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PP122-SUN: Outstanding abstract: Nutritional support in Chronic Obstructive Pulmonary Disease (COPD): A Randomised Trial
Nutrition and chronic diseases PP121-SUN Outstanding abstract EFFECT OF THE FODMAP-RESTRICTED DIET ON COLONIC GAS PRODUCTION CAPACITY IN PATIENTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS M.L. Ones1 , I. Thun1 , F. Van Megen1 , M.H. Morken1 , G.E. Kahrs1 , T. Hausken1 , J.G. Hatlebakk1 . 1 Department of Clinical Nutrition and Section of Gastroenterology, Department of Medicine, Clinical Institute 1 (K1), University of Bergen, Haukeland University Hospital, Bergen, Norway Rationale: The FODMAP (fermentable oligo-, di-, and monosaccharides and polyols) restricted diet is used as a treatment for functional gastrointestinal disorders such as irritable bowel syndrome (IBS), to reduce fermentation and gas production. We wanted to investigate whether the capacity for gas production changed when consuming a FODMAP-restricted diet among patients with IBS and functional dyspepsia (FD). Methods: 29 patients with IBS (n = 19) or FD (n = 10) were diagnosed according to the ROME III criteria (24F/5M, age 34±11 y). A clinical dietician instructed the participants about the diet and followed them closely for 6±1 w. Repeated 4 days prospective food records (baseline and 6 w) measured diet changes and adherence. Lactulose breath test was performed before, and during the last week of the diet. 10 g of lactulose in 120 ml water were consumed after baseline breath test, and breath samples took place every 15 min for 180 min. Breath samples were analysed for H2 and methane (SC Quintron Gas Chromatograph) and expressed as area under the curve (AUC). Statistics: paired t-test, Wilcoxon signed rank and Spearman and Pearson correlation tests. Results: FODMAP intake decreased significantly from median 37 g to 1 g (p < 0.0001). 28 (18 IBS/10 FD) patients had H2 production and there was a significant reduction from 4418 to 1710 ppmxmin (p = 0.0035) during the diet intervention. 9 (7 IBS/2FD) participants had methane production, with a reduction from 9698 to 6750 ppmxmin (p = 0.5415). Correlation between the change in FODMAP intake and change in H2 (r = 0.1609, p = 0.4045) or methane production was not significant (r = 0.1019, p = 0.7943). Conclusion: The FODMAP-restricted diet was associated with a reduction in the capacity for hydrogen gas production in patients with IBS or FD, which might indicate a shift in colonic microbiome. Disclosure of Interest: None Declared.
PP122-SUN Outstanding abstract NUTRITIONAL SUPPORT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A RANDOMISED TRIAL P.F. Collins1,2,3 , R.J. Stratton1 , M. Elia1 . 1 Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; 2 Nutrition & Dietetics, Princess Alexandra Hospital, 3 School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia Rationale: Nutritional support is effective in managing malnutrition in COPD (Collins et al., 2012) leading to functional improvements (Collins et al., 2013). However, comparative trials of first line interventions are lacking. This randomised trial compared the effectiveness of individualised
S65 dietary advice by a dietitian (DA) versus oral nutritional supplements (ONS). Methods: A target sample of 200 stable COPD outpatients at risk of malnutrition (‘MUST’; medium + high risk) were randomised to either a 12-week intervention of ONS (ONS: ~400 kcal/d, ~40 g/d protein) or DA with supportive written advice. The primary outcome was quality of life (QoL) measured using St George’s Respiratory Questionnaire with secondary outcomes including handgrip strength, body weight and nutritional intake. Both the change from baseline and the differences between groups was analysed using SPSS version 20. Results: 84 outpatients were recruited (ONS: 41 vs. DA: 43), 72 completed the intervention (ONS: 33 vs. DA: 39). Mean BMI was 18.2 SD 1.6 kg/m2 , age 72.6 SD 10 years, FEV1% predicted 36 SD 15% (severe COPD). In comparison to the DA group, the ONS group experienced significantly greater improvements in protein intakes above baseline values at both week 6 (+21.0 SEM 4.3 g/d vs. +0.52 SEM 4.3 g/d; p < 0.001) and week 12 (+19.0 SEM 5.0 g/d vs. +1.0 SEM 3.6 g/d; p = 0.033;ANOVA). QoL and secondary outcomes remained stable at 12 weeks in both groups with slight improvements in the ONS group but no differences between groups. Conclusion: In outpatients at risk of malnutrition with severe COPD, nutritional support involving either ONS or DA appears to maintain nutritional status, functional capacity and QoL. However, larger trials, and earlier, multi-modal nutritional interventions for an extended duration should be explored. References Collins et al., (2012) Am. J. Clin. Nutr 95 (6), 1385 1395 Collins et al., (2013) Respirology 18 (4), 616 629. Disclosure of Interest: P. Collins Grant/Research Support from: PhD funding as part of an unrestricted educational grant from Nutricia Ltd., R. Stratton Other: Employee of Nutricia Ltd., M. Elia: None Declared.
PP123-SUN Outstanding abstract IRON DEFICIENCY IMPACTS NEGATIVELY ON SURVIVAL IN HEART FAILURE PATIENTS J.R.D.S. Gentil1 , P.V. Schwartzmann1 , F. Marques1 , G.J. Volpe1 , V.M.M. Suen1 , J.S. Marchini1 , M. Vinicius Sim˜ oes1 . 1 Department of Internal Medicine, Medical School of Ribeirao Preto University of S˜ ao Paulo, Ribeirao Preto, Ribeir˜ ao Preto, Brazil Rationale: Iron deficiency (ID) is a highly prevalent disorder in heart failure (HF) and its presence is related to exercise intolerance and severity of the cardiac syndrome. We aim to identify distinct iron metabolic states and its clinical correlations and determine the survival impact of ID in HF patients. Methods: Cohort study, in which 105 patients with chronic HF were enrolled, evaluated and follow-up for mean time of 731±276 days. All patients were assessed for their clinical aspects and iron indexes. ID was defined as ferritin <100 ng/dL or ferritin 100 300 ng/dL with TSAT <20%. It was characterized as absolute (TSAT <20%, ferritin <100 ng/dL) or functional deficiency (TSAT <20%) or depleted iron stores (ferritin <100 ng/dL). Statistic analysis were performed with Student t or Mann Whitney U test, Fisher’s exact test, Kaplan Meier method and Cox proportional hazards regression, with significance level established at p < 0.05.
PP122-SUN Outstanding abstract NUTRITIONAL SUPPORT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): A RANDOMISED TRIAL P.F. Collins1,2,3 , R.J. Stratton1 , M. Elia1 . 1 Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; 2 Nutrition & Dietetics, Princess Alexandra Hospital, 3 School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia Rationale: Nutritional support is effective in managing malnutrition in COPD (Collins et al., 2012) leading to functional improvements (Collins et al., 2013). However, comparative trials of first line interventions are lacking. This randomised trial compared the effectiveness of individualised
S65 dietary advice by a dietitian (DA) versus oral nutritional supplements (ONS). Methods: A target sample of 200 stable COPD outpatients at risk of malnutrition (‘MUST’; medium + high risk) were randomised to either a 12-week intervention of ONS (ONS: ~400 kcal/d, ~40 g/d protein) or DA with supportive written advice. The primary outcome was quality of life (QoL) measured using St George’s Respiratory Questionnaire with secondary outcomes including handgrip strength, body weight and nutritional intake. Both the change from baseline and the differences between groups was analysed using SPSS version 20. Results: 84 outpatients were recruited (ONS: 41 vs. DA: 43), 72 completed the intervention (ONS: 33 vs. DA: 39). Mean BMI was 18.2 SD 1.6 kg/m2 , age 72.6 SD 10 years, FEV1% predicted 36 SD 15% (severe COPD). In comparison to the DA group, the ONS group experienced significantly greater improvements in protein intakes above baseline values at both week 6 (+21.0 SEM 4.3 g/d vs. +0.52 SEM 4.3 g/d; p < 0.001) and week 12 (+19.0 SEM 5.0 g/d vs. +1.0 SEM 3.6 g/d; p = 0.033;ANOVA). QoL and secondary outcomes remained stable at 12 weeks in both groups with slight improvements in the ONS group but no differences between groups. Conclusion: In outpatients at risk of malnutrition with severe COPD, nutritional support involving either ONS or DA appears to maintain nutritional status, functional capacity and QoL. However, larger trials, and earlier, multi-modal nutritional interventions for an extended duration should be explored. References Collins et al., (2012) Am. J. Clin. Nutr 95 (6), 1385 1395 Collins et al., (2013) Respirology 18 (4), 616 629. Disclosure of Interest: P. Collins Grant/Research Support from: PhD funding as part of an unrestricted educational grant from Nutricia Ltd., R. Stratton Other: Employee of Nutricia Ltd., M. Elia: None Declared.
PP123-SUN Outstanding abstract IRON DEFICIENCY IMPACTS NEGATIVELY ON SURVIVAL IN HEART FAILURE PATIENTS J.R.D.S. Gentil1 , P.V. Schwartzmann1 , F. Marques1 , G.J. Volpe1 , V.M.M. Suen1 , J.S. Marchini1 , M. Vinicius Sim˜ oes1 . 1 Department of Internal Medicine, Medical School of Ribeirao Preto University of S˜ ao Paulo, Ribeirao Preto, Ribeir˜ ao Preto, Brazil Rationale: Iron deficiency (ID) is a highly prevalent disorder in heart failure (HF) and its presence is related to exercise intolerance and severity of the cardiac syndrome. We aim to identify distinct iron metabolic states and its clinical correlations and determine the survival impact of ID in HF patients. Methods: Cohort study, in which 105 patients with chronic HF were enrolled, evaluated and follow-up for mean time of 731±276 days. All patients were assessed for their clinical aspects and iron indexes. ID was defined as ferritin <100 ng/dL or ferritin 100 300 ng/dL with TSAT <20%. It was characterized as absolute (TSAT <20%, ferritin <100 ng/dL) or functional deficiency (TSAT <20%) or depleted iron stores (ferritin <100 ng/dL). Statistic analysis were performed with Student t or Mann Whitney U test, Fisher’s exact test, Kaplan Meier method and Cox proportional hazards regression, with significance level established at p < 0.05.