- Email: [email protected]
Acceptability study on a new oral nutritional supplement in adult patients: Evaluation of gastrointestinal (GI) tolerance, palatability and compliance
138
Abstracts / Clinical Nutrition ESPEN 22 (2017) 116e147
nursing teams/allied health professionals. The majority of referrals (61%) were for care home residents. Following assessment 26% of referrals were deemed inappropriate by the Dietitian. From March to July 2015 the dietetic team established the ‘Community Refocus Project’. The community nursing teams and allied health professionals highlighted a lack of awareness of referral criteria, the use of outdated referral forms and patient information literature, a lack of weighing equipment and a perceived lack of effective multidisciplinary working between Dietitian and community staff. The key objectives for the project are shown in Table 1. Table 1 Key Objectives Revise ‘Malnutrition Universal Screening Tool’ form Develop community dietetic referral criteria and triage process Revise community dietitian referral form Develop working links with community healthcare professionals Revise patient information leaflet Implement and evaluate training package
The local community malnutrition screening tool was revised in consultation with our community healthcare teams and based on guidance from British Association for Parenteral and Enteral Nutrition (BAPEN). Triage criteria for referrals were revised to base prioritisation on the ‘Malnutrition Universal Screening Tool’ score and dysphagia risk. The referral form was updated to reflect information required for appropriate triaging and a standard response letter was developed for incomplete or inappropriate referrals. An information leaflet was developed for healthcare professionals to use with patients requiring first line food fortification advice. GPs and community healthcare teams were informed of the new processes. An education package including a teaching session and resource pack for healthcare professionals was developed covering all aspects of malnutrition management in the community. Training sessions were attended by more than 50 community staff and 100% positive feedback received. All resources developed were made available on the WSHFT public facing website and some were also included in the local CCG Adult Oral Nutritional Supplement Formulary. To date, the team report that the new referral and triage process is more robust and that having up to date resources available is beneficial. This work has also led to improvements in working relationships with community nursing teams and the medicines management team. Initial findings from a repeat review of referrals in January and February 2016 showed that the total number of referrals remained the same and that these continued to be predominately for care home residents (68%). There was a decrease in referrals from community staff from 25% to 11%; however, there was an increase in referrals coming from GPs. These initial findings highlight potential key areas for development, although further evaluation of the project within the wider community is required. OC52 NUTRITIONAL STATUS OF PRE-OPERATIVE EARLY STAGE LUNG CANCER PATIENTS AND DIETARY INTAKE ASSESSMENT POST-OPERATIVELY E. O’Sullivan a, A. McAdam b, M. O'Sullivan b, R. Ryan c, V. Young c. a Department of Clinical Nutrition, St. James's Hospital, Dublin 8, Ireland; b Department of Clinical Medicine, Trinity Centre for Health Sciences, Dublin 8, Ireland; c Consultant Cardiothoracic Surgeon, St. James's Hospital, Dublin 8, Ireland Background: There is limited published data regarding malnutrition risk in early stage lung cancer patients. This study aimed to:
assess the nutritional status of early stage lung cancer patients pre-operatively assess the nutritional intake of a subset of patients postoperatively. Methods: Nutritional assessment was carried out in the pre-admission clinic on 51 patients undergoing lobectomy or pneumonectomy for lung
cancer including BMI (body mass index), MST (malnutrition screening tool) and MUST (malnutrition universal screening tool). Dietary intake data was collected on a subset of 9 patients at 3 time points after surgery; day 1 or 2, day 3 or 4 & day 5 or 6. A customised photographic food atlas was developed based on the menu in St. James’s Hospital. A portion size record form was devised to assess the quantity of each food consumed by patients at each meal. A snack assessment form was also developed that covered any extra food consumed outside the hospital main meals. The daily energy (kcal) & protein (g) intake at the 3 time points were estimated for each patient. Results: MST identified more patients at malnutrition risk than MUST, 18% and 12% respectively. Of the study population, 10% of patients had a BMI <20kg/m2, 57% were overweight or obese. At postoperative day 5/6, patients were on average meeting 56% of energy and 51% of protein requirements. 89% of the patient subset did not meet estimated energy (kcal) and protein (g) requirements by Day 5/6. Conclusion: Many lung cancer patients were malnourished or at risk of malnutrition pre-operatively according to MST & MUST screening tools. The patients were predominately overweight or obese and thus may not routinely be identified as requiring nutritional screening or nutrition intervention. Dietary intake post-operatively was inadequate, with the majority of patients not meeting their energy (kcal) and protein (g) requirements. As a result of this study, all lobectomy & pneumonectomy patients attending the pre-admission clinic have an MST completed as part of their assessment. To address the energy and protein deficits observed in the first post-operative week, we currently offer high protein high energy supplements as standard practice twice/day. OC53 ACCEPTABILITY STUDY ON A NEW ORAL NUTRITIONAL SUPPLEMENT IN ADULT PATIENTS: EVALUATION OF GASTROINTESTINAL (GI) TOLERANCE, PALATABILITY AND COMPLIANCE N. Trott, M. Kurien, D.S. Sanders. Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK Malnutrition is common in hospitalised patients. It can influence morbidity and mortality, as well as recovery time and hospital length of stay. For patients with functioning gastrointestinal tracts who are unable to meet their energy and nutrient requirements with normal food intake, nutritional support is recommended using oral nutritional supplements (ONS). This study assesses the GI tolerance, palatability and compliance of a new ONS (Nutricomp® Drink Plus, B Braun Melsungen AG). The ONS drinks were initially prescribed in hospital with patients taking the supplements on 7 consecutive days either in a hospital or in the community setting. This prospective open label study was conducted in a University Teaching Hospital. The recruitment target was 15 patients with inclusion criteria comprising patients who are adults (18 years+) with a MUST score 1 and an anticipated period of nutritional support 7 days. Each patient tasted all 4 flavours (vanilla, strawberry, chocolate, banana) of Nutricomp® Drink Plus, completing a palatability questionnaire for each. The patients took the Investigational Product (IP) for a period of 7 days. A patient diary that documented IP daily intake, GI tolerance parameters and compliance was completed for each patient for this 7 day period. Of the 23 patients that provided informed consent most were hospitalised due to oncological treatment (56.5%, of which approximately half had underlying malignant disease of the gastrointestinal tract, liver or spleen) or maxillary osteostomy (21.7%). 15 patients successfully completed the study by taking the prescribed IP for 7 consecutive days. 8 patients did not complete the study according to the protocol. Nutricomp® Drink Plus showed mostly 'good' to 'very good', but at least 'acceptable' results concerning the several acceptability parameters evaluated including colour, smell, texture, taste and overall acceptance of the product. 26 gastrointestinal adverse events were documented in 10 of 23 patients, none of which were considered to be serious, judged as being related to the IP or led to discontinuation of the IP. The calculated overall compliance was 93.8% (SD 30.7) and Nutricomp® Drink Plus was judged as acceptable by 94.4% of all patients. For the 15 patients that competed the study, calculated compliance was 100% (SD 27.6%) for the total treatment period. All of these 15 patients also confirmed that they would continue using
Abstracts / Clinical Nutrition ESPEN 22 (2017) 116e147
Nutricomp® Drink Plus if necessary and would recommend Nutricomp® Drink Plus to other people in need of an ONS. This is the first UK study to evaluate Nutricomp® Drink Plus, demonstrating good tolerability, acceptability, safety profile and compliance. No adverse events relating to Nutricomp Drink plus were reported during the study. Nutricomp® Drink Plus was shown to be acceptable, palatable and well tolerated in patients with a generally reduced health status or a vulnerable/ pre-damaged GI system. OC54 NUTRITION INTERVENTION REDUCES COMMUNITY LIVING OLDER PERSONS
MALNUTRITION
RISK
IN
C. Honohan a, F. Dunlevy a, D. Robinson b, L. Healy a. a Department of Clinical Nutrition, St James's Hospital, Dublin, Ireland; b Medicine for the Elderly Dictorate, St James's Hospital, Dublin, Ireland Malnutrition risk increases with age and is associated with adverse outcomes. This study assessed compliance with and tolerance of a low volume, energy and protein oral nutritional supplement (ONS) in older persons living in the community, in conjunction with increased dietetic input and its impact on nutritional outcomes, and malnutrition risk using the malnutrition universal screening tool (MUST). Elderly patients from community with a MUST score 1 or Body Mass Index (BMI) <24 kg/m2 with a triceps skinfold or mid upper arm circumference <10th centile were eligible for inclusion. Patients were excluded if ONS were taken in the last 4 weeks or required thickened fluids. Patients were prescribed 120mls/day for 4 weeks (Pro-Cal shot®) providing 400 kcals (3.3 kcal/ml) and 8 g protein, in addition to increased dietetic contact (twice per week). Assessments completed at 3 time points include; anthropometry, nutritional intake (analysed by Nutritics®), tolerance and compliance (self-reported and measured). Statistical analysis was performed using SPSS®. Ethical approval was obtained from the local ethics committee. Fifteen completed the study (mean 81+8.4 years, BMI 20.5+4.2 kg/m2, 60% female, 40% cognitively impaired). Average 4 week compliance was 92% (57e100%). The ONS was well tolerated with no adverse gastrointestinal symptoms or appetite changes. A third changed flavour preference. Weight (p¼0.012), total reported energy (p<0.05) and fluid intake (p<0.05) significantly increased with supplementation, with no effect on other anthropometric measures. Reported dietary intake did not change (p¼0.122). After 4 weeks of supplementation, 67% reduced their malnutrition risk to MUST score 0 (low risk). The low volume, well tolerated ONS, combined with increased dietetic input and self-monitoring resulted in high compliance. This intervention for ‘at risk’ patients, resulted in small but significant weight-gain and reduction of malnutrition risk in older persons in the community. OC55 GROUP VERSUS INDIVIDUAL WEIGHT LOSS INTERVENTIONS: A LOOK AT WEIGHT LOSS RESULTS AND PATIENT EXPERIENCE J. Singh, S. Awatli, E. O'Driscoll, S. Daborn. St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK Obesity remains a major public health issue in the United Kingdom. The National Institute of Clinical Excellence (NICE) recommends a multifaceted approach to weight loss [1]. This is reflected in our current service at St Thomas' Hospital which provides an option of group or individual intervention for our weight management patients. A 5-10% weight loss goal is often widely accepted as a realistic aim [2]; however, the mean percentage weight loss in an NHS setting is approximately 3% [1]. Despite this NICE have highlighted that patients still find health benefits with this moderate reduction in weight [1]. Future studies may need to also assess quality of life and patient experience, user satisfaction and adherence [1]. The aims of this study were to (a) compare weight change and BMI change in groups versus individual interventions and (b) to explore patient experience with regards to user satisfaction, adherence and common themes.
139
The inclusion criteria were: patients seen between January 2015 e December 2015 and patients who have had an initial and at least one follow eup appointment within the specified time frame. The exclusion criteria were: patients who have only attended one appointment or one group session. The following outcomes were collected: weight, height, BMI, co-morbidities e.g. diabetes and hypercholesterolemia. For individual sessions resources were chosen on an individual basis, for group sessions structured lesson plans were used to deliver 6 sessions covering healthy eating and physical activity. A qualitative department questionnaire including the NHS Friends and Family Test was used to assess patient experience in both intervention groups. The results demonstrated no significant difference between baseline and final weight in the one to one or group sessions over the 12 month period. Paired T-Test analysis showed no significant difference in weight loss between the two groups (P¼0.1, 95% confidence interval, equal variances’ not assumed). Although there was no change in weight, patients rated their experience with the dietitians highly for all the parameters measured (Median Score 5/5). The limitations of the study included: baseline characteristics were not adjusted for confounding factors, small sample size due to large attrition rate in both intervention groups, large differences in sample size between the two intervention groups, frequency of contact with dietitians in 1:1 vs. group sessions and no specialist physical activity input for 1:1 sessions. Study strengths include: minimal inclusion and exclusion criteria applied and the intervention was conducted under real world clinical practice conditions. In conclusion, the existing weight loss interventions at St Thomas’ Hospital have not shown significant reductions in patient’s weight or BMI. However patient’s rated their experience of the service highly. Looking at alternative outcomes such as waist circumference, biochemical markers of co-morbidities or quality of life measures may be more beneficial to assess the effectiveness of our service. It may also be worth considering other innovative evidenced-based strategies such as meal replacement, VLCD, 5:2 as alternative approaches to weight loss [3,4]. References [1] National Institute of Clinical Excellence. Obesity: identification, assessment and management. CG189 2014. [2] Catford JC, Caterson ID. Snowballing obesity: Australians will get run over if they just sit. [3] Harvie M, Howell A. Energy restriction and prevention of breast cancer. Nutrition Society. March 2012 [Online]. [4] Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very low calorie diet and 6 months of weight stability in type 2 diabetes; pathiophysiologic changes in responders and non-responders. Diabetes Care (Online) March 2016. OC56 HOW DIETITIANS CAN HELP IDENTIFY THE PREVALENCE OF LOW VITAMIN D LEVELS IN A HOSPITAL SETTING N. Bergin, L. Nash. Department of Nutrition and Dietetics, Airedale General Hospital, Skipton Road, Steeton, Keighley, West Yorkshire, BD20 6HP, UK Until recently, it was assumed that, for most people, the amount of vitamin D produced by exposure to sunlight containing UVB would be sufficient to achieve serum concentrations >25 nmol/L during winter. However, it is now known that this is not the case [1]. Adult population groups at increased risk of vitamin D deficiency in the UK include those with minimal sunshine exposure e.g. frail and institutionalised people, adults aged over 65 years, and those who wear clothing that covers most of the skin while outdoors [1]. Serum 25(OH) D concentration is widely considered to be the best indicator of total vitamin D exposure because it has along half-life in the circulation (about 2e3weeks) and is not subject to tight homeostatic control [1]. National data for institutionalised adults revealed mean plasma 25(OH) D concentrations of 33.7 nmol/L in men and 32.5 nmol/L in women. Thirtyeight per cent of men and 37% of women had a plasma 25(OH) D concentration of <25 nmol/L [2].
Abstracts / Clinical Nutrition ESPEN 22 (2017) 116e147
nursing teams/allied health professionals. The majority of referrals (61%) were for care home residents. Following assessment 26% of referrals were deemed inappropriate by the Dietitian. From March to July 2015 the dietetic team established the ‘Community Refocus Project’. The community nursing teams and allied health professionals highlighted a lack of awareness of referral criteria, the use of outdated referral forms and patient information literature, a lack of weighing equipment and a perceived lack of effective multidisciplinary working between Dietitian and community staff. The key objectives for the project are shown in Table 1. Table 1 Key Objectives Revise ‘Malnutrition Universal Screening Tool’ form Develop community dietetic referral criteria and triage process Revise community dietitian referral form Develop working links with community healthcare professionals Revise patient information leaflet Implement and evaluate training package
The local community malnutrition screening tool was revised in consultation with our community healthcare teams and based on guidance from British Association for Parenteral and Enteral Nutrition (BAPEN). Triage criteria for referrals were revised to base prioritisation on the ‘Malnutrition Universal Screening Tool’ score and dysphagia risk. The referral form was updated to reflect information required for appropriate triaging and a standard response letter was developed for incomplete or inappropriate referrals. An information leaflet was developed for healthcare professionals to use with patients requiring first line food fortification advice. GPs and community healthcare teams were informed of the new processes. An education package including a teaching session and resource pack for healthcare professionals was developed covering all aspects of malnutrition management in the community. Training sessions were attended by more than 50 community staff and 100% positive feedback received. All resources developed were made available on the WSHFT public facing website and some were also included in the local CCG Adult Oral Nutritional Supplement Formulary. To date, the team report that the new referral and triage process is more robust and that having up to date resources available is beneficial. This work has also led to improvements in working relationships with community nursing teams and the medicines management team. Initial findings from a repeat review of referrals in January and February 2016 showed that the total number of referrals remained the same and that these continued to be predominately for care home residents (68%). There was a decrease in referrals from community staff from 25% to 11%; however, there was an increase in referrals coming from GPs. These initial findings highlight potential key areas for development, although further evaluation of the project within the wider community is required. OC52 NUTRITIONAL STATUS OF PRE-OPERATIVE EARLY STAGE LUNG CANCER PATIENTS AND DIETARY INTAKE ASSESSMENT POST-OPERATIVELY E. O’Sullivan a, A. McAdam b, M. O'Sullivan b, R. Ryan c, V. Young c. a Department of Clinical Nutrition, St. James's Hospital, Dublin 8, Ireland; b Department of Clinical Medicine, Trinity Centre for Health Sciences, Dublin 8, Ireland; c Consultant Cardiothoracic Surgeon, St. James's Hospital, Dublin 8, Ireland Background: There is limited published data regarding malnutrition risk in early stage lung cancer patients. This study aimed to:
assess the nutritional status of early stage lung cancer patients pre-operatively assess the nutritional intake of a subset of patients postoperatively. Methods: Nutritional assessment was carried out in the pre-admission clinic on 51 patients undergoing lobectomy or pneumonectomy for lung
cancer including BMI (body mass index), MST (malnutrition screening tool) and MUST (malnutrition universal screening tool). Dietary intake data was collected on a subset of 9 patients at 3 time points after surgery; day 1 or 2, day 3 or 4 & day 5 or 6. A customised photographic food atlas was developed based on the menu in St. James’s Hospital. A portion size record form was devised to assess the quantity of each food consumed by patients at each meal. A snack assessment form was also developed that covered any extra food consumed outside the hospital main meals. The daily energy (kcal) & protein (g) intake at the 3 time points were estimated for each patient. Results: MST identified more patients at malnutrition risk than MUST, 18% and 12% respectively. Of the study population, 10% of patients had a BMI <20kg/m2, 57% were overweight or obese. At postoperative day 5/6, patients were on average meeting 56% of energy and 51% of protein requirements. 89% of the patient subset did not meet estimated energy (kcal) and protein (g) requirements by Day 5/6. Conclusion: Many lung cancer patients were malnourished or at risk of malnutrition pre-operatively according to MST & MUST screening tools. The patients were predominately overweight or obese and thus may not routinely be identified as requiring nutritional screening or nutrition intervention. Dietary intake post-operatively was inadequate, with the majority of patients not meeting their energy (kcal) and protein (g) requirements. As a result of this study, all lobectomy & pneumonectomy patients attending the pre-admission clinic have an MST completed as part of their assessment. To address the energy and protein deficits observed in the first post-operative week, we currently offer high protein high energy supplements as standard practice twice/day. OC53 ACCEPTABILITY STUDY ON A NEW ORAL NUTRITIONAL SUPPLEMENT IN ADULT PATIENTS: EVALUATION OF GASTROINTESTINAL (GI) TOLERANCE, PALATABILITY AND COMPLIANCE N. Trott, M. Kurien, D.S. Sanders. Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK Malnutrition is common in hospitalised patients. It can influence morbidity and mortality, as well as recovery time and hospital length of stay. For patients with functioning gastrointestinal tracts who are unable to meet their energy and nutrient requirements with normal food intake, nutritional support is recommended using oral nutritional supplements (ONS). This study assesses the GI tolerance, palatability and compliance of a new ONS (Nutricomp® Drink Plus, B Braun Melsungen AG). The ONS drinks were initially prescribed in hospital with patients taking the supplements on 7 consecutive days either in a hospital or in the community setting. This prospective open label study was conducted in a University Teaching Hospital. The recruitment target was 15 patients with inclusion criteria comprising patients who are adults (18 years+) with a MUST score 1 and an anticipated period of nutritional support 7 days. Each patient tasted all 4 flavours (vanilla, strawberry, chocolate, banana) of Nutricomp® Drink Plus, completing a palatability questionnaire for each. The patients took the Investigational Product (IP) for a period of 7 days. A patient diary that documented IP daily intake, GI tolerance parameters and compliance was completed for each patient for this 7 day period. Of the 23 patients that provided informed consent most were hospitalised due to oncological treatment (56.5%, of which approximately half had underlying malignant disease of the gastrointestinal tract, liver or spleen) or maxillary osteostomy (21.7%). 15 patients successfully completed the study by taking the prescribed IP for 7 consecutive days. 8 patients did not complete the study according to the protocol. Nutricomp® Drink Plus showed mostly 'good' to 'very good', but at least 'acceptable' results concerning the several acceptability parameters evaluated including colour, smell, texture, taste and overall acceptance of the product. 26 gastrointestinal adverse events were documented in 10 of 23 patients, none of which were considered to be serious, judged as being related to the IP or led to discontinuation of the IP. The calculated overall compliance was 93.8% (SD 30.7) and Nutricomp® Drink Plus was judged as acceptable by 94.4% of all patients. For the 15 patients that competed the study, calculated compliance was 100% (SD 27.6%) for the total treatment period. All of these 15 patients also confirmed that they would continue using
Abstracts / Clinical Nutrition ESPEN 22 (2017) 116e147
Nutricomp® Drink Plus if necessary and would recommend Nutricomp® Drink Plus to other people in need of an ONS. This is the first UK study to evaluate Nutricomp® Drink Plus, demonstrating good tolerability, acceptability, safety profile and compliance. No adverse events relating to Nutricomp Drink plus were reported during the study. Nutricomp® Drink Plus was shown to be acceptable, palatable and well tolerated in patients with a generally reduced health status or a vulnerable/ pre-damaged GI system. OC54 NUTRITION INTERVENTION REDUCES COMMUNITY LIVING OLDER PERSONS
MALNUTRITION
RISK
IN
C. Honohan a, F. Dunlevy a, D. Robinson b, L. Healy a. a Department of Clinical Nutrition, St James's Hospital, Dublin, Ireland; b Medicine for the Elderly Dictorate, St James's Hospital, Dublin, Ireland Malnutrition risk increases with age and is associated with adverse outcomes. This study assessed compliance with and tolerance of a low volume, energy and protein oral nutritional supplement (ONS) in older persons living in the community, in conjunction with increased dietetic input and its impact on nutritional outcomes, and malnutrition risk using the malnutrition universal screening tool (MUST). Elderly patients from community with a MUST score 1 or Body Mass Index (BMI) <24 kg/m2 with a triceps skinfold or mid upper arm circumference <10th centile were eligible for inclusion. Patients were excluded if ONS were taken in the last 4 weeks or required thickened fluids. Patients were prescribed 120mls/day for 4 weeks (Pro-Cal shot®) providing 400 kcals (3.3 kcal/ml) and 8 g protein, in addition to increased dietetic contact (twice per week). Assessments completed at 3 time points include; anthropometry, nutritional intake (analysed by Nutritics®), tolerance and compliance (self-reported and measured). Statistical analysis was performed using SPSS®. Ethical approval was obtained from the local ethics committee. Fifteen completed the study (mean 81+8.4 years, BMI 20.5+4.2 kg/m2, 60% female, 40% cognitively impaired). Average 4 week compliance was 92% (57e100%). The ONS was well tolerated with no adverse gastrointestinal symptoms or appetite changes. A third changed flavour preference. Weight (p¼0.012), total reported energy (p<0.05) and fluid intake (p<0.05) significantly increased with supplementation, with no effect on other anthropometric measures. Reported dietary intake did not change (p¼0.122). After 4 weeks of supplementation, 67% reduced their malnutrition risk to MUST score 0 (low risk). The low volume, well tolerated ONS, combined with increased dietetic input and self-monitoring resulted in high compliance. This intervention for ‘at risk’ patients, resulted in small but significant weight-gain and reduction of malnutrition risk in older persons in the community. OC55 GROUP VERSUS INDIVIDUAL WEIGHT LOSS INTERVENTIONS: A LOOK AT WEIGHT LOSS RESULTS AND PATIENT EXPERIENCE J. Singh, S. Awatli, E. O'Driscoll, S. Daborn. St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK Obesity remains a major public health issue in the United Kingdom. The National Institute of Clinical Excellence (NICE) recommends a multifaceted approach to weight loss [1]. This is reflected in our current service at St Thomas' Hospital which provides an option of group or individual intervention for our weight management patients. A 5-10% weight loss goal is often widely accepted as a realistic aim [2]; however, the mean percentage weight loss in an NHS setting is approximately 3% [1]. Despite this NICE have highlighted that patients still find health benefits with this moderate reduction in weight [1]. Future studies may need to also assess quality of life and patient experience, user satisfaction and adherence [1]. The aims of this study were to (a) compare weight change and BMI change in groups versus individual interventions and (b) to explore patient experience with regards to user satisfaction, adherence and common themes.
139
The inclusion criteria were: patients seen between January 2015 e December 2015 and patients who have had an initial and at least one follow eup appointment within the specified time frame. The exclusion criteria were: patients who have only attended one appointment or one group session. The following outcomes were collected: weight, height, BMI, co-morbidities e.g. diabetes and hypercholesterolemia. For individual sessions resources were chosen on an individual basis, for group sessions structured lesson plans were used to deliver 6 sessions covering healthy eating and physical activity. A qualitative department questionnaire including the NHS Friends and Family Test was used to assess patient experience in both intervention groups. The results demonstrated no significant difference between baseline and final weight in the one to one or group sessions over the 12 month period. Paired T-Test analysis showed no significant difference in weight loss between the two groups (P¼0.1, 95% confidence interval, equal variances’ not assumed). Although there was no change in weight, patients rated their experience with the dietitians highly for all the parameters measured (Median Score 5/5). The limitations of the study included: baseline characteristics were not adjusted for confounding factors, small sample size due to large attrition rate in both intervention groups, large differences in sample size between the two intervention groups, frequency of contact with dietitians in 1:1 vs. group sessions and no specialist physical activity input for 1:1 sessions. Study strengths include: minimal inclusion and exclusion criteria applied and the intervention was conducted under real world clinical practice conditions. In conclusion, the existing weight loss interventions at St Thomas’ Hospital have not shown significant reductions in patient’s weight or BMI. However patient’s rated their experience of the service highly. Looking at alternative outcomes such as waist circumference, biochemical markers of co-morbidities or quality of life measures may be more beneficial to assess the effectiveness of our service. It may also be worth considering other innovative evidenced-based strategies such as meal replacement, VLCD, 5:2 as alternative approaches to weight loss [3,4]. References [1] National Institute of Clinical Excellence. Obesity: identification, assessment and management. CG189 2014. [2] Catford JC, Caterson ID. Snowballing obesity: Australians will get run over if they just sit. [3] Harvie M, Howell A. Energy restriction and prevention of breast cancer. Nutrition Society. March 2012 [Online]. [4] Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very low calorie diet and 6 months of weight stability in type 2 diabetes; pathiophysiologic changes in responders and non-responders. Diabetes Care (Online) March 2016. OC56 HOW DIETITIANS CAN HELP IDENTIFY THE PREVALENCE OF LOW VITAMIN D LEVELS IN A HOSPITAL SETTING N. Bergin, L. Nash. Department of Nutrition and Dietetics, Airedale General Hospital, Skipton Road, Steeton, Keighley, West Yorkshire, BD20 6HP, UK Until recently, it was assumed that, for most people, the amount of vitamin D produced by exposure to sunlight containing UVB would be sufficient to achieve serum concentrations >25 nmol/L during winter. However, it is now known that this is not the case [1]. Adult population groups at increased risk of vitamin D deficiency in the UK include those with minimal sunshine exposure e.g. frail and institutionalised people, adults aged over 65 years, and those who wear clothing that covers most of the skin while outdoors [1]. Serum 25(OH) D concentration is widely considered to be the best indicator of total vitamin D exposure because it has along half-life in the circulation (about 2e3weeks) and is not subject to tight homeostatic control [1]. National data for institutionalised adults revealed mean plasma 25(OH) D concentrations of 33.7 nmol/L in men and 32.5 nmol/L in women. Thirtyeight per cent of men and 37% of women had a plasma 25(OH) D concentration of <25 nmol/L [2].