: Malnutrition risk prevalence was high in our NUTRITION IN THE UNITED STATES
patient cohort according to NRS-2002 score, while no correl- M. Mundi1 *, A. Pattinson2, M. Mcmahon2, R. Hurt2. 1Division of
ation between NRS-2002 score and albumin or TLC depletion Endocrinology, 2Mayo Clinic, Rochester, United States
was found.
Disclosure of Interest: None declared.
Rationale: In the United States (US), given our healthcare
insurance landscape, it has been very difficult to ascertain the
true prevalence of HPEN.
Methods: Medicare beneficiary data for 2013 was obtained
Nutritional epidemiology 2 using the CMS Chronic Condition Data Warehouse (CCW).
MON-P220 Commonly used Healthcare Common Procedure Coding system
HOME ARTIFICIAL NUTRITION – RESULTS FROM AN (HCPCS) codes were used for both home enteral (HEN) and
EPIDEMIOLOGICAL FOLLOW-UP SURVEY IN SWITZERLAND home parenteral nutrition (HPN). Data regarding number of
patients and insurance providers was obtained from three of
L. J. Vogt1 *, M. Rühlin1,2, N. Wagener3, C. Möltgen2,4, the largest DME providers in US (Coram/CVS, Option Care
L. Genton2,5, P. E. Ballmer1,2. 1Department of Medicine and Enterprises, and Bioscrip). Using the ratio of Medicare to non-
Division of Dietetics and Clinical Nutrition, Winterthur Medicare billing, estimate of prevalence of HPEN was obtained.
Cantonal Hospital, Winterthur, 2Board Member, Swiss Society Results: For 2013, there were 6,778 Medicare beneficiaries for
for Clinical Nutrition (GESKES), Geneva, 3SVK, Swiss HPN and 114,287 for HEN. Ratio of Medicare to Non-Medicare
Consortiums of Health Insurance Companies for Joint Tasks in was 0.271 for HPN and 0.261 for HEN leading to estimated
the Field of Transplantation, Dialysis, HAN and Home prevalence of 25,011 patients on HPN (79/million US inhabi-
Ventilation, Solothurn, 4Hospital Pharmacy, Aarau Cantonal tants) and 437,882 patients on HEN (1,385/million US
Hospital, Aarau, 5Clinical Nutrition, Geneva University inhabitants).
Hospitals, Geneva, Switzerland
Rationale: Home artificial nutrition (HAN) is an important Parenteral Enteral
Nutrition Nutrition
possibility to prevent and treat malnutrition. The first analysis
of epidemiological data in Switzerland was published in 20131 Total Medicare Beneficiaries 6,778 114,287
Total Medicare Beneficiaries per million US 21 361
and the aim of this follow-up study is to examine the inhabitants
development of HAN. Total Number of Referring Providers 6,724 73,770
Methods: This study investigated retrospectively all new cases Total DME provider patients 16,193 98,550
Number on Medicare −4,388 −25,722
of HAN in Switzerland from 2010 to 2015, which were registered
Number on Medicaid −2,140 −20,842
by the Swiss Consortium of Health Insurance Companies - Number with Commercial or other −9,664 −51,966
(SVK). Demographic and anthropometric data, diagnosis, type insurance
of HAN and duration of HAN were examined. Ratio of Medicare to Non-Medicare 0.271 0.261
insurance
Results: In six years, a total of 39,624 cases (49.0% men, 51.0% Estimate of Patients for 2013 25,011 437,882
women) with an average body mass index of 21.2 ± 4.5 kg/m2 Estimate per million US inhabitants 79 1,385
and 68.9 ± 17.7 years were registered. 59.3% of all cases were Infusion company % of pediatric patients 16.5 43.2
Infusion company % of adult patients 83.5 56.8
classified as malnourished and 36.1% were at high risk for Estimate of Pediatric patients 4,129 189,036
malnutrition. The group of 60 to 79 years old persons Estimate of Adult patients 20,883 248,846
constituted the largest group of patients (45.8%). 46.0% of all
cases were diagnosed with malignant neoplasms, 12.2% with Conclusion: Compared to previous results from 1992, the
diseases of the nervous system and 11.1% with diseases of the prevalence of HEN has increased dramatically while the
S260
prevalence of HPN has declined. Prevalence of HPEN per
million inhabitants is still significantly higher in US compared to
Europe.
Disclosure of Interest: None declared.
MON-P222
PREVALENCE OF UNDERNUTRITION, PARASITOSIS AND
ANEMIA IN CHILDREN 5–12 YEARS OLD FROM ECUADORIAN
RURAL COAST: POST-EARTHQUAKE ANALYSIS.
M. Chisaguano1 *, M. E. Herrera Fontana1, V. Villagomez1,
M. Villar1, N. Castro1. 1Escuela de Salud Publica, Nutricion,
Universidad San Francisco De Quito, Quito, Ecuador
Rationale: Undernutrition is a public health problem in Ecuador
that is related to the presence of parasitic infections, adverse
health conditions, and low socioeconomic levels. This situation
can change after natural disasters such as the earthquake that
occurred in Ecuador on April 16, 2016. Thus, in this study, we
assess the prevalence of undernutrition, intestinal parasitosis,
and anemia in children from vulnerable families.
Methods: Children aged 5–12 years (n = 72) were selected from
the rural community ‘La Punta’, located in the parish of
Cojimíes, province of Manabí, Ecuador. The evaluation of
malnutrition was carried out using weight-for-age (WAZ),
length-for-age (LAZ) and BMI-for-age (BMIZ) Z scores, accord-
ing to the WHO child growth standards. The occurrence of
parasitosis was determined through the qualitative-quantita-
tive identification of the different types of parasites. The levels
of anemia were determined using the Hemocue method and
hemoglobin cut-off points at sea level.
Results: 34.4% of the children are infected with some type of
parasite, being Entamoeba histolytica the most predominant.
21.9% had mild anemia and 31.3% had moderate anemia. In
regard to undernutrition, 40.6% of the children are stunted.
Of these, a higher prevalence is observed in females. Not all
cases of undernutrition had anemia and parasites, showing that
other factors can contribute to its development, such as the
quality of diet, the access to basic services, and the
socioeconomic level.
Conclusion: Undernutrition and anemia remain significant
problems in Ecuadorian rural areas, showing a higher level of
undernutrition (46.9%) when compared to regional data of
Manabí province (<20%). These findings show how necessary it
is to intervene appropriately in rural communities after natural
disasters.
Disclosure of Interest: None declared.
MON-P223
EATING BEHAVIOR OF BRAZILIAN AND PORTUGUESE
UNIVERSITY STUDENTS
M. S. Santana1 *, W. R. Silva1, J. Marôco2, J. A. D. B. Campos3.
1
Food and Nutrition, São Paulo State University, School of
Pharmaceutical Sciences, Araraquara, Brazil, 2William Janes
Center for Research – WJCR, University Institute of
Psychological Sciences, Social and Life, ISPA, Lisbon, Portugal,
3
Food and Nutrition, University Institute of Psychological
Sciences, Social and Life, ISPA, Araraquara, Brazil
Rationale: Eating behavior can be evaluated by of the Three
Factor Eating Questionnaire (TFEQ-18), which investigates the
Cognitive Restriction (CR), the Emotional Eating (EA), and the
Poster
Uncontrolled Eating (UE). Estimate the contribution of the
body size dissatisfaction and demographic and academic
characteristics in the eating behavior of Brazilian and
Portuguese university students.
Methods: 1,275 Brazilian and 1,163 Portuguese university
students participated in the study. The Portuguese version of
the TFEQ-18 was used. Confirmatory factor analysis was
performed using the ratio of chi-square to degrees of
freedom (χ2/df ), Comparative Fit Index (CFI), Tucker-Lewis
Index (TLI), and Root Mean Square Error of Approximation
(RMSEA). The TFEQ-18 was not invariant between countries
and, therefore, it fitted a structural model for each country.
The z test was used to estimate the significance of trajectories
(β) (α = 5%) of the structural model designed considering the
variables CR, EA and UE as dependent variables.
Results: Brazilian students presented the EA and UE scores
higher than Portuguese students (β = 0.151–0.181 p < 0.001).
The structural model presented satisfactory fit in Brazil
(χ2/df = 2.62; CFI = .93; TLI = 0.92; RMSEA = 0.04) and Portugal
(χ2/df = 1.76; CFI = .95; TLI = 0.95; RMSEA = 0.02). The indivi-
duals’ gender, the wish to decrease body size, and the use of
medications to change the body shape significantly contributed
with the CR and EA factors in both countries, and age, course
year and thoughts of dropping-out contributed with the UE
factor. The significance of the contribution of variables such as
socioeconomic stratum, course year, course performance, work
concurrent with the study, and Body Mass Index for the TFEQ-18
factor was different between countries.
Conclusion: The contribution of the body size dissatisfaction
and of the demographic and academic variables on the eating
behavior of university students was different in Brazil and
Portugal.
Disclosure of Interest: None declared.
MON-P224
CONSUMPTION OF ENERGY DRINKS AMONG NORWEGIAN
ADOLESCENTS; EXCESSIVE CONSUMPTION IS DETERMINED BY
MALE GENDER, HIGH SCREEN TIME, SEDENTARY LIFESTYLE
AND LOW SOCIO-ECONOMIC STATUS
N. Degirmenci1 *, T. A. Strand2,3, A. Vaktskjold4,5,
M. N. Holten-Andersen1,6. 1Department of Pediatrics,
Lillehammer Hospital, 2Division for Research, Innlandet
Health Trust, Lillehammer, 3Center for Intervention Studies in
Maternal and Child Health, University of Bergen, Bergen,
4
Department of Public Health, Inland Norway University of
Applied Sciences, Elverum, 5Division for Research, Innlandet
Health Trust, Sanderud, 6Institute of Clinical Medicine,
University of Oslo, Oslo, Norway
Rationale: The consumption of energy drinks (ED) is increasing,
causing concern among health care professionals. Case studies
link excessive ED intake to serious adverse events. The aim of
the study was to investigate the use of ED among Norwegian
adolescents and to explore determinants for regular and
excessive consumption.
Methods: We used data from the Ungdata survey conducted in
2015 and 2016. The survey is a voluntary, electronic question-
naire conducted annually in Norwegian schools, including
students in 8th–13th grade. In addition to an standardized
questionnaire on the every-day life, the participants reported
on their consumption of ED.
Nutritional epidemiology 2
Results: 31,091 adolescents completed the questions about ED
(65.1% response rate). Of the participants, 52.3% reported
being ED consumers, 3.5% reported to be high consumers
(4 times per week or more), and 1.6% exceeded the upper limit
for daily caffeine dose by their average daily ED intake alone.
Compared to females, male participants consumed twice as
much ED (mean ED difference 95.2% [CI: 88.2–102.5]), and the
proportion of male high consumers was 3.7 [CI: 3.1–4.3] fold
increased. Participants who never exercised had a 2.5 fold
increased risk of being high consumers compared to partici-
pants who exercised once a week or more (OR: 2.5 [CI: 1.8–
3.4]). Increasing time spent in front of a screen was associated
with an increasing risk of being a high consumer. Regular and
excessive intake of ED showed an increasing trend towards
lower socioeconomic class and rural residency.
Conclusion: A substantial proportion of the responders
consume ED. Excessive intake was predominantly seen among
males, those with sedentary lifestyle, those from the lowest
socioeconomic class, and those spending more time on screen
related activities. Efforts to reduce the consumption of ED
should target these groups.
Disclosure of Interest: None declared.
MON-P225
UNDERNUTRITION IN 2904 BELGIAN COMMUNITY DWELLING
OLDER PEOPLE; DATA FROM THE BELGIAN AGING
STUDIES (BAS)
N. De Witte1 *, J. Schols2, D. Verté1. 1Faculty of Psychology and
Educational Sciences, Vrije Universiteit Brussel, Brussel,
Belgium, 2Health Services Research, Maastricht University,
Maastricht, Netherlands
Rationale: The aim of this study was to assess the prevalence of
undernutrition among community dwelling older people (60+)
in Belgium according to age, income, activities of daily living,
quality of life, loneliness and frailty.
Methods: This study involved a secondary data analysis of data
from the Belgian Aging Studies (BAS). Within the cross-sectional
BAS, different aspects of quality of life of community dwelling
older people (60+) are assessed, using a structured question-
naire. From 2004 on, 180 municipalities in Belgium have
participated. In each municipality a proportionally stratified
random sample of minimum 400 older people was drawn from
the population registers.
As earlier studies (Cuervo et al. 2008) showed that three
questions of the Mini Nutritional Assessment explained 65% of
the variance in undernutrition in community dwelling older
people, these questions were added to the BAS questionnaire in
2013.
Results: Within the 2904 community dwelling older people
included in this study, 7,9% were severely undernourished and
11,9% showed moderate undernutrition. Chi-square tests
showed a significantly higher prevalence in the aged 80+
( p = ,000), in those hampered for ADL ( p = ,000), with a
monthly income <1499€ ( p = ,001) and living too far from
shops ( p = ,000).
Moreover, undernutrition was related to different aspects of
quality of life. Not satisfied with life ( p = ,000), loneliness
( p = ,001) and frailty were all positively associated to under-
nutrition ( p = ,000).
S261
Conclusion: This study reveals that undernutrition is a relevant
problem in Belgian community dwelling older people, that is
associated with different aspects of Quality of Life and
influenced by both individual and social variables. Referring
to the EU policy of promoting aging in place, prevention of
undernutrition is a challenge for both care professionals and
policymakers.
Disclosure of Interest: None declared.
MON-P226
DIETARY FACTORS AND NON-ALCOHOLIC FATTY LIVER
DISEASE INCIDENCE: A SYSTEMATIC REVIEW OF PROSPECTIVE
STUDIES
S. Khalatbari-Soltani1,2 *, F. Imamura1, P. Marques-Vidal2,
N. G. Forouhi1. 1Medical Research Council, Epidemiology Unit,
University of Cambridge, School of Clinical Medicine, Institute
of Metabolic Science, Cambridge, United Kingdom,
2
Department of Medicine, Internal Medicine, Lausanne
University Hospital (CHUV), Lausanne, Switzerland
Rationale: Diet and nutrition are likely to be key modifiable
factors for the prevention of non-alcoholic fatty liver disease
(NAFLD); however, there is currently no systematic evaluation
of dietary factors and NAFLD incidence.
Methods: A systematic literature search was conducted to
identify peer-reviewed articles published by March 2017 using
PubMed and Web of Science. Inclusion criteria were prospective
studies examining associations of any dietary variables with the
risk of NAFLD defined by clinical diagnosis or indexes of liver
health.
Results: 439 publications were identified and screened; of
which five prospective studies met our inclusion criteria. Five
studies evaluated different dietary variables in populations
from Australia, England and Israel. Three studies recruited
children/adolescents and 2 recruited adults. In one study,
higher total energy and energy-adjusted sugar intake (not
specified) in childhood was associated with greater odds of
NAFLD risk of 1.79 (95% CI: 1.14, 2.79) and elevated γ -glutamyl
transferase (GGT) of 3 (1.00, 5.00) in late adolescence,
respectively, while another study found no significant associ-
ation between sugar intake and GGTamong older adults after 5
years follow-up. Another study reported that fructose but not
total sugars (free mono and disaccharides) in obese adoles-
cents aged 14 was associated with risk of NAFLD at age 17. The
same study also showed a positive association of western
dietary pattern with the NAFLD risk. Finally, one study with 7
years follow-up in the general population found no association
between coffee consumption and NAFLD onset.
Conclusion: Overall, the available evidence is insufficient to
draw conclusions regarding the effects of diet on NAFLD onset
due to heterogeneity of study exposures and inconsistent study
findings. Further population-based prospective studies are
needed to establish the impact of dietary intake on NAFLD
onset.
Disclosure of Interest: None declared.
S262
MON-P227
REGIONAL DIFFERENCES OF MALNUTRITION PREVALENCE
AND MANAGEMENT IN SWITZERLAND
S. Khalatbari-Soltani1 *, C. de Mestral2, G. Waeber1,
P. Marques-Vidal1. 1Department of Medicine, Internal
Medicine, Lausanne University Hospital (CHUV), 2Lausanne
University Hospital, Institute of Social and Preventive
Medicine (IUMSP), Lausanne, Switzerland
Rationale: Malnutrition is a frequent condition among hospi-
talized patients, with a significant impact on patient’s
outcome. Whether malnutrition is reported and managed
similarly at the national level has seldom been assessed. We
aimed to evaluate regional differences within Switzerland
regarding malnutrition prevalence and management.
Methods: Observational cross-sectional study including routine
statistics from the Swiss hospital discharge databases for years
2013 and 2014 (seven administrative regions). All adults aged
≥20 with length of hospital stay of at least 1 day were included.
Reported malnutrition was defined based on the International
Classification of Diseases (ICD)-10 codes. Nutritional manage-
ment was also assessed.
Results: Of the initial 1,784,855 hospitalizations, 66,009 (3.7%)
had reported malnutrition, the prevalence ranging between
1.8% (Ticino) and 4.7% (Mittelland). Use of the different
malnutrition-related ICD-10 codes also varied considerably
across regions. Multivariate analysis showed a two-fold variation
in reported malnutrition; multivariate-adjusted odds ratio and
95% confidence interval relative to Eastern Switzerland was
2.21 (2.14; 2.28) for Mittelland and 0.71 (0.67; 0.76) for Ticino.
Slightly over half (54.1%) of hospitalizations with reported
malnutrition also had information on malnutrition management;
compare to Eastern Switzerland, Ticino had a lower likelihood
[Odds ratio (95% CI): 0.28 (0.24; 0.31)] while Zürich had a higher
likelihood [1.25 (1.17; 1.34)] of reporting any nutritional
management. In all regions, the most prevalent nutritional
management was a dietitian consultation, followed by enteral
nutrition, parenteral nutrition and multimodal interventions.
Conclusion: In Switzerland, there is considerable regional
variation regarding reporting of malnutrition prevalence and
management. Malnutrition appears to be insufficiently
managed and valued.
Disclosure of Interest: None declared.
MON-P228
CHANGES IN AETIOLOGY OF TYPE 3 INTESTINAL FAILURE
OVER 37 YEARS: A SINGLE CENTRE EXPERIENCE
S. Oke1 *, D. A. Lloyd2, J. M. Nightingale1, S. M. Gabe1. 1Lennard
Jones Intestinal Failure Unit, St Mark’s Hospital, Harrow,
2
Hampshire Hospitals NHS Foundation Trust, Winchester,
United Kingdom
Rationale: At our institution our first patient was started on
long-term parenteral support for intestinal failure (IF) in the
1970’s. We now care for the largest number of intestinal failure
patients in the UK. We describe changes in aetiology as seen in
our unit over the last 37 years.
Methods: Clinical records of 974 adult patients receiving home
parenteral support for IF at our tertiary referral centre were
analysed from a period from January 1979 until October 2016.
Demographic data was recorded. Difference between groups
Poster
were analysed by with chi-squared tests, and the Cox’s
regression model was used to assess survival.
Results: Since 1979 the mean age of patients thas increased
from 31 ± 16.5 to 52 ± 17.6 years. There has also been a change
in the underlying aetiology over this time period, with a
increase in percentage of patients with IF due to surgical
complications (3.4% to 28.8% ( p < 0.001)), fewer with IBD
(37.9% to 22.6%) ( p < 0.001) and malignancy now forming a
proportion of our patient cohort (0% to 8.4%). Over the same
time period percentages of patients with catheter related
blood-stream infections (71.4% to 42.2%) ( p < 0.005) and
central venous catheter associated thrombosis (36% to 5.3%)
( p < 0.001) have reduced. We noted that overall survival was
better in the pre 1995 era HR 0.2–0.4 ( p = 0.02).
Conclusion: At our institution the underlying aetiology and
demographics of patients with IF has changed. The age of our
patients is increasing with a reduction in the proportion of
patients with IBD with an increase in surgical complications and
malignancy. Our data also shows that there has been a
reduction in the percentage of patients with complications
related to IF. Notably survival outcomes were significantly
better in the period pre 1995, which is likely explained by the
fact that we now are treating older patients with complex
underlying conditions associated with poorer outcomes.
Disclosure of Interest: None declared.
MON-P229
ALBUMIN IS CRUCIAL TO LIVE EFFECTIVELY FOR THE ELDERLY
PEOPLE
T. Shimizu1 *, T. Namikawa2, K. Banba3, T. Nishikimi4.
1
Department of Cerebrovascular Diseases, Wakakusa-Tatsuma
Rehabilitation Hospital, Daito, Osaka, 2Department of
Rehabilitation, Suita Tokushuen, Suita, Osaka, 3Department of
Rehabilitation, Matsubara Tokushukai Hospital, Matsubara,
Osaka, 4Department of Medicine, Wakakusa-Tatsuma
Rehabilitation Hospital, Daito, Osaka, Japan
Rationale: It is important to live effectively with an appropri-
ate activity of daily living (ADL). ADL may be influenced partly
by body mass index (BMI) change, infectious disease such as
pneumonia and degradation of nutritional status due to aging.
The changes of ADL, BMI, immunity and nutritional status due
to aging were analyzed. Then the association of ADL with BMI,
immunity and nutritional status was investigated.
Methods: Eighty five elderly people (18 males, 67 females,
mean age 84 years) who has been long-term admitted in a
stable state to a geriatric health facility, were subjected. The
correlation of age with ADL evaluated by Barthel Index, BMI or
immunity reflected by the CD4 + lymphocytes count (CD4) was
investigated. Then the association of ADL with BMI, immunity
and the nutritional status evaluated by albumin, transferrin,
transthyretin and retinol binding protein, was investigated.
Results: ADL was not correlated with age (r = −0.032371,
p = 0.7686). BMI was correlated with age (r = −0.30982, p =
0.003908) and CD4 was also correlated with age (r = −0.21748,
p = 0.04557). In the investigation of association of ADL with
BMI, immunity and nutritional status, ADL was correlated
with BMI (r = 0.354686, p = 0.00086655), but was not correlated
with CD4 (r = −0.0201, p = 0.8544). ADL was correlated with
albumin (r = 0.41003, p = 9.732 × 10−5) but was not correlated
with other serum proteins. BMI was correlated with albumin
Nutritional epidemiology 2
(r = 0.2251, p = 0.03854). CD4 was correlated with albumin
(r = 0.229204, p = 0.034855) and transferrin (r = 0.2251,
p = 0.0383).
Conclusion: It was meaningful that ADL did not deteriorate due
to aging. On the other hand, ADL was associated with albumin
and BMI. BMI was also associated with albumin. However ADL
was not associated with CD4, good immunity is definitely
required for healthy life. CD4 was associated with albumin and
transferrin. This study suggests that albumin is crucial to live
effectively keeping a good ADL for the elderly people.
Disclosure of Interest: None declared.
MON-P230
IS FOOD ADDICTION THE MISSING LINK TO OVERWEIGHT AND
OBESITY IN ISRAELI PRESCHOOLERS?
V. Kaufman-Shriqui1,2 *, R. Aviram-Friedman3, D. R. Shahar4.
1
Nutritional Sciences, Ariel University, Ariel, Israel, 2Center
for Urban Health Solutions (C-UHS), St., Michael’s Hospital,
Toronto, Canada, 3Department of Life Sciences, Zlotowski
Centre for Neuroscience, Ben-Gurion University of the Negev,
Israel, 4School of public Health, Faculty of Health Sciences,
Ben-Gurion University of the Negev, Beer-Sheva, Israel
Rationale: Childhood obesity is a major public health concern,
with higher rates among children of low socioeconomic status
(LSES). A controversy exists on whether addiction to processed
food is associated with obesity among children. This study aims
to explore the association between food addiction and weight
status among LSES Israeli preschoolers.
Methods: Data were collected during the school year from
preschoolers in Southern Israel. Height and weight were
measured, sociodemographic characteristics and food fre-
quency questionnaires (FFQs) were administered in an inter-
view to mothers of children aged 4–7 years. Socioeconomic
status was defined using the Israeli Ministry of Welfare criteria.
OWOB was calculated using WHO BMI-z-score cutoff values. For
each FFQ food item, a score will be calculated based on an
existing algorithm (Schulte 2015) taking into account total
calories (Kcal/day), sugar, fat, trans fatty acids, sodium
(g/day), and the level of food processing. We will use a
multivariable logistic regression model to identify the inde-
pendent contribution of addictive food to OWOB beyond
traditional risk factors.
Results: Two-hundred and thirty-eight children were included,
32% were LSES, 47.4% boys, mean age was 63.4 ± 6.5 months.
Mean BMI was 16.3 ± 2.2, OWOB rate was 29.8%. Mean maternal
BMI was 26.5 ± 5.6, and 16.2% of the mothers had post-secondary
education. Fifty-two percent of the children consumed
candies daily, 47.3% drank one or more portion of soft drinks a
day. We will present additional results on differences in the food
addiction score comparing OWOB vs. normal weight children.
Conclusion: In the present study we aim to identify an
addictive perspective in association with Israeli children’s
weight status, beyond the contribution of total energy intake.
This may shed a new light on childhood obesity, and direct
policy makers toward relevant guidelines for the prevention
and management of childhood obesity.
Disclosure of Interest: None declared.
S263
MON-P231
ENTERAL TUBE FEEDING IN HOSPITALIZED AND AMBULATORY
PATIENTS IN AN SPECIFIC HEALTH AREA IN SPAIN.
RETROSPECTIVE STUDY DURING 2013–2016.
V. Garcia Zafra1 *, J. F. Sanchez Romera2, A. Rubio Gambin3,
A. Cayuela García1, A. Chica Marchal4, M. I. Pedreño Belchi1,
M. Ferrer Gómez5, L. Ramírez1. 1Endocrinology and Nutrition,
Hospital General Universitario Santa Lucia, Cartagena,
2
Hospital Clínico Universitario Virgen de la Arrixaca, Murcia,
3
Hospital General Universitario Santa Lucia, Cartagena, Spain,
4
Pharmacy, Hospital General Universitario Santa Lucia,
Cartagena, 5Endocrinology and Nutrition, Hospital Clínico
Universitario Virgen de la Arrixaca, Murcia, Spain
Rationale: It is evident that undernutrition is an independent
risk factor for increased length of hospital stay, higher
readmission rates and hospital costs mortality. Moreover,
there is a shift in care provisions from acute to community
settings. Due to those reasons there is an increased on enteral
tube feeding (ETF) use. Our objective was to evaluate key
aspects of all the ETF in our health area.
Methods: We conducted a retrospective study during 4 years
(2013–2016) of the systematic register of enteral nutrition in
the main hospital of our area (Hospital Santa Lucia de
Cartagena, Murcia, Spain) were all the equipments for ETF
are collected by patients. This registry includes hospitalized
and ambulatory ETF.
Results: A total of 1197 patients with a mean age of 73.9 (SD:
14.9) years were registered, of those 51% were women.
Neurologic disease was the pathology that justified the use of
ETF in 64.8%, followed by cancer 24.1% and gastrointestinal
pathologies 4.5%. The most prevalent route of administration
for neurological patients was nasogastric tube 78.9% and in
cancer patients was gastrostomy 54%. (47.2% endoscopic vs
48.2% radiological). Specific diabetes mellitus (DM) formula
was used in 25% of the sample, 29.3% in neurological disease vs
16.3% in cancer (n = 47). Mean age of patients with DM formula
was 77.5 years (SD: 10.1). Main reason for removing the ETF was
death (47.9%).
Conclusion: Our results are representative for our health area
because all the equipments for patients with ETF are provided
in this hospital. Compared with other registers, neurological
disease followed by cancer are the most prevalent reasons for
using ETF. Although DM specific formula is not generalized
recommended for patients with DM, in our sample is frequent
and more prevalent in patients with neurological disease and
older.
Disclosure of Interest: None declared.
MON-P233
NUTRITION EDUCATION IN MEDICAL, DENTAL, PHARMACY AND
NURSING SCHOOLS IN GREECE
Z. Pafili1 *, A. Lioupis2. 1Department of Dietetics, 2General
Surgery Clinic, Volos General Hospital, Volos, Greece
Rationale: Physicians, dentists, pharmacists and nurses are
often asked to address patients’ nutritional concerns, and
nutrition is an integral part of treatment in a number of
diseases. However, nutrition training of health care profes-
sionals has been found to be inadequate. Our aim was to assess
S264
the nutrition education through separate nutrition courses in
medical, dental, pharmacy and nursing schools in Greece.
Methods: Review of school curricula as presented on their web
pages and phone confirmation of their content with school
secretaries.
Results: Three out of 7 medical schools do not include a
separate nutrition course in their curricula. A nutrition course
is provided in 3 medical schools as an elective course, totaling
26–27 hours of lectures. Only in one medical school a nutrition
course is compulsory, totaling 16 hours of lectures. None of the
2 dental and 3 pharmacy schools provide a separate nutrition
course, however some topics of nutrition are covered as part of
other courses. Two out of 10 nursing schools do not provide a
separate nutrition course. From the rest 8, half provide a
nutrition course as an elective course and the other half as
a compulsory one. Total course duration is 26 hours in the 7
nursing schools and in the 8th (where the course is compulsory)
total course duration is 39 hours, including 26 hours of lectures
and 13 hours of clinical practice.
Conclusion: The majority of medical, dental, pharmacy and
nursing school students in Greece do not attend a nutrition
course during their undergraduate studies. These results are
comparable with survey results from Europe and the USA.
Reference
Chung M, van Buul VJ, Wilms E, Nellessen N, Brouns FJPH. Nutrition
education in European medical schools: results of an international
survey, Eur J Clin Nutr. 2014 Jul;68(7):844–6.
Disclosure of Interest: None declared.
Nutritional techniques and formulations
MON-P234
FLUSH NOW: THE USE OF TECHNOLOGY TO PREVENT
OCCLUSIONS IN JEJUNAL FEEDING TUBES - A PILOT
EVALUATION
B. Nadeau1, R. Weissbrod2, B. Trierweiler-Hauke3 *. 1Medtronic,
Mansfield, United States, 2Medtronic, Jerusalem, Israel,
3
University Hospital of Heidelberg, Heidelberg, Germany
Rationale: The provision of water flushes and hydration via the
enteral route requires a patient-specific intervention, delivery
mechanism, and prescription compliance. Inadequate water
delivery may lead to feeding tube occlusion, fluid imbalance,
and nutritional insufficiency [1]. This evaluation aimed to
assess the ability of the Kangaroo™ ePump system (Medtronic,
Mansfield, MA, USA) to deliver water flushes, with the ultimate
goal of helping to avoid occlusions in jejunal feeding tubes and
improving nursing workload.
Methods: The current facility enteral flushing protocol via
jejunal feeding tubes includes up to 10 flushes/day after
feeding, residual check, or medication.
Flushes were delivered manually via a syringe or automatically
using the Kangaroo™ ePump system on a sample of patients.
Results: Utilizing manual flushing, 57% of jejunal tubes
became occluded, of which, only 42% could be reopened
(Table 1). Conversely, using automatic pump flushing, none of
the jejunal tubes were occluded (Table 1).
Poster
Table 1: Comparison of flush method on occlusions and re-openings.
Flush Method Jejunal Occlusions Reopening Failed re-
tubes (%) time openings (%)
Manual 21 12 (57) 15–90 min 7 (58%)
Automatic Pump 9 0 (0) N/A N/A
Over the course of one year (10 patients/nurse/d, each
receiving 4 flushes/d), manual syringe flushing (2 min/flush)
versus automatic pump flushing (1 min/flush) consumes more
staffing hours (486.6 versus 243.3) and nursing time cost
(€16,398 versus 8,199).
Conclusion: In this limited analysis, automatic pump delivery
of enteral water flushes and hydration eliminated jejunal
feeding tube occlusions on a hospital ward. The use of
technology to deliver water flush orders may reduce nursing
time and improve nursing efficiency.
Reference
1. Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal,
percutaneous endoscopic gastrostomy, or jejunostomy: its indica-
tions and limitations. Postgrad Med J. Apr 2002;78(918):198–204.
Disclosure of Interest: B. Nadeau Other: Medtronic employee,
R. Weissbrod Other: Medtronic employee, B. Trierweiler-Hauke
Other: devices were provided for evaluation by Medtronic.
MON-P235
TREATING SARCOPENIA IN LONG-TERM CARE RESIDENTS: AN
HYPOTHESIS GENERATING TRIAL
S. Dimori1, L. Giorgio1, L. Fior1, F. Gasparotto1, E. Cereda2 *.
1
Fondazione Angelo Poretti e Angelo Magnani ONLUS, Vedano
Olona, Varese, 2Nutrition and Dietetics Service, Fondazione
Irccs Policlinico San Matteo, Pavia, Italy
Rationale: Nowadays, there is little information on the
potential management (screening and treatment) of sarcope-
nia in old adults living in long-term care institutions.
Methods: All old residents living in a long-term care institution
were screened for the presence of sarcopenia ( phase 1). Then,
based on the Tinetti scale (TS) score, sarcopenic patients were
included in two parallel single-arm trials ( phase 2) and
accordingly assigned to receive a vitamin D and leucine-
enriched whey protein-based nutritional supplement in com-
bination (TS ≥ 10) or not (TS < 10) with a supervised physical
exercise rehabilitation program (a 40-min session every 3 days)
for 12 months. The nutritional supplement was administered
twice daily for the first 3 months; and then once daily for 3
months; none for 3 months and once daily for the last 3 months.
Results: We screened 95 residents and 81 had low skeletal
muscle mass (SMM). Functional status could be assessed in 45
subjects and 39 out of these were included in the intervention
phase due to sarcopenia. Patients receiving the nutritional
support alone (n = 17) showed significant improvement in body
weight and composition with an increase in phase angle (PhA),
fat-free mass (FFM), SMM and SMM index (SMI), but not in
handgrip strength (HS). However, patients in the multidiscip-
linary program that included also exercise physical activity
(n = 22) showed an improvement not only in PhA, FFM, SMM and
SMI but also in HS, gait speed and Short Physical Performance
Battery (SPPB). The effect was present until discontinuation of
the intervention and was restored after its re-introduction.
Nutritional techniques and formulations
Conclusion: The present study showed that physical activity
and nutritional intervention could be feasible strategies to
improve muscle mass and function in old adults living in long-
term care institutions.
Disclosure of Interest: None declared.
MON-P236
E-LEARNING TO IMPROVE PEDIATRIC PARENTERAL NUTRITION
KNOWLEDGE? A PILOT STUDY IN TWO HOSPITALS.
L.-M. Petit1 *, P. Le Pape2, N. Bajwa3, L. Garzoni1,
D. Schluckebier1, V. Mclin1, C. Fonzo-Christe2, D. Belli1,
P. Bonnabry2. 1Gastro-enterologie Pediatrique, 2Pharmacie,
3
General Pediatrics, Hopital Universitaire De Geneve, Geneve
14, Switzerland
Rationale: We aimed to assess and compare in two hospitals the
impact of a self-made E-learning module designed to teach
prescription of paediatric PN, on the ability of physicians to
manage theoretical clinical cases.
Methods: Two university hospitals (HOSP1: prescribing
physicians, HOSP2: non-prescribing physicians, clinical
pharmacists).
Physicians were randomized in 2 groups in each hospital. All
participants completed a test to establish baseline knowledge.
• Intervention-group: E-learning module followed by a post-
test, one month after test. Satisfaction of the E-learning
module evaluated on a questionnaire.
• Control-group: post-test one month after test only.
Pre- and post-test included 3 clinical cases. Six months after
inclusion, HOSP1’s participants passed a 3rd test, to evaluate
persistence of prescription skills.
Results: 65 physicians participated (36 HOSP1, 29 HOSP2).
Initial knowledge scores were higher in HOSP1 ( p < 0.001).
No significant E-learning impact was observed globally.
Improvement of knowledge by the E-learning group was higher
in HOSP2 than in HOSP1. At the 6 months test, participants of
HOSP1 showed persistence of knowledge without significant
improvement compared to pre-test scores. Satisfaction with the
E-learning tool was very high: 100% of participants estimated
that the E-learning module met their needs and would
recommend it to their colleagues.
Conclusion: In this pilot study, there was no impact of an
E-learning module on the knowledge of physicians. However,
the direct responsability on PN prescription appears to be in
relationship with the results of initial knowledge tests.
Persistence of ability to prescribe PN could be due to
participation in the study, which serves as training tool in
that hospital. The high level of satisfaction with this new
pedagogic tool is a sign to keep on assessing how to use it
optimally in post-graduate medical education.
Disclosure of Interest: None declared.
MON-P237
A NEW DEVICE FOR ENTERAL NUTRITION
L. Casarotto1 *. 1Phoenix R&D, Rovigo, Italy
Rationale: Administration of enteral formulas is done by means
of electronic pumps or gravity systems with roller clamp. In the
similar field of intravenous infusion a third way exists: a gravity
system with flow regulator, which is more affordable and easier
S265
to use than pumps and much more reliable than roller clamps. A
new device is here presented: a flow regulator specific for
enteral formulas, since an IV flow regulator can not be used
with these solutions because of the risk of obstructions.
Methods: The core of an IV flow regulator is a narrow channel
called ‘mouse-tail channel’ because of its variable cross
section. This channel is too tight for enteral solutions, which
easily create obstructions. Therefore, an enteral flow regulator
needs to based on a new working principle. We have developed
and tested an innovative channel made of a sequence of knots,
each determining a pressure drop.
Results: Our tests demonstrate that the new device is able to
adjust the delivery within the range of typical administration
flow rates. The flow remains stable over time and no
obstructions are observed. This behaviour is much better
than the behaviour of a gravity system with roller clamp, which
needs so much frequently to be checked that it results almost
useless. The device is aimed for PEG therapy with adult
patients in hospitals or at home care.
Conclusion: In light of these performances, the new device is
an ideal replacement for roller clamp and could even be
employed for some applications currently in the field of
electronic pumps.
Disclosure of Interest: None declared.
MON-P238
HOME PARENTERAL NUTRITION PROVISION MODALITIES FOR
CHRONIC INTESTINAL FAILURE (CIF) IN ADULT PATIENTS: AN
INTERNATIONAL CROSS-SECTIONAL SURVEY
L. Pironi1 *, on behalf of Home Artificial Nutrition & Chronic
Intestinal Failure Special Interest Group of ESPEN. 1University
of Bologna, Bologna, Italy
Rationale: To investigate the HPN management for CIF in
different Countries, a multicenter study was carried out
using the structured database devised for the ESPEN ‘CIF
Action Day’.
Methods: In March 2015, 65 centers from 22 countries enrolled
3239 patients (benign disease 90%, cancer 10%), recording
patient characteristics, CIF pathophysiological mechanism and
HPN provision characteristics. HPN provision was categorized as
by health care system local pharmacy (LP) or by home care
company (HCC). Intravenous supplementation (IVS) was cate-
gorized as fluids and electrolytes alone (FE) or parenteral
nutrition admixture either commercially premixed (PA) or
customized to the individual patient (CA) alone or plus extra FE
(PAFE or CAFE). Statistics: chi square.
Results: HPN provision (%): HCC 66, LP 34; no difference
between benign and cancer CIF. LP was the main modality in
Denmark, the Netherlands and in other 9 European Countries;
HCC prevailed in UK, Italy, France, Poland, Israel, USA, South
America and Oceania ( p < 0.001). IVS types (%): FE 10, PA 17,
PAFE 17, CA 38, CAFE 18; PA + PAFE was greater in cancer and
CA + CAFE was greater in benign CIF ( p < 0.001); PA + PAFE
prevailed in those Countries were LP HPN provision prevailed;
CA + CAFE prevailed in the other Countries ( p < 0.001). In the
CIF mechanism categories, CA + CAFE ranged from 44% in
mucosal disease to 72% in fistulas and FE ranged from 2% in
mechanical occlusion to 17% in short bowel with jejunostomy
( p < 0.001).
S266
Conclusion: HCC was the main modality of HPN provision and
CA ± FE the main type of IVS for CIF. There were significant
differences among Countries for both HPN provision and IVS
types; provision modalities and IVS types looked associated.
IVS type also differed between the benign and malignant nature
of the disease and among the pathophysiological mechanisms
of CIF.
Disclosure of Interest: None declared.
MON-P239
HIGH PROTEIN, LOW CARBOHYDRATE, 100% WHEY BASED
ENTERAL FORMULA IS ASSOCIATED WITH LOWER BLOOD
GLUCOSE RESPONSE
M. B. Huhmann1 *, J. Neutel2, S. S. Cohen3, J. B. Ochoa4.
1
Clinical Sciences, Nestle Health Science, Florham Park,
2
Orange County Research Center, Tustin, 3EpidStat Institute,
Ann Arbor, 4Nestle Health Science, Florham Park, United States
Rationale: Hyperglycemia is prevalent among critically ill
patients and, similar to type 2 diabetes mellitus (T2DM), is
associated with insulin resistance. The role of diet, particularly
protein, has been insufficiently studied in this setting. The
objective of this study was to determine if a high protein, low
carbohydrate, 100% whey based enteral nutrition (EN) formula
could provide better control of postprandial blood glucose
relative to a high protein whey-casein based formula.
Methods: This randomized, crossover clinical trial of 12 adults
(mean age 56, range 40–66; 50% male) with T2DM assessed
glycemic and insulin responses following ingestion of an
isocaloric amount of two EN formulas. Subjects were rando-
mized to a 450 mL bolus of one of two interventions following
an overnight fast; 100% whey based (Peptamen Intense VHP
1.0 kcal/mL, P 37%, C 29%, F 34%) or whey-casein based (Vital
HP 1.0 kcal/mL, P 35%, C 45%, F 20%) formula on two separate
days, 1 week apart. Blood glucose and insulin levels were
collected at 0, 10, 20, 30, 60, 90, 120, 150, 180, 210, and 240
minutes. No antidiabetic medication was provided during
this time.
Results: The mean AUC for glucose was significantly lower with
100% whey formula than with whey-casein formula ( p = 0.025),
with no difference at baseline. At 60’ ( peak), the between-
group difference in change from baseline in mean glucose was
2.5 mmol/l ( p = 0.003). Mean insulin levels over time were not
statistically different between formulas.
Conclusion: This study demonstrated improved blood glucose
levels in adults with T2DM following high protein, low
carbohydrate whey-based EN formula compared with a whey-
casein based formula. This suggests a potential role of EN as a
co-therapeutic for glucose management in critically ill patients
with hyperglycemia.
Disclosure of Interest: M. Huhmann Other: Employee of Nestle Health
Science, J. Neutel Grant/Research Support from: Nestle Health
Science, S. Cohen Consultant for: Nestle Health Science, J. Ochoa
Other: Employee of Nestle Health Science.
Poster
MON-P240
ASSESSING THE PH OF ASPIRATE FROM NASOGASTRIC TUBES:
ARE TWO HEADS BETTER THAN ONE?
M. Small1 *. 1Clinical Nutrition, St Mark’s Hospital, Harrow,
United Kingdom
Rationale: pH of aspirate is the 1st line method for assessing
nasogastric tube position. National guidelines recommend a 2nd
person check readings between pH 5 & 61, suggesting that
double checking is more accurate than single, but this has not
been formally evaluated. This study aimed to determine if
double checking resulted in more correct answers than single
checking & how often readings obtained independently
correlated with those taken with a 2nd checker.
Methods: The pH of 10 clear non buffered fluids was
assessed using a CE marked pH indicator by 14 raters, once
on their own & once with a 2nd checker. Values were
compared with those from a pH meter to determine the
number of correct answers made by single raters compared to
those from a ‘group’ (rater plus 2nd checker). The measure-
ments in agreement per rater was also calculated to see how
often results arrived at independently correlated with those
obtained by a group.
Results: The mean number of correct answers for the 10 fluids
from the 14 single raters was 41 ± 28.2 (7–100)%, whereas the
number from the 7 groups was 31 ± 40.3 (0–100)%, p = 0.09.
There were 5 fluids where none of the groups obtained the
correct answer, whereas the single raters obtained the
correct value 3.4 ± 3.4 (1–8) times. The measurements in
agreement between individual raters vs those obtained by the
groups was 54 ± 26 (20–100)%. Only 1 rater obtained the same
values for all 10 fluids when reading the values on their own vs
in a group.
Rater 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Measurements in 20 20 60 90 20 40 60 50 100 50 70 80 30 40
agreement %
Conclusion: More correct answers were obtained when raters
made their decision alone suggesting accuracy is not increased
by having a 2nd checker. The lack of correlation between the
values obtained singly vs those by a group highlights the
subjectivity of visually assessing pH values and the need for
objective methods of assessment.
Reference
1. Patient Safety Alert NPSA/2011/PSA002
Disclosure of Interest: None declared.
MON-P241
FEASIBILITY OF INTERNATIONAL PROPOSED STANDARDIZED
ENTERAL CONNECTOR FOR SEMI-SOLID FORMULA FEEDING
M. J. Maruyama1 *, T. Higashiguchi1, I. Ishibashi1, Y. Suzuki1,
S. Iijima1, M. Inukai1, T. Iishi1, N. Kawasaki1, N. Kurata1,
M. Chiba1, F. Teramoto1, E. Nakamura1, J. Kayashita1, I. Tabei1.
1
New Connector Working Group, JSPEN, Tokyo, Japan
Rationale: Administration of semi-solid enteral formula though
a percutaneous endoscopic gastrostomy (PEG) tube is popular
practice in Japan. The current study was undertaken to assess if
the semi-solid formulas could be used for PEG patient with a
Nutritional techniques and formulations
new ENFit connector set with similar force to current various
PEG tubes.
Methods: Experiment 1: We measured the applied pressure
(force) needed to compress the syringe containing seven
viscous semi-solid formulas of which viscosity showed 6,000–
20,000 mPa.s with 20Fr PEG tube and low-profile tube though
ENFit connector or the current connector. Experiment 2: This
experiment was conducted to evaluate the compression force
though the current connector or ENFit connector in three
infusion velocity (50, 100, 150 ml/min), seven PEG tube types
with two semi-solid formulas.
Results: Experiment 1: The force needed to compress the
syringe though prototype ENFit connector was slightly higher
than that through the current connector in three semi-solid
formulas with 20Fr low-profile tube, otherwise there were no
significant differences between the current connector and
prototype ENFit connector. Experiment 2: Each of semi-solid
formulas required slightly higher force in prototype ENFit
connector in 6 experimental settings out of 21.
Conclusion: The ENFit connector will likely not show the
remarkable change in the force for the compression of syringe
to administer the semi-solid formula from the current study.
This study revealed the feasibility of PEG patients to receive
the semi-solid formulas through ENFit connector in a same
manner.
Disclosure of Interest: None declared.
MON-P242
5 CASES TRIAL OF THE NEW TECHNIQUE OF PERCUTANEOUS
TRANS ESOPHAGEAL GASTROTUBING(PTEG) WITH 130CM
LONG RUPTURE FREE BALLOON CATHETER FOR PLACING TO
POST PYLORUS WITH ONE STEP PROCEDURE
N. Katsura1 *. 1Surgery, Miyazu Takeda Hospital, Kyoto, Japan
Rationale: Percutaneous Trans Esophageal Gastrotubing(PTEG)
has been common in Japan and some Asian countries as the
salvage method of the case that is impossible to Percutaneous
Endoscopic Gastrostomy(PEG). We have sometimes experi-
enced some cases that need PTEG in spite of no gastrectomy
due to no safety zone of PEG procedure.
Methods: Currently, we can use the commercial based kit
(Sumitomo Bakelite Co. Ltd. Tokyo, Japan) which includes
70 cm Rupture Free Balloon(RFB) catheter. However, it is too
short to reach duodenum by one step to prevent reflux to
esophagus. We tried to make 130 cm long RFB catheter and use
it for the one step procedure to reduce the extraload of
patients. From December, 2015, to April, 2017, 5 cases of 1 step
method were performed PTEG with 130 cm RFB catheter. We
compared 5 cases with earlier 5 cases who underwent PTEG of 2
step method with 70 cm RFB catheter from the next 4 points;
operation time, body temperature(BT) on post operative day
(POD) 1, 3, and 7, count of white blood cells, cross reacting
protein(CRP) on POD 1.
Results: We recognized significant differences statistically
about operative time, data of BTon POD 3, and WBC, and CRP on
POD 1; operative time, 47 ± 14 minutes with 70 cm catheter by
2 step method, 39 ± 11 minutes with 130 cm catheter by one
step method ( p < 0.01). WBC, 11,000 ± 2450 vs 89,000 ± 1,400
( p < 0.05). CRP, 3.2 ± 1.3 vs 1.3 ± 0.4 ( p < 0.01). In BT, on day 3,
36.8 ± 0.5 vs 36.2 ± 0.8 ( p < 0.05), respectively.
S267
Conclusion: 1 step procedure to place PTEG tube in the post
pylorus, using 130 cm catheter of RFB, could become the
effective method.
References: no reference
Disclosure of Interest: None declared.
MON-P243
ACHIEVING NUTRITIONAL COMPLIANCE BY MANUAL
ITERATIVE METHOD AND MATHEMATICAL MODEL
S. Silvestre1 *, E. P. C. Rocha Junior2, L. C. D. L. Gontijo1,
H. F. R. Cunha3, L. S. Monteiro da Silva3. 1Serviço de Nutrologia,
Hospital Felício Rocho, 2Serviço de Nutrologia, Hospital Felício
Roxo, Belo Horizonte, MG, 3Nutrotech, Rio de Janeiro, Brazil
Rationale: Guidelines compliance is standard care for
nutrition support and the prescription of nutrition support is
usually made by a trial-and-error manual iterative method
(MIM) and provides feasible but not necessarily optimal
compliance or cost solutions. The objective of this study is to
compare manual iterative method to a mathematical linear
programming model (LPM) in terms of compliance achieve-
ments and cost reduction.
Methods: A cross section database extraction of 36 prescrip-
tions obtained from a tertiary level hospital was used.
Anthropometric data, protein and calorie prescriptions were
obtained. Obese patients were excluded. Protein (1.2–2.0 g/
kg/d) and calorie (25–30 kcal/kg/d) recommendations from
guidelines were considered as standard compliance. Protein
and calorie densities of enteral formulas used by the institution
were obtained from regular nutrition facts table. On the other
hand, costs were compared to an arbitrary formula in order to
avoid identification and prices exposure. Previous decisions
were then compared to the results obtained from the linear
programming model whose objective function was to minimize
relative costs. Compliance achievements and relative costs
were compared.
Results: The results showed that MIM is inferior to LPM
performance in terms of compliance achievements and relative
cost reduction. MIM achieved 47,22% less compliant decisions
and exceeded LPM in relative cost by more than 55%. Besides
that, MIM used only one enteral formula, despite the fact that
LPM achieved better results using more than one.
Conclusion: Healthcare systems and companies should review
their calculation methods in order to benefit from the potential
showed in this experimentation.
Disclosure of Interest: None declared.
MON-P244
DISPENSING A HIGH CALORIC, HIGH PROTEIN ORAL
NUTRITIONAL SUPPLEMENT 3 TIMES DAILY IS WELL
TOLERATED AND INCREASE COMPLIANCE IN ELDERLY
C. Koch1, A. Dax1, A. Warnke1, L. Pauly2, S. Reichart2 *,
E. A. Pestana2, J. Stover2, K. Lekkos3. 1SocraTec R&D GmbH,
Erfurt, 2Fresenius Kabi Deutschland GmbH, Bad Homburg,
3
Helios Klinikum, Hildesheim, Germany
Rationale: Malnutrition is a common problem in elderly.
Distributing small amounts (40–60 mL) of calorically dense
supplements (≥2 kcal/mL) three or four times daily in between
meals increases compliance and improves nutrition status. The
present study aimed at evaluating acceptability and
S268
compliance during administration of lower volumes of a
calorically dense ONS distributed 3 times a day in elderly.
Methods: Open-label study in 20 elderly in residential homes in
Germany (76 ± 5 years, 11 female/ 9 male, BMI 25.1 ± 1.9
kg*m−2). Participants received 3 × 40 mL of the ONS Fresubin®
3.2 kcal DRINK, corresponding to 400 kcal and 20 g protein, for
7 days. ONS was consumed in the morning, lunchtime, evening
at least 1 hour before meals, and handout with medication
round. Primary outcome was gastrointestinal (GI) tolerance;
secondary outcomes were palatability and compliance. Data
were analysed and evaluated descriptively.
Results: All participants completed the 7-days study period;
and consumed approx. 95% of prescribed dose, i.e., corre-
sponding to 38/40 ml. All subjects ingested the study product
immediately and were compliant. The majority of subjects
rated the palatability of the product as good or excellent after
first ingestion on day 1 (smell: 16/20, taste: 15/20, appearance
18/20) and after last ingestion on day 7 (smell: 16/20, taste:
16/20, appearance 18/20). The number of GI symptoms was
comparable at baseline and at the end of the supplementation
period; 13/20 subjects did not report any GI symptoms.
Conclusion: High energy, high protein ONS, delivered in 3
portions during the day, was well tolerated and accepted
among elderly in residential homes. Dispensing a lower volume
of a calorically dense ONS provides a convenient way to
supplement calories and protein and was associated with high
compliance in elderly subjects in need of supplementation.
Disclosure of Interest: C. Koch Other: contracted research organiza-
tion, A. Dax Other: contracted research organization, A. Warnke Other:
contracted research organization, L. Pauly Other: Fresenius Kabi
employee, S. Reichart Other: Fresenius Kabi employee, E. Pestana
Other: Fresenius Kabi employee, J. Stover Other: Fresenius Kabi
employee, K. Lekkos Other: Helios Klinikum Department Head Geriatric
Unit.
MON-P245
NEW HIGH PROTEIN AND HIGH ENERGY ORAL NUTRITIONAL
SUPPLEMENT FOR COMPLIANCE AND TOLERANCE IN
ELDERLY CARE
C. Koch1, A. Dax1, B. Schug1, L. Pauly2, S. Reichart2 *, J. Stover2,
E. A. Pestana2, K. Lekkos3. 1SocraTec R&D GmbH, Erfurt,
2
Fresenius Kabi Deutschland GmbH, Bad Homburg, 3Helios
Klinikum, Hildesheim, Germany
Rationale: Volume strongly determines compliance to an oral
nutritional supplement (ONS), hindering to achieve the
effective dose of protein and energy necessary to be clinically
effective in the management of malnutrition. For this, high
protein, high energy ONS are considered beneficial. In the
present study, a new ONS providing high protein and energy in a
low volume was evaluated in daily practice of a residential
home.
Methods: Open-label study in 20 elderly in residential homes
in Germany (75 ± 4 years, 12 female/ 8 male, BMI 24.7 ± 1.9
kg*m−2). Participants received one bottle a day (125 ml) of the
ONS Fresubin® 3.2 kcal DRINK, corresponding to 400 kcal and
20 g protein, for 7 days. Primary outcome was gastrointestinal
(GI) tolerance, secondary outcomes were palatability and
compliance (ratio of prescribed vs. actual intake). Data of the
full analysis set were evaluated descriptively.
Results: All participants completed the 7-days study period.
Participants consumed 96% of the prescribed volume. All
Poster
subjects ingested the study product within one hour. The
majority of subjects rated the palatability of the product as
good or excellent after first ingestion on day 1 (smell: 18/20,
taste: 16/20, appearance 16/20) and after last ingestion on day
7 (smell: 17/20, taste: 15/20, appearance 16/20). The number
of GI-symptoms was comparable at baseline and at the end of
the supplementation period. 11/20 subjects did not report any
GI-symptoms.
Conclusion: A high energy, high protein ONS delivered in a
small volume was well tolerated and accepted in elderly in
residential homes, with an excellent compliance. The new ONS
thus represent a clinically valuable option for improving
effectiveness of nutritional therapy in situations with
restricted food and fluid tolerance
Disclosure of Interest: C. Koch Other: contracted research organization,
A. Dax Other: contracted research organization, B. Schug Other:
contracted research organization, L. Pauly Other: Fresenius Kabi
employee, S. Reichart Other: Fresenius Kabi employee, J. Stover
Other: Fresenius Kabi employee, E. Pestana Other: Fresenius Kabi
employee, K. Lekkos Other: Helios Klinikum Department Head Geriatric
Unit.
Obesity and the metabolic syndrome 2
MON-P246
METABOLIC ADAPTATION AFTER BARIATRIC SURGERY: A
COMPARISON OF ROUX-EN-Y GASTRIC BYPASS AND SLEEVE
GASTRECTOMY
L. Plank1 *, R. Murphy2, N. Davies2, M. B. Booth3. 1Surgery,
2
Medicine, University of Auckland, 3Surgery, North Shore
Hospital, Auckland, New Zealand
Rationale: A reduction in resting energy expenditure (REE) is
seen after weight loss. It is not clear whether the massive
weight loss seen after bariatric surgery induces changes in REE
which are consistent with changes in body composition nor
whether these changes differ between types of bariatric
surgery.
Methods: In a double-blind ( patient and assessor) trial of
patients with type 2 diabetes mellitus randomised to laparo-
scopic silastic ring Roux-en-Y gastric bypass (GBP; 17M, 23F) or
to laparoscopic sleeve gastrectomy (SG; 24M, 18F), REE was
measured by indirect calorimetry before and 12 months after
operation. All patients underwent dual-energy X-ray absorpti-
ometry for total body fat mass (FM) and fat-free mass (FFM).
Linear regression analysis was used to determine significant
predictors of REE at baseline. These predictors were used in a
mixed-model analysis of covariance to adjust the changes in
REE over the 12-month period and to examine the effect of type
of surgery.
Results: Twelve-month weight loss in GBP patients was
31.2 ± 1.7[SEM] kg made up of 25.5 ± 1.5 kg FM and
5.8 ± 0.4 kg FFM. Corresponding measures in SG patients were
30.4 ± 2.1 kg (P = 0.75), 24.1 ± 1.8 kg (P = 0.56) and 6.3 ± 0.5 kg
(P = 0.45). REE at baseline was 1739 ± 47 kcal/d in GBP and
1896 ± 52 kcal/d in SG (P = 0.029). At 12 months, REE was
1461 ± 41 and 1543 ± 33 kcal/d, respectively. FFM, FM, age, and
sex were significant predictors of baseline REE. After adjust-
ment for these variables, REE remained significantly lower than
at baseline by 94 ± 34 kcal/d for GBP (P = 0.007) and 131 ± 31
Obesity and the metabolic syndrome 2 S269

kcal/d for SG (P < 0.0001). These reductions did not differ by Disclosure of Interest: M. Torrego: None declared, A. Barabash: None
type of surgery (P = 0.25). declared, F. Cuesta: None declared, L. Fernandez: None declared,
Conclusion: Adaptive reductions in REE to weight loss in obese R. Cabrera: None declared, M. Ceballos: None declared, M. A. Rubio:
individuals were observed in the 12 months following both GBP None declared, P. Matía Grant/Research Support from: FIS PI14/00972
PREDIMED PLUS, U. Garin: None declared.
and SG bariatric surgery which may predispose these patients
to weight regain.
MON-P248
Disclosure of Interest: None declared.
PREDICTION OF CHANGES IN THE VISCERAL FAT AREA
AND THE SKELETAL MUSCLE MASS/VISCERAL FAT AREA
MON-P247 RATIO DURING WEIGHT REDUCTION BY LIFESTYLE
SARCOPENIC OBESITY OR PHASE ANGLE IN A COHORT OF INTERVENTION
PATIENTS WITH METABOLIC SYNDROME. WHICH IS BETTER
M. M. A. Abulmeaty1,2 *, M. Y. Berika3, A. M. Al-Othman4.
PREDICTOR OF MUSCULAR STRENGTH, FUNCTIONALITY AND 1
Clinical Nutrition Program, Community Health Sciences, King
ACTIVITY LEVEL?
Saud University, Riyadh, Saudi Arabia, 2Obesity Management
M. Torrego1 *, A. Barabash1, F. Cuesta2, L. Fernandez3, and Research Unit, Medical Physiology Department, Zagazig
R. Cabrera4, M. Ceballos5, M. A. Rubio1, P. Matía1, U. Garin1. University, Zagazig, Egypt, 3Rehabilitation Sciences
1
Endocrinology, 2Geriatrics, 3Endocrinology Laboratory, San Department, King Saud University, 4Clinical Nutrition
Carlos Clinical Hospital, 4Health Care, Espronceda Center, Consultant and Head, Health and Nutrition Training Center,
5
Health Care, Lucero Center, Madrid, Spain Riyadh, Saudi Arabia
Rationale: Determinate the phase angle (PA) and the preva- Rationale: To predict the changes in the visceral fat area (VFA),
lence of sarcopenic obesity (SO) in patients with metabolic skeletal muscle mass (SMM) and SMM/VFA ratio1 during weight
syndrome (MS) and define associations with muscular strength, loss in adult men with obesity.
muscular function and level of physical activity. Methods: A prospective study included eighty-two males, 20–
Methods: Patients with MS. Body composition: Bodystat 60 y, for 3 months in the weight reduction clinic, KSU, between
QuadScan 4000 and Akern BIA 101. Skeletal muscle mass Sept, 2016 and Feb, 2017. Patients were instructed to follow a
(SMM): Jansseńs formula ([0.401 × (height – cm−2/resistance – balanced hypocaloric diet (1200–1600 kcal/d, 50% complex
omhs-) + (3.825 × gender –M = 1;F = 0-) – (0.071 × age)] + 5.102). carbohydrates, 30% unsaturated lipids, 20% protein), physical
SO: sum of low SMM/height2 < 8,25 (M) and <6,68 kg/m2 (F), activity plan for 60 min/d and a practical advice for combating
and high fat mass >25,0 (M) and >35,0% (F). Hand grip strength: the unhealthy lifestyle. Body mass index (BMI) was calculated
JAMAR Plus dynamometer; dominant arm; mean of three as weight(Wtkg)/height(m)2. The InBody-720 bioelectric
determinations. Muscle function: chair test. Physical activity at impedance was used to measure fat mass (FM), VFA, SMM,
three levels: RAPA1-Rapid Assessment of Physical Activity SMM/VFA ratio, and osseous mass (OM) before and after the
Questionnaire- + chair test: Low Active, Moderately Active study period. Percent of change in a given parameter (%) was
and Active. calculated as before-after difference/before-value x100.
Results: 124 patients, 49.2% M; 50.8% F. Median age 64 years Stepwise regression analysis was used to test the predictors
(IQR: 61–69), median BMI 32.26 (IQR: 29.5–34.7). Prevalence of of changes in FVA and SMM/VFA ratio.
SO: 19.3%; Median PA: 5.43 (IQR: 4.85–5.95). PA was associated Results: A significant reduction in Wt, BMI, VFA and FM
with grip strength (Rho spearman 0.36; p < 0.001), chair test ( p < 0.001), in addition to a significant rise of SMM/VFA ratio
number of repetitions (Rho Spearman 0.263; p = 0.006) and ( p < 0.001), and an insignificant changes of OM and SMM were
level of activity (median values of 5.2 in low, 6 in medium and detected. % Wt, BMI & VFA losses were 5.70%, 5.38%, & 13.59%,
4.95 in active;p = 0.002). respectively, while % of rise in SMM/VFA ratio was 18.14%. % VFA
Conclusion: SO diagnostic and low PA are significantly loss was predicted by this equation; 3.245 + 1.92 x %BMI loss,
associated with a lower muscular function. Low PA values are (β = 0.668, r2 = 0.447, p < 0.001). Additionally, %BMI loss signifi-
associated with lower functionality and level of physical cantly predict the rise in the SMM/VFA ratio (β = −0.588,
activity. r2 = 0.346, p < 0.001) and the equation = –5.175–2.406 x %BMI
loss.
Conclusion: The lifestyle intervention produced reduction in
SO (A = yes; B = no) Phase angle (A < 4,85;
B > 4,85) the VFA more than double that of the Wt or BMI with rise of
SMM/VFA ratio and these changes could be predicted by
Grip strength (kg);IQ A:17.9(15.9–21.3) A:20.9(18–24.9)
B:28.6(21.4–38.2) B:30(21.2–40) %BMI loss.
p < 0.001 p = 0.001 Reference
Chair test (n) A:13(10.5–14) A:12(10–14)
B:13(11–14) B:13(11–15) 1. Hwang Y, et al. The ratio of skeletal muscle mass to visceral fat area
p = 0.2 p = 0.04 is a main determinant linking circulating irisin to metabolic
Physical activity (n,%) Low. A:20(95.2); B:71 Low. A:25(92.6); B:75 phenotype. Cardiovasc Diabetol 2016; 15: 9.
(79.8) (78.1)
Medium. A:0(0); B:15 Medium. A:0(0); B:19 Disclosure of Interest: None declared.
(16.9) (19.8)
High. A:1(4.8); B:3(3.5) High. A:2(7.4); B:2(2.1)
p = 0.032 P = 0.113

*M = male, F = female
S270
MON-P249
BIOLOGICAL AND PSYCHOLOGICAL ASPECTS OF WEIGHT LOSS
AMONG OBESE AND OVERWEIGHT SUBJECTS
M. Černelič Bizjak1 *, M. Stubelj1, A. Petelin1,
Z. Jenko Pražnikar1. 1Department of Nutritional Counselling,
Dietetics, University of Primorska, Faculty of Health Sciences,
Izola, Slovenia
Rationale: This study investigate biological and psychological
aspects of weight loss. It was hypothesised that participants
with higher body dissatisfaction over a period of 6 months will
exhibit increased inflammation compared with those who
change from dissatisfied to satisfied, and that these changes
will be independent of relevant health-related behaviour
changes.
Methods: The participants were recruited for a multidiscip-
linary weight management programme. Subjects were re-
quired to be older than 25 years; to have a BMI between 25
and 35 kg/m2; to be healthy, with no metabolic, cardiovas-
cular, endocrine, acute or chronic inflammatory diseases. A
total of 33 subjects, aged 38.9 ± 6.5 years, completed the
whole intervention programme. Daily energy requirements
were calculated from the individual’s resting metabolic rate
and physical activity level factor, with a moderate energy
restriction of 2100 kJ.
Results: Hierarchical regressions analyses revealed that demo-
graphics and changes in obesity indicators accounted for 26% of
the variation in reduction of inflammation biomarker TNF-a,
23% in CRP, 18% in increase in anti-inflammatory adiponectin.
Five lifestyle behaviours explained additional 13% of the
variation in the reduction of serum level of CRP, 29% of TNF-a
and 25% in increase of adiponectin. The change in body
dissatisfaction was the significant predictor of decreased
inflammation level and uniquely explained 7–8% of the
variation of inflammatory biomarkers and 17% of the variation
of adiponectin.
Conclusion: The findings provide important information that
body dissatisfaction may be a psychological marker of a higher
metabolic risk independently of most traditional risk factors
such a gender, BMI and intra-abdominal adiposity. This
constructs must be considered as relevant health-related
factors in weight management programme.
Disclosure of Interest: None declared.
MON-P250
EVALUATION OF INSULIN RESISTANCE WITH
ANTHROPOMETRIC AND ATHEROGENIC PREDICTORS IN
DIABETES
O. Kucukerdonmez1, M. S. Karacil Ermumcu2 *, S. Seckiner3,
E. Koksal2. 1Nutrition and Dietetics, Ege University Faculty of
Health Sciences, İzmir, 2Nutrition and Dietetics, Gazi
University Faculty of Health Sciences, Ankara, 3Endocrinology
and Metabolism, Ege University Faculty of Medicine, İzmir,
Turkey
Rationale: Some anthropometric and atherogenic predictors of
insulin resistance are common used in clinical. This study was
conducted to evaluate anthropometric and atherogenic pre-
dictors of insulin resistance in diabetes.
Methods: A total of 100 (34 men and 66 women) patients with
type 2 diabetes were enrolled. The demographic parameters,
Poster
antropometric measurements, body composition analysis and
biochemical findings were taken for all participants. Visceral
adiposity index (VAI), body mass index (BMI), waist/hip ratio,
waist/height ratio, triglyceride/high-density lipoprotein chol-
esterol ratio (TG/HDL-C) and homeostatic model assessment of
insulin resistance (HOMA-IR) levels were calculated in all
individuals.
Results: The mean age of participants was 52.6 ± 10.43 years.
The mean value of HOMA-IR of men and women 7.5 ± 5.75 and
5.7 ± 4.49 respectively ( p > 0.05). HOMA-IR was not correlated
with total cholesterol (r = 0.032, p = 0.751) and low-density
lipoprotein cholesterol levels (r = 0.037, p = 0.711) but HOMA-
IR was positively correlated with triglyceride levels (r = 0.289,
p = 0.004) and it was negatively correlated with high-density
lipoprotein cholesterol levels (r = −0.364, p = 0.000) among
biochemical findings but the strongest association was found
with TG/HDL-C ratio (r = 0.339, p = 0.001). HOMA-IR was not
correlated with waist to hip ratio (r = 0.176, p = 0.080) and
waist to height ratio (r = 0.125, p = 0.216) but HOMA-IR was
positively correlated with body fat mass (r = 0.200, p = 0.046)
and visceral fat percentage (r = 0.201, p = 0.044), BMI (r =
0.202, p = 0.035) and waist circumference (r = 0.222, p = 0.027)
among antropometric measurements/calculations and body
composition analysis but the strongest association was found
with VAI (r = 0.297, p = 0.003).
Conclusion: Visceral adiposity index and triglyceride/high-
density lipoprotein cholesterol ratio are the practical markers
of insulin resistance in the clinical evaluation of type 2 diabetes
patients.
Disclosure of Interest: None declared.
MON-P251
IRON SUPPLEMENTS FOR THE TREATMENT OF IRON
DEFICIENCY AFTER ROUX-EN-Y GASTRIC BYPASS
N. Steenackers1,2 *, I. Gesquiere1,2, M. Lannoo3,
B. Van der Schueren1,2, C. Matthys1,2. 1Clinical and
Experimental Endocrinology, KU Leuven, 2Endocrinology,
3
Abdominal Surgery, University Hospitals Leuven, Leuven,
Belgium
Rationale: Obese patients are predisposed to develop iron
deficiency (ID) due to inadequate dietary iron intake, increased
blood volume and obesity-associated inflammation. Today,
Roux-en-Y gastric bypass (RYGB) is the gold standard to treat
morbid obesity. However, this procedure increases the risk to
develop ID. Therefore, we examined the disposition of iron
supplements in obese volunteers before and after RYGB.
Methods: Oral absorption studies with iron(II)sulphate and iron
bisglycinate supplements were performed in 6 subjects before
RYGB and in 3 subjects at 1 month after RYGB. Before oral
administration, blood samples were collected to determine
serum iron concentration, iron-related markers, hepcidin and
C-reactive protein (CRP). After administration, blood samples
were collected at 15, 30, 60, 90 minutes and at 2; 2.5; 3; 3.5; 4
and 5 hours to determine serum iron concentration.
Nutrikinetic properties of both supplements were assessed by
calculating the adjusted for baseline AUC0-5h, Cmax and Tmax
before and after surgery.
Results: Before RYGB, the AUC0–5h was significantly higher after
iron(II)sulfate administration compared to iron bisglycinate as
seen in Table 1. No significant differences were obtained for
Obesity and the metabolic syndrome 2 S271

the other nutrikinetic properties, neither after surgery. Post- should allow a better understanding of the mechanisms by
RYGB, iron status markers and hepcidin concentration were not which CIT alters fat mass in humans.
statistically significant changed, however CRP was significantly Reference
decreased ( p = 0.03).
Joffin et al. Citrulline induces fatty acid release selectively in visceral
Table 1: Nutrikinetics results at the preoperative absorption tests. adipose tissue from old rats. MNFR 2014.
Before RYGB Disclosure of Interest: None declared.
1 2
Parameters Iron(II)sulfate Iron bisglycinate P-value
(n = 6) (n = 6) MON-P253
AUC0–5h (μg/dL*h) 7.8 (5.1–12.5) 7.0 (3.7–9.4) 0.03 SARCOPENIC OBESITYAND METABOLIC SYNDROME. WHICH OF
Cmax (μg/dL) 1.9 (1.5–2.6) 1.6 (1.2–2.2) 0.06 THE INDIVIDUAL COMPONENTS ARE ASSOCIATED WITH THE
Tmax (h) 2.8 (2.3–4.3) 2.0 (1.4–3.9) 0.56 SARCOPENIC OBESITY PHENOTYPE?
P. Matía1 *, M. Torrego1, A. Barabash1, U. Garin1, M. V. Sáez1,
Conclusion: Before RYGB, disposition of iron(II)sulfate is C. Aragoneses2, C. Moreno2, M. Gonzalez-Cerrajero3,
superior compared to iron bisglycinate, while post-RYGB no M. Á. Rubio1. 1Endocrinology and Nutrition, Hospital Clínico
differences could be found. SAN CARLOS., 2Centro de Salud Lucero, 3Centro de Salud
Disclosure of Interest: None declared. Guzmán el Bueno, Atención Primaria, Madrid, Spain

MON-P252 Rationale: Associations between metabolic syndrome (MS) and

CITRULLINE INDUCES LYPOLYSIS IN SUBCUTANEOUS ADIPOSE sarcopenic obesity (SO) have been established, but how the
TISSUE FROM DYNAPENIC-OBESE ELDERLY PEOPLE individual components of MS contribute to the SO phenotype
needs further investigation. Objective:to describe relation-
P. Noirez1,2 *, A. Meziani2,3, M. Dulac2,3, G. El Hajj Boutros2,3,
ships between waist circumference (WC), glycaemic control,
V. Marcangeli2,3, J. Morais4, C. Forest5,
HDL-chol, triglycerides, inflammation, and SO in patients
M. Aubertin-Leheudre2,3. 1UFR staps, IRMES, EA7329,
with MS.
Universite Paris Descartes, Paris, France, 2Département des
Methods: Body composition:Bodystat QuadScan 4000 and
Sciences de l’activité physique, UQAM, 3Centre de Recherche
BIA 101. Skeletal muscle mass (SMM): Jansseńs formula
l’Institut Universitaire de Gériatrie de Montréal, 4Geriatric
([0.401 x (height–cm−2/resistance–omhs) + (3.825 x gender –
Department, Mc-Gill Universitary Hospital, Montréal, Canada,
5 M = 1;F = 0-) – (0.071 x age)] + 5.102). SO:sum of low SMM/
Inserm Umr-S 1124, Universite Paris Descartes, Paris, France
height2 < 8,25 (M) and <6,68 kg/m2 (F), and high fat mass >25,0
Rationale: In elderly, an increase in fat mass (FM) and a (M) and >35,0% (F). Statistics: binary logistic regression
decrease in muscle strength (dynapenia) is often oberved and (univariated and adjusted by age and gender).
could lead to the onset of metabolic syndrome. In animal Results: 110 patients. Median age 64 years (IQ: 61–69). Median
studies, Citrulline (CIT) induces lipolysis observed by the BMI 31.8 Kg/m2 (IQ: 29.5–34.7). SO: 19.3% of the sample.
release of non-esterifed fatty acids (NEFA) from white Conclusion: In our cohort of patients with MS, their individual
adipose tissue. Our aim was to evaluate the effect of an components were not associated to the OS phenotype. Only the
acute exposure (24h) of human abdominal subcutaneous WC showed a paradoxical relationship with SO. It is neccesary
adipose tissue (SCAT) to CIT in elderly dynapenic-obese (DO) to explore different definition of SO and its association with the
people. global CV risk.
Methods: Seven women (w) (age:68.6 ± 3.3 yrs; FM:46.4 ± Table 1:
2.8%; handgrip strength/BodyWeight-HS/BW:0.32 ± 0.04 kg/kg) Univariate Adjusted by age and gender
and 14 men (m) (age:66.9 ± 4.3 yrs; FM:34.3 ± 2.8%; HS/
BW:0.45 ± 0.08 kg/kg) with dynapenia (HS/BW < 0.44 for w OR (CI 95%) of SO p OR (CI 95%) of SO p
and <0.5 for m) and obesity (fat mass >30% for w and >25% Basal glucose (mg/dl) 0.986 (0.955–1.017) 0.360 0.999 (0.964–1.034) 0.940
for m) were recruited. SCAT biopsies from all participants were HbA1c (%) 0.458 (0.151–1.392) 0.169 0.458 (0.125–1.674) 0.237
HOMA 1.016 (0.820–1.258) 0.886 1.085 (0.855–1.376) 0.503
incubated in KREBS medium with glucose (5 mM). Twenty-four HDL-cholest (mg/dl) 1.003 (0.964–1.045) 0.870 0.954 (0.901–1.010) 0.103
hours later, the medium was replaced with KREBS medium, HDL-cholest (low vs 1.500 (0.567–3.967) 0.414 1.896 (0.662–5.428) 0.233
5 mM glucose, containing or not CIT (2.5 mM). At 24 h of high)*
Triglycerides (mg/dl) 1.001 (0.991–1.011) 0.817 1.003 (0.992–1.013) 0.609
incubation, the medium was collected for the estimation of
PCR (mg/dl) 1.021 (0.451–2.309) 0.961 0.897 (0.392–2.052) 0.797
NEFA (mM · mg−1) and glycerol (g · L-1 · mg−1) release. WC (cm) 0.892 (0.829–0.959) 0.002 0.923 (0.856–0.996) 0.040
Results: The analyses of lipolytic products in the medium WC (high vs low)** 1.707 (0.199–14.680) 0.626 0.345 (0.027–4.341) 0.410
suggested that CIT increased NEFA (DO w: 0.24 ± 0.13 vs
0.15 ± 0.07; DO m: 0.23 ± 0.14 vs 0.12 ± 0.06) and glycerol (DO Disclosure of Interest: P. Matía Grant/Research Support from: FIS PI14/
w: 0.22 ± 0.05 vs 0.15 ± 0.07; DO m: 0.25 ± 0.23 vs 0.09 ± 0.08) 00972 PREDIMED PLUS, M. Torrego: None declared, A. Barabash: None
declared, U. Garin: None declared, M. V. Sáez: None declared, C.
release from SCAT of both gender ( p < 0.0001).
Aragoneses: None declared, C. Moreno: None declared, M. Gonzalez-
Conclusion: As observed in animal, our data show that CIT
Cerrajero: None declared, M. Á. Rubio: None declared.
stimulates the release of NEFA and glycerol from human SCAT. To
determine whether this amino acid could potentially by used
for such a purpose in DO elderly adults, further analyses of
lipolysis, FA re-esterification and beta-oxidation processes
S272
MON-P254
WEIGHT BIAS AMONG FACULTY STAFF, PHYSICIANS IN
TRAINING, AND NURSES ATAN ACADEMIC MEDICAL CENTER IN
THAILAND
D. Ratanapichayachai1, R. Paothong1, S. Phattharayuttawat2,
P. Pramyothin1 *. 1Department of Medicine, 2Department of
Psychiatry, Siriraj Hospital, Bangkok, Thailand
Rationale: Weight bias among health professionals adversely
affects treatment outcomes in obese patients. We aimed to
assess weight bias and associated factors among health
professionals at the Department of Medicine of a tertiary
hospital in Bangkok, Thailand.
Methods: A questionnaire assessing demography, anthropom-
etry, and weight bias was administered to faculty staffs,
physicians in training, and nurses between 2013–2015.
Validated questionnaires utilized included the Attitudes
Toward Obese Persons (ATOP) Scale, the Fat Phobia Scale
(F-scale), and the Beliefs About Obese People (BAOP) scale.
Results: One-hundred and twenty physicians in training (56.7%
female), 52 faculty staffs (45.1%female), and 129 nurses (98.4%
female) were included in the study. Mean age was 28.5 ± 1.5,
45.2 ± 8.0, and 30.6 ± 9.7 years; mean BMI was 21.5 ± 3.5,
23.2 ± 2.8, and 21.6 ± 4.0 kg/m2, respectively. Physicians in
training had significantly more negative attitudes toward obese
patients as compared with faculty staffs and nurses, as
determined by lower ATOP scores and higher F-scale (ATOP
scores 68.9 ± 14.4 vs. 72.4 ± 13.0 vs. 73.2 ± 13.1, p = 0.041; F-
scale 3.7 ± 0.4 vs. 3.3 ± 0.3 vs. 3.1 ± 0.4, p < 0.001). Compared
with women, men had more negative attitudes as shown by
significantly higher F-scale (3.5 ± 0.5 vs. 3.3 ± 0.5, p < 0.001)
and ATOP scores which tended to be lower (69.2 ± 14.5 vs.
72.3 ± 13.4, p = 0.09). ATOP scores and F-scale did not
significantly correlate with age or BMI. BAOP scores tended to
be higher among physicians in training compared with faculty
staffs and nurses (18.2 ± 5.4 vs. 17.4 ± 4.4 vs. 16.7 ± 5.3,
p = 0.09), indicating stronger belief that obesity occurred due
to biological factors rather than patient’s lack of self control.
Conclusion: Weight bias was prevalent among Thai HCPs
practicing in internal medicine. Development of interventions
to decrease weight bias may be targeted towards physicians in
training and male HCPs.
Disclosure of Interest: None declared.
MON-P255
A NEGATIVE IMPACT OF RECENT WEIGHT LOSS ON RISK OF
DEATH IS NOT MODIFIED BY OBESITY IN HOSPITALIZED
PATIENTS – EVIDENCE FROM THE NUTRITIONDAY DATABASE
R. Barazzoni1 *, I. Sulz2, K. Schindler3, S. C. Bischoff4, P. Bauer2,
M. Hiesmayr5, on behalf of nutrition Day Research Group. 1Dept
of Medical, Surgical and Health Sciences, University of Trieste,
Trieste, Italy, 2Section for Medical Statistics, Center for
Medical Statistics, Informatics and Intelligent Systems,
Medical University Vienna, 3BMGF, BMGF, Vienna, Austria,
4 Vienna, Vienna, Austria, 4Department of Nutritional
Department of Nutritional Medicine/Prevention, University
of Hohenheim, Stuttgart, Germany, 5Department of
Poster
Anaesthesiology, General Intensive Care and Pain Control,
Division Cardiac, Thoracic, Vascular Anaesthesia and Intensive
Care, Medical University Vienna, Vienna, Austria
Rationale: Obesity is a major risk factor for developing acute
and chronic disease conditions with negative impact on
mortality in the general population. Mounting evidence has
however suggested that being obese may reduce the risk of
death associated with several diseases. Potential interactions
between weight loss and obesity in modulating risk of death in
acute disease conditions remain largely undefined.
Methods: We investigated the ESPEN nutritionDay database of
hospitalized patients without missing outcome, BMI or
PANDORA score to assess potential interactions between self-
reported 3–month weight loss (WL1: 2.5–6.6%; WL2: 6.6–12.6%,
WL3: >12.6%) and obesity (BMI > 30 kg/m2) in modulating 30-
day mortality. Multivariate Cox regression was used to estimate
hazard ratios (HR) with confidence intervals (CI) for the two
subgroups. Stable weight was used as reference category.
Results: In 111767 patients risk of death increased with WL.
After adjustment for gender, disease severity (PANDORA score)
and surgical treatment, risk of death remained significantly
higher compared to weight-stable for class 2 and 3 WL. Absolute
risk of death and relative increments through increasing WL
categories were comparable in non-obese and obese
individuals.
Weight loss in last 3 HR + CI for BMI<=30 HR + CI for BMI > 30
months
Gained 0.89 [0.69,1.13] 1.06 [0.74,1.52]
2.5–6.6% lost 1.07 [0.93, 1.24] 0.99 [0.68,1.44]
6.6–12.6% lost 1.49 [1.31,1.70] 1.25 [0.88,1.78]
>12.6% lost 1.65 [1.46,1.86] 1.48 [1.06,2.07]
Conclusion: In the ESPEN nutritionDay cohort, stepwise
increments in recent weight loss independently enhance 30-
day mortality. Weight loss similarly enhances mortality in non-
obese and obese individuals. Obesity has therefore no
protective impact against weight loss-associated mortality in
hospitalized patients.
Disclosure of Interest: None declared.
MON-P256
THE ASSOCIATION BETWEEN BODY MASS INDEX AND
MOBILITY: AN ANALYSIS OF PATIENTS FROM THE
NUTRITIONDAY HOSPITAL COHORT
R. Woerdenbach1 *, I. Sulz2, S. Kosak3, S. C. Bischoff4,
K. Schindler5, M. Hiesmayr3, R. Barazzoni6,7. 1Vrije University
Amsterdam, Amsterdam, Netherlands, 2Section for Medical
Statistics, Center for Medical Statistics, Informatics and
Intelligent Systems, 3Department of Anaesthesiology, General
Intensive Care and Pain Control, Division Cardiac -, Thoracic -,
Vascular Anaesthesia and Intensive Care, Medical University
Medicine/Prevention, University of Hohenheim, Stuttgart,
Germany, 5BMGF, BMGF, Vienna, Austria, 6Medical, Surgical and
Health Sciences, 7Dept of Medical, Surgical and Health
Sciences, University of Trieste, Trieste, Italy
Rationale: Evidence has shown that increased mobility is
related to better outcome. In addition, being obese in
Obesity and the metabolic syndrome 2
hospitalised patients may reduce the risk of death associated
with several diseases. It is not clear whether this ‘obesity
paradox’, or on the other hand having a low BMI, in hospitalised
patients are associated with differences in mobility.
Methods: Cross-sectional data from the nutritionDay database
of hospitalized patients was used. Patients with missing data on
BMI and mobility were excluded. Four BMI groups following the
WHO classification were analysed in relation to three mobility
categories (can walk alone, can walk with assistance and stay in
bed). A Chi-square test with its associated p-value was used to
determine whether an association existed.
Results: The total hospital study population consisted of
128.471 patients. There was a significant association between
BMI and mobility: e.g. only 54.5% in the low BMI group (<18.5)
could walk alone, whereas 65.6% in the highest BMI group
(>30.0) were able to walk alone (chi-square test in the 5 times 3
table of BMI groups versus mobility p < 0.0001; lowest and
highest groups shown in Table).
Table:
BMI Can walk Can walk with Stay in bed
alone assistance
<18.5 5149 (54.5%) 2682 (28.4%) 1624 (17.2%)
>30.0 16373 (65.6%) 6360 (25.5%) 2242 (9.0%)
Conclusion: There is a clear relationship between BMI and
mobility in this hospital population. In particular, very low BMI
is associated with decreased mobility.
Disclosure of Interest: None declared.
MON-P257
DO ATTITUDES AND BEHAVIOURS OF THE PARENTS AFFECT ON
BODY MASS INDEX IN ELEMANTARY SCHOOL CHILDREN?
S. Erdem1 *, S. Yılmaz Işıkhan2, H. Gokmen Ozel1. 1Nutrition
and Dietetics, Faculty of Health Sciences, 2Biostatistics
Department, Faculty of Medicine, Hacettepe University,
Ankara, Turkey
Rationale: Parents are key partners in efforts to prevent
childhood overweight and obesity and may effect on child’s
meal choices, energy intake, feeling of hunger, satiety and
body weight. The aim of this study was to investigate
parental beliefs, attitudes and practices in elementary school
children.
Methods: A total of 632 (299 boys, 333 girls) children, aged
between 6 and 10 years and their parents aged 23–56 years (191
men, 441 woman) from different socioeconomic status were
included. Child Feeding Questionnaire (CFQ) was used to
measure parental beliefs, attitudes and practices in relation
to child feeding. CFQ classified their child’s weight on a 5-point
Likert scale. In this study all subfactors were administrated
including, ‘perceived feeding responsibility’, ‘concerns about
child overweight’, ‘perceived parental weight’, ‘perceived
child weight’, ‘concern for child’, ‘restriction’, ‘pressure
to eat’ and ‘monitoring’. Body weight and height were
measured. BMI were calculated and classified using WHO
2007 Standards.
Results: ‘Perceived responsibility’ was the highest subfactor in
boys of the parents among different socioeconomic status.
Similarly ‘Perceived responsibility’ was the highest in girls of
the parents among low and high socioeconomic status and
‘monitoring’ was the highest in girls of the parents in median
S273
socioeconomic status. ‘Restriction’ subfactor was highest in the
underweight BMI group and the lowest in the overweight BMI
group of children. ‘Pressure’ subfactor was the lowest in obese
children and the highest in underweight children. ‘Monitoring’
subfactor was the lowest in overweight children and the highest
in underweight children.
Conclusion: It is important to understand how parental
concern about child weight affects parents’ and children’s
behaviors, parents’ involvement in obesity prevention inter-
ventions and, ultimately, children’s weight outcomes.
Disclosure of Interest: None declared.
MON-P258
MAY TRIGLYCERIDE GLUCOSE INDEX AND TRIGLYCERIDE TO
HDL RATIO BE AN INDICATOR FOR INSULIN RESISTANCE?
S. Ünal1 *, N. Ülger Öztürk2, H. Çabuk Güllüoğlu3,
E. Bellikci Koyu2, G. Kaner2. 1Nutrition and Diet Clinic,
Gaziemir Nevvar Salih İsgoren State Hospital, 2Faculty of
Health Sciences, Department of Nutrition and Dietetics,
İzmir Katip Çelebi University, 3Department of Internal
Medicine, Gaziemir Nevvar Salih İsgören State Hospital, İzmir,
Turkey
Rationale: Triglyceride elevation in serum and tissue is
related to decreased insulin sensitivity. We aimed to determine
the relationship between homeostatic model assessment of
insulin resistance (HOMA-IR) and plasma levels of TG and HDL
cholesterol (TG/HDL-C) as well as TG and glucose index (TyG).
Methods: A total of 183 women diagnosed with IR who applied
to diet clinic were included in this study. Weight, height, waist
and hip circumference was measured, body mass index (BMI),
waist to hip and waist to height ratio was calculated. TyG index,
calculated as Ln (TG [mg/dL] × glucose [mg/dL]/2), and the
TG/HDL-C ratio was evaluated.
Results: Mean age of women were 38.9 ± 10.66 years. A
majority of women (72.1%) were obese and nearly all of the
women’s (93.4%) waist circumference was higher than 88 cm. In
addition, more than half of the women’s (58.5%) waist to height
ratio were higher than 0.6. A positive significant correlation
was found between HOMA-IR and TyG index (r = 0.184, p =
0.013) as well as TG/HDL-C (r = 0.158, p = 0.033).
Conclusion: Our study results suggest that TyG index and TG/
HDL-C may be useful for screening IR in women.
Disclosure of Interest: None declared.
MON-P259
INTEREST OF PROFILING THE GUT MICROBIOTA TO EVALUATE
THE EFFECT OF DIETARY INULIN ON OBESITY-RELATED
METABOLIC DISORDERS IN HUMANS: THE FOOD4GUT
INTERVENTION STUDY
S. Hiel1 *, J. Rodriguez1, M. Gianfrancesco2, D. Portheault3,
G. Kalala4, A. Neyrinck1, B. Pachikian1, S. Potgëns1, L. Bindels1,
J. Bindelle4, N. Paquot2, M. Cnop3, J.-P. Thissen5, N. Delzenne1.
1
LDRI, Metabolism and Nutrition Research Group, Université
Catholique de Louvain, Brussels, 2Laboratoire de Diabétologie,
Nutrition et Maladies Métaboliques, Université de Liège,
Liège, 3ULB Center for Diabetes Research, Division of
Endocrinology, Université Libre de Bruxelles, Brussels,
S274 Poster
4
Precision LIvestock and Nutrition Unit, Gembloux Agro-Bio had higher total HEI-2005 score (63.02 ± 5.2, p < 0.05) and
Tech, Gembloux, 5Pole of Endocrinology, Diabetology and higher whole fruit, higher whole grain, higher milk and higher
Nutrition, Université Catholique de Louvain, Brussels, Belgium meat and bean scores. MHO had less mins/day in sitting time
(531.5 ± 91.6, p < 0.05) compared with MUO. No significant
Rationale: In the context of increased obesity rates in Europe, differences were observed between MHO and MUO for total PA
we launched the multidisciplinary project FOOD4GUT (funded scores and health related quality of life components.
by the Excellence Program of the Walloon Region, Belgium) Conclusion: Compared to MUO, MHO demonstrate healthier
which proposes an innovative nutritional approach – food and lifestyle habits with healthier dietary quality and less sitting
supplement intervention to increase inulin prebiotic intake – to time. But physical activity scores and HRQoL scores do not
control obesity and related metabolic disorders. We aim to support account for the absence of cardiometabolic abnormal-
examine whether a shift in the gut microbiota composition by ities in MHO. Future studies are needed to replicate this
prebiotic improves the obese phenotype. findings with larger samples with men and women.
Methods: Placebo-controlled parallel study including 150
Disclosure of Interest: None declared.
obese subjects (BMI > 30 kg · m−2; 18–65 years, recruited in
three university hospitals in Belgium), with at least one of the
following criteria: ( pre-)diabetes, hypertension, dyslipidemia, MON-P261
and/or liver steatosis. The participants were randomly assigned EFFECTS OF A SIX WEEK INTERVENTION WITH NOVEL ΒETA-
to receive either 16 g/day of inulin (fibruline, Cosucra) or GLUCAN-ENRICHED OATCAKES ON BODY COMPOSITION IN
placebo (maltodextrin, Cargill) with dietary advice to increase OVERWEIGHT AND OBESE INDIVIDUALS: A PILOT STUDY
or not the consumption of vegetables rich in inulin type S. M. M. Zaremba1 *, I. F. Gow1, J. T. Mccluskey1,
fructans intake for 3 months. G. J. Mcdougall2, S. Drummond1. 1Dietetics, Nutrition and
Results: Recipes containing high amounts (around 15 g/day) of Biological Sciences, Queen Margaret University, Edinburgh,
2
inulin were validated prior the start of the trial. So far, 31 Environmental and Biochemical Sciences Group, James
patients were recruited in the St-Luc-UCL Hospital (age Hutton Institute, Dundee, United Kingdom
51 ± 1.9; BMI 34.9 ± 0.8 kg/m2). The gut microbiota analysis
before the intervention revealed that patients exhibiting a Rationale: EFSA claim that consuming ≥3 g β-glucan (BG) /day
higher level of Bifidobacterium and Faecalibacterium, are lowers cholesterol and blood glucose responses1, yet evidence
associated with a low level of Lactobacillus, Blautia and is inconclusive with regards to the effectiveness of BG
Akkermansia muciniphila. Some bacteria such as Bilophila are consumption on weight reduction and body composition. The
not discriminant. purpose of this study was to assess the impact of daily
Conclusion: The first outcome data will be collected in May consumption of a novel oatcake (containing 4.46 g BG) on
2017, including blood parameters, anthropometric measure- body composition in overweight/obese adults.
ments, fibroscan and abdominal CT-scan. We expect differen- Methods: Twenty-one eligible overweight subjects were
tial biological response to the dietary intervention in view of randomly assigned to the study group (n = 13; BG oatcakes
the patient’s initial microbial profile. The results will be daily for 6 wks, 228 kcal/day) or control group (n = 8;
presented for the first time in the ESPEN congress in Krackawheat® Crackers daily for 6 wks, 221 kcal/day). Both
September 2017. groups were encouraged to maintain their habitual diet and
physical exercise routine throughout the study. Anthropometric
Disclosure of Interest: None declared.
measurements of height, weight, waist circumference (WC),
sagittal abdominal diameter (SAD) and body fat (%BF) were
MON-P260 assessed. Body composition was determined using dual
DIET QUALITY AND LIFESTYLE BEHAVIORS IN METABOLICALLY frequency bioelectrical impedance analysis.
HEALTHY AND UNHEALTHY OVERWEIGHT AND OBESE WOMEN Results: Groups did not differ significantly at baseline (BL) for
S. Öteleş1 *, P. Özekşi2, P. Bilgiç1. 1Nutrition and Dietetic, all parameters measured ( p > 0.05). There were no changes
2
Medicine, Hacettepe University, Ankara, Turkey between groups in anthropometric measurements at BL, post
intervention ( p > 0.05) or within groups ( p > 0.05). Intervention
Rationale: The aim of this study is to determine whether diet, snacks were well tolerated with only one minor SE reported
physical activity, sitting time and health related quality of life (bloating, n = 2).
differ between metabolically healthy overweight/obese (MHO)
Control (5F:3M) Intervention (11F:2M)
and metabolically unhealthy overweight/obese (MUO).
Methods: Fifty overweight/obese (BMI ≥ 25 kg/m2) premeno- BL Post BL Post
pausal women 19–50 years were classified by cardiometabolic mean SD mean SD mean SD mean SD
risk factors, including elevated blood pressure, triglyceride,
Weight (kg) 88.6 13.0 88.8 13.3 86.6 19.7 87.1 20.6
glucose, low high density lipoprotein, and insulin resistance BMI(kg/m2) 29.9 3.6 30.0 3.8 29.9 4.2 30.0 4.5
(MUO ≥ 2; MHO, <2). Healthy Eating Index 2005 (HEI-2005) WC (cm) 99.7 9.9 98.3 8.1 96.3 11.6 96.3 11.6
scores were calculated from 24-hour recall data (two days). SAD (cm) 26.9 2.3 27.3 2.7 25.9 3.5 25.9 3.5
%BF 34.1 9.6 34.2 9.3 36.3 5.1 36.1 5.0
Physical activity scores and sitting time were determined using
International Physical Activity Questionnaire- Short Form.
Health-related quality of life (HRQoL) was measured using Conclusion: This 6 wk pilot trial showed that consumption of
the Short Form 36- item questionnaire (SF-36). 4.46 g/day oat BG-enriched oatcakes had no effect on
Results: Women were 33.7 ± 10.7 years with a mean of BMI anthropometric indices associated with obesity in
30.3 ± 2.6, and %52 were MHO (n = 26). Compared to MUO, MHO
Obesity and the metabolic syndrome 2
overweight/obese individuals. A larger sample size may be
required to detect changes in such variable anthropometric
measures.
Reference
1. EFSA Journal 2009;7(9):1254.
Disclosure of Interest: S. Zaremba Other: Nairn’s Oatcakes Ltd.,
Edinburgh, manufactured β-glucan-enriched oatcakes and has given
financial support towards analytical costs for SZ’s PhD study., I. Gow:
None declared, J. McCluskey: None declared, G. McDougall: None
declared, S. Drummond: None declared.
MON-P262
ACUTE EFFECTS OF DIFFERENTLY COMPOSED MEALS ON
POSTPRANDIAL METABOLISM IN OLDER ADULTS WITH A CVD
RISK PHENOTYPE
Y. B. Schönknecht1 *, S. Crommen1, B. Stoffel-Wagner2,
M. Coenen3, R. Fimmers4, P. Stehle1, S. Egert1. 1Department of
Nutrition and Food Sciences, University of Bonn, 2Institute of
Clinical Chemistry and Clinical Pharmacology, 3Study Centre,
Institute of Clinical Chemistry and Clinical Pharmacology,
4
Institute of Medical Biometry, University Hospital Bonn, Bonn,
Germany
Rationale: The postprandial situation is characterized by
lipaemia, glycaemia/insulinaemia and associated events such
as oxidative stress and inflammation. Repeated overshoot of
this ‘stress-like’ postprandial response may lead to low-grade
chronic inflammation, especially in individuals with an already
existing metabolic syndrome. We hypothesize that the magni-
tude and duration of the postprandial response depend on the
meal composition.
Methods: In a randomized crossover design 60 subjects with
metabolic syndrome traits and mean age 70 ± 5 y consumed
three differently composed iso-energetic (4300 kJ) meals: a
Western diet high fat (WDHF), a Western diet high carbohydrate
(WDHC), and a Mediterranean diet (MED; rich in oleic acid and
antioxidants) meal. Blood samples were collected at fasting
and 1, 2, 3, 4, and 5 h postprandial and analysed for parameters
of glucose and lipid metabolism and plasma interleukin-6. Data
were analysed by linear mixed models.
Results: MED and WDHF meal showed lower glycaemic response
(incremental AUC (iAUC): MED = 244 min*mmol/l, WDHF = 177
min*mmol/l vs. WDHC = 293 min*mmol/l) and insulinaemic
response (iAUC: MED = 86108 min*pmol/l, WDHF = 63555
min*pmol/l vs. WDHC = 108735 min*pmol/l) than WDHC meal.
Magnitude of serum triglyceride increase was lowest in the
WDHC meal (iAUC: 175 min*mmol/l) compared with MED (iAUC:
184 min*mmol/l) and WDHF meal (iAUC: 243 min*mmol/l).
Insulin and triglycerides remained elevated after 5 h inde-
pendent of meal composition. Plasma interleukin-6 signifi-
cantly increased postprandial without significant differences
between meals.
Conclusion: In line with our hypothesis, magnitude of the
postprandial response depends on the meal composition. A
Mediterranean-like diet rich in unsaturated fatty acids and
antioxidative compounds may diminish the risk for the
development of low-grade inflammation.
Disclosure of Interest: None declared.
S275
MON-P263
INCREASED AWARENESS OF OBESITY IS RELATED WITH
DECREASED METABOLIC SYNDROME RISK IN OBESE CHILDREN
Y. Ertaş1 *, R. Bozbulut2, E. Köksal1. 1Nutrition and Dietetics,
2
Faculty of Medicine, GAZI University, Ankara, Turkey
Rationale: The prevalence of metabolic syndrome (MetS) is
increasing in parallel with the increasing of obesity in
childhood. Increased knowledge about obesity in children
may reduce the risk of having MetS. Assessment of obesity
awareness and diet quality of obese children according to MetS
groups were aimed in this study.
Methods: This study was consist of totally 236 children (119
male and 117 female) aged 10–14 years. Anthropometric
measurements (body weight (kg), height (cm), waist circum-
ference (cm)) and biochemical parameters (glucose, insulin,
total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol
(HDL-C) and triglyceride) of the children were taken.
Diagnosis of metabolic syndrome (MetS) were done according
to The International Diabetes Federation (IDF) consensus
definition. Having MetS was demonstrated as MetS (+) and not
having was MetS (-). Obesity knowledge of children were
assessed with ‘Obesity Awareness (OBA) Scale’ and diet quality
were evaluated via ‘Adapted Healthy Lifestyle-Diet Index for
Turkey (HLD-TR)’.
Results: Median ± IQR values of age were 14.0 ± 1.25 and
12.0 ± 2.00 years for MetS (+) and MetS (−) respectively.
Having MetS was higher in male gender (58.1%) than female
gender. Higher median OBA index scores and HLD-TR index
scores were found in Met (−) group ( p < 0.001). As the OBA index
scores increased HLD-TR index scores (r = 0.265, p < 0.001),
HDL-C levels (r = 0.205, p = 0.002) increased and body weight
(r = −0.191, p < 0.001), waist circumference (r = −0.238, p <
0.001) and glucose levels (r = −0.221, p = 0.001) decreased.
Conclusion: Increased obesity awareness were related with
decreased MetS occurrence and associated health outcomes.
Furthermore, diet quality were positively associated with
increased obesity knowledge suggested that obesity awareness
have impact for healthy nutritional behaviors in obese children.
Disclosure of Interest: None declared.
MON-P264
TOTAL SERUM ANTIOXIDANT CAPACITY IN HEALTHY NORMAL
WEIGHT AND ASYMPTOMATIC OVERWEIGHT ADULTS
Z. Jenko Pražnikar1 *, A. Petelin1, M. Stubelj1. 1Dietetics,
University of Primorska Faculty of Health Sciences, Izola,
Slovenia
Rationale: Obesity and overweight are major contributors to
the burden of chronic disease. Both are defined as abnormal or
excessive fat accumulation and by increased production of free
radicals leading to oxidative stress. The aim of the present
study was to evaluate whether overweight and fat accumula-
tion is associated with serum total antioxidant capacity (TAC) in
men and women, irrespective of nutritional habits, nutrient
intakes, physical activity, smoking, and other confounders,
which may be responsible for modifying the association
between serum TAC and overweight/obesity measures.
Methods: This cross-sectional study was conducted on 60
normal weight and 60 overweight adults aged 25–49. All
participants underwent standard anthromorphological
S276
measurements of body composition, blood pressure and
biochemical measurements, aerobic capabilities assessment
and dietary intake evaluation. TAC was measured by using the
photochemioluminescence method. All data were analysed
with SPSS software.
Results: Men had higher values of TAC than women and
concentrations of TAC were significantly higher in overweight
subjects compared to normal weight subjects. In the present
study TAC tended to be increased by various metabolic risk
factors, especially overweight/obesity parameters (body mass
index, body fat), inflammation and increased serum levels of
Cysteine, irrespective of nutritional habits, nutrient intakes,
physical activity and smoking.
Conclusion: Overweight and obesity at an early stage may
stimulate TAC. Therefore, the elevation of TAC in overweight
adults may be a compensatory response to oxidative stress,
generated by reactive oxygen species.
Disclosure of Interest: None declared.
Paediatrics 2
MON-P265
PREVALENCE OF MALNUTRITION AMONG CHILDREN AND
ADOLESCENTS IN AN ONCOLOGY PEDIATRIC UNIT:
PRELIMINARY RESULTS
M. Cintoni1 *, E. Rinninella1, S. Triarico2, A. Ruggiero2,
P. Maurizi2, G. Attinà2, S. Mastrangelo2, R. Riccardi2, L. Basso1,
S. Leone1, V. Blasi1, G. A. D. Miggiano1, A. Gasbarrini1,
M. C. Mele1. 1Clinical Nutrition, Gastroenterology Area,
2
Pediatric Oncology, Fondazione Policlinico ‘A. Gemelli’,
Roma, Rome, Italy
Rationale: Malnutrition in pediatric oncology is a frequent
condition influencing drug tolerability, hospital stay and
prognosis [1]. Aim of this study is to evaluate the rate of
malnutrition in a Pediatric Oncology Unit.
Methods: Twenty-one patients (children and adolescents)
admitted, between December 2016 and March 2017 in the
Pediatric Oncology Division of ‘A. Gemelli’ Hospital in Rome,
were examined. Data collection included information on
disease, anthropometry, lab tests and STRONGkids test was
used as malnutrition risk score. Multifrequency bioimpedance
analysis derived Phase Angle at 50 kHz (PhA) and Prediction
Marker™ (PM) (ratio between impedance at 200 kHz and at 5
kHz) were used as surrogate markers of lean body mass [2].
Statistical analysis were performed using STATA software. PhA
was reported as mean ± SD, PM as median (IQR). Differences
between groups were determined using Student’s t test or
Wilcoxon rank sum test. P values <0.05 were considered
statistically significant.
Results: Eleven girls (52%) and ten boys (48%) were examined.
Sixteen (76%) were affected by solid tumors, eight (38%) had a
metastastic disease. Mean overall PhA was 4.28 ± 1.07, median
PM was 0.85 (0.81–0.88). According to STRONGkids, fifteen
(71.4%) were at medium risk and six (28.6%) at high risk of
malnutrition. PhA and PM were significatively worse in the high
risk group, respectively 4.62 ± 0.98 vs 3.43 ± 0.33 ( p = 0.01) and
0.84 (0.80–0.85) vs 0.88 (0.86–0.93) ( p = 0.009).
Conclusion: All children and adolescents in the Pediatric
Oncology Unit of our hospital were at medium or high risk of
Poster
malnutrition. PhA and PM were significantly lower in the high
malnutrition risk patients than in the medium risk ones. A
nutritional assessment is mandatory in these patients to
ameliorate care.
References
1. Rogers PC. Importance of nutrition in pediatric oncology. Indian J
Cancer 2015;52:176–8.
2. ESPEN Blue Book. Basics Clin Nutr-Fourth Ed 2011.
Disclosure of Interest: None declared.
MON-P266
SERUM IGF-1 LEVEL AND NUTRITIONAL ASSESSMENT IN
CHILDREN WITH SHORT BOWEL SYNDROME
M. Chiba1 *, A. Toki1. 1Nutrition Support Team, Showa
University Hospital, Tokyo, Japan
Rationale: Nutritional status is a key factor in the regulation of
pediatric linear growth. Measurement of the serum concentra-
tion of insulin-like growth factor-I (IGF-l) is generally used as a
screening investigation for short stature children. Moreover,
IGF-I concentration is sensitive to alterations in the nutritional
state. Short bowel syndrome is a group of problems related to
poor absorption of nutrients. However, there is no easy way to
measure absorption capacity. The aim of this study is to
determine the serum levels of IGF-1 in children with short
bowel syndrome and their correlations with growth.
Methods: A retrospective chart review was performed on 6
patients. The correlations of changes in nutritional adminis-
tration status, serum albumin (Alb), transthyretin (TTR) and
IGF-1 levels, in relation to increased height and weight, were
analyzed. Since the rate of change in height/weight varies with
age, Z-score was calculated. The difference between Z-score at
the time of evaluation and one month before was taken as the
growth score (Growth Score). Similarly, Z-score was calculated
for IGF-1.
Results: Alb and TTR were kept in the normal range, and there
were no correlations with Growth Score. On the other hand,
IGF-1 levels had a significant positive correlation with Growth
Score. Even when oral and enteral administration was limited,
increases in IGF-1 levels were recognized with the aid of an
effective nutritional administration such as increased intra-
venous nutrition.
Conclusion: The serum IGF-1 levels were useful as one
predictor for determining the nutritional dosage in consider-
ation of the absorption capacity of the intestinal remnant. We
think that in promoting intestinal rehabilitation, IGF-1 levels
will be major nutritional evaluation indicators in the future.
Disclosure of Interest: None declared.
MON-P267
MATERNAL SERUM AND BREAST MILK HORMONES AND
WEIGHT GAIN İN İNFANCY
M. Aydin Cil1 *, F. G. Eroglu Samur2, M. A. Gul3. 1Nutrition and
Dietetic, Health Science Faculty, Ataturk University, Erzurum,
2
Nutrition and Dietetic, Health Science Faculty, Hacettepe
University, Ankara, 3Medical Biochemistry, Health Science
Institute, Ataturk University, Erzurum, Turkey
Rationale: Leptin and ghrelin are some of hormones that
presence in maternal serum and breast milk are important of
Paediatrics 2
regulation of energy balance. These are adjusting growth and
development in neonatal and infant period while regulating
energy balance during childhood and adulthood. The aim of this
study was to determine the relationship between maternal
serum and breast milk leptin and ghrelin levels and neonatal
weight gain during 4 months.
Methods: The study was conducted with 30 healthy mother and
their breast-fed infants in a prospective longitudinal study.
Some anthropometric measurements of infants and biochem-
ical analysis of mothers (maternal serum and breast milk leptin,
ghrelin) were performed by using ELİSA for leptin, RIA for
ghrelin.
Results: The weight gain of infants was 2306.7 ± 731.0 g and
mean weight was 6770.0 ± 983,0 g. It was found that 1th and 4th
ghrelin levels of maternal serum and breast milk respectively
1973.1 ± 1182.4, 3026.5 ± 1613.7; 1888.4 ± 681.9, 3272.9 ±
2531.8 pg/mL. 1th and 4th leptin levels of maternal serum
and breast milk was respectively 9.8 ± 5.9, 1.4 ± 0.4; 10.3 ± 6.8,
1.6 ± 0.9 ng/mL. There was determined negative statistically
significant correlation between infants weight gain and
maternal serum leptin both 1th and 4th months ( p < 0.05)
while no statistically significant correlation with breast milk
leptin levels ( p > 0.05). First month maternal serum leptin
levels and 4th month weights of infants had negative correlation
( p < 0.05). No statistically significant correlation was found
between maternal serum and breast milk ghrelin levels and
infants weight and weight gain ( p > 0.05).
Conclusion: The study demostrated a negative significant
relation between maternal serum leptin levels and infants
weight gain. Mother’s hormones levels may effect on growth in
infancy. Further studies are required in order to reveal the
relation between maternal serum and breast milk leptin and
ghrelin levels and infant weight gain.
Disclosure of Interest: None declared.
MON-P268
ANALYSIS OF SERUM FERRITIN AND IRON CONCENTRATION
ACCORDING TO NUTRITIONAL STATUS AND SEX IN CHILDREN
FROM THE ANDEAN REGION OF ECUADOR
P. Miño1,2, M. Balladares-Saltos1,2, X. Robalino1,2,
M. Guerendiain1,3 *. 1Metabolism and Nutrition Disorders
Research Group, 2School of Clinical Laboratory, 3School of
Medicine, National University of Chimborazo, Riobamba,
Ecuador
Rationale: Although anaemia is one of the most prevalent
public health problems in childhood and its diagnosis is difficult
in regions above 2500 above sea level, such as Andean
Cordillera, studies in highlands are limited. Thus, the objective
of this research was to compare haematological parameters
according to nutritional status and sex in schoolchildren of San
Juan, Chimborazo.
Methods: Forty-one children (8.44 ± 1.69 years, EVANES project
participants) from San Juan (3240 meters above sea level) were
recruited. Blood samples were collected, and ferritin, iron,
haemoglobin and haematocrit concentration were determined.
Weight and height were measured and body mass index [BMI,
weight (Kg)/height (m)2] was calculated. The standard
deviation score of BMI and height were determined.
Results: The means of iron, ferritin, haematocrit, haemoglobin,
BMI and height were 79.44 ± 32.89 μdL, 31.83 ± 12.71 ng/dL,
S277
43.63 ± 2.28%, 14.58 g/dL, 16.80 ± 1.53 Kg/m2 and 120.04 ±
10.78 cm, respectively. When haematological parameters were
compared according to sex, it was observed that serum
ferritin was lower in girls than boys, independently of age
and BMI. No differences were found in ferritin and iron between
anaemic and non-anaemic children, and stunting and normal
height. BMI was higher in quartile (Q) 3 of serum ferritin than
Q2 and Q4, independently of sex and age.
Conclusion: School-age girls living in Andean region of
Chimborazo, Ecuador, have lower ferritin concentration than
boys. Serum iron and ferritin were independent of nutritional
status of children, but ferritin was associated with BMI.
Disclosure of Interest: None declared.
MON-P269
FORMA STUDY: USE OF INFANT FORMULAS FOR COW’s MILK
PROTEIN ALLERGY BY SPANISH PAEDIATRICIANS
A. Santamaria-Orleans1, R. DE LA Iglesia-Arnaez1 *,
A. Canals-Baeza2. 1Scientific Comunication, Laboratorios
Ordesa, Sant Boi del Llobregat, 2CS Alicante-Sta Faz, Servicio
Valenciano de Salud, Alicante, Spain
Rationale: Aim of FORMA study was to analyze clinical practice
and recommendations regarding infant formulas destined to
dietary treatment of CMPA by Spanish paediatricians and in
particular, about [Blemil plus FH (BP FH)] (extensively
hydrolyzed formula) and [Blemil plus arroz hidrolizado (BP
ah] (rice proteins formula).
Methods: Clinical practice questionnaires were fulfilled by 98
public and private paediatricians, providing retrospective data
of 366 infants with CMPA. Statistical analysis of the results was
performed with the IBM SPSS Statistics 22.0 program.
Results: Paediatricians estimated that 8.5% of infants attend-
ing their practice presented CMPA. Mean (SD) age of CMPA
diagnostic was 3.7 (2.7) months. Main parameters considered
to select formula in each patient were symptoms (8.6/10
points), personal experience (8.4 points) and ESPGHAN
recommendations (8.0 points). Formula of choice for 85.4% of
paediatricians was extensively hydrolyzed one, followed by
rice-based one (9.4%). In the 366 cases studied, 52.6% had IgE-
mediated allergy and 47.4% non-IgE-mediated. Most common
symptoms were crying/discomfort (56%), atopic dermatitis
(39%) and diarrhoea (38%). 82.6% of infants took BP FH 1 or 2
and 17.4% BP ah 1 or 2 (according to age). Average number of
days to perceive an improvement in symptoms was 10.3, higher
for infants >6 months (14.2 vs 9.4, ( p < 0,001) and in non-IgE-
mediated allergies (11,3 vs 10,8; p = 0,013). Improvement was
considered at least moderate in 89% of cases with digestive
symptoms, 80% with crying/discomfort and 60% dermatologic
and respiratory manifestations.
Conclusion: Prevalence of CMPA reported by Spanish paedia-
tricians was in accordance with published data. Patient
symptoms, personal experience and ESPGHAN recommenda-
tions were main factors considered for selecting formulas.
Average time to perceive an improvement was higher in older
infants (>6 months) and non-IgE-mediated cases.
Disclosure of Interest: A. SANTAMARIA-ORLEANS Other: Laboratorios
Ordesa employee, R. DE LA IGLESIA-ARNAEZ Other: Laboratorios Ordesa
employee, A. CANALS-BAEZA: None declared.
S278
MON-P270
A META-ANALYSIS OF THE EFFECTIVENESS OF DAILY ENTERAL
NUTRITION IN THE MAINTENANCE OF LONG TERM REMISSION
IN CROHN’s DISEASE
S. Ghosal1 *, S. Ghosal2. 1Paediatrics, Royal Stoke University
Hospital, Stoke on Trent, 2Psychology, University of Derby,
Derby, United Kingdom
Rationale: Maintaining long term remission in Paediatric
Crohn’s disease without complications remains a challenge.
Liquid enteral nutrition treatment is safe and effective for
short term induction of remission, but there are few studies for
its long term use and its application still remains limited. This
meta-analysis aims to provide stronger evidence by pooling of
current data.
Methods: A search of Medline, Ovid and Cochrane databases
were carried out (1992–2017) to identify published studies
looking at the efficacy of Enteral nutrition ( providing 30–50% of
daily calorie intake) for the maintenance of remission in
Paediatric Crohn’s disease. The search parameters were
Crohn’s disease, enteral nutrition, maintenance therapy and
children. Statistical analysis was carried out by Chi square test
comparing to placebo for likelihood of clinical response to
treatment.
Results: Seven studies met the inclusion criteria; of these 4
were prospective studies, 2 were retrospective studies and
there was 1 randomised controlled trial. Study periods ranged
from 12–60 months with 327 patients given daily liquid enteral
nutrition supplements. Out of the 327 there were 245 (75%)
in remission at 1 year ( p < 0.05 compared to placebo). This
compares favourably with 73% (357 of 489 patients) 1 year
remission reported from use of immunomodulators and 61%
with placebo.1
Conclusion: Enteral nutrition is beneficial in maintaining
remission in Crohn’s disease and its efficacy is comparable
with immunomodulators, but without their side effects.
However, taste/palatability can be a limiting factor. The
limitation of this meta-analysis is due to the small sample
sizes of the individual studies and their slightly different
parameters. Further studies are needed to directly compare
enteral nutrition with immunomodulators and biologics.
Reference
1. Chande N, et al. Cochrane Database of Systematic Reviews.
2015;10.
Disclosure of Interest: None declared.
MON-P271
EFFECT OF INTERVENTION OF CHILDHOOD CANCER
NUTRITION PROJECT TEAM FOR ACUTE LYMPHOCYTIC
LEUKEMIA
T. Takamasu1,2 *, M. Wada2,3, M. Taguchi2,3, H. Goto4,
H. Taniguchi5. 1Department of Allergy, 2Nutrition Support
Team, 3Department of Dietetics, 4Department of Hemato-
Oncology/Regenerative Medicine, Kanagawa Children’s
Medical Center, 5Perioperative Support Center, Saiseikai
Yokohamashi Tobu Hospital, Yokohama, Japan
Rationale: Nutritional intervention has significant role in the
treatment of childhood cancer, however, the effect of
nutritional team approaches is not fully investigated. We
established nutrition project team for childhood cancer in June
Poster
2012, and started nutritional and dental intervention from the
beginning of the treatment, and compared the outcome before
and after the team was established.
Methods: Study design is case-control study. Patients, diag-
nosed as acute lymphocytic leukemia (ALL) below 18 years of
age were enrolled. The patients admitted from June 2012 to
October 2014 were classified as Intervention Group (IG). The
patients admitted before June 2012 matched disease severity
and age group with IG were classified as Non-intervention
Group (NIG). Change in body weight standard deviation (BW-
SD), and body mass index standard deviation (BMI-SD) during
hospitalization, duration of nil per os (NPO), duration of
stomatitis, and duration of analgesic and opioid use for
stomatitis were compared between NIG and IG.
Results: Numbers of cases of NIG and IG were 14, respectively.
Medians of BMI-SD on admission day were 0.05 (NIG) vs −0.31
(IG), and medians of BMI-SD on discharge day were 0.63 vs 0.30
(n.s.). Medians of duration of NPO were 2.1 days/year in NIG,
0.6 days/year in IG (n.s.). Medians of duration of stomatitis
were 30.7 days/year, vs 19.7 days/year, and cases with
stomatitis for more than 10 days/year were 7 vs 2 ( p < 0.05).
Medians of duration of analgesic use were 23.8 days/year vs 5.0
days/year, and cases of analgesic use for more than 30 days
were 6 vs 1 ( p < 0.05). Medians of duration of opioid use were
4.4 days/year vs 3.6 days/year (n.s.).
Conclusion: Changes of BMI during admission had no difference
between NIG and IG, whereas duration of stomatitis and
duration of analgesic use has decreased in IG, which con-
tributed improvement of quality of life for the patients.
Disclosure of Interest: None declared.
MON-P272
ANALYSIS OF PERIODIC PHYSICAL EXAMINATION STATUS IN
INFANT FROM A TOWNSHIP HOSPITAL IN POOR REGIONS OF
YUNNAN PROVINCE
X. Zheng1 *, J. Chen1, D. Yue2, Y. Fu2. 1Department of Child
Healthcare, Shanghai Children’s Hospital, Shanghai Jiaotong
University, Shanghai, 2Wude Township Hospital, Zhenxiong
County, Zhaotong, China
Rationale: To investigate the periodic physical examination
status in infant from poor areas of Yunnan province, and provide
reference to facilitate the development of grass-root child
healthcare.
Methods: The follow-up examination informations of infants
born from January 2015 to September 2016 and established
physical examination files in Wude Township Hospital of Yunnan
province were retrospectively analyzed.
Results: A total of 237 infants were established physical
examination files in Wude Township Hospitalr. Among these
infants, only 34 (14.3%) infants were insisted on follow-up. The
prevalence of loss to follow-up were 16.0%, 12.7%, 7.6%, 10.1%,
4.6% and 0.4% respectively after they were accepted physical
examination at 1 month old, 3 months old, 6 month old, 8
months old, 12 month old and 18 month old. And other 81
(34.2%) infants remained uncertainty due to the appointed
physical examination time didn,t come yet. In addition, anemia
prevalence were 12.1% and 15.2% respectively at 6 month old
and 8 month old.
Conclusion: The prevence of periodic physical examination in
infant from the township hospital is low and the anemia at 6
Perioperative care 2
months old are not treated effectively. Extensive efforts should
be payed to improve the level of child health service and
healthcare systematic management of township hospital and to
strengthen child healthcare consciousness of local people at
the same time.
Disclosure of Interest: None declared.
MON-P273
FEEDING PRACTICE IN CHILDREN WITH ACUTE PANCREATITIS
IN TURKEY
B. Aksoy1, P. Kuyum Töz1, Y. Öztürk1 *. 1Department of Pediatric
Gastroenterology, Dokuz Eylül University, School of Medicine,
Izmir, Turkey
Rationale: To specify the feeding practice of in children with AP
in our center.
Methods: The medical records of children with AP were
analyzed retrospectively. Data of 46 children were evaluated.
Age, gender, etiology, laboratory and imaging findings,
medications, fasting time duration, parenteral, enteral or
oral nutrition managements, AP related complications and
mortality rate were noted.
Results: Mean age of children with AP was 9.8 ± 4.6 years. The
most common etiologic factors were idiopathic (%37) and
systemic diseases, drugs (%32.6). Twenty-eight children (%60.8)
were not fed for 1–27 days. Total parentral nutrition was
applied to 34 children (%74). Tube feeding was used in five
children (%10.8). All of the using formulas were standard
polymeric formula. At the beginning of the diagnosis 7 children
(%15.7) fed orally. L-asparaginase induced severe necrotizing
pancreatitis developed in two children. The complication rate
of AP was %21.7. Mortality rate was %4.3.
Conclusion: Long-term fasting, high rate of using total
parenteral nutrition, low rate of using oral and tube feeding
were detected in management of children with AP at our
center. The real necessary to these treatment modalities on
the basis of the patient’s characteristics should be investi-
gated. This may be related to complications and/or mortality
rate.
Disclosure of Interest: None declared.
Perioperative care 2
MON-P274
FASTING ABBREVIATION: A CASE OF SUCCESS
L. F. O. Figliolino1, T. F. Giacometti1, K. C. T. Piza1,
U. R. Fernandes1, S. A. Garnes2 *, A. Bottoni2. 1Hospital
Rede D´Or São Luiz Unidade Villa Lobos, 2Funzionali, São
Paulo, Brazil
Rationale: The abbreviation fasting brings numerous benefits
to patients: accelerate postoperative recovery, ameliorate the
inflammatory response, improve nitrogen and hydroelectrolyte
balance, improve immune response and healing, and decrease
length of hospital stay.
Methods: Offered net diet with carbohydrate and protein up to
four hours of surgery. Morbid obese, with gastroesophageal
disorders and obstructive TGI cancer were excluded from the
process.
S279
Results: In twelve months (February 2016 to February 2017),
the fasting of 249 patients (41%) was abbreviated, out of a
total of 605 patients who remained fasting for more than 12
hours in our institution for surgery. Urology patients would
remain fasted for 580 hours, with the abbreviation, time
dropped to 152 hours (74% reduction). The orthopedics total
time was 733 hours, with the protocol the time was for 200
hours (reduction of 73%). In general surgery patients the total
time was 478 hours, but shortened the fast, were 124 hours
(reduction of 74%). There was reduction in one day of
hospitalization of the patients who received the abbreviation
fasting and especially the patients of the specialties of
urology, gynecology and general surgery. As for orthopedics,
we found that patients submitted to fracture surgeries who
received the abbreviation of fasting were three days less than
those who did not participate in this protocol. We found that
99% (n = 2) of the patients in the protocol had no hunger and
hunger effects after returning from surgery, and 100% of the
patients did not present postoperative nausea/vomiting. 100%
said they would do the abbreviation again and would not mind
being woken up.
Conclusion: The abbreviation fasting therefore modifies the
patient’s perception of the services provided, reduces total
fasting and hospitalization time, and avoids symptoms of
nausea and vomiting.
Reference
Crenshaw J.T. Preoperative fasting: will the evidence ever be put into
practice? AmJ Nurs, v. 15, sep 2011.
Disclosure of Interest: None declared.
MON-P275
IMPACT OF THE NUTRITIONAL STATUS OF HEART
TRANSPLANT PATIENTS BEFORE AND AFTER SURGERY ON THE
SURVIVAL RATE
D. A. Almutawa1,2, M. N. Al-Muammar1, M. M. A. Abulmeaty1 *,
N. Selimovic3, A. S. Alnafisah4. 1Clinical Nutrition Program,
Community Health Sciences, King Saud University, 2Cardiology
Clinical Nutrition, King Faisal Specialized Hospital, 3Adult
Cardiology, Heart Center, King Faisal Specialist Hospital,
4
Department of Nutrition Services, King Faisal Specialized
Hospital, Riyadh, Saudi Arabia
Rationale: Nutritional assessment of the heart transplant
(HTx) candidates may expect transplant outcomes. The aim is
to investigate the malnutrition risk among heart recipients
before and one-year after transplant and its impact on the
survival.
Methods: A total of ninety adult heart transplant recipients
(men 77.7%), between 2009 and 2015, from the King Faisal
Specialist Hospital, Riyadh, SA, were studied. The basal
assessment included anthropometric, biochemical, bone
mineral density (BMD) measurements and the nutritional risk
index (NRI) calculation. In addition, the postoperative data also
included the mortality analysis. Paired t-test, Cox regression
and Kaplan-Meier (KM) curves were used.
Results: After 1 year, the prevalence of malnutrition risk based
on the NRI and severe risk (NRI < 83.5) decreased from 60% to
18.51% and 7.78–1.23%, respectively, ( p < 0.001) and males had
higher NRI scores ( p < 0.05) than females. Hemoglobin,
albumin, prealbumin and cholesterol increased ( p < 0.05).
Vitamin D deficiency decreased (94.19% to 76.37%, p < 0.001).
S280
Osteopenia at lumbar spine decreased (30.19–28.85%, p <
0.05), but increased at femoral neck (24.53–50%, p < 0.001).
Osteoporosis increased more than double at both sites (3.7–
13.64% and 3.7–7.69%, respectively, p < 0.001). Among all
studied parameters (Table 1), the moderate to severe
postoperative NRI score (NRI < 97.5) had the shortest survival
(HR= 0.82; 95% CI, 0.75–0.89; P < 0.001).
Table 1: Cox regression analysis of some variables.
Parameter Hazard Ratio 95% CI
Pre-HTx NRI 0.97 0.92–1.02
Post-HTx NRI 0.82 0.75–0.89
BMI 1.54 0–3669.1
Lymphocytes 0.98 0.83–1.15
Total cholesterol 0.79 0.02–31.79
Conclusion: Nutrition risk was highly prevalent among HTx
cases. All tested parameters of malnutrition were ameliorated
1-year after HTx except BMD. Postoperative NRI was the most
important predictor of survival as shown in KM curves.
Disclosure of Interest: None declared.
MON-P276
EVALUATION OF QUALITY OF LIFE AFTER NUTRITION
CONSULTATION IN OSTOMIZED PATIENTS
M. Moreno Santa Maria1,2, J. J. Arenas Villafranca1,2,
C. López Rodriguez1, M. P. Utrilla Navarro2,3,
M. I. González Peral4, L. Rey Fernández1, L. Visiedo Rodas1,
J. Abilés Osinaga1,2 *. 1Pharmacy and Nutrition Department,
Hospital Costa del Sol, Marbella, 2Doctoral Programme in
Pharmacy, 3Pharmacology Department, University of Granada,
Granada, 4Surgery Department, Hospital Costa del Sol,
Marbella, Spain
Rationale: Ostomized patients must face situations that can
heavily affect their quality of life. The goal of the study is
evaluate this quality of life after the implementation of a
nutritional consultation at surgery discharge.
Methods: A prospective study was performed. At discharge, the
patient’s weight was recorded and an analytical study was
requested. At 7–10 days (visit1) and a month later (visit2), the
patient visits nutritionist consultation for assessment and
diagnosis, diet progression review and output stoma control
education. In both visits the quality of life was evaluated using
the Montreux questionnaire, validated in ostomized patients.
This questionnaire uses a scale of 1–5 to assess different aspects
and is divided into three sections: Quality of Life, Self-
Sufficiency and General Issues. Descriptive statistical analysis
was performed. The mean change in qualitative variables was
estimated using Mann-Whitney U test.
Results: 37 patients were recruited, median 66.9 ± 13.3 years,
81% men. The main cause of stoma formation was 73%
colorectal cancer, 2.7% gynecological cancer, 2.7% inflamma-
tory bowel disease, 21.6% benign causes. Nutritional diagnosis
at Visit1 was 37.8% good nutritional status, 18.9% nutritional
risk, 13.5% mild protein-calorie malnutrition, 27% moderate
and 2.7% severe. At Visit2 was 64.3% good nutritional status,
32.1% nutritional risk and 3.6 mild protein-calorie malnutri-
tion. Only 24 patiens complete questionnaire in both visits. The
overall score increased between visits from 102.4 ± 21.5 to
Poster
116.1 ± 29.6 ( p = 0.006), quality of life part from 69.5 ± 14.9
to 76.6 ± 21.1 ( p = 0.059), self-sufficiency from 17.2 ± 6.3 to
20.2 ± 5.8 ( p = 0.010), general issues 17.1 ± 4.2 to 19.5 ± 5.2
( p = 0.036)
Conclusion: An improvement in quality of life measured in our
patients after nutritional intervention is shown. Individually
each section which valued specific areas were improved,
special the self-sufficiency section
Disclosure of Interest: None declared.
P
0.20
<0.001
MON-P277
0.91 AN OSTOMIZED NUTRITIONAL CONSULTATION FOR HIGH
0.78 OUTPUT STOMA AND ITS PHYSIOLOGICAL CONSECUENCES
0.91
CONTROL.
M. Moreno Santa Maria1,2, J. J. Arenas Villafranca1,2,
L. Visiedo Rodas1, C. López Rodriguez1, L. Rey Fernández1,
P. Utrilla Navarro2,3, J. Abilés Osinaga1,2 *. 1Pharmacy and
Nutrition Department, Hospital Costa del Sol, Marbella,
2
Doctoral Programme in Pharmacy, 3Pharmacology
Department, University of Granada, Granada, Spain
Rationale: High output stoma (HOS) is an ostomies complica-
tions that involves a large amounts of water and electrolytes
losses such as long-term malnutrition. Our Hospital had
previously established a HOS detection and management
protocol during admission. The goal of this study is to evaluate
the impact of a nutrition consultation for ostomized patients
after discharge taking into account HOS self-control and
nutritional status monitoring
Methods: A prospective study was performed. During admis-
sion, HOS detection and management protocol application was
recorded. At discharge, an analytical study with electrolytes
was requested. At 7–10 days (visit1) and a month later (visit2),
the patient visits nutrition consultation for assessment and
diagnosis, HOS ambulatory management education and ana-
lytical control. Demographic parameters, nutritional diagnosis,
Na, K, Ca, P and Mg levels were recorded at each visit.
Statistical analysis was performed.
Results: 37 patients were recruited, median 66.9 ± 13.3years,
81% men. 11% patients presented HOS during hospitalization
(100% ileostomies) and HOS protocol succeeded in all cases.
Only two patients reported HOS at Visit2 (100% ileostomies).
Visit1 electrolytes records showed 3.2% patients with mild
hypokalemia (N = 31), 5.9% mild hypophosphatemia (N = 34),
5.7% mild hypomagnesaemia (N = 35) and 5.9% mild hypocal-
cemia (N = 34). At Visit2, There were no alterations (N = 26).
Nutritional diagnosis at Visit1 was 37.8% good nutritional
status, 18.9% nutritional risk, 13.5% mild malnutrition*, 27%
moderate* and 2.7% severe*; at Visit2 was 64.3% good
nutritional status, 32.1% nutritional risk and 3.6 mild malnu-
trition* (*All protein-calorie).
Conclusion: After the first consultation visit, a significant
improvement of all nutritional parameters evaluated and in
electrolytes control was observed. HOS is well controlled by
patients ambulatory and during admission.
Disclosure of Interest: None declared.
Perioperative care 2
MON-P278
MAY HIGH COMPLEXITY SURGERY, IN GYNECOLOGICAL
ONCOLOGY PATIENTS, WORSEN NUTRITIONAL STATUS
DURING HOSPITAL STAY? A CROSS-SECTIONAL STUDY IN AN
ITALIAN UNIVERSITY HOSPITAL
M. Cintoni1 *, E. Rinninella1, A. Fagotti2, L. Basso1, S. Leone1,
V. Blasi1, G. Scambia2, G. A. D. Miggiano1, A. Gasbarrini1,
M. C. Mele1. 1Clinical Nutrition, Gastroenterology Area,
2
Gynecological Oncology, Fondazione Policlinico ‘A. Gemelli’,
Roma, Rome, Italy
Rationale: Malnutrition in gynecological oncology affects
between 20 and 53% of patients at diagnosis [1]. Aim of this
study is to evaluate if high complexity surgery may worsen this
condition during hospital stay.
Methods: Three hundred and nineteen oncological patients,
consecutively admitted between December 2016 and March
2017 to the Gynecologic Oncology Division of ‘A. Gemelli’
Hospital, were enrolled. Medical history, anthropometry, BIA
derived Phase Angle (PhA) and lab tests were collected at
admission and at discharge. Patients were divided into two
broad categories: high complexity surgery (HCS) (40 patients
12.6%), when resections of other abdominal organs (besides
uterus and ovaries) and/or extended lymphadenectomy and/or
peritonectomy were performed and standard gynecological
surgery when they were not (SGS) (277 patients 87.3%).
Statistical analysis was performed with STATA. Data were
presented as mean ± SD, median (IQR) or number ( percentage).
Differences between groups were determined with Student’s t
test, Wilcoxon rank sum or signed-rank test. P values <0.05
were considered significant.
Results: Overall PhA was different between admission 5.3 (4.8–
5.7) and discharge 4.8 (4.0–5.4), p < 0.001. Dividing the
population according to surgery complexity, PhA decrease was
found only in those patients who underwent HCS [HCS: 5.1 (4.6–
5.6) vs 4.3 (3.6–4.9), p < 0.001; SGS: 5.3 (5.0–5.8) vs 5.1 (4.7–
6.0), p = ns] and LOS was also higher in this group [2.8 ± 2.4 days
vs 8.5 ± 6.8 days, p < 0.001].
Conclusion: HCS worsens nutritional status from admission to
discharge and increases LOS in our hospital setting. Patients
who undergo HCS should be considered for perioperative
nutritional support during hospital stay.
Reference
1. Obermair A, et al. Nutrition interventions in patients with
gynecological cancers requiring surgery. Gynecol Oncol
2017;145:192–9.
Disclosure of Interest: None declared.
MON-P279
ARE POSTOPERATIVE FEEDING PRACTICES IN-LINE WITH
EVIDENCE-BASED GUIDELINES: A SYSTEMATIC REVIEW
M. Rattray1 *, S. Roberts2, A. Marshall3, B. Desbrow1. 1School of
Allied Health Sciences, 2Menzies Health Institute Queensland,
3
School of Nursing and Midwifery, Griffith Unversity, Gold
Coast, Australia
Rationale: Early oral feeding after surgery is best practice
among adult, non-critically ill patients. Evidenced-based
guidelines (EBG) recommend commencing liquid and solid
feeding within 24 hours of surgery to improve patient (e.g.
reduced morbidity) and hospital (e.g. reduced length of stay)
S281
outcomes. Whether these EBG are adhered to in usual clinical
practice remains unknown. The aim of this study was to identify
the time to commencement of first oral feed (liquid or solid)
and first solid feed among postoperative, non-critically ill,
adult patients.
Methods: MEDLINE, CINAHL, SCOPUS and Web of Science
databases were searched from inception to June 2016 for
observational studies reporting liquid and/or solid feeding
practices among postoperative patients. Studies reporting a
mean/median time to first feed or first solid feed within 24
hours of surgery or where ≥75% of patients were feeding by
postoperative day one were deemed in-line with EBG.
Results: Of 5826 articles retrieved, 29 studies were included.
Only 40% and 22% of studies reported time to first feed and time
to first solid feed in-line with EBG, respectively. Clear and free
liquids were the first diet types commenced in 86% of studies.
When solids were commenced, 44% of studies reported using
various therapeutic diet types (e.g. light) prior to the
commencement of a regular diet. Patients that underwent
gastrointestinal procedures appeared more likely to experience
delayed postoperative feeding.
Conclusion: Our findings demonstrate a gap between post-
operative feeding evidence and its practical application. This
information provides a strong rationale for interventions
targeting improved nutritional care following surgery.
Disclosure of Interest: None declared.
MON-P280
DIFFERENT LIPID PROFILE IN PATIENTS WITH OR WITHOUT
EPIDURAL
N. D. Vukovic1 *, D. Jovanovic2. 1Center for Anaesthesiology and
Reanimation, Clinical Center Nish, Nish, 2Center for
Anaesthesiology and Resuscitation, Clinical Center
Kragujevac, Kragujevac, Serbia
Rationale: Surgery and pain lead to a sympathetic activation
with various metabolic responses. The aim of this study was to
compare the metabolic effects of general versus combined
general and epidural anaesthesia on plasma concentration of
cholesterol, lipoproteins and triglycerides in surgery patients.
Methods: This was retrospective observational study that
investigated plasma concentration of cholesterol, lipoproteins
and triglycerides preoperatively and on the third and fifth day
after Mainz Pouch cystectomy. Patients were randomly assigned
to receive either general anaesthesia or combined general and
epidural anaesthesia. Primary outcome of study was occur-
rence of postoperative surgical wound complications.
Statistical analysis was performed using Student`s t-test and
Mann-Whitney test, were probability of P < 0.05 was considered
to be significant.
Results: Among 60 patients, 35 patients had general and 25 had
combined general and epidural anaesthesia. The average age
was 62.7 ± 7.9 years and mean body mass index 24.2 ± 3.2 kg/m2.
There was no statistical difference in perioperative concen-
tration of measured parameters. There was statistical differ-
ence on the third postoperative day between patients in group
that had epidural, were patients with wound complications had
lower values of cholesterol, high density lipoprotein and low
density lipoproteins (P < 0.05). In the same group, triglycerides
showed higher concentrations in patients with complications
(P < 0.05). High density lipoprotein was also statistically
S282
lower on the fifth postoperative day in the epidural group with
wound complications (P < 0.05).
Conclusion: Patients with epidural anaesthesia with wound
complications had significantly lower values of cholesterol and
lipoproteins and higher concentrations of triglycerides on the
third postoperative day.
Disclosure of Interest: None declared.
MON-P281
EARLY ENTERAL NUTRITION WITHIN 24 HOURS OF LOWER
GASTROINTESTINAL SURGERY VERSUS LATER
COMMENCEMENT – EFFECTS ON HOSPITAL STAY AND
POSTOPERATIVE COMPLICATIONS
G. Herbert1, R. Perry1 *, H. K. Andersen2, C. Atkinson1,
C. Penfold1, S. Lewis3, A. Ness1, S. Thomas4. 1NIHR Bristol
Biomedical Research Centre (Nutrition Theme) at the
University Hospitals Bristol NHS Foundation Trust and the
University of Bristol, Bristol, United Kingdom, 2The Cochrane
Collorectal Group, Bispebjerg Hosptial, Building 39N,
Copenhagen, Denmark, Copenhagen, Denmark, 3Dept of
Gastroenterology, Level 7, Derriford Hospital, Plymouth,
4
Head and Neck Surgery, University Hospitals, Bristol NHS
Trust, Bristol, United Kingdom
Rationale: To evaluate whether early commencement of
postoperative enteral nutrition (within 24 hours) compared to
traditional management (no nutritional supply) is associated
with a shorter length of hospital stay (LoHS) and fewer
complications in patients undergoing lower gastrointestinal
surgery (where an anastomosis is formed distal to the ligament
of Treitz).
Methods: We searched five databases and hand-searched
reference lists of identified studies. Two authors extracted
data and assessed study quality. The primary outcome was
LoHS. The secondary outcomes were: mortality, postoperative
complications (wound infections, intraabdominal abscesses,
anastomotic dehiscence, pneumonia) and adverse events
(nausea, vomiting). We used random effects models for the
primary outcome (LoHS) and secondary outcomes when
appropriate. Fixed effect models were used if there was only
a small number of studies or events were rare.
Results: Seventeen RCTs were identified. The pooled mean
difference in LoHS was 1.96 (−3.00 to −0.92, P < 0.001) days
shorter in the intervention group. However, there was a high
level of heterogeneity between studies (Chi2 = 79.35, I2 = 81%,
P < 0.00001). There was moderate evidence of a reduction in
mortality with early post-operative feeding (RR = 0.55, 0.27–
1.10, P = 0.09). There was also moderate evidence of an
increase in the relative risk of vomiting among patients fed
early (RR = 1.23, 0.96–1.58, P = 0.10) with little heterogeneity
(Chi2 = 4.98, I2 = 0%, P = 0.55). There was no evidence of an
effect of treatment on the postoperative complications.
Conclusion: There is no obvious advantage in keeping patients
‘nil by mouth’ following lower gastrointestinal surgery, so this
review continues to support the notion of early commencement
of enteral feeding.
Disclosure of Interest: None declared.
Poster
MON-P282
EARLY ENTERAL PHARMACONUTRITION IN PREVENTION OF
POSTOPERATIVE INTESTINAL FAILURE
R. Yagubyan1 *, M. Petrova2, M. Storchai2, R. Mohan3,
M. Nakade3, M. Sobolev4. 1Anesthesiology and Critical Care,
Pirogov Russian National Research Medical University,
2
Anesthesiology and Critical Care, Rudn University,
3
Anesthesiology and Critical Care, Rudn Univercity,
4
Anesthesiology and Intensive Care, I.M. Sechenov First
Moscow State Medical University, Moscow, Russian Federation
Rationale: Intestinal failure (IF) is a frequent complication of
early postoperative period in abdominal surgery. One of the
main goals during early postoperative period is initiating
adequate enteral nutrition. The aim of study was to evaluate
effectiveness of early enteral pharmaconutrition in preventing
development of IF after emergency abdominal surgery.
Methods: The study included 35 patients aged 57,5 ± 11,5 y.o.
which had emergency abdominal surgery. These patients were
divided in two groups: group 1 (17 pts.) during 2 days after
surgery received daily 500 ml of enteral pharmaconutrition
containing 30 g of glutamine and on the 3rd day – standard
enteral nutrition, group 2 (18 pts.) for 2 days received daily
500 ml of balanced crystalloid solution enterally and on the 3rd
day – standard enteral nutrition. Immediately after surgery and
on day 3 we evaluated severity of IF based on bowel sounds’
presence, intra-abdominal pressure (IAP) level and results of
ultrasound exam of intestinal wall. Statistical analyses were
conducted with IBM SPSS Statistics 21.
Results: Severity of IF was scored from 1 to 3. Mean score in
group 1 immediately after surgery was 2,9 ± 0,2, in group 2–
2,8 ± 0,3 ( p = 0,43). After initial enteral treatment on day 3 in
group 1 mean score was 1,8 ± 0,68, in group 2–2,8 ± 0,3
( p < 0,05). Due to the fact that bowel sounds are less accurate
and ultrasound exam of intestinal wall is limited in ICU settings
we recommed using dynamic of IAP as a factor of the
postoperative IF. On day 3 IAP in group 1 was 13,7 ± 1,35 cmH2O,
in group 2–19,3 ± 1,6 cmH2O ( p < 0,05).
Conclusion: The results allowed us to conclude, that enteral
nutrition should be initiated with pharmaconutrition including
glutamine to ensure better tolerance. The level of IAP is a
prognostic factor of the dynamics of postoperative IF and must
be used on bedside to determine the tactics of postoperative
nutritional therapy.
Disclosure of Interest: None declared.
MON-P283
CHANGE IN DIETARY INTAKE AND NUTRITIONAL STATUS USING
MEALWORMS AS HOSPITAL MEAL IN POSTOPERATIVE PATIENTS
H. Kim1, S. Kim1 *, J. Shon1, J. S. Park2, J. Kang2, J. W. Kim3,
M. Kim4, J. Hwang4, E. Yun5. 1Dept. of Nutrition and Dietetics,
2
Dept. of Surgery, Gangnam Severance Hospital, 3Dept. of
Surgery, Chung-ang University Hospital, Seoul, 4Dept. of
Agricultural Biology, The National Academy of Agricultural
Science, Rural Development Administration, Jeonju, 5Dept. of
Integrated Bioindustry, Sejong University, Seoul, Republic
of Korea
Rationale: The purpose of this study was to investigate the
effect of nutritional status with hospital meal intake using
Mealworms(Insect food) with increased nutrition density. We
Perioperative care 2
provided a meal for postoperative patients and conducted
analysis of dietary intake and nutritional status of patients and
assessment of acceptability of the meal.
Methods: This study was carried out as a randomized control
trial. Patients were supplied either a hospital meal using
Mealworms (Experimental group) or a regular hospital meal
(Control group). We investigated the administration amounts of
parenteral nutrition (PN) and food intake of patients after
surgery and measured anthropometry, body composition, and
blood tests before surgery and at hospital discharge. Data were
analyzed using IBM SSPS Statistic ver 23.0. The 0.05 level of
significance was used for all analyses.
Results: We included 34 postoperative patients who were
admitted to Gangnam Severance Hospital from March to
September in 2016. In the groups of patients not supplied
with PN, the experimental group (964.68 ± 284.6 kcal, 38.82 ±
12.9 g) had significantly higher dietary calorie and protein
intake than the control group (666.62 ± 153.7 kcal,
24.47 ± 4.9 g)(P < 0.05). Additionally in the group of patients
not supplied with PN, the experimental group (1.37%) showed a
significantly higher increase in fat free mass index than the
control group (−3.46%)(P < 0.05). In all subjects, calorie
density and protein density were significantly higher in the
experimental group (P < 0.001), and acceptability of calorie
(P < 0.05) and protein (P < 0.05) was also significantly higher in
the experimental group.
Conclusion: Therefore, the hospital meal using Mealworms
(Insect food) may beneficial effect on fat free mass in
postoperative patients without PN supplement.
Disclosure of Interest: None declared.
MON-P284
CHANGE OF BODY COMPOSITION DURING PERIOPERATIVE
PERIOD OF GASTROINTESTINAL SURGERY.
T. Nagahama1 *. 1Surgery, Kudanzaka Hospital, Tokyo, Japan
Rationale: Dual Energy X-ray Absorptiometry (DEXA) was
regarded as one of most objective and quantified method to
evaluate body composition. We have adopted DEXA to estimate
the influence of gastrointestinal surgery on body composition
during perioperative period,
Methods: 25 patients of gastrointestinal surgery for malignancy
received DEXA and body weight measurement before surgery
and 2 months after surgery. By DEXA total weight of fat mass
(FM), and fat free mass(FFM) were calculated. Skeletal Muscle
Index(SMI) was calculated by FFM of extremities and heights
(FFM of extremities/(heights)2 to evaluate the volume of
muscle mass. The change of body composition during peri-
operative period were evaluated.
Results: The use of DEXA for the assessment of body
composition was examined in 25 patients (15 male and 10
females, 15 stomach and 10 colons, and 13 open surgery and 12
laparoscopic surgery) ranging in age from 51 to 85 years. During
perioperative period mean FFM (Male pre-41.0, post-40.9,
Female pre-33.0, post-33.0) and mean SMI (Male pre-6.18,
post-6.10, Female pre-5.71, post-5.73) demonstrated no
significant change. Mean body weight demonstrated significant
decrease during perioperative period only in female (Male pre-
58.2, post-56.5: n.s., Female pre-54.3, post-51.4: p < 0.01)
Mean FM demonstrated significant decrease in both sex (Male
pre-14.8, post-13.2: p < 0.01, Female pre-19.6, post-13.7:
S283
p < 0.01) during perioperative period. Changes of body com-
position values (BW, FFM, FM, SMI) did not demonstrate
significant difference by resected organ or approach of surgery.
Conclusion: Our results demonstrated that during periopera-
tive period, change of body composition were observed mainly
in fat mass not in fat free mass. Body weight loss by decrease of
fat mass preserving fat free mass was characteristic finding of
body composition during perioperative period after gastro-
intestinal surgery.
Disclosure of Interest: None declared.
MON-P285
NUTRITIONAL AND PREOPERATIVE PROFILE OF THE PATIENT
CANDIDATE FOR ELECTIVE COLORECTAL SURGERY IN FELÍCIO
ROCHO HOSPITAL, BELO HORIZONTE – BRAZIL
T. M. Rettore1 *, E. P. Rocha Junior1, S. C. Silvestre1. 1Nutrology,
Hospital Felício Rocho, Belo Horizonte, Brazil
Rationale: Knowing nutritional status and previous pathologic
history of patients who are about to undergo surgeries is
important so that specific interventions could be taken. These
evidence-based interventions tend to reduce post-operative
complications, morbidity and mortality as well as hospital stay
and hospitalization costs.
Methods: Cross-sectional study with adult patients, candidates
to undergo coloproctological surgery in a Hospital in Brazil.
Local ethical committee approved this study before data
collection. 31 patients were analyzed by their base disease,
co-morbidities, weigh history, functional status, gastrointes-
tinal symptoms and had anthropometric measures, such as BMI,
handgrip strength (HS) and Thickness of the Adductor Pollicis
Muscle (TAPM) collected. Serum albumin (SA) was also
analyzed, such as existence of co-morbidities and lifestyle.
All data were crossed to determine nutritional status,
prevalence of diseases and the use of SA, HS and TAPM to
help in nutritional diagnosis. Statistical analyses were per-
formed using descriptive statistics, regression, and t-test.
Results: About 50% of patients were classified as malnourished
before surgery when using Subjective Global Assessment (SGA).
83,9% were diagnosed with colonic or rectum tumors.
Spontaneous weight loss was prevalent in 41,9% of patients
and 22,5% had their functional capacity reduced. Hypertension
was seen in 51,6% of patients and diabetes in 16,1%. Only one
patient was an active smoker. Sedentary lifestyle was 74,1%
prevalent. SA, HS and TAPM were not correlated to nutritional
status diagnosis ( p > 0,05) when compared to SGA.
Conclusion: Undernutrition was highly prevalent in this study
population and hospital stay was longer in this group. Other
comorbidities and sedentary lifestyle were also prevalent. SA,
HS and TAPM were not considered isolated diagnostic methods
for undernutrition
Disclosure of Interest: None declared.
S284
Protein and amino acid metabolism 2
MON-P286
IS N-CARBAMOYL PUTRESCINE, A CITRULLINE
DECARBOXYLATION DERIVATIVE, AN EFFECTOR OF
METABOLISM?
D. Ramani1,2, S. Nakib1,2, E. Nubret1, H. Chen3, C. Garbay3,
L. Cynober1,2, J.-P. De Bandt1,2 *. 1EA4466, Université Paris
Descartes, 2Clinical Chemistry Dpt, Hôpital Cochin, APHP,
3
UMR 8601 CNRS, Université Paris Descartes, Paris, France
Rationale: Decarboxylation derivatives of ornithine and
arginine (aliphatic polyamines and agmatine respectively)
have important properties in terms of cell proliferation and
differentiation. We questioned whether N-carbamoyl putres-
cine (NCP), the decarboxylation derivative of citrulline, could
also have significant effects. Our aim was to evaluate the
effects of an oral administration of NCP in the rat either at a
dose equivalent to the dietary intake of polyamines or at a ten-
fold higher dose.
Methods: Twenty 8-week-old rats received a standard feed
alone (control) or supplemented with NCP at either 5 (NCP5) or
50 mg/kg/d (NCP50) for 14 days. Weight gain and behavior
were monitored. At the end of the feeding period, body
composition, hepatic and renal function, metabolic status, and
plasma and tissue polyamines were evaluated. Statistics:
ANOVA and Fisher’s PLSD test; simple regression analysis.
Results: NCP did not modify animal behavior, weight gain or
body composition at any dose. Protein content in soleus muscle
(but not in tibialis) was significantly increased in the NCP5
group compared to the control group (Control: 12.7 ± 1.8,
NCP5: 14.5 ± 0.7, NCP50: 14,0 ± 0.8 g/100 g; p < 0.02 NCP5 vs
control). NCP induced a dose-dependent decrease in plasma
glutamine and ornithine and a significant increase in plasma
urea in the NCP50 group. Finally, NCP resulted in a dose-
dependent decrease in spermine in the kidney and tibialis and
an increase in putrescine in the soleus.
Conclusion: Oral NCP at a dose of 5 mg/kg/d induces an
increase in protein content of the soleus, rich in type I fibers,
but not in tibialis, rich in type II fibers. The role of increased
muscle content in putrescine needs to be explored. On the
other hand, at a 50 mg/kg/d dose, NCP is probably inefficient
and this may be related to the observed decrease in glutamine
availability and the increase in amino acid catabolism judged
on urea production.
Disclosure of Interest: None declared.
MON-P287
CARGLUMIC ACID IN THE TREATMENT OF HYPERAMMONAEMIC
CRISIS IN PATIENTS WITH PROPIONIC ACIDURIA – OUR
EXPERIENCES
K. Brennerova1 *, V. Bzduch1, D. Behulova2, A. Hlavata1,
M. Skoknova3, L. Podracka4. 1Paediatric Clinic, Medical Faculty
and University Children’s Hospital, 2Departmant of Laboratory
Medicine, University Children’s Hospital, Bratislava, Slovakia,
3 15 M (AT: 31 ± 5%, 70 ± 5 y) and 20 W (AT: 39 ± 10%; 68 ± 5 y),
Neonatal Clinic of Intensive Care Medicine, Medical Faculty
and University Children’s Hospital, 4Paediatric Clinic,
Medical Faculty and University Children’s Hospital,
Bratislava, Slovakia
Rationale: Hyperammonaemia in the patients with propionic
aciduria (PA) is caused secondary, by the blocking activity of the
Poster
first urea cyclés enzyme. During severe metabolic decompen-
sation of neonatal forms of PA we often reduced hyperammo-
naemia using extracorporal elimination, along with pharmaco –
elimination and symptomatic treatment. Now it is possible to
use a carglumic acid – a drug registered for the treatment of
hyperammonaemia in N-acetylglutamatsyntase deficiency
(NAGS) and in the organic acidurias.
Methods: Carglumic acid is a structural analogue of NAG – a
natural activator of the first enzyme of urea cycle. The
mechanism of action of carglumic acid is based on the ability
to replace the NAG function and to restore the activity of the
urea cycle. Recommended dose in acute hyperamonaemia is
100–250 mg/kg/day enterally.
Results: The authors describe their experience with the
carglumic acid in the treatment of acute hyperammonaemia
in patients with PA:
• Two neonates with manifestation of PA during the first week
of life, with hyperammonaemia above 500 umol/L;
• 7 year old girl suffered by the neonatal form of PA, with
repeated attacks of severe metabolic acidosis and marked
elevation of ammonia in blood.
They are documented the course of hyperammonaemia,
treatment and clinical course of the disease in these patients.
Conclusion: Carglumic acid effectively reduces hyperammo-
naemia and has a low risk of adverse effects. Therefore, it is
currently recommended its early submission during severe
hyperammonaemia – already in the time of differential
diagnosis and to all patients with confirmed organic aciduria
caused by methabolic disorders of branched amino acids.
Disclosure of Interest: None declared.
MON-P288
EFFECT OF CITRULLINE COMBINED WITH HIGH-INTENSITY
INTERVAL TRAINING ON PHYSICAL PERFORMANCE IN OBESE
ELDERLY ADULTS: IS IT SEX-DEPENDENT?
M. Dulac1 *, G. El Hajj Boutros2, L. Carvalho3, V. Marcangeli2,
P. Gaudreau4, G. Gouspillou2, J. Morais5, P. Noirez6,
M. Aubertin-Leheudre2. 1Biology, 2Physical Activity Sciences,
UQAM, Montreal, Canada, 3Federal University of Sao Carlos,
Sao Carlos, Brazil, 4Université de Montreal, 5McGill, Montreal,
Canada, 6University Paris Descartes, Paris, France
Rationale: With aging, muscle mass (MM) decreases whereas
adipose tissue (AT) increases. These changes lead to an
increased risk of developing metabolic dysfunctions and
functional decline. High-Intensity Interval Training (HIIT) is a
promising avenue to prevent these phenomena considering its
high effectiveness and short duration. Citrulline supplementa-
tion (CIT), a non-proteinogenic aminoacid acts on muscle tissue
(increasing protein synthesis) and AT (increasing lipolysis) in
both rats and young adults. The aim of this study was to
determine the effects of CIT combined with HIIT in obese
elderly men (M) and women (W).
Methods: Thirty-five inactive elderly and obese participants;
were randomly and double-blindly divided into 2 groups: (1)
HIIT + CIT (n = 19, 6 M/13 W) and (2) HIIT + Placebo (PLA)
(n = 16, 9 M/7 W). Supplementation: single ingestion of 10 g/
day of CITor PLA. Intervention: 12-week HIIT (elliptical device;
cycle: 30 sec at 85% and 90 sec at 65% of maximal age-
predicted heart rate; 3 × 30 min/week). Body composition [BC]
Protein and amino acid metabolism 2
(DXA: MM and AT) was measured pre and post-intervention.
p < 0.05 was considered significant.
Results: At baseline, all groups were comparable in age and BC.
Following the intervention, in M, total ATwas further decreased
in HIIT + CIT(delta% [HIIT + PLA vs. HIIT + CIT]: 0.74 ± 1.29% vs.
−4.88 ± 1.31%; p = 0.018). However, in W, total MM was further
increased in HIIT + CIT. (delta% (HIIT + PLA vs. HIIT + CIT):
−0.92 ± 1.22% vs. 0.34 ± 1.15%; p = 0.003).
Conclusion: The present results suggest more favorable effects
of HIIT when combined with CIT on BC in elderly obese people.
These effects appear to involve different sex-dependent
mechanisms of action, which is reflected in M by a decrease
in AT, but in W by an increase in MM. These promising
preliminary results are currently being validated in a larger
cohort.
Disclosure of Interest: None declared.
MON-P289
EFFECT OF AGEING ON IMMUNE-ENHANCING DIET (IED) AMINO
ACID AVAILABILITY AFTER A SURGICAL STRESS
N. Tennoune El hafaia1 *, G. Ventura1, S. Le Plénier1, C. Choisy1,
N. Neveux1,2, L. Cynober1,2, J.-P. De Bandt1,2,
A. Raynaud-Simon1,3. 1EA4466, Université Paris Descartes,
2
Clinical Chemistry Dpt, Hôpital Cochin, APHP, 3Geriatry,
Hôpital Bichat, APHP, Paris, France
Rationale: Amino acid (AA) requirements increase after a
surgical stress while systemic AA availability from the diet
decreases with age, owing to splanchnic sequestration (SSAA).
While IEDs have been recommended for the nutritional
management of surgical patients, the adequacy of their AA
supply has not been evaluated in aged patients. This was
determined in surgically-stressed IED-fed aged rats.
Methods: Thirty-four 5-month or 21-month old male SD rats
were used. After gastrostomy and placement of a jugular vein
catheter and a one-week recovery, the animals underwent 24h-
enteral feeding (Impact®, Nestlé Health Science) before
(healthy state) and 18 h after laparotomy (surgical stress).
Blood samples were repeatedly collected for the measurement
of plasma AA enrichment (areas under the curve: AUC) at 5 and
24 h. Surgical stress was evaluated from urinary cathechola-
mines, and plasma protein profile. Statistical analysis: two way
ANOVA.
Results: Aged rats presented significantly higher catechol-
amine response to surgery than adults but similar inflammation
and lower plasma glucose. Plasma AA AUC between t0 and 5 h
were similar whatever age and stress. At 24 h, Met, Phe, and His
AUC, and Ser AUC only in adults, were lower in stressed than in
healthy rats (−140 to −50%, p < 0.05). Asn, Gly, Cys AUC were
lower in healthy aged compared to healthy adults (−160 to
−40%, p < 0.05), and for Gly and Cys in stressed aged compared
with stressed adults (−170 to −60%, p < 0.05). Arg, Orn and Cit
AUC were similar in the 4 conditions.
Conclusion: IED administration similarly increases the plasma
concentration of all AA in aged and adult stressed rats and the
peripheral availability of Arg and most AA from IED is not
affected by ageing in this stress situation. The lower plasma
Gly, and Cys enrichment in stressed aged rats may be
independent of SSAA as it appears only after 5 h of EN and
related to increased glutathione turnover.
S285
Disclosure of Interest: N. Tennoune El hafaia: None declared,
G. Ventura: None declared, S. Le Plénier: None declared, C. Choisy:
None declared, N. Neveux: None declared, L. Cynober Consultant for:
Nestlé Health Science, J.-P. De Bandt Grant/Research Support from:
Nestlé Health Science, A. Raynaud-Simon: None declared.
MON-P290
ASSOCIATIONS BETWEEN BRANCHED CHAIN AMINO ACID
INTAKE AND FASTING SERUM LEUCINE IN LEAN AND OBESE
N. Mohorko1 *, A. Petelin1, Z. Jenko-Pražnikar1. 1University of
Primorska, Faculty of Health Sciences, Izola, Slovenia
Rationale: It is not clear, whether the increased fasting serum
leucine level (fsLeu), typical of disrupted metabolic state in
obese, is associated with high Leu and branched-chain amino
acid (BCAA) intake and is direct contributor to insulin
resistance or is merely the consequence and thereby the
marker of the later (Yoon, 2016).
Methods: 96 participants were divided into three groups:
MetS0: no MetS component, MetS1: one MetS component, and
MetS2, two or more MetS components. MetS0 and MetS2
significantly differed in BMI, metabolic health characteristics,
fitness index and fsLeu, and represented normal and disrupted
metabolic state, accordingly. Sera of the participants were
analysed for fsLeu and C-reactive protein (CRP). Three-day
weighted habitual food intake record was analysed, and BCAA
and BCAA source intake data associations with fsLeu within
each group were analysed by Spearman correlation.
Results: Leu and BCAA intake significantly positively correlated
with fsLeu in MetS0, but significantly negatively correlated
with CRP in MetS0. There were no correlations between Leu and
BCAA intake and fsLeu nor CRP in MetS2. Milk and dairy intake
positively correlated with fsLeu in MetS0, with no correlations
in MetS2. On the other hand, meat intake positively correlated
with fsLeu and CRP in MetS2, with no correlations with fsLeu
nor CRP in MetS0.
Conclusion: Increased fsLeu in disrupted metabolic state was
not associated with BCAA intake. Associations between
BCAA and protein source intake differ in different metabolic
states. BCAA dietary source is relevant when observing the
effect on fsLeu.
Reference
Yoon MS. Nutrients 2016;8. pii: E405.
Disclosure of Interest: None declared.
MON-P291
DIETARY PROTEIN CONTENT MODULATES THE AMINO-ACID
AND IGF1 RESPONSES TO SUCROSE OVERFEEDING IN
HUMANS.
P. Jegatheesan1,2 *, A. Surowska2, V. Campos2, J. Cros2,
N. Stefanoni2, V. Rey2, P. Schneiter2, J.-P. De Bandt1, L. Tappy2.
1
EA4466 Laboratoire de Biologie de la Nutrition, University of
Paris Descartes, Paris, France, 2Department of Physiology,
University of Lausanne, Lausanne, Switzerland
Rationale: High sucrose diets decrease muscle anabolism
through insulin resistance and changes in plasma amino acid
(AA) level in animal studies while data in humans remain
unknown. This study proposes to compare the short-term
effects of high vs low protein intake during a short-term
S286
hypercaloric high-sucrose diet on fasting blood AAs and IGF1
concentrations in healthy humans.
Methods: We performed a randomized, crossover study on 12
healthy young male and female volunteers. Each participant
was studied after a 3-day run-in diet containing 100% daily
energy requirement (45% starch, 10% sucrose, 33% lipid, 12%
protein), and after 7-day on hypercaloric diet containing 150%
daily energy requirement with 45% starch, 50% sucrose, 10%
lactose, and either 37.5% lipid and 7.5% protein (HSLP) or 15%
lipid and 30% protein (HSHP). Fasting and postprandial plasma
insulin, glucagon and IGF1 concentrations were assessed before
and after each intervention, and fasting plasma AAs level.
Results: Compared to basal, HSHP increased plasma glucagon
(19.2 ± 1.0 vs 26.0 ± 2.5 ng/ml*300 min, p < 0.05), while HSLP
had no effect. Neither HSHP nor HSLP changed insulin level.
HSHP and HSLP increased Ala and Pro, and decreased Ser levels.
The increase in Ala elicited by sucrose overfeeding was blunted
with HSHP (249 ± 18 vs 386 ± 11 μM, p < 0.001) compared to
HSLP (251 ± 20 vs 464 ± 33 μM). Leu concentration decreased
(130 ± 4 vs 116 ± 5 μM) after HSLP, but not after HSHP (139 ± 6 vs
140 ± 7 μM). Compared to HSLP, plasma BCAA, Phe, Tyr, and Pro
were significantly higher with HSHP than HSLP. Fasting IGF1
concentration increased (174 ± 18 vs 208 ± 15 μg/dl) after HSHP
and decreased (212 ± 13 vs 173 ± 12 μg/dl) after HSLP
( p = 0.04).
Conclusion: Sucrose overfeeding decreases IGF1 and Leu level
when associated with a LP intake. This may be associated with
decreased muscle protein synthesis. These effects are pre-
vented when sucrose overfeeding is associated with a HP
intake.
Disclosure of Interest: None declared.
MON-P292
EVALUATION OF PROTEIN TURNOVER REVEALS A TISSUE-
SPECIFIC ADAPTIVE RESPONSE IN FEMALE MICE DURING
ACTIVITY-BASED ANOREXIA
S. Nobis1,2, A. Morin1,2, N. Achamrah1,2,3, A. Goichon1,2,
C. L’huillier1,2, A. Amamou1,2, J. C. do Rego2,4,
P. Déchelotte1,2,3 *, L. Belmonte1,2,3, M. Coeffier1,2,3. 1INSERM
U1073, Normandie Univ, URN, 2Institute for Research and
Innovation in Biomedicine, Normandie Univ, 3Nutrition
Department, Rouen University Hospital, 4Animal Behavior
Platform SCAC, Normandie Univ, Rouen, France
Rationale: Anorexia nervosa is an eating disorder leading to a
severe undernutrition with reduced lean and fat mass and to
metabolic alterations. To better understand the regulation of
energy-protein homeostasis in anorexia, we aimed to evaluate
the protein turnover in different tissue in the activity-based
anorexia (ABA) model in female mice.
Methods: Female C57Bl/6 mice were placed in cages with
activity wheel (ABA) or not (Control, CT and limited food
access, LFA). Both ABA and LFA mice had a progressive limited
access to food from 6 hours/d at d6 to 3 hours/d at d9 and until
the end of experiment. At d17, 20 minutes before euthanasia,
intravenous injection of puromycin was performed to evaluate
in different tissues the protein synthesis rate by SUnSET
method. In addition, autophagy was assessed by measuring
LC3II/LC3I ratio by western blot.
Results: At d17, ABA mice exhibited lower body weight and
lower cumulative food intake than LFA mice ( p < 0.05). In
Poster
hypothalamus, colon and liver, we observed that LC3II/LC3I
ratio was increased in ABA mice ( p < 0.05 vs CT), but not in LFA
mice. Interestingly, the protein synthesis rate was increased in
hypothalamus in ABA mice ( p < 0.05 vs CT), while it was
decreased in the colon and the soleus muscle ( p < 0.05 vs CT).
Finally, in liver and anterior tibialis muscle, the protein
synthesis rate was similar in the three groups.
Conclusion: Our results reveal a tissue-specific adaptive
response for protein metabolism during activity-based anorexia
in female mice. In particular, only hypothalamus exhibits
stimulated protein synthesis certainly to favour food intake.
Disclosure of Interest: None declared.
MON-P293
EFFECT OF DIFFERENT TYPES OF PHYSICAL EXERCISE ON THE
INCREASE IN PLASMA CITRULLINE LEVELS AFTER POST-
EXERCISE GLUTAMINE SUPPLEMENTATION
S. Kartaram1 *, M. Mensink2, M. Teunis1, E. Schoen3, G. Witte4,
E. Voogd4, L. Janssen-Duijghuijsen2, M. Verschuren5,
A. van Helvoort4, L. M’rabet1, J. G. Garssen4, R. Witkamp2,
R. Pieters1, K. van Norren2. 1Innovative Testing in Life Sciences
and Chemistry, Utrecht University Of Applied Sciences,
Utrecht, 2Division Human Nutrition, Wageningen University &
Research, Wageningen, 3Netherlands Organization for Applied
Scientific Research (TNO), Zeist, 4Nutricia Research, Utrecht,
5
Research group Analysis techniques in the Life Science, Avans
University of Applied Sciences, Breda, Netherlands
Rationale: Citrulline, a marker for enterocyte metabolic mass,
is reduced in case of intestinal dysfunction. The aim of the
present study was to investigate whether the post-exercise rise
in citrulline levels after oral glutamine intake is dependent on
the intensity of the exercise and the hydration status and
whether there is a relation with intestinal dysfunction.
Methods: Fifteen healthy young men performed in a randomly
assigned cross-over design five experimental protocols with
different intensity and/or hydration status: (1) rest,( 2) and (3)
70% Wmax respectively euhydrated and dehydrated, (4) 50%
Wmax, (5) intermittent 85/55% Wmax in blocks of 2 min. After
exercise or rest, subjects received a glutamine-alanine bolus.
Blood samples were collected before, during and at several
time points up to 24 h afterwards Citrulline was analyzed by
UFLC. Serum intestinal fatty acid binding protein (iFABP), as
marker of intestinal dysfunction, was measured with ELISA.
Data was analyzed using a multilevel mixed linear statistical
model, with multiple test correction.
Results: The mild exercise protocol (50% Wmax) showed the
highest increase in citrulline levels (44.04 μm/L ± 2.5, p < 0.05)
compared to rest (32.13 μm/L ± 1.6). The strenuous exercise of
70% Wmax in dehydrated condition however, showed less
increase compared to the resting condition and hydrated
protocols. In contrast, serum iFABP levels increased in the
moderate exercise at 70% Wmax in hydrated condition, but
showed the highest levels in the strenuous dehydrated protocol
(1443.72 μm/L ± 249.9, p < 0.001).
Conclusion: This study indicates that the art and intensity of
the exercise affects the post-exercise rise of citrulline levels
after glutamine supplementation. Moreover, it indicates that
this rise might be related to intestinal dysfunction measured by
levels of iFABP.
Disclosure of Interest: None declared.
Vitamins, antioxidants and minerals 2
Vitamins, antioxidants and minerals 2
MON-P294
MAGNESIUM SULPHATE ALLERGY AND SUBSEQUENT
TOLERANCE TO MAGNESIUM CHLORIDE IN A PATIENT WITH
INTESTINAL FAILURE
K. C. Fragkos1 *, S. Mehta1, S. Di Caro1, F. Rahman1,
M. Dziadzio2, J. Lukawska2,3. 1GI Services, 2Specialist Allergy
and Clinical Immunology, University College London Hospitals
Nhs Foundation Trust, 3Imaging Sciences, King’s College
London, London, United Kingdom
Rationale: Magnesium is commonly used in hospital medicine
in treatment of eclampsia and preeclampsia, arrhythmia,
severe asthma, and migraine. Its utilisation is customary in
patients with short bowel syndrome and intestinal failure, who
often require intravenous magnesium sulphate (MgSO4). MgSO4
is also a routine additive in intravenous fluids for parenteral
nutrition formulations. In spite of its frequent use, reports of
allergic reactions to the compound are very rare (1).
Methods: Case report
Results: We present a case of a 40-year-ol female with a
background of ileostomy and intestinal failure, who developed
allergic reactions (skin flushing, skin rash, lip angioedema and
throat tightness) to intravenous MGSO4 infusions, which
precluded its further use. Patient was seen by in-house
Clinical Allergy Service and skin testing to MgSO4 was
performed. She tested negative to neat skin prick and positive
at intradermal testing at 1:100 (non-irritant concentration).
Suggesting possible IgE mediated mechanism. Skin testing was
repeated with Magnesium Chloride (MgCl2). Patient tested
negative to MgCl2 neat skin prick test and to intradermal testing
at the same concentration. Subsequently, magnesium chloride
infusion was performed and well tolerated with no evidence of
allergic reaction.
Conclusion: Magnesium is one of the most abundant minerals in
human body and it is essential to our well-being. Allergic
reactions to MGSO4 are very rare (only 3 cases described in the
literature), however, when suspected pose a significant
problem for patients and their clinicians. Following careful
allergological review and skin testing, MgCl2 may represent a
safe alternative in patients with allergy to MGSO4.
Reference
1. Al-Fares AA, Abdulmalek KA, Al-Herz W. Magnesium sulfate-
induced nonallergic anaphylaxis. Annals of Allergy, Asthma and
Immunology 98: 303, No. 3, Mar 2007.
Disclosure of Interest: None declared.
MON-P295
ASSOCIATION BETWEEN SERUM MICRONUTRIENT LEVELSIN
PATIENTS DISCHARGED FROM ICU TO WARDS AND 90-DAY
MORTALITY, RE-ADMISSION TO INTENSIVE CARE UNIT: SINGLE
CENTER OBSERVATIONAL STUDY
K. Gundogan1 *, Y. Gunay1, R. Coskun1, N. A. Mendil1,
M. Guven1, M. Sungur1. 1Erciyes University, Kayseri, Turkey
Rationale: Trace elements included in nutritional support have
a central role in maintaining human physiological functions.
The study aim of this study is to identify serum micronutrient
levels in patients who are transferred from intensive care unit
S287
(ICU) to wards and their relationwith re-admission to ICU and
mortality rate.
Methods: This study was conducted prospectively in Erciyes
University Medical ICU. Patients who are above 18 years old and
stayed in the ICU more than 48 hours and then transferred to a
ward were included into the study. Blood samples for
micronutrient levels were taken at the time of transfer.
Results: We enrolled 100 patients. Total of 52 of patients were
male (52%) and 48 were female (48%). Mean agewas 56.2 ± 19.2
years. Mean APACHE II score was 15,4 ± 7,8. Mean SOFA score at
the time of discharge from ICU was 3 (range 0–7). The route for
nutrition was oral in 50%, enteral in 21%, oral and enteral in 13%
and parenteral in 15% of the patients. Low levels of thiamine
(98%), vitamin B6 (98%), vitamin B12 (11%), copper (21%), zinc
(90%), selenium (36%), chromium (98%), and cobalt (35%)were
identified in the patients. Low levels of vitamin B6 was an
independent risk factor for 90 day mortality and re-admission
to the ICUin multivariate analysis(OR: 0,283, CI 95%:0,099–
0,812, p: 0,019 OR: 0,231 CI 95%:0,071–0,745, p: 0,014
respectively). Median duration of ICU stay was 5 (range 3–32)
days. Re-admission rate to the ICU within 90 days was 24% and
90 day mortality rate was 29%.
Conclusion: Vitamin B1, B6, zinc and chromium levels were
very low in these group patients. Low levels of vitamin B6
identified as an independent risk factor for 90 day mortality
rate and re-admission to the ICU.
Disclosure of Interest: None declared.
MON-P296
A SNAPSHOT OF VITAMIN D DEFICIENCY IN HOME PARENTERAL
NUTRITION PATIENTS IN NORTHERN ENGLAND
L. Shabeer1 *, D. Burke2. 1School of Medicine, University of
Leeds, 2Department of Colorectal Surgery, St. James’s
University Hospital, Leeds, United Kingdom
Rationale: Vitamin D deficiency is increasingly common with an
occurrence of 1 in every 5 adults, approximating to 10 million
people across England in the general population. Those on
home parenteral nutrition (HPN) are at increased risk of
deficiency, making these patients of clinical interest. However,
current data are limited to small sample size and the topic has
not recently been explored in northern European countries.
The aim of this study was to examine the prevalence of vitamin
D deficiency in HPN patients in northern England.
Methods: Serum Vitamin D (25-hydroxyvitamin D [(25(OH)D])
values from all HPN patients at St James’s Hospital, Leeds were
obtained with sufficiency defined by the range, 75–250 nmol/
L. The most recent non-fasting serum values for vitamin D in
the last six months, patient age and ethnicity were recorded.
Results: Data were obtained on 139 patients (51 male and 88
female). 94% of patients were of White British ethnicity.
Vitamin D levels in the sub-normal range were seen in 61.2%.
Five patients did not have any recorded vitamin D values within
the last six months. Similar levels of vitamin D insufficiency
were seen between male and female cohorts (60.8% and 61.4%
respectively). 28% of patients were over the age of 65 with
51.3% of these having insufficient vitamin D levels.
Conclusion: This study uses the largest sample size to date and
is the first study conducted in a European cohort. Inadequate
vitamin D levels were seen amongst a large number of HPN
patients, despite monitored supplementation. There is a need
S288
for a consideration of the most effective methods to sustain
adequate levels of vitamin D in HPN patients.
Disclosure of Interest: None declared.
MON-P297
JAPANESE HOSPITAL’S ORDINARY MEAL 2ND REPORT –FOCUS
ON VITAMIN B1
M. Hasegawa1 *, M. Shiga2. 1Physician, 2Dietitian, Kariya Toyota
General Hospital Takahama Branch, Takahama, Japan
Rationale: In 2015, we reported ordinary meal in Japanese
hospital about total energy, protein, lipids and carbohydrate.
Methods: We surveyed using questionnaire total energy,
protein, lipids, carbohydrate some vitamins and minerals on
November 5th–7th 2014. And obtain 96 data. Type: acute care
setting (AC) 39, rehabilitation setting (Reha) 32, Nursing home
etc (NH) 25.
Results: Show 3 days average. Total energy 1835 ± 137 kcal,
Protein 69.5 ± 5.9 g, Lipid 45.4 ± 5.0g, Carbohydrate 277 ±
28.5g. Energy ratio Protein 15.1 ± 0.9%, Lipids 22.0 ± 0.7%,
Carbohydrate 61.0 ± 3.2%. Salt 8.3 ± 1.3 g,VA 946 ± 1256 (μg
RAE), VB1 1.10 ± 0.49 (mg), VB2 1.15 ± 0.19 (mg),VB6
1.35 ± 0.25(mg), VB12 6.91 ± 18.46 (μg), VC 115.5 ± 30.9 (mg),
VD 16.2 ± 42.6 (μg), VE 7.96 ± 4.26 (mg), Potassium 2324 ± 662
(mg), Calcium 623 ± 87.7 (mg), Iron 9.19 ± 3.34 (mg), Zinc
8.89 ± 4.15 (mg), Copper 1.39 ± 1.49 (mg), Phosphorus 1046 ±
91.8 (mg). Total energy doesn’t corre1late with VB1 r = 0.114
( p = 0.164), VB2 r = 0.024 ( p = 0.820). But it correlate with
Phosphorus r = 0.533 ( p = 5.41E-8).
0.61 ± 0.26 mg VB1 per 1000 calories. AC 0.54 ± 010, Reha
0.60 ± 0.24, NH 0.56 ± 0.18 respectively
Dietary Reference Intakes for Japanese (2015) says, the
recommended dietary allowance for VB1 (thiamine hydrochlor-
ide) is 0.54 mg per 1000 calories. This sentence means the
recommended dietary allowance for thiamine is 0.45 mg per
1000 calories. Judging from this figure, 54.3% of facilities are
short of thiamine. On the other hand, FAO/ WHO joint report
(1967) 1 says, the recommended intake for thiamine is 0.40 mg
per 1000 calories. Judging from this figure, 18.1% of facilities
are short of VB1.
Conclusion: Japanese hospital. ordinary meal contains much
VB12, Copper and Phosphorus, less VE and Calcium. VB1 part of
Dietary Reference Intakes for Japanese might need review.
Reference
1. World Health Organization Technical Report series No362. FAO
Nutrition Meeting Report Series No.41. Requirements of Vitamin A,
Thiamine, Riboflavin and Niacin.
Disclosure of Interest: None declared.
MON-P298
THE PREVALENCE OF VITAMIN D DEFICIENCY IN PATIENTS
WITH INFLAMMATORY BOWEL DISEASE
N. G. Ünal1, N. Oruç1 *, A. Ö. Özütemiz1. 1Gastroenterology, Ege
University Faculty of Medicine, İzmir, Turkey
Rationale: It’s well known that thevitamin D deficiency may
predispose a higher disease activity, suboptimal response to
treatment and higher incidence of hospitalization in IBD
patients.1 On the other hand IBD patients maybe at an
increased risk for low serum 25 (OH) D levels cause of disease
Poster
releated conditions.1 The aim of the study is to determine the
vitamin D deficiency of the IBD patients in a referal center.
Methods: IBD patients admitted to outpatient clinic between
january 2016-january 2017 were retrospective evaluated.
Diseases activity, location, extraintestinal complications and
medical history were recorded from charts. Serum biochemical
parameters and serum vitamin D levels were measured on day
of admission. Body mass index and mini nutrutional assesment
test (MNA) were recorded. Vit D levels were categorised as
follow; <25 mmol was defined as severe deficiency, 25–50 mmol
as mild deficiency and 50–125 mmol as normal.
Results: Fortynine (42%) patients have the diagnosis of Crohn’s
disease and 68 of patients (58%) were ulcerative colitis. The
mean age was 45,7 years, mean BMI 24 kg/m2. A total of 117
patients were 58 women. Out of 117 patients %17 had severe,
37% had mild, 46% had normal vit D levels. Twenty of the
patients (17%) were malnourished, 45(37%) were at risk of
malnutrition and 52(46%) were normal. Relation between
disease related paremeters and Vit D levels were analysed.
No statistical relation between of vitamin d deficiency and
disease parameters such as age, gender and body mass index
(BMI) and nutritional status were found.
Conclusion: Vit D deficiency is common among the IBD patients
and it should be take into account of worse disease outcome.
Reference
1. Pallav Kumar, Riche Daniel, May Warren L, Sanchez Patrick,
Gupta Nitin K . Predictors of vitamin D deficiency in inflammatory
bowel disease and health: A Mississippi perspective. World J
Gastroenterol 2017 January 28; 23(4): 638–645.
Disclosure of Interest: None declared.
MON-P299
VITAMIN D LEVELS AND DEFICIENCY RISKS ANALYSIS IN
SPANISH TOP ATHLETES
N. Palacios1 *, E. Saura2, J. Fernández3, G. Elvira2, E. Diaz1.
1
Centro de Medicina del Deporte, AEPSAD, Consejo Superior de
Deportes, Madrid, 2Hospital Clínico Universitario Virgen de la
Arrixaca, Murcia, 3Centro de Medicina del Deporte, AEPSAD.
Consejo Superior de Deportes, Madrid, Spain
Rationale: Describe Vitamin D levels in athletes of different
sports and to investigate the influence of sport(indoor or
outdoor)and the season of the year when the samples were
taken(autumn/winter or spring/summer).
Methods: From February 2016 to February 2017 we included
126 athletes who had their annual medical examination at
Sports Medicine Center High Sport Council (49 female, 77 male,
average age 24.4 ± 6.1, 23 ± 2.7 IMC, 13.03 ± 6.7 fat percent-
age, 17 Gymnastics, 37 Field Hockey, 12 Boxing, 27 Basketball,
7 Handball and 18 Rowing) Vitamin D levels were determined by
radio immunoanalysis.
Results: According to the European Guidelines of
Endocrinology, normal levels of Vitamin D are defined as
those over 30 ng/ml, insufficiency between 20.05–30 ng/ml
and deficiency below 20 ng/ml.
According to the sport, there was significantly more insuffi-
ciency-deficiency in boxing, gymnastics and handball( p <
0.001)being all of them indoor sports.
In Field Hockey, of 5 goalkeepers 1(20%)deficiency and 2(40%)
insufficiency, of 32 field players 6(18.7%)had insufficiency, no
cases of deficient levels. The prevalence of insufficiency-
Vitamins, antioxidants and minerals 2 S289

deficiency among goalkeepers was 60%,significantly higher Table 1: Univariate binary logistic regression analysis for AMD versus no AMD,
than the 18.7%among field players( p < 0.001)Of 17gymnastic adjusted for age and gender.
athlets who showed low vitamin D levels in the beginning of the OR 95%Cl p
follow-up showed an adverse evolution in the absence of
Vitamin A 1.0 0.99–1.0 0.011
treatment, with a mean decrease of 5.5 ± 5.3 ng/ml after 1 Lutein + zeaksantin 1.0 0.99–1.0 0.003
year( p < 0.01) Carotenoids 0.70 0.61–0.93 0.036
Vitamin C 0.97 0.80–1.03 0.000
Vitamin E 0.76 0.63–0.88 0.130
Mean Vitamin D(ng/ml) Athletes Zinc 0.38 0.20–0.50 0.002
Selenium 1.49 0.22–98.3 0.853
Indoor 31.6 ± 14.1 71(56%) Dietary antioxidant capacity 1.0 0.99–1.00 0.094
Outdoor 41.6 ± 12.2 55(44%)
Autumn/Winter 23.4 ± 9.7 36(29%)
Disclosure of Interest: None declared.
Spring/Summer 41 ± 12.5 90(71%)
Normal 44.5 ± 9.8 80(63.4%)
Insufficiency 24.7 ± 2.7 29(23.01%) MON-P301
Deficiency 14.9 ± 3.8 17(13.4%)
RELATIONSHIP BETWEEN SERUM 25-HYDROXYVITAMIN D
(p < 0.001) LEVELS AND FALL RISK AS MEASURED BY DYNAMIC STABILITY
AND MOBILITY-RELATED OUTCOMES IN OLDER ADULTS
Conclusion: In our study, a high percentage of athletes showed
T. Lockhart1 *, S. Garvey2, O. Kelly2. 1Biomedical Engineering,
inadequate Vitamin D levels according to current guidelines.
Arizona State University, Mesa, 2Abbott Nutrition R&D,
With these results, we recommend vitamin D levels to be
Columbus, United States
determined in this population in order to avoid its deficiency
and the possible negative effects, above all in those at higher Rationale: Sufficient vitamin D is critical for infant and
risk(indoor sports and those with low solar exposure) childhood bone growth, yet additionally implicated in chronic
Disclosure of Interest: None declared. disease risk in adults. In particular, low circulating levels of the
vitamin D catabolite, 25-hydroxyvitamin D [25(OH)D], have
MON-P300 been reported to be related to decreased muscle function and
THE ASSOCIATION BETWEEN DIETARY INTAKE OF increased risk of falls in older adults.
ANTIOXIDANTS AND AGE RELATED MACULAR DEGENERATION Methods: A total of 34 older adults (mean age: 82 years
old ± 4.1 years; 21 females; 13 males) were studied. Serum 25
S. Arslan1 *, S. Kadayıfçılar2, G. Samur1. 1Nutrition and
(OH)D levels were classified as relatively high (>40 ng/ml),
Dietetics, 2Department of Ophthalmology, Hacettepe
medium (30–40 ng/ml), or low (<30 ng/ml). Dynamic stability
University, Ankara, Turkey
parameter linked to fall risks (root mean square ratio-RMSR)
Rationale: In current data, the effect of the intake of was assessed using the inertial sensors at the trunk segment in
carotenoid and antioxidant increased with diet on AMD is not anterior-posterior (AP) and medial-Lateral (ML) directions
coherent. This study was planned with the aim of the possible during 2 minute walking task. The RMSR is the ratio between
effect of nutrition on the occurrence of disease was evaluated the RMS value in Vertical, Mediolateral, Anterior-Posterior
by comparing healthy individuals with dietary total antioxidant Direction and the RMS vector Magnitude. Additionally, mobility
capacity. parameters were derived using the ABC scores.
Methods: Total 200 (100 study group, 100 control group), >50 Results: A significant differences were found between the RMS
years old participants in Hacettepe University are attended to ratio in Medial-Lateral direction during normal walking for the
the study. By using food intake frequency amounts, dietary three groups (F-ratio = 3.751, p = 0.045). The mean (LSM) value
total antioxidant capacity was tried to be determined of RMSR in Medial-Lateral direction during normal walk in the
approximately with the use of data obtained from a large- INS group is higher than the HS and LS group for the sample
scale study made by Carlsen (Carlsen et al. 2010) for developing population. The mean of RMSR in Medial-Lateral Direction is
a database including total antioxidant component of essential 0.097 for HS, 0.12 for LS and.13 for INS groups. Dynamic
nutrients. stability and mobility were closely linked to their vitamin D
Results: While the dietary total antioxidant activity of case serum levels (r = .82). Furthermore, risk of falls (both indoors
group was 1232.8 ± 346.6 mmol/day, it was 1490.6 ± 501.8 and outdoors) were associated with vitamin D serum levels
mmol/day in control group. The dietary total antioxidant below 35 ng/ml similar to normal mobility function.
activity of control group was found statistically higher than Conclusion: To summarize, older adults with serum 25(OH)D
case group ( p < .001). levels lower than 35 ng/ml may benefit from vitamin D
When food intake frequencies were analyzed; it was found that supplementation to improve or maintain mobility and stability.
the individuals, who intake carotenoids, vitamin c, vitamin e References: none
and zinc higher, have lower risk of disease (respectively Disclosure of Interest: None declared.
OR:0.70, OR:0.97, OR:0.76, OR:0.38). (Table 1).
Conclusion: Consequently, in our study, compared with healthy
individuals, and their dietary total antioxidant intake was also
found lower, compared with healthy individuals. We found that
participants who had higher intake of carotenoids, vitamin c,
vitamin e and zinc have lower risks of AMD.
S290
MON-P302
PREVALENCE OF VITAMIN D3 ON INTESTINAL FAILURE-
ASSOCIATED LIVER DISEASE IN SHORT BOWEL SYNDROME: A
PILOT STUDY
Y. Li1 *, S. Fan2. 1Department of Surgery, Shanghai Ninth
People’s Hospital, Shanghai Jiaotong Univesity School of
Medicine, Shanghai, 2Department of Surgery, Gulou Hospital,
Nanjing Univsersity School of Medicine, Nanjing, China
Rationale: The aim of this study was to investigate the
protective effect of vitamin D3 on intestinal failure associated
liver disease.
Methods: From July 2014 to July 2015, we recruited 11 patients
with short bowel syndrome who were treated in our center and
met the inclusion criteria. We assigned them into two groups
randomly: control group and experimental group. In the
experimental group, patients were given an oral vitamin D3
supplementation. The dose and duration of vitamin D3
supplementation was 800 IU/time three times daily for one
month. Blood samples were collected each week for analysis of
liver function.
Results: Serum bilirubin and liver enzyme were highly
increased in control group than that in experimental group
(P < 0.05). After four weeks, there were significant differences
as to serum bilirubin and liver enzyme between control group
and experimental group, the intestinal failure associated liver
disease relevant indicators of experimental group were
significantly better than that of control group.
Conclusion: Supplementation of vitamin D3 was effective in
the protection of intestinal failure associated liver disease in
patients with short bowel
Disclosure of Interest: None declared.
Late Breaking Abstract 2
MON-LB303
SELENIUM STATUS AND DNA INTEGRITY IN CRITICALLY ILL
PATIENTS WITH SIRS
E. Planells1 *, J. Molina-López1, L. Herrera-Quintana1,
B. Quintero-Osso2, M. Rodriguez-Elvira3, A. Pérez de la Cruz4,
I. Pérez-Moreno1, Y. Gamarra-Morales1. 1Physiology,
2
Physicochemical, University of Granada, Spain, 3Unidad
Critical Care, Hospital Universitario Granada, 4Nutricion,
University of Granada, Spain, Granada, Spain
Rationale: Selenium deficient status could affect the integrity
of DNA and clinical course during the patient’s stay in the
intensive care unit (ICU), and together with hypercatabolic
state, could result in an increase of oxidative stress which has
been recognized as a central mechanism in the pathophysiology
of critical illnesses, particularly the appearance of multiorgan
failure.
Methods: A blood sample was obtained on the day of admission
in the ICU from 65 critically ill patients in Granada province
(southern Spain) who fulfilled the inclusion criteria, i.e.,
presence of systemic inflammatory response syndrome (SIRS)
and APACHE score >15 (among others). Plasma concentration of
selenium and erythrocyte concentration of GPx enzyme were
determined. Selenium was measured with inductively coupled
plasma mass spectrometry (ICP-MS). GPx was measured
Poster
indirectly as enzyme activity (reduction of organic peroxides
by c-GPx). Comet assay was carried on for the analysis of DNA
integrity.
Results: On admission to the ICU, GPx enzyme activity was
below the reference value (<5.6 U/mL) in 65,4% of the
patients, and this proportion had increased significantly to
87,2% ( p < 0.05) by day 7 of their ICU stay. Normal activity levels
were not seen in any of the patients (>24 U/mL). Mean plasma
concentration of selenium was 53 ± 10.5 μg/dL, and on the
day of admission 67.7% of the patients were selenium deficient.
By day 7 of their ICU stay this proportion had increased
significantly to 100% ( p < 0.05). A significant association
( p < 0.05) was found between both, GPx activity and Se
plasma levels, with DNA integrity at the end of the stay.
Conclusion: During their ICU stay, antioxidant GPx enzyme
activity and plasma concentration of selenium decreased in the
critical care patients. This selenium deficiency can lead to
increased oxidative stress and an increased DNA damage during
ICU stay. This situation can exhaust the available plasma stores
of this trace element in which patients depend on. In patients
admitted to the ICU, selenium support should be monitored in
order to ensure optimum antioxidant response and palliate the
adverse effects of this nutritional deficiency.
Disclosure of Interest: None declared.
MON-LB304
FOLLOW-UP OF BIOELECTRICAL IMPEDANCE ANALYSIS (BIA)
IN THE CRITICALLY ILL
K. Dams1 *, N. Van Regenmortel2, P. G. Jorens1. 1Intensive Care
Medicine, Antwerp University Hospital, Edegem, 2Intensive
Care Medicine, Ziekenhuis Netwerk Antwerpen Campus
Stuivenberg, Antwerp, Belgium
Rationale: To assess the time course of BIA parameters (Xc
(reactance), Rz (resistance), PhA ( phase angle)), as well as
their association with intensive care (ICU) mortality in critically
ill patients.
Methods: We conducted a longitudinal, single-centre, obser-
vational cohort study in a mixed ICU-setting. In 73 adult
patients, estimated to be mechanically ventilated for >48 h, Xc
and Rz were measured (BIA 101 Akern SRL, Italy; 800 mA, 50-
kHz alternating currents) within 48 h of admission, PhA was
calculated. BIA was reassessed on a weekly basis, at discharge
and 180 days after admission. We also collected data on age,
gender, body weight, BMI and severity of disease (SAPS-3
score). We graphically explored the evolution of Rz, Xc and PhA
over time, dichotomized by ICU mortality. Univariable logistic
regression models of the different BIA-parameters were
constructed with ICU-mortality as the outcome variable.
Finally, the models were adjusted for confounding by introdu-
cing age, BMI and SAPS-3.
Results: 73 patients were studied (51% survived). Already
within 48h of admission, PhA was significantly lower in non-
survivors compared to survivors (2.8 vs 3.7; p = 0.02) While PhA
in non-survivors was consistently low, it decreased gradually
over time in survivors, only recovering after discharge.
Univariable logistic regression models show a clear association
between mortality and BIA parameters at admission: Xc (OR
0.96, p = 0.048; 95%CI 0.93–0.10) and PhA (OR 0.72, p-value
0.039, 95% CI 0.53–0.98). After introducing age, BMI and SAPS-
3, however, this association ceased to be significant.
Late Breaking Abstract 2 S291

Conclusion: Xc and PhA, assessed shortly after admission in MON-LB306

mechanically ventilated critically ill patients, act as markers of PROTEIN INTAKE AND CLINICAL OUTCOME IN ICU PATIENTS: A
severity of disease and outcome. They do not improve, SYSTEMATIC REVIEW AS A BASIS FOR ESPEN GUIDELINES
however, the prognostic power of the current ICU-score. In DEVELOPMENT
survivors, they recover only after discharge. M. Guadagni1 *, M. T. Streppel2, C. Schuurman2, G. Biolo1,
Disclosure of Interest: None declared. Y. Boirie3, O. Rooijackers4, J. Kondrup5, P. J. Weijs2,6,7.
1
Department of Medical, Surgical and Health Sciences, Clinica
MON-LB305 Medica, ASUITs, University of Trieste, Trieste, Italy, 2Faculty of
EARLY ENERGY OVERFEEDING IS ASSOCIATED WITH HIGHER Sport and Nutrition, Amsterdam University of Applied
MORTALITY IN ICU PATIENTS WITH REFEEDING Sciences, Amsterdam, Netherlands, 3Human Nutrition Unit,
HYPOPHOSPHATEMIA, A RETROSPECTIVE STUDY Department of Clinical Nutrition, University of Clermont
Auvergne, Clermont-Ferrand, France, 4Department of Clinical
M. Guadagni1 *, W. G. Looijaard2, M. Tieland3, G. Biolo1,
Science, Intervention and Technology Clintec, Karolinska
H. M. Oudemans-van Straaten2, P. J. Weijs2,3,4. 1Department of
Institutet, Stockholm, Sweden, 5Clinical Nutrition Unit,
Medical, Surgical and Health Sciences, Clinica Medica, ASUITs,
Rigshospitalet University Hospital, Copenhagen, Denmark,
University of Trieste, Cattinara University Hospital, Trieste, 6
Department of Nutrition and Dietetics, Internal Medicine,
Italy, 2Department of Intensive Care Medicine, VU University 7
Department of Intensive Care Medicine, VU University
Medical Center, 3Faculty of Sport and Nutrition, Amsterdam
Medical Center, Amsterdam, Netherlands
University of Applied Sciences, 4Department of Nutrition and
Dietetics, Internal Medicine, VU University Medical Center, Rationale: Recent evidence suggests that enhancing protein
Amsterdam, Netherlands intake can attenuate catabolic response and improve outcome
in critically ill patients. Optimal protein intake is still debated;
Rationale: The relationship between early energy delivery and
current guidelines indicate as target 1.2–1.5 g/kg/day and
outcome in ICU patients with refeeding syndrome has been
expert opinion even higher intake. Solid data on the effect of
scarcely investigated1. We hypothesized that early overfeeding
protein intake on clinical and functional outcome parameters
would be associated with increased mortality in patients
are lacking.
developing refeeding hypophosphatemia.
Methods: We performed a systematic review to assess the
Methods: We included ventilated ICU patients from our
evidence behind protein intake and hospital outcome in ICU
nutritional database with energy expenditure (EE) measured
patients, focusing on clinical and functional outcome based
by indirect calorimetry. Refeeding hypophosphatemia was
studies. MEDLINE was searched for original articles published
defined as a decrease of serum phosphate to ≤0.65 mmol/L
up until June 2017. Quality assessment was done according to
within 72h after starting nutrition; early energy overfeeding as
guidelines devised by the Nordic Nutrition Recommendations
mean energy intake in the first 2 days ≥100% of measured EE.
(NNR) 5 Working Group. The level of evidence was graded as
Cox regression analysis, adjusted for age, BMI and APACHE II
convincing, probable, suggestive or inconclusive.
score, was performed in patients developing refeeding hypo-
Results: A total of 28 full text articles were included in the
phosphatemia and patients who did not (as suggested by
systematic review: 15 randomized clinical trials (RCTs) and 13
statistical interaction).
prospective cohort studies. Overall, protein intake was low, not
Results: A total of 646 patients were included. Mean age was
achieving current recommendations in 72% of the studies. The
63 ± 16 years, BMI 26 ± 5.9 kg/m2 and APACHE II 23 ± 8.
evidence was graded as suggestive for an association between
Refeeding hypophosphatemia developed in 273 (42.3%)
higher protein intake and lower mortality in ICU patients. The
patients. Hospital mortality was 31.9% vs. 39.5% in the
limited amount of studies and low actual intake of protein
refeeding and non-refeeding cohort respectively (P = 0.057).
preclude conclusions on other outcomes, such as duration of
Early energy overfeeding was an independent risk factor for
mechanical ventilation, length of hospital and ICU stay, and
hospital mortality in patients with refeeding hypophosphate-
nosocomial infection. From two studies included in the review,
mia (HR = 3.19, 95% CI 1.16–8.79, P = 0.025), but not in patients
a promising positive role of protein on physical performance
without (HR = 1.71, 95% CI 0.73–4.02, P = 0.217). Hospital
emerged.
mortality was significantly higher in overfed compared to
Conclusion: Future RCTs, matching recommended protein
non-overfed patients only in the refeeding hypophosphatemia
target (or even higher target) and comparing different
cohort (71.4% vs. 30.6%, P = 0.022).
protein intake, are urgently needed to assess the evidence
Conclusion: Energy overfeeding in the early phase of
behind protein intake in ICU patients.
critical illness is specifically associated with high hospital
mortality in ventilated ICU patients developing refeeding Disclosure of Interest: None declared.
hypophosphatemia.
Reference
1. Doig et al. Lancet Respir Med. 2015
Disclosure of Interest: None declared.
S292
MON-LB307
RELATIONSHIP BETWEEN NUTRITIONAL ASSESSMENT AND
NUTRITIONAL ADEQUACY IN ICU
N. Higashibeppu1 *, D. K. Heyland2, on behalf of Investigators
of the International Nutrition Survey. 1Department of
Anesthesia and Critical Care, Kobe City Medical Center
General Hospital, Kobe, Japan, 2Clinical Evaluation
Research Unit, Kingston General Hospital, Kingston,
Ontario, Canada
Rationale: Nutritional assessment at the initiation of nutri-
tional therapy is considered important in the care of critically
ill patients, but there are no reports demonstrating its value.
We examined the effect of the initial nutritional assessment on
subsequent nutritional adequacy.
Methods: Design: Prospective observational cohort. Setting: A
total of 196 ICUs worldwide. Patients: A total of 3943
mechanically ventilated patients in ICU. We omit patients
that received oral intake only. Interventions: none.
We compared the adequacy of nutrition therapy between
nutritional assessed group ( patients which had the target
dosage of energy and protein set at the start of nutrition) and
non-assessed. The primary outcome was the absolute amount
of energy (kcal/kg/day) and protein (g/kg/day) in the first 12
days in ICU, and the secondary outcome was the percentage of
patients who received enteral nutrition and parenteral
nutrition.
Normally distributed continuous variables were analyzed with
T test and the categorical variables were analyzed with the chi-
square test. Also, we conducted a multivariate analysis using
multiple regression analysis and binomial logistic analysis with
assessment, APACHEII score, duration of nutrition evaluable
days, and geographic regions as covariates. SPSS® ver. 23 was
used for statistical analysis.
Results: 3363 cases (85.5%) were assessed nutritionally.
The assessed group were given more energy and protein than
the non-assessed. Energy; mean, 22.4, standard deviation (SD)
11.4 vs 10.7 (11.4) kcal/kg/day, p < 0.01; 95% adjusted
confidential interbal (aCI), 3.19–4.54; Protein: 1.11 (0.65) vs
0.44 (0.55) g/kg/day, p < 0.01; 95% aCI, 0.19–0.26, p < 0.01.
The assessed group received more EN than non-assessed (OR,
6.56; 95%CI, 5.42–7.93), the aOR, 4.3; 95%aCI, 2.97–5.50). The
assessed group received less PN with no clinical reason (OR,
0.26; 95%CI, 0.14–0.46), the aOR, 0.36; 95%aCI;0.24–0.53).
Conclusion: Timely assessment of nutritional requirements
may improve adequacy of nutrition therapy in critically ill
patients.
Disclosure of Interest: N. Higashibeppu Speaker bureau of: Otsuka,
Meiji, Yoshindo, D. Heyland Consultant for: GlaxoSmithKline, Speaker
bureau of: GlaxoSmithKline.
MON-LB308
BENCHMARKING ENTERAL NUTRITION PROVISION IN A NEWLY
ESTABLISHED INTENSIVE CARE UNIT (ICU) IN THE UNITED
ARAB EMIRATES
R. Kaddoura1 *, A. Speedy1. 1Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates
Rationale: The European Society of Parenteral and Enteral
Nutrition (ESPEN) and the American Society of Parenteral and
Enteral Nutrition (ASPEN) recommend the initiation of EN
Poster
within 24–48 hours of admission in the critically ill patient who
is unable to maintain volitional intake. This audit served as a
tool to provide regional data of nutritional practices in ICU, of
which there is minimal published data. The aims were to
determine the time from ICU admission to initiation of enteral
feeding and quantify the amount of calories and protein
delivered to patients over the first five days of ICU admission.
Methods: A prospective observational audit was conducted in
the ICU at Cleveland Clinic Abu Dhabi (CCAD). Patients were
included if they were >18 years old with an expected length of
stay >48 hours and if they were mechanically ventilated within
24 hours of admission. Patients who met the inclusion criteria
had their Electronic Medical Record (EMR) reviewed for date
and time of initiation of EN. For five consecutive days the
patients’ EMR was reviewed to obtain the volume and type of
feed prescribed and delivered. This included the delivery of
any protein modules. All statistical analyses were performed
using Microsoft Excel 2010.
Results: Twenty patients met the inclusion criteria. Enteral
nutrition was started within the first 23 (2–51) hours of
admission. Over the first five days of their ICU admission,
patients received an average of 1268 ± 385 kcal/day. This
translated to an average of 73 ± 22% of their prescribed
energy requirements. Patients also received an average of
61 ± 21 g of protein over the first five days. This translated to
and an average of 68% (±23%) of prescribed protein
requirements.
Conclusion: In the first 16–20 months of operation, the ICU at
CCAD was able to meet international guidelines of early
initiation of enteral feeding in critically ill patients within
24hours. Patients achieve approximately 70% of their prescribed
energy and protein requirements over the first five days.
Disclosure of Interest: None declared.
MON-LB309
NEUROMUSCULAR ELECTRICAL STIMULATION (NMES) MAY
ALTER THE ENERGY SUBSTRATE METABOLISM AND SURVIVAL
OF THE ACUTE ENDOTOXIC SHOCK MICE
T. Irahara1 *, N. Sato2, K. Otake1, S. Murata3, K. Inoue4,
K. Koike3, H. Yokota1. 1Department of Emergency and Critical
Care Medicine, Nippon Medical School, Tokyo, 2Department of
Aeromedical Services for Emergency and Trauma Care, Ehime
University, Matsuyama, 3Department of Primary Care and
Emergency Medicine, 4Laboratory of Nutrition Chemistry,
Graduate School of Agriculture, Kyoto University, Kyoto, Japan
Rationale: We have revealed that low-intensity exercise in the
acute phase of endotoxic shock mice might exert a therapeutic
effect such as improving lipid metabolism and survival by
stimulating PGC-1α expression (PMID:26953756). In this study,
we investigated whether neuromuscular electrical stimulation
(NMES) also have a similar effect.
Methods: C57BL/6 mice were given 20 mg/kgBW of lipopoly-
saccharide (LPS) intraperitoneally and divided into C (control)
group and NMES groups (n = 10–12/group). NMES to the bilateral
gastrocnemius muscle was performed to NMES groups for 1
hour. Frequency and voltage were set to low-frequency
(LF = 2 Hz) or high-frequency(HF = 50 Hz) and low-voltage
(LV = 10V) or high-voltage(HV = 50V). The alterations of energy
metabolism were measured using indirect calorimetry until 24
hours after NMES. Survival proportions were also measured
Late Breaking Abstract 2 S293

until 72 hours after LPS administration. Next, in LF-LV and LF-

FiO2 [%] VO2_Deltatrac® VO2_Quark RMR®
HV group, NMES was performed twice to compare with [ml/min] [ml/min]
those receiving once. Lastly, PGC-1α expression after NMES
Infinity 500® 39.5 (0.2) 241 (11) 238 (9)
was evaluated in liver and gastrocnemius muscle by quantita- S1® 40.2 (0.5) 250 (10) 267 (37)
tive PCR.
Results: NMES altered the energy substrate metabolism and
survival depending on its conditions. In LF-LV group, fatty acid Conclusion: Stability of FiO2 provided by the mechanical
oxidation (FAO) increased ( p < 0.05) and carbohydrate oxida- ventilators greatly influenced the VO2 measured by the breath-
tion (CHO) decreased ( p < 0.05). In LF-HV group, FAO also by-breath indirect calorimeter. This point should be addressed
increased ( p < 0.01) and CHO did not change. In HF-LV group, in future development and validation studies of ICs for
both FAO and CHO did not change. In HF-HV group, FAO mechanically ventilated subjects.
markedly increased ( p < 0.0001) and CHO did not change. Disclosure of Interest: T. Oshima Grant/Research Support from: Public
Survival proportions significantly improved only in LF-LV group Foundation Nutrition 2000plus, Geneva University Hospital, Other:
( p < 0.01). When NMES was performed twice in LF-LV group, COSMED, Nestle, C.-P. Heidegger Other: Baxter, Nestle Nutrition, A.-M.
both FAO and CHO tended to increase. In LF-HV group, FAO Makhlouf: None declared, S. Graf: None declared, Y.-M. Dupertuis:
increased and CHO did not change. Survival proportions None declared, C. Pichard Grant/Research Support from: Swiss
National Science Foundation, Nestle Nutrition, Baxter, BBraun,
significantly improved in LF-HV group ( p < 0.05) and worsened
Fresenius-Kabi, COSMED, Consultant for: Baxter, Abbott, BBraun,
in LF-LV group ( p < 0.05) compared with those receiving once. COSMED, Fresenius-Kabi, Novartis, Danone, Pfizer, Solvay, Vifor.
PGC-1α expression after NMES once in LF-LV group and twice in
LF-HV group was significantly upregulated ( p < 0.05) in
gastrocnemius muscle. MON-LB311
Conclusion: NMES may exert a therapeutic effect especially IN-VITRO VALIDATION OF THE NEW INDIRECT CALORIMETER
under the conditions that mildly change energy metabolism AGAINST MASS SPECTROMETRY MEASUREMENTS IN
from glucose into lipid predominance. These effects may occur SIMULATED GAS EXCHANGE
through PGC-1α upregulation like exercise intervention. T. Oshima1 *, Y.-M. Dupertuis1, S. Graf1, A.-M. Makhlouf1,
Disclosure of Interest: None declared. M. Ragusa2, C.-P. Heidegger3, C. Pichard1. 1Clinical Nutrition,
Geneva University Hospital, Geneva, 2Research and
Development, Cosmed Srl, Rome, 3Service of Intensive Care,
MON-LB310
Geneva University Hospital, Geneva, Switzerland
CAN MECHANICAL VENTILATORS AFFECT INDIRECT
CALORIMETRY MEASUREMENTS? Rationale: This study aimed at validating the accuracy of the
T. Oshima1 *, C.-P. Heidegger2, A.-M. Makhlouf1, S. Graf1, new IC developed for the ICALIC study1 (Q-NRG; Cosmed, Italy)
Y.-M. Dupertuis1, C. Pichard1. 1Clinical Nutrition, 2Service of by simulating human gas exchange under mechanically venti-
Intensive Care, Geneva University Hospital, Geneva, lated condition in the in-vitro setting. Gold standard mass
Switzerland spectrometer (MS) was used in the gas composition analysis of
the reference IC using the mixing chamber technique.
Rationale: Stability of inhaled O2 fraction (FiO2) is important Methods: Mechanical ventilator (Dräger, Germany) generated
for the stable O2 consumption (VO2) measurement in indirect respiratory cycles at different FiO2 (21, 40, 60%). Simulator
calorimetry. We measured the FiO2s generated by 2 different circuit consisting of a test lung and mass flow controller
ventilators, and investigated the effect of FiO2 stability on (Bronkhorst, Germany) was connected in place of the patient.
the VO2 measurements by different indirect calorimetry CO2 gas mixtures of equal concentrations to the FiO2 (21, 40,
techniques. 60%) were injected into the circuit to simulate CO2 production
Methods: FiO2s of Infinity 500® (Dräger, Germany) and S1® (VCO2) and O2 consumption (VO2) of 250 ml/min. Measurements
(Hamilton Medical, Switzerland) mechanical ventilators by the Q-NRG were compared with the reference IC.
adjusted to 40% were measured by a quadruple mass Results: Means of 10 measurements by the Q-NRG (VO2,
spectrometer (MAX300-LG®, Extrel) calibrated to measure O2 VCO2_Q-NRG) were within 3% of the reference IC measure-
and CO2 gas concentrations. CO2 gas mixture (40%, balance N2) ments (VO2, VCO2_MS) in all test conditions.
was injected into the pneumatic circuit of the mechanical
ventilators using precision mass flow controllers to simulate
VO2 and VCO2 of 250 ml/min. Indirect calorimetry was FiO2 VO2_Q-NRG VO2_MS VO2_Diff VCO2_Q-NRG VCO2_MS VCO2_Diff
conducted using devices with different technologies: mixing (%) (ml/min) (ml/min) (%) (ml/min) (ml/min) (%)
chamber (Deltatrac®, Datex, Finland) and breath-by-breath 21 236 243 −3.0 239 240 −0.5
(Quark RMR®, Cosmed, Italy). Stability was evaluated as 40 246 250 −1.2 249 247 + 0.9
60 222 228 −2.8 233 233 + 0.1
accuracy and precision: accuracy was defined as closeness of
the measured values to the supposed values, and precision was
defined as smaller standard deviation (SD). Conclusion: Excellent agreement between the Q-NRG and the
Results: Results are presented as mean (SD). Infinity 500 reference IC measurements confirms the accuracy of the
presented better FiO2 precision while S1 presented better measurement by the Q-NRG in the clinically relevant conditions
accuracy. Deltatrac measured the simulated VO2 accurately and simulated in the in-vitro setting.
precisely, regardless of the type of ventilator. Imprecision of Reference
FiO2 by S1 had great influence on the precision and accuracy of
1. International multicenter study for the development and validation
the VO2 measurement by Quark RMR®.
of a new indirect calorimeter, sponsored by ESPEN.
S294
Disclosure of Interest: T. Oshima Grant/Research Support from: Public
Foundation Nutrition 2000plus, Geneva University Hospital, Other:
COSMED, Nestle, Y.-M. Dupertuis: None declared, S. Graf: None
declared, A.-M. Makhlouf: None declared, M. Ragusa Other: COSMED,
C.-P. Heidegger Other: Baxter, Nestle Nutrition, C. Pichard Grant/
Research Support from: Swiss National Science Foundation, Nestle
Nutrition, Baxter, BBraun, Fresenius-Kabi, COSMED, Consultant for:
Baxter, Abbott, BBraun, COSMED, Fresenius-Kabi, Novartis, Danone,
Pfizer, Solvay, Vifor.
MON-LB312
QUALITY INDICATOR FOR NUTRITIONAL MANAGEMENT OF
HOSPITALIZED PATIENTS
A. L. C. C. Rodrigues1 *, A. N. Severine1, A. Yamaguti1.
1 male: 58.2%), aged 19–65 years, admitted to hospital,
Nutrition, Hospital Sírio-Libanês, São Paulo, Brazil
Rationale: Malnutrition can adversely affect the clinical
evolution of hospitalized patients, increasing the incidence of
infections, associated diseases and postoperative complica-
tions and prolonging the length of stay and hospital costs.
The aim of this study is to evaluate the efficacy of nutritional
management to hospitalized patients through a quality
indicator.
Methods: This study describes the monitoring of the indicator
to evaluate the quality of nutritional care in order to facilitate
the diagnosis of nutritional disorders and the follow-up of
dietary interventions. A database containing information on
nutritional markers such as the presence of edema, changes in
laboratory tests, altered anthropometric variables (Body
Mass Index, Calf Circumference in the elderly over 60 years,
Brachial Circumference and Bioelectrical Impedance analysis)
has been obtained. Three quality indicators have been
monitored: improvement of nutritional status, maintenance
of nutritional status and worsening of nutritional status, being
monitored every 10 days of hospitalization of each patient at
nutritional risk.
Results: 7936 patients at nutritional risk have been evaluated
between March 2016 and March 2017. From those 677 patients
presented improvement in nutritional status, 6.515 main-
tained nutritional status and 744 worsened their nutritional
status. All patients with worsening nutritional status received
individualized nutritional interventions to ensure the best
therapy for clinical recovery or quality of life. The average
nutritional interventions were: 11 enteral/parenteral nutri-
tion therapy adjustments; 5 proteins, lipids and fiber modules
introduction; 13 nutritional supplements introduction or
adaptation and 10 dietary changes to improve food
acceptance.
Conclusion: It is paramount to systematically evaluate the
nutritional status of patients at nutritional risk for adequate
interventions in the prevention and treatment of malnutrition.
Reference
Kondrup J, Allison SP, Elia M, et al. ESPEN Guidelines for Nutrition
Screening 2002. Clin Nutr 2003; 22(4):415–21.
Disclosure of Interest: None declared.
Poster
MON-LB313
EVALUATION OF NUTRITIONAL STATUS IN PRE-OPERATIVE
PATIENTS WITH GASTROINTESTINAL SYSTEM CANCER WITH
TWO DIFFERENT NUTRITIONAL SCREENING TOOLS
A. Sahin Kaya1 *, A. G. Pekcan2. 1Nutrition and Dietetics, Namık
Kemal University School of Health, Tekirdağ, 2Nutrition and
Dietetics, Hasan Kalyoncu University School of Health,
Gaziantep, Turkey
Rationale: To determine the nutritional status of gastrointes-
tinal cancer patients with two different nutritional screening
tools and compare the tools.
Methods: This study was held in 110 patients (female; 41.8%
diagnosed with gastrointestinal system cancer (not operated).
The objective was to determine the nutritional status of the
patients with nutrition screening tools (Subjective Global
Assessment-SGA, Nutritional Risk Screening-NRS 2002),
compare the tools, and describe the malnutrition status of
patients. Socio-demographic characteristics, anthropometric
measurements, biochemical parameters and 24-hour dietary
recalls, frequency of foods consumed were determined.
Results: Out of total, 54.7% of males and 56.5% of females had
normal Body Mass Index-BMI. Using SGA, 49.1% of the patients
had serious, 41.8% had moderate degree of malnutrition.
According to NRS-2002, percentages of severely, moderately
and mildly undernourished patients were 54.6%, 33.6% and
11.8%, respectively. The percentage of patients meeting the
recommended daily allowances was 47.2% and 58.1%, respect-
ively for males and females. According to NRS and SGA tools,
statistically significant differences with current weight, ideal
body weight, usual body weight, percentage of weight loss,
BMI, mid-upper arm circumference, triceps skinfold thickness,
mid-upper arm muscle area, mid-upper arm muscle circumfer-
ence and mid-upper arm fat area ( p < 0.05) were found.
Nutritional status of patients with SGA and NRS tests showed
consistent similarity (κ = 0.671, p < 0.001). Similar changes
were found between SGA and NRS scores. Consistency was
found statistically significant (r = 0.786 and p =< 0.001).
Conclusion: One of the malnutrition screening tools could be
preoperatively applied in gastrointestinal system cancer
patients. Nutritional support should be planned and adminis-
tered, when needed.
Disclosure of Interest: None declared.
MON-LB314
AN EVALUATION OF THE SUGGESTED ESPEN MALNUTRITION
CRITERIA IN LIGHT OF THE CRITERIA FOR MALNUTRITION AS
PRESENTED IN THE NORWEGIAN NATIONAL GUIDELINES
H. K. Brekke1, E. Hoeisaether1, C. Holth1 *. 1University of Oslo,
Oslo, Norway
Rationale: The European society of clinical nutrition and
metabolism (ESPEN) recently published a consensus for
malnutrition criteria. Our aim was to evaluate the newly
suggested ESPEN malnutrition criteria (EMC) in light of the
currently used Norwegian national criteria for malnutrition
(ICD-10 NO) in cancer patients. Furthermore, we aimed to
examine the overlap between the three ESPEN criteria, and
whether bioelectrical impedance analysis (BIA) could replace
Late Breaking Abstract 2
dual energy X-ray absorptiometry (DXA) as method for
determining Fat Free Mass Index (FFMI).
Methods: We recruited 69 outpatient cancer patients. The
patients were assessed for nutritional risk using Patient-
Generated Subjective Global Assessment (PG-SGA) and
Nutrition risk screening 2002 (NRS-2002), and considered for
malnutrition using the EMC and the ICD-10 NO. FFMI was
measured using DXA (Lunar iDXA, GE Healthcare) and BIA (Seca
BCA 515).
Results: Initial assessment by PG-SGA and NRS-2002 showed
that 41 (59.4%) and 31 (44.9%) patients were at nutritional risk,
respectively. EMC and ICD-10 NO identified 16 (23.2%) and 29
(42.0%) patients as malnourished, respectively. The three
ESPEN criteria showed low degree of overlap. Assessment of
FFMI showed similar results using BIA and DXA.
Conclusion: The newly suggested malnutrition criteria by
ESPEN showed limited agreement to the Norwegian malnutri-
tion criteria. The disagreement was primarily caused by EMC
not considering WL alone a criterion for malnutrition. The
criterion including FFMI identified the majority of malnour-
ished patients when using the EMC. BIA (Seca BCA 515) and DXA
(Lunar iDXA GE Healthcare) could be used interchangeably for
assessing FFMI.
Disclosure of Interest: None declared.
MON-LB315
USING ANDHII TO APPLY THE NUTRITION CARE PROCESS AND
ANSWER NUTRITION RESEARCH QUESTIONS
C. Papoutsakis1 *, A. Steiber1. 1Research International
Scientific Affairs, Academy of Nutrition and Dietetics,
Chicago, United States
Rationale: There is limited data on the impact on nutrition care
and related health outcomes, and research tools are lacking to
aggregate data in a systematic fashion.
Methods: The Academy of Nutrition and Dietetics Health
Informatics Infrastructure (ANDHII) is a web-based platform
designed to enter individual patient data and aggregate
outcomes of nutrition interventions. Nutrition professionals
are able to use ANDHII from anywhere in the world via internet
access. ANDHII is based on the Nutrition Care Process (NCP) and
terminology (NCPT: Nutrition Care Process Terminology).
Results: Nutrition care data has been collected on a national
scale (in the US) and internationally (in Australia, New Zealand,
and Singapore). ANDHII has over 2,000 practitioner users
entering case data that contributes to nutrition outcomes
research, education initiatives in academia and practice
placements, quality improvement, and impact demonstration.
To date, 10 clinical projects are collecting data using ANDHII in
different areas of practice including acute care, private
practice, and public health nutrition.
In this poster presentation, we present up-to date data
collection activity by clinical project, usage of most nutrition
assessment terms, diagnoses, and respective nutrition
interventions.
Conclusion: ANDHII makes possible the aggregation of data to
explore the impact of nutrition care on patient outcomes in
different countries and settings. Still, experimental research is
necessary to duplicate findings and account for confounding
factors.
S295
References
Murphy WJ, Steiber AL. A new breed of evidence and the tools to
generate it: Introducing ANDHII. Journal of the Academy of Nutrition
and Dietetics. 2015;115:19–22.
Nutrition care process and model part I: the 2008 update. J Am Diet
Assoc. 2008;108:1113–1117.
Nutrition Care Process Part II: Using the International Dietetics and
Nutrition Terminology to Document the Nutrition Care Process.
Journal of the American Dietetic Association. 2008;108:1291–1293.
Disclosure of Interest: None declared.
MON-LB316
VALIDATION STUDY OF A HANDHELD METABOLIC ANALYZER IN
MEASURING ENERGY EXPENDITURE AND RESPIRATORY
QUOTIENT.
A. Atsalakis1, P. Papadiamantis1, T. Souren1, P. Papageorgiou1,
D. Karagiannis2 *, A. Baschali2. 1Research, Development Team,
2
Clinical Nutrition and Dietetics, Evangelismos Hospital,
Athens, Greece
Rationale: Recently, many new indirect calorimeters were
introduced as a convenient solution to determine resting
metabolic rate (RMR) for assessment of daily energy needs.1
The aim of this study was to report the validity of a new, hand-
held indirect calorimeter device developed by ENDO Medical
Inc.
Methods: Twenty-five (25) healthy volunteers (17 male, 8
female) with an age range 23–60 years old were asked to breath
for at least 5 minutes to a mouthpiece that was connected in
series withthe hand-held device of ENDO Medical and with a
Metabolic Cart (Quark CPET, COSMED) that allowed the
simultaneous analysis of the subjects’ breath by both
devices. The Quark CPET system represents an established
clinical standard that has been validated against clinical and
industrial golden standard devices (Deltratrac, Datex-Ohmeda,
Finland) as well as a Douglas Bag system. Statistical significance
was set at p < 0.05 level and values are presented as mean ± SD.
Results: The system developed by ENDO Medical exhibited
good agreement with the Quark CPET by COSMED with an
average mean difference of −7.1 ± 11.5 mL/min for VO2 ( p =
0.70) and −7.6 ± 11.9 mL/min for VCO2 ( p = 0.78). The 95%
confidence intervals for the limits of agreement were found
within the acceptable range of ±50 mL/min as defined by the
medical grade accuracy standards of indirect calorimetry, using
the Bland-Altman test ([−38, 23] for VO2 and [−39, 24] for
VCO2). The mean energy expenditure measured by both
devices was in a very good agreement as well (2484 ± 475
kCal/day for Quark CPET of COSMED and 2432 ± 482 kCal/day
for the hand-held device of ENDO Medical, p = 0.72).
Conclusion: These data indicate that the handheld metabolic
analyzer that has been developed by ENDO Medical Inc. is in
good agreement with a Metabolic Cart Analyzer, making it
reliable for energy expenditure and RQ measurements based on
the medical grade accuracy criterion of ± 50 mL/min for VO2
and VCO2.
Reference
1. Oshima T, Berger MM, De Waele E, Guttormsen AB, Heidegger CP,
Hiesmayr M, Singer P, Wernerman J, Pichard C. Indirect
calorimetry in nutritional therapy. A position paper by the ICALIC
study group. Clin Nutr. 2017 Jun;36(3):651–662
Disclosure of Interest: None declared.
S296
MON-LB317
NUTRITION-RELATED PROGNOSTIC SCORE FOR HOSPITALIZED
PATIENTS VIA EMERGENCY ROOM
H. Baba1 *, J. Hatakeyama2, H. Ono1, J. Unoura3, Y. Nakayama4,
on behalf of Nutrition support team. 1Surgery, 2Intinsive Care
Medicine, 3Respiratory Medicine, 4Emergency Medicine,
Yokohama City Red Cross Hospital, Yokohama, Japan
Rationale: There are literatures describing the relationship
between abnormal electrolytes and increased in-hospital
mortality among the elderly who are hospitalized via emer-
gency room. However, whether association of nutrition-related
prognostic score in this setting is unknown.
Methods: We retrospectively investigated the relationship
between the nutrition-related prognostic score and the
elderly who were hospitalized at our tertiary emergency
medical center. 185 patients who visited our emergency room
in ten consecutive days starting from January 1, 2015 were
retrospectively reviewed. Obstetric and pediatric emergency
patients were excluded. Serum albumin, C-reactive protein
and leukocytes were investigated and nutritional prognostic
index (NPI), neutrophil-lymphocyte ratio (NLR) and Glasgow
prognostic score (GPS) were calculated. Patients were
classified into three groups, below 65 (group A), between
65 and 80 (group B) and 80 or more (group C). Data analysis
was performed using SPSS software. Continuous variables
were expressed as mean ± SD. Chi-squared test was used to
identify significant differences between proportions and
variables. Kaplan-Meier analysis was used to analyze patient
survival rate. A p value <0.05 was considered statistically
significant.
Results: Among 185 admissions, 151 were eligible for the study.
Median age was 73 (range; 18∼98). NPI of each group was 46.0,
41.2 and 37.6, respectively ( p < 0.05). NLR was 9.7, 10.3 and
13.7, respectively. 54 patients were GPS 0, 44 were GPS 1 and
46 were GPS 2 ( p < 0.05). Hospital stay were longer as age
became higher, group A being 9.5days, group B, 12 days and
group C, 14.5 days. In-hospital mortality rate was 13.2%, group
C being the majority counting 85% of all deaths and was
statistically significant ( p = 0.001). Kaplan-Meier survival curve
showed a trend towards the lower the GPS, the better the
survival.
Conclusion: In-hospital mortality is significantly high in the age
80 or more group. Among several nutrition-related prognostic
scores, GPS may be closely associated to survival among
patients hospitalized via emergency room.
Disclosure of Interest: None declared.
MON-LB318
AGREEMENT BETWEEN RECTUS FEMORIS MUSCLE THICKNESS
BY ULTRASOUND AND SKELETAL MUSCLE MASS BY BIO-
ELECTRICAL IMPEDANCE ANALYSIS: A PILOT STUDY
I. L. Rodenburg1 *, W. Nijholt1, M. J. Sealy2,3, C. P. van de
Schans1,4,5, J. S. Hobbelen1,6, H. Jager-Wittenaar1,2.
1
Research Group Healthy Ageing, Allied Health Care and
Nursing, Hanze University of Applied Sciences, 2Department of
Maxillofacial Surgery, 3Research Group Healthy Ageing, Allied
Health Care and Nursing, 4Departement of Health Psychology
Research, 5Department of Rehabilitation Medicine,
6
Departement of General Practice and Elderly Care Medicine,
Poster
University of Groningen, University Medical Center Groningen,
Groningen, Netherlands
Rationale: Sarcopenia is a major problem and is common in
community-dwelling elderly. In daily practice, there is need for
low cost and easily assessable measurement tools to assess
depletion of skeletal muscle (SM) mass, for example as one of
the indicators of sarcopenia. Bio-electrical impedance analysis
(BIA) is often used to estimate body composition, whereas
ultrasound measurement is an upcoming and promising tool, as
it is quick, easy to use and inexpensive in comparison with other
tools that assess SM mass. Ultrasound could assess site-specific
loss of SM mass and determine myoesteatosis. Therefore, in this
pilot study we aimed to assess agreement between muscle
thickness of rectus femoris (RF) by ultrasound and SM mass by
BIA in an older population.
Methods: Twenty-six older adults (mean ± standard deviation
(SD) age 64 ± 5.0 y, 62% women) from the Hanze Health and
Ageing Study were included. SM mass by BIA was estimated
using the Janssen equation. Muscle thickness of RF was
assessed by analyzing ultrasound images from the right leg.
Two non-parametric tests were used for analysis. Correlation
between ultrasound and BIA was assessed with Spearman Rho.
Agreement was determined with Kendall’s coefficient of
concordance (Kendall’s W). In both tests a score ≥ 0.7 was
considered a strong correlation.
Results: Mean (±SD) RF thickness was 18.9 (±3.8) mm. Median
SM mass (Interquartile range) was 23.5 (20.8–34.7) kg.
Correlation between RF thickness and SM mass was moderately
positive (Spearman r = 0.611; P = 0.001), whereas Kendall’s W
showed a strong agreement (W = 0.835; P = 0.002).
Conclusion: Ultrasound measurement of RF showed an
acceptable agreement with skeletal muscle mass assessed by
BIA in our sample of older adults. Therefore, ultrasound could
be a promising portable tool to estimate muscle size.
Disclosure of Interest: None declared.
MON-LB319
INTRA- AND INTER-RATER RELIABILITY OF ASSESSMENT OF
BICEPS MUSCLE SIZE BY ULTRASOUND IN ELDERLY
J. P. Pinho1 *, R. Azevedo1,2, J. Silveira3, P. Rocha4, W. Nijholt5,6,
H. Jager-Wittenaar6,7. 1Nutrition Services, Centro Hospitalar
Médio Ave, EPE, V.N. Famalicão, 2Faculty of Nutrition and Food
Science, University of Porto, 3Nutrition Services, Eurico de
Almeida, ORL Clinic, 4Radiotherapy Service, Francisco Gentil
Portuguese Institute of Oncology of Porto, EPE, Porto,
Portugal, 5Department of Rehabilitation Medicine, University
of Groningen, University Medical Center Groningen, 6Research
Group Healthy Ageing, Allied Health Care and Nursing, Hanze
University of Applied Sciences, 7Maxillofacial Surgery,
University of Groningen, University Medical Center Groningen,
Groningen, Netherlands
Rationale: Although ultrasound has been reported as valid and
reliable tool to assess muscle size in older adults1, little is
known about intra-rater reliability (intra-RR) and inter-rater
reliability (inter-RR) of BodyMetrix in specific to assess small
muscles. Therefore, in this study we aimed to assess intra-RR
and inter-RR of biceps muscle size (thickness) in elderly.
Methods: Thirty elderly (81.9 ± 6.3 years; 80% women; BMI
26.7 ± 5.3 kg/m2) living in a Portuguese nursing home/
Late Breaking Abstract 2 S297

residence were included. To assess procedural intra-RR and Table:

inter-RR, ultrasound measurements were performed by two RMR RMR < 80% RMR80–89% RMR90–110% RMR111–119% RMR > 119%
raters (R1, R2, beginners level) by BodyMetrixTM BX2000, on the
biceps of the right arm. R1 repeated the ultrasound measure- N = 82 5(6%) 4(5%) 9(11%) 6(7%) 58(71%)
Average kcal/day kcal/day kcal/day kcal/day kcal/day
ment once. To assess measurement intra-RR and inter-RR, RMR (HB) 1578 2059 1684 1754 1675
images were analyzed by three raters (R1, R2, and R3 RMR (IC) 1166 1739 1723 2027 2274
[experienced level]). Agreement was analyzed by intraclass Difference +412 +320 −39 −273 −599
kcal/day
correlation coefficient. ICC values of 0.50–0.75 were consid- n = 82 BMI predicted% RMR-HB RMR-IC day of IC
ered moderate to good, and >0.75 as good to excellent. vs HB kcal/d kcal/d
Statistical significance was set at p < 0.05. mean 25,6 124 1694 2101 6,7
SD (4,1) (23,1) (266,1) (468,0) (2,3)
Results: Mean muscle thickness at 1st and 2nd measurement
(R1) was 23.4 ± 4.5 and 23.7 ± 3.8 mm, respectively. For
procedural intra-RR, ICC was 0.630. For inter-RR of image 1 Conclusion: Indirect calorimetry is easy to perform and give a
(R1) vs. image 2 (R2), ICC was 0.622. For inter-RR of image 2 measurement of current metabolism for each individual
(R2) vs. image 3 (R1) ICC was 0.534. For measurement patient, compared with calculated results. Most patients
reliability, ICCs for intra-RR of R1 and R2 were 0.865 and after liver transplantation have higher metabolism than
0.766, respectively. ICCs for inter-RR of R1 vs. R2, R2 vs. R3, and calculated based on the Harris-Benedicts equation. Indirect
R1 vs. R3 were 0.865, 0.800, and 0.815, respectively. All ICCs calorimetry should be performed routinely in all liver trans-
were statistically significant ( p ≤ 0.001). planted patients to ensure adequate energy intake for each
Conclusion: The results of our study indicate that procedural patient.
reliability of biceps muscle size as assessed by BodyMetrix in Disclosure of Interest: None declared.
elderly is moderate to good, and measurement reliability is
good to excellent. Increasing the level of experience may MON-LB321
further improve procedural reliability. AMINO ACID DERIVED ACYL-CARNITINE CONCENTRATIONS
Reference CHANGE DOSE-DEPENDENTLY UPON CHICKEN MEAT INTAKE
1. Nijholt W, Scafoglieri A, Jager-Wittenaar H, et al. The reliability P. J. Giesbertz1 *, B. Ott2, Y.-M. Lee2, H. Daniel1, T. Skurk2.
and validity of ultrasound to quantify muscles in older adults: a 1
Lehrstuhl für Ernährungsphysiologie, Technische Universität
systematic review. Journal of Sarcopenia Cachexia and Muscle. 2017 München, 2Core Facility Human Studies, ZIEL, Institute for
[in press] Food and Health, Freising, Germany
Disclosure of Interest: None declared.
Rationale: Metabolic responses are highly individual upon
MON-LB320 ingestions of different types of foods. We aimed to study
INDIRECT CALORIMETRY AFTER LIVER TRANSPLANTATION IS appearance and disappearance of metabolite markers in
NEEDED TO ENSURE THE RIGHT AMOUNT OF ENERGY plasma and urine after intake of different doses of chicken
SUPPLIED. meat.
Methods: Within the JPI funded FOODBALL-consortium, we
P. Nordstedt1 *, C. Lindqvist2, G. Nowak1. 1Department of
performed a well-controlled human cross-over intervention in
Transplantation Surgery, 2Department of Clinical Nutrition,
which 12 volunteers (6 m/6 f ) consumed defined doses of
Karolinska University Hospital, Stockholm, Sweden
chicken breast (0g, 100 g and 200 g) and were followed during
Rationale: Patients undergoing liver transplantation may have subsequent 24 hours. Using our targeted LC-MS/MS method, we
an altered metabolism, that is individual and difficult to measured plasma and urine samples and analysed a broad panel
predict. To ensure the right amount of energy supplied to each of acylcarnitine species,
individual patient we compared calculated with measured Results: In plasma, a dose-dependent increase in acylcarnitine
resting metabolic rate, using Harris-Benedicts equation (HB) species derived from amino acid breakdown could be observed
and indirect calorimetry (IC). (see Table: increases at higher doses are expressed as relative
Methods: During the period 2010–2017, energy requirements compared to 0 g chicken meat). In contrast, no changes in rates
were measured with indirect calorimetry(IC) and calculated of appearance and disappearance between the different doses
with the Harris-Benedicts equation (HB). All measurements of meat were seen for fatty acid-derived acylcarnitine species.
were performed on the postoperative day 2–15. The measure- Analysis of urine showed similar dose-dependency of amino
ments were standardized and performed with Cosmed Fitmate acid derived acylcarnitines.
apparatus with a breathing mask for 20 minutes. Table:
Results: Totally, 82 measurements in 82 patients were Acylcarnitine Relative peak Relative peak
performed. Of these, 71% of the patients, had a high measured increase 100 g/0g increase 200 g/0g
resting metabolic rate (mean 2095 kcal/d), in average 124%
C3 1 1.49 1.77
compared to predicted using Harris-Benedicts equation (mean 3-M-C4 1 1.39 1.63
1701 kcal/d). The difference between measured and calcu- 2-M-C4 1 1.44 1.59
lated needs varied widely, with an underestimation of 2-M-C3 1 1.21 1.37
C5-M-DC 1 1.04 1.28
599 kcal/day in average. Center results in Table C4 1 1.07 1.16
2/3-M-C4:1 1 1.24 1.13
S298
Conclusion: The intake of meat caused a dose-dependent
increase in amino acid derived acylcarnitines. Increased plasma
concentrations of amino acid-derived acylcarnitine species at
high doses were seen 12 hours at consumption and changes in
plasma concentrations largely mirrored changes in urine.
Disclosure of Interest: None declared.
MON-LB322
SUITABILITY OF THE EQUATIONS BY HARRIS-BENEDICT AND
MÜLLER, SCALFI AND SCHEBENDACH FOR ESTIMATING
RESTING ENERGY EXPENDITURE IN MODERATELY TO
SEVERELY UNDERWEIGHT WOMEN
S. Ramminger1 *, L. Valentini1, U. Elbelt2,
K. Kohlenberg-Müller3, J.-P. Keil4, D. Lamers5.
1
Neubrandenburg Institute of Evidence-based Dietetics,
Neubrandenburg University of Applied Sciences,
Neubrandenburg, 2Department of Endocrinology, Diabetes and
Nutrition, Charité-Universitätsmedizin Berlin, Berlin,
3
Department of Ecotrophology, University of Applied Sciences
Fulda, Fulda, 4Dietrich Bonhoeffer Klinikum Neubrandenburg,
Neubrandenburg, 5Profil Institute for Metabolic Research,
Neuss, Germany
Rationale: In underweight women conventional equations for
estimating resting energy expenditure (REE), such as Harris-
Benedict or Müller, are commonly used in clinical practice. Yet,
it is unclear if these equations provide reliable results or if
special equations should be used. The objective was to
compare measured REE with 2 universal and 2 specific
equations.
Methods: REE was measured in 57 underweight women (28 ± 10
years, BMI 15.2 ± 2.2 kg/m²) by indirect calorimetry (IC)
(Cosmed, Quark RMR, Rome, Italy) under standardized condi-
tions. Overall, 49 women (86%) were diagnosed with anorexia
nervosa, the remaining 8 women were healthy. REE-IC was
compared with the equations of Harris Benedict and Müller
2004 (both for the general population), Scalfi (18–30-year-old
women with anorexia nervosa) and Schebendach (modified
Harris-Benedict formula for anorexia nervosa).
Results: The participants had a mean REE-IC of 1019 ± 194 kcal/
d. Scalfi reached comparable results to REE-IC (mean devi-
ation: −2 ± 16%) in the BMI range of 14–18.4 kg/m², but
underestimated REE with BMI <14 kg/m². All remaining
equations led to significant mean deviations of + 16 ± 25%
with Harris-Benedict, −24 ± 15% with Müller and −15 ± 17%
with Schebendach (see Table 1).
Table 1: Comparison between the measured and estimated resting energy
expenditure (REE).
BMI (kg/m²) REE-IC Scalfi Schebendach HB Müller
(kcal/d) (kcal/d) (kcal/d) (kcal/d) (kcal/d)
<14.0 (n = 16) 900 ± 210 794 ± 90* 695 ± 126** 1158 ± 69*** 614 ± 88***
14.0–16.4 (n = 21) 980 ± 146 951 ± 94 837 ± 133** 1235 ± 72*** 743 ± 90***
16.5–18.4 (n = 20) 1155 ± 142 1154 ± 113 983 ± 120*** 1314 ± 65*** 905 ± 137***
Unpaired t-test, *p < 0.001, **p < 0.01, ***p < 0.05, IC = indirect calorimetry,
HB = Harris Benedict.
Conclusion: Universal equations for estimating REE (Harris-
Benedict, Müller) are unreliable for underweight women, even
in moderate underweight. Only the simple equation of Scalfi
(REE = 96.3 x body weight) seems suitable for underweight
women, at least for BMIs equal or higher than 14 kg/m².
Poster
Reference
Scalfi L, et al. The prediction of basal metabolic rate in female patients
with anorexia nervosa. Int J Obes Relat Metab Disord, 2001. 25(3):
359–364.
Disclosure of Interest: None declared.
MON-LB323
ULTRASOUND MEASURED MUSCLE SIZE IN RELATION TO
MUSCLE STRENGTH AND MASS: AN EXPLORATIVE STUDY IN
PATIENTS WITH COPD
W. Nijholt1,2 *, L. ter Beek2,3, J. S. M. Hobbelen2,4,
H. van der Vaart3, J. Wempe3, C. P. van der Schans1,2,5,
H. Jager-Wittenaar2,6. 1Department of Rehabilitation
Medicine, University of Groningen, University Medical Center
Groningen, 2Research Group Healthy Ageing, Allied Health
Care and Nursing, Hanze University of Applied Sciences,
Groningen, 3Department of Pulmonary Diseases and
Tuberculosis, Center for Rehabilitation, University of
Groningen, University Medical Center Groningen, Haren,
Groningen, 4Department of General Practice and Elderly Care
Medicine, 5Department of Health Psychology Research,
6
Department of Maxillofacial Surgery, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Rationale: Muscle wasting is common in patients with COPD and
may impact exercise tolerance and quality of life. Ultrasound
can be used to quantify specific muscles. This study aims to
correlate ultrasound measured muscle size with muscle
strength and mass in patients with COPD.
Methods: Patients with COPD at the start of a pulmonary
rehabilitation program were asked to participate in this cross-
sectional study. Rectus femoris muscle size (thickness in cm)
was determined by ultrasonography (Philips VISIQ). Skeletal
muscle mass (SMI) was estimated by BIA using the equation of
Janssen et al (kg/m2). Handgrip strength was measured in
kilograms (HGS in kg) and the five times sit to stand test
(seconds, higher scores indicating decreased strength) was
assessed as a proxy measure of lower extremity strength. The
relationships between muscle size and mass and strength were
determined using a Spearman or Pearson’s correlation
coefficient.
Results: 30 COPD patients (mean age 59.77 ± 8.55 years, 43%
male, median FEV1%pred 37 [IQR = 23–52]) were included.
Mean muscle size was 1.81 ± 0.40 cm for males and 1.58 ± 0.28
cm for females. Muscle size was correlated to SMI and HGS
(r = 0.553, p = 0.002 and r = 0.475, p = 0.009, respectively). The
correlation between muscle size and lower extremity strength
was r=-0.332, p = 0.091.
Conclusion: This exploratory study shows that, in patients
with COPD, rectus femoris muscle size is moderately strong
correlated with skeletal muscle mass and handgrip strength. A
weak, not significant, correlation was found between muscle
size and lower extremity strength, maybe due to low power.
These findings may indicate the potential of ultrasound to
quantify muscle status COPD patients.
Reference
Janssen I, Heymsfield SB, Baumgartner RN, et al. Estimation of
skeletal muscle mass by bioelectrical impedance analysis. J. Appl
Physiol 2000;89:465–71.
Disclosure of Interest: None declared.
Late Breaking Abstract 2
MON-LB324
APPLICATION OF NRS-2002 AND MNA TO SCREEN
NUTRITIONAL RISK IN ELDERLY PATIENTS IN A CHINESE
UNIVERSITY HOSPITAL
X. Zhigang1 *, Y. Wang1, J. Yu1. 1General Surgery, Peking Union
Medical College Hospital, Beijing, China
Rationale: We aimed to investigate nutritional risk in elderly
patients using Nutrition risk screening-2002 and Mini-nutri-
tional assessment, and to determine the difference and
consistence of nutritional risk assessment tools.
Methods: In this prospective observational study, 284 patients
in department of general surgery over 65 years old were
included from July 2010 to April 2011. The nutrition risk profile
was determined using NRS-2002 and MNA on admission.
Nutrition-related hematological levels, nutrition support and
health-economic data were collected. Comparisons between
patients ‘at risk’ and ‘not at risk’ and logistic regression
analyzes were performed.
Results: Nutrition risk rate in elderly patients using NRS-2002
and MNA was 37.7% and 26.8% respectively. When using NRS-
2002 tool, nutrition risk rate in GI tumor (72.8%, 83/114) is
higher than that in cholelithiasis (23.1%, 18/78), thyroid tumor
(8.5%, 5/59), hernia (10%, 3/10). While using MNA tool,
nutrition risk rate in GI tumor, cholelithiasis, thyroid tumor
and hernia were 48.2%, 19.2%, 5.1%, 10% respectively. Serum
total protein(TP), albumin, prealbumin(PA), BMI in patients at
nutritional risk were significantly lower than those without
nutrition risk ( p < 0.05 as significance). And nutritional risk
patients had significantly longer length of stay (LOS) and higher
medical expenses. NRS-2002 and MNA for nutritional status
assessment show good consistency. While we analyzed those
patients with GI tumor assessed as at nutrition risk using NRS-
2002 but not at nutritional risk using MNA. These patients with
preoperative nutrition support(PNS) had significantly shorter
LOS (10.3 ± 3.3 vs 14.8 ± 5.9 d, p = 0.014) and lower medical
expenses (9841 ± 4264 vs 16863 ± 10040 RMB, p < 0.020).
Conclusion: Elderly patients especially those with GI tumor
had a relatively high nutritional risk rate. Patients at nutrition
risk had significantly lower TB, albumin, PA, BMI and higher LOS
and medical expenses. PNS helps to decrease postoperative
LOS. NRS-2002 maybe more suitable for elderly patients
than MNA.
References
1. Kondrup J, et al. Clin Nutr. 2003,22(4):415–21.
2. Guigoz Y, et al. Nutr Revi, 1996,54(1):s55–s65.
3. Schiesser M, et al. Surgery. 2009,145(5):519–26.
Disclosure of Interest: X. Zhigang Grant/Research Support from:
Central Health Care Program, Y. Wang Grant/Research Support
from: Central Health Care Program, J. Yu Grant/Research Support
from: Central Health Care Program.
MON-LB325
A CHANGE IN TEMPORAL MUSCLE THICKNESS CORRELATES
WITH PAST ENERGY ADEQUACY IN ELDERLY INDIVIDUALS: A
PROSPECTIVE COHORT STUDY
Y. Uehata1,2 *, M. Yoshida3,4, A. Sato5, Y. Fujimoto6,
T. Minematsu7,8, J. Sugama9, R. Sekine1, N. Kubota1,
H. Sanada2,8. 1Department of Clinical Nutrition Therapy, The
University of Tokyo Hospital, 2Department of Gerontological
Nursing/Wound Care Management, 3Imaging Nursing Science,
S299
The University of Tokyo Graduate School of Medicine, 4Global
Nursing Research Center, The University of Tokyo Graduate
School of Medicine, Tokyo, 5Department of Nursing Science,
Faculty of Nursing and Social Welfare Sciences, Fukui
Prefectural University, Fukui, 6School of Health and Nursing
Science, Wakayama Medical University, Wakayama,
7
Department of Skincare Science, 8Global Nursing Research
Center, The University of Tokyo Graduate School of Medicine,
Tokyo, 9Advanced Health Care Science Research Unit,
Innovative Integrated Bio-Research Core, Kanazawa University,
Ishikawa, Japan
Rationale: Energy inadequacy has a significant impact on
patient’s clinical outcomes, though it is difficult to assess
energy status of bedridden elderly patients. Recently, we have
revealed that temporal muscle thickness (TMT) reflects the
nutritional status indicators such as body mass index. Since
changes in muscle mass are associated with imbalanced energy
intake, we hypothesize that changes in TMT can be used as a
marker for detecting energy inadequacy. The aim of this study
is to examine the relationship of changes in TMTand the energy
status of patients.
Methods: A prospective cohort study of bedridden elderly
individuals was conducted from September 2015 to June 2016.
TMT was measured using ultrasonography at baseline and after
4 weeks. Average daily energy intake was calculated using the
photographic diet records of 4 weeks. Energy inadequacy was
defined as energy intake/energy needs <75%. Harris-Benedict
equation was used to estimate energy needs.
Results: Forty-eight participants were included in the study
(mean age 84.4 ± 7.8 years; 26 women [54.2%]; 32 on an oral
diet [66.7%]). The mean TMT was 3.6 ± 0.9 mm at baseline and
3.5 ± 1.0mm at 4 weeks, therefore the change after 4 weeks
was −0.1 ± 0.7 mm (−1.9 ± 21.8%). Mean daily energy intake
and energy adequacy were 1099 ± 294 kcal and 92.2 ± 28.1%,
respectively. The percentage change in TMT significantly
correlated with energy adequacy (r = 0.733, p < 0.001).
Receiver operating characteristic analysis identified a percent
change of TMTof -3.6% as an optimal cut-off point for detecting
energy inadequacy, with a sensitivity of 92.9% and a specificity
of 76.5%.
Conclusion: Ultrasonographic evaluation of TMT can detect
energy inadequacy, and thus could be useful for detecting
energy status in bedridden elderly patients.
Disclosure of Interest: None declared.
MON-LB326
THE ASSOCIATION OF FAST FOOD PATTERN AND ITS RELATION
WITH HISTORY OF HYPERTENSION IN WOMEN LIVING IN
NORTH OF TEHRAN
A. Rezazadeh1 *, B. Rshidkhani1, N. Omidvar1, on behalf of.
1
Department of Community Nutrition National Nutrition and
Food Technology Research Institute Faculty of Nutrition
Sciences and Food Technology Shahid Behehshti University of
Medical Sciences, Tehran, Islamic Republic of Iran
Rationale: Emerging evidences suggest that high consumption
of fast food is positively related to hypertension. This study
aimed to determine the association between fast food dietary
pattern and having history of hypertension in women living in
Tehran.
S300
Methods: In this cross-sectional study, 460women aged 20–
50years were selected through stratified random sampling.
Dietary information was collected by a valid and reliable semi-
quantitative food frequency questionnaire by trained dieti-
tians. History of hypertension was assessed through having
systolic/diastolic Blood pressure ≥140/90mmHg, previously
diagnosed by a doctor. Anthropometric data were measured
with standard methods. Physical activity level was obtained
with a validated questionnaire for Iranians Fast food dietary
pattern was defined through factor analysis of four items
(hamburger, salami, sausages, fried potato and pizza).
Multivariate logistic regression was used to estimate odds
ratio(OR) and 95% confidence intervals(CI). P-Value < 0.05 was
considered as significant.
Results: The mean ± SD age of participants was 33.5 ± 9.7
years. History of diagnosed hypertension was reported by 47
(10.2%) of subjects. The mean ± SD of fast foods consumption
were 89.03 ± 114.01 g/month for sausages, 77.81 ± 145.5 g/
month for salami,46.3 ± 167 g/month for hamburger, 120.27 ±
177.2 g/month for pizza and 359.3 ± 1083 g/month for fried
potato. After adjusting for confounders (age, smoking, physical
activity and energy intake), being in the highest quartile
category of fast food dietary pattern was positively associated
with having history of hypertension (OR:1.9,95%CI:1.67–4.01)
compared to the lowest quartile ( p-trend: P < 0.05).
Conclusion: Our findings support the positive relation between
hypertension and fast food pattern in the studied women. This
finding should be noted in interventional and educational
programs.
Reference
Odegaard AO, Koh WP, Yuan J-M, Gross MD, Pereira MA. Western-Style
Fast Food Intake and Cardiometabolic Risk in an Eastern
CountryClinical Perspective. Circulation. 2012;126(2):182–8.
Disclosure of Interest: None declared.
MON-LB327
ASSOCIATION BETWEEN MALNUTRITION, HEALTH OUTCOMES
AND HEALTHCARE COSTS AMONG OLDER CHINESE ADULTS
S. Goates1 *, J. Wei2, L. Claytor3, Y. Zhang4, S. Li5, L. Fan6,
S. Sulo7, J. Partridge8. 1Abbott Laboratories, Abbott
Laboratories, Columbus, United States, 2Beijing Hospital,
Beijing, China, 3Abbott Laboratories, Singapore, Singapore,
4
National Health Development Research Center, Beijing,
5
Abbott Laboratories, Shanghai, China, 6Abbott Laboratories,
Urbana-Champaign, 7Abbott Laboratories, Chicago, 8Abbott
Laboratories, Columbus, United States
Rationale: China has the largest elderly population in the
world, but limited research assessing the relation between
malnutrition and the health of older Chinese adults exists. This
research investigated the association between malnutrition,
health outcomes, depression, and healthcare costs among
community-dwelling older Chinese adults.
Methods: A national sample of over 5,900 adults aged 60 years
or older from the 2013 China Health and Retirement
Longitudinal Study (CHARLS) survey was used. Handgrip
strength, body mass index, and weight loss were utilized as
indicators of malnutrition. Functional independence was
assessed with activities of daily living (ADLs) and instrumental
ADLs (IADLs). Mental health and depressive symptoms were
evaluated through the Center for Epidemiological Studies
Poster
Depression Scale (CES-D). Ordered logit and standard logit
regressions were employed to analyze the associations
between malnutrition and various health outcomes. Subjects’
socio-demographics were also controlled for.
Results: Malnutrition was associated with significantly lower
IADLs (OR = 0.87, p < 0.05), poorer health status (OR = 0.68,
p < 0.001), higher probability of stroke (OR = 1.40, p <0.05) and
chronic stomach disease (OR = 1.24, p < 0.001). Consequently,
malnutrition was associated with an increased hospital cost of
¥214 (14% increase, p < 0.01) per person per year. Furthermore,
malnutrition was associated with a 51% higher likelihood of
being depressed (OR = 1.513, p < 0.001) and a 66% increase
( p < 0.01) in healthcare cost among depressed older adults.
Conclusion: Malnutrition was associated with poorer mental
and physical health, and higher hospital costs among commu-
nity-dwelling older Chinese adults. Our results highlight the
importance of malnutrition and depression screening, identi-
fication/assessment, and treatment.
Disclosure of Interest: S. Goates Shareholder at: Abbott Nutrition,
Other: Employee of Abbott Nutrition, J. Wei: None declared, L. Claytor
Shareholder at: Abbott Nutrition, Other: Employee of Abbott Nutrition,
Y. Zhang: None declared, S. Li Shareholder at: Abbott Nutrition, Other:
Employee of Abbott Nutrition, L. Fan Other: Employee of Abbott
Nutrition, S. Sulo Shareholder at: Abbott Nutrition, Other: Employee of
Abbott Nutrition, J. Partridge Shareholder at: Abbott Nutrition, Other:
Employee of Abbott Nutrition.
MON-LB328
A RETROSPECTIVE EVALUATION OF TPN UTILIZATION FOR
SHORT-TERM NUTRITIONAL SUPPORT: RESULTS OF A FIVE-
YEAR STUDY
V. Alivizatos1 *, P. Athanasopoulos2, G. Tzouvekas2,
P. Demetriou2, L. Tchabashvili2, A. Kanellopoulou1. 1Surgery,
Nutrition Unit, 2Surgery, General Hospital of Patra,
Patra, Greece
Rationale: TPN use is generally considered appropriate if the
patient cannot be fed enterally for a period of at least 7–10
days. However, occasionally there are patients who receive TPN
for less than one week, whereas the documentation for TPN
administration may be often unclear and incomplete; these
factors may lead to complications and influence the cost/risk
and cost/benefit ratios. The aim of this study was to evaluate
the appropriateness of short-term (<7 days) TPN therapy, if
other alternative nutritional methods such as enteral nutrition
could have been utilized, or if the period of time the patient
was unable to receive oral diet or enteral nutrition warranted
TPN use.
Methods: All adult patients of the department of surgery of our
hospital who received TPN for less than 7 days during a five-year
period (1/1/2012–31/12/2016) were retrospectively studied.
The parameters evaluated were the TPN indications (gastro-
intestinal tract non-functioning and/or non-usuable), the
adaptation to the patients needs (excessive versus inadequate
energy provision, addition or absence of trace elements and
vitamins), and whether the patients met criteria for the
appropriateness of TPN therapy.
Results: Out of 115 patients who received TPN during the whole
study period, 38 (33%) received TPN for less than 7 days (range
2–6, mean 4.6 ± 1.2 days). Out of these, TPN was discontinued
in 29 (76.3%) due to tolerance to an oral diet or tube enteral
feeding, in 7 (18.4%) due to patient discharge, and in 2 (5.2%)
Late Breaking Abstract 2
due to patient’s death. Twenty eight patients (73.6%) had a
clear indication for TPN, while the remaining 10 (26.3%) had
questionable appropriateness or inappropriateness. Althought
indications for short-term TPN were justified in 73.6% of the
cases, the adaptation to the patients needs was 47.3%.
Conclusion: The results of this study show that, a considerable
percentage of patients receiving short-term TPN support has
not clear and complete documentation for TPN therapy,
whereas the nutritional support is often not adapted to the
patient nutritional requirements. These findings create the
need for the development of a TPN quality control program that
must be available to physicians when they initiate TPN which
will aid to use cost effective and appropriate nutritional
therapies.
Disclosure of Interest: None declared.
MON-LB329
TAUROLIDINE-CITRATE CVC-LOCK SOLUTION REDUCES CRBSI
RATE IN PATIENTS WITH CHRONIC INTESTINAL FAILURE IN HPN
F. D. Merlo1 *, C. Ivaldi1, U. Aimasso1, A. De Francesco1.
1
Clinical Nutrition and Dietetics, A.O.U. Citta Della Salute
E Della Scienza, Torino, Italy
Rationale: Home parenteral nutritition (HPN) is a life–saving
therapy for patients with chronic intestinal failure (CIF).
Central venous catheters (CVC) are essential devices for
parenteral nutrition’ administration. Unfortunately, the use
of these devices can lead to catheter-related bloodstream
infections (CRBSI) that are associated with increased morbidity
and mortality rates. Previous studies showed the efficacy of
taurodine lock-solution for secondary prevention of CRBSI in
adult and pediatric patients on hemodialysys and chemother-
aphy. Recently a number of studies confirmed the efficacy of
taurolidine in HPN patients at high risk of CRBSI and also ESPEN
guidelines on CIF in adults suggest that CVC-lock with
taurolidine may be used to prevent infections. The aim of the
authors was to evaluate the impact of a taurolidine lock
solution on CRBSI rate in HPN adult patients with CIF at high risk
of CRBSI
Methods: Enrollment started in january 2013 (when taurolidine
lock solution was first available in our Care Center), ended in
december 2013. We retrospectively collected data on 139
patients in HPN for CIF from january 2011 to december 2012
and selected those who had at least one CRBSI in the 24 months.
We also selected patients presenting with a first CRBSI from
january to december 2013. Overall 23 high risk patients (10
females, 13 males) were enrolled in the study. Taurolidine-
citrate 4% CVC-lock solution was applied from enrollment.
Patients were observed prospectively for 12 months after the
start. Incidence rates of CRBSI were expressed per 1000
catheter-days.
Results: CRBSI rate decreased from 1.65/1000 catheter-days to
0.00/1000 catheter-days respectively before and after starting
taurolidine-citrate lock ( p = 0.004)
Conclusion: Taurolidine-citrate lock solution was safe and
effective in reducing the CRBSI rate in high risk patients with
CIF in HPN. Further researches are needed to confirm these
results in larger series of patients
Disclosure of Interest: None declared.
S301
MON-LB330
ENDOSCOPIC NASOENTERAL FEEDING TUBE FIXATION WITH
HEMOCLIP REDUCES TUBE DISLODGEMENT
J. Han1 *, H. K. Na1, J.-Y. Ahn1, J. H. Lee1, D. H. Kim1,
K. W. Jung1, K. D. Choi1, H. J. Song1, G. H. Lee1, H.-Y. Jung1.
1
Division of Gastroenterology, Department of Internal
Medicine, University of Ulsan College of Medicine, Asan
Medical Center, Seoul, Republic of Korea
Rationale: Spontaneous retrograde migration of nasoenteral
feeding tube is frequent in clinical practice. The aim of study
was to evaluate the effectiveness of nasoenteral feeding tube
tip fixation with hemoclips to prevent the tube dislodgement.
Methods: We retrospectively reviewed the patients who
underwent endoscopic nasoenteral feeding tube insertion
with or without tube tip fixation with hemoclips at Asan
Medical Center in Korea from January 2016 to January 2017. We
compared the incidence of tube dislodgment and procedure
related complications between two groups.
Results: Of the total 207 procedures, 57 procedures were
performed with clip-assisted method while 150 procedures
were performed with standard non clip-assisted method. Tube
dislodgement occurred in 2 (3.5%) clipping group and 21 (14%)
non clipping group ( p = 0.03). The Odd ratio for tube
dislodgement was 4.48 (95% confidence interval 1.02–19.75).
Incidence bleeding, aspiration pneumonia, Mallory-Weiss tear,
ileus and tube obstruction were not different between two
groups. Procedure time did not differ significantly between two
groups (17.4 ± 8.9 in clipping group vs. 16.4 ± 8.3 in non-
clipping group, p = 0.45).
Conclusion: Clip-assisted fixation of nasoenteral feeding tube
was effective to prevent the tube dislodgement.
Disclosure of Interest: None declared.
MON-LB331
NEX-METHOD STILL THE BEST PRACTICE? ESTIMATING
INTERNALTUBE LENGTH TO PREDICT THE IDEALTIP POSITION
OF A NASOGASTRIC TUBE: A RANDOMIZED
CONTROLLED TRIAL
T. Torsy1 *, R. Saman1, K. Boeykens2. 1Health Care, Odisee
University College, 2Health Care, AZ Nikolaas, Sint-Niklaas,
Belgium
Rationale: A correct position of nasogastric tubes in the
stomach is essential to minimize complications such as reflux
and aspiration of tube feeding in the lungs. The NEX-method
(nasal tip – earlobe – xiphoid process) is widely used to estimate
the insertion length. Several observational or retrospective
studies revealed that this method is probably unreliable[1].
Already in 1979 Hanson suggested to use a formula
(NEX × 0,38696) + 30,37 cm to pursue correct positioning[2].
This study compares the use of that formula with the use of the
NEX-method in adults.
Methods: A 9-month RCT was conducted in a Belgian general
hospital. External measurement to define the internal tube
length was performed by two specialized nutrition support
nurses. During the study, two different methods were used to
define the internal tube length: NEX-method and
(NEX × 0,38696) + 30,37 cm. After (re)positioning, 183 tubes
were eligible to be assessed through X-ray by 3 radiologists. The
S302
ideal tube position was defined as a tube placed with the tip 3
cm or more beyond the LES (= lower esophageal sphincter)[1].
Results: There is no significant difference between the NEX-
method and (NEX × 0,38696) + 30,37 cm to become an ideal tip
position into the stomach. In respectively 20,2% and 22,6% of
the patients, ideal tip positioning was underestimated (too
close to the LES or even not beyond the LES). In the NEX-group
was an overestimation of the tube length to be inserted. In
17,2% of the patients tip position was located more than 10 cm
beyond the LES.
Conclusion: Unlike earlier research, (NEX × 0,38696) +
30,37 cm does not result in a better positioning of the tube
into the stomach with the tip 3 cm or more beyond the LES as a
benchmark. Further research is needed to determine which
theoretical concept of length determination is applicable in
order to insert the tube to the appropriate length into the
stomach.
References
[1] Ellett M.L., Beckstrand J., Flueckiger J., Perkins S.M. & Johnson C.
S. (2005). Predicting the insertion distance for placing gastric
tubes. Clinical Nursing Research, 14 (1), 11–27.
[2] Hanson R.L. (1979). Predictive criteria for length of nasogastric
tube insertion for tube feeding. Journal of Parenteral and Enteral
Nutrition, 3 (3), 160–163.
Disclosure of Interest: None declared.
MON-LB332
VALUABLE ALTERNATIVE TO THE NEX-METHOD? CONEX AS A
NEW METHOD TO PREDICT THE INTERNAL TUBE POSITION OF
A NASOGASTRIC TUBE: A PILOT STUDY
T. Torsy1 *, R. Saman1, K. Boeykens2. 1Health Care, Odisee
University College, 2Health Care, AZ Nikolaas, Sint-Niklaas,
Belgium
Rationale: The NEX-method (nose-earlob-xiphoid process) is
widely used to predict internal nasogastric tube length. A
possible alternative is the Hanson formula: (NEX × 0,38696) +
30,37 cm. Earlier unpublished research[1] revealed that with
both methods, tip position was located too close or even not
beyond the lower esophageal sphincter (=LES) in >20% of all
patients. Assessment of the internal tube length by 3
radiologists in 183 patients suggested a correction of the
Hanson formula: (NEX × 0,38696) + 30,37 cm ± 6 cm. Aim of the
study is to determine whether this correction can be a valuable
alternative to the other methods.
Methods: A 3-month pilot study was conducted in a Belgian
general hospital. External measurement to define the internal
tube length was performed by 2 nutrition support nurses. The
CoNEX[2]-method used to determine the internal tube length
was (NEX × 0,38696) + 36,37 cm. After (re)positioning, 58 tubes
were eligible to be assessed through X-ray by 2 independent
radiologists. The ideal tube position was defined as a tube
placed with the tip 3 cm or more beyond the LES[3].
Results: There is a significant difference between the use of
the CoNEX-method and the two other methods (‘NEX. and
‘(NEX × 0,38696) + 30,37 cm’) to become an ideal tip position.
The use of the CoNEX-method in all patients (n = 58) led to 100%
of well-positioned nasogastric tubes. The CoNEX-method also
resulted in a significantly higher probability to aspirate gastric
contents after the insertion of the nasogastric tube: 69% of all
patients compared to 56% or less in both two other methods.
Poster
Conclusion: The CoNEX-method can be a valuable alternative
to predict the internal tube position of a nasogastric tube. The
CoNEX-method makes it also possible to obtain gastric aspirate
in a higher amount of cases than the other two described
methods.
References
[1] Torsy T., Saman R., Boeykens K. (2017). [Internal length determin-
ation]. Unpublished raw data.
[2] Correction of the NEX.
[3] Ellett et al. (2005). Predicting the insertion distance for placing
gastric tubes. Clinical Nursing Research, 14 (1), 11–27.
Disclosure of Interest: None declared.
MON-LB333
THE SUPPLYMENT OF Ω3 POLYUNSATURATEDFATTY ACIDS
ATTENUATES OBESITY-INDUCED INFLAMMATION AND ALTERS
GUT MICROBIOTA IN HIGH FAT DIET-FED MICE
Z. Li1, Z. Cao1, J. Yu1 *, W. Kang1. 1Department of General
Surgery, Peking Union Medical College Hospital, Chinese
Academy of Medical Sciences And Peking Union Medical
College, Beijing, China
Rationale: High dietary fat intake can cause metabolic
syndrome, and previous studies have demonstrated the effect
of ω3 polyunsaturated fatty acids (PUFA) on dyslipidemia. Here,
we examined the anti-inflammatory and intestinal barrier-
protecting effect of ω3 PUFA in mices.
Methods: Sprague-Dawley mices were fed a normal-fat diet
(NFD), high-fat diet (50% kcal from fat, HFD), NFD supplemen-
ted with ω3 PUFA (NFDω3) and HFD supplemented with ω3 PUFA
(HFDω3) for 10 weeks. The changes in gut microbial compos-
ition was detected by real-time PCR. Portal vein were analyzed
for hsCRP and cytokine levels using ELISA, and endotoxin levels
using modified azo chromogenic substrate limulus amebocyte
lysate assay. Western blotting was used to detect tight junction
protein of intestinal mucosa.
Results: PUFA ω3 had no effect on food consumption but
prevented weight gain (HFD: 680.5 ± 26.3 g; NFD:554.0 ±
113.5 g; HFDω3:609.2 ± 15.9 g; NFDω3:540.8 ± 36.7 g, HFD vs
HFDω3 P < 0.01, NFD vs NFDω3 P > 0.01). There were more
contents of the Firmicutes, Enterobacteriales, and less con-
tents of Bacteroidetes, Bifidobacterium spp. and ratios of
Bacteroidetes to Firmicutes in the fecal of the rats from HFD
group compared to the NFD and HFD ω3 groups. The Pearson’s
correlation coefficient shows that there was a negative
correlation between the body weight and the ratios of
Bacteroidetes-to-Firmicutes. Intestinal permeability(L/M)
was increased significantly in HFD group compared to NFD
and HFDω3 groups. The endotoxin (HFD: 0.074 ± 0.025 EU/ml,
NFD:0.045 ± 0.014EU/ml, P < 0.01) and inflammatory factors
(CRP,TNF-α,IL-6) levels from rats of HFD group were higher than
NFD and HFD ω3 groups, but expression of claudin and occludin
in intestinal mucosa of HFD group were lower NFD and HFDω3
groups.
Conclusion: HFD-induced obesity changed the gut microbiota
and increased intestinal permeability. Supplement with
ω3PUFAs could counteract these gut dysbiosis and reduce the
intestinal permeability as well as improve inflammatory factors
and the body weight.
Disclosure of Interest: None declared.
Late Breaking Abstract 2
MON-LB334
THE RELATIONSHIP BETWEEN OXIDATIVE STRESS
PARAMETERS AND NUCLEAR FACTOR KAPPA B AND
PEROXISOME PROLIFERATOR ACTIVATING RECEPTOR GAMMA
IN METABOLIC SYNDROME
A. O. Sahin1, O. Tabak2 *, H. Uzun1, F. Erdenen3, E. Altunoglu3,
S. Civelek1. 1Biochemistry, Cerrahpasa School of Medicine,
2
Internal Medicine, Kanuni Sultan Suleyman Education
Research Hospital, 3Internal Medicine, Istanbul Education
Research Hospital, Istanbul, Turkey
Rationale: The aim of this study was to investigate the
importance of the levels of the nuclear factor-kappa (NF-κB)
and the peroxisome proliferator-activating receptor-gamma
(PPAR-γ) in patients with metabolic syndrome (MetS) and also
to enlighten the relationship between the components of MetS
with these parameters. In addition, the redox homeostasis has
been evaluated via determination of serum malondialdehyde
levels (MDA) and serum catalase (CAT) and CuZn-superoxide
dismutase (CuZn-SOD) activities in patients with MetS.
Methods: 52 patients (17 M, 35 F) referring to Ministry of
Health, Istanbul Education and Research Hospital Internal
Medicine Clinic who has received MetS diagnosis according to
National Cholesterol Education Program-Adult Treatment Panel
III (NCEP-ATP III) criteria and 28 healthy individuals (10 M, 18 F)
as a control group has been included in the study. The levels of
NF-κB and PPARγ has been studied via ELISA method and MDA
levels, CAT and CuZn-SOD activities has been studied via
spectrophotometric methods in the samples taken from study
and control groups.
Results: In the study, the NF-κB and MDA levels were
significantly higher in MetS group whereas PPARγ levels, CAT
and CuZn-SOD activities were significantly lower compared to
control group. When the diagnosis of MetS has been investigated
by ROC analysis, NF-κB had the highest sensitivity and
specificity. There was a significant negative correlation in all
groups between PPARγ and BMI, waist and hip ratio, HOMA-IR and
NF-κB.
Conclusion: Our findings indicates that the oxidative stress has
been increased and the redox homeostasis has been deterio-
rated because of increased levels of MDA and decreased
activities of CAT and CuZn-SOD. It has been suggested that,
with its high sensitivity and specificity, NF-κB can be included in
components of MetS. PPAR-γ could be a new anti-diabetic
marker because of the negative correlation between PPAR-γ and
HOMA-IR. Yet, more studies are needed to support our findings.
Disclosure of Interest: None declared.
MON-LB335
SUBJECTIVE RATINGS OF APPETITE AND AD LIBITUM FOOD
INTAKE FOLLOWING A BREAKFAST CONTAINING 4G OAT
Β-GLUCAN IN HEALTHY SUBJECTS: A PILOT STUDY
S. M. M. Zaremba1 *, J. T. Mccluskey1, I. F. Gow1, S. Drummond1,
R. E. Steinert2. 1Dietetics, Nutrition and Biological Sciences,
Queen Margaret University, Edinburgh, United Kingdom, 2R&D
Human Nutrition and Health, DSM Nutritional Products Ltd.,
Basel, Switzerland
Rationale: Adding viscous soluble fibre to food alters the
structural properties of meals and the viscosity of digestive
contents, thus slowing gastric emptying.1 Despite a link
S303
between the rate of gastric emptying and human eating,
there is inconsistent data regarding the effect of oat β-glucan
consumption on appetite and energy intake.2
Methods: Thirty-one healthy normal-overweight subjects (20
female/11 male, mean age (yrs): 27.0 ± 5.9, BMI (kg/m2):
23.5 ± 2.0) completed the study. In a double-blinded, rando-
mized, placebo-controlled cross-over fashion, subjects con-
sumed a breakfast that consisted of Rice Krispies cereal with
milk and Greek-style yoghurt, with and without the addition of
4 g oat β-glucan (14.7 g OatWell®28). Protein, fat and carbo-
hydrate content of each breakfast were matched. Visual
analogue scales were used to assess subjective appetite
ratings, which were administered every 15 minutes over a 150
minute period, after which an ad libitum lunch was served.
Two-factor ANOVA was used to identify treatment effects over
the postprandial period. Differences between caloric intakes
were assessed by paired samples t-tests.
Results: Preliminary analysis showed there was an effect on
subjective appetite with increased satisfaction ( p < 0.05) and
reduced feelings of prospective food consumption ( p < 0.05)
over the 150 minute postprandial period following oat β-glucan
consumption. No significant effect was identified in caloric
intakes during the ad libitum lunch, with 722 kcal ± 287
consumed following the control breakfast and 689 kcal ± 256
after the oat β-glucan breakfast (n = 28, p > 0.05).
Conclusion: This acute study showed that consumption of 4 g
oat β-glucan at breakfast beneficially modulates subjective
appetite, yet ad libitum eating did not change. Although
feeling more satisfied did not directly translate into eating less,
this effect may be of benefit during calorie-restricted diets.
Perhaps a shorter inter-meal interval is required to detect an
effect of viscous fibres on energy intakes.
References
1. Grundy et al. 2016 BJN (116), 816–833.
2. Clark and Slavin 2013 JACN (32), 200–212.
Disclosure of Interest: S. Zaremba: None declared, J. McCluskey: None
declared, I. Gow: None declared, S. Drummond: None declared,
R. Steinert Other: RES is an employee of DSM Nutritional Products. DSM
provided the study with OatWell®28.
MON-LB336
IMPACT OF ORANGE JUICE ON THE METABOLIC PROFILE OF
INDIVIDUALS WITH METABOLIC SYNDROME
T. B. Cesar1 *, O. F. Ponce1, R. O. Benassi1. 1Food and Nutrition,
Sao Paulo State University, UNESP, Araraquara, Brazil
Rationale: Previously it was shown that the habitual intake of
orange juice by obese1 and dyslipidemic2 subjects improved
metabolic parameters and reduced cardiovascular risk. In this
study, subjects with metabolic syndrome (MetSyn) received
two cups of orange juice per day, incorporated into a balanced
diet for 12 weeks, aiming to improve their metabolic condition
and health status.
Methods: A randomized controlled study of 70 subjects with
metabolic syndrome (ATP III, AHA/NHLA) divided into parallel
groups were individually instructed to maintain a balanced diet
for 12 weeks. Control group (n = 35) was treated with balanced
and controlled diet, while the experimental group (n = 35)
received two additional cups of orange juice (OJ) daily
(500 mL/d), nor exceeding the Estimated Energy Requirement
(EER). It was evaluated biochemical and clinical parameters
S304
associated with MetSyn, and diet composition along to the
intervention.
Results: All subjects showed similar reduction of body weight
(2 kg), body fat mass (2 kg) and waist circumference (6.5 cm)
( p < 0.05). In both groups was a decreased of LDL-C (11%),
triglycerides (5%) and systolic and diastolic blood pressure (8%
and 9%, respectively, p < 0.05), with no changes for HDL-C and
insulin levels. Nevertheless, orange juice group have shown a
reduction in glycaemia over the experimental period (3%;
p < 0.05). Both groups presented similar results for energy and
macronutrient consumption, but OJ group increased vitamin C
intake by 157%.
Conclusion: Orange juice associated with balanced dietary has
decreased hyperglycemia, in addition to ameliorate lipid
profile, and contribute nutritionally to the quality of the
diet. Therefore, OJ may be consider as a functional food on the
nutrition therapy for MetSyn.
References
1. Ribeiro et al., Nutrition 2017; 38:13.
2. Aptekmann and Cesar Lipids in Health and Disease 2013; 12:119.
Disclosure of Interest: None declared.
MON-LB337
THE ADDITIONAL COSTS OF DISEASE RELATED MALNUTRITION
IN HOSPITALIZED CHILDREN
K. Freijer1 *, E. V. Puffelen2, K. F. Joosten2, J. M. Hulst2,
M. A. Koopmanschap3. 1Maastricht University, Maastricht,
2
Erasmus Medical Centre-Sophia, 3Erasmus University,
Rotterdam, Netherlands
Rationale: The objective of the current study was to estimate
the annual additional costs of Disease Related Malnutrition in
pediatric patients as was done for adults.
Methods: A cost-of-illness analysis was performed to calculate
the annual additional costs of DRM in 2015 pediatric patients
(aged 1 month up to and including 17 years) admitted to non-
academic hospitals in The Netherlands. DRM was assessed with
weight-for-age, weight-for-height and height-for-age. Input
variables in the formula used were length of stay and prevalence
of DRM. The costs were estimated per disease as classified in the
International Classification of Diseases by the WHO (ICD-10), per
gender and age group. The results were expressed as an absolute
monetary value as well as a percentage of the Dutch national
health expenditure. Robustness of the results was checked by a
sensitivity analysis.
Results: The total additional direct medical costs of DRM in
pediatric patients in 2013 were estimated to be €51 million for
acute malnutrition, €46 million when focused on chronic
malnutrition and €80 million in case of overall malnourished
children. This equals 5.6% of the total Dutch hospital costs for
these hospitalized children.
Conclusion: This study has shown that DRM in hospitalized
children increase the annual hospital costs with an additional
amount of €80 million, of which acute malnutrition account for
the largest part.
References
Freijer K, Tan SS, Koopmanschap MA, et al. The economic costs of
disease related malnutrition. Clin Nutr 2013; 32: 136–141.
Hecht C, Weber M, Grote V, et al. Disease associated malnutrition
correlates with length of hospital stay in children. Clin Nutr 2015; 34:
53–59.
Poster
Hulst JM, Zwart H, Hop WC, et al. Dutch national survey to test the
STRONGkids nutritional risk screening tool in hospitalized children.
Clin Nutr 2010; 29: 106–111.
Van der Velde K, Olieman JF, Winder E, et al. Follow-up of
malnourished hospitalized children: a Dutch multicenter study. Clin
Nutr 2014;33 (Suppl 1):S8.
World Health Organisation. International Statistical Classification of
Diseases and Related Health Problems, 10th Revision (ICD-10).
Geneva: WHO, 1992 (Accessed Dec 7th, 2016 at http://www.
icd10data.com/ICD10CM/Codes].
Disclosure of Interest: K. Freijer Grant/Research Support from:
unrestricted agreement with NAMN to do research for Maastricht
University, E. Puffelen: None declared, K. Joosten: None declared,
J. Hulst: None declared, M. Koopmanschap: None declared.
MON-LB338
DOES LONG TERM PARENTERAL NUTRITION DURING
CHILDHOOD INFLUENCE GROWTH AND FINAL ADULT HEIGTH?
M. M. Leuvrey1 *, E. Dugelay1, F. Liebert1, B. Dubern2,
E. M. Marinier1. 1Pediatric Gastroenterology, Hopital R Debré,
2
Pediatric Gastroenterology, Hopital Trousseau, Paris, France
Rationale: Long term parenteral nutrition (PN) is used to cover
nutritionnal requirements and achieve a normal growth in
children when digestive route is impossible because of
transient or chronic intestinal failure.
Whether patients under PN during chilhood reach a normal
target size (TS) is not known, nor are others factors responsible
for, under this condition. We designed a retrospective study to
adress these questions.
Methods: Patients attending our PN clinic between 1995 and
2016 were selected according to the following criterias:
Age > 16 years, PN duration >1 year, onset of PN prior to 11 years
of age.
Exclusion criteria: intestinal transplantation, death <16 years
old.
We collected : Weight and size when patient >16 years old, TS
( parenteral sizes +/− 6.5)/2), duration of PN, underlying
disease, birth data.
Results: 51 patients (26 girls) were eligible for study. Mean age
was 22 y +/− 5 y (16 y–35 y). Mean parenteral duration was
8.4 +/− 6.6 y (1 y–18 y); (for patients older than 18 y still under
PN we collected data up to 18 y).
Underlying disease was: Short bowel syndrome (SBS) 39%,
Congenital enteropathy (CE) 18%, CIPO 25%, Aganglionosis 12%,
miscellanous 6%.
Seven patients were lost for follow up. 2 patients had no target
size available (adoption)
69% of patients reached >93% of their TS (>-2DS) (groupA). 31%
were <-2ds of the TS (group B). There was no difference in PN
duration (Group A : 8.6 +/− 6y; Group B: 10.3 +/− 7 y) In
contrast the repartition according to the underlying disease
show:
SBS : 46% in Group B, vs 31% in group A; CE: 38% in B vs 10% in A,
motility disorders (CIPO and Aganglionosis) 8% in B vs 54% in A
Birth data show : prematurity in 45% of patients in group B
versus 16% in group A
Conclusion: 69% of patients reached their TS +/− 2 ds. Among
predictive factors of small final size, the underlying disease and
neonatal conditions have a major importance. PN is effective
to help reaching a normal adult size.
Disclosure of Interest: None declared.
Late Breaking Abstract 2
MON-LB339
PREDICTORS OF EARLY POST-OPERATIVE FEEDING: AN
OBSERVATIONAL STUDY IN A COLORECTAL SURGERY
POPULATION
C. Atkinson1 *, V. Short2, A. Ness1, S. Lewis3, R. Longman4,
S. Thomas5, S. Leary1, W. Hollingworth6, C. Penfold1. 1NIHR
Bristol Biomedical Research Centre (Nutrition Theme) at the
University Hospitals Bristol NHS Foundation Trust and the
University of Bristol, Bristol, 2National Perinatal Epidemiology
Unit, Nuffield Department of Population Health, University of
Oxford, Oxford, 3Plymouth Hospitals NHS Trust, Plymouth,
4
University Hospitals Bristol NHS Foundation Trust, 5School of
Oral and Dental Sciences, 6School of Social and Community
Medicine, University of Bristol, Bristol, United Kingdom
Rationale: Early post-operative feeding is recommended as
part of the enhanced recovery after surgery programme. We
conducted an observational analysis in a contemporary colo-
rectal surgery population to describe post-operative feeding
practices and to explore factors associated with early feeding.
Methods: Data from 321 participants in a previously conducted
RCT of chewing gum vs. usual care were used in this analysis.
Amounts of meals eaten on post-operative days (POD) 1–5 were
recorded as none, a quarter, half, three-quarters, or all. ‘Early’
consumers were classed as those who ate at least a quarter of a
meal on POD1. ‘Early’ tolerance was classed as the consump-
tion of at least half of three meals on POD1 or 2 without
vomiting. Selected peri-operative factors (bowel preparation,
pre-operative dietary preparation, surgical approach, primary
procedure, POD1 anti-emetics, POD1 opiate analgesics) were
assessed as potential predictors of early feeding and tolerance
in unadjusted and adjusted analyses.
Results: 236 (73.5%) consumed solid food early, and 115 (35.8%)
tolerated solid food early. Preliminary findings suggest that:
pre-operative bowel preparation is associated with delayed
feeding and tolerance; pre-operative diet preparation is
associated with early feeding; and laparoscopic/laparoscopic
assisted vs. open/converted to open surgery is associated with
early feeding and tolerance. Some potential differences
related to primary procedure were also observed.
Conclusion: In this population, almost three quarters ate solid
food early but only one third tolerated solid food early. Data
are being further explored, but our preliminary findings suggest
that avoidance of bowel preparation, use of pre-operative
dietary preparation, and laparoscopic surgery are associated
with early consumption and tolerance of solid food.
Disclosure of Interest: None declared.
MON-LB340
THE EVALUATION OF PREOPERATIVE ORAL CARBOHYDRATE-
RICH SOLUTION EFFECTS ON INSULIN RESISTANCE IN
PATIENTS UNDERGOING COLECTOMY
K. Jung1 *, C. A. Sio2, M.-O. Yoon3, H.-J. Jang3, H. J. Jang4.
1 Methods: Clinical redesign methodology was used to engage
General Surgery, Jeju National University Hospital, Jeju,
Republic of, Korea, 2General Surgery, Department of Surgery,
University of Santo Tomas Hospital, Manila, Philippines,
3
General Surgery, 4Nuclear Medicine, Seoul National University
Bundang Hospital, Seongnam, Republic of Korea
Rationale: This study aims to show the benefits of oral
rehydration solution administration two hours prior to surgery
S305
for patients undergoing elective colectomy, particularly
postoperative insulin resistance
Methods: All patients undergoing elective colectomy is
included and randomized to the control arm or treatment
arm. The control arm consists of the standard bowel prepar-
ation and one day of NPO, while the treatment arm consists of
the standard bowel preparation and allowing carbohydrate-rich
oral rehydration solution intake until 2 hours before surgery.
The Homeostatic Model Assessment – Insulin Resistance (HOMA-
IR) will be determined right after induction, 6 hours, 24 hours,
and 48 hours postoperativelyand compared between the two
groups.
Results: There was no significant in the difference of HOMA-IR
according to groups and time (Repeated-Measure ANOVA)
although the graph looked like showing some differences
( p = 0.516). Cortisol and TG were also not significant,
respectively ( p = 0.706, p = 0.241). Patients who drunk ORS
preoperatively were satisfied ( p < 0.001)
Conclusion: Preoperative oral carbohydrate-rich solution had a
limited effect on postoperative Insulin-resistance in patients
undergoing colectomy.
References
1. Ljungqvist O. Jonathan E. Rhoads Lecture 2011: Insulin resistance
and enhanced recovery after surgery. J Parenter Enteral Nutr
2012;36:389–99
2. Ljungqvist O, Nygren J, Thorell A. Modulation of post-operative
insulin resistance by pre-operative carbohydrate loading. Proc Nutr
Soc 2002;61:329–335.
3. Kratzing C. Pre-operative nutrition and carbohydrate loading. Proc
Nutr Soc 2011;70:311–5.
4. Yang DJ, Zhang S, He WL, et al. Fast tract surgery accelerate the
recovery of postoperative insulin sensitivity. Chin Med J
2012;125:3261–5.
5. Søreide E, et al. Pre-operative fasting guidelines: an update. Acta
Anaesthesiol Scand. 2005; 49(8):1041–7.
Disclosure of Interest: K. Jung Grant/Research Support from: Daesang
WeLife, C. Sio Grant/Research Support from: Daesang WeLife, M.-O.
Yoon Grant/Research Support from: Daesang WeLife, H.-J. Jang Grant/
Research Support from: Daesang WeLife, H. J. Jang Grant/Research
Support from: Daesang WeLife.
MON-LB341
‘FEED NOT FAST’: A MULTIDISCIPLINARY SYSTEMS APPROACH
TO MALNUTRITION IN AN ACUTE HOSPITAL
S. Courtice1 *, A. Mohanlal1, L. Ward1, S. Naidu2, J. Finucane3,
O. Wright4. 1Nutrition and Dietetics, 2Department of Surgery,
3
Nursing Director Medical, Queen Elizabeth II Jubilee Hospital,
4
School of Human Movement and Nutrition Sciences, University
of Queensland, Brisbane, Australia
Rationale: A redesign of the nutrition model of care in an acute
hospital with a focus on malnutrition was developed in response
to a malnutrition prevalance of 30%, low rates of malnutrition
screening and inadequate nutritional intakes.
hospital staff. Multidisciplinary nutrition action teams were
formed and priority areas identified. The menu was reviewed
and evaluated using a validated patient satisfaction survey and
energy and protein intake consumed. Key nutrition indicators
were developed by the multidisciplinary team and evaluated
regularly.
S306
Results: Nursing led malnutrition screening increased from 53%
to 88%; weights on admission from 47% to 86%; timely feeding
assistance from 55% to 92%; an increase in patient satisfaction
with foodservices from an overall score of 3.7/5 to 4.4/5
(n = 65); increased energy intake of main meals by 16% (n = 47);
a reduction in preoperative fasting time in elective colorectal
surgery patients from an average of 15.4 hours to 3.2 hours
(n = 30) and a 30% increase in patients coded with a diagnosis of
malnutrition each month.
Conclusion: Aligning the hospital team with a multidisciplinary
systems approach to nutrition care can improve malnutrition
screening and diagnosis, patient satisfaction with foodservices
and nutritional intake. Clinical redesign can assist in embed-
ding system change in acute care.
References
Ben-Tovim D, Dougherty M, O’Connell T, McGrath K. Patient journeys:
the process of clinical redesign. Med J Aust 2008; 188(6):14.
Capra S, Wright O, Sardie M, Bauer J, Askew D. The acute hospital
foodservice patient satisfaction questionnaire: the development of a
valid and reliable tool to measure patient satisfaction with acute
care hospital foodservices. Journal of Foodservice 2005; 16:1–14.
Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and
reliable malnutrition screening tool for adult acute hospital
patients. Nutrition 1999:15(6):458–464.
Gustarfsson U, Scott M, Schwenk W, Demartines N, Roulin D, Francis
N, McNaught C, MacFie J, Liberman A, Soop M, Hill A, Kennedy R,
Lobo D, Fearon K, Ljungqvist O. Guidelines for perioperative care in
elective colonic surgery: Enhanced Recovery After Surgery (ERAS)
Society recommendations. Clin Nutr 2012;31:783–800.
Disclosure of Interest: None declared.
MON-LB342
INFLUENCE OF MAGNESIUM STATUS ON THE GLYCEMIC
CONTROL IN PATIENTS WITH TYPE 2 DIABETES
H. Ozcaliskan Ilkay1 *, F. G. Samur2. 1Nutrition and Dietetics,
Erciyes University/Faculty of Health Sciences/Department of
Nutrition and Dietetics, Kayseri, 2Nutrition and Dietetics,
Hacettepe University/Faculty of Health Sciences/Department
of Nutrition and Dietetics, Ankara, Turkey
Rationale: Some epidemiological studies have reported hypo-
magnesemia in type 2 diabetes (T2D) owing to the fact that
magnesium occupies an important position in carbohydrate and
insulin metabolism. The aim of this study was therefore to
investigate the relationship between serum magnesium level
and glycemic control among type 2 diabetics.
Methods: The study included 119 type 2 diabetics (93 female,
mean age 54.7 ± 8.4 years) who were admitted to an university
endocrinology department in the period from January to May
2014 in Turkey. Serum magnesium level was measured by
spectrophotometric method. Hypomagnesemia was defined as
a serum magnesium level less than 0.75 mmol/L whereas
normomagnesemia was defined as serum magnesium level
≥0.75 mmol/L. Other biochemical measurements were also
performed using standard methods. The collected data
included comprehensive assessment of nutritional status and
anthropometric indexes/measures. The data were analysed
with univariate general linear model to adjust for potential
non-dietary and dietary confounders (adjustments for age,
gender, dietary energy intake (kcal/day), body mass index,
Poster
current smoking status, vitamin/mineral supplement use,
antihypertensive drug use, oral antidiabetic drug use, insulin
use, dietary fat intake (g/day) and dietary saturated fat intake
(g/day), dietary fiber intake (g/day) and dietary calcium/
magnesium ratio)
Results: In diabetic patients with hypomagnesemia, serum
levels of fasting plasma glucose, postprandial plasma glucose
and HbA1c were significantly higher compared to patients with
normomagnesemia (respectively 179.0 ± 64.9 vs. 148.7 ± 52.0
mg/dl, p < 0.01 for Model 1 but not significant for other models;
287.9 ± 108.4 vs. 226.8 ± 89.4 mg/dl, p < 0.01 for Model 1 and
p < 0.05 for others; %8.0 ± 1.9 vs. %6.5 ± 1.2, p= 0.000 for all
models). Although serum magnesium concentration was asso-
ciated to glycemic control parameters, dietary magnesium
intake wasn’t significantly related to glycemic parameters.
Conclusion: Hypomagnesemia in T2D is directly associated
with poor glycemic control. Clinical care should therefore
focus on increasing dietary magnesium intake or magnesium
supplementation to improve glycemic control in type 2
diabetics.
Disclosure of Interest: None declared.
MON-LB343
EFFECT OF INTRADIALYTIC-AEROBIC EXERCISE ON CLINICAL
OUTCOMES OF HEMODIALYSIS PATIENTS IN UNITED ARAB
EMIRATES: STUDY PROTOCOL AND BASELINE DATA
M. Karavetian1 *, N. Salhab2, J. Kooman3, E. Fiaccadori4.
1
Department of Health Sciences, Zayed University, Dubai,
United Arab Emirates, 2Maastricht University, Maastricht,
Netherlands, 3Maastricht University, Maastricht, United Arab
Emirates, 4Parma University, Parma, Italy
Rationale: Examine the effect of intradialytic aerobic exercise
on hemodialysis (HD) patient clinical outcomes and the barriers
to physical activity in united arab emirates (UAE)
Methods: An HD unit was randomly chosen from UAE, ethical
approval was received from Zayed University and Ministry of
Health’s ethical committees, after which, all patients (n = 150)
in the unit were included in the interventional study. Patients
were their own controls, and study parameters were collected
before and after the study for each patient inclusion criteria
were: stable HD patients ≥ 18 years, dialyzing 3 times per
week, cognitively aware, able to sign a consent form and
received a clearance from the nephrologist to enter the study.
The intervention will include an intradialytic aerobic low
intensity exercise of 45 minutes per HD session, tailored to each
the patients’ fitness scale (BORG scale) for 6 months. Patients
will be educated on the importance of exercise, its effect on
quality of life and efficacy of dialysis. Main outcome measures
were barriers to exercise, serum phosphorus-P, Urea Reduction
Ratio (URR), malnutrition inflammation score (MIS), quality of
life (QOL using euroqol5) collected at baseline and will be
collected post intervention
Results: 54 patients were included in the study, 58% were
males; 90% suffered with hypertension, 61% with diabetes and
26% with cardiovascular disease. Mean age was 51.8 ± 14.7
years, BMI 25.3 ± 5.6, serum P 5.6 ± 1.66 mg/dl, URR
69.4 ± 14.9% and kt/v’s 1.33 ± 0.11. The main barrier to
exercise was identified to be fatigue on HD days by 60% of
Late Breaking Abstract 2
patients, followed by shortness of breath, pain and lack of time
(37%). Finally, 96% of patient were mildly malnourished (MIS
score), and QOL scale was 63.55% ± 20.5.
Conclusion: The current clinical trial is the first in UAE to
reveal patient clinical characteristics and to introduce an
exercise regimen in the HD unit. The data show room for
S307
improvement. The intradialytic exercise regimen, if proven to
be effective, can be integrated in routine practice and improve
patients’ outcomes
Disclosure of Interest: None declared.
Clinical Nutrition (2017) 36(S1), S309–S328
j o u r n a l h o m e p a g e : h t t p : / / w w w. e l s e v i e r . c o m / l o c at e / c l n u
Author index
A Akishita, M., S167 (SUN-LB307)
Abadía, B., S37 (PT04.3)
Abad, S. Molinero, S233 (MON-P146)
Abbasi, E., S164 (SUN-P300)
Abbasi, H., S141 (SUN-P235)
Abdelhamid, E. R., S19 (OR47),
S144 (SUN-P244)
Abdelrazek, M., S163 (SUN-P297)
Abdullah, D. F., S245 (MON-P182)
Abiés, J., S229 (MON-P136)
Abilashan, M. S., S213 (MON-P093)
Abilés Osinaga, J., S237 (MON-P158),
S280 (MON-P276), S280 (MON-P277)
Ablett, J., S108 (SUN-P145), S160 (SUN-P288)
Abraham, A., S10 (OR23)
Abuin-Fernandez, J., S89 (SUN-P095),
S89 (SUN-P096)
Abulmeaty, M.M.A., S134 (SUN-P216),
S223 (MON-P121), S269 (MON-P248),
S279 (MON-P275)
Acar Tek, N., S241 (MON-P171), S242 (MON-
P172)
Aceto, P., S96 (SUN-P115)
Achamrah, N., S200 (MON-P057), S244 (MON-
P180), S286 (MON-P292)
Achar, E., S251 (MON-P198)
Açıkgöz, A., S124 (SUN-P191)
Adal, E., S200 (MON-P056)
Adiguzel, E., S131 (SUN-P208)
Adjemian, D., S61 (SUN-P023)
Aeberhard, C., S120 (SUN-P179)
Agca, M., S233 (MON-P147)
Agnes Peyron, M., S167 (SUN-LB306)
Agostinho, L., S219 (MON-P109)
Agostini, F., S202 (MON-P062)
Aguilar-Diosdado, M., S123 (SUN-P187)
Ahmed, N., S154 (SUN-P272)
Ahn, J. Y., S79 (SUN-P070)
Ahn, J.-Y., S301 (MON-LB330)
Aikawa, M., S153 (SUN-P269)
Aimasso, U., S301 (MON-LB329)
Ait, S., S48 (PT09.2), S77 (SUN-P065)
Ajgal, Z., S221 (MON-P116)
Ajibodu, S., S109 (SUN-P150), S215 (MON-
P096), S215 (MON-P097)
Akal Yıldız, E., S45 (PT07.5), S147 (SUN-P252),
S165 (SUN-P302)
Akashi, Y. J., S247 (MON-P188)
Akatsu, H., S165 (SUN-P301)
Akbıyık, H., S103 (SUN-P133), S104 (SUN-P134)
Contents lists available at ScienceDirect
Clinical Nutrition
Amálio, S., S161 (SUN-P291)
Akiyama, D., S199 (MON-P055) Amamou, A., S286 (MON-P292)
Akiyama, K., S75 (SUN-P059) Amaral, T. F., S192 (MON-P035)
Aksan, A., S124 (SUN-P191) Ambroszkiewicz, J., S42 (PT06.5), S52 (PT10.6)
Aksoy, B., S279 (MON-P273) Amemiya, F., S32 (PT02.4)
Aksungar, F. B., S53 (SUN-P001) Amiri-Moghadam, S., S76 (SUN-P061)
Aktaş, A., S98 (SUN-P118) Amizur-Levi, R., S179 (SUN-LB338)
Akyol Mutlu, A., S142 (SUN-P238), Ammann, R. A., S17 (OR43), S20 (OR50)
S257 (MON-P216) Amparo, F. C., S100 (SUN-P125)
Akyüz, C., S217 (MON-P104), S218 (MON-P105) Anastácio, L., S17 (OR41)
Al Kalaldeh, M. T., S180 (MON-P004) Andersen, H. K., S282 (MON-P281)
Alaidarous, T. A., S134 (SUN-P216) Andersen, J. R., S35 (PT03.5),
Alcocer-Varela, J., S226 (MON-P129) S108 (SUN-P147), S155 (SUN-P275),
Aldisi, D., S223 (MON-P121) S213 (MON-P093)
Alejo-Ramos, M., S115 (SUN-P165), Andersen, S. K., S35 (PT03.5)
S115 (SUN-P166), S116 (SUN-P167), Andrade, J.R.D., S219 (MON-P109)
S143 (SUN-P240) Andraus, W., S124 (SUN-P190)
Alessandri, F., S57 (SUN-P012) Andreeva, N., S192 (MON-P033)
Alexandre, J., S221 (MON-P116) Andreotti, S., S178 (SUN-LB334)
Alexandre, L., S255 (MON-P208) Andres, B., S223 (MON-P120)
Alexiadi, M., S258 (MON-P219) Andurell, L., S197 (MON-P048)
Alferink, L., S80 (SUN-P072) Ang, B., S59 (SUN-P019)
Ali Abdelhamid, Y., S180 (MON-P003) Angkatavanich, J., S247 (MON-P187)
Alikhanian, H., S145 (SUN-P246), Angulo, R. Cañas, S234 (MON-P150)
S159 (SUN-P287) An, J. Y., S174 (SUN-LB325), S175 (SUN-LB327)
Alivizatos, V., S300 (MON-LB328) Antczak, K., S100 (SUN-P124)
Alkhtani, N. M., S134 (SUN-P216) Antunes, M. S., S164 (SUN-P298)
Al-Leswas, D., S27 (OR68), S199 (MON-P052), Anzolin, F., S132 (SUN-P212)
S199 (MON-P053) Aoun, A., S84 (SUN-P083), S113 (SUN-P160),
Allinquant, B., S69 (SUN-P044) S113 (SUN-P161), S162 (SUN-P295)
Allo Miguel, G., S214 (MON-P094) Aperstein, Y., S24 (OR60)
Almadani, N. K., S223 (MON-P121) Apostolopoulou, A., S56 (SUN-P011)
Almajwal, A. M., S223 (MON-P121) Applegate, L. A., S50 (PT10.1)
Al-Muammar, M. N., S279 (MON-P275) Aprobato, F.G.G., S164 (SUN-P298)
Almutawa, D. A., S279 (MON-P275) Aragoneses, C., S271 (MON-P253)
Alnafisah, A. S., S279 (MON-P275) Arai, S., S165 (SUN-P301)
Al-Othman, A. M., S269 (MON-P248) Arakawa, K., S165 (SUN-P301)
Alparslan Mesci, B., S136 (SUN-P221) Arantes, S., S27 (OR67)
Alquraishii, M., S223 (MON-P121) Arapaki, M., S111 (SUN-P153)
Alramadan, M., S140 (SUN-P232) Araújo, L. B., S95 (SUN-P111)
Alsharari, Z., S55 (SUN-P009) Araújo, W.M.C., S65 (SUN-P034)
Altieri, S., S96 (SUN-P115) Ardoino, G., S135 (SUN-P219),
Altunoglu, E., S303 (MON-LB334) S189 (MON-P028)
Altwegg, J., S129 (SUN-P205) Aredes, M. A., S90 (SUN-P097),
Alvarez, A., S147 (SUN-P254) S211 (MON-P087), S212 (MON-P088)
Alvaro, E., S229 (MON-P136) Arenas Villafranca, J. J., S237 (MON-P158),
Alves, F. R., S122 (SUN-P186) S280 (MON-P276), S280 (MON-P277)
Alves, F., S122 (SUN-P185) Arenas, J., S229 (MON-P136)
Alves, R., S100 (SUN-P125) Arensberg, M. E., S168 (SUN-LB308)
Amabile, M. I., S57 (SUN-P012), S96 (SUN-P115) Arhip, L., S203 (MON-P064), S203 (MON-P065),
Amado, A., S129 (SUN-P203) S212 (MON-P089)
S310
Ariëns, M. P., S84 (SUN-P082)
Ariës, M. J., S25 (OR61)
Arikan, N., S82 (SUN-P078)
Arinc, S., S233 (MON-P147)
Arjaans, W., S49 (PT09.4)
Arman, G., S138 (SUN-P227)
Armengol-Debeir, L., S5 (OR11)
Arrais, A. V., S122 (SUN-P185)
Arribas, L., S91 (SUN-P101), S211 (MON-P085)
Arruda, A.R.D. C., S64 (SUN-P033)
Arshad, A., S88 (SUN-P094), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108),
S214 (MON-P095)
Arslan, D. O., S53 (SUN-P001)
Arslan, S., S45 (PT07.6), S289 (MON-P300)
Arthey, K., S83 (SUN-P080)
Ashbolt, K., S175 (SUN-LB328)
Ashikaga, K., S247 (MON-P188)
Ashmore, T., S176 (SUN-LB329)
Athanasopoulos, P., S300 (MON-LB328)
Atkins, M., S172 (SUN-LB320)
Atkinson, C., S282 (MON-P281),
S305 (MON-LB339)
Atsalakis, A., S295 (MON-LB316)
Attinà, G., S276 (MON-P265)
Aubertin-Leheudre, M., S38 (PT04.5),
S229 (MON-P137), S271 (MON-P252),
S284 (MON-P288)
Aubry, E., S37 (PT04.2), S120 (SUN-P179)
Augsburger, M., S50 (PT10.1)
Au-Yeung, C., S15 (OR37)
Avanzi, G. C., S64 (SUN-P032)
Avdjukevics, J., S138 (SUN-P226)
Avilés, V., S239 (MON-P165), S240 (MON-P166)
Aviles, V., S197 (MON-P048)
Aviram-Friedman, R., S263 (MON-P230)
Ayaz, A., S257 (MON-P216)
Ayçiçek, G. S., S241 (MON-P169),
S243 (MON-P177)
Aydin Cil, M., S242 (MON-P174),
S276 (MON-P267)
Aydin, A., S81 (SUN-P076)
Azevedo, G. A., S179 (SUN-LB337)
Azevedo, M. J., S26 (OR64)
Azevedo, R., S296 (MON-LB319)
Azriel Mira, S., S178 (SUN-LB336)
B Batırel, S., S200 (MON-P056)
Baba, H., S296 (MON-LB317)
Badía-Tahull, M., S79 (SUN-P069)
Bae, J. M., S174 (SUN-LB325), S219 (MON-P108)
Baek, S., S190 (MON-P029)
Baggerman, M. R., S25 (OR61)
Baggerman, M., S22 (OR55)
Bahlouli, W., S97 (SUN-P116)
Bahr, L., S110 (SUN-P151), S110 (SUN-P152)
Baik, H. W., S176 (SUN-LB331)
Bailén-García, M. Á., S123 (SUN-P187)
Bajwa, N., S265 (MON-P236)
Bakers, F. C., S25 (OR61)
Bakker, G. J., S54 (SUN-P004)
Balbino, A. M., S179 (SUN-LB337)
Balcı, C., S241 (MON-P169)
Balci, C., S243 (MON-P177)
Baldevarona, J. L., S162 (SUN-P293)
Baldwin, C., S43 (PT07.1), S97 (SUN-P117)
Baldwin, J., S120 (SUN-P180)
Author index
Balladares-Saltos, M., S277 (MON-P268)
Ballesteros-Pomar, M. D., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
Ballmer, P. E., S141 (SUN-P234),
S259 (MON-P220)
Bally, L., S120 (SUN-P179)
Banba, K., S195 (MON-P043),
S262 (MON-P229)
Bandt, J.-P. De, S221 (MON-P116)
Banning, L. B., S132 (SUN-P211)
Barabash, A., S269 (MON-P247),
S271 (MON-P253)
Baracos, V. E., S47 (PT08.5)
Baracos, V., S219 (MON-P109)
Barahona, R., S177 (SUN-LB332)
Barajas-Galindo, D., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
Barata, A., S163 (SUN-P296)
Barata, A.T.D.C.F., S83 (SUN-P079)
Barazzoni, R., S1 (OR01), S6 (OR15),
S74 (SUN-P056), S272 (MON-P255),
S272 (MON-P256)
Barbosa, E., S41 (PT06.1)
Barcellos, P. S., S231 (MON-P142)
Barceló, M., S119 (SUN-P178)
Barcelos, S., S16 (OR40)
Bardon, L. A., S30 (PT01.3), S131 (SUN-P209),
S189 (MON-P027)
Bardou-Jacquet, E., S209 (MON-P082)
Barichella, M., S101 (SUN-P128)
Barnoud, D., S48 (PT09.2), S77 (SUN-P065)
Barnova, I., S50 (PT10.2)
Barragry, J., S96 (SUN-P114), S109 (SUN-P150),
S215 (MON-P096), S215 (MON-P097)
Barrera Rebollo, A., S225 (MON-P125)
Bartol-Puyal, F., S37 (PT04.3)
Başar, H., S58 (SUN-P017)
Baschali, A., S101 (SUN-P126),
S295 (MON-LB316)
Basile, R., S193 (MON-P036)
Basrai, M., S196 (MON-P046)
Basso, L., S87 (SUN-P091), S152 (SUN-P267),
S276 (MON-P265), S281 (MON-P278)
Basualdo Hammond, C., S172 (SUN-LB320)
Bathe, O. F., S47 (PT08.5)
Bats, H. D., S205 (MON-P071)
Bauer, J., S131 (SUN-P209)
Bauer, P., S83 (SUN-P080),
S272 (MON-P255)
Bayoumy, A., S19 (OR47)
Beau, P., S5 (OR11)
Beck, A. M., S43 (PT07.1), S97 (SUN-P117),
S166 (SUN-LB305)
Becker, W., S30 (PT01.4)
Beermann, T., S217 (MON-P102)
Beheshti-Namdar, A., S76 (SUN-P061)
Behulova, D., S284 (MON-P287)
Beijer, S., S84 (SUN-P082), S174 (SUN-LB324)
Beijers, R.J.H.C.G., S232 (MON-P145)
Bejarano, S., S120 (SUN-P180)
Belaidi, E., S6 (OR14)
Belarmino, G., S16 (OR40),
S124 (SUN-P190)
Belle, F. N., S17 (OR43), S20 (OR50)
Belli, D., S265 (MON-P236)
Bellikci Koyu, E., S146 (SUN-P249),
S257 (MON-P216), S273 (MON-P258)
Bellikci-Koyu, E., S164 (SUN-P299)
Bell, J., S125 (SUN-P194)
Belmonte, L. E., S200 (MON-P057)
Belmonte, L., S286 (MON-P292)
Bemer, P., S102 (SUN-P129), S231 (MON-P140)
Benassi, R. O., S303 (MON-LB336)
Benazzo, M., S24 (OR59)
Bendavid, I., S25 (OR63), S183 (MON-P012),
S184 (MON-P013)
Benincá, S. C., S116 (SUN-P169)
Bergeat, D., S143 (SUN-P242),
S209 (MON-P082)
Berger, M. M., S50 (PT10.1), S183 (MON-P011)
Bergoin, C., S48 (PT09.2), S77 (SUN-P065)
Berika, M. Y., S269 (MON-P248)
Bering, T., S133 (SUN-P213), S202 (MON-P063)
Berlana, D., S61 (SUN-P024)
Bernal Canales, T., S234 (MON-P150)
Bernardi, J. R., S136 (SUN-P222)
Bernardo, K., S155 (SUN-P276)
Bersani, G., S50 (PT09.5)
Bertéus Forslund, H., S194 (MON-P039),
S194 (MON-P040)
Berthet, D., S129 (SUN-P205)
Betriu, L., S61 (SUN-P024)
Bétry, C., S77 (SUN-P065)
Beurskens Meijerink, J., S108 (SUN-P146)
Beurskens, D., S22 (OR55)
Bezmarevic, M., S23 (OR56), S181 (MON-P006)
Bhangal, C., S214 (MON-P095)
Bhardwaj, V., S220 (MON-P113)
Biesinger, V., S196 (MON-P046)
Bilgiç, P., S131 (SUN-P208), S274 (MON-P260)
Bilgic, P., S166 (SUN-LB304)
Bilgrau, A. E., S213 (MON-P091)
Bilku, D. K., S27 (OR68), S199 (MON-P052),
S199 (MON-P053), S199 (MON-P054)
Bindelle, J., S273 (MON-P259)
Bindels, L., S22 (OR54), S273 (MON-P259)
Bingisser, R., S67 (SUN-P040)
Biolo, G., S64 (SUN-P032), S291 (MON-LB305),
S291 (MON-LB306)
Biondi, A., S152 (SUN-P267)
Biruete, A., S35 (PT03.4)
Bischoff, S. C., S196 (MON-P046),
S272 (MON-P255), S272 (MON-P256)
Bise, T., S198 (MON-P049)
Bjøro, T., S91 (SUN-P100)
Blaak, E. E., S25 (OR61)
Blaauw, R., S251 (MON-P198)
Blais, R., S19 (OR48)
Blanchet, S., S157 (SUN-P280)
Blanc, M.-C., S221 (MON-P116)
Blanco, L., S224 (MON-P122)
Blasi, V., S276 (MON-P265), S281 (MON-P278)
Blat, S., S143 (SUN-P242)
Blauw, G. J., S72 (SUN-P051)
Blauwhoff-Buskermolen, S., S112 (SUN-P157)
Blomhoff, R., S46 (PT08.1), S91 (SUN-P100)
Blyth, F., S30 (PT01.5)
Boaz, M., S176 (SUN-LB330)
Bobovnick, S., S185 (MON-P017)
Bobowicz, M., S173 (SUN-LB323)
Bochud, M., S17 (OR43)
Bodier, V., S126 (SUN-P195)
Boehm, V., S5 (OR11)

Boeing, H., S167 (SUN-LB306)
Boel, T., S155 (SUN-P275)
Boesveldt, S., S69 (SUN-P045),
S171 (SUN-LB318)
Boeykens, K., S301 (MON-LB331),
S302 (MON-LB332)
Bøhn, S. K., S46 (PT08.1)
Boirie, Y., S34 (PT03.1), S291 (MON-LB306)
Bolayır, B., S241 (MON-P169), S243 (MON-P177)
Bole-Feysot, C., S200 (MON-P057)
Bolliri, C., S101 (SUN-P128)
Bol, M. E., S25 (OR61)
Bol, M., S22 (OR55)
Bolstad, N., S91 (SUN-P100)
Boltes Reis, G., S178 (SUN-LB334)
Bonato, V., S74 (SUN-P056)
Bond, A., S10 (OR23)
Bonetti, L., S68 (SUN-P042), S135 (SUN-P219),
S189 (MON-P028)
Bonnabry, P., S265 (MON-P236)
Bonoli, A., S50 (PT09.5)
Booth, M. B., S268 (MON-P246)
Boracchi, P., S135 (SUN-P219)
Borba, L.G.D., S60 (SUN-P022)
Bordier, V., S255 (MON-P209)
Borek, P., S119 (SUN-P176)
Borges, N., S231 (MON-P142)
Borins, E. P., S138 (SUN-P226)
Borroni, F., S227 (MON-P131)
Bosaeus, I., S216 (MON-P099)
Bossche, N., S20 (OR49), S80 (SUN-P072),
S80 (SUN-P073)
Bot, D., S75 (SUN-P060), S78 (SUN-P067)
Bottoni, A., S279 (MON-P274)
Bou Mosleh, J., S113 (SUN-P161)
Boudjema, K., S143 (SUN-P242),
S209 (MON-P082)
Boulbasakos, G., S101 (SUN-P126)
Bouma, G., S49 (PT09.4)
Bouras, E., S63 (SUN-P029)
Bourgoin-Voillard, S., S157 (SUN-P279)
Boutry, C., S4 (OR09)
Bouville, A., S135 (SUN-P218)
Bouyon, S., S6 (OR14)
Bovera, M. M., S120 (SUN-P181)
Bozbulut, R., S275 (MON-P263)
Bozkurt Cakir, I., S136 (SUN-P221)
Bradley, E., S249 (MON-P192)
Bradshaw, C., S159 (SUN-P286)
Brand, H., S74 (SUN-P055)
Brandt, C. F., S39 (PT05.3), S234 (MON-P149)
Brant, C. Q., S117 (SUN-P172)
Bras, L., S131 (SUN-P210)
Breedveld-Peters, J.J.L., S84 (SUN-P082)
Breen, A., S159 (SUN-P286)
Brekke, H. K., S294 (MON-LB314)
Brennerova, K., S284 (MON-P287)
Bresolin, N. L., S41 (PT06.1)
Bretón Lesmes, I., S203 (MON-P064),
S203 (MON-P065), S212 (MON-P089)
Breton, I., S177 (SUN-LB332)
Breuillard, C., S3 (OR07), S6 (OR14),
S157 (SUN-P279)
Breuillé, D., S4 (OR09)
Brinksma, A., S11 (OR26)
Brito-Ashurst, I. D., S65 (SUN-P034)
Brøbech, P., S39 (PT05.3)
Broebech, P., S234 (MON-P149)
Author index
Broens, B., S186 (MON-P020)
Brosnan, N., S252 (MON-P201)
Brouns, J., S249 (MON-P191),
S250 (MON-P194)
Brouwer-Brolsma, E. M., S31 (PT01.6)
Brouwer, I. A., S12 (OR30)
Brummer, R., S194 (MON-P039),
S194 (MON-P040)
Brundrett, D., S51 (PT10.3)
Bruno, K. A., S90 (SUN-P097)
Bruno, K.D.A., S211 (MON-P087)
Bruno, L. L., S50 (PT09.5)
Buettner, S., S80 (SUN-P072), S80 (SUN-P073)
Bufato, H. F., S118 (SUN-P175)
Buhler, S., S172 (SUN-LB320)
Burgos, R., S16 (OR39), S61 (SUN-P024),
S197 (MON-P048), S239 (MON-P165),
S240 (MON-P166)
Burke, D., S287 (MON-P296)
Busni, D., S227 (MON-P131)
Butler-Browne, G., S72 (SUN-P051)
Buturovic-́ Ponikvar, J., S98 (SUN-P119)
Buyuktuncer, Z., S240 (MON-P168),
S257 (MON-P216)
Bzduch, V., S284 (MON-P287)
C Cassani, E., S101 (SUN-P128)
Caballero Arredondo, M., S41 (PT06.2)
Cabezas Garcia, G., S225 (MON-P124)
Cabrera, A., S147 (SUN-P254)
Cabrera, R., S269 (MON-P247)
Cabrita, P., S161 (SUN-P291)
Çabuk Güllüoğlu, H., S273 (MON-P258)
Caccialanza, R., S24 (OR59)
Cachero Triadú, M., S94 (SUN-P109)
Cachero, M., S136 (SUN-P223)
Caferoglu, Z., S18 (OR45), S43 (PT06.6)
Cai, Z., S201 (MON-P060), S202 (MON-P061)
Cakmak, G., S145 (SUN-P247)
Calderón Vicente, D., S140 (SUN-P232)
Calder, P., S12 (OR29), S58 (SUN-P016)
Çalışkan, H., S241 (MON-P169),
S243 (MON-P177)
Calvo, P., S37 (PT04.3)
Camblor Álvarez, M., S203 (MON-P064),
S203 (MON-P065)
Camblor Alvarez, M., S212 (MON-P089)
Camblor, M., S177 (SUN-LB332)
Campos, J.A.D. B., S260 (MON-P223)
Campos, V., S285 (MON-P291)
Campoy, C., S36 (PT04.1), S41 (PT06.2)
Canals-Baeza, A., S277 (MON-P269)
Cando, I., S150 (SUN-P260)
Cani, P., S22 (OR54)
Cankurtaran, M., S241 (MON-P169),
S243 (MON-P177)
Cano, N., S62 (SUN-P028)
Cano-Rodríguez, I., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
cao, S., S221 (MON-P115)
Cao, S., S188 (MON-P023)
Cao, Z., S302 (MON-LB333)
Cappello, S., S24 (OR59)
Caraccia, M., S24 (OR59)
Caran, E.M.M., S252 (MON-P199),
S252 (MON-P200)
S311
Cárdenas, G., S16 (OR39), S197 (MON-P048),
S239 (MON-P165), S240 (MON-P166)
Cardoso, A., S17 (OR41)
Carlsen, M. H., S91 (SUN-P100)
Carlsson, A., S55 (SUN-P009)
Carneiro, D., S64 (SUN-P031)
Carnell, J., S204 (MON-P066)
Caronni, S., S101 (SUN-P128)
Carpentier, B., S23 (OR57)
Carrascal Fabián, M. L., S203 (MON-P064)
Carrascal Fabian, M. L., S212 (MON-P089)
Carrasqueira, H., S161 (SUN-P291)
Carrier, N., S75 (SUN-P057)
Carsin, M., S32 (PT02.2)
Carus, A., S217 (MON-P102)
Carvalho, A. M., S57 (SUN-P013)
Carvalho, L. P., S229 (MON-P137)
Carvalho, L., S284 (MON-P288)
Carvalho, L.S.F., S65 (SUN-P034)
Carvalho, R., S185 (MON-P015)
Casal, M. C., S109 (SUN-P148)
Casanova Rodriguez, C., S178 (SUN-LB336)
Casarotto, L., S265 (MON-P237)
Casarsa, C., S64 (SUN-P032)
Casillas, E., S224 (MON-P122)
Casique-Pérez, V., S209 (MON-P081)
Castaldo, A., S68 (SUN-P042),
S135 (SUN-P219), S189 (MON-P028)
Castellano, I., S172 (SUN-LB319)
Castello, L. M., S64 (SUN-P032)
Castellote, A. I., S36 (PT04.1), S41 (PT06.2)
Castillo, C. Montes, S226 (MON-P127)
Castillo-Martínez, L., S117 (SUN-P170),
S209 (MON-P081), S226 (MON-P129)
Castro-Eguiluz, D., S209 (MON-P081)
Castro, M., S181 (MON-P005)
Castro, N., S260 (MON-P222)
Catalina, I., S177 (SUN-LB332)
Caviezel, D., S233 (MON-P148)
Cawley, C., S108 (SUN-P145)
Cawood, A. L., S7 (OR18), S175 (SUN-LB328)
Cawthon, P. M., S12 (OR30)
Cayón-Blanco, M., S236 (MON-P156)
Cayon-Blanco, M., S134 (SUN-P217)
Cayuela García, A., S263 (MON-P231)
Cazaubon, E., S4 (OR09)
Ceballos, M., S269 (MON-P247)
Cecati, M., S227 (MON-P131)
Cederholm, T., S30 (PT01.4), S55 (SUN-P009)
Ceniccola, G. D., S64 (SUN-P033),
S65 (SUN-P034)
Ceniceros Rozalen, I., S62 (SUN-P028)
Cereda, E., S24 (OR59), S101 (SUN-P128),
S264 (MON-P235)
Černelič Bizjak, M., S141 (SUN-P236),
S243 (MON-P176), S270 (MON-P249)
Cervantes, L. S., S35 (PT03.4)
César, R., S185 (MON-P015)
Cesar, T. B., S303 (MON-LB336)
Cetina-Pérez, L., S209 (MON-P081)
Chadwick, P., S10 (OR23)
Chambrier, C., S5 (OR11), S48 (PT09.2),
S77 (SUN-P065)
Chammas, R., S113 (SUN-P161)
Chan, C. K., S15 (OR37)
Chang, Y.-S., S23 (OR58)
Chan, L., S15 (OR38)
S312
Chan, P., S97 (SUN-P116)
Chan, W. Y., S255 (MON-P208)
Chan, Y. H., S59 (SUN-P019)
Chao, C.-T., S44 (PT07.4)
Chapman, M., S180 (MON-P003)
Chapple, L., S180 (MON-P003)
Charidemou, E., S176 (SUN-LB329)
Charrière, M., S183 (MON-P011)
Chaves, G. V., S39 (PT05.2), S90 (SUN-P097),
S211 (MON-P087), S212 (MON-P088)
Chee, V., S120 (SUN-P180)
Chełchowska, M., S42 (PT06.5), S52 (PT10.6)
Chen, C. W., S86 (SUN-P087)
Cheng, H., S152 (SUN-P266)
Cheng, T. P., S15 (OR37)
Chen, H., S284 (MON-P286)
Chen, J., S139 (SUN-P230), S278 (MON-P272)
Chen, L., S138 (SUN-P228)
Chen, W., S138 (SUN-P228)
Chen, W.-J., S79 (SUN-P071)
Chermesh, I., S254 (MON-P206)
Cheung, K., S130 (SUN-P207)
Cheung, W., S199 (MON-P054)
Chiang Alvarez, M., S234 (MON-P150)
Chiarello, P., S81 (SUN-P074)
Chiba, M., S266 (MON-P241), S276 (MON-P266)
Chica Marchal, A., S263 (MON-P231)
Chikhi, M., S113 (SUN-P159), S129 (SUN-P205)
Chikugo, M., S178 (SUN-LB335)
Chisaguano Tonato, A. M., S36 (PT04.1),
S41 (PT06.2)
Chisaguano, M., S260 (MON-P222)
Chi-Sheng, W., S23 (OR58)
Chittawatanarat, K., S247 (MON-P187)
Chiu, P., S15 (OR38)
Chmielewski, M., S119 (SUN-P176)
Cho, H. J., S190 (MON-P029)
Choi, K. D., S79 (SUN-P070),
S301 (MON-LB330)
Choi, M. G., S174 (SUN-LB325),
S219 (MON-P108)
Choi, N.-J., S182 (MON-P009)
Choisy, C., S285 (MON-P289)
Chopard, P., S129 (SUN-P205)
Chourdakis, M., S56 (SUN-P011),
S63 (SUN-P029), S109 (SUN-P148),
S140 (SUN-P233)
Cho, Y. Y., S219 (MON-P108)
Cho, Y., S69 (SUN-P044)
Chriestya, F., S226 (MON-P128)
Chung, W. Y., S214 (MON-P095)
Chung, W., S23 (OR58), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108)
Chu, Q., S47 (PT08.4)
Cicek, B., S145 (SUN-P248)
Cieślak, W., S100 (SUN-P124)
Çiftçi, S., S235 (MON-P153)
Cignacco, E., S20 (OR50)
Cil, M. Aydin, S228 (MON-P133)
Cintoni, M., S87 (SUN-P091), S152 (SUN-P267),
S276 (MON-P265), S281 (MON-P278)
Cioffi, I., S103 (SUN-P131), S126 (SUN-P196)
Ciudin, A., S16 (OR39)
Civelek, S., S303 (MON-LB334)
Clamagirand, C., S69 (SUN-P044)
Clarke, M., S30 (PT01.3), S131 (SUN-P209),
S189 (MON-P027)
Clausen, J.K.B., S108 (SUN-P147)
Author index
Claytor, L., S168 (SUN-LB309),
S300 (MON-LB327)
Clynes, R., S252 (MON-P201)
Cnop, M., S273 (MON-P259)
Cobilinschi, C., S60 (SUN-P020),
S60 (SUN-P021)
Cocco, M., S253 (MON-P202)
Coebergh van den Braak, R., S80 (SUN-P073),
S128 (SUN-P201)
Coëffier, M., S34 (PT03.1), S97 (SUN-P116),
S200 (MON-P057), S244 (MON-P180)
Coeffier, M., S286 (MON-P292)
Coelho, M.P.P., S133 (SUN-P213),
S202 (MON-P063)
Coenen, M., S275 (MON-P262)
Cohen Fox, L., S24 (OR60)
Cohen, J., S24 (OR60), S25 (OR63),
S183 (MON-P012), S184 (MON-P013)
Cohen, S. S., S266 (MON-P239)
Coker, A., S81 (SUN-P076)
Cola, C., S193 (MON-P036)
Colange, G., S244 (MON-P180)
Colizzi, E., S68 (SUN-P041)
Collado Amores, M. C., S203 (MON-P064),
S203 (MON-P065)
Collins, A. R., S46 (PT08.1)
Collins, P. F., S231 (MON-P141)
Collo, A., S172 (SUN-LB319)
Colls-González, M., S79 (SUN-P069)
Colombo, M. G., S73 (SUN-P054)
Colombo, S., S24 (OR59)
Çolpan Öksüz, D., S87 (SUN-P090)
Comas Martínez, M., S240 (MON-P166)
Comas, M., S197 (MON-P048), S239 (MON-P165)
Commeyne, S., S150 (SUN-P261)
Concollato, E., S74 (SUN-P056)
Conde Vicente, R., S225 (MON-P124)
Contaldo, F., S40 (PT05.6), S44 (PT07.2),
S103 (SUN-P131), S126 (SUN-P196)
Contreras-Bolivar, V., S89 (SUN-P095),
S89 (SUN-P096)
Contreras, M. G., S173 (SUN-LB321)
Cooke, J., S27 (OR68), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108),
S199 (MON-P052), S199 (MON-P053)
Cook, M. E., S213 (MON-P091),
S217 (MON-P102)
Corbella, F., S24 (OR59)
Corcos, O., S5 (OR11)
Corish, C. A., S189 (MON-P027)
Corish, C., S30 (PT01.3), S131 (SUN-P209)
Corne, C., S3 (OR07)
Correia, M. I., S17 (OR41)
Correia, M.I.T. D., S133 (SUN-P213),
S202 (MON-P063)
Cortez, I., S57 (SUN-P014)
Cortina, R. A., S35 (PT03.4)
Coskun, R., S287 (MON-P295)
Costa, F., S219 (MON-P109)
Costa, H., S185 (MON-P015)
Costa, M.P.S., S151 (SUN-P264)
Costa, V. L., S26 (OR64)
Couchet, M., S3 (OR07), S6 (OR14)
Couratier, P., S34 (PT03.1), S34 (PT03.3)
Courtice, S., S305 (MON-LB341)
Courtin, C., S22 (OR54)
Cravo, M., S151 (SUN-P264), S219 (MON-P109)
Crespo Soto, C., S225 (MON-P125)
Creus, G., S91 (SUN-P101)
Crommen, S., S275 (MON-P262)
Cros, J., S285 (MON-P291)
Croveto, M., S133 (SUN-P215)
Crudo, M., S96 (SUN-P115)
Cruthirds, C., S34 (PT03.2), S36 (PT03.6)
Cruz, R., S219 (MON-P109)
Cuellar Olmedo, L., S225 (MON-P124),
S225 (MON-P125)
Cuerda Compés, C., S212 (MON-P089)
Cuerda Compés, M. C., S203 (MON-P064),
S203 (MON-P065)
Cuerda, C., S177 (SUN-LB332)
Cuesta, F., S269 (MON-P247)
Cui, H., S243 (MON-P175)
Cukier, C., S122 (SUN-P186)
Culkin, A., S51 (PT10.3), S76 (SUN-P063)
Cullen, K., S249 (MON-P192)
Cumming, R., S30 (PT01.5)
Cunha, C., S219 (MON-P109)
Cunha, H.F.R., S267 (MON-P243)
Cunin, V., S157 (SUN-P279)
Cunneen, S., S252 (MON-P201)
Cuvelier, I., S190 (MON-P030)
Cynober, L., S69 (SUN-P044), S90 (SUN-P098),
S221 (MON-P116), S253 (MON-P203),
S284 (MON-P286), S285 (MON-P289)
Czarnecki, D., S100 (SUN-P124)
Czyzewska, M., S105 (SUN-P139)
D
D’Albuquerque, L.A.C., S124 (SUN-P190)
D’almeida, C. A., S215 (MON-P098)
D’almeida, C., S29 (PT01.2)
d’Assignies, G., S62 (SUN-P028)
D’ugo, D., S152 (SUN-P267)
da Camara, A. O., S212 (MON-P088)
Dale, H. F., S32 (PT02.3)
Damaraju, V., S47 (PT08.4)
Damiani, L., S124 (SUN-P190)
Dams, K., S290 (MON-LB304)
Daniel, H., S297 (MON-LB321)
Danko, M., S18 (OR44), S150 (SUN-P262)
Danner-Boucher, I., S56 (SUN-P010)
Dardevet, D., S167 (SUN-LB306)
Darmaun, D., S56 (SUN-P010)
Darwish Murad, S., S80 (SUN-P072)
Davies, N., S268 (MON-P246)
Dax, A., S267 (MON-P244), S268 (MON-P245)
de Aguilar-Nascimento, J. E.,
S118 (SUN-P175)
De Aguilar-Nascimento, J. E., S27 (OR67)
De Baat, C., S74 (SUN-P055)
De Bandt, J.-P., S7 (OR17), S90 (SUN-P098),
S253 (MON-P203), S284 (MON-P286),
S285 (MON-P289), S285 (MON-P291)
de Bree, R., S83 (SUN-P081)
de Bruin, R., S80 (SUN-P072), S80 (SUN-P073),
S128 (SUN-P201)
De Caprio, C., S40 (PT05.6), S44 (PT07.2),
S103 (SUN-P131)
De Cloet, J., S150 (SUN-P261)
De Colle, P., S74 (SUN-P056)
de Damas Medina, M., S226 (MON-P127)
De Faire, U., S55 (SUN-P009)
De Filippo, E., S40 (PT05.6), S44 (PT07.2),
S103 (SUN-P131)

De Francesco, A., S172 (SUN-LB319),
S301 (MON-LB329)
de Groot, C. P., S166 (SUN-LB305)
De Groot, I.A.M., S104 (SUN-P136)
de Groot, L. C., S9 (OR21)
De Groot, L., S167 (SUN-LB306)
de Groot, M. H., S68 (SUN-P043)
De Groot, M., S220 (MON-P112)
de Jong, N., S72 (SUN-P051)
De Koning, B., S42 (PT06.4)
de la Garza Puentes, A., S36 (PT04.1),
S41 (PT06.2)
DE LA Iglesia-Arnaez, R., S277 (MON-P269)
De Lorenzi, D.R.S., S98 (SUN-P120)
De Luca, A., S148 (SUN-P255), S155 (SUN-P276)
de Man, R. A., S133 (SUN-P214)
de Mestral, C., S262 (MON-P227)
De Oliveira, A.B.M., S65 (SUN-P034)
de Paula, N. S., S90 (SUN-P097),
S211 (MON-P087), S212 (MON-P088)
de Pinho, N. B., S215 (MON-P098)
de Sá, B. L., S253 (MON-P202)
De Schepper, J., S151 (SUN-P263)
de Smoker, M., S238 (MON-P161)
de Theije, C. C., S26 (OR66)
de van der Schueren, M. A., S30 (PT01.3),
S71 (SUN-P050), S72 (SUN-P052),
S131 (SUN-P209), S166 (SUN-LB305)
De Van Der Schueren, M. A., S238 (MON-P161)
de Van Der Schueren, M., S112 (SUN-P157)
de van der Schueren, M., S216 (MON-P101)
De van der Schueren, M., S69 (SUN-P045),
S73 (SUN-P053), S83 (SUN-P080),
S93 (SUN-P105)
De Vogel-Van den Bosch, J., S232 (MON-P144)
de Vries, J., S107 (SUN-P144)
De Wachter, E., S151 (SUN-P263)
De Waele, E., S62 (SUN-P027),
S180 (MON-P002)
De Witte, N., S261 (MON-P225)
Deane, A. M., S33 (PT02.6)
Deane, A., S180 (MON-P003)
Debain, A., S180 (MON-P002)
De-Bandt, J.-P., S69 (SUN-P044)
Déchelotte, P., S97 (SUN-P116),
S200 (MON-P057), S244 (MON-P180),
S286 (MON-P292)
Degirmenci, N., S260 (MON-P224)
Dehnavi, Z., S121 (SUN-P183)
Dekker, I., S187 (MON-P021)
Del Piano, C., S103 (SUN-P131)
Delay, J., S200 (MON-P057),
S244 (MON-P180)
Delgado-Martínez, A. D., S226 (MON-P127)
Delgado-Rodríguez, M., S226 (MON-P127)
Dell’utri, D., S57 (SUN-P012)
Dellière, S., S253 (MON-P203)
Delzenne, N., S2 (OR04), S22 (OR54),
S273 (MON-P259)
Demetriou, P., S300 (MON-LB328)
Demiral Sezer, S., S218 (MON-P107)
Demirel, Z. Büyüktuncer, S235 (MON-P152),
S235 (MON-P153)
Demir, N. B., S11 (OR27)
Demir, N., S103 (SUN-P132)
Demol, J., S62 (SUN-P027)
Deniz, O., S11 (OR27), S195 (MON-P042)
Denneman, N., S186 (MON-P020)
Author index
Dennison, A. R., S199 (MON-P054),
S214 (MON-P095)
Dennison, A., S23 (OR58), S27 (OR68),
S88 (SUN-P094), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108),
S199 (MON-P052), S199 (MON-P053)
Desbrow, B., S281 (MON-P279)
Desmet, S., S63 (SUN-P030)
Desport, J. C., S8 (OR19), S19 (OR48),
S34 (PT03.1), S34 (PT03.3), S127 (SUN-P200)
Deutz, N. E., S46 (PT08.3), S70 (SUN-P046),
S70 (SUN-P047), S99 (SUN-P123),
S156 (SUN-P277), S227 (MON-P130)
Deutz, N., S34 (PT03.2), S36 (PT03.6),
S244 (MON-P178)
Devriese, L. A., S83 (SUN-P081)
Dewansingh, P., S250 (MON-P195)
Dhaliwal, R., S210 (MON-P083)
Di Caro, S., S50 (PT10.2), S96 (SUN-P114),
S109 (SUN-P150), S130 (SUN-P207),
S215 (MON-P096), S215 (MON-P097),
S287 (MON-P294)
Di Girolamo, F. G., S64 (SUN-P032)
di Rosa, M., S193 (MON-P036)
Di Somma, S., S64 (SUN-P032)
Di Vincenzo, O., S126 (SUN-P196)
Diamantopoulos, P., S111 (SUN-P153)
Díaz Guardiola, P., S178 (SUN-LB336)
Diaz, E., S288 (MON-P299)
Díaz, M., S228 (MON-P134)
Diaz, M., S225 (MON-P126)
Dibb, M., S10 (OR23)
Diekmann, R., S73 (SUN-P054)
Diemer, D., S159 (SUN-P284)
Diez-Garcia, R. W., S48 (PT08.6),
S95 (SUN-P111), S95 (SUN-P112)
Dijk, A. V., S112 (SUN-P158)
Dijkhuizen, M., S107 (SUN-P144)
Dijkstra, G., S205 (MON-P071)
Dijxhoorn, D. N., S10 (OR24), S255 (MON-P210)
Dikmen, D., S116 (SUN-P168),
S135 (SUN-P220), S142 (SUN-P239)
Dimori, S., S264 (MON-P235)
Dimosthenopoulos, C., S59 (SUN-P018)
Dinçbaş, F. Ö., S87 (SUN-P090)
Diniz, K.G.D., S133 (SUN-P213),
S202 (MON-P063)
Djurhuus, M., S155 (SUN-P275)
do Carmo, A. S., S111 (SUN-P154)
do Rego, J. C., S286 (MON-P292)
Doaei, S., S213 (MON-P090)
Dobinsky, R., S176 (SUN-LB330)
Dock, D. D., S118 (SUN-P175)
Dock-Nascimento, D. B., S27 (OR67)
Dogan Varan, H., S11 (OR27), S195 (MON-P042)
Doğru Ersöz, D., S103 (SUN-P133),
S104 (SUN-P134)
Doğrul, R. T., S241 (MON-P169),
S243 (MON-P177)
Doherty, L., S159 (SUN-P286)
Doi, S., S247 (MON-P188)
Dolman, R., S251 (MON-P198)
Domingo, J. C., S119 (SUN-P178)
Domin, I., S65 (SUN-P035)
Doncel-Moriano, A., S123 (SUN-P187)
Donini, L. M., S7 (OR16)
Donker, A., S78 (SUN-P067)
Doorduijn, A., S69 (SUN-P045), S73 (SUN-P053)
S313
Doornink, N., S84 (SUN-P082)
Dos Santos, N.D.C., S64 (SUN-P033)
Dos Santos, P.F.S., S64 (SUN-P033)
Dos Santos, S.S.M., S64 (SUN-P033)
Doulatram-Gamgaram, V., S89 (SUN-P096)
Doundoulakis, I., S63 (SUN-P029)
Doves, M., S72 (SUN-P052)
Dronkelaar, C., S129 (SUN-P204)
Droop, A., S75 (SUN-P060), S78 (SUN-P067)
Druet-Cabanac, M., S8 (OR19)
Druml, W., S25 (OR62)
Drummond, S., S274 (MON-P261),
S303 (MON-LB335)
Drustrup, L., S211 (MON-P086)
Duarte, Y. C., S102 (SUN-P130)
Dubern, B., S304 (MON-LB338)
Dubin, J., S125 (SUN-P193)
Dubrova, K., S65 (SUN-P035)
Dubrov, S., S65 (SUN-P035)
Ducrotté, P., S97 (SUN-P116)
Dugelay, E., S304 (MON-LB338)
Duignan, E., S252 (MON-P201)
Duizer, L., S75 (SUN-P057)
Du, K., S168 (SUN-LB308)
Đukanovic,́ M., S127 (SUN-P198)
Dulac, M. C., S229 (MON-P137)
Dulac, M., S38 (PT04.5), S271 (MON-P252),
S284 (MON-P288)
Dulery, R., S23 (OR57)
Duncan, S., S108 (SUN-P147)
Dundar, G., S249 (MON-P193)
Dupertuis, Y.-M., S293 (MON-LB310),
S293 (MON-LB311)
Dupont Cuisinier, M., S8 (OR19)
Durán-Aguero, S., S133 (SUN-P215)
Durand, J.-P., S90 (SUN-P098)
Dussaulx, L., S32 (PT02.2)
Dynnyk, N., S204 (MON-P068)
Dziadzio, M., S287 (MON-P294)
E
Ebiloğlu, D., S58 (SUN-P017)
Ede, G., S17 (OR42), S124 (SUN-P191)
Egert, S., S275 (MON-P262)
Eggink, H. M., S54 (SUN-P004)
Eghtesadi1, S., S76 (SUN-P061)
Eglseer, D., S71 (SUN-P048)
El Gerges, N., S113 (SUN-P160),
S162 (SUN-P295)
El Hajj Boutros, G., S38 (PT04.5),
S229 (MON-P137), S271 (MON-P252),
S284 (MON-P288)
El Jabbour, F., S113 (SUN-P160)
El Osta, L., S84 (SUN-P083), S113 (SUN-P160)
El Osta, N., S84 (SUN-P083)
Elbelt, U., S298 (MON-LB322)
El-gendy, Y. G., S19 (OR47)
El-Gohary, P.C.G., S12 (OR29)
Eliakim, R., S13 (OR31)
Elizur, A., S179 (SUN-LB338)
Elsadek, M. F., S223 (MON-P121)
Elshakankiry, H. M., S19 (OR47)
El-Tweri, A., S23 (OR58)
Elvira, G., S288 (MON-P299)
Emanuelli, M., S227 (MON-P131)
Emiralioğlu, N., S103 (SUN-P133),
S104 (SUN-P134)
S314
Emken, B.-E. G., S77 (SUN-P064)
Endo, R., S139 (SUN-P229)
Endo, S., S52 (PT10.5)
Engberink, M. F., S10 (OR25), S12 (OR30)
Engberink, M., S135 (SUN-P218)
Engelbert, R., S129 (SUN-P204)
Engelen, M. P., S46 (PT08.3), S70 (SUN-P046),
S70 (SUN-P047), S99 (SUN-P123),
S156 (SUN-P277), S227 (MON-P130)
Engelen, M., S34 (PT03.2), S36 (PT03.6),
S244 (MON-P178)
Engelheart, S., S194 (MON-P039),
S194 (MON-P040)
Engel, T., S13 (OR31)
Erbakan, A., S136 (SUN-P221)
Erdem, N. B., S205 (MON-P070)
Erdem, S., S273 (MON-P257)
Erdenen, F., S303 (MON-LB334)
Erdinc, A. S., S135 (SUN-P220)
Eren Fidanci, B., S149 (SUN-P257)
Ergen, S. A., S87 (SUN-P090)
Ergun, R., S235 (MON-P152)
Ersin, S., S218 (MON-P107)
Ersoy, G., S246 (MON-P184), S246 (MON-P185)
Ersoy, N., S246 (MON-P184), S246 (MON-P185),
S247 (MON-P186)
ERTAŞ, Y., S256 (MON-P213)
Ertaş, Y., S256 (MON-P211), S256 (MON-P212),
S257 (MON-P214), S257 (MON-P215),
S275 (MON-P263)
Ertugrul, M., S88 (SUN-P093)
Esfarjani, F., S145 (SUN-P246),
S159 (SUN-P287)
Esin, K., S200 (MON-P056)
Espinoza, V., S133 (SUN-P215)
Esteban-Sánchez, C., S79 (SUN-P069)
Esteves, L., S185 (MON-P015)
Estrella, A., S102 (SUN-P130)
Etienne, Q., S205 (MON-P069)
Ettema, R., S152 (SUN-P268)
Euwes, M., S250 (MON-P195)
Evill, R. H., S217 (MON-P103)
F Garcia, F. D., S133 (SUN-P213)
Fabri, M., S227 (MON-P131)
Fafournoux, P., S155 (SUN-P276)
Fagnani, D., S193 (MON-P036)
Fagotti, A., S281 (MON-P278)
Faierman, S. A., S101 (SUN-P128)
Fakhoury, J., S84 (SUN-P083)
Fan, L., S168 (SUN-LB309), S300 (MON-LB327)
Fan, S., S4 (OR08), S290 (MON-P302)
Farah, S., S214 (MON-P095)
Farcomeni, A., S57 (SUN-P012)
Farias, M. S., S41 (PT06.1)
Farías, S. S., S57 (SUN-P014)
Farre, M., S61 (SUN-P024)
Farshidfar, F., S47 (PT08.5)
Fauler, G., S3 (OR06)
Faustmann, G., S3 (OR06), S156 (SUN-P278)
Fayemendy, P., S8 (OR19), S19 (OR48),
S34 (PT03.1), S34 (PT03.3), S127 (SUN-P200)
Feferbaum, R., S185 (MON-P016)
Feldblum, I., S166 (SUN-LB305)
Fellinger, T., S25 (OR62)
Feo Ortega, G., S212 (MON-P089)
Fernández, J., S288 (MON-P299)
Author index
Fernandez, L., S269 (MON-P247)
Fernández-Lucas, M., S224 (MON-P122),
S225 (MON-P126)
Fernandez-Lucas, M., S228 (MON-P134)
Fernández-Martínez, P., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
Ferreira, A. S., S151 (SUN-P264)
Ferreira, C., S219 (MON-P109)
Ferreira, D. F., S122 (SUN-P185)
Ferreira, L.S.A., S133 (SUN-P213)
Ferreira, S. C., S17 (OR41)
Ferreirea, D. F., S122 (SUN-P186)
Ferrer Gómez, M., S263 (MON-P231)
Ferrer Gomez, M., S234 (MON-P150)
Ferreras, A., S37 (PT04.3)
Ferretti, R.D.L., S252 (MON-P199),
S252 (MON-P200)
Ferri, V., S101 (SUN-P128)
Fiaccadori, E., S182 (MON-P008),
S306 (MON-LB343)
Fidilio, E., S16 (OR39)
Figliolino, L.F.O., S279 (MON-P274)
Figueiras, M., S161 (SUN-P291)
Figueiredo, E. J., S64 (SUN-P031)
Fimmers, R., S275 (MON-P262)
Fini, L., S96 (SUN-P114)
Fink, J. S., S40 (PT05.4), S111 (SUN-P154)
Finocchiaro, E., S172 (SUN-LB319)
Finucane, J., S305 (MON-LB341)
Fior, L., S264 (MON-P235)
Fiotti, N., S64 (SUN-P032)
Firat, O., S218 (MON-P107)
Fischer, M., S37 (PT04.4)
Fisher, V., S186 (MON-P018)
Fisunoglu, M., S138 (SUN-P227)
Fitzgerald, P., S117 (SUN-P171)
Fliers, E., S54 (SUN-P004)
Flood, V., S162 (SUN-P294)
Flores-Cisneros, L., S209 (MON-P081)
Flores, M., S120 (SUN-P180)
Floros, I., S59 (SUN-P018)
Folope, V., S200 (MON-P057), S244 (MON-P180)
Fong, D. Y., S15 (OR37)
Fonseca, D. C., S16 (OR40), S38 (PT04.6)
Fonseca, J., S83 (SUN-P079), S128 (SUN-P202),
S163 (SUN-P296)
Fontaine, E., S3 (OR07), S157 (SUN-P280)
Fonzo-Christe, C., S265 (MON-P236)
Forbes, A., S255 (MON-P208)
Forchielli, M. L., S50 (PT09.5)
Forest, C., S38 (PT04.5), S271 (MON-P252)
Formolo, J. P., S136 (SUN-P222)
Forouhi, N. G., S261 (MON-P226)
Fort, E., S91 (SUN-P101)
Fragkos, K. C., S96 (SUN-P114),
S109 (SUN-P150), S130 (SUN-P207),
S287 (MON-P294)
Fragkos, K., S50 (PT10.2), S215 (MON-P096),
S215 (MON-P097)
Franco, L., S107 (SUN-P142)
Frandsen, L. S., S228 (MON-P132)
Franssen, F., S6 (OR13)
Franz, K., S110 (SUN-P151), S110 (SUN-P152)
Freijer, K., S304 (MON-LB337)
Freitas, B. J., S64 (SUN-P031)
Frost, G. S., S111 (SUN-P155)
Fuglsang, K. A., S39 (PT05.3), S234 (MON-P149)
Fujimoto, Y., S299 (MON-LB325)
Fujiwara, T., S14 (OR33)
Fukatsu, K., S1 (OR02), S15 (OR36),
S46 (PT08.2), S78 (SUN-P068),
S85 (SUN-P085), S171 (SUN-LB316),
S201 (MON-P058)
Fukushima, R., S139 (SUN-P229)
Fumelli, D., S227 (MON-P131)
Funakoshi, H., S78 (SUN-P066),
S189 (MON-P026)
Fu, Y., S278 (MON-P272)
G
Gabe, S. M., S4 (OR10), S8 (OR20),
S33 (PT02.5), S51 (PT10.3), S81 (SUN-P075),
S230 (MON-P139), S262 (MON-P228)
Gabrielli, C. P., S116 (SUN-P169)
Gaillard, T., S168 (SUN-LB308)
Gajete-Martín, L. M., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
Gajewska, J., S42 (PT06.5), S52 (PT10.6)
Gallego Herreros, G., S225 (MON-P124),
S225 (MON-P125)
Gallon, C. W., S98 (SUN-P120),
S116 (SUN-P169), S136 (SUN-P222),
S143 (SUN-P241)
Galmiche, M., S200 (MON-P057)
Gamarra-Morales, Y., S290 (MON-LB303)
Gao, X., S222 (MON-P118)
Gapeyeva, H., S72 (SUN-P051)
Garbay, C., S284 (MON-P286)
García Castañeda, M. A., S126 (SUN-P197)
García Cayuela, A. M., S234 (MON-P150)
García de Gregorio, J., S178 (SUN-LB336)
Garcia Garcia-Doncel, L., S134 (SUN-P217),
S236 (MON-P156)
García Peris, P., S203 (MON-P064),
S203 (MON-P065), S212 (MON-P089)
Garcia Zafra, V., S234 (MON-P150),
S263 (MON-P231)
García-Bermudez, M., S36 (PT04.1),
S41 (PT06.2)
Garcia-FIgueras Mateos, C., S134 (SUN-P217)
Garcia-Figueras Mateos, C., S236 (MON-P156)
Garcia-Figueras-Mateos, C., S236 (MON-P155)
García, G. Cabezas, S224 (MON-P123)
García-Morales, J. M., S226 (MON-P129)
Garcia, N., S197 (MON-P048)
Garcia-Peris, P., S177 (SUN-LB332)
García-Valdés, M. L., S36 (PT04.1),
S41 (PT06.2)
Garib, R. A., S164 (SUN-P298)
Garin, U., S269 (MON-P247), S271 (MON-P253)
Garla, P. C., S164 (SUN-P298)
Garla, P., S16 (OR40), S38 (PT04.6)
Garnes, S. A., S279 (MON-P274)
Garrido, V., S10 (OR25)
Garssen, J. G., S286 (MON-P293)
Garvey, S., S289 (MON-P301)
Garzoni, L., S265 (MON-P236)
Gasbarrini, A., S87 (SUN-P091),
S152 (SUN-P267), S276 (MON-P265),
S281 (MON-P278)
Gasparotto, F., S264 (MON-P235)
Gaspersz, M., S80 (SUN-P073)

Gasser, M., S37 (PT04.2)
Gaudreau, P., S229 (MON-P137),
S284 (MON-P288)
Gauthier, J., S23 (OR57)
Gautier, Y., S143 (SUN-P242)
Geerlings, P., S191 (MON-P031),
S248 (MON-P190), S249 (MON-P191),
S250 (MON-P194)
Gehrke, I., S190 (MON-P030)
Geirsdottir, O. G., S43 (PT07.1),
S97 (SUN-P117)
Geisler, C., S118 (SUN-P173)
Gelvez, J., S173 (SUN-LB321)
Genton, L., S113 (SUN-P159), S129 (SUN-P205),
S141 (SUN-P234), S197 (MON-P047),
S259 (MON-P220)
George, E., S169 (SUN-LB311)
Geraldi, M. V., S95 (SUN-P112)
Gesquiere, I., S270 (MON-P251)
Gezmen-KARADAĞ , M., S256 (MON-P213)
Gezmen-Karadağ, M., S257 (MON-P214),
S257 (MON-P215)
Ghiorghiu, Z., S60 (SUN-P020), S60 (SUN-P021)
Gholamalizadeh, M., S213 (MON-P090)
Ghosal, S., S278 (MON-P270)
Ghouzali, I., S97 (SUN-P116)
Giacca, M., S1 (OR01)
Giacometti, T. F., S279 (MON-P274)
Gianfrancesco, M., S273 (MON-P259)
Giannella Neto, D., S16 (OR40)
Giannella-Neto, D., S38 (PT04.6)
Gibney, E. R., S30 (PT01.3), S131 (SUN-P209),
S189 (MON-P027)
Giebułtowicz, J., S49 (PT09.3)
Giesbertz, P. J., S297 (MON-LB321)
Gies, I., S151 (SUN-P263)
Gil Martínez, C., S203 (MON-P065)
Gillam, M., S172 (SUN-LB320)
Gil, N. L., S178 (SUN-LB334), S179 (SUN-LB337)
Ginguay, A., S69 (SUN-P044)
Gionti, L., S193 (MON-P038)
Giorgini, N., S193 (MON-P036)
Giorgio, L., S264 (MON-P235)
Giribés, M., S239 (MON-P165),
S240 (MON-P166)
Giribes, M., S16 (OR39)
Gisbertz, I.A.M., S104 (SUN-P136)
Gislason, T., S43 (PT07.1), S97 (SUN-P117)
Glavas, S., S82 (SUN-P077)
Gnessi, L., S7 (OR16)
Goates, S., S168 (SUN-LB308),
S168 (SUN-LB309), S300 (MON-LB327)
Godin, J.-P., S4 (OR09)
Goessens, J. P., S2 (OR05)
Goetzenich, A., S26 (OR65)
Goichon, A., S97 (SUN-P116), S286 (MON-P292)
Gojda, J., S139 (SUN-P231), S184 (MON-P014)
Gokalp, K., S228 (MON-P133), S242 (MON-P174)
Goker, B., S11 (OR27), S195 (MON-P042)
Goker, E., S81 (SUN-P076)
Gokmen Ozel, H., S18 (OR45), S43 (PT06.6),
S104 (SUN-P134), S208 (MON-P078),
S208 (MON-P079), S209 (MON-P080),
S217 (MON-P104), S218 (MON-P105),
S273 (MON-P257)
Gökmen Özel, H., S103 (SUN-P132),
S103 (SUN-P133), S124 (SUN-P191)
Goktas, Z., S144 (SUN-P243), S205 (MON-P070)
Author index
Goldberg, M. R., S179 (SUN-LB338)
Goldwasser, F., S90 (SUN-P098),
S221 (MON-P116)
Gomez Giralda, B., S225 (MON-P125)
Gonçalves, S.E.A., S253 (MON-P202)
Gonen, O., S136 (SUN-P221)
Gontijo, L.C.D. L., S267 (MON-P243)
Gonzalez Granda, A., S196 (MON-P046)
González López, J., S140 (SUN-P232)
González Peral, M. I., S280 (MON-P276)
Gonzalez Sagrado, M., S225 (MON-P124),
S225 (MON-P125)
Gonzalez-Cerrajero, M., S271 (MON-P253)
González-Herráez, L., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
Gonzalez, M. C., S124 (SUN-P190)
González-Tampán, R., S91 (SUN-P101)
Gonzalo, M., S89 (SUN-P095)
Goodarzi, M. T., S105 (SUN-P137)
Goron, A., S157 (SUN-P279), S157 (SUN-P280)
Gortan Cappellari, G., S1 (OR01), S6 (OR15),
S74 (SUN-P056)
Gosker, H. R., S232 (MON-P145)
Goto, H., S278 (MON-P271)
Gouspillou, G., S229 (MON-P137),
S284 (MON-P288)
Gow, I. F., S274 (MON-P261), S303 (MON-LB335)
Grabher, J., S3 (OR06)
Graf, C. E., S197 (MON-P047)
Graf, S., S129 (SUN-P205), S293 (MON-LB310),
S293 (MON-LB311)
Gramlich, L. M., S172 (SUN-LB320)
Gramlich, L., S210 (MON-P083)
Gravelat, M., S8 (OR19)
Griffin, J. L., S176 (SUN-LB329)
Grigioni, S., S200 (MON-P057),
S244 (MON-P180)
Grill, E., S73 (SUN-P054)
Groen, A. K., S54 (SUN-P004)
Groot Koerkamp, B., S80 (SUN-P073)
Gross, L. A., S26 (OR64)
Groszek, P., S106 (SUN-P140)
Gruber, H.-J., S156 (SUN-P278)
Guadagni, M., S291 (MON-LB305),
S291 (MON-LB306)
Guarda, I.F.D.M.S., S38 (PT04.6)
Guarda, I.F.M. S., S16 (OR40)
Guedes, K.J.T., S252 (MON-P199),
S252 (MON-P200)
Guerendiain, M., S122 (SUN-P184),
S148 (SUN-P256), S150 (SUN-P260),
S277 (MON-P268)
Guérin, C., S200 (MON-P057)
Guerin, S., S143 (SUN-P242)
Guerra, R. S., S192 (MON-P035)
Guerrero, M., S16 (OR39), S239 (MON-P165),
S240 (MON-P166)
Gugiari, M. C., S68 (SUN-P042),
S135 (SUN-P219), S189 (MON-P028)
Guidetti, M., S202 (MON-P062)
Guidon, C., S148 (SUN-P255)
Guildford, N., S7 (OR18), S175 (SUN-LB328)
Guimaraes, M. P., S122 (SUN-P185)
Guimarães, M., S122 (SUN-P186)
Guimber, D., S148 (SUN-P255)
Güleç, A., S142 (SUN-P238)
Gul, M. A., S276 (MON-P267)
S315
Gumus, D., S118 (SUN-P174), S125 (SUN-P192),
S241 (MON-P170), S254 (MON-P204)
Gunay, Y., S287 (MON-P295)
Gundogan, K., S287 (MON-P295)
Güneş Yalçın, E., S103 (SUN-P133),
S104 (SUN-P134)
Gunnarsdottir, I., S43 (PT07.1), S97 (SUN-P117)
Guo, S., S138 (SUN-P228)
Gurba, F., S113 (SUN-P159)
Gürsel, O., S208 (MON-P078),
S208 (MON-P079), S209 (MON-P080)
Gussoni, M., S68 (SUN-P042)
Gutierrez Gutierrez, G., S178 (SUN-LB336)
Guven Sade, E., S192 (MON-P034)
Guven, M., S287 (MON-P295)
H
Hafner-Giessauf, H., S3 (OR06)
Hagiwara, G., S199 (MON-P055)
Haidich, A. B., S56 (SUN-P011)
Haken, A., S184 (MON-P014)
Haler, Ž., S98 (SUN-P119)
Halfens, R. J., S9 (OR21)
Halil, M., S241 (MON-P169), S243 (MON-P177)
Hall, T., S27 (OR68), S199 (MON-P052),
S199 (MON-P053), S199 (MON-P054)
Halmos, G. B., S131 (SUN-P210)
Haloun, A., S56 (SUN-P010)
Hamaguchi, Y., S14 (OR35), S39 (PT05.1),
S76 (SUN-P062), S153 (SUN-P270),
S206 (MON-P072)
Hamerschlak, N., S253 (MON-P202)
Hammarqvist, F., S2 (OR03)
Hanachi, M., S102 (SUN-P129),
S231 (MON-P140)
Hanai, T., S170 (SUN-LB313)
Han, J., S301 (MON-LB330)
Hankard, R., S148 (SUN-P255),
S155 (SUN-P276)
Hannon, M., S252 (MON-P201)
Hannon, R., S252 (MON-P201)
Han, W. M., S92 (SUN-P103)
Han, Y., S14 (OR34)
Harada, N., S178 (SUN-LB335)
Harada, T., S247 (MON-P188)
Harbron, J., S251 (MON-P198)
Hardis, A.L.S., S35 (PT03.5)
Harris, T. B., S12 (OR30)
Harrykissoon, R., S34 (PT03.2),
S99 (SUN-P123)
Hartman, E., S73 (SUN-P053)
Harvey, M., S176 (SUN-LB329)
Hasegawa, M., S288 (MON-P297)
Hashimoto, K., S220 (MON-P111)
Hassan, H. M., S223 (MON-P121)
Hastings, N., S252 (MON-P201)
Hatakeyama, J., S296 (MON-LB317)
Hatanaka, T., S78 (SUN-P066), S85 (SUN-P084),
S219 (MON-P110)
Hatipoglu, N., S18 (OR45), S43 (PT06.6)
Hatlebakk, J. G., S32 (PT02.3), S77 (SUN-P064)
Hauser, B., S151 (SUN-P263)
Haushchild, D. B., S41 (PT06.1)
Hausken, T., S207 (MON-P076)
Havel, E., S186 (MON-P019)
Hebestreit, A., S167 (SUN-LB306)
Heide, F.V.D., S205 (MON-P071)
S316
Heidegger, C.-P., S293 (MON-LB310),
S293 (MON-LB311)
Heinen, M., S152 (SUN-P268)
Helal, R. G., S19 (OR47)
Helder, J.V.D., S129 (SUN-P204),
S159 (SUN-P284)
Hellenius, M.-L., S55 (SUN-P009)
Hellerman, M., S182 (MON-P008)
Hendricks, A., S196 (MON-P046)
Hennequin, M., S84 (SUN-P083)
Henriksen, C., S46 (PT08.1)
Henriksen, H. B., S46 (PT08.1)
Henriques, M., S185 (MON-P015)
Herbert, G., S282 (MON-P281)
Hernandez, I., S102 (SUN-P130),
S120 (SUN-P180)
Hernandez, L., S107 (SUN-P142)
Hernández-Moreno, A., S116 (SUN-P167)
Hernandez-Moreno, A., S115 (SUN-P165),
S115 (SUN-P166), S143 (SUN-P240)
Herren, S., S37 (PT04.2)
Herrera Fontana, M. E., S260 (MON-P222)
Herrera-Fontana, M. E., S120 (SUN-P181)
Herrera-Quintana, L., S290 (MON-LB303)
Herrera, V., S223 (MON-P120)
Herreros, G. Gallego, S224 (MON-P123)
Herrmann, F. R., S197 (MON-P047)
Heyland, D. K., S63 (SUN-P029),
S292 (MON-LB307)
Heyland, D., S26 (OR65)
Heyman, J. K., S169 (SUN-LB312)
Heymsfield, S. B., S16 (OR40), S124 (SUN-P190)
Heymsfield, S., S38 (PT04.6)
Hickson, M., S111 (SUN-P155)
Hiel, S., S2 (OR04), S273 (MON-P259)
Hiesmayr, M., S272 (MON-P255),
S272 (MON-P256)
Higashibeppu, N., S292 (MON-LB307)
Higashiguchi, T., S75 (SUN-P059),
S266 (MON-P241)
Higashizono, K., S1 (OR02), S15 (OR36),
S46 (PT08.2), S85 (SUN-P085),
S171 (SUN-LB316), S201 (MON-P058)
Higuera Pulgar, I., S203 (MON-P064),
S203 (MON-P065)
Hill, S., S42 (PT06.4)
Hinojosa-Azaola, A., S226 (MON-P129)
Hirani, V., S30 (PT01.5)
Hisajima, T., S168 (SUN-LB310)
Hisamori, S., S220 (MON-P111)
Hishikawa, H., S170 (SUN-LB315)
Hiyama, K., S154 (SUN-P273)
Hlais, S., S162 (SUN-P295)
Hlavata, A., S284 (MON-P287)
Hobbelen, J. S., S296 (MON-LB318)
Hobbelen, J.S.M., S298 (MON-LB323)
Hoeisaether, E., S294 (MON-LB314)
Hoek, B. V., S78 (SUN-P067)
Hofstede, J., S67 (SUN-P039)
Hogrel, J.-Y., S29 (PT01.1), S72 (SUN-P051)
Ho, J. W., S15 (OR37)
Ho, L., S162 (SUN-P293)
Holanda, T. P., S65 (SUN-P034)
Holec, E., S100 (SUN-P124)
Hollander, F., S112 (SUN-P158)
Holle, R., S73 (SUN-P054)
Hollingworth, W., S305 (MON-LB339)
Holm, M. O., S213 (MON-P093)
Author index
Holst, M., S211 (MON-P086), S213 (MON-P091),
S228 (MON-P132)
Holten-Andersen, M. N., S260 (MON-P224)
Holth, C., S294 (MON-LB314)
Holwerda, A. M., S2 (OR05)
Ho, M., S152 (SUN-P266)
Hong, L., S149 (SUN-P259)
Hong, S. K., S166 (SUN-P303)
Hong, T. H., S190 (MON-P029)
Honore, P., S180 (MON-P002)
Hopanci, D. B., S81 (SUN-P076)
Horcajada, M.-N., S4 (OR09)
Horie, L. M., S181 (MON-P005)
Horsmans, Y., S205 (MON-P069)
Horst, C., S27 (OR68), S199 (MON-P052),
S199 (MON-P053), S199 (MON-P054)
Hoshino, T., S78 (SUN-P066), S85 (SUN-P084)
Hosoda, A., S32 (PT02.4)
Hosonuma, K., S219 (MON-P110)
Hosseini, H., S159 (SUN-P287)
Hosseinipanah, S. M., S141 (SUN-P235)
Houinato, D., S127 (SUN-P200)
Houston, D. K., S12 (OR30)
Hovdenak, N., S32 (PT02.3), S207 (MON-P076)
Hronek, M., S186 (MON-P019)
Hruz, P., S233 (MON-P148)
Hsu, Y.-P., S188 (MON-P024)
Huang, C. W., S86 (SUN-P087)
Huang, C.-W., S87 (SUN-P089)
Huang, Y., S4 (OR08)
Hueso, T., S23 (OR57)
Huhmann, M. B., S266 (MON-P239)
Huijbers, A., S31 (PT02.1)
Huisman - de Waal, G., S152 (SUN-P268)
Huisman de Waal, G., S108 (SUN-P146)
Hukins, C., S231 (MON-P141)
Hulst, J. M., S304 (MON-LB337)
Hulst, J., S11 (OR26), S42 (PT06.4)
Hung, K.-Y., S44 (PT07.3), S44 (PT07.4)
Huppertz, V., S9 (OR21)
Hurtós, L., S91 (SUN-P101), S211 (MON-P085)
Hurt, R., S204 (MON-P066), S259 (MON-P221)
Hu, W., S243 (MON-P175)
Huysentruyt, K., S151 (SUN-P263)
Huysmans, S., S232 (MON-P145)
Hwang, J., S282 (MON-P283)
Hyams, G., S254 (MON-P206)
Hyodo, T., S234 (MON-P151)
Hyspler, R., S170 (SUN-LB314)
I S298 (MON-LB323)
Ianes, A., S68 (SUN-P042), S135 (SUN-P219),
S189 (MON-P028)
Ibrahim, K., S193 (MON-P037)
Ichikawa, H., S55 (SUN-P008)
Iglesias, C., S237 (MON-P160)
Iida, T., S189 (MON-P026)
Iijima, S., S266 (MON-P241)
Iishi, T., S266 (MON-P241)
Ijmker-Hemink, V. E., S255 (MON-P210)
Ijzermans, J., S80 (SUN-P072), S80 (SUN-P073),
S128 (SUN-P201)
Ijzermans, J.N.M., S133 (SUN-P214)
Ikarashi, M., S55 (SUN-P008)
Ikematsu, Y., S173 (SUN-LB322),
S196 (MON-P044)
Ilgaz, F., S103 (SUN-P132), S124 (SUN-P191)
Ilhan, A., S114 (SUN-P162), S166 (SUN-LB304)
Ilovaisky, S., S254 (MON-P206)
Imai, K., S168 (SUN-LB310)
Imamura, F., S154 (SUN-P273),
S261 (MON-P226)
Imarisio, I., S24 (OR59)
Inagawa, M., S78 (SUN-P066), S85 (SUN-P084),
S189 (MON-P026)
İnanç, N., S245 (MON-P183)
Inan-Eroglu, E., S116 (SUN-P168)
Ingadottir, A. R., S43 (PT07.1)
Ingadottir, A., S97 (SUN-P117)
Inoue, K., S165 (SUN-P301), S292 (MON-LB309)
Inoue, T., S254 (MON-P207)
Inukai, M., S266 (MON-P241)
Iorio, L., S101 (SUN-P128)
Irahara, T., S292 (MON-LB309)
Iryaningrum, M. R., S226 (MON-P128)
Isabel, M. G.-M. G.-M., S229 (MON-P136)
Isgin, K., S257 (MON-P216)
Isherwood, J., S23 (OR58), S88 (SUN-P094),
S93 (SUN-P106), S93 (SUN-P107),
S94 (SUN-P108), S214 (MON-P095)
Ishibashi, I., S266 (MON-P241)
Ishida, R., S16 (OR40), S38 (PT04.6)
Ishiguro, K., S189 (MON-P026)
Ishihara, H., S189 (MON-P026)
Ishii, M., S167 (SUN-LB307)
Ishii, S., S139 (SUN-P229)
Ishitani, M., S52 (PT10.5)
Ishizaki, M., S170 (SUN-LB315)
Ito, C., S247 (MON-P188)
Ito, M., S52 (PT10.5)
Iuchi, M., S178 (SUN-LB335)
Ivaldi, C., S301 (MON-LB329)
Iwayama, S., S96 (SUN-P113)
Iyer, K., S230 (MON-P139)
Izurieta, R., S120 (SUN-P180)
J
Jaalouk, D., S113 (SUN-P161)
Jackson, H., S251 (MON-P197)
Jacobsen, C. K., S77 (SUN-P064)
Jafari, P., S50 (PT10.1)
Jager-Wittenaar, H., S84 (SUN-P082),
S129 (SUN-P203), S131 (SUN-P210),
S132 (SUN-P211), S158 (SUN-P282),
S160 (SUN-P289), S222 (MON-P119),
S247 (MON-P187), S250 (MON-P195),
S296 (MON-LB318), S296 (MON-LB319),
Jagielak, D., S119 (SUN-P177)
Jakus, T., S141 (SUN-P236)
Jang, H. J., S305 (MON-LB340)
Jang, H.-J., S305 (MON-LB340)
Janse, A., S31 (PT01.6)
Jansen, I., S129 (SUN-P204)
Jansen, J., S159 (SUN-P284)
Janssen-Duijghuijsen, L., S286 (MON-P293)
Janssen, M., S104 (SUN-P135),
S126 (SUN-P195), S255 (MON-P209)
Januszczyk, J., S105 (SUN-P139)
Japur, C. C., S95 (SUN-P111)
Jarkovský, J., S229 (MON-P135)
Jaskiewicz, J., S173 (SUN-LB323)
Jazayeri, S., S76 (SUN-P061)
Jegatheesan, P., S7 (OR17), S285 (MON-P291)

Jenkins, B., S58 (SUN-P016)
Jenko Pražnikar, Z., S141 (SUN-P236),
S243 (MON-P176), S270 (MON-P249),
S275 (MON-P264)
Jenko-Pražnikar, Z., S285 (MON-P290)
Jeon, M. S., S227 (MON-P130)
Jeppesen, P. B., S4 (OR10), S33 (PT02.5),
S39 (PT05.3), S81 (SUN-P075),
S230 (MON-P139), S234 (MON-P149)
Jeppesen, P., S13 (OR32)
Jésus, P., S8 (OR19), S19 (OR48), S34 (PT03.1),
S34 (PT03.3), S127 (SUN-P200)
Jeung, H. C., S95 (SUN-P110)
Jiang, T., S187 (MON-P022)
Jiang, Y., S14 (OR34)
Jiang, Z., S54 (SUN-P006)
Jiménez, C. Tenorio, S226 (MON-P127)
Jimenez, I., S223 (MON-P120)
Jiménez-Lima, R., S209 (MON-P081)
Jimenez, R., S177 (SUN-LB332)
Jiménez-Sanmartín, M., S37 (PT04.3)
Jirka, A., S56 (SUN-P010)
Joaquín Ortiz, C., S94 (SUN-P109)
Joaquin, C., S136 (SUN-P223)
Jobse, I., S166 (SUN-LB305)
Joly, F., S5 (OR11)
Jonckheer, J., S180 (MON-P002)
Joncquel Chevalier Curt, M., S23 (OR57)
Jones, D., S88 (SUN-P094)
Jones, R., S251 (MON-P197)
Jones, S. E., S214 (MON-P095)
Jongejan, H., S104 (SUN-P136)
Jonkers, R., S99 (SUN-P123)
Joosten, K. F., S20 (OR49),
S304 (MON-LB337)
Joosten, K., S11 (OR26)
Jorens, P. G., S290 (MON-LB304)
Joskova, V., S186 (MON-P019)
Jouinot, A., S90 (SUN-P098)
Joundi, J., S113 (SUN-P160)
Jousse, C., S155 (SUN-P276)
Jovanovic, D., S281 (MON-P280)
Jukic Peladic, N., S193 (MON-P036)
Julià Torras, J., S94 (SUN-P109)
Julian, A. R., S111 (SUN-P155)
Juliano, Y., S117 (SUN-P172)
Jung, H.-Y., S79 (SUN-P070),
S301 (MON-LB330)
Jung, J. H., S182 (MON-P009)
Jung, K. W., S79 (SUN-P070), S301 (MON-LB330)
Jung, K., S305 (MON-LB340)
Junqueira, G., S177 (SUN-LB333)
Jurczak, P., S21 (OR52), S106 (SUN-P140)
Jurdana, M., S141 (SUN-P236)
Justina, T. D., S116 (SUN-P169)
K
Kabasakal Çetin, A., S124 (SUN-P191),
S142 (SUN-P238)
Kabata, P., S173 (SUN-LB323)
Kadayıfçılar, S., S45 (PT07.6), S289 (MON-P300)
Kaddoura, R., S292 (MON-LB308)
Kagan, I., S24 (OR60), S25 (OR63),
S182 (MON-P008), S183 (MON-P012),
S184 (MON-P013)
Kahrs, G. E., S77 (SUN-P064)
Kaibori, M., S170 (SUN-LB315)
Author index
Kaido, T., S14 (OR35), S21 (OR53),
S39 (PT05.1), S76 (SUN-P062),
S153 (SUN-P270), S206 (MON-P072)
Kakavas, S., S101 (SUN-P126)
Kakehasi, A. M., S202 (MON-P063)
Kakehi, T., S254 (MON-P207)
Kakiuchi, M., S254 (MON-P207)
Kakizaki, S., S78 (SUN-P066), S85 (SUN-P084),
S219 (MON-P110)
Kalala, G., S273 (MON-P259)
Kalesopoulou, C., S258 (MON-P219)
Kamarli Altun, H., S192 (MON-P034)
Kameyama, H., S55 (SUN-P008)
Kamiga, M., S154 (SUN-P273)
Kamiya, A., S165 (SUN-P301)
Kamo, N., S14 (OR35), S39 (PT05.1),
S76 (SUN-P062), S153 (SUN-P270),
S206 (MON-P072)
Kampman, E., S171 (SUN-LB318)
Kampman, N., S104 (SUN-P136)
Kanai, M., S189 (MON-P026)
Kanellopoulou, A., S300 (MON-LB328)
Kanematsu, T., S165 (SUN-P301)
Kaner, G., S51 (PT10.4), S123 (SUN-P188),
S131 (SUN-P208), S145 (SUN-P248),
S146 (SUN-P249), S146 (SUN-P250),
S146 (SUN-P251), S192 (MON-P034),
S245 (MON-P183), S273 (MON-P258)
Kang, J., S282 (MON-P283)
Kang, W., S138 (SUN-P228), S171 (SUN-LB317),
S302 (MON-LB333)
Kanioura, E., S111 (SUN-P153)
Kan, W. S., S15 (OR37)
Kaoura, A., S111 (SUN-P153)
Karabudak, E., S242 (MON-P173),
S256 (MON-P211), S256 (MON-P212)
Karaca, A., S256 (MON-P211), S256 (MON-P212)
Karachaliou, A., S101 (SUN-P126)
Karacil Ermumcu, M. S., S241 (MON-P171),
S242 (MON-P172), S242 (MON-P173),
S270 (MON-P250)
Karadimitris, A., S174 (SUN-LB326)
Karaduman, A. A., S103 (SUN-P132)
Karagiannis, D., S295 (MON-LB316)
Karavetian, M., S306 (MON-LB343)
Karayiannis, D., S101 (SUN-P126),
S137 (SUN-P224)
Karber, M., S204 (MON-P067), S206 (MON-P073)
Karimeh, T., S162 (SUN-P295)
Karli, A., S101 (SUN-P126)
Karlsen, A. S., S91 (SUN-P100)
Karlsson, M., S30 (PT01.4)
Kar, P., S180 (MON-P003)
Karsegard, V. L., S197 (MON-P047)
Kartaram, S., S286 (MON-P293)
Kasapidou, E., S140 (SUN-P233)
Kashiya, S., S216 (MON-P100)
Kaska, M., S170 (SUN-LB314)
Kasperts, N., S83 (SUN-P081)
Kasteler, R., S17 (OR43)
Katayama, T., S32 (PT02.4)
Katsura, N., S244 (MON-P179),
S267 (MON-P242)
Katz, Y., S179 (SUN-LB338)
Kaufman-Shriqui, V., S263 (MON-P230)
Kauppi, K., S130 (SUN-P206)
Kawahara, Y., S189 (MON-P026)
Kawamura, H., S52 (PT10.5)
S317
Kawamura, K. S., S181 (MON-P005)
Kawasaki, N., S266 (MON-P241)
Kaya, E. B., S98 (SUN-P118)
Kaya, S., S11 (OR27), S195 (MON-P042)
Kayashita, J., S266 (MON-P241)
Kaydıhan, N., S87 (SUN-P090)
Kaymak, Ç., S58 (SUN-P017)
Kayser, N., S102 (SUN-P129), S231 (MON-P140)
Kazeminia, N., S182 (MON-P010)
Keane, N., S50 (PT10.2), S96 (SUN-P114),
S109 (SUN-P150), S130 (SUN-P207),
S215 (MON-P096), S215 (MON-P097)
Kearney, P., S167 (SUN-LB306)
Keil, J.-P., S298 (MON-LB322)
Kelishadi, R., S145 (SUN-P246)
Keller, H., S75 (SUN-P057), S125 (SUN-P193),
S125 (SUN-P194)
Kelly, M., S167 (SUN-LB306)
Kelly, O., S289 (MON-P301)
Kennis, M., S174 (SUN-LB324)
Kerim, E. S., S249 (MON-P193)
Keskinler, M. V., S136 (SUN-P221)
Khaksar, R., S159 (SUN-P287)
Khalafi, M., S145 (SUN-P246)
Khalatbari-Soltani, S., S261 (MON-P226),
S262 (MON-P227)
Khalili, M., S76 (SUN-P061)
Khan, Z. A., S5 (OR12)
Khodadadi Kholan, I., S164 (SUN-P300)
Khodadadi Kohlan, I., S105 (SUN-P137)
Khosravi, A., S76 (SUN-P061)
Kida, K., S247 (MON-P188)
Kieslinger, P., S3 (OR06)
Kiesswetter, E., S73 (SUN-P054),
S167 (SUN-LB306)
Kievit, W., S48 (PT09.1)
Kiliç, S., S149 (SUN-P258)
Kilicturgay, S., S249 (MON-P193)
Kim, D. H., S79 (SUN-P070), S301 (MON-LB330)
Kim, H. M., S95 (SUN-P110)
Kim, H., S282 (MON-P283)
Kim, J. W., S282 (MON-P283)
Kim, J., S190 (MON-P029)
Kim, M., S190 (MON-P029), S282 (MON-P283)
Kim, S., S174 (SUN-LB325), S219 (MON-P108),
S282 (MON-P283)
Kimura, K., S199 (MON-P055)
Kimura, M., S189 (MON-P026)
Kim, Y. J., S219 (MON-P108)
Kim, Y. N., S175 (SUN-LB327)
Kingma, B.R.M., S232 (MON-P145)
Kiper, N., S103 (SUN-P133), S104 (SUN-P134)
Kirbiyik, F., S88 (SUN-P093)
Kiryachkov, Y., S188 (MON-P025)
Kiselev, J., S110 (SUN-P151), S110 (SUN-P152)
Kishi, J., S178 (SUN-LB335)
Kiss, C., S67 (SUN-P040), S233 (MON-P148)
Kitajima, Y., S234 (MON-P151)
Kitamoto, Y., S85 (SUN-P084)
Kizilarslanoğlu, M. C., S195 (MON-P042)
Kizilarslanoglu, M. C., S11 (OR27)
Kizil, M., S118 (SUN-P174), S125 (SUN-P192),
S145 (SUN-P247), S241 (MON-P170),
S254 (MON-P204)
Klek, S., S105 (SUN-P139), S207 (MON-P074)
Klemarczyk, W., S42 (PT06.5)
Klersy, C., S24 (OR59)
Knap, B., S98 (SUN-P119)
S318
Knap, K., S98 (SUN-P119)
Knappe-Drzikova, B., S85 (SUN-P086),
S114 (SUN-P163), S206 (MON-P073)
Kneppers, A.E.M., S26 (OR66)
Knuijt, S., S255 (MON-P209)
Knüppel, S., S85 (SUN-P086)
Kobayashi, A., S14 (OR35), S39 (PT05.1),
S76 (SUN-P062), S153 (SUN-P270),
S206 (MON-P072)
Kobayashi, T., S55 (SUN-P008)
Koch, C., S267 (MON-P244), S268 (MON-P245)
Koek, M., S128 (SUN-P201)
Koelfat, K. V., S31 (PT02.1), S33 (PT02.6)
Koelfat, K., S22 (OR55)
Koeman, F., S46 (PT08.3), S70 (SUN-P046),
S156 (SUN-P277)
Kofina, K., S56 (SUN-P011)
Kohlenberg-Müller, K., S298 (MON-LB322)
Køhler, M., S40 (PT05.5), S239 (MON-P164)
Koike, K., S292 (MON-LB309)
Kok, A., S83 (SUN-P081), S84 (SUN-P082),
S112 (SUN-P158)
Kok, D. E., S171 (SUN-LB318)
Köksal, E., S275 (MON-P263)
Koksal, E., S242 (MON-P173), S270 (MON-P250)
Köksel, H., S235 (MON-P152),
S235 (MON-P153)
Kolak, Z., S198 (MON-P050)
Kolay, M., S53 (SUN-P001)
Komino, A.C.M., S178 (SUN-LB334)
Kondrup, J., S291 (MON-LB306)
Kong, E., S162 (SUN-P293)
Konstantyner, T., S42 (PT06.3)
Kontogianni, M., S137 (SUN-P224)
Koo, J., S92 (SUN-P103)
Kooman, J., S306 (MON-LB343)
Koopmanschap, M. A., S304 (MON-LB337)
Kopp Lugli, A., S67 (SUN-P040)
Kosak, S., S272 (MON-P256)
Kossovsky, M., S113 (SUN-P159)
Kostin, D., S62 (SUN-P026)
Kosugi, S.-I., S55 (SUN-P008)
Kosyura, S., S157 (SUN-P281)
Kotani, J., S139 (SUN-P229)
Kotlowitz, J., S154 (SUN-P272)
Kouw, I.W.K., S191 (MON-P031)
Kovacs, C., S100 (SUN-P125)
Kovarik, M., S186 (MON-P019)
Koyama, I., S153 (SUN-P269)
Koyama, Y., S55 (SUN-P008), S139 (SUN-P229),
S189 (MON-P026)
Kramer, I. F., S2 (OR05)
Krasnova, T., S157 (SUN-P281)
Kravanja, I., S71 (SUN-P048)
Kremer, S., S25 (OR63)
Kremers, S., S6 (OR13)
Kressig, R., S67 (SUN-P040)
Kriel, J., S154 (SUN-P272)
Krijger, I., S75 (SUN-P060)
Krill, M., S47 (PT08.5)
Kristensen, S. T., S161 (SUN-P292)
Kruijning, S., S129 (SUN-P204)
Kruizenga, H. M., S238 (MON-P161)
Kruizenga, H., S121 (SUN-P182)
Krznaric, Z., S62 (SUN-P028)
Książyk, J., S18 (OR44)
Ksiazyk, J., S150 (SUN-P262)
Kubota, N., S299 (MON-LB325)
Author index
Kucukerdonmez, O., S242 (MON-P173),
S270 (MON-P250)
Kudo, T., S85 (SUN-P084)
Kuehni, C. E., S17 (OR43), S20 (OR50)
Kuise, T., S14 (OR33)
Kumakura, A., S189 (MON-P026)
Kunecki, M., S49 (PT09.3), S207 (MON-P075)
Kungler, E., S67 (SUN-P040)
Kupczyk, K., S62 (SUN-P028)
Kurata, N., S32 (PT02.4), S266 (MON-P241)
Kurmukov, I., S216 (MON-P100)
Kuroda, M., S178 (SUN-LB335)
Kurokawa, Y., S109 (SUN-P149)
Kuwamura, J., S109 (SUN-P149)
Kuyum Töz, P., S279 (MON-P273)
Kværner, A. S., S46 (PT08.1)
Kwok, H., S96 (SUN-P114), S109 (SUN-P150),
S215 (MON-P096), S215 (MON-P097)
Kwok, S. S., S15 (OR37)
Kwon, A.-H., S170 (SUN-LB315)
Kwon, M., S212 (MON-P089)
Kwon, S. Y., S190 (MON-P029)
L Lee, J., S15 (OR38)
L’huillier, C., S286 (MON-P292)
La Meir, M., S62 (SUN-P027)
La Spada, C., S117 (SUN-P171)
Lacaze, L., S209 (MON-P082)
Lachowicz, K., S21 (OR52), S106 (SUN-P140),
S106 (SUN-P141)
Lackoff, A. S., S231 (MON-P141)
Ladwig, K.-H., S73 (SUN-P054)
Lahav, M., S13 (OR31)
Lai, B., S162 (SUN-P294)
Lai, C., S96 (SUN-P115)
Lai, H.-S., S79 (SUN-P071)
Lai, S., S96 (SUN-P115)
Lai, S.-L., S79 (SUN-P071)
Lakenman, P.L.M., S248 (MON-P189)
Lallemand, J., S5 (OR11)
Lal, S., S10 (OR23), S108 (SUN-P145),
S160 (SUN-P288)
Lamarche, F., S3 (OR07)
Lam, C. F., S15 (OR37)
Lamers, D., S298 (MON-LB322)
Landgraf, M. A., S178 (SUN-LB334),
S179 (SUN-LB337)
Landgraf, R. G., S178 (SUN-LB334),
S179 (SUN-LB337)
Lang, A., S13 (OR31)
Langen, R.C.J., S26 (OR66)
Langius, J., S75 (SUN-P060), S78 (SUN-P067),
S83 (SUN-P080), S112 (SUN-P157),
S216 (MON-P101)
Langius, J.A.E., S68 (SUN-P043),
S220 (MON-P112)
Langleite, T. M., S46 (PT08.1)
Lannoo, M., S270 (MON-P251)
Lanthier, N., S205 (MON-P069)
Laquente, B., S91 (SUN-P101)
Lardiés, B., S37 (PT04.3)
Lardiés-Sánchez, B., S114 (SUN-P164)
Larsen, T., S207 (MON-P076)
Larumbe, M.C.Terroba, S224 (MON-P123),
S225 (MON-P124)
Lascouts, E., S62 (SUN-P028)
Laur, C., S125 (SUN-P193), S125 (SUN-P194)
Lauretani, F., S68 (SUN-P041),
S193 (MON-P038)
Lau, S. Y., S15 (OR37)
Lautrette, G., S34 (PT03.3)
Lauverjat, M., S48 (PT09.2), S77 (SUN-P065)
Lau, W. S., S15 (OR37)
Laviano, A., S57 (SUN-P012), S83 (SUN-P080)
Layec, S., S32 (PT02.2)
Le Flahec, C., S8 (OR19)
Le Pape, P., S265 (MON-P236)
Le Plénier, S., S285 (MON-P289)
Leander, K., S55 (SUN-P009)
Leão, D.O.D., S64 (SUN-P033)
Leary, S., S305 (MON-LB339)
Lebrun, V., S205 (MON-P069)
Leclercq, I. A., S205 (MON-P069)
Lee, A., S190 (MON-P029)
Lee, G. H., S79 (SUN-P070), S301 (MON-LB330)
Lee, H.-M., S4 (OR10), S33 (PT02.5),
S81 (SUN-P075), S230 (MON-P139)
Lee, J. H., S59 (SUN-P019), S79 (SUN-P070),
S174 (SUN-LB325), S301 (MON-LB330)
Lee, J. I., S190 (MON-P029)
Lee, K. F., S15 (OR38)
Lee, M.W.K., S15 (OR37)
Leermakers-Vermeer, M. J., S83 (SUN-P081)
Lee, S. O., S15 (OR37)
Lee, Y.-M., S297 (MON-LB321)
Leibovitz, E., S176 (SUN-LB330)
Leiderman, I., S58 (SUN-P015)
Leij - Halfwerk, S., S181 (MON-P007)
Leij-Halfwerk, S., S131 (SUN-P209)
Leij, S., S104 (SUN-P135), S126 (SUN-P195),
S255 (MON-P209)
Lei, Q., S187 (MON-P022)
Leistra, E., S121 (SUN-P182),
S174 (SUN-LB324), S238 (MON-P161)
Leiva-Badosa, E., S79 (SUN-P069)
Lekkos, K., S267 (MON-P244), S268 (MON-P245)
Lelieveld, M., S78 (SUN-P067)
Lemieux, M., S26 (OR65)
Lengyel, C., S75 (SUN-P057)
Lenicek, M., S31 (PT02.1), S33 (PT02.6)
Lennon, R., S159 (SUN-P286)
Lenzi, A., S7 (OR16)
León Sanz, M., S214 (MON-P094)
Leone, S., S87 (SUN-P091), S152 (SUN-P267),
S276 (MON-P265), S281 (MON-P278)
León, J., S35 (PT03.4)
Lepoivre, T., S56 (SUN-P010)
Leung, L. K., S15 (OR37)
Leung, W. S., S15 (OR37)
Leuvrey, M. M., S304 (MON-LB338)
Levolger, S., S80 (SUN-P073), S128 (SUN-P201)
Lewandowski, L., S52 (PT10.6)
Lewis, S., S282 (MON-P281), S305 (MON-LB339)
Leyva Islas, J. A., S126 (SUN-P197)
Leyva, J. A., S35 (PT03.4)
Liaño, F., S224 (MON-P122), S225 (MON-P126),
S228 (MON-P134)
Liaskas, T., S111 (SUN-P153)
Lichodziejewska–Niemierko, M.,
S119 (SUN-P176)
Lichthart, S., S174 (SUN-LB324)
Lieben, C. K., S70 (SUN-P046), S70 (SUN-P047),
S99 (SUN-P123)
Lieben, C., S244 (MON-P178)

Liebert, F., S304 (MON-LB338)
Lied, G. A., S32 (PT02.3), S207 (MON-P076)
Liener, U. C., S196 (MON-P046)
Lienhardt-Roussie, A., S19 (OR48)
Ligerini, L., S148 (SUN-P256)
Li, J., S187 (MON-P022), S222 (MON-P118)
Lilleby, W., S91 (SUN-P100)
Lima, A., S17 (OR41)
Lima, F. B., S178 (SUN-LB334)
Lima, F. C., S64 (SUN-P033)
Lim, C., S162 (SUN-P293)
Lim, C.Y.S., S59 (SUN-P019)
Lim, Y. P., S161 (SUN-P290), S162 (SUN-P293)
Li, N., S14 (OR34)
Lindqvist, C., S297 (MON-LB320)
Lins, L., S122 (SUN-P185), S122 (SUN-P186)
Lin, V. A., S155 (SUN-P275)
Lioupis, A., S258 (MON-P217),
S258 (MON-P219), S263 (MON-P233)
Li, S., S168 (SUN-LB309), S300 (MON-LB327)
Lissner, L., S71 (SUN-P049)
Li, T., S47 (PT08.5)
Liu, D., S171 (SUN-LB317)
Liu, K., S169 (SUN-LB312)
Liu, S. Y., S144 (SUN-P245)
Liu, X., S138 (SUN-P228)
Liu, Y., S138 (SUN-P228)
Livantsova, E., S157 (SUN-P281)
Li, X., S138 (SUN-P228), S176 (SUN-LB329)
Li, Y., S201 (MON-P060), S202 (MON-P061),
S290 (MON-P302)
Li, Z., S302 (MON-LB333)
Ljungqvist, O., S2 (OR03), S194 (MON-P039),
S194 (MON-P040)
Llop-Talaveron, J., S79 (SUN-P069)
Llorente, L., S226 (MON-P129)
Lloyd, D. A., S8 (OR20), S262 (MON-P228)
Lockhart, T., S289 (MON-P301)
Lohrmann, C., S71 (SUN-P048)
Loh, Y. J., S59 (SUN-P019)
Longman, R., S305 (MON-LB339)
Looijaard, W. G., S186 (MON-P020),
S187 (MON-P021), S291 (MON-LB305)
Lopes, A., S161 (SUN-P291)
Lopes, M., S129 (SUN-P203)
López Rodriguez, C., S237 (MON-P158),
S280 (MON-P276), S280 (MON-P277)
Lopez, C., S102 (SUN-P130)
Lopez-Lluch, G., S107 (SUN-P142)
Lopez-Martinez, I., S89 (SUN-P095),
S89 (SUN-P096)
López-Sabater, M. C., S36 (PT04.1),
S41 (PT06.2)
López-Urdiales, R., S91 (SUN-P101)
Lopez-Urdiales, R., S223 (MON-P120)
Lorite, R., S197 (MON-P048)
Lourenço, A.D.S. N., S42 (PT06.3)
Lou, Y. T., S86 (SUN-P087)
Low, E., S161 (SUN-P290), S162 (SUN-P293)
Lozada-Mellado, M., S226 (MON-P129)
Lozano, A., S211 (MON-P085)
Lozano-Andreu, T., S79 (SUN-P069)
Lubisco, A., S101 (SUN-P128)
Lubrano, C., S7 (OR16)
Luiking, Y. C., S66 (SUN-P037), S66 (SUN-P038),
S67 (SUN-P039), S158 (SUN-P283)
Luisa, G., S151 (SUN-P264)
Lukawska, J., S287 (MON-P294)
Author index
Luna-Camacho, Y., S101 (SUN-P127)
Lupia, E., S64 (SUN-P032)
Luse, L., S226 (MON-P128)
Lusignani, M., S68 (SUN-P042),
S135 (SUN-P219), S189 (MON-P028)
Lydon, R., S159 (SUN-P286)
Lyons, M., S252 (MON-P201)
M S262 (MON-P227)
M’bouyou-Boungou, J., S7 (OR17)
M’rabet, L., S286 (MON-P293)
Maasberg, S., S85 (SUN-P086),
S114 (SUN-P163), S206 (MON-P073)
Maas, D., S255 (MON-P209)
Ma, C.-J., S86 (SUN-P088)
Macarena, F., S133 (SUN-P215)
MaCdonald - Ottevanger, M., S123 (SUN-P189)
Machado, N. M., S16 (OR40), S38 (PT04.6)
Maciejewski, T. M., S52 (PT10.6)
Macovei, R. A., S60 (SUN-P020), S60 (SUN-P021)
Madali, B., S116 (SUN-P168)
Madden, M., S214 (MON-P095)
Maggio, M. G., S193 (MON-P038)
Maggio, M., S68 (SUN-P041)
Magnes, C., S156 (SUN-P278)
Magnoni, D., S60 (SUN-P022), S100 (SUN-P125)
Magri, M., S68 (SUN-P042), S135 (SUN-P219),
S189 (MON-P028)
Mahjoub, H., S141 (SUN-P235)
Maia-Lemos, P. S., S252 (MON-P199),
S252 (MON-P200)
Maier, A. B., S29 (PT01.1), S71 (SUN-P050),
S72 (SUN-P051), S72 (SUN-P052),
S195 (MON-P041)
Maillard, G., S6 (OR14)
Maio, R., S219 (MON-P109)
Maissen, S., S233 (MON-P148)
Maitre, I., S167 (SUN-LB306)
Majewska, K., S21 (OR52), S49 (PT09.3),
S91 (SUN-P102), S106 (SUN-P140),
S106 (SUN-P141), S207 (MON-P075)
Makhlouf, A.-M., S62 (SUN-P028),
S113 (SUN-P159), S293 (MON-LB310),
S293 (MON-LB311)
Maki, H., S32 (PT02.4)
Malfroot, A., S151 (SUN-P263)
Małgorzewicz, S., S119 (SUN-P176),
S119 (SUN-P177)
Manca, C. S., S177 (SUN-LB333)
Manca, C., S81 (SUN-P074)
Mandal, A.K.A., S5 (OR12), S220 (MON-P113)
Mansinho, H., S83 (SUN-P079)
Mantovani, M., S68 (SUN-P041)
Marano, G., S135 (SUN-P219)
Marburger, C., S190 (MON-P030)
Marcadenti, A., S40 (PT05.4), S111 (SUN-P154)
Marcangeli, V., S38 (PT04.5), S229 (MON-P137),
S271 (MON-P252), S284 (MON-P288)
Mareschal, J., S129 (SUN-P205)
Maria, M. Moreno Santa, S229 (MON-P136)
Mariani, S., S7 (OR16)
Maribo, T., S191 (MON-P032)
Maric, L., S147 (SUN-P254)
Maridaki, M., S236 (MON-P154),
S258 (MON-P218)
Marin, B., S34 (PT03.1), S34 (PT03.3)
Marinho, A., S129 (SUN-P203)
S319
Marinho, R., S129 (SUN-P203)
Marinier, E. M., S304 (MON-LB338)
Marino, L., S58 (SUN-P016)
Marklund, M., S55 (SUN-P009)
Marnic,́ M., S127 (SUN-P198)
Marôco, J., S260 (MON-P223)
Marques, G., S95 (SUN-P112)
Marques-Vidal, P., S261 (MON-P226),
Marquet-de Rougé, P., S69 (SUN-P044)
Marra, M., S40 (PT05.6), S44 (PT07.2),
S103 (SUN-P131), S126 (SUN-P196)
Marrinan, G., S252 (MON-P201)
Marrugo, J., S107 (SUN-P142)
Marshall, A., S281 (MON-P279)
Martín González, C., S178 (SUN-LB336)
Martín Iglesias, D., S140 (SUN-P232)
Martinelli, A.D.L. C., S177 (SUN-LB333)
Martinez Del Rio Requejo, I., S126 (SUN-P197)
Martinez Del Rio, I., S35 (PT03.4)
Martínez López, E., S94 (SUN-P109)
Martinez, B., S107 (SUN-P142)
Martinez, E., S136 (SUN-P223)
Martinez, F., S147 (SUN-P254)
Martínez, M. Garrido, S226 (MON-P127)
Martínez-Ramírez, M. J., S226 (MON-P127)
Martinez-Tyson, D., S120 (SUN-P180)
Martin, L., S159 (SUN-P286), S172 (SUN-LB320)
Martin, M., S136 (SUN-P223)
Martin, N., S214 (MON-P095)
Martinsen, L., S108 (SUN-P147)
Martinsson, I., S130 (SUN-P206)
Martion Giol, M., S94 (SUN-P109)
Martucci, R. B., S29 (PT01.2), S215 (MON-P098)
Maruyama, M. J., S266 (MON-P241)
Maruyama, M., S165 (SUN-P301)
Masaki, Y., S165 (SUN-P301)
Maslim, Y., S226 (MON-P128)
Masterson, L., S252 (MON-P201)
Masters, R., S251 (MON-P196)
Mastora, Z., S101 (SUN-P126)
Mastrangelo, S., S276 (MON-P265)
Mastroluca, D., S96 (SUN-P115)
Mastrominas, M., S137 (SUN-P224)
Matía Martin, P., S203 (MON-P065)
Matía, P., S269 (MON-P247), S271 (MON-P253)
Matsuda, H., S247 (MON-P188)
Matsui, K., S170 (SUN-LB315)
Matta, L. F., S19 (OR47)
Matthys, C., S270 (MON-P251)
Matuhara, A. M., S185 (MON-P016)
Matushima, H., S170 (SUN-LB315)
Maurizi, P., S276 (MON-P265)
Mayorga-Mazón, C., S148 (SUN-P256),
S150 (SUN-P260)
Mazurak, V. C., S47 (PT08.4), S47 (PT08.5)
Mazur, J., S52 (PT10.6)
Mazzanti, L., S227 (MON-P131)
Mc Cloat, A., S159 (SUN-P286)
Mc Loone, M., S159 (SUN-P286)
McCaughan, G. W., S169 (SUN-LB312)
Mccluskey, J. T., S274 (MON-P261),
S303 (MON-LB335)
Mcdonald, B., S26 (OR65)
Mcdougall, G. J., S274 (MON-P261)
Mcelligott, K., S252 (MON-P201)
Mclin, V., S265 (MON-P236)
McMahon, M., S204 (MON-P066)
S320
Mcmahon, M., S259 (MON-P221)
Mcmahon, S., S252 (MON-P201)
McMonagle, G., S159 (SUN-P286)
McNally, B., S176 (SUN-LB329)
McNicholl, T., S125 (SUN-P194)
Mcnicholl, T., S125 (SUN-P193)
Mcphee, J. S., S29 (PT01.1)
Mearelli, F., S64 (SUN-P032)
Meessen, E. C., S54 (SUN-P004)
Meex, S. J., S232 (MON-P145)
Mega, A. M., S59 (SUN-P018)
Mehdizadeh Hakkak, A., S76 (SUN-P061)
Mehta, S., S50 (PT10.2), S96 (SUN-P114),
S109 (SUN-P150), S130 (SUN-P207),
S215 (MON-P096), S215 (MON-P097),
S287 (MON-P294)
Meier, C., S37 (PT04.2)
Meijerink, M., S93 (SUN-P105)
Meinitzer, A., S156 (SUN-P278)
Meirelles, C. S., S48 (PT08.6)
Meisinger, C., S73 (SUN-P054)
Melchior, J.-C., S102 (SUN-P129),
S231 (MON-P140)
Mele, M. C., S87 (SUN-P091), S152 (SUN-P267),
S276 (MON-P265), S281 (MON-P278)
Melgaard, D., S191 (MON-P032)
Melissopoulou, T., S59 (SUN-P018)
Membrez, F., S4 (OR09)
Memelink, R. G., S10 (OR25), S232 (MON-P144)
Mena, F., S133 (SUN-P215)
Mendes, K. G., S98 (SUN-P120),
S136 (SUN-P222), S143 (SUN-P241)
Mendil, N. A., S287 (MON-P295)
Mendonça, V. S., S65 (SUN-P034)
Mendorou, C., S137 (SUN-P224)
Menéndez, A. M., S57 (SUN-P014)
Menendez, C., S148 (SUN-P256)
Meng, Q., S14 (OR34)
Mensink, M., S181 (MON-P007),
S286 (MON-P293)
Mercanlıgil, S. M., S45 (PT07.5),
S147 (SUN-P252), S165 (SUN-P302)
Merdrignac, A., S209 (MON-P082)
Merlo, F. D., S301 (MON-LB329)
Mesa, J., S16 (OR39)
Meschi, T., S68 (SUN-P041), S193 (MON-P038)
Mesia, R., S211 (MON-P085)
Meskers, C. G., S71 (SUN-P050),
S72 (SUN-P051), S72 (SUN-P052)
Meskers, C.G.M., S29 (PT01.1),
S195 (MON-P041)
Mesotten, D., S20 (OR49)
Metcalfe, M., S27 (OR68), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108),
S199 (MON-P052), S199 (MON-P053)
Metnitz, B., S25 (OR62)
Metnitz, P., S25 (OR62)
Metselaar, H. J., S133 (SUN-P214)
Metselaar, H., S80 (SUN-P072)
Meulen van der, T., S49 (PT09.4)
Meurice, P., S209 (MON-P082)
Meza, C., S107 (SUN-P142)
Meziani, A., S38 (PT04.5), S271 (MON-P252)
Midtgaard, J., S160 (SUN-P289)
Miecinikovsski, R., S98 (SUN-P120)
Miggiano, G.A.D., S87 (SUN-P091),
S152 (SUN-P267), S276 (MON-P265),
S281 (MON-P278)
Author index
Mihara, C., S139 (SUN-P229)
Mijan de la Torre, A., S233 (MON-P146)
Mikkelsen, K. K., S155 (SUN-P275)
Millan-Lopez, M., S238 (MON-P162),
S238 (MON-P163)
Millotte, C., S8 (OR19)
Mills, S., S193 (MON-P037)
Minaguchia, J., S46 (PT08.1)
Minano, E., S102 (SUN-P129)
Minematsu, T., S299 (MON-LB325)
Miño, P., S277 (MON-P268)
Mirkovic, D., S23 (OR56), S181 (MON-P006)
Mitichkin, A., S82 (SUN-P078)
Mitri, C. Bou, S113 (SUN-P161)
Mitrovic, M., S23 (OR56)
Miura, K., S55 (SUN-P008)
Miura, T., S168 (SUN-LB310)
Miyawaki, Y., S153 (SUN-P269)
Mizéhoun-Adissoda, C., S127 (SUN-P200)
Mizuide, M., S85 (SUN-P084)
Modreker, M. K., S190 (MON-P030)
Moens, M., S251 (MON-P198)
Moeyerson, W., S180 (MON-P002)
Mohammadi, F., S145 (SUN-P246),
S159 (SUN-P287)
Mohanlal, A., S305 (MON-LB341)
Mohan, R., S282 (MON-P282)
Mohorko, N., S285 (MON-P290)
Moinard, C., S3 (OR07), S6 (OR14),
S157 (SUN-P279), S157 (SUN-P280)
Moisejevs, G., S138 (SUN-P226)
Mojarrad, M., S76 (SUN-P061)
Mok, Y. H., S59 (SUN-P019)
Molfino, A., S57 (SUN-P012), S96 (SUN-P115)
Molina-López, J., S290 (MON-LB303)
Möltgen, C., S141 (SUN-P234),
S259 (MON-P220)
Monaco, T., S24 (OR59)
Monajemi, F., S101 (SUN-P128)
Monfá Bosch, J. M., S224 (MON-P123)
Monsonego-Ornan, E., S179 (SUN-LB338)
Monteiro da Silva, L. S., S267 (MON-P243)
Monteiro, A. S., S100 (SUN-P125)
Montemerlo, H. J., S57 (SUN-P014)
Montero-Galván, A., S123 (SUN-P187)
Montes Goyanes, R., S36 (PT04.1), S41 (PT06.2)
Montserrat, M., S223 (MON-P120)
Monzón, A., S148 (SUN-P256)
Mooney, E., S159 (SUN-P286)
Moore, B., S252 (MON-P201)
Moore, F., S176 (SUN-LB330)
Moradkhani, S., S164 (SUN-P300)
Moraes, R. B., S26 (OR64)
Morais, J. A., S229 (MON-P137)
Morais, J., S38 (PT04.5), S271 (MON-P252),
S284 (MON-P288)
Morales Cerchiaro, A., S212 (MON-P089)
Morales, F., S122 (SUN-P184)
Moreira Carrasco, L. P., S173 (SUN-LB321)
Moreira, P., S100 (SUN-P125)
Moreno Santa Maria, M., S237 (MON-P158),
S280 (MON-P276), S280 (MON-P277)
Moreno Zabaleta, R., S178 (SUN-LB336)
Moreno, C., S271 (MON-P253)
Moreno, Y.M.F., S41 (PT06.1)
Moriarty, C., S159 (SUN-P286)
Morin, A., S286 (MON-P292)
Morita, S., S21 (OR53)
Moriya, T., S1 (OR02), S201 (MON-P058)
Moroboshi, A., S189 (MON-P026)
Moro, K., S55 (SUN-P008)
Morrison, J., S75 (SUN-P057)
Moser, C. E., S39 (PT05.3), S234 (MON-P149)
Mosillo, P., S57 (SUN-P012)
Mossavibahar, H., S141 (SUN-P235)
Mota, I.C.P., S60 (SUN-P022)
Motilla de la Cámara, M. L., S203 (MON-P064)
Motilla De La Cámara, M., S212 (MON-P089)
Motilla, M., S177 (SUN-LB332)
Motter, F. R., S136 (SUN-P222)
Mottolese, A., S101 (SUN-P128)
Mouillot, T., S77 (SUN-P065)
Moulin, S., S6 (OR14)
Moura, A., S60 (SUN-P022)
Moura, E.G.H., S16 (OR40), S38 (PT04.6)
Mühlebach, S., S120 (SUN-P179)
Muiesan, M. L., S64 (SUN-P032)
Mullally, D., S30 (PT01.3)
Müller, M. J., S118 (SUN-P173)
Müller-Werdan, U., S110 (SUN-P151),
S110 (SUN-P152)
Mulliez, A., S62 (SUN-P028)
Munaò, R., S1 (OR01)
Mundi, M., S204 (MON-P066),
S259 (MON-P221)
Muñoz, A., S133 (SUN-P215)
Muñoz-Blanco, J. L., S177 (SUN-LB332)
Munyi, F., S251 (MON-P198)
Murakoshi, S., S1 (OR02), S15 (OR36),
S46 (PT08.2), S78 (SUN-P068),
S85 (SUN-P085), S171 (SUN-LB316),
S201 (MON-P058)
Murata, S., S292 (MON-LB309)
Murena, L., S74 (SUN-P056)
Murphy, R., S47 (PT08.4), S268 (MON-P246)
Murray, K., S109 (SUN-P150), S215 (MON-P096),
S215 (MON-P097)
Muscaritoli, M., S57 (SUN-P012),
S96 (SUN-P115)
Mustafa, N., S214 (MON-P095)
N
Naaman, N., S84 (SUN-P083)
Nachshon, L., S179 (SUN-LB338)
Nadeau, B., S264 (MON-P234)
Nagahama, T., S283 (MON-P284)
Nagahashi, M., S55 (SUN-P008)
Naganathan, V., S30 (PT01.5)
Naganuma, A., S78 (SUN-P066),
S85 (SUN-P084), S189 (MON-P026),
S219 (MON-P110)
Nagashima, T., S219 (MON-P110)
Nagel, G., S167 (SUN-LB306)
Na, H. K., S79 (SUN-P070), S301 (MON-LB330)
Nahar-van Venrooij, L., S123 (SUN-P189)
Naidu, S., S305 (MON-LB341)
Nair, P., S162 (SUN-P294)
Nakade, M., S282 (MON-P282)
Nakajima, M., S55 (SUN-P008)
Nakamura, E., S266 (MON-P241)
Nakamura, H., S189 (MON-P026)
Nakamura, T., S55 (SUN-P007)
Nakamura, Y., S170 (SUN-LB315)
Nakano, Y., S154 (SUN-P273)
Nakatake, R., S170 (SUN-LB315)

Nakayama, Y., S296 (MON-LB317)
Nakaya, Y., S178 (SUN-LB335)
Nakib, S., S7 (OR17), S284 (MON-P286)
Namikawa, M., S219 (MON-P110)
Namikawa, T., S195 (MON-P043),
S196 (MON-P045), S262 (MON-P229)
Narayanan, V., S214 (MON-P095)
Narici, M. V., S72 (SUN-P051)
Narici, M., S68 (SUN-P041)
Naudin, S., S48 (PT09.2)
Navarro, A. M., S177 (SUN-LB333)
Navis, G. J., S158 (SUN-P282)
Navratilova, M., S229 (MON-P135)
Neelemaat, F., S166 (SUN-LB305)
Neelis, E., S42 (PT06.4)
Nel, D., S251 (MON-P198)
Nelson, G., S172 (SUN-LB320)
Nematy, M., S76 (SUN-P061), S121 (SUN-P183)
Nergiz Unal, R., S257 (MON-P216)
Nergiz-Unal, R., S53 (SUN-P002),
S54 (SUN-P003)
Neri, D. A., S42 (PT06.3)
Ness, A., S282 (MON-P281), S305 (MON-LB339)
Neutel, J., S266 (MON-P239)
Neveu, N., S221 (MON-P116)
Neveux, N., S90 (SUN-P098), S253 (MON-P203),
S285 (MON-P289)
Newman, A. B., S12 (OR30)
Neyrinck, A., S2 (OR04), S22 (OR54),
S273 (MON-P259)
Ng, E. K.-W., S144 (SUN-P245)
Ng, E., S15 (OR38)
Nguyen, T., S180 (MON-P003)
Nicolaes, G., S22 (OR55)
Nicolai, A., S227 (MON-P131)
Nicolai, G., S227 (MON-P131)
Nicoll, A., S169 (SUN-LB311)
Nicol, M., S34 (PT03.1), S34 (PT03.3)
Nielsen, M. M., S191 (MON-P032)
Nielsen, R. E., S217 (MON-P102)
Niessen, W., S128 (SUN-P201)
Nieuwdorp, M., S54 (SUN-P004)
Nightingale, J. M., S8 (OR20), S262 (MON-P228)
Nijholt, W., S296 (MON-LB318),
S296 (MON-LB319), S298 (MON-LB323)
Nikolenko, A., S58 (SUN-P015)
Nilsson, B., S35 (PT03.5)
Nishigori, T., S220 (MON-P111)
Nishihara, Y., S78 (SUN-P068)
Nishikimi, T., S195 (MON-P043),
S262 (MON-P229)
Nishioka, Y., S178 (SUN-LB335)
Nishizawa, M., S170 (SUN-LB315)
Nitichai, N., S247 (MON-P187)
Nobili, A., S68 (SUN-P042), S135 (SUN-P219),
S189 (MON-P028)
Nobis, S., S286 (MON-P292)
Nobuoka, D., S14 (OR33)
Noda, S., S139 (SUN-P229)
Noguchi, M., S15 (OR36), S46 (PT08.2),
S78 (SUN-P068), S85 (SUN-P085),
S171 (SUN-LB316), S201 (MON-P058)
Noirez, P., S38 (PT04.5), S229 (MON-P137),
S271 (MON-P252), S284 (MON-P288)
Noordhoff, H., S205 (MON-P071)
Noort, H. V., S152 (SUN-P268)
Nordstedt, P., S297 (MON-LB320)
Norman, K., S110 (SUN-P151), S110 (SUN-P152)
Author index
Nouvenne, A., S68 (SUN-P041)
Novo, N. F., S117 (SUN-P172)
Nowak, G., S297 (MON-LB320)
Ntanasis-Stathopoulos, I., S174 (SUN-LB326)
Nubret, E., S7 (OR17), S284 (MON-P286)
Nuijten, M., S237 (MON-P159)
Nunes, G., S83 (SUN-P079), S128 (SUN-P202),
S163 (SUN-P296)
Nuñez Ortega, F., S225 (MON-P125)
Nurmohamed, S., S112 (SUN-P157)
Nussler, A. K., S196 (MON-P046)
Nuzzo, A., S5 (OR11)
Nyatefe, D., S251 (MON-P198)
O
O’callaghan, S., S109 (SUN-P150),
S215 (MON-P096), S215 (MON-P097)
O’connor, E., S167 (SUN-LB306)
O’connor, P., S249 (MON-P192)
O’donoghue, M., S252 (MON-P201)
O’hanlon, C., S252 (MON-P201)
O’herlihy, E., S167 (SUN-LB306)
O’keeffe, M., S167 (SUN-LB306)
O’toole, P., S167 (SUN-LB306)
Obama, K., S220 (MON-P111)
Obbard, S., S109 (SUN-P150),
S215 (MON-P096), S215 (MON-P097)
Obeid, C., S162 (SUN-P295)
Oberänder, N., S37 (PT04.4)
Obermayer-Pietsch, B., S156 (SUN-P278)
Obregón, A. M., S133 (SUN-P215)
Obukhova, O., S216 (MON-P100)
Ocampo, Y., S107 (SUN-P142)
Ochoa, J. B., S266 (MON-P239)
Ogasawara, T., S173 (SUN-LB322),
S196 (MON-P044)
Ogata-Medel, M., S226 (MON-P129)
Ogawa, K., S109 (SUN-P149)
Ogawa, S., S167 (SUN-LB307)
Ogawa, T., S78 (SUN-P066), S85 (SUN-P084),
S189 (MON-P026)
Ogawa, Y., S78 (SUN-P066), S85 (SUN-P084),
S189 (MON-P026)
Öge Yılmaz, B., S145 (SUN-P248)
Ogiku, M., S173 (SUN-LB322)
Oguz, A., S136 (SUN-P221)
Ohanyan, H., S102 (SUN-P129),
S231 (MON-P140)
Ohara, H., S165 (SUN-P301)
Ohnawa, M., S78 (SUN-P068)
Oh, S. E., S174 (SUN-LB325)
Ohyama, T., S219 (MON-P110)
Okajima, H., S14 (OR35), S39 (PT05.1),
S76 (SUN-P062), S153 (SUN-P270)
Okamoto, K., S153 (SUN-P269)
Okamura, A. B., S64 (SUN-P033)
Oke, S., S8 (OR20), S262 (MON-P228)
Okumura, S., S39 (PT05.1), S76 (SUN-P062),
S153 (SUN-P270), S206 (MON-P072)
Okumura, T., S170 (SUN-LB315)
Olde Damink, S. W., S25 (OR61), S31 (PT02.1),
S33 (PT02.6), S54 (SUN-P004)
Olde Damink, S., S22 (OR55)
Olde Damink, S.W.M., S47 (PT08.5)
Olea Salinas, O. O., S126 (SUN-P197)
Olea, O. O., S35 (PT03.4)
Olesen, S. S., S40 (PT05.5), S239 (MON-P164)
S321
Olieman, J., S11 (OR26)
Olinto, M.T.A., S98 (SUN-P120),
S143 (SUN-P241)
Oliva, A., S147 (SUN-P253)
Olivar Roldán, J., S178 (SUN-LB336)
Oliveira Filho, R. S., S164 (SUN-P298)
Oliveira, A. R., S57 (SUN-P013)
Oliveira, F.L.C., S42 (PT06.3)
Oliveira, L.D.D. A., S41 (PT06.1)
Oliveira, P., S219 (MON-P109)
Oliveira, P.A.D., S60 (SUN-P022)
Oliveira, R. B., S177 (SUN-LB333)
Olivier, C., S4 (OR10), S33 (PT02.5),
S81 (SUN-P075), S230 (MON-P139)
Olmedilla, Y., S177 (SUN-LB332)
Olmedo, L. Cuellar, S224 (MON-P123)
Olszewska, K., S18 (OR44), S150 (SUN-P262)
Olveira, G., S89 (SUN-P095), S89 (SUN-P096)
Omidi, M., S106 (SUN-P141), S207 (MON-P075)
Omidvar, N., S299 (MON-LB326)
Oñate, G., S133 (SUN-P215)
Ongan, D., S164 (SUN-P299)
Ong, C., S59 (SUN-P019), S92 (SUN-P103)
Ono, H., S296 (MON-LB317)
Oogiku, M., S196 (MON-P044)
Orford, E., S176 (SUN-LB329)
Orlandoni, P., S193 (MON-P036)
Ors, E. D., S144 (SUN-P243)
Ortiz, A., S16 (OR39)
ORUÇ, N., S245 (MON-P181)
Oruç, N., S288 (MON-P298)
Oruc, N., S81 (SUN-P076)
Oshima, T., S293 (MON-LB310),
S293 (MON-LB311)
Osowska, S., S49 (PT09.3), S207 (MON-P075)
Osumi, S., S167 (SUN-LB307)
Otake, K., S292 (MON-LB309)
Ota, Y., S52 (PT10.5)
Öteleş, S., S274 (MON-P260)
Ott, B., S297 (MON-LB321)
Otten, L., S110 (SUN-P151), S110 (SUN-P152)
Ottery, F. D., S129 (SUN-P203),
S131 (SUN-P210), S222 (MON-P119),
S247 (MON-P187), S250 (MON-P195)
Öttl, K., S3 (OR06)
Oudaert, E., S150 (SUN-P261)
Oudemans, H., S187 (MON-P021)
Oudemans-van Straaten, H. M.,
S186 (MON-P020), S291 (MON-LB305)
Oudshoorn, C., S248 (MON-P189)
Ouelaa, W., S7 (OR17)
Ouro, S., S151 (SUN-P264)
Ouwehand, M., S49 (PT09.4)
Overkamp, M., S2 (OR05)
Ozawa, Y., S32 (PT02.4)
Ozcaliskan Ilkay, H., S306 (MON-LB342)
Özcan, A., S58 (SUN-P017)
Özcan, N., S58 (SUN-P017)
Özçelik, H. U., S103 (SUN-P133),
S104 (SUN-P134)
Ozdemir, A., S116 (SUN-P168), S142 (SUN-P239)
Özekşi, P., S274 (MON-P260)
Ozel, H. Gokmen, S235 (MON-P152),
S235 (MON-P153)
Ozgen, G., S164 (SUN-P299)
Ozgen, L., S137 (SUN-P225)
Özgürtaş, T., S247 (MON-P186)
Ozhan Oktar, S., S11 (OR27)
S322
Ozisik, H., S164 (SUN-P299)
Ozkan, E., S88 (SUN-P093)
Özsürekçi, C., S241 (MON-P169)
Özsürekci, C., S243 (MON-P177)
Ozturk Duran, E. E., S137 (SUN-P225)
Ozturk-Duran, E. E., S135 (SUN-P220)
Öztürk, S., S217 (MON-P104), S218 (MON-P105)
Öztürk, Y., S279 (MON-P273)
Özütemiz, A. Ö., S245 (MON-P181),
S288 (MON-P298)
P Pedrollo, T., S116 (SUN-P169)
Pablo-Francisco, A., S101 (SUN-P127)
Pachikian, B., S2 (OR04), S273 (MON-P259)
Pafili, Z., S236 (MON-P154), S258 (MON-P217),
S258 (MON-P218), S258 (MON-P219),
S263 (MON-P233)
Paganno, A. P., S81 (SUN-P074)
Paine, P., S160 (SUN-P288)
Paiva, C.C.J., S100 (SUN-P125)
Pak, M., S53 (SUN-P001)
Palacios, N., S288 (MON-P299)
Palanca, A., S136 (SUN-P223)
Palavra, M., S101 (SUN-P126)
Palazzo, C., S95 (SUN-P111)
Palibrk, I., S127 (SUN-P198)
Palma, D., S42 (PT06.3)
Palmela, C., S151 (SUN-P264)
Palomeque, M., S120 (SUN-P181)
Pamuk, G., S51 (PT10.4)
Panisic, M., S181 (MON-P006)
Panisic-Sekeljic, M., S23 (OR56)
Pantet, O., S50 (PT10.1), S183 (MON-P011)
Pantoja, F., S50 (PT10.2)
Paothong, R., S272 (MON-P254)
Papadiamantis, P., S295 (MON-LB316)
Papageorgiou, P., S295 (MON-LB316)
Papanikolaou, A., S101 (SUN-P126)
Papapietro, K., S61 (SUN-P023)
Papet, I., S167 (SUN-LB306)
Pape, U.-F., S85 (SUN-P086), S114 (SUN-P163),
S204 (MON-P067), S206 (MON-P073),
S230 (MON-P139)
Papier, I., S254 (MON-P206)
Papoutsakis, C., S295 (MON-LB315)
Papovic, V., S82 (SUN-P077)
Pappa, E., S59 (SUN-P018)
Paquot, N., S273 (MON-P259)
Paraiso, V.M.C., S122 (SUN-P185)
Paraizo, V. C., S122 (SUN-P186)
Pardo-Pacheco, B. R., S101 (SUN-P127)
Park, J. S., S95 (SUN-P110), S282 (MON-P283)
Partridge, J., S168 (SUN-LB309),
S300 (MON-LB327)
Pasanisi, F., S40 (PT05.6), S44 (PT07.2),
S103 (SUN-P131), S126 (SUN-P196)
Pascher, A., S85 (SUN-P086), S114 (SUN-P163),
S206 (MON-P073)
Pasqua, M., S101 (SUN-P128)
Passos, C., S81 (SUN-P074)
Patel, P. S., S109 (SUN-P150), S215 (MON-P096),
S215 (MON-P097)
Patel, P., S50 (PT10.2)
Patkova, A., S186 (MON-P019)
Pattinson, A., S259 (MON-P221)
Paulon, E., S96 (SUN-P114), S109 (SUN-P150),
S215 (MON-P096), S215 (MON-P097)
Author index
Paulussen, K. J., S2 (OR05)
Pauly, L., S267 (MON-P244), S268 (MON-P245)
Paur, I., S46 (PT08.1), S91 (SUN-P100)
Pautex, S., S113 (SUN-P159)
Pawlucha, K., S100 (SUN-P124)
Paz, L.P.S., S64 (SUN-P033)
Pazzeschi, C., S202 (MON-P062)
Pearson, M., S51 (PT10.3)
Pedrazzoli, P., S24 (OR59)
Pedrazzoni, M., S68 (SUN-P041)
Pedreño Belchi, M. I., S263 (MON-P231)
Pedziwiatr, M., S207 (MON-P074)
Peers, G., S20 (OR49)
Peiró, I., S91 (SUN-P101), S211 (MON-P085)
Pekcan, A. G., S294 (MON-LB313)
Penaforte, F., S17 (OR41)
Pena, J. W., S147 (SUN-P253)
Pence, M. C., S11 (OR27)
Penfold, C., S282 (MON-P281),
S305 (MON-LB339)
Pennestrì, F., S152 (SUN-P267)
Pequeno, R.S.F., S65 (SUN-P034)
Pereira, A. Z., S253 (MON-P202)
Pereira, C.C.A., S16 (OR40)
Pereira, M., S81 (SUN-P074)
Pereira, S., S168 (SUN-LB308)
Pereira, T. G., S40 (PT05.4)
Peres, W., S29 (PT01.2)
Peres, W.A.F., S215 (MON-P098)
Peretti, N., S148 (SUN-P255)
Pérez de la Cruz, A., S290 (MON-LB303)
Pérez Jiménez, C., S237 (MON-P158)
Pérez Rodríguez, J., S140 (SUN-P232)
Perez-Cruz, E., S101 (SUN-P127)
Pérez-Fernández, L., S114 (SUN-P164)
Pérez-Moreno, I., S290 (MON-LB303)
Permana, H., S245 (MON-P182)
Perrier, M., S8 (OR19)
Perry, R., S282 (MON-P281)
Persiani, R., S152 (SUN-P267)
Pession, A., S50 (PT09.5)
Pessoa, A., S129 (SUN-P203)
Pestana, E. A., S267 (MON-P244),
S268 (MON-P245)
Pestour, S., S3 (OR07)
Petelin, A., S141 (SUN-P236),
S243 (MON-P176), S270 (MON-P249),
S275 (MON-P264), S285 (MON-P290)
Peters, A., S73 (SUN-P054)
Petersen, A. H., S39 (PT05.3)
Petersen, J. H., S39 (PT05.3)
Peters, S., S160 (SUN-P288)
Petit, A., S200 (MON-P057), S244 (MON-P180)
Petit, L.-M., S265 (MON-P236)
Petrolo, M., S71 (SUN-P049)
Petrova, M., S282 (MON-P282)
Pevny, S., S204 (MON-P067), S206 (MON-P073)
Pezzoli, G., S101 (SUN-P128)
Phattharayuttawat, S., S272 (MON-P254)
Piasecki, M., S29 (PT01.1)
Pichard, C., S62 (SUN-P028), S113 (SUN-P159),
S129 (SUN-P205), S293 (MON-LB310),
S293 (MON-LB311)
Picot, D., S32 (PT02.2)
Pieters, R., S286 (MON-P293)
Pietka, M., S207 (MON-P074)
Pijnappels, M., S72 (SUN-P051)
Piloquet, H., S148 (SUN-P255)
Pinarbasi, A., S53 (SUN-P001)
Pina, S., S161 (SUN-P291)
Pineda-Juárez, J. A., S226 (MON-P129)
Pinelli, G., S101 (SUN-P128)
Pinho, J. P., S296 (MON-LB319)
Pinho, J., S129 (SUN-P203)
Pinho, N., S29 (PT01.2)
Pintor De La Maza, B., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
Piovacari, S. F., S64 (SUN-P031)
Piro, F., S50 (PT09.5)
Pironi, L., S13 (OR32), S19 (OR46), S21 (OR51),
S202 (MON-P062), S265 (MON-P238)
Pisarska, M., S207 (MON-P074)
Pita Martín, M. L., S57 (SUN-P014)
Piza, K.C.T., S279 (MON-P274)
Planells, E., S290 (MON-LB303)
Plank, L., S268 (MON-P246)
Plauth, M., S11 (OR28), S240 (MON-P167)
Player, E., S255 (MON-P208)
Plenier, S. Le, S221 (MON-P116)
Pleple, A., S102 (SUN-P129)
Plumb, A., S130 (SUN-P207)
Plummer, M. P., S33 (PT02.6)
Podracka, L., S284 (MON-P287)
Poekes, L., S205 (MON-P069)
Poggiogalle, E., S7 (OR16)
Pokrotnieks, J., S138 (SUN-P226)
Polak, W., S80 (SUN-P072)
Polinder, S., S20 (OR49)
Politis, D., S111 (SUN-P153)
Pollard, C., S23 (OR58), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108)
Pol, R. A., S132 (SUN-P211)
Ponce, O. F., S303 (MON-LB336)
Poorter, R., S174 (SUN-LB324)
Popadic, A., S23 (OR56), S181 (MON-P006)
Popińska, K., S18 (OR44), S150 (SUN-P262)
Portheault, D., S273 (MON-P259)
Postma, E. M., S171 (SUN-LB318)
Potgëns, S., S273 (MON-P259)
Poulia, K. A., S109 (SUN-P148)
Poulia, L., S111 (SUN-P153)
Poullenot, F., S5 (OR11)
Pourhassan, M., S190 (MON-P030)
Povedano, M., S119 (SUN-P178),
S223 (MON-P120)
Power, L. C., S30 (PT01.3), S131 (SUN-P209),
S189 (MON-P027)
Pramyothin, P., S272 (MON-P254)
Prats, A., S223 (MON-P120)
Preiser, J.-C., S62 (SUN-P028)
Prelous, I., S58 (SUN-P015)
Preux, P. M., S34 (PT03.1), S34 (PT03.3),
S127 (SUN-P200)
Psachoula, C., S258 (MON-P219)
Psaltopoulou, T., S174 (SUN-LB326)
Puffelen, E. V., S304 (MON-LB337)
Puggioli, C., S50 (PT09.5)
Pugnaloni, S., S227 (MON-P131)
Puig Piña, R., S94 (SUN-P109)
Puiggrós, C., S239 (MON-P165),
S240 (MON-P166)
Puiggros, C., S61 (SUN-P024)
Puig, R., S136 (SUN-P223)
Pusani, C., S101 (SUN-P128)

Q Riccardi, R., S276 (MON-P265)
Queiroz, D.M.M., S202 (MON-P063)
Quero, M. Serrano, S226 (MON-P127)
Quilliot, D., S5 (OR11)
Quintano Pindado, A., S225 (MON-P124)
Quintero-Osso, B., S290 (MON-LB303)
R Rinninella, E., S87 (SUN-P091),
Rabito, E. I., S40 (PT05.4), S111 (SUN-P154)
Ræder, H., S46 (PT08.1)
Raffoul, W., S50 (PT10.1)
Ragusa, M., S293 (MON-LB311)
Rahman, F., S13 (OR32), S50 (PT10.2),
S96 (SUN-P114), S109 (SUN-P150),
S130 (SUN-P207), S215 (MON-P096),
S215 (MON-P097), S287 (MON-P294)
Ramalho, A., S29 (PT01.2)
Ramani, D., S284 (MON-P286)
Ramel, A., S43 (PT07.1), S97 (SUN-P117)
Ramesh, N., S220 (MON-P113)
Ramírez, L., S263 (MON-P231)
Ramirez, M., S61 (SUN-P023)
Ramminger, S., S298 (MON-LB322)
Ramos, A.P.A., S178 (SUN-LB334)
Ramos-Vázquez, A., S117 (SUN-P170)
Rascov, F., S181 (MON-P005)
Rasic, I., S82 (SUN-P077)
Rasmussen, H. H., S40 (PT05.5),
S213 (MON-P091), S228 (MON-P132),
S239 (MON-P164)
Rasmussen, H., S13 (OR32)
Ratanapichayachai, D., S272 (MON-P254)
Ratti, C., S74 (SUN-P056)
Rattray, M., S281 (MON-P279)
Ravi, C., S5 (OR12)
Raynaud-Simon, A., S285 (MON-P289)
Raz, A., S254 (MON-P206)
Razak, S., S223 (MON-P121)
Razmpour, F., S121 (SUN-P183)
Reckman, G.A.R., S158 (SUN-P282)
Reddy, A., S169 (SUN-LB311)
Reichart, S., S267 (MON-P244),
S268 (MON-P245)
Reijnierse, E. M., S29 (PT01.1),
S71 (SUN-P050), S72 (SUN-P051),
S72 (SUN-P052), S195 (MON-P041)
Reijven, P., S248 (MON-P190),
S249 (MON-P191), S250 (MON-P194)
Reina-Ortiz, M., S120 (SUN-P180)
Reinders, I., S166 (SUN-LB305)
Renke, M., S105 (SUN-P139)
Rensen, S. S., S47 (PT08.5)
Rettore, T. M., S283 (MON-P285)
Rey Fernández, L., S237 (MON-P158),
S280 (MON-P276), S280 (MON-P277)
Reyes Lopez, M. A., S238 (MON-P162),
S238 (MON-P163)
Reyes-Torres, C. A., S117 (SUN-P170)
Rey, L., S229 (MON-P136)
Rey, V., S285 (MON-P291)
Rezaei, N., S164 (SUN-P300)
Rezazadeh, A., S299 (MON-LB326)
Rha, M. Y., S219 (MON-P108)
Ribalta, J., S156 (SUN-P278)
Ribeiro, A.A.F., S253 (MON-P202)
Ribeiro, P. C., S127 (SUN-P199)
Author index
Ricci, S., S221 (MON-P116)
Riego Valledor, A., S233 (MON-P146)
Riemslag Baas, S., S133 (SUN-P214)
Rijksen, B., S169 (SUN-LB312)
Ri, M., S78 (SUN-P068), S201 (MON-P058)
Rimbert, A., S200 (MON-P057),
S244 (MON-P180)
S152 (SUN-P267), S276 (MON-P265),
S281 (MON-P278)
Risérus, U., S55 (SUN-P009)
Rivero, M.E.J., S185 (MON-P016)
Rizzo, O., S4 (OR09)
Robalino, X., S277 (MON-P268)
Roberts, H. C., S193 (MON-P037)
Roberts, S., S169 (SUN-LB311),
S281 (MON-P279)
Robins, R., S155 (SUN-P276)
Rocha Junior, E. P., S283 (MON-P285)
Rocha Junior, E.P.C., S267 (MON-P243)
Rocha, G. A., S133 (SUN-P213),
S202 (MON-P063)
Rocha, P., S296 (MON-LB319)
Rock, E., S156 (SUN-P278)
Rodenas Esteve, I., S107 (SUN-P143)
Rodenburg, I. L., S296 (MON-LB318)
Rodrigues, A.L.C. C., S294 (MON-LB312)
Rodrigues, C. S., S39 (PT05.2)
Rodrigues, C., S117 (SUN-P172)
Rodrigues, V. D., S29 (PT01.2),
S215 (MON-P098)
Rodriguez-Aguilera, J. C., S107 (SUN-P142)
Rodriguez-Elvira, M., S290 (MON-LB303)
Rodriguez, J., S2 (OR04), S273 (MON-P259)
Rodríguez-Mendiola, N., S225 (MON-P126),
S228 (MON-P134)
Rodriguez, R. E., S46 (PT08.3), S70 (SUN-P046),
S156 (SUN-P277)
Rodriguez, S., S147 (SUN-P254)
Rogulska, J., S49 (PT09.3)
Rojas-Mandujano, A., S226 (MON-P129)
Rolland, Y., S167 (SUN-LB306)
Rollnik, J. D., S9 (OR22)
Romero, C., S61 (SUN-P023)
Romero, D., S16 (OR39)
Romero, E., S119 (SUN-P178), S223 (MON-P120)
Romijn, J. A., S54 (SUN-P004)
Ronco, C., S64 (SUN-P032)
Roob, J. M., S3 (OR06), S156 (SUN-P278)
Roodenburg, J. L., S131 (SUN-P210),
S132 (SUN-P211), S160 (SUN-P289),
S222 (MON-P119)
Rooijackers, O., S291 (MON-LB306)
Roosenboom, B., S48 (PT09.1)
Roque, R., S219 (MON-P109)
Rosinhas, J., S129 (SUN-P203)
Rossi Fanelli, F., S96 (SUN-P115)
Rossum, M. V., S104 (SUN-P135)
Rothenberg, E., S71 (SUN-P049)
Rotovnik Kozjek, N., S62 (SUN-P028),
S244 (MON-P178)
Roustaee, R., S145 (SUN-P246),
S159 (SUN-P287)
Rowicka, G., S42 (PT06.5)
Rshidkhani, B., S299 (MON-LB326)
Rubio Gambin, A., S234 (MON-P150),
S263 (MON-P231)
S323
Rubio, M. Á., S271 (MON-P253)
Rubio, M. A., S269 (MON-P247)
Rudka, T., S66 (SUN-P038)
Ruggiero, A., S276 (MON-P265)
Rühlin, M., S141 (SUN-P234), S259 (MON-P220)
Ruiz Alonso, A., S214 (MON-P094)
Ruíz-Roso, G., S225 (MON-P126),
S228 (MON-P134)
Ruiz-Vico, M., S89 (SUN-P095), S89 (SUN-P096)
Runau, F., S88 (SUN-P094), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108),
S214 (MON-P095)
Runia, S., S112 (SUN-P158)
Ruozi, G., S1 (OR01)
Ruperto Lope, M.D.M., S225 (MON-P126)
Ruperto Lopez, M.D.M., S237 (MON-P160)
Ruperto, M.D.M., S228 (MON-P134)
Ruppen, W., S67 (SUN-P040)
Rutten, M., S104 (SUN-P135)
Ryan, M., S169 (SUN-LB311)
Rye, B., S76 (SUN-P063)
Ryttergaard, L., S228 (MON-P132)
S
Saad, R., S84 (SUN-P083)
Sabatino, A., S182 (MON-P008)
Sabbatinelli, J., S227 (MON-P131)
Sáez, M. V., S271 (MON-P253)
Safaz, I., S131 (SUN-P208)
Saginova, E., S157 (SUN-P281)
Sagrado, M. Gonzalez, S224 (MON-P123)
Sahin Kaya, A., S294 (MON-LB313)
Sahin, A. O., S303 (MON-LB334)
Sahin, M. A., S240 (MON-P168)
Şahin, M., S87 (SUN-P090)
Saidijam, M., S164 (SUN-P300)
Saito, K., S139 (SUN-P229)
Saito, S., S219 (MON-P110)
Sakai, P., S16 (OR40), S38 (PT04.6)
Sakai, Y., S220 (MON-P111)
Sakata, J., S55 (SUN-P008)
Sakaue, H., S178 (SUN-LB335)
Sakaue, M., S52 (PT10.5)
Sakuramoto, S., S153 (SUN-P269)
Sala, P. C., S12 (OR29)
Sala, P., S16 (OR40), S38 (PT04.6),
S124 (SUN-P190)
Salas Lorenzo, I., S36 (PT04.1)
Salas-García, I., S37 (PT04.3)
Salazar, J. L., S102 (SUN-P130)
Salehi, M., S76 (SUN-P061)
Salentijn, A., S70 (SUN-P047)
Salhab, N., S306 (MON-LB343)
Salpakoski, A., S29 (PT01.1)
Samaan, M., S50 (PT10.2)
Saman, R., S301 (MON-LB331),
S302 (MON-LB332)
Sammarco, R., S40 (PT05.6), S44 (PT07.2),
S126 (SUN-P196)
Samur, F. G., S306 (MON-LB342)
Samur, F.G.Eroglu, S276 (MON-P267)
Samur, G., S17 (OR42), S45 (PT07.6),
S88 (SUN-P092), S98 (SUN-P118),
S124 (SUN-P191), S289 (MON-P300)
Sanada, H., S299 (MON-LB325)
Sanches, L. M., S122 (SUN-P186)
Sanches, L.T.M., S122 (SUN-P185)
S324
Sánchez Romera, J. F., S234 (MON-P150)
Sanchez Romera, J. F., S263 (MON-P231)
Sanchez Sequero, P., S234 (MON-P150)
Sánchez, C., S91 (SUN-P101)
Sánchez-López, M., S209 (MON-P081)
Sánchez-Migallón Montull, J. M.,
S94 (SUN-P109)
Sanchez-Migallon, J. M., S136 (SUN-P223)
Sanchez-Torralvo, F. J., S89 (SUN-P095)
Sanchez-Torralvo, F., S89 (SUN-P096)
Sancho, A., S197 (MON-P048),
S239 (MON-P165), S240 (MON-P166)
Şanlıer, N., S200 (MON-P056)
Santamaria-Orleans, A., S277 (MON-P269)
Santana, M. S., S260 (MON-P223)
Santarpia, L., S103 (SUN-P131),
S126 (SUN-P196)
Santini Sánchez, A. F., S126 (SUN-P197)
Santo, M. A., S16 (OR40), S38 (PT04.6)
Santos, C. A., S128 (SUN-P202)
Santos, C., S83 (SUN-P079), S163 (SUN-P296)
Santos, D. M., S64 (SUN-P031)
Santos, K.G.D., S100 (SUN-P125)
Santos, M. C., S219 (MON-P109)
Santos, M.J.D., S60 (SUN-P022)
Santoso, P., S245 (MON-P182)
Santos, R. L., S122 (SUN-P186)
Santulario, L., S61 (SUN-P024)
Sanz-París, A., S114 (SUN-P164)
Sanz-Valero, J., S107 (SUN-P143)
Sapen, H. D., S62 (SUN-P027)
Sarantidou, M., S101 (SUN-P126)
Saray, A., S82 (SUN-P077)
Sarer-Yurekli, B. P., S164 (SUN-P299)
Sarkut, P., S249 (MON-P193)
Sarto, B., S239 (MON-P165), S240 (MON-P166)
Sasdelli, A. S., S202 (MON-P062)
Sato, A., S168 (SUN-LB310), S299 (MON-LB325)
Sato, H., S153 (SUN-P269)
Sato, K., S78 (SUN-P066), S85 (SUN-P084),
S219 (MON-P110)
Sato, N., S292 (MON-LB309)
Sato, Y., S234 (MON-P151)
Sattler, M. C., S3 (OR06)
Saunders, C., S215 (MON-P098)
Saura, E., S288 (MON-P299)
Sawyer, M., S47 (PT08.4)
Scambia, G., S281 (MON-P278)
Schaap, F. G., S31 (PT02.1), S33 (PT02.6),
S54 (SUN-P004)
Schaap, F., S22 (OR55)
Scheffer, H., S93 (SUN-P105)
Scheike, T., S234 (MON-P149)
Schindera, C., S17 (OR43)
Schindler, K., S83 (SUN-P080),
S272 (MON-P255), S272 (MON-P256)
Schippers, H.-J., S128 (SUN-P201)
Schluckebier, D., S265 (MON-P236)
Schmidt, S. B., S9 (OR22)
Schnabel, R. M., S25 (OR61)
Schneider, A., S147 (SUN-P254)
Schneider, S., S5 (OR11)
Schneiter, P., S285 (MON-P291)
Schoen, E., S286 (MON-P293)
Schols, A., S6 (OR13)
Schols, A.M.W. J., S26 (OR66),
S232 (MON-P145)
Schols, J. M., S9 (OR21)
Author index
Schols, J., S74 (SUN-P055), S261 (MON-P225)
Schönknecht, Y. B., S275 (MON-P262)
Schrader, E., S73 (SUN-P054)
Schueren de van der, M., S49 (PT09.4)
Schug, B., S268 (MON-P245)
Schulz, H., S73 (SUN-P054)
Schunck, W.-H., S204 (MON-P067)
Schüssler, S., S71 (SUN-P048)
Schuurman, C., S291 (MON-LB306)
Schweitzer, L., S118 (SUN-P173)
Scialanga, F., S152 (SUN-P267)
Scislo, L., S207 (MON-P074)
Sealy, M. J., S160 (SUN-P289),
S296 (MON-LB318)
Sebe, M., S178 (SUN-LB335)
Seckiner, S., S270 (MON-P250)
Sedef, E., S87 (SUN-P090)
Segal-Lieberman, G., S13 (OR31)
Segura Moreno, M. T., S36 (PT04.1)
Segura-Moreno, M. T., S41 (PT06.2)
Segurola, H., S16 (OR39), S197 (MON-P048),
S239 (MON-P165), S240 (MON-P166)
Seguy, D., S23 (OR57)
Seidner, D. L., S4 (OR10), S33 (PT02.5),
S81 (SUN-P075), S230 (MON-P139)
Seiva, D., S16 (OR40)
Sekine, R., S299 (MON-LB325)
Sekine, S., S189 (MON-P026)
Selimovic, N., S279 (MON-P275)
Semolic, A., S1 (OR01), S6 (OR15)
Sendros Madroño, M. J., S94 (SUN-P109)
Sendros, M. J., S136 (SUN-P223)
Senkyrik, M., S139 (SUN-P231)
Seo, J. M., S174 (SUN-LB325)
Serel Arslan, S., S103 (SUN-P132)
Seremet Kürklü, N., S146 (SUN-P249),
S146 (SUN-P250), S146 (SUN-P251),
S245 (MON-P183)
Seremet Kurklu, N., S51 (PT10.4),
S123 (SUN-P188), S192 (MON-P034)
Sergentanis, I. N., S174 (SUN-LB326)
Sergentanis, T. N., S174 (SUN-LB326)
Serlie, M. J., S54 (SUN-P004)
Serralde-Zúñiga, A. E., S117 (SUN-P170)
Serteser, M., S53 (SUN-P001)
Seto, Y., S15 (OR36)
Sève, M., S157 (SUN-P279)
Severine, A. N., S294 (MON-LB312)
Sevim, S., S118 (SUN-P174), S125 (SUN-P192),
S241 (MON-P170), S254 (MON-P204)
Sezer, T. Ö., S218 (MON-P107)
Shaaban, S. Y., S19 (OR47)
Shabeer, L., S287 (MON-P296)
Shahar, D. R., S166 (SUN-LB305),
S263 (MON-P230)
Shahbazi Feshtali, S., S75 (SUN-P060),
S78 (SUN-P067)
Shan, H., S149 (SUN-P259)
Shelkunova, I., S188 (MON-P025)
Shen, N., S61 (SUN-P025)
Sheppard, C., S172 (SUN-LB320)
Shestopalov, A., S82 (SUN-P078)
Shiga, M., S288 (MON-P297)
Shi, H., S139 (SUN-P230)
Shih, Y.-L., S92 (SUN-P104), S210 (MON-P084)
Shiloah, M., S254 (MON-P206)
Shimazu, S., S66 (SUN-P036), S198 (MON-P049)
Shimizu, M., S170 (SUN-LB313)
Shimizu, T., S195 (MON-P043),
S196 (MON-P045), S262 (MON-P229)
Shiozaki, M., S96 (SUN-P113)
Shiozawa, Y., S189 (MON-P026)
Shirai, H., S14 (OR35), S39 (PT05.1),
S76 (SUN-P062), S153 (SUN-P270),
S206 (MON-P072)
Shiraishi, A., S66 (SUN-P036), S198 (MON-P049)
Shiraki, M., S170 (SUN-LB313)
Shon, J., S282 (MON-P283)
Short, V., S305 (MON-LB339)
Siahpoushi, E., S105 (SUN-P137)
Sibilska, M., S18 (OR44), S150 (SUN-P262)
Sicchieri, J.M.F., S48 (PT08.6), S81 (SUN-P074),
S95 (SUN-P111), S95 (SUN-P112),
S177 (SUN-LB333)
Sieber, C. C., S73 (SUN-P054)
Sierra Bracamonte, M., S214 (MON-P094)
Sierro, C., S129 (SUN-P205)
Silva Junior, J. M., S64 (SUN-P031)
Silva, E.M.F. E., S143 (SUN-P241)
Silva, F. M., S40 (PT05.4), S111 (SUN-P154)
Silva, F., S173 (SUN-LB321)
Silva, F.D.F., S178 (SUN-LB334)
Silva, I.D.C. G., S16 (OR40), S38 (PT04.6)
Silva, L. D., S133 (SUN-P213), S202 (MON-P063)
Silva, M. M., S16 (OR40), S179 (SUN-LB337)
Silva, M., S17 (OR41)
Silva, S. G., S129 (SUN-P203)
Silva, W. R., S260 (MON-P223)
Silveira, J., S129 (SUN-P203),
S296 (MON-LB319)
Silvestre, S. C., S283 (MON-P285)
Silvestre, S., S267 (MON-P243)
Simões, B. P., S48 (PT08.6)
Simões, B., S95 (SUN-P112)
Sinai, T., S179 (SUN-LB338)
Singer, P., S13 (OR32), S24 (OR60), S25 (OR63),
S182 (MON-P008), S183 (MON-P012),
S184 (MON-P013)
Singh, N. A., S5 (OR12)
Sin, M., S117 (SUN-P171)
Sio, C. A., S305 (MON-LB340)
Sipilä, S., S72 (SUN-P051)
Sipila, S., S29 (PT01.1)
Sirichindakul, B., S247 (MON-P187)
Sisa, I., S120 (SUN-P181)
Sistanizad, M., S182 (MON-P010)
Siviero, J., S116 (SUN-P169), S136 (SUN-P222)
Sivri, E., S245 (MON-P183)
Sjögren, P., S55 (SUN-P009)
Sjogren, P., S30 (PT01.4)
Skadhauge, L. B., S213 (MON-P091)
Skoknova, M., S284 (MON-P287)
Sköldenberg, O., S2 (OR03)
Skurk, T., S297 (MON-LB321)
Slaughter, S., S75 (SUN-P057)
Slavuta, H., S65 (SUN-P035)
Small, M., S266 (MON-P240)
Smeets, E. T., S166 (SUN-LB305)
Smeland, S., S46 (PT08.1), S91 (SUN-P100)
Smith, O., S252 (MON-P201)
Smith, T. R., S175 (SUN-LB328),
S217 (MON-P103)
Smith, T., S7 (OR18)
Smit, T. C., S46 (PT08.3), S70 (SUN-P046),
S156 (SUN-P277)
Soares, M.M.S., S202 (MON-P063)

Sobhanian, S., S201 (MON-P059)
Sobocki, J., S21 (OR52), S49 (PT09.3),
S91 (SUN-P102), S106 (SUN-P140),
S106 (SUN-P141), S153 (SUN-P271),
S179 (MON-P001), S207 (MON-P075)
Sobolev, M., S282 (MON-P282)
Soetedjo, N.N.M., S245 (MON-P182)
Soeters, M. R., S54 (SUN-P004)
Sohn, T. S., S174 (SUN-LB325),
S219 (MON-P108)
Soja, A.M.B., S35 (PT03.5)
Soldatovic, I., S23 (OR56)
Somers, A., S150 (SUN-P261)
Somlaw, N., S247 (MON-P187)
Song, H. J., S79 (SUN-P070),
S301 (MON-LB330)
Sood, S., S169 (SUN-LB311)
Sospedra Martínez, M., S94 (SUN-P109)
Soto Celix, M., S233 (MON-P146)
Soto, C. Crespo, S224 (MON-P123),
S225 (MON-P124)
Sotoodeh Jahromi, A., S198 (MON-P051),
S201 (MON-P059)
Souren, T., S295 (MON-LB316)
Sourisseau, H., S34 (PT03.1), S34 (PT03.3)
Sousa, A. S., S192 (MON-P035)
Sousa, A.G.D.M.R., S60 (SUN-P022)
Souza, I.A.O., S127 (SUN-P199)
Sparvoli, D., S193 (MON-P036)
Speedy, A., S292 (MON-LB308)
Speranza, E., S103 (SUN-P131),
S126 (SUN-P196)
Spörri, A., S197 (MON-P047)
Staessens, K., S62 (SUN-P027)
Stamou, A., S111 (SUN-P153)
Stancari, A., S50 (PT09.5)
Stanga, Z., S37 (PT04.2), S120 (SUN-P179)
Stanislaus, A., S47 (PT08.4)
Stanton, C., S167 (SUN-LB306)
Stapel, S., S187 (MON-P021)
Starodubova, A., S157 (SUN-P281)
Staun, M., S39 (PT05.3), S234 (MON-P149)
Steele, C., S75 (SUN-P057)
Steenackers, N., S270 (MON-P251)
Steenhagen, E., S112 (SUN-P158)
Stefanoni, N., S285 (MON-P291)
Steffen, R., S37 (PT04.2)
Stehle, P., S73 (SUN-P054), S275 (MON-P262)
Steiber, A., S295 (MON-LB315)
Steinert, R. E., S303 (MON-LB335)
Stelmach, M., S167 (SUN-LB306)
Stenroth, L., S72 (SUN-P051)
Stoddard, L., S159 (SUN-P286)
Stoecklin, P., S183 (MON-P011)
Stoffel-Wagner, B., S275 (MON-P262)
Stollhof, L., S196 (MON-P046)
Stoppe, C., S26 (OR65)
Storchai, M., S282 (MON-P282)
Stover, C. M., S199 (MON-P054)
Stover, J., S267 (MON-P244), S268 (MON-P245)
Strand, T. A., S260 (MON-P224)
Stratton, R. J., S7 (OR18), S175 (SUN-LB328),
S217 (MON-P103)
Streicher, M., S167 (SUN-LB306),
S189 (MON-P027)
Streppel, M. T., S291 (MON-LB306)
Stubbe, J., S135 (SUN-P218),
S159 (SUN-P284)
Author index
Stubelj, M., S141 (SUN-P236),
S243 (MON-P176), S270 (MON-P249),
S275 (MON-P264)
Stuiver, M. M., S160 (SUN-P289)
Stukan, M., S105 (SUN-P139)
Sturm, A., S85 (SUN-P086), S114 (SUN-P163)
Suárez-Lledó, A., S79 (SUN-P069)
Suchkov, D., S61 (SUN-P025)
Sugama, J., S299 (MON-LB325)
Sugawara, L. M., S55 (SUN-P007)
Suhm, N., S67 (SUN-P040)
Suker, M., S80 (SUN-P073)
Sulmont Rosse, C., S167 (SUN-LB306)
Sulo, S., S168 (SUN-LB309), S300 (MON-LB327)
Suluhan, D., S149 (SUN-P257), S149 (SUN-P258)
Sulz, I., S83 (SUN-P080), S272 (MON-P255),
S272 (MON-P256)
Sümer, F., S241 (MON-P169), S243 (MON-P177)
Sumi, Y., S154 (SUN-P273)
Summers, M., S180 (MON-P003)
Sundaram, L., S249 (MON-P191),
S250 (MON-P194)
Sundh, V., S71 (SUN-P049)
Šundov, A., S198 (MON-P050)
Sundov, Z., S198 (MON-P050)
Sungur, M., S287 (MON-P295)
Sun, H., S138 (SUN-P228)
Sun, L. C., S210 (MON-P084)
Sun, L.-C., S87 (SUN-P089), S92 (SUN-P104)
Sürer, I., S149 (SUN-P257)
Suriano, F., S22 (OR54)
Surowska, A., S285 (MON-P291)
Susam Şen, H., S217 (MON-P104),
S218 (MON-P105)
Sütcüoglu, O., S249 (MON-P193)
Su, W.-C., S221 (MON-P114)
Suzuki, H., S219 (MON-P110)
Suzuki, K., S247 (MON-P188)
Suzuki, N., S247 (MON-P188)
Suzuki, T., S168 (SUN-LB310)
Suzuki, Y., S266 (MON-P241)
Svobodova, I., S170 (SUN-LB314)
Sweeney, E., S252 (MON-P201)
Swierblewski, M., S173 (SUN-LB323)
Sytema, B., S84 (SUN-P082)
Szczepanek, K., S207 (MON-P074)
T Teran, E., S102 (SUN-P130),
Tabak, O., S303 (MON-LB334)
Tabak, S., S205 (MON-P071)
Tabbers, M., S42 (PT06.4)
Tabei, I., S266 (MON-P241)
Taberna, M., S211 (MON-P085)
Taddei, C. R., S185 (MON-P016)
Tagliaferri, S., S193 (MON-P038)
Taguchi, M., S278 (MON-P271)
Takagi, H., S219 (MON-P110)
Takagi, K., S14 (OR33)
Takamasu, T., S278 (MON-P271)
Takaori, K., S206 (MON-P072)
Takemoto, H., S139 (SUN-P229)
Takenouchi, M., S155 (SUN-P274)
Tamai, K., S168 (SUN-LB310)
Tamai, Y., S14 (OR35)
Tamanaha, É. M., S164 (SUN-P298)
Tamayo-Serrato, J., S123 (SUN-P187)
Tam, C. K., S15 (OR37)
S325
Tanaka, H., S165 (SUN-P301), S189 (MON-P026)
Tanaka, S., S52 (PT10.5)
Tanaka, T., S78 (SUN-P066), S85 (SUN-P084),
S165 (SUN-P301), S254 (MON-P207)
Tanaka, Y., S167 (SUN-LB307),
S168 (SUN-LB310)
Tang, C.-H., S44 (PT07.3), S44 (PT07.4)
Tan, H., S162 (SUN-P293)
Taniguchi, H., S155 (SUN-P274),
S278 (MON-P271)
Taniguchi, L. U., S127 (SUN-P199)
Tani, M., S52 (PT10.5)
Tan, K. Y., S152 (SUN-P266)
Tan, M., S242 (MON-P174)
Tan, S., S14 (OR34)
Tan, T. H., S59 (SUN-P019)
Tan, T. L., S162 (SUN-P293)
Tan, Z. H., S59 (SUN-P019)
Tapia-Valdés, S., S117 (SUN-P170)
Tap, P., S107 (SUN-P144)
Tappy, L., S285 (MON-P291)
Taura, K., S76 (SUN-P062)
Taus, M., S227 (MON-P131)
Tavolacci, M. P., S200 (MON-P057)
Tayebinia, H., S105 (SUN-P137),
S164 (SUN-P300)
Taylor, M., S10 (OR23), S108 (SUN-P145)
Tchabashvili, L., S300 (MON-LB328)
Teh, R., S167 (SUN-LB306)
Teixeira, A., S81 (SUN-P074)
Teixeira, R. T., S202 (MON-P063)
Teixeira, R., S133 (SUN-P213)
Tel Adıgüzel, K., S124 (SUN-P191),
S131 (SUN-P208), S146 (SUN-P249),
S208 (MON-P078), S208 (MON-P079),
S209 (MON-P080)
Telessy, I. G., S105 (SUN-P138)
Tengilimoglu Metin, M. M., S241 (MON-P170),
S254 (MON-P204)
Tengilimoglu Metin, M., S118 (SUN-P174),
S125 (SUN-P192)
Tennoune El hafaia, N., S285 (MON-P289)
Teo, W. S., S162 (SUN-P293)
ter Beek, L., S131 (SUN-P210),
S132 (SUN-P211), S222 (MON-P119),
S250 (MON-P195), S298 (MON-LB323)
Teramoto, F., S266 (MON-P241)
S120 (SUN-P180), S120 (SUN-P181)
Terashima, H., S154 (SUN-P273)
Terhaard, C. H., S83 (SUN-P081)
Terroba Larumbe, M. C., S225 (MON-P125)
Teruel, J. L., S224 (MON-P122),
S225 (MON-P126), S228 (MON-P134)
Tesinsky, P., S139 (SUN-P231),
S184 (MON-P014)
Tesser, A., S164 (SUN-P298)
Teubner, A., S10 (OR23)
Teunis, M., S286 (MON-P293)
Theilla, M., S13 (OR32), S24 (OR60),
S25 (OR63), S182 (MON-P008),
S183 (MON-P012), S184 (MON-P013)
Theodoro, H., S98 (SUN-P120),
S136 (SUN-P222), S143 (SUN-P241)
Thibault, R., S62 (SUN-P028), S143 (SUN-P242),
S209 (MON-P082)
Thissen, J.-P., S2 (OR04), S273 (MON-P259)
Thomas, A., S50 (PT10.1)
S326
Thomas, S., S282 (MON-P281),
S305 (MON-LB339)
Thomas, T., S255 (MON-P208)
Thompson, J., S23 (OR58), S93 (SUN-P106),
S93 (SUN-P107), S94 (SUN-P108)
Thong, D., S130 (SUN-P207)
Thorand, B., S73 (SUN-P054)
Thuler, L.C.S., S215 (MON-P098)
Thurmann, D., S204 (MON-P067),
S206 (MON-P073)
Tian, F., S187 (MON-P022)
Tian, Z., S138 (SUN-P228)
Ticha, A., S170 (SUN-LB314)
Ticinesi, A., S68 (SUN-P041), S193 (MON-P038)
Tieland, M., S129 (SUN-P204),
S159 (SUN-P284), S163 (SUN-P297),
S166 (SUN-LB305), S291 (MON-LB305)
Tierney, A. C., S169 (SUN-LB311)
Timmons, S., S167 (SUN-LB306)
Tincu, I. F., S60 (SUN-P020), S60 (SUN-P021)
Tincu, R. C., S60 (SUN-P020), S60 (SUN-P021)
Tiran, B., S3 (OR06), S156 (SUN-P278)
Tirnova, I., S249 (MON-P193)
Tlemsani, C., S90 (SUN-P098)
Tobota, K., S150 (SUN-P262)
Tognon, G., S71 (SUN-P049)
Toh, C. H., S152 (SUN-P266)
Toigo, G., S74 (SUN-P056)
Toka, O., S88 (SUN-P092)
Tokarczyk, J., S49 (PT09.3), S207 (MON-P075)
Tokay, A., S114 (SUN-P162)
Toki, A., S276 (MON-P266)
Toledo, D. O., S57 (SUN-P013), S64 (SUN-P031)
Toledo, D., S181 (MON-P005)
Toloi, J., S57 (SUN-P013)
Tominaga, E., S78 (SUN-P068)
Tonietto, T. A., S26 (OR64)
Topal, G. G., S125 (SUN-P192),
S241 (MON-P170), S254 (MON-P204)
Topal, G., S118 (SUN-P174)
Torbahn, G., S167 (SUN-LB306)
Torrego, M., S269 (MON-P247),
S271 (MON-P253)
Torres, D., S231 (MON-P142)
Torres, E., S102 (SUN-P130)
Torres, J., S151 (SUN-P264)
Torrinhas, R. S., S124 (SUN-P190)
Torrinhas, R.S.M. M., S16 (OR40)
Torrinhas, R.S.M.D.M., S38 (PT04.6),
S164 (SUN-P298)
Torsy, T., S301 (MON-LB331), S302 (MON-LB332)
Totti, F. R., S122 (SUN-P185), S122 (SUN-P186)
Tran, T., S161 (SUN-P292)
Trappenburg, M. C., S29 (PT01.1),
S71 (SUN-P050), S72 (SUN-P051),
S72 (SUN-P052), S195 (MON-P041)
Tretyakova, E., S61 (SUN-P025)
Tretyakov, D., S61 (SUN-P025)
Triarico, S., S276 (MON-P265)
Tribler, S., S13 (OR32), S39 (PT05.3),
S234 (MON-P149)
Trierweiler-Hauke, B., S264 (MON-P234)
Trivin, F., S32 (PT02.2)
Tsai, H. L., S86 (SUN-P087)
Tsai, H.-L., S90 (SUN-P099), S92 (SUN-P104),
S221 (MON-P114)
Tsuchida, J., S55 (SUN-P008)
Tsui, O. Y., S15 (OR37)
Author index
Tsuji, Y., S66 (SUN-P036)
Tsukizaki, H., S154 (SUN-P273)
Tsunoda, S., S220 (MON-P111)
Tsutsumi, R., S178 (SUN-LB335)
Tsutsumi, Y., S178 (SUN-LB335)
Tůmová, J., S229 (MON-P135)
Tuncil, E., S138 (SUN-P227)
Tupper, O., S35 (PT03.5)
Türkoğlu, I., S45 (PT07.5), S124 (SUN-P191),
S147 (SUN-P252), S165 (SUN-P302)
Turri, A., S24 (OR59)
Twist, K., S160 (SUN-P288)
Tylavsky, F. A., S12 (OR30)
Tzanninis, I.-G., S111 (SUN-P153),
S174 (SUN-LB326)
Tzouvekas, G., S300 (MON-LB328)
U
Uebaba, K., S168 (SUN-LB310)
Ueda, R., S189 (MON-P026)
Uehara, D., S78 (SUN-P066), S85 (SUN-P084),
S219 (MON-P110)
Uehata, Y., S299 (MON-LB325)
Uemoto, S., S14 (OR35), S21 (OR53),
S39 (PT05.1), S76 (SUN-P062),
S153 (SUN-P270), S206 (MON-P072)
Ueno, H., S1 (OR02)
Ueno, T., S219 (MON-P110)
Ugur, E., S53 (SUN-P002), S54 (SUN-P003)
Ukleja, A., S147 (SUN-P254)
Ülfer, G., S200 (MON-P056)
Ülger Öztürk, N., S273 (MON-P258)
Ulmann, G., S90 (SUN-P098)
Ulrik, C. S., S35 (PT03.5)
Umeda, Y., S14 (OR33)
Ünal, G., S245 (MON-P183)
Ünal, N. G., S245 (MON-P181),
S288 (MON-P298)
Ünal, S., S273 (MON-P258)
Unoura, J., S296 (MON-LB317)
Unsal, I., S53 (SUN-P001)
Urganci, N., S230 (MON-P138)
Urioste-Fondo, A., S115 (SUN-P165),
S115 (SUN-P166), S116 (SUN-P167),
S143 (SUN-P240)
Ushigome, K., S155 (SUN-P274)
Uslu, R., S81 (SUN-P076)
Uthirapathy, J., S162 (SUN-P293)
Utrilla Navarro, M. P., S280 (MON-P276)
Utrilla Navarro, P., S237 (MON-P158),
S280 (MON-P277)
Uzun, H., S303 (MON-LB334)
V van Loon, L.J.C., S26 (OR66),
Vaez, I.D.A., S118 (SUN-P175)
Vahidinia, A., S141 (SUN-P235)
Vaktskjold, A., S260 (MON-P224)
Valaitis, R., S125 (SUN-P193), S125 (SUN-P194)
Valentini, L., S298 (MON-LB322)
Valeriani, L., S132 (SUN-P212)
Valladares, M., S133 (SUN-P215)
Val-Laillet, D., S143 (SUN-P242),
S209 (MON-P082)
Van Aarle, D., S66 (SUN-P037)
van Amerongen, A., S68 (SUN-P043)
van Beers, M., S6 (OR13)
van Bodegraven, A., S93 (SUN-P105)
van Bokhorst, Q., S216 (MON-P101)
van de Bool, C., S6 (OR13), S232 (MON-P145)
Van De Maele, K., S151 (SUN-P263)
van de Poll, M. C., S25 (OR61)
van de Poll, M., S22 (OR55)
Van de Rest, O., S69 (SUN-P045)
van den Berg, A., S11 (OR26)
Van den Berghe, G., S20 (OR49)
Van Den Berghe, S., S220 (MON-P112)
van den Berghe, S., S68 (SUN-P043)
van den Berg, M.G.A., S10 (OR24),
S84 (SUN-P082), S255 (MON-P210)
Van der Flier, W., S69 (SUN-P045),
S73 (SUN-P053)
van der Held-Horinga, G., S123 (SUN-P189)
van der Linde, J., S181 (MON-P007)
Van Der Meij, B. S., S46 (PT08.3),
S70 (SUN-P046), S156 (SUN-P277)
van der Meij, B., S47 (PT08.4)
Van Der Pant, K., S112 (SUN-P157)
Van Der Putten, G.-J., S74 (SUN-P055)
van der Putten, G.-J., S9 (OR21)
van der Schans, C. P., S131 (SUN-P210),
S132 (SUN-P211), S158 (SUN-P282),
S160 (SUN-P289), S222 (MON-P119),
S250 (MON-P195), S298 (MON-LB323)
Van der Schueren, B., S270 (MON-P251)
van der Sluis, G., S250 (MON-P195)
van der Spek, A. H., S54 (SUN-P004)
van der Steen, A., S163 (SUN-P297)
van der Vaart, H., S222 (MON-P119),
S298 (MON-LB323)
Van Der Werf, A., S112 (SUN-P157),
S216 (MON-P101)
van der Werf, A., S83 (SUN-P080)
van Dijk, D. P., S25 (OR61)
Van Dijk, D.P.J., S47 (PT08.5)
van Dronkelaar, C., S163 (SUN-P297)
van Eijck, C., S80 (SUN-P073)
van Elsacker, T.J.E., S220 (MON-P112)
van Galen, K. A., S54 (SUN-P004)
van Gassel, R., S22 (OR55), S25 (OR61)
Van Gossum, A., S66 (SUN-P037),
S66 (SUN-P038), S67 (SUN-P039)
van Helvoort, A., S6 (OR13),
S286 (MON-P293)
Van Hoek, B., S75 (SUN-P060)
van Kanten, A., S123 (SUN-P189)
van Kemenade, M. C., S133 (SUN-P214)
Van Kralingen, M. A., S181 (MON-P007)
Van Laer, E., S63 (SUN-P030)
van Lieshout, R., S84 (SUN-P082)
van Loon, L. J., S2 (OR05)
S191 (MON-P031), S232 (MON-P145)
van Lummel, R. C., S72 (SUN-P051)
van Miert, L., S174 (SUN-LB324)
van Norren, K., S286 (MON-P293)
van Oort, A.G.C. M., S104 (SUN-P136)
van Orten-Luiten, A.C.B., S31 (PT01.6)
Van Puffelen, E., S20 (OR49)
Van Regenmortel, N., S290 (MON-LB304)
van Rhenen, R., S135 (SUN-P218)
van Rijn, R. V., S135 (SUN-P218)
Van Schalkwyk, J., S117 (SUN-P171)
van Veen, M. R., S84 (SUN-P082)
van Velzen, A., S163 (SUN-P297)

Van Vugt, J., S80 (SUN-P072), S80 (SUN-P073),
S128 (SUN-P201)
van Vugt, J.L.A., S133 (SUN-P214)
Van Wijngaarden, J. P., S66 (SUN-P037),
S67 (SUN-P039), S158 (SUN-P283)
Van Wijngaarden, J., S66 (SUN-P038)
Van Winckel, M., S150 (SUN-P261)
van Winckel, M., S42 (PT06.4)
Van Zwienen-Pot, J. I., S166 (SUN-LB305)
Vandewoude, M., S66 (SUN-P037),
S66 (SUN-P038), S67 (SUN-P039)
Vanhorebeek, I., S20 (OR49)
Vargas, J.G.D., S98 (SUN-P120)
Varli, M., S166 (SUN-LB304)
Vasant, D., S108 (SUN-P145), S160 (SUN-P288)
Vasold, A. S., S9 (OR22)
Vaudry, D., S97 (SUN-P116)
Veen, K., S128 (SUN-P201)
Velasco Gimeno, V., S212 (MON-P089)
Velasco, C., S177 (SUN-LB332)
Velasquez, M., S16 (OR39)
Velázquez-Morales, U., S209 (MON-P081)
Veley, E., S34 (PT03.2), S99 (SUN-P123)
Velho, S., S151 (SUN-P264), S219 (MON-P109)
Veličkovic,́ J., S127 (SUN-P198)
Venables, M., S176 (SUN-LB329)
Ventosa Viña, M., S225 (MON-P124),
S225 (MON-P125)
Ventura, G., S285 (MON-P289)
Ventura, J. C., S41 (PT06.1)
Venturini, C., S193 (MON-P036)
Verardi, A., S68 (SUN-P042), S135 (SUN-P219),
S189 (MON-P028)
Verbruggen, S. C., S20 (OR49)
Verdes, G., S37 (PT04.3)
Verdes-Sanz, G., S114 (SUN-P164)
Verdijk, L. B., S2 (OR05), S26 (OR66),
S232 (MON-P145)
Verhelle, K., S63 (SUN-P030)
Verheul, H., S216 (MON-P101)
Verhoef, C., S80 (SUN-P073)
Verlaan, S., S71 (SUN-P050), S158 (SUN-P283)
Vernay, A., S183 (MON-P011)
Verreijen, A. M., S10 (OR25), S12 (OR30),
S232 (MON-P144)
Verschuren, M., S286 (MON-P293)
Verspreet, J., S22 (OR54)
Verstraete, S., S20 (OR49)
Verté, D., S261 (MON-P225)
Viana, L. V., S26 (OR64)
Viana, M. V., S26 (OR64)
Vicente De Sousa, O. L., S192 (MON-P035)
Vicente, C., S7 (OR17)
Vieira, D. A., S133 (SUN-P213),
S202 (MON-P063)
Vieira, J., S128 (SUN-P202)
Vieira, T. S., S127 (SUN-P199)
Vignini, A., S227 (MON-P131)
Vilajosana, E., S211 (MON-P085)
Vílchez-López, F. J., S123 (SUN-P187)
Viligorska, K., S140 (SUN-P233)
Villagomez, V., S260 (MON-P222)
Villar, M., S260 (MON-P222)
Viña, M. Ventosa, S224 (MON-P123)
Viñas, M. Chimeno, S224 (MON-P123)
Vincent, J., S69 (SUN-P044)
Vinci, P., S1 (OR01)
Viniou, N.-A., S111 (SUN-P153)
Author index
Vinter-Jensen, L., S13 (OR32),
S228 (MON-P132)
Virgili-Casas, M., S223 (MON-P120)
Virgili, M., S119 (SUN-P178)
Virgili, N., S211 (MON-P085)
Visakha, V., S226 (MON-P128)
Visiedo Rodas, L., S237 (MON-P158),
S280 (MON-P276), S280 (MON-P277)
Visser, J., S154 (SUN-P272), S251 (MON-P198)
Visser, L., S132 (SUN-P211)
Visser, M., S10 (OR25), S12 (OR30),
S69 (SUN-P045), S73 (SUN-P053),
S166 (SUN-LB305), S167 (SUN-LB306)
Vogt, L. J., S141 (SUN-P234), S259 (MON-P220)
Voirin, N., S48 (PT09.2)
Volby, A. W., S155 (SUN-P275)
Volkert, D., S73 (SUN-P054), S166 (SUN-LB305),
S167 (SUN-LB306), S189 (MON-P027),
S190 (MON-P030)
von der Weid, N., S17 (OR43)
Vonderbeck, D., S85 (SUN-P086),
S114 (SUN-P163)
Vonk, R. J., S158 (SUN-P282)
Voogd, E., S286 (MON-P293)
Voravud, N., S247 (MON-P187)
Vosooghinia, H., S76 (SUN-P061)
Vroomen, A., S249 (MON-P191),
S250 (MON-P194)
Vroomen, L., S93 (SUN-P105)
Vucea, V., S75 (SUN-P057)
Vukovic, N. D., S281 (MON-P280)
W
Wada, M., S278 (MON-P271)
Waeber, G., S262 (MON-P227)
Wagener, N., S141 (SUN-P234),
S259 (MON-P220)
Waitzberg, D. L., S12 (OR29), S16 (OR40),
S38 (PT04.6), S124 (SUN-P190),
S164 (SUN-P298)
Wakai, T., S55 (SUN-P008)
Waki, H., S168 (SUN-LB310)
Walewska, E., S207 (MON-P074)
Walker, D. K., S227 (MON-P130)
Walker, D., S36 (PT03.6)
Wallengren, O., S216 (MON-P099)
Walrand, S., S34 (PT03.1)
Walsh, D., S252 (MON-P201)
Walters, E. R., S175 (SUN-LB328)
Wanden-Berghe, C., S107 (SUN-P143)
Wang, J. Y., S86 (SUN-P087), S92 (SUN-P104)
Wang, J.-Y., S86 (SUN-P088), S87 (SUN-P089),
S90 (SUN-P099), S210 (MON-P084),
S221 (MON-P114)
Wang, L., S221 (MON-P115)
Wang, M., S213 (MON-P092)
Wang, S., S138 (SUN-P228)
Wang, X., S138 (SUN-P228), S187 (MON-P022),
S222 (MON-P118)
Wang, Y., S299 (MON-LB324)
Wang, Z., S243 (MON-P175)
Wanten, G. J., S31 (PT02.1)
Wanten, G., S13 (OR32), S48 (PT09.1),
S104 (SUN-P135), S108 (SUN-P146),
S126 (SUN-P195), S255 (MON-P209)
Wanten, G.J.A., S10 (OR24), S255 (MON-P210)
Ward, L., S305 (MON-LB341)
S327
Warnke, A., S267 (MON-P244)
Wäsch, M., S11 (OR28), S240 (MON-P167)
Wassell, S., S176 (SUN-LB329)
Watanabe, M., S109 (SUN-P149)
Watanabe, T., S1 (OR02), S15 (OR36),
S46 (PT08.2), S78 (SUN-P068),
S85 (SUN-P085), S171 (SUN-LB316),
S201 (MON-P058), S220 (MON-P111)
Watkins, A., S1 (OR02), S15 (OR36),
S46 (PT08.2), S85 (SUN-P085),
S171 (SUN-LB316)
Watokins, A., S201 (MON-P058)
Wearden, A., S160 (SUN-P288)
Weekes, C. E., S43 (PT07.1), S97 (SUN-P117),
S111 (SUN-P155)
Wegener, S., S130 (SUN-P206)
Wehbe, A., S162 (SUN-P295)
Wei, J., S243 (MON-P175), S300 (MON-LB327)
Weijs, P. J., S10 (OR25), S12 (OR30),
S163 (SUN-P297), S186 (MON-P020),
S187 (MON-P021), S232 (MON-P144),
S291 (MON-LB305), S291 (MON-LB306)
Weijs, P., S129 (SUN-P204), S135 (SUN-P218),
S159 (SUN-P284)
Weijzen, M.E.G., S191 (MON-P031)
Weimann, A., S37 (PT04.4)
Weinel, L., S180 (MON-P003)
Weissbrod, R., S264 (MON-P234)
Wempe, J. B., S222 (MON-P119)
Wempe, J., S298 (MON-LB323)
Wenke-Zobler, J., S20 (OR50)
Wen-Yi, C., S44 (PT07.3), S44 (PT07.4)
Wernio, E. W., S119 (SUN-P177)
Wernio, E., S119 (SUN-P176)
Wessel, I., S213 (MON-P093)
Weylandt, K.-H., S204 (MON-P067)
White, C., S252 (MON-P201)
Wiedswang, G., S46 (PT08.1)
Wierdsma, N., S93 (SUN-P105),
S112 (SUN-P157)
Wierzchowska-Mcnew, A., S227 (MON-P130)
Wigodski, S., S61 (SUN-P023)
Wijnhoven, H. A., S166 (SUN-LB305)
Wilcox, C. R., S193 (MON-P037)
Willemssen, F., S128 (SUN-P201)
Willschrei, H.-P., S190 (MON-P030)
Wilson, B., S108 (SUN-P147)
Winklhofer-Roob, B. M., S3 (OR06),
S156 (SUN-P278)
Winnicki, W., S25 (OR62)
Winter, R., S9 (OR22)
Wirth, R., S190 (MON-P030)
Witkamp, R. F., S31 (PT01.6)
Witkamp, R., S286 (MON-P293)
Witte, G., S286 (MON-P293)
Witteman, B., S107 (SUN-P144)
Witvliet-Van Nierop, J., S93 (SUN-P105)
Wodzig, W. K., S2 (OR05)
Woerdenbach, R., S272 (MON-P256)
Wolters, M., S167 (SUN-LB306)
Wong, K. Y., S15 (OR37)
Wong, S. K., S144 (SUN-P245)
Wong, S., S15 (OR38)
Wong, V., S15 (OR38)
Wood, C., S175 (SUN-LB328)
Woollacott, A. E., S162 (SUN-P294)
Wouters, E., S6 (OR13)
Wouters, P. J., S20 (OR49)
S328
Wouters, Y., S13 (OR32), S48 (PT09.1)
Wright, L., S120 (SUN-P180)
Wright, O., S305 (MON-LB341)
Wroczyński, P., S49 (PT09.3)
Wu, A. H., S15 (OR37)
Wu, G., S14 (OR34)
Wu, H., S208 (MON-P077)
Wu, J., S138 (SUN-P228)
Wu, S.-C., S79 (SUN-P071)
Wu, X., S138 (SUN-P228)
X Yiğit, P., S200 (MON-P056)
Xia, J.-Z., S165 (SUN-P301)
Xi, Q., S14 (OR34)
Xiu, D., S243 (MON-P175)
Xu, Y., S125 (SUN-P193)
Y S165 (SUN-P302)
Yagi, S., S14 (OR35), S39 (PT05.1),
S76 (SUN-P062), S153 (SUN-P270),
S206 (MON-P072)
Yagi, T., S14 (OR33)
Yagubyan, R., S282 (MON-P282)
Yakoub-Agha, I., S23 (OR57)
Yalçın, T., S124 (SUN-P191)
Yamada, N., S78 (SUN-P068)
Yamaguchi, M., S139 (SUN-P229)
Yamaguchi, S., S153 (SUN-P269)
Yamaguchi, Y., S167 (SUN-LB307)
Yamaguti, A., S294 (MON-LB312)
Yamamoto, J., S1 (OR02)
Yamamoto, M., S21 (OR53)
Yamamoto, T., S109 (SUN-P149)
Yamanaka-Okumura, H., S32 (PT02.4)
Yaman, F., S233 (MON-P147)
Yamaniac, N. E., S46 (PT08.1)
Yang, G., S243 (MON-P175)
Yang, J., S166 (SUN-P303), S187 (MON-P022)
Yang, X., S243 (MON-P175)
Yang, Y., S243 (MON-P175)
Yao, S., S39 (PT05.1), S76 (SUN-P062),
S153 (SUN-P270), S206 (MON-P072)
Yassıbaş, E., S88 (SUN-P092)
Yasuhara, H., S1 (OR02), S15 (OR36),
S46 (PT08.2), S78 (SUN-P068),
Author index
S85 (SUN-P085), S171 (SUN-LB316),
S201 (MON-P058)
Yasuoka, H., S85 (SUN-P084)
Yavuz, B. B., S241 (MON-P169),
S243 (MON-P177)
Yayla, A., S228 (MON-P133), S242 (MON-P174)
Yazıcı, K., S45 (PT07.5), S147 (SUN-P252),
S165 (SUN-P302)
Yeh, Y. S., S86 (SUN-P087)
Yeung, S.S.Y., S29 (PT01.1), S195 (MON-P041)
Yiannakouris, N., S137 (SUN-P224)
Yildiran, H., S256 (MON-P213)
Yildiz, D., S149 (SUN-P257),
S149 (SUN-P258)
Yıldız, E., S124 (SUN-P191)
Yılmaz Işıkhan, S., S273 (MON-P257)
Yoca, G., S45 (PT07.5), S147 (SUN-P252),
Yokota, H., S292 (MON-LB309)
Yoneda, J., S96 (SUN-P113)
Yoon, M.-O., S305 (MON-LB340)
Yoshida, M., S299 (MON-LB325)
Yoshida, R., S14 (OR33)
Yoshida, T., S189 (MON-P026)
Yoshimura, Y., S66 (SUN-P036),
S198 (MON-P049)
Ystad, S. O., S32 (PT02.3),
S207 (MON-P076)
Yuan, S., S187 (MON-P022)
Yu, C., S14 (OR34)
Yue, D., S278 (MON-P272)
Yu, J., S138 (SUN-P228), S299 (MON-LB324),
S302 (MON-LB333)
Yun, E., S282 (MON-P283)
Yung, M. Y., S15 (OR38)
Yürük, A. A., S124 (SUN-P191)
Yu, S. Y., S219 (MON-P108)
Yu, Z., S14 (OR34)
Yüzbaşıoğlu Marangoz, F.,
S123 (SUN-P188)
Z
Zachria, A., S99 (SUN-P123)
Zadák, Z., S170 (SUN-LB314)
Zadak, Z., S186 (MON-P019)
Zajic, P., S25 (OR62)
Zakrzewska, E., S91 (SUN-P102)
Zaloudkova, L., S170 (SUN-LB314)
Zaltz, Z., S254 (MON-P206)
Zamani, A., S105 (SUN-P137)
Zanetti, E., S68 (SUN-P042), S135 (SUN-P219),
S189 (MON-P028)
Zanetti, M., S1 (OR01), S6 (OR15),
S64 (SUN-P032), S74 (SUN-P056)
Zani, M., S68 (SUN-P042), S135 (SUN-P219),
S189 (MON-P028)
Zarate, E., S107 (SUN-P142)
Zaremba, S.M.M., S274 (MON-P261),
S303 (MON-LB335)
Zec, S., S127 (SUN-P198)
Zhang, H., S54 (SUN-P006)
Zhang, L., S138 (SUN-P228), S187 (MON-P022),
S222 (MON-P118)
Zhang, P., S138 (SUN-P228)
Zhang, R. J., S161 (SUN-P290)
Zhang, X., S138 (SUN-P228)
Zhang, Y., S168 (SUN-LB309), S208 (MON-P077),
S300 (MON-LB327)
Zheng, X., S278 (MON-P272)
Zhigang, X., S299 (MON-LB324)
Zhou, J., S187 (MON-P022)
Zhou, Y., S188 (MON-P023),
S221 (MON-P115)
Zhuang, Q., S14 (OR34)
Zhu, C., S99 (SUN-P121),
S99 (SUN-P122)
Zhu, M., S243 (MON-P175)
Zijlstra, H., S135 (SUN-P218)
Zimmer, J., S199 (MON-P054)
Zimmermann, K., S20 (OR50)
Ziółkowski, M., S100 (SUN-P124)
Žnidaršič, M., S127 (SUN-P198)
Zoni, L., S132 (SUN-P212)
Zukova, O., S138 (SUN-P226)
Zusman, O., S183 (MON-P012),
S184 (MON-P013)
Zweers, H., S104 (SUN-P135), S126 (SUN-P195),
S255 (MON-P209)
Zwinkels, I., S68 (SUN-P043)
Żydak, J., S18 (OR44)
Zydak, J., S150 (SUN-P262)
Zyla-Pawlak, A., S18 (OR44)