O028 PREVALENCE AND PREDICTORS OF METABOLIC SYNDROME AFTER LIVER TRANSPLANTATION

Obesity and the metabolic syndrome

13

Methods: Mini nutritional assessment (MNA) was performed to 413 consequtive patients those admitted to our outpatient clinics in the last 12 months. Nutritional status was compared with the existing geriatric syndromes. Results: In the whole population, 181 patients (44%) showed poor nutritional status (13% malnutrition, 31% malnutrition risk). Patients with low MNA score had low body mass indexes (p < 0.0001), blood haemoglobin (p = 0.019), serum total protein (p < 0.0001) and albumin (p < 0.0001). Their erythrocyte sedimentation rate (p < 0.0001) and serum C-reactive protein levels (p = 0.002) were increased and they had increased number of chronic diseases (4±2 vs 3±2, p < 0.0001) and daily drug intake (6±3 vs 5±3, p = 0.003). They had more geriatric syndromes (6±2 vs 3±2, p < 0.0001). Most of the patients with depression, fecal incontinence, decreased cognitive functions and functional dependence showed low MNA test scores (depression: p < 0.0001, c2 = 3.270, fecal incontinence: p < 0.0001, c2 = 17.016, dementia: p < 0.0001, c2 = 25.084 and dependence: p < 0.0001, c2 = 58.158)(Table). Table: Association of various geriatric syndromes with the nutritional status of the patients Geriatric Syndromes

Normal/ Undernutrition (N = 232/181)

P Value

Urinary incontinence Fecal incontinence Falls Insomnia Dementia Depression Neurological disorders Caregiver need

75/72 2/16 72/77 51/69 46/77 75/110 57/89 12/62

NS <0.0001 0.018 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001

NS: non-significant

Conclusion: Malnutrition rates of our patients were found similar with the previous data and malnutrition risk showed positive correlation with the number of existing geriatric syndromes. Depression, dementia, functional dependence and co-morbidities were associated with poor nutritional status. Disclosure of Interest: None declared

Obesity and the metabolic syndrome O027 IS METABOLIC SYNDROME THE LINK BETWEEN OBESITY AND POSTMENOPAUSAL BREAST CANCER? L.A. Healy1 , A.M. Ryan2 , P. Carroll3 , E.M. Connolly3 , T. Boyle3 , M.J. Kennedy4 , J.V. Reynolds3 . 1 CLinical Nutrition, 2 Clinical Nutrition, 3 Surgery, 4 Clinical Oncology, St James’s Hospital, Dublin 8, Ireland Rationale: Obesity is implicated both in breast cancer risk and cancer mortality. The proposed mechanisms underpinning these associations are abdominal obesity,

insulin resistance, altered sex steroids, adipokines, inflammation and oxidative stresses. The clustering of some of these risk factors is the cornerstone of metabolic syndrome (MetS) diagnosis, and may be considered a high risk state for cancer [1]. The aim was to describe the incidence of MetS in postmenopausal breast cancer and examine its association with tumour pathology. Methods: This was a prospective observational study of postmenopausal breast cancer patients. Individuals underwent a metabolic and nutritional assessment prior to treatment. MetS was defined according to the International Diabetes Federation definition [2]. Results: One hundred and seven female breast cancer patients were consented. The median age was 67 years (Range 40 84). The mean BMI was 28.3±5.3 kg/m2 , with 72% patients overweight or obese and a further 87% centrally obese. MetS was diagnosed in 40% patients, which exceeds the population norms reported at 21% [3. MetS was significantly associated with central obesity (p < 0.005); a 13 cm greater waistline, higher total and trunk fat mass, as well as higher systolic BP (p = 0.008), and insulin levels (p = 0.015). Obesity was associated with larger tumours (p = 0.021), while the presence of metabolic syndrome was significantly associated with a later stage of disease (P = 0.000) and axillary node involvement (P = 0.028). Conclusion: We report a high prevalence of MetS and central obesity in a cohort of Irish breast cancer patients. If obesity is an independent prognosis factor is still under debate, but MetS appears to be associated with a more aggressive tumor phenotype and this presents an exciting avenue for future prevention and treatment of breast cancer. References [1] Cowey & Hardy. The Am J Pathol 2006;168:1505-1522 [2] Alberti KGMM, et al. Diabetic Medicine 2006; 23: 469-480 [3] Waterstone DF, et al. Ir J Med Sci 2009 [Epub] Disclosure of Interest: None Declared

O028 PREVALENCE AND PREDICTORS OF METABOLIC SYNDROME AFTER LIVER TRANSPLANTATION L.R. Anast´ acio1 , L.G. Ferreira1 , H.S. Ribeiro2 , J.C. Liboredo1 , A.S. Lima3 , M.T.D. Correia3 . 1 Food Science Post Graduation Program, 2 Nutrition Course, 3 Medical School and Alfa Institute of Gastroenterology, Federal University of Minas Gerais, Belo Horizonte, Brazil Rationale: Metabolic Syndrome (MetS) is associated with increased risk of cardiovascular events and damage to the liver. Obesity, insulin resistance, high blood pressure and dyslipidemia coexist in MetS and these are widely prevalent after liver transplantation (LTx). The prevalence and the predictors of MetS after LTx were assessed. Methods: Patients who underwent LTx were evaluated for the presence of MetS according to the International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) criteria. Demographic, socioeconomic, lifestyle, clinical, anthropometric and dietetic variables were collected as well as length of time on steroids and

14 its cumulative dose. Statistics were assessed by univariate and multivariate logistic regression analysis. Results: We assessed 153 patients (Mar/Oct 08). Prevalence of MetS was 37.1% (NCEP) and 48.7% (IDF). The logistic regression model was able to predict MetS by the IDF criteria in 80% of the cases and in 76% by the NCEP classification. Older age (IDF: OR:1.07; IC:1.03 1.11/NCEP: OR:1.07; IC:1.02 1.12), shorter time since LTx (IDF: OR:1.03; IC:1.01 1.03/NCEP: OR:1.02; IC:1.01 103) and history of excessive weight prior to liver dysfunction (IDF: OR:6.08; IC:2.5 14.8/NCEP: OR:3.44; IC:1.2 9.6) were predictors of MetS. Other predictors of MetS (IDF) were indication for LTx due to alcohol abuse (OR:4.68; IC:1.6 13.9), physical inactivity (OR:9.88; IC:2.1 45.7) and intake of vitamin B5 below the recommendations (OR:15.76; IC:2.6 94.4), which was suggestive of lower calcium intake (p < 0.05). The presence of MetS (NCEP) was also predicted by anxiety and/or depression (OR:4.29; IC:1.5 12.5) and lower intake of potassium (OR:8.13; IC:1.8 37.0), suggestive of lower fiber and folic acid intake (p < 0.01). Conclusion: MetS is widely prevalent after LTx and there are different nutritional preventable factors. Thus adequate nutrition counseling is recommended. Disclosure of Interest: None declared.

O029 FRUCTOSE AND FAT HAVE ADDITIVE EFFECTS ON INTRAHEPATIC LIPIDS AND OPPOSITE EFFECTS ON PLASMA TRIGLYCERIDES H. Sobrecases1 , L. Tappy1 , K. Lˆ e1 , M. Bortolotti1 , M. Ith2 , R. Kreis2 , C. Boesch2 . 1 Department of physiology, University of lausanne, Lausanne; 2 Department of clinical research, Inselspital, Bern, Switzerland Rationale: Intrahepatocellular lipids (IHCL)and intramyocellular lipids (IMCL) are closely linked to obesity and insulin resistance, and can be increased by dietary factors, such as high-fructose or high-fat diets. In Western diets, those two nutrients are consumed in increasing amounts, and most of the time found together. However, the relative contribution of excess energy intake, fat and carbohydrates on increasing IHCL remains unknown. The aim was to determine the interactions between fat and fructose on IHCL and plasma triglycerides. Methods: Three groups of healthy male subjects were studied on two occasions, ie after an isocaloric diet and after 7 days of either: 1) Fru: +3.5 g fructose/kg fat-free mass (ffm)/day, +35% caloric intake; 2) Fat: +30% caloric intake as saturated fat; 3) FruFat: +3.5 g fructose/kgffm/day +30% calories as saturated fat, +65% caloric intake. IHCL and IMCL were measured by 1H magnetic resonance spectroscopy. Results: All three dietary conditions increased IHCL (P < 0.05), and this increment was of greatest magnitude after FruFat (Fru: +75%; Fat: +87%; FruFat: +133%, P < 0.05). VLDL-TG increased after Fru (from 0.66±0.05 to 0.89±0.10 mmol/L, P < 0.05) and decreased after Fat (0.83±0.07 to 0.69±0.06 mmol/L, P < 0.05), while no change was observed after FruFat. Fasting plasma NEFA were suppressed to the same extent with all 3 conditions (Fru: 40%; Fat: 26%; FruFat: 48%). Only

Oral presentations / Free scientific presentations FruFat significantly increased alanine aminotransferase (+73%) and IMCL (+129%), while Fru or Fat alone had no such effect. Conclusion: High fat, high fructose-, and high fat-high fructose diets all led to increases in IHCL. This hepatic lipid deposition was however not related to changes in hepatic insulin sensitivity. Fat and fructose overfeeding led to similar increases in IHCL, but had opposite effects on plasma TG; furthermore, overfeeding with fat + fructose together had additive effects on IHCL, but neutralizing effects on VLDL-TG. This suggests that the mechanisms underlying hepatic fat deposition are different for fat and fructose. Disclosure of Interest: None

O030 SERUM FOLIC ACID IN WEIGHT REDUCTION PROGRAM OBESE PATIENTS T. Parece1 , R. Carvalho1 , I. Machado1 , I. Sousa1 , R. Cesar1 . 1 Endocrinology and Nutrition Service, Divino Espirito Santo Hospital, Ponta Delgada, Portugal Rationale: Despite the high food and energy intake in obese patients, nutritional deficits have been observed as for example for folic acid. Low intake of fruits and vegetables appear to be the main responsible for the low levels of folic acid sometimes observed. The decrease of serum levels of this vitamin leads to an elevation of plasma levels of homocysteine, a factor strongly associated with increased risk of cardiovascular disease (CVD). Deficiency in folic acid is also associated with other diseases, such as the Neural Tube Defects (NTD). Evaluate the serum levels of folic acid in obese patients following a weight reduction program with strong advice for the consumption of fruits and vegetables. Methods: The sample consisted in 52 patients, 45 females and 7 males, with aged >18 years, BMI > 30 kg/m2 , with more than one year of medical-nutrition follow-up. Statistical analysis was performed using the program SPSS for windows, version 16.0. Results: The sample, BMI of 40.86±7.55 kg/m2 , had mean folic acid values 7.93±3.29 nmol/L, without significant differences between sexes. However, in young females, (18 49 years) had lower levels than older women (6.96±2.43 and 8.89±3.82, respectively). According to Dhonukshe-Rutten et al, 80.8% of the sample had a low serum folic acid, 11.5% moderate and 7.7% favourable. There was an inverse association between BMI and serum folic acid (R = 0.030; p > 0.05) and a positive correlation between age and the status of the vitamin (R = 0.309; p < 0.05). In this study 57.7% of individual had elevated blood pressure, 36.5% dyslipidemia and 26.9% are diabetic. Conclusion: In this study (mostly women of childbearing age) there was a very low concentration of folic acid in 80.8% of patients, with a tendency to decrease with increasing BMI. The results show the need for corrective or preventive measures to fight this malnutrition. Disclosure of Interest: None Declared