M.A. de van der Schueren

Bioelectrical impedance analysis to estimate body composition in surgical and oncological patients: a systematic review

Objective:Bioelectrical impedance analysis (BIA) is a commonly used method for the evaluation of body composition. However, BIA estimations are subject to uncertainties.The aim of this systematic review was to explore the variability of empirical prediction equations used in BIA estimations and to evaluate the validity of BIA estimations in adult surgical and oncological patients.Subjects:Studies developing new empirical prediction equations and studies evaluating the validity of BIA estimations compared with a reference method were included. Only studies using BIA devices measuring the entire body were included. Studies that included patients with altered body composition or a disturbed fluid balance and studies written in languages other than English were excluded.To illustrate variability between equations, fixed normal reference values of resistance values were entered into the existing empirical prediction equations of the included studies and the results were plotted in figures. The validity was expressed by the difference in means between BIA estimates and the reference method, and relative difference in %.Results:Substantial variability between equations for groups (including men and women) was found for total body water (TBW) and fat free mass (FFM). The gender-specific existing general equations assume less variability for TBW and FFM. BIA mainly underestimated TBW (range relative difference −18.8% to +7.2%) and FFM (range relative differences −15.2% to +3.8%). Estimates of the fat mass (FM) demonstrated large variability (range relative difference −15.7 to +43.1%).Conclusions:Application of equations validated in healthy subjects to predict body composition performs less well in oncologic and surgical patients. We suggest that BIA estimations, irrespective of the device, can only be useful when performed longitudinally and under the same standard conditions.

SUN-P032: Protein and Leucine Intake of Malnourished Older Patients During Hospitalization

Rationale: The recommended protein intake for geriatric hospitalized patients is 1.2-1.5 g/kg/day and at least 25- 30 g/meal. Furthermore, recent guidelines state that a minimum of 2.5-2.8 g leucine per meal is required for optimal muscle protein synthesis. The objective of this study was to examine the current daily protein intake, and protein and leucine intake per meal of malnourished, older patients during hospitalization. Methods: Nutritional intake of 25 older, malnourished patients (mean age 80.7 ± 10.9 years, 32% male) was measured on 3 consecutive hospital days by measuring food intake and weighing food leftovers. Leucine intake was estimated based on 8% leucine in vegetable-protein and 10% in animal-protein. Results: Mean protein intake was 0.9 ± 0.2 g/kg/day; 88% of patients did not meet the minimum protein recommendation of 1.2 g/kg/day. In 56% (n = 14) of patients, the leucine-goal of 2.5 g/meal was met once a day, in 4% (n = 1) this was twice a day. None of the patients achieved the recommendation of 2.5 g leucine three times a day. Conclusion: Both protein and leucine intake of malnourished elderly during hospitalization are far below recommendations. To achieve an adequate intake, in order to stimulate muscle protein synthesis and preserve muscle mass, extra attention should be given to protein intake, especially during breakfast and lunch. (Table Presented).

MON-P084: The Prediction of Preoperative Decline in Nutritional Status During Chemo-Radiation Therapy in Patients with Esophageal Cancer

Rationale: Patients with esophageal cancer are at high risk for developing malnutrition during neo-adjuvant chemo-radiation therapy (NA-CRTh), which in turn is associated with postoperative morbidity. The aim of this study was to identify which pre-treatment parameters were predictive for a decline in nutritional status during NA-CRTh. Methods: In this prospective study, 87 patients with esophageal cancer treated with NA-CRTh were included. Age, gender, % weight change, body mass index (kg/m2), fat (free) mass index (kg/m2), phase angle (°), handgrip strength (kg), energy (%EI)- and protein intake (%PI) as % of requirements, tumor classification and performance score were measured. A prediction model was constructed to analyze which of these parameters predicted a decline in nutritional status (defined as weight loss of >5% and/or decline in fat free mass of ≥1,4 kg) during NA-CRTh. Results: Nutritional status declined in 36% of the patients during NA-CRTh. Main predictors were a higher phase angle (OR 1.76 (95% CI 1.05-2.94)) and a lower %PI (OR 0.97 (95% CI 0.94- 0.99)). The prediction formula was defined as: -1.486 + 0.566∗PA-0.035∗%PI. This indicates for example a 55% chance to decline in nutritional status during NA-CRTh in a patient with a phase angle of 6 and %PI of 50%. Quality of the prediction model was tested by the Hosmer and Lemeshow test (p = 0.97). The ROC-AUC was 0.70 (95% CI 0.58-0.81). Conclusion: Results of this study suggest that patients in a good nutritional status (i.e. higher phase angle) but with a poor nutritional intake (i.e. lower %PI) are at highest risk to decline in nutritional status during NA-CRTh. This give opportunities for targeted dietetic care in patients with esophageal cancer who receive NA-CRTh.

OR040: The Association of Nutritional Status with Brain Atrophy and Cerebrovascular Lesions on Mri in a Cohort of Geriatric Outpatients

Rationale: Little information exists on the relation between malnutrition and brain atrophy and cerebrovascular lesions. Methods: In 359 geriatric outpatients nutritional status was assessed by MNA and by vitamin B1, B6, B12, and folic acid levels. White Matter Hyperintensities (WMHs), Global Cortical brain Atrophy (GCA) or Medial Temporal lobe Atrophy (MTA) on MRI were quantified using visual rating scales. Cognitive functioning was assessed by neuropsycological examination (n = 192) or by MMSE. Logistic regression analyses were performed to associate MNA categories and micronutrients (per SD decrease or absolute deficiency) with severe WHMs, GCA and MTA. All analyses were adjusted for age, sex, education, comorbidities, alcohol use and smoking and MNA scores were additionally adjusted for vitamin B levels. Analyses were repeated after stratification for cognitive status (healthy n = 94, unhealthy n = 265). Results: Mean age was 80 (SD 7) years, 13% were malnourished, and 55% were at risk of malnutrition. Vitamin deficiencies were observed in 5% (B1), 1.7% (B6), 8.1% (B12), and 1.9% (folic acid). Malnutrition and risk of malnutrition were associated with an increased risk of having severe WHMs, ORs (95% CI) 2.15 (1.10-4.22) and 2.98 (1.25-7.09). Results held after additional adjustment for B-vitamin status. Stratification for cognitive status showed similar results in cognitively (un)healthy patients. Lower vit B1 and vit B12 levels were associated with increased risk of WMHs [OR per SD decrease vit B1 1.49 (1.08-2.08), OR for absolute vit B12 deficiency 2.55 (1.04-6.26)]. Conclusion: Malnutrition and vit B1 and B12 deficiencies were associated with increased risk of WMHs, independent of each other and of cognitive status. Underlying mechanisms need to be further clarified and it also needs to be studied whether these findings are modifiable by nutritional interventions.

MON-PP095: Muscle Wasting of ≥10% During Chemotherapy is Independently Associated with Survival

Rationale: A low muscle mass is prevalent in up to 40% of patients with colorectal cancer and has been associated with poor outcome. Until now, longitudinal evaluation is lacking. This study aimed to investigate skeletal muscle changes of patients with metastatic colorectal cancer (mCRC) during palliative chemotherapy in relation to treatment modifications and survival. Methods: We included 67 consecutive patients with mCRC, starting palliative chemotherapy (mean age 66.4+/-10.6 years, 63% male). Muscle area (cm2) was assessed using L3 Computed Tomography scans before and during chemotherapy. Delay, dose reduction or termination of chemotherapy due to toxicity were regarded as treatment modifications. Six months and 1 year survival rates were obtained for the association between relative change in muscle area and survival (logrank). Regression analyses, adjusted for confounders, were performed for the association with treatment modifications and overall survival. Results: Muscle area decreased significantly during chemotherapy with 5.4% over 80 days (95% CI- 7.4 to 3.3, p 10% of their initial muscle area. Change in muscle area was not associated with treatment modifications. Patients with >10% decrease in muscle area during chemotherapy had significantly lower survival rates than patients with 10% remained independently associated with survival when adjusted for sex, age, baseline LDH concentration, comorbidity, mono- or multiorgan metastases, treatment line and tumour progression at 1st evaluation by CT scan (HR 3.3, 95% CI- 1.6-6.7, p = 0.001). Conclusion: Muscle area decreased significantly during chemotherapy and was independently associated with survival. An RCT is required to investigate whether interventions like nutritional counseling and exercise training may preserve muscle area and improve outcome.

PP081-SUN: Nutritional Status of RCDII and EATL Patients is Poor Compared to Newly Diagnosed Coeliac Disease Patients

Rationale: A minority of newly diagnosed coeliac disease (CD) patients does not show clinical improvement or relapse upon a strict gluten free diet and might suffer from Refractory Coeliac DiseaseII (RCDII) or Enteropathy Associated T-cell Lymphoma (EATL). We aimed to comprehensively assess nutritional status and intestinal absorption capacity in RCDII, EATL and CD patients, at first presentation. Methods: Nutritional status was assessed by antropom-etry, BMI (