S4
`
`NUTRITION WEEK 2003 ABSTRACTS
`
`Vol. 27, No. 1
`
`Australian radiation oncology facility were eligible for
`inclusion. Sixty patients (51M;9F; mean age 61.9±14.0yr)
`were enrolled and randomised to receive either usual care
`(UC)(n=3 I) provided by the nurses or nutrition intervention
`(NI)(n=29) in the form of regular and intensive nutrition
`counselling by a dietitian. Baseline characteristics did not
`differ between groups. Nutritional status was measured by the
`scored Patient-Generated-Subjective Global Assessment (PG(cid:173)
`SGA). Body weight, BMI and percentage weight loss in the
`previous six months were also recorded. QoL was measured
`by the European Organisation for the Research and Treatment
`of Cancer (EORTC) QLQ-C30 version 3. Outcomes were
`assessed at the commencement of radiotherapy and after four
`weeks. Three subjects were lost to followup. Results: The UC
`group had a significantly greater deterioration in PG-SGA
`score with a mean change of 6.6 compared with 1.9 in the NI
`group (p=0.001 ). The UC group experienced significant
`deteriorations in weight and QoL compared with the NI group
`(Table 1 ). Nutrition measures used in practice to provide
`broad assessments, such as BMI and SGA do not appear to
`reflect subtle changes in nutritional status over this period.
`Conclusion: Early and
`intensive nutrition
`intervention
`provides beneficial outcomes in terms of minimising weight
`loss and deterioration
`in nutritional status and QoL in
`oncology outpatients receiving radiotherapy to the head, neck
`or GIT area. Tools which are composed of multiple constructs
`appear to be more useful in determining outcomes compared
`with tools designed for broad assessment * A positive value
`for change in PG-SGA score or change in percentage weight
`the past six months reflects a deterioration
`in
`loss in
`nutritional status ** A negative value for change in QoL
`reflects a deterioration in quality oflife.
`
`Table 1. Change in nutritional status and QoL after four weeks
`of radiotherapy
`
`Center, Memphis, TN; Richard A. Helms, Pharm.D., The
`University of Tennessee Health Science Center, Memphis, TN
`Background: Cysteine (CysH) is a conditionally essential
`amino acid (AA) in the infant and young child. Our previous
`work has shown that CysH supplementation in infants who
`require parenteral nutrition (PN) results in a more normal
`plasma sulfhydral amino acid profile. However, the relation
`between CysH dose during PN and resulting plasma amino
`acid levels has not been systematically examined. We recently
`demonstrated that CysH supplementation at 20,30, and 40
`in PN
`resulted
`in
`sequentially
`increasing
`mg/g AA
`concentrations of plasma taurine (Tau) in children receiving
`home PN due
`to short bowel syndrome. Plasma Tau
`concentrations were within our normal range for children at
`CysH doses of 30 and 40 mg/g AA in PN. Methods: In the
`current study, we evaluated CysH doses of 0, 10, 20, and 40
`mg/g AA in LBW premature infants who required PN. This
`was a double blinded, randomized trial to evaluate the
`resulting plasma concentrations of Tau, methionine (Met), and
`cystine (Cys). Eighteen infants with a gestational age 30-37
`weeks and a post-natal age less than 4 weeks who required PN
`for at least two weeks were enrolled. Infants were excluded if
`they had an inborn genetic error or significant organ failure.
`Target PN dosage was 2.5 gANkg/d with a caloric goal
`(carbohydrate and fat) of 125 kcal/kg/d. All infants initially
`received PN with no supplemented CysH for three days.
`Infants then received one of six randomly assigned CysH
`dosing schedules. Each CysH dose was administered for three
`days. On the morning of the last day in each dosing interval
`(study days 3, 6, 9, and 12) blood was drawn between 8 and
`10 AM and immediately processed for amino acid analysis.
`Samples were deproteinized with 5'-sulfosalicylic acid (40
`mg/mL) and stored at -70° C until assay. All samples were
`analyzed upon completion of the last study period for that
`subject. Samples were analyzed on a Beckman 6300 AA
`Analyzer using a four buffer (lithium citrate) expanded
`physiological program. Results: The resulting plasma AA
`concentrations(nmoles/mL, mean / SEM) are:
`
`CysH Dose (mg/g AA)
`Plasma AA (mean of
`normal)
`
`0
`
`IO
`
`20
`
`40
`
`Tau (83.9)
`
`Cys (51.9)
`
`Met (35.8)
`
`41.2 /
`76.1 /
`64.8 /
`54.8 /
`9.60
`5.22
`5.47
`4.27
`54.3 /
`46.7 /
`45.8 /
`38.9 /
`4.89
`3.71
`7.90
`3.31
`60.6/
`59.5/
`65.3/
`74.1 /
`4.55
`4.08
`7.59
`3.44
`Plasma Tau and Cys concentrations generally increased with
`CysH dose. Plasma Met was initially above our normal range
`and tended to fall with CysH dosing. All other AA were
`within our normal
`range. Plasma Tau was positively
`correlated to CysH dosing (r2=0.982). The increases in
`plasma Tau with CysH dose were similar to those we
`previously observed in our study of SBS patients on home
`PN. Conclusion: We conclude that CysH supplementation to
`PN
`in LBW
`infants
`results
`in normal plasma Tau
`
`Variable
`N
`
`Nutrition Intervention
`(NI)
`(27)
`
`1.9 ± 5.6
`
`0.18 ±2.0
`
`Usual Care
`(UC)
`(30)
`Change in PG-SGA 6_6 ± 5_0
`score*
`No change (<I) No change (<I)
`Change in SGA
`Change in weight _2_ 1 ± 2_9
`(kg)
`Change
`(kg/m2)
`Change in
`pe~entage .
`weight loss m past
`6 months (kg)*
`Change Quality of _15 0 ± 15 1
`life**
`.
`.
`
`in BMI _0_7 ± 1.0
`
`0.2 ±0.9
`
`2_6 ± 3_4
`
`-0.22 ± 3.3
`
`-2.5 ± 19.6
`
`P
`
`0.001
`
`0.001
`
`0.003
`
`0.009
`
`008 Cysteine Supplementation Normalizes Plasma
`Taurine Concentrations in Low Birth Weight Premature
`Infants Requiring Parenteral Nutrition Support. Michael
`C. Storm, Ph.D., The University of Tennessee Health Science
`
`Eton Ex. 1085
`1 of 2
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`

`

`fanuary-February 2003
`
`NUTRITION WEEK 2003 ABSTRACTS
`
`S5
`
`concentrations and is necessary in this population to produce a
`more normal plasma sulthydral AA profile.
`
`009 Fatty acid metabolism in malabsorptlon treated with
`TPN. Karen C. McCowen, MD, Beth Israel Deaconess
`Medical Center, Boston, MA; Pei-Ra Ling, MD, Beth Israel
`J)eaconess Medical Center, Boston, MA; Justin A. Maykel,
`MD, Beth Israel Deaconess Medical Center, Boston, MA ;
`Mario Ollero, PhD, Beth Israel Deaconess Medical Center,
`Boston, MA; Bruce R Bistrian, MD, Beth Israel Deaconess
`Medical Center, Boston, MA
`Despite being well-nourished without essential fatty acid
`deficiency (EF AD), a marked increase in arachidonic acid
`(AA) to linoleic acid (LA) ratio was present in plasma
`phospholipid of home TPN patients. Substantial increases in
`soluble TNF receptor and IL6 were found in blood and urine
`Vs healthy controls. Our hypothesis is that AA is produced in
`excess from LA due to its presentation to the liver by
`parenteral rather than enteral route. Arachidonic acid excess
`may
`lead
`to a pro-inflammatory milieu. We
`therefore
`investigated fatty acid metabolism in a rodent model of
`malabsorption.
`Sprague Dawley rats, -300g, underwent laparotomy and 80%
`small bowel resection, (or sham surgery) and placement of
`jugular vein catheters. Rats (n=32, 16 sham, 16 short gut)
`were randomly assigned to TPN with lipid, or fat-free TPN,
`continued for 5 d. Only tap water was allowed orally. TPN
`contained amino acids, dextrose, and essential micronutrients
`at 200 kcal/kg/day. Rats randomized to lipid (n=8 per group)
`got 30% non-protein energy as fat, using 20% Jntralipid. After
`5 d, blood was drawn for plasma phospholipid fatty acid
`analysis.
`After 5 d, weight loss was 36 ± 18g in short gut, 28 ±9g in
`sham. Analysis of phospholipids demonstrated that while
`EFAD had not developed, 20:3n-9 (Mead acid) was relatively
`increased in fat-free TPN groups, as were other distal very
`long chain
`fatty acids
`(Table below). Both nutrition
`(TPN/lipid Vs fat-free TPN) and surgery type (sham Vs short
`gut) were significant in determining AA levels. Relatively
`elevated AA occurred
`in both groups of fat-free rats,
`suggesting increased A6 desaturase activity, as expected. In
`contrast, AA was lower (suggesting appropriately down(cid:173)
`regulated t.6 desaturase) in sham animals given TPN/fat, but
`NOT in short gut animals fed TPN/lipid. The ratio ofLN AA
`was suggestive of lower turnover of LA in sham rats given
`lipid compared with the other groups.
`These results suggest that IV lipid was not appropriately
`sensed in the short gut rat, analogous to our human patients.
`The short gut rat may have a heightened desaturase activity
`inappropriate with adequate delivery of essential fatty acid
`provided parenterally. Therefore, the short gut rat is an
`appropriate model to study further this vexing problem.
`Serum phospholipid fatty acid profiles, mo)%, mean ±
`SEM
`Fatty acids
`
`Sham
`Short gut Short gut Sham
`TPN/ lipid Fat-free
`TPN/ lipid Fat free
`Cl8:2w6 (LA) 14.8 + I
`14.6 +0.9 17.9 + I
`14.8 + I
`Cl8:3w3*
`0.08+0.0l 0.03+0.0I 0.1 +0.01 0.01 +0.01
`
`0.4 + 0.06 0.7 + 0.06 0.6 + 0.06 0.7 + 0.06
`C20:3w6*
`0.09 + 0.02 0.2 + 0.02 0.1 + 0.02 0.2 + 0.02
`C20:3w9*
`C20:4w6(AA)20.l+I
`19.6+0.9 17.8+1" 22+1
`C20:5w3#
`0.3 + 0.09 0.5 + 0.08 0.2 + 0.09 0.5 + 0.09
`0.8+0.I
`0.8+0.09 1+0.1"" 0.7+0.I
`LA/AA
`*p<0.01, #p<0.05, fat free Vs lipid; "p<0.05, 1\/\p = 0.057 Vs
`other 3 groups;
`All statistics by 2 way ANOV A
`
`010 Accuracy of methods
`ionized and
`to estimate
`"corrected" serum calcium concentrations in critically ill
`multiple trauma patients receiving specialized nutrition
`support. Roland N. Dickerson, Pharm.D., University of
`Tennessee, Memphis, TN; Kathryn L. Holliday, MS, RD,
`Regional Medical Center, Memphis, TN; Angelina C.
`Tidwell, PharmD, University of Tennessee, Memphis, TN;
`Shanna K. Chennault, PharmD, Regional Medical Center,
`Memphis, TN; Martin A. Croce, MD, University of
`Tennessee, Memphis, TN; Gayle Minard, MD, University of
`Tennessee, Memphis, TN; Rex 0 . Brown, PharmD,
`University ofTennessee, Memphis, TN
`The accuracy of twenty-three published methods to estimate
`serum ionized calcium (iCa) and "corrected" total serum
`in critically-ill, multiple
`calcium (totCa) concentrations
`trauma patients was evaluated. Eight of these formulas
`estimated iCa and fifteen were directed towards predicting a
`"corrected" totCa. Forty adult patients (29M/1 IF, 46 ± 18 yrs
`of age, APACHE II 15.3 ± 6.7, 14 patients with head injury
`and 35 with mechanical ventilation) admitted to the trauma
`intensive care unit who received specialized nutrition support
`were recruited for study. Patients who received blood
`products, intravenous calcium or therapeutic doses of heparin
`within 24 hours prior to the laboratory measurements, had a
`history of cancer, bone disease, parathyroid disease,
`hyperphosphatemia (~ 6 mg/di), or renal failure requiring
`dialysis were excluded from study entry. Serum chemistries,
`arterial blood gas measurements, and
`ionized calcium
`concentrations were simultaneously collected from each
`patient.
`Patients were studied 5.8 ± 4.3 days post-injury and were
`receiving enteral nutrition (n=35), parenteral nutrition (n=4)
`or both (n=I). None of the patients had hypomagnesemia
`(serum Mg ~ 1.5 mEq/L). Eight patients (20%) were
`hypocalcemic (iCa =:: 1.12 mmol/L) and 3 (7.5%) were
`hypercalcemic (iCa ~ 1.32 mmol/L). Serum totCa correlated
`modestly with iCa (r2 = 0.207, p<0.01.). No significant
`differences were found for iCa for patients with sepsis (n=23)
`versus without sepsis (n=l7; 1.18 ± 0.07 versus 1.21 ± 0.09
`mmol/L,
`p=N.S.,
`respectively),
`those who
`received
`(n=I 5) versus no
`intravenous
`lipid emulsion/propofol
`lipid/propofol (n=25; 1.19 ± 0.08 versus 1.19 ± 0.07 mmol/L,
`p=N.S., respectively) or between those with a low (< 7.35),
`nonnal, or increased (> 7.45) arterial pH (1.20 ± 0.06 versus
`1.20 ± 0.08 versus 1.18 ± 0.08 mmol/L, p=N.S., respectively).
`However, those with a serum albumin=:: 2 g/dL (n=18) had a
`lower ionized calcium concentration than those (n=l2) with
`an albumin of > 2 g/dL ( 1.16 ± 0.04 versus 1.22 ± 0.08
`mmol/L, p<0.0 I, respectively).
`·
`
`Eton Ex. 1085
`2 of 2
`
`