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PP081 NUTRITIONAL PARAMETERS ARE OF MAJOR PROGNOSTIC SIGNIFICANCE IN AMYOTROPHIC LATERAL SCLEROSIS (ALS) PATIENTS
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Poster presentations
and true effectiveness in clinical practice should be reassessed, given the changes in levodopa formulations and the introduction of several adjuvants (levodopa degradation inhibitors and/or dopamine agonists).
PP081 NUTRITIONAL PARAMETERS ARE OF MAJOR PROGNOSTIC SIGNIFICANCE IN AMYOTROPHIC LATERAL SCLEROSIS (ALS) PATIENTS
Disclosure of Interest: None declared
J.C. Desport1,2 , B. Marin1,3 , P. Kajeu1 , P. Jesus2 , P.M. Preux1,3 , P. Couratier1,4 . 1 EA3174, Faculty of Medicine, 2 Nutrition Unit, 3 Biostatistics Unit, 4 Neurology, University Hospital, Limoges, France
PP080 PREDICTING FATIGUE IN DUTCH PATIENTS ON HOME PARENTERAL NUTRITION: A LONGITUDINAL STUDY G. Huisman-De Waal1 . 1 IQ healthcare / Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands Rationale: Home Parenteral Nutrition (HPN) is a lifesaving therapy and has a large impact on daily life. Many patients suffer from fatigue and depression, and experience significant limitations in social activities. Altogether these aspects significantly contribute to a lower Quality of Life (QoL). Methods: Fatigue is the most frequently mentioned problem in Dutch HPN patients. To assess the prevalence, course, and predictors of fatigue in this group, we conducted a longitudinal study. Patients were asked to complete questionnaires at baseline and follow up (12 months later) concerning several aspects (fatigue, depression, functional impairment, social support, self-efficacy, coping, anxiety and acceptance). Relevant laboratory measures, were obtained from the medical records. Descriptive statistics, correlations, and linear regression analysis were performed for data analysis. Results: The response rate was 71% (75 out of 106 patients). Sixty-five percent of the patients were severely fatigued (n = 49). Eighty-nine percent experienced persistent fatigue. Baseline fatigue predicted 57% of the variance of fatigue at follow-up (table 1). No significant correlations between fatigue and laboratory measures were found. A cross-sectional analysis showed that 46% of the variance of fatigue was explained by functional impairment, self-efficacy, and depression. Table 1
Longitudinal model Constant Fatigue baseline Avoidance Cross-sectional model Constant Functional impairment BDI Selfefficacy
B
SE B
B
P-value
1.777 0.714 0.597
5.231 0.082 0.298
0.720 0.165
0.735 0.000 0.049
49.472 0.465 1.102 1.100
7.742 0.136 0.535 0.385
0.366 0.230 0.279
0.000 0.001 0.043 0.006
Conclusion: Severe fatigue is a persistent problem for HPN patients. Baseline fatigue was the strongest predictor of fatigue at follow up. Functional impairment, self-efficacy, and depression are strongly related to fatigue. Early recognition and treatment of fatigue are important. Disclosure of Interest: None declared
Rationale: ALS is a severe chronic neurological disease with a short survival (2 5 y). Malnutrition, induced by swallowing disorders or hypermetabolism, is an independent prognostic factor for survival when assessed during the follow-up. In the same way, a low BMI at time of gastrostomy or at time of non invasive ventilation decision is a deleterious factor for survival. Aims of the study were to analyze the modifications of nutritional parameters from diagnosis to death and to assess their relationships with survival at time of diagnosis and during the whole follow-up. Methods: After obtaining agreement of ethical committee and patients consent, 92 ALS patients were assessed every three months (neurological ALS indexes, forced vital capacity, weight, BMI, % weight loss). Validated bioimpedance formulas gave fat-free mass (FFM), fat mass (FM), and hydration and phase angle were measured. Survival analyses were performed from diagnosis to death or censoring date using Cox model. Results: During the follow-up, weight, BMI, FFM and phase angle decreased, and FM and extracellular/intracellular water volume ratio increased. There was an adjusted 30% increased risk of death for a 5% decrease of usual weight at time of diagnosis (RR 1.30 IC95% 1.08 1.56) and, during the follow up, an adjusted increase of 34% and 24% for risks of death associated with each 5% decrease of usual weight and each unit decrease of usual BMI respectively (p < 0.0001). Malnutrition was associated with a shorter survival (p = 0.02), and a 5 kg FM increase with a better outcome (RR 0.80). Conclusion: Weight loss, a routine easily obtained variable, is of major interest as soon as at diagnosis time, but also during the follow-up of ALS patients. Weight loss, BMI decrease and malnutrition during the followup increase the risk of death. An increase in FM, possibly obtained by nutritional management is requested in this disease. Disclosure of Interest: None declared
PP082 PULVERIZED LANTHANUM CARBONATE HYDRATE ADMINISTRATION IN TUBE FEEDING AND ORAL FEEDING HEMODIALYSIS PATIENTS T. Takahashi1 , H. Ogawa1 , J. Yamada1 , Y. Moriyama2 , Y. Sato3 . 1 Blood Purification Center, Sato Junkanki Hospital, Matsuyama, 2 Nutrition and Health Promotion, Hiroshima Jogakuin University, Hiroshima, 3 Internal Medicine, Sato Junkanki Hospital, Matsuyama, Japan Rationale: Lanthanum carbonate hydrate, a drug for the treatment of hyperphosphatemia, is normally chewed before swallowing. In this study, pulverized lanthanum carbonate hydrate was administered to tube feeding
Poster presentations
and true effectiveness in clinical practice should be reassessed, given the changes in levodopa formulations and the introduction of several adjuvants (levodopa degradation inhibitors and/or dopamine agonists).
PP081 NUTRITIONAL PARAMETERS ARE OF MAJOR PROGNOSTIC SIGNIFICANCE IN AMYOTROPHIC LATERAL SCLEROSIS (ALS) PATIENTS
Disclosure of Interest: None declared
J.C. Desport1,2 , B. Marin1,3 , P. Kajeu1 , P. Jesus2 , P.M. Preux1,3 , P. Couratier1,4 . 1 EA3174, Faculty of Medicine, 2 Nutrition Unit, 3 Biostatistics Unit, 4 Neurology, University Hospital, Limoges, France
PP080 PREDICTING FATIGUE IN DUTCH PATIENTS ON HOME PARENTERAL NUTRITION: A LONGITUDINAL STUDY G. Huisman-De Waal1 . 1 IQ healthcare / Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands Rationale: Home Parenteral Nutrition (HPN) is a lifesaving therapy and has a large impact on daily life. Many patients suffer from fatigue and depression, and experience significant limitations in social activities. Altogether these aspects significantly contribute to a lower Quality of Life (QoL). Methods: Fatigue is the most frequently mentioned problem in Dutch HPN patients. To assess the prevalence, course, and predictors of fatigue in this group, we conducted a longitudinal study. Patients were asked to complete questionnaires at baseline and follow up (12 months later) concerning several aspects (fatigue, depression, functional impairment, social support, self-efficacy, coping, anxiety and acceptance). Relevant laboratory measures, were obtained from the medical records. Descriptive statistics, correlations, and linear regression analysis were performed for data analysis. Results: The response rate was 71% (75 out of 106 patients). Sixty-five percent of the patients were severely fatigued (n = 49). Eighty-nine percent experienced persistent fatigue. Baseline fatigue predicted 57% of the variance of fatigue at follow-up (table 1). No significant correlations between fatigue and laboratory measures were found. A cross-sectional analysis showed that 46% of the variance of fatigue was explained by functional impairment, self-efficacy, and depression. Table 1
Longitudinal model Constant Fatigue baseline Avoidance Cross-sectional model Constant Functional impairment BDI Selfefficacy
B
SE B
B
P-value
1.777 0.714 0.597
5.231 0.082 0.298
0.720 0.165
0.735 0.000 0.049
49.472 0.465 1.102 1.100
7.742 0.136 0.535 0.385
0.366 0.230 0.279
0.000 0.001 0.043 0.006
Conclusion: Severe fatigue is a persistent problem for HPN patients. Baseline fatigue was the strongest predictor of fatigue at follow up. Functional impairment, self-efficacy, and depression are strongly related to fatigue. Early recognition and treatment of fatigue are important. Disclosure of Interest: None declared
Rationale: ALS is a severe chronic neurological disease with a short survival (2 5 y). Malnutrition, induced by swallowing disorders or hypermetabolism, is an independent prognostic factor for survival when assessed during the follow-up. In the same way, a low BMI at time of gastrostomy or at time of non invasive ventilation decision is a deleterious factor for survival. Aims of the study were to analyze the modifications of nutritional parameters from diagnosis to death and to assess their relationships with survival at time of diagnosis and during the whole follow-up. Methods: After obtaining agreement of ethical committee and patients consent, 92 ALS patients were assessed every three months (neurological ALS indexes, forced vital capacity, weight, BMI, % weight loss). Validated bioimpedance formulas gave fat-free mass (FFM), fat mass (FM), and hydration and phase angle were measured. Survival analyses were performed from diagnosis to death or censoring date using Cox model. Results: During the follow-up, weight, BMI, FFM and phase angle decreased, and FM and extracellular/intracellular water volume ratio increased. There was an adjusted 30% increased risk of death for a 5% decrease of usual weight at time of diagnosis (RR 1.30 IC95% 1.08 1.56) and, during the follow up, an adjusted increase of 34% and 24% for risks of death associated with each 5% decrease of usual weight and each unit decrease of usual BMI respectively (p < 0.0001). Malnutrition was associated with a shorter survival (p = 0.02), and a 5 kg FM increase with a better outcome (RR 0.80). Conclusion: Weight loss, a routine easily obtained variable, is of major interest as soon as at diagnosis time, but also during the follow-up of ALS patients. Weight loss, BMI decrease and malnutrition during the followup increase the risk of death. An increase in FM, possibly obtained by nutritional management is requested in this disease. Disclosure of Interest: None declared
PP082 PULVERIZED LANTHANUM CARBONATE HYDRATE ADMINISTRATION IN TUBE FEEDING AND ORAL FEEDING HEMODIALYSIS PATIENTS T. Takahashi1 , H. Ogawa1 , J. Yamada1 , Y. Moriyama2 , Y. Sato3 . 1 Blood Purification Center, Sato Junkanki Hospital, Matsuyama, 2 Nutrition and Health Promotion, Hiroshima Jogakuin University, Hiroshima, 3 Internal Medicine, Sato Junkanki Hospital, Matsuyama, Japan Rationale: Lanthanum carbonate hydrate, a drug for the treatment of hyperphosphatemia, is normally chewed before swallowing. In this study, pulverized lanthanum carbonate hydrate was administered to tube feeding