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P199 NUTRITIONAL FOLLOW-UP OF ADULT PATIENTS WITH CELIAC DISEASE ON GLUTEN-FREE DIET
Nutrition and chronic diseases 1
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in selected patients with acute intestinal failure. It may facilitate intestinal adaptation and can be used to successfully restore nutritional and metabolic status prior to reconstructive surgery.
P198 PLASMA AND ERYTHROCYTE MG CONTENT IN INTENSIVE CARE PATIENTS AT ADMISSION AND 7TH DAY OF STAY IN ICU
Disclosure of Interest: None declared
E.M. Planells1 , M. Rodriguez-Elvira2 , J. Casta˜ no2 , 3 4 A. P´ erez De La Cruz , B. Quintero , J. Llopis5 , es6 , D. Florea5 , C. Sanchez5 , E. Millan5 , J. Abil´ 5 7 ´ vila , C. Cabeza , R. Moreno-Torres3 , M. Garc´ ıa-A 5 1 P. Aranda . Physiology, University of Granada, 2 ICU, 3 NDU, HVN, 4 Physico-Chemistry, 5 Physiology, UGR, 6 UCI, HVN, 7 Physico-Chemical, UGR, Granada, Spain
P197 HOME PARENTERAL NUTRITION IN SCOTLAND OUTCOME IN A GEOGRAPHICAL POPULATION R.F. McKee1 , N. Hallum1 , J.P. Baxter2 , A. McKinlay3 . 1 Department of Coloproctology, Glasgow Royal Infirmary, Glasgow, 2 Scottish HPN Managed Clinical Network, Ninewells Hospital, Dundee, 3 Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom Rationale: Most reports of outcome in home parenteral nutrition (HPN) patients come from single centres. The Scottish Managed Clinical Network (MCN) for HPN can now report outcome data for all patients treated with HPN in a country of 5.1 million. Methods: The Scottish MCN has been collecting data prospectively since 2000 and this report includes all patients on HPN from Jan 2001 until December 2007. Data are collected on an MS Access database in each of 13 centres and amalgamated yearly by the network staff. Demographic data are reported in addition to underlying disease and survival. Results: 173 patients have been treated over six years with a yearly prevalence of 16 per million population. Prevalence in different regions of Scotland varies from 2.2 to 38.4 per million. The number of patients treated per centre over 6 years ranges from 1 patient (2 centres) to 46 patients. 115 females and 58 males were treated with an age range of 16 92 years and a median age of 47 years at the start of treatment. The underlying disease was Crohn’s disease 62 patients; bowel ischaemia 32; malignancy 12; motility disorder 17; radiation enteritis 7; other 43. Around 25% of the group change each year. Of 173 patients 62 remained on HPN in Dec 2007, 54 had died and 57 had stopped for other reasons. Kaplan Meier survival of patients remaining on HPN was 85% at 1 year; 75% at 2 years; 68% at 3 years and 49% at 5 years (59 patients available for 5 year followup). The majority of the deaths were due to the underlying disease rather than complications of HPN. Conclusion: These figures are unique in describing outcome of HPN throughout an entire population. Longer term outcome seems less good than in previous reports. This probably reflects the unselected population treated countrywide rather than a selected population in a tertiary referral centre. The underlying disease process remains an important cause of death. References [1] Messing B et al Gastroenterology 1995; 117:1043 1050. [2] Lloyd D Ali Pharm Ther 2006;24:1231 1240. Disclosure of Interest: None declared
Rationale: Measurement and monitoring of magnesium (Mg) are important to prevent the development of serious and potentially fatal complications in critically ill patients. The aim of this study was to define the prevalence of admission and 7d of ICU stay hypomagnesemia in critically ill patients and to evaluate its relationship with Mg intake and stay. Methods: A prospective study was done on 20 critically ill consecutive patients with inclusion criteria: 18 years old, admitted to the medical-surgical intensive care unit (ICU) at the University Hospital, APACHE II and SIRS diagnostic. Mg was measured by Atomic Absorption Spectophotometry (AAS) in wet-mineralyzed samples of plasma and erythrocyte of patients. Mg content in administered nutrition was recorded daily during the 7 days. Results: At admission 16% and 35% of hipomagnesemic patients (measured in plasma and erythrocyte respectively), increase to 29% and 46% at seventh day of ICU stay. There was significant difference between % of hypomagnesemic patients established by plasma and erythrocyte levels (p < 0.05). A weak correlation was found between Mg administered by nutritional treatment (94% below RDIs) and plasma magnesium content (p < 0.07) at seventh day. However, is significant that correlation with erythrocyte magnesium content (p < 0.02). Conclusion: Monitoring of magnesium levels in plasma and erythrocyte is needed at admission and during ICU stay of patients and may have prognostic, and perhaps therapeutic, implications. Development of hypomagnesemia during an ICU stay may be associated with different metabolic and clinical alterations that are attributed to other causes or are unknown, but complicate evolution of critically ill patient. Disclosure of Interest: I declare that I do not have any affiliation with orfinancial interest in a commercial organisation that poses a conflict of interest.
P199 NUTRITIONAL FOLLOW-UP OF ADULT PATIENTS WITH CELIAC DISEASE ON GLUTEN-FREE DIET M. Brugnani1 , C. Vecchio2 , F. D’Andrea1 . 1 Clinical Nutrition Unit, Maggiore della Carit` a Hospital, Novara, 2 Clinical Nutrition Unit, Luigi Sacco Hospital, Milano, Italy Rationale: Celiac disease (CD) is an immune-mediated disorder induced by the ingestion of gluten-containing cereals: the only treatment is a lifelong gluten-free diet (GFD). CD patients on GFD need a regular follow-up to evaluate effects of GFD on clinical and nutritional status.
114 Methods: 97 adult patients (M/F 24/73, mean age 38±13 years), affected by CD diagnosed according to ESPGHAN (European Society Paediatric Gastroenterology Hepatology and Nutrition) criteria were included in the study. We evaluated at CD diagnosis (T0) and after 2 years of GFD (T2): body mass index (BMI); IgA endomysium antibody (EmA) and IgA tissue transglutaminase antibody (tTG); serum levels of hemoglobin, iron, ferritin, total proteins, albumin, total cholesterol, HDL cholesterol, triglycerides, calcium, vitamin B12, folate; bone mineral density by a dual-energy x-ray absorptiometry (DEXA) scan (at T2 only if altered at T0). Results: Mean BMI (T0 vs T2): 21.6±3.2 vs 23.6±3.3 (p < 0.005); BMI < 18.5 in 15.5% vs 5.2%; BMI > 25 in 11.3% vs 35.8%. Serologic parameters (T0 vs T2): hemoglobin 11.8±2.1 g/l vs 14.0±1.2 (p < 0.005); iron 47.6±38.2 mcg/dl vs 99.2±29.8 (p < 0.005); ferritin 15±25.8 ng/ml vs 54.0±40.9 (p < 0.005); total proteins 7.0±0.6 g/l vs 7.5±0.4 (p < 0.005), albumin 3.9±0.5 g/l vs 4.3±0.3 (p < 0.005); total cholesterol 166.4±29.5 mg/dl vs 184.1±35.6 (p < 0.005; >200 mg/dl at T2 in 34.0%); HDL-cholesterol 46.0±12.0 mg/dl vs 52.2±11.6 (p < 0.005; low HDL-cholesterol at T2 in 36.1%); triglycerides 74.5±43.2 mg/dl vs 79.6±53.4 (p = 0.65); calcium 8.8±0.7 mg/dl vs 9.3±0.4 (p < 0.005), vitamin B12 419.3±191.1 pg/ml vs 524.8±190.9 (p < 0.005); folate 3.4±2.1 ng/ml vs 8.0±5.2 (p < 0.005). DEXA scan: normal values at T0 in 47.4%, at T2 in 78.3%. Conclusion: The strict adherence to GFD in CD patients leads to an improvement of nutritional status and of nutrition-related serologic parameters but increase in body weight and change in lipid profile are a potential cause of morbidity and need a careful follow-up. Disclosure of Interest: None declared
P200 CANADIAN HOME TOTAL PARENTERAL NUTRITION REGISTRY (HTPNR): VALIDATION AND 2 YEAR FOLLOW-UP OF LIVER PARAMETERS IN A SUBSET OF PATIENTS B. Kaila1 , E. Aghdassi1 , M. Baun1 , L. Fairholm1 , O. Saqui1 , M. Yeung1 , J.P. Allard1 . 1 Internal Medicine, Division of Gastroenterology, University of Toronto, Toronto General Hospital, Toronto, Canada Rationale: HTPN is associated with numerous complications including liver disease (LD). Objectives: 1) To validate the data entry at baseline with regards to LD and; 2) To conduct a 2 year follow-up. Methods: A prospective cohort study in a subset of patients from the Canadian HTPNR. The reproducibility of baseline data collection was assessed by re-extracting data from charts and were then reviewed for the 2-year follow-up. Intra-class correlation coefficient (ICC) was used to assess correlation and agreement between the baseline entries and a paired t-test was used to compare 2-year to baseline. Results: Data re-entry was done on 48 (29 female, 19 male) patients, mean age 51±2 years, small bowel length 77 cm ± 16, 8 with no colon, 17 with partial colon and 10 with an intact colon. LD was registered as present in 11 patients of whom 9 were TPN-related (TPNLD)
Poster presentations based on liver function tests (LFTs), abdominal ultrasound and/or liver biopsies. They correlated significantly with the first entry. The agreement was significant but weak: ICC = 0.53 and ICC = 0.55, respectively. However, if both observers agreed on the presence of LD, the ICC for the diagnosis of “TPNLD” was strong (ICC = 0.91, P = 0.0001). The agreements for LFTs were also significant with ICC of 0.55, 0.84, 0.47, and 0.94 for ALP, AST, ALT and bilirubin respectively. Of the 9 patients with TPNLD, 1 died of liver failure during the 2-year follow-up. In the remaining 8 subjects, with standard management, mean LFTs remained stable: ALP:762.4±245.9 vs 2y: 559.1±254.8 U/L, P = 0.13; AST:102.3±29.3 vs 2y: 65.0±28.5 U/L, P = 0.11; bilirubin:31.35±17.59, 2y: 42.72±33.50 mmol/L; P = 0.75. Over the 2 year period, 6 new cases of TPNLD were diagnosed. Conclusion: Correlations were significant between the 2 data sets at baseline. Although the agreement was weak for the presence of LD, it was strong for the diagnosis of TPNLD. Lack of agreement may have been due to inconsistencies in retrieving reports for LFTs, ultrasound and biopsies. Disclosure of Interest: None declared
P201 IN PURSUIT OF THE MAGIC PRESCRIPTION: HOW ARE THE ENERGY REQUIREMENTS OF CRITICALLY ILL PATIENTS BEING DETERMINED? N.E. Jones1 , L. Gramlich2 , C. Alberda3 , K. Jeejeebhoy4 , C. Johnson Stoklossa5 , D. Duerksen6 , J. Drover7 , A. Tremblay8 , R. Dhaliwal9 , D. Heyland10 . 1 Dept. Community Health and Epidemiology, Queens University, Kingston, 2 Royal Alexandra Hospital, University of Alberta, 3 Nutrition and Dietetics, Royal Alexandra, Edmonton, 4 Dept. Medicine, University Toronto, Toronto, 5 Nutrition and Dietetics, Ropyal Alexadra Hospital, Edmonton, 6 Dept Medicine, University of Manitoba, Winnipeg, 7 Dept. Medicine, Queens University, Kingston, 8 Dept Medicine, Laval University, Quebec City, 9 Clinical Evaluation Research Unit, Kingston General Hospital, 10 Dept Medicine & Epidemiology, Queens University, Kingston, Canada Rationale: Accurate determination of patients’ energy requirements is a daily challenge faced by practitioners in the Intensive Care Unit (ICU). There is currently insufficient evidence to make recommendations regarding the optimal assessment method, and little is known about what is actually happening in ICUs. The purpose of this study was to describe the methods of determining energy requirements used in daily practice. Methods: In January 2007, we conducted an international, prospective, observational, cohort study in 158 ICUs. Each ICU collected data on nutrition practices on 20 consecutive mechanically ventilated adult patients, including details of the baseline nutritional assessment. Results: Data was collected on 2946 patients. The most frequent methods used to calculate energy requirements was weight based dosing at 25 30 Kcal/kg (32.1%), the Harris Benedict Equation (13.4%) and the Schofield Equation with adjustment for stress or activity (13.3%). Several weights were used for calculating the nutrition
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in selected patients with acute intestinal failure. It may facilitate intestinal adaptation and can be used to successfully restore nutritional and metabolic status prior to reconstructive surgery.
P198 PLASMA AND ERYTHROCYTE MG CONTENT IN INTENSIVE CARE PATIENTS AT ADMISSION AND 7TH DAY OF STAY IN ICU
Disclosure of Interest: None declared
E.M. Planells1 , M. Rodriguez-Elvira2 , J. Casta˜ no2 , 3 4 A. P´ erez De La Cruz , B. Quintero , J. Llopis5 , es6 , D. Florea5 , C. Sanchez5 , E. Millan5 , J. Abil´ 5 7 ´ vila , C. Cabeza , R. Moreno-Torres3 , M. Garc´ ıa-A 5 1 P. Aranda . Physiology, University of Granada, 2 ICU, 3 NDU, HVN, 4 Physico-Chemistry, 5 Physiology, UGR, 6 UCI, HVN, 7 Physico-Chemical, UGR, Granada, Spain
P197 HOME PARENTERAL NUTRITION IN SCOTLAND OUTCOME IN A GEOGRAPHICAL POPULATION R.F. McKee1 , N. Hallum1 , J.P. Baxter2 , A. McKinlay3 . 1 Department of Coloproctology, Glasgow Royal Infirmary, Glasgow, 2 Scottish HPN Managed Clinical Network, Ninewells Hospital, Dundee, 3 Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom Rationale: Most reports of outcome in home parenteral nutrition (HPN) patients come from single centres. The Scottish Managed Clinical Network (MCN) for HPN can now report outcome data for all patients treated with HPN in a country of 5.1 million. Methods: The Scottish MCN has been collecting data prospectively since 2000 and this report includes all patients on HPN from Jan 2001 until December 2007. Data are collected on an MS Access database in each of 13 centres and amalgamated yearly by the network staff. Demographic data are reported in addition to underlying disease and survival. Results: 173 patients have been treated over six years with a yearly prevalence of 16 per million population. Prevalence in different regions of Scotland varies from 2.2 to 38.4 per million. The number of patients treated per centre over 6 years ranges from 1 patient (2 centres) to 46 patients. 115 females and 58 males were treated with an age range of 16 92 years and a median age of 47 years at the start of treatment. The underlying disease was Crohn’s disease 62 patients; bowel ischaemia 32; malignancy 12; motility disorder 17; radiation enteritis 7; other 43. Around 25% of the group change each year. Of 173 patients 62 remained on HPN in Dec 2007, 54 had died and 57 had stopped for other reasons. Kaplan Meier survival of patients remaining on HPN was 85% at 1 year; 75% at 2 years; 68% at 3 years and 49% at 5 years (59 patients available for 5 year followup). The majority of the deaths were due to the underlying disease rather than complications of HPN. Conclusion: These figures are unique in describing outcome of HPN throughout an entire population. Longer term outcome seems less good than in previous reports. This probably reflects the unselected population treated countrywide rather than a selected population in a tertiary referral centre. The underlying disease process remains an important cause of death. References [1] Messing B et al Gastroenterology 1995; 117:1043 1050. [2] Lloyd D Ali Pharm Ther 2006;24:1231 1240. Disclosure of Interest: None declared
Rationale: Measurement and monitoring of magnesium (Mg) are important to prevent the development of serious and potentially fatal complications in critically ill patients. The aim of this study was to define the prevalence of admission and 7d of ICU stay hypomagnesemia in critically ill patients and to evaluate its relationship with Mg intake and stay. Methods: A prospective study was done on 20 critically ill consecutive patients with inclusion criteria: 18 years old, admitted to the medical-surgical intensive care unit (ICU) at the University Hospital, APACHE II and SIRS diagnostic. Mg was measured by Atomic Absorption Spectophotometry (AAS) in wet-mineralyzed samples of plasma and erythrocyte of patients. Mg content in administered nutrition was recorded daily during the 7 days. Results: At admission 16% and 35% of hipomagnesemic patients (measured in plasma and erythrocyte respectively), increase to 29% and 46% at seventh day of ICU stay. There was significant difference between % of hypomagnesemic patients established by plasma and erythrocyte levels (p < 0.05). A weak correlation was found between Mg administered by nutritional treatment (94% below RDIs) and plasma magnesium content (p < 0.07) at seventh day. However, is significant that correlation with erythrocyte magnesium content (p < 0.02). Conclusion: Monitoring of magnesium levels in plasma and erythrocyte is needed at admission and during ICU stay of patients and may have prognostic, and perhaps therapeutic, implications. Development of hypomagnesemia during an ICU stay may be associated with different metabolic and clinical alterations that are attributed to other causes or are unknown, but complicate evolution of critically ill patient. Disclosure of Interest: I declare that I do not have any affiliation with orfinancial interest in a commercial organisation that poses a conflict of interest.
P199 NUTRITIONAL FOLLOW-UP OF ADULT PATIENTS WITH CELIAC DISEASE ON GLUTEN-FREE DIET M. Brugnani1 , C. Vecchio2 , F. D’Andrea1 . 1 Clinical Nutrition Unit, Maggiore della Carit` a Hospital, Novara, 2 Clinical Nutrition Unit, Luigi Sacco Hospital, Milano, Italy Rationale: Celiac disease (CD) is an immune-mediated disorder induced by the ingestion of gluten-containing cereals: the only treatment is a lifelong gluten-free diet (GFD). CD patients on GFD need a regular follow-up to evaluate effects of GFD on clinical and nutritional status.
114 Methods: 97 adult patients (M/F 24/73, mean age 38±13 years), affected by CD diagnosed according to ESPGHAN (European Society Paediatric Gastroenterology Hepatology and Nutrition) criteria were included in the study. We evaluated at CD diagnosis (T0) and after 2 years of GFD (T2): body mass index (BMI); IgA endomysium antibody (EmA) and IgA tissue transglutaminase antibody (tTG); serum levels of hemoglobin, iron, ferritin, total proteins, albumin, total cholesterol, HDL cholesterol, triglycerides, calcium, vitamin B12, folate; bone mineral density by a dual-energy x-ray absorptiometry (DEXA) scan (at T2 only if altered at T0). Results: Mean BMI (T0 vs T2): 21.6±3.2 vs 23.6±3.3 (p < 0.005); BMI < 18.5 in 15.5% vs 5.2%; BMI > 25 in 11.3% vs 35.8%. Serologic parameters (T0 vs T2): hemoglobin 11.8±2.1 g/l vs 14.0±1.2 (p < 0.005); iron 47.6±38.2 mcg/dl vs 99.2±29.8 (p < 0.005); ferritin 15±25.8 ng/ml vs 54.0±40.9 (p < 0.005); total proteins 7.0±0.6 g/l vs 7.5±0.4 (p < 0.005), albumin 3.9±0.5 g/l vs 4.3±0.3 (p < 0.005); total cholesterol 166.4±29.5 mg/dl vs 184.1±35.6 (p < 0.005; >200 mg/dl at T2 in 34.0%); HDL-cholesterol 46.0±12.0 mg/dl vs 52.2±11.6 (p < 0.005; low HDL-cholesterol at T2 in 36.1%); triglycerides 74.5±43.2 mg/dl vs 79.6±53.4 (p = 0.65); calcium 8.8±0.7 mg/dl vs 9.3±0.4 (p < 0.005), vitamin B12 419.3±191.1 pg/ml vs 524.8±190.9 (p < 0.005); folate 3.4±2.1 ng/ml vs 8.0±5.2 (p < 0.005). DEXA scan: normal values at T0 in 47.4%, at T2 in 78.3%. Conclusion: The strict adherence to GFD in CD patients leads to an improvement of nutritional status and of nutrition-related serologic parameters but increase in body weight and change in lipid profile are a potential cause of morbidity and need a careful follow-up. Disclosure of Interest: None declared
P200 CANADIAN HOME TOTAL PARENTERAL NUTRITION REGISTRY (HTPNR): VALIDATION AND 2 YEAR FOLLOW-UP OF LIVER PARAMETERS IN A SUBSET OF PATIENTS B. Kaila1 , E. Aghdassi1 , M. Baun1 , L. Fairholm1 , O. Saqui1 , M. Yeung1 , J.P. Allard1 . 1 Internal Medicine, Division of Gastroenterology, University of Toronto, Toronto General Hospital, Toronto, Canada Rationale: HTPN is associated with numerous complications including liver disease (LD). Objectives: 1) To validate the data entry at baseline with regards to LD and; 2) To conduct a 2 year follow-up. Methods: A prospective cohort study in a subset of patients from the Canadian HTPNR. The reproducibility of baseline data collection was assessed by re-extracting data from charts and were then reviewed for the 2-year follow-up. Intra-class correlation coefficient (ICC) was used to assess correlation and agreement between the baseline entries and a paired t-test was used to compare 2-year to baseline. Results: Data re-entry was done on 48 (29 female, 19 male) patients, mean age 51±2 years, small bowel length 77 cm ± 16, 8 with no colon, 17 with partial colon and 10 with an intact colon. LD was registered as present in 11 patients of whom 9 were TPN-related (TPNLD)
Poster presentations based on liver function tests (LFTs), abdominal ultrasound and/or liver biopsies. They correlated significantly with the first entry. The agreement was significant but weak: ICC = 0.53 and ICC = 0.55, respectively. However, if both observers agreed on the presence of LD, the ICC for the diagnosis of “TPNLD” was strong (ICC = 0.91, P = 0.0001). The agreements for LFTs were also significant with ICC of 0.55, 0.84, 0.47, and 0.94 for ALP, AST, ALT and bilirubin respectively. Of the 9 patients with TPNLD, 1 died of liver failure during the 2-year follow-up. In the remaining 8 subjects, with standard management, mean LFTs remained stable: ALP:762.4±245.9 vs 2y: 559.1±254.8 U/L, P = 0.13; AST:102.3±29.3 vs 2y: 65.0±28.5 U/L, P = 0.11; bilirubin:31.35±17.59, 2y: 42.72±33.50 mmol/L; P = 0.75. Over the 2 year period, 6 new cases of TPNLD were diagnosed. Conclusion: Correlations were significant between the 2 data sets at baseline. Although the agreement was weak for the presence of LD, it was strong for the diagnosis of TPNLD. Lack of agreement may have been due to inconsistencies in retrieving reports for LFTs, ultrasound and biopsies. Disclosure of Interest: None declared
P201 IN PURSUIT OF THE MAGIC PRESCRIPTION: HOW ARE THE ENERGY REQUIREMENTS OF CRITICALLY ILL PATIENTS BEING DETERMINED? N.E. Jones1 , L. Gramlich2 , C. Alberda3 , K. Jeejeebhoy4 , C. Johnson Stoklossa5 , D. Duerksen6 , J. Drover7 , A. Tremblay8 , R. Dhaliwal9 , D. Heyland10 . 1 Dept. Community Health and Epidemiology, Queens University, Kingston, 2 Royal Alexandra Hospital, University of Alberta, 3 Nutrition and Dietetics, Royal Alexandra, Edmonton, 4 Dept. Medicine, University Toronto, Toronto, 5 Nutrition and Dietetics, Ropyal Alexadra Hospital, Edmonton, 6 Dept Medicine, University of Manitoba, Winnipeg, 7 Dept. Medicine, Queens University, Kingston, 8 Dept Medicine, Laval University, Quebec City, 9 Clinical Evaluation Research Unit, Kingston General Hospital, 10 Dept Medicine & Epidemiology, Queens University, Kingston, Canada Rationale: Accurate determination of patients’ energy requirements is a daily challenge faced by practitioners in the Intensive Care Unit (ICU). There is currently insufficient evidence to make recommendations regarding the optimal assessment method, and little is known about what is actually happening in ICUs. The purpose of this study was to describe the methods of determining energy requirements used in daily practice. Methods: In January 2007, we conducted an international, prospective, observational, cohort study in 158 ICUs. Each ICU collected data on nutrition practices on 20 consecutive mechanically ventilated adult patients, including details of the baseline nutritional assessment. Results: Data was collected on 2946 patients. The most frequent methods used to calculate energy requirements was weight based dosing at 25 30 Kcal/kg (32.1%), the Harris Benedict Equation (13.4%) and the Schofield Equation with adjustment for stress or activity (13.3%). Several weights were used for calculating the nutrition