Nutrition and chronic diseases 2
MON-PP110
CORRELATION OF TWO METHODS OF NUTRITIONAL
SCREENING WITH THE NEW ESPEN CRITERIA OF DEFINING
MALNUTRITION
K.-A. Poulia1 , S. Klek2 , D. Karagiannis3 , I. Doundoulakis4 ,
A. Baschali3 , M. Chourdakis5 . 1 Department of Nutrition and
Dietetics, Laiko General Hospital, Athens, Greece; 2 Stanley
Dudrick’s Memorial Hospital, Skawina, Poland; 3 Department
of Nutrition and Dietetics, Evangelismos Hospital, 4 401
Military Hospital, Athens, 5 School of Medicine, Aristotle
University of Thessaloniki, Thessaloniki, Greece
Rationale: In 2015 the European Society of Clinical Nutrition
and Metabolism (ESPEN) published a consensus regarding the
definition of malnutrition [1]. The aim this study was to
correlate the results of two nutritional screening tools with
the new criteria.
Methods: On admission to the hospitals 3115 patients were
screened (1467 men, mean age 53.9±21.1 yrs, mean BMI
26.5±5.33 kg/m2 , mean hospital stay 4.18±5.80 d). Nutri-
tional screening was performed with two nutritional screening
tools; Nutritional Risk Screening 2002-NRS2002 and Malnutri-
tion Universal Screening Tool-MUST. Cohen’s kappa (ú) statistic
was calculated to determine the diagnostic concordance
between the results of the screening tools and the diagnostic
criteria of malnutrition by ESPEN (i.e. weight loss 10% or 5% in
3 months and BMI <20 kg/m2 for patients <70 yrs or <22 kg/m2
for patients 70 yrs).
Results: With NRS2002 (N = 1941) 24.4% of the patients were
found to be at moderate or severe risk of malnutrition
(NRS2002 3) and 37.5% at low risk (NRS2002 1 2). With MUST
(N = 3001) 76.9% of the sample was on no risk of malnutrition,
13.5% on moderate risk and 9.6% on severe risk. Analysis
showed that highest agreement with the diagnostic criteria
was found in MUST [64.7% (68/105) of patients (ú = 0.620,
p = 0.000)] and the lowest in NRS2002 [55.3% (57/103) of
patients (ú = 0.268, p = 0.000)].
Conclusion: Prevalence of malnutrition varied according to
the screening tool used (9.6 24.4% for severe risk, 13.5 37.5%
for moderate risk). MUST was found to be more accurate
in revealing malnourished patients according to the defining
criteria of ESPEN. It is of crucial to early detecting those in
need for nutritional support in order to avoid complications,
prolonged length of stay and increased costs.
References
[1] Cederholm, T., et al., Diagnostic criteria for malnutrition An
ESPEN Consensus Statement. Clin Nutr, 2015.
Disclosure of Interest: None declared
MON-PP111
ACUTE EFFECTS OF A GLUCAGON-LIKE PEPTIDE 2 ANALOG,
TEDUGLUTIDE, ON GASTROINTESTINAL FUNCTIONS IN
ADULTS WITH SHORT BOWEL SYNDROME
J. Iturrino1 , M. Camilleri1 , A. Acosta1 , J. O’Neill1 , D. Burton1 ,
J. Edakkanambeth1 , A.R. Zinsmeister2 , R.T. Hurt3 .
1
Gastroenterology, 2 Division of Biomedical Statistics and
Informatics, 3 Division of General Internal Medicine, Mayo
Clinic, Rochester, United States
Rationale: Glucagon-like peptide (GLP)-2 agonists decrease
need for total parenteral nutrition (TPN) in short bowel
S169
syndrome (SBS). Mechanisms for the benefits are poorly
understood.
Aim: To measure gastric emptying (GE), fluid balance,
intestinal absorption and permeability in patients with SBS on
GLP-2 agonist, teduglutide (TED), compared to placebo (PLA).
Methods: In a crossover study of 8 adults with SBS on TPN,
we compared effects of daily sq TED (0.05 mg/kg) and PLA,
each for 7 days separated by 14 day washout, on GE solids
(scintigraphy), intestinal absorption and permeability after
oral mannitol (M) and lactulose (L) measured in urine by liquid
chromatography-mass spectrometry; stool weight and urine
volume over 8 h. Statistical analysis utilized paired t test. Data
show mean±SEM.
Results: In 8 SBS patients [4M, age 54±13 y, BMI 25±4 kg/m2 ,
residual small intestine 63±12 cm and 25±15% of colon
remaining (4 no colon)], TED (compared to PLA) numerically
improved fluid balance: reduced stool weight (0 8 h; 106±43 g
PLA vs 77±18 TED, p = 0.42) and increased urine volume
(table). TED increased urine mannitol excretion during 0 2 h
and 0 8 h, suggesting increased monosaccharide uptake. The
lack of differences in urine lactulose excretion (0.38±0.14 mg
PLA vs 0.42±0.14 TED) or in L:M ratio (0.021±0.005 PLA vs
0.024±0.005 TED) suggests no effect on mucosal permeability.
No treatment effect on GE was observed (106±20 min PLA vs
113±16 TED, p = 0.74).
Parameter PLA TED P value
Urine volume (0 8 h), mL 365.7±57.3 408.9±52.2 0.34
Total urine mannitol excretion 0 2 h, mg 11.3±2.2 16.2±3.6 0.20
Total urine mannitol excretion 0 8 h, mg 32.7±5.9 48.8±8.9 0.17
Conclusion: This 1-week crossover study of 8 patients is
consistent with beneficial effects of TED including numerically
enhanced fluid balance and monosaccharide absorption, with
no effects on GE or mucosal permeability. Larger, longer
studies in SBS are warranted.
Disclosure of Interest: J. Iturrino Grant/Research Support from:
NPS Pharmaceuticals provided the medication and a research grant
to support this study. M. Camilleri Grant/Research Support from:
NPS Pharmaceuticals provided the medication and a research grant
to support this study. A. Acosta: None declared, J. O’Neill: None
declared, D. Burton: None declared, J. Edakkanambeth: None
declared, A. Zinsmeister: None declared, R. Hurt: None declared
MON-PP112
EFFECTS ON NUTRITIONAL AND FUNCTIONAL RECOVERY
IN PATIENTS WITH PROTEIN-ENERGY MALNUTRITION
AFTER PROLONGED HOSPITALIZATION: EFFECTS OF A
SPECIFIC PROTEIN-CALORIE SUPPLEMENTATION ENRICHED
IN CALCIUM HYDROXYMETHYL BUTYRATE (HMB)
J.M. Garcia-Almeida1 , I. Vegas-Aguilar1 , R. Rioja-Vazquez1 ,
J.A. Lopez-Medina1 , F. Cardona-Diaz1 , J. Alcaide1 ,
F. Tinahones-Madueño1 . 1 Endocrinology and Nutrition Unit,
Hospital V. Victoria. H. R. Malaga, Malaga, Spain
Rationale: Protein-calorie malnutrition associated with a
process that requires hospitalization and specialized nutri-
tional support (parenteral nutrition) requires an adequate
nutritional and functional recovery. The objective of this
study is evaluate the clinical response (nutritional, body
composition and functional goals) after intervention with
S170
oral supplement enriched with b-hydroxy b-methyl butyrate
calcium (HMB).
Methods: Study of nutritional intervention n = 50, where labo-
ratory (albumin, prealbumin, CRP) and nutritional (anthropo-
metric parameters, body composition and dynamometry) tests
were performed. Periods: baseline (BV) and 3 months (FV).
Results: Mean age 59.7±15 years (women 49% and men 51%).
The main admission diagnoses were 79% surgical reasons, of
which 59% were oncologic and 20% were general surgery, and
21% medical reasons. Subjective Global Assessment (SGA) at
discharge were 96% grade C and 4% grade B. At the 3rd month
SGA were 8% C, 12% B, 80% A. At the end of treatment
82% of patients have very good tolerance and 80% with good
adherence to supplementation.
Parameter Weight (kg) Fat-free Intake Protein Dynamo-
mass (kg) (kcal) (g) metry
BV
FV
67.7±12.4
71.1±12.7
49±9.2
50.4±9.7
1400±319
1711±399
54.4±18
70.2±22
19.2±16
26.6±21
Conclusion: Severe malnutrition (96%) associated to acute
illness that required TPN is observed. Nutritional intervention
allow a recovery of food intake associated with enteral
supplementation. Weight gain and recovery of nutritional
and inflammatory parameters were evidence. A correlation
between gains in lean mass and increased total energy intake
diet, improved albumin and muscle function.
Disclosure of Interest: None declared
MON-PP113
INFLUENCE OF DIABETES PROGRESSION ON b-HYDROXY-
b-METHYLBUTYRATE (HMB) PHARMACOKINETIC:
A RAT STUDY
P. Bueno-Vargas1 , A. Santos-Fandila1 , M. Manzano1 ,
J.M. López-Pedrosa1 . 1 R&D, Abbott nutrition, Granada, Spain
Rationale: Physiological changes occurring in Diabetes Mel-
litus (DM) patients could alter the pharmacokinetics of
bioactive metabolites used to prevent/treat adverse out-
comes related to diabetes progression. The aim of the study
was to evaluate the effect of experimental diabetes on
pharmacokinetic parameters of HMB after oral administration
of HMB to Diabetic Zucker rats at the stages I (10 wks) and IV
(20 wks) that characterize progression of diabetes
Methods: Zucker Diabetic Fatty (ZDF) and Lean (Lean) rats
at 10 and 20 wks of age were divided in 4 groups: 3 oral
doses (30, 300 and 500 mg HMB/kg BW) and one intravenous
(30 mgHMB/kg BW). Serum samples were collected during
different intervals up to 600 min. HMB concentration in
serum was analyzed by UHPLC-MS/MS. PK parameters were
calculated using PKSolver software. Statitistical t-test was
performed to evaluate differences in the means between lean
and ZDF for each dose and age
Results: Regardless the group and the age, the area under
the curve (AUC) and the peak plasma concentration (Cmax)
increased proportionally in a dose-dependent manner. While
at 10 wks old no differences were found, at 20 wks of age,
with an established diabetes, the ZDF rats showed a significant
reduction of total amount of circulating HMB (30% at 300 and
500 mg/kgBW doses) and Cmax (20%, at 300 and 500 mg/kgBW
doses) when compared with same-age Lean rats. Moreover,
at this age, HMB Clearance was increased (35 40%) and HMB
Poster presentations
half-life reduced (20%, at 300 and 40% at 500 mg/kgBW) in the
ZDF group as compared with Lean group
Conclusion: The progression of the DM affected PK of HMB
as consequence of a decrease on its bioavailability and an
increase of its clearance. These observations indicate that
HMB PK may be affected in patients with diabetes, especially
in the late stage of the disease
Disclosure of Interest: P. Bueno-Vargas Other: Employee, A. Santos-
Fandila Other: Employee, M. Manzano Other: Employee, J. López-
Pedrosa Other: Employee
MON-PP114
GOOD NUTRITIONAL PRACTICE FAILS WHEN PATIENTS ARE
TRANSFERRED BETWEEN WARDS
Albumin Prealbum CRP (mg/l) T. Beermann1 , K. Kaasby2 . 1 Centre for Nutrition and Bowel
(g/dl) (mg/dl)
Diseases, 2 Clinic Anesthesia, Aalborg University Hospital,
3.1±0.8
3.9±0.4
21.3±7.8
26.0±7.4
28.3±41.6
11.7±38.0
Aalborg, Denmark
Rationale: In Danish hospitals it’s mandatory to screen all
patients for nutritional risk and give nutritional therapy
according to the result of the screening, defined as Good
Nutritional Practice (GNP). However, when patients are
transferred between wards, sharing information about GNP
is sometimes missing, not useful or misinterpreted, according
to observations from clinical practice. The aim of this study
was to investigate to which degree information about GNP
was documented, when patients with COPD were transferred
between wards. COPD patients often have co-morbidities,
making transfer most likely to occur, and almost 60% suffer
from malnutrition, making GNP extremely relevant.
Methods: A retrospective audit of randomly selected journals
from hospitalized COPD patients (3 consecutive days), in
Aalborg University Hospital in 2013, whereas 1 day had been
in the ICU.
Results: 21 patient journals were investigated (8 W +13 M).
All had 1 co-morbidity: most common were cardio-vascular
diseases (81%) and diabetes (43%). Average age was 70 (range
51 83) years, BMI at admittance (n = 11) was 22.8 (14.5 30.3),
LOS in hospital was 23.1 (3 115) days, LOS in ICU was 9.7
(1 80) days and number of transfers were 3.5 (1 8).
Nine patients (43%) had been screened during hospitalization
period, 13 (62%) had assessment of nutritional requirement
and 17 (81%) had weight and/or nutritional intake monitored.
When transferred between wards, information about GNP
where documented for 8 patients (31%). For no patients,
information about GNP had been documented at all transfers
during the hospitalization period.
Conclusion: Information about GNP when patients were trans-
ferred between wards was inadequate for more than two-
thirds. This caused unnecessary delays in patient’s nutritional
therapy, adding risk for developing further malnutrition.
Disclosure of Interest: None declared