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SUN-P094: Plasma Proteomic Analysis of Intravenous Omega-3 Fatty Acid and Gemcitabine in Advanced Pancreatic Adenocarcinoma
S88 by liver diseases. Further studies are required to confirm these preliminary data. References 1. Purnak T, Yilmaz Y, Liver disease and malnutrition. Best Pract Res Clin Gastroenterol. 2013 Aug; 27:619–29. 2. Schütte K, et al. P.Malnutrition is a prognostic factor in patients with hepatocellular carcinoma (HCC). Clin Nutr. 2015 Dec;34:1122–7. Disclosure of Interest: E. Rinninella Grant/Research Support from: Fresenius, M. Cintoni: None declared, L. Basso: None declared, S. Leone: None declared, G. A. D. Miggiano: None declared, A. Gasbarrini: None declared, M. C. Mele Grant/Research Support from: Fresenius.
SUN-P092 ARE SERUM VITAMIN D LEVELS RELATED WITH COLORECTAL CANCER RISK? E. Yassıbaş1 *, G. Samur2, O. Toka3. 1Department of Nutrition and Dietetics, Gazi University, 2Department of Nutrition and Dietetics, 3Department of Statistics, Hacettepe University, Ankara, Turkey Rationale: Colorectal cancer is the third most common cancer in Turkey. Understanding the role of nutrition which is a modifiable risk factor in colorectal carcinogenesis is one of the primary prevention strategies and the most of studies has addressed the relationship between vitamin D and colorectal cancer risk. This research was planned and conducted to evaluate the relationship between serum vitamin D levels, nutrition, some lifestyle factors and colorectal cancer risk. Methods: Fifty one colorectal cancer patients who were diagnosed in last three months and 51 age and sex matched control who were not diagnosed cancer or colon diseases and have no family colorectal cancer history participated to this study. A questionnaire which include information about general characteristics, dietary habits and food consumption frequency was applied to all participants. Serum vitamin D levels were analysed from were obtained blood samples. Logistic regression analyse was made for the serum vitamin D levels. Results: As a result, mean serum vitamin D levels was 21.41 ± 12.90 ng/mL in colorectal cancer patients and 31.22 ± 19.05 ng/mL in controls. 10 ng/mL decrease in serum vitamin D levels increased colorectal cancer risk by 0.45 fold (OR:1.046, 95%CI:1.013–1.086). It was determined that serum vitamin D deficiency (<20 ng/mL) increase the colorectal cancer risk approximately 5.5 times (OR:5.452, 95%CI:1.909–15.568). It was not found significant association between body mass index, body fat percentage, dietary vitamin D intake and serum vitamin D levels in both groups. Conclusion: Developing strategies for achieve normal serum vitamin D levels and raising awareness of healthy nutrition of individuals are important to decrease colorectal cancer prevalence. Disclosure of Interest: None declared.
SUN-P093 APPROACHES AND KNOWLEDGE OF MEDICAL ONCOLOGISTS TO NUTRITION THERAPY: A QUESTIONNAIRE STUDY F. Kirbiyik1 *, E. Ozkan1, M. Ertugrul1. 1Nutricia Medical Nutrition, Istanbul, Turkey Rationale: Undernutiriton and cachexia, which are the indicators of poor prognosis, are common in oncology patients
Poster and nutrition therapy is an important cornerstone in the treatment of cancer patients. Nevertheless, it has been reported that malnutrition is often neglected, screening techniques are not sufficient, and there is insufficient consensus on malnutrition evaluation criteria. This study aimed to determine the awareness and knowledge of medical oncologists in Turkey about nutrition therapy, to evaluate their approaches to defining malnutrition and the importance of malnutrition in the treatment, to determine their educational status regarding clinical nutrition, and to investigate their educational expectations. Methods: A questionnaire form was used to obtain demographic and occupational information of the physicians as well as their knowledge, attitudes, and behaviors about clinical nutrition education through two scenario cases. Results: Among the physicians who answered the questionnaire (n = 109), 43.1% reported that they had clinical nutrition education and 33.9% followed the oncology sections in the ESPEN guidelines. A scoring system was established according to the answers given to the knowledge questions by the physicians. There were 31 (28.4%) physicians with a knowledge score of <3 and 78 (71.6%) physicians with a knowledge score of ≥3 (higher level of knowledge). The rate of physicians having clinical nutrition education and the rate of physicians following the oncology sections in the ESPEN guidelines were significantly higher among those with a score of ≥3 as compared with those with a score of <3. Conclusion: Our findings emphasized the importance of education and suggested that routine use of clinical nutrition would be more frequent as the knowledge and awareness of physicians increases. Disclosure of Interest: F. Kirbiyik Other: Employee of Nutricia Medical Nutrition, Turkey, E. Ozkan Other: Employee of Nutricia Medical Nutrition, Turkey, M. Ertugrul Other: Employee of Nutricia Medical Nutrition, Turkey.
SUN-P094 PLASMA PROTEOMIC ANALYSIS OF INTRAVENOUS OMEGA-3 FATTY ACID AND GEMCITABINE IN ADVANCED PANCREATIC ADENOCARCINOMA F. Runau1 *, A. Arshad1, J. Isherwood1, D. Jones2, A. Dennison1. 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, 2Department of Cancer Studies, University of Leicester, Leicester, United Kingdom Rationale: Intravenous omega-3 fatty acid (n-3FA) for advanced pancreatic adenocarcinoma patients receiving gemcitabine chemotherapy shows disease stabilisation and improved progression free survival. Utilising high definition plasma proteomics we aimed to elucidate the underlying biological mechanism. Methods: Plasma from 13 patients with histologically confirmed un-resectable pancreatic adenocarcinoma, collected pre-treatment (baseline, n = 3), after one month treatment with intravenous gemcitabine and n-3FA (treatment, n = 5) and intravenous gemcitabine only (control, n = 5). Plasma was 99% immuno-depleted, reduced, alkylated and tryptically digested. A 2 × 2 (baseline vs treatment, treatment vs control group) experimental design where each individual sample was labelled with TMT-6plex, then combined for high-pH reversedphase fractionation. Fractions were injected into a QExactive-
Nutrition and cancer 1 Orbitrap LC-MS/MS and analysed on Proteome Discoverer 2.1 and Scaffold 4.7. Bioinformatic analysis was performed on Protein Centre for Gene Ontology Biological Process (GO-BP: p < 0.05, Bonferroni corrected), Cytoscape for visualisation and KEGG pathway analysis. Results: 3,476 proteins were identified with 125 significant pancreatic cancer markers. Anti-inflammatory markers (CRP, Haptoglobin and Serum amyloid A1) were reduced in the treatment group. GO-BP showed a reduction in angiogenesis, upregulation of complement immune systems and epigenetic modifications on histones. KEGG pathway analysis identified direct action via the Pi3K-AKT pathway, with decreased HSP90 and increased inhibitory protein 14-3-3. Serum amyloid A1 was significantly reduced ( p < 0.01) as a potential biomarker of efficacy for n-3FA. Conclusion: Administration of n-3FA has anti-inflammatory, anti-angiogenic and pro-apoptotic effect via direct mechanism on cancer signalling pathways in patients with advanced pancreatic adenocarcinoma. Disclosure of Interest: None declared.
SUN-P095 MALNUTRITION AND FAT FREE MASS INDEX IN ONCOLOGIC PATIENTS AND ITS ASSOCIATION WITH LENGTH OF HOSPITAL STAY AND MORTALITY F. J. Sanchez-Torralvo1, V. Contreras-Bolivar1, G. Olveira1 *, M. Ruiz-Vico2, J. Abuin-Fernandez1, I. Lopez-Martinez2, M. Gonzalo1. 1Endocrinología y Nutrición, 2Oncología Médica, Hospital Regional Universitario de Malaga, Malaga, Spain Rationale: Malnutrition and cancer cachexia occur up to in 50% of oncologic patients. Latest ESPEN guidelines have established cut-off points according to fat free mass index (FFMI) as a criteria of malnutrition: 17 kg/m2 for men and 15 kg/m2 for women. Methods: Objective: To study the association between FFMI and Subjective Global Assessment test (SGA) in admitted patients with solid and hematologic neoplasms and to associate nutritional status with length of hospital stay and mortality. Prospective study, in hospitalised patients in Oncology and Hematology between August 2016 and February 2017. A complete nutritional assessment was carried out and anthropometric data was gathered. Results: 153 patients, 51.6% men and 48.4% women, aged 60.6 ± 12.5 years. BMI was 24.42 ± 4.5 kg/m2, with FFMI of 16.23 ± 2.38 kg/m2 (16.8 ± 2.13 kg/m2 for men y 15.63 ± 2.49 kg/m2 for women). SGA found 19.5% of normo-nourished, 24.8% of moderately malnourished and 55.7% of severely malnourished. Stratifying according to SGA, mean FFMI in men was 18.69 kg/ m2 in normo-nourished, 16.63 kg/m2 in moderately malnourished and 16.21 kg/m2 in severely malnourished ( p = 0.001); whilst in women was 17.83 kg/m2 in normo-nourished, 15.92 kg/m2 in moderately malnourished and 14.75 kg/m2 in severely malnourished ( p = 0.001). Length of stay in patients with malnutrition criteria according to FFMI was 11.8 ± 6.3 days vs 8.3 ± 3 days in normo-nourished patients ( p = 0.008). A total of 28 deaths were registered: 22 in malnourished and 6 in normo-nourished ( p < 0.001).
S89 Conclusion: There is an association between SGA and FFMI. The prevalence of malnutrition according to FFMI is associated with prolongation of length of stay and mortality. Disclosure of Interest: F. Sanchez-Torralvo: None declared, V. Contreras-Bolivar Grant/Research Support from: ABBOTT-SANCYD, G. Olveira Grant/Research Support from: ABBOTT-SANCYD, M. RuizVico: None declared, J. Abuin-Fernandez: None declared, I. LopezMartinez: None declared, M. Gonzalo: None declared.
SUN-P096 NUTRITIONAL ASSESSMENT IN HOSPITALISED ONCOLOGIC PATIENTS V. Contreras-Bolivar1, F. Sanchez-Torralvo1, J. Abuin-Fernandez1, M. Ruiz-Vico2, I. Lopez-Martinez2, V. Doulatram-Gamgaram1, G. Olveira1 *. 1Endocrinologia y Nutricion, 2Oncologia Medica, Hospital Regional Universitario De Malaga, Málaga, Spain Rationale: To determine the prevalence of malnutrition in hospitalised oncologic patients in our environment. Assess the use of quadriceps dynamometer as an alternative to handgrip. Relate FFMI, BMI and dynamometry with cut-off points established by ESPEN. Methods: Cross-sectional study, in hospitalised patients in Oncology and Hematology between August and February of 2017. Subjective Global Assessment test (SGA), anthropometric data and muscular strength with handgrip (Jamar) and quadriceps dynamometer (Commander) were determined. FFM was calculated with Durnin and Siri formulae. Results: 153 patients, 79.7% admitted in Oncology (122) and 20.3% in Hematology (31). 51.6% men and 48.4% women, aged 60.6 ± 12.5 years. BMI was 24.52 ± 4.5 kg/m2, with LBMI of 16.23 ± 2.38 g/m2 (16.8 ± 2.13 kg/m2 for men and 15.63 ± 2.49 kg/m2 for women). We found positive correlation between quadriceps dynamometry of both legs (r = 0.928; p < 0.001), as well as between handgrip and quadriceps dynamometry (r = 0.546 and 0.549; left and right respectively; p < 0.001). Positive correlation was found between handgrip dynamometry and LBMI (r = 0.279, p = 0.005). Malnourished patients according to BMI obtained lesser dynamometry values than normo-nourished in handgrip (22.9 ± 9.2 kg vs 18.8 ± 7.7 kg; p = 0.02) and in quadriceps (13.2 ± 5.1 kg vs 10.5 ± 5.4 kg; p = 0.009). No statistical differences were found out stratifying nutritional status according to LBMI. Conclusion: Malnutrition prevalence amongst our series was high. There is correlation between handgrip and quadriceps strength measured by dynamometry. Quadriceps dynamometry can be considered as an alternative to handgrip. Patients with malnutrition criteria according to BMI presented less muscular strength. Disclosure of Interest: V. Contreras-Bolivar Grant/Research Support from: Abbot-SANCYD, F. Sanchez-Torralvo: None declared, J. AbuinFernandez: None declared, M. Ruiz-Vico: None declared, I. LopezMartinez: None declared, V. Doulatram-Gamgaram: None declared, G. Olveira Grant/Research Support from: Abbot-SANCYD.
SUN-P092 ARE SERUM VITAMIN D LEVELS RELATED WITH COLORECTAL CANCER RISK? E. Yassıbaş1 *, G. Samur2, O. Toka3. 1Department of Nutrition and Dietetics, Gazi University, 2Department of Nutrition and Dietetics, 3Department of Statistics, Hacettepe University, Ankara, Turkey Rationale: Colorectal cancer is the third most common cancer in Turkey. Understanding the role of nutrition which is a modifiable risk factor in colorectal carcinogenesis is one of the primary prevention strategies and the most of studies has addressed the relationship between vitamin D and colorectal cancer risk. This research was planned and conducted to evaluate the relationship between serum vitamin D levels, nutrition, some lifestyle factors and colorectal cancer risk. Methods: Fifty one colorectal cancer patients who were diagnosed in last three months and 51 age and sex matched control who were not diagnosed cancer or colon diseases and have no family colorectal cancer history participated to this study. A questionnaire which include information about general characteristics, dietary habits and food consumption frequency was applied to all participants. Serum vitamin D levels were analysed from were obtained blood samples. Logistic regression analyse was made for the serum vitamin D levels. Results: As a result, mean serum vitamin D levels was 21.41 ± 12.90 ng/mL in colorectal cancer patients and 31.22 ± 19.05 ng/mL in controls. 10 ng/mL decrease in serum vitamin D levels increased colorectal cancer risk by 0.45 fold (OR:1.046, 95%CI:1.013–1.086). It was determined that serum vitamin D deficiency (<20 ng/mL) increase the colorectal cancer risk approximately 5.5 times (OR:5.452, 95%CI:1.909–15.568). It was not found significant association between body mass index, body fat percentage, dietary vitamin D intake and serum vitamin D levels in both groups. Conclusion: Developing strategies for achieve normal serum vitamin D levels and raising awareness of healthy nutrition of individuals are important to decrease colorectal cancer prevalence. Disclosure of Interest: None declared.
SUN-P093 APPROACHES AND KNOWLEDGE OF MEDICAL ONCOLOGISTS TO NUTRITION THERAPY: A QUESTIONNAIRE STUDY F. Kirbiyik1 *, E. Ozkan1, M. Ertugrul1. 1Nutricia Medical Nutrition, Istanbul, Turkey Rationale: Undernutiriton and cachexia, which are the indicators of poor prognosis, are common in oncology patients
Poster and nutrition therapy is an important cornerstone in the treatment of cancer patients. Nevertheless, it has been reported that malnutrition is often neglected, screening techniques are not sufficient, and there is insufficient consensus on malnutrition evaluation criteria. This study aimed to determine the awareness and knowledge of medical oncologists in Turkey about nutrition therapy, to evaluate their approaches to defining malnutrition and the importance of malnutrition in the treatment, to determine their educational status regarding clinical nutrition, and to investigate their educational expectations. Methods: A questionnaire form was used to obtain demographic and occupational information of the physicians as well as their knowledge, attitudes, and behaviors about clinical nutrition education through two scenario cases. Results: Among the physicians who answered the questionnaire (n = 109), 43.1% reported that they had clinical nutrition education and 33.9% followed the oncology sections in the ESPEN guidelines. A scoring system was established according to the answers given to the knowledge questions by the physicians. There were 31 (28.4%) physicians with a knowledge score of <3 and 78 (71.6%) physicians with a knowledge score of ≥3 (higher level of knowledge). The rate of physicians having clinical nutrition education and the rate of physicians following the oncology sections in the ESPEN guidelines were significantly higher among those with a score of ≥3 as compared with those with a score of <3. Conclusion: Our findings emphasized the importance of education and suggested that routine use of clinical nutrition would be more frequent as the knowledge and awareness of physicians increases. Disclosure of Interest: F. Kirbiyik Other: Employee of Nutricia Medical Nutrition, Turkey, E. Ozkan Other: Employee of Nutricia Medical Nutrition, Turkey, M. Ertugrul Other: Employee of Nutricia Medical Nutrition, Turkey.
SUN-P094 PLASMA PROTEOMIC ANALYSIS OF INTRAVENOUS OMEGA-3 FATTY ACID AND GEMCITABINE IN ADVANCED PANCREATIC ADENOCARCINOMA F. Runau1 *, A. Arshad1, J. Isherwood1, D. Jones2, A. Dennison1. 1 Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, 2Department of Cancer Studies, University of Leicester, Leicester, United Kingdom Rationale: Intravenous omega-3 fatty acid (n-3FA) for advanced pancreatic adenocarcinoma patients receiving gemcitabine chemotherapy shows disease stabilisation and improved progression free survival. Utilising high definition plasma proteomics we aimed to elucidate the underlying biological mechanism. Methods: Plasma from 13 patients with histologically confirmed un-resectable pancreatic adenocarcinoma, collected pre-treatment (baseline, n = 3), after one month treatment with intravenous gemcitabine and n-3FA (treatment, n = 5) and intravenous gemcitabine only (control, n = 5). Plasma was 99% immuno-depleted, reduced, alkylated and tryptically digested. A 2 × 2 (baseline vs treatment, treatment vs control group) experimental design where each individual sample was labelled with TMT-6plex, then combined for high-pH reversedphase fractionation. Fractions were injected into a QExactive-
Nutrition and cancer 1 Orbitrap LC-MS/MS and analysed on Proteome Discoverer 2.1 and Scaffold 4.7. Bioinformatic analysis was performed on Protein Centre for Gene Ontology Biological Process (GO-BP: p < 0.05, Bonferroni corrected), Cytoscape for visualisation and KEGG pathway analysis. Results: 3,476 proteins were identified with 125 significant pancreatic cancer markers. Anti-inflammatory markers (CRP, Haptoglobin and Serum amyloid A1) were reduced in the treatment group. GO-BP showed a reduction in angiogenesis, upregulation of complement immune systems and epigenetic modifications on histones. KEGG pathway analysis identified direct action via the Pi3K-AKT pathway, with decreased HSP90 and increased inhibitory protein 14-3-3. Serum amyloid A1 was significantly reduced ( p < 0.01) as a potential biomarker of efficacy for n-3FA. Conclusion: Administration of n-3FA has anti-inflammatory, anti-angiogenic and pro-apoptotic effect via direct mechanism on cancer signalling pathways in patients with advanced pancreatic adenocarcinoma. Disclosure of Interest: None declared.
SUN-P095 MALNUTRITION AND FAT FREE MASS INDEX IN ONCOLOGIC PATIENTS AND ITS ASSOCIATION WITH LENGTH OF HOSPITAL STAY AND MORTALITY F. J. Sanchez-Torralvo1, V. Contreras-Bolivar1, G. Olveira1 *, M. Ruiz-Vico2, J. Abuin-Fernandez1, I. Lopez-Martinez2, M. Gonzalo1. 1Endocrinología y Nutrición, 2Oncología Médica, Hospital Regional Universitario de Malaga, Malaga, Spain Rationale: Malnutrition and cancer cachexia occur up to in 50% of oncologic patients. Latest ESPEN guidelines have established cut-off points according to fat free mass index (FFMI) as a criteria of malnutrition: 17 kg/m2 for men and 15 kg/m2 for women. Methods: Objective: To study the association between FFMI and Subjective Global Assessment test (SGA) in admitted patients with solid and hematologic neoplasms and to associate nutritional status with length of hospital stay and mortality. Prospective study, in hospitalised patients in Oncology and Hematology between August 2016 and February 2017. A complete nutritional assessment was carried out and anthropometric data was gathered. Results: 153 patients, 51.6% men and 48.4% women, aged 60.6 ± 12.5 years. BMI was 24.42 ± 4.5 kg/m2, with FFMI of 16.23 ± 2.38 kg/m2 (16.8 ± 2.13 kg/m2 for men y 15.63 ± 2.49 kg/m2 for women). SGA found 19.5% of normo-nourished, 24.8% of moderately malnourished and 55.7% of severely malnourished. Stratifying according to SGA, mean FFMI in men was 18.69 kg/ m2 in normo-nourished, 16.63 kg/m2 in moderately malnourished and 16.21 kg/m2 in severely malnourished ( p = 0.001); whilst in women was 17.83 kg/m2 in normo-nourished, 15.92 kg/m2 in moderately malnourished and 14.75 kg/m2 in severely malnourished ( p = 0.001). Length of stay in patients with malnutrition criteria according to FFMI was 11.8 ± 6.3 days vs 8.3 ± 3 days in normo-nourished patients ( p = 0.008). A total of 28 deaths were registered: 22 in malnourished and 6 in normo-nourished ( p < 0.001).
S89 Conclusion: There is an association between SGA and FFMI. The prevalence of malnutrition according to FFMI is associated with prolongation of length of stay and mortality. Disclosure of Interest: F. Sanchez-Torralvo: None declared, V. Contreras-Bolivar Grant/Research Support from: ABBOTT-SANCYD, G. Olveira Grant/Research Support from: ABBOTT-SANCYD, M. RuizVico: None declared, J. Abuin-Fernandez: None declared, I. LopezMartinez: None declared, M. Gonzalo: None declared.
SUN-P096 NUTRITIONAL ASSESSMENT IN HOSPITALISED ONCOLOGIC PATIENTS V. Contreras-Bolivar1, F. Sanchez-Torralvo1, J. Abuin-Fernandez1, M. Ruiz-Vico2, I. Lopez-Martinez2, V. Doulatram-Gamgaram1, G. Olveira1 *. 1Endocrinologia y Nutricion, 2Oncologia Medica, Hospital Regional Universitario De Malaga, Málaga, Spain Rationale: To determine the prevalence of malnutrition in hospitalised oncologic patients in our environment. Assess the use of quadriceps dynamometer as an alternative to handgrip. Relate FFMI, BMI and dynamometry with cut-off points established by ESPEN. Methods: Cross-sectional study, in hospitalised patients in Oncology and Hematology between August and February of 2017. Subjective Global Assessment test (SGA), anthropometric data and muscular strength with handgrip (Jamar) and quadriceps dynamometer (Commander) were determined. FFM was calculated with Durnin and Siri formulae. Results: 153 patients, 79.7% admitted in Oncology (122) and 20.3% in Hematology (31). 51.6% men and 48.4% women, aged 60.6 ± 12.5 years. BMI was 24.52 ± 4.5 kg/m2, with LBMI of 16.23 ± 2.38 g/m2 (16.8 ± 2.13 kg/m2 for men and 15.63 ± 2.49 kg/m2 for women). We found positive correlation between quadriceps dynamometry of both legs (r = 0.928; p < 0.001), as well as between handgrip and quadriceps dynamometry (r = 0.546 and 0.549; left and right respectively; p < 0.001). Positive correlation was found between handgrip dynamometry and LBMI (r = 0.279, p = 0.005). Malnourished patients according to BMI obtained lesser dynamometry values than normo-nourished in handgrip (22.9 ± 9.2 kg vs 18.8 ± 7.7 kg; p = 0.02) and in quadriceps (13.2 ± 5.1 kg vs 10.5 ± 5.4 kg; p = 0.009). No statistical differences were found out stratifying nutritional status according to LBMI. Conclusion: Malnutrition prevalence amongst our series was high. There is correlation between handgrip and quadriceps strength measured by dynamometry. Quadriceps dynamometry can be considered as an alternative to handgrip. Patients with malnutrition criteria according to BMI presented less muscular strength. Disclosure of Interest: V. Contreras-Bolivar Grant/Research Support from: Abbot-SANCYD, F. Sanchez-Torralvo: None declared, J. AbuinFernandez: None declared, M. Ruiz-Vico: None declared, I. LopezMartinez: None declared, V. Doulatram-Gamgaram: None declared, G. Olveira Grant/Research Support from: Abbot-SANCYD.