- Email: [email protected]
P.80 Energy and protein metabolism during recovery from malnutrition due to non-neoplastic gastrointestinal disease in humans
10th Session - N U T R I T I O N A L A S S E S S M E N T , B O D Y C O M P O S I T I O N , E N E R G Y E X P E N D I T U R E status determined by subjective and objective methods. The determination of IGF-I concentrations seems more valuable than those of albumin which were not correlated to the nutritional status.
P.77 Validation of multiple-frequency bio-electrical impedance in patients with inflammatory bowel disease (IBD) to estimate total body water and extra-cellular water B. Geerling 1, W. v. Marken Lichtenbelt 2, R. StockbrEtgger ~ and R.-J.
P.79 Relationship between resting energy expenditure, plasma and urine cytokine levels in melanoma patients treated by interleukin-2 and interferon-~
Brummer1 Dept of Gastroenterology University Hospital of Maastricht, 2Dept of Human Biology, University of Limburg, The Netherlands.
P. ~'ivn~], E. Bure~ov~ ~, J. Buret,
L. PIf~kova, V. Pali~ka, O. Kopeck~1, R. Machata2 and P. Til#er 2 Institute of Clinical Biochemistry and Diagnostics, 1Institute of Clinical Immunology, 2Dept of Cardiopulm. and Vascular Diagnostics, University Hospital, Charles' University, Hradec Kr~lov6, Czech Republic.
Introduction: The most appropriate methods for measuring body water compartments are dilution techniques. However, these techniques are invasive, time-consuming and expensive. Multiple-frequency bio-electrical impedance (MF-BIA) is a rapid, safe, inexpensive, non-invasive and reproducible method in healthy volunteers. The aim of this study was to assess the validity of MF-BIA in a group of patients with IBD (Crohn's disease (CD) and ulcerative colitis (UC)). Methods: Total body water (TBW) and extra-cellular water (ECW) were assessed using deuterium (920) and bromide (Br) dilution techniques respectively, and MF-BIA, in 25 patients (11 M, 14F) with IBD: 14 patients with IBD (6 CD, 8 UC) at time of diagnosis (IBD-diagn.) and 11 patients with CD for more than 10 years with one or more small bowel resections (CD-Iong). MFBIA estimates ECW and TBW by extrapolation from the range of impedance measurements at different frequencies. Volume estimations were calculated directly. Non-parametric tests were used for statistical analysis (SPSS-X). Results: Comparison of the mean differences of TBW and ECW, measured by dilution and MF-BIA, between IBD-diagn. and CD-Iong, showed no significant differences. There was a highly significant correlation between TBW measured by D20 dilution and MF-BIA (r = 0.96, SEE = 1.96, P < 0.001). The Bland-Airman plot of the differences of TBW measured by D20 dilution, minus TBW measured by MF-BIA, against their mean, showed a mean difference of +1.6 litre (4% of mean TBW), with limits of agreement of -2.3 and 5.6 litre. We observed a highly significant correlation between ECW measured by Br dilution and MF-BIA (r = 0.92, SEE = 0.97, P < 0.001). The mean difference in ECW, measured by Br dilution, minus ECW measured by MF-BIA, in the Bland-Altman plot, was +0.5 litre (3% of mean ECW) with limits of agreement of -1.5 and 2.4 litre. Conclusion: We conclude that MF-BIA seems to be a useful non-invasive method to estimate TBW and ECW in patients with IBD.
Aim: To evaluate the effect of a low dose interleukin-2 (IL-2) and interferon-c~ (IFN-c0 administration on plasma and urine levels of related cytokines and resting energy expenditure (REE) in malignant melanoma patients. Patients and methods: The study included 10 melanoma patients (6 men, 4 women, 25-73 years old, mean 55.1, Kamofsky index 70-80%) treated by cytokine administration: IL-2 (3 million units/m 2 of body surface area s.c.) and IFN-o~ (3 million units/m 2 s.c.). Blood samples for cytokine analyses were obtained and REE was measured by means of indirect calorimetry (MedGraphics, using canopy) before and 90, 180, 360 min, 24 and 48 h respectively after the cytokine administration. Urine samples were collected during these intervals (i.e. during 90, 90, 180min, 18, 24 and 24h). Plasma and urine cytokine levels were measured using enzyme-linked immunosorbent assays (Quantikine, RD systems, USA). Statistical analysis (paired t-test, Mann-Whitney Rank Sum Test, Pearson Correlation) was done using Jandel Scientific. Results: Selected results (before therapy and 360 min after cytokine administration) are presented as mean and standard error of the mean. Cytokine levels are given in pg/ml. We observed no significant changes in plasma TNF-c~ levels (10.1 _+2,2 before therapy, 8.6 + 2.9 360 min after cytokine administration). Tumour necrosis factor (TNF)-c( level in urine was 9.3 + 3.1 before and 1.8 -+ 1.8 after administration. IL-6 plasma level was 6.0 + 2.2 before therapy, 49.3 + 18.9 (P= 0.044) 360rain after administration and IL-6 urine level was 45.9 + 39.1 before and 4.8 + 1,8 after administration. IL-2 plasma level before therapy was 0.0 + 0.0 and 131.8 _+19.4 (P = 0.0001) after administration. IL-2 in urine was not detected. REE (in per cent of predicted value according to Harris,and Benedict) was 105,4 + 3.63 before therapy and 139.8 _+5.97 after administration (P = 0.0001). Conclusions: The increase in IL-6 and IL-2 plasma levels is associated with a marked increase of resting energy expenditure (REE) in melanoma patients treated with IFN-o~and IL-2. No significant changes of plasma and urine TNF-(z were observed.
1°.78 Plasma insulin-like growth factor-I concentrations reflect the nutritional status in hospitalized patients J. P. Thissen, S. Marandi, N. Guyen, M. Lievens and J. M.
Ketelslegers Diabetes and Nutrition, Biochemistry Units, University of Louvain, Brussels, Belgium. Insulin-like growth factor-I (IGF-I) is a short half-life circulating peptide whose production by the liver is dependent on growth hormone. It is also regulated by dietary intake. Although studies showed reduced plasma IGF-I concentrations in dietary restricted subjects, the ability of plasma IGF-I to reflect the nutritional status in patients is still debated. To investigate the role of IGF-I as a marker of nutritional status, we compared the plasma IGF-I to the nutritional status assessed by 'subjective global assessment', anthropometry, bioimpedance, albumin and transthyretin determination in 100 hospitalized patients. Only patients at risk of malnutrition on the basis of their primary diagnosis (head and neck cancers 65, HIV seropositivity 16, anorexia nervosa 15, varia 4) were enrolled. IGF-I was measured by radioimmunoassay after plasma extraction. Results were expressed in percentage of the median of control subjects after age and sex stratification. Plasma IGF-I was positively correlated with body mass index (r= 0.44; P< 0.001) and negatively with body weight loss (r= -0.34; P < 0.001). Malnourished patients ranked 'B' and 'C' according to 'subjective global assessment' had significantly lower IGF-I values than well-nourished patients ranked 'A' (A: 68 -+4% vs B: 48 _+7% and C: 44 _ 6%, P< 0.002). IGF-I was also correlated with triceps skinfold (r= 0.33; P < 0.001), mid-arm circumference (r= 0.38; P < 0.001) and mid-arm muscle area (r= 0.38; P< 0.001). Fat-free mass index (FFM/height 2) and fatmass index (FM/height2), determined by bioimpedance, were also correlated with IGF-I (respectively, r = 0.27, P < 0.01 and r = 0.30, P < 0.01). In contrast, IGF-I was not correlated with albumin or transthyretin, nor with muscle strength assessed by dynamometry. Albumin was not correlated to any of those nutritional indices. Our results show that plasma IGF-I concentrations in hospitalized patients reflect the nutritional
P.80 Energy and protein metabolism during recovery from malnutrition due to non-neoplastic gastrointestinal disease in humans Franck Carbonnel1, Bernard Messing 1, Agnes Rimbert 1, Monique Rongier~, Joseph Koziet 2 and Dominique Darmaun 11nstitut National de la Sant# et de la Recherche M6dicale Unit# 290, HSpital St Lazare, 75010 Paris, 2Laboratoire de recherche PemodRicard, Cr6teil, France. The magnitude of metabolic adaptation to malnutrition is still debated and few studies have investigated the phase of recovery from malnutrition. Aim: To determine whether refeeding was associated with adaptive changes in (1) energy expenditure, (2) the maximal capacity for oxidizing fat and (3) whole-body protein turnover. Methods: Eleven malnourished patients with non-neoplastic gastrointestinal diseases were studied, using indirect calorimetry and L-[113C]leucine infusion, while being infused with lipid-rich TPN. The same study was performed before initiation of total parenteral nutrition and after a mean gain of 6.5 kg in body weight. Results: Although, in absolute values resting energy expenditure (REE) increased after weight gain (4.05 _+0.85 vs 4.60 _+1.05 MJ/d; Mean +_SD; P = 0.005), REE per unit of fat-free-mass did not change significantly (120 -+ 17 vs 123 -+ 25 kJ/kg FFM/d; NS). Fat oxidation decreased after 44
body weight gain (0.82 _+0.34 vs 0.44 _+0.35 mg/kg/min; P < 0.01); the change in fat oxidation was negatively correlated to the rate of gain in fat mass (Spearman correlation coefficient = 0.49, P = 0.06). Protein turnover did not change significantly during body weight gain. However, the change in protein turnover was found to correlate with change in fatfree mass (r= 0.624; P-- 0.05). Conclusions: Our data suggest that, in the category of patients studied and during recovery from malnutrition, adaptive mechanisms: (1) prevent any increase in REE/FFM and (2) favour fat mass replenishment. Consequently, the lipid intake should be reduced in the course of parenteral refeeding.
weight/day (kcal/kg IBW/d) in group 1 and 26.1 _+ 1.0kcal/kg IBW/d in group 2 (NS). Oral intakes were higher in group 1 than in group 2 (23.1 _+ 1.6 vs 18.8 _+ 1.2 kcal/kg IBW/d: P < 0.05) and total energy intakes were 2.86 and 2.62 x REE in groups 1 and 2, respectively (NS). GND improved significantly more in group 1 (22.8 4-_2.1% to 13.3 :-~ 1.4%) than in group 2 (22.6 _+ 1.7% to 17.2 _+ 1.5%) (P < 0.01). Evolution of body composition parameters (Mean + SEM) between DO and D21 is represented in the Table.
P.81 Body composition assessment by dual-energy Xray absorptiometry compared to deuterium dilution in patients with stable COPD
Conclusion: Fat free mass and body cell mass are better improved by three weeks CyEN in younger than in older patients, suggesting age-specific metabolic changes. Future studies should be conducted to test specific diet or anabolic drugs in the elderly.
Net gain Body Fat free (kg) weight mass BCM Fat mass ECV ICV TV <65years 4 . 4 + _ 0 . 4 3.6_+0.5 2.6_+0.4 0.8_+0.3 1.0_+0.4 0.9_+0,3 1.9_+0.6 >_65years 2 . 8 _ + 0 . 4 2.4_+0.5 1.7_+0,2 0,4-+0.2 0.7-+0.4 0.8_+0.4 1.5-+0,7 Pvalue <0.01 0.04 0.01 0,15 0.31 0.40 0.34 BCM: body cell mass; ECV: extra cellular volume; ICV: intra cellular volume; TV: total volume.
M. P K. J. Engelen, A. M. W. J. Schols, G. A. K. Heidendal 1 and E. F.
Reference:
M. Wouters Depts of Pulmonology and 1Nuclear Medicine, University Hospital Maastricht and Astmacenter Homerheide, Hem, The Netherlands.
[1] JAMA 1995; 273: 638-643.
Introduction: Depletion of fat-free mass (FFM), which commonly
P,83 Total daily energy expenditure in clinically stable COPD patients with a normal or increased resting energy expenditure
occurs in patients with chronic obstructive pulmonary disease (COPD), is known to negatively influence physical capacity. Recently dualenergy X-ray absorptiometry (DEXA), a new method to differentiate body composition into 3 compartments (lean-mass, fat-mass (FM) and bone mass) was introduced. In this study validation of DEXA was performed in stable COPD patients, using deuterium dilution (DEU) as the reference method. Methods: In 70 COPD patients with severe airflow obstruction (m/f: 57/13) (age: 65 _+8 years; FEVI: 39 + 14% pred.) FFM and FM were assessed by DEXA and compared to DEU; total body water was used to estimate DEU based FFM (FFMDEu) assuming a hydration factor of 0.73. Results: A highy significant correlation coefficient was found between FFMDExA and FFMDEu (r:. 0.96; SEE: 2.2kg, P < 0.001) and between FMDExA and FMDEU (P. 0.95; SEE: 2.4 kg, P < 0.001). DEXA on average revealed an overestimation of FFM by 1.4 _+2.3 kg (P < 0.001 ) and an underestimation of FM by -0.7 _+2.7 kg (P < 0.05). The difference in FFM between the methods (FFMDExA_DEU)and FFM-index (FFMDEu/height 2) was significantly correlated (r. -0.43; SEE: 1.9 kg; P < 0.001). After stratification by FFMI into a depleted (FFMI < 15 (female)/16 (male) kg/m 2, n = 25) and a non-depleted group (FFMI > 15/16kg/m 2, n = 45), DEXA significantly overestimated FFM in the depleted group (2.6 _+ 1.6 vs 0.7 + 2.4kg; P < 0.001); significance remained even after adjustment for gender. On the contrary no significant difference in FM was found between the depleted and nondepleted group when comparing DEXA and DEU (-1.0 +_2.0 vs -0.5 _+ 3.0 kg). Conclusions: Compared to deuterium dilution DEXA overestimates FFM in depleted COPD patients.
E. M. Baarends 1, A. M. W. J. Schols 1'3, K. R. Westerterp 2 and E. E
M. Wouters 1 I Dept of Pulmonology and 2Dept of Human Biology, University of Maastricht, 3Astma Centre Homerheide, Horn, The Netherlands.
Introduction: An elevated resting energy expenditure (REE) commonly occurs in patients with COPD. Earlier we demonstrated an increased total daily energy expenditure (TDE) in COPD patients compared to healthy elderly subjects, independently of REE [1]. The purpose of this study was to investigate the effect of an elevated REE on Tr)E in 20 COPD patients (19 male, 1 female, FEV~: 37 _+14% pred). Methods: TDE was measured over a 2-week interval using doubly labelled water. Fat free mass (FFM) was calculated from deuterium dilution (total body water/0.73). REE was measured using a ventilated hood system. Patients were defined to have either an increased REE (HYPER) or normal REE (NORM) based on REE adjusted for FFM. Differences between groups were tested with the Mann-Whitney U-test (level of sign, P< 0.05). Results are presented as median (range). Results: Although HYPER patients (n = 12 male)had a significantly higher REE (125 (26) %pred) than NORMO patients (110 (17) %lpred, P< 0.001), TDE was not significantly different (TDEH,,,pER: 2641 (1052) kcal/day, TDENoRMO: 2557 (741) kcal/day, P = 0.443). T'herefore, TDE/REE was significantly lower in the HYPER (1.59 (0.57)) than in the NORMO (1.78 (0.50), P< 0.05). TDE was significantly correlated to REE (NORMO: P = 0.55, P< 0.05; HYPER: P = 0.40, P< 0.05) and all except for two HYPER patients were situated beneath the NORMO regression line. TDE/REE was not related to body composition, airflow obstruction or diffusion capacity, but was significantly correlated to percentage predicted total lung capacity (P = 0.65, P < 0.05) in the NORMO. Conclusions:TDE in COPD patients with an elevated REE is not significantly higher than COPD patients with a normal REE.
P,82 Effect of 21 days cyclic enteral nutrition on the body composition of undernourished patients: comparison of young and elderly X. Hdbuterne,
Reference: [1] Baarends et al. Am J Resp Crit Care Med 1995; 151 (4): a206,
J. L. Peroux, S. Schneider, M. Dubian and
P. Rampal Unite d'Assistance Nutritive, HOpital de I'Archet, 06202 Nice, Cedex 03, France.
P,84 Sustained reduction of metabolic rate after surgically induced weight loss Wim G. van Gemert, Klaas R. Westerterp*, Jan Willem M. Greve
Cyclic enteral nutrition (CyEN) is a well-tolerated and effective treatment of undernutrition in elderly patients but it seems less effective in elderly than in younger patients [1]. The aim of the present study was to compare the effects of a 21-day refeeding period with CyEN on the body composition of elderly and younger ambulatory undernourished patients. Methods: Twenty patients (10F/10M), mean age +_ SEM: 50.3 _+ 2.7 years (22-64 years) and 24 patients (12 F/12 M), 74.8 +_1.5 years (65-92 years), received a polymeric enteral diet via a nasogastric tube during the night; in the daytime patients were allowed to eat. Primary diagnoses associated with undernutrition were similar in the two groups, Resting energy expenditure (REE) was measured at day 0 (DO) by indirect calorimetry. At DO and D21 : (1) 10 biological and anthropometric parameters and global nutritional deficiency (GND); (2) body composition using bipolar bioe]ectric impedance analysis were measured. Results: Enteral energy intakes were 27.4 _+ 1.2 kcal/kg ideal body
and Peter B.Soeters Department of Surgery and *Human Biology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Morbidly obese patients have a reduced sleeping metabolic rate (SMR) after surgically-induced weight loss. This study was performed to test the hypothesis that the reduction of SMR is sustained as long as weight loss is maintained. SMR was measured in a respiration chamber (SMRm) and predicted with a regression equation (SMRp = 0.85 + 0.102 FFM + 0.024 FM). Body composition was measured by means of a deuterated water dilution. Group I consisted of 6 patients measured before and 6, 12, 27 and 54 weeks after surgery and compared with group II consisting of 10 patients more than 36 months after surgery (mean 98 _+30) with more :han 30% 45
P.77 Validation of multiple-frequency bio-electrical impedance in patients with inflammatory bowel disease (IBD) to estimate total body water and extra-cellular water B. Geerling 1, W. v. Marken Lichtenbelt 2, R. StockbrEtgger ~ and R.-J.
P.79 Relationship between resting energy expenditure, plasma and urine cytokine levels in melanoma patients treated by interleukin-2 and interferon-~
Brummer1 Dept of Gastroenterology University Hospital of Maastricht, 2Dept of Human Biology, University of Limburg, The Netherlands.
P. ~'ivn~], E. Bure~ov~ ~, J. Buret,
L. PIf~kova, V. Pali~ka, O. Kopeck~1, R. Machata2 and P. Til#er 2 Institute of Clinical Biochemistry and Diagnostics, 1Institute of Clinical Immunology, 2Dept of Cardiopulm. and Vascular Diagnostics, University Hospital, Charles' University, Hradec Kr~lov6, Czech Republic.
Introduction: The most appropriate methods for measuring body water compartments are dilution techniques. However, these techniques are invasive, time-consuming and expensive. Multiple-frequency bio-electrical impedance (MF-BIA) is a rapid, safe, inexpensive, non-invasive and reproducible method in healthy volunteers. The aim of this study was to assess the validity of MF-BIA in a group of patients with IBD (Crohn's disease (CD) and ulcerative colitis (UC)). Methods: Total body water (TBW) and extra-cellular water (ECW) were assessed using deuterium (920) and bromide (Br) dilution techniques respectively, and MF-BIA, in 25 patients (11 M, 14F) with IBD: 14 patients with IBD (6 CD, 8 UC) at time of diagnosis (IBD-diagn.) and 11 patients with CD for more than 10 years with one or more small bowel resections (CD-Iong). MFBIA estimates ECW and TBW by extrapolation from the range of impedance measurements at different frequencies. Volume estimations were calculated directly. Non-parametric tests were used for statistical analysis (SPSS-X). Results: Comparison of the mean differences of TBW and ECW, measured by dilution and MF-BIA, between IBD-diagn. and CD-Iong, showed no significant differences. There was a highly significant correlation between TBW measured by D20 dilution and MF-BIA (r = 0.96, SEE = 1.96, P < 0.001). The Bland-Airman plot of the differences of TBW measured by D20 dilution, minus TBW measured by MF-BIA, against their mean, showed a mean difference of +1.6 litre (4% of mean TBW), with limits of agreement of -2.3 and 5.6 litre. We observed a highly significant correlation between ECW measured by Br dilution and MF-BIA (r = 0.92, SEE = 0.97, P < 0.001). The mean difference in ECW, measured by Br dilution, minus ECW measured by MF-BIA, in the Bland-Altman plot, was +0.5 litre (3% of mean ECW) with limits of agreement of -1.5 and 2.4 litre. Conclusion: We conclude that MF-BIA seems to be a useful non-invasive method to estimate TBW and ECW in patients with IBD.
Aim: To evaluate the effect of a low dose interleukin-2 (IL-2) and interferon-c~ (IFN-c0 administration on plasma and urine levels of related cytokines and resting energy expenditure (REE) in malignant melanoma patients. Patients and methods: The study included 10 melanoma patients (6 men, 4 women, 25-73 years old, mean 55.1, Kamofsky index 70-80%) treated by cytokine administration: IL-2 (3 million units/m 2 of body surface area s.c.) and IFN-o~ (3 million units/m 2 s.c.). Blood samples for cytokine analyses were obtained and REE was measured by means of indirect calorimetry (MedGraphics, using canopy) before and 90, 180, 360 min, 24 and 48 h respectively after the cytokine administration. Urine samples were collected during these intervals (i.e. during 90, 90, 180min, 18, 24 and 24h). Plasma and urine cytokine levels were measured using enzyme-linked immunosorbent assays (Quantikine, RD systems, USA). Statistical analysis (paired t-test, Mann-Whitney Rank Sum Test, Pearson Correlation) was done using Jandel Scientific. Results: Selected results (before therapy and 360 min after cytokine administration) are presented as mean and standard error of the mean. Cytokine levels are given in pg/ml. We observed no significant changes in plasma TNF-c~ levels (10.1 _+2,2 before therapy, 8.6 + 2.9 360 min after cytokine administration). Tumour necrosis factor (TNF)-c( level in urine was 9.3 + 3.1 before and 1.8 -+ 1.8 after administration. IL-6 plasma level was 6.0 + 2.2 before therapy, 49.3 + 18.9 (P= 0.044) 360rain after administration and IL-6 urine level was 45.9 + 39.1 before and 4.8 + 1,8 after administration. IL-2 plasma level before therapy was 0.0 + 0.0 and 131.8 _+19.4 (P = 0.0001) after administration. IL-2 in urine was not detected. REE (in per cent of predicted value according to Harris,and Benedict) was 105,4 + 3.63 before therapy and 139.8 _+5.97 after administration (P = 0.0001). Conclusions: The increase in IL-6 and IL-2 plasma levels is associated with a marked increase of resting energy expenditure (REE) in melanoma patients treated with IFN-o~and IL-2. No significant changes of plasma and urine TNF-(z were observed.
1°.78 Plasma insulin-like growth factor-I concentrations reflect the nutritional status in hospitalized patients J. P. Thissen, S. Marandi, N. Guyen, M. Lievens and J. M.
Ketelslegers Diabetes and Nutrition, Biochemistry Units, University of Louvain, Brussels, Belgium. Insulin-like growth factor-I (IGF-I) is a short half-life circulating peptide whose production by the liver is dependent on growth hormone. It is also regulated by dietary intake. Although studies showed reduced plasma IGF-I concentrations in dietary restricted subjects, the ability of plasma IGF-I to reflect the nutritional status in patients is still debated. To investigate the role of IGF-I as a marker of nutritional status, we compared the plasma IGF-I to the nutritional status assessed by 'subjective global assessment', anthropometry, bioimpedance, albumin and transthyretin determination in 100 hospitalized patients. Only patients at risk of malnutrition on the basis of their primary diagnosis (head and neck cancers 65, HIV seropositivity 16, anorexia nervosa 15, varia 4) were enrolled. IGF-I was measured by radioimmunoassay after plasma extraction. Results were expressed in percentage of the median of control subjects after age and sex stratification. Plasma IGF-I was positively correlated with body mass index (r= 0.44; P< 0.001) and negatively with body weight loss (r= -0.34; P < 0.001). Malnourished patients ranked 'B' and 'C' according to 'subjective global assessment' had significantly lower IGF-I values than well-nourished patients ranked 'A' (A: 68 -+4% vs B: 48 _+7% and C: 44 _ 6%, P< 0.002). IGF-I was also correlated with triceps skinfold (r= 0.33; P < 0.001), mid-arm circumference (r= 0.38; P < 0.001) and mid-arm muscle area (r= 0.38; P< 0.001). Fat-free mass index (FFM/height 2) and fatmass index (FM/height2), determined by bioimpedance, were also correlated with IGF-I (respectively, r = 0.27, P < 0.01 and r = 0.30, P < 0.01). In contrast, IGF-I was not correlated with albumin or transthyretin, nor with muscle strength assessed by dynamometry. Albumin was not correlated to any of those nutritional indices. Our results show that plasma IGF-I concentrations in hospitalized patients reflect the nutritional
P.80 Energy and protein metabolism during recovery from malnutrition due to non-neoplastic gastrointestinal disease in humans Franck Carbonnel1, Bernard Messing 1, Agnes Rimbert 1, Monique Rongier~, Joseph Koziet 2 and Dominique Darmaun 11nstitut National de la Sant# et de la Recherche M6dicale Unit# 290, HSpital St Lazare, 75010 Paris, 2Laboratoire de recherche PemodRicard, Cr6teil, France. The magnitude of metabolic adaptation to malnutrition is still debated and few studies have investigated the phase of recovery from malnutrition. Aim: To determine whether refeeding was associated with adaptive changes in (1) energy expenditure, (2) the maximal capacity for oxidizing fat and (3) whole-body protein turnover. Methods: Eleven malnourished patients with non-neoplastic gastrointestinal diseases were studied, using indirect calorimetry and L-[113C]leucine infusion, while being infused with lipid-rich TPN. The same study was performed before initiation of total parenteral nutrition and after a mean gain of 6.5 kg in body weight. Results: Although, in absolute values resting energy expenditure (REE) increased after weight gain (4.05 _+0.85 vs 4.60 _+1.05 MJ/d; Mean +_SD; P = 0.005), REE per unit of fat-free-mass did not change significantly (120 -+ 17 vs 123 -+ 25 kJ/kg FFM/d; NS). Fat oxidation decreased after 44
body weight gain (0.82 _+0.34 vs 0.44 _+0.35 mg/kg/min; P < 0.01); the change in fat oxidation was negatively correlated to the rate of gain in fat mass (Spearman correlation coefficient = 0.49, P = 0.06). Protein turnover did not change significantly during body weight gain. However, the change in protein turnover was found to correlate with change in fatfree mass (r= 0.624; P-- 0.05). Conclusions: Our data suggest that, in the category of patients studied and during recovery from malnutrition, adaptive mechanisms: (1) prevent any increase in REE/FFM and (2) favour fat mass replenishment. Consequently, the lipid intake should be reduced in the course of parenteral refeeding.
weight/day (kcal/kg IBW/d) in group 1 and 26.1 _+ 1.0kcal/kg IBW/d in group 2 (NS). Oral intakes were higher in group 1 than in group 2 (23.1 _+ 1.6 vs 18.8 _+ 1.2 kcal/kg IBW/d: P < 0.05) and total energy intakes were 2.86 and 2.62 x REE in groups 1 and 2, respectively (NS). GND improved significantly more in group 1 (22.8 4-_2.1% to 13.3 :-~ 1.4%) than in group 2 (22.6 _+ 1.7% to 17.2 _+ 1.5%) (P < 0.01). Evolution of body composition parameters (Mean + SEM) between DO and D21 is represented in the Table.
P.81 Body composition assessment by dual-energy Xray absorptiometry compared to deuterium dilution in patients with stable COPD
Conclusion: Fat free mass and body cell mass are better improved by three weeks CyEN in younger than in older patients, suggesting age-specific metabolic changes. Future studies should be conducted to test specific diet or anabolic drugs in the elderly.
Net gain Body Fat free (kg) weight mass BCM Fat mass ECV ICV TV <65years 4 . 4 + _ 0 . 4 3.6_+0.5 2.6_+0.4 0.8_+0.3 1.0_+0.4 0.9_+0,3 1.9_+0.6 >_65years 2 . 8 _ + 0 . 4 2.4_+0.5 1.7_+0,2 0,4-+0.2 0.7-+0.4 0.8_+0.4 1.5-+0,7 Pvalue <0.01 0.04 0.01 0,15 0.31 0.40 0.34 BCM: body cell mass; ECV: extra cellular volume; ICV: intra cellular volume; TV: total volume.
M. P K. J. Engelen, A. M. W. J. Schols, G. A. K. Heidendal 1 and E. F.
Reference:
M. Wouters Depts of Pulmonology and 1Nuclear Medicine, University Hospital Maastricht and Astmacenter Homerheide, Hem, The Netherlands.
[1] JAMA 1995; 273: 638-643.
Introduction: Depletion of fat-free mass (FFM), which commonly
P,83 Total daily energy expenditure in clinically stable COPD patients with a normal or increased resting energy expenditure
occurs in patients with chronic obstructive pulmonary disease (COPD), is known to negatively influence physical capacity. Recently dualenergy X-ray absorptiometry (DEXA), a new method to differentiate body composition into 3 compartments (lean-mass, fat-mass (FM) and bone mass) was introduced. In this study validation of DEXA was performed in stable COPD patients, using deuterium dilution (DEU) as the reference method. Methods: In 70 COPD patients with severe airflow obstruction (m/f: 57/13) (age: 65 _+8 years; FEVI: 39 + 14% pred.) FFM and FM were assessed by DEXA and compared to DEU; total body water was used to estimate DEU based FFM (FFMDEu) assuming a hydration factor of 0.73. Results: A highy significant correlation coefficient was found between FFMDExA and FFMDEu (r:. 0.96; SEE: 2.2kg, P < 0.001) and between FMDExA and FMDEU (P. 0.95; SEE: 2.4 kg, P < 0.001). DEXA on average revealed an overestimation of FFM by 1.4 _+2.3 kg (P < 0.001 ) and an underestimation of FM by -0.7 _+2.7 kg (P < 0.05). The difference in FFM between the methods (FFMDExA_DEU)and FFM-index (FFMDEu/height 2) was significantly correlated (r. -0.43; SEE: 1.9 kg; P < 0.001). After stratification by FFMI into a depleted (FFMI < 15 (female)/16 (male) kg/m 2, n = 25) and a non-depleted group (FFMI > 15/16kg/m 2, n = 45), DEXA significantly overestimated FFM in the depleted group (2.6 _+ 1.6 vs 0.7 + 2.4kg; P < 0.001); significance remained even after adjustment for gender. On the contrary no significant difference in FM was found between the depleted and nondepleted group when comparing DEXA and DEU (-1.0 +_2.0 vs -0.5 _+ 3.0 kg). Conclusions: Compared to deuterium dilution DEXA overestimates FFM in depleted COPD patients.
E. M. Baarends 1, A. M. W. J. Schols 1'3, K. R. Westerterp 2 and E. E
M. Wouters 1 I Dept of Pulmonology and 2Dept of Human Biology, University of Maastricht, 3Astma Centre Homerheide, Horn, The Netherlands.
Introduction: An elevated resting energy expenditure (REE) commonly occurs in patients with COPD. Earlier we demonstrated an increased total daily energy expenditure (TDE) in COPD patients compared to healthy elderly subjects, independently of REE [1]. The purpose of this study was to investigate the effect of an elevated REE on Tr)E in 20 COPD patients (19 male, 1 female, FEV~: 37 _+14% pred). Methods: TDE was measured over a 2-week interval using doubly labelled water. Fat free mass (FFM) was calculated from deuterium dilution (total body water/0.73). REE was measured using a ventilated hood system. Patients were defined to have either an increased REE (HYPER) or normal REE (NORM) based on REE adjusted for FFM. Differences between groups were tested with the Mann-Whitney U-test (level of sign, P< 0.05). Results are presented as median (range). Results: Although HYPER patients (n = 12 male)had a significantly higher REE (125 (26) %pred) than NORMO patients (110 (17) %lpred, P< 0.001), TDE was not significantly different (TDEH,,,pER: 2641 (1052) kcal/day, TDENoRMO: 2557 (741) kcal/day, P = 0.443). T'herefore, TDE/REE was significantly lower in the HYPER (1.59 (0.57)) than in the NORMO (1.78 (0.50), P< 0.05). TDE was significantly correlated to REE (NORMO: P = 0.55, P< 0.05; HYPER: P = 0.40, P< 0.05) and all except for two HYPER patients were situated beneath the NORMO regression line. TDE/REE was not related to body composition, airflow obstruction or diffusion capacity, but was significantly correlated to percentage predicted total lung capacity (P = 0.65, P < 0.05) in the NORMO. Conclusions:TDE in COPD patients with an elevated REE is not significantly higher than COPD patients with a normal REE.
P,82 Effect of 21 days cyclic enteral nutrition on the body composition of undernourished patients: comparison of young and elderly X. Hdbuterne,
Reference: [1] Baarends et al. Am J Resp Crit Care Med 1995; 151 (4): a206,
J. L. Peroux, S. Schneider, M. Dubian and
P. Rampal Unite d'Assistance Nutritive, HOpital de I'Archet, 06202 Nice, Cedex 03, France.
P,84 Sustained reduction of metabolic rate after surgically induced weight loss Wim G. van Gemert, Klaas R. Westerterp*, Jan Willem M. Greve
Cyclic enteral nutrition (CyEN) is a well-tolerated and effective treatment of undernutrition in elderly patients but it seems less effective in elderly than in younger patients [1]. The aim of the present study was to compare the effects of a 21-day refeeding period with CyEN on the body composition of elderly and younger ambulatory undernourished patients. Methods: Twenty patients (10F/10M), mean age +_ SEM: 50.3 _+ 2.7 years (22-64 years) and 24 patients (12 F/12 M), 74.8 +_1.5 years (65-92 years), received a polymeric enteral diet via a nasogastric tube during the night; in the daytime patients were allowed to eat. Primary diagnoses associated with undernutrition were similar in the two groups, Resting energy expenditure (REE) was measured at day 0 (DO) by indirect calorimetry. At DO and D21 : (1) 10 biological and anthropometric parameters and global nutritional deficiency (GND); (2) body composition using bipolar bioe]ectric impedance analysis were measured. Results: Enteral energy intakes were 27.4 _+ 1.2 kcal/kg ideal body
and Peter B.Soeters Department of Surgery and *Human Biology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Morbidly obese patients have a reduced sleeping metabolic rate (SMR) after surgically-induced weight loss. This study was performed to test the hypothesis that the reduction of SMR is sustained as long as weight loss is maintained. SMR was measured in a respiration chamber (SMRm) and predicted with a regression equation (SMRp = 0.85 + 0.102 FFM + 0.024 FM). Body composition was measured by means of a deuterated water dilution. Group I consisted of 6 patients measured before and 6, 12, 27 and 54 weeks after surgery and compared with group II consisting of 10 patients more than 36 months after surgery (mean 98 _+30) with more :han 30% 45