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P062 THE LONGITUDINAL CHANGE IN MID-ARM CIRCUMFERENCE AND THE ASSOCIATION WITH FUNCTIONAL DECLINE IN JAPANESE COMMUNITY-DWELLING FRAIL ELDERLY
54 Conclusion: The nunaces of these responses and implications in bone formation and remodelling will be discussed. Since osteoporosis is a major health care issue in the US, these studies are important to pursue. Disclosure of Interest: None declared
P060 INHIBITORY EFFECT OF VEGETABLE EXTRACTS ON PEPT1 OLIGOPEPTIDE TRANSPORTER EXPRESSION IN THE HUMAN INTESTINAL CELL LINE T. Shiraga1 . 1 Department of Foods and Human Nutrition, Faculty of Human Life Sciences, Notre Dame Seishin University, Okayama, Japan Rationale: Dietary proteins are absorbed as di- and tripeptides via an intestinal oligopeptide transporter, PEPT1. It is known PEPT1 possesses a high capacity to absorb dietary nitrogen sources as compared with a series of amino acid transporters. In patients with renal failure, diets restricted in mainly protein have been used, but dietary restriction may influence the quality of life in these patients. It can therefore be considered important to downregulate intestinal PEPT1 in dietary therapy for renal failure. The aim of this study was to investigate whether vegetable extracts can influence mRNA levels of PEPT1 in the human intestinal cell line Caco-2. Methods: Caco-2 cells were cultured in the 10% FBS/Dulbecco’s modified Eagle’s medium containing water extracts of dried vegetables at various concentrations. Total RNAs from the cells were used for reverse transcription-polymerase chain reaction. Results: Addition of 1.75 and 7.0 mg/ml of extracts of mulukhiya and tomato to the cell culture medium decreased not only PEPT1 mRNA but also human Na+dependent glucose transporter SGLT1 levels. While celery extract tended to lower PEPT1 mRNA levels without downregulation of SGLT1 expression, details of this mechanism are still unclear. Conclusion: It was suggested effect of celery extract was more specific on inhibition of PEPT1 expression. Further study is required to identify the inhibitory element in celery extract. Disclosure of Interest: I declare that I do not have any affiliation with or financial interest in a commercial organisation that poses a conflict of interest.
Geriatrics 1 P061 ACCEPTABILITY AND NUTRITIONAL OUTCOMES OF PEG AMONG OLDER ADULTS E. Mala1 , L. Sobotka2 , J. Prachar3 . 1 Dpt. of Gerontology and Metabolism, 2 Medical Faculty, 3 Dpt.of Cardiology, University Teaching Hospital, Hradec Kralove, Czech Republic Rationale: PEG has become preferred method to provide enteral tube feeding to older adults with dysphagia and other problems [stroke (56%), neurodegenerative
Poster presentations disorders and cancer (27%)]. The effectiveness of PEG tube feeding in older cohort patients with severe illness remains controversial. The aim of our study was to assess the outcome (changes in nutrition, functional status and health-related quality of life) and perspectives of patients and their care-givers, and about acceptability about PEG tube placement. Methods: 100 patients, 75% patients over 65 years (mean age 78.9 years) in targeted community. The length of receiving nutrition via PEG: over 24 month period. We obtained information from our outpatient department for enteral nutrition, where were provided dispensary care of these patients (subjective health status, cognitive function (MMSE), nutritional status and clinical characteristics (tolerance, complication rates and health service and mortality). Results: Mean MMSE was 20. All measures of functional, nutritional and cognitive status and quality of life demonstrated profound and any life threatening impairement. 30-day mortality was 8%, 12-month mortality was 36%, 1-year mortality 47%. The mean numer of PEG tube feeding was 307 days. The mean cost for PEG tube feeding (only enteral formula) of patients was 1.253. Among patients surviving more than 60 days, at least 74% had no significant improvement in followed qualities except subjective health status. 47 (47%) felt easy in feeding, 54% would like to have PEG tube again if required. 32% of the patients felt the feeding was too frequent. We had 3% of serious complications (p-value > 0.001). Conclusion: We found PEG tube feeding to be safe for long-term complications-in severally and chronically ill older patients. We found improving of subjective health status or probably quality of life. Majority of caregivers (74%) considere PEG tube feeding to help in feeding in this cohort of the patients. Disclosure of Interest: None declared
P062 THE LONGITUDINAL CHANGE IN MID-ARM CIRCUMFERENCE AND THE ASSOCIATION WITH FUNCTIONAL DECLINE IN JAPANESE COMMUNITYDWELLING FRAIL ELDERLY S. Izawa1 , H. Enoki1 , Y. Hirakawa1 , M. Iwata2 , J. Hasegawa3 , H. Nishioka4 , A. Iguchi5 , M. Kuzuya1 . 1 Department of Geriatrics, Nagoya University Graduate School of Medicine, 2 Emergency Dapartment, 3 Department of Geriatrics, Nagoya Ekisaikai Hospital, 4 Department of General Internal Medicine, Nagoya Memorial Hospital, 5 Faculty of Medical Welfare Department of Community Care Philanthropy, Aichi Syukutoku University, Nagoya, Japan Rationale: To examine the association between anthropometric measurements at baseline or longitudinal changes in those measurements and physical function decline during 2-year follow-up in community-dwelling frail Japanese elderly. Methods: Design: Prospective cohort study (the Nagoya Longitudinal Study for Frail Elderly). Setting: Communitybased. Participants: 543 community-dwelling elderly (men, 201; women, 342). Measurements: Data included the clients’ demographic characteristics, basic activities
Geriatrics 1 of daily living (ADL), comorbidity, number of prescribed medications, number of regular medical checks, use of day-care service, and anthropometric measurements including body weight, height, mid-arm circumference (AC) and the triceps skin fold (TSF) at baseline and at 2-year follow-up. To evaluate the risk of participants with decline of ADL score, which was expressed as an odds ratio (RO) with a corresponding 95% confidence interval (CI), logistic regression models were used. Results: Among the 543 participants, 418 (77.0%) maintained or improved their ADL levels and 125 (23%) showed ADL decline during 2-year follow-up. There were no differences in baseline anthropometric measurements between two groups with/without ADL decline during follow-up. The negative changes in AC and BMI during follow-up were associated with ADL decline during the 2-year period. Conclusion: Anthropometric measurements at baseline are not a predictor of physical function decline during 2-year follow-up in community-dwelling frail elderly. There is the association between the negative changes in anthropometric measurements during follow-up period and the decline of ADL function. Disclosure of Interest: None declared
P063 CAROTENOIDS AS PREVENTION OF DISABILITY. THE INCHIANTI STUDY F. Lauretani1 , R. Semba2 , L. Ferrucci3 , S. Bandinelli4 . 1 Geriatric unit, Geriatric-Rehabilitation, University Hospital of Parma, Parma, Italy; 2 John Hopkins University, 3 Longitudinal Studies Section, Clinical Research Branch, NIA, NIH, Baltimore, Maryland, USA; 3 Geriatric unit, Geriatric-Rehabilitation, Geriatric Unit, ASL of Florence, Florence, Italy Rationale: To examine the relationship of total plasma carotenoids, an indicator of fruit and vegetable intake, with walking speed and severe walking disability in older adults. Methods: 928 men and women aged 65 to 102 years from the InCHIANTI study, a population-based cohort in Tuscany, Italy. Plasma carotenoids were measured at enrollment (1998 2000), and walking speed over 4 meters and 400 meters distance were assessed at enrollment and 6 years later (2004 2006). Results: At enrollment, 85 of 928 (9.2%) participants had severe walking disability (defined as being unable to walk or having a walking speed at the 4-meter walking test <0.4 m/sec). After adjusting for potential confounders, participants with high total plasma carotenoids were significantly less likely to have prevalent severe walking disability (O.R. 0.59, 95% C.I. 0.38 0.90, P = 0.01) and had higher walking speed over 4 m (beta = 0.024, standard error [SE] = 0.011, P = 0.03) and over 400 m (beta = 0.019, SE = 0.010, P = 0.04). Of 621 participants without severe walking disability at enrollment who were seen 6 years later, 68 (11.0%) developed severe walking disability. After adjusting for potential confounders, higher total plasma carotenoids were associated with a significantly lower risk of developing severe walking disability (O.R. 0.51, 95% C.I. 0.30 0.86, P = 0.01) and were associated
55 with a less steep decline in 4-m walking speed over a six-year follow-up (n = 579) (beta = 0.026, SE = 0.012, P = 0.03) and with lower incidence rates of being unable to successfully complete the 400-meter walking test at the 6-year follow-up visit (beta = 0.054, SE = 0.03, P = 0.04). Conclusion: High plasma carotenoids concentrations may be protective against the decline in walking speed observed in many older persons and the development of severe walking disability. References Ferrucci L, et al. J Am Geriatr Soc 2000; 48: 1618 1625. Disclosure of Interest: This work was supported by National Institute on Aging Contracts N01-AG-916413, N01-AG-821336, N01-AG-5 0002, and NIA Grant R01 AG027012. This research was supported in part by the Intramural Research Program, National Institute on Aging, NIH.
P064 EFFECTIVENESS OF MULTIDISCIPLINARY NUTRITIONAL CARE ON NUTRITIONAL STATUS AND QUALITY OF LIFE IN PATIENTS WITH ACUTE HIP FRACTURES J.C. Hoekstra1 , J.H.M. Goosen2 , S. de Wolf3 , C.C.P. Verheyen2 . 1 Dietetic, 2 Orthopaedic Surgery and Traumatology, Isala Clinics, Zwolle, 3 Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands Rationale: The purpose of this study was first to determine the effectiveness of a multidisciplinary intervention program on nutritional intake and second of the intake on nutritional status and quality of life (QOL) in patients treated for a hip fracture. Methods: A controlled prospective cohort study included 66 patients in the control group and 61 patients in the intervention group, age 65 years and older and suffering from a hip fracture. Postoperative the control group received standard nutritional care and the intervention group multidisciplinary nutritional care, focused on nutritional support during hospitalisation and a transfer of nutritional care after discharge. The nutrient intakes were monitored with food records, nutritional status was determined by the Mini Nutritional Assessment and body cell mass was assessed by bio-electrical impedance analysis. The EuroQol (EQ-5D) was used to assess QOL. Patients were evaluated at baseline and after 3 months. Results: There was a significant difference in the daily energy intake of patients between both groups during the first 7 days postoperative: respectively 1127 kcal (±309) in the control group and 1292 kcal (±280) (P = 0.002) in the intervention group. The mean protein intake [57 g (±12)] in the intervention group was significantly higher than in the control group [48 g (±14), p = 0.000]. The intervention group demonstrated a less decrease of the EQ-5D index scores [ 0.10 (±0.28)], compared with the control group [ 0.29 (±0.30), p = 0.001] after three months. At three months, less patients in the intervention group were classified as malnourished or at risk of malnutrition. Conclusion: Among elderly patients with a hip fracture, a multidisciplinary approach of nutritional care was associated with an increase of the energy and protein intake
P060 INHIBITORY EFFECT OF VEGETABLE EXTRACTS ON PEPT1 OLIGOPEPTIDE TRANSPORTER EXPRESSION IN THE HUMAN INTESTINAL CELL LINE T. Shiraga1 . 1 Department of Foods and Human Nutrition, Faculty of Human Life Sciences, Notre Dame Seishin University, Okayama, Japan Rationale: Dietary proteins are absorbed as di- and tripeptides via an intestinal oligopeptide transporter, PEPT1. It is known PEPT1 possesses a high capacity to absorb dietary nitrogen sources as compared with a series of amino acid transporters. In patients with renal failure, diets restricted in mainly protein have been used, but dietary restriction may influence the quality of life in these patients. It can therefore be considered important to downregulate intestinal PEPT1 in dietary therapy for renal failure. The aim of this study was to investigate whether vegetable extracts can influence mRNA levels of PEPT1 in the human intestinal cell line Caco-2. Methods: Caco-2 cells were cultured in the 10% FBS/Dulbecco’s modified Eagle’s medium containing water extracts of dried vegetables at various concentrations. Total RNAs from the cells were used for reverse transcription-polymerase chain reaction. Results: Addition of 1.75 and 7.0 mg/ml of extracts of mulukhiya and tomato to the cell culture medium decreased not only PEPT1 mRNA but also human Na+dependent glucose transporter SGLT1 levels. While celery extract tended to lower PEPT1 mRNA levels without downregulation of SGLT1 expression, details of this mechanism are still unclear. Conclusion: It was suggested effect of celery extract was more specific on inhibition of PEPT1 expression. Further study is required to identify the inhibitory element in celery extract. Disclosure of Interest: I declare that I do not have any affiliation with or financial interest in a commercial organisation that poses a conflict of interest.
Geriatrics 1 P061 ACCEPTABILITY AND NUTRITIONAL OUTCOMES OF PEG AMONG OLDER ADULTS E. Mala1 , L. Sobotka2 , J. Prachar3 . 1 Dpt. of Gerontology and Metabolism, 2 Medical Faculty, 3 Dpt.of Cardiology, University Teaching Hospital, Hradec Kralove, Czech Republic Rationale: PEG has become preferred method to provide enteral tube feeding to older adults with dysphagia and other problems [stroke (56%), neurodegenerative
Poster presentations disorders and cancer (27%)]. The effectiveness of PEG tube feeding in older cohort patients with severe illness remains controversial. The aim of our study was to assess the outcome (changes in nutrition, functional status and health-related quality of life) and perspectives of patients and their care-givers, and about acceptability about PEG tube placement. Methods: 100 patients, 75% patients over 65 years (mean age 78.9 years) in targeted community. The length of receiving nutrition via PEG: over 24 month period. We obtained information from our outpatient department for enteral nutrition, where were provided dispensary care of these patients (subjective health status, cognitive function (MMSE), nutritional status and clinical characteristics (tolerance, complication rates and health service and mortality). Results: Mean MMSE was 20. All measures of functional, nutritional and cognitive status and quality of life demonstrated profound and any life threatening impairement. 30-day mortality was 8%, 12-month mortality was 36%, 1-year mortality 47%. The mean numer of PEG tube feeding was 307 days. The mean cost for PEG tube feeding (only enteral formula) of patients was 1.253. Among patients surviving more than 60 days, at least 74% had no significant improvement in followed qualities except subjective health status. 47 (47%) felt easy in feeding, 54% would like to have PEG tube again if required. 32% of the patients felt the feeding was too frequent. We had 3% of serious complications (p-value > 0.001). Conclusion: We found PEG tube feeding to be safe for long-term complications-in severally and chronically ill older patients. We found improving of subjective health status or probably quality of life. Majority of caregivers (74%) considere PEG tube feeding to help in feeding in this cohort of the patients. Disclosure of Interest: None declared
P062 THE LONGITUDINAL CHANGE IN MID-ARM CIRCUMFERENCE AND THE ASSOCIATION WITH FUNCTIONAL DECLINE IN JAPANESE COMMUNITYDWELLING FRAIL ELDERLY S. Izawa1 , H. Enoki1 , Y. Hirakawa1 , M. Iwata2 , J. Hasegawa3 , H. Nishioka4 , A. Iguchi5 , M. Kuzuya1 . 1 Department of Geriatrics, Nagoya University Graduate School of Medicine, 2 Emergency Dapartment, 3 Department of Geriatrics, Nagoya Ekisaikai Hospital, 4 Department of General Internal Medicine, Nagoya Memorial Hospital, 5 Faculty of Medical Welfare Department of Community Care Philanthropy, Aichi Syukutoku University, Nagoya, Japan Rationale: To examine the association between anthropometric measurements at baseline or longitudinal changes in those measurements and physical function decline during 2-year follow-up in community-dwelling frail Japanese elderly. Methods: Design: Prospective cohort study (the Nagoya Longitudinal Study for Frail Elderly). Setting: Communitybased. Participants: 543 community-dwelling elderly (men, 201; women, 342). Measurements: Data included the clients’ demographic characteristics, basic activities
Geriatrics 1 of daily living (ADL), comorbidity, number of prescribed medications, number of regular medical checks, use of day-care service, and anthropometric measurements including body weight, height, mid-arm circumference (AC) and the triceps skin fold (TSF) at baseline and at 2-year follow-up. To evaluate the risk of participants with decline of ADL score, which was expressed as an odds ratio (RO) with a corresponding 95% confidence interval (CI), logistic regression models were used. Results: Among the 543 participants, 418 (77.0%) maintained or improved their ADL levels and 125 (23%) showed ADL decline during 2-year follow-up. There were no differences in baseline anthropometric measurements between two groups with/without ADL decline during follow-up. The negative changes in AC and BMI during follow-up were associated with ADL decline during the 2-year period. Conclusion: Anthropometric measurements at baseline are not a predictor of physical function decline during 2-year follow-up in community-dwelling frail elderly. There is the association between the negative changes in anthropometric measurements during follow-up period and the decline of ADL function. Disclosure of Interest: None declared
P063 CAROTENOIDS AS PREVENTION OF DISABILITY. THE INCHIANTI STUDY F. Lauretani1 , R. Semba2 , L. Ferrucci3 , S. Bandinelli4 . 1 Geriatric unit, Geriatric-Rehabilitation, University Hospital of Parma, Parma, Italy; 2 John Hopkins University, 3 Longitudinal Studies Section, Clinical Research Branch, NIA, NIH, Baltimore, Maryland, USA; 3 Geriatric unit, Geriatric-Rehabilitation, Geriatric Unit, ASL of Florence, Florence, Italy Rationale: To examine the relationship of total plasma carotenoids, an indicator of fruit and vegetable intake, with walking speed and severe walking disability in older adults. Methods: 928 men and women aged 65 to 102 years from the InCHIANTI study, a population-based cohort in Tuscany, Italy. Plasma carotenoids were measured at enrollment (1998 2000), and walking speed over 4 meters and 400 meters distance were assessed at enrollment and 6 years later (2004 2006). Results: At enrollment, 85 of 928 (9.2%) participants had severe walking disability (defined as being unable to walk or having a walking speed at the 4-meter walking test <0.4 m/sec). After adjusting for potential confounders, participants with high total plasma carotenoids were significantly less likely to have prevalent severe walking disability (O.R. 0.59, 95% C.I. 0.38 0.90, P = 0.01) and had higher walking speed over 4 m (beta = 0.024, standard error [SE] = 0.011, P = 0.03) and over 400 m (beta = 0.019, SE = 0.010, P = 0.04). Of 621 participants without severe walking disability at enrollment who were seen 6 years later, 68 (11.0%) developed severe walking disability. After adjusting for potential confounders, higher total plasma carotenoids were associated with a significantly lower risk of developing severe walking disability (O.R. 0.51, 95% C.I. 0.30 0.86, P = 0.01) and were associated
55 with a less steep decline in 4-m walking speed over a six-year follow-up (n = 579) (beta = 0.026, SE = 0.012, P = 0.03) and with lower incidence rates of being unable to successfully complete the 400-meter walking test at the 6-year follow-up visit (beta = 0.054, SE = 0.03, P = 0.04). Conclusion: High plasma carotenoids concentrations may be protective against the decline in walking speed observed in many older persons and the development of severe walking disability. References Ferrucci L, et al. J Am Geriatr Soc 2000; 48: 1618 1625. Disclosure of Interest: This work was supported by National Institute on Aging Contracts N01-AG-916413, N01-AG-821336, N01-AG-5 0002, and NIA Grant R01 AG027012. This research was supported in part by the Intramural Research Program, National Institute on Aging, NIH.
P064 EFFECTIVENESS OF MULTIDISCIPLINARY NUTRITIONAL CARE ON NUTRITIONAL STATUS AND QUALITY OF LIFE IN PATIENTS WITH ACUTE HIP FRACTURES J.C. Hoekstra1 , J.H.M. Goosen2 , S. de Wolf3 , C.C.P. Verheyen2 . 1 Dietetic, 2 Orthopaedic Surgery and Traumatology, Isala Clinics, Zwolle, 3 Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands Rationale: The purpose of this study was first to determine the effectiveness of a multidisciplinary intervention program on nutritional intake and second of the intake on nutritional status and quality of life (QOL) in patients treated for a hip fracture. Methods: A controlled prospective cohort study included 66 patients in the control group and 61 patients in the intervention group, age 65 years and older and suffering from a hip fracture. Postoperative the control group received standard nutritional care and the intervention group multidisciplinary nutritional care, focused on nutritional support during hospitalisation and a transfer of nutritional care after discharge. The nutrient intakes were monitored with food records, nutritional status was determined by the Mini Nutritional Assessment and body cell mass was assessed by bio-electrical impedance analysis. The EuroQol (EQ-5D) was used to assess QOL. Patients were evaluated at baseline and after 3 months. Results: There was a significant difference in the daily energy intake of patients between both groups during the first 7 days postoperative: respectively 1127 kcal (±309) in the control group and 1292 kcal (±280) (P = 0.002) in the intervention group. The mean protein intake [57 g (±12)] in the intervention group was significantly higher than in the control group [48 g (±14), p = 0.000]. The intervention group demonstrated a less decrease of the EQ-5D index scores [ 0.10 (±0.28)], compared with the control group [ 0.29 (±0.30), p = 0.001] after three months. At three months, less patients in the intervention group were classified as malnourished or at risk of malnutrition. Conclusion: Among elderly patients with a hip fracture, a multidisciplinary approach of nutritional care was associated with an increase of the energy and protein intake