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PP231-MON WEIGHT CHANGE AND BODY COMPOSITION IN THE MULTIMODALITY TREATMENT OF OBESE PATIENTS. CAN WEIGHT LOSS BE PREDICTED?
S208 PP230-MON IMPROVING THE PRIMARY-SPECIALTY CARE INTERFACE IN MORBID OBESITY: BEYOND THE DERIVATION CRITERIA M. Cay´ on1 , M.J. Luque2 , C. García-Figueras3 , R. L´ opez1 , I. Torres1 . 1 Endocrinology and Nutrition Unit, Hospital Sas de Jerez de la Frontera, 2 H.C. Las Delicias, Sanitary Area Jerez-Costa Noroeste Sierra de C´ adiz, 3 Internal Medicine Unit, Hospital Sas de Jerez de la Frontera, Jerez de la Frontera, Spain Rationale: A proper coordination between primary and specialty care is critical. The objectives of this study were to monitor the appropriateness of referrals due to morbid obesity made from Primary Care (PC) to an obesity unit (OU) and evaluate aspects that generalist physicians (GP) value most when assessment by OU is requested. Methods: Descriptive study of clinical characteristics of obese patients referred from PC to OU in a period of 3 months. “Appropriate referral” was considered if one of the following criteria was met: (A) Body mass index (BMI) 35 kg/m2 with comorbidities or (B) BMI 40 kg/m2 . Comorbidity was considered “newly diagnosed” if it was diagnosed at the visit prior to referral. Clinical aspects that GP value most for referring to OU were registered using an anonymous survey. Results: Data from 51 patients (58.8% female, mean BMI: 44.9±6.6 kg/m2 ) were recorded. The duration of obesity was over 10 years in 33%. 90.2% of the referrals were “adequate”. Prevalence of type 2 diabetes and dyslipidemia was 31.4% and 56.9% respectively and were the most newly diagnosed comorbidities (23.5%). The proportion of patients with comorbidities was not significantly different according to the criteria used (A or B). 75% of the GP requested to participate in survey, knew the referral criteria but, BMI 40 kg/m2 even without comorbidities, was the most ignored criterion. 40% of them chose BMI 50 kg/m2 as the primary reason for referral and 20% the need for bariatric surgery. 25% referred patients after 1 to 5 years of follow up. Conclusion: The appropriateness of referrals from PC to OU is high but, when patients are received in the OU, have very high BMI, chronic obesity and a high rate of newly diagnosed metabolic complications regardless of the criteria analyzed. This observation is consistent with the overall results of the survey. To disclose these results to GP would optimize the pattern of referrals. Disclosure of Interest: None Declared
PP231-MON WEIGHT CHANGE AND BODY COMPOSITION IN THE MULTIMODALITY TREATMENT OF OBESE PATIENTS. CAN WEIGHT LOSS BE PREDICTED? S. Wolf1 , S. Tomaschewsky2 , M.J. M¨ uller1 , A. Weimann2 . 1 Institute of Human Nutrition and Food Science, Christian-Albrechts-University, Kiel, 2 Obesity Study Group St George’s Hospital, Leipzig, Germany Rationale: Determination of the effectiveness of a structured multidisciplinary obesity therapy program on the basis of a temporary very-low-calorie-diet (liquid diet with 800 calories/day) in combination with the implantation of an intragastric balloon. Furthermore the weight change was predicted by a web-based calculation program [1] and
Poster presentations compared to the actual own data as well as data from the American College of Surgeons-Bariatric Surgery Center Network. [2] Methods: 75 overweight and obese patients [mean initial parameters: 142.4 kg, BMI 49.5 kg/m2 , 70.6 kg fat mass (FM), 69.1 kg fat-free mass (FFM)] were investigated before and six months (mths) after the treatment. In 51 patients (mean initial parameters: 136.6 kg, BMI 48.2 kg/m2 ) the weight change were observed again after one year. Statistical analysis: Wilcoxon test; p < 0.05. Results: After six months the body weight was reduced by 22.2 kg (15.7 percent) and after one year, there was no further significant weight loss (overall 17.2 percent). Besides the patients reduces their FM by 28.1 percent and their FFM by 8.7 percent. In addition, the predicted weight loss was after six mths 7.7 percent and after twelve mths 25.0 percent lower than the actual weight. Conclusion: The intervention program indicates a good initial weight loss, followed by weight stabilization. The actual weight loss and BMI reduction could not be predicted by the simulated data from the calculation program. These findings might be explained by metabolic adaptation during weight loss, which could be underestimated by the simulation formula. This was also confirmed by the bariatric surgery data (2). References [1] Hall et al Lancet 2011; 378: 826 37 [2] Hutter et al Ann Surg 2011; 254: 410 22 Disclosure of Interest: None Declared
PP232-MON NUTRITIONAL STATUS OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME TREATED BY POSITIVE AIRWAY PRESSURE P. Jesus1,2 , V. Arnold3 , P. Fayemendy4 , P. Samptiaux3 , B. Melloni5 , J.C. Desport1,2,4 . 1 Regional Care Centre for Severe Obesity, University Hospital, 2 INSERM UMR1094, Neuroepidemiology, School of Medicine, 3 ALAIR & AVD, ALAIR & AVD, 4 Nutrition Unit, 5 Department of respiratory pathology, University Hospital, Limoges, France Rationale: Obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography Apnea Hypopnea Index (AHI) 5/h of sleep, is common (5 10% of adults). It is often treated with PAP. Aims of the study were i) to assess the nutritional status of patients with OSAS treated by PAP and supported by a care giver at home ii) to look for a link between nutritional status and OSAS after a long positive airway pressure (PAP) treatment. Methods: AHI was recorded when PAP was established. After a 66.4±45.9 months, one collected AHI, Epworth’s sleepiness scale (up to 15, normal <8), compliance (h), weight, body mass index (BMI). Results: PAP at home was set in 435 patients with initial AHI at 52.8±25.9. At the final assessment, they were aged 63.8±10.4 years, with a sex ratio M/F at 3.7 and a BMI at 33.5±6.1. Nutritional status was normal in 5.7% of cases, 23.0% of patients were overweighted, 71.3% were obese (massive obesity: 12.9%). AHI decreased to 4.0±4.0 (p < 0.0001), Epworth’s scale was at 4.3±3.0 and observance at 7.1±1.8 hours. For sleep, alertness, memory and headache,
PP231-MON WEIGHT CHANGE AND BODY COMPOSITION IN THE MULTIMODALITY TREATMENT OF OBESE PATIENTS. CAN WEIGHT LOSS BE PREDICTED? S. Wolf1 , S. Tomaschewsky2 , M.J. M¨ uller1 , A. Weimann2 . 1 Institute of Human Nutrition and Food Science, Christian-Albrechts-University, Kiel, 2 Obesity Study Group St George’s Hospital, Leipzig, Germany Rationale: Determination of the effectiveness of a structured multidisciplinary obesity therapy program on the basis of a temporary very-low-calorie-diet (liquid diet with 800 calories/day) in combination with the implantation of an intragastric balloon. Furthermore the weight change was predicted by a web-based calculation program [1] and
Poster presentations compared to the actual own data as well as data from the American College of Surgeons-Bariatric Surgery Center Network. [2] Methods: 75 overweight and obese patients [mean initial parameters: 142.4 kg, BMI 49.5 kg/m2 , 70.6 kg fat mass (FM), 69.1 kg fat-free mass (FFM)] were investigated before and six months (mths) after the treatment. In 51 patients (mean initial parameters: 136.6 kg, BMI 48.2 kg/m2 ) the weight change were observed again after one year. Statistical analysis: Wilcoxon test; p < 0.05. Results: After six months the body weight was reduced by 22.2 kg (15.7 percent) and after one year, there was no further significant weight loss (overall 17.2 percent). Besides the patients reduces their FM by 28.1 percent and their FFM by 8.7 percent. In addition, the predicted weight loss was after six mths 7.7 percent and after twelve mths 25.0 percent lower than the actual weight. Conclusion: The intervention program indicates a good initial weight loss, followed by weight stabilization. The actual weight loss and BMI reduction could not be predicted by the simulated data from the calculation program. These findings might be explained by metabolic adaptation during weight loss, which could be underestimated by the simulation formula. This was also confirmed by the bariatric surgery data (2). References [1] Hall et al Lancet 2011; 378: 826 37 [2] Hutter et al Ann Surg 2011; 254: 410 22 Disclosure of Interest: None Declared
PP232-MON NUTRITIONAL STATUS OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME TREATED BY POSITIVE AIRWAY PRESSURE P. Jesus1,2 , V. Arnold3 , P. Fayemendy4 , P. Samptiaux3 , B. Melloni5 , J.C. Desport1,2,4 . 1 Regional Care Centre for Severe Obesity, University Hospital, 2 INSERM UMR1094, Neuroepidemiology, School of Medicine, 3 ALAIR & AVD, ALAIR & AVD, 4 Nutrition Unit, 5 Department of respiratory pathology, University Hospital, Limoges, France Rationale: Obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography Apnea Hypopnea Index (AHI) 5/h of sleep, is common (5 10% of adults). It is often treated with PAP. Aims of the study were i) to assess the nutritional status of patients with OSAS treated by PAP and supported by a care giver at home ii) to look for a link between nutritional status and OSAS after a long positive airway pressure (PAP) treatment. Methods: AHI was recorded when PAP was established. After a 66.4±45.9 months, one collected AHI, Epworth’s sleepiness scale (up to 15, normal <8), compliance (h), weight, body mass index (BMI). Results: PAP at home was set in 435 patients with initial AHI at 52.8±25.9. At the final assessment, they were aged 63.8±10.4 years, with a sex ratio M/F at 3.7 and a BMI at 33.5±6.1. Nutritional status was normal in 5.7% of cases, 23.0% of patients were overweighted, 71.3% were obese (massive obesity: 12.9%). AHI decreased to 4.0±4.0 (p < 0.0001), Epworth’s scale was at 4.3±3.0 and observance at 7.1±1.8 hours. For sleep, alertness, memory and headache,