PP176 CHANGES OF BODY WEIGHT AND PHYSICAL ACTIVITY IN OBESE PATIENTS AFTER LIFESTYLE INTERVENTION

Obesity and the metabolic syndrome I fructose consumption had less larger, more buoyant LDL-I particles with a concomitant increase in the smaller, more dense LDL-IIIA subclass.. LDL size was further associated with triglycerides (p < 0.001), HDL- (p = 0.006) and LDLcholesterol (p = 0.043). Conclusion: In conclusion, even in a homogeneous group of normal weight, healthy men, smaller, denser LDL particles, the atherogenic lipoprotein phenotype, was associated with a higher consumption of free fructose and free glucose, underlining the potential negative effect of these monosaccharides with regard to metabolic abnormalities. Disclosure of Interest: None declared

PP173 SPINAL CLINIC FOR OBESITY OUTPATIENT PROJECT (SCOOP): A 12 MONTHS REPORT S.S.H. Wong1,2 , A. Graham3 , A. Forbes2 , G. Grimble2 . 1 Nutrition and Dietetics, National Spinal Injuries Centre, Aylesbury, 2 Centre of Gastroenterolgoy and Clinical Nutrition, University College London, London, 3 National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, United Kingdom Rationale: Overnutrition leading to obesity in the Spinal Cord Injury (SCI) population is an urgent health problem needing to be tackled. SCI individuals of all ages appear to be at a higher risk than the general population for nutrition related complications1 . Methods: This study was done over 12 months to assess the effectiveness of a dietitian led weight management clinic. 54 patients with chronic SCI with a body mass index (BMI) range of 26.4 46.4 kg/m2 were referred for consultation covering nutrition, exercise and cognitive behaviour therapy in 3 consultations over 3 months. Outcomes measured include body composition by anthropometric measurements of BMI, mid upper-arm circumference (MUAC), triceps-skinfold thickness (TSF) and mid-arm muscle circumference (MAMC) and sitting blood pressure. Results: 11 individuals were excluded, 27 individuals attended their follow up appointment and 19 patients completed the intervention. At week 12, there was a significant reduction of weight [mean (s.d.): 103.1 (19.7 kg) v 97.8 (18.2 kg), P < 0.0001], BMI [mean (s.d.): 35.5 (5.63) v 34 (5.6), P < 0.0001, TSF [mean (s.d.): 28.3 (7.18) mm v 24.7 (5.81) mm, P =0.019] and an increase of MAMC [mean (s.d.): 29.5 (4.98) cm v 30.0 (5.69) cm, P =0.045]. Sitting blood pressure (mm/Hg) were reduced [systolic: mean (s.d.), 134 (16.9) v 101 (36.9), P =0.026; Diastolic: mean (s.d.), 88 (25.8) v 86.9 (27), P =0.206]. Conclusion: We conclude that the weight management clinic may be able to help SCI patients to achieve weight loss without compromising total lean body mass. It is anticipated that additional organisational cost will be incurred initally, but this has a potential to decrease health care costs if patient’s clinical outcome and quality of life is improved. Further research with a larger sample size is planned to assess long term outcomes in this specific ’at risk’ group of patient. References [1] Gupta N, White K & Sandford P (2006) Spinal Cord 44, 92 94. Disclosure of Interest: None declared

91 PP175 HIGH BEVERAGE SUGAR AS WELL AS HIGH ANIMAL PROTEIN INTAKE AT INFANCY INCREASES OVERWEIGHT RISK AT 8 YEARS: A PROSPECTIVE LONGITUDINAL STUDY P.J. Weijs1,2 , L. Kool1 , N. van Baar1 , A.M. van Bavel-Verreijen1 , S. van der Zee3 . 1 Nutrition and Dietetics, Hogeschool van Amsterdam, University of Applied Sciences, 2 Nutrition and Dietetics, VU University Medical Center, 3 Environmental Health, Municipal Health Service Amsterdam, Amsterdam, Netherlands Rationale: Neither the relation between beverage sugar intake as well as animal protein intake during infancy and the risk of later overweight is clear. A prospective study into beverage sugar intake and animal protein intake during infancy and overweight risk at 8 years. Methods: A prospective survey with a random sample of 1250 parents with infants was conducted, including a 2 day food record. At 8 year follow-up all initial responders were surveyed again. Main outcome measure was overweight at 8 years as defined by BMIsds  +1. Results: In 2001 response was 226 parents with infants between 4 and 13 months of age (18%) and at 8 year follow-up in 2009 120 parents (53%). 20 children were self-reported overweight at 8 years (17%). Unadjusted odds ratios [OR (95% CI)] for overweight at 8 years were 1.10 (1.02, 1.18) for beverage sugar intake per one percent of energy intake and 4.06 (1.50, 11.00) for the highest tertile of animal protein intake at infancy. Adjusted ORs, considering sex, age, breastfed at intake assessment, and social economic status, were 1.13 (1.03, 1.24) for beverage sugar, and 9.67 (2.57, 36.38) for highest tertile of animal protein intake. In a subgroup (n = 63) ORs were also adjusted for current maternal overweight, physical activity, and energy intake, but ORs remained significantly associated with overweight at 8 years. Conclusion: A high intake of sugar-containing beverages as well as animal protein in the first year of life increases the risk of overweight at 8 years. Disclosure of Interest: None declared

PP176 CHANGES OF BODY WEIGHT AND PHYSICAL ACTIVITY IN OBESE PATIENTS AFTER LIFESTYLE INTERVENTION T. Schuetz1 , S. Burkert2 , U. Elbelt1 . 1 Gastroenterology, Hepatology and Endocrinology, 2 Institute of Medical Psychology, Charit´ e Universit¨ atsmedizin Berlin, Berlin, Germany Rationale: Conservative therapy of patients with severe obesity is tedious. The aim of this study was to examine, whether a one-time lifestyle counselling and subsequent endocrinologic out-patient consultation results in changes of body composition and activity pattern after 6 months. Methods: In 22 out-patients (6 m, 16 f; age: 44.1±15.5 years) with obesity (grade I: n = 3; grade II: n = 6; grade III: n = 13) body composition (bioimpedance analysis; Nutrigard-M), total energy expenditure and physical activity for 3 days (SenseWear™ armband) were measured at baseline (t0) and after 6 months (t1). All patients took

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Poster presentations

part in a one-time information session concerning the necessary reduction of energy intake and concomitant increase of physical activity. Results: After 6 months 14 patients had lost 6.6±8.7 kg body weight, 8 patients had gained 1.8±1.5 kg body weight. At t0 body composition and physical activity were similar in weight-losing and weight-gaining patients. After 6 months the changes (t1 t0) were significantly different between groups in terms of decreasing fat mass and increasing duration and energy expenditure from physical activity in patients with weight loss (table 1). While weight-losing patients could increase active energy expenditure by 119±264 kcal/d, it was decreased by 207±279 kcal/d in patients with weight gain.

in fat-free mass (FFM; b coeff = 22.0; P = 0.032) and FM (b coeff = 17.3; P = 0.049), while the decrease in REE/FFM ( 0.92 kcal/kg [95% CI: 0.25, 1.60; P = 0.008) was associated only with DFM (b coeff = 0.66; P = 0.042). Conclusion: When appropriate WL program are designed (long duration and mild calorie deficit), NWO patients are likely to profitably lose more FM than FFM and to improve cardiovascular risk profile. The reduction in REE appears appropriate for WL and related to quantitative and functional changes in FM. Present data justify and support the efforts in achieving WL also in normal weight subjects characterized by an excess of body FM.

Table 1. Differences (t1 t0)

PP178 PREGNANCY FOLLOWING BARIATRIC SURGERY: EXPERIENCE IN A REFERENCE CENTER

Fat-free mass (kg) Fat mass (kg) Active energy expenditure (>3 MET) (kcal/kg/d) Duration of physical activity (min/d)

Weight loss (n = 14)

Weight gain (n = 8)

4.2±4.9 2.4±7.9* +0.28±0.49* +27±50 *

1.5±2.8 +3.3±3.2 0.32±0.30 31±30

*p < 0.05 (Mann-Whitney-U-test); MET: metabolic unit.

Conclusion: In 58% of obese patients a one-time counselling concerning changes in lifestyle resulted in a moderate weight loss after six months. Active energy expenditure was approximately 325 kcal/d higher in these patients. The sustainability of this approach must further be evaluated. Disclosure of Interest: None declared

PP177 CHANGES IN RESTING ENERGY EXPENDITURE AFTER WEIGHT LOSS IN NORMAL WEIGHT OBESE SUBJECTS E. Cereda1 , C. Usai2 , R. Caccialanza1 , L. Vignati2 , R. Verney2 , A. Spadafranca2 , S. Bertoli2 , A. Battezzati2 . 1 Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, 2 International Center for the Assessment of Nutritional Status (ICANS), Dipartimento di Scienze e Tecnologie Alimentari e Microbiologiche (DISTAM), Universit` a degli Studi di Milano, Milano, Italy Rationale: Given the pathophysiologic role of adipose tissue, a new subset of subjects candidate for weight loss (WL) has been identified: the “normal-weight obese” (NWO). In women, this syndrome is defined by a normal BMI (18.5 <25 kg/m2 ) but a total body fat mass (FM) >30%. As WL-related reduction in resting energy expenditure (REE) has been fingered a determinant of long-term WL maintenance and weight regain, we assessed the changes in REE resulting from WL in such patients. Methods: Anthropometric variables, body composition by skinfold thickness, REE by indirect calorimetry and cardiovascular risk parameters were assessed in 66 NWO women. 104 overweight women were taken as controls. Results: NWO subjects presented cardiometabolic features similar to those overweight. At the end of the follow-up (median [inter-quartile range], 24 [18 34] weeks), WL was 5.8±2.3 kg (83% FM) and resulted in a significant improvement of cardiovascular risk profile. At group level, a decrease of REE relative to WL of 7.8 kcal/kg (~6%) was observed. By adjusted multivariate analysis, DREE appeared dependent on the reduction

Disclosure of Interest: None declared

I. Gonz´ alez1 , J.L. Pereira Cunill1 , P. Serrano Aguayo1 , S. Morales Conde2 , P.P. García Luna1 . 1 endocrinología y nutrici´ on, 2 Laparoscopic surgery unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain Rationale: About half of the patients who undergo bariatric procedures are women in reproductive age. Because nutrition is a vital component of pregnancy, it is imperative to understand the effects of bariatric surgery on pregnancy outcomes. Methods: Retrospective analysis of pregnancies following bariatric surgery from 2003 to 2009 in Virgen del Rocío Universitary Hospital (Seville, Spain). Our followup examinations included: clinical examination by an obstetrician and an endocrinologist every 12 weeks, weight and body mass index (BMI) before pregnancy, interval between surgery and pregnancy, comorbilities, polyvitaminic supplements, anemia, vitamin deficiency, nutritional support, maternal and fetal outcomes. Results: 15 pregnancies in 10 women (2 actually in their course). 70% women undergone biliopancreatic diversion and 30% Y-en-roux gastric bypass. Mean age at pregnancy was 32.2±2.5 years, mean BMI 35.7 kg/m2 and a median of 17 months (8 80) between bariatric procedure and pregnancy. We detected iron deficiency in 80%, cholecalciferol in 46.7%, vitamin A in 20%, tocopherol 13.3% and cobalamin in 26.7%. Any woman has needed parenteral nutrition but one needed enteral nutrition due to gravidic hyperemesis. We did not found any case of gestational diabetes, pregnancy-induced hypertension, preeclampsia or surgery during pregnancy. There were nine deliveries with mean gestational age of 39±1.2 weeks and only one cesarean. Mean weight of the newborn was 3014±290 gr, with 3 cases of small for gestational age, and one case of aspiration pneumonia, without congenital anomalies. There were 3 stillbirths and one preterm delivery with fetal death. Conclusions: (1) Pregnancy following bariatric surgery should be considered a high risk situation and requires multidisciplinar approach at Surgery, Obstetric and Nutrition Units. (2) Women who have undergone bariatric surgery may have less risk than obese women for certain pregnancy complications. Disclosure of Interest: None declared