Oral Presentations

R – 186

Comparison of BIA, CPC on pre and post transplant patients: an on-going study

V. Jayanthi, Georgi Abraham, Geetha.K, Obulakshmi.O, Shanmuga Bhaskar

Madras Medical Mission, Chennai, India.

Objective: To assess the BIA and CPC of hemodialysis subjects pre and post transplant.

Methodology: 16 patients who were on hemodialysis were selected and their body composition were assessed by Maltron BF Analyser 907 after dialysis. The same subjects were again assessed post transplant after a month. Of which 14 patients were and 2 were vegetarianism.

Result: The mean weight pre transplant was 54.16 and post transplant 57.23. The body fat% pre transplant was 26.78 and post transplant 25.55, the lean body mass% pre transplant was 73.03 and post transplant 74.36. The total body water% pre transplant was 53.21and post transplant 54.59. The calorie intake pre transplant was 1445.31 and post transplant 1533.06 (p<0.05). The protein intake pre transplant was 39.31 and post transplant 46.62(P<0.01). 98% non-vegetarians and 2% vegetarians.

Conclusion: The BIA of the study group was done at 1 month interval. There is significant difference. It is suggested that it should be done at 1 month, 6 months and 12 months interval to see the difference in the BIA. The study showed that there was definite improvement in their calorie and protein intake after transplant. PTP had a better modality of BIA, CPC when compared to the HD patients. This is an ongoing study.

Abbreviations: BIA: Bioelectrical Impedence Analysis CPC: Calorie Protein Count. PTP : Post Transplant Patient

Contact person email address: jayanthyjoel@yahoo.com

To view the presentation in PDF click on this: V. Jayanthi et al (Top)

 

R – 275

Nutritional status of gastric cancer patients after radical gastrectomy

Seung wan Ryu, Hwa jin Lee, Sun kyung Park, Young ae Kong, Yung gil Son, In ho Kim

NST Team, Keimyung University Dong-San medical center, Daegu, Korea

Objective: Gastrectomy is associated with poor oral intake and poor nutritional status in almost all cases. For the purpose of aiding the evaluation of the postoperative clinical course of gastric cancer patients, we have prospectively compared patient nutritional status following both total gastrectomy and subtotal gastrectomy.

Methods: We have prospectively studied 80 patients with no evidence of recurrent disease and follow up loss following curative surgery for gastric cancer from October 2005. Among this group 9 underwent total gastrectomy and 71 subtotal gastrectomy. At admission, postoperative 7 days, postoperative 6 months and 12 months, the patients were assessed on the following items: Subjective Global Assessment(SGA), Nutritional Risk Index(NRI), Anthropometric measurements(TSF, MAC, MAMC), body weight, Body Mass Index(BMI), Total lymphocyte count(TLC), serum total protein, serum albumin, total serum cholesterol, serum iron and Vitamin B12.

Results: At admission, 31% of the patients were malnourishd according to the SGA, while 60% of the patients were malnourished according to the NRI. At postoperative 6months, 51% of the patients were severe malnourished and total 70% of the patients were malnourished according to the SGA. During the postoperative 6month, Body weight, BMI, Triceps skin fold(TSF) and Mid arm circumference(MAC) were significantly decreased, but there was no difference between postoperative 6months and 12months. Especially Total gastrectomy patients showed significantly decreased nutritional status in anthropometric measurement compared subtotal gastrectomy patients at post operative 12months. Total lymphocyte count, Total protein, choresterol and serum iron level were no difference during the postoperative period. But, In case of total gastrectomy patients, vitamin B12 level was severe decreased during the postoperative 12 months.

Conclusion: Malnutrition in patients undergoing gastrectomy was severe at postoperative 6month. Subjective Global Assessment, Nutritional Risk Index nutrition tests and Anthropometric measurements are predictive for malnutrition and postoperative status in gastrectomy patients. Poor nutritional status can result in decreased quality of life, functional status and response to therapy. Therefore the early diagnosis and management is essential.

Contact person email address: gsman@dsmc.or.kr

To view the presentation in PDF click on this: Seung Wan Ryu et al (Top)

 

R – 331

The differences of Subjective Global Assessment between nurses and dietitians

Rie Furukawa, RD, Keiko Zama, RD, Atsuo Ohashi, RD, Fumiaki Katada, MD, MPH, CNSP*

Kameda Medical Center, Kamogawa, Japan

Background: A number of doctors, nurses, and dietitians are evaluating Subjective Global Assessment (SGA) every day. However, there are few studies reporting the tendency of assessment depending on their specialties.

Objectives: To clarify the concordance proportion of SGA between nurses and dietitians, and to examine the tendency of assessment between them.

Setting: A tertiary emergency hospital in Chiba, Japan.

Methods: Consecutive patients who were newly admitted Kameda Medical Center in July 2007 were included. All patients were evaluated SGA by one nurse and one dietitian. They assessed SGA independently and the results were masked to each other. The concordance proportion of SGA between nurses and dietitians were calculated. When the SGA evaluation between nurses and dietitians disagree, the tendency of assessment of each SGA items depending on their specialties were assessed.

Results: During the study period, a total of 201 patients were evaluated. The concordance proportion of SGA was 82.1% (165/201). The concordance proportion of each SGA items was 80% or more, except for two items (Gastrointestinal symptoms 78.6%, Nutritional requirements 56.2%). The “disagree” cases were 17.9% (36/201). Among them, nurses evaluated SGA lower than dietitian in 12 cases, and SGA items related to “History” (e.g. gastrointestinal symptoms, Functional capacity) were tended to score lower by nurses. On the other hand, dietitians evaluated SGA lower than nurses in 24 cases, and SGA items related to “Physical” (e.g. Loss of subcutaneous fat, Muscle wasting) were tended to score lower by dietitians.

Conclusion: The concordance proportion of SGA was 82.1% between nurses and dietitians. When they disagree, nurses tended to think the patients’ history important, and dietitians tended to regard the patients’ physical important. To do a better assessment, it is important to consider each other’s viewpoint.

Contact person email address: *katada@kameda.jp

To view the presentation in PDF click on this: Furukawa R et al (Top)

 

R –220

Clinical trials of an instant tube feeding formula in enterally fed patients in a hospital setting

Celeste C. Tanchoco(1*), Milagros F. Villadolid(1), Marietta P. Rodriguez(1), Marietta B. Pangan(1), Judaline S. Robles(1), Ida Marie M. Tabangay(2), Marie France G. Dado(3), and Joan Marie P. Sumpio(3)

(1) Clinical Nutrition Section, Medical Nutrition Division, Food and Nutrition Research Institute, Department of Science and Technology; (2) Department of Surgery, Clinical Division, Santo Tomas University Hospital; (3) Dietary Department, Santo Tomas University Hospital

Background/Objective(s): The instant tube feeding formula developed by the Food and Nutrition Research Institute was clinically tested among 14 tube-fed patients, confined at the Santo Tomas University Hospital to determine its efficacy, suitability, acceptability and safety as a source of nutritional support. 

Methodology: Each patient received the reconstituted tube feeding formula during the clinical trial period of two weeks. Evaluation of dietary intake, anthropometric measurements, biochemical analyses and diet tolerance were undertaken to provide information about the response to treatment. Microbiological examinations were done on 13 formulas prepared in the hospital. 

Results: The study showed that the formula can prevent significant nutritional deterioration in most tube-fed patients. In terms of nutrient density, the formula was found to be comparable to a commercial formula.  The formulas provided fair to more than adequate amounts of protein, calcium, iron and the major vitamins except niacin and vitamin C. The high microbiological susceptibility of blenderized diets were also observed.  Excellent tolerance of the formula was noted favoring recommendation of its use as a means of nutritional support.

Contact person email address: *cct@fnri.dost.gov.ph

To view the presentation in PDF click on this: Tanchoco et al. (Top)

 

R – 419

Percutaneous Endoscopic Gastrostomy (PEG) indications, complications, and effect on nutritional status on elderly patients in a tertiary care hospital in the Philippines from January to December 2004

Jiloca JL (1), Ramos MA (1), Llido LO (2)

(1) Geriatric Center and (2) Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines

Background/Objective(s): Percutaneous endoscopic gastrostomy (PEG) is widely used for pediatric and adult patients with inadequate oral intake, but few studies evaluated its value in the elderly patients as to tolerance and nutritional status. This study analyzes the profile of geriatric patients with PEG in our institution and correlates PEG with the indications, complications, and patient nutritional status.

Methods: Admitted geriatric patients with PEG were followed up during the months of January to December 2004.  The patient profile, medical condition, co-morbidities, indication(s), complication(s), and follow up nutritional status (BMI) after PEG were gathered.

Results: 44 geriatric patients with PEG were collected from 117 cases of PEG inserted patients admitted in year 2004. The median age is 84 years (range 60 to 101 years), 21 males and 23 females. The main conditions when PEG was inserted were: gastrointestinal (26%), neurological (24%), cardiovascular (14%), and infectious (14%). Follow up was within 6 months (52%) to one year (48%). Follow up BMI showed nutritional status to be: normal (52.3%), overweight (22.7%), underweight (18.2%), and obese (6.8%). Most of the underweight were from the 80 to 89 year old age group (28.6%). Adequate intake as shown by the nutritional status was achieved in 81.8% (p<0.05) of patients. Complication rate was 14% (wound infection 4.3%, diarrhea 3.4%, aspiration 2.6%, and vomiting 1.7%). The mortality of 9% was not associated with PEG status, but with the disease process.

Conclusion: PEG improves intake and subsequent nutritional status in 81.8% of admitted geriatric patients. Complication rate was minimal with no associated mortality.

Contact person email address: llido2001@yahoo.com

To view the presentation in PDF click on this: Jiloca et al (Top)

 

R – 208

Complications associated with subclavian vein catheter insertion: the role of nutrition support team

John Kotsikoris, Vassilios Alivizatos, Pavlos Athanasopoulos, Mathiew Souchlakis

Department of Surgery, Nutrition Unit, “St. Andrew General Hospital, Patras, Greece

Background/Aim: Complications directly attributable to central venous catheter insertion occur in 3 – 12% of cases. The aim of this study was to determine the incidence of such complications, as well as to evaluate the role of a Nutrition Support Team to preventing or keeping the incidence to a minimum.

Methods: During a two-year period (8/2005 – 7/2007), 350 consecutive patients requiring central venous access mainly for parenteral nutrition support were prospectively studied. In all the patients, the insertion of the central venous catheter was done in the subclavian vein by percutaneous puncture. Catheterization was made by 4 experienced medical doctors, forming a Nutrition Support Team, in all the cases. There was determined the incidence of technical complications related to catheter insertion.

Results: Complications related to catheter insertion were presented in 9 patients (overall incidence 2.5%); out of these, in 4 patients (1.1%) was noted malposition of the catheter requiring reinsertion, in 3 patients (0.8%) artery injury requiring no specific treatment, and in 2 patients (0.6%) a local haematoma requiring no specific treatment also. There was not any case of pneumothorax neither any other complication.

Conclusion: The results of this study suggest that the complication rate of subclavian vein catheter insertion can be minimized by careful attention to technique and concentrating experience in the hands of a few dedicated individuals forming a Nutrition Support Team.

Contact person email address: valiviz@hol.gr

To view the presentation in PDF click on this: Alivizatos V. et al. (Top)

 

R –231

Lipidemic complication and awareness in the use of all-in-one parenteral nutrition

Jinda Preechaverakul (1), Putisak Putawibul (2), Saipin Panbumrung (3)

Department of Pharmacy (1), Surgery (2), and Nursing (3); Faculty of Medicine, Prince of Songkhla University, Han Yai, Songkhla, Thailand

Background: All-in-one (AIO) parenteral nutrition (PN) is widely used because of its convenience and adequate provision of calorie replacement through lipid. The short term use of parenteral fat emulsion is safe, but the effect of long term use is unknown. The awareness of lipidemia among clinicians could prevent complication.

Objective: To study the clinicians’ awareness of lipidemia from the use of AIO solution and the occurrence of complications.

Methods: Prospective study was conducted in 174 surgical patients receiving AIO PN at Songkhlanagarind hospital during January 2005 to July 2006. Patient care team (PCT) collected the data on indication for PN, lipidemic complication, awareness of complication. The team also gave suggestion for safe practices on PN administration.

Results: One hundred and seventy four patients (112 male with average age of 63) received AIO PN because of NPO (N=80), inadequate intake (N=80). Mean duration of PN therapy was 8 days. Thirteen patients (7.55% of total patients) had hypertriglyceridemia. Serum lipid before PN therapy had not been monitored in 126 patients. Forty patients (23% of total patients) were monitored serum lipid after PCT’s recommendation and 86 patients (50% of total patients) had not been monitored serum lipid after received PN.

Conclusion(s): Fifty percent of physicians did not investigate serum lipid both before and after order of PN. Thirteen patients had lipidemic complication. There were no adverse effects of all patients.

Contact person email address:  pjinda@medicine.psu.ac.th

To view the presentation in PDF click on this: Jinda et al (Top)

 

R – 162

Active hexose correlated compound enhances immune function in microgravity analog for space flight effects in mice

Mari Kogiso (1, 2), Koji Wakame (1, 3), Mehran Haidari (4), Eva Golunski (4), Mohammad Madjid (4), Tohru Sakai (2, 5), Shigeru Yamamoto (6), Anil D. Kulkarni (1*)

(1) Surgery, The University of Texas Health Science Center and GSBS at Houston, Houston, USA; (2) International Nutrition, Institution of Health Bioscience, The University of Tokushima, Tokushima, Japan; (3) Amino Up Chemical Co; Ltd., Sapporo, Japan; (4) Cardiology, Texas Heart Institute, Houston, USA; (5) Clinical Nutrition, Institution of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan; (6) Ochanomizu University Graduate School of Humanities and Sciences, Tokyo, Japan

Objectives: Microgravity-induced immune dysfunction is a potential risk to astronauts and space mission. This report presents assessment of a potential nutritional countermeasure for prevention of immune dysfunction in microgravity. Active Hexose Correlated Compound (AHCC), a compound from fermented extract of the mycelia of Basidiomycetes mushrooms has immunomodulating effects. We examined the role of AHCC supplementation on microgravity-induced immune changes employing hindlimb unloading (HU) of mice as a microgravity analog.

Methods: BALB/c mice (8-10 weeks old) were divided into 2 main groups, HU and non-HU. Each group was further divided into 4 subgroups (5 mice/group) receiving drinking water containing 0, 0.1, 1, and 10 g/kg bw/day AHCC, respectively, for 7 days. On day 7, splenocytes from experimental mice were cultured with Con A and LPS to stimulate T cell and B cell, respectively, for 48 hours and proliferative response was measured by tritiated thymidine uptake. Further, LPS-stimulated cytokine and chemokine productions in supernatants were measured using Bio-Plex suspension array system. Statistical analysis was carried out using one-way ANOVA.

Results: Proliferative responses to Con A and LPS were significantly decreased in HU group as compared to non-HU group (p<0.05, p<0.005, respectively). AHCC supplementation reversed these responses. AHCC was most effective at 1 g/kg bw/day dose. LPS-stimulated cytokines (IL-1, IL-1, IL-6) and chemokines (MIP-1, MIP-1, G-CSF, KC) productions were increased in HU group as compared to non-HU group. AHCC supplementation further increased those levels in HU group.

Conclusions: AHCC supplementation ameliorates HU-induced immune suppression of T and B cell functions. Increased cytokine and chemokine productions in mice in AHCC-fed HU group suggest enhanced proinflammatory response. These data suggest that AHCC supplementation under microgravity may have beneficial role in maintenance of immune system.

 Contact person email address: Anil.D.Kulkarni@uth.tmc.edu

To view the presentation in PDF click on this: Kogiso et al (Top)

 

R – 253

Are mineral and trace element contents of hospital diets sufficient to hospitalized patients

Kuo-Cheng Lin, (1) Mei-Due Yang (1,2), Chin-Ching Wu (3), Walter Chen, (4) Guoo-Shyng Wang Hsu (5)

Department of Clinical Nutrition (1), Department of Surgery (2), China Medical University Hospital China Medical University (3), China Medical University Beigang Hospital (4), Fu Jen Catholic University (5), Taiwan.

Objective: The hospital diet belongs to the quantitative food preparation. Bleeching usually is the first step of cooking, especially for the green vegetables.  However, minerals are lost from the draining.  If there is sufficient amount of minerals in the hospital diets need to be concerned, especially for patients in the long-term medical care facility. 

Methods: 126 samples (Normal diets and eight therapeutic diets of spring and autumn menu of in–patient) were collected from a medical center in central Taiwan. Calcium, magnesium, iron, zinc, copper, manganese, Chromium and molybdenum of samples of above diet were analyzed by using of Inductively Coupled Plasma Mass Spectrum ( ICPMS ) analyzer, Inductively Coupled Plasma Optical Emission Spectrophotometer ( ICPOES ) and/or the Atomic Absorption Spectrophotometry (AAS). Data were evaluated by t-test (SAS software release 8.0; procedure guide SAS Institute, Cary, NC). Differences with P-values < 0.05 were considered significant

Result: Calcium and magnesium contents in all diets were unable to meet Dietary Reference Intake (RDIs) of the nutrients.  Iron contents of all diets could meet DRI for adult males (10 mg/day).  Except the parturient diet, other diets were unable meet the DRIs for Zinc. With the exception of the vegetarian diet, which showed a serious deficiency in selenium and iron levels, all other diet were able to provide sufficient levels of copper, selenium manganese chromium, molybdenum, and other trance elements, to meet the DRIs. Manganese, Chromium, and Molybdenum on some kinds of diets were significantly different between spring and autumn.

Conclusion: The integration of this study’s results suggests that there is a need to add more calcium-rich magnesium-rich, and iron-rich foods in the parturient diet, and calcium, iron, magnesium, zinc foods and/or nutrient supplement in all other diets when a dietitian plans and designs these diets.

Contact person email address: lin_kuo_cheng@yahoo.com.tw

To view the presentation in PDF click on this: Lin et al (Top)

 

R – 308

The adequacy of nutrition intervention in intensive care unit

Jeannie Miu-Sim Poon

Dietetic Services and Intensive Care Unit; Hongkong Sanatorium and Hospital, Hongkong, PRC

Background/Objective(s): To determine the prevalence and the risk level of malnutrition in patients admitted to intensive care unit (ICU) and to examine the adequacy of current doctor’s referral as an early nutrition therapy for patient with mild to severe malnutrition risk.

Methods: Despite the concept of early nutrition in periods of stress being well documented, it is often neglected or not appropriately practiced in the critically ill. Dietetic referrals of patient in ICU were studied during the period from March 15 to June 14, 2006 to assess the adequacy of nutrition intervention. Nutritional screening using a modified format of the subjective global assessment was performed on all patient admitted or transferred to the ICU. The risk level of malnutrition was determined and he prevalence of dietetic referrals recorded.

Results: A total of 41 ICU patients screened. Results indicated 56 percent of the ICU patients examined had mild to severe malnutrition risk (27% with mild, 22% with moderate, 7 percent with malnutrition risk). Of the malnourished patients, only three were referred for nutrition assessment and intervention, whereas two patients with no malnutrition risk level were referred for medical nutrition therapy, thus showing no correlation between the degree of malnutrition risk and dietetic referrals.

Conclusion: Due to the complications of the disease and illness, the nutrition needs of ICU patients were often overlooked; malnutrition can delay the length of recovery. Unless assertive nutrition intervention is given in the early stage of management, patient recovery will eventually be compromised.

Contact person email address: dietitian@hksh.com.hk

To view the presentation in PDF click on this: Poon J (Top)

 

R – 197

Relationship of nutritional status at time of admission to length of hospital stay and mortality

KH Choi, M.D. KY Yoon, M.D. SM Ann (2), YM Sin M.D MK Jang (1), SH Lee (1), JY Park (2)

Department of Surgery, (1) Pharmacy, and (2) Nutrition, Gospel Hospital, Kosin Medical College, Pusan, Korea

Background/Aims: The length of hospital stay (LHS) is an indication of the patient's recovery rate. LHS has also become an important economic factor for hospitals. This study was conducted to determine the relationship of nutritional status at time of admission to LHS and mortality.

Methods: The study subjects were 1,619 patients with cancer admitted to Kosin University Gospel Hospital during 2005 who met study criteria were included in the study. Patients were classified to Not at risk, At risk ¥°, At risk ¥±, At risk ¥², At risk ¥³. for malnutrition on the basis of established criteria serum albumin <3.0 g/dl, total lymphocyte count £¼1500 cells/mm3, cholesterol ¡Ã240 mg/dl or ¡Â130 mg/dl, weight for height ¡Ã120% or £¼90% ideal body weight.

Results: 24.3% of the patients were classified as Not at risk Group, 37.6% as At risk Group ¥°, 24.2% as At risk Group ¥±, 10.3% as At risk Group ¥², 3.6% as At risk Group ¥³. The at risk group(At risk ¥², At risk ¥³) had a significantly higher prevalence of liver disease. The relationship between liver disease and low serum albumin levels may have confounded the data. Although the estimated LOS was similar in all groups, the average length of stay was 14.4¡¾16.38 days in the malnourished group(At risk Group ¥³) compared to approximately 2.8 days in Not at risk Group. The more the patients had the nutritional risk factors, the longer the LHS and significant the higher the mortality rate were. Correlation was not observed risk factors and LHS but as well as correlation mortality rate.

Conclusions: These results suggest that a patient's nutritional status upon admission has an effect on the LHS for patients with carcinoma.  

Contact person email address: Yoonky@ns.kosinmed.or.kr

To view the presentation in PDF click on this: Choi et al (Top)