P070 THE DEFINITION OF LIVER DISEASE DETERMINES THE INCIDENCE OF PARENTERAL NUTRITION-ASSOCIATED LIVER DISEASE

54 P068 VERY LOW CALORIE DIET REDUCES LIVER STEATOSIS IN MORBIDLY OBESE PATIENTS M.D. Ballesteros-Pomar1 , R. Diez Rodriguez2 , A. Calleja-Fern´ andez1 , A.M. Urioste-Fondo1 , alez-Herr´ aez3 , V. Sim´ o3 , A. Vidal-Casariego1 , L. Gonz´ S. Calleja-Antolín4 , T. Gonz´ alez de Francisco3 , I. Cano-Rodríguez1 . 1 Endocrinology and Nutrition, 2 Gastroenterology, 3 Surgery, 4 Inmunology, Complejo Asistencial de Leon, Leon, Spain Rationale: Fatty liver disease (NAFLD) is highly prevalent in obese patients. Weight loss before bariatric surgery with Very Low Calorie Diet (VLCD) appears to reduce liver size so surgical access is improved and surgical complications are diminished. OBJECTIVES: To assess the effects of 6 weeks of a VLCD on the histopathological features of NAFLD. Methods: Retrospective analysis of 108 patients undergoing bariatric surgery who had a intraoperatory liver biopsy: 20 of them were placed on a VLCD (Optisource® ) for 6 weeks preoperatively and the rest of them did not follow any specific dietary recommendation. The liver biopsy was defined following the scoring system proposed by Brunt. Preoperative BMI, age, AST and ALT are expressed as mean (standard deviation) and are compared by T-student test. Chi2 test was performed to evaluate the relationship with the grade of steatosis, inflammation or fibrosis. Results: Control group: 14M, 74F; VLCD group: 4M, 16F. No significant differences in age [control 41.0(11.2) vs VLCD 41.3(10.5)] AST (24.0(14.8) vs 20.5(6.9) UI/L), ALT (33.8(28.6) vs 23.4(10.9) UI/L were found, but BMI was higher in the control group (52.5(8.2) vs 46.1(4.1) kg/m2 , so analysis were adjusted by BMI groups. In the subgroup of BMI 40 50, VLCD significantly reduced the degree of steatosis, with p 0.029. The percentage of patients with steatosis grade 0 1 2 3 was 7.5 52.5 25.0 15.0 in the control group and 20.0 66.7 13.3 0 in the VLCD group. In superobese patients, VLCD also diminished steatosis, with p 0.023. No significant differences were found for inflammation or fibrosis. Conclusion: VLCD could be useful to reduce the degree of liver steatosis in morbidly obese patients.

Poster presentations Methods: We used data from questionnaires prepared by ESPEN organisation for Nutrition day in Europe. We evaluated nutrition status and support in abdominal surgical patients. Basic parameters were weight loss, reasons for losing kilos and types of nutritional support. We used t test for our data. Results: Total number of patients was 123 in 2008 and 132 in 2009. There were few more patients with weight loss in 2009 than in 2008 (p > 0.05). The number of patients losing 0 4 kg was significantly higher in 2009 (21.9%) comparing with 2008 (13.1%) (p < 0.05). Percentage of weight loss in a group of patients losing 5 8 kg in these two selected years was without significant difference. Loss of more than 8 kg in 2009 had 20.4% and 29.9% in 2008 (p < 0.05) (table 1). In 2008 there were 28.95% patients with bad appetite but in 2009 the percentage was higher up to 57% (p < 0.05). There was also a higher number of those who had nausea (5.61% in 2008; 19.69% in 2009) (p < 0.05) and problems with swallowing and mastication (14% in 2008 and 29.54% in 2009) (p < 0.05). Only 5% of patients were on enteral nutrition support in 2009 while 14.6% of them in 2008 (p < 0.05). On parenteral nutrition support were 26% of patients in 2008 and 7.5% in 2009 (p < 0.05). Table: Category of weight decrease ND in Serbia

Reporting weight loss

0 4 kg

5 8 kg

>8 kg

Not sure

2008 2009

56.1% 57.5%

13.1% 21.9%

10.3% 10.6%

29.9% 20.4%

2.80% 4.6%

Conclusion: Our patients need special nutritive approach. The data show the need for nutritional team in our hospital to introduce and follow the European recommendations and guidelines for nutrition and metabolism. References I. Palibrk, M.V. Matic, P. Pesko, V. Rankovic, L. Tomasevic, M. Milenkovic, B. Nenadic, V. Masirevic. Nutrition day in Serbia, 30th Congress of ESPEN, Florence, 2008;3(Suppl.1):75. Disclosure of Interest: None declared.

Disclosure of Interest: Study partially funded by a Grant from the Junta de Castilla y Le´ on, Proyecto de Investigaci´ on en Biomedicina, Biotecnología y Ciencias de la Salud GRS 325/B/08

Liver and Gastrointestinal Tract II P069 NUTRITION DAY 2009 IN ONE HOSPITAL IN SERBIA. WHAT SHOULD WE DO? I. Palibrk1 , V. Pantic Palibrk2 , M.V. Matic1 , M. Milenkovic1 , V. Masirevic1 , V. Rankovic1 . 1 Anesthesiology, Clinic for digestive surgery, Clinical centre of Serbia, 2 Nutrition, Institute for public health, Belgrade, Serbia Rationale: The aim of this study was to show and compare some results of nutrition status and nutrition support of patients who entered the Nutrition Day survey 2008 and 2009 at the Clinic for digestive surgery. Based on the outcome data we tried to give some directions for improvement of nutritional support for the patients.

P070 THE DEFINITION OF LIVER DISEASE DETERMINES THE INCIDENCE OF PARENTERAL NUTRITION-ASSOCIATED LIVER DISEASE M.J. Cruijsen1 , L.G.M. van Rossum1 , M.W.J. Versleijen1 , M.G.H. van Oijen1 , G.J.A. Wanten1 . 1 Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Rationale: The reported incidence of parenteral nutrition-associated liver disease (PNALD) differs widely as do the definitions for PNALD. To assess the influence of the definition of PNALD herein we assessed the incidence in

Liver and Gastrointestinal Tract II our own population on home parenteral nutrition (HPN) according to frequently applied definitions. Methods: Records of consecutive patients who started on HPN between January 2000 and June 2008 were reviewed. Follow-up ended November 1st 2008. Adult patients with a duration of HPN of >6 months, mainly receiving parenteral calories, were included. Exclusion criteria: pre-existent liver disease, incomplete laboratory data, malignancies, and alcohol abuse. Liver-associated laboratory parameters were recorded with 3-month intervals. The incidence, incidence rate, and baseline prevalence (i.e. before HPN was started) were calculated by four commonly cited definitions: 1. alkaline phosphatase(ALP), gamma-glutamyl transferase(GGT), bilirubin; 2. ALP, GGT, bilirubin, albumin, alanine transaminase(ALT); 3. ALP, aspartate aminotransferase(AST); 4. bilirubin. Results: After applying the criteria for in- and exclusion, our study population comprised 48 patients with a mean age at start on HPN of 48.3 years(SD±13.3). Incidence of PNALD was 29% for definition 1, 71% for definition 2, 60% for definition 3, and 10% for definition 4, resp. Incidence rates varied from 0.03 0.58 persons per year of followup. Baseline prevalence ranged from 20%-50%. Conclusion: The incidence of PNALD is determined by the definition of PNALD, decreasing generalizability with previous studies. We recommend to report all deranged liver-associated laboratory parameters, initiated after 6 months of HPN (to correct for baseline prevalence of liver-test-abnormalities) and include the incidence rate. Disclosure of Interest: None declared.

P071 KAMPO (HOCHUEKKITO, TJ-41) INHIBITS THE INDUCTION OF INOS GENE EXPRESSION IN PROINFLAMMATORY CYTOKINE-STIMULATED HEPATOCYTES M. Matsumiya1 , Y. Araki1 , T. Matsuura1 , M. Kaibori1 , T. Okumura1 , M. Nishizawa2 , A.H. Kwon1 . 1 Surgery, Kansai Medical University, Osaka; 2 Life sciences, Ritsumeikan University, Shiga, Japan Rationale: Kampo (Hochuekkito, TJ-41) is Chinese traditional medicine with various efficacies such as improvements of a postoperative physical strength fall and a digestive organ symptom. During liver injury, the production of pro-inflammatory cytokines including interleukin (IL)-1b; is stimulated in Kupffer cells, leading to the induction of inducible nitric oxide synthase (iNOS) gene expression in hepatocytes. Excess production of NO seems to be involved in the pathogenesis of liver dysfunction, which is caused by a variety of insults such as ischemia-reperfusion, infection, cancer and inflammation. The induction of iNOS is regulated by the transactivation of iNOS promoter through transcription factors including nuclear factor (NF)-kB, and by the stabilization of iNOS mRNA through its 3 -untranslated region. In this report, the objective was to examine the effect of TJ-41 on the induction of iNOS in hepatocytes. The possibility of TJ-41 inhibition on NO production by

55 iNOS was investigated as a potential liver-protecting mechanism. Methods: Hepatocytes were isolated from rats (male Wistar, 200 250 g) by collagen perfusion method and cultured in 5% CO2 incubator at 37ºC. Primary cultured hepatocytes were treated with pro-inflammatory cytokine IL-1b; (1 nM) in the absence or presence of TJ-41 (Tsumura Co.Ltd., Japan). The iNOS induction and its signal were analyzed. Results: TJ-41 reduced the increased levels of NO production and iNOS protein stimulated by IL-1b. TJ-41 inhibited the activation of NF-úB and the upregulation of IL-1receptorI, which are essential signals involved in iNOS induction in hepatocytes. Conclusion: Further study is under investigation to delineate the molecular basis of TJ-41 effect on such signal pathways. In vivo experiment with animal models of various liver injuries is needed to examine whether TJ-41 influences the iNOS induction and has a protective effect in the liver. Disclosure of Interest: None declared.

P072 INVOLVEMENT OF THE FUNCTIONAL FOOD OLIGONOL IN HEPATOPROTECTION BY REDUCTION OF NITRIC OXIDE M. Nishizawa1 , R. Yamanishi1 , T. Miura2 , A.H. Kwon3 , T. Okumura4 . 1 Department of Biomedical Sciences, Ritsumeikan University, College of Life Sciences, Kusatsu; 2 Research and Development Division, Amino Up Chemical Co. Ltd., Sapporo; 3 Department of Surgery, Kansai Medical University, Moriguchi; 4 Research Organization of Science and Technology, Ritsumeikan University, Kusatsu, Japan Rationale: The functional food Oligonol is an oligomerized polyphenol mixture derived from lychee fruit and has anti-oxidant and anti-inflammatory activities. Effects of Oligonol on expression of inflammation relating genes, such as inducible nitric oxide synthase (iNOS) and cytokine genes, were unclear. Thus, we examined whether Oligonol affected these genes. Methods: Primary cultured rat hepatocytes were incubated with interleukin 1b (IL-1b) and/or Oligonol. Expression levels of iNOS and cytokine genes, as well as relating genes, were analyzed by Western blot analysis, and reverse transcription-polymerase chain reaction. Results: When Oligonol was incubated with IL-1b-treated hepatocytes, production of nitric oxide and the expression levels of iNOS gene and several cytokine genes were significantly reduced. Interestingly, Oligonol also reduced the level of iNOS antisense RNA, which is a natural noncoding transcript of iNOS gene and stabilizes iNOS mRNA (Hepatology 47:686 697, 2008). Electrophoretic mobility shift assay showed that Oligonol decreased nuclear translocation and DNA-binding of the transcription factor nuclear factor-úB (NF-úB). Moreover, Oligonol suppressed phosphorylation and subsequent degradation of IúB-a in hepatocytes. Conclusion: Oligonol reduces iNOS gene expression in the IL-1b-treated hepatocytes via the mRNA stabilizing system by the antisense RNA and the NF-úB signaling pathway,