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P225 ELEVATED BLIRUBIN IN CHRONIC HOME PARENTERAL NUTRITION PATIENTS: CORRELATION WITH PATIENT CHARACTERISTICS AND CALORIE PROVISIONS
Nutrition and chronic diseases 3
125
P224 TWELVE WEEKS TUBE FEEDING WITH A DIABETESSPECIFIC FEED IMPROVES GLYCAEMIC CONTROL IN TYPE 2 DIABETES PATIENTS
P225 ELEVATED BLIRUBIN IN CHRONIC HOME PARENTERAL NUTRITION PATIENTS: CORRELATION WITH PATIENT CHARACTERISTICS AND CALORIE PROVISIONS
N. Vaisman1 , M. Lansink2 , K.M.J. van Laere2 , T.E. Bowling3 , D.L. Waitzberg4 , J. Morley5 . 1 Unit of Clinical Nutrition, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; 2 Medical Nutrition, Danone Research Centre for Specialised Nutrition, Wageningen, Netherlands; 3 Clinical Nutrition and Gastroenterology, Queens Medical Centre, Nottingham, United Kingdom; 4 Department of Gastroenterology, LIM 35, University of S˜ ao Paulo Medical School, S˜ ao Paulo, Brazil; 5 Department of Internal Medicine, Saint Louis University, Saint Louis, USA
J.K. Siepler1 , T. Diamantidis1 , R.A. Nishikawa1 , R. Okamoto1 . 1 Pharmacy, Nutrishare, Inc, Elk Grove, USA
Rationale: Diabetes-specific feeds (DSF) have been developed to improve glycaemic control. We have studied the long term (12 weeks) effects of tube feeding with a DSF compared with a standard feed (SF) on postprandial glucose response, glycaemic control (HbA1c), lipid profile, (pre-)albumin, and tolerance in diabetic patients. Methods: The study had a randomized, controlled, double-blind, parallel group design and 25 type 2 diabetic patients (21 in-patients, 4 out-patients) in need of nutritional support by tube feeding were randomized. Patients received a soy protein based, high monounsaturated fatty acid DSF (Diason® ) or an isocaloric, fibre-containing SF for 12 weeks, while continuing their anti-diabetic medication. At the start of the study (1st assessment) and after 6 and 12 weeks, postprandial glucose responses to a bolus of 200 ml of either the DSF or SF were assessed. The data were analyzed by multilevel analysis. Results: A lower postprandial glucose response (iAUC) was observed at the 1st assessment to DSF as compared with SF (difference in intercept: p = 0.008) and this difference did not significantly change in time (treatment*time: p = 0.601). Similar results were found for (delta) peak glucose levels. Tube feeding with DSF resulted in a reduction in HbA1c over time compared with SF (treatment*time: p = 0.034). Estimated marginal mean HbA1c (±SEM) decreased in the DSF group (6.9±0.3% at baseline, 6.2±0.4% at 12 weeks), whereas it increased in the SF group (7.9±0.3% to 8.7±0.4%). No significant treatment*time effect was found for fasting glucose, insulin, (pre-)albumin or lipid profile, except for HDL (increase in DSF group). No clinically relevant differences in tolerance were observed. Conclusion: In addition to anti-diabetic medication, the DSF can further improve overall glycaemic control (HbA1c) and can result in lower postprandial glucose responses in diabetic patients. This could have beneficial implications to the clinical course of their illness. Disclosure of Interest: N. Vaisman, Danone Research-Centre for Specialised Nutrition, consultant. M. Lansink, Danone Research Centre for Specialised Nutrition, employee. K. van Laere, Danone Research Centre for Specialised Nutrition, employee. T. Bowling, none. D. Waitzberg, none. J. Morley, none
Rationale: Patients who require home parenteral nutrition (HPN) can develop an elevated bilirubin (BILI). We wanted to determine the incidence of elevated BILI in a large cohort of HPN patients, and correlate this with HPN macronutrients. Methods: All patients from one home care provider who had been on HPN >1 year and were not likely to get off HPN in the next year qualified. The records of those patients were recorded for two years (6/2005 6/2007). The information included patient demographics, HPN calorie provisions and BILI. Primary outcome was the frequency of abnormal BILI. Secondary outcome was the correlation of abnormal BILI with HPN calorie provisions. Statistics were done with logistic regression. Results: There were 1711 labs done in 139 patients. Mean age was 45±20 years, 83 (61%) were female, and mean duration of HPN was 13.9±8.9 years. Abnormal BILI was seen in 26 (18.7%) patients. Using logistic regression, there was no significant correlation of patients with elevated BILI and age, gender, duration of HPN use, amino, or fat dose (gm/kg/day). Dextrose (CHO) dose (gm/kg/day) correlated significantly with abnormal BILI (OR = 1.17 (95%CI:1.03 1.33. p < 0.05). BILI > 5 was less common, occurring in 6 (4.3%) patients but also correlated with CHO dose (OR = 1.23;95%CI:1.04 1.46.p < 0.05). Conclusion: We examined abnormal BILI in HPN patients finding the abnormality occurred in 18.7% of patients. This abnormality correlated with HPN CHO dose, but not age, gender, HPN duration, amino acid, or fat dose. It is not possible to conclude from these data that the patients with abnormal BILI actually have hepatic abnormalities, but these results are often the first step to further investigation. These data are similar to work presented by others at ESPEN in 2007. The correlation with dextrose dose is not surprising, and needs to be investigated further. Disclosure of Interest: None declared
P226 INTESTINAL ANTI-INFLAMMATORY ACTIVITY OF A MIXTURE OF VEGETABLES IN TNBS MODEL OF RAT COLITIS R. Moreno-Torres1 , C. P´ erez Roca2 , J. G´ alvez3 , 3 3 D. Camuesco , B. Arribas , A. P´ erez de la Cruz1 , A. Zarzuelo3 . 1 Clinical Nutrition and Dietetic Unit, Universitary Hospital Virgen de las Nieves, 2 Director T´ ecnico, Verbiotech I+D+I S.L., 3 Department of Pharmacology, University of Granada, Granada, Spain Rationale: Previous studies have reported the intestinal anti-inflammatory activity of different natural compounds, including flavonoids and dietary fiber, in the trinitrobencenesulphonic acid (TNBS) model of rat colitis, an experimental model with some resemblance to human Crohn’s disease. The aim of this study was to test
125
P224 TWELVE WEEKS TUBE FEEDING WITH A DIABETESSPECIFIC FEED IMPROVES GLYCAEMIC CONTROL IN TYPE 2 DIABETES PATIENTS
P225 ELEVATED BLIRUBIN IN CHRONIC HOME PARENTERAL NUTRITION PATIENTS: CORRELATION WITH PATIENT CHARACTERISTICS AND CALORIE PROVISIONS
N. Vaisman1 , M. Lansink2 , K.M.J. van Laere2 , T.E. Bowling3 , D.L. Waitzberg4 , J. Morley5 . 1 Unit of Clinical Nutrition, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; 2 Medical Nutrition, Danone Research Centre for Specialised Nutrition, Wageningen, Netherlands; 3 Clinical Nutrition and Gastroenterology, Queens Medical Centre, Nottingham, United Kingdom; 4 Department of Gastroenterology, LIM 35, University of S˜ ao Paulo Medical School, S˜ ao Paulo, Brazil; 5 Department of Internal Medicine, Saint Louis University, Saint Louis, USA
J.K. Siepler1 , T. Diamantidis1 , R.A. Nishikawa1 , R. Okamoto1 . 1 Pharmacy, Nutrishare, Inc, Elk Grove, USA
Rationale: Diabetes-specific feeds (DSF) have been developed to improve glycaemic control. We have studied the long term (12 weeks) effects of tube feeding with a DSF compared with a standard feed (SF) on postprandial glucose response, glycaemic control (HbA1c), lipid profile, (pre-)albumin, and tolerance in diabetic patients. Methods: The study had a randomized, controlled, double-blind, parallel group design and 25 type 2 diabetic patients (21 in-patients, 4 out-patients) in need of nutritional support by tube feeding were randomized. Patients received a soy protein based, high monounsaturated fatty acid DSF (Diason® ) or an isocaloric, fibre-containing SF for 12 weeks, while continuing their anti-diabetic medication. At the start of the study (1st assessment) and after 6 and 12 weeks, postprandial glucose responses to a bolus of 200 ml of either the DSF or SF were assessed. The data were analyzed by multilevel analysis. Results: A lower postprandial glucose response (iAUC) was observed at the 1st assessment to DSF as compared with SF (difference in intercept: p = 0.008) and this difference did not significantly change in time (treatment*time: p = 0.601). Similar results were found for (delta) peak glucose levels. Tube feeding with DSF resulted in a reduction in HbA1c over time compared with SF (treatment*time: p = 0.034). Estimated marginal mean HbA1c (±SEM) decreased in the DSF group (6.9±0.3% at baseline, 6.2±0.4% at 12 weeks), whereas it increased in the SF group (7.9±0.3% to 8.7±0.4%). No significant treatment*time effect was found for fasting glucose, insulin, (pre-)albumin or lipid profile, except for HDL (increase in DSF group). No clinically relevant differences in tolerance were observed. Conclusion: In addition to anti-diabetic medication, the DSF can further improve overall glycaemic control (HbA1c) and can result in lower postprandial glucose responses in diabetic patients. This could have beneficial implications to the clinical course of their illness. Disclosure of Interest: N. Vaisman, Danone Research-Centre for Specialised Nutrition, consultant. M. Lansink, Danone Research Centre for Specialised Nutrition, employee. K. van Laere, Danone Research Centre for Specialised Nutrition, employee. T. Bowling, none. D. Waitzberg, none. J. Morley, none
Rationale: Patients who require home parenteral nutrition (HPN) can develop an elevated bilirubin (BILI). We wanted to determine the incidence of elevated BILI in a large cohort of HPN patients, and correlate this with HPN macronutrients. Methods: All patients from one home care provider who had been on HPN >1 year and were not likely to get off HPN in the next year qualified. The records of those patients were recorded for two years (6/2005 6/2007). The information included patient demographics, HPN calorie provisions and BILI. Primary outcome was the frequency of abnormal BILI. Secondary outcome was the correlation of abnormal BILI with HPN calorie provisions. Statistics were done with logistic regression. Results: There were 1711 labs done in 139 patients. Mean age was 45±20 years, 83 (61%) were female, and mean duration of HPN was 13.9±8.9 years. Abnormal BILI was seen in 26 (18.7%) patients. Using logistic regression, there was no significant correlation of patients with elevated BILI and age, gender, duration of HPN use, amino, or fat dose (gm/kg/day). Dextrose (CHO) dose (gm/kg/day) correlated significantly with abnormal BILI (OR = 1.17 (95%CI:1.03 1.33. p < 0.05). BILI > 5 was less common, occurring in 6 (4.3%) patients but also correlated with CHO dose (OR = 1.23;95%CI:1.04 1.46.p < 0.05). Conclusion: We examined abnormal BILI in HPN patients finding the abnormality occurred in 18.7% of patients. This abnormality correlated with HPN CHO dose, but not age, gender, HPN duration, amino acid, or fat dose. It is not possible to conclude from these data that the patients with abnormal BILI actually have hepatic abnormalities, but these results are often the first step to further investigation. These data are similar to work presented by others at ESPEN in 2007. The correlation with dextrose dose is not surprising, and needs to be investigated further. Disclosure of Interest: None declared
P226 INTESTINAL ANTI-INFLAMMATORY ACTIVITY OF A MIXTURE OF VEGETABLES IN TNBS MODEL OF RAT COLITIS R. Moreno-Torres1 , C. P´ erez Roca2 , J. G´ alvez3 , 3 3 D. Camuesco , B. Arribas , A. P´ erez de la Cruz1 , A. Zarzuelo3 . 1 Clinical Nutrition and Dietetic Unit, Universitary Hospital Virgen de las Nieves, 2 Director T´ ecnico, Verbiotech I+D+I S.L., 3 Department of Pharmacology, University of Granada, Granada, Spain Rationale: Previous studies have reported the intestinal anti-inflammatory activity of different natural compounds, including flavonoids and dietary fiber, in the trinitrobencenesulphonic acid (TNBS) model of rat colitis, an experimental model with some resemblance to human Crohn’s disease. The aim of this study was to test