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MON-P071: Increase in BMI after Intestinal Transplantation (ITX) in Adults without Total Parenteral Nutrition (TPN)
Liver and gastrointestinal tract 2 patients with NAFLD. Also we discover how this program can improve hepatic apoptosis as a main predictor of Nonalcoholic fatty liver disease progression, which can be measured by biomarker cytokeratin 18. Methods: 58 patients with NAFLD were randomized in a two groups. All of them had diagnosed NAFLD. We described importance of weight loss for the improving NAFLD. We gave diet recommendations which consists of reducing portions of food, avoiding drinking soda water, reducing carbohydrates intake and increasing fiber intake. For better diet adherence every day first group were writing food diaries. Each person from first group had 8 personalised sessions with doctor during 6 months. On each sessions patients were measured of weight, waist circumference and fat percentage measured by bioelectric impedancemetry. To those from control group were just given general recommendations of changing eating behavior without controlled sessions with doctor during 6 months. Results: We observed significant decreasing in weight loss ( p < 0,01), cytokeratin18 fragments M30 ( p < 0,01), Fatty liver index, Visceral adiposity index and Fat contain measured by bioelectric impedancemetry. Conclusion: Individualized controlled and motivational program of changing eating behavior leads to weight loss and improves steatosis and Cytokeratin 18 levels in patients with NAFLD during 6 months. Disclosure of Interest: None declared.
MON-P069 LIPID, FETUIN-A AND MACROPHAGE ZONATION IN HIGH FAT DIET FOZ-FOZ MICE WITH NON-ALCOHOLIC STEATOHEPATITIS N. Lanthier1,2 *, Q. Etienne1, V. Lebrun1, L. Poekes1, Y. Horsmans1,2, I. A. Leclercq1. 1Laboratory of Gastroenterology and Hepatology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, 2 Service d’Hépato-Gastro-Entérologie, Cliniques universitaires Saint-Luc, Brussels, Belgium Rationale: Innate immunity and insulin resistance constitute potential mechanisms underlying non-alcoholic steatohepatitis (NASH) progression. Here, we explore the effect of a high fat diet (HFD) on a liver-derived protein increased in diabetic patients called fetuin-A and its relation with the development of steatosis, cell injury and liver macrophage activation in a mouse model of obesity and NASH. Methods: Male foz/foz mice were fed a normal diet (ND) or a HFD for 12 (long term HFD or LHFD) or 30 weeks (very long term HFD or VLHFD) to induce early or definite fibrosing NASH, respectively. Results: Compared to ND-fed foz/foz mice, HFD-fed foz/foz mice developed obesity, insulin resistance and either steatosis (LHFD) or steatohepatitis with steatosis, hepatocyte ballooning, inflammation and fibrosis (VLHFD). In ND fed mice, fetuin-A staining was positive in the cytoplasm of zone 3 centrilobular hepatocytes while F4/80+ Kupffer cells were located in the sinusoids of the intermediate lobular zone 2. In LHFD fed mice, lipid deposition occurred in the zone 3 centrilobular hepatocytes. Liver m-RNA expression showed a 2-fold increased level of F4/80+ macrophage mRNA compared to ND. In VLHD, a loss of zonation of liver steatosis with the presence of fat loaded hepatocytes in all liver lobular zones was
S205 observed. Fetuin-A was highest in periportal fat-ladden hepatocytes and next to inflammatory infiltrates. There was a 4-fold F4/80 mRNA increased level upon VLHFD compared to ND. Interestingly, F4/80+ cells from lipogranuloma were positive for fetuin-A protein staining. Conclusion: Lipid deposition, macrophage infiltration and fetuin-A production may be important factors in the liver tissue remodeling observed during NASH development. Disclosure of Interest: None declared.
MON-P070 EFFECTS OF REDUCED SATURATED FATTY ACID ON BODY COMPOSITION IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) N. B. Erdem1 *, Z. Goktas1. 1Nutrition and Dietetics, Hacettepe University, Ankara, Turkey Rationale: Lifestyle changes including dietary patterns represents the main target for the prevention and treatment of nonalcoholic fatty liver disease (NAFLD). Saturated fatty acids (SFA) have unfavorable effects on lipid and glucose metabolism which might worsen the progression of NAFLD. The aim of this study to determine the effects of reduced saturated fatty acid diet (7%) on anthropometric measurements of individuals with non-alcoholic fatty liver disease. Methods: A total of 23 adults aged between 19 and 65 years participated in the study. Subjects were randomly divided into two groups. Both groups followed a diet treatment for three months; group 1 with 7% saturated fatty acid (n = 11) and group 2 with 12% saturated fatty acid (n = 12). Participants visited at baseline, 1st month and 3rd month. Data collected during each visit included height, weight, waist, hip, neck circumferences, body fat composition, body muscle composition and intra abdominal fat. Body fat and muscle compositions were collected using bioelectrical impedance analysis. Intra abdominal fat was measured via VISCAN. Results: A total of 12 female and 11 male subjects participated in the study. In both groups, weight significantly decreased; from 86.1 to 81.2 in 7% SFA group and from 76.8 to 74.0 in 12% SFA group ( p < 0.05). Moreover; waist circumferences, intraabdominal fat and Body Mass Index (BMI) changes were significant in both groups ( p < 0.05). For 7% SFA group waist hip ratio change wasn’t significant ( p > 0.05) however, it was significantly changed for 12% SFA group ( p < 0.05). Conclusion: Within each group there was significant decrease in terms of anthropometric measurements such as weight, BMI, waist circumference, intra abdominal fat. However there were no significant differences in anthropometric measurements between different SFA groups. Disclosure of Interest: None declared.
MON-P071 INCREASE IN BMI AFTER INTESTINAL TRANSPLANTATION (ITX) IN ADULTS WITHOUT TOTAL PARENTERAL NUTRITION (TPN) S. Tabak1 *, H. Noordhoff1, H. D. Bats1, F. V. D. Heide1, G. Dijkstra1. 1Gastroenterology and Hepatology, UMCG, Groningen, Netherlands Rationale: Is intestinal transplantation (ITx) a succesful treatment of chronic intestinal failure to increase BMI
S206 without TPN; results of 10 adult transplantations of the University Medical Centre Groningen. Methods: Retrospective observational study from September 2001 to March 2017. Results: The University Medical Center Groningen (UMCG) is the only intestinal transplant (ITx) center in the Netherlands. In the last 15 years, only 11 intestinal transplants were needed in adult patients with chronic intestinal failure. Ten patients (2 male and 8 female, aged 24–55 years, median 42) were transplanted between September 2001 till March 2017, with a follow up period of 8–165 months (median 17). All patients had a regular diet, before ITx. Indications for ITx were line occlusion and infection (9), a perceived poor quality of life (2). Patients were dependent of TPN before ITx during 9 and 164 months (median 74). Body weight before ITx was ranged from 46 to 75 kg (median 57), the Body Mass Index (BMI) was ranged from 15,5 to 23,1, median 20,7. Body weight after ITx at the end of follow up was ranged from 49 to 98 kg (median 60,5) and the BMI after ITx was ranged from 17,4 to 39,3 (median 21,5). In 4 patients bodyweight was increased with 6–41 kg (median 16), the bodyweight of one patient remained the same, for one patient the bodyweight decreased with 15 kg (BMI 17,4). At the end of follow up, the graft of 6 patients was intact, 2 patients died, in 2 patients the graft had to be removed because of rejection. All patients were able to eat a regular diet at hospital discharge, only 1 of them needed additionally TPN. Conclusion: After intestinal transplantation, in 67% of the patients the BMI increases with a regular diet and without TPN. Disclosure of Interest: None declared.
MON-P072 VISCERAL ADIPOSITY AND SARCOPENIC OBESITY ARE CLOSELY ASSOCIATED WITH MORTALITY AND RECURRENCE AFTER PANCREATIC CANCER RESECTION: USEFULNESS OF BODY COMPOSITION ANALYSIS S. Okumura1 *, T. Kaido1, Y. Hamaguchi1, A. Kobayashi1, H. Shirai1, S. Yao1, S. Yagi1, N. Kamo1, K. Takaori1, S. Uemoto1. 1 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, Kyoto, Japan Rationale: Sarcopenia and muscle steatosis, characterized as the decrease in muscle mass and function, have been identified as poor prognostic factors for pancreatic cancer. However, the significance of visceral adiposity and sarcopenic obesity on outcomes after the resection of pancreatic cancer remains unclear. Methods: A retrospective analysis of 301 patients who underwent resection for localized pancreatic cancer between 2004 and 2015 was performed. Visceral adiposity [visceral to subcutaneous adipose tissue area ratio (VSR)] was measured on preoperative computed tomography images, together with visceral fat area (VFA), skeletal muscle index (SMI) and muscle attenuation (MA). The impacts of these body composition parameters on outcomes after pancreatic resection were analyzed. Results: The overall survival (OS) and recurrence-free survival (RFS) rates were significantly lower in patients with high VSR than those in patients with low VSR (P = 0.001, P = 0.007, respectively). There were no differences in OS and RFS between high VFA and low VFA group, however, when analyzed
Poster together with sarcopenic factors, OS and RFS rates of the patients with sarcopenic obesity were significantly lower compared with those of the others. Multivariate analyses revealed that high VSR (visceral adiposity) was an independent risk factor for mortality [Hazard ratio (HR) = 1.576, P = 0.009] and recurrence (HR = 1.405, P = 0.026) together with low SMI (sarcopenia), low MA (muscle steatosis), high CA19–9, microvascular invasion, and nodal metastasis. Conclusion: Visceral adiposity and sarcopenic obesity were closely associated with mortality and recurrence after the resection of pancreatic cancer. Disclosure of Interest: None declared.
MON-P073 TREATMENT WITH TEDUGLUTIDE IN PATIENTS WITH SHORT BOWEL SYNDROME: PARENTERAL SUPPORT AND BIOELECTRICAL IMPEDANCE ANALYSIS IN CLINICAL ROUTINE S. Pevny1, S. Maasberg1, M. Karber1 *, B. Knappe-Drzikova1, D. Thurmann1, A. Pascher2, U.-F. Pape1. 1Department of Gastroenterology, Hepatology and Endocrinology, 2Department of General, Visceral and Transplantation Surgery, Charité University Medicine Berlin, Berlin, Germany Rationale: Teduglutide (TED), an analogue of the gastrointestinal hormone glucagon like peptide-2 (GLP-2) that promotes regeneration of the intestinal mucosa, is effective for enhancing intestinal adaption in patients ( pts) with short bowel syndrome (SBS) and chronic intestinal failure. Data of clinical routine treatment are not available yet. Methods: Center based prospectively collected clinical and paraclinical data of pts with benign SBS were analyzed retrospectively from a single university hospital. Within a subcohort, nutritional status was assessed in clinical routine by bioelectrical impedance analysis (BIA). Results: In total, 24 pts with heterogeneous bowel anatomy were treated since Oct. 2014. Three month after initiation of TED treatment pts showed a 2,679 ml (17%) reduction in intravenous fluid (IVF) requirements (n = 17; p = 0.007) and a 1,522 kcal (17%) reduction in intravenous energy requirement (n = 17; p = 0.007) per week. After one year, the difference of reduction approximately doubled (n = 9; p = 0,001 and p = 0,005 resp.) accompanied by a significant reduction in parenteral nutrition (PN) of 1.9 days/week ( p = 0,01) and no reduction in IVF days/week. Three out of 20 pts (15%) who are currently on TED were weaned off PN after a mean treatment of 25 weeks (SD: 12 wks.), two continuing on IVF. Analysis of BIA parameters revealed stability in body mass index, phase angle α, body cell mass, and intra- or extracellular water albeit reduction in parenteral support after 24 (n = 9) and 45 (n = 7) weeks on TED. Conclusion: The gradual reduction of IVF and PN support in TED-treated SBS demonstrates a beneficial effect at no cost of body composition suggesting stability of nutritional status with improved intestinal function. Applying BIA for monitoring body composition as a surrogate of nutritional status in clinical routine can guide decision making in IVF/PN management. Disclosure of Interest: S. Pevny: None declared, S. Maasberg: None declared, M. Karber: None declared, B. Knappe-Drzikova: None declared, D. Thurmann: None declared, A. Pascher: None declared, U.-F. Pape Grant/Research Support from: Shire, Speaker Bureau of: Shire.
MON-P069 LIPID, FETUIN-A AND MACROPHAGE ZONATION IN HIGH FAT DIET FOZ-FOZ MICE WITH NON-ALCOHOLIC STEATOHEPATITIS N. Lanthier1,2 *, Q. Etienne1, V. Lebrun1, L. Poekes1, Y. Horsmans1,2, I. A. Leclercq1. 1Laboratory of Gastroenterology and Hepatology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, 2 Service d’Hépato-Gastro-Entérologie, Cliniques universitaires Saint-Luc, Brussels, Belgium Rationale: Innate immunity and insulin resistance constitute potential mechanisms underlying non-alcoholic steatohepatitis (NASH) progression. Here, we explore the effect of a high fat diet (HFD) on a liver-derived protein increased in diabetic patients called fetuin-A and its relation with the development of steatosis, cell injury and liver macrophage activation in a mouse model of obesity and NASH. Methods: Male foz/foz mice were fed a normal diet (ND) or a HFD for 12 (long term HFD or LHFD) or 30 weeks (very long term HFD or VLHFD) to induce early or definite fibrosing NASH, respectively. Results: Compared to ND-fed foz/foz mice, HFD-fed foz/foz mice developed obesity, insulin resistance and either steatosis (LHFD) or steatohepatitis with steatosis, hepatocyte ballooning, inflammation and fibrosis (VLHFD). In ND fed mice, fetuin-A staining was positive in the cytoplasm of zone 3 centrilobular hepatocytes while F4/80+ Kupffer cells were located in the sinusoids of the intermediate lobular zone 2. In LHFD fed mice, lipid deposition occurred in the zone 3 centrilobular hepatocytes. Liver m-RNA expression showed a 2-fold increased level of F4/80+ macrophage mRNA compared to ND. In VLHD, a loss of zonation of liver steatosis with the presence of fat loaded hepatocytes in all liver lobular zones was
S205 observed. Fetuin-A was highest in periportal fat-ladden hepatocytes and next to inflammatory infiltrates. There was a 4-fold F4/80 mRNA increased level upon VLHFD compared to ND. Interestingly, F4/80+ cells from lipogranuloma were positive for fetuin-A protein staining. Conclusion: Lipid deposition, macrophage infiltration and fetuin-A production may be important factors in the liver tissue remodeling observed during NASH development. Disclosure of Interest: None declared.
MON-P070 EFFECTS OF REDUCED SATURATED FATTY ACID ON BODY COMPOSITION IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) N. B. Erdem1 *, Z. Goktas1. 1Nutrition and Dietetics, Hacettepe University, Ankara, Turkey Rationale: Lifestyle changes including dietary patterns represents the main target for the prevention and treatment of nonalcoholic fatty liver disease (NAFLD). Saturated fatty acids (SFA) have unfavorable effects on lipid and glucose metabolism which might worsen the progression of NAFLD. The aim of this study to determine the effects of reduced saturated fatty acid diet (7%) on anthropometric measurements of individuals with non-alcoholic fatty liver disease. Methods: A total of 23 adults aged between 19 and 65 years participated in the study. Subjects were randomly divided into two groups. Both groups followed a diet treatment for three months; group 1 with 7% saturated fatty acid (n = 11) and group 2 with 12% saturated fatty acid (n = 12). Participants visited at baseline, 1st month and 3rd month. Data collected during each visit included height, weight, waist, hip, neck circumferences, body fat composition, body muscle composition and intra abdominal fat. Body fat and muscle compositions were collected using bioelectrical impedance analysis. Intra abdominal fat was measured via VISCAN. Results: A total of 12 female and 11 male subjects participated in the study. In both groups, weight significantly decreased; from 86.1 to 81.2 in 7% SFA group and from 76.8 to 74.0 in 12% SFA group ( p < 0.05). Moreover; waist circumferences, intraabdominal fat and Body Mass Index (BMI) changes were significant in both groups ( p < 0.05). For 7% SFA group waist hip ratio change wasn’t significant ( p > 0.05) however, it was significantly changed for 12% SFA group ( p < 0.05). Conclusion: Within each group there was significant decrease in terms of anthropometric measurements such as weight, BMI, waist circumference, intra abdominal fat. However there were no significant differences in anthropometric measurements between different SFA groups. Disclosure of Interest: None declared.
MON-P071 INCREASE IN BMI AFTER INTESTINAL TRANSPLANTATION (ITX) IN ADULTS WITHOUT TOTAL PARENTERAL NUTRITION (TPN) S. Tabak1 *, H. Noordhoff1, H. D. Bats1, F. V. D. Heide1, G. Dijkstra1. 1Gastroenterology and Hepatology, UMCG, Groningen, Netherlands Rationale: Is intestinal transplantation (ITx) a succesful treatment of chronic intestinal failure to increase BMI
S206 without TPN; results of 10 adult transplantations of the University Medical Centre Groningen. Methods: Retrospective observational study from September 2001 to March 2017. Results: The University Medical Center Groningen (UMCG) is the only intestinal transplant (ITx) center in the Netherlands. In the last 15 years, only 11 intestinal transplants were needed in adult patients with chronic intestinal failure. Ten patients (2 male and 8 female, aged 24–55 years, median 42) were transplanted between September 2001 till March 2017, with a follow up period of 8–165 months (median 17). All patients had a regular diet, before ITx. Indications for ITx were line occlusion and infection (9), a perceived poor quality of life (2). Patients were dependent of TPN before ITx during 9 and 164 months (median 74). Body weight before ITx was ranged from 46 to 75 kg (median 57), the Body Mass Index (BMI) was ranged from 15,5 to 23,1, median 20,7. Body weight after ITx at the end of follow up was ranged from 49 to 98 kg (median 60,5) and the BMI after ITx was ranged from 17,4 to 39,3 (median 21,5). In 4 patients bodyweight was increased with 6–41 kg (median 16), the bodyweight of one patient remained the same, for one patient the bodyweight decreased with 15 kg (BMI 17,4). At the end of follow up, the graft of 6 patients was intact, 2 patients died, in 2 patients the graft had to be removed because of rejection. All patients were able to eat a regular diet at hospital discharge, only 1 of them needed additionally TPN. Conclusion: After intestinal transplantation, in 67% of the patients the BMI increases with a regular diet and without TPN. Disclosure of Interest: None declared.
MON-P072 VISCERAL ADIPOSITY AND SARCOPENIC OBESITY ARE CLOSELY ASSOCIATED WITH MORTALITY AND RECURRENCE AFTER PANCREATIC CANCER RESECTION: USEFULNESS OF BODY COMPOSITION ANALYSIS S. Okumura1 *, T. Kaido1, Y. Hamaguchi1, A. Kobayashi1, H. Shirai1, S. Yao1, S. Yagi1, N. Kamo1, K. Takaori1, S. Uemoto1. 1 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, Kyoto, Japan Rationale: Sarcopenia and muscle steatosis, characterized as the decrease in muscle mass and function, have been identified as poor prognostic factors for pancreatic cancer. However, the significance of visceral adiposity and sarcopenic obesity on outcomes after the resection of pancreatic cancer remains unclear. Methods: A retrospective analysis of 301 patients who underwent resection for localized pancreatic cancer between 2004 and 2015 was performed. Visceral adiposity [visceral to subcutaneous adipose tissue area ratio (VSR)] was measured on preoperative computed tomography images, together with visceral fat area (VFA), skeletal muscle index (SMI) and muscle attenuation (MA). The impacts of these body composition parameters on outcomes after pancreatic resection were analyzed. Results: The overall survival (OS) and recurrence-free survival (RFS) rates were significantly lower in patients with high VSR than those in patients with low VSR (P = 0.001, P = 0.007, respectively). There were no differences in OS and RFS between high VFA and low VFA group, however, when analyzed
Poster together with sarcopenic factors, OS and RFS rates of the patients with sarcopenic obesity were significantly lower compared with those of the others. Multivariate analyses revealed that high VSR (visceral adiposity) was an independent risk factor for mortality [Hazard ratio (HR) = 1.576, P = 0.009] and recurrence (HR = 1.405, P = 0.026) together with low SMI (sarcopenia), low MA (muscle steatosis), high CA19–9, microvascular invasion, and nodal metastasis. Conclusion: Visceral adiposity and sarcopenic obesity were closely associated with mortality and recurrence after the resection of pancreatic cancer. Disclosure of Interest: None declared.
MON-P073 TREATMENT WITH TEDUGLUTIDE IN PATIENTS WITH SHORT BOWEL SYNDROME: PARENTERAL SUPPORT AND BIOELECTRICAL IMPEDANCE ANALYSIS IN CLINICAL ROUTINE S. Pevny1, S. Maasberg1, M. Karber1 *, B. Knappe-Drzikova1, D. Thurmann1, A. Pascher2, U.-F. Pape1. 1Department of Gastroenterology, Hepatology and Endocrinology, 2Department of General, Visceral and Transplantation Surgery, Charité University Medicine Berlin, Berlin, Germany Rationale: Teduglutide (TED), an analogue of the gastrointestinal hormone glucagon like peptide-2 (GLP-2) that promotes regeneration of the intestinal mucosa, is effective for enhancing intestinal adaption in patients ( pts) with short bowel syndrome (SBS) and chronic intestinal failure. Data of clinical routine treatment are not available yet. Methods: Center based prospectively collected clinical and paraclinical data of pts with benign SBS were analyzed retrospectively from a single university hospital. Within a subcohort, nutritional status was assessed in clinical routine by bioelectrical impedance analysis (BIA). Results: In total, 24 pts with heterogeneous bowel anatomy were treated since Oct. 2014. Three month after initiation of TED treatment pts showed a 2,679 ml (17%) reduction in intravenous fluid (IVF) requirements (n = 17; p = 0.007) and a 1,522 kcal (17%) reduction in intravenous energy requirement (n = 17; p = 0.007) per week. After one year, the difference of reduction approximately doubled (n = 9; p = 0,001 and p = 0,005 resp.) accompanied by a significant reduction in parenteral nutrition (PN) of 1.9 days/week ( p = 0,01) and no reduction in IVF days/week. Three out of 20 pts (15%) who are currently on TED were weaned off PN after a mean treatment of 25 weeks (SD: 12 wks.), two continuing on IVF. Analysis of BIA parameters revealed stability in body mass index, phase angle α, body cell mass, and intra- or extracellular water albeit reduction in parenteral support after 24 (n = 9) and 45 (n = 7) weeks on TED. Conclusion: The gradual reduction of IVF and PN support in TED-treated SBS demonstrates a beneficial effect at no cost of body composition suggesting stability of nutritional status with improved intestinal function. Applying BIA for monitoring body composition as a surrogate of nutritional status in clinical routine can guide decision making in IVF/PN management. Disclosure of Interest: S. Pevny: None declared, S. Maasberg: None declared, M. Karber: None declared, B. Knappe-Drzikova: None declared, D. Thurmann: None declared, A. Pascher: None declared, U.-F. Pape Grant/Research Support from: Shire, Speaker Bureau of: Shire.