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P415 ORAL REPLETION OF VITAMIN D IN PATIENTS WITH PN-DEPENDENT INTESTINAL FAILURE
204
Poster presentations
Disclosure of Interest: None declared
P414 THE ROLE OF VITAMIN B1 IN LACTATE METABOLISM DURING FRUCTOSE INFUSION IN OPERATED PATIENTS
P413 HIGH PREVALENCE OF VITAMIN B12 DEFICIENCY IN SAMARITAN COMMUNITY ON THE MOUNT GERIZIM
Z. Sundov1 , Z. Nincevic2 , S. Tomic3 , J. Nincevic4 , A. Ujevic2 . 1 Dept. of Internal Medicine, 2 Anesthesiology, University Hospital Split, 3 Pathology, University Hospital Split, 4 Public Health Institute Split, Split, Croatia
manner by suppressing in vivo lipid peroxidation and stimulating activity of antioxidant system in smokers.
E.A. Merzon1 , P. Singer2 , R. Schneeweiss3 , T. Rips1 , E. Kitai1 . 1 Department of Family Medicine, Tel Aviv University, Tel Aviv, 2 Department of General Intensive Care, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel; 3 Department of Family Medicine, University of Washington, Seattle, USA Rationale: Ethnic differences in vitamin B12 (cobalamin) concentrations have been noted in the general population and result from combinations of hereditary and acquired causes. Some studies found low cobalamin levels in both Jewish and Arab populations; but there is a lack of research concerning vitamin B12 concentration in different ethnic groups throughout the Mediterranean region. The study objective was to assess the prevalence of vitamin B12 deficiency among highly consanguineous community, the Samaritans, living on Mt Gerizim in Israel. Methods: We analyzed the electronic database of Leumit Health Fund, one of the four HMOs in Israel. Cross sectional analysis of serum cobalamin, folic acid, homocysteine and blood cell parameters were performed. An association between the ethnic groups and vitamin B12 levels was determined by multiple regression analysis. Results: A total of 134 patients from a regional primary care clinic data were observed: 41 Samaritans and 93 Non-Samaritans who served as a control group. The Samaritans, have a higher prevalence of vitamin B12 deficiency 75.6% (95% CI 56; 90%), compared to Non-Samaritans 22.5% (95% CI 13.9; 30.1%). The mean serum vitamin B12 value in Samaritans was 157.9 pg/ml (95% CI 133.7; 182.3) and 353.2 pg/ml amongst the NonSamaritans (95% CI 311.8; 394.6). Linear regression analysis found that the difference in mean cobalamin level between Samaritans and Non-Samaritans was 176.1 pg/ml (p < 0.001). The differences between Samaritan and Non-Samaritan population remained significant, after dividing all included patients into two groups with vitamin deficiency and without: 57.2 pg/ml (p < 0.001) and 119.9 pg/ml (p < 0.05) respectively. Conclusion: Our data indicate that Samaritans on the Mt. Gerizim have a low serum vitamin B12 concentration. Detailed nutritional assessment and allelic association study of this population may be useful in investigating the molecular defect underlying vitamin B12 deficiency. Disclosure of Interest: The authors have no finantial or other interest in the presented abstract.
Rationale: To determine whether the daily use of 250 mg of vitamin B1 during first three postoperative days influences venous blood lactate concentration as well as arterial blood pH value after infusing 1000 mL of 10% fructose at the speed of 0.5 g/kg/h on the fourth postoperative day. Methods: The study included 40 patients (18 women and 22 men) aged 29 60, who had been operated at Surgery Clinic from 1995. to 2000. They spent the postoperative period at the Intensive Care Unit randomly assigned to one of two groups with 20 patients during first three postoperative days. The first group patients were not treated with vitamin B1, as opposed to the second group who were. On the fourth postoperative day, one hour before fructose was administered, lactate value in venous blood as well as acid-base status of arterial blood had been determined in all patients. The same day before fructose was administered, APACHE II score had been determined in all patients. 1000 mL of 10% fructose at the speed of 0.5 g/kg/h was infused afterwards. At the end of fructose infusion, lactate value and acid-base status were analysed. Results: The group of patients postoperatively treated with vitamin B1 showed significant decrease in lactate production after fructose infusion in relation to the group not treated with vitamin B1 (P < 0.010). The group of patients who were not treated postoperatively with vitamin B1 showed significant decrease in pH blood after fructose infusion, yet with no development of lactic acidosis. Conclusion: An indirect indicator of vitamin B1 postoperative depletion is significant increase in lactate values as well as significant decrease in blood pH after infusing the group of patients postoperatively deprived of vitamin B1 with 1000 ml of 10% fructose. It can occur due to weakened activity of pyruvate dehydrogenase enzyme complex where its coenzyme thiamine-pyrophosphate is being of greatest importance. References [1] Shiota M, et al. Am J Physiol Metab 2005;288(6). [2] Wei Y, et al.J Nutr 2004;134(3). Disclosure of Interest: None declared
P415 ORAL REPLETION OF VITAMIN D IN PATIENTS WITH PN-DEPENDENT INTESTINAL FAILURE J.I. Boullata1 , C.W. Compher1 , P.A. Schiavone1 , N.E. Stoner1 , K. Hoff1 , B.P. Kinosian1 . 1 Clinical Nutrition Support Services, University of Pennsylvania, Philadelphia, USA Rationale: Patients with intestinal failure may receive chronic parenteral nutrition (PN) at home and can
Vitamins, antioxidants and minerals 2
205
exhibit alterations in vitamin D status with subsequent impact on bone. Our previous work described vitamin D deficits [defined as 25(OH)D 30 ng/mL] that occurred despite the inclusion of this nutrient in the intravenous multivitamin preparations and the addition of oral vitamin D supplementation. No other parenteral vitamin D product is commercially available in the U.S. The slow responses to oral vitamin D repletion led us to consider a more aggressive management plan. Aim: To describe the benefit of an aggressive oral vitamin D supplementation regimen in several of our PNdependent patients with intestinal failure. Methods: A prospective evaluation of the PN-dependent patients managed by our team was conducted. Patients were instructed to use only vitamin D3 (cholecalciferol). The initial dosing of vitamin D was based on serum 25-OHvitamin D concentrations and renal function. Subsequent dose escalations were based on patient response. Results: A total of 5 patients with available data were evaluated thus far. The summary findings (baseline data, dosing regimen, subsequent data) are provided in the table.
(900.6±316.9/mm3) and 63% had undetectable viral load. Health status was considered poor in 5.3%, fair/good in 79.4%, and excellent in 15.5% of participants. Vitamin/ mineral supplement was used by 216 (76.3%). They were used to: prolong life (71.3%); treat HIV-related conditions (26.4%); increase energy level (56%); boost immunity (36%); treat medication side effects (17.6%). Other reasons include: it is better than chemicals (14.4%), it is chemical free (13%) and it is harmless (14.8%). Among participants, 54.4% were somewhat familiar with supplements, 43.8% trusted the information on the labels and 26% felt if a supplement is available for sale, it is safe. Supplements were mostly purchased at local pharmacies (44.9%) and health food stores (31.1%). Only 24% and 29% of participants discussed their use of supplements with their HIV or family doctor respectively. Conclusion: Micronutrient supplements are frequently used by PLWH without consulting their doctor. Considering the potential toxicity from vitamin/mineral overdose and possible interactions with HIV medications, doctors may need to be more involved in decisions about the use/choice of nutritional supplements.
Results of Vitamin D Oral Repletion
Disclosure of Interest: This study was funded by The Ontario HIV Treatment Network.
Patient
1 2 3 4 5
Baseline data
Dose
Duration
Subsequent data
25(OH)D (ng/mL)
PTH (pg/mL)
Ca (mg/dL)
(mg/d)
(mo)
25(OH)D (ng/mL)
PTH (pg/mL)
Ca (mg/dL)
6 16 18 21 20
76 260 62 165 9
9.2 8.8 8.8 8.2 8.2
150 75 175 50 50
2 1 2 3 2
27 24 37 37 35
n/a 68.7 n/a 96 n/a
9.7 8.9 8.8 8.6 8.2
Conclusion: In the absence of parenteral vitamin D, an aggressive oral vitamin D supplementation regimen in PN-dependent patients can improve vitamin D status. At the same time there were no detrimental effects of the regimen on calcium status. Disclosure of Interest: None declared
P416 NUTRITION AND NUTRITIONAL SUPPLEMENTS: KNOWLEDGE AND ATTITUDES OF HIV-POSITIVE PATIENTS E. Aghdassi1 , H. Bondar1 , I.E. Salit1 , J. Tinmouth2 , J.P. Allard1 . 1 Medicine, The University Health Network, 2 Medicine, The Sunnybrook Health center, Toronto, Canada Rationale: To assess the knowledge and attitudes of Patients Living with HIV (PLWH) with respect to the use of micronutrient supplements. Methods: A questionnaire was developed and mailed to PLWH in Ontario that were part of HIV/AIDS organizations. PLWH attending the HIV-clinic of the University Health Network were also approached. Results: The survey was completed by 283 PLWH (85 female, 182 male, 16 unknown). Ethnic background includes: Hispanic 3%, African/American 21.6%, white/nonHispanic 62.5%, Asian 4.2%, native American 1.8%, and unknown in 6.7%. 52.3% were homosexual, 7.4% were bisexual, 33.2% were heterosexual, and 7.1% is unknown. HIV transmission was through IV drug use in 4.6%, blood transfusion in 5.3%, sexual in 78.8% and unknown in 11.3%. Subjects had a relatively good CD4 count
P417 EFFECTS OF SEA BUCKTHORN BERRIES ON INFECTIONS AND INFLAMMATION P.S. Larmo1 , J.A. Alin2 , E.K. Salminen3 , H.P. Kallio1 , R.L. Tahvonen4 . 1 Department of Biochemistry and Food Chemistry, 2 Department of Biostatistics, 3 Department of Radiotherapy and Oncology, University of Turku, Turku, 4 Functional Foods Forum/EPANET, University of Turku, Sein¨ ajoki, Finland Rationale: Sea buckthorn berries contain bioactive compounds, and have traditionally been used in Eastern medicine. The objective was to study the effect of sea buckthorn berries on the common cold (CC), digestive and urinary tract infections (DTI, UTI), and serum C-reactive protein (CRP) concentrations. Methods: A total of 254 healthy volunteers were randomly assigned to receive sea buckthorn or placebo product during the double-blind study, which 233 of them completed. During the 3 month observation period the participants took 28 g of the product daily, and kept a logbook of infection symptoms. Blood samples were obtained at the beginning and end of the observation period for the analysis of CRP concentrations. Results: There were no significant differences in the number or duration of CC or DTI between groups (CC: relative risks (sea buckthorn vs. placebo) for the number and duration were 1.15 (95% CI 0.90 1.48) and 1.05 (95% CI 0.87 1.27), respectively). In the sea buckthorn group, as compared to the placebo, the serum CRP concentrations decreased significantly (difference in median change 0.059 mg/L, P = 0.039). The number of UTI was too small to draw solid conclusions, but the results indicate the subject merits further investigation. Conclusion: Sea buckthorn berries did not prevent CC or DTI. However, a reductive effect on CRP, a marker of inflammation, and a risk factor for cardiovascular diseases, was detected.
Poster presentations
Disclosure of Interest: None declared
P414 THE ROLE OF VITAMIN B1 IN LACTATE METABOLISM DURING FRUCTOSE INFUSION IN OPERATED PATIENTS
P413 HIGH PREVALENCE OF VITAMIN B12 DEFICIENCY IN SAMARITAN COMMUNITY ON THE MOUNT GERIZIM
Z. Sundov1 , Z. Nincevic2 , S. Tomic3 , J. Nincevic4 , A. Ujevic2 . 1 Dept. of Internal Medicine, 2 Anesthesiology, University Hospital Split, 3 Pathology, University Hospital Split, 4 Public Health Institute Split, Split, Croatia
manner by suppressing in vivo lipid peroxidation and stimulating activity of antioxidant system in smokers.
E.A. Merzon1 , P. Singer2 , R. Schneeweiss3 , T. Rips1 , E. Kitai1 . 1 Department of Family Medicine, Tel Aviv University, Tel Aviv, 2 Department of General Intensive Care, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel; 3 Department of Family Medicine, University of Washington, Seattle, USA Rationale: Ethnic differences in vitamin B12 (cobalamin) concentrations have been noted in the general population and result from combinations of hereditary and acquired causes. Some studies found low cobalamin levels in both Jewish and Arab populations; but there is a lack of research concerning vitamin B12 concentration in different ethnic groups throughout the Mediterranean region. The study objective was to assess the prevalence of vitamin B12 deficiency among highly consanguineous community, the Samaritans, living on Mt Gerizim in Israel. Methods: We analyzed the electronic database of Leumit Health Fund, one of the four HMOs in Israel. Cross sectional analysis of serum cobalamin, folic acid, homocysteine and blood cell parameters were performed. An association between the ethnic groups and vitamin B12 levels was determined by multiple regression analysis. Results: A total of 134 patients from a regional primary care clinic data were observed: 41 Samaritans and 93 Non-Samaritans who served as a control group. The Samaritans, have a higher prevalence of vitamin B12 deficiency 75.6% (95% CI 56; 90%), compared to Non-Samaritans 22.5% (95% CI 13.9; 30.1%). The mean serum vitamin B12 value in Samaritans was 157.9 pg/ml (95% CI 133.7; 182.3) and 353.2 pg/ml amongst the NonSamaritans (95% CI 311.8; 394.6). Linear regression analysis found that the difference in mean cobalamin level between Samaritans and Non-Samaritans was 176.1 pg/ml (p < 0.001). The differences between Samaritan and Non-Samaritan population remained significant, after dividing all included patients into two groups with vitamin deficiency and without: 57.2 pg/ml (p < 0.001) and 119.9 pg/ml (p < 0.05) respectively. Conclusion: Our data indicate that Samaritans on the Mt. Gerizim have a low serum vitamin B12 concentration. Detailed nutritional assessment and allelic association study of this population may be useful in investigating the molecular defect underlying vitamin B12 deficiency. Disclosure of Interest: The authors have no finantial or other interest in the presented abstract.
Rationale: To determine whether the daily use of 250 mg of vitamin B1 during first three postoperative days influences venous blood lactate concentration as well as arterial blood pH value after infusing 1000 mL of 10% fructose at the speed of 0.5 g/kg/h on the fourth postoperative day. Methods: The study included 40 patients (18 women and 22 men) aged 29 60, who had been operated at Surgery Clinic from 1995. to 2000. They spent the postoperative period at the Intensive Care Unit randomly assigned to one of two groups with 20 patients during first three postoperative days. The first group patients were not treated with vitamin B1, as opposed to the second group who were. On the fourth postoperative day, one hour before fructose was administered, lactate value in venous blood as well as acid-base status of arterial blood had been determined in all patients. The same day before fructose was administered, APACHE II score had been determined in all patients. 1000 mL of 10% fructose at the speed of 0.5 g/kg/h was infused afterwards. At the end of fructose infusion, lactate value and acid-base status were analysed. Results: The group of patients postoperatively treated with vitamin B1 showed significant decrease in lactate production after fructose infusion in relation to the group not treated with vitamin B1 (P < 0.010). The group of patients who were not treated postoperatively with vitamin B1 showed significant decrease in pH blood after fructose infusion, yet with no development of lactic acidosis. Conclusion: An indirect indicator of vitamin B1 postoperative depletion is significant increase in lactate values as well as significant decrease in blood pH after infusing the group of patients postoperatively deprived of vitamin B1 with 1000 ml of 10% fructose. It can occur due to weakened activity of pyruvate dehydrogenase enzyme complex where its coenzyme thiamine-pyrophosphate is being of greatest importance. References [1] Shiota M, et al. Am J Physiol Metab 2005;288(6). [2] Wei Y, et al.J Nutr 2004;134(3). Disclosure of Interest: None declared
P415 ORAL REPLETION OF VITAMIN D IN PATIENTS WITH PN-DEPENDENT INTESTINAL FAILURE J.I. Boullata1 , C.W. Compher1 , P.A. Schiavone1 , N.E. Stoner1 , K. Hoff1 , B.P. Kinosian1 . 1 Clinical Nutrition Support Services, University of Pennsylvania, Philadelphia, USA Rationale: Patients with intestinal failure may receive chronic parenteral nutrition (PN) at home and can
Vitamins, antioxidants and minerals 2
205
exhibit alterations in vitamin D status with subsequent impact on bone. Our previous work described vitamin D deficits [defined as 25(OH)D 30 ng/mL] that occurred despite the inclusion of this nutrient in the intravenous multivitamin preparations and the addition of oral vitamin D supplementation. No other parenteral vitamin D product is commercially available in the U.S. The slow responses to oral vitamin D repletion led us to consider a more aggressive management plan. Aim: To describe the benefit of an aggressive oral vitamin D supplementation regimen in several of our PNdependent patients with intestinal failure. Methods: A prospective evaluation of the PN-dependent patients managed by our team was conducted. Patients were instructed to use only vitamin D3 (cholecalciferol). The initial dosing of vitamin D was based on serum 25-OHvitamin D concentrations and renal function. Subsequent dose escalations were based on patient response. Results: A total of 5 patients with available data were evaluated thus far. The summary findings (baseline data, dosing regimen, subsequent data) are provided in the table.
(900.6±316.9/mm3) and 63% had undetectable viral load. Health status was considered poor in 5.3%, fair/good in 79.4%, and excellent in 15.5% of participants. Vitamin/ mineral supplement was used by 216 (76.3%). They were used to: prolong life (71.3%); treat HIV-related conditions (26.4%); increase energy level (56%); boost immunity (36%); treat medication side effects (17.6%). Other reasons include: it is better than chemicals (14.4%), it is chemical free (13%) and it is harmless (14.8%). Among participants, 54.4% were somewhat familiar with supplements, 43.8% trusted the information on the labels and 26% felt if a supplement is available for sale, it is safe. Supplements were mostly purchased at local pharmacies (44.9%) and health food stores (31.1%). Only 24% and 29% of participants discussed their use of supplements with their HIV or family doctor respectively. Conclusion: Micronutrient supplements are frequently used by PLWH without consulting their doctor. Considering the potential toxicity from vitamin/mineral overdose and possible interactions with HIV medications, doctors may need to be more involved in decisions about the use/choice of nutritional supplements.
Results of Vitamin D Oral Repletion
Disclosure of Interest: This study was funded by The Ontario HIV Treatment Network.
Patient
1 2 3 4 5
Baseline data
Dose
Duration
Subsequent data
25(OH)D (ng/mL)
PTH (pg/mL)
Ca (mg/dL)
(mg/d)
(mo)
25(OH)D (ng/mL)
PTH (pg/mL)
Ca (mg/dL)
6 16 18 21 20
76 260 62 165 9
9.2 8.8 8.8 8.2 8.2
150 75 175 50 50
2 1 2 3 2
27 24 37 37 35
n/a 68.7 n/a 96 n/a
9.7 8.9 8.8 8.6 8.2
Conclusion: In the absence of parenteral vitamin D, an aggressive oral vitamin D supplementation regimen in PN-dependent patients can improve vitamin D status. At the same time there were no detrimental effects of the regimen on calcium status. Disclosure of Interest: None declared
P416 NUTRITION AND NUTRITIONAL SUPPLEMENTS: KNOWLEDGE AND ATTITUDES OF HIV-POSITIVE PATIENTS E. Aghdassi1 , H. Bondar1 , I.E. Salit1 , J. Tinmouth2 , J.P. Allard1 . 1 Medicine, The University Health Network, 2 Medicine, The Sunnybrook Health center, Toronto, Canada Rationale: To assess the knowledge and attitudes of Patients Living with HIV (PLWH) with respect to the use of micronutrient supplements. Methods: A questionnaire was developed and mailed to PLWH in Ontario that were part of HIV/AIDS organizations. PLWH attending the HIV-clinic of the University Health Network were also approached. Results: The survey was completed by 283 PLWH (85 female, 182 male, 16 unknown). Ethnic background includes: Hispanic 3%, African/American 21.6%, white/nonHispanic 62.5%, Asian 4.2%, native American 1.8%, and unknown in 6.7%. 52.3% were homosexual, 7.4% were bisexual, 33.2% were heterosexual, and 7.1% is unknown. HIV transmission was through IV drug use in 4.6%, blood transfusion in 5.3%, sexual in 78.8% and unknown in 11.3%. Subjects had a relatively good CD4 count
P417 EFFECTS OF SEA BUCKTHORN BERRIES ON INFECTIONS AND INFLAMMATION P.S. Larmo1 , J.A. Alin2 , E.K. Salminen3 , H.P. Kallio1 , R.L. Tahvonen4 . 1 Department of Biochemistry and Food Chemistry, 2 Department of Biostatistics, 3 Department of Radiotherapy and Oncology, University of Turku, Turku, 4 Functional Foods Forum/EPANET, University of Turku, Sein¨ ajoki, Finland Rationale: Sea buckthorn berries contain bioactive compounds, and have traditionally been used in Eastern medicine. The objective was to study the effect of sea buckthorn berries on the common cold (CC), digestive and urinary tract infections (DTI, UTI), and serum C-reactive protein (CRP) concentrations. Methods: A total of 254 healthy volunteers were randomly assigned to receive sea buckthorn or placebo product during the double-blind study, which 233 of them completed. During the 3 month observation period the participants took 28 g of the product daily, and kept a logbook of infection symptoms. Blood samples were obtained at the beginning and end of the observation period for the analysis of CRP concentrations. Results: There were no significant differences in the number or duration of CC or DTI between groups (CC: relative risks (sea buckthorn vs. placebo) for the number and duration were 1.15 (95% CI 0.90 1.48) and 1.05 (95% CI 0.87 1.27), respectively). In the sea buckthorn group, as compared to the placebo, the serum CRP concentrations decreased significantly (difference in median change 0.059 mg/L, P = 0.039). The number of UTI was too small to draw solid conclusions, but the results indicate the subject merits further investigation. Conclusion: Sea buckthorn berries did not prevent CC or DTI. However, a reductive effect on CRP, a marker of inflammation, and a risk factor for cardiovascular diseases, was detected.