I. Cano Rodríguez

One-year effectiveness of two hypocaloric diets with different protein/carbohydrate ratios in weight loss and insulin resistance

BACKGROUND The maintenance of weight loss may be influenced by the distribution of macronutrients in the diet and insulin sensitivity. OBJECTIVE The objective of the study was to evaluate the longterm effect of two hypocaloric diets with different protein/carbohydrate ratios in overweight and obese individuals either with insulin resistance (IR) or without insulin resistance (IS). DESIGN Prospective, randomized, clinical intervention study. Forty patients were classified as IR/IS after a 75 g oral glucose tolerance test and then randomized to a diet with either 40% carbohydrate/30% protein/30% fat (diet A) or 55% carbohydrate/15% protein/30% fat (diet B). RESULTS After one year of follow-up there was no difference in weight loss between diets A and B in each group, but the IS group maintained weight loss better than the IR group [-5.7 (3.9) vs. -0.6 (4.1); P = 0.04]. No differences were found in either Homeostasis Model Assessment (HOMA) or other metabolic glucose parameters except lower insulin at 120 minutes with diet A [21.40 (8.30) vs. 71.40 (17.11); P = 0.02]. CONCLUSIONS The hypocaloric diets with different protein/carbohydrate ratios produced similar changes in weight. Insulin resistance may play a negative role in maintaining weight loss.

EFECTOS DE LA PÉRDIDA DE PESO MEDIANTE UNA DIETA MUY BAJA EN CALORÍAS (VLCD) SOBRE LA PÉRDIDA DE PESO TRAS DERIVACIÓN BILIOPANCREÁTICA EN PACIENTES CON OBESIDAD SEVERA

BACKGROUND Weight loss before bariatric surgery, achieved by means of a very low calorie diet (VLCD) has been recently reported to be related to a lower rate of postoperative complications. However, it is controversial if preoperative weight loss after VLCD could improve postoperative weight loss. AIMS To assess the effectiveness of a preoperative VLCD for 6 weeks in weight loss one year after bariatric surgery. To evaluate the changes obtained in anthropometric measures and biochemical parameters after VLCD. METHODS Prospective uncontrolled study including severely obese patients undergoing biliopancreatic diversion in our Obesity Unit in 2008-2010. Patients included followed a VLCD providing 840 kcal and 60 g of protein (Optisource®). Descriptive data are presented as mean (standard deviation) and after checking a normal distribution is followed, they were analyzed by Student s T test, ANOVA or Pearson correlation. RESULTS We evaluated 107 obese patients, 43.5 (10.2) years-old, 72% women, with initial weight 122.4 (18.6) Kg and BMI 46.8 (5.5) kg/m(2). 24.5% of them lost more than 10 % of initial weight and 73.5% more than 5% after following VLCD. Mean percentage of excess weight loss (% PSP) one year after surgery was 59.6 (13.4)%, and although it was higher for those patients losing more weight after VLCD, a significant correlation was not found: those who lost more than 5% showed %PSP 59.5 (13.8) % after twelve months and 68.4 (16.2) % of percentage of excess BMI loss (%PEIMC), vs 57,9 (13,1) % and 68.5 (16.6) % if they didn t lose that amount of weight. Those patients losing more than 10% achieved %PSP 63.3 (13.7) and %PEIMC 70.9 (14.7) vs 58.2 (14.0) y 67.7 (16.7) vs those not losing that amount. Significant correlations between preoperative loss with VLCD and %PSP or %PEIMC at 3,6,9 and 12 months were not found, and only %PSP 1 month after surgery correlated with %PSP after VLCD (r = 0.454, p = 0.003). CONCLUSIONS Preoperative weight loss with VLCD in severely obese patients did not show to improve either %PSP or %PEIMC one year after bariatric surgery.

Effect of nutritional support on survival in patients with amyotrophic lateral sclerosis

INTRODUCTION Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease. METHODS A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition. RESULTS There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38). CONCLUSIONS The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.INTRODUCTION: Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease. METHODS: A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition. RESULTS: There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38). CONCLUSIONS: The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.

PP223-MON VISCERAL ADIPOSITY INDEX IN SEVERELY OBESE PATIENTS: RELATIONSHIP TO INSULIN RESISTANCE, INFLAMMATORY PARAMETERS AND OBESITY TREATMENT

There were no significant differences in terms of age, sex and levels of 25 OHD. Serum Ca and phosphate levels were normal in 96% and 88% of patients respectively. Patients with higher levels of body fat have lower serum 25 OHD (r = 0.50, p = 0.009), with no differences between men and women. Following weight loss, the prevalence of hypovitaminosis was reduced to 46% and the rate of hyperparathyroidism fell by 78%. At the same time, a significant correlation between this hormone and serum 25 OHD; r = 0.554, P= 0.01 was found. The loss of fat mass appears to be associated with the reduction of hypovitaminosis, as we observe an inverse correlation between increased serum levels of 25 OHD; r = 0.35, p = 0.001 and adipose tissue. Conclusion: hypovitaminosis D is highly prevalent in MO patients. Serum levels improve following the loss of fat mass, which suggests higher plasma availability.

OP047 FLUID THERAPY DURATION AND NUTRITIONAL STATUS INFLUENCE OUTCOME IN MEDICAL HOSPITALIZED PATIENTS

Rationale: Fluid and sodium overload has been related to poorer outcomes in surgical patients. The aim of the study was to determine the adequacy of fluid therapy in hospitalized patients of medical wards, and its influence on outcomes. Methods: Cross-sectional study including nil-per-os patients admitted in medical wards from September 2011 to February 2012. We compared the administered fluid therapy with standardized requirements: water 35ml/kg; K: 1mmol/kg, Na/Cl: 2mmol/kg; glucose >130 g/d. Nutritional status was evaluated with SGA. Fasting was considered inappropriate if lasted >7 days in wellnourished and >5 days in malnourished, and nutritional support had not been provided. Multivariate analysis was performed with linear/logistic regression. Results: A sample of 100 patients was included, 51% male, 76.6 (13.3) yr. Fluid therapy lasted 4 (IQR = 2) days, and fasting was inadequately maintained in 27% of patients. Fluid requirements were correctly fulfilled: they needed 2299.6 (355.4) ml and received 2295.7 (683.4) ml. Data about electrolytes are summarized in the table. Glucose supply was 68.8 (29.2) g/d, and 99% received <130 g/d. Patients with inadequate duration of fasting had a longer hospital stay [22.0 (IQR = 13.0) vs 13.0 (IQR = 11.0) days, p = 0.001], after adjusting for sex, age, nutritional status, infused volume, electrolytes, glucose and diseases. After adjusting for these factors, only malnutrition predicted mortality during hospitalization (OR 10.5; CI95% 1.3 to 83.2).