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O010 PROTEIN PULSE FEEDING IMPROVES LEAN MASS IN MALNOURISHED HOSPITALIZED ELDERLY PATIENTS. A PROSPECTIVE RANDOMIZED STUDY
ESPEN Best Abstracts 2009 Methods: Three girls and four boys (mean age: 11.8) were enrolled. All but one have been on LTPN since birth for intractable diarrhea (2), chronic pseudoobstruction(1), intestinal epithelial dysplasia(2), short bowel syndrome(1), microvillous atrophia(1). Mean height SDS was 2.4 ( 4 to 0.5), mean BMI SDS: +0.7 ( 0.9 to +1.7). Three children were pubertal (Tanner Stage II n = 2, Stage III n = 1). Parenteral and oral intakes were recorded. The following parameters were measured: Pharmacological GH by stimulation tests (Normal GH peak values >20mUI/l); Plasma IGF1 levels, expressed as SDS for CA; Body composition by DEXA: lean mass (LM) and fat mass (FM) were expressed as % of body weight (BW);Resting energy expenditure (REE) by indirect calorimetry; fat and nitrogen losses (g/d) in stools. Results: Total caloric intakes covered 102 to 199% of the REE added with the caloric fecal loss. Parenteral intake accounted for 60 to 100% of the total intake with protein intake ranging from 0.8 to 1.9 g/kg/d of amino acids. Mean IGF1 levels were low in all patients, even during puberty (mean: 2.7SD, 4.5 to 1.1) contrasting with normal or high GH concentrations (GH peaks values ranging from 19.5 to 90 mUI/l) in 6/7 patients.1 patient had low GH levels (GH peak: 11.5mUI/l). 6/7 patients had decreased LM (mean: 62%, 54 to 71% of BW) and increased FM (mean: 33%, 25 43%). Conclusion: Despite adequate caloric and protein intakes, children on LTPN have partial acquired GH resistance, leading to short stature and disturbances in body composition. Studies in larger groups of patients are needed to confirm these data. Disclosure of Interest: None declared
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ESPEN Best Abstracts 2009 O010 PROTEIN PULSE FEEDING IMPROVES LEAN MASS IN MALNOURISHED HOSPITALIZED ELDERLY PATIENTS. A PROSPECTIVE RANDOMIZED STUDY O. Bouillanne1 , B. Hamon-Vilcot2 , E. Curis3 , I. Nicolis3 , P. Chr´ etien4 , N. Schauer2 , I. Coulombel2 , J. Vincent5 , L. Cynober6 , C. Aussel7 . 1 Service de G´ erontologie 2, Hˆ opital Emile-Roux, APHP, Limeil-Brevannes, Laboratoire de Biologie de la Nutrition, EA 2498, Universit´ e Paris Descartes, Facult´ e de Pharmacie, Paris; 2 Service de G´ erontologie 2, Hˆ opital Emile-Roux, APHP, Limeil-Brevannes; 3 Laboratoire de Biomath´ ematiques (plateau iB2), Universit´ e Paris Descartes, Facult´ e de ematologie, Pharmacie, Paris; 4 Service d’Immunologie-H´ Centre Hospitalier Intercommunal de Cr´ eteil, Cr´ eteil, 5 Service de G´ erontologie 4, Hˆ opital Emile-Roux, opital APHP, Limeil-Brevannes; 6 Service de Biochimie, Hˆ Hˆ otel-Dieu. APHP, Laboratoire de biologie de la nutrition, EA 2498, Universit´ e Paris Descartes, Facult´ e opital Emile-Roux, de Pharmacie; 7 Service de Biologie, Hˆ APHP, Limeil-Brevannes, Laboratoire de Biologie de Nutrition, EA 2498, Universit´ e Paris Descartes, Facult´ e de Pharmacie, Paris, France Rationale: Aging is associated with a blunted anabolic response to dietary intake which could be related to a decreased systemic availability of amino acid (AA). The latter could be linked to an increased AA metabolism in the splanchnic area. Arnal [1] showed that this splanchnic sequestration can be saturated by a pulse-feeding (80 % of daily protein intake in a single meal) and leads to an increase in protein synthesis. Methods: This prospective randomized study (approved by the hospital ethical committee and supported by a governmental grant) enrolled 68 malnourished hospitalized elderly patients. All patients were given a controlled diet for 42 days. In the spread diet group, dietary protein was spread over the four meals. In the pulse diet group, 80% of dietary protein was consumed in one meal (12.00 h). Patients were evaluated at admission and after six weeks for their body composition [body cell mass (BCM), appendicular skeletal muscle mass (ASMM), lean mass (LM), measured by X ray absorptiometry and combined to bioelectrical impedance analysis]. Table: Changes in body composition over 6 weeks
BCM (kg) ASMM (kg) LM (kg)
Spread diet (n = 27)
Pulse diet (n = 23)*
Comparison of changes p**
0.07 [ 0.67; 0.53]*** 0.24 [ 0.87; 0.38] 0.52 [ 1.41; 0.37]
1.36 [0.60; 2.11] 0.78 [0.11; 1.45] 1.14 [0.25; 2.03]
0.004 0.025 0.009
*n = 24 for ASMM **Student’s T-test ***Mean and 95% confidence interval on mean
Results: At the beginning of the study there was no significant difference in body mass index between the two
6 groups although BCM and LM were higher in the spread diet group. The protein pulse-feeding was more efficient than the protein spread-feeding in improving LM, BCM and ASMM. Conclusion: This study demonstrates for the first time that optimizing the protein feeding has a positive clinically relevant effect on BCM in malnourished hospitalized elderly patients. References [1] Am J Clin Nutr 1999;69:1202-8 Disclosure of Interest: None declared
O011 DIETARY VITAMIN K2 SUPPLEMENT IMPROVES BONE STATUS AFTER LUNG AND HEART TRANSPLANTATION L. Forli1 , J. Bollerslev1 , S. Simonsen2 , G.A. Isaksen1 , K. Godang1 , K.E. Kvamsdal1 , G. Gadeholt3 , O. Bjortuft4 . 1 Medical, 2 Cardiology, 3 Biochemestry, 4 Respiratory Medicine, Rikshospitalet, Oslo, Norway Rationale: Bone disease after transplantation is a recognized clinical problem and there is ongoing need for improved treatment. Studies in the last years have given strong indications for vitamin K to have an important role in optimal bone health. The aim of this prospective, randomized, placebo controlled double blind, longitudinal study was to investigate the effect of vitamin K2 supplement (180 mg menakinon (MK)-7) on bone mass the first year after lung and heart transplantation. Methods: After preoperative baseline investigation of bone mass and bone related biochemistry 35 lung recipients and 59 heart recipients aged between 21 and 67 years were investigated. Bone mass was measured using dual X-ray absoptiometry (DEXA). The recipients were also advised an intake of vitamin D of 10 20 mg and 1000 mg calsium per day. Results: One year after tx, in all patients the difference between placebo and vitamin K after controlling for baseline bone mineral density (BMD) was for the L2L4 region BMD 0.028 (SE 0.014) g/cm2 (P = 0.055). In a forward stepwise linear regression analysis fitted to model differences in the L2-L4 region BMD and controlling for possible confounding variables (including use of bisphosponate), the only significant predictors were organ (if heart, B = 0.065 g/cm2 , P < 0.001) and vitamin K2 vs. placebo (B = 0.034 g/cm2 , P = 0.019).One year after transplantation intact parathyroid hormone was higher in the MK-7 supplemented group than in the placebo group indicating an insufficient vitamin D status and a higher need for vitamin D in the vitamin K2 supplemented group. Conclusion: Supplementation with vitamin K2 the first year after lung and heart transplantation seemed to have a favourable effect on trabecular bone. Vitamin D status should receive more attention. Disclosure of Interest: No conflict of interest
Oral presentations / Free scientific presentations O012 LOSS OF BODY MASS AND EXERCISE ENDURANCE UNDER HYPOXIC CONDITIONS IS REDUCED WITH GLYCEROPHOSPHOLIPIDS ENRICHED IN DOCOSAHEXAENOICACID (GPL-DHA) SUPPLEMENTATION IN RODENTS C. Tardieu1 , V. Chat´ e1 , R. Guzun1 , M. Armand2 , 3 G. Pieroni , T. Coste3 , V. Saks1 , H. Dubouchaud1 , N. Cano4 , C. Pison5 . 1 Inserm884, Univ. J. Fourier, Grenoble; 2 Inserm476/INRA1260, Univ. M´ editeran´ ee, editeran´ ee, Hauterive; Marseille; 3 ASL, Univ. M´ 4 CRNH, UMR1019, Univ. Auvergne, Clermont-Ferrand; 5 Inserm884, CHU Grenoble, Grenoble, France Rationale: Systemic features of chronic respiratory failure (CRF) secondary to chronic obstructive pulmonary disease (COPD) include hypoxemia, oxidative stress and inflammation leading to sarcopenia, an independent predictor of death risk. The aim of our work was to evaluate the effect of a 12-week oral DHA supplementation (90 mg/kg body mass/day) in the form of phospholipids (GPL-DHA) on body mass, exercise endurance and mitochondrion function assessed by muscle skin fibre technique. Methods: Four groups of weaned male Wistar rats were fed with omega-3 impoverished regimen during 12 weeks, exposed to chronic hypoxia with FiO2:0.12 during the last 3 weeks, except in controls. GPL-DHA group, (n = 10) was compared to a group receiving triglyceride (Tg-DHA, n = 5), a group given a placebo P (n = 6), and a control group on room air during 12 weeks and receiving P (C, n = 10). Results: m±SD. Day0 body mass (g) was 67±19, 52±4, 61±3, 50±9 and by week 12: 360±45, 200±23*, 280±35*, 308±81*# in C, P, Tg-DHA, GPL-DHA groups respectively (p < 0.05 *compared to C, # compared to P). Changes in body mass from week 10 to 12 (%) were +9±3, 26±4*, 12±4*, +3±3 respectively. In P, Tg-DHA, GPLDHA, endurance time (min) was 20±3, 20±4, 29±7# respectively. In C, P, Tg-DHA and GPL-DHA, apparent Km (mM) for exogenous ADP, a marker of oxidative dependant metabolism, was 184±143, 148±47, 79±42*, 160±41 in Soleus and 193±100, 90±45*, 49±40*, 121±51 in Diaphragm respectively. Conclusion: In hypoxemic rodents, GPL-DHA supplementation resulted in a markedly preservation of body mass, exercise endurance and system organization at the level of energy production and transfer in muscles with a better preservation of oxidative intracellular energy units. Mechanisms need to be unravelled: effects of DHA on hypoxia related anorexia, mitochondrial biogenesis via PPAR pathway and/or mitochondrion membrane properties. Disclosure of Interest: None declared
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ESPEN Best Abstracts 2009 O010 PROTEIN PULSE FEEDING IMPROVES LEAN MASS IN MALNOURISHED HOSPITALIZED ELDERLY PATIENTS. A PROSPECTIVE RANDOMIZED STUDY O. Bouillanne1 , B. Hamon-Vilcot2 , E. Curis3 , I. Nicolis3 , P. Chr´ etien4 , N. Schauer2 , I. Coulombel2 , J. Vincent5 , L. Cynober6 , C. Aussel7 . 1 Service de G´ erontologie 2, Hˆ opital Emile-Roux, APHP, Limeil-Brevannes, Laboratoire de Biologie de la Nutrition, EA 2498, Universit´ e Paris Descartes, Facult´ e de Pharmacie, Paris; 2 Service de G´ erontologie 2, Hˆ opital Emile-Roux, APHP, Limeil-Brevannes; 3 Laboratoire de Biomath´ ematiques (plateau iB2), Universit´ e Paris Descartes, Facult´ e de ematologie, Pharmacie, Paris; 4 Service d’Immunologie-H´ Centre Hospitalier Intercommunal de Cr´ eteil, Cr´ eteil, 5 Service de G´ erontologie 4, Hˆ opital Emile-Roux, opital APHP, Limeil-Brevannes; 6 Service de Biochimie, Hˆ Hˆ otel-Dieu. APHP, Laboratoire de biologie de la nutrition, EA 2498, Universit´ e Paris Descartes, Facult´ e opital Emile-Roux, de Pharmacie; 7 Service de Biologie, Hˆ APHP, Limeil-Brevannes, Laboratoire de Biologie de Nutrition, EA 2498, Universit´ e Paris Descartes, Facult´ e de Pharmacie, Paris, France Rationale: Aging is associated with a blunted anabolic response to dietary intake which could be related to a decreased systemic availability of amino acid (AA). The latter could be linked to an increased AA metabolism in the splanchnic area. Arnal [1] showed that this splanchnic sequestration can be saturated by a pulse-feeding (80 % of daily protein intake in a single meal) and leads to an increase in protein synthesis. Methods: This prospective randomized study (approved by the hospital ethical committee and supported by a governmental grant) enrolled 68 malnourished hospitalized elderly patients. All patients were given a controlled diet for 42 days. In the spread diet group, dietary protein was spread over the four meals. In the pulse diet group, 80% of dietary protein was consumed in one meal (12.00 h). Patients were evaluated at admission and after six weeks for their body composition [body cell mass (BCM), appendicular skeletal muscle mass (ASMM), lean mass (LM), measured by X ray absorptiometry and combined to bioelectrical impedance analysis]. Table: Changes in body composition over 6 weeks
BCM (kg) ASMM (kg) LM (kg)
Spread diet (n = 27)
Pulse diet (n = 23)*
Comparison of changes p**
0.07 [ 0.67; 0.53]*** 0.24 [ 0.87; 0.38] 0.52 [ 1.41; 0.37]
1.36 [0.60; 2.11] 0.78 [0.11; 1.45] 1.14 [0.25; 2.03]
0.004 0.025 0.009
*n = 24 for ASMM **Student’s T-test ***Mean and 95% confidence interval on mean
Results: At the beginning of the study there was no significant difference in body mass index between the two
6 groups although BCM and LM were higher in the spread diet group. The protein pulse-feeding was more efficient than the protein spread-feeding in improving LM, BCM and ASMM. Conclusion: This study demonstrates for the first time that optimizing the protein feeding has a positive clinically relevant effect on BCM in malnourished hospitalized elderly patients. References [1] Am J Clin Nutr 1999;69:1202-8 Disclosure of Interest: None declared
O011 DIETARY VITAMIN K2 SUPPLEMENT IMPROVES BONE STATUS AFTER LUNG AND HEART TRANSPLANTATION L. Forli1 , J. Bollerslev1 , S. Simonsen2 , G.A. Isaksen1 , K. Godang1 , K.E. Kvamsdal1 , G. Gadeholt3 , O. Bjortuft4 . 1 Medical, 2 Cardiology, 3 Biochemestry, 4 Respiratory Medicine, Rikshospitalet, Oslo, Norway Rationale: Bone disease after transplantation is a recognized clinical problem and there is ongoing need for improved treatment. Studies in the last years have given strong indications for vitamin K to have an important role in optimal bone health. The aim of this prospective, randomized, placebo controlled double blind, longitudinal study was to investigate the effect of vitamin K2 supplement (180 mg menakinon (MK)-7) on bone mass the first year after lung and heart transplantation. Methods: After preoperative baseline investigation of bone mass and bone related biochemistry 35 lung recipients and 59 heart recipients aged between 21 and 67 years were investigated. Bone mass was measured using dual X-ray absoptiometry (DEXA). The recipients were also advised an intake of vitamin D of 10 20 mg and 1000 mg calsium per day. Results: One year after tx, in all patients the difference between placebo and vitamin K after controlling for baseline bone mineral density (BMD) was for the L2L4 region BMD 0.028 (SE 0.014) g/cm2 (P = 0.055). In a forward stepwise linear regression analysis fitted to model differences in the L2-L4 region BMD and controlling for possible confounding variables (including use of bisphosponate), the only significant predictors were organ (if heart, B = 0.065 g/cm2 , P < 0.001) and vitamin K2 vs. placebo (B = 0.034 g/cm2 , P = 0.019).One year after transplantation intact parathyroid hormone was higher in the MK-7 supplemented group than in the placebo group indicating an insufficient vitamin D status and a higher need for vitamin D in the vitamin K2 supplemented group. Conclusion: Supplementation with vitamin K2 the first year after lung and heart transplantation seemed to have a favourable effect on trabecular bone. Vitamin D status should receive more attention. Disclosure of Interest: No conflict of interest
Oral presentations / Free scientific presentations O012 LOSS OF BODY MASS AND EXERCISE ENDURANCE UNDER HYPOXIC CONDITIONS IS REDUCED WITH GLYCEROPHOSPHOLIPIDS ENRICHED IN DOCOSAHEXAENOICACID (GPL-DHA) SUPPLEMENTATION IN RODENTS C. Tardieu1 , V. Chat´ e1 , R. Guzun1 , M. Armand2 , 3 G. Pieroni , T. Coste3 , V. Saks1 , H. Dubouchaud1 , N. Cano4 , C. Pison5 . 1 Inserm884, Univ. J. Fourier, Grenoble; 2 Inserm476/INRA1260, Univ. M´ editeran´ ee, editeran´ ee, Hauterive; Marseille; 3 ASL, Univ. M´ 4 CRNH, UMR1019, Univ. Auvergne, Clermont-Ferrand; 5 Inserm884, CHU Grenoble, Grenoble, France Rationale: Systemic features of chronic respiratory failure (CRF) secondary to chronic obstructive pulmonary disease (COPD) include hypoxemia, oxidative stress and inflammation leading to sarcopenia, an independent predictor of death risk. The aim of our work was to evaluate the effect of a 12-week oral DHA supplementation (90 mg/kg body mass/day) in the form of phospholipids (GPL-DHA) on body mass, exercise endurance and mitochondrion function assessed by muscle skin fibre technique. Methods: Four groups of weaned male Wistar rats were fed with omega-3 impoverished regimen during 12 weeks, exposed to chronic hypoxia with FiO2:0.12 during the last 3 weeks, except in controls. GPL-DHA group, (n = 10) was compared to a group receiving triglyceride (Tg-DHA, n = 5), a group given a placebo P (n = 6), and a control group on room air during 12 weeks and receiving P (C, n = 10). Results: m±SD. Day0 body mass (g) was 67±19, 52±4, 61±3, 50±9 and by week 12: 360±45, 200±23*, 280±35*, 308±81*# in C, P, Tg-DHA, GPL-DHA groups respectively (p < 0.05 *compared to C, # compared to P). Changes in body mass from week 10 to 12 (%) were +9±3, 26±4*, 12±4*, +3±3 respectively. In P, Tg-DHA, GPLDHA, endurance time (min) was 20±3, 20±4, 29±7# respectively. In C, P, Tg-DHA and GPL-DHA, apparent Km (mM) for exogenous ADP, a marker of oxidative dependant metabolism, was 184±143, 148±47, 79±42*, 160±41 in Soleus and 193±100, 90±45*, 49±40*, 121±51 in Diaphragm respectively. Conclusion: In hypoxemic rodents, GPL-DHA supplementation resulted in a markedly preservation of body mass, exercise endurance and system organization at the level of energy production and transfer in muscles with a better preservation of oxidative intracellular energy units. Mechanisms need to be unravelled: effects of DHA on hypoxia related anorexia, mitochondrial biogenesis via PPAR pathway and/or mitochondrion membrane properties. Disclosure of Interest: None declared