- Email: [email protected]
SUN-PP124: Correlation between Mini Nutritional Assessment and Hand Grip Strength in Geriatric Patients with Gastrointestinal Cancer
Nutrition and cancer 1
S69
SUN-PP123 THE ROLE OF HYPERMETABOLISM IN CANCER CACHEXIA: A PROSPECTIVE STUDY IN 310 CANCER PATIENTS PRIOR CHEMOTHERAPY INITIATION
SUN-PP124 CORRELATION BETWEEN MINI NUTRITIONAL ASSESSMENT AND HAND GRIP STRENGTH IN GERIATRIC PATIENTS WITH GASTROINTESTINAL CANCER
C. Vazeille1,2 , A. Jouinot1,2 , J.-P. Durand1,2 , N. Neuveux3,4 , A. Cessot1,2 , P. Boudou-Rouquette1,2 , J. Giroux1,2 , I. Gataa1,2 , S. Bellanger1 , J. Alexandre1,2 , J.-P. De Bandt3,4 , F. Goldwasser1,2 . 1 Medical Oncology, Hˆ opital Cochin, 2 Universit´ e Paris Descartes, 3 Clinical Chemistry, Hˆ opital Cochin, 4 Laboratory of Nutrition Biology EA 4466, Universit´ e Paris Descartes, Paris, France
D. Hopanci Bicakli1 , A. Ozveren1 , B. Karabulut1 , R. Uslu1 , R.M. Dalak2 , R. Cehreli3 , F. Akcicek1 , M. Uyar4 . 1 Medical Oncology Department, 2 Nutrition and Dietetetic, Ege University, 3 Preventive Oncology, 9 Eylul University, 4 Department of Anesthesiology and Reanimation, Ege University, Izmır, Turkey
Rationale: Cachexia is a major cause of death in cancer patients (pts) and is associated with treatment toxicity. Resting energy expenditure (REE) is increased in cancer pts and may contribute to cachexia. We studied the relationship between REE and clinical and biological markers of cachexia and treatment toxicity. Methods: In chemo-naive cancer pts we used the ratio of measured REE (indirect calorimetry), to calculated REE (Harris Benedict), to define hypermetabolic (ratio 110%) and normometabolic (90 110%) pts. We recorded weight loss (WL), performance status (PS), CRP, Albumin, Nutritional Risk Index (NRI), daily energy intake, energetic gap (daily energy intakes REE), and early limiting toxicities (ELT) after first cycle of chemotherapy. Results: A total of 310 pts were included: 62% male, median age 66 years, 67% had metastatic disease. Primary tumour: genitourinary (28%), gastrointestinal (21%), pulmonary (18%); 35% had PS2. Mean weight loss was 5.2%. Mean DER was 1679 kcal/d. 62% of pts were hypermetabolic. Hypermetabolic pts had deeper energetic gap ( 112 vs +215 kcal/d; p < 0.001) despite equivalent daily energy intakes, increased WL (WL >5%: 48% vs 34%; p < 0.02), altered PS (PS 2: 40% vs 29%; p = 0.04), higher systemic inflammation (CRP = 26.9 vs 18.1 mg/l; p = 0.04), lower albumin (39 vs 40 g/l; p = 0.04) and lower NRI (98.5 vs 101.1; p < 0.02). In 222 pts evaluable for toxicity, ELT occurrence was associated with hypermetabolism, OR = 2.43 [1.13 5.21], p = 0.025. 47% of hypermetabolic pts had no inflammation (CRP <10 mg/L), 96% had normal or high BMI and 49% had PS 0 or 1. These pts may be at risk for cachexia. Conclusion: Hypermetabolism correlates with clinical and biological markers of cachexia and acute toxicity. The measurement of REE may improve the identification of pts at risk for cachexia and potential candidates for early nutritional intervention. Disclosure of Interest: C. Vazeille Other: Amgen Sandoz Fresenius Kabi, A. Jouinot Other: none, J.-P. Durand Consultant for: Fresenius Baxter MSD, Speaker Bureau for: Fresenius Baxter MSD, Other: Baxter, N. Neuveux Other: none, A. Cessot Other: none, P. Boudou-Rouquette Consultant for: Roche, Other: Novartis, J. Giroux Other: none, I. Gataa Other: none, S. Bellanger Other: none, J. Alexandre Other: Janser Merck MSD Pharmamar Roche Sanofi, J.-P. De Bandt Other: none, F. Goldwasser Grant/Research Support from: Bayer, Consultant for: Boehringer Fresenius Bayer
Rationale: Malnutrition is common among gastrointestinal (GI) cancer patients for many reasons. Mini nutritional assessment (MNA) and hand grip strength (HGS) are recognized as good indicators of nutrition status. The objective of this study was to examine the correlation among body mass index (BMI), MNA and HGS in elderly cancer patients. Methods: 200 consecutive geriatric patients with GI cancer enrolled in this prospective, observational study for 4-month in a cancer center. The nutritional status was evaluated by MNA and HGS. The cut-off values of HGS indicating malnutrition are 30 kg for men and 20 kg for women. BMI was also recorded, <22 kg/m2 considered as malnourished. Results: The subjects are 71±5.8 yrs old (74F, 126M). 76% of all patients are malnourished or at risk according to MNA. 22% of females and 28% of males were found under 22 kg/m2 . 60% of females had a HGS of <20 kg and 47% of males had a HGS of <30 kg. Both males and females showed a positive correlation between BMI and HGS (r = 0.475, p < 0.001, r = 0.494, p < 0.001, respectively) and also between MNA and HGS (rs = 0.451, p < 0.001, rs = 0.534, p < 0.001 respectively). The HGS difference was significant between malnourished (BMI <22 kg/m2 ) and normal females, (15.4±3.82 kg vs 19.8±3.69 kg, p < 0.001). It was the same for males (25.1±6.9 kg vs 32.7±6.2 kg, p < 0.001). The number of malnourished and at risk females according to MNA having a HGS of <20 kg vs normal females was different (p < 0.001). It was similar for males having a HGS of <30 kg (p < 0.001). Conclusion: Malnutrition is prevalent among geriatric patients with GI tumors according to both BMI and MNA. The positive correlation between HGS and BMI and also between HGS and MNA indicates the potential of HGS as a simple bed side parameter to provide valuable information to health care professionals working with malnourished geriatric cancer patients. Disclosure of Interest: None declared
SUN-PP125 CHANGES IN NUTRITIONAL STATUS AFTER MINIMALLY INVASIVE OESOPHAGECTOMY WITH AN ENHANCED RECOVERY AFTER SURGERY (ERAS) PROGRAMME & AGGRESSIVE NUTRITIONAL INTERVENTION E. Ni Bhuachalla1,1 , S. Cushen1 , T. Murphy2 , A.M. Ryan1 . 1 Dept. Food and Nutritional Sciences, University College Cork, 2 Department of Surgery, Mercy University Hospital, Cork, Ireland Rationale: Oesophagectomy is an exemplar of controlled major trauma associated with impaired nutritional status. Early aggressive nutritional support may limit catabolism, but its role in an ERAS protocol after major surgery is unclear. The
S69
SUN-PP123 THE ROLE OF HYPERMETABOLISM IN CANCER CACHEXIA: A PROSPECTIVE STUDY IN 310 CANCER PATIENTS PRIOR CHEMOTHERAPY INITIATION
SUN-PP124 CORRELATION BETWEEN MINI NUTRITIONAL ASSESSMENT AND HAND GRIP STRENGTH IN GERIATRIC PATIENTS WITH GASTROINTESTINAL CANCER
C. Vazeille1,2 , A. Jouinot1,2 , J.-P. Durand1,2 , N. Neuveux3,4 , A. Cessot1,2 , P. Boudou-Rouquette1,2 , J. Giroux1,2 , I. Gataa1,2 , S. Bellanger1 , J. Alexandre1,2 , J.-P. De Bandt3,4 , F. Goldwasser1,2 . 1 Medical Oncology, Hˆ opital Cochin, 2 Universit´ e Paris Descartes, 3 Clinical Chemistry, Hˆ opital Cochin, 4 Laboratory of Nutrition Biology EA 4466, Universit´ e Paris Descartes, Paris, France
D. Hopanci Bicakli1 , A. Ozveren1 , B. Karabulut1 , R. Uslu1 , R.M. Dalak2 , R. Cehreli3 , F. Akcicek1 , M. Uyar4 . 1 Medical Oncology Department, 2 Nutrition and Dietetetic, Ege University, 3 Preventive Oncology, 9 Eylul University, 4 Department of Anesthesiology and Reanimation, Ege University, Izmır, Turkey
Rationale: Cachexia is a major cause of death in cancer patients (pts) and is associated with treatment toxicity. Resting energy expenditure (REE) is increased in cancer pts and may contribute to cachexia. We studied the relationship between REE and clinical and biological markers of cachexia and treatment toxicity. Methods: In chemo-naive cancer pts we used the ratio of measured REE (indirect calorimetry), to calculated REE (Harris Benedict), to define hypermetabolic (ratio 110%) and normometabolic (90 110%) pts. We recorded weight loss (WL), performance status (PS), CRP, Albumin, Nutritional Risk Index (NRI), daily energy intake, energetic gap (daily energy intakes REE), and early limiting toxicities (ELT) after first cycle of chemotherapy. Results: A total of 310 pts were included: 62% male, median age 66 years, 67% had metastatic disease. Primary tumour: genitourinary (28%), gastrointestinal (21%), pulmonary (18%); 35% had PS2. Mean weight loss was 5.2%. Mean DER was 1679 kcal/d. 62% of pts were hypermetabolic. Hypermetabolic pts had deeper energetic gap ( 112 vs +215 kcal/d; p < 0.001) despite equivalent daily energy intakes, increased WL (WL >5%: 48% vs 34%; p < 0.02), altered PS (PS 2: 40% vs 29%; p = 0.04), higher systemic inflammation (CRP = 26.9 vs 18.1 mg/l; p = 0.04), lower albumin (39 vs 40 g/l; p = 0.04) and lower NRI (98.5 vs 101.1; p < 0.02). In 222 pts evaluable for toxicity, ELT occurrence was associated with hypermetabolism, OR = 2.43 [1.13 5.21], p = 0.025. 47% of hypermetabolic pts had no inflammation (CRP <10 mg/L), 96% had normal or high BMI and 49% had PS 0 or 1. These pts may be at risk for cachexia. Conclusion: Hypermetabolism correlates with clinical and biological markers of cachexia and acute toxicity. The measurement of REE may improve the identification of pts at risk for cachexia and potential candidates for early nutritional intervention. Disclosure of Interest: C. Vazeille Other: Amgen Sandoz Fresenius Kabi, A. Jouinot Other: none, J.-P. Durand Consultant for: Fresenius Baxter MSD, Speaker Bureau for: Fresenius Baxter MSD, Other: Baxter, N. Neuveux Other: none, A. Cessot Other: none, P. Boudou-Rouquette Consultant for: Roche, Other: Novartis, J. Giroux Other: none, I. Gataa Other: none, S. Bellanger Other: none, J. Alexandre Other: Janser Merck MSD Pharmamar Roche Sanofi, J.-P. De Bandt Other: none, F. Goldwasser Grant/Research Support from: Bayer, Consultant for: Boehringer Fresenius Bayer
Rationale: Malnutrition is common among gastrointestinal (GI) cancer patients for many reasons. Mini nutritional assessment (MNA) and hand grip strength (HGS) are recognized as good indicators of nutrition status. The objective of this study was to examine the correlation among body mass index (BMI), MNA and HGS in elderly cancer patients. Methods: 200 consecutive geriatric patients with GI cancer enrolled in this prospective, observational study for 4-month in a cancer center. The nutritional status was evaluated by MNA and HGS. The cut-off values of HGS indicating malnutrition are 30 kg for men and 20 kg for women. BMI was also recorded, <22 kg/m2 considered as malnourished. Results: The subjects are 71±5.8 yrs old (74F, 126M). 76% of all patients are malnourished or at risk according to MNA. 22% of females and 28% of males were found under 22 kg/m2 . 60% of females had a HGS of <20 kg and 47% of males had a HGS of <30 kg. Both males and females showed a positive correlation between BMI and HGS (r = 0.475, p < 0.001, r = 0.494, p < 0.001, respectively) and also between MNA and HGS (rs = 0.451, p < 0.001, rs = 0.534, p < 0.001 respectively). The HGS difference was significant between malnourished (BMI <22 kg/m2 ) and normal females, (15.4±3.82 kg vs 19.8±3.69 kg, p < 0.001). It was the same for males (25.1±6.9 kg vs 32.7±6.2 kg, p < 0.001). The number of malnourished and at risk females according to MNA having a HGS of <20 kg vs normal females was different (p < 0.001). It was similar for males having a HGS of <30 kg (p < 0.001). Conclusion: Malnutrition is prevalent among geriatric patients with GI tumors according to both BMI and MNA. The positive correlation between HGS and BMI and also between HGS and MNA indicates the potential of HGS as a simple bed side parameter to provide valuable information to health care professionals working with malnourished geriatric cancer patients. Disclosure of Interest: None declared
SUN-PP125 CHANGES IN NUTRITIONAL STATUS AFTER MINIMALLY INVASIVE OESOPHAGECTOMY WITH AN ENHANCED RECOVERY AFTER SURGERY (ERAS) PROGRAMME & AGGRESSIVE NUTRITIONAL INTERVENTION E. Ni Bhuachalla1,1 , S. Cushen1 , T. Murphy2 , A.M. Ryan1 . 1 Dept. Food and Nutritional Sciences, University College Cork, 2 Department of Surgery, Mercy University Hospital, Cork, Ireland Rationale: Oesophagectomy is an exemplar of controlled major trauma associated with impaired nutritional status. Early aggressive nutritional support may limit catabolism, but its role in an ERAS protocol after major surgery is unclear. The