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Physicochemical stability assessment of parenteral nutrition admixtures for pediatric patients compounded with different kinds of fish oil-based emulsion
Selected Abstracts / Nutrition 32 (2016) 399–408
Materials and Methods: We retrospectively analyzed data from 124 patients who underwent pancreatic resections from January 2007 to February 2015 and performed a CT scan as staging at our center. CT images were processed to obtain measures of skeletal muscle area (SMA), visceral fat area (VFA) and adipose infiltration of muscle. Total abdominal muscle area was then normalized for height. The occurrence and severity of complications were assessed according to Clavien-Dindo and ISGPF Classification for pancreatic fistula (PF). Univariate and multivariate analysis were performed to investigate possible correlations between non-fat mass composition and post-operative complications and the predictive ability of each parameter was investigated by ROC-curves methodology. Results: Major complications occurred in 43 patients (34.4%) and clinically relevant PF occurred in 26 patients (20.8%). According to international threshold, most of the patients were sarcopenic. Statistical analyses showed that the depletion in muscle area alone did not correlate with the onset of complications, while the muscle/fat volume rate was highly predictive of postoperative major complications (OR 5.38, 95%CI 1.35-21.33). Conclusions: Low rate of abdominal muscle, associated with increased abdominal fat are predictive of major complication onset after pancreatic resection. 10. INTRADIALYTIC PARENTERAL NUTRITION IN MALNOURISHED UREMIC PATIENTS: EFFECTS ON NUTRITIONAL STATUS, ORAL INTAKES AND QUALITY OF LIFE 1, E. Raschioni 1, E. Ferrari 1, G. Lagana 2, P. Lanzi 1, D. Noe 3 3 3 G. Arrigo , A. Fornasieri , M. Gallieni 1 SSD Clinical Nutrition Unit, AO Ospedale San Carlo Borromeo, Milan, Italy 2 Clinical Pharmacy Unit, AO Ospedale San Carlo Borromeo, Milan, Italy 3 Nephrology and Dialysis Unit, AO Ospedale San Carlo Borromeo, Milan, Italy Introduction: Intradialytic parenteral nutrition (IDPN) may improve the nutritional status and outcome of hemodialysis patients who are malnourished or at high nutritional risk. Aim of the study: to confirm the positive effect of IDPN in uremic patients and its impact on their quality of life. Materials and Methods: 31 hemodialysis patients (20M,11F, mean age 6919 yrs, post-dialysis weight 5612 kg, BMI 204 kg/m2) were treated with personalized IDPN bags for at least 3 months. Bags’ composition ranged as follows: volume 6001000ml, glucides 70-130gr, proteins 40-50gr, lipids 20-40gr, kcal 600-1000, depending on the patient’s weight, comorbidities, dialysis time and n.weekly sessions. Body weight, BMI, nutritionrelated blood tests, oral intakes (total energy/glucides/proteins/ lipids) and a quality of life (QL) score (ranging 0/10) for the whole group, and subgroups according to D weight (A: >+1kg, B: 1kg, C:<-1kg) were obtained. Results: IDPN treatment provided weekly a range of 1800/3000kcal and 120/150gr proteins. In addition, during IDPN treatment, oral intakes increased significantly (energy +383389kcal, protein +1518gr, lipids +1820gr, p<0.001; glucides +3378gr, p<0.05). 10 patients (30%) gained weight (D¼+32kg); 9 patients (30%) maintained (D¼0.080.6 kg) and 12 patients (40%) lost a mean of -2.21.6kg. Among nutritionrelated tests, serum albumin improved significantly (+0.240.89 gr/dl, p<0.01). QL score improved in A group (from 4 to 5.5) and was stable in group B and C. Conclusions: IDPN not only provides nutritional support, but it is also associated with improved oral intake of nutrients. Overall,
403
we observed a significant improvement of nutritional status. IDPN is also associated with improved QL scores in patients gaining weight. 11. PHYSICOCHEMICAL STABILITY ASSESSMENT OF PARENTERAL NUTRITION ADMIXTURES FOR PEDIATRIC PATIENTS COMPOUNDED WITH DIFFERENT KINDS OF FISH OIL-BASED EMULSION M.L. Forchielli 1, A. Bonoli 2, L.L. Bruno 3, F. Piro 3, A. Stancari 3, A.M. Guarguaglini 3, S. Maselli 3, A. Pession 1, C. Puggioli 3, G. Bersani 4 1 Paediatrics, S. Orsola-Malpighi Medical School, Bologna, Italy 2 Civil, Environmental and Materials Engineering Department, University of Bologna, Italy 3 Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy 4 Consulting Pharmacist, Bologna, Italy Introduction: Different kinds of fish oil-based emulsion (FO), pure FO and two mixtures of long-chain+medium-chain (LCT+MCT) triglycerides along with FO, are currently available on the market. Lipid emulsions are safely infused when particle diameter ranges between 0.4-1.0 micrometers (like chylomicra), according to European guidelines. Our aim is to evaluate the stability of the different branded FO-emulsions in pediatric PN admixtures with special attention to calcium concentration. Materials and Methods: Stability studies were carried out on twelve PN admixtures having calcium concentration of 6 mmol/L and 9 mmol/L compounded with soybean/olive oil LCT+MCT+FO and soybean oil LCT+MCT+FO emulsion, respectively. The analyses were performed immediately (t¼0) and 24, 48, 72, 96 (t¼96) hours after compounding. Particle diameter was determined by Light Scattering-Reverse Fourier Optics technique. Every sample was stored at 4 C and triple tested. Statistical significance was verified by f-test. Results: In all tested admixtures physicochemical stability did not change between t¼0 and t¼96 and particle diameter was in the range of 0.3-1.0 micrometers provided calcium concentration did not exceed 4.5 mmol/L. When calcium exceeded that level, 12% of particles diameters was larger than 1.0 micrometer and 2% exceeded 5.0 micrometers immediately after compounding. Conclusions: Analysis results show that there is no difference in stability between the admixtures compounded with the two different kinds of FO-emulsion. They can be safely infused to patients’ when calcium concentration is maintained below 4.5 mmol/L. If calcium level exceeds this limit, it is advisable to infuse FO-emulsion alone through a second intravenous line. 12. ITALIAN VERSION OF THE EDMONTON FRAIL SCALE (EFS) IN ELDERLY AND ITS ASSOCIATION WITH MULTIDIMENSIONAL AND NUTRITIONAL INDEXES S. Perna 1, F. Moncaglieri 1, D. Guido 2, M.A. Faliva 1, G. Peroni 1, M. Naso 1, M. Rondanelli 1 1 University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Azienda di Servizi alla Persona, Pavia, Italy 2 University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Biostatistics and Clinical Epidemiology Unit, Pavia, Italy Introduction: The aim of this study was to evaluate the effectiveness of the Italian version of the Edmonton Frail Scale (EFS) on the evaluation of frailty areas in elderly and its association
Materials and Methods: We retrospectively analyzed data from 124 patients who underwent pancreatic resections from January 2007 to February 2015 and performed a CT scan as staging at our center. CT images were processed to obtain measures of skeletal muscle area (SMA), visceral fat area (VFA) and adipose infiltration of muscle. Total abdominal muscle area was then normalized for height. The occurrence and severity of complications were assessed according to Clavien-Dindo and ISGPF Classification for pancreatic fistula (PF). Univariate and multivariate analysis were performed to investigate possible correlations between non-fat mass composition and post-operative complications and the predictive ability of each parameter was investigated by ROC-curves methodology. Results: Major complications occurred in 43 patients (34.4%) and clinically relevant PF occurred in 26 patients (20.8%). According to international threshold, most of the patients were sarcopenic. Statistical analyses showed that the depletion in muscle area alone did not correlate with the onset of complications, while the muscle/fat volume rate was highly predictive of postoperative major complications (OR 5.38, 95%CI 1.35-21.33). Conclusions: Low rate of abdominal muscle, associated with increased abdominal fat are predictive of major complication onset after pancreatic resection. 10. INTRADIALYTIC PARENTERAL NUTRITION IN MALNOURISHED UREMIC PATIENTS: EFFECTS ON NUTRITIONAL STATUS, ORAL INTAKES AND QUALITY OF LIFE 1, E. Raschioni 1, E. Ferrari 1, G. Lagana 2, P. Lanzi 1, D. Noe 3 3 3 G. Arrigo , A. Fornasieri , M. Gallieni 1 SSD Clinical Nutrition Unit, AO Ospedale San Carlo Borromeo, Milan, Italy 2 Clinical Pharmacy Unit, AO Ospedale San Carlo Borromeo, Milan, Italy 3 Nephrology and Dialysis Unit, AO Ospedale San Carlo Borromeo, Milan, Italy Introduction: Intradialytic parenteral nutrition (IDPN) may improve the nutritional status and outcome of hemodialysis patients who are malnourished or at high nutritional risk. Aim of the study: to confirm the positive effect of IDPN in uremic patients and its impact on their quality of life. Materials and Methods: 31 hemodialysis patients (20M,11F, mean age 6919 yrs, post-dialysis weight 5612 kg, BMI 204 kg/m2) were treated with personalized IDPN bags for at least 3 months. Bags’ composition ranged as follows: volume 6001000ml, glucides 70-130gr, proteins 40-50gr, lipids 20-40gr, kcal 600-1000, depending on the patient’s weight, comorbidities, dialysis time and n.weekly sessions. Body weight, BMI, nutritionrelated blood tests, oral intakes (total energy/glucides/proteins/ lipids) and a quality of life (QL) score (ranging 0/10) for the whole group, and subgroups according to D weight (A: >+1kg, B: 1kg, C:<-1kg) were obtained. Results: IDPN treatment provided weekly a range of 1800/3000kcal and 120/150gr proteins. In addition, during IDPN treatment, oral intakes increased significantly (energy +383389kcal, protein +1518gr, lipids +1820gr, p<0.001; glucides +3378gr, p<0.05). 10 patients (30%) gained weight (D¼+32kg); 9 patients (30%) maintained (D¼0.080.6 kg) and 12 patients (40%) lost a mean of -2.21.6kg. Among nutritionrelated tests, serum albumin improved significantly (+0.240.89 gr/dl, p<0.01). QL score improved in A group (from 4 to 5.5) and was stable in group B and C. Conclusions: IDPN not only provides nutritional support, but it is also associated with improved oral intake of nutrients. Overall,
403
we observed a significant improvement of nutritional status. IDPN is also associated with improved QL scores in patients gaining weight. 11. PHYSICOCHEMICAL STABILITY ASSESSMENT OF PARENTERAL NUTRITION ADMIXTURES FOR PEDIATRIC PATIENTS COMPOUNDED WITH DIFFERENT KINDS OF FISH OIL-BASED EMULSION M.L. Forchielli 1, A. Bonoli 2, L.L. Bruno 3, F. Piro 3, A. Stancari 3, A.M. Guarguaglini 3, S. Maselli 3, A. Pession 1, C. Puggioli 3, G. Bersani 4 1 Paediatrics, S. Orsola-Malpighi Medical School, Bologna, Italy 2 Civil, Environmental and Materials Engineering Department, University of Bologna, Italy 3 Pharmacy Service, S. Orsola-Malpighi Hospital, Medical School, Bologna, Italy 4 Consulting Pharmacist, Bologna, Italy Introduction: Different kinds of fish oil-based emulsion (FO), pure FO and two mixtures of long-chain+medium-chain (LCT+MCT) triglycerides along with FO, are currently available on the market. Lipid emulsions are safely infused when particle diameter ranges between 0.4-1.0 micrometers (like chylomicra), according to European guidelines. Our aim is to evaluate the stability of the different branded FO-emulsions in pediatric PN admixtures with special attention to calcium concentration. Materials and Methods: Stability studies were carried out on twelve PN admixtures having calcium concentration of 6 mmol/L and 9 mmol/L compounded with soybean/olive oil LCT+MCT+FO and soybean oil LCT+MCT+FO emulsion, respectively. The analyses were performed immediately (t¼0) and 24, 48, 72, 96 (t¼96) hours after compounding. Particle diameter was determined by Light Scattering-Reverse Fourier Optics technique. Every sample was stored at 4 C and triple tested. Statistical significance was verified by f-test. Results: In all tested admixtures physicochemical stability did not change between t¼0 and t¼96 and particle diameter was in the range of 0.3-1.0 micrometers provided calcium concentration did not exceed 4.5 mmol/L. When calcium exceeded that level, 12% of particles diameters was larger than 1.0 micrometer and 2% exceeded 5.0 micrometers immediately after compounding. Conclusions: Analysis results show that there is no difference in stability between the admixtures compounded with the two different kinds of FO-emulsion. They can be safely infused to patients’ when calcium concentration is maintained below 4.5 mmol/L. If calcium level exceeds this limit, it is advisable to infuse FO-emulsion alone through a second intravenous line. 12. ITALIAN VERSION OF THE EDMONTON FRAIL SCALE (EFS) IN ELDERLY AND ITS ASSOCIATION WITH MULTIDIMENSIONAL AND NUTRITIONAL INDEXES S. Perna 1, F. Moncaglieri 1, D. Guido 2, M.A. Faliva 1, G. Peroni 1, M. Naso 1, M. Rondanelli 1 1 University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Azienda di Servizi alla Persona, Pavia, Italy 2 University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Biostatistics and Clinical Epidemiology Unit, Pavia, Italy Introduction: The aim of this study was to evaluate the effectiveness of the Italian version of the Edmonton Frail Scale (EFS) on the evaluation of frailty areas in elderly and its association