Rationale: Sarcopenia is recognised in patients with intestinal failure (IF) & has been associated with poorer survival in several chronic diseases. CT can measure sarcopenia through a L3 skeletal muscle index (LSMI). We aim to evaluate the prevalence of sarcopenia in our IF population using LSMI, & evaluate the effect of home parenteral support (HPN) on LSMI & survival.

Introduction Sarcopenia is recognised in patients with intestinal failure (IF) and has been associated with poorer survival in several chronic diseases. CT can measure sarcopenia through a L3 skeletal muscle index (LSMI). We aim to evaluate the prevalence of sarcopenia in our IF population using LSMI, and evaluate the effect of home parenteral support (HPN) on LSMI and survival. Additionally, we aim to assess any association between LSMI, BMI and other anthropometric measurements. Methods IF patients on HPN treated at St Mark’s Hospital between 1/1/2006–1/10/2016 were identified from a prospectively maintained database. Patients were included if they were on HPN and had 2 CTs: the first ≤30 days before start of HPN (pre-HPN); the second ≥100 days from HPN start (post-HPN). Patient records were reviewed to obtain clinical and demographic information and date of death. Anthropometric measurements and BMI contemporaneous to CT scans were recorded. Results 64 patients met inclusion criteria (M:F 1:1). 83% of our cohort had LSMI below previously published thresholds for sarcopenia. Mean pre-HPN LSMI was 36.5±6.8 cm2/m2. Mean BMI pre-HPN was 22.1±4.8 kg/m2. Both BMI (p<0.001) and LSMI (p=0.003) increased post-HPN. A positive correlation was seen between BMI and LSMI pre (p<0.001) and post-HPN (p=0.003). No correlation was seen between LSMI and anthropometric measurements pre-HPN (p=0.78) or post-HPN (p=0.96). 11 (17%) patients died during the study period; a low LSMI pre-HPN was not a risk factor for mortality (HR 0.97 p=0.55). Conclusions This study is the first to look at sarcopenia and survival using CT defined LSMI in the IF population. 83% of our cohort had a pre-HPN LSMI below previously published thresholds, yet we found no relationship between lower baseline LSMI and survival. This may reflect the heterogeneity of the prognoses of the IF population, or that parenteral nutrition itself affects survival. Our study showed that LSMI and BMI improved following HPN but demonstrated that other anthropometric measurements had poor correlation with LSMI and showed no significant improvement overall after HPN, confirming the known problems of inter-operator and patient variability of these measurements. Whilst we found significant correlation between LSMI and BMI, BMI significantly underestimated the presence and degree of sarcopenia. We have shown LSMI can provide an objective and reproducible measure of sarcopenia in IF. Future larger studies should be performed to evaluate associations with patient outcomes and utility in clinical decision making.

Introduction Colorectal cancer (CRC) is the 4thmost common cancer in the UK.1The prevalence of malnutrition in CRC ranges from 2–48% depending on the definition used and stage of cancer.2 Surgery is the primary treatment for CRC but may increase the risk of malnutrition by altering the metabolism of the patient.3 Malnutriton before gastrointestinal surgery is associated with worse outcome.4 Enhanced Recovery After Surgery (ERAS) aims to reduce the metabolic response to surgery promoting an earlier return to normal physiology.5The aim of this study was to examine the perioperative nutritional status of patients with CRC on an ERAS programme. Method A prospective observational design was used. A nutritional assessment was completed in clinic before and after surgery. This included weight, height, BMI, percentage weight loss, tricep skinfold thickness, mid-arm muscle circumference, hand grip strength, five times sit to stand test and the malnutrition universal screening tool (MUST). A preoperative micronutrient blood test was taken. Descriptive statistics, paired sample t-test, multiple and linear regression were performed. Ethical approval was obtained. Results Twenty-five patients were recruited. Table 1shows the prevalence of malnutrition before and after surgery. Fifty-six percent of patients had vitamin D deficiency or insufficiency and 32% were anaemic preoperatively. Preoperative zinc and selenium levels were normal in all patients. Significant reductions in weight (-3.7 kg, p = 0.001) BMI (-1.3 kg/m², p = 0.001), mid-arm circumference (-1.5 cm, p = 0.001), tricep skinfold thickness (-1.2 mm, p = 0.004) and mid-arm muscle circumference (-1 cm, p-0.001) were found post-operatively. No significant changes in hand grip or sit to stand test were found. Preoperative BMI (p = 0.024), tricep skinfold thickness (p = 0.004) and hand grip strength (p = 0.028) may predict length of hospital stay but limited by sample size. Conclusion Patients with CRC awaiting surgery are at risk of malnutrition, reduced functional capacity, vitamin D deficiency and anaemia. This study demonstrates patients on an ERAS programme experienced significant deteriorations in perioperative nutritional status. Preoperative nuritional assessment is able to identify patients at risk of malnutrition and may facilitate initiation of preoperative nutritional support. Disclosure of interest None Declared. References Cancer Research UK. Bowel Cancer 2014 [Online] Garth AK, et al.J Hum Nutr Diet 2010;23:393–401 Finnerty CC, et al.JPEN2013;37:21–29 Jean-Claude M, et al.Clin Nutr 2012;31:896–902 Rao PKD, Haray PN. Surgery2014;32:185–189

Introduction Vitamin D is essential due to its role in bone health and its immunomodulatory propeties.1 Patients with intestinal failure (IF) are at risk of Vitamin D deficiency due to inadequate absorption and lack of exposure to UVB light. Deficiency has been demonstrated in IF patients dependent on home parenteral nutrition.2 We aimed to determine the prevalence of vitamin D deficiency in hospital patients with IF and the efficacy of subsequent prescribed treatment. Methods All patients admitted to St Mark9s Hospital with IF over a 12-month period were included and data on demographics, serum total vitamin D concentration, IF aetiology and vitamin D supplementation prescribed were obtained. If deficiency was identified (≤50 nmol/l) the efficacy of treatment provided was assessed. Descriptive analysis and t-tests were performed. Results Eighty-four patients were included in the study (42 female, mean age 53±15 years, 92% Caucasian). The aetiology of IF included short bowel (n=30), fistula (n=34), small bowel obstruction (n=13), malabsorption (n=5) and others (n=2). Vitamin D was measured in 76% (n=64) of patients and 75% (n=48) were deficient (mean 41±25 nmol/l, range 9–126). Vitamin D concentrations were lower in men (33.4±15.3 nmol/l) compared to women (49.5±29.5 nmol/l) (p=0.009). No association was demonstrated with age, aetiology of IF, or ethnicity. There was a trend towards reduced Vitamin D and increasing BMI (p=0.187, r2=0.028). No seasonal variation was demonstrated between summer (June–November, 42.8±26.5 nmol/l) and winter (December–May, 39.3±21.6 nmol/l) (p=0.57). Only 26% (n=22) of patients had repeat vitamin D concentrations before discharge. There was a significant increase in vitamin D concentrations from 35±22 nmol/l to 44.8±14.3 nmol/l, (p=0.03). Twenty-nine patients received intramuscular Vitamin D at a dose of 300 000 IU. In these patients there was an increase in concentration before (28.4±13.6 nmol/l) and after (42.8±12.7 nmol/l). Due to the small numbers of patients it was not possible to determine the efficacy of the different vitamin D preparations or the effect of the multivitamin preparation used in parenteral nutrition (Cernevit®) on serum concentrations. Conclusion Vitamin D deficiency is common and occurs in three-quarters of IF patients. Male gender was associated with lower concentrations. Robust policies need to be in place for the identification of vitamin D deficiency including the supplementation and monitoring of vitamin D deficiency in patients with IF to ensure adequate serum concentrations are achieved. Competing interests None declared. References 1. Michal L, Melamed. 25-Hydroxyvitamin D levels and the risk of mortality in the general population Arch Intern Med 2008;168:1629. 2. Tee CT, et al. Hypovitaminosis D in patients on long-term parenteral nutrition. Proc Nut Soc 2010;69:E554.