- Email: [email protected]
The creatinine-arm index as an alternative for creatinine-height index in the elderly
NUTRITION AND IMMUNITY/NUTRITIONAL
The patients submitted to BMT showed a good nutritional state at the beginning. Protein catabolism and UNE were found increased associated with a negative NB. There were no significant changes in plasma ALB and RBP levels. The use of TPN in BMT has been shown advii as we obtained a reduction in negative NB and a faster recovery of visceral proteins.
P.92 Effectsof bng term parenteral nuttition on complement activation in patknts with cystic fibrosis Bsm+d Ad&bag, OlfiKirveli3, David P. Katz and JeffreyAskanazi. Nassau County Medal Center, NY, US4 and Montefiore Medical Center and ths Albert Einsrein College of Medicine, NY, USA. Excess energy consumption due to increased work of breathing, with inadequate oral intake and malabsorption, contributes to malnutrition in patients with cystic fibrosis (CF). Malnutrition alSo has negative effects on immune function. The aim of the current investigation was to assess the consequence of long-term fat based total parenteral nutrition FPN) on the complement system. Eleven patients with CF and severe pulmonary disease were given TPN at 115% of measured resting energy expenditure for a 4 month period. Bloods were drawn before and after 4 months of treatment and 2 months after TPN was discontinued. Levels of factor-B, the activated fragment Bb, SC5b-9 and fatty acid profiles were determined. The resuits (mean + SEM) are listed below:
~WW Factor-B(mfl sC5b-9(rg/m.)
Pm-TPN
4montb
Post.TPN
35f1.2 3%+36 416ki97
12.6e2.7 364*30 62*57
2.2+0.9 324+40 325?210
P.94 Influence of dietary supplemenUon status and mortality in geriatric patients
The present study explored the effect of dietary supplementation on nutriiional status and mortality in a large group of geriatric patients (n = 501). 311 females and 1QO males who remained hospitalized for more than 3 weeks entered the study. The patients were randomized into an exparimental group which received nutriiional supplementation (4OOkcal) to up to 26 weeks together with a standard hospital diet, and a control group. The nutritional state was studied by using anthropometry (weight index, TSF, AK), serum protein analysis (prealbumin, albumin) and a delayed hypersensitivity skin test on admission and after 8 and 26 weeks. To identify patients with protein energy malnutrition, three or more of the criieria had to be fulfilled at the same time. The geriatric patients showed a malnutriiion frequency of 28.5% on admission. Hospitalization per se resulted in a gradual deterioration of nutritional status. Nutritional supplementation generally improved nutritional state. Of the patients well nourished on admission, and subsequently receiving dietary supplementation, 8.3% fulfilled malnutrition criteriaafter 26 weeks, while 21 .l% were considered malnourished in the control group (p i 0.05). The improvement observed in transport proteins was suggested to be related to the nutritional support and not only to the reversal of inflammation. In the well nourished group, comprising more than 300 patiits, the mortality rate was 8.6% if given nutritional support compared to 18.6% in the control group (p < 0.02). Nutritional supplementation preserved and improved nutritional state and reduced mortality especially among initially well nourished patients.
P
P.93 Total parenteral nutrition in bone marrow transplant patients F.J. JimBnez-Jim&ez, C. CM-Leyba, M. Sarros-Perez, J. GamachoMontero. intensive Care Unit, Hospital “Vkgen de/ Rocio”, Sevilla, Spain Bone manow transplantation (BMT) involves the use of high doses of chemotherapy and total body ikradiation. As a result, even well nourished patients exhibit negative nitrogen balance (NB) and hypoproteinemia. The purpose of this study was to evaluate the effects of TPN on the nutritional state of bone marrow transplant patients. A prospective study was performed on 11 patients submitted to autologous BMT, 9 leukemias and 2 Hodgkins lymphoma. One patient died and ten survived to the transplantation period. The ages were 6 to 29. We evaluated thefollowing parameters. Albumin (ALB), Transferrin (TRS), Prealbumin (PA), Retinal binding protein (RBP), Colesterol, Triglycerides, uninary nitrogen excretion (UNE) and nitrogen balance (NB). All data were measured and/or quantified at three intervals: before starting total parenteral nutrition (TPN), 7 days and 15 days of TPN. The patients received a standard TPN protocol. Nitrogen intake was 1.4 f 0.4gr aminoacids/kg/d. Wilcoxon test was performed as statistical method. Bul P 7* t5dlyt 3.9+0.7 3.6+1.1 NS 3.920.6 196237 254%?a 213+2Q =003 16.1i4.9 17.2t2.5 NS 15.7t2.6 4.4tO.Q 4.2f0.4 NS 4.1t0.4 15.2k7.5 12.5t4.7 16.2t7.7 NS -16.6e6.9 -4.6t5.1 -107t6.6 =o.w4 NBw24h) 156*31 129+36 NS 126+32 ~Wd(w-db Tfglycendes(mg/d~ IL%36 120+44 NS lOlf35 ~sal-15days'=0.01."=D.wo4."'=D~~
P.95 The creatinine-arm index as an alternative for creatinine-height index in the elderly T. Hartoko, M. Vandewoude, R. Van Hoeyweghen, 1. De Leeuw Department of EndocriinobgylNutrition and Geriatrics, University of Antwerp, Belgium. Creatinine-Height Index (CHI) is often used as a parameter to estimate lean body mass in nutritional assessment. In the elderly body-height, lean body mass and urinary creatinine excretion were reduced even in the absence of malnutrition. Otherwise arm length does not change significantly with ageing. The purpose of this study is to adapt the CHI-formula to the elderly. In a prospective control study 74 non malnourished elderly of both sexes with normal renal function were divided in 2 groups: the “young-old” (YO) group was between 60-75 years and the “old-old” (CO)-group was over 75 years old. The control M-group consisted of 100 healthy young volunteers of both s8xes. To evaluate the usafulness of CHI in the elderly, a complete nutritional profile was taken in all groups. A hiih correlation was observed in the Y-group between total arm length (TAL) and body height (BH) (r = 0.86; p < 0.001). From theregression line and the ideal body weight (IBW) formula, it was possible to determine IBW from parameters that were not age-dependent: IBW = (2 x WC) t (1.25 x TAL) - 40.9.
P NS NS NS NS =O.Ol =O.w3" MS"' NS"'
57 CN
E
on nutritional
J. Larsaon, M. Unosson, A.C. Ek and P. Bjun~if Departments of Surgery, Preventive and Social Medicine, Clinical Chemistry, Geriatrics and Caring Sciences, University Hospital, Linkbping, Sweden
There were no significant changes in factor-b and SCSb-9 before, during, and after TPN. Baseline Bb pre-TPN was significantly higher than normal levels. TPN caused a highly significant increase in Bb that returned to pm-treatment levels after cessation of therapy. The levels of plasma arachidonic acid were directly related to Bb levels (r = 0.53, p c 0.09). The results suggest that fat based TPN affects the activation of the alternate pathway of the complement system and may be important in modulating immune function in patients with CF.
Abumm(gr/fl Transferrln(~d9 Fmabumm bw'dll RBP(Wd9 UNE@R4h)
ASSESSMENT
From the 24 hr urinary creatinine excretion and IBW values the mathematical development showed that the numerical values to multiply IBW for obtaining the expected dally creatinine excretion were 16mg/kg IBW/d for men and 11.6mg/kgIBW/dforwomenintheYOgroup, 12.3mg/kglBW/dformenand 9.7mg/kg IBw/d for women in the 00 group. We concluded that in the geriatric patients, CHI is of limited value and should be replaced by Creatinine-Arm Index (CAI) which is less dependent on ageing processes as body-height.
P.98 The reliabilii nutritional status
of clinical judgement in the evaluation of
L. Lupo,0.C.Pannarale, D.F.Momare,L. Cap& lambrenghi, G. Chefta, N. Palasciano, V. Memeo, M. Rubino lstituto di Clinica Chimrgica, Universiti deg/i Studi di Sari, Ma/y Nutritional status is generally evaluated by anthropometrical, biohumoral and immunological measurements, largely ignoring the importance of clinical opinion owing to the difficulty of quantifying and reproducing the latter. A prospective double blind study has therefore been undertaken to evaluate the reproducibility and reliability of clinical judgement in nutritional evaluation. Three observers, unaware of the diagnosis, independently examined 64 surgical patients following a schema whereby objective and anamnestic variables were scored on a decimal analogue visual scale. The overall assessment was allotted to one of four categories; normal nourishment, mild, moderate and severe malnutrition. The variability between observers was analysed with K statistics. Clinical judgement was compared with blood level of albumin, transferrin, HB, total serum proteins and cholesterol. Total agreement between observers in classifying the patients was found in 49 of 64 patients (77%) and partial agreement in 15 (23%) with a significant value of K = 0.74 (p < 0.01). Furthermore, clinical judgement well correlated with albumin, transferrin, cholesterol and weight loss (R2 = 0.73, P < 0.001). Clinical evaluation of nutritional status was found to be reproducible and reliable, worthy of greater consideration alongside the conventional methods.
P.g7 Zinc status and absorption in ileal pouch-anal anastomosis (IPAA). L. Pironi, tM. Mig/io/i, E. Ruggeri, MA. Dallasta, G. L. Comia, #S. Piazzi, %. Poggioi, *G. Gouetti, L. Barbara. lstituto di Clinica Medica e Gastroenterologa and ‘Clinica Chirurgca //, University of Bologna; tCattedra di Gastroenferologia, University of Chieti; #Laboratorio Cenfralizzato, Ospedale S. &so/a, Bologna, Italy. The major lossesof Zn occur through the intestinal tract and are proportional to stool weight. Pts with IPAA have a stool weight 2-3 times greater than normal. Hence, a risk of Zn depletion can be hypothesized. Plasma (P: W/dl),24 hr urinary excretion (U$fday), dietary intake (D:mg/day) and absorption (A) of Zn were evaluated in 7 adult pts with recanalized IPAA (6M, 1F; pouchitis: l), 9 ? 5mos, 23+4mos and 26+4mos after closure of the protective ileostomy. Mean PZn (normal value: > 80) was 69 ? 6 after Smos, 83 * 9 after 23 mos (p > 0.03) and 75 f 3 after 26mos. Mean UZn did not differ between the groupsand was normal (290 - 650) in all but 3 cases in which it was low. DZn ranged from 12 to 30 (RDA: 15) and was similar between the groups. Serum albumin was normal in all the cases and no pts showed changes in muscle mass during the study. ESA was increased in the pt with pouchitis and normal in all the others. After an oral dose of 220mg ZnSOd, ZnA was normal in all the cases. Oral Zn supplementation (66mg ZnS04 = 15mg Zn) for one mo improved both PZn and UZn in all but 2 pts. The pt with pouchitis showed low PZn and UZn, delayed ZnA, a normal DZn and an increased fecal weight. Concluaionr:lowPZn are frequent in IPAA in spite of normal DNz, UZn, ZnA, normal serum albumin, absence of inflammation and unchanged Zn requirements for muscle anabolism. This suggests the presence of a mild Zn depletion due to increased fecal losses of the metal. Pouchitis can further impair Zn status.
P.gS Impedance measurements of fatfree mass are influenced by changes of extracellular fluids 1.de Leeuw, G. Vansant and L. Van Gaal Depatiment of EnoiWnologgy, Metabolism and Clinical Nutrition, University of Antwerp (U/A), Antwerp, Belgium. Bio-electrical impedance measurement is a new, safe, noninvasive and rapid method to measure body composition in humans. In theory, this method is applicable to follow the effect of nutritional intervention like total parenteral nutrition, even in severely ill patients. However, since it is known that the resistance strongly depends on the amount of intra- and extracellular water (ICW, ECW), body impedance have to be interpreted carefully. Edema and dehydration are conditions frequently seen in these patients. On the other hand, during the first period of total parenteral nutrition, large changes in body water balance may be expected. In this situation, further validation of the method is needed. In a small experiment, we measured the impedance when the amount of extracellular water changed over a short period of time. impedance was measured in 13 patients with an interval of 15 minutes. Within this limited period of time, 150ml blood was sampled. Resistance increased from 495 SD 730hm to 511 SD 880hm. This difference of 16ohm corresponds with a decrease in fatfree mass (FFM) of 1.40 kg. Sinceonly 150ml blood (=O.l5kg FFM) was withdrawn, the total loss of fat free mass was over-estimated with 1.25kg. This study indicates that changes in FFM dueto loss of extracellular water are overestimated by this measurement. For this reason impedance should not be used as a measurement of short term changes of fatfree mass during nutritional intervention.
P.99 Postoperative complications after kidney and pancreas transplantation: can they be predicted by simple preoperative assessment? K. Filip, M. And6/, 1! Barto& J. Maw, P. Pave/, 1. Van&, V. Ko6andrle lnstitufe for Clinical and Experimental Medicine, Prague, Czechoslovakia Cadaveric organ transplantation, even though an elective operation, is mostly performed as an urgent procedure with no time enough to perform a detailed nutritional assessment. Only clinical status evaluation and basic laboratory data are available before surgery. Is the information sufficient to identify high-risk patients? In order to answer this question we analyzed retrospectively the clinical notes of 36 uremic diabetics undergoing simultaneous kidney and pancreas transplantation. They were divided into 3 groups: A. Oeaths from major postoperative complications wtih sepsis, B. All complications within the first 3 weeks, C. Patients without complications during the same period. Age, body weight index (BWI = act. weight/height 100) total protein (TP), hemoglobin (Hb), leucocyte count (Le) and prothrombin time (PTj were evaluated by Student’s t-test (mean -+ SD). Age@m BWI TWO HbfM Le(10%) nw1
Ah=9 38.4+3.2 0.96ro.12 64.6_c9.2 93.0+10.4 6.4t2.0 62.Ot14.4
S[#l=ZlJ 345+5.i 0.95+0.13 67.1i7.6 %.lf16.0 6.7k2.1 666+14.3
C[n=16j 396+&o 0.94~0.11 69.6t5.6 e4.4fi6.0 6.3t2.6 6i.ot105
Conclusion: There were no significant differences among these groups. If the nutritional status influences postoperative mortality and morbidity, a more detailed assessment has to be performed in transplant recipients to identify high-risk patients in order to individualize nutritional support, immunosuppressive therapy and antimicrobial prophylaxis.
P.100 Effect of alcohol intake on the anthropometric parameters in the Catalonian working age population. F. Gonzalez-Huix, WRicarr, I/. Conde, C. Ada/id J. Aguilar, J. Montsenai, M. Cava, D. &a//a, J. Castej& D. Acero and M.A. Gassull Gasfroenferotogy and .Endccrino/ogy Units, Hospitai of Girona. Heafth & Hygiene Centers (HHC)? Labour Department, Generalitat de Catalunya. Gastroenterology Dpt. Hosp. Germans Trias i Pujol. Badalona. Spain.
58
The patients submitted to BMT showed a good nutritional state at the beginning. Protein catabolism and UNE were found increased associated with a negative NB. There were no significant changes in plasma ALB and RBP levels. The use of TPN in BMT has been shown advii as we obtained a reduction in negative NB and a faster recovery of visceral proteins.
P.92 Effectsof bng term parenteral nuttition on complement activation in patknts with cystic fibrosis Bsm+d Ad&bag, OlfiKirveli3, David P. Katz and JeffreyAskanazi. Nassau County Medal Center, NY, US4 and Montefiore Medical Center and ths Albert Einsrein College of Medicine, NY, USA. Excess energy consumption due to increased work of breathing, with inadequate oral intake and malabsorption, contributes to malnutrition in patients with cystic fibrosis (CF). Malnutrition alSo has negative effects on immune function. The aim of the current investigation was to assess the consequence of long-term fat based total parenteral nutrition FPN) on the complement system. Eleven patients with CF and severe pulmonary disease were given TPN at 115% of measured resting energy expenditure for a 4 month period. Bloods were drawn before and after 4 months of treatment and 2 months after TPN was discontinued. Levels of factor-B, the activated fragment Bb, SC5b-9 and fatty acid profiles were determined. The resuits (mean + SEM) are listed below:
~WW Factor-B(mfl sC5b-9(rg/m.)
Pm-TPN
4montb
Post.TPN
35f1.2 3%+36 416ki97
12.6e2.7 364*30 62*57
2.2+0.9 324+40 325?210
P.94 Influence of dietary supplemenUon status and mortality in geriatric patients
The present study explored the effect of dietary supplementation on nutriiional status and mortality in a large group of geriatric patients (n = 501). 311 females and 1QO males who remained hospitalized for more than 3 weeks entered the study. The patients were randomized into an exparimental group which received nutriiional supplementation (4OOkcal) to up to 26 weeks together with a standard hospital diet, and a control group. The nutritional state was studied by using anthropometry (weight index, TSF, AK), serum protein analysis (prealbumin, albumin) and a delayed hypersensitivity skin test on admission and after 8 and 26 weeks. To identify patients with protein energy malnutrition, three or more of the criieria had to be fulfilled at the same time. The geriatric patients showed a malnutriiion frequency of 28.5% on admission. Hospitalization per se resulted in a gradual deterioration of nutritional status. Nutritional supplementation generally improved nutritional state. Of the patients well nourished on admission, and subsequently receiving dietary supplementation, 8.3% fulfilled malnutrition criteriaafter 26 weeks, while 21 .l% were considered malnourished in the control group (p i 0.05). The improvement observed in transport proteins was suggested to be related to the nutritional support and not only to the reversal of inflammation. In the well nourished group, comprising more than 300 patiits, the mortality rate was 8.6% if given nutritional support compared to 18.6% in the control group (p < 0.02). Nutritional supplementation preserved and improved nutritional state and reduced mortality especially among initially well nourished patients.
P
P.93 Total parenteral nutrition in bone marrow transplant patients F.J. JimBnez-Jim&ez, C. CM-Leyba, M. Sarros-Perez, J. GamachoMontero. intensive Care Unit, Hospital “Vkgen de/ Rocio”, Sevilla, Spain Bone manow transplantation (BMT) involves the use of high doses of chemotherapy and total body ikradiation. As a result, even well nourished patients exhibit negative nitrogen balance (NB) and hypoproteinemia. The purpose of this study was to evaluate the effects of TPN on the nutritional state of bone marrow transplant patients. A prospective study was performed on 11 patients submitted to autologous BMT, 9 leukemias and 2 Hodgkins lymphoma. One patient died and ten survived to the transplantation period. The ages were 6 to 29. We evaluated thefollowing parameters. Albumin (ALB), Transferrin (TRS), Prealbumin (PA), Retinal binding protein (RBP), Colesterol, Triglycerides, uninary nitrogen excretion (UNE) and nitrogen balance (NB). All data were measured and/or quantified at three intervals: before starting total parenteral nutrition (TPN), 7 days and 15 days of TPN. The patients received a standard TPN protocol. Nitrogen intake was 1.4 f 0.4gr aminoacids/kg/d. Wilcoxon test was performed as statistical method. Bul P 7* t5dlyt 3.9+0.7 3.6+1.1 NS 3.920.6 196237 254%?a 213+2Q =003 16.1i4.9 17.2t2.5 NS 15.7t2.6 4.4tO.Q 4.2f0.4 NS 4.1t0.4 15.2k7.5 12.5t4.7 16.2t7.7 NS -16.6e6.9 -4.6t5.1 -107t6.6 =o.w4 NBw24h) 156*31 129+36 NS 126+32 ~Wd(w-db Tfglycendes(mg/d~ IL%36 120+44 NS lOlf35 ~sal-15days'=0.01."=D.wo4."'=D~~
P.95 The creatinine-arm index as an alternative for creatinine-height index in the elderly T. Hartoko, M. Vandewoude, R. Van Hoeyweghen, 1. De Leeuw Department of EndocriinobgylNutrition and Geriatrics, University of Antwerp, Belgium. Creatinine-Height Index (CHI) is often used as a parameter to estimate lean body mass in nutritional assessment. In the elderly body-height, lean body mass and urinary creatinine excretion were reduced even in the absence of malnutrition. Otherwise arm length does not change significantly with ageing. The purpose of this study is to adapt the CHI-formula to the elderly. In a prospective control study 74 non malnourished elderly of both sexes with normal renal function were divided in 2 groups: the “young-old” (YO) group was between 60-75 years and the “old-old” (CO)-group was over 75 years old. The control M-group consisted of 100 healthy young volunteers of both s8xes. To evaluate the usafulness of CHI in the elderly, a complete nutritional profile was taken in all groups. A hiih correlation was observed in the Y-group between total arm length (TAL) and body height (BH) (r = 0.86; p < 0.001). From theregression line and the ideal body weight (IBW) formula, it was possible to determine IBW from parameters that were not age-dependent: IBW = (2 x WC) t (1.25 x TAL) - 40.9.
P NS NS NS NS =O.Ol =O.w3" MS"' NS"'
57 CN
E
on nutritional
J. Larsaon, M. Unosson, A.C. Ek and P. Bjun~if Departments of Surgery, Preventive and Social Medicine, Clinical Chemistry, Geriatrics and Caring Sciences, University Hospital, Linkbping, Sweden
There were no significant changes in factor-b and SCSb-9 before, during, and after TPN. Baseline Bb pre-TPN was significantly higher than normal levels. TPN caused a highly significant increase in Bb that returned to pm-treatment levels after cessation of therapy. The levels of plasma arachidonic acid were directly related to Bb levels (r = 0.53, p c 0.09). The results suggest that fat based TPN affects the activation of the alternate pathway of the complement system and may be important in modulating immune function in patients with CF.
Abumm(gr/fl Transferrln(~d9 Fmabumm bw'dll RBP(Wd9 UNE@R4h)
ASSESSMENT
From the 24 hr urinary creatinine excretion and IBW values the mathematical development showed that the numerical values to multiply IBW for obtaining the expected dally creatinine excretion were 16mg/kg IBW/d for men and 11.6mg/kgIBW/dforwomenintheYOgroup, 12.3mg/kglBW/dformenand 9.7mg/kg IBw/d for women in the 00 group. We concluded that in the geriatric patients, CHI is of limited value and should be replaced by Creatinine-Arm Index (CAI) which is less dependent on ageing processes as body-height.
P.98 The reliabilii nutritional status
of clinical judgement in the evaluation of
L. Lupo,0.C.Pannarale, D.F.Momare,L. Cap& lambrenghi, G. Chefta, N. Palasciano, V. Memeo, M. Rubino lstituto di Clinica Chimrgica, Universiti deg/i Studi di Sari, Ma/y Nutritional status is generally evaluated by anthropometrical, biohumoral and immunological measurements, largely ignoring the importance of clinical opinion owing to the difficulty of quantifying and reproducing the latter. A prospective double blind study has therefore been undertaken to evaluate the reproducibility and reliability of clinical judgement in nutritional evaluation. Three observers, unaware of the diagnosis, independently examined 64 surgical patients following a schema whereby objective and anamnestic variables were scored on a decimal analogue visual scale. The overall assessment was allotted to one of four categories; normal nourishment, mild, moderate and severe malnutrition. The variability between observers was analysed with K statistics. Clinical judgement was compared with blood level of albumin, transferrin, HB, total serum proteins and cholesterol. Total agreement between observers in classifying the patients was found in 49 of 64 patients (77%) and partial agreement in 15 (23%) with a significant value of K = 0.74 (p < 0.01). Furthermore, clinical judgement well correlated with albumin, transferrin, cholesterol and weight loss (R2 = 0.73, P < 0.001). Clinical evaluation of nutritional status was found to be reproducible and reliable, worthy of greater consideration alongside the conventional methods.
P.g7 Zinc status and absorption in ileal pouch-anal anastomosis (IPAA). L. Pironi, tM. Mig/io/i, E. Ruggeri, MA. Dallasta, G. L. Comia, #S. Piazzi, %. Poggioi, *G. Gouetti, L. Barbara. lstituto di Clinica Medica e Gastroenterologa and ‘Clinica Chirurgca //, University of Bologna; tCattedra di Gastroenferologia, University of Chieti; #Laboratorio Cenfralizzato, Ospedale S. &so/a, Bologna, Italy. The major lossesof Zn occur through the intestinal tract and are proportional to stool weight. Pts with IPAA have a stool weight 2-3 times greater than normal. Hence, a risk of Zn depletion can be hypothesized. Plasma (P: W/dl),24 hr urinary excretion (U$fday), dietary intake (D:mg/day) and absorption (A) of Zn were evaluated in 7 adult pts with recanalized IPAA (6M, 1F; pouchitis: l), 9 ? 5mos, 23+4mos and 26+4mos after closure of the protective ileostomy. Mean PZn (normal value: > 80) was 69 ? 6 after Smos, 83 * 9 after 23 mos (p > 0.03) and 75 f 3 after 26mos. Mean UZn did not differ between the groupsand was normal (290 - 650) in all but 3 cases in which it was low. DZn ranged from 12 to 30 (RDA: 15) and was similar between the groups. Serum albumin was normal in all the cases and no pts showed changes in muscle mass during the study. ESA was increased in the pt with pouchitis and normal in all the others. After an oral dose of 220mg ZnSOd, ZnA was normal in all the cases. Oral Zn supplementation (66mg ZnS04 = 15mg Zn) for one mo improved both PZn and UZn in all but 2 pts. The pt with pouchitis showed low PZn and UZn, delayed ZnA, a normal DZn and an increased fecal weight. Concluaionr:lowPZn are frequent in IPAA in spite of normal DNz, UZn, ZnA, normal serum albumin, absence of inflammation and unchanged Zn requirements for muscle anabolism. This suggests the presence of a mild Zn depletion due to increased fecal losses of the metal. Pouchitis can further impair Zn status.
P.gS Impedance measurements of fatfree mass are influenced by changes of extracellular fluids 1.de Leeuw, G. Vansant and L. Van Gaal Depatiment of EnoiWnologgy, Metabolism and Clinical Nutrition, University of Antwerp (U/A), Antwerp, Belgium. Bio-electrical impedance measurement is a new, safe, noninvasive and rapid method to measure body composition in humans. In theory, this method is applicable to follow the effect of nutritional intervention like total parenteral nutrition, even in severely ill patients. However, since it is known that the resistance strongly depends on the amount of intra- and extracellular water (ICW, ECW), body impedance have to be interpreted carefully. Edema and dehydration are conditions frequently seen in these patients. On the other hand, during the first period of total parenteral nutrition, large changes in body water balance may be expected. In this situation, further validation of the method is needed. In a small experiment, we measured the impedance when the amount of extracellular water changed over a short period of time. impedance was measured in 13 patients with an interval of 15 minutes. Within this limited period of time, 150ml blood was sampled. Resistance increased from 495 SD 730hm to 511 SD 880hm. This difference of 16ohm corresponds with a decrease in fatfree mass (FFM) of 1.40 kg. Sinceonly 150ml blood (=O.l5kg FFM) was withdrawn, the total loss of fat free mass was over-estimated with 1.25kg. This study indicates that changes in FFM dueto loss of extracellular water are overestimated by this measurement. For this reason impedance should not be used as a measurement of short term changes of fatfree mass during nutritional intervention.
P.99 Postoperative complications after kidney and pancreas transplantation: can they be predicted by simple preoperative assessment? K. Filip, M. And6/, 1! Barto& J. Maw, P. Pave/, 1. Van&, V. Ko6andrle lnstitufe for Clinical and Experimental Medicine, Prague, Czechoslovakia Cadaveric organ transplantation, even though an elective operation, is mostly performed as an urgent procedure with no time enough to perform a detailed nutritional assessment. Only clinical status evaluation and basic laboratory data are available before surgery. Is the information sufficient to identify high-risk patients? In order to answer this question we analyzed retrospectively the clinical notes of 36 uremic diabetics undergoing simultaneous kidney and pancreas transplantation. They were divided into 3 groups: A. Oeaths from major postoperative complications wtih sepsis, B. All complications within the first 3 weeks, C. Patients without complications during the same period. Age, body weight index (BWI = act. weight/height 100) total protein (TP), hemoglobin (Hb), leucocyte count (Le) and prothrombin time (PTj were evaluated by Student’s t-test (mean -+ SD). Age@m BWI TWO HbfM Le(10%) nw1
Ah=9 38.4+3.2 0.96ro.12 64.6_c9.2 93.0+10.4 6.4t2.0 62.Ot14.4
S[#l=ZlJ 345+5.i 0.95+0.13 67.1i7.6 %.lf16.0 6.7k2.1 666+14.3
C[n=16j 396+&o 0.94~0.11 69.6t5.6 e4.4fi6.0 6.3t2.6 6i.ot105
Conclusion: There were no significant differences among these groups. If the nutritional status influences postoperative mortality and morbidity, a more detailed assessment has to be performed in transplant recipients to identify high-risk patients in order to individualize nutritional support, immunosuppressive therapy and antimicrobial prophylaxis.
P.100 Effect of alcohol intake on the anthropometric parameters in the Catalonian working age population. F. Gonzalez-Huix, WRicarr, I/. Conde, C. Ada/id J. Aguilar, J. Montsenai, M. Cava, D. &a//a, J. Castej& D. Acero and M.A. Gassull Gasfroenferotogy and .Endccrino/ogy Units, Hospitai of Girona. Heafth & Hygiene Centers (HHC)? Labour Department, Generalitat de Catalunya. Gastroenterology Dpt. Hosp. Germans Trias i Pujol. Badalona. Spain.
58