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The effect of micronutrient supplementation on mood in older institutionalised people — A randomised controlled trial
S36
EUROPEAN
not available (Zn, Cu, Mn) only gross excess or deficiency is clinically recognized. The question is whether a tissue, amenable to frequent biopsy, such as muscle, could be a useful indicator of critical tissue stores.
133-P. COPPER, SELENIUM, AND ZINC BALANCES IN CRITICALLY ILL DURING CONTINUOUS VENOVENOUS HEMODIAFILTRATION (CWHDF) M.M. Bergeer’, A. She&in’, M.D. Bollmann’, J.P. Revelly ’, M.C. Cayeux t , E. Robeas’, R.L. Chiolero ’ ‘Soins Intensifs chirurgicaux, CHUR Lausanne, Switzerland, ‘Clinical Chemistry, Royal University Hospital, Liverpool, United Kingdom Rationale: Acute renal failure is a serious complication in the ICU patient and frequently requires dialysis. Trace element metabolism is altered in chronic and acute renal failure: balance data are lacking. The study investigated the trace element balances during CVVH Method: CVVHDF using alternatively commercial bicxbonate (BIC) and lactate (LAC) substitution fluids on 2 consecutive days in ICU patients with acute renal failure. Measurements during S-hr periods. Determination of Cu, Se and Zn in plasma and replacement solutions; hourly determination in the ultrafiltrate (=UF). Balances were calculated as the difference between fluids administerd and the UF losses; they were compxed to recommended daily TPN intakes (RI) Results: 11 patients were enrolled, aged 65flO yezus, with a SAPS11score of 62f22; 19 sessions were studied. Plasma concentrations: Cu was normal; Se and Zn wele below ref. ranges; glutathione peroxidase (GSHPx) was in the lower range. The replacement solutions contained no Cu, but Se 0.01 wmol/I, and Zn (BIC 1.42 wmol/I, LAC 0.85 wmol/I). Cu, Se and Zn were detectable in the UF of all patients: UF concentrations were stable over time, with large interpatient vxiability. Balances were negative for Cu and Se (no difference BIC vs LAC), slightly positive for Zn Table
8-h 24.hr
1
balances balances
(19) pal pal
(mg kg)
Zn
Se
6.89 zk5.67
-0.32 zkO.23
20.7 (1.3 mg)
-0.97 (-73 fkg)
CU
SOCIETY
OF PARENTERAL
AND
135-P. DIAGNOSIS AND DEFINITION O F MAGNESIUM DEPLETION IN PATIENTS W ITH GASTROINTESTINAL DISEASE A. Martinez-Riquelme ‘, S.R. Morley’, J.K. Rawlings’, D.J. Hosking’, S .P. Allison ’ ‘Clinical Nutrition, University Hospital, Queen’s Medical Centre, ‘Endocrinology, City Hospital, Nottingham, United Kingdom Rationale: Hypomagnesaemia is common in gastrointestinal disease with loge fluid losses, and may persist despite oral supplements. The gold standard for clinical diagnosis of magnesium (Mg) depletion is the intravenous M g loading test (MgLT), and 24-horns urine M g (24-b uMg) has been correlated with this. W e report a simplified approach to diagnosis. Method: 10 patients, mean age 64.9f12.9 yrs. 2 with fistulae, 8 with short bowel syndrome (6 ileostomy, 2 colon in continuity), mean length of small bowel 139 ems. Renal function was normal in all cases. Measurements: 1) Baseline serum M g (sMg), 2) Random mine Mg/creatinine ratio (uMg/creat) (n=7), 3) Baseline 24-hr uMg (n=5), and 4) MgLT: 0.1 mmol/Kg iv in 50 ml 5% dextrose in 4 hrs, and 24-b urine for % M g retained (normal ~=25%) (n=lO). Results: % retention is high in 900 patients, with good correlation to 24-b uMg and random uMg/creat (see table). 88% correlation was found between 24-hr uMg and random uMg/creat (piO.05). Table
1 Mean&SD
mg)
SpearmanR
Range
(with
Conclusions: CVVHDF resulted in significant Se and Cu losses, equivalent to 2 daily RI for Se (35 wg), 0.3 daily RI for Cu (1.2 mg) while Zn balances were modestly positive (+0.2 RI =6.5 mg). Prolonged CVVHDF is likely to have deleterious consequences on Se status and on antioxidant defences in critically ill patients
134-P. THE EFFECT O F MICRONUTRIENT SUPPLEMENTATION ON M O O D IN OLDER INSTITUTIONALISED PEOPLE - A RANDOMISED CONTROLLED TRIAL M.F. Hammond’, M. Gosney ‘, S. Allsup’, W . Taylor’, A. She&n’ ’Geriattic Medicine, ‘Clinical Chemistry, University of Liverpool, Liverpool, United Kingdom Rationale: Symptoms of depression are common in older people living in long-telm canz. W e tested the hypothesis that a micronutrient supplement would improve mood in this population. Method: 73 residents of nursing or residential homes (median age 82 yezus) were randomised to receive either a vitamin and trace element supplement providing the reference nutrient intake (n=36) or placebo (n=37) for eight weeks. Plasma micronutrient concentrations (selenium, folate, vitamin C) and mood were assessedat baseline and 8 weeks. Mood was assessedusing the Hospital Anxiety and Depression Scales (HADS) and the MontgomeryAsberg Depression Rating Scale (MADRS). Results: At baseline, there was a significant negative association between selenium and HADS depression scores (r= -0.341, p=O.O04) and selenium and MADRS score (r= -0.358, p=O.O03). No other significant correlations were observed between mood and micronutrient concentration. Of the participants with an abnormal HADS depression score (>7) at base-
NUTRlTION
line, those administered supplement (n=lO) had a significant decrease in depression score (baseline HADS median score 10, endpoint median score 6.5; Wilcoxon signed ranks test Z= -2.15; l-tailed significance 0.016) and a significant increase in selenium concentration (paired t test -2.94, df 9; l-tailed significance 0.009) after 8 weeks. Conclusions: Low mood in older people living in long telm care is associated with a low plasma selenium concentration. Both mood and selenium concentration can be significantly improved by a micronutrient supplement administered over eight weeks.
-2.18 *1.2x -6.54 (-0.40
ENTERAL
% Mg retention
73.X&32.5
9.4
99.6
Baseline
sMg (mmol/L)
0.57&0.25
0.08
0.95
Random
uMg/creat
0.26&0.5
0.0005
3.9*3.3
0.1
24-h
uMg
(mmo1/24
hr)
1.3 6.5
P
% Mg ret)
0.59
0.046
0.73
0.01
0.81
50.01
Conclusions: W e confilm that M g load test and 24-b minxy M g are more sensitive to detect M g depletion than serum Mg. Mg/creatinine ratio in random mine sample correlates well with M g loading test and 24-b urinary M g and is simpler to perform. A serum M g and random mine sample may be therefore be able to detect M g depletion in most cases. However, normal serum M g concentration do not exclude M g deficiency.
136-P. HYPOMAGNESAEMIA IN GASTROINTESTINAL FAILURE: CORRELATION T O SYMPTOMS, SINGS AND CALCIUM HOMEOSTASIS A. Martinez-Riquelme ‘, S.R. Morley’, J.K. Rawlings’, D.J. Hosking’ ‘Clinical Nutrition, University hospital Queen’s Medical Centre, ‘Endocrinology, City Hospital, Nottingham, United Kingdom Rationale: Hypomagnesaemia is common with loge gastrointestinal fluid losses, yet overt neurological symptoms xe infrequent. W e postulate that symptoms and signs may be related to seconday hyperparathyroidism and hypeocalcaemia. Method: 8 patients with short bowel syndrome (mean 128.8f58 ems), mean age 65.8f8.8 years and magnesium depletion by magnesium loading test (MgLT) (mean 88.4f25.8% retention). All patients had oral nutrition, with calcium and vitamin D supplements. Symptoms (eg. pxaesthesiae) and signs (Trousseau) assessedat each visit. Serum calcium (&a), magnesium (sMg), pxathyroid hormone (sPTH) and total vitamin D (sVitD) measured
EUROPEAN
not available (Zn, Cu, Mn) only gross excess or deficiency is clinically recognized. The question is whether a tissue, amenable to frequent biopsy, such as muscle, could be a useful indicator of critical tissue stores.
133-P. COPPER, SELENIUM, AND ZINC BALANCES IN CRITICALLY ILL DURING CONTINUOUS VENOVENOUS HEMODIAFILTRATION (CWHDF) M.M. Bergeer’, A. She&in’, M.D. Bollmann’, J.P. Revelly ’, M.C. Cayeux t , E. Robeas’, R.L. Chiolero ’ ‘Soins Intensifs chirurgicaux, CHUR Lausanne, Switzerland, ‘Clinical Chemistry, Royal University Hospital, Liverpool, United Kingdom Rationale: Acute renal failure is a serious complication in the ICU patient and frequently requires dialysis. Trace element metabolism is altered in chronic and acute renal failure: balance data are lacking. The study investigated the trace element balances during CVVH Method: CVVHDF using alternatively commercial bicxbonate (BIC) and lactate (LAC) substitution fluids on 2 consecutive days in ICU patients with acute renal failure. Measurements during S-hr periods. Determination of Cu, Se and Zn in plasma and replacement solutions; hourly determination in the ultrafiltrate (=UF). Balances were calculated as the difference between fluids administerd and the UF losses; they were compxed to recommended daily TPN intakes (RI) Results: 11 patients were enrolled, aged 65flO yezus, with a SAPS11score of 62f22; 19 sessions were studied. Plasma concentrations: Cu was normal; Se and Zn wele below ref. ranges; glutathione peroxidase (GSHPx) was in the lower range. The replacement solutions contained no Cu, but Se 0.01 wmol/I, and Zn (BIC 1.42 wmol/I, LAC 0.85 wmol/I). Cu, Se and Zn were detectable in the UF of all patients: UF concentrations were stable over time, with large interpatient vxiability. Balances were negative for Cu and Se (no difference BIC vs LAC), slightly positive for Zn Table
8-h 24.hr
1
balances balances
(19) pal pal
(mg kg)
Zn
Se
6.89 zk5.67
-0.32 zkO.23
20.7 (1.3 mg)
-0.97 (-73 fkg)
CU
SOCIETY
OF PARENTERAL
AND
135-P. DIAGNOSIS AND DEFINITION O F MAGNESIUM DEPLETION IN PATIENTS W ITH GASTROINTESTINAL DISEASE A. Martinez-Riquelme ‘, S.R. Morley’, J.K. Rawlings’, D.J. Hosking’, S .P. Allison ’ ‘Clinical Nutrition, University Hospital, Queen’s Medical Centre, ‘Endocrinology, City Hospital, Nottingham, United Kingdom Rationale: Hypomagnesaemia is common in gastrointestinal disease with loge fluid losses, and may persist despite oral supplements. The gold standard for clinical diagnosis of magnesium (Mg) depletion is the intravenous M g loading test (MgLT), and 24-horns urine M g (24-b uMg) has been correlated with this. W e report a simplified approach to diagnosis. Method: 10 patients, mean age 64.9f12.9 yrs. 2 with fistulae, 8 with short bowel syndrome (6 ileostomy, 2 colon in continuity), mean length of small bowel 139 ems. Renal function was normal in all cases. Measurements: 1) Baseline serum M g (sMg), 2) Random mine Mg/creatinine ratio (uMg/creat) (n=7), 3) Baseline 24-hr uMg (n=5), and 4) MgLT: 0.1 mmol/Kg iv in 50 ml 5% dextrose in 4 hrs, and 24-b urine for % M g retained (normal ~=25%) (n=lO). Results: % retention is high in 900 patients, with good correlation to 24-b uMg and random uMg/creat (see table). 88% correlation was found between 24-hr uMg and random uMg/creat (piO.05). Table
1 Mean&SD
mg)
SpearmanR
Range
(with
Conclusions: CVVHDF resulted in significant Se and Cu losses, equivalent to 2 daily RI for Se (35 wg), 0.3 daily RI for Cu (1.2 mg) while Zn balances were modestly positive (+0.2 RI =6.5 mg). Prolonged CVVHDF is likely to have deleterious consequences on Se status and on antioxidant defences in critically ill patients
134-P. THE EFFECT O F MICRONUTRIENT SUPPLEMENTATION ON M O O D IN OLDER INSTITUTIONALISED PEOPLE - A RANDOMISED CONTROLLED TRIAL M.F. Hammond’, M. Gosney ‘, S. Allsup’, W . Taylor’, A. She&n’ ’Geriattic Medicine, ‘Clinical Chemistry, University of Liverpool, Liverpool, United Kingdom Rationale: Symptoms of depression are common in older people living in long-telm canz. W e tested the hypothesis that a micronutrient supplement would improve mood in this population. Method: 73 residents of nursing or residential homes (median age 82 yezus) were randomised to receive either a vitamin and trace element supplement providing the reference nutrient intake (n=36) or placebo (n=37) for eight weeks. Plasma micronutrient concentrations (selenium, folate, vitamin C) and mood were assessedat baseline and 8 weeks. Mood was assessedusing the Hospital Anxiety and Depression Scales (HADS) and the MontgomeryAsberg Depression Rating Scale (MADRS). Results: At baseline, there was a significant negative association between selenium and HADS depression scores (r= -0.341, p=O.O04) and selenium and MADRS score (r= -0.358, p=O.O03). No other significant correlations were observed between mood and micronutrient concentration. Of the participants with an abnormal HADS depression score (>7) at base-
NUTRlTION
line, those administered supplement (n=lO) had a significant decrease in depression score (baseline HADS median score 10, endpoint median score 6.5; Wilcoxon signed ranks test Z= -2.15; l-tailed significance 0.016) and a significant increase in selenium concentration (paired t test -2.94, df 9; l-tailed significance 0.009) after 8 weeks. Conclusions: Low mood in older people living in long telm care is associated with a low plasma selenium concentration. Both mood and selenium concentration can be significantly improved by a micronutrient supplement administered over eight weeks.
-2.18 *1.2x -6.54 (-0.40
ENTERAL
% Mg retention
73.X&32.5
9.4
99.6
Baseline
sMg (mmol/L)
0.57&0.25
0.08
0.95
Random
uMg/creat
0.26&0.5
0.0005
3.9*3.3
0.1
24-h
uMg
(mmo1/24
hr)
1.3 6.5
P
% Mg ret)
0.59
0.046
0.73
0.01
0.81
50.01
Conclusions: W e confilm that M g load test and 24-b minxy M g are more sensitive to detect M g depletion than serum Mg. Mg/creatinine ratio in random mine sample correlates well with M g loading test and 24-b urinary M g and is simpler to perform. A serum M g and random mine sample may be therefore be able to detect M g depletion in most cases. However, normal serum M g concentration do not exclude M g deficiency.
136-P. HYPOMAGNESAEMIA IN GASTROINTESTINAL FAILURE: CORRELATION T O SYMPTOMS, SINGS AND CALCIUM HOMEOSTASIS A. Martinez-Riquelme ‘, S.R. Morley’, J.K. Rawlings’, D.J. Hosking’ ‘Clinical Nutrition, University hospital Queen’s Medical Centre, ‘Endocrinology, City Hospital, Nottingham, United Kingdom Rationale: Hypomagnesaemia is common with loge gastrointestinal fluid losses, yet overt neurological symptoms xe infrequent. W e postulate that symptoms and signs may be related to seconday hyperparathyroidism and hypeocalcaemia. Method: 8 patients with short bowel syndrome (mean 128.8f58 ems), mean age 65.8f8.8 years and magnesium depletion by magnesium loading test (MgLT) (mean 88.4f25.8% retention). All patients had oral nutrition, with calcium and vitamin D supplements. Symptoms (eg. pxaesthesiae) and signs (Trousseau) assessedat each visit. Serum calcium (&a), magnesium (sMg), pxathyroid hormone (sPTH) and total vitamin D (sVitD) measured