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PP176-SUN: Resting Energy Expenditure in Patients with Myotonic Dystrophy in Relation to Body Composition
Nutritional assessment
S85
107 of the 815 cases (13.1%) the diagnosis of malnutrition triggered additional revenues of 1,387€ per case, in total amounting to 148,465€. The cost of nutritional therapy was preliminarily estimated to be about 80€ per case. Number of cases with malnutrition diagnosed and coded
2012 (baseline) 2013
Severe
Moderate
Mild
Total
21 201
168 548
10 66
199 815
Conclusion: The 1-year evaluation of this project shows that targeted screening for malnutrition boosts the rate of detection and the patients may then be offered suitable nutritional support. Our data also suggest that nutrition therapy is a cost-effective measure to fight disease-related malnutrition. Disclosure of Interest: None Declared.
PP174-SUN VALIDATION OF MULTIPLE 24-HOUR RECALLS IN DUTCH ELITE ATHLETES BY MULTIPLE 24-HOUR URINARY NITROGEN EXCRETIONS F. Wardenaar1 , J. Steenis2 , M. Mensink3 , J. de Vries3 . 1 Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, 2 InnoSportLab Papendal, Arnhem, 3 Human Nutrition, Wagening University, Wageningen, Netherlands Rationale: Multiple dietary recalls are considered a good tool to estimate dietary intake. In the present study we aimed to validate the protein intake by multiple 24 hour recalls (24HR) with multiple 24 hour nitrogen in urine (24HN) in elite athletes. Methods: Forty-eight healthy disabled and non-disabled Dutch male and female elite athletes (aged 18 50 y) participated in the study. Subjects reported dietary intake on 3 independent days by a web-based 24HR, and collected 3 time 24HN during 3 week period, at least 3 days apart. Completeness of urine collection was checked with using PABA supplements. To examine whether nitrogen-balance was stable, body weight was measured on recall days and creatinine levels were analysed in the 24HN. Urine samples were analyzed on nitrogen content with the Kjeldahl-method. Repeated Measured ANOVA (using Mixed Models) was performed to examine changes in creatinine and body weight over the research period. Correlation analysis was performed to assess the association between reported protein intake from 24hR and protein calculated from 24HN levels. Results: Mean±SD protein intake estimated by the 24 h recall was 107±36 g/d and by the 24 h urine was 142±39 g/d. Thus, the 24 h recall method underestimated the mean actual protein intake with 35.5±32 g/d or 30%. Urinary creatinine levels and body weight did not differ between the recall days (p = 0.08 and p = 0.78, respectively). Crude correlation between the intake estimates was r = 0.61 (95% CI: 0.42 0.74), and after correction for energy intake and body weight it was r = 0.54 (95% CI: 0.33 0.70). Conclusion: Based on the stable bodyweight and urinary creatinine levels the assumption of nitrogen-balance appears to be correct. Therefore, the amount of urinary nitrogen most likely best reflects protein intake. We conclude that
multiple 24HR underestimate protein intake in elite athletes with approximately one-third. Disclosure of Interest: None Declared.
PP175-SUN EFFECT OF NUTRITIONAL STATUS ON FUNCTIONALITY: SCOUTING BODY COMPOSITION CONFOUNDING VARIABLES IN ELDERLY S. Perna1 , S. Sacco1 , G. Peroni1 , M.A. Faliva1 , D. Guido1 , M. Rondanelli1 . 1 University of Pavia, Pavia, Italy Rationale: The aim of the present study was to assess the potential confounding role of body fat distribution markers, measured by DEXA device, on the causal relationship between MNA levels and Barthel Index. Methods: A study was conducted on 164 elderly (65+ y) patients (120 females, 44 males, age = 82±6.62 y). Barthel Index (58.52±26.90 u), MNA levels (17.89±4.04 u) and body fat distribution markers, i.e. fat mass (19.898±8.889 kg), fat mass% (31.80±11.10), android% (34.63±12.20) and ginoid% (38.58±10.25), were measured. We used a multiple linear regression models adjusted for gender, age and BMI. We verified the crude relationship between MNA levels and Barthel Index and verified which body fat distribution markers were associated to the MNA levels and which of them could be classified as potential confounders. Finally, they assessed the confounding effect (D%) for each body fat distribution marker and also fitted the overall regression model. Results: The crude effect of MNA levels on Barthel Index resulted equal to +1.8843 (P < 0.001). According to gender, age and BMI, for a unit increase of MNA level, functionality increased of 1.8843 Barthel units: this effect was very strong. All fat distribution markers showed a positive and highly significant association (P < 0.001) with nutritional index. Finally, according to the last regression models adjusted for potential confounders, the percentage variations of MNABarthel causal effect resulted +3.2% for fat mass, +6.9% for fat mass%, +1.2% for android% and +4.5% for ginoid%. Conclusion: Results shows that the magnitude of MNA-Barthel causal relationship could be reduced by the presence of an excess of fat mass also in normal weight elderly subjects. Fat mass could mask the presence of a condition of hypercaloric malnutrition not revealed by MNA. Disclosure of Interest: None Declared.
PP176-SUN RESTING ENERGY EXPENDITURE IN PATIENTS WITH MYOTONIC DYSTROPHY IN RELATION TO BODY COMPOSITION P.L.M. Reijven1 . 1 Dietetics, University hospital Maastricht, Maastricht, Netherlands Rationale: Myotonic dystrophy (MD) is an inheritable multisystem disorder characterized by muscle weakness and multiple organ impairment. Patients are prone to develop malnutrition. True caloric needs are often not known. Aim: To compare measured resting energy expenditure (REE) in patients with MD with predicted values. Methods: In 61 patients (28 female, 33 male) REE was measured by indirect calorimetry (ventilated hood system) and compared with Harris Benedict predictions. Body composition was measured with the skinfold technique.
S86
Poster presentations
Results: See the table. Table: Comparison between measured and predicted REE (kcal/d)
All (N = 61) Male (N = 33) Female (N = 28)
REE measured (SD)
REE predicted (SD)
Difference pred meas (SD)
1339 (357) 1343 (380) 1335 (335)
1620 (254) 1718 (236) 1504 (227)
281 (284)** 376 (314)** 169 (195)**
**P < 0.0001 Paired T-test.
Mean fat free mass index (FFMI) was 18.4 kg/m2 (SD 3.6) in males and 16.7 kg/m2 (SD 2.9) in females. In 39% of the males FFMI was below 17.4 (5th percentile) and in 25% of females FFMI was below 15.0 kg/m2 (5th percentile). Mean fat mass index (FMI) was 6.8 kg/m2 (SD 3.6) in males and 10.7 kg/m2 (SD 4.4) in females. FMI was low in 14% of males (<4.0 kg/m2 ) and 9% of females (<4.8 kg/m2 ) and high in 54% of males (>5.1 kg/m2 ) and 73% of females (>8.2 kg/m2 ). Mean REE/kg FFM was 25.6 kcal/kg (SD 6.1). REE measured correlated significantly with body weight (R = 0.62), FFM (R = 0.59) and FM (R = 0.47) but the difference between measured and predicted REE did not correlate with body compartment measures. Conclusion: REE is substantially decreased in MD. Changes in body composition do not explain this decrease. Metabolic changes might play a role. For the assessment of caloric needs in individual patients it is advisable to measure REE. Disclosure of Interest: None Declared.
PP177-SUN PORTABLE INDIRECT CALORIMETRY FOR ESTIMATING RESTING METABOLIC RATE BOTH RELIABLE AND FEASIBLE IN COMMUNITY DIETETICS J.A. Langius1,2 , A. Steensma1 , C.X. Kaloter1 , P.M. Groen1 , F.M. Vlieland1 , W.A. Visser1 , D.W. Voskuil1 . 1 Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, 2 Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center Amsterdam, Amsterdam, Netherlands Rationale: Indirect calorimetry measuring O2 and CO2 is a standard but expensive way to assess energy expenditure. New portable and more affordable indirect calorimeters, measuring only O2, have improved accessibility for community dietetic practices (CDP). They are properly validated [1]. However, reliability and feasibility in CDP may be limited due to difficulties in keeping the strict (pre)measurement protocol. Objective: To assess test retest reliability of a desktop indirect calorimeter (FitMateRMR, Cosmed) in identical and different circumstances, and to study dietitians’ and clients’ perception of feasibility in CDP. Methods: Test retest reliability was studied by intra-class correlation coefficients (ICC) in a total of 70 healthy individuals under identical and different circumstances, i.e., fasting vs light breakfast, no vs light exercise, supine vs sitting position and morning vs afternoon. To study feasibility, 8 dietitians and 8 clients were interviewed after conducting and experiencing a RMR measurement resp. Semi-structured interviews were audio-recorded and transcribed. Data were analyzed thematically and segments of text were identified and labeled. Results: All ICC’s were higher than 0.70, suggesting sufficient reliability. The highest ICC (0.96; mean difference 44 kcal)
was found for repeated measurements under identical circumstances on the same day. The lowest ICC (0.71; mean difference 141 kcal) was found for different circumstances (fasting vs non-fasting) on different days. Dietitians found RMR assessment applicable in their dietetic practice and expected it to improve personalized counseling. Clients experienced no barriers for RMR measurement and expected it to increase their insight in energy balance and diet. Conclusion: Estimating RMR using the FitMateRMR is sufficiently to excellent reliable, and feasible to implement in CDP. References [1] Nieman et al, Res Sports Med 2006; 14: 89 96. Disclosure of Interest: None Declared.
PP178-SUN ENERGY EXPENDITURE PHENOTYPING IN RESPONSE TO LOW-INTENSITY PHYSICAL ACTIVITY IN UNTRAINED HUMANS: VALIDATION DURING LOW POWER CYCLING E.-J. Fares1 , L. Isacco1 , N. Charri` ere1 , J. Miles-Chan1 , 1 1 J.-P. Montani , Y. Schutz , A.G. Dulloo1 . 1 Department of Medicine, Division of Physiology, University of Fribourg, Fribourg, Switzerland Rationale: Standardized approaches to study human energy expenditure (EE) are well defined at rest (as basal metabolic rate and thermic effect of feeding), but not in relation to lowintensity physical activities compatible with daily life. Our aim was to develop and validate a standardized test, using the bicycle ergometer, for assessing the energy cost of lowintensity dynamic work by linear regression across the range of low power output cycling. Methods: EE was assessed by face-mask indirect calorimetry during cycling for 5 min each at no-load, 5W, 10W, 15W, 20W, 30W, 40W, 50W, and the steady-state EE were then plotted against power load. All studies were conducted in overnight fasted young healthy untrained men and women (n = 15) of normal BMI, and repeatability assessed in 6 subjects on 3 separate days for each subject. Results: Within the low power range of cycling, a strong linearity of the EE vs power relationship was observed between 10 50W for every subject (r > 0.98); the slope and its reciprocal delta efficiency (Mean: 28.3%, SD: 2.3%) showing low inter- and intra-individual variability, with the coefficient of variability (CV) being ~6%, independently of gender. Conclusion: This standardized and validated approach to study human delta efficiency in response to low-intensity cycling open up new avenues for research in human EE phenotyping with implications for research in metabolic predisposition to leanness and fatness. Disclosure of Interest: None Declared.
S85
107 of the 815 cases (13.1%) the diagnosis of malnutrition triggered additional revenues of 1,387€ per case, in total amounting to 148,465€. The cost of nutritional therapy was preliminarily estimated to be about 80€ per case. Number of cases with malnutrition diagnosed and coded
2012 (baseline) 2013
Severe
Moderate
Mild
Total
21 201
168 548
10 66
199 815
Conclusion: The 1-year evaluation of this project shows that targeted screening for malnutrition boosts the rate of detection and the patients may then be offered suitable nutritional support. Our data also suggest that nutrition therapy is a cost-effective measure to fight disease-related malnutrition. Disclosure of Interest: None Declared.
PP174-SUN VALIDATION OF MULTIPLE 24-HOUR RECALLS IN DUTCH ELITE ATHLETES BY MULTIPLE 24-HOUR URINARY NITROGEN EXCRETIONS F. Wardenaar1 , J. Steenis2 , M. Mensink3 , J. de Vries3 . 1 Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, 2 InnoSportLab Papendal, Arnhem, 3 Human Nutrition, Wagening University, Wageningen, Netherlands Rationale: Multiple dietary recalls are considered a good tool to estimate dietary intake. In the present study we aimed to validate the protein intake by multiple 24 hour recalls (24HR) with multiple 24 hour nitrogen in urine (24HN) in elite athletes. Methods: Forty-eight healthy disabled and non-disabled Dutch male and female elite athletes (aged 18 50 y) participated in the study. Subjects reported dietary intake on 3 independent days by a web-based 24HR, and collected 3 time 24HN during 3 week period, at least 3 days apart. Completeness of urine collection was checked with using PABA supplements. To examine whether nitrogen-balance was stable, body weight was measured on recall days and creatinine levels were analysed in the 24HN. Urine samples were analyzed on nitrogen content with the Kjeldahl-method. Repeated Measured ANOVA (using Mixed Models) was performed to examine changes in creatinine and body weight over the research period. Correlation analysis was performed to assess the association between reported protein intake from 24hR and protein calculated from 24HN levels. Results: Mean±SD protein intake estimated by the 24 h recall was 107±36 g/d and by the 24 h urine was 142±39 g/d. Thus, the 24 h recall method underestimated the mean actual protein intake with 35.5±32 g/d or 30%. Urinary creatinine levels and body weight did not differ between the recall days (p = 0.08 and p = 0.78, respectively). Crude correlation between the intake estimates was r = 0.61 (95% CI: 0.42 0.74), and after correction for energy intake and body weight it was r = 0.54 (95% CI: 0.33 0.70). Conclusion: Based on the stable bodyweight and urinary creatinine levels the assumption of nitrogen-balance appears to be correct. Therefore, the amount of urinary nitrogen most likely best reflects protein intake. We conclude that
multiple 24HR underestimate protein intake in elite athletes with approximately one-third. Disclosure of Interest: None Declared.
PP175-SUN EFFECT OF NUTRITIONAL STATUS ON FUNCTIONALITY: SCOUTING BODY COMPOSITION CONFOUNDING VARIABLES IN ELDERLY S. Perna1 , S. Sacco1 , G. Peroni1 , M.A. Faliva1 , D. Guido1 , M. Rondanelli1 . 1 University of Pavia, Pavia, Italy Rationale: The aim of the present study was to assess the potential confounding role of body fat distribution markers, measured by DEXA device, on the causal relationship between MNA levels and Barthel Index. Methods: A study was conducted on 164 elderly (65+ y) patients (120 females, 44 males, age = 82±6.62 y). Barthel Index (58.52±26.90 u), MNA levels (17.89±4.04 u) and body fat distribution markers, i.e. fat mass (19.898±8.889 kg), fat mass% (31.80±11.10), android% (34.63±12.20) and ginoid% (38.58±10.25), were measured. We used a multiple linear regression models adjusted for gender, age and BMI. We verified the crude relationship between MNA levels and Barthel Index and verified which body fat distribution markers were associated to the MNA levels and which of them could be classified as potential confounders. Finally, they assessed the confounding effect (D%) for each body fat distribution marker and also fitted the overall regression model. Results: The crude effect of MNA levels on Barthel Index resulted equal to +1.8843 (P < 0.001). According to gender, age and BMI, for a unit increase of MNA level, functionality increased of 1.8843 Barthel units: this effect was very strong. All fat distribution markers showed a positive and highly significant association (P < 0.001) with nutritional index. Finally, according to the last regression models adjusted for potential confounders, the percentage variations of MNABarthel causal effect resulted +3.2% for fat mass, +6.9% for fat mass%, +1.2% for android% and +4.5% for ginoid%. Conclusion: Results shows that the magnitude of MNA-Barthel causal relationship could be reduced by the presence of an excess of fat mass also in normal weight elderly subjects. Fat mass could mask the presence of a condition of hypercaloric malnutrition not revealed by MNA. Disclosure of Interest: None Declared.
PP176-SUN RESTING ENERGY EXPENDITURE IN PATIENTS WITH MYOTONIC DYSTROPHY IN RELATION TO BODY COMPOSITION P.L.M. Reijven1 . 1 Dietetics, University hospital Maastricht, Maastricht, Netherlands Rationale: Myotonic dystrophy (MD) is an inheritable multisystem disorder characterized by muscle weakness and multiple organ impairment. Patients are prone to develop malnutrition. True caloric needs are often not known. Aim: To compare measured resting energy expenditure (REE) in patients with MD with predicted values. Methods: In 61 patients (28 female, 33 male) REE was measured by indirect calorimetry (ventilated hood system) and compared with Harris Benedict predictions. Body composition was measured with the skinfold technique.
S86
Poster presentations
Results: See the table. Table: Comparison between measured and predicted REE (kcal/d)
All (N = 61) Male (N = 33) Female (N = 28)
REE measured (SD)
REE predicted (SD)
Difference pred meas (SD)
1339 (357) 1343 (380) 1335 (335)
1620 (254) 1718 (236) 1504 (227)
281 (284)** 376 (314)** 169 (195)**
**P < 0.0001 Paired T-test.
Mean fat free mass index (FFMI) was 18.4 kg/m2 (SD 3.6) in males and 16.7 kg/m2 (SD 2.9) in females. In 39% of the males FFMI was below 17.4 (5th percentile) and in 25% of females FFMI was below 15.0 kg/m2 (5th percentile). Mean fat mass index (FMI) was 6.8 kg/m2 (SD 3.6) in males and 10.7 kg/m2 (SD 4.4) in females. FMI was low in 14% of males (<4.0 kg/m2 ) and 9% of females (<4.8 kg/m2 ) and high in 54% of males (>5.1 kg/m2 ) and 73% of females (>8.2 kg/m2 ). Mean REE/kg FFM was 25.6 kcal/kg (SD 6.1). REE measured correlated significantly with body weight (R = 0.62), FFM (R = 0.59) and FM (R = 0.47) but the difference between measured and predicted REE did not correlate with body compartment measures. Conclusion: REE is substantially decreased in MD. Changes in body composition do not explain this decrease. Metabolic changes might play a role. For the assessment of caloric needs in individual patients it is advisable to measure REE. Disclosure of Interest: None Declared.
PP177-SUN PORTABLE INDIRECT CALORIMETRY FOR ESTIMATING RESTING METABOLIC RATE BOTH RELIABLE AND FEASIBLE IN COMMUNITY DIETETICS J.A. Langius1,2 , A. Steensma1 , C.X. Kaloter1 , P.M. Groen1 , F.M. Vlieland1 , W.A. Visser1 , D.W. Voskuil1 . 1 Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, 2 Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center Amsterdam, Amsterdam, Netherlands Rationale: Indirect calorimetry measuring O2 and CO2 is a standard but expensive way to assess energy expenditure. New portable and more affordable indirect calorimeters, measuring only O2, have improved accessibility for community dietetic practices (CDP). They are properly validated [1]. However, reliability and feasibility in CDP may be limited due to difficulties in keeping the strict (pre)measurement protocol. Objective: To assess test retest reliability of a desktop indirect calorimeter (FitMateRMR, Cosmed) in identical and different circumstances, and to study dietitians’ and clients’ perception of feasibility in CDP. Methods: Test retest reliability was studied by intra-class correlation coefficients (ICC) in a total of 70 healthy individuals under identical and different circumstances, i.e., fasting vs light breakfast, no vs light exercise, supine vs sitting position and morning vs afternoon. To study feasibility, 8 dietitians and 8 clients were interviewed after conducting and experiencing a RMR measurement resp. Semi-structured interviews were audio-recorded and transcribed. Data were analyzed thematically and segments of text were identified and labeled. Results: All ICC’s were higher than 0.70, suggesting sufficient reliability. The highest ICC (0.96; mean difference 44 kcal)
was found for repeated measurements under identical circumstances on the same day. The lowest ICC (0.71; mean difference 141 kcal) was found for different circumstances (fasting vs non-fasting) on different days. Dietitians found RMR assessment applicable in their dietetic practice and expected it to improve personalized counseling. Clients experienced no barriers for RMR measurement and expected it to increase their insight in energy balance and diet. Conclusion: Estimating RMR using the FitMateRMR is sufficiently to excellent reliable, and feasible to implement in CDP. References [1] Nieman et al, Res Sports Med 2006; 14: 89 96. Disclosure of Interest: None Declared.
PP178-SUN ENERGY EXPENDITURE PHENOTYPING IN RESPONSE TO LOW-INTENSITY PHYSICAL ACTIVITY IN UNTRAINED HUMANS: VALIDATION DURING LOW POWER CYCLING E.-J. Fares1 , L. Isacco1 , N. Charri` ere1 , J. Miles-Chan1 , 1 1 J.-P. Montani , Y. Schutz , A.G. Dulloo1 . 1 Department of Medicine, Division of Physiology, University of Fribourg, Fribourg, Switzerland Rationale: Standardized approaches to study human energy expenditure (EE) are well defined at rest (as basal metabolic rate and thermic effect of feeding), but not in relation to lowintensity physical activities compatible with daily life. Our aim was to develop and validate a standardized test, using the bicycle ergometer, for assessing the energy cost of lowintensity dynamic work by linear regression across the range of low power output cycling. Methods: EE was assessed by face-mask indirect calorimetry during cycling for 5 min each at no-load, 5W, 10W, 15W, 20W, 30W, 40W, 50W, and the steady-state EE were then plotted against power load. All studies were conducted in overnight fasted young healthy untrained men and women (n = 15) of normal BMI, and repeatability assessed in 6 subjects on 3 separate days for each subject. Results: Within the low power range of cycling, a strong linearity of the EE vs power relationship was observed between 10 50W for every subject (r > 0.98); the slope and its reciprocal delta efficiency (Mean: 28.3%, SD: 2.3%) showing low inter- and intra-individual variability, with the coefficient of variability (CV) being ~6%, independently of gender. Conclusion: This standardized and validated approach to study human delta efficiency in response to low-intensity cycling open up new avenues for research in human EE phenotyping with implications for research in metabolic predisposition to leanness and fatness. Disclosure of Interest: None Declared.