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T1283 Malnutrition Is An Independent Risk Factor for Muscle Weakness and Impaired Functional Status in Cancer Patients
Table 2: Kcal
T1281 The Influence of Teduglutide, a Novel GLP-2 Analogue, On Energy Absorption in Short Bowel Syndrome (SBS) Patients Dependent On Parenteral Nutrition (PN) Palle B. Jeppesen, Kelly A. Tappenden, Richard Gilroy, Stephen J. O'Keefe, Douglas L. Seidner, Nancy McGraw, Henry Chu, Bernard Messing
** P<0.001, vs. healthy & Day 3 * P<0.05, vs. healthy T1283
Given the disabling clinical conditions and healthcare burden associated with intestinal failure, therapies to enhance intestinal function could reduce PN dependence of afflicted individuals. Teduglutide (TG), a degradation resistant analog of the intestinaltrophic peptide glucagon-like peptide-2, is a potential candidate for PN-dependent SBS patients. Background: PN-dependent SBS patients are at risk of serious long-term complications and therapies to improve gut function are limited. The GLP-2 analogue teduglutide (TG) reduced PN volumes in PN-dependent SBS patients in a 24-week placebo-controlled study. Aim: A 72-hour balance sub-study was conducted to quantify the ability of teduglutide to increase energy absorption. Methods: At baseline, weeks 8 and 24, patients recorded food and beverages consumed, based on their standard diets. Energy in diet and feces was measured by bomb calorimetry. Absolute energy absorption was calculated as the difference between oral intake and fecal excretion. Relative energy absorption was determined as the absolute absorption divided by oral intake multiplied by 100. SBS patients received daily sc injections of 4 placebo, 10 teduglutide 0.05 mg/kg/d or 7 teduglutide 0.10 mg/kg/d. Ten were male, 50±14 years, post duodenal remnant small bowel 57±44cm, 14 with 70±21% remnant colon and PN for 7±6 years. Results: Complete data sets were obtained in 14 of the 21 pts (3 placebo, 6 TG 0.05 mg/kg/d and 5 TG 0.10mg/kg/d). No significant changes were seen in the placebo group. The pooled teduglutide groups (n=11) demonstrated a reduction in fecal energy excretion of 220±270 kcal at week 24 (p=0.026), but no significant increase in the overall energy absorption (80±500 kcal/d, p=0.49) because energy intake did not remain constant. However, in those whose dietary energy content did not differ by more than 10% from baseline values (High Dietary Compliance~HDC), fecal energy excretion decreased and intestinal absorption increased significantly (p<0.05) at week 8 and at week 24 compared to baseline. Conclusion: After 6 month's treatment, teduglutide significantly increased energy absorption in PN-dependent SBS patients provided their dietary intake remained constant. These data merit further evaluation in larger patient populations.
Malnutrition Is An Independent Risk Factor for Muscle Weakness and Impaired Functional Status in Cancer Patients Kristina Norman, Daniela Zocher, Nicole Stobaeus, Christine Smoliner, Herbert Lochs, Matthias Pirlich Introduction: Fatigue and muscle weakness are prominent features in cancer patients which directly affect their quality of life. We investigated determinants of muscle function assessed by hand grip and knee extension strength as well as functional status in cancer patients. Methods: 203 consecutively admitted cancer patients (102 male; 61.1 +/-12.6 yrs old: GI cancer: n=105, head and neck cancer: n= 30, others: n= 68) were recruited. Muscle function was assessed by hand grip and knee extension strength, functional status by Karnofsky Performance Scale and Barthel Index. Nutritional status was assessed with Subjective Global Assessment (SGA). SGA, age, gender, clinical variables such as duration of disease (defined as length of time in days since diagnosis), cancer location, presence of distant metastases, tumour burden according to TNM stage, UICC stage, number of drugs per day, number of comorbidities, and type of treatment were investigated as potential risk factors for muscle weakness and impaired functional status in a multiple regression analysis. Results: 85 patients (39 male) were classified moderately or severely malnourished. Malnutrition emerged as a major determinant for impaired muscle strength and functional status next to age and gender. Among the disease parameters, only amount of daily medication exhibited a significant influence on all muscle function parameters and on functional status. Also, duration of disease had an impact on knee extension strength and Karnofsky Performance Scale. Conclusion: Muscle weakness and impaired functional status does not result from tumour disease or treatment alone. Malnutrition however is a strong independent risk factor for reduced muscle strength and functional status in cancer patients. Treatment of nutritional deficits must be considered essential.
p-value~One Way Repeated Measures ANOVA. *~p<0.05 by Bonferoni Method compared to baseline. T1282 Absorption of Lipid Is Impaired Longer Than That of Carbohydrate After Abdominal Aortic Aneurysm (AAA) Repair: An Implication for Nutritional Management in Surgical Patients Nam Q. Nguyen, Robert J. Fraser, Laura Bryant, Carly Burgstad, Jim Burnett, Richard H. Holloway Optimal nutrient absorption depends on both the integrity of the small intestinal (SI) mucosa and transit for adequate mixing of chyme. Although SI motor function is often disrupted in patients after AAA repair, the impact of this on SI flow episodes and absorption of carbohydrate and lipid is unclear. Aim: To examine the interactions between proximal SI flow and absorption of carbohydrate and lipid in the first 3 days after AAA repair. Methods: In 13 patients (12M; 77±2 yrs) who underwent open AAA repair, concurrent proximal SI motility (manometry, 10 sensors over 30cm), flow (SI impedance, 7 x 2-cm segments), lipid absorption (13C triolein breath test) and carbohydrate absorption (serum 3-OMG measurements) were assessed immediately and 3 days after surgery. On each occasion, patients received a 3h duodenal nutrient infusion of Ensure (222kcal, 21% fat). Data were compared with those from 10 healthy volunteers (9M; 57±4 yrs). A flow event was defined as >12% impedance drop from baseline, over ≥ 3 consecutive segments; and bursts were defined as ≥10 pressure waves/minute for ≥ 2 min with sequential migration ≥4 channels. Results: There were more bursts but fewer SI flow events immediately after surgery, and the absorption of both 13C-triolein and 3-OMG was significantly lower in patients than in healthy subjects (Table). By day 3, whilst the number of bursts and flow events were similar between patients and healthy subjects, there were fewer retro-grade and more ante-grade
T1284 Validation of 3-O-(14c)Methylglucose As a Marker of Glucose Absorption Paul Kuo, Reawika Chaikomin, Max Bellon, Michael Horowitz, Karen L. Jones, Chris Rayner Plasma concentrations of the glucose analogue, 3-O-methylglucose (3-OMG), are widely used as an index of glucose absorption, as enterally administered 3-OMG is absorbed by the same mechanism as glucose, but not metabolized by the liver. However, chromatographic analysis of plasma 3-OMG is costly and labour-intensive. We aimed to validate the use of 3-O-(14C)methylglucose (3-O-(14C)MG) as an alternative, since its plasma concentration
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AGA Abstracts
AGA Abstracts
flow events in the patients. 13C-triolein absorption remained low on Day 3 and correlated positively with the number of flow events (r = 0.49; P<0.01). The absorption of 3-OMG, however, normalized to that observed in health subjects by Day 3. Conclusion: The disruption in SI motility and flow events preferentially impaired the absorption of 13C-triolein for at least 3 days after major non-GI surgery, suggesting that inadequate mixing of chyme from altered motility contributes to reduced lipid absorption in these patients. Together with the finding that 3-OMG absorption normalized by Day 3 postoperatively, enteral nutrition support in these patients should, therefore, constitute a high carbohydrate and low fat formula.
T1281 The Influence of Teduglutide, a Novel GLP-2 Analogue, On Energy Absorption in Short Bowel Syndrome (SBS) Patients Dependent On Parenteral Nutrition (PN) Palle B. Jeppesen, Kelly A. Tappenden, Richard Gilroy, Stephen J. O'Keefe, Douglas L. Seidner, Nancy McGraw, Henry Chu, Bernard Messing
** P<0.001, vs. healthy & Day 3 * P<0.05, vs. healthy T1283
Given the disabling clinical conditions and healthcare burden associated with intestinal failure, therapies to enhance intestinal function could reduce PN dependence of afflicted individuals. Teduglutide (TG), a degradation resistant analog of the intestinaltrophic peptide glucagon-like peptide-2, is a potential candidate for PN-dependent SBS patients. Background: PN-dependent SBS patients are at risk of serious long-term complications and therapies to improve gut function are limited. The GLP-2 analogue teduglutide (TG) reduced PN volumes in PN-dependent SBS patients in a 24-week placebo-controlled study. Aim: A 72-hour balance sub-study was conducted to quantify the ability of teduglutide to increase energy absorption. Methods: At baseline, weeks 8 and 24, patients recorded food and beverages consumed, based on their standard diets. Energy in diet and feces was measured by bomb calorimetry. Absolute energy absorption was calculated as the difference between oral intake and fecal excretion. Relative energy absorption was determined as the absolute absorption divided by oral intake multiplied by 100. SBS patients received daily sc injections of 4 placebo, 10 teduglutide 0.05 mg/kg/d or 7 teduglutide 0.10 mg/kg/d. Ten were male, 50±14 years, post duodenal remnant small bowel 57±44cm, 14 with 70±21% remnant colon and PN for 7±6 years. Results: Complete data sets were obtained in 14 of the 21 pts (3 placebo, 6 TG 0.05 mg/kg/d and 5 TG 0.10mg/kg/d). No significant changes were seen in the placebo group. The pooled teduglutide groups (n=11) demonstrated a reduction in fecal energy excretion of 220±270 kcal at week 24 (p=0.026), but no significant increase in the overall energy absorption (80±500 kcal/d, p=0.49) because energy intake did not remain constant. However, in those whose dietary energy content did not differ by more than 10% from baseline values (High Dietary Compliance~HDC), fecal energy excretion decreased and intestinal absorption increased significantly (p<0.05) at week 8 and at week 24 compared to baseline. Conclusion: After 6 month's treatment, teduglutide significantly increased energy absorption in PN-dependent SBS patients provided their dietary intake remained constant. These data merit further evaluation in larger patient populations.
Malnutrition Is An Independent Risk Factor for Muscle Weakness and Impaired Functional Status in Cancer Patients Kristina Norman, Daniela Zocher, Nicole Stobaeus, Christine Smoliner, Herbert Lochs, Matthias Pirlich Introduction: Fatigue and muscle weakness are prominent features in cancer patients which directly affect their quality of life. We investigated determinants of muscle function assessed by hand grip and knee extension strength as well as functional status in cancer patients. Methods: 203 consecutively admitted cancer patients (102 male; 61.1 +/-12.6 yrs old: GI cancer: n=105, head and neck cancer: n= 30, others: n= 68) were recruited. Muscle function was assessed by hand grip and knee extension strength, functional status by Karnofsky Performance Scale and Barthel Index. Nutritional status was assessed with Subjective Global Assessment (SGA). SGA, age, gender, clinical variables such as duration of disease (defined as length of time in days since diagnosis), cancer location, presence of distant metastases, tumour burden according to TNM stage, UICC stage, number of drugs per day, number of comorbidities, and type of treatment were investigated as potential risk factors for muscle weakness and impaired functional status in a multiple regression analysis. Results: 85 patients (39 male) were classified moderately or severely malnourished. Malnutrition emerged as a major determinant for impaired muscle strength and functional status next to age and gender. Among the disease parameters, only amount of daily medication exhibited a significant influence on all muscle function parameters and on functional status. Also, duration of disease had an impact on knee extension strength and Karnofsky Performance Scale. Conclusion: Muscle weakness and impaired functional status does not result from tumour disease or treatment alone. Malnutrition however is a strong independent risk factor for reduced muscle strength and functional status in cancer patients. Treatment of nutritional deficits must be considered essential.
p-value~One Way Repeated Measures ANOVA. *~p<0.05 by Bonferoni Method compared to baseline. T1282 Absorption of Lipid Is Impaired Longer Than That of Carbohydrate After Abdominal Aortic Aneurysm (AAA) Repair: An Implication for Nutritional Management in Surgical Patients Nam Q. Nguyen, Robert J. Fraser, Laura Bryant, Carly Burgstad, Jim Burnett, Richard H. Holloway Optimal nutrient absorption depends on both the integrity of the small intestinal (SI) mucosa and transit for adequate mixing of chyme. Although SI motor function is often disrupted in patients after AAA repair, the impact of this on SI flow episodes and absorption of carbohydrate and lipid is unclear. Aim: To examine the interactions between proximal SI flow and absorption of carbohydrate and lipid in the first 3 days after AAA repair. Methods: In 13 patients (12M; 77±2 yrs) who underwent open AAA repair, concurrent proximal SI motility (manometry, 10 sensors over 30cm), flow (SI impedance, 7 x 2-cm segments), lipid absorption (13C triolein breath test) and carbohydrate absorption (serum 3-OMG measurements) were assessed immediately and 3 days after surgery. On each occasion, patients received a 3h duodenal nutrient infusion of Ensure (222kcal, 21% fat). Data were compared with those from 10 healthy volunteers (9M; 57±4 yrs). A flow event was defined as >12% impedance drop from baseline, over ≥ 3 consecutive segments; and bursts were defined as ≥10 pressure waves/minute for ≥ 2 min with sequential migration ≥4 channels. Results: There were more bursts but fewer SI flow events immediately after surgery, and the absorption of both 13C-triolein and 3-OMG was significantly lower in patients than in healthy subjects (Table). By day 3, whilst the number of bursts and flow events were similar between patients and healthy subjects, there were fewer retro-grade and more ante-grade
T1284 Validation of 3-O-(14c)Methylglucose As a Marker of Glucose Absorption Paul Kuo, Reawika Chaikomin, Max Bellon, Michael Horowitz, Karen L. Jones, Chris Rayner Plasma concentrations of the glucose analogue, 3-O-methylglucose (3-OMG), are widely used as an index of glucose absorption, as enterally administered 3-OMG is absorbed by the same mechanism as glucose, but not metabolized by the liver. However, chromatographic analysis of plasma 3-OMG is costly and labour-intensive. We aimed to validate the use of 3-O-(14C)methylglucose (3-O-(14C)MG) as an alternative, since its plasma concentration
A-539
AGA Abstracts
AGA Abstracts
flow events in the patients. 13C-triolein absorption remained low on Day 3 and correlated positively with the number of flow events (r = 0.49; P<0.01). The absorption of 3-OMG, however, normalized to that observed in health subjects by Day 3. Conclusion: The disruption in SI motility and flow events preferentially impaired the absorption of 13C-triolein for at least 3 days after major non-GI surgery, suggesting that inadequate mixing of chyme from altered motility contributes to reduced lipid absorption in these patients. Together with the finding that 3-OMG absorption normalized by Day 3 postoperatively, enteral nutrition support in these patients should, therefore, constitute a high carbohydrate and low fat formula.