SUN-P205: Indication and Prescription of Oral Nutritional Supplements in a Swiss University Hospital

Nutritional assessment 1

S129

SUN-P203 DIAGNOSTIC ACCURACY OF THE PG-SGA SHORT FORM AND NRS 2002 IN INTERNAL MEDICINE WARD J. Pinho1 *, R. Marinho2, J. Silveira3, S. G. Silva4, A. Amado5, A. Pessoa6, J. Rosinhas7, M. Lopes8, F. D. Ottery9,10, H. Jager-Wittenaar9,11, A. Marinho12, on behalf of APNEP Nutrition and Internal Medicine Working Group. 1Nutrition Services, CHMA, EPE, 2Internal Medicine Service, Centro Hospitalar do Porto, 3Nutrition Services, Eurico de Almeida, ORL Clinic, Porto, 4Nutrition Services, BioParadigma, Integrative Medicine Clinic, Barcelos, 5Nutrition Services, PortugalFoods, 6Internal Medicine Service, CHMA, EPE, Porto, 7 Internal Medicine Service, Unidade Local de Saúde de Matosinhos, Matosinhos, 8Hemato-Oncology Service, Centro Hospitalar do Porto, Porto, Portugal, 9Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands, 10Ottery & Associates, Vernon Hills (Chicago), United States, 11 Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands, 12Intensive Care Department, Centro Hospitalar do Porto, Porto, Portugal Rationale: The PG-SGA is a validated instrument to assess malnutrition and its risk factors. Its patient component, i.e. the PG-SGA Short Form (SF), can be used as screening instrument. In this multicenter study, we aimed to assess diagnostic accuracy of the PG-SGA SF and NRS 2002, in patients at the Internal Medicine ward. Methods: In 192 patients (76.0 ± 13.5 years; 53% female) in 9 Portuguese internal medicine wards, malnutrition risk was assessed by PG-SGA SF and NRS 2002. PG-SGA SF ≤8 was defined as low/medium malnutrition risk and NRS 2002 ≤2 as low risk. PG-SGA SF ≥9 and NRS 2002 ≥3 were defined as high malnutrition risk. Nutritional status was assessed by the full PG-SGA (reference method). Malnutrition was defined as PGSGA Stage B (moderate/suspected malnutrition) or Stage C (severely malnourished). Diagnostic accuracy was tested by sensitivity, specificity, positive and negative predictive value, and receiver operating curve. Agreement between PG-SGA and NRS-2002 was tested by McNemar’s test and Cohen’s kappa (κ). Results: Forty-six % and 53% were categorized as at risk of malnutrition by PG-SGA SF and NRS 2002, respectively. In total, 55% were malnourished. Sensitivity, specificity, positive and negative predictive value of PG-SGA SF and NRS 2002 were 0.84, 1.00, 1.00, 0.83 and 0.74, 0.74, 0.77 and 0.70, respectively. Area under curve of PG-SGA SF and NRS 2002 was 0.987 and 0.778 respectively. McNemar’s test showed no significant disagreement ( p = 0.86) between PG-SGA SF and NRS 2002. Cohen’s kappa showed weak agreement (κ=0.492; p < 0.001) (Table 1). Table 1: Agreement between PG-SGA SF and NRS 2002.

PG-SGA SF Low/medium risk PG-SGA SF High risk Total

NRS 2002 Low risk

NRS 2002 High risk

73 18 91

31 70 101

Total 104 88 192

Conclusion: Our findings indicate that in patients at the internal medicine ward, PG-SGA SF shows better diagnostic accuracy than NRS 2002, i.e. better sensitivity and specificity.

Disclosure of Interest: J. Pinho: None declared, R. Marinho: None declared, J. Silveira: None declared, S. Silva: None declared, A. Amado: None declared, A. Pessoa: None declared, J. Rosinhas: None declared, M. Lopes: None declared, F. Ottery Other: Copyright holder of the Patient-Generated Subjective Global Assessment (PGSGA), co-owner and co-developer of the PG-SGA based Pt-Global app, H. Jager-Wittenaar Other: Co-developer of the PG-SGA based Pt-Global app, A. Marinho: None declared.

SUN-P204 VALIDATION OF BIO-ELECTRICAL IMPEDANCE ANALYSIS TO ASSESS SARCOPENIA IN OLDER ADULTS J. V. D. Helder1 *, I. Jansen1, S. Kruijning1, C. Dronkelaar1, R. Engelbert2,3, M. Tieland1, P. Weijs1,4. 1Faculty of Sports and Nutrition, 2Faculty of Health, Amsterdam University of Applied Sciences, 3Department of Rehabilitation, Academic Medical Center, 4Nutrition and Dietetics, VU University Medical Center, Amsterdam, Netherlands Rationale: The increasing aging population causes sarcopenia to be a rising phenomenon. Sarcopenia can be indicated by whole body or low fat free mass (FFM). An easy, cheap and feasible technique to measure these variables is bio-electrical impedance analysis (BIA). The aim of this study was to validate FFM measurements by BIA with dual energy X-ray absorptiometry (DXA). Methods: Older adults included into the VITAMINE trial were assessed at baseline for whole body and appendicular FFM by BIA (Tanita MC-780; 8-polar) and DXA (Hologic A). Pearsoncorrelation was used to determine correlation between the FFM of the BIA and DXA. The paired t-test was used to determine whether there was a significant difference between the two techniques. Agreement between the two techniques was assessed by the Bland-Altman plot. Results: Included were 45 older adults. Correlation between whole body FFM by BIA and DXA was high (r = 0.952, p < 0.0001). Whole body FFM by BIAwas not different from DXA (47.71 ± 6.78 vs 47.87 ± 6.14, p = 0.615). However, Bland-Altman plot showed wide limits of agreement (LoA-3.94, 4.25). Appendicular FFM of the BIA was significantly associated with appendicular FFM of DXA (r = 0.934, p < 0.0001). Appendicular FFM by BIA was significantly lower by 2.2% than from DXA (19.94 ± 2.81 vs 20.38 ± 3.33, p = 0.019). Bland-Altman plot showed wide limits of agreement (LoA −1.96, 2.84). Conclusion: The Tanita MC-780 appears to be accurate for sarcopenia diagnosis on group level, however variation is high for individual level. Disclosure of Interest: None declared.

SUN-P205 INDICATION AND PRESCRIPTION OF ORAL NUTRITIONAL SUPPLEMENTS IN A SWISS UNIVERSITY HOSPITAL J. Mareschal1 *, J. Altwegg2, D. Berthet3, M. Chikhi1, P. Chopard4, S. Graf1, C. Sierro5, C. Pichard1, L. Genton1. 1 Nutrition Unit, Geneva University Hospitals, Geneva, 2 Nutradom - Homecare, Cortaillod, 3On behalf of Fresucare Homecare, 4Division of Quality of Care, Geneva University Hospitals, Geneva, 5Proximos - Homecare, Carouge, Switzerland Rationale: Oral nutritional supplements (ONS) are a simple and effective medical treatment of nutritional risk. In our hospital,

S130 ONS can be provided on medical prescription or on the caregivers’ personal initiative. At discharge for home, in Switzerland, a Nutrition Risk Screening-2002 (NRS-2002) ≥ 3, a medical prescription and an ONS delivery at the patient’s home by a homecare service are required for the reimbursement of ONS by the public insurance. This survey aimed at documenting: (1) the adequacy and existence of ONS medical prescription during hospitalization and discharge for home, and (2) the persistence of ONS treatment one month after discharge for home. Methods: Data of this prospective observational survey were collected in patients hospitalized in surgery, medicine or rehabilitation and about to receive ONS on their meal trays. Patients already on ONS, with major consciousness disorders or refusing to consume ONS were excluded. Adequacy of ONS indication assessed by a NRS-2002 ≥ 3 and ONS prescription were evaluated at first ONS delivery on the meal tray and at hospital discharge. One month after discharge, the persistence of ONS consumption was evaluated by the homecare service. Results are presented as mean ± SD or percentages. Results: 416 patients (71.7 ± 14.1yrs, 52.6%♂, BMI 23.6 ± 5.2 kg/m2) were included. At first ONS delivery on the meal tray, 82.7% (n = 344) of patients had an NRS-2002 ≥ 3 and 44.5% (n = 185) had no ONS medical prescription. Out of 207 patients discharged for home, only 24.2% (n = 50) had an adequate homecare ONS prescription. One month after discharge, 76.3% (n = 29) were still on ONS. Conclusion: During hospitalization, ONS are mostly given to patients at nutritional risk but medical prescription is often missing. At discharge for home, few patients receive ONS prescription and homecare service. If a medical ONS prescription is performed, ONS are generally continued one month after discharge. Disclosure of Interest: None declared.

SUN-P206 UNHEALTHY DIET AMONG HOSPITALIZED PATIENTS – FOOD INTAKE ASSESSMENT AS PART OF A ONE-DAY SURVEY OF NUTRITIONAL STATUS K. Kauppi1 *, S. Wegener2, I. Martinsson3. 1Unit for Health Promoting Hospital, 2Unit for Clinical Nutrition, 3Unit for Quality and Care, Uppsala University Hospital, Uppsala, Sweden Rationale: Unhealthy diet is the strongest contributor to the burden of disease in Sweden. Approximately 20% of the general population has considerably unhealthy diet. There is a lack of studies in hospitalized patients. The aim was to investigate the prevalence of unhealthy diet among hospitalized patients and if they were offered dietary counselling. Methods: A dietary index (DI) developed by the Swedish National Board of Health and Welfare was included in a yearly one-day survey of malnutrition at Uppsala University Hospital in 2015 (Y1) and 2016 (Y2). The index identifies individuals with unhealthy diet from a disease-preventive perspective, to whom dietary counselling should be offered. The DI is based on consumption of fruit, vegetables, fish and low nutritious foods. The hospital’s goal is to screen >50% of the patients, using the DI and >70% of those at risk should be offered dietary counselling.

Poster Results: The number of patients included in the survey was 418 (Y1) and 411 (Y2). Screening with the DI increased from 38% to 59%. In both years just above one quarter of the patients had a healthy diet and about one fifth had considerably unhealthy diets. In this group the men were more likely to have unhealthy diet, 78% (Y1) and 60% (Y2). In Y1 22% and in Y2 13%, of these were underweight and 16% and 21% had a BMI >30. About 65% had normal BMI in both years. Only one (Y1) and two (Y2) patients with unhealthy diet received dietary counselling. Conclusion: The goal of screening 50% of the patients was obtained the second year. In this survey the number of hospitalized patients with unhealthy diet corresponds fairly well to the national prevalence. Men were more likely to have unhealthy diets. Most patients had a “normal” BMI. Unhealthy diets did not correspond to BMI. The goal of offering dietary counselling was not obtained. Continuous improvement of the nutrition process is ongoing. Disclosure of Interest: None declared.

SUN-P207 TOWARDS A NEW MARKER OF NUTRITIONAL STATUS IN ENTEROCUTANEOUS FISTULAE: LEAN BODY MASS IN CT K. C. Fragkos1 *, K. Cheung2, D. Thong3, N. Keane4, S. Mehta1, F. Rahman1, A. Plumb2, S. Di Caro1. 1GI Services, 2Imaging, University College London Hospitals NHS Foundation Trust, 3 Division of Medicine, University College London, 4Dietetics, University College London Hospitals NHS Foundation Trust, London, United Kingdom Rationale: We aimed to investigate the correlation between body weight, body mass index, albumin levels and radiological indices of lean body mass in patients undergoing Enterocutaneous fistula (ECF) repair with surgical outcomes. Methods: Biochemistry parameters and anthropometric characteristics at the time of ECF surgery were collected for a set of patients undergoing ECF repair. Skeletal muscle and visceral and subcutaneous adiposity was measured at the level of the L3 region (slice and volumetric analysis, Image J). Statistical analysis was performed with percentages, means, Spearman’s rho and dendrograms. Results: 27 patients (14F, 55 ± 3.0 years) were identified in one year. Aetiology of ECF was: surgical complications in 13 patients, extensive bowel disease in the remaining (Crohn’s disease, diverticulitis, radiation enteropathy). 36% of patients had a BMI less than 18.5 kg/m2, 50% had albumin less than 30 g/ L. None of the L3 measurements were statistically different when compared between patients with albumin less or over 30 g/L. Parenteral nutrition was given peri-operatively in 48.1% of patients. Pre-operative albumin had a strong positive correlation with all radiological indices (rho 0.402–0.522, p < 0.05) when sepsis was cleared. Weight and BMI were strongly positively correlated with radiological indices (rho 0.527–0.918). Dendrograms identified two clusters that correlated with imaging indices: heamatological parameters (largely negative correlations) and nutritional parameters (weight, albumin and others) (mainly positive correlations) None of the L3 measurements were different with respect to ECF recurrence and PN administration ( p > 0.05). Conclusion: L3 measurements strongly correlate with nutritional parameters at the time of surgery when sepsis is cleared. Surgical outcomes might be improved with early identification