- Email: [email protected]
Obesity paradox in elderly patients with cardiac failure- an updated review of current evidence
e72
Abstracts / Clinical Nutrition ESPEN 13 (2016) e55ee74
substitute in food industry, on attenuation of glucose levels is not fully elucidated. Aim: The objective of the present study was to evaluate the postprandial glucose response of healthy subjects to oat biscuits (OB) containing maltitol and oat biscuits in which maltitol was partly substituted with 4% inulin (OBIN). Materials and methods: In this randomized controlled crossover trial, 11 healthy volunteers (age 22.8±1.6 years, BMI 24.6±2.8 kg/m2) participated. They consumed on three separate occasions 80g OB, 81g OBIN and 50g glucose dissolved in 250mL water (reference food). Venous blood samples were collected before consumption and at 15, 30, 45, 60, 90 and 120 min postprandially. Results: The consumption of OB and OBIN resulted in significantly lower mean plasma glucose at 15, 30, 45 and 60 min postprandially, compared to glucose (p<0.05). The incremental area under the curve for glucose was calculated 69% and 55% lower compared to glucose (p<0.05), and glycaemic index (GI) 32.8±8.1 and 45.7±8.7 for OB and OBIN, respectively. Conclusions: The present work indicates that the oat biscuits studied are low GI foods (<55). The partial substitution of maltitol for inulin in oat biscuits does not exert further beneficial impact on glycaemic response of healthy volunteers. INCORPORATION OF BETA-GLUCANS INTO BREAD: POSTPRANDIAL GLUCOSE, INSULIN AND GHRELIN RESPONSE OF HEALTHY SUBJECTS Nikoleta S. Stamataki 1, Amalia E. Yanni 1, Maria G. Stoupaki 2, Alexandros Tsigkas 1, Panagiotis Konstantopoulos 2, Irene Pateras 3, Nikolaos Tentolouris 2, Despina N. Perrea 2, Vaios T. Karathanos 1. 1 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; 2 School of Medicine, National and Kapodistrian University of Athens, Greece; 3 ELBISCO Industrial & Commercial Food SA, Pikermi Attica, Greece Introduction: Bread and cereal products are the main source of available carbohydrates in the daily dietary intake. Milder postprandial glucose and insulin responses are associated with lower cardiometabolic risk, while the suppression of appetite is proven to exert beneficial effect on body weight regulation. Aim: This study was designed to examine the effect of a whole wheat/ rye/barley bread enriched with 2% oat beta-glucans (WRRBBG) consumption on postprandial levels of glucose, insulin and ghrelin of healhy volunteers. Materials and methods: Twelve healthy subjects (age 23±4 years, BMI 22.4±2.5 kg/m2) consumed on two separate occasions the WRRBBG and the reference food (white bread, WB), in amounts that yielded 50g of available carbohydrates. Venous blood samples were drawn for 180 min to determine plasma glucose, insulin and ghrelin concentrations. Subjective appetite ratings were evaluated via visual analogue scales. Results: The glycaemic index for WWRBBG was calculated 37.9±5.5 (p<0.05). Compared to WB, acute ingestion of WWRBBG exhibited 69% and 32% lower incremental area under the curve (iAUC) for glucose and insulin respectively. Mean insulin concentration was significantly lower 45 min postprandially. Postprandial suppression of ghrelin lasted for 120 min in WWRBBG versus 60 min in WB. WWRBBG decreased feeling of hunger and prospective consumption 30 and 60 min postprandially (p<0.05). Conclusions: Enrichment of whole wheat/rye/barley bread with oat betaglucans, exhibited lower postprandial glucose and insulin responses, and high satiety value in healthy subjects. OBESITY PARADOX IN ELDERLY PATIENTS WITH CARDIAC FAILURE- AN UPDATED REVIEW OF CURRENT EVIDENCE Ioannis Doundoulakis 1, Kalliopi-Anna Poulia 2, Christina Antza 3, Eirini Kasapidou 4, Michael Chourdakis 4. 1 71st Airbone Brigade, Nea Santa, Greece; 2 LAIKO General Hospital, Athens, Greece; 3 3rd Department of Internal Medicine, Aristotle University, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou General Hospital, Thessaloniki, Greece; 4 School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Introduction: It has been observed that obesity (BMI>30) can be a protective factor for elderly patients (>65 yrs) with cardiac failure (CF), for reasons that have not been fully explored. Aim: The aim of the study was tο review current evidence in order to identify possible underlying mechanisms of the “obesity paradox” in elderly patients with CF. Materials and methods: A review of current evidence was performed, including reviews, evidence based practices and clinical trials, for obesity paradox in CF. Data were collected from the data bases Pubmed, Scopus, Iatrotek from published clinical trials, reviews and systematic reviews (2009-2014), using the key words: “cardiac risk”, “cardiac failure”, “malnutrition”, “obesity paradox”, “cachexia”. The results ended up in 86 studies. Eighteen were excluded due to small sample size. Sixteen were excluded because they were conducted before 2005. The methodological quality was acceptable but not optimum. Great heterogenity between the studies was reported. Results: All the studies concluded that elderly patients with CF should not target the reduction of BMI but the reduction of body fat, without reducing lean body mass. Obese patients had better long term prognosis compared to overweight (p<0,5 0,01-0,5), normal weight (p<0,5 0,001-0,5) and underweight (p<0,5 0,001-0,5) patients. Malnourished patients had a higher mortality risk compared to the patients with good nutritional status (p<0,5, 0,009-0,5). Conclusion: The re-evaluation of reviews is a quicker procedure than the systematic review and it was proven efficient for the deduction of safe conclusions regarding benefits from a higher BMI on mortality or the nutritional management of patients with CF. Key words: Obesity paradox, Cardiac cachexia, Albumin, cardiac failure. SOMATOMETRIC EVALUATION OF CHILDREN AND EARLY ADOLESCENTS Viktoria Naco, Artemissia-Phoebe Nifli. Department of Nutrition & Dietetics, TEI of Thessaly, Karditsa, Greece Introduction: During the recent decades there is a significant increase in childhood obesity. Aim: The purpose of this study was to record child somatometrics in the urban area of Karditsa city, to investigate their nutritional habits and possible correlations. Materials and methods: Following written parental consent, 113 middle school students, of 2nd (27 girls and 27 boys) and 5th (27 girls, 32 boys) grade, living in Karditsa, participated in the study. We evaluated weight, height, 4 skinfolds (triceps, biceps, suprailiac and subscapular), waist and hip circumferences and body fat by BIA. Results: According to WHO BMI standards, 29.6% of 7-years old were overweight and 7.40% of girls and 14.81% of boys obese. In young adolescents, 22.22% of girls and 31.25% of boys were classified as obese. Overall, % body fat (ВІА) significantly correlated with BMI (p<0.001), though according to IOTF cut-offs, several children were classified as underfat and on the other hand an increased in obesity was observed. The exploitation of skinfolds for the calculation of BMI resulted in the displacement towards normal-underweight in the 7-8 years group, and diminished correlation with BMI in girls (r¼0.638, p<0.05). Triceps skinfold, as compared to NHANESI, amassed the classification as normal by 12% in boys-adolescents, and in parallel as overweight in younger age (by 7-12%). Conclusions: Independently from the method used for somatometric analysis, the percentage of overweight-obese subjects is in accordance with the epidemiological data, and is increased in boys and in the beginning of adolescence. The evaluation of 4 skinfolds lacks in accuracy, highlighting the absence of relative formulas and the lack of standards. VASCULAR SURGERY PATIENTS NUTRITION DATA Marianna Kechagia 3, Ioannis Nikolaos Degermetzoglou 1, 2, Lazarides 1. 1 Vascular Surgery Department, 1st Surgery Clinic Aristotle University of Thessaloniki, General Hospital of Thessaloniki “Papageorgiou”, Thessaloniki, Greece; 2 Vascular Surgery Clinic, 251 Hellenic Air Force
Abstracts / Clinical Nutrition ESPEN 13 (2016) e55ee74
substitute in food industry, on attenuation of glucose levels is not fully elucidated. Aim: The objective of the present study was to evaluate the postprandial glucose response of healthy subjects to oat biscuits (OB) containing maltitol and oat biscuits in which maltitol was partly substituted with 4% inulin (OBIN). Materials and methods: In this randomized controlled crossover trial, 11 healthy volunteers (age 22.8±1.6 years, BMI 24.6±2.8 kg/m2) participated. They consumed on three separate occasions 80g OB, 81g OBIN and 50g glucose dissolved in 250mL water (reference food). Venous blood samples were collected before consumption and at 15, 30, 45, 60, 90 and 120 min postprandially. Results: The consumption of OB and OBIN resulted in significantly lower mean plasma glucose at 15, 30, 45 and 60 min postprandially, compared to glucose (p<0.05). The incremental area under the curve for glucose was calculated 69% and 55% lower compared to glucose (p<0.05), and glycaemic index (GI) 32.8±8.1 and 45.7±8.7 for OB and OBIN, respectively. Conclusions: The present work indicates that the oat biscuits studied are low GI foods (<55). The partial substitution of maltitol for inulin in oat biscuits does not exert further beneficial impact on glycaemic response of healthy volunteers. INCORPORATION OF BETA-GLUCANS INTO BREAD: POSTPRANDIAL GLUCOSE, INSULIN AND GHRELIN RESPONSE OF HEALTHY SUBJECTS Nikoleta S. Stamataki 1, Amalia E. Yanni 1, Maria G. Stoupaki 2, Alexandros Tsigkas 1, Panagiotis Konstantopoulos 2, Irene Pateras 3, Nikolaos Tentolouris 2, Despina N. Perrea 2, Vaios T. Karathanos 1. 1 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; 2 School of Medicine, National and Kapodistrian University of Athens, Greece; 3 ELBISCO Industrial & Commercial Food SA, Pikermi Attica, Greece Introduction: Bread and cereal products are the main source of available carbohydrates in the daily dietary intake. Milder postprandial glucose and insulin responses are associated with lower cardiometabolic risk, while the suppression of appetite is proven to exert beneficial effect on body weight regulation. Aim: This study was designed to examine the effect of a whole wheat/ rye/barley bread enriched with 2% oat beta-glucans (WRRBBG) consumption on postprandial levels of glucose, insulin and ghrelin of healhy volunteers. Materials and methods: Twelve healthy subjects (age 23±4 years, BMI 22.4±2.5 kg/m2) consumed on two separate occasions the WRRBBG and the reference food (white bread, WB), in amounts that yielded 50g of available carbohydrates. Venous blood samples were drawn for 180 min to determine plasma glucose, insulin and ghrelin concentrations. Subjective appetite ratings were evaluated via visual analogue scales. Results: The glycaemic index for WWRBBG was calculated 37.9±5.5 (p<0.05). Compared to WB, acute ingestion of WWRBBG exhibited 69% and 32% lower incremental area under the curve (iAUC) for glucose and insulin respectively. Mean insulin concentration was significantly lower 45 min postprandially. Postprandial suppression of ghrelin lasted for 120 min in WWRBBG versus 60 min in WB. WWRBBG decreased feeling of hunger and prospective consumption 30 and 60 min postprandially (p<0.05). Conclusions: Enrichment of whole wheat/rye/barley bread with oat betaglucans, exhibited lower postprandial glucose and insulin responses, and high satiety value in healthy subjects. OBESITY PARADOX IN ELDERLY PATIENTS WITH CARDIAC FAILURE- AN UPDATED REVIEW OF CURRENT EVIDENCE Ioannis Doundoulakis 1, Kalliopi-Anna Poulia 2, Christina Antza 3, Eirini Kasapidou 4, Michael Chourdakis 4. 1 71st Airbone Brigade, Nea Santa, Greece; 2 LAIKO General Hospital, Athens, Greece; 3 3rd Department of Internal Medicine, Aristotle University, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou General Hospital, Thessaloniki, Greece; 4 School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Introduction: It has been observed that obesity (BMI>30) can be a protective factor for elderly patients (>65 yrs) with cardiac failure (CF), for reasons that have not been fully explored. Aim: The aim of the study was tο review current evidence in order to identify possible underlying mechanisms of the “obesity paradox” in elderly patients with CF. Materials and methods: A review of current evidence was performed, including reviews, evidence based practices and clinical trials, for obesity paradox in CF. Data were collected from the data bases Pubmed, Scopus, Iatrotek from published clinical trials, reviews and systematic reviews (2009-2014), using the key words: “cardiac risk”, “cardiac failure”, “malnutrition”, “obesity paradox”, “cachexia”. The results ended up in 86 studies. Eighteen were excluded due to small sample size. Sixteen were excluded because they were conducted before 2005. The methodological quality was acceptable but not optimum. Great heterogenity between the studies was reported. Results: All the studies concluded that elderly patients with CF should not target the reduction of BMI but the reduction of body fat, without reducing lean body mass. Obese patients had better long term prognosis compared to overweight (p<0,5 0,01-0,5), normal weight (p<0,5 0,001-0,5) and underweight (p<0,5 0,001-0,5) patients. Malnourished patients had a higher mortality risk compared to the patients with good nutritional status (p<0,5, 0,009-0,5). Conclusion: The re-evaluation of reviews is a quicker procedure than the systematic review and it was proven efficient for the deduction of safe conclusions regarding benefits from a higher BMI on mortality or the nutritional management of patients with CF. Key words: Obesity paradox, Cardiac cachexia, Albumin, cardiac failure. SOMATOMETRIC EVALUATION OF CHILDREN AND EARLY ADOLESCENTS Viktoria Naco, Artemissia-Phoebe Nifli. Department of Nutrition & Dietetics, TEI of Thessaly, Karditsa, Greece Introduction: During the recent decades there is a significant increase in childhood obesity. Aim: The purpose of this study was to record child somatometrics in the urban area of Karditsa city, to investigate their nutritional habits and possible correlations. Materials and methods: Following written parental consent, 113 middle school students, of 2nd (27 girls and 27 boys) and 5th (27 girls, 32 boys) grade, living in Karditsa, participated in the study. We evaluated weight, height, 4 skinfolds (triceps, biceps, suprailiac and subscapular), waist and hip circumferences and body fat by BIA. Results: According to WHO BMI standards, 29.6% of 7-years old were overweight and 7.40% of girls and 14.81% of boys obese. In young adolescents, 22.22% of girls and 31.25% of boys were classified as obese. Overall, % body fat (ВІА) significantly correlated with BMI (p<0.001), though according to IOTF cut-offs, several children were classified as underfat and on the other hand an increased in obesity was observed. The exploitation of skinfolds for the calculation of BMI resulted in the displacement towards normal-underweight in the 7-8 years group, and diminished correlation with BMI in girls (r¼0.638, p<0.05). Triceps skinfold, as compared to NHANESI, amassed the classification as normal by 12% in boys-adolescents, and in parallel as overweight in younger age (by 7-12%). Conclusions: Independently from the method used for somatometric analysis, the percentage of overweight-obese subjects is in accordance with the epidemiological data, and is increased in boys and in the beginning of adolescence. The evaluation of 4 skinfolds lacks in accuracy, highlighting the absence of relative formulas and the lack of standards. VASCULAR SURGERY PATIENTS NUTRITION DATA Marianna Kechagia 3, Ioannis Nikolaos Degermetzoglou 1, 2, Lazarides 1. 1 Vascular Surgery Department, 1st Surgery Clinic Aristotle University of Thessaloniki, General Hospital of Thessaloniki “Papageorgiou”, Thessaloniki, Greece; 2 Vascular Surgery Clinic, 251 Hellenic Air Force