- Email: [email protected]
PP167-SUN: Malnutrition Screening Tool Accuracy in Patients Scheduled for Cardiac Surgery
S82 airflow, T and RH were continuously monitored to assess the stability of the system over time. Results: Reproducibility of the measurements was <4.5% for VO2 and VCO2 , and 1.2% for RER (n = 6). Recovery, measured by comparing to pure ethanol burning, was 9.8% for VO2 , 15.6% for VCO2 , and 6.5% for RER (n = 6). Moreover, a high stability was maintained during the experimental period for the measured outcomes (VO2 : ±0.31 ml/min, VCO2 ±0.24 ml/min, RER ±0.03), as well as for the experimental conditions inside the chamber (airflow ±0.43 ml/min, T ±1.04ºC, RH = 0.39%, SE, n = 6). Conclusion: The new whole-body calorimetry chamber provides stable and reproducible data, as the variability remains below the intra-subject variability. Poor recovery (mainly for VCO2 ) is attributed to metabolic cart technical limitations and can be improved. In conclusion, our system is a new suitable device for adequately measuring human REE and TEF over several hours in clinical trials. Disclosure of Interest: None Declared.
PP166-SUN RESTING ENERGY METABOLISM OF PATIENTS WITH END STAGE LIVER DISEASE TREATED IN THE LEIDEN UNIVERSITY MEDICAL CENTRE A. Donker1 . 1 Dietetics, LUMC, Leiden, Netherlands Background and Aims: Liver cirrhosis is present in about 80% of the patients waiting for a liver transplantation (LTx) Patients with cirrhosis often suffer from malnutrition due to the metabolic complications. Formula’s to estimate the resting energy expenditure (REE) are not reliable in this patient group. Either hypermetabolism, normometabolism or hypometabolim occur. Hypermetabolism can cause malnutrition and can have a negative impact on the patients outcome. The aim of this study was to assess the REE of these patients and to identify the prevalence of hyper and hypometabolism. Methods: A total of 33 patients with end stage liver disease who visited the outdoor clinic in April and May 2013 were assessed. In this group 29 patients had liver cirrhosis. Their age was between 20 and 67. The REE was measured by indirect calorimetry using the Fimate GS (Cosmed) and predicted by the Harris and Benedict formula 1984 (REEHB). Patients were classified as hypermetabolic if the ratio REE/REEHB was >120%, and as hypometabolic if the ratio REE/REEHB was <80%. Results: The mean measured REE was 1627 kcal/dag [female (n = 6): 1430; male: 1681 (n = 27)]. The REE was overestimated by the REEHB in 24% (N = 8) and underestimated in 6% of the patients (N = 2). The difference between indirect calorimetry and Harris and Benedict is significant (Wilcoxon p < 0.005). The REE is 92% from the REEHB. Conclusion: Our study confirmed that in patients with an end stage liver disease resting energy expenditure should be measured. The Harris Benedict formula is not able to detect hypo- or hypermetabolism. Disclosure of Interest: None Declared.
Poster presentations PP167-SUN MALNUTRITION SCREENING TOOL ACCURACY IN PATIENTS SCHEDULED FOR CARDIAC SURGERY D. Ringaitiene1 , D. Gineityte1 , V. Vicka1 , I. Norkiene1 , J. Sipylaite1 . 1 Faculty of Medicine, Vilnius University, Vilnius, Lithuania Rationale: Preoperative malnutrition (MN) is related to adverse postoperative outcomes after cardiac surgery and is poorly detected despite extensive research. The aim of our study is to create a modified preoperative screening tool most accurately predicting MN in cardiac surgery population. Methods: A prospective study was performed. The nutritional status of the patients undergoing open cardiac surgery was assessed using MN screening tools and phase angle value, measured using bioelectrical impedance analysis. A low phase angle (LPA) value of 5.44 was set as an indicator of MN. To compare Nutrition Risk Screening 2002 (NRS2002), Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assesment (MNA) screening tools with respect to their accuracy in detecting a LPA receiver operator charactaristic-based area under the curve (ROC AUC) was calculated. The most accurate screening tool was adapted by adding risk factors determining LPA. Results: A total of 252 patients were included. The incidence of preoperative MN was higher using BIA (BIA 47.6% vs. NRS2002 17.5%, MUST 5.2%, MNA 13.5%). ROC AUC to detect LPA were 0.56 (95% CI: 0.49 0.63) for NRS-2002, 0.50 (95% CI: 0.43 0.57) for MUST, 0.52 (95% CI: 0.44 0.59) for MNA. Age 65, female gender and depression were determined as risk factors for LPA, respectively OR = 4.5, 95% CI 2.6 7.8, OR = 1.9, 95% CI 1.1 3.5, OR = 4.7, 95% CI 1.4 15.5. A new more accurate scoring system was developed using NRS-2002 and the later risk factors [ROC AUC 0.70 (95% CI 0.6 0.8) vs. 0.56 (95% CI 0.5 0.6)]. Conclusion: Accuracy in detecting MN prior to cardiac surgery was highest for NRS-2002, however every third patient was misclassified as well nourished contrary to BIA results. Extending NRS-2002 with age 65, female gender and depression improves diagnostic accuracy of MN in cardiac surgery patients. The use of the developed tool should be evaluated furthermore in succeeding studies. Disclosure of Interest: None Declared.
PP168-SUN NUTRITION IMPACT SYMPTOMS AND BODY COMPOSITION IN PATIENTS WITH COPD J. Nord´ en1 , A.M. Gr¨ onberg1 , I. Bosaeus1 , H. Bert´ eus Forslund1 , 1 1 2 L. Hulth´ en , E. Rothenberg , J. Karlsson , O. Wallengren1 , F. Slinde1 . 1 Sahlgrenska Academy, University of Gothenburg, ¨ rebro University Hospital, O ¨ rebro, Sweden G¨ oteborg, 2 O Rationale: Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat free mass depletion. Methods: The results in this cross-sectional study are based on 169 COPD patients (62% females). Body composition was
PP166-SUN RESTING ENERGY METABOLISM OF PATIENTS WITH END STAGE LIVER DISEASE TREATED IN THE LEIDEN UNIVERSITY MEDICAL CENTRE A. Donker1 . 1 Dietetics, LUMC, Leiden, Netherlands Background and Aims: Liver cirrhosis is present in about 80% of the patients waiting for a liver transplantation (LTx) Patients with cirrhosis often suffer from malnutrition due to the metabolic complications. Formula’s to estimate the resting energy expenditure (REE) are not reliable in this patient group. Either hypermetabolism, normometabolism or hypometabolim occur. Hypermetabolism can cause malnutrition and can have a negative impact on the patients outcome. The aim of this study was to assess the REE of these patients and to identify the prevalence of hyper and hypometabolism. Methods: A total of 33 patients with end stage liver disease who visited the outdoor clinic in April and May 2013 were assessed. In this group 29 patients had liver cirrhosis. Their age was between 20 and 67. The REE was measured by indirect calorimetry using the Fimate GS (Cosmed) and predicted by the Harris and Benedict formula 1984 (REEHB). Patients were classified as hypermetabolic if the ratio REE/REEHB was >120%, and as hypometabolic if the ratio REE/REEHB was <80%. Results: The mean measured REE was 1627 kcal/dag [female (n = 6): 1430; male: 1681 (n = 27)]. The REE was overestimated by the REEHB in 24% (N = 8) and underestimated in 6% of the patients (N = 2). The difference between indirect calorimetry and Harris and Benedict is significant (Wilcoxon p < 0.005). The REE is 92% from the REEHB. Conclusion: Our study confirmed that in patients with an end stage liver disease resting energy expenditure should be measured. The Harris Benedict formula is not able to detect hypo- or hypermetabolism. Disclosure of Interest: None Declared.
Poster presentations PP167-SUN MALNUTRITION SCREENING TOOL ACCURACY IN PATIENTS SCHEDULED FOR CARDIAC SURGERY D. Ringaitiene1 , D. Gineityte1 , V. Vicka1 , I. Norkiene1 , J. Sipylaite1 . 1 Faculty of Medicine, Vilnius University, Vilnius, Lithuania Rationale: Preoperative malnutrition (MN) is related to adverse postoperative outcomes after cardiac surgery and is poorly detected despite extensive research. The aim of our study is to create a modified preoperative screening tool most accurately predicting MN in cardiac surgery population. Methods: A prospective study was performed. The nutritional status of the patients undergoing open cardiac surgery was assessed using MN screening tools and phase angle value, measured using bioelectrical impedance analysis. A low phase angle (LPA) value of 5.44 was set as an indicator of MN. To compare Nutrition Risk Screening 2002 (NRS2002), Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assesment (MNA) screening tools with respect to their accuracy in detecting a LPA receiver operator charactaristic-based area under the curve (ROC AUC) was calculated. The most accurate screening tool was adapted by adding risk factors determining LPA. Results: A total of 252 patients were included. The incidence of preoperative MN was higher using BIA (BIA 47.6% vs. NRS2002 17.5%, MUST 5.2%, MNA 13.5%). ROC AUC to detect LPA were 0.56 (95% CI: 0.49 0.63) for NRS-2002, 0.50 (95% CI: 0.43 0.57) for MUST, 0.52 (95% CI: 0.44 0.59) for MNA. Age 65, female gender and depression were determined as risk factors for LPA, respectively OR = 4.5, 95% CI 2.6 7.8, OR = 1.9, 95% CI 1.1 3.5, OR = 4.7, 95% CI 1.4 15.5. A new more accurate scoring system was developed using NRS-2002 and the later risk factors [ROC AUC 0.70 (95% CI 0.6 0.8) vs. 0.56 (95% CI 0.5 0.6)]. Conclusion: Accuracy in detecting MN prior to cardiac surgery was highest for NRS-2002, however every third patient was misclassified as well nourished contrary to BIA results. Extending NRS-2002 with age 65, female gender and depression improves diagnostic accuracy of MN in cardiac surgery patients. The use of the developed tool should be evaluated furthermore in succeeding studies. Disclosure of Interest: None Declared.
PP168-SUN NUTRITION IMPACT SYMPTOMS AND BODY COMPOSITION IN PATIENTS WITH COPD J. Nord´ en1 , A.M. Gr¨ onberg1 , I. Bosaeus1 , H. Bert´ eus Forslund1 , 1 1 2 L. Hulth´ en , E. Rothenberg , J. Karlsson , O. Wallengren1 , F. Slinde1 . 1 Sahlgrenska Academy, University of Gothenburg, ¨ rebro University Hospital, O ¨ rebro, Sweden G¨ oteborg, 2 O Rationale: Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat free mass depletion. Methods: The results in this cross-sectional study are based on 169 COPD patients (62% females). Body composition was