ESPEN 2008.

30th Congress of ESPEN

Firenca, 13.-16.09. 2008.

Dr. Mladen Ivanovski, dr. Helga Komen

30th Congress of ESPEN, Firenca, 13.-16.09.2008.


Main Topics of ESPEN 2008

•The chronic critically ill patient •Oxygen delivery and tissue metabolism in sepsis

•Metabolic therapies in ICU: controversies or consensus? •The impact of anesthesia on metabolism

•Phytochemicals and cancer •Obesity and cancer risk

•Nutrition-related cancer risk •Tumor-specific metabolic changes

•Fatty acids modulation of anti-cancer therapy •Preventing cancer-related malnutrition

•Protein kinetics in the elderly •Metabolomics and proteomics in nutrition

•Chronic intestinal failure •Growing up on parenteral nutrition •Strategies to prevent hepatosteatosis

•Brain metabolism and nutrition •Nutritional support in wounds and pressure ulcers

•Nutritional control of immunity •Amino acid metabolism in the gastrointestinal tract


Frailty syndrom eng. frailty - krhkost, neotpornost

Frailty syndrome: A condition, seen particularly in older patients, characterized by low functional reserve, easy tiring, mood disturbance, accelerated osteoporosis, decreased muscle strength, and high susceptibility to disease.

Frailty is based on cutoffs in 5 components - Muscle weakness, weight loss, low physical activity, exhaustion, and slow walking speed. Subjects below certain cutoffs on 3 or more components are deemed frail, those with 1-2 components below cutoffs are deemed intermediately or moderately frail, and those scoring higher than cut points on all 5 measures are deemed non-frail or robust.


Increasing recognition in literatureIncreasing recognition in literature


Frailty Syndrome EpidemiologyFrailty Syndrome Epidemiology

3 or more of 5 criteria3 or more of 5 criteria

6.7% of community residing elderly6.7% of community residing elderly

3 year incidence 3 year incidence ——7%7%

Increases with age: 3%Increases with age: 3%--65; 26% 65; 26% --8585--8989

Fried L, et al J Gerontol Med Sci 2001: 560: M146Fried L, et al J Gerontol Med Sci 2001: 560: M146--M156M156


Treatment of FrailtyTreatment of Frailty

Prevent dwindlesPrevent dwindles Early detection of acute illness and polypharmacy Early detection of acute illness and polypharmacy

((Geriatric Giants or atypical presentation)Geriatric Giants or atypical presentation)

Assess cognition and moodAssess cognition and mood Optimize sensory inputsOptimize sensory inputs MobilizeMobilize

–– Bed is BADBed is BAD–– Minimize Muscle WastingMinimize Muscle Wasting

Improve nutritionImprove nutrition


EARLY ENERGY SUPPLY DECREASES ICU AND HOSPITAL MORTALITY: A MULTICENTRE STUDY

IN A COHORT OF 1209 PATIENTSC Pichard et al.. University Hospital Geneva, Switzerland

• Early (< 3 day) vs. delayed nutrition (enteral and/or parenteral)

• > 1500 kcal/d

• Lower mortality in ‘early’ group (18,7% vs. 24,2%)

Supplemental parenteral nutrition combined with enteral nutritioncan be considered to cover the energy and protein targets when enteral nutrition alone fails to achieve the caloric goal.


Oxygen delivery and tissue metabolism in sepsis

Leverve X. et al.. Université Joseph Fourier, Grenoble, France,

[email protected].

• Laktati nisu dobar pokazatelj anaerobnog metabolizma u sepsi

• Klirens laktata je smanjen (240 → 4), a produkcija nije značajno povećana (10 → 20)

• Svaki antioksidans u suvišku počinje se ponašati kao slobodni radikal

• Vitamin E

• Vitamin C (je najbolji antioksidans)

→


Fatty acids and inflammationPhilipe Calder, Institute of Human Nutrition and School of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD,

UK. [email protected]

• Human immune cells are typically rich in arachidonic acid

• Arachidonic acid and EPA contents can be altered through oral administration of those fatty acids

• Changing the fatty acid composition of immune cells affects phagocytosis, T-cell signaling and antigen presentation capability

∀ ↓ immune response

∀ ↓ incidence of MODS


Hydration in surgical patientsLobo DN at al.. Division of Gastrointestinal Surgery, Section of Surgery, E Floor, West Block, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH,

UK. [email protected]

• The goal of fluid therapy in the elective setting is to maintain the effective circulatory volume while avoiding interstitial fluid overload

• Weight gain in elective surgical patients should be minimized in an attempt to achieve a 'zero fluid balance status‘

• Avoid the need to resuscitate fluid-depleted patients in the anaesthetic room or after the induction of anaesthesia

• It could take 3 weeks to excrete overloaded water

• Oedema – eyes, face, ancle, lower leg, forearm


Clinical use of glutamine supplementation.

Wernerman J., Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, 14186

Stockholm, Sweden. [email protected]

• Endogenous production of glutamine may become insufficient during critical illness. The major part of endogenously produced glutamine comes from skeletal muscle

– Decrease in plasma concentration, is a prognostic factor for poor outcome in sepsis

• Exogenous glutamine supplementation is necessary

• i.v. glutamine supplementation to critically ill patients on parenteral nutrition must be regarded as the standard of care (adding 20-25 g/24 h)

• There are no reported adverse or negative effects attributable to glutamine supplementation.


Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery,

major trauma, and subarachnoid hemorrhage patients.Berger MM et al. Department of Intensive Care Medicine & Burns Centre, University

Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. [email protected].

• Micronutrients contributing to the antioxidant (AOX) defense exhibit low plasma levels during critical illness

• Intravenous supplements for 5 days (selenium 270 mug, zinc 30 mg, vitamin C 1.1 g, and vitamin B1 100 mg)

• The AOX intervention did not reduce early organ dysfunction but significantly reduced the inflammatory response


Oxepa®Therapeutic Nutrition for Modulating Inflammation in Sepsis, ARDS, and ALI

• OXEPA is clinically shown to modulate the inflammatory response in critically ill, mechanically ventilated patients, including those with sepsis, SIRS (systemic inflammatory response syndrome), ALI (acute lung injury), or ARDS (acute respiratory distress syndrome).

• Calorically dense (1.5 Cal/mL)• Contains 4.6 g/L of EPA and 4 g/L of GLA-

to help modulate inflammation • Elevated levels of antioxidants-to help prevent

free radical damage

• Meets or exceeds 100% of the RDI for 24 essential

vitamins and minerals in 1420 Cal (946 mL) • Gluten-Free, Lactose-Free, Low-Residue

EPA = eicosapentaenoic acid, GLA = gamma-linolenic acid


Oxepa®Therapeutic Nutrition for Modulating Inflammation in Sepsis, ARDS, and ALI

• ......beneficial effects of OXEPA on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the incidence of new organ failures.


Bodystat® Illness MarkerTM

& Dehydration Index

forClinical assessment

of

for

BODY CELL HEALTH STATUSMONITORING of HYDRATION

STATUS

and as a inPREDICTOR OF OUTCOME COMPETETIVE ATHLETES

in seriously ill patients

using

BIA multi-frequency technology

impedance valuesat 5 kHz and 200 kHz

ONLY

and

independent of weight, age and sex.


LLL – Life Long Learning

• The Life Long Learning (LLL) programme in Nutrition is an extremely effective educational programme for medical doctors and health specialists offering training On-line and at Live courses.• On-line courses are freely accessible after registration

• http://www.lll-nutrition.com/ed/


• Nutrigenomics is the study of molecular relationships between nutrition and the response of genes.

• Nutrigenomics focuses on the effect of nutrients on the genome.

• Nutrigenomics has been associated with the idea of personalized nutrition based on genotype.

Nutrigenomics


ESPEN 2009. - Beč. Austrija

ESPEN 2010. - Nica, Francuska


www.nutritioncare.org

http://pen.sagepub.com/

www.espen.org

www.ccmjournal.com

http://abbottnutrition.com/

www.fresenius.com

ESPEN 2008.

Health & Medicine

Transcript of ESPEN 2008.