Nutritional techniques and formulations II
agents (gel or paste) in semi-solid nutrients may also inhibit mineral absorption, thus resulting in mineral deﬁciencies. This study examined the effect of thickening agents on mineral absorption to measure the dissolution of minerals (Fe, Cu, Zn, Mn) under various conditions. Methods: Six samples including 3 gel and 3 paste types were tested. The samples were mixed with artiﬁcial digestive juice. The mixing conditions were “mild stirring” at 3 rpm for 5 min and “hard stirring” at 65 rpm for 60 min. The residual dross was ﬁltered from the stirred samples through mesh and the weight was measured. The minerals in the ﬁltrate were assayed by using Atomic Emission Spectrometry. Results: All semi-solid nutrients maintained their structures under “mild stirring”, which assumed the physiological digestive conditions in the stomach. “Hard stirring” caused the paste type to degrade into pieces of about 95 96% whereas the gel types degraded by about 12 67%. The percentage of eluted minerals with “hard stirring” is shown in the Table. There were signiﬁcantly less eluted minerals from the gel type than that of paste type in digestive juice. Table: Percentage of eluted minerals under the “hard stirring” with digestive juice
Gel + Paste Gel + Paste
Gastric Juice + Gastric Juice Intestinal Juice + Intestinal Juice
89 95% 100% 45 74% 100%
39 62% 100% 64 87% 100%
79 87% 99 100% 69 88% 100%
83 99 47 99
93% 100% 91% 100%
Conclusion: The dissolution of minerals is altered by thickening agents mixed with digestive juice. Although semi-solid nutrients contain sufﬁcient minerals, the gel type semi-solid nutrients may decrease the absorption of such minerals. Disclosure of Interest: None Declared.
PP165-MON BIA VALIDITY IN HOSPITALISED PATIENTS L.H. Jakobsen1 , J. Kondrup2 , J.M. Sorensen1 , P. Christensen1 , B.S. Rasmussen1 , A.-M. Ravn1 , S.F. Noergaard2 . 1 Nutritional Unit, 2 Rigshospitalet, Copenhagen Oe, Denmark Rationale: BIA is used to estimate lean body mass (LBM) in patients by equations derived in healthy individuals, which are not valid in patients with overhydration/edema. Decision on validity, as based on clinical signs of edema, may not be adequate since considerable overhydration can occur without visible edema. Methods: In total, 192 subjects were analysed. Of these, 36 were healthy (BMI: 22.3±0.3, mean±SE), 125 were patients without edema (BMI: 23.0±0.4), and 31 were patients with edema (BMI: 24.6±0.9). The ratio between extracellular water and total body water (ECW/TBW,%) was calculated by conventional BIA equations. This was compared to a novel approach in which hydration is expressed in relation to normal hydration of LBM (73%), calculated from age and sex adjusted BIVA graphs (EFG™ and Hydragram® , Akern, Italy)
as in . Kruskal Wallis test was used for comparison between groups. Results: ECW/TBW,% was not signiﬁcantly different between patients with and without edema, in contrast to Hydration%, suggesting a higher discrimination power of the latter. 69 of 125 patients without edema had Hydration% values above the 95% percentile of healthy subjects (73.5%), suggesting overhydration in a large fraction of patients without edema.
ECW/TBW,%, median (IQR) Hydration%, median (IQR)
(b) No edema
(c) With edema
41.7 (40.1 42.7) 73.0 (72.8 73.1)
52.8 (48.2 57.6) 73.7 (73.3 75.1)
54.5 (51.2 63.0) 78.1 (73.7 81.6)
ECW/TBW,%: P a vs b <0.001; b vs c: n.s. Hydration%: P a vs b <0.001; b vs c <0.001.
Conclusion: Hydragram® is useful for estimating hydration status and conventional BIA equations may be invalid in patients with hydration >73.5%. Based on comparison with ECW/TBW,%, this corresponds to an ECW/TBW,% of approximately >47%. Acknowledgement: T. Talluri for computing Hydration% with a proprietary approach. References  Valle R. et al. Heart Fail Rev 2011 Nov; 16(6): 519 29. Disclosure of Interest: None Declared.
PP166-MON INCIDENCE OF CENTRAL VENOUS CATHETER RELATED BLOODSTREAM INFECTIONS IN ADULTS AND CHILDREN ON HOME PARENTERAL NUTRITION: HEPARIN VERSUS TAUROLIDINE CATHETER LOCK C. Jonkers1 , K.I. Looman2 , M.M. Tabbers1 , T.A. Tas1 , M.J. Serlie1 . 1 HPN-team, Departments of Endocrinology and Metabolism and Pediatrics, Academic Medical Center, Amsterdam, 2 VWO, Revius Lyceum, Doorn, Netherlands Rationale: The use of home parenteral nutrition (HPN) is increasing worldwide. The most threatening complication is a central venous catheter-related bloodstream infection (CBRSI). Besides thorough training in catheter care of the patients and hospital staff, locking the catheter with heparin is common use. Since 2010, we switched from heparin to taurolidine 2% (Taurosept® ) catheter-locks because of its assumed antibacterial effect. Taurolidine lock was used in all central venous accesses [CVC, peripheral inserted central venous catheters (PICC) and implanted ports (PAC)]. We hypothesized that taurolidine 2% reduces the incidence of CBRSI. Methods: We performed a retrospective analysis in our HPN population (114 adults and 37 children) and included all patients who were treated for 365 days with HPN in 2009 and 2010. Positive blood cultures (from a peripheral vein and the central venous access) were categorized as CBRSI incident.
Catheter days CBRSI 2009 (n per CVCday) CBRSI 2010 (n per CVCday)
11680 17 (0.0014) 4 (0.0003)
2920 4 (0.0014) 1 (0.0003)
Results: 32 adults and 8 children were included representing a total of 14,600 catheter days (CVCday). In adults