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Bioelectrical impedance assessment (BIA) in malnourished digestive patient: role of the phase angle
P.3fl
NutrItIonalsupport after total laryngactomy
0. LouWli, 1.M&i and G. Varmssi Univ;srsily of L3lqu&
Dept. of Atmstheaiol~
and lntmsive Cme
Thii stwty ~8s parfomd to eva!uste the influence of different nutritionaf Support (enteraf vs parentera on rrutdhionalstatus, postoperative complications and length of hospitalization in patients undergoing total laryngectomy. Twenty-four patients (group A) received enteral nutrllion by percutaneous endoscopic gashostomy (PEG) placed befors Surgery. The nutritional support was started 12 hcurs after surgery with a polymeric diet 1 kcaVml administered by peristafbic pump in slow continuous infusion. Twenty-four patients (group B) were fed by parenteral route through central venous catheter with Manced formula containing 30% lipids. The caloric intake, cakulated by Harris-Benedict fomUa x 1.4, resulted in 2050 + 420 kcal (group A) and 2180 f 610 kcal (group B). The nutritional status was evaluated before surgery and then every five days studying the following pamrMem: body weight, triceps fold, arm mid muscular circumference and serum albumin, transferrin, total lymphocytes and T helperFT suppressor. The resuks of this study show a satisfactory preservation of the nutritional status in the postoperative pariod with no statistically significant diierences in the nutritiinal parameters between the two groups. PEG was well tolerated by the pabants and the only complication was wound infection which rqufred in&ii and drainage in OIW patient wfth no further sequelae. The nutrition related complications were always of lesser importance in group A (dii 4 patients, gastric bloating 3, tube obstruction 3) compared to group B (catheter related 3, metabolic 7). No difference resulted regard@ postoperative surgical complications but patients in group B required longer hospitalization (35 f 13 vs 27 ? 11 days) probably because of the parenteral nutrition complications.
P.31 NuMional status parameters are poor indicators of affecthranassof nubigonal support SAM. Va&qtpen,M.F. von Mm]enfeldt, W.J.H.J. Meijwink, h4.M.W.E. &ees,R.R.W.J. vdHu/st, M. Rour7attandP.B. Soeters bpt. of w, Uniwsity Hospital Maastricht, P.O. Box 5800 6202 AZ Maastfkzht, rheNetheMds IWe pWioUSiy demonstrated in malnourished gastric and colorefrtal cancer patisnts that preoperative nutrllional support, either by parentera or enteral route, results in significantly fewer compiiiions. Whether preoperative nutritional support results in improvement of nutritional status parameters, and whether improvement of nutritional status parameters are asaocfatsd with significant fewer complications is scarcely InvMfgated. Both correlatiins were analysed in the above mentioned trial. PaUmb awd methods 194 gastric and colorectal cancer patients participated in a prospective randomfzed perioperative nutritional support trial from October 1983 till December 1987. The patients were divided into a well nourishsd group (n = 42) and a malnourished group (n = 152) using niMtii index (Nl) that considsrs albumin, percent ideal body weight and total fymphocyte count. The malnourished group was randomized to receive TPN (n L+so). enteral nutrition (TEN) (n = 52) and to a control group (n = 52).
The following - generatfy accepted - nutritional status parameters were anafysed for their association with nutritional support and compliitions: prealbumin, albumin, NI and 3-methythistkJins (3MH). Beauttm Prealbumin, albumin and NI displayed significantly highervaluesin ttreTENgtaupifcMparedtatheTPNgrolpdwlngthepreoperaHvecourse. These differences remained sign&ant in the postoperative phase for albumin and NI. At no point group differences existed in 3MH values. Furthermore no association between the developmsnt of postoperative complications and changes in these parameters could be demonstrated. Mao TF'N TEN MN WN
Rrhmhrfse Me0
0.215 0.240 -
0.210 0.218' 0.23M 0.299
mfos
DAQI7 MQO DA09 23.55 30.59 0.199 0.142 35.48 x5.w 0.136' 33.74t 0.158 39.12't 'p
MaI7 25.58 31.20. 29.72 3146
MO
DAD0 Ma9 193.3 219.1 220.6 162.8 220.1 214.2
Ma17 230.3 277.8 232.5 249.6
We conclude that nutrttiinal status parameters are poor indicators of the effectiveness of nutritional support. Nutritional parameters correlate poorly with postoperative complications.
ConckpMn:
P.32 Biiiectrical impedance assessment (HA) in malnourisheddigestivepatient: role of ths phase angle SO. Sukkar,A. Giawsa and F. Frascio National Institute Cancer Res., Genova, Italy The aim of the present experience is to define the usefulness of the BlA parameter phase angle (PA) in defining the nutritional status of cancer patients and in differentiating BIA behaviour according to cancer localization. 64 cancer patients (stomach (KG): 15 pts. colon (KC): 5 pts, esophagus (KE): 7 pts, pancreas (KP): 2 pts, head and neck (KHN): 27 pts, others (KO): 6 pts) clinically malnourished, untreatable as far as curative therapy is concerned, were studied. 30 health pts (well matched for sex, age and height (H)) and with normal body mass index @Ml) values were considered ascrmtrol group (CTR). All the pts underwent anthropometric and BfA determination with the analysis of the following parameters: resistance (R), reactance (Xc) and PA. According to BIA and anthropometric data, lean body mass (LBM) and the ratio height/resistance (WA) (expressive of extracellular water) were processed.
casas PAm sd
CTR 30 6.7 1.3
WI
Wti KWtl KEftl 21 15 5 7 5.4 3.5 5.2 3.1 1.1 0.9 1.3 0.9 fVSC~:pC0.05,-pC0.01,tp~O.Wt
fmm
2 6.4 0.9
Karl 8 5.1 0.54
The analysis of the observed data shows: 1) significant difference of weight and all BlA data between cancer and controls and in particular of PA @ < 0.001); 2) high percental value of LBM in cancer pts ccrrelatad with extracellular water increase [demonstrated by the significative difference in HEI); 3) differentiation of cancer kocalization accordina to PA. Therefore PA defined through BlA detenination appears usefulh the evakratii of malnourished cancer pts, since it is not influenced by extracellular water variations.
35
NutrItIonalsupport after total laryngactomy
0. LouWli, 1.M&i and G. Varmssi Univ;srsily of L3lqu&
Dept. of Atmstheaiol~
and lntmsive Cme
Thii stwty ~8s parfomd to eva!uste the influence of different nutritionaf Support (enteraf vs parentera on rrutdhionalstatus, postoperative complications and length of hospitalization in patients undergoing total laryngectomy. Twenty-four patients (group A) received enteral nutrllion by percutaneous endoscopic gashostomy (PEG) placed befors Surgery. The nutritional support was started 12 hcurs after surgery with a polymeric diet 1 kcaVml administered by peristafbic pump in slow continuous infusion. Twenty-four patients (group B) were fed by parenteral route through central venous catheter with Manced formula containing 30% lipids. The caloric intake, cakulated by Harris-Benedict fomUa x 1.4, resulted in 2050 + 420 kcal (group A) and 2180 f 610 kcal (group B). The nutritional status was evaluated before surgery and then every five days studying the following pamrMem: body weight, triceps fold, arm mid muscular circumference and serum albumin, transferrin, total lymphocytes and T helperFT suppressor. The resuks of this study show a satisfactory preservation of the nutritional status in the postoperative pariod with no statistically significant diierences in the nutritiinal parameters between the two groups. PEG was well tolerated by the pabants and the only complication was wound infection which rqufred in&ii and drainage in OIW patient wfth no further sequelae. The nutrition related complications were always of lesser importance in group A (dii 4 patients, gastric bloating 3, tube obstruction 3) compared to group B (catheter related 3, metabolic 7). No difference resulted regard@ postoperative surgical complications but patients in group B required longer hospitalization (35 f 13 vs 27 ? 11 days) probably because of the parenteral nutrition complications.
P.31 NuMional status parameters are poor indicators of affecthranassof nubigonal support SAM. Va&qtpen,M.F. von Mm]enfeldt, W.J.H.J. Meijwink, h4.M.W.E. &ees,R.R.W.J. vdHu/st, M. Rour7attandP.B. Soeters bpt. of w, Uniwsity Hospital Maastricht, P.O. Box 5800 6202 AZ Maastfkzht, rheNetheMds IWe pWioUSiy demonstrated in malnourished gastric and colorefrtal cancer patisnts that preoperative nutrllional support, either by parentera or enteral route, results in significantly fewer compiiiions. Whether preoperative nutritional support results in improvement of nutritional status parameters, and whether improvement of nutritional status parameters are asaocfatsd with significant fewer complications is scarcely InvMfgated. Both correlatiins were analysed in the above mentioned trial. PaUmb awd methods 194 gastric and colorectal cancer patients participated in a prospective randomfzed perioperative nutritional support trial from October 1983 till December 1987. The patients were divided into a well nourishsd group (n = 42) and a malnourished group (n = 152) using niMtii index (Nl) that considsrs albumin, percent ideal body weight and total fymphocyte count. The malnourished group was randomized to receive TPN (n L+so). enteral nutrition (TEN) (n = 52) and to a control group (n = 52).
The following - generatfy accepted - nutritional status parameters were anafysed for their association with nutritional support and compliitions: prealbumin, albumin, NI and 3-methythistkJins (3MH). Beauttm Prealbumin, albumin and NI displayed significantly highervaluesin ttreTENgtaupifcMparedtatheTPNgrolpdwlngthepreoperaHvecourse. These differences remained sign&ant in the postoperative phase for albumin and NI. At no point group differences existed in 3MH values. Furthermore no association between the developmsnt of postoperative complications and changes in these parameters could be demonstrated. Mao TF'N TEN MN WN
Rrhmhrfse Me0
0.215 0.240 -
0.210 0.218' 0.23M 0.299
mfos
DAQI7 MQO DA09 23.55 30.59 0.199 0.142 35.48 x5.w 0.136' 33.74t 0.158 39.12't 'p
MaI7 25.58 31.20. 29.72 3146
MO
DAD0 Ma9 193.3 219.1 220.6 162.8 220.1 214.2
Ma17 230.3 277.8 232.5 249.6
We conclude that nutrttiinal status parameters are poor indicators of the effectiveness of nutritional support. Nutritional parameters correlate poorly with postoperative complications.
ConckpMn:
P.32 Biiiectrical impedance assessment (HA) in malnourisheddigestivepatient: role of ths phase angle SO. Sukkar,A. Giawsa and F. Frascio National Institute Cancer Res., Genova, Italy The aim of the present experience is to define the usefulness of the BlA parameter phase angle (PA) in defining the nutritional status of cancer patients and in differentiating BIA behaviour according to cancer localization. 64 cancer patients (stomach (KG): 15 pts. colon (KC): 5 pts, esophagus (KE): 7 pts, pancreas (KP): 2 pts, head and neck (KHN): 27 pts, others (KO): 6 pts) clinically malnourished, untreatable as far as curative therapy is concerned, were studied. 30 health pts (well matched for sex, age and height (H)) and with normal body mass index @Ml) values were considered ascrmtrol group (CTR). All the pts underwent anthropometric and BfA determination with the analysis of the following parameters: resistance (R), reactance (Xc) and PA. According to BIA and anthropometric data, lean body mass (LBM) and the ratio height/resistance (WA) (expressive of extracellular water) were processed.
casas PAm sd
CTR 30 6.7 1.3
WI
Wti KWtl KEftl 21 15 5 7 5.4 3.5 5.2 3.1 1.1 0.9 1.3 0.9 fVSC~:pC0.05,-pC0.01,tp~O.Wt
fmm
2 6.4 0.9
Karl 8 5.1 0.54
The analysis of the observed data shows: 1) significant difference of weight and all BlA data between cancer and controls and in particular of PA @ < 0.001); 2) high percental value of LBM in cancer pts ccrrelatad with extracellular water increase [demonstrated by the significative difference in HEI); 3) differentiation of cancer kocalization accordina to PA. Therefore PA defined through BlA detenination appears usefulh the evakratii of malnourished cancer pts, since it is not influenced by extracellular water variations.
35