- Email: [email protected]
OP014 THE IMPACT OF DUODENAL-JEJUNAL EXCLUSION ON SATIETY HORMONES
S6 arterialized-venous plasma by LC-MS/MS. Fat-free mass was assessed by Dual-energy X-ray Absorptiometry. Statistics were done using Student’s t-Test. Results: Total ARG and CIT production were not different between COPD patients and healthy controls. However, de novo ARG production was reduced in COPD (7.12±0.6 vs. 10.6±1.5 mmol/kg FFM/h, p = 0.027) and lower values were also found for whole body NO synthesis (0.31±0.1 vs. 0.74±0.1 mmol/kg FFM/h, p < 0.01). Conclusion: Compromised NO synthesis is associated with a reduced de novo ARG production in patients with stable COPD. This suggests that in order to upregulate whole body NO synthesis in COPD, higher dietary intake of ARG or its precursor CIT is necessary.
Oral communications Bloom: None Declared, W. Buurman: None Declared, C. le Roux: None Declared, N. Bouvy Grant/Research Support: open research grant from GI Dynamics, J. W. Greve Grant/Research Support: open research grant from GI Dynamics
OP015 IMPACT OF ORAL NUTRITIONAL SUPPLEMENTATION ON HOSPITAL OUTCOMES T. Philipson1 , J.T. Snider2 , D.N. Lakdawalla3 , B. Stryckman2 , D.P. Goldman3 . 1 Irving B. Harris Graduate School of Public Policy Studies, The University of Chicago, Chicago, 2 Precision Health Economics, 3 School of Pharmacy and Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
Disclosure of Interest: None Declared
OP014 THE IMPACT OF DUODENAL-JEJUNAL EXCLUSION ON SATIETY HORMONES C. De Jonge1,2 , S.S. Rensen2 , F.J. Verdam2 , R.P. Vincent3 , S.R. Bloom4 , W.A. Buurman2 , C.W. le Roux3 , N.D. Bouvy2 , J.W.M. Greve1 . 1 Atrium Medical Center Parkstad, Heerlen, 2 Maastricht University Medical Centre, Maastricht, Netherlands; 3 King’s College Hospital NHS Foundation Trust, 4 Imperial College London, London, United Kingdom Rationale: Bariatric procedures that exclude the proximal small intestine lead to significant weight loss which is probably mediated by changes in hormones that alter appetite, such as peptide YY (PYY), ghrelin, cholecystokinin (CCK), and leptin. We investigated the effect of the duodenal-jejunal bypass liner (DJBL) on hormones implicated in appetite control. Methods: Seventeen obese patients (BMI 30 50 kg/m2 ) with type 2 diabetes received the DJBL for 24 weeks. Plasma levels of GLP-1, PYY, CCK, and ghrelin were analyzed after a standardized meal before and during DJBL treatment. In addition, fasting leptin levels were analyzed. Results: At baseline, patients had an average body weight of 116.0±5.8 kg. One week after implantation, subjects had lost 4.3±0.6 kg (p < 0.01). Weight loss further progressed to 12.7±1.3 kg at 24 weeks post-implantation. All subjects reported reduced caloric intake following DJBL implantation. In addition, satiety increased in 15/17 patients. As early as one week after implantation, post-prandial GLP-1, PYY, and ghrelin levels were increased (baseline vs. week 1 vs. week 24 GLP-1: 4,440±249 vs. 6,407±480 vs. 6,008±429 pmol/L/min, PYY: 2,584±154 vs. 4,084±418 vs. 4,121±697 pmol/L/min, and ghrelin: 7,881±1,783 vs. 11,042±1,807 vs. 10,562±1,783 pg/mL/min, all p < 0.05). The CCK response to a meal decreased (baseline vs. week 1 vs. week 24: 434±51 vs. 229±52 vs. 256±51 pmol/L/min, p < 0.01). Fasting leptin levels also decreased, reaching statistical significance at week 24, and positively correlated with BMI (baseline vs. week 24: 98.4±16.8 vs. 53.1±10.2 ng/mL, p < 0.01 and rs = 0.58, p < 0.05 respectively). Conclusion: DJBL treatment increases satiety paralleled by changes in hormones involved in appetite control. We propose that the increase in satiety is associated with activation of the ileal brake, as supported by elevated post-prandial GLP-1 and PYY response, and the increased ghrelin response to a meal. Disclosure of Interest: C. De Jonge: None Declared, S. Rensen: None Declared, F. Verdam: None Declared, R. Vincent: None Declared, S.
Rationale: A growing body of evidence suggests that oral nutrition supplements (ONS) might improve outcomes among hospitalized patients; however, previous studies suffer from limitations, including modest sample sizes, narrowly selected patient populations, and in observational studies, possible selection bias. This study assessed the effect of inpatient ONS use on length of stay, episode cost, and 30-day readmission probability. Methods: An eleven-year retrospective study (2000 to 2010) was conducted using the Premier Perspectives Database, which contained information on 44.0 million adult inpatient episodes. Using a matched sample of ONS and non-ONS episodes for any inpatient diagnosis, instrumental variables regression analysis was performed to quantify the effect of ONS use on length of stay, episode cost, and probability of approximate 30-day readmission. For the readmission outcome, the matched sample was restricted to episodes where the patient was known to be at risk of readmission. The fraction of a hospital’s episodes in a given quarter involving ONS was used as an instrumental variable. Results: Within the database, 1.6% of 44.0 million adult inpatient episodes involved ONS use. Based on a matched sample of 1.2 million episodes, ONS patients had a shorter length of stay by 2.3 days (95% confidence interval [CI] 2.42 to 2.16), from 10.9 to 8.6 days (21.0% decline), and decreased episode cost of $4,734 (95% CI $4,754 to $4,714), from $21,950 to $17,216 (21.6% decline). Restricting the matched sample to the 862,960 episodes where patients were readmitted at some point, ONS patients had a reduced probability of early readmission (within 30 days) of 2.3 percentage points (95% CI 0.027 to 0.019), from 34.3% to 32.0% (6.7% decline). Conclusion: Use of ONS decreases length of stay, episode cost, and 30-day readmission risk in the inpatient population. Disclosure of Interest: T. Philipson Consultant for: Dr. Philipson was involved in the preparation of this manuscript while serving as a partner at Precision Health Economics, which received consulting fees from Abbott Nutrition., J. Snider Consultant for: Dr. Snider was involved in the preparation of this manuscript while employed by Precision Health Economics, which received consulting fees from Abbott Nutrition., D. Lakdawalla Consultant for: Dr. Lakdawalla was involved in the preparation of this manuscript while serving as a partner at Precision Health Economics, which received consulting fees from Abbott Nutrition., B. Stryckman Consultant for: Mr. Stryckman was involved in the preparation of this manuscript while employed by Precision Health Economics, which received consulting fees from Abbott Nutrition., D. Goldman Consultant for: Dr. Goldman was involved in the preparation of this manuscript while serving as a
Oral communications Bloom: None Declared, W. Buurman: None Declared, C. le Roux: None Declared, N. Bouvy Grant/Research Support: open research grant from GI Dynamics, J. W. Greve Grant/Research Support: open research grant from GI Dynamics
OP015 IMPACT OF ORAL NUTRITIONAL SUPPLEMENTATION ON HOSPITAL OUTCOMES T. Philipson1 , J.T. Snider2 , D.N. Lakdawalla3 , B. Stryckman2 , D.P. Goldman3 . 1 Irving B. Harris Graduate School of Public Policy Studies, The University of Chicago, Chicago, 2 Precision Health Economics, 3 School of Pharmacy and Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
Disclosure of Interest: None Declared
OP014 THE IMPACT OF DUODENAL-JEJUNAL EXCLUSION ON SATIETY HORMONES C. De Jonge1,2 , S.S. Rensen2 , F.J. Verdam2 , R.P. Vincent3 , S.R. Bloom4 , W.A. Buurman2 , C.W. le Roux3 , N.D. Bouvy2 , J.W.M. Greve1 . 1 Atrium Medical Center Parkstad, Heerlen, 2 Maastricht University Medical Centre, Maastricht, Netherlands; 3 King’s College Hospital NHS Foundation Trust, 4 Imperial College London, London, United Kingdom Rationale: Bariatric procedures that exclude the proximal small intestine lead to significant weight loss which is probably mediated by changes in hormones that alter appetite, such as peptide YY (PYY), ghrelin, cholecystokinin (CCK), and leptin. We investigated the effect of the duodenal-jejunal bypass liner (DJBL) on hormones implicated in appetite control. Methods: Seventeen obese patients (BMI 30 50 kg/m2 ) with type 2 diabetes received the DJBL for 24 weeks. Plasma levels of GLP-1, PYY, CCK, and ghrelin were analyzed after a standardized meal before and during DJBL treatment. In addition, fasting leptin levels were analyzed. Results: At baseline, patients had an average body weight of 116.0±5.8 kg. One week after implantation, subjects had lost 4.3±0.6 kg (p < 0.01). Weight loss further progressed to 12.7±1.3 kg at 24 weeks post-implantation. All subjects reported reduced caloric intake following DJBL implantation. In addition, satiety increased in 15/17 patients. As early as one week after implantation, post-prandial GLP-1, PYY, and ghrelin levels were increased (baseline vs. week 1 vs. week 24 GLP-1: 4,440±249 vs. 6,407±480 vs. 6,008±429 pmol/L/min, PYY: 2,584±154 vs. 4,084±418 vs. 4,121±697 pmol/L/min, and ghrelin: 7,881±1,783 vs. 11,042±1,807 vs. 10,562±1,783 pg/mL/min, all p < 0.05). The CCK response to a meal decreased (baseline vs. week 1 vs. week 24: 434±51 vs. 229±52 vs. 256±51 pmol/L/min, p < 0.01). Fasting leptin levels also decreased, reaching statistical significance at week 24, and positively correlated with BMI (baseline vs. week 24: 98.4±16.8 vs. 53.1±10.2 ng/mL, p < 0.01 and rs = 0.58, p < 0.05 respectively). Conclusion: DJBL treatment increases satiety paralleled by changes in hormones involved in appetite control. We propose that the increase in satiety is associated with activation of the ileal brake, as supported by elevated post-prandial GLP-1 and PYY response, and the increased ghrelin response to a meal. Disclosure of Interest: C. De Jonge: None Declared, S. Rensen: None Declared, F. Verdam: None Declared, R. Vincent: None Declared, S.
Rationale: A growing body of evidence suggests that oral nutrition supplements (ONS) might improve outcomes among hospitalized patients; however, previous studies suffer from limitations, including modest sample sizes, narrowly selected patient populations, and in observational studies, possible selection bias. This study assessed the effect of inpatient ONS use on length of stay, episode cost, and 30-day readmission probability. Methods: An eleven-year retrospective study (2000 to 2010) was conducted using the Premier Perspectives Database, which contained information on 44.0 million adult inpatient episodes. Using a matched sample of ONS and non-ONS episodes for any inpatient diagnosis, instrumental variables regression analysis was performed to quantify the effect of ONS use on length of stay, episode cost, and probability of approximate 30-day readmission. For the readmission outcome, the matched sample was restricted to episodes where the patient was known to be at risk of readmission. The fraction of a hospital’s episodes in a given quarter involving ONS was used as an instrumental variable. Results: Within the database, 1.6% of 44.0 million adult inpatient episodes involved ONS use. Based on a matched sample of 1.2 million episodes, ONS patients had a shorter length of stay by 2.3 days (95% confidence interval [CI] 2.42 to 2.16), from 10.9 to 8.6 days (21.0% decline), and decreased episode cost of $4,734 (95% CI $4,754 to $4,714), from $21,950 to $17,216 (21.6% decline). Restricting the matched sample to the 862,960 episodes where patients were readmitted at some point, ONS patients had a reduced probability of early readmission (within 30 days) of 2.3 percentage points (95% CI 0.027 to 0.019), from 34.3% to 32.0% (6.7% decline). Conclusion: Use of ONS decreases length of stay, episode cost, and 30-day readmission risk in the inpatient population. Disclosure of Interest: T. Philipson Consultant for: Dr. Philipson was involved in the preparation of this manuscript while serving as a partner at Precision Health Economics, which received consulting fees from Abbott Nutrition., J. Snider Consultant for: Dr. Snider was involved in the preparation of this manuscript while employed by Precision Health Economics, which received consulting fees from Abbott Nutrition., D. Lakdawalla Consultant for: Dr. Lakdawalla was involved in the preparation of this manuscript while serving as a partner at Precision Health Economics, which received consulting fees from Abbott Nutrition., B. Stryckman Consultant for: Mr. Stryckman was involved in the preparation of this manuscript while employed by Precision Health Economics, which received consulting fees from Abbott Nutrition., D. Goldman Consultant for: Dr. Goldman was involved in the preparation of this manuscript while serving as a