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O.22 Value of preoperative and postoperative supplemental enteral nutrition in patients undergoing major gastrointestinal surgery
However, whole body Ra of GLN increased in WPI+GLN, but not in GLNPEP (table). Whole body Ra of PHE, corrected for the amount of PHE in the enteral nutrition was not different, indicating comparable protein turnover. Group Postabsorptive WPI WPI+GLN GLNPEP
GLN in meal nmol/kg bw/min 1890 4000 (2200 free) 4000
Whole body Ra GLN nmol/kg bw/min 9005 + 715 10207 _+1280 19361+4580 10354 + 888
Whole body Ra PHE nmol/kg bw/min 1790 + 118 1419_+ 131 1678-+413 1426 -+ 237
Conclusion: Enteral nutrition with GLN added in the form of intact protein, in contrast to free GLN, does not increase the whole body Ra of GLN. Whether this is due to enhanced uptake in the splanchnic region or a greater reduction of the endogenous GLN production, remains to be established.
0.21 Two-phase randomised controlled clinical trial of oral dietary supplements in surgical patients A. M. Keele 1, M. J. Bray 1, P. W. Emery 2 and D. B. A. Silk 1 1Department of Gastroenterology and Nutrition, Central Middlesex Hospital NHS Trust, London NWIO 7NS and 2Department of Nutrition and Dietetics, King's College, London W8 7AH. It has previously been shown that oral dietary supplements have clinically significant short-term benefits in surgical patients. The aims of the present study were (1) to re-evaluate the short-term clinical efficacy of oral dietary supplements administered postoperatively to in-patients undergoing gastrointestinal surgery (phase 1), and (2) to investigate the clinical efficacy of oral dietary supplements given during the first 4 months following hospital discharge (phase 2). 100 patients who were scheduled to undergo moderate to major gastrointestinal surgery entered the study. They were randomly assigned to receive a normal ward diet postoperatively, or the same diet supplemented ad libitum with an oral nutritional supplement (Fortisip, Nutricia, 6.3kJ/ml, 8mg N/ml). The study period was from the day the patients started ingesting free fluids postoperatively (mean 5.3 days after surgery) until the day of hospital discharge. On discharge patients were further randomised to their usual home diet, or taking the oral supplement in addition to their usual diet for 4 months, thus resulting in the formation of 4 treatment groups in phase 2. In phase 1, the mean daily energy and protein intakes were significantly higher in the treatment group than in the control groups at study days 1,2, 3 and 4 (by an average 1473 + SEM 122 kJ, 13 _+ 1.3 g protein). Patients in the treatment group lost significantly less weight than control patients by discharge: 2.2 + 0.5 kg vs 4.2 _+ 0.4 kg (p < 0.001). Control patients showed a significant reduction in hand grip strength over their hospital stay (p < 0.02), whereas treatment patients maintained their hand grip strength. Significantly more patients in the control group (12) developed serious complications (wound infection 7, wound dehiscence 2, gastrointestinal perforation 1, subphrenic abscess 1, multiple complications 1) than in the treatment group (4) (wound infection 2, wound dehiscence 1, multiple complications 1; p < 0.05). In phase 2, supplemented patients had significantly higher energy and protein intake one month after discharge, and a significantly higher energy intake 2 months after discharge, compared with control patients. There were no significant differences in indices of nutritional status and wellbeing between the groups. We conclude that the prescription of oral dietary supplements postoperatively to patients undergoing moderate to major gastrointestinal surgery results in clinically significant benefits. However, in this study the benefits were restricted to the in-patient phase.
0.22 Value of preoperative and postoperative supplemental enteral nutrition in patients undergoing major gastrointestinal surgery P. M. Murchan, /. Bradford, D. Palmer, S. Townsend, J. D. Harrison, C. J. Mitchell and J. Macfie Combined Gastroenterology Unit, Scarborough General Hospital, Scarborough, UK. Aims: To determine the impact of supplemental enteral nutrition given in the pro- and post-operative period on nutritional status and outcome of patients undergoing major excisional gastrointestinal surgery. Methods: Patients were randomised to receive either normal diet or diet supplemented by commercially available nutrition 'sip feeds' (20 g protein/600 kcal/400 ml per day), for a minimum period of 14 days prior to surgery and further randomised to receive or not in the post operative period. Parameters analysed include pre- and post-operative weight, duration of hospital stay, POSSUM score and complications. Dynamometric assessment of muscle function was serially measured using a Duffield hand dynamometer. Serial anthropometric measurements, liver function and retinol binding protein results were analysed. Results: 34 patients were recruited and randomised to group A (pre- and postoperative supplements, n = 10), group B (preoperative supplement only, n = 8), group C (post-operative supplements only, n = 7) group D (no supplemental nutrition, n = 9). Patients were well matched for age, sex and type of operation. Patients receiving pre-operative nutritional support (group A & B) showed a mean weight gain (0.14 + 0.05 kg) from randomisation to day of surgery, differing significantly with a weight loss (1.2 + 0.3 kg) in those not supplementally fed (p < 0.05, Mann-Whitney U test). Weight loss was sustained in all groups following surgery but was significantly greater in control group (D vs A, B or C, p < 0.05). Preoperative feeding was associated with less weight loss than patients receiving post-operative feeding alone (A & B vs C, p < 0.05). Duration of hospital stay was also longer in patients not receiving any sip feeds compared to patients receiving both pro- and post-operative nutrition (mean stay 12 + 2 vs 18 _+3, p < 0.05). No group differences were observed in complication rates, Possum scores, grip strength or biochemical indices. Conclusion: Pre- and post-operative supplemental nutrition minimises the inevitable weight toss and duration of hospital stay associated with major excisional surgery. Its routine use is recommended.
0.23 Effects of enteral nutrition supplemented with short-chain fatty acids on intestinal metabolism during short bowel syndrome in pigs C. F. M. Welters, N. E. P. Deutz, C. H. C. Dejong, P. B. Soeters and E. Heineman Dept of Surgery, University of Limburg, Maastricht, The Netherlands. Introduction: Growth and development are compromised in growing individuals with short bowel syndrome (SBS). Short-chain fatty acids (SCFA) are known to have trophic effects on the small bowel mucosa. Thus, enteral SCFA supplementation could be beneficial by optimizing adaptation of the gut remnant. Hypothesis: Supplementation of enteral nutrition with the SCFA butyrate (BUT) during SBS improves growth and development and enhances gut function and protein synthesis. Methods: SBS was created in growing pigs (18-22 kg) by 75% small bowel resection. Catheters were placed in the aorta, portal vein and stomach. Postoperatively, pigs were fed intragastrically during 15h per day via a swivel system with a liquid meal
GLN in meal nmol/kg bw/min 1890 4000 (2200 free) 4000
Whole body Ra GLN nmol/kg bw/min 9005 + 715 10207 _+1280 19361+4580 10354 + 888
Whole body Ra PHE nmol/kg bw/min 1790 + 118 1419_+ 131 1678-+413 1426 -+ 237
Conclusion: Enteral nutrition with GLN added in the form of intact protein, in contrast to free GLN, does not increase the whole body Ra of GLN. Whether this is due to enhanced uptake in the splanchnic region or a greater reduction of the endogenous GLN production, remains to be established.
0.21 Two-phase randomised controlled clinical trial of oral dietary supplements in surgical patients A. M. Keele 1, M. J. Bray 1, P. W. Emery 2 and D. B. A. Silk 1 1Department of Gastroenterology and Nutrition, Central Middlesex Hospital NHS Trust, London NWIO 7NS and 2Department of Nutrition and Dietetics, King's College, London W8 7AH. It has previously been shown that oral dietary supplements have clinically significant short-term benefits in surgical patients. The aims of the present study were (1) to re-evaluate the short-term clinical efficacy of oral dietary supplements administered postoperatively to in-patients undergoing gastrointestinal surgery (phase 1), and (2) to investigate the clinical efficacy of oral dietary supplements given during the first 4 months following hospital discharge (phase 2). 100 patients who were scheduled to undergo moderate to major gastrointestinal surgery entered the study. They were randomly assigned to receive a normal ward diet postoperatively, or the same diet supplemented ad libitum with an oral nutritional supplement (Fortisip, Nutricia, 6.3kJ/ml, 8mg N/ml). The study period was from the day the patients started ingesting free fluids postoperatively (mean 5.3 days after surgery) until the day of hospital discharge. On discharge patients were further randomised to their usual home diet, or taking the oral supplement in addition to their usual diet for 4 months, thus resulting in the formation of 4 treatment groups in phase 2. In phase 1, the mean daily energy and protein intakes were significantly higher in the treatment group than in the control groups at study days 1,2, 3 and 4 (by an average 1473 + SEM 122 kJ, 13 _+ 1.3 g protein). Patients in the treatment group lost significantly less weight than control patients by discharge: 2.2 + 0.5 kg vs 4.2 _+ 0.4 kg (p < 0.001). Control patients showed a significant reduction in hand grip strength over their hospital stay (p < 0.02), whereas treatment patients maintained their hand grip strength. Significantly more patients in the control group (12) developed serious complications (wound infection 7, wound dehiscence 2, gastrointestinal perforation 1, subphrenic abscess 1, multiple complications 1) than in the treatment group (4) (wound infection 2, wound dehiscence 1, multiple complications 1; p < 0.05). In phase 2, supplemented patients had significantly higher energy and protein intake one month after discharge, and a significantly higher energy intake 2 months after discharge, compared with control patients. There were no significant differences in indices of nutritional status and wellbeing between the groups. We conclude that the prescription of oral dietary supplements postoperatively to patients undergoing moderate to major gastrointestinal surgery results in clinically significant benefits. However, in this study the benefits were restricted to the in-patient phase.
0.22 Value of preoperative and postoperative supplemental enteral nutrition in patients undergoing major gastrointestinal surgery P. M. Murchan, /. Bradford, D. Palmer, S. Townsend, J. D. Harrison, C. J. Mitchell and J. Macfie Combined Gastroenterology Unit, Scarborough General Hospital, Scarborough, UK. Aims: To determine the impact of supplemental enteral nutrition given in the pro- and post-operative period on nutritional status and outcome of patients undergoing major excisional gastrointestinal surgery. Methods: Patients were randomised to receive either normal diet or diet supplemented by commercially available nutrition 'sip feeds' (20 g protein/600 kcal/400 ml per day), for a minimum period of 14 days prior to surgery and further randomised to receive or not in the post operative period. Parameters analysed include pre- and post-operative weight, duration of hospital stay, POSSUM score and complications. Dynamometric assessment of muscle function was serially measured using a Duffield hand dynamometer. Serial anthropometric measurements, liver function and retinol binding protein results were analysed. Results: 34 patients were recruited and randomised to group A (pre- and postoperative supplements, n = 10), group B (preoperative supplement only, n = 8), group C (post-operative supplements only, n = 7) group D (no supplemental nutrition, n = 9). Patients were well matched for age, sex and type of operation. Patients receiving pre-operative nutritional support (group A & B) showed a mean weight gain (0.14 + 0.05 kg) from randomisation to day of surgery, differing significantly with a weight loss (1.2 + 0.3 kg) in those not supplementally fed (p < 0.05, Mann-Whitney U test). Weight loss was sustained in all groups following surgery but was significantly greater in control group (D vs A, B or C, p < 0.05). Preoperative feeding was associated with less weight loss than patients receiving post-operative feeding alone (A & B vs C, p < 0.05). Duration of hospital stay was also longer in patients not receiving any sip feeds compared to patients receiving both pro- and post-operative nutrition (mean stay 12 + 2 vs 18 _+3, p < 0.05). No group differences were observed in complication rates, Possum scores, grip strength or biochemical indices. Conclusion: Pre- and post-operative supplemental nutrition minimises the inevitable weight toss and duration of hospital stay associated with major excisional surgery. Its routine use is recommended.
0.23 Effects of enteral nutrition supplemented with short-chain fatty acids on intestinal metabolism during short bowel syndrome in pigs C. F. M. Welters, N. E. P. Deutz, C. H. C. Dejong, P. B. Soeters and E. Heineman Dept of Surgery, University of Limburg, Maastricht, The Netherlands. Introduction: Growth and development are compromised in growing individuals with short bowel syndrome (SBS). Short-chain fatty acids (SCFA) are known to have trophic effects on the small bowel mucosa. Thus, enteral SCFA supplementation could be beneficial by optimizing adaptation of the gut remnant. Hypothesis: Supplementation of enteral nutrition with the SCFA butyrate (BUT) during SBS improves growth and development and enhances gut function and protein synthesis. Methods: SBS was created in growing pigs (18-22 kg) by 75% small bowel resection. Catheters were placed in the aorta, portal vein and stomach. Postoperatively, pigs were fed intragastrically during 15h per day via a swivel system with a liquid meal