A.-M. Makhlouf

Body composition and all-cause mortality in subjects older than 65 y

BACKGROUND A low or high body mass index (BMI) has been associated with increased mortality risk in older subjects without taking fat mass index (FMI) and fat-free mass index (FFMI) into account. This information is essential because FMI is modulated through different healthcare strategies than is FFMI. OBJECTIVE We aimed to determine the relation between body composition and mortality in older subjects. DESIGN We included all adults ≥65 y old who were living in Switzerland and had a body-composition measurement by bioelectrical impedance analysis at the Geneva University Hospitals between 1990 and 2011. FMI and FFMI were divided into sex-specific quartiles. Quartile 1 (i.e., the reference category) corresponded to the lowest FMI or FFMI quartile. Mortality data were retrieved from the hospital database, the Geneva death register, and the Swiss National Cohort until December 2012. Comorbidities were assessed by using the Cumulative Illness Rating Scale. RESULTS Of 3181 subjects included, 766 women and 1007 men died at a mean age of 82.8 and 78.5 y, respectively. Sex-specific Cox regression models, which were used to adjust for age, BMI, smoking, ambulatory or hospitalized state, and calendar time, showed that body composition did not predict mortality in women irrespective of whether comorbidities were taken into account. In men, risk of mortality was lower with FFMI in quartiles 3 and 4 [HR: 0.78 (95% CI: 0.62, 0.98) and 0.64 (95% CI: 0.49, 0.85), respectively] but was not affected by FMI. When comorbidities were adjusted for, FFMI in quartile 4 (>19.5 kg/m(2)) still predicted a lower risk of mortality (HR: 0.72; 95% CI: 0.54, 0.96). CONCLUSIONS Low FFMI is a stronger predictor of mortality than is BMI in older men but not older women. FMI had no impact on mortality. These results suggest potential benefits of preventive interventions with the aim of maintaining muscle mass in older men. This trial was registered at clinicaltrials.gov as NCT01472679.

Healthcare-associated infections are associated with insufficient dietary intake: an observational cross-sectional study

Background Indicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population. Methods and findings Dietary intake was assessed by dedicated dieticians on one day for all hospitalized patients receiving three meals per day. Nutritional risk was assessed using Nutritional Risk Screening (NRS)-2002, and defined as a NRS score ≥ 3. Energy needs were calculated using 110% of Harris-Benedict formula. HCAIs were diagnosed based on the Center for Disease Control criteria and their association with nutritional risk and measured energy intake was done using a multivariate logistic regression analysis. From 1689 hospitalised patients, 1024 and 1091 were eligible for the measurement of energy intake and nutritional risk, respectively. The prevalence of HCAI was 6.8%, and 30.1% of patients were at nutritional risk. Patients with HCAI were more likely identified with decreased energy intake (i.e. ≤ 70% of predicted energy needs) (30.3% vs. 14.5%, P = 0.002). The proportion of patients at nutritional risk was not significantly different between patients with and without HCAI (35.6% vs.29.7%, P = 0.28), respectively. Measured energy intake ≤ 70% of predicted energy needs (odds ratio: 2.26; 95% CI: 1.24 to 4.11, P = 0.008) and moderate severity of the disease (odds ratio: 3.38; 95% CI: 1.49 to 7.68, P = 0.004) were associated with HCAI in the multivariate analysis. Conclusion Measured energy intake ≤ 70% of predicted energy needs is associated with HCAI in hospitalised patients. This suggests that insufficient dietary intake could be a risk factor of HCAI, without excluding reverse causality. Randomized trials are needed to assess whether improving energy intake in patients identified with decreased dietary intake could be a novel strategy for HCAI prevention.

Identification of CHEK1, SLC26A4, c-KIT, TPO and TG as new biomarkers for human follicular thyroid carcinoma

The search for preoperative biomarkers for thyroid malignancies, in particular for follicular thyroid carcinoma (FTC) diagnostics, is of utmost clinical importance. We thus aimed at screening for potential biomarker candidates for FTC. To evaluate dynamic alterations in molecular patterns as a function of thyroid malignancy progression, a comparative analysis was conducted in clinically distinct subgroups of FTC and poorly differentiated thyroid carcinoma (PDTC) nodules. NanoString analysis of FFPE samples was performed in 22 follicular adenomas, 56 FTC and 25 PDTC nodules, including oncocytic and non-oncocytic subgroups. The expression levels of CHEK1, c-KIT, SLC26A4, TG and TPO were significantly altered in all types of thyroid carcinomas. Based on collective changes of these biomarkers which correlating among each other, a predictive score has been established, allowing for discrimination between benign and FTC samples with high sensitivity and specificity. Additional transcripts related to thyroid function, cell cycle, circadian clock, and apoptosis regulation were altered in the more aggressive oncocytic subgroups only, with expression levels correlating with disease progression. Distinct molecular patterns were observed for oncocytic and non-oncocytic FTCs and PDTCs. A predictive score correlation coefficient based on collective alterations of identified here biomarkers might help to improve the preoperative diagnosis of FTC nodules.

Paraoxonase 1 (PON1) and pomegranate influence circadian gene expression and period length.

ABSTRACT The circadian timing system regulates key aspects of mammalian physiology. Here, we analyzed the effect of the endogenous antioxidant paraoxonase 1 (PON1), a high-density lipoprotein-associated lipolactonase that hydrolyses lipid peroxides and attenuates atherogenesis, on circadian gene expression in C57BL/6J and PON1KO mice fed a normal chow diet or a high-fat diet (HFD). Expression levels of core-clock transcripts Nr1d1, Per2, Cry2 and Bmal1 were altered in skeletal muscle in PON1-deficient mice in response to HFD. These findings were supported by circadian bioluminescence reporter assessments in mouse C2C12 and human primary myotubes, synchronized in vitro, where administration of PON1 or pomegranate juice modulated circadian period length.

Safety of Bioelectrical Impedance Analysis in Patients Equipped With Implantable Cardioverter Defibrillators.

Background. Current guidelines warn of potential electromagnetic interferences (EMI) when using bioelectrical impedance analysis (BIA) to measure body composition in patients equipped with implantable cardioverter-defibrillators (ICDs). We aimed to test the occurrence of EMI in a setting where this risk was experimentally maximized. Materials and Methods. Outpatients scheduled for routine ICD controls simultaneously underwent a BIA measurement using an electrical current of 0.8 mAmp at frequencies from 5–100 kHz. ICD sensitivity levels were set to maximum levels while therapies were temporarily inactivated. The device electrograms were monitored in real time to detect sensed and/or visible EMI during BIA measurement. Results. A total of 63 patients equipped with single-chamber (n = 13), dual-chamber (n = 18), or biventricular (n = 32) ICDs from 5 major manufacturers were included. No EMI were detected by the ICDs in these patients, nor were any artifacts visualized during real-time electrogram recordings. Conclusion. BIA can be safely performed in patients equipped with ICDs without cardiac monitoring. Current guidelines should be updated accordingly.

Low risk of electromagnetic interference between smartphones and contemporary implantable cardioverter defibrillators.

AIMS Manufacturers of implantable cardioverter defibrillators (ICDs) recommend that cell phones be maintained at a distance of ∼15 cm from the implanted device in order to avoid risk of dysfunction due to electromagnetic interference (EMI). Data relating to this issue are outdated and do not reflect modern technology. Our aim was to evaluate whether EMI is still an issue with contemporary ICDs and smartphones. METHODS AND RESULTS Consecutive patients implanted with a wireless-enabled ICD were tested for potential interference with two models of recent 4G smartphones in conditions intended to maximize risk of EMI. A magnet effect (due to the phone speakers) was tested by placing the smartphones in the standby mode directly over the ICD generator. The presence of EMI artefacts on the real-time electrograms was evaluated by placing the smartphones in the standby, dialling, and operating modes directly over the generator casing and over the parasternal region in the vicinity of the ventricular lead. A total of 63 patients equipped with 29 different models of single, dual, or biventricular ICDs from five major manufacturers were included. None of the patients showed any evidence of interference with the smartphones during any of the 882 tests. CONCLUSION The risk of EMI between modern smartphones and contemporary ICDs is low. This is probably due to the filters incorporated in the ICDs and low emission by the phones, as well as the small size of the magnets in the smartphones tested. STUDY REGISTRATION NCT02330900 (http://www.clinicaltrials.gov).

OR048: Healthcare-Associated Infections (HCAI) are Associated with Insufficient Dietary Intake

OR048 HEALTHCARE-ASSOCIATED INFECTIONS (HCAI) ARE ASSOCIATED WITH INSUFFICIENT DIETARY INTAKE A.-M. Makhlouf1, R. Thibault1,2, M. Kossovsky3, J. Iavindrasana4, M. Chikhi1, R. Meyer5, D. Pittet6, W. Zingg6, C. Pichard1. 1Nutrition Unit, University Hospital of Geneva, Geneva, Switzerland; 2Nutritional and digestive rehabilitation, Clinique Saint-Yves, Rennes, France; 3Rehabilitation and Geriatrics, 4Business Intelligence Division, 5Department of Informatics, 6Infection Control Programme, University Hospital of Geneva, Geneva, Switzerland

PP171-SUN IDENTIFICATION OF THE RISK OF NOSOCOMIAL INFECTIONS WITH THE NUTRITIONAL RISK SCORE (NRS)-2002 IN HOSPITALIZED PATIENTS

of PEM as distinct diagnosis is hardly accomplished in most hospitals. The department of medicine of our hospital is documenting the risk for PEM by the Nutrition Risk Score 2002 (NRS) since the year 2011 in the electronic health record. With the present study we aimed at reporting NRS and displaying PEM systematically as distinct diagnosis. Methods: NRS was repositioned and integrated in the medical history of our electronic health record (Phoenix 6.32.3.4) by July 2012. The doctor has to tick the nutritional and health status score of the NRS and the system then calculates the total score (+ 1 point for age 70 years). The score is automatically converted into the corresponding ICD-10 codes for PEM, i.e. E43 (NRS 5) or E44.0 (NRS = 4) or E44.1 (NRS = 3) and directly transferred as separate diagnosis to the list of diagnoses. The nutritional assessment by the dietitian and appropriate nutritional therapy are mandatory. Not completed NRS are weekly reported to the responsible doctor. Results: The table summarises the number of cases coded with PEM.