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Cholesterol improves the utilization of parenteral lipid
FATTY
ACIDS,
LIPIDS,
s19
OBESITY
from adult patients with cystic fibrosis (CF) with healthy subjects, as well as the role of the normal diet in this fatty acids profile. Method: W e studied 32 adult patients with CF and with stable pulmonary disease and 45 healthy controls of similar age, weigh and BMI. W e canied out a prospective dietary record during 7 days. A blood sample was drawn after overnight fasting to determine blood glucose level, serum lipids and the FASP by gas-liquid-chromatography. Results: The fasting blood glucose were significantly higher in the patients group and total cholesterol and cLDL levels were significantly lower in the patients group. The percentage of miristic, palmitoleic, estezuic, and total monounsaturated and saturated fatty acids were higher in the patients group, and docohexanoic, linoleic and total polyunsaturated (~6 and ~3) fatty acids were lower in patients with CF with respect to the healthy controls. In the patients group the total caloric intake was significantly higher in both, total group (3.122,5*721 vs. 2.615 f 749 kcal per day) and by sex. Likewise, the intake in grams of carbohydrate (CH), lipids (L) and proteins (P) was also higher in the CF group. The caloric distribution was similar in both groups CH: 45f6 vs. 46f5%; L: 39f6 vs. 39f5% y P: 15f3 vs. 14f2%. Conclusions: The fatty acids profile in serum phospholipid from adult patients with CF is clezuiy different from that of the healthy subjects. The caloric intake seems that do not explain the difference in such profile, suggesting an abnomal fatty acid metabolism in patients with CF.
068-P. DOES DIETARY ASSESSMENT O F FISH INTAKE RELATE T O INCORPORATION O F N-3 FATTY ACIDS IN GRANULOCYTES AND ADIPOSE TISSUE? L.J. Bierregaxd t , I.V. Aardestrup t , J.H. Christensen’, E.B. Schmidt t ‘Department of Preventive Cardiology, 2Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark Rationale: W e have previously reported that fish intake determined by a simple scoring system is positively associated with the content of n-3 fatty acids (PUFA) in granulocytes and adipose tissue (Circulation 2001;103:6517). W e here report the results of separating total fish intake to fish intake at lunch and at dinner, respectively. Method: Patients (n=291) referred for coronary angiography due to angina pectoris were included in the study. They filled out a food questionnaire regarding fish intake at lunch and at dinner. A score was given accordingly: Fish score ‘5 (fish once a week or less) or fish score > 5 (fish 2-3 times a week or more). Fish intake was related to n-3 PUFA content in granulocytes and adipose tissue. Results: Only patients eating fish at lunch at least 2-3 times a week had significantly higher levels of n-3 PUFA in granulocytes and adipose tissue compared to patients eating fish once a week or less. Table
1 Fish score 55
Fish score ~5
Fish score 55
Fish score ~5
lunch
lunch
dinner
dinner (n=66)
(~150)
(~141)
(~225)
Granulocytes EPA 20:5 n-3
0.73(0.36)
1.01(0.47)*
0.X1(0.40)
1.05(0.52)
DHA
1.54(0.42)
1.x4(0.47)*
1.65(0.46)
1.X0(0.4X)
2216 n-3
Adipose
tissue
EPA 20:5 n-3
O.ll(O.04)
0.14(0.05)*
0.12(0.05)
0.14(0.06)
DHA
0.31(0.13)
0.41(0.16)*
0.34(0.15)
0.40(0.17)
2216 n-3
* P5 0.001
(compared
to lunch
with
a fish score 55).
Results
are mean & SD
Conclusions: Dietary assessment of fish intake at lunch was positively associated with n-3 PUFA in granulocytes and in adipose tissue. The strong association with fish intake at lunch may reflect the Scandinavian dietary habits, which may be different from other European countries. This food questionnaire may be a simple and useful way to determine patients fish intake.
069-P. COMPARATIVE STUDY BETWEEN TOTAL PARENTERAL NUTRITION (TPN) AND NO NUTRITIONAL SUPPORT IN PERIOPERATIVE BARIATRIC SURGERY M.J. Mzutinez’, M.A. Martinez’, M.J. Morales’, P. Pxada3, I. Otero3, I. Marmi3, N. Mzutinez’ , E. Casa13 ‘Pharmacy, 2Endocrinology, 3Surgery, Meixoeiro Hospital, Vigo, Spain Rationale: To evaluate p&operatively the influence of nutritional support (TPN vs no pxenteral nutrition) on nutritional outcome, complications, and stay in bxiatric surgery (BS). Method: Study of all patients under BS (15 gastric bypass and 47 biliopancreatic diversion) in a General Teaching Hospital (421 beds). The first 38 consecutive received TPN and the next 24 patients didn’t receive it (nPN) during the fasting postoperative period. After fasting a progressive oral diet with protein supplementation was introduced. Nutritional status, perioperative complications and post-surgical hospital stay were compxed. Chi square, Student’s t and Mann-Whitney tests were used for statistic analysis. Results: 62 patients (53 female), mean age 39.5 SD 11.2 years, BMI 50.6 SD 5.9 Kg/m2, were included. All had normal serum albumin (SA) before BS (3.9 SD 0.26 g/dL). 38 patients received TPN (2138 SD 153 Kcal/d, 0.12 gN/Kg, 125 SD 18 non-protein Kcal/gN) during 8.72 SD 2.64 days. No significant differences between groups were found in age, final fasting period SA (3.03 SD 0.39 vs 2.94 SD 0.27 g/dL) and 30 days postoperative SA (3.78 SD 0.26 vs 3.79 SD 0.34 g/dL). Mean weight loss at 30 days was 8.7 SD 2.9% from initial. No differences were found in non-catheter related infections, mainly minxy tract infections (23.7% in TPN vs 20.8% in nPN). Bacteriemia was present in 21.1% in TPN group and 16.7% in nPN (p=O,4). Median hospital stay after surgery was 14 SD 10 days in TPN and 11.5 SD 11 days in nPN (p=O.O03). Conclusions: 1) Nutritional status under BS perioperatively and 30 days post-surgery was no different between patients received TPN or nPN. 2) Surgical hospital stay was significantly decreased in nPN without a gleater incidence of complications. 3) TPN seems no necessary perioperatively in BS unless other post-surgical complications.
070-P. CHOLESTEROL PARENTERAL LIPID
IMPROVES THE UTILIZATION
OF
W . Druml, M. Fischer Medical Department III, Vienna General Hospital, Vienna, Austria Rationale: Previous attempts to improve the composition of lipid emulsions have focused mainly on the triglyceride moiety. In the first fundamental modification of a lipid emulsion since the broader introduction into clinical medicine, we included free cholesterol into a lipid emulsion Method: In 10 healthy male nolmolipemic volunteers we evaluated elimination and hy&olysis of triglycerides and lipid oxydation (by indirect calorimetry) comparing a conventional lipid emulsion (20% triglycerides) with an otherwise identical emulsion with addition of 4 g/I free cholesterol. Results: The rise in plasma triglycerides was mitigated during infusion of the cholesterol enriched solution (323.9 + 29.0 vs. 209.9 + 19.5 m g dL-1, piO.OOl), plasma half life was reduced (41.6 + 5.4 vs. 29.3 + 5.1 min, piO.OS), total body clearance was enhanced (0.96 + 0.1 vs. 1.52 + 0.2 ml. b.w. min-1, p ~0.02). The rise in plasma free fatty acids (402.5 + 35.0 vs. 532.2 + 64.0 wmol L-l; piO.02) and in ketone bodies (fi-hy&oxy butyrate) (179.8 + 28.7 vs. 259.5 + 37.0 wmol L-l; p ~0.02) was augmented. Increases in plasma insulin and glucagon were blunted (piO.05). The fall in respiratory quotient was more pronounced and fraction of lipid oxydation as percentage of total energy expenditure was increased (67.3 + 3.9 vs. 70.4 + 4.9%, piO.05) during infusion of the modified solution. No impatiment of gas exchange or other side effects were observed. Conclusions: Taken together these results indicate that the elimination of a cholesterol supplemented lipid emulsion is accelerated, triglyceride hydrolysis is enhanced, and lipid oxydation is augmented. Thus, addition of cholesterol to a lipid emulsion might not only presents a means of providing cholesterol in parentera nutrition but helps to reshape artificial lipid pavtitles to a more chylomicron resembling composition and improves lipid
ACIDS,
LIPIDS,
s19
OBESITY
from adult patients with cystic fibrosis (CF) with healthy subjects, as well as the role of the normal diet in this fatty acids profile. Method: W e studied 32 adult patients with CF and with stable pulmonary disease and 45 healthy controls of similar age, weigh and BMI. W e canied out a prospective dietary record during 7 days. A blood sample was drawn after overnight fasting to determine blood glucose level, serum lipids and the FASP by gas-liquid-chromatography. Results: The fasting blood glucose were significantly higher in the patients group and total cholesterol and cLDL levels were significantly lower in the patients group. The percentage of miristic, palmitoleic, estezuic, and total monounsaturated and saturated fatty acids were higher in the patients group, and docohexanoic, linoleic and total polyunsaturated (~6 and ~3) fatty acids were lower in patients with CF with respect to the healthy controls. In the patients group the total caloric intake was significantly higher in both, total group (3.122,5*721 vs. 2.615 f 749 kcal per day) and by sex. Likewise, the intake in grams of carbohydrate (CH), lipids (L) and proteins (P) was also higher in the CF group. The caloric distribution was similar in both groups CH: 45f6 vs. 46f5%; L: 39f6 vs. 39f5% y P: 15f3 vs. 14f2%. Conclusions: The fatty acids profile in serum phospholipid from adult patients with CF is clezuiy different from that of the healthy subjects. The caloric intake seems that do not explain the difference in such profile, suggesting an abnomal fatty acid metabolism in patients with CF.
068-P. DOES DIETARY ASSESSMENT O F FISH INTAKE RELATE T O INCORPORATION O F N-3 FATTY ACIDS IN GRANULOCYTES AND ADIPOSE TISSUE? L.J. Bierregaxd t , I.V. Aardestrup t , J.H. Christensen’, E.B. Schmidt t ‘Department of Preventive Cardiology, 2Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark Rationale: W e have previously reported that fish intake determined by a simple scoring system is positively associated with the content of n-3 fatty acids (PUFA) in granulocytes and adipose tissue (Circulation 2001;103:6517). W e here report the results of separating total fish intake to fish intake at lunch and at dinner, respectively. Method: Patients (n=291) referred for coronary angiography due to angina pectoris were included in the study. They filled out a food questionnaire regarding fish intake at lunch and at dinner. A score was given accordingly: Fish score ‘5 (fish once a week or less) or fish score > 5 (fish 2-3 times a week or more). Fish intake was related to n-3 PUFA content in granulocytes and adipose tissue. Results: Only patients eating fish at lunch at least 2-3 times a week had significantly higher levels of n-3 PUFA in granulocytes and adipose tissue compared to patients eating fish once a week or less. Table
1 Fish score 55
Fish score ~5
Fish score 55
Fish score ~5
lunch
lunch
dinner
dinner (n=66)
(~150)
(~141)
(~225)
Granulocytes EPA 20:5 n-3
0.73(0.36)
1.01(0.47)*
0.X1(0.40)
1.05(0.52)
DHA
1.54(0.42)
1.x4(0.47)*
1.65(0.46)
1.X0(0.4X)
2216 n-3
Adipose
tissue
EPA 20:5 n-3
O.ll(O.04)
0.14(0.05)*
0.12(0.05)
0.14(0.06)
DHA
0.31(0.13)
0.41(0.16)*
0.34(0.15)
0.40(0.17)
2216 n-3
* P5 0.001
(compared
to lunch
with
a fish score 55).
Results
are mean & SD
Conclusions: Dietary assessment of fish intake at lunch was positively associated with n-3 PUFA in granulocytes and in adipose tissue. The strong association with fish intake at lunch may reflect the Scandinavian dietary habits, which may be different from other European countries. This food questionnaire may be a simple and useful way to determine patients fish intake.
069-P. COMPARATIVE STUDY BETWEEN TOTAL PARENTERAL NUTRITION (TPN) AND NO NUTRITIONAL SUPPORT IN PERIOPERATIVE BARIATRIC SURGERY M.J. Mzutinez’, M.A. Martinez’, M.J. Morales’, P. Pxada3, I. Otero3, I. Marmi3, N. Mzutinez’ , E. Casa13 ‘Pharmacy, 2Endocrinology, 3Surgery, Meixoeiro Hospital, Vigo, Spain Rationale: To evaluate p&operatively the influence of nutritional support (TPN vs no pxenteral nutrition) on nutritional outcome, complications, and stay in bxiatric surgery (BS). Method: Study of all patients under BS (15 gastric bypass and 47 biliopancreatic diversion) in a General Teaching Hospital (421 beds). The first 38 consecutive received TPN and the next 24 patients didn’t receive it (nPN) during the fasting postoperative period. After fasting a progressive oral diet with protein supplementation was introduced. Nutritional status, perioperative complications and post-surgical hospital stay were compxed. Chi square, Student’s t and Mann-Whitney tests were used for statistic analysis. Results: 62 patients (53 female), mean age 39.5 SD 11.2 years, BMI 50.6 SD 5.9 Kg/m2, were included. All had normal serum albumin (SA) before BS (3.9 SD 0.26 g/dL). 38 patients received TPN (2138 SD 153 Kcal/d, 0.12 gN/Kg, 125 SD 18 non-protein Kcal/gN) during 8.72 SD 2.64 days. No significant differences between groups were found in age, final fasting period SA (3.03 SD 0.39 vs 2.94 SD 0.27 g/dL) and 30 days postoperative SA (3.78 SD 0.26 vs 3.79 SD 0.34 g/dL). Mean weight loss at 30 days was 8.7 SD 2.9% from initial. No differences were found in non-catheter related infections, mainly minxy tract infections (23.7% in TPN vs 20.8% in nPN). Bacteriemia was present in 21.1% in TPN group and 16.7% in nPN (p=O,4). Median hospital stay after surgery was 14 SD 10 days in TPN and 11.5 SD 11 days in nPN (p=O.O03). Conclusions: 1) Nutritional status under BS perioperatively and 30 days post-surgery was no different between patients received TPN or nPN. 2) Surgical hospital stay was significantly decreased in nPN without a gleater incidence of complications. 3) TPN seems no necessary perioperatively in BS unless other post-surgical complications.
070-P. CHOLESTEROL PARENTERAL LIPID
IMPROVES THE UTILIZATION
OF
W . Druml, M. Fischer Medical Department III, Vienna General Hospital, Vienna, Austria Rationale: Previous attempts to improve the composition of lipid emulsions have focused mainly on the triglyceride moiety. In the first fundamental modification of a lipid emulsion since the broader introduction into clinical medicine, we included free cholesterol into a lipid emulsion Method: In 10 healthy male nolmolipemic volunteers we evaluated elimination and hy&olysis of triglycerides and lipid oxydation (by indirect calorimetry) comparing a conventional lipid emulsion (20% triglycerides) with an otherwise identical emulsion with addition of 4 g/I free cholesterol. Results: The rise in plasma triglycerides was mitigated during infusion of the cholesterol enriched solution (323.9 + 29.0 vs. 209.9 + 19.5 m g dL-1, piO.OOl), plasma half life was reduced (41.6 + 5.4 vs. 29.3 + 5.1 min, piO.OS), total body clearance was enhanced (0.96 + 0.1 vs. 1.52 + 0.2 ml. b.w. min-1, p ~0.02). The rise in plasma free fatty acids (402.5 + 35.0 vs. 532.2 + 64.0 wmol L-l; piO.02) and in ketone bodies (fi-hy&oxy butyrate) (179.8 + 28.7 vs. 259.5 + 37.0 wmol L-l; p ~0.02) was augmented. Increases in plasma insulin and glucagon were blunted (piO.05). The fall in respiratory quotient was more pronounced and fraction of lipid oxydation as percentage of total energy expenditure was increased (67.3 + 3.9 vs. 70.4 + 4.9%, piO.05) during infusion of the modified solution. No impatiment of gas exchange or other side effects were observed. Conclusions: Taken together these results indicate that the elimination of a cholesterol supplemented lipid emulsion is accelerated, triglyceride hydrolysis is enhanced, and lipid oxydation is augmented. Thus, addition of cholesterol to a lipid emulsion might not only presents a means of providing cholesterol in parentera nutrition but helps to reshape artificial lipid pavtitles to a more chylomicron resembling composition and improves lipid