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PP103-MON NUTRITIONAL SUPPORT AND FUNCTIONAL CAPACITY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A SYSTEMATIC REVIEW AND META-ANALYSIS
Nutrition and chronic diseases II BMI below 18.5 kg/m2 was confirmed in 25% (20/80) of patients, protein malnutrition (low albumin) in 50% (40/80) of patients, reduced values of vitamins B9 and B12 in 36% (29/80) of patients. Conclusion: In patients with advanced liver cirrhosis, different pathological mechanism, such as inadequate offer and impaired absorption of nutrients, hypermetabolic state and diminished synthetic capacity of the liver are the main reasons that lead to malnutrition. Identifying patients that are approaching the state of malnutrition is necessary in order to provide nutritional support to those that need it most. Disclosure of Interest: None Declared
PP101-MON PATIENTS WITH SHORT BOWEL SYNDROME TREATED WITH BOVINE COLOSTRUM TO IMPROVE INTESTINAL FUNCTION; A DOUBLE BLINDED, PLACEBO CONTROLLED, CROSS-OVER, PILOT STUDY P. Lund1 , P.T. Sangild2 , L. Aunsholt3 , B. Hartmann4 , J.J. Holst4 , J. Mortensen5 , P.B. Mortensen1 , P.B. Jeppesen1 . 1 Dept. of Gastroenterology, Rigshospitalet, 2 Dept. of Human Nutrition, Copenhagen University, Cph, 3 Dept. of Paediatrics, Odense University Hospital, Odense, 4 Dept. of Endocrinology Research, Copenhagen University, 5 Dept. of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Cph, Denmark Rationale: Additional therapeutic options for treatment of short bowel syndrome (SBS) are desired. Colostrum, raw milk, is rich in immunoregulatory, antimicrobial and trophic components that stimulates intestinal development and function in newborns. This study investigated, if bovine colostrum enhanced intestinal adaptation and function in adult SBS patients. Methods: 12 SBS patients, 5 female, 7 male, 56±11 years, with a remnant small bowel length of 177±97 cm, 5 with colon, received in random sequence; 4 weeks intake of 500 ml/d colostrum or an iso-protein-energy placebo (~2.5 MJ/d, 34% protein) added to their regular diet, separated by a 4-week wash-out period. At 4 hospital admissions 72-hours fluid, electrolyte and nutrient balance studies, testing of hand grip strength, lung function tests and measures of body composition were done. Results: Per protocol results were obtained in 8 patients. Both protein-energy supplements (colostrum, placebo) increased absolute protein (~0.9 MJ/d, p 0.0004) and energy (~1.5 MJ/d, p 0.011) absorption compared to baseline measurements (Student’s t-test). However, faecal wet weight excretion was increased (~250 g/d, p 0.034) during both treatments. Increased protein/energy intake and uptake led to improvement of handgrip strength (p 0.035) and for placebo an almost 1 kg increase in lean body mass (p = 0.049). Colostrum did not benefit overall intestinal protein or energy absorption compared to placebo. Conclusion: Benefit of oral protein-energy supplement was established, but it was at the expense of increased fecal wet weight excretion. Colostrum was not superior to placebo. Disclosure of Interest: None Declared
153 PP102-MON NUTRITIONAL SUPPORT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A SYSTEMATIC REVIEW AND META-ANALYSIS P.F. Collins1 , R.J. Stratton1 , M. Elia1 . 1 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: A Cochrane review concluded nutritional support in COPD had no effect on anthropometry and functional outcomes [1] but other reviews suggest this may not be so [2]. This review aimed to clarify the current evidence base. Methods: A systematic review identified 13 randomised controlled trials (n 419) of nutritional support (dietary advice, oral nutritional supplements (ONS), tube feeding) vs. control. Meta-analysis was performed of nutritional intake, weight, mid-arm muscle circumference (MAMC) and handgrip strength (HGS) (Comprehensive Meta-analysis v2). In contrast to previous Cochrane reviews, which examined only data at the end of intervention, this review examined the changes induced by the intervention. Results: Eleven of the 13 studies used ONS. Meta-analysis found nutritional support significantly increased energy intake (227 SE 53 kcal/d, p < 0.001, fixed effect model), body weight (1.95 SE 0.24 kg, p < 0.001 (undernourished) and 1.3 SE 0.34 kg, p < 0.001 (nourished)) and HGS (5.3 SE 2.7%, p < 0.05 random effects model). Where data on dispersion was not available, significant improvements were also found using mean values (one-sample t-test) for MAMC (3%, range 0.7 7%, p = 0.034) and protein intakes (17 SD 6.7 g/d, p = 0.005). Conclusion: In contrast to the findings of a Cochrane review, this review concludes that nutritional support, mostly involving ONS, significantly improves nutritional intake, body weight, muscle mass and HGS in COPD. References [1] Ferreira I et al., (2005) Cochrane Database of Systematic Reviews 2005 Issue 2. [2] Stratton RJ et al., (2003) Disease-related malnutrition: an evidence-based approach to treatment, CABI: Oxford. Disclosure of Interest: P. Collins: None Declared, R. Stratton Other: Nutricia Ltd., M. Elia: None Declared
PP103-MON NUTRITIONAL SUPPORT AND FUNCTIONAL CAPACITY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A SYSTEMATIC REVIEW AND META-ANALYSIS P.F. Collins1 , R.J. Stratton1 , M. Elia1 . 1 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: Controversies exist about the value of using nutritional support to improve functional outcomes in COPD with a Cochrane review reporting no evidence of benefit [1]. This updated review aimed to re-examine the evidence base. Methods: A systematic review identified 13 randomised controlled trials (n 419) of nutritional support (dietary advice (n 1), oral nutritional supplements (n 11) or enteral tube feeding (n 1)) versus control in COPD. Respiratory muscle strength (PI max and PE max),
154
Poster presentations
handgrip strength (HGS), walking distance and quality of life (QoL) were investigated (Comprehensive Metaanalysis v2). In contrast to the Cochrane review which examined only between group differences, this review examined the changes induced by the intervention. Results: Compared to the control group, those receiving nutritional support showed a significantly greater increase in PE max (15.2 SE 4.88 cm H2 O, p = 0.002), a nonsignificant increase in PI max (0.36 SE 0.34 cm H2 O, p = 0.143) and a significant increase in HGS (0.9 SE 0.366 kg, p = 0.014 fixed effect model; 1.3 SE 0.69 kg, p = 0.05 random effects model). Walking distance was reported in five trials, four of which favoured the intervention group. Two of these were meta-analysable (p = 0.59) with only one favouring the intervention group. Two studies examined QoL (non meta-analysable) each reporting clinically and statistically significant improvements favouring nutritional support (p = 0.001 to p < 0.05). Conclusion: Unlike the Cochrane review, this systematic review found that nutritional support in COPD results in improved respiratory and peripheral muscle strength and quality of life.
18.8(3.7) kcal/kg/d while the total energy intake varied between 14 26 kcal/kg/d. Mean ESPEN calculated need was 25 kcal/kg/d, while REE calculated need was 24.5±2.2 kcal/kg/d and it varied from 20 29 kcal/kg/d. Average deficit of energy intake was 534kcal/d, which gives a deficit of 4275 kcal during the first week after LT. Conclusion: Only 8% of the patients met their energy requirements after LT showing that given nutrition do not follow recommendations or patients needs. Results of our study stress need for individualisation of nutrition routines, which can in a better way meet the patient individual need. This could probably achieved by introduction of modified nutrition guidelines combining early enteral and parenteral nutrition after liver transplantation.
References [1] Ferreira I et al., (2005) Cochrane Database of Systematic Reviews 2005 Issue 2.
Rationale: Bioimpedance is a quick, non-invasive method to assess body composition, to track changes in fat proportion during a weight-loss programme and to followup changes in body water proportion and shift between extra- and intracellular spaces. These parameters are of interest in a cardiac rehabilitation unit. Methods: Patients were selected based on their willingness to participate in a weight-loss programme during their rehabilitation. Quadscan4000 was used to measure body composition. We used a balanced, low-fat diet based on the measured Basal Metabolic Rate. Beside the routine physical training, patients were advised to walk an extra 5 km, monitored with a pedometer. Data were analysed with Student’s paired T-test. Results: Ten patients undertook the programme. Their mean age was 57±11 years. The mean BMI was proved to be 38.6 at the start. The average weight-loss was 4% (p = 0.01). The measured initial fat proportion was 46.8%, that declined significantly (p = 0.01) to 44.5%. The lean body mass did not changed significantly, even a slight increase could be detected (52.2 kg to 52.4 kg). The BMI decreased significantly (p = 0.01) to 37.3. The BFMI decreased from 18.3 to 16.5 (p = 0.007), meanwhile the FFMI was stable. Patients daily walked on average 4 km. They reached or exceeded the 5 km limit in 30% of the days (min: 1.14 km, max: 13.7 km). Conclusion: Patients who intended to loose weight could succeed with the help of professionals in a controlled environment. This initial change is crucial, because it demonstrates the result of efforts and it is a fix point that can be referred to in the later phase of weight-loss programmes. Bioimpedance analysis serves as control in adherence to the programme and raises the compliance of the patients.
Disclosure of Interest: P. Collins: None Declared, R. Stratton Other: Nutricia Ltd., M. Elia: None Declared
PP104-MON POST TRANSPLANT ENERGY DEFICIT IN PATIENTS UNDERGOING LIVER TRANSPLANTATION P. Nordstedt1 , K. Holmberg2 , J. Skiold3 , M. Annborn4 , M. Backlund5 , M. Holst6 , O. Irtun7 , A. Odlund-Olin8 . 1 Department of Transplantation Surgery, 2 Center for Allogen Stem Cell Transplantation, karolinska university hospital, Stockholm, 3 Skane Oncology Department, Skane, Skane University Hospital Malmoe, Malmoe, 4 Department of Anaesthesia and Intensive Care, Skane University Hospital Lund, Lund, Sweden; 5 Department of Intensive Care, Helsinki University Hospital, Helsinki, Finland; 6 Centre for Nutrition and Bowel Disease, Gastroenterology Dept, Aalborg University Hospital, Aalborg, Denmark; 7 Department of GI-Surgery, University hospital North-Norway, Tromso, Norway; 8 Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden Rationale: Malnutrition is a risk factor in patients undergoing liver transplantation (LT). ESPEN guidelines recommend 25 kcal/kg/day for this group of patients. The aim of the study was to evaluate if this general ESPEN recommendation is followed and to compare energy need recommended by ESPEN with individual calculations using Harris-Benedict’s formula (REE). Methods: A total of 24 (17 men) patients were included in the study. The patients total energy needs were calculated using ESPEN recommendation (25 kcal/kg/day) and the Harris-Benedict’s formula (REE). The daily amount of energy intake was registered during day 0 7 and the energy balance was calculated. Results: The energy intake was low compared to the energy requirements. The mean energy intake was
Disclosure of Interest: None Declared
PP106-MON BIOIMPEDANCE ANALYSIS IN A WEIGHT-LOSS PROGRAMME DURING CARDIAC REHABILITATION R. Kegyes Bozo1 , D. Jobst1 . 1 Cardiac rehabilitation, SZT Lukacs Hospital Dombovar, Dombovar, Hungary
Disclosure of Interest: None Declared
PP101-MON PATIENTS WITH SHORT BOWEL SYNDROME TREATED WITH BOVINE COLOSTRUM TO IMPROVE INTESTINAL FUNCTION; A DOUBLE BLINDED, PLACEBO CONTROLLED, CROSS-OVER, PILOT STUDY P. Lund1 , P.T. Sangild2 , L. Aunsholt3 , B. Hartmann4 , J.J. Holst4 , J. Mortensen5 , P.B. Mortensen1 , P.B. Jeppesen1 . 1 Dept. of Gastroenterology, Rigshospitalet, 2 Dept. of Human Nutrition, Copenhagen University, Cph, 3 Dept. of Paediatrics, Odense University Hospital, Odense, 4 Dept. of Endocrinology Research, Copenhagen University, 5 Dept. of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Cph, Denmark Rationale: Additional therapeutic options for treatment of short bowel syndrome (SBS) are desired. Colostrum, raw milk, is rich in immunoregulatory, antimicrobial and trophic components that stimulates intestinal development and function in newborns. This study investigated, if bovine colostrum enhanced intestinal adaptation and function in adult SBS patients. Methods: 12 SBS patients, 5 female, 7 male, 56±11 years, with a remnant small bowel length of 177±97 cm, 5 with colon, received in random sequence; 4 weeks intake of 500 ml/d colostrum or an iso-protein-energy placebo (~2.5 MJ/d, 34% protein) added to their regular diet, separated by a 4-week wash-out period. At 4 hospital admissions 72-hours fluid, electrolyte and nutrient balance studies, testing of hand grip strength, lung function tests and measures of body composition were done. Results: Per protocol results were obtained in 8 patients. Both protein-energy supplements (colostrum, placebo) increased absolute protein (~0.9 MJ/d, p 0.0004) and energy (~1.5 MJ/d, p 0.011) absorption compared to baseline measurements (Student’s t-test). However, faecal wet weight excretion was increased (~250 g/d, p 0.034) during both treatments. Increased protein/energy intake and uptake led to improvement of handgrip strength (p 0.035) and for placebo an almost 1 kg increase in lean body mass (p = 0.049). Colostrum did not benefit overall intestinal protein or energy absorption compared to placebo. Conclusion: Benefit of oral protein-energy supplement was established, but it was at the expense of increased fecal wet weight excretion. Colostrum was not superior to placebo. Disclosure of Interest: None Declared
153 PP102-MON NUTRITIONAL SUPPORT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A SYSTEMATIC REVIEW AND META-ANALYSIS P.F. Collins1 , R.J. Stratton1 , M. Elia1 . 1 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: A Cochrane review concluded nutritional support in COPD had no effect on anthropometry and functional outcomes [1] but other reviews suggest this may not be so [2]. This review aimed to clarify the current evidence base. Methods: A systematic review identified 13 randomised controlled trials (n 419) of nutritional support (dietary advice, oral nutritional supplements (ONS), tube feeding) vs. control. Meta-analysis was performed of nutritional intake, weight, mid-arm muscle circumference (MAMC) and handgrip strength (HGS) (Comprehensive Meta-analysis v2). In contrast to previous Cochrane reviews, which examined only data at the end of intervention, this review examined the changes induced by the intervention. Results: Eleven of the 13 studies used ONS. Meta-analysis found nutritional support significantly increased energy intake (227 SE 53 kcal/d, p < 0.001, fixed effect model), body weight (1.95 SE 0.24 kg, p < 0.001 (undernourished) and 1.3 SE 0.34 kg, p < 0.001 (nourished)) and HGS (5.3 SE 2.7%, p < 0.05 random effects model). Where data on dispersion was not available, significant improvements were also found using mean values (one-sample t-test) for MAMC (3%, range 0.7 7%, p = 0.034) and protein intakes (17 SD 6.7 g/d, p = 0.005). Conclusion: In contrast to the findings of a Cochrane review, this review concludes that nutritional support, mostly involving ONS, significantly improves nutritional intake, body weight, muscle mass and HGS in COPD. References [1] Ferreira I et al., (2005) Cochrane Database of Systematic Reviews 2005 Issue 2. [2] Stratton RJ et al., (2003) Disease-related malnutrition: an evidence-based approach to treatment, CABI: Oxford. Disclosure of Interest: P. Collins: None Declared, R. Stratton Other: Nutricia Ltd., M. Elia: None Declared
PP103-MON NUTRITIONAL SUPPORT AND FUNCTIONAL CAPACITY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A SYSTEMATIC REVIEW AND META-ANALYSIS P.F. Collins1 , R.J. Stratton1 , M. Elia1 . 1 Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom Rationale: Controversies exist about the value of using nutritional support to improve functional outcomes in COPD with a Cochrane review reporting no evidence of benefit [1]. This updated review aimed to re-examine the evidence base. Methods: A systematic review identified 13 randomised controlled trials (n 419) of nutritional support (dietary advice (n 1), oral nutritional supplements (n 11) or enteral tube feeding (n 1)) versus control in COPD. Respiratory muscle strength (PI max and PE max),
154
Poster presentations
handgrip strength (HGS), walking distance and quality of life (QoL) were investigated (Comprehensive Metaanalysis v2). In contrast to the Cochrane review which examined only between group differences, this review examined the changes induced by the intervention. Results: Compared to the control group, those receiving nutritional support showed a significantly greater increase in PE max (15.2 SE 4.88 cm H2 O, p = 0.002), a nonsignificant increase in PI max (0.36 SE 0.34 cm H2 O, p = 0.143) and a significant increase in HGS (0.9 SE 0.366 kg, p = 0.014 fixed effect model; 1.3 SE 0.69 kg, p = 0.05 random effects model). Walking distance was reported in five trials, four of which favoured the intervention group. Two of these were meta-analysable (p = 0.59) with only one favouring the intervention group. Two studies examined QoL (non meta-analysable) each reporting clinically and statistically significant improvements favouring nutritional support (p = 0.001 to p < 0.05). Conclusion: Unlike the Cochrane review, this systematic review found that nutritional support in COPD results in improved respiratory and peripheral muscle strength and quality of life.
18.8(3.7) kcal/kg/d while the total energy intake varied between 14 26 kcal/kg/d. Mean ESPEN calculated need was 25 kcal/kg/d, while REE calculated need was 24.5±2.2 kcal/kg/d and it varied from 20 29 kcal/kg/d. Average deficit of energy intake was 534kcal/d, which gives a deficit of 4275 kcal during the first week after LT. Conclusion: Only 8% of the patients met their energy requirements after LT showing that given nutrition do not follow recommendations or patients needs. Results of our study stress need for individualisation of nutrition routines, which can in a better way meet the patient individual need. This could probably achieved by introduction of modified nutrition guidelines combining early enteral and parenteral nutrition after liver transplantation.
References [1] Ferreira I et al., (2005) Cochrane Database of Systematic Reviews 2005 Issue 2.
Rationale: Bioimpedance is a quick, non-invasive method to assess body composition, to track changes in fat proportion during a weight-loss programme and to followup changes in body water proportion and shift between extra- and intracellular spaces. These parameters are of interest in a cardiac rehabilitation unit. Methods: Patients were selected based on their willingness to participate in a weight-loss programme during their rehabilitation. Quadscan4000 was used to measure body composition. We used a balanced, low-fat diet based on the measured Basal Metabolic Rate. Beside the routine physical training, patients were advised to walk an extra 5 km, monitored with a pedometer. Data were analysed with Student’s paired T-test. Results: Ten patients undertook the programme. Their mean age was 57±11 years. The mean BMI was proved to be 38.6 at the start. The average weight-loss was 4% (p = 0.01). The measured initial fat proportion was 46.8%, that declined significantly (p = 0.01) to 44.5%. The lean body mass did not changed significantly, even a slight increase could be detected (52.2 kg to 52.4 kg). The BMI decreased significantly (p = 0.01) to 37.3. The BFMI decreased from 18.3 to 16.5 (p = 0.007), meanwhile the FFMI was stable. Patients daily walked on average 4 km. They reached or exceeded the 5 km limit in 30% of the days (min: 1.14 km, max: 13.7 km). Conclusion: Patients who intended to loose weight could succeed with the help of professionals in a controlled environment. This initial change is crucial, because it demonstrates the result of efforts and it is a fix point that can be referred to in the later phase of weight-loss programmes. Bioimpedance analysis serves as control in adherence to the programme and raises the compliance of the patients.
Disclosure of Interest: P. Collins: None Declared, R. Stratton Other: Nutricia Ltd., M. Elia: None Declared
PP104-MON POST TRANSPLANT ENERGY DEFICIT IN PATIENTS UNDERGOING LIVER TRANSPLANTATION P. Nordstedt1 , K. Holmberg2 , J. Skiold3 , M. Annborn4 , M. Backlund5 , M. Holst6 , O. Irtun7 , A. Odlund-Olin8 . 1 Department of Transplantation Surgery, 2 Center for Allogen Stem Cell Transplantation, karolinska university hospital, Stockholm, 3 Skane Oncology Department, Skane, Skane University Hospital Malmoe, Malmoe, 4 Department of Anaesthesia and Intensive Care, Skane University Hospital Lund, Lund, Sweden; 5 Department of Intensive Care, Helsinki University Hospital, Helsinki, Finland; 6 Centre for Nutrition and Bowel Disease, Gastroenterology Dept, Aalborg University Hospital, Aalborg, Denmark; 7 Department of GI-Surgery, University hospital North-Norway, Tromso, Norway; 8 Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden Rationale: Malnutrition is a risk factor in patients undergoing liver transplantation (LT). ESPEN guidelines recommend 25 kcal/kg/day for this group of patients. The aim of the study was to evaluate if this general ESPEN recommendation is followed and to compare energy need recommended by ESPEN with individual calculations using Harris-Benedict’s formula (REE). Methods: A total of 24 (17 men) patients were included in the study. The patients total energy needs were calculated using ESPEN recommendation (25 kcal/kg/day) and the Harris-Benedict’s formula (REE). The daily amount of energy intake was registered during day 0 7 and the energy balance was calculated. Results: The energy intake was low compared to the energy requirements. The mean energy intake was
Disclosure of Interest: None Declared
PP106-MON BIOIMPEDANCE ANALYSIS IN A WEIGHT-LOSS PROGRAMME DURING CARDIAC REHABILITATION R. Kegyes Bozo1 , D. Jobst1 . 1 Cardiac rehabilitation, SZT Lukacs Hospital Dombovar, Dombovar, Hungary
Disclosure of Interest: None Declared