OR015: ROUX-EN-Y Gastric Bypass Surgery and Folate Deficiency: Contributions of Reduced Gene Expression of Folate Transporters (SLC19A1 AND SLC46A1) in Addition to Low Folate Intake

Clinical Nutrition and Metabolism 1 Results: H in ambulatory conditions decreased protein synthesis ( 8±3%, p = 0.02) and degradation ( 9±3%, p = 0.01). Protein turnover did not change in HBR. PGC1-a decreased in all conditions (p < 0.05). Ubiquitin ligase mRNA levels do not showed any changes except for atrogin1 that increased in HBR by 45.1±3.9% (p < 0.05). BR decreased levels of S6Rp phosphorylation (49.2±3.9%, p < 0.05). H decreased Akt phosphorylation (42.56±2.8%, p < 0.05); BR blunted this reduction. No change of the autophagy markers was observed. Conclusion: H per se decreased whole body protein turnover. These effects of H on protein kinetics were completely blunted by BR. These results were confirmed by muscle gene expression of Akt. PGC1-a associated to muscle loss decreased by BR and H. Disclosure of Interest: None declared

OR013 CHRONIC DIETARY EXPOSURE TO BRANCHED CHAIN AMINO ACIDS CAUSES IMPAIRED GLUCOSE DISPOSAL AND HIGHER ADIPOSE TISSUE LIPOGENESIS J. Gojda1,2 , R. Strakova2 , L. Rossmeislova1 , J. Tumova1 , M. Elkalaf1 , M. Jacek1 , P. Tuma1 , J. Potockova1 , J. Trnka1 , V. Stich1 , M. Andel1,2 . 1 Centre for Research on Diabetes, Metabolism and Nutrition, 2 2nd Internal Department, Charles University in Prague, Prague 10, Czech Republic Rationale: Vegan diet is considered to be protective against insulin resistance-associated diseases. The aim of this study is to investigate whether a chronic increase in BCAA intake in vegans (to the estimated intake level of the omnivorous population) elicits changes in IS parameters. Methods: 8 vegans and 8 matched omnivorous controls were recruited in a study. The intervention comprised 15 or 20 grams of BCAA daily for 3 months. Anthropometry, hyperinsulinaemic clamp, arginine test, muscle biopsy [citrate-synthase activity (CS), electron transport chain (ETC) complexes, gene expression] and adipose tissue (AT) biopsy (gene expression of adiponectin, CD3, BCKDHA, BCKDHB, GLUT4, IRS1, FASN, SCD1, DGAT2, PLIN1, PPAR-g) were performed at baseline (A), after three month intervention (B) and then after a six month wash-out period (C). Results: Vegans had a higher baseline glucose disposal expressed as M-value and MCR respectively (p < 0.05) than omnivores. Glucose disposal declined significantly in vegans after the intervention [M-value A 9.63 vs. B 7.99 mg·kg 1 ·min 1 (p < 0.05)] and returned to baseline values after the wash-out period [M-value B 7.99 mg·kg 1 ·min 1 vs. C 9.64 mg·kg 1 ·min 1 (p < 0.05)] the effect that was not observed in omnivores. No change in gene expression in skeletal muscle, in activity of CS or ETC complexes except for an increased complex II activity in omnivores (p < 0.05) was observed. There was an apparent trend towards increased AT gene expression of IRS-1, GLUT4 and PPAR-g, statistical significance was reached only for DGAT2 (p < 0.05) in omnivores. Conclusion: Long-term increase in BCAA intake in vegans leads to impaired IS. Increasing dietary BCAA proportion in an ordinary omnivorous diet does not have any detrimental effect on IS, probably due to compensatory increase in AT lipogenic activity. Disclosure of Interest: None declared

S5 OR014 SERUM TRACE ELEMENTS IN DYSPHAGIC PATIENTS THAT UNDERWENT ENDOSCOPIC GASTROSTOMY FOR LONG TERM ENTERAL FEEDING C.A. Santos1 , J. Fonseca1 , E. Carolino2 , A. Sousa Guerreiro3 . 1 GENE Enteral Nutrition Group, Hospital Garcia de Orta, 2 Departamento das Ciˆ encias Naturais e Exatas, Escola Superior de Tecnologias da Sa´ ude de Lisboa, 3 Centro de Estudos de Doen¸cas Cr´ onicas, CEDOC, NOVA Medical School/Faculdade de Ciˆ encias M´ edicas, Universidade Nova de Lisboa, Nova Medical School, Lisboa, Portugal Rationale: Patients who underwent endoscopic gastrostomy (PEG) present protein-energy malnutrition, but little is known about Trace Elements (TE), Zinc (Zn), Copper (Cu), Selenium (Se), Iron (Fe), Chromium (Cr). Our aim was the evaluation of serum TE in patients who underwent PEG and its relationship with serum proteins, BMI and nature of underlying disorder. Methods: A prospective observational study was performed collected: patient’s age, gender, underlying disorder, NRS-2002, BMI, serum albumin, transferrin and TE concentration. We used ferrozine colorimetric method for Fe; Inductively Coupled Plasma-Atomic Emission Spectroscopy for Zn/Cu; Furnace Atomic Absorption Spectroscopy for Se/Cr. The patients were divided into head and neck cancer (HNC) and neurological dysphagia (ND). Results: 146 patients (89 males), 21 95 years: HNC-56; ND-90. Low BMI in 78. Low values mostly for Zn (n = 122) and Fe (n = 69), but less for Se (n = 31), Cu (n = 16), Cr (n = 7); low albumin in 77, low transferrin in 94 and 66 with both proteins low. Significant differences between the groups of underlying disease only for Zn (t140,326 = 2.642, p < 0.01) and a correlation between proteins and TE respectively albumin and Zn (r = 0.197, p = 0.025), and albumin and Fe (r = 0.415, p = 0.000). Conclusion: When gastrostomy was performed, patients display low serum TE namely Zn, but also Fe, less striking regarding others TE. It was related with prolonged fasting, whatever the underlying disease. Low proteins were associated with low TE. Teams taking care of PEG-patients should use Zn supplementation and include other TE evaluation as part of the nutritional assessment of PEG candidates. Disclosure of Interest: None declared

OR015 ROUX-EN-Y GASTRIC BYPASS SURGERY AND FOLATE DEFICIENCY: CONTRIBUTIONS OF REDUCED GENE EXPRESSION OF FOLATE TRANSPORTERS (SLC19A1 AND SLC46A1) IN ADDITION TO LOW FOLATE INTAKE P.C. Sala1 , G. Belarmino1 , N.M. Machado1 , M.M. Silva1 , R. Dippolito1 , R.K. Ishida1 , I. Guarda1 , D. Giannella-Neto2 , M.A. Santo1 , E.G.H. Moura1 , P. Sakai1 , I.D.C. Guerreiro3 , S.S. Manuel4 , J. Ye4 , S. Heymsfield4 , D.L. Waitzberg1 . 1 University of S˜ ao Paulo Medical School, 2 Nove de Julho University, 3 UNIFESP, S˜ ao Paulo, Brazil; 4 Pennington Biomedical Research Center, Baton Rouge, United States Rationale: Folate is efficiently absorbed in the jejunum. After Roux-en-Y Gastric Bypass (RYGB) one-half of patients require daily supplements to avoid folate deficiency. Our aim was

S6 to examine potential mechanisms associated with the oftenobserved folate deficiency following RYGB. Methods: Intestinal biopsies were acquired through doubleballoon endoscopy in 20 obese women (age, 46.5±6.6 yrs; BMI, 45.7±4.1 kg/m2 ) before and 3 months after RYGB (BMI, 37.7±3.4 kg/m2 ). Gut gene microarray analysis was performed using a Human GeneChip 1.0 ST array (Affymetrix, Inc., Santa Clara, CA). Folate intake was assessed from seven-day food records analyzed with Virtual Nutri Plus® software. Results: Folate transporter (SLC19A1) gene expression was significantly reduced in duodenum ( 0.479 fold change, p < 0.05) and jejunum ( 0.781 fold change, p < 0.05) following RYGB. The SLC19A1 folate transporter is involved in the regulation of intracellular concentrations of folate. Also the folate transporter (SLC46A1) was significantly reduced in the ileum after RYGB ( 0.608 fold change, p < 0.05). The SLC46A1 gene encodes a transmembrane proton-coupled folate transporter protein that facilitates the movement of folate and anti-folate substrates across cell membranes, optimally in acidic pH environments. In addition, we observed post-operative reductions in folate intake (pre-operative 139±95 mg vs. post-operative period 79±63 mg). Conclusion: Folate deficiency following RYGB may be caused by a combination of reduced folate intake and a lower availability of folate binding proteins. Disclosure of Interest: This study was approved by Ethical Committee of University of S˜ ao Paulo. Clinicaltrials.gov: NCT01251016. The authors declare that they have no competing interests. Research supported by FAPESP 2011/09612 3, BEPE 2014/07742 5.

Nutrition and Cancer OR016 NUTRITIONAL REGIME FOR THE PREVENTION OF REFEEDING SYNDROME IN SURGICAL HEAD AND NECK CANCER PATIENTS K.B. Dester1 , M.D. Hansen1 , H. Carlsen1 , A.D.L. Schramm1 , I. Wessel2 , J.R. Andersen1,3 . 1 Department of Nutrition, Exercise and Sports, University of Copenhagen, 2 Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, 3 Nutrition Unit 5711, Rigshospitalet, Copenhagen, Denmark Rationale: Refeeding syndrome is observed in totally 25% of patients with head and neck cancer admitted for surgery in this department. We have previously defined a subpopulation with increased risk (heavy alcohol consumption, pain at swallowing, weight loss over several months). Methods: The design was a randomized, controlled, unblinded, parallel-group trial for one week. 76 patients (35 intervention 41 controls) with head- and neckcancer admitted for surgical treatment and in increased risk of developing refeeding syndrome were randomized. The control group received the standard dietary regime of the department, while the intervention group received a sodium- and carbohydrate reduced regime. 21 patients were excluded from the analysis after randomization for different reasons (early discharge, violence of protocol, no malignancy) equally distributed in the two groups. Results: 43% in the control group developed Refeeding Syndrome compared to 29% in the intervention group (NS). In tube fed patients 62% developed Refeeding syndrome

Oral communications in the control group compared to 17% in the intervention group (p < 0.05). In the orally fed patients there was major difficulties in respecting the control regimen in the everyday clinical practice meaning that a low sodium regime was introduced for clinical reasons. Conclusion: It is possible to prevent the development of the refeeding syndrome to some extent with a sodium- and carbohydrate reduced dietary regimen. Disclosure of Interest: None declared

OR017 THE ASSESSMENT OF ANOREXIA IN PATIENTS WITH CANCER: CUT-OFF VALUES FOR THE FAACT-A/CS AND THE VAS FOR APPETITE S. Blauwhoff-Buskermolen1,2 , C. Ruijgrok1 , R.W. Ostelo3,4 , H.C. de Vet3 , H.M. Verheul2 , M.A. de van der Schueren1,5 , J.A. Langius1,6 . 1 Nutrition and Dietetics, Internal Medicine, 2 Medical Oncology, 3 Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, 4 Health Sciences, VU University, Amsterdam, 5 Faculty of Health and Social Studies, Department of Nutrition, Sports and Health, HAN University of Applied Sciences, Nijmegen, 6 Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, Netherlands Rationale: Anorexia is a frequently observed symptom in patients with cancer and is associated with limited food intake. In combination with cancer cachexia, anorexia induces muscle wasting and weight loss. Diagnostic instruments such as the Anorexia/Cachexia Subscale (A/CS) of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire and the Visual Analogue Scale (VAS) for appetite have been recommended in the assessment of anorexia, but validated cut-off values are lacking. This study aimed to obtain cut-off values of these instruments for the assessment of anorexia in patients with cancer. Methods: The FAACT-A/CS and the VAS for appetite were administered to patients with cancer before start of chemotherapy. As reference standard for anorexia, two external criteria were used: (1) a cut-off value of 2 on the anorexia symptom scale of the EORTC QLQ C-30; (2) the question “Do you experience a decreased appetite?” (Yes/No). ROC curves were used to examine the optimal cut-off values for the FAACT-A/CS and VAS. Results: A total of 273 patients (58% male; 64.0±10.6 years) was included. The median score on the FAACT-A/CS was 38 (IQR 32 42) points and 77 (IQR 47 93) points on the VAS. Considering both external criteria, the optimal cutoff value for the FAACT-A/CS was 37 [Sensitivity (se) 80%, specificity (sp) 81%, positive predictive value (PV+ ) 79%, negative predictive value (PV ) 82%] and for the VAS was 70 (se 76%, sp 83%, PV+ 80%, PV 79%). Conclusion: For the assessment of anorexia in patients with cancer our study suggests cut-off values of 37 for the FAACT-A/CS and 70 for the VAS for appetite. Future studies should confirm our findings in other patient samples. Disclosure of Interest: None declared