ELSEVIER
YCLNU_v38_i3_COVER.indd 1 17-04-2019 18:33:29
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VOL. 38 SUPPLEMENT 1
SEPTEMBER 2019
ISSN 0261-5614
Abstracts of the 41st ESPEN Congress,
Krakow, Poland, 31 August–3 September, 2019
Publication of this Abstract Book is supported by the European Society for Clinical Nutrition and Metabolism (ESPEN), with editorial assistance from MCI Geneva.
Clinical
Nutrition
An international journal devoted to
clinical nutrition and metabolism
Official Journal of ESPEN — The European Society for Clinical Nutrition and Metabolism
Editor
N.E.P. Deutz, MD, PhD
Center for Translational Research in Aging & Longevity,
Department of Health & Kinesiology,
Texas A&M University,
College Station, Texas 77843-4253, U.S.A.
E-mail: espenjournals@espen.org
Amsterdam • Boston • London • New York • Oxford • Paris • Philadelphia • San Diego • St. Louis
M.D. Ballesteros-Pomar, MD, PhD (Spain)
J. Bauer, MD, PhD (Germany)
M. Beattie (UK)
M.M. Berger, MD, PhD (Switzerland)
E. Cereda, MD, PhD (Italy)
M. Chourdakis, MD, PhD (Greece)
A. Forbes, BSc, MD, FRCP, FHEA (UK)
Y. Hamada, MD, PhD (Japan)
L. Holm, MD, PhD (UK)
K. Joosten, MD, PhD (The Netherlands)
S. Klek, MD, PhD (Poland)
A. Laviano, MD (Italy)
D. Lobo, MS, DM, FRCS, FACS (UK)
M. Muscaritoli, MD, PhD (Italy)
K. Neal, MD (Statistical Associate Editor) (UK)
K. Norman, MSc, PhD (Germany)
C. Pichard, MD, PhD (Switzerland)
C. Prado, PhD (Canada)
J.C. Preiser, MD, PhD (Belgium)
P. Ravasco, RD, MD, Msc, PhD (Portugal)
M. Rondanelli, MD, PhD (Italy)
S. Ruiz-Santana, MD, PhD (Spain)
M.J. Serlie, MD, PhD (Spain)
P. Singer, MD (Israel)
M.R. Soeters, MD, PhD (The Netherlands)
R. Thibault, MD, PhD (France)
M. Usami, MD, PhD (Japan)
D.L. Waitzberg, MD (Brazil)
P. Wischmeyer, MD (USA)
Associate Editors
Managing Editor
J.A. Mays
Center for Translational Research in Aging & Longevity,
Department of Health & Kinesiology,
Texas A&M University,
College Station, Texas 77843-4253, U.S.A.
E-mail: espenjournals@espen.org
G.A.M. Ten Have, PhD
Center for Translational Research in Aging & Longevity,
Department of Health & Kinesiology,
Texas A&M University,
College Station, Texas 77843-4253, U.S.A.
E-mail: espenjournals@espen.org
YCLNU_v38_i3_FM.indb i 17-04-2019 19:18:46
Past Editor–in–Chief
M.A. Gassull (Spain)
Past Associate Editors
G. Biolo (Italy)
E. Cabré (Spain)
P. Calder (UK)
T. Cederholm (Sweden)
A. Davies (Australia)
X. Forceville (France)
L. Gramlich (Canada)
P. Greenhaff (UK)
R. Griffiths (UK)
B. Koletzko (Germany)
H. Lochs (Germany)
Y. Luiking (USA)
B. Morio (France)
H. Ohyanagi (Japan)
O. Rooyackers (Sweden)
M.A.E. van Bokhorst – de
van der Schueren
(The Netherlands)
E. Volpi (USA)
B.M. Winklhofer-Roob
(Austria)
T. Ziegler (USA)
J. Arends (Germany)
M. Bahar (Turkey)
M.D. Ballesteros-Pomar
(Spain)
R. Barazzoni (Italy)
J.Bauer (Germany)
J. Baxter (UK)
M.M. Berger (Switzerland)
Y.N. Berner (Israel)
H.K. Biesalski (Germany)
J. Bines (Australia)
G. Biolo (Italy)
S.C. Bischoff (Germany)
B. Bistrian (USA)
G. Bodoky (Hungary)
Y. Boirie (France)
I. Bosaeus (Sweden)
F. Bozzetti (Italy)
M. Braga (Italy)
I. Bretón (Spain)
A. Buchman (USA)
R. Burgos Peláez (Spain)
E. Cabre (Spain)
M.E. Camilo (Portugal)
B. Campillo (France)
A.C.L. Campos (Brazil)
N. Cano (France)
Y.A. Carpentier (Belgium)
J.J. Carrero (Sweden)
T. Cederholm (Sweden)
E. Cereda (Italy)
I. Chermesh (Israel)
I. Correia (Brazil)
A.G. Cosslett (UK)
M. Cravo (Portugal)
C. Cuerda (Spain)
L. Cynober (France)
E. Dárdai (Hungary)
A. Davies (Australia)
J.-P. de Bandt (France)
I. de Blaauw
(The Netherlands)
P. Dechelotte (France)
C.H.C. Dejong
(The Netherlands)
N.E.P. Deutz (USA)
S.J. Dudrick (USA)
M. Elia (UK)
J. Faintuch (Brazil)
K.C.H. Fearon (UK)
E. Fiaccadori (Italy)
G. Filippatos (Greece)
E. Fontaine (France)
A. Forbes (UK)
X. Forceville (France)
C. Fusch (Canada)
M.A. Gassull (Spain)
L. Genton (Switzerland)
O. Genzel-Boroviczeny
(Germany)
A. Gil (Spain)
J.M. Gómez Sáez (Spain)
F. Gottrand (France)
O.J. Goulet (France)
L. Gramlich (Canada)
E. Granot (Israel)
R. Griffiths (UK)
R.F. Grimble (UK)
I. Grintescu (Romania)
G. Guarnieri (Italy)
D.C. Guttridge (USA)
Y. Hamada (Japan)
G. Hardy (New Zealand)
X. Hébuterne (France)
B.L. Heitmann (Denmark)
O. Hernell (Sweden)
M. Holst (Denmark)
P. Howard (UK)
G. Iapichino (Italy)
Ø. Irtun (Norway)
K.N. Jeejeebhoy (Canada)
G.L. Jensen (USA)
P.B. Jeppesen (Denmark)
C.G. Jonkers-Schuitema
(The Netherlands)
K. Joosten (Netherlands)
F.E. Kalfarentzos (Greece)
S. Kilicturgay (Turkey)
S. Klek (Poland)
S.S.K. Kolacˇek (Croatia)
B. Koletzko (Germany)
R. Komsa-Penkova
(Bulgaria)
J. Kondrup (Denmark)
Z. Krznaric (Croatia)
J. Ksiazyk (Poland)
A. Lapillonne (France)
A. Laviano (Italy)
M. Leon-Sanz (Spain)
E. Lerebours (France)
B. Lindholm (Sweden)
O. Ljungqvist (Sweden)
D. Lobo (UK)
H. Lochs (Austria)
C. Löser (Germany)
Y. Luiking (USA)
K. Lundholm (Sweden)
J. MacFie (UK)
E.M.H. Mathus-Vliegen
(The Netherlands)
R. Meier (Switzerland)
J.-C. Melchior (France)
K. Melzer (Switzerland)
M. Merli (Italy)
B. Messing (France)
W.A. Mihatsch (Germany)
A. Miján (Spain)
J.M. Moreno (Spain)
B. Morio-Liondore
(France)
S. Mühlebach
(Switzerland)
M.M.J. Müller (Germany)
M. Muscaritoli (Italy)
G. Nitenberg (France)
K. Norman (Germany)
I.B. Nyulasi (Australia)
J.G. Ockenga (Germany)
H. Ohyanagi (Japan)
R. Olav (Sweden)
M. Pertkiewicz (Poland)
C. Pichard (Switzerland)
L. Pironi (Italy)
M. Pirlich (Germany)
C. Pison (France)
M. Plauth (Germany)
C. Prado (Canada)
J.-C.E.A.M. Preiser
(Belgium)
J. Puntis (UK)
P. Ravasco (Portugal)
O. Riggio (Italy)
O. Rooyackers (Sweden)
F. Rossi-Fanelli (Italy)
G.S. Rozen (Israel)
S.M. Schneider (France)
A.(AMWJ). Schols
(The Netherlands)
J.M.G.A. Schols
(The Netherlands)
T. Schütz (Germany)
J.L. Shaffer (UK)
R. Shamir (Israel)
A. Shenkin (UK)
D. Silk (UK)
P. Singer (Israel)
R.J.E. Skipworth (UK)
L. Sobotka (Czech Republic)
M.R. Soeters (The Netherlands)
P. Soeters (Belgium)
Z. Stanga (Switzerland)
M. Staun (Denmark)
R. Stratton (UK)
H. Szajewska (Poland)
P. Szitányi (Czech Republic)
K.A. Tappenden (USA)
L. Tappy (Switzerland)
V. Teplan (Czech Republic)
P. Tesinsky (Czech Republic)
D. Teta (Switzerland)
J.-P.M. Thissen (Belgium)
A.G. Thomas (UK)
A. Thorell (Sweden)
M. Usami (Japan)
M. Uyar (Turkey)
N. Vaisman (Israel)
L. Valentini (Germany)
M.A.E. van Bokhorst – de
van der Schueren
(The Netherlands)
G. van den Berghe
(Belgium)
A. van Gossum (Belgium)
P.A.M. van Leeuwen
(The Netherlands)
C.W. Van Way (USA)
M.F.J. Vandewoude
(Belgium)
M. von Meyenfeldt
(The Netherlands)
J. Wahren (Sweden)
D.L. Waitzberg (Brazil)
A. Weimann (Germany)
J. Wernerman (Sweden)
B.M. Winklhofer-Roob
(Austria)
P. Wischmeyer (USA)
Z. Zadak (Czech Republic)
M. Ziva (Slovenia)
Editorial Advisory Board/ESPEN Faculty
YCLNU_v38_i3_FM.indb ii 17-04-2019 19:18:46
ESPEN
Abstracts of the
37th ESPEN Congress
Lisbon, Portugal, 5 8 September 2015
Authors are responsible for content and language quality of abstracts
38th
Copenhagen, Denmark, 17–20 September 2016
Past Editor–in–Chief
M.A. Gassull (Spain)
Past Associate Editors
G. Biolo (Italy)
E. Cabré (Spain)
P. Calder (UK)
T. Cederholm (Sweden)
A. Davies (Australia)
X. Forceville (France)
L. Gramlich (Canada)
P. Greenhaff (UK)
R. Griffiths (UK)
B. Koletzko (Germany)
H. Lochs (Germany)
Y. Luiking (USA)
B. Morio (France)
H. Ohyanagi (Japan)
O. Rooyackers (Sweden)
M.A.E. van Bokhorst – de
van der Schueren
(The Netherlands)
E. Volpi (USA)
B.M. Winklhofer-Roob
(Austria)
T. Ziegler (USA)
J. Arends (Germany)
M. Bahar (Turkey)
M.D. Ballesteros-Pomar
(Spain)
R. Barazzoni (Italy)
J.Bauer (Germany)
J. Baxter (UK)
M.M. Berger (Switzerland)
Y.N. Berner (Israel)
H.K. Biesalski (Germany)
J. Bines (Australia)
G. Biolo (Italy)
S.C. Bischoff (Germany)
B. Bistrian (USA)
G. Bodoky (Hungary)
Y. Boirie (France)
I. Bosaeus (Sweden)
F. Bozzetti (Italy)
M. Braga (Italy)
I. Bretón (Spain)
A. Buchman (USA)
R. Burgos Peláez (Spain)
E. Cabre (Spain)
M.E. Camilo (Portugal)
B. Campillo (France)
A.C.L. Campos (Brazil)
N. Cano (France)
Y.A. Carpentier (Belgium)
J.J. Carrero (Sweden)
T. Cederholm (Sweden)
E. Cereda (Italy)
I. Chermesh (Israel)
I. Correia (Brazil)
A.G. Cosslett (UK)
M. Cravo (Portugal)
C. Cuerda (Spain)
L. Cynober (France)
E. Dárdai (Hungary)
A. Davies (Australia)
J.-P. de Bandt (France)
I. de Blaauw
(The Netherlands)
P. Dechelotte (France)
C.H.C. Dejong
(The Netherlands)
N.E.P. Deutz (USA)
S.J. Dudrick (USA)
M. Elia (UK)
J. Faintuch (Brazil)
K.C.H. Fearon (UK)
E. Fiaccadori (Italy)
G. Filippatos (Greece)
E. Fontaine (France)
A. Forbes (UK)
X. Forceville (France)
C. Fusch (Canada)
M.A. Gassull (Spain)
L. Genton (Switzerland)
O. Genzel-Boroviczeny
(Germany)
A. Gil (Spain)
J.M. Gómez Sáez (Spain)
F. Gottrand (France)
O.J. Goulet (France)
L. Gramlich (Canada)
E. Granot (Israel)
R. Griffiths (UK)
R.F. Grimble (UK)
I. Grintescu (Romania)
G. Guarnieri (Italy)
D.C. Guttridge (USA)
Y. Hamada (Japan)
G. Hardy (New Zealand)
X. Hébuterne (France)
B.L. Heitmann (Denmark)
O. Hernell (Sweden)
M. Holst (Denmark)
P. Howard (UK)
G. Iapichino (Italy)
Ø. Irtun (Norway)
K.N. Jeejeebhoy (Canada)
G.L. Jensen (USA)
P.B. Jeppesen (Denmark)
C.G. Jonkers-Schuitema
(The Netherlands)
K. Joosten (Netherlands)
F.E. Kalfarentzos (Greece)
S. Kilicturgay (Turkey)
S. Klek (Poland)
S.S.K. Kolacˇek (Croatia)
B. Koletzko (Germany)
R. Komsa-Penkova
(Bulgaria)
J. Kondrup (Denmark)
Z. Krznaric (Croatia)
J. Ksiazyk (Poland)
A. Lapillonne (France)
A. Laviano (Italy)
M. Leon-Sanz (Spain)
E. Lerebours (France)
B. Lindholm (Sweden)
O. Ljungqvist (Sweden)
D. Lobo (UK)
H. Lochs (Austria)
C. Löser (Germany)
Y. Luiking (USA)
K. Lundholm (Sweden)
J. MacFie (UK)
E.M.H. Mathus-Vliegen
(The Netherlands)
R. Meier (Switzerland)
J.-C. Melchior (France)
K. Melzer (Switzerland)
M. Merli (Italy)
B. Messing (France)
W.A. Mihatsch (Germany)
A. Miján (Spain)
J.M. Moreno (Spain)
B. Morio-Liondore
(France)
S. Mühlebach
(Switzerland)
M.M.J. Müller (Germany)
M. Muscaritoli (Italy)
G. Nitenberg (France)
K. Norman (Germany)
I.B. Nyulasi (Australia)
J.G. Ockenga (Germany)
H. Ohyanagi (Japan)
R. Olav (Sweden)
M. Pertkiewicz (Poland)
C. Pichard (Switzerland)
L. Pironi (Italy)
M. Pirlich (Germany)
C. Pison (France)
M. Plauth (Germany)
C. Prado (Canada)
J.-C.E.A.M. Preiser
(Belgium)
J. Puntis (UK)
P. Ravasco (Portugal)
O. Riggio (Italy)
O. Rooyackers (Sweden)
F. Rossi-Fanelli (Italy)
G.S. Rozen (Israel)
S.M. Schneider (France)
A.(AMWJ). Schols
(The Netherlands)
J.M.G.A. Schols
(The Netherlands)
T. Schütz (Germany)
J.L. Shaffer (UK)
R. Shamir (Israel)
A. Shenkin (UK)
D. Silk (UK)
P. Singer (Israel)
R.J.E. Skipworth (UK)
L. Sobotka (Czech Republic)
M.R. Soeters (The Netherlands)
P. Soeters (Belgium)
Z. Stanga (Switzerland)
M. Staun (Denmark)
R. Stratton (UK)
H. Szajewska (Poland)
P. Szitányi (Czech Republic)
K.A. Tappenden (USA)
L. Tappy (Switzerland)
V. Teplan (Czech Republic)
P. Tesinsky (Czech Republic)
D. Teta (Switzerland)
J.-P.M. Thissen (Belgium)
A.G. Thomas (UK)
A. Thorell (Sweden)
M. Usami (Japan)
M. Uyar (Turkey)
N. Vaisman (Israel)
L. Valentini (Germany)
M.A.E. van Bokhorst – de
van der Schueren
(The Netherlands)
G. van den Berghe
(Belgium)
A. van Gossum (Belgium)
P.A.M. van Leeuwen
(The Netherlands)
C.W. Van Way (USA)
M.F.J. Vandewoude
(Belgium)
M. von Meyenfeldt
(The Netherlands)
J. Wahren (Sweden)
D.L. Waitzberg (Brazil)
A. Weimann (Germany)
J. Wernerman (Sweden)
B.M. Winklhofer-Roob
(Austria)
P. Wischmeyer (USA)
Z. Zadak (Czech Republic)
M. Ziva (Slovenia)
Editorial Advisory Board/ESPEN Faculty
YCLNU_v38_i3_FM.indb ii 17-04-2019 19:18:46
ESPEN
Abstracts of the
37th ESPEN Congress
Lisbon, Portugal, 5 8 September 2015
Authors are responsible for content and language quality of abstracts
38th
Copenhagen, Denmark, 17–20 September 2016
Publication of this Abstract Book is supported by the European Society for Clinical Nutrition and Metabolism (ESPEN), with editorial assistance from MCI Geneva.
41st
Krakow, Poland, 31 August–3 September, 2019
Clinical Nutrition Aims and Scope
Clinical Nutrition, the official journal of ESPEN, The European Society
for Clinical Nutrition and Metabolism, is an international journal providing scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.
Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism.
focused on basic research or clinical disciplines, the journal reflects the scientific nature of this multidisciplinary background and encourages the coordination of investigation and research from these disciplines. The journal publishes high quality papers like guidelines, consensus statements, review papers, original articles, short communications, and letters to the Editor on those factors in acute and chronic diseases, which have metabolic and nutritional implications. It also publishes scientific works related to the development of new techniques and their application in the field of clinical nutrition.
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Volume 38
Number 3
June 2019
Pages 969–1488
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Clinical
Nutrition
An international journal devoted to clinical nutrition and metabolism
Official Journal of ESPEN—The European Society for Clinical Nutrition and Metabolism
CONTENTS
ESPEN ENDORSED RECOMMENDATION
Nutrition education in medical schools (NEMS). An ESPEN position paper
C. Cuerda , M. Muscaritoli , L.M. Donini , P. Baqu é , R. Barazzoni , E. Gaudio , D. Jezek , Z. Krznaric ,
M. Pirlich , M. Schetgen , S. Schneider , J.A. Vargas , A. Van Gossum
969
REVIEWS
Lean non-alcoholic fatty liver disease
A.Y. Wang , J. Dhaliwal , M. Mouzaki
975
Feeding mitochondria: Potential role of nutritional components to improve critical illness
convalescence
E. Wesselink , W.A.C. Koekkoek , S. Grefte , R.F. Witkamp , A.R.H. van Zanten
982
A systematic review and meta-analysis of the effects of soy on serum hs-CRP
M. Khodarahmi , M.A. Jafarabadi , J. Moludi , M. Abbasalizad Farhangi
996
High-protein diets for weight management: Interactions with the intestinal microbiota and
consequences for gut health. A position paper by the my new gut study group
F. Blachier , M. Beaumont , K.J. Portune , N. Steuer , A. Lan , M. Audebert , N. Khodorova , M. Andriamihaja ,
G. Airinei , R. Benamouzig , A.-M. Davila , L. Armand , S. Rampelli , P. Brigidi , D. Tom é , S.P. Claus ,
Y. Sanz
1012
RANDOMIZED CONTROL TRIALS
Growth, stool consistency and bone mineral content in healthy term infants fed
sn -2-palmitate-enriched starter infant formula: A randomized, double-blind, multicentre
clinical trial
L. B é ghin , X. Marchandise , E. Lien , M. Bricout , J.-P. Bernet , J.-F. Lienhardt , F. Jeannerot , V. Menet ,
J.-C. Requillart , J. Marx , N. De Groot , J. Jaeger , P. Steenhout , D. Turck
1023
http://www.elsevier.com/locate/clnu
Contents continued over page
Available online at www.sciencedirect.com
ScienceDirect
YCLNU_v38_i3_FM.indb iv 17-04-2019 19:18:46
Clinical Nutrition Aims and Scope
Clinical Nutrition, the official journal of ESPEN, The European Society
for Clinical Nutrition and Metabolism, is an international journal providing scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.
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YCLNU_v38_i3_FM.indb iii 17-04-2019 19:18:46
Abstracts Page(s)
Orals
Clinical Nutrition Symposium
CN01-CN06
S1-S3
GLIM
GM01-GM02 S3-S4
Oral Communication I: Critical Care
OR01-OR09
S4-S8
Oral Communication II: GI
+ Liver
OR10-OR18
S8-S11
Oral Communication III: Macronutrients
OR19-OR27
S11-S14
Oral Communication IV: Nutritional Assessment Intervention
and Outcome I
OR28-OR36
S14-S18
ESPEN Best Abstracts 2019 & ESPEN Travel Awards
OR37-OR41
S18-S20
Oral Communication V: Nutritional Assessment Intervention
and Outcome II
OR42-OR50
S20-S24
Oral Communication VI: Paediatrics
OR51-OR59
S24-S27
Oral Communication VII: Vitamins/Hormones/Minerals/Mediators
OR60-OR68
S27-S31
Poster tours
Critical care/Liver and gastrointestinal tract/Perioperative care
PT01.1-PT01.6
S33-S35
Geriatrics/Nutrition and chronic disease/Nutritional epidemiology
PT02.1-PT02.6
S35-S38
Nutrition and cancer/Nutritional assessment/Qualitative
design studies
PT03.1-PT03.6
S38-S40
Nutrition and cancer/Obesity and the metabolic syndrome
PT04.1-PT04.6
S40-S42
Nutrition and chronic disease/Nutritional assessment/Nutritional
techniques and formulations
PT05.1-PT05.6
S42-S44
Obesity and the metabolic syndrome
PT06.1-PT06.6
S45-S47
Contents continued over page
S1–S354
Supplement 1
September 2019
Nutritional techniques and formulations/Obesity and the metabolic
syndrome/Nutrition and cancer/Nutritional assessment
PT07.1-PT07.6
S47-S49
Vitamins, antioxidants and minerals
PT08.1-PT08.6
S49-S51
Nutrition and chronic disease/Vitamins, antioxidants
and minerals
PT09.1-PT09.6
S51-S53
Nutritional assessment/Protein and amino acid
metabolism/Nutrition and cancer
PT10.1-PT10.6
S53-S56
Nutrition and cancer
PT11.1-PT11.6
S56-S58
Posters
Carbohydrate and lipid metabolism
SUN-PO001-SUN-PO009
S59-S62
Critical care 1
SUN-PO011-SUN-PO031
S62-S69
Geriatrics I
SUN-PO032-SUN-PO051
S69-S76
Liver and gastrointestinal tract I
SUN-PO052-SUN-PO068
S77-S84
Nutrition and cancer I
SUN-PO069-SUN-PO119
S84-S103
Nutrition and chronic disease I
SUN-PO120-SUN-PO177
S103-S125
Nutritional assessment I
SUN-PO178-SUN-PO241
S125-S149
Nutritional epidemiology I
SUN-PO242-SUN-PO259
S149-S155
Nutritional techniques and formulations I
SUN-PO260-SUN-PO274
S155-S160
Obesity and the metabolic syndrome I
SUN-PO275-SUN-PO289
S160-S166
Paediatrics I
SUN-PO290-SUN-PO300
S166-S171
Perioperative care I
SUN-PO301-SUN-PO314
S171-S175
Protein and amino acid metabolism
SUN-PO315-SUN-PO320
S175-S177
Hormones, mediators and immunity
MON-PO323
S177-S178
Qualitative design studies
MON-PO324-MON-PO330
S178-S180
Geriatrics II
MON-PO331-MON-PO348
S180-S187
Liver and gastrointestinal tract II
MON-PO349-MON-PO365
S187-S193
Nutrition and cancer II
MON-PO366-MON-PO416
S194-S213
Nutrition and chronic disease II
MON-PO417-MON-PO475
S213-S234
Nutritional assessment II
MON-PO476-MON-PO538
S234-S258
Nutritional epidemiology II
MON-PO539-MON-PO555
S258-S265
Nutritional techniques and formulations II
MON-PO556-MON-PO571
S265-S271
Obesity and the metabolic syndrome II
MON-PO572-MON-PO585
S271-S276
Paediatrics II
MON-PO586-MON-PO596
S276-S280
Perioperative care II
MON-PO597-MON-PO609
S280-S285
Critical care II
MON-PO610-MON-PO629
S285-S292
Vitamins, antioxidants and minerals
MON-PO630-MON-PO639
S292-S296
Late Breaking
Late breaking abstracts 1
SUN-LB640-SUN-LB671
S297-S309
Late breaking abstracts 2
MON-LB672-MON-LB702
S309-S321
Author index
S323
Orals
Clinical Nutrition Symposium
CN01
WHEY PROTEIN ISOLATE SUPPLEMENTATION IMPROVES BODY COMPOSITION, MUSCLE STRENGTH AND TREATMENT TOLERANCE IN MALNOURISHED ADVANCED CANCER PATIENTS UNDERGOING CHEMOTHERAPY
E. Cereda1*, A. Turri1, C. Klersy2, S. Cappello1, A. Ferrari3, A.R. Filippi4, S. Brugnatelli3, M. Caraccia1, S. Chiellino3, V. Borioli1, T. Monaco3, G.M. Stella5, L. Arcaini6, M. Benazzo7, G. Grugnetti8, P. Pedrazzoli3, R. Caccialanza1.1Clinical Nutrition and Dietetics Unit, 2Biometry and Clinical Epidemiology Service, 3Medical Oncology Unit, 4Radiation Oncology Unit, 5Unit of Respiratory System Diseases, 6Division of Hematology, Fondazione Irccs Policlinico San Matteo, 7Department of Otolaryngology, University of Pavia and Head Neck Surgery Fondazione IRCCS Policlinico San Matteo, 8Nursing Technical and Rehabilitation Service, Fondazione Irccs Policlinico San Matteo, Pavia, Italy
* Corresponding author.
Rationale: WP represents the soluble class of dairy proteins which are known immune-enhancing constituents linked to a range of bioactive functions, such as prebiotic effects, promotion of tissue repair, maintenance of intestinal integrity, destruction of pathogens and elimination of toxins. WPs are rich in substrates for glutathione synthesis and could play a major role in cell protection against free radicals, ionizing radiation, reactive oxygen species and carcinogens. Furthermore, supplementation with WP may also induce more muscle protein synthesis than other protein sources, due to their higher anabolic potential. We evaluated the benefit of whey protein isolate (WPI) supplementation in addition to nutritional counseling in malnourished advanced cancer patients undergoing chemotherapy (CT).
Methods: In a single-center, randomized, pragmatic, parallel-group controlled trial (ClinicalTrials.gov: NCT02065726; February 2014– June 2018), 166 malnourished advanced cancer patients with mixed tumor entities candidate to or undergoing CT, were randomly assigned to receive nutritional counseling with (N = 82) or without (N = 84) WPI supplementation (20 grams/daily) for 3 months. Primary endpoint was the change in phase angle (PhA). Secondary endpoints included changes in standardized PhA (SPA), fat-free mass index (FFMI), body weight, muscle strength, quality of life and CT toxicity (CTCAE 4.0 events).
Results: In patients with the primary endpoint assessed (modified intention-to-treat population), counseling plus WPI (N = 66) resulted in improved PhA compared to nutritional counseling alone (N = 69): mean difference, 0.48° [95%CI, 0.05 to 0.90] (P = 0.027). Imputation of missing outcomes yielded consistent findings. WPI supplementation resulted also in improved SPA (P = 0.021), FFMI (P = 0.041), body weight (P = 0.023), muscle strength (P < 0.001) and in a reduced risk of CT toxicity (risk difference,−9.8% [95%CI, −16.9 to −2.6]; P = 0.009), particularly of severe (grade≥3) events (risk difference, −30.4% [95%CI, −44.4 to −16.5]; P = 0.001).
Conclusions: In malnourished advanced cancer patients undergoing CT and receiving nutritional counseling, a 3-month supplementation with WPI resulted in improved body composition, muscle strength, body weight and reduced CT toxicity. Further trials, aimed at verifying the efficacy of this nutritional intervention on mid and long-term primary clinical endpoints in newly diagnosed specific cancer types, are warranted.
Disclosure of Interest: None declared.
CN02
β-HYDROXY-β-METHYLBUTYRATE (HMB), ARGININE AND GLUTAMINE COMPLEX ON MUSCLE VOLUME LOSS IN CRITICALLY ILL PATIENTS: A RANDOMIZED CONTROL TRIAL
K. Nakamura1*, T. Sonoo1, H. Naraba1, H. Nakano1, A. Shimada1, N. Tomizawa1, D. Takai1, Y. Takahashi1, H. Hashimoto1.1Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
* Corresponding author.
Rationale: β-hydroxy-β-methylbutyrate (HMB), a metabolite of leucine, can strongly induce muscle protein synthesis. We evaluated the efficacy of HMB complex on muscle volume loss during critical care.
Methods: For this prospective, single-center, randomized control trial, we created control and HMB groups by random assignment of critically ill intensive care unit (ICU) patients for whom enteral nutrition could be performed. From day 2 after admission, HMB group participants were administered 3 g HMB, 14 g arginine, and 14 g glutamine daily in addition to standard nutrition therapy. Early rehabilitation with electrical muscle stimulation was started from day 2 in both groups. As a primary outcome, we evaluated femoral muscle volume using computed tomography on days 1 and 10 after ICU admission.
Results: From 164 ICU patients, 88 severely ill patients were included and assigned: 43 to control and 45 to HMB. Day 1 and day 10 femoral muscle volumes of 24 control and 26 HMB group participants were analyzed as per protocol. Volumes decreased significantly during days 1–10 (p < 0.0001). Volume loss rates were 14.4 ± 7.1% for control participants and 11.4 ± 8.1% for HMB participants ( p = 0.18). In a subgroup of the sequential organ failure assessment scores <10, femoral muscle volume loss was 14.0 ± 6.9% for control participants and 8.7 ± 6.4% for HMB ( p = 0.0474). Results of intention-to-treat analysis of the two groups showed no differences in basic character-istics or outcomes.
Conclusions: For critically ill patients, HMB complex supplementation from the acute phase of intensive care does not inhibit muscle volume loss. Only moderately severe patients received a benefit.
Disclosure of Interest: None declared. Contents lists available atScienceDirect
Clinical Nutrition
CN03
TICACOS INTERNATIONAL: A MULTI-CENTER, RANDOMIZED, PROSPECTIVE CONTROLLED STUDY COMPARING TIGHT CALORIE CONTROL VERSUS LIBERAL CALORIE ADMINISTRATION STUDY P. Singer1*, E. De Waele2, C. Sanchez3, S. Ruiz-Santana4, J.C. Montejo5, P. Laterre6, A. Soroksky7, L. Moscovici1, I. Kagan1.1Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Tel Aviv, Israel,2Department of Surgical ICU, UZ Brussel, Brussels, Belgium, 3Intensive Care, Hospital General Reina Sofía, Maaga, 4Inteisve Care, Hospital Universitario Dr Negrín., Las Palmas de Gran Canaria,5Inteisive Care, Hospital Universitario 12 Octubre, Madrid, Spain,6Intensive Care, UCL St Luc, Leuven, Belgium,7Inteisive Care, Wolfson Hospital, Holon, Israel
* Corresponding author.
Rationale: Following TICACOS pilot study (1), a multicenter prospect-ive, randomized, controlled non blinded study assessed the advantage of guiding nutritional support in critically patients by daily measured resting energy expenditure (REE).
Methods: From 580 adult ventilated ICU patients planned to stay more than 48 hours, nutritional support was aimed to meet 100% of energy requirement measured by indirect calorimetry or by 25 kcal/kg IBW/d) in the Control Group. Parenteral Nutrition (PN) was added if enteral nutrition (EN) caloric supply <90% calculated needs. Enteral and parenteral formulas enriched in protein were used. Indirect calorim-etry was performed using Deltatrac II, COVX (GE) or Quark (Cosmed, Italy). Statistics used T test for equality of means (independent samples test) and correlations with the Pearson correlation test. A p level <0.05 was considered as significant. Cross tabs procedure used Chi-square test for testing differences in complication rates, length of stay and length of ventilation. Kaplan Meir curves assessed the proportion of surviving patients in the 2 groups.
Results: Seven centers recruited 417 ITT patients from 4737 screened (339 per protocol). Study was stopped due to slow recruitment. No baseline differences between control and study groups in age, sex BMI, SOFA (7.1 ± 3.1 vs 7.4 ± 3.3) and APACHE II (22.4 ± 7.9 vs 22.2 ± 7.4). Measured REE was similar in the 2 groups. Study group received more total energy (1747 ± 467 vs 1305 ± 418 kcal/d, p < 0.02), more propofol (137 ± 37 vs 40 ± 28 kcal/d, p < 0.02) and protein (79 ± 20 vs 62 ± 7 g/d, p < 0.001) and was in a lower negative energy balance (−357 ± 1091 vs −875 ± 270 kcal/d, p < 0.001). When administered, calories from PN were larger in the study group (1477 vs 958 kcal/d, p < 0.02). Rate of infections (40 vs 31), including VAP, rate of pressure ulcers, surgery and dialysis requirement, length of ventilation, LOS ICU and hospital were similar. ICU Mortality (30 in the control vs 21 in the study group) was not different according to Kaplan Meir curve. None of these parameters reached significant difference. However, the decreased mortality observed in the study group added to the previous study may have a positive effect on a meta-analysis.
Conclusions: Tight Calorie Control guided by indirect calorimetry decreased rate of infection and mortality but not significantly in this study stopped prematurely. Compared to the pilot study, less over-feeding and more protein were associated with less complications. The trend in decrease mortality may reinforce the results of the meta-analysis exploring the effects of IC guided nutrition on mortality. Reference
1. Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill. Intensive Care Med 2011.
Disclosure of Interest: None declared.
CN04
EFFECTS OF A BLENDED HOME-BASED EXERCISE PROGRAM AND PROTEIN COUNSELLING IN COMMUNITY DWELLING OLDER ADULTS: RESULTS OF THE VITAMIN RCT
J. van den Helder1,2*, S. Mehra3, M. Tieland1, B. Visser2, B.J. Kröse3,4, R.H. Engelbert2,5, P.J. Weijs1,6on Behalf of Vitamin Research Group. 1Faculty of Sports and Nutrition,2Faculty of Health,3Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, 4Informatics Institute, University of Amsterdam, 5Department of Rehabilitation, Amsterdam University Medical Centers, AMC, 6Department of Nutrition and Dietetics, Amsterdam University Medical Centers, VUmc, Amsterdam, Netherlands
* Corresponding author.
Rationale: With the ageing population, there is an increasing demand for strategies to optimise muscle mass, strength and physical performance in community dwelling older adults. We designed a new innovative e-health intervention“VITAMIN” to improve physical performance in older adults. The blended home-based exercise intervention contains digital support to improve personalised coach-ing as well as dietary protein counsellcoach-ing. This study evaluates the 6 months effectiveness of the intervention.
Methods: The cluster RCT included 245 community dwelling older adults (age≥ 55 y) randomised to control, exercise, and exercise + dietary protein counselling group. Data was collected at baseline and after 6 months of intervention. The primary outcome was the modified Physical Performance test (mPPT) with an emphasis on daily functioning. Secondary measures were gait speed (GS; m/s), physical activity level (PAL), protein intake (g/kg/d), appendicular skeletal muscle mass by DXA (ASMM; kg), hand grip strength (HGS; kg). For statistical analysis SPSSv24.0 was used. A mixed models analysis was performed, with group, time and group*time interaction as fixed factors, subject and cluster as random factors, and additional posthoc Bonferroni test.
Results: Mean age of the 224 evaluated participants was 72.0 ± 6.5 y, 71% were females and 44% low educated. No significant intervention effect was found for mPPT ( p = 0.889). Secondary outcomes showed a significant intervention effect: GS ( p = 0.002), PAL ( p = 0.014), protein intake ( p < 0.001), ASSM ( p = 0.029), HGS ( p < 0.001). Posthoc Bonferroni showed that exercise+protein group had statistical improved outcome compared to control for these secondary outcomes ( p < 0.001; p = 0.003; p < 0.001; p = 0.009; p < 0.001). Control group showed declined values at 6 months compared to baseline for GS (Δ−0.23 m/s), PAL (Δ−0.03), ASSM (Δ−0.32 kg) and HGS (Δ−0.96 kg). Conclusions: Older adults had already very high scores for physical performance (mPPT). However, the blended home-based exercise intervention with protein counselling was still effective for gait speed, physical activity level, dietary protein intake, muscle mass and strength. This personalised innovative e-health intervention showed to be a promising strategy for community dwelling older adults for maintenance instead of declining physical function.
Disclosure of Interest: None declared.
CN05
PROSPECTIVE ASSOCIATIONS OF POOR DIET QUALITY WITH INCIDENT FRAILTY IN COMMUNITY-DWELLING OLDER ADULTS: THE HEALTH ABC STUDY
L.M. Hengeveld1*, H.A.H. Wijnhoven1, M.R. Olthof1, I.A. Brouwer1, E.M. Simonsick2, S.B. Kritchevsky3, D.K. Houston3, A.B. Newman4, M. Visser1. 1Department of Health Sciences, Vrije Universiteit, Amsterdam, Netherlands, 2Intramural Research Program, National
Institute on Aging, Baltimore,3Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem,4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, United States
* Corresponding author.
Rationale: Poor diet is considered an important determinant of the development of frailty. None of the studies on associations between dietary components and frailty considered time to onset of frailty nor potential competing risks. This study aimed to examine associations of diet quality indicators relevant in old age with 4-year incidence of frailty (accounting for competing risks of death) in community-dwelling older adults.
Methods: Data were from 2154 community-dwelling men and women aged 70–81 y in 1998–1999 (present study’s baseline) from the Health ABC Study. In 1998–1999, dietary intake over the preceding year was assessed with a food frequency questionnaire. Indicators of diet quality include overall diet quality as estimated with the Healthy Eating Index (HEI; categorized as poor, medium, and good), energy intake, and protein intake (a priori adjusted for energy intake using the nutrient residual model). Frailty status was determined using Fried’s five-component frailty phenotype and categorized into “robust” (0 components present),“pre-frail” (1–2), or “frail” (3–5). Cox propor-tional hazards analysis was used to examine associations of the diet quality indicators with 4-year incidence of 1) frailty and 2) pre-frailty or frailty. Competing risks analysis was used to examine associations with incidence of frailty by accounting for competing risks of death. Results: During the 4-year follow-up, 277 of the 2154 participants, robust or pre-frail at baseline, developed frailty, and 629 of the 1020 participants, robust at baseline, developed pre-frailty or frailty. Among the robust and pre-frail, after adjustment for confounders including energy intake, those consuming poor- and medium-quality diets had a higher frailty incidence than those consuming good-quality diets (HR: 1.92, 95% CI: 1.17–3.17 and 1.40, 0.99–1.98, respectively). No associa-tions for energy or protein intake were observed. Competing risks analysis yielded similar results. Among the robust, those with lower vegetable protein intake had a higher“pre-frailty or frailty” incidence ( per−10 g/d: 1.20, 1.04–1.39). No other associations were observed. Conclusions: Better overall diet quality and lower vegetable but not animal protein intake may increase the risk of becoming frail in old age. Although some prospective studies showed that higher total protein intake may lower frailty risk, our study indicates that the quality of the overall diet may be more important than protein intake for reducing the development of frailty in old age.
Disclosure of Interest: None declared. CN06
IMPROVING REHABILITATION IN SARCOPENIA (IRIS) BY MUSCLE-TARGETED NUTRITIONAL SUPPORT: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
M. Rondanelli1, E. Cereda2*, C. Klersy3, M.A. Faliva4, G. Peroni4, M. Nichetti4, C. Gasparri4, D. Spadaccini4, V. Infantino4, S. Perna5. 1Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia,2Clinical Nutrition and Dietetics Unit, 3Biometry and Clinical Epidemiology Service, Fondazione Irccs Policlinico San Matteo,4Azienda di Servizi alla Persona (ASP) di Pavia, University of Pavia, Pavia, Italy,5Department of Biology, College of Science, University of Bahrain, Sakhir Campus, Bahrain
* Corresponding author.
Rationale: Sarcopenia is a negative prognostic condition of aging. A combined intervention with physical exercise and nutritional support should be considered. We evaluated the efficacy of a muscle-targeted nutritional support on the outcome of a physical exercise rehabilita-tion program in old adults with sarcopenia.
Methods: A single-site, double-blind, randomized (1:1), placebo-controlled trial (NCT03120026) in sarcopenic old adults (≥65 years) without severe cognitive impairment (Mini Mental State Examination ≥18) and admitted to an in-patient rehabilitation facility for a physical rehabilitation program. In addition to a standard hospital diet, patients (n = 140) were randomized to receive until discharge (for at least 4 weeks and up to 8 weeks) a whey protein-based nutritional supplement enriched with leucine and vitamin D or an iso-caloric placebo twice daily. The primary efficacy endpoint was the change in 4-meter gait speed per month. Key secondary endpoints were change in physical performance outcome measures: chair-stand test, Timed up and go test, Short Physical Performance Battery. Other secondary outcome variables were change in: Tinetti scale, handgrip strength, Barthel Index, activities of daily living (ADL), body weight, appendicular muscle mass (AMM), skeletal muscle mass index (SMMI), cognitive status (Trail making test, MMSE) and quality of life (12-item Short-Form health Survey). The overall economic benefits (surrogate measures: length of stay and duration of rehabilitation) were also evaluated. Results: Intention-to-treat analyses were based on patients re-assessed at discharge (n = 127). Supplementation with the experi-mental formula (n = 64) resulted in greater increase in gait speed than placebo (n = 63): mean difference, 0.063 meters/sec/month [95%CI, 0.043 to 0.082] (P < 0.001). A significant effect was also found for all physical performance, functional and cognitive function endpoints (P < 0.001 for all), AMM (P = 0.011) and SMMI (P = 0.023). No difference was observed in quality of life. Supplementation resulted also in higher proportion of patients improving their rehabilitation intensity profile (P = 0.003) and being discharged at home (P = 0.002) and in shorter rehabilitation (P < 0.001) and hospital stay ( p < 0.001).
Conclusions: In old adults with sarcopenia admitted to hospital for rehabilitation the consumption of a whey protein-based nutritional formula enriched with leucine and vitamin D improved physical performance and function, muscle mass and reduced the intensity and costs of care.
Disclosure of Interest: None declared.
GLIM
GM01
COMPARISON OF ESPEN 2015 AND GLIM CRITERIA FOR ASSESSING MALNUTRITION IN SYSTEMIC SCLEROSIS
A. Gigante1, M.L. Gasperini1, A. Iacolare1, A. Molfino1, L. Proietti1, E. Rosato1, M. Muscaritoli1*.1Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
* Corresponding author.
Rationale: Systemic sclerosis (SSc) is a rare, chronic autoimmune disease characterized by fibrosis of the skin and internal organs. Gastrointestinal involvement may lead to malnutrition which can in turn negatively affect morbidity, mortality and quality of life. The aim of the study was to assess the prevalence of malnutrition in SSc patients with both the ESPEN 2015 and the recently published GLIM criteria and to assess whether it relates with disease activity and severity.
Methods: Adults patients with diagnosis of SSc admitted to our Scleroderma Unit were included in the study. Biochemical analyses, disease activity index (DAI), disease severity scale (DSS), anthropo-metric data and body composition from bioelectrical impedance (BIA) were recorded at the time of enrollment. Group comparisons were made by Student’s unpaired two-tailed t-test or Kruskal–Wallis test. Pearson or Spearman correlation coefficients (r) were used as appropriate.
Results: One hundred and two SSc patients were enrolled (86 females; mean age 55 ± 14 years). Fifty-seven patients had limited cutaneous
SSc and forty-five had diffuse cutaneous SSc. The prevalence of malnutrition was 8.8% (9/102) according to ESPEN 2015 criteria and 16.6% (17/102) according to GLIM criteria. GLIM severity grading of malnutrition was moderate in 13 patients (12.7%), severe in 4 patients (3.9%). In SSc patients with malnutrition according to GLIM criteria, DAI and DSS were significantly higher than in SSc patients without malnutrition ( p < 0.0001), while no association was observed between malnutrition and DAI or DSS when using the ESPEN 2015 criteria. Conclusions: In our study the prevalence of malnutrition is higher using GLIM criteria with respect to ESPEN 2015 criteria. In SSc, GLIM criteria appear to better discriminate for the presence of malnutrition associated with higher degree of disease severity and activity. Disclosure of Interest: None declared.
GM02
VALIDATION OF GLIM MALNUTRITION CRITERIA FOR DIAGNOSIS OF MALNUTRITION IN ICU PATIENTS
M. Theilla1*
, S. Rattanachaiwong2, I. Kagan3, M. Rigler4, I. Bendavid4, P. Singer4.1Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,2Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,3Department of General Intensive Care and Institute for Nutrition Research, Nutrition Department, 4
Department of General Intensive Care and Institute for Nutrition Research, Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
* Corresponding author.
Rationale: Patients in ICU are at high risk of malnutrition. Global Leadership Initiative on Malnutrition (GLIM) is a new malnutrition-screening tool.1 The present study compares the nutrition-related parameters of the following tools: GLIM tool, Patient- And Nutrition-Derived Outcome Risk Assessment (PANDORA) score, and low FFMI (Fat Free Mass Index) to the gold standard SGA (Subjective Global Assessment) regarding their values on predicting malnutrition in severely ill patients.
Methods: 84 ICU patients included. The tools mentioned above were assessed for diagnosis of malnutrition. All patients were defined as suffering from acute disease and received medical nutrition therapy. Statistical analysis was based on Stepwise regression to demonstrate correlation between proposed parameters. In addition, T-Test and Pearson correlation was used between variances.
Results: Mean age was 50 ± 20 years, BMI 25.3 ± 5.1 kg/m2, APACHE II 20.5 ± 7.7, PANDORA score 32 ± 8.5. GLIM malnutrition criteria was significantly correlated with low FFMI, with PA (Phase Angle) and with PANDORA score (R = 0.778, p≤ 0.00; R = −0.307, p ≤ 0.005; R = 0.215, p≤ 0.05 respectively). SGA assessment was correlated with GLIM malnutrition criteria and PANDORA score (R = 0.518, p≤ 0.00; R = 0.517, p≤ 0.00 respectively). According to the stepwise regression, the measurement of low FFMI and SGA predicts 77% of the GLIM score (R2= 0.620; P < 0.00; R2= 0.770; P < 0.00 respectively).
Conclusions: There is a high correlation between PA, and PANDORA score with GLIM criteria in ICU patients. A low FFMI and SGA predict the GLIM malnutrition criteria with a high level of precision. GLIM malnutrition assessment seems to be acceptable in the ICU setting. Reference
1. Cederholm T., Cederholm T., Jensen G.L., Jensen G.L., Correia M.I.T. D., Correia M.I.T.D.,…, Fuchs V. (2019). GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clinical Nutrition, 38(1), 1–9. Disclosure of Interest: None declared.
Oral Communication I : Critical Care
OR01
COMBINATION OF ENTERAL AND PARENTERAL NUTRITION IN COMPARISON TO ENTERAL NUTRITION ALONE– DOES COMBINATION TIMING MATTER?
A. Hill1,2*, C. Benstoem1,2, D.K. Heyland3, C. Stoppe1,2.1Department of Intensive Care, 23CARE, Cardiovascular Critical Care & Anesthesia Evaluation and Research, Medical Faculty RWTH Aachen, Aachen, Germany,3Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Canada
* Corresponding author.
Rationale: A combination of enteral nutrition (EN) and parenteral nutrition (PN) may avoid large nutrition debts in critically ill patients. One strategy is the combined use of EN and PN (EN + PN) starting early after admission to the intensive care unit. Another possibility is the early initiation of EN with delayed start of supplemental PN if the nutritional targets cannot be reached (SPN).
In our recent meta-analysis (under submission) evaluating influence of the route of administration EN alone vs. a combination of EN and PN, heterogeneity was observed with regards to publication date and supplementation strategies. This subgroup analysis investigates the influences of a) publication year (before or after 2000) and b) the supplementation strategy (EN + PN or SPN) on 30-day mortality and hospital length-of-stay (LOS).
Methods: The detailed methodology was previously published (www.criticalcarenutrition.com). In short, randomized controlled trials (RCTs) targeting the effect of EN alone vs. a combination of EN and PN in critically ill and mechanically ventilated patients were systematically identified and pooled in a meta-analysis.
Of the 10 RCTs meeting the inclusion criteria, 5 were published before 2000 and 5 afterwards, 8 RCTs compared EN + PN to EN alone and 2 RCTs compared SPN to EN alone. Dichotomous variables are presented as risk ratio (RR), continuous variables as weighted mean difference (WMD) with 95% confidence intervals (CI).
Results: Detailed results are displayed in the table 1. Including all studies, on average, there was no treatment effect on 30-day mortality with a combination of EN and PN (RR 1.00, CI 0.70, 1.41, 10 studies, n = 880, p = 0.98, heterogeneity I2= 41%) compared to EN alone. A combination of EN and PN compared to EN alone was, on average, associated with a trend towards a reduced LOS (WMD− 3.14, 95% CI −6.46, 0.18, 6 studies, n = 771, p = 0.06, heterogeneity I2
= 38%. In the subgroup of EN+PN vs. EN, the overall mean difference was significant (−4.38 [−8.53, −0.24], p = 0.04), whereas in the SPN vs. EN subgroup no influence was observed.
Outcome Group Studies RR or WMD [95% CI] p-Value Interpretation 30-day mortality EN+PN vs. EN 8 1.01 [0.64, 1.60] 0.96 RR values >1 favor EN alone SPN vs. EN 2 0.96 [0.50, 1.82] 0.89 Before 2000 5 1.27 [0.82, 1.94] 0.28 After 2000 5 0.77 [0.47, 1.27] 0.31 All trials included 10 1.00 [0.70, 1.14] 0.98 Hospital-LOS EN+PN vs. EN 4 −4.38 [−8.53, −0.24] 0.04 SPN vs. EN 2 −1.00 [−5.25, 3.25] 0.64 All trials included 6 −3.14 [−6.46, 0.18] 0.06
Conclusions: Regarding mortality, a combination of enteral and parenteral nutrition is non-inferior to enteral nutrition alone. An early combination of EN+PN might be more effective than SPN to reduce hospital-LOS.
