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MON-PP107: Nutritional Knowledge and Eating Behaviour in Patients with Eating Disorders
Nutrition and chronic diseases 2 MON-PP105 HOME PARENTERAL NUTRITION
S167
NATIONAL RECORD 2014
C. Wanden-Berghe1 , C. Cuerda Comp´ es1 , J. Moreno Villares1 , A. Perez de la Cruz1 , R. Burgos1 , C. G´ omez Candela1 , N. Virgili Casas1 , M. Penacho L´ azaro1 , C. Martinez Faedo1 , M. Gonzalo Marín1 , C. Garde Orbaiz1 , C. Campos Martín1 , E. Sanchez Martos1 , A. Sanz Paris1 , P. García Luna1 , P. Matía Martín1 , S. Mauri1 , M. Hern´ andez Nieto1 , J. Alvarez1 , F. Caraba˜ na Perez1 , M. García Zafra1 , C. Martinez Costa1 , D. De Luis Rom´ an1 , J. Suarez Llanos1 , 1 1 A. Zugasti , A. Apezetxea , J. Urgelles Planella1 , L. Laborda Gonzalez1 , O. S´ anchez-Vilar Burdiel1 , C. Joaquín Ortiz1 , M. Gil Martínez1 , A. Calleja1 , P. Leyes Garcia1 , M. Ponce Gonzalez1 , M. Del Olmo García1 , L. Luengo1 , on behalf of NADYA-SENPE Group. 1 NADYA-SENPE, Madrid, Spain Rationale: Present the data of the SENPE NADYA group record for Home Paternal Nutrition (HPN) in Spain, 2014. Methods: Descriptive study of the national record database of NADYA-SENPE group for HPN (on 1st of January of 2014 until 9th of December of 2014), the latest data published by the Statistics National Institute (1-1-2014) were used for calculation of prevalence. Results: Have been reported a total of 212 patients from 37 hospitals representing a rate of 4.56 patients/million habitants/year 2014 with 217 episodes of HPN because 5 of them registered 2 episodes. Women were 118 (55.7%) and 9 (4.2%) children were identified. The mean age of adults was 51.97±15.67 years and for children was 1.33±1.32. Congenital anomalies were the most frequent diagnosis for children showed in 3 cases (37.5%) and for adults registered in 45 (22.2%) followed by palliative treated cancer 41 (20.2%) (Fig. 1). Majority of patients had the indication for small bowel syndrome in children and adults (Fig. 2). A total PN was received in 106 (50.0%) cases and the rest had complementary PN. The mean duration of the HPN was 1348±1889 days/patient with a maximum 10897 and 3 as minimum. The route of access was recorded in 185 times (Fig. 3). A total of 64 metabolic complications were registered 0.22 times per 1000 days of PN. Non septic complications related with catheter were 44 per 1000 days 0.15. A record of 171 septic complications related with catheter 0.60 per 1000 days of PN. Finalized 52 episodes of HPN, caused by death 25 (48.07%) (Fig. 4). Activity levels and autonomy are shown in Fig. 5. In 28 (13.2%) occasions the patient was candidate for intestinal transplant. Conclusion: The number of participating hospital and the registered patients has increased compared to the last year. A very low number of complications was registered which leads to believe that these data probably are not properly registered because of its evolutionary type. Disclosure of Interest: None declared
MON-PP106 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG): A RETROSPECTIVE REVIEW OF INDICATIONS, COMPLICATIONS AND OUTCOME ´. Gamito1 , C. Martins1 , S. Ribeiro1 , C. Teixeira1 , E 1 1 C. Cardoso , I. Cremers , J. Mangualde1 , A.P. Oliveira1 . 1 Centro Hospitalar de Set´ ubal, Joane, Portugal Rationale: Percutaneous endoscopic gastrostomy (PEG), first described in 1980 by Ponsky and Gaudener, has become the
modality of choice for providing enteral access to patients who require long-term enteral nutrition. It’s a rapid and inexpensive procedure that doesn’t require anesthesia or laparotomy as opposed to surgical gastrostomy. Objectives: Identify the main indications, assess to the evolution and survival of patients and describe the complications associated with the placement of PEG. Methods: Retrospective study of patients undergoing PEG between January 2009 and December 2014. Results: PEG was performed in 69 patients comprising 46 males (67%) and 23 females (33%). Their ages ranged from 17 to 89 years with a mean age of 65 years. Neurological disease was the main indication for placement of PEG (78%) and malignant neoplasms of the oral cavity and oesophagus accounted for 20% of the total. Wound infection was the most common complication (10%). There were two major early complications (3.3%) that required surgery: one case of peritonitis and another of haemoperitoneum. There were no deaths directly related to the procedure. The survival was longer than 6 months in 59% of cases and 28 patients are still alive (41%). Of the 41 deaths reported, 51% were due to infectious complications not related to PEG (mainly respiratory infections) while the remaining 49% were due to the progression of the underlying disease. Conclusion: PEG placement is a safe procedure and an effective enteral feeding method when oral feeding is not possible and there is a functionally intact gastrointestinal tract. In our series, the main indication for PEG placement was the stroke and the main complications were minor. All the deaths were related to infectious complications and the progression of the underlying disease. There were no deaths related to the procedure. Disclosure of Interest: None declared
MON-PP107 NUTRITIONAL KNOWLEDGE AND EATING BEHAVIOUR IN PATIENTS WITH EATING DISORDERS D. Vranesic Bender1 , A. Sigurnjak2 , M. Kozina2 , D. Ljubas Kelecic1 , A. Kunovic1 , Z. Krznaric1 . 1 Center of Clinical Nutrition, University Hospital Zagreb, 2 Faculty of Food Technology and Biotechnology, Zagreb, Croatia Rationale: It is assumed that individuals diagnosed with eating disorders have greater knowledge about nutrition and have different eating behaviour compared to general population. The aim of this study was to determine and compare nutritional knowledge and behaviour among the patients with anorexia nervosa (AN), bulimia nervosa (BN) and control group (CG). Methods: Participants completed General Nutritional Knowledge Questionnaire (GNKQ) and the Eating Attitude Test (EAT-26). GNKQ assesses 4 domains of general nutrition knowledge: dietary guidelines, sources of nutrients, choosing everyday foods, diet disease relationships. The EAT-26 has been used as a screening tool to assess “eating disorder risk”. 14 hospitalized patients diagnosed with eating disorders (9 AN patients and 5 BN patients) and 14 subjects in CG were included. Results: The overall nutritional knowledge score of patients with eating disorders was 55%, compared to 53% in CG, without any significant difference concerning 4 domains
S168 of the questionnaire. There was no significant difference between the group of patients with AN and BN in level of knowledge detected (p = 0.06; p > 0.05). 6 patients with AN, 4 patients with BN and none of the subjects in CG, scored EAT-26 score 20. Statistical analysis showed difference in average EAT-26 score between patients with AN and BN (p = 0.00001; p < 0.05). Results have shown there is no statistically significant difference in EAT-26 score between CG and patients with BN (p = 0.08; p > 0.05). On the other hand, the difference between EAT-26 scores between patients with AN and CG was statistically significant (p = 0.0000002; p < 0.05). Conclusion: These findings suggest that patients with eating disorders display the same levels of nutritional knowledge as control group. Statistical analysis of the results showed a significant difference in eating attitudes among patients with eating disorders and the control group. Disclosure of Interest: None declared
MON-PP108 A POOR QUALITY DIET IS ASSOCIATED WITH HIGHER EXACERBATION RATE IN PATIENTS WITH COPD E. Rutten1 , L.E. Vanfleteren1 , E. Clevers1 , P. van Melick1 , M.A. Spruit1 , C. Hanson2 , E.F. Wouters1,3 , F. Franssen1 . 1 Research and Education, Centre of expertise for chronic organ failure, CIRO+, Horn, Netherlands; 2 School of allied health Professions, University of Nebraska Medical Centre, Omaha, United States; 3 Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands Rationale: Dietary vitamin D (VD) intake was too low in many patients with chronic obstructive pulmonary disease (COPD), and these patients had also more often inadequate intake of vitamin A, E and protein [1]. A poor quality diet has already been associated with faster disease progression, but the relation with exacerbation rate has been scarcely investigated. We aimed to study the characteristics, including exacerbation history of patients consuming a poor quality diet. Methods: In 197 COPD patients [63.6 (7.2) years, 58% male and pb FEV1: 52.8(18.6)% pred] entering pulmonary rehabilitation, dietary intake was assessed by validated cross-check dietary history method. Poor quality diet was defined by inadequate VD and protein intake according to gender- and age group specific Dutch governmental recommendations. Prevalence of severe (hospitalizations) and moderate (use of corticosteroids/antibiotics) exacerbations the foregoing year was categorized as low (0 or 1) and high (2 or more). Results: Thirty-seven (19%) patients reported to consume a poor quality diet. These patients consumed also less total energy [1524.2 (503.3) vs. 2226.0 (714.1) kcal, p < 0.01], and the energy % from protein [14.7 (2.5) vs. 15.8 (3.2)%, p = 0.05] compared to the patients with adequate intake of VD and protein (control group). Patients with a poor diet had more often inadequate intake of vitamin A (68% vs. 36%, p < 0.01) and of vitamin C (59% vs. 27%, p < 0.01). The prevalence of a high exacerbation rate was higher in the poor diet group (59% vs. 43%, p = 0.06). In the multivariate binary regression corrected for age, gender, BMI and FEV1 , the risk of experiencing 2 or more exacerbations previous year was 2.5 times higher (95% CI 1.11 5.88, p = 0.03) in the poor diet group than in the control group.
Poster presentations Conclusion: A poor quality diet is associated with a higher exacerbation rate in COPD patients entering pulmonary rehabilitation. References [1] van de Bool et al., Eur J Clin Nutr 2014: 68(2); 159. Disclosure of Interest: None declared
MON-PP109 TREATMENT OF HOME PARENTERAL NUTRITION RELATED CATHETER INFECTIONS WITH CATHETER RETENTION ´. Straub2 , G. Udvarhelyi1 , I. Bír´ o1 , A. M´ esz´ arosn´ e T.2 , E C. Fej´ er2 , J. Fut´ o2 , L. Topa1 , P. Sahin1 . 1 Department of Gastroenterology, 2 Intensive Care, St. Imre Teaching Hospital, Budapest, Hungary Rationale: HPN-associated bloodstream infection is one of the serious complications of HPN. Between 2010 and 2011 seven patients were treated in our own centre and during 1000 days of care we encountered 0.51 catheter infections. Between 2012 and 2014 we had 11 patients, the infection rate was 1.58. As the infection rate was increasing we made a catheter reservation protocol. Methods: We set up a catheter retention protocol: (1) immediate catheter removal upon infections caused by fungi, Pseudomonas, MRSA or other resistant pathogens; (2) in the event of repeated and proven catheter infections: use of the infected catheter is prohibited; (3) 3 × catheter closing with 70% ethanol; (4) the catheter is reused upon the normalization of white blood cell count and CRP; (5) thereafter the central catheter is closed with Tauroloc-Hepa on every second day of nutrition. We examined the catheter retention time and the complications of the infection. Results: There were three patients with repeated catheter infections, two of them had a jejunostomy and one had a tumour. Average age: 51 years. Patient 1: 3× E. coli infections, after the third instance the catheter was replaced, there were no complications; catheter retention: 112 days. Patient 2: 1× coag.-neg staph.; catheter retention: 65 days. Patient 3: Enterococcus faecalis, Klebsiella pneumoniae, later on coag.-neg staph.; catheter retention: 179 days. Infection rate with this group: 3.95. In two of the three cases reviewed there were no complications; catheter replacement times could be prolonged by 118.7 days on average. After the third recurring infection of the patient with a tumour and a jejunostomy endocarditis occurred as a complication. Conclusion: Male gender and >450 days of HPN cause increased risk, as described in the literature. We changed our protocol and now remove the central catheter if a second proven recurring catheter infection occurs. Disclosure of Interest: None declared
S167
NATIONAL RECORD 2014
C. Wanden-Berghe1 , C. Cuerda Comp´ es1 , J. Moreno Villares1 , A. Perez de la Cruz1 , R. Burgos1 , C. G´ omez Candela1 , N. Virgili Casas1 , M. Penacho L´ azaro1 , C. Martinez Faedo1 , M. Gonzalo Marín1 , C. Garde Orbaiz1 , C. Campos Martín1 , E. Sanchez Martos1 , A. Sanz Paris1 , P. García Luna1 , P. Matía Martín1 , S. Mauri1 , M. Hern´ andez Nieto1 , J. Alvarez1 , F. Caraba˜ na Perez1 , M. García Zafra1 , C. Martinez Costa1 , D. De Luis Rom´ an1 , J. Suarez Llanos1 , 1 1 A. Zugasti , A. Apezetxea , J. Urgelles Planella1 , L. Laborda Gonzalez1 , O. S´ anchez-Vilar Burdiel1 , C. Joaquín Ortiz1 , M. Gil Martínez1 , A. Calleja1 , P. Leyes Garcia1 , M. Ponce Gonzalez1 , M. Del Olmo García1 , L. Luengo1 , on behalf of NADYA-SENPE Group. 1 NADYA-SENPE, Madrid, Spain Rationale: Present the data of the SENPE NADYA group record for Home Paternal Nutrition (HPN) in Spain, 2014. Methods: Descriptive study of the national record database of NADYA-SENPE group for HPN (on 1st of January of 2014 until 9th of December of 2014), the latest data published by the Statistics National Institute (1-1-2014) were used for calculation of prevalence. Results: Have been reported a total of 212 patients from 37 hospitals representing a rate of 4.56 patients/million habitants/year 2014 with 217 episodes of HPN because 5 of them registered 2 episodes. Women were 118 (55.7%) and 9 (4.2%) children were identified. The mean age of adults was 51.97±15.67 years and for children was 1.33±1.32. Congenital anomalies were the most frequent diagnosis for children showed in 3 cases (37.5%) and for adults registered in 45 (22.2%) followed by palliative treated cancer 41 (20.2%) (Fig. 1). Majority of patients had the indication for small bowel syndrome in children and adults (Fig. 2). A total PN was received in 106 (50.0%) cases and the rest had complementary PN. The mean duration of the HPN was 1348±1889 days/patient with a maximum 10897 and 3 as minimum. The route of access was recorded in 185 times (Fig. 3). A total of 64 metabolic complications were registered 0.22 times per 1000 days of PN. Non septic complications related with catheter were 44 per 1000 days 0.15. A record of 171 septic complications related with catheter 0.60 per 1000 days of PN. Finalized 52 episodes of HPN, caused by death 25 (48.07%) (Fig. 4). Activity levels and autonomy are shown in Fig. 5. In 28 (13.2%) occasions the patient was candidate for intestinal transplant. Conclusion: The number of participating hospital and the registered patients has increased compared to the last year. A very low number of complications was registered which leads to believe that these data probably are not properly registered because of its evolutionary type. Disclosure of Interest: None declared
MON-PP106 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG): A RETROSPECTIVE REVIEW OF INDICATIONS, COMPLICATIONS AND OUTCOME ´. Gamito1 , C. Martins1 , S. Ribeiro1 , C. Teixeira1 , E 1 1 C. Cardoso , I. Cremers , J. Mangualde1 , A.P. Oliveira1 . 1 Centro Hospitalar de Set´ ubal, Joane, Portugal Rationale: Percutaneous endoscopic gastrostomy (PEG), first described in 1980 by Ponsky and Gaudener, has become the
modality of choice for providing enteral access to patients who require long-term enteral nutrition. It’s a rapid and inexpensive procedure that doesn’t require anesthesia or laparotomy as opposed to surgical gastrostomy. Objectives: Identify the main indications, assess to the evolution and survival of patients and describe the complications associated with the placement of PEG. Methods: Retrospective study of patients undergoing PEG between January 2009 and December 2014. Results: PEG was performed in 69 patients comprising 46 males (67%) and 23 females (33%). Their ages ranged from 17 to 89 years with a mean age of 65 years. Neurological disease was the main indication for placement of PEG (78%) and malignant neoplasms of the oral cavity and oesophagus accounted for 20% of the total. Wound infection was the most common complication (10%). There were two major early complications (3.3%) that required surgery: one case of peritonitis and another of haemoperitoneum. There were no deaths directly related to the procedure. The survival was longer than 6 months in 59% of cases and 28 patients are still alive (41%). Of the 41 deaths reported, 51% were due to infectious complications not related to PEG (mainly respiratory infections) while the remaining 49% were due to the progression of the underlying disease. Conclusion: PEG placement is a safe procedure and an effective enteral feeding method when oral feeding is not possible and there is a functionally intact gastrointestinal tract. In our series, the main indication for PEG placement was the stroke and the main complications were minor. All the deaths were related to infectious complications and the progression of the underlying disease. There were no deaths related to the procedure. Disclosure of Interest: None declared
MON-PP107 NUTRITIONAL KNOWLEDGE AND EATING BEHAVIOUR IN PATIENTS WITH EATING DISORDERS D. Vranesic Bender1 , A. Sigurnjak2 , M. Kozina2 , D. Ljubas Kelecic1 , A. Kunovic1 , Z. Krznaric1 . 1 Center of Clinical Nutrition, University Hospital Zagreb, 2 Faculty of Food Technology and Biotechnology, Zagreb, Croatia Rationale: It is assumed that individuals diagnosed with eating disorders have greater knowledge about nutrition and have different eating behaviour compared to general population. The aim of this study was to determine and compare nutritional knowledge and behaviour among the patients with anorexia nervosa (AN), bulimia nervosa (BN) and control group (CG). Methods: Participants completed General Nutritional Knowledge Questionnaire (GNKQ) and the Eating Attitude Test (EAT-26). GNKQ assesses 4 domains of general nutrition knowledge: dietary guidelines, sources of nutrients, choosing everyday foods, diet disease relationships. The EAT-26 has been used as a screening tool to assess “eating disorder risk”. 14 hospitalized patients diagnosed with eating disorders (9 AN patients and 5 BN patients) and 14 subjects in CG were included. Results: The overall nutritional knowledge score of patients with eating disorders was 55%, compared to 53% in CG, without any significant difference concerning 4 domains
S168 of the questionnaire. There was no significant difference between the group of patients with AN and BN in level of knowledge detected (p = 0.06; p > 0.05). 6 patients with AN, 4 patients with BN and none of the subjects in CG, scored EAT-26 score 20. Statistical analysis showed difference in average EAT-26 score between patients with AN and BN (p = 0.00001; p < 0.05). Results have shown there is no statistically significant difference in EAT-26 score between CG and patients with BN (p = 0.08; p > 0.05). On the other hand, the difference between EAT-26 scores between patients with AN and CG was statistically significant (p = 0.0000002; p < 0.05). Conclusion: These findings suggest that patients with eating disorders display the same levels of nutritional knowledge as control group. Statistical analysis of the results showed a significant difference in eating attitudes among patients with eating disorders and the control group. Disclosure of Interest: None declared
MON-PP108 A POOR QUALITY DIET IS ASSOCIATED WITH HIGHER EXACERBATION RATE IN PATIENTS WITH COPD E. Rutten1 , L.E. Vanfleteren1 , E. Clevers1 , P. van Melick1 , M.A. Spruit1 , C. Hanson2 , E.F. Wouters1,3 , F. Franssen1 . 1 Research and Education, Centre of expertise for chronic organ failure, CIRO+, Horn, Netherlands; 2 School of allied health Professions, University of Nebraska Medical Centre, Omaha, United States; 3 Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands Rationale: Dietary vitamin D (VD) intake was too low in many patients with chronic obstructive pulmonary disease (COPD), and these patients had also more often inadequate intake of vitamin A, E and protein [1]. A poor quality diet has already been associated with faster disease progression, but the relation with exacerbation rate has been scarcely investigated. We aimed to study the characteristics, including exacerbation history of patients consuming a poor quality diet. Methods: In 197 COPD patients [63.6 (7.2) years, 58% male and pb FEV1: 52.8(18.6)% pred] entering pulmonary rehabilitation, dietary intake was assessed by validated cross-check dietary history method. Poor quality diet was defined by inadequate VD and protein intake according to gender- and age group specific Dutch governmental recommendations. Prevalence of severe (hospitalizations) and moderate (use of corticosteroids/antibiotics) exacerbations the foregoing year was categorized as low (0 or 1) and high (2 or more). Results: Thirty-seven (19%) patients reported to consume a poor quality diet. These patients consumed also less total energy [1524.2 (503.3) vs. 2226.0 (714.1) kcal, p < 0.01], and the energy % from protein [14.7 (2.5) vs. 15.8 (3.2)%, p = 0.05] compared to the patients with adequate intake of VD and protein (control group). Patients with a poor diet had more often inadequate intake of vitamin A (68% vs. 36%, p < 0.01) and of vitamin C (59% vs. 27%, p < 0.01). The prevalence of a high exacerbation rate was higher in the poor diet group (59% vs. 43%, p = 0.06). In the multivariate binary regression corrected for age, gender, BMI and FEV1 , the risk of experiencing 2 or more exacerbations previous year was 2.5 times higher (95% CI 1.11 5.88, p = 0.03) in the poor diet group than in the control group.
Poster presentations Conclusion: A poor quality diet is associated with a higher exacerbation rate in COPD patients entering pulmonary rehabilitation. References [1] van de Bool et al., Eur J Clin Nutr 2014: 68(2); 159. Disclosure of Interest: None declared
MON-PP109 TREATMENT OF HOME PARENTERAL NUTRITION RELATED CATHETER INFECTIONS WITH CATHETER RETENTION ´. Straub2 , G. Udvarhelyi1 , I. Bír´ o1 , A. M´ esz´ arosn´ e T.2 , E C. Fej´ er2 , J. Fut´ o2 , L. Topa1 , P. Sahin1 . 1 Department of Gastroenterology, 2 Intensive Care, St. Imre Teaching Hospital, Budapest, Hungary Rationale: HPN-associated bloodstream infection is one of the serious complications of HPN. Between 2010 and 2011 seven patients were treated in our own centre and during 1000 days of care we encountered 0.51 catheter infections. Between 2012 and 2014 we had 11 patients, the infection rate was 1.58. As the infection rate was increasing we made a catheter reservation protocol. Methods: We set up a catheter retention protocol: (1) immediate catheter removal upon infections caused by fungi, Pseudomonas, MRSA or other resistant pathogens; (2) in the event of repeated and proven catheter infections: use of the infected catheter is prohibited; (3) 3 × catheter closing with 70% ethanol; (4) the catheter is reused upon the normalization of white blood cell count and CRP; (5) thereafter the central catheter is closed with Tauroloc-Hepa on every second day of nutrition. We examined the catheter retention time and the complications of the infection. Results: There were three patients with repeated catheter infections, two of them had a jejunostomy and one had a tumour. Average age: 51 years. Patient 1: 3× E. coli infections, after the third instance the catheter was replaced, there were no complications; catheter retention: 112 days. Patient 2: 1× coag.-neg staph.; catheter retention: 65 days. Patient 3: Enterococcus faecalis, Klebsiella pneumoniae, later on coag.-neg staph.; catheter retention: 179 days. Infection rate with this group: 3.95. In two of the three cases reviewed there were no complications; catheter replacement times could be prolonged by 118.7 days on average. After the third recurring infection of the patient with a tumour and a jejunostomy endocarditis occurred as a complication. Conclusion: Male gender and >450 days of HPN cause increased risk, as described in the literature. We changed our protocol and now remove the central catheter if a second proven recurring catheter infection occurs. Disclosure of Interest: None declared