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PP228-SUN IS CITRULLINE A MARKER OF SMALL INTESTINAL ABSORPTION? A SYSTEMATIC REVIEW AND META- ANALYSIS
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Poster presentations
PP227-SUN EFFECT OF PARENTERAL GLUTAMINE SUPPLEMENT ON TOTAL LYMPHOCYTE COUNT IN BLOOD IN SURGICAL PATIENTS I. Yeste Gomez1 , R.M. Romero Jimenez1 , V. Escudero Vilaplana1 , B. Marzal Alfaro1 , A. De Lorenzo Pinto1 , I. Garcia Lopez1 , L. Cortejoso Fernandez1 , I. Ansoleaga De Santiago1 , M. Sanjurjo Saez1 . 1 Pharmacy, Hospital General Universitario Gregorio Mara˜ non, Madrid, Spain Rationale: In vitro, glutamine is essential for the proliferation of a variety of rapidly dividing cells, including lymphocytes. The aim of this study was to analyze the effect of parenteral glutamine supplement on total lymphocyte count in blood in surgical patients. Methods: Observational study performed from January 1 to December 31 2010. Study Population: Surgical patients who started parenteral nutrition during the study period with lymphocyte counts below normal (<1.3 10E3/mL). Patients were divided into two groups: 1. Glutamine group: patients who received parenteral nutrition supplemented with glutamine for 7 days. 2. Control group: patients who received parenteral nutrition without glutamine. We recorded lymphocyte counts at the start of parenteral nutrition and after 7 days. We calculated the variation in the count in both groups and applied the Mann-Whitney test to identify significant differences between them. Data were collected from the software used to prepare parenteral nutrition (Multicomp® ) and the clinical documentation program. The statistical analysis was performed using SPSS® . Results: The glutamine group comprised 55 patients and the control group 56 patients. The average increase in lymphocyte count was 0.42 10E3/mL in the glutamine group and 0.302 10E3/mL in the control group. Increment Mann-Whitney Wilcoxon Z Asymptotic significance (2-tailed)
1495.500 3091.500 0.264 0.792
Conclusion: Although there was a greater increase in the lymphocyte count in the glutamine group, the difference was not statistically significant. Disclosure of Interest: None Declared
PP228-SUN IS CITRULLINE A MARKER OF SMALL INTESTINAL ABSORPTION? A SYSTEMATIC REVIEW AND METAANALYSIS K.C. Fragkos1 , A. Forbes1 . 1 Centre for Gastroenterology and Nutrition, University College London, London, United Kingdom Rationale: Although citrulline appears to be a marker of enterocyte mass, it is not clear whether it functions as a successful absorption biomarker. The aim of this paper is to synthesize quantitative data from the available nutrition literature. Methods: A systematic literature review was performed in Pubmed, EMBASE and Google Scholar. All studies (full
papers and abstracts) reporting correlation coefficients (CCs) of citrulline plasma levels with absorptive markers were taken into consideration. A random-effects model was employed to produce a pooled estimate of CCs, which was the effect size in the current analysis. Fisher’s Z transformation of the CCs was needed for the analysis. All computations were executed with Stata 10.0. Results: We identified 202 studies in our search and only 8 were eligible for meta-analysis (n = 327). Studies included patients with short bowel syndrome, celiac disease and who had undergone anti-neoplastic treatment. The pooled CC of citrulline levels with carbohydrates absorption, mainly quantified by D-xylose test, was 0.326 (95% CI 0.166 0.507, n = 7, range 0.047 0.560); with protein absorption the pooled estimate was 0.293 (95% CI 0.107 0.460, n = 5, range 0.053 0.480). Publication bias was not present in either analyses (Egger’s test p > 0.05), however Failsafe N was only 28 in the carbohydrate absorption estimate and 7 in protein absorption estimate. Heterogeneity was also not present in both analyses (Q = 7.23, df = 6, p = 0.300; I2 = 17.0%, t = 0.09; Q = 6.03, df = 4, p = 0.197; I2 = 33.6%, t = 0.13). Conclusion: Although a previous meta-analysis of ours supports that citrulline is a marker of enterocyte mass, it is not clear whether static measurements of citrulline reflect absorption. This implies a need for studies examining the absorptive capacity per se of citrulline measurements with better experimental designs. Disclosure of Interest: None Declared
PP229-SUN PROTEIN REQUIREMENTS IN PATIENTS WITH 15% OR MORE BURNED SURFACE AREA (BSA) L.H. Jakobsen1 , J. Astrup2 , J. Kondrup1 . 1 Nutritional Unit, 2 Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen Oe, Denmark Rationale: Provision of protein reduces net protein catabolism. We have estimated protein requirements based on urinary urea excretion in 174 n patients with moderate to severe BSA. Methods: All adult patients with 15% BSA received nutritional therapy. Energy requirements were calculated by the Sutherland formula. Protein requirement was calculated as: urinary urea (mmol/day)×0.18+25, where 0.18 converts urea to proteinequivalents and 25 represents estimated protein-N losses from faeces, skin and miscellaneous. Datafrom 174 consecutive patients have been collected since 1998. Of these, 34 patients were also weighed at the end of nutritional therapy. The initial weight was either estimated or obtained from patients. Results: Protein requirement was (134+4.2)/75.1 = 1.84 g protein/kg BW per day, where 134 is protein loss calculated from urinary urea, 4.2 is the negative protein balance and 75.1 is initial BW (table). The wound protein loss (g protein/kg BW per day) can be estimated from the observed loss of BW in the 34 patients: (4668×0.71×0.21)/28.8 17.5)/78.9 = 0.08 g protein/kg BW per day, where 4668 is observed BW loss (g), 0.71 converts to lean body mass (LBM), 0.21 converts to protein in LBM, 28.8 is days in nutritional therapy, 17.5 is the observed negative protein balance and 78.9 is initial BW.
Poster presentations
PP227-SUN EFFECT OF PARENTERAL GLUTAMINE SUPPLEMENT ON TOTAL LYMPHOCYTE COUNT IN BLOOD IN SURGICAL PATIENTS I. Yeste Gomez1 , R.M. Romero Jimenez1 , V. Escudero Vilaplana1 , B. Marzal Alfaro1 , A. De Lorenzo Pinto1 , I. Garcia Lopez1 , L. Cortejoso Fernandez1 , I. Ansoleaga De Santiago1 , M. Sanjurjo Saez1 . 1 Pharmacy, Hospital General Universitario Gregorio Mara˜ non, Madrid, Spain Rationale: In vitro, glutamine is essential for the proliferation of a variety of rapidly dividing cells, including lymphocytes. The aim of this study was to analyze the effect of parenteral glutamine supplement on total lymphocyte count in blood in surgical patients. Methods: Observational study performed from January 1 to December 31 2010. Study Population: Surgical patients who started parenteral nutrition during the study period with lymphocyte counts below normal (<1.3 10E3/mL). Patients were divided into two groups: 1. Glutamine group: patients who received parenteral nutrition supplemented with glutamine for 7 days. 2. Control group: patients who received parenteral nutrition without glutamine. We recorded lymphocyte counts at the start of parenteral nutrition and after 7 days. We calculated the variation in the count in both groups and applied the Mann-Whitney test to identify significant differences between them. Data were collected from the software used to prepare parenteral nutrition (Multicomp® ) and the clinical documentation program. The statistical analysis was performed using SPSS® . Results: The glutamine group comprised 55 patients and the control group 56 patients. The average increase in lymphocyte count was 0.42 10E3/mL in the glutamine group and 0.302 10E3/mL in the control group. Increment Mann-Whitney Wilcoxon Z Asymptotic significance (2-tailed)
1495.500 3091.500 0.264 0.792
Conclusion: Although there was a greater increase in the lymphocyte count in the glutamine group, the difference was not statistically significant. Disclosure of Interest: None Declared
PP228-SUN IS CITRULLINE A MARKER OF SMALL INTESTINAL ABSORPTION? A SYSTEMATIC REVIEW AND METAANALYSIS K.C. Fragkos1 , A. Forbes1 . 1 Centre for Gastroenterology and Nutrition, University College London, London, United Kingdom Rationale: Although citrulline appears to be a marker of enterocyte mass, it is not clear whether it functions as a successful absorption biomarker. The aim of this paper is to synthesize quantitative data from the available nutrition literature. Methods: A systematic literature review was performed in Pubmed, EMBASE and Google Scholar. All studies (full
papers and abstracts) reporting correlation coefficients (CCs) of citrulline plasma levels with absorptive markers were taken into consideration. A random-effects model was employed to produce a pooled estimate of CCs, which was the effect size in the current analysis. Fisher’s Z transformation of the CCs was needed for the analysis. All computations were executed with Stata 10.0. Results: We identified 202 studies in our search and only 8 were eligible for meta-analysis (n = 327). Studies included patients with short bowel syndrome, celiac disease and who had undergone anti-neoplastic treatment. The pooled CC of citrulline levels with carbohydrates absorption, mainly quantified by D-xylose test, was 0.326 (95% CI 0.166 0.507, n = 7, range 0.047 0.560); with protein absorption the pooled estimate was 0.293 (95% CI 0.107 0.460, n = 5, range 0.053 0.480). Publication bias was not present in either analyses (Egger’s test p > 0.05), however Failsafe N was only 28 in the carbohydrate absorption estimate and 7 in protein absorption estimate. Heterogeneity was also not present in both analyses (Q = 7.23, df = 6, p = 0.300; I2 = 17.0%, t = 0.09; Q = 6.03, df = 4, p = 0.197; I2 = 33.6%, t = 0.13). Conclusion: Although a previous meta-analysis of ours supports that citrulline is a marker of enterocyte mass, it is not clear whether static measurements of citrulline reflect absorption. This implies a need for studies examining the absorptive capacity per se of citrulline measurements with better experimental designs. Disclosure of Interest: None Declared
PP229-SUN PROTEIN REQUIREMENTS IN PATIENTS WITH 15% OR MORE BURNED SURFACE AREA (BSA) L.H. Jakobsen1 , J. Astrup2 , J. Kondrup1 . 1 Nutritional Unit, 2 Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen Oe, Denmark Rationale: Provision of protein reduces net protein catabolism. We have estimated protein requirements based on urinary urea excretion in 174 n patients with moderate to severe BSA. Methods: All adult patients with 15% BSA received nutritional therapy. Energy requirements were calculated by the Sutherland formula. Protein requirement was calculated as: urinary urea (mmol/day)×0.18+25, where 0.18 converts urea to proteinequivalents and 25 represents estimated protein-N losses from faeces, skin and miscellaneous. Datafrom 174 consecutive patients have been collected since 1998. Of these, 34 patients were also weighed at the end of nutritional therapy. The initial weight was either estimated or obtained from patients. Results: Protein requirement was (134+4.2)/75.1 = 1.84 g protein/kg BW per day, where 134 is protein loss calculated from urinary urea, 4.2 is the negative protein balance and 75.1 is initial BW (table). The wound protein loss (g protein/kg BW per day) can be estimated from the observed loss of BW in the 34 patients: (4668×0.71×0.21)/28.8 17.5)/78.9 = 0.08 g protein/kg BW per day, where 4668 is observed BW loss (g), 0.71 converts to lean body mass (LBM), 0.21 converts to protein in LBM, 28.8 is days in nutritional therapy, 17.5 is the observed negative protein balance and 78.9 is initial BW.