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MON-LB035: The Effect of Acute Bout of Resistance Exercise Mtorc1 Signaling During Starvation
LATE BREAKING ABSTRACTS II
S263
Table 1. BMI (kg/m2 ) Fat mass (%) Resting metabolic rate (kcal/d) Respiratory Quotient CHO oxidation (mg/min) Fat oxidation (mg/min) Steps/day SF-36 score Energy intake (kcal/day) CHO (%) Fat (%) Protein (%)
Sleep duration <300 min
Sleep duration >300 min
p
39.8±3.0 39.5±5.4 2000.7±370.4 0.63±0.1 18.2±9.8 190.1±66.7 5842.9±2084.6 49.0±12.6 1969.6±707.1 53.3±5.1 31.4±5.8 15.3±3.0
37.0±6.9 36.6±5.5 1837.9±395.8 0.79±0.1 139.2±47.0 95.5±65.7 16703.0±10457.6 36.0±19.1 2160.3±951.3 48.4±9.2 35.5±7.6 16.1±2.2
<0.05 <0.05 NS <0.05 <0.05 <0.05 <0.05 <0.05 NS <0.05 <0.05 NS
Conclusion: Reduced sleep duration influenced adiposity, energy expenditure, substrate use and quality of life, but not energy intake in obese subjects. Subjects with sleep deficiency were more physically inactive. Disclosure of Interest: None declared
MON-LB033 BODY COMPOSITION IN GASTROINTESTINAL CANCER PATIENTS REFERRED TO RADIOTHERAPY P. Ravasco1,2 , P. Neves1 , D.R. Jo˜ ao1 . 1 Laborat´ orio de Nutri¸ca ˜o, Faculdade de Medicina de Lisboa, 2 Hospital de Santa Maria CHLN, Lisboa, Portugal Rationale: Malnutrition is common among gastrointestinal (GI) cancer patients (pts) and is worsened by radiotherapy (RT). Yet body composition (BC) inadequacy may be a key factor affecting cancer outcomes. Sarcopenia has emerged as a prevalent BC phenotype which is predictive of poor functional status, shorter time of tumor progression, shorter survival, and higher incidence of dose-limiting toxicity. This study aimed to analyze nutritional status (NS) and BC of pts diagnosed with GI cancers, referred for RT. Methods: 18 pts. Evaluated parameters: height, weight, weight loss and body mass index (BMI) was calculated. NS: Patient-Generated Subjective Global Assessment (PG-SGA). BC (phase angle, fat mass index [FMI] and fat free mass index [FFMI]): Bioelectrical Impedance Analyzes (BIABiodynamics 450® ). Results: Colorectal cancer was the most frequent (88.9%; n = 16). Cancer Stage: III 83.3% (n = 15); IV 11.1% (n = 2); II 5.6% (n = 1). The majority (61.1%; n = 11) presented the smallest weight loss level (0 1, 9% 1 M; 0 1, 9% 6 M), according to PG-SGA. This tool classified 88.9% (n = 16) of pts as moderately malnourished or suspected malnutrition and 11.1% (n = 2) as well-nourished. According to BMI, the prevalence of overweight/obesity was 61.1% (n = 11). 66.7% (n = 12) indicated a critical need for improved symptom management and/or nutrient intervention options. 20% (n = 1) of women and 30.7% (n = 4) of men presented a high FMI. There were no cases of low FFMI in both genders. Relative to phase angle, one patient was below P5. Conclusion: The prevalence of malnutrition was high, according to PG-SGA, and the majority of pts presented symptoms with nutritional impact. However, BMI indicated a high prevalence of overweight/obesity which is reinforced by BIA. Given the role that NS and BC play in cancer treatment outcomes, the inadequate NS found in these pts and the excessive adiposity call for effective nutritional assessment and for an integrated nutritional intervention in GI cancer pts. Disclosure of Interest: None declared
MON-LB034 NASOGASTRIC TUBE FEEDING IN ACUTE ELDERLY PATIENTS: WHEN AND WHY? A.M.D.D.S. Vieira1 , C.M. Gon¸ calves1 , B. Castelo1 , H. Gaspar1 , A.M. Lopes2 . 1 Clinical Nutrition Team, Centro hospitalar do Algarve, Portim˜ ao, 2 Clinical Nutrition Team, Centro hospitalar do Algarve, Faro, Portugal Rationale: As we found many geriatric inpatients in our hospital wards with enteral tube nutrition support, our purpose was to regard the needs for this procedure. Methods: Using an observational and prospective methodology, in May 2015, we collected data from all adult noncritical acute inpatients admitted in Portim˜ ao Lagos Unit. Out of this group, we studied all patients with nasogastric tube (NGT) feeding and we analyzed the demographic characteristics, the main diagnosis, the indication and day of tube insertion and the inpatient mortality. Statistical analysis was performed using SPSS for Windows. Results: A total of 206 patients were admitted, out of which 43 (20.9%) had NGT feeding. Were excluded 13 (6.3%) patients as the tube insertion was prior the admission. Out of the 30 patients analyzed, 16 (53%) were female. The mean age was 85.2±9.2 years. Most patients were admitted due to an infectious disease [21/30 (70%)]. The most frequent comorbidity observed was advanced dementia [9/30 (30%)]. Food refusal was the main reason to use a NGT [24 (80%)]. The tube was inserted in the first 24 h of hospitalization in 14 (47%) patients. The inpatient mortality was 37% (11) and the mean survival 12 days. Conclusion: NGT feeding in elderly patients is a really concerning and emergent health problem with an estimated prevalence of more than 200:1000 inpatients. At least 80% of the patients with NGT feeding didn’t have a justifiable clinical condition. In almost half the cases, this decision was too premature, not allowing time for acute disease recovery. The authors would like to point out that patients with short life expectancy do not always benefit from artificial nutrition. Interdisciplinary collaboration and proactive planning within the institution are important for benefit of the patient. Disclosure of Interest: None declared
MON-LB035 THE EFFECT OF ACUTE BOUT OF RESISTANCE EXERCISE MTORC1 SIGNALING DURING STARVATION K. Sase1 , S. Fujita1 . 1 Ritsumeikan University, Kusatsu, Japan Rationale: Previous studies have reported that endurance exercise during food deprivation further augments skeletal muscle proteolysis. Although resistance exercise has been shown to induce muscle protein synthesis and subsequent muscle hypertrophy, the effect of RE during food deprivation state has not been reported. Therefore, the purpose of this study was to investigate the effect of RE during starvation on the expression of signaling proteins related to muscle protein synthesis. Methods: Male SD rats (aged 11 weeks) were randomly assigned to either extended fasting + resistance exercise (FE, exercise after 72 hr fasting) or resistance exercise with regular overnight fasting (E, exercise with 12 hr fasting) groups. Contralateral legs were used for non-exercised
S264 controls (F, 72 hr fasting; CN, 12 hr fasting, respectively). Resistance exercise was conducted by percutaneous electrical stimulation in right gastrocnemius muscle. Animals were sacrificed and muscle samples were taken at 3 h after the exercise bout. Western blotting analysis was used to measure expression of signaling proteins [SF1] associated with skeletal muscle hypertrophy. Results: Phosphorylation of p70S6K was significantly increased in E group compared with non-exercised leg. FE group was tended to increase compared with non-exercise leg (p = 0.07). But the phosphorylation of p70S6K of exercise legs were not different between FE and E groups. *p < 0.05 vs. Control leg, # p = 0.07 vs. Control leg. Conclusion: Acute bout of resistance exercise during starvation can augment muscle cell signaling related to protein synthesis in rats. Disclosure of Interest: None declared
MON-LB036 HOME PARENTERAL NUTRITION (HPN) IN PATIENTS WITH POST-BARIATRIC SURGERY COMPLICATIONS: INDICATIONS AND OUTCOME A. Van Gossum1 , L. Pironi2 , F. Joly3 , on behalf of ESPEN HAN CIF contributors. 1 Service de Gastroent´ erologie, Hˆ opital Erasme, Brussels, Belgium; 2 Center of Chronic Intestinal Failure, St Orsola-Malpighi Hospital, Bologna, Italy; 3 Service de Gastroenterologie et Assistance Nutritive, Hˆ opital Beaujon, Paris, France Rationale: Obesity is a worldwide health problem. Bariatric surgery (BS) is becoming one of the most commonly used method for fighting obesity and its associated comorbidities. Any type of BS techniques may induce early or late complications that may require a nutritional support. The aim of this retrospective observational study is to determine the indications for HPN in patients who developed post-bariatric surgery complications and the outcome. Methods: A specific questionnaire was designed by the ESPEN HAN/CIF working group and submitted to HPN centers. This questionnaire included: patient’s demographics, type of surgery, BMI before surgery and at start of HPN, indications for HPN (early within 2 months after surgery or late) including technical and nutritional complications, outcome, PN regimen, HPN complications. Patients were retrospectively included from January 2008 to June 2014. Results: Eighteen HPN centers did answer covering a total of 2880 HPN patients during this period, 77 of whom had BS (65 females; mean age 51±7 years); gastric by-pass was performed in 69% of the patients; the mean BMI was 44.4 and 23.2 before surgery and at start of HPN, respectively. Indications for HPN were early complications in 17 cases and late complications in 60 cases. Early complications were mostly anastomotic leakage/fistula; late complications were hypoalbuminemia, vitamins, trace elements deficiencies. Out of 77 patients, 16 needed a surgical reintervention, 29 were weaned off HPN but 6 died (no HPN related death). During the HPN period, 58% of the patients were rehospitalized and central venous complications were observed in 41%. Diabetes mellitus was described in 17/77 patients. HPN was supportive in 60 patients and exclusive in 17 patients (mean caloric intake: 23±6 kcal/k BW/day and 1.2 g/kBW/day). Only 7/77 patients had professional activities on HPN.
Late Breaking Abstracts Conclusion: This is the largest observational multicenter study that describes the use of HPN in patients with postBS complications. Severe hypoalbuminemia is a major late complication. Rate of rehospitalisation and CVC infection are high. HPN may be a “bridge therapy” before surgical revision. The high mortality rate reflects the complexity of these cases. Disclosure of Interest: None declared
S263
Table 1. BMI (kg/m2 ) Fat mass (%) Resting metabolic rate (kcal/d) Respiratory Quotient CHO oxidation (mg/min) Fat oxidation (mg/min) Steps/day SF-36 score Energy intake (kcal/day) CHO (%) Fat (%) Protein (%)
Sleep duration <300 min
Sleep duration >300 min
p
39.8±3.0 39.5±5.4 2000.7±370.4 0.63±0.1 18.2±9.8 190.1±66.7 5842.9±2084.6 49.0±12.6 1969.6±707.1 53.3±5.1 31.4±5.8 15.3±3.0
37.0±6.9 36.6±5.5 1837.9±395.8 0.79±0.1 139.2±47.0 95.5±65.7 16703.0±10457.6 36.0±19.1 2160.3±951.3 48.4±9.2 35.5±7.6 16.1±2.2
<0.05 <0.05 NS <0.05 <0.05 <0.05 <0.05 <0.05 NS <0.05 <0.05 NS
Conclusion: Reduced sleep duration influenced adiposity, energy expenditure, substrate use and quality of life, but not energy intake in obese subjects. Subjects with sleep deficiency were more physically inactive. Disclosure of Interest: None declared
MON-LB033 BODY COMPOSITION IN GASTROINTESTINAL CANCER PATIENTS REFERRED TO RADIOTHERAPY P. Ravasco1,2 , P. Neves1 , D.R. Jo˜ ao1 . 1 Laborat´ orio de Nutri¸ca ˜o, Faculdade de Medicina de Lisboa, 2 Hospital de Santa Maria CHLN, Lisboa, Portugal Rationale: Malnutrition is common among gastrointestinal (GI) cancer patients (pts) and is worsened by radiotherapy (RT). Yet body composition (BC) inadequacy may be a key factor affecting cancer outcomes. Sarcopenia has emerged as a prevalent BC phenotype which is predictive of poor functional status, shorter time of tumor progression, shorter survival, and higher incidence of dose-limiting toxicity. This study aimed to analyze nutritional status (NS) and BC of pts diagnosed with GI cancers, referred for RT. Methods: 18 pts. Evaluated parameters: height, weight, weight loss and body mass index (BMI) was calculated. NS: Patient-Generated Subjective Global Assessment (PG-SGA). BC (phase angle, fat mass index [FMI] and fat free mass index [FFMI]): Bioelectrical Impedance Analyzes (BIABiodynamics 450® ). Results: Colorectal cancer was the most frequent (88.9%; n = 16). Cancer Stage: III 83.3% (n = 15); IV 11.1% (n = 2); II 5.6% (n = 1). The majority (61.1%; n = 11) presented the smallest weight loss level (0 1, 9% 1 M; 0 1, 9% 6 M), according to PG-SGA. This tool classified 88.9% (n = 16) of pts as moderately malnourished or suspected malnutrition and 11.1% (n = 2) as well-nourished. According to BMI, the prevalence of overweight/obesity was 61.1% (n = 11). 66.7% (n = 12) indicated a critical need for improved symptom management and/or nutrient intervention options. 20% (n = 1) of women and 30.7% (n = 4) of men presented a high FMI. There were no cases of low FFMI in both genders. Relative to phase angle, one patient was below P5. Conclusion: The prevalence of malnutrition was high, according to PG-SGA, and the majority of pts presented symptoms with nutritional impact. However, BMI indicated a high prevalence of overweight/obesity which is reinforced by BIA. Given the role that NS and BC play in cancer treatment outcomes, the inadequate NS found in these pts and the excessive adiposity call for effective nutritional assessment and for an integrated nutritional intervention in GI cancer pts. Disclosure of Interest: None declared
MON-LB034 NASOGASTRIC TUBE FEEDING IN ACUTE ELDERLY PATIENTS: WHEN AND WHY? A.M.D.D.S. Vieira1 , C.M. Gon¸ calves1 , B. Castelo1 , H. Gaspar1 , A.M. Lopes2 . 1 Clinical Nutrition Team, Centro hospitalar do Algarve, Portim˜ ao, 2 Clinical Nutrition Team, Centro hospitalar do Algarve, Faro, Portugal Rationale: As we found many geriatric inpatients in our hospital wards with enteral tube nutrition support, our purpose was to regard the needs for this procedure. Methods: Using an observational and prospective methodology, in May 2015, we collected data from all adult noncritical acute inpatients admitted in Portim˜ ao Lagos Unit. Out of this group, we studied all patients with nasogastric tube (NGT) feeding and we analyzed the demographic characteristics, the main diagnosis, the indication and day of tube insertion and the inpatient mortality. Statistical analysis was performed using SPSS for Windows. Results: A total of 206 patients were admitted, out of which 43 (20.9%) had NGT feeding. Were excluded 13 (6.3%) patients as the tube insertion was prior the admission. Out of the 30 patients analyzed, 16 (53%) were female. The mean age was 85.2±9.2 years. Most patients were admitted due to an infectious disease [21/30 (70%)]. The most frequent comorbidity observed was advanced dementia [9/30 (30%)]. Food refusal was the main reason to use a NGT [24 (80%)]. The tube was inserted in the first 24 h of hospitalization in 14 (47%) patients. The inpatient mortality was 37% (11) and the mean survival 12 days. Conclusion: NGT feeding in elderly patients is a really concerning and emergent health problem with an estimated prevalence of more than 200:1000 inpatients. At least 80% of the patients with NGT feeding didn’t have a justifiable clinical condition. In almost half the cases, this decision was too premature, not allowing time for acute disease recovery. The authors would like to point out that patients with short life expectancy do not always benefit from artificial nutrition. Interdisciplinary collaboration and proactive planning within the institution are important for benefit of the patient. Disclosure of Interest: None declared
MON-LB035 THE EFFECT OF ACUTE BOUT OF RESISTANCE EXERCISE MTORC1 SIGNALING DURING STARVATION K. Sase1 , S. Fujita1 . 1 Ritsumeikan University, Kusatsu, Japan Rationale: Previous studies have reported that endurance exercise during food deprivation further augments skeletal muscle proteolysis. Although resistance exercise has been shown to induce muscle protein synthesis and subsequent muscle hypertrophy, the effect of RE during food deprivation state has not been reported. Therefore, the purpose of this study was to investigate the effect of RE during starvation on the expression of signaling proteins related to muscle protein synthesis. Methods: Male SD rats (aged 11 weeks) were randomly assigned to either extended fasting + resistance exercise (FE, exercise after 72 hr fasting) or resistance exercise with regular overnight fasting (E, exercise with 12 hr fasting) groups. Contralateral legs were used for non-exercised
S264 controls (F, 72 hr fasting; CN, 12 hr fasting, respectively). Resistance exercise was conducted by percutaneous electrical stimulation in right gastrocnemius muscle. Animals were sacrificed and muscle samples were taken at 3 h after the exercise bout. Western blotting analysis was used to measure expression of signaling proteins [SF1] associated with skeletal muscle hypertrophy. Results: Phosphorylation of p70S6K was significantly increased in E group compared with non-exercised leg. FE group was tended to increase compared with non-exercise leg (p = 0.07). But the phosphorylation of p70S6K of exercise legs were not different between FE and E groups. *p < 0.05 vs. Control leg, # p = 0.07 vs. Control leg. Conclusion: Acute bout of resistance exercise during starvation can augment muscle cell signaling related to protein synthesis in rats. Disclosure of Interest: None declared
MON-LB036 HOME PARENTERAL NUTRITION (HPN) IN PATIENTS WITH POST-BARIATRIC SURGERY COMPLICATIONS: INDICATIONS AND OUTCOME A. Van Gossum1 , L. Pironi2 , F. Joly3 , on behalf of ESPEN HAN CIF contributors. 1 Service de Gastroent´ erologie, Hˆ opital Erasme, Brussels, Belgium; 2 Center of Chronic Intestinal Failure, St Orsola-Malpighi Hospital, Bologna, Italy; 3 Service de Gastroenterologie et Assistance Nutritive, Hˆ opital Beaujon, Paris, France Rationale: Obesity is a worldwide health problem. Bariatric surgery (BS) is becoming one of the most commonly used method for fighting obesity and its associated comorbidities. Any type of BS techniques may induce early or late complications that may require a nutritional support. The aim of this retrospective observational study is to determine the indications for HPN in patients who developed post-bariatric surgery complications and the outcome. Methods: A specific questionnaire was designed by the ESPEN HAN/CIF working group and submitted to HPN centers. This questionnaire included: patient’s demographics, type of surgery, BMI before surgery and at start of HPN, indications for HPN (early within 2 months after surgery or late) including technical and nutritional complications, outcome, PN regimen, HPN complications. Patients were retrospectively included from January 2008 to June 2014. Results: Eighteen HPN centers did answer covering a total of 2880 HPN patients during this period, 77 of whom had BS (65 females; mean age 51±7 years); gastric by-pass was performed in 69% of the patients; the mean BMI was 44.4 and 23.2 before surgery and at start of HPN, respectively. Indications for HPN were early complications in 17 cases and late complications in 60 cases. Early complications were mostly anastomotic leakage/fistula; late complications were hypoalbuminemia, vitamins, trace elements deficiencies. Out of 77 patients, 16 needed a surgical reintervention, 29 were weaned off HPN but 6 died (no HPN related death). During the HPN period, 58% of the patients were rehospitalized and central venous complications were observed in 41%. Diabetes mellitus was described in 17/77 patients. HPN was supportive in 60 patients and exclusive in 17 patients (mean caloric intake: 23±6 kcal/k BW/day and 1.2 g/kBW/day). Only 7/77 patients had professional activities on HPN.
Late Breaking Abstracts Conclusion: This is the largest observational multicenter study that describes the use of HPN in patients with postBS complications. Severe hypoalbuminemia is a major late complication. Rate of rehospitalisation and CVC infection are high. HPN may be a “bridge therapy” before surgical revision. The high mortality rate reflects the complexity of these cases. Disclosure of Interest: None declared