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MON-P188: Relationship Between Skeletal Muscle Mass and Each Nutritional Index of Heart Failure Patients: Does BMI and Biochemical Indicators Reflect Skeletal Muscle Mass?
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 participation. 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 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 crossculturally 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 comprehensibility (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), coowner 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 Rationale: The European Society of Clinical Nutrition and Metabolism (ESPEN) Consensus Statement recommends diagnosis 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 tomography 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, measurements 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 differences 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 Females
0,922 0,913
0,901 0,800
0,846* 0,696
0,755* 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.
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 participation. 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 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 crossculturally 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 comprehensibility (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), coowner 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 Rationale: The European Society of Clinical Nutrition and Metabolism (ESPEN) Consensus Statement recommends diagnosis 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 tomography 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, measurements 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 differences 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 Females
0,922 0,913
0,901 0,800
0,846* 0,696
0,755* 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.