ESPEN 2008.

30th Congress of ESPEN
Firenca, 13.-16.09. 2008.

Dr. Mladen Ivanovski, dr. Helga Komen

30th Congress of ESPEN, Firenca, 13.-16.09.200

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 literature


Frailty Syndrome Epidemiology

 3 or more of 5 criteria
 6.7% of community residing elderly
 3 year incidence —7%
 Increases with age: 3%-65; 26% -
85-89

Fried L, et al J Gerontol Med Sci 2001: 560: M146-M156
M146-


Treatment of Frailty

 Prevent dwindles
 Early detection of acute illness and polypharmacy
(Geriatric Giants or atypical presentation)
 Assess cognition and mood
 Optimize sensory inputs
 Mobilize
– Bed is BAD
– Minimize Muscle Wasting
 Improve nutrition


EARLY ENERGY SUPPLY DECREASES ICU AND
HOSPITAL MORTALITY: A MULTICENTRE STUDY
IN A COHORT OF 1209 PATIENTS
C 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 nutrition
can 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,
xavier.leverve@ujf-grenoble.fr.

• 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 inflammation
Philipe Calder, Institute of Human Nutrition and School of Medicine,
University of Southampton, Tremona Road, Southampton SO16 6YD,
UK. pcc@soton.ac.uk

• 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 patients
Lobo DN at al.. Division of Gastrointestinal Surgery, Section of Surgery, E Floor,
West Block, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH,
UK. dileep.lobo@nottingham.ac.uk

• 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. jan.wernerman@karolinska.se

• 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. Mette.Berger@chuv.ch.

• 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 &
Dehydration Index
MarkerTM
for for
Clinical assessment MONITORING of HYDRATION
BODY CELL HEALTH STATUS
of STATUS
and as a in
PREDICTOR OF OUTCOME COMPETETIVE ATHLETES
in seriously ill patients

using

BIA multi-frequency
technology
impedance values
at 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

• 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.


ESPEN 2009. - Beč. Austrija

ESPEN 2010. - Nica, Francuska


www.nutritioncare.org

www.espen.org

http://pen.sagepub.com/
www.ccmjournal.com

http://abbottnutrition.com/

www.fresenius.com

ESPEN 2008.

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