Weight loss post lower limb fracture despite an intensive oral nutrition and exercise intervention

S86 A difference in LOSNDI between intervention patients with complications (14f2 days, meanfSE, N=lS ) and control patients with complications (20f2 days, N=14) was statistically significant (ANOVA; P=O.O15).In the same patients, LOS was 17f2 days in the intervention group and 22f2 days in the control group (P=O.O28). No difference was seen among the remaining patients. Conclusions: Protein and energy intake of nutritionally at-risk patients was increased which resulted in shorter LOSNDI and LOS among patients with complications.

320-P. WEIGHT LOSS POST LOWER LIMB FRACTURE DESPITE AN INTENSIVE ORAL NUTRITION AND EXERCISE INTERVENTION L.A. Daniels’, M. Miller’, E. BanneIman’, C. Whitehead’, M. Crotty’ ‘Nutrition and Dietetics, 2Rehabilitation and Aged Care, Flinders University, Adelaide, Australia Rationale: To evaluate nutrition support and resistance training on % weight change over 12 weeks in elderly patients after hip or lower limb fracture. Method: 100 nutritionally at-risk (MAC 525th%ile) participants were randomized to control(C), nutrition(N), exercise(E) or nutrition and exercise(NE). The interventions wele individually prescribed from day 7 post injury: nutrition - 1.5kcal/ml sip feed for 6 weeks; exercise - lower limb shengthening using resistive elastic bands for 12 weeks supervised by a Physiotherapist. All groups received home visits 3/week from discharge to 6 weeks and weekly from weeks 7-12. Repeated measures ANOVA were performed on % weight change at weeks l-6, 8, 10 and 12. Results: The mean (SD) % weight changes at 12 weeks were as follows: N 5.9% (5.2%), E-6.3% (4.6%), NE-4.7% (5.8%) and C-5.6% (9.0%). There was a time effect on % weight change (PiO.001) but this pattern was sirnil= between groups (P=O.23). There was a treatment effect in overall weight change (P=O.Ol). N % weight loss was significantly less than E (P=O.Ol). Overall mean (SD)% weight change at 12 weeks was -5.6% (6.3%). Conclusions: Despite comprehensive nutrition and/or resistance training interventions, we were unable to pievent clinically significant weight loss in any group over 12 weeks post injury. Those in E lost significantly more weight then those in NE, suggesting the need for routine nutrition support in elderly orthopedic patients undergoing an exercise program post fracture. Further resezuch is required to assist in explaining the weight loss, pxticuLily with respect to changes in energy expenditure following orthopaedic trauma and evaluation of alternative approaches to nutrition support, such as nasogastric feeding, to account for the catabolic nature of the injury.

321-P. ACUTE PANCREATITIS: COMPARISON BETWEEN POLYMERIC NUTRITION AND SEMI-ELEMENTAL NUTRITION M.A. Piquet t, L.E. Tiengou’, I. Ollivier’ , R. Gloro ‘, K. Bouhier’, F. Amaud-Battandier ‘, .I. P&e’, T. Dao ’ ‘Gastroenterology and Nutrition, CHU, CAEN, ‘Nest1 , Nutrition, Paris, France Rationale: Jejunal enteral nutrition is recommended in patients with acute pancreatitis. Clinical benefits of semi-elemental nutrition are not demonstrated. Method: A prospective randomised study, stratified on severity score was performed in 30 patients with acute pancreatitis undergoing jejunal nutrition. The semi-elemental group (n=15) received Peptamen (35 kcal/kg/d). The polymeric group (n=15) received the same amount of Sondalis-iso. Tolerance was assessedafter 7 days by visual analogic scale (VAS), stool frequency and analysis. Absorption was evaluated by 2 hour-xylosemia after ingestion of 25 g D-xylose. The outcome was assessedby weight loss, length of stay, and prevalence of infection. Results: (meanfsem, t test or chi-2) There was no difference between 2 groups regxding age, sex, and severity. Nutrition was well tolerated in both groups (semi-elemental vs polymeric: VAS: 7.4f0.5 vs 7.1f0.5 NS); stool frequency per day: 1.7f0.4 vs l.Sf0.4 NS), steatorrhea and creatorrhea were below normal range in both groups. Day 0 xylosemia was

EUROPEAN SOCIETY OF PARENTERAL AND ENTERAL NUTRlTION

sirnil= in the 2 groups whereas after 7 days nutrition, it increased in the semi-elemental group and decreased in polymeric group (+0.5f0.9 vs 0.99f0.99; NS). There were significantly more patients showing a 30% increase in xylosemia in semi-elemental group than in polymeric group (piO.05). In semi-elemental group length of stay was shorter (23f2 days vs 27f1, p=O.O06), weight loss was lesser (If1 kg vs 2fO p=O.Ol). One patient was infected in semi-elemental group vs 3 in polymeric group (NV. Conclusions: Semi-elemental and polymeric nutrition xe very well tolerated in acute pancreatitis. Our results suggest that semi-elemental nutrition allows a more favourable clinical outcome and a better maintenance of digestive trophicity.

322-P. UTILITY AND IMPORTANCE OF CALORIC SUPPLEMENTATION WITH AN IMMUNE-ENHANCING GASTRECTOMIZED PATIENTS

DIET IN

U. Bolder, A. Hellmann, A. Niebauer, M. Wintersberger, K. Jauch, H. Schlitt Surgery, University of Regensburg, Regensburg, Germany Rationale: Gastrectomy results in a fundamental change of upper digestive tract functions. This study aimed to test the value of a 6 weeks postoperative supplementation of calories, protein, and immune nutrients in gastrectom&d patients. Method: 21 patients with RO gastrectomy with Roux-en-Y reconstruction wele randomised to a conventional diet with calorie intake ad libitum (CONV group, n=9) or were allowed to eat ad libitum with additional 500 kcal/day as immune-enhancing diet (IED group; Impact@, n=12) administered via feeding jejunostomy for 6 weeks post surgery. Patients were monitored for morbidity and mortality, body weight, body composition, grip strength and biochemical variables. Data were recorded on days 1, 5-7, 14, 42 and at 3 and 6 month. Results: All patients with IED were alive at 6 month, whereas 2 patients in the CONV group died. During supplementation fat free mass (FFM) rose by 3 kg with IED, whereas a decrease of 5.2 kg was detected in the CONV group. Grip strength rose by 1.2% in IED patients, whereas a decrease by 7.4% was detected in the CONV group. CRP levels at day 5-7 were higher in the CONV group (mean f SEM) compared with the IED group (130.8 f 32.5 vs. 55.6 f 12.2 mg/L; PiO.03). Prealbumin levels were higher with IED cornpled to CONV treatment at day 5-7 (16.7 f 1.0 vs 12.6 f 1.4 mg/dL; PiO.03). HLA-DR expressing lymphocytes remained constant throughout the entire period with IED (lOO%, pre-OP; 92.6%, day 5-7; 1 lo%, 6 weeks). In contrast a decrease was detected with CONV treatment (lOO%, pre-OP; 54%, day 5-7 (PiO.O5);115%, 6 weeks). Conclusions: Supplemental feeding of IED for 6 weeks leads to down regulation of the inflammatory status, improved immune competence and improved physical strength.

323-P. CYTOKINE PROFILE IN SURGICAL TOTAL PARENTERAL NUTRITION

PATIENTS AFTER

G. Lech ’ R. Slotwi ski ‘, M. Zaleska’, M. Slodkowski ‘, W. Cebulski ‘, ~B. Szczygie ’ 3J , I W. Krasnod bski’ ’Department of General, Gastroenterological Surgery and Nutrition, The Medical University of Warsaw, ‘Department of Surgical Research and Transplantology, Medical Research Center; Polish Academy of Sciences, Warsaw, Poland Rationale: The role of the of systemic inflammatory response (SIRS) and compensatory anti-inflammatory response (CARS) during severe complications after major surgical trauma remains unclear. Inflammatoiy cytokines and naturally occurring inhibitors have been detected in increased serum concentrations after severe injury and may lead to multiple organ failure and death. Method: The present study was conducted to examine the changes in systemic production of IL-6, IL-S, IL-lo, sTNFR1 and IL-lra following major elective operation in the patients on a total parenteral nutrition (TPN.Plasma cytokines concentrations were measured in 22 patients (10 treated with TPN