Synergy in Motion: Combining nutrition and exercise for optimal physical function. Saturday, September 8, :00-13:30

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1 ABSTRACT BOOK ESPEN 2012 SYMPOSIUM Synergy in Motion: Combining nutrition and exercise for optimal physical function Saturday, September 8, :00-13:30 International Convention Centre, Room: Miró Barcelona, Spain

2 Visit: As Nutrition Screening as Malnutrition is associated with a 3 times higher infection rate and higher mortality rate 1,2 MNA : The GOLD standard in nutrition screening for the older adult Most validated tool for the elderly Quick, convenient and easy to use Identifies patients who need nutrition intervention Most commonly used nutrition screening tool by geriatricians 3 Scan with your iphone to download the MNA App * or visit * As featured in the Journal of the American Geriatrics Society: Annals of Long-term Care 4 Mini Nutritional Assessment MNA Last name: First name: Sex: Age: Weight, kg: Height, cm: Date: Complete the screen by filling in the boxes with the appropriate numbers. Total the numbers for the final screening score. Screening Screen and intervene. Nutrition can make a difference. A Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties? 0 = severe decrease in food intake 1 = moderate decrease in food intake 2 = no decrease in food intake B Weight loss during the last 3 months 0 = weight loss greater than 3 kg (6.6 lbs) 1 = does not know 2 = weight loss between 1 and 3 kg (2.2 and 6.6 lbs) 3 = no weight loss C Mobility 0 = bed or chair bound 1 = able to get out of bed / chair but does not go out 2 = goes out D Has suffered psychological stress or acute disease in the past 3 months? 0 = yes 2 = no E Neuropsychological problems 0 = severe dementia or depression 1 = mild dementia 2 = no psychological problems F1 Body Mass Index (BMI) (weight in kg) / (height in m 2 ) 0 = BMI less than 19 1 = BMI 19 to less than 21 2 = BMI 21 to less than 23 3 = BMI 23 or greater IF BMI IS NOT AVAILABLE, REPLACE QUESTION F1 WITH QUESTION F2. DO NOT ANSWER QUESTION F2 IF QUESTION F1 IS ALREADY COMPLETED. F2 Calf circumference (CC) in cm 0 = CC less than 31 3 = CC 31 or greater Screening score (max. 14 points) points: Normal nutritional status 8-11 points: At risk of malnutrition 0-7 points: Malnourished References 1.Vellas B, Villars H, Abellan G, et al. Overview of the MNA - Its History and Challenges. J Nutr Health Aging. 2006;10: Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA- SF). J. Geront. 2001;56A: M Guigoz Y. The Mini-Nutritional Assessment (MNA ) Review of the Literature - What does it tell us? J Nutr Health Aging. 2006; 10: Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form (MNA -SF): A practical tool for identification of nutritional status. J Nutr Health Aging. 2009; 13: Société des Produits Nestlé, S.A., Vevey, Switzerland, Trademark Owners Nestlé, 1994, Revision N /99 10M For more information: 1. Sorensen J et al. Clin Nutr 2008; 27(3): Schneider SM et al. Br J Nutr 2004; 92(1): Vandewoude M et al. European Geriatric Medicine 2011; vol 2, issue 2: Annals of Long-Term Care. 2012;20(2):51.

3 Synergy in Motion: Combining nutrition and exercise for optimal physical function PROGRAM Synergy in Motion: Combining nutrition and exercise for optimal physical function Saturday, September 8, :00-13:30 International Convention Centre, Room: Miró Barcelona, Spain Chair: Yves Boirie, MD, PhD (France) The role of nutrition in optimizing strength and function Francesco Landi, MD, PhD (Italy) Functional decline and nutritional status in the older adult Pedro Abizanda Soler, MD, PhD (Spain) Physical activity programs for the older adult: Success factors Miriam Nelson, PhD (USA) 3

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5 Synergy in Motion: Combining nutrition and exercise for optimal physical function CHAIRMAN BIOGRAPHY KEY MESSAGES Yves Boirie, MD, PhD Yves Boirie, MD, PhD, is Chair of the Clinical Nutrition Department at the University Hospital of Clermont-Ferrand (France), and the leader of a research team called Nutrition, Muscle Mass and Metabolism (NuTriM) in the Human Nutrition Unit (UMR 1019, INRA/University of Auvergne) belonging to the Human Nutrition Research Centre of Clermont-Ferrand (France). After a medical background in endocrinology, diabetes and metabolic diseases, Professor Boirie contributed to the foundation of the first French Research Center in Human Nutrition. He also completed training in metabolic research through a PhD in Physiology and Nutrition, and a postdoctoral fellowship in the Endocrine Research Unit of the Mayo Clinic (Rochester, USA). Professor Yves Boirie is involved in basic as well as pre-clinical and clinical research studies in the field of protein-energy metabolism, especially with regards to its regulation by nutrients and hormones in healthy individuals or ill patients. Focus areas of research are on the mechanisms of muscle mass loss with aging, obesity and other chronic diseases through protein kinetic approaches using stable isotopes. He also works on the impact of nutrients in their capacity to promote muscle anabolism in healthy subjects or patients. He serves as board member of several national and international nutrition societies, as well as clinical nutrition journals, and has been appointed as the Chairman of ESPEN Scientific Committee. He has published over 150 peer-reviewed original papers and chapters in international journals. The loss of muscle mass and strength that occurs with advancing age or during chronic disease is now widely recognised as a condition associated with higher rates of morbidity and health care cost. Indeed, the age-related decline in muscle performance leads to physical disability, falls, impaired mobility, metabolic disorders and mortality in elderly people. The clinical and social impact of sarcopenia is largely underestimated in the population, so that its screening should be regularly performed on the basis of simple tests including not only muscle mass measurement but also muscle function through muscle strength or performance. Interestingly, the rate of decline in muscle function may be quite variable among the elderly population which suggests that modifiable factors such as diet and lifestyle are capable to influence the individual trajectory of muscle dysfunction in older age. Many experimental as well as epidemiological studies have demonstrated that diet through its different components (especially essential amino acids and specific proteins) was linked to muscle mass and strength, implying that nutritional strategies to prevent or limit sarcopenia development in older age should be proposed. Other important studies have demonstrated a strong relationship between physical exercise and strength improvement, confirming the efficacy of various exercise programs for the prevention and treatment of sarcopenia. Altogether these reports indicate that targeted interventions on nutrition and muscle training may limit or prevent the age-related decline in muscle mass and function. Therefore, this symposium will explain how exercise and nutrition are the best synergy for optimizing physical function through three lectures focused on: 1) The role of nutrition in optimizing strength and function by Francesco Landi, MD, PhD (Italy) 2) Functional decline and nutritional status in the older adult by Pedro Abizanda Soler, MD (Spain) 3) Physical activity programs for the older adult: Success factors by Miriam Nelson, PhD (USA) 5

6 SPEAKER BIOGRAPHY KEY MESSAGES Francesco Landi, MD, PhD Francesco Landi, MD, PhD, is Associate Professor of Internal Medicine and Geriatrics at the Catholic University of Sacred Heart (Rome, Italy), and a specialist in geriatric medicine and gerontology serving as Director of the Geriatric Rehabilitation Unit of the A. Gemelli Hospital (Rome, Italy). He is also Director of the teaching nursing homes of the Catholic University (L Aquila, Italy). Contributions to advance scientific knowledge and medical practice include active involvement in research and the application to patient care. Professor Landi is a member of the Scientific Committee and Clinical Section Coordinator of the Italian Geriatric Society. He is a member of the Editorial Board of several international geriatric journals and also a peer reviewer for numerous international medical journals. He has acted as Principal Investigator in many multicenter national and international trials, and is a member of national and international expert groups that work on guidelines in the field of nutrition and functionality in elderly subjects. Sarcopenia plays an important etiologic role in the frailty process of elderly subjects, being also a key player of its latent phase and explaining many aspects of the frailty status itself. Diagnosis of sarcopenia requires the documentation of low muscle mass plus the documentation of either low muscle strength or low physical performance. Anorexia is one of the most important risk factors for the onset of sarcopenia. Anorexia of aging especially in the early stage may be correlated with a high risk of qualitative low intake of single nutrients, in particular, protein and vitamins. It could be hypothesized that this selective malnutrition for example, in terms of single macro- or micronutrients is directly correlated with sarcopenia. It is well known that the amount of protein available plays a key role in the ability to develop muscle mass and strength. High quality protein such as high leucine balanced essential amino acids stimulates protein synthesis at muscle level by activation of the mtor system. For these reasons it is realistic to hypothesize that adequate protein intake plays a key role in preservation of muscle mass and physical function in older persons. He has over 200 peer-reviewed original papers in international medical journals, many of which are in the area of frailty, sarcopenia and functional status of older people. Professor Landi is particularly interested in the role of nutrition as part of the integrated care of older adults, and participated in the development of the European consensus on the definition and diagnosis of sarcopenia. 6

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8 SPEAKER BIOGRAPHY KEY MESSAGES Pedro Abizanda Soler, MD, PhD Pedro Abizanda Soler, MD, PhD, is Chief of the Geriatrics Department at the Complejo Hospitalario Universitario de Albacete. He is Associate Professor in Geriatrics at the Medicine Faculty from Castilla-La Mancha University. His PhD degree was granted by the Universidad Autónoma de Madrid. He serves as President of the Ethics Research Committee from Albacete, and member of the Geriatrics Specialty National Commission. He is the author of books and publications in international journals covering issues among older persons in community and hospital settings. Focus areas include cognitive and physical function, frailty, and disability; validated clinical methods of assessment, and therapeutic interventions for rehabilitation. Physiologic, functional, cognitive, psychological and social factors interact in the elderly with nutritional aspects, to conform a true subspecialty. It is known that nutrition is one of the main components of healthy and active aging. A good nutrition plays a major role in the maintenance of function and mental health, free of illness and disability, while a bad nutrition contributes to the development of chronic diseases, disability, dependence and death. The WHO in the 1950s, stated that health in older adults must be measured in terms of function. Function is the main health index in this population group, more than any other illness including cancer, coronary artery disease or stroke, and also more than disease burden or comorbidity. In the FRADEA study (Frailty and Dependency in Albacete), frailty and function were the adjusted strongest predictors of death or incident disability. In addition, nutrition was a predictor of good or bad function in older adults. Although the treatment recommendations of the main regulatory agencies for nutrition are similar independently of the age group, there is evidence that older adults have special needs, in energy intake, protein intake, and diet composition. Moreover, not every older adult has the same needs, and frailty, disability, physical activity, and chronic illness modulate these requirements. A correct diet or nutritional supplements can help reduce the incidence, severity and progression of frailty, disability and age-associated chronic illnesses, although more investigation is needed to determine the pathophysiological aspects that are associated in this relationship. 8

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10 SPEAKER BIOGRAPHY KEY MESSAGES Miriam E. Nelson, PhD Miriam Nelson, PhD is Professor of Nutrition at the Friedman School of Nutrition Science and Policy, and founder and Director of the John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention at Tufts University. She also co-directs ChildObesity180, a multi-sector, childhood obesity prevention initiative. As a leader in research targeting physical activity, nutrition, and public health, Dr. Nelson has published on the impact of both nutrition and exercise on the prevention of obesity, heart disease, diabetes, osteoporosis, and arthritis. Based on her innovative research, Dr. Nelson has published nine books including Strong Women Stay Young and four other New York Times bestsellers. Her tenth book, The Social Network Diet: Change Yourself, Change the World, was published September Together, these books have sold over a million copies in fourteen languages. Dr. Nelson s research has been the foundation of the StrongWomen Program, a community based nutrition and exercise program for women currently being implemented in over thirty-five states. Older adults who lead physically active lives and eat nutritiously live longer and have decreased risk for heart disease, diabetes, obesity, mental health disorders, osteoporosis, sleep disturbances, and functional decline and many other chronic conditions that we associate with aging. Aerobic exercise has been shown to improve cardiovascular health but does not seem to influence muscle mass or muscle strength; whereas, strength training has been shown to increase these factors. There is now evidence that both aerobic and strengthening exercises have the ability to improve depressive symptoms and sleep problems in older individuals. Optimizing mood and quality of sleep are important for overall quality of life. The best exercise prescription for improving overall health in older adults is a program that incorporates both aerobic exercise and strength training. The reality is that very few older adults participate in any exercise program. This lecture will discuss not only the benefits of physical activity for older adults, but also the success factors that relate to overall physical activity participation and improved fitness. As founder and Director of the John Hancock Research Center, Dr. Nelson has assembled a world-class faculty and staff focused on innovative research, training future leaders, and influencing public policy to improve the nation s food and physical activity environment. Through its research and outreach, the center has trained over 5,600 allied health professionals and community partners to implement healthy change in their communities. 10

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12 ESPEN LATE BREAKING ABSTRACT SUPERIOR PREFERENCE FOR A SPECIFIC FRUIT-BASED ORAL NUTRITIONAL SUPPLEMENT AMONG OLDER ADULTS Authors: K. Kaspar 1,*, K. Herentrey 1, E. Pradon 1 1 Nestlé Health Science, Vevey, Switzerland Rationale: ESPEN Geriatrics guidelines recommend the use of oral nutritional supplements (ONS) in patients who are undernourished or at risk of undernutrition based on Grade A evidence. Presumably, the nutritional intervention is better suited to support good patient outcomes if an older adult finds a specific ONS appealing. The objective of this study was to investigate the taste and texture characteristics of and preferences for various ready-to-drink, fruit-based ONS. Methods: Two separate studies were conducted among older adults (aged 70y and above) who would consider using ONS in the future. In a first study, individuals (n=300) in France directly-compared orange-, apple-, and blackcurrantflavored Clinutren Fruit ONS (Nestlé) [A], with the flavor-matched products Fortimel Jucy (Nutricia) [B], and Fresubin Jucy (Fresenius Kabi) [C]. In a second study, individuals (n=100) in Sweden compared orange- and blackcurrantflavored Resource Fruit ONS (Nestlé) [A] with the flavor-matched products Fortimel Jucy (Nutricia) [B]. Each participant evaluated 2 flavors (4 products in total). All products were presented in an unbranded and randomized manner. Each product was assessed by at least 100 consumers. Results: Consumers identified significant preference for ONS A in all direct comparison tests conducted (6 in France, and 2 in Sweden). Between 75% and 50% of older adults reported overall preference for ONS A vs. the comparable ready-to-drink, fruit-based ONS B or C. Conclusion: In all direct comparison tests conducted, older adults judged a fruit-based ONS (product range A) superior to comparable products. Preference for ONS A was attributed to taste and texture characteristics including sweetness, fruit flavor, and liquid thickness. Disclosure of Interest: K. Kaspar Other: Kala Kaspar is an employee of Nestlé Health Science or its affiliates., K. Herentrey Other: Klaus Herentrey is an employee of Nestlé Health Science or its affiliates, E. Pradon Other: Emmanuel Pradon is an employee of Nestlé Health Science or its affiliates Keywords: GERIATRICS, oral nutritional supplements 12

13 Synergy in Motion: Combining nutrition and exercise for optimal physical function ESPEN ORAL PRESENTATION ACCURACY OF A NEW SELF-COMPLETED NUTRITION SCREENING TOOL FOR COMMUNITY DWELLING OLDER ADULTS Authors: M. B. Huhmann 1, K. Kaspar 2,*, V. Perez 3, D. D. Alexander 3, D. R. Thomas 4 1 Nestle Health Science, Florham Park, United States, 2 Nestle Health Science, Vevey, Switzerland, 3 Exponent, Inc. Health Sciences, Chicago, 4 Division of Geriatrics/Gerontology, St. Louis University School of Medicine, St. Louis, United States Rationale: Malnutrition is common in community-dwelling older adults and is associated with poor health, hospitalization, and mortality. Previous studies have found that malnutrition or being at risk for malnutrition is prevalent in 38% of community subjects 1. ESPEN encourages nutrition screening and suggests that the Mini-Nutritional Assessment (MNA ) is appropriate for older adults. Recently, the MNA -Short Form (SF), a 6-question survey, was validated for rapid nutrition screening. Ideally, nutrition screening would be performed by individuals or their caregivers at home, prior to, or during an outpatient visit; thus, allowing for early detection of malnutrition and ongoing monitoring of nutrition status. Methods: We compared responses from the MNA -SF administered by a Healthcare Professional (HCP) to a 6-item self-administered screening tool (Self -MNA) in 463 community-dwelling adults (mean age: 76.8±6.8 years) who gave informed consent. Women comprised 60% of the population. The HCP was blinded to the responses on the Self-MNA. Using the MNA -SF, 27% of subjects had normal nutrition, 38% were at risk, and 35% were malnourished. Results: Compared to the HCP administered MNA -SF, the accuracy of the Self -MNA for identifying malnourished subjects was 99% (sensitivity [Se] 99%, specificity [Sp] 98%, false negative rate [FNR] 1%, false positive rate [FPR] 2%) and 83% (Se 89%, Sp 77%, FNR 11%, FPR 23%) for identifying subjects at risk of malnutrition. Conclusion: We conclude that, in this initial assessment, the Self -MNA is a valid nutrition screening tool demonstrating good interrater reliability for use in community-dwelling older adults. Future research will extend the validation to other populations. Reference(s): 1, Kaiser et al. Frequency of Malnutrition in Older Adults: A Multinational Perspective Using the Mini Nutritional Assessment J Am Geriatr Soc 58: , Disclosure of Interest: M. Huhmann Other: Employed by Sponsor, K. Kaspar Other: Employed by Sponsor, V. Perez: None Declared, D. Alexander: None Declared, D. Thomas Consultant of: Nestle Health Sciences Keywords: Geriatric, Nutrition screening 13

14 ESPEN LATE BREAKING ABSTRACT THERAPEUTIC EFFECT OF XANTHAN GUM-BASED THICKENER ON SWALLOWING FUNCTION IN PATIENTS WITH OROPHARYNGEAL DYSPHAGIA Authors: L. Rofes 1,*, V. Arreola 2, R. Mukherjee 3, P. Clavé 1 1 CIBERehd - Hospital de Mataró, 2 Hospital de Mataró, Mataró, Spain, 3 Nestlé Research Center, Nestec Ltd, Lausanne, Switzerland Rationale: Oropharyngeal dysphagia (OD) is a major contributor to malnutrition. Starch-based thickeners improve safety of deglutition but increase residue. We aimed to evaluate the therapeutic effect of a xanthan gum-based thickener, Resource ThickenUp Clear (RTUC, Nestlé Health Science). Methods: We studied 120 patients with OD with videofluoroscopy while swallowing a series of 5-20 ml liquid boluses at nectar, thin and extreme spoon-thick (EST) viscosities measured at 50/s 20 C and obtained with a hydrosoluble X-Ray contrast (50/50 vol with water) and RTUC. We assessed prevalence of penetrations and aspirations for impaired safety, oropharyngeal residue for impaired efficacy, bolus velocity, timing of the swallow response, and the nutritional risk (MNASF, NRS 2002). Results: Prevalence of malnutrition or risk of malnutrition was 71% according to MNA-SF and 76% according to NRS Increasing bolus viscosity: a) improved safety of swallow as 24% of patients with OD presented safe swallow at thin, 55% at nectar (P<0.001) and 85% at EST (P<0.001). Prevalence of aspiration was 16% at thin, 9% at nectar (P<0.01) and 5% at EST (P<0.01). The score of the penetration-aspiration scale was 3.3±0.2 (thin), 2.2±0.2 ( P<0.001, nectar) and 1.5±0.1 (P<0.001, EST); b) did not enhance oropharyngeal residue; c) did not affect timing of swallow response; d) reduced bolus velocity from 0.25±0.01m/s at thin to 0.21±0.01m/s at EST (P<0.05). Conclusion: Prevalence of malnutrition among neurological and older patients with OD is very high. Increasing bolus viscosity with RTUC exerts a strong therapeutic effect by improving the safety of swallow without increasing oropharyngeal residue, an advantage of new generation versus conventional thickening agents. This effect might help to improve the nutritional treatments for these patients. Disclosure of Interest: L. Rofes: None Declared, V. Arreola: None Declared, R. Mukherjee: None Declared, P. Clavé Grant/Research Support from: Nestec Ltd Keywords: Dysphagia, malnutrition 14

15 Synergy in Motion: Combining nutrition and exercise for optimal physical function ESPEN LATE BREAKING ABSTRACT DIAGNOSTIC ACCURACY OF THE EATING ASSESSMENT TOOL AND THE VOLUME-VISCOSITY SWALLOW TEST FOR CLINICAL SCREENING AND ASSESSMENT OF OROPHARYNGEAL DYSPHAGIA Authors: L. Rofes 1,*, V. Arreola 2, R. Mukherjee 3, P. Clavé 1 1 CIBERehd - Hospital de Mataró, 2 Hospital de Mataró, Mataró, Spain, 3 Nestlé Research Center, Nestec Ltd, Lausanne, Switzerland Rationale: Oropharyngeal dysphagia (OD) is a major contributor to malnutrition. We aimed to determine the diagnostic accuracy of the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST) for OD. Methods: We studied 120 patients with swallowing difficulties and 14 healthy persons. OD was clinically evaluated by a 10-item questionnaire (EAT-10) and a bedside method (V-VST). Scoring 3 in the EAT-10 is considered abnormal. The VVST consisted of the administration of 5-20 ml liquid boluses at nectar (1.2g/100 ml water), thin (water) and extreme spoonthick (6g/100 ml water) viscosities obtained with a xanthan gum based thickener (Resource ThickenUpClear, Nestlé Health Science). The V-VST was considered positive for OD when one or more of the following signs were present: cough, fall in oxygen saturation 3%, voice changes (impaired safety); piecemeal deglutition or residue (impaired efficacy). Videofluoroscopy was the reference standard for OD diagnosis. Diagnostic accuracy was assessed by the AUC of the ROC curve and sensitivity and specificity values. Results: Prevalence of OD was 94% and that of aspirations 19% according to the videofluoroscopic study. The EAT-10 showed a ROC AUC of 0.88 for OD and a sensitivity and specificity of 79% and 87% for EAT The V-VST presented 94% sensitivity and 87% specificity for OD, 86% sensitivity and 79% specificity for impaired safety, 91% sensitivity and 28% specificity for aspirations, and 78% sensitivity and 74% specificity for impaired efficacy. Conclusion: Clinical methods for screening (EAT-10) and assessment (V-VST) of OD offer high diagnostic accuracy. We recommend their universal application to improve the nutritional management of older and neurological patients at risk for OD. Reference(s): Disclosure of Interest: L. Rofes: None Declared, V. Arreola: None Declared, R. Mukherjee: None Declared, P. Clavé Grant/ Research Support from: Nestec Ltd Keywords: Dysphagia, malnutrition 15

16 ESPEN ORAL PRESENTATION ADMINISTRATION OF CITRULLINE AND LEUCINE DURING A SLIMMING DIET IN RATS: INTEREST FOR PRESERVING MUSCLE FUNCTION Authors: G. Ventura 1,*, P. NOIREZ 2, D. BREUILLE 3, C. CHOISY 1, S. LE PLENIER 1, V. BASTIC SCHMID 3, L. CYNOBER 1, C. MOINARD 1 1 Laboratoire de Biologie de la Nutrition, 2 Laboratoire de Biologie de la Nutrition, Université Paris Descartes - EA 4466, Paris, France, 3 Nutrition Department, Nestlé Research Center, Lausane, Switzerland Rationale: Leucine (LEU) and Citrulline (CIT) are known to stimulate muscle protein synthesis (MPS) in the post-prandial and postabsorptive states, respectively. We postulated that the sequential administration of Leu (mixed in chow) and Cit (in drinking water before the rest period) could be beneficial for preserving muscle function during food restriction. Methods: After an acclimatization period, 40 female Sprague-Dawley rats (aged 22 weeks old) were randomized into 6 groups: a control group (C) fed a standard diet ad libitum, and 5 diet-restricted groups (60% of two-week spontaneous intake) receiving a standard diet (R), CIT (0.2 g/kg/d or 1.0 g/kg/d), LEU (1.0 g/kg/d), or CIT+LEU (1.0 g/kg/d each). At the end of the experiment, muscle contractile properties and MPS rate (flooding-dose method) were studied in the tibialis anterior. Data were tested for normality and analyzed by ANOVA or Kruskal-Wallis tests. Results: Dietary restriction tended to decrease MPS (R: 2.5 ± 0.2 vs C: 3.4 ± 0.4%/d, p = 0.06) and significantly decreased muscle strength (R: 3369 ± 688 vs C: 5206 ± 449 A.U., p = 0.03). CIT administration (at 1 g/kg) restored MPS (CIT 1.0: 3.4 ± 0.3 vs R: 2.5 ± 0.2%/d, p = 0.05), and increased both muscle maximum tetanic force (CIT 1.0: 455 ± 16 vs R: 405 ± 26 g, p = 0.05) and muscle strength (CIT 1.0: 4612 ± 378 vs R: 3369 ± 688, p = 0.05 and CIT 1.0: 4612 ± 378 vs. CIT 0.2: 3395 ± 367 A.U., p = 0.02). These effects were not observed in the LEU and CIT+LEU groups. Conclusion: The results of this study highlight the ability of CIT administered alone to preserve MPS and muscle strength during dietary restriction. This study also found that LEU antagonized CIT. The mechanisms involved warrant further study. Disclosure of Interest: G. Ventura: None Declared, P. NOIREZ: None Declared, D. BREUILLE: None Declared, C. CHOISY: None Declared, S. LE PLENIER Shareholder of: Citrage company, V. BASTIC SCHMID: None Declared, L. CYNOBER Grant/Research Support from: Inneov company, Consultant of: Inneov company, Shareholder of: Citrage company, C. MOINARD Shareholder of: Citrage company Keywords: dietary restriction, muscle mass, slimming diet, protein synthesis 16

17 Synergy in Motion: Combining nutrition and exercise for optimal physical function ESPEN 2012 MICROGEL FORMATION OF WHEY PROTEIN REDUCES ITS INSULINOGENIC INDEX WITHOUT MODIFYING GLYCEMIC RESPONSE IN HEALTHY MEN Authors: Etienne Pouteau 1,2, Lionel Bovetto 2, Gaëlle Schlup-Ollivier 2, Dominik Grathwohl 2, Maurice Beaumont 2, Katherine Macé 2 1 Nestlé Research of Santiago, Chile; 2 Nestlé Research Centre of Lausanne, Switzerland. Rationale: Chronically increased insulin demand may result in pancreatic beta cell failure, impaired glucose tolerance and diabetes. Whey protein is particularly insulinogenic. The aim of this trial was to test 3 processed whey proteins (Intact vs Hydrolyzed vs Microgel) in a meal on insulin, glucagon and glycemic responses in men. Method: In a cross-over, randomized, double blinded trial, 23 healthy adult men ingested 4 high-protein meals (30% energy) separated by a week. The proteins were the whey protein as isolate (WPI), hydrolysate (WPH) and microgel (WPM) and as reference, casein (CAS). Blood was collected after ingestion. Statistical pair-wise comparisons were used. Results: The areas under the curve (AUCs) of glycemia were similar between meals. The insulinogenic indexes were 3.7 ± 0.5, 2.6 ± 0.4, 2.3 ± 0.2 and 1.9 ± 0.2 (Mean ± SE) after WPH, WPI, CAS and WPM meal ingestion, respectively (P<0.04 between WPH and other proteins, otherwise NS). Insulin peak concentration (Cmax) after WPM meal (573 ± 47 pmol.l-1) was similar than after CAS meal and lower than after WPH and WPI meals ( pmol.l-1, P<0.004). Glucagonemia of WPM and CAS were lower than that of WPH and WPI (P<0.05). WPH and WPI induced highest GLP 1. Amino acidemia (AA) after WPH and WPI meals was higher than after CAS meal. WPM meal induced equaled AA Cmax than WPI meal but delayed by 30 min. Total AA, essential AA, branched-chain AA and leucine showed lowest values 30 min and highest values 120 min after WPM meal intake. Conclusions: WPM meal reduces acutely insulinemia and glucagonemia compared to WPH and WPI meals, while showing same glycemia in healthy men. WPM meal shows a delayed AA peak, which might explain the reduced hormonal responses. Forming microgels confers new biological functionalities to the whey protein with potential long-term health benefits. 17

18 ESPEN ABSTRACT SUBMISSION COST-EFFECTIVENESS ANALYSIS OF IMMUNONUTRITION FOR UPPER GASTROINTESTINAL CANCER PATIENTS UNDERGOING SURGERY IN BRITISH HOSPITALS Authors: H. Chevrou-Severac 1,*, L. Weijers 2, I. Eijgelshoven 2 1 Health Economics, NESTLE HEALTH SCIENCES, Vevey, Switzerland, 2 Mapi Consultancy, Houten, Netherlands Rationale: Immunonutrition (IN) containing arginine decreases complications and length of hospital stay in surgical patients (Cerantola et al. 2011). Its impact on hospital costs has already been assessed in gastrointestinal (GI) cancer surgery in US and Switzerland (Mauskopf et al. 2011; Chevrou-Séverac et al, 2011). The objective of this study is to assess whether IN is a cost-effective option in British hospitals in upper GI surgery. Methods: An economic model was used to estimate the cost saving of IN therapy in patients with upper GIsurgery. Clinical data from the meta-analysis of Cerantola et al. (2011) demonstrated that IN decreased the risk of complication significantly and the length of stay (LOS). The difference in costs per patient were performed a) based on cost per day related to the LOS reduction; and b) based on British HRG hospital costs for patients with and without complications. Results: The difference in cost per patient for approach a) was 2,586 per patient. The cost saving in approach b) reached 879 per patient. In the approach b), even for a complication rate as low as 5%, use of IN pre-operatively remained cost-savings. Conclusion: Costs of IN are more than offset by the savings linked to decrease in LOS and to avoided costs of treatment for complications. Thus, IN is an effective and cost-saving nutritional intervention for British hospitals in upper GI surgery. Reference(s): Braga M, Gianotti L. JPEN J Parenter Enteral Nutr. 2005;29(1 Suppl):S Cerantola Y, et al.; Br J Surg. 2011;98(1): Chevrou-Séverac H., et al.; Intensive Care Medicine 2011; Vol 37, Suppl 1, S35 Mauskopf J. et al.; Clinical Nutrition Supp 2011 ; Vol 6 Supp 1, pp Senkal et al. Arch Surg. 1999;134(12): Disclosure of Interest: H. Chevrou-Severac Other: Employee of NHSc, L. Weijers Consultant of: NHSc, I. Eijgelshoven Consultant of: NHSc Keywords: immunonutrition, surgery 18

19 Synergy in Motion: Combining nutrition and exercise for optimal physical function ESPEN ABSTRACT MUSCLE PROTEIN MASS RECOVERY IS ACCELERATED BY NUTRITIONAL LEUCINE AND ANTIOXIDANT SUPPLEMENTATION AFTER IMMOBILIZATION-INDUCED ATROPHY IN ADULT RATS. Authors: I. Savary-Auzeloux 1,*, D. Rémond 1, C. Migné 1, D. Breuillé 2, M. Faure 2, G. Williamson 2, H. Magne 1, L. Combaret 1, D. Dardevet 1 1 Unité de Nutrition Humaine, INRA, Ceyrat, France, 2 Nestlé Research Center, Lausanne, Switzerland Rationale: Limb immobilization induces a reduction of muscle mass which alters the defences of organisms (as muscle is an important store of body amino acids). A prevention of muscle loss during the immobilization period followed by a better recovery is then important. This study aimed to investigate the impact of a dietary supplementation of leucine (LEU) and antioxidants (AOX) on immobilization-induced muscle atrophy and subsequent recovery in adult rats. Methods: 120 adult rats were subjected to unilateral hind limb casting immobilization for 8 days (I0 to I8) and recovered for 10 to 40 days (I8, R10, R15, R30, R40; n=18/time). Animals were fed a control diet (C) or the same diet (EXP) supplemented with AOX (hesperitin-7-o-glucoside, vitamin E, green tea catechins, curcumin, rutin) (I0 to I8), AOX+LEU (I8 to R15) and LEU (R15 to R40). Muscle mass and protein synthesis were measured in the post prandial state in immobilized and nonimmobilized gastrocnemius muscle. Data were analysed by ANOVA. Results: At I8, muscle protein mass was decreased similarly (-39%, P<0.05) in C and EXP diets followed by a more rapid recovery of muscle protein mass in EXP diet. A significant higher muscle protein mass in EXP diet was observed at R30 (+9% vs C) and R40 (+10% vs C) (P<0.05). A higher post-prandial muscle protein synthesis rate in gastrocnemius muscle (Diet effect, P<0.01) was observed in the EXP vs C diet. Conclusion: After immobilization, the muscle protein mass recovery is accelerated when adult rats were fed a sequential AOX and LEU supplemented diet. Such supplementation stimulated the post-prandial muscle protein synthesis and shortened the duration of the recovery period in adults. Disclosure of Interest: None Declared Keywords: muscle atrophy, recovery 19

20 ESPEN ABSTRACT SUBMISSION UNIT COST ESTIMATION OF POST-STROKE DYSPHAGIC PATIENTS IN THE USA Authors: C. Takizawa 1,*, R. Marty 2, S. Roze 2 1 Nestle Health Science, Vevey, Switzerland, 2 HEVA SAS, Lyon, France Rationale: Dysphagia is a frequent complication occurring after stroke as a consequence of neurologic lesions at stake in controlling swallowing reflexes. Unmanaged dysphagia has been associated with an increased risk of aspiration pneumonia and even mortality. Alongside morbi-mortality, dysphagia has also been shown to increase inpatient length of stay. This often leads to incremental inpatient costs of care directly or through its complications. This study aimed at gathering unit costs related to dysphagia for stroke patients. Methods: A combined literature and expert-based costing study was carried out for the following dysphagia cost items: screening, severity staging, rehabilitation and pulmonary complications. These costs were primarily estimated based on medical fees and technical procedures billing US unit costs and charges according to Medicare perspective were estimated Results: Early bedside screening and basic Speech Language Pathologist (SLP) based clinical assessment ranged between USD and USD respectively. Instrumental severity staging by either Videofluoroscopy, or Fiberoptic Endoscopic Evaluation (with sensory testing or not) was estimated to USD 331. Swallowing disorder rehabilitative session mediated by an SLP is charged around USD94. Aspiration pneumonia secondary to dysphagia in stroke patients estimates ranged between USD Conclusion: This study demonstrated the potential economic benefits of any intervention aiming at reducing the risk of aspiration when considering the high costs of associated pneumonia. Disclosure of Interest: C. Takizawa Other: Nestle Employee, R. Marty Consultant of: Nestle, S. Roze Consultant of: Nestle Keywords: Cost, Dysphagia 20

21 Synergy in Motion: Combining nutrition and exercise for optimal physical function ESPEN ABSTRACT SUBMISSION EXPERTS OPINIONS OF PRACTICES IN DYSPHAGIA SCREENING & MANAGEMENT AMONG POSTSTROKE PATIENTS NEED FOR A PROTOCOL Authors: C. Takizawa 1,*, K. Altman 2, L. Derex 3, R. Martino 4, R. Speyer 5 1 Nestle Health Science, Vevey, Switzerland, 2 Mount Sinai School of medicine, New York, United States, 3 Hopital Neurologique de Lyon, Lyon, France, 4 University of Toronto, Toronto, Canada, 5 HAN University of Applied Sciences, Nijmegen, Netherlands Rationale: Dysphagia is common health condition associated with stroke. However no clear picture of dysphagia screening and management appears in the literature. This study aims at understanding dysphagia management usual practices in 4 different countries, to identify commonalities and gaps and to begin to work toward an international clinical protocol for dysphagia among post-stroke patients. Methods: A focus group was conducted with two medical doctors and two Speech-Language Pathologists (SLP), from the USA, France, Canada and The Netherlands respectively, to share their opinion about dysphagia management among poststroke patients. Based on literature search and their practice, we designed the commonalities and differences between these four countries. Results: North American & European guidelines recommend screening for dysphagia after a stroke, but no guidelines exist regarding which test to use. There is consensus on the screening and diagnostic pathway: with nurses administering screening, a full clinical assessment performed by SLPs is required in cases with a positive screen, instrumental evaluation (VFS or FEES) is required only if the clinical assessment result is unclear, otherwise patients go directly on to intervention. In contrast, there is variation between countries regarding the clinician who conducts the instrumental evaluation and which behavioral strategies are the common treatment base. Conclusion: This study reflects usual dysphagia management practices with in-patients in teaching hospitals across four countries. Further assessments of practices in other countries would help understanding and raising the importance of a common dysphagia management protocol. Disclosure of Interest: C. Takizawa Other: Nestle employee, K. Altman Consultant of: consultant for Nestle, L. Derex Consultant of: consultant for Nestle, R. Martino Consultant of: Consultant for Nestle, R. Speyer Consultant of: Consultant for Nestle Keywords: Dysphagia, Protocol 21

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