Adequate nutrition is a cornerstone of healthy ageing, yet malnutrition is an escalating concern among older adults in sub-Saharan Africa (SSA). Despite its impact on independence and chronic disease risk, empirical syntheses of the relationship between nutritional status and physical function in this region remain scarce. To systematically review the prevalence of malnutrition among older adults in sub-Saharan Africa and its relationship with physical function. A systematic search was conducted across five electronic databases for peer-reviewed studies published in English between 2000 and 2025. Study selection, data extraction, and quality assessment were performed independently by two reviewers. The review targeted studies that assessed nutritional status (e.g., body mass index, Mini Nutritional Assessment) and physical function (e.g., activities of daily living, handgrip strength) in SSA populations aged 60+. Narrative synthesis was used to synthesise and report data outcomes. Fifteen studies met the inclusion criteria. The prevalence of undernutrition (malnutrition) varied widely, ranging from 1.7

The importance of vitamin D is well established for bone health and there is some evidence that inadequate/deficient vitamin D status is associated with reduced skeletal muscle strength and physical function in older adults. Most of this evidence for the muscular effect has come from white population groups and the evidence base is sparse for other ethnic groups. This study investigates the relationship between vitamin D status, muscle strength and function in UK South Asian women aged ≥ 60 years. This cross-sectional study included 120 community-dwelling Indian and Pakistani women, aged ≥ 60 years living in the North of England. Circulating blood 25(OH)D concentration was assessed by HPLC–MS using finger prick blood samples; functional capacity was assessed using handgrip strength, single and repeated chair stands, timed up and go, and balance test. Regression analysis was used to analyse the relationships between vitamin D status and muscle strength and function. The median (IQR) age of the women was 66 (64–73) years. Forty-seven percent of the women were vitamin D inadequate/deficient. Around forty-one percent of the women reported taking a daily vitamin D supplement, 86

Supplementary Table 1 shows the list of SNPs that were analysed by the Fluidigm assay.

The aim of this study was to explore the associations between diet quality, socio-demographic measures, smoking, and weight status in a large, cross-sectional cohort of adults living in Yorkshire and Humber, UK. Data from 43, 023 participants aged over 16 years in the Yorkshire Health Survey, 2nd wave (2013-2015) were collected on diet quality, socio-demographic measures, smoking, and weight status. Diet quality was assessed using a brief, validated tool. Associations between these variables were assessed using multiple regression methods. Split-sample cross-validation was utilised to establish model portability. Observed patterns in the sample showed that the greatest substantive differences in diet quality were between females and males (3.94 points; P < 0.001) and non-smokers vs smokers (4.24 points; P < 0.001), with higher diet quality scores observed in females and non-smokers. Deprivation, employment status, age, and weight status categories were also associated with diet quality. Greater diet quality scores were observed in those with lower levels of deprivation, those engaged in sedentary occupations, older people, and those in a healthy weight category. Cross-validation procedures revealed that the model exhibited good transferability properties. Inequalities in patterns of diet quality in the cohort were consistent with those indicated by the findings of other observational studies. The findings indicate population subgroups that are at higher risk of dietary-related ill health due to poor quality diet and provide evidence for the design of targeted national policy and interventions to prevent dietary-related ill health in these groups. The findings support further research exploring inequalities in diet quality in the population.

BACKGROUND:The seAFOod randomized controlled trial tested colorectal polyp prevention by the omega-3 (ω-3) highly unsaturated fatty acid (HUFA) eicosapentaenoic acid (EPA) and aspirin. Variable dietary intake of omega-3 HUFAs (also including docosahexaenoic acid [DHA]) and differential EPA capsule compliance could confound analysis of trial outcomes. OBJECTIVE:The objective of this study was to investigate the relationship between total (diet and capsule) daily omega-3 HUFA intake, red blood cell (RBC), and rectal mucosa omega-3 HUFA concentrations, and colorectal polyp outcomes in a secondary analysis of the seAFOod trial. METHODS:Individual-participant dietary omega-3 HUFA intake (mg/d) was derived from food frequency questionnaires using the European Prospective Investigation into Cancer and Nutrition-Norfolk fatty acid nutrient database. Capsule EPA intake (mg/d) was adjusted for compliance (capsule counting). Fatty acids were analyzed by liquid chromatography-tandem mass spectrometry (as % of total fatty acids). HUFA oxidation was measured using the HUFA/saturated fatty acid (SAT) ratio. The colorectal polyp detection rate (PDR; % with ≥1 polyps) and polyp number per participant were analyzed according to the change in RBC EPA concentrations during the trial (ΔEPA), irrespective of treatment allocation. RESULTS:There was a small degree of HUFA degradation over time in RBC samples stored at > -80oC at research sites (r = -0.36, P<0.001 for HUFA/SAT ratio over time), which did not affect analysis of omega-3 HUFA concentrations. Low baseline EPA concentration, as well as allocation to EPA and % compliance, were associated with a high ΔEPA. Individuals with a ΔEPA value >+0.5% points (ΔEPAhigh), irrespective of allocation to EPA or placebo, had a lower PDR than ΔEPAlow individuals (odds ratio: 0.63; 95% confidence interval [CI]: 0.40, 1.01) and reduced colorectal polyp number (incidence rate ratio: 0.74; 95% CI: 0.54, 1.02). CONCLUSIONS:Analysis of the seAFOod trial according to the change in EPA concentration, instead of treatment allocation, revealed a protective effect of EPA treatment on colorectal polyp recurrence (ISRCTN05926847).

BackgroundThe use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals’ and patients’ preferences. ObjectiveThis study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. MethodsThis mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. ResultsMost participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app’s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). ConclusionsThe app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia.

IntroductionWe examined the relationship between Apolipoprotein E (APOE) genotype and n-3 highly unsaturated fatty acid (HUFA) levels in participants of the seAFOod trial, who were undergoing colonoscopy surveillance after removal of colorectal polyps.MethodsBaseline and on-treatment (eicosapentaenoic acid [EPA] 2 g daily or placebo for 6 months) levels of n-3 HUFAs, and plasma 18-hydroxyeicosapentaenoic acid (HEPE), were analysed according to APOE genotype (based on polymorphisms rs429358 and rs7412) in 584 participants.ResultsBefore treatment, APOE2/2 individuals had lower levels, and APOE4/4 participants had higher levels, of n-3 HUFAs, including EPA, than APOE3/3 counterparts (P < 0.01 for the APOE2/2 versus APOE4/4 comparison). After EPA supplementation, n-3 HUFA levels were not significantly different when stratified by APOE genotype, although APOE4 carriers displayed lower plasma 18-HEPE levels than individuals without an APOE4 allele (P = 0.002).ConclusionsAPOE genotype is associated with differential n-3 HUFA and 18-HEPE levels in individuals with multiple colorectal polyps.

Background: When commencing enteral feeding, patients and families will want to know the likelihood of returning to an oral diet. There is a paucity of data on the prognosis of patients with gastrostomies. We describe a large dataset of patients, which identifies factors influencing gastrostomy removal and assesses the likelihood of the patient having at home enteral nutrition. Methods: Retrospective data was collected on patients from Sheffield Teaching Hospitals who had received a gastrostomy and had outpatient enteral feeding between January 2016 and December 2019. Demographic data, indication and outcomes were analysed. Results: A total of 451 patients were assessed, median age: 67.7. 183/451(40.6%) gastrostomies were for head and neck cancer, 88/451 (19.5%) for stroke, 28/451 (6.2%) for Motor Neuron Disease, 32/451 (7.1%) for other neurodegenerative causes, 120/451 (26.6%) other. Of the 31.2% who had their gastrostomy removed within 3 years, head and neck cancer was the most common indication (58.3%) followed by stroke (10.2%), Motor Neuron Disease (7.1%) and other neurodegenerative diseases (3.1%). Gastrostomy removal was significantly influenced by age, place of residence, and having head and neck cancer (p < 0.05). There was the greatest likelihood of removal within the first year (24%). 70.5% had enteral feeding at home. Conclusion: This large cohort study demonstrates 31.2% of patients had their gastrostomy removed within 3 years. Head and neck cancer patients, younger age and residing at home can help positively predict removal. Most patients manage their feeding at home rather than a nursing home. This study provides new information on gastrostomy outcomes when counselling patients to provide realistic expectations.

BACKGROUND:The seAFOod polyp prevention trial was a randomised, placebo-controlled, 2 × 2 factorial trial of aspirin 300 mg and eicosapentaenoic acid (EPA) 2000 mg daily in individuals who had a screening colonoscopy in the English Bowel Cancer Screening Programme (BCSP). Aspirin treatment was associated with a 20% reduction in colorectal polyp number at BCSP surveillance colonoscopy 12 months later. It is unclear what happens to colorectal polyp risk after short-term aspirin use.AIM:To investigate colorectal polyp risk according to the original trial treatment allocation, up to 6 years after trial participation.METHODS:All seAFOod trial participants were scheduled for further BCSP surveillance and provided informed consent for the collection of colonoscopy outcomes. We linked BCSP colonoscopy data to trial outcomes data.RESULTS:In total, 507 individuals underwent one or more colonoscopies after trial participation. Individuals grouped by treatment allocation were well matched for clinical characteristics, follow-up duration and number of surveillance colonoscopies. The polyp detection rate (PDR; the number of individuals who had ≥1 colorectal polyp detected) after randomization to placebo aspirin was 71.1%. The PDR was 80.1% for individuals who had received aspirin (odds ratio [OR] 1.13 [95% confidence interval 1.02, 1.24]; p = 0.02). There was no difference in colorectal polyp outcomes between individuals who had been allocated to EPA compared with its placebo (OR for PDR 1.00 [0.91, 1.10]; p = 0.92).CONCLUSION:Individuals who received aspirin in the seAFOod trial demonstrated increased colorectal polyp risk during post-trial surveillance. Rebound elevated neoplastic risk after short-term aspirin use has important implications for aspirin cessation driven by age-related bleeding risk. ISRCTN05926847.

Introduction UK endoscopy training faces challenges from increasing service pressure and changes to specialty training curricula.1 Endoscopy training academies are a potential solution and in the North East and North Cumbria, a multicentre immersion training model was established in September 2022. Novice gastroscopy trainees will attend a 4-week block of 20 dedicated training lists at one of four immersion centres, in addition to regular training at base hospital site. Methods The JETS eportfolio KPI and DOPS data of novice gastroscopy trainees were compared between 3 historical trainees receiving weekly dedicated training lists (DTLs) plus other ad hoc training, and 4 trainees undergoing an immersion block in the first 20 weeks of gastroscopy training plus typical weekly DTLs and other ad hoc. For each trainee, five 4-weekly PDF summaries were taken from their eportfolios from the start of their endoscopy training to give a summary of their KPIs over 20 weeks. The 4-week period was chosen to allow for immersion block effect. Results Higher procedure volumes were seen in the immersion group (table 1) and this was associated with shorter time to achieve minimum D2 intubation and unassisted procedure rates. DOPS competence for independent practice was similar at each interval for both groups. Conclusion Early immersion training can lead to earlier acquisition of minimum KPI requirements for certification, compared to historical controls. Similar rates of DOPS assessed competence aligns with previous studies indicating that procedure competence should incorporate ENTS and pathology recognition.2 This was a small sample but indicates the potential of this model accelerate skill acquisition and reduce time to certification. Further work is required to expand this intervention to surgical and clinical endoscopists and incorporate ENTS and pathology recognition into the programme. References FitzPatrick M, et al. How can gastroenterology training thrive in a post-COVID world? Frontline Gastroenterology 2020;0:1–4. doi:10.1136/flgastro-2020-101601 Ward ST, Hancox A, Mohammed MA, et al. The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database. Gut 2017;66:1022–1030.

IntroductionThere are limited studies comparing the safety and effectiveness of Radiologically Assisted Gastrostomies (RAGs) against Percutaneous Endoscopic Gastrostomies (PEGs). The Sheffield Gastrostomy Score (SGS) can be used to help predict 30-day mortality, more information is needed on its validity in RAGs. Our aim is to compare mortality between RAGs (Radiologically Inserted Gastrostomies (RIGs) and Per-oral Image Guided Gastrostomies (PIGs)) with PEGs and validate the SGS.MethodData on gastrostomies newly inserted in three hospitals from 2016-2019 were retrospectively collected. Demographics, indication, insertion date, date of death, inpatient status and blood tests (albumin, CRP and eGFR) were recorded.Results1977 gastrostomies were performed: Gastrostomy mortality at 7 days was 1.3% and at 30 days was 6%. There was a 5% 30-day mortality for PEGs, 5.5% RIGs, 7.2% PIGs (p = 0.215). Factors increasing 30 day mortality were age & GE;60 years (p = 0.039), albumin <35 g/L (p = 0.005), albumin <25 g/L (p < 0.001) and CRP & GE;10 mg/L (p < 0.001). For patients who died within 30 days; 0.6% had an SGS of 0, 3.7% = 1, 10.2% = 2 and 25.5% = 3, with similar trends for RAGs and PEGs. ROC curves showed the area under the curve for all gastrostomies, RAGs and PEGs as 0.743, 0.738, 0.787 respectively.DiscussionThere was no significant difference between 30-day mortality for PEGs, RIGs and PIGs. Factors predicting risk include age & GE;60 years, albumin <35 g/L, albumin <25 g/L and CRP & GE;10 mg/L. The SGS has been validated in this study for PEGs and for the first time in RAGs as well..

Clinical characteristics of the study cohort of 542 seAFOod trial participants who had a SNP genotype profile and trial colonoscopy outcome data.

Abstract Aspirin and eicosapentaenoic acid (EPA) reduce colorectal adenomatous polyp risk and affect synthesis of oxylipins including prostaglandin E2. We investigated whether 35 SNPs in oxylipin metabolism genes such as cyclooxygenase (PTGS) and lipoxygenase (ALOX), as well as 7 SNPs already associated with colorectal cancer risk reduction by aspirin (e.g., TP53; rs104522), modified the effects of aspirin and EPA on colorectal polyp recurrence in the randomized 2 × 2 factorial seAFOod trial. Treatment effects were reported as the incidence rate ratio (IRR) and 95% confidence interval (CI) by stratifying negative binomial and Poisson regression analyses of colorectal polyp risk on SNP genotype. Statistical significance was reported with adjustment for the false discovery rate as the P and q value. 542 (of 707) trial participants had both genotype and colonoscopy outcome data. Reduction in colorectal polyp risk in aspirin users compared with nonaspirin users was restricted to rs4837960 (PTGS1) common homozygotes [IRR, 0.69; 95% confidence interval (CI), 0.53–0.90); q = 0.06], rs2745557 (PTGS2) compound heterozygote-rare homozygotes [IRR, 0.60 (0.41–0.88); q = 0.06], rs7090328 (ALOX5) rare homozygotes [IRR 0.27 (0.11–0.64); q = 0.05], rs2073438 (ALOX12) common homozygotes [IRR, 0.57 (0.41–0.80); q = 0.05], and rs104522 (TP53) rare homozygotes [IRR, 0.37 (0.17–0.79); q = 0.06]. No modification of colorectal polyp risk in EPA users was observed. In conclusion, genetic variants relevant to the proposed mechanism of action on oxylipins are associated with differential colorectal polyp risk reduction by aspirin in individuals who develop multiple colorectal polyps. SNP genotypes should be considered during development of personalized, predictive models of colorectal cancer chemoprevention by aspirin. Prevention Relevance: Single-nucleotide polymorphisms in genes controlling lipid mediator signaling may modify the colorectal polyp prevention activity of aspirin. Further investigation is required to determine whether testing for genetic variants can be used to target cancer chemoprevention by aspirin to those who will benefit most.

seAFOod trial participants and samples contributing to the gene × treatment interaction analysis. 666 of 707 seAFOod trial participants provided at least one buffy coat sample for DNA extraction. The number of samples lost during either DNA extraction or SNP genotyping is described at each stage. The final study population consisted of 542 participants for whom SNP genotype and trial exit colonoscopy data were available. EPA, eicosapentaenoic acid; SNP, single-nucleotide polymorphism.

Urinary prostaglandin (PG) E metabolite (PGE-M) and 11-dehydro (d)-thromboxane (TX) B2 are biomarkers of cyclooxygenase-dependent prostanoid synthesis. We investigated (1) the effect of aspirin 300 mg daily and eicosapentaenoic acid (EPA) 2000 mg daily, alone and in combination, on urinary biomarker levels and, (2) whether urinary biomarker levels predicted colorectal polyp risk, during participation in the seAFOod polyp prevention trial. Urinary PGE-M and 11-d-TXB2 were measured by liquid chromatography-tandem mass spectrometry. The relationship between urinary biomarker levels and colorectal polyp outcomes was investigated using negative binomial (polyp number) and logistic (% with one or more polyps) regression models. Despite wide temporal variability in PGE-M and 11-d-TXB2 levels within individuals, both aspirin and, to a lesser extent, EPA decreased levels of both biomarkers (74% [P ≤ .001] and 8% [P ≤ .05] reduction in median 11-d-TXB2 values, respectively). In the placebo group, a high (quartile [Q] 2-4) baseline 11-d-TXB2 level predicted increased polyp number (incidence rate ratio [IRR] [95% CI] 2.26 [1.11,4.58]) and risk (odds ratio [95% CI] 3.56 [1.09,11.63]). A low (Q1) on-treatment 11-d-TXB2 level predicted reduced colorectal polyp number compared to placebo (IRR 0.34 [0.12,0.93] for combination aspirin and EPA treatment) compared to high on-treatment 11-d-TXB2 values (0.61 [0.34,1.11]). Aspirin and EPA both inhibit PGE-M and 11-d-TXB2 synthesis in keeping with shared in vivo cyclooxygenase inhibition. Colorectal polyp risk and treatment response prediction by 11-d-TXB2 is consistent with a role for platelet activation during early colorectal carcinogenesis. The use of urinary 11-d-TXB2 measurement for a precision approach to colorectal cancer risk prediction and chemoprevention requires prospective evaluation.

Background Significant morbidity and mortality can be associated with gastrostomy insertion, likely influenced by patient selection, indication and aftercare. We aimed to establish what current variation in practice exists and how this has improved by comparison to our previously published British Society of Gastroenterology survey of 2010. Methods We approached all National Health Service (NHS) hospitals in England (n=198). Email and web-based questionnaires were circulated. These data were correlated with the National Endoscopy Database (NED). Results The response rate was 69% (n=136/198). Estimated Percutaneous Endoscopic Gastrostomy (PEG) placements in the UK are currently 6500 vs 17000 in 2010 (p<0.01). There is a dedicated PEG consultant involved in 59% of the centres versus 30% in 2010 (p<0.001). Multidisciplinary team meeting (MDT) discussion occurs in 66% versus 40% in 2010 (p<0.05). Formal aftercare provision occurs in 83% versus 64% in 2010 (p<0.001). 74/107 respondents (69%) reported feeling pressurised to authorise a gastrostomy. Conclusion This national survey, validated by the results from NED, demonstrates a reduction of over 60% for PEG insertion rates compared with previous estimates. There has also been an increase in consultant involvement, MDT discussion and aftercare provision. However, two-third of responders described 'pressure' to insert a gastrostomy. Perhaps further efforts are needed to include and educate other specialty teams, patients and next of kin.

Introduction Within the NHS, the delivery of flexible roles, including less than full time (LTFT) working, is important for recruiting and retaining staff for the provision of clinical services.1 The BSG has issued a position statement recommending flexible and LTFT working where practicable.2 We aimed to determine the proportion of UK endoscopy trainers who worked flexibly or LTFT and explore their provision of training. Methods An online survey was sent to endoscopy trainers registered on JETS eportfolio via email. Trainers were asked to record their professional role and if they worked flexibly/LTFT. They were asked if they provided regular Dedicated Training Lists (DTL) or Adhoc (ATL) endoscopy training lists, had completed endoscopy trainer courses (Train the Trainer or TTT). They were asked if they had access to trainer development opportunities and if they completed DOTS using a 5-point Likert scale (Always, Often, Sometimes, Rarely, Never) Results In total, 1024 responses were received from a total of 3292 trainers registered on JETS. 159 trainers (15%) reported they worked flexibly/LTFT. of these 159 trainers 32% were clinical endoscopists, 40% were gastro consultants and 14% were surgeons. A full breakdown of training list provision and training course participation is provided in table 1. In terms of appraisal, 40% of LTFT/flexible trainers had their DOTS and LETS reviewed, compared to 37% of full timers. and 25% of LTFT/flexible trainers and 23% of full timers were 'Always' encouraged to access trainer development opportunities. Conclusion Flexible/LTFT trainers report strikingly similar frequency of registered endoscopy training provision in their job plan as well as delivering similar regular DTL and ATL per week compared to their full time colleagues. TTT completion, acting as faculty and appraisals were equivalent to full timers. This suggests that despite working potentially fewer clinical sessions, there is no self-reported reduction in training provision and, in fact, higher participation in regional training courses. References https://www.england.nhs.uk/wp-content/uploads/2022/02/B0395-flexible-working-raising-the-standards-for-the-NHS.pdf. Accessed 17 January 2023 https://www.bsg.org.uk/workforce-reports/british-society-of-gastroenterology-position-statement-on-flexible-working/. Accessed 17 January 2023

SNP genotypes in PTGS genes that are associated with modification of the effect of aspirin on colorectal polyp number in the seAFOod polyp prevention trial.

Introduction There are a limited number of studies comparing the safety and effectiveness of Radiologically Assisted Gastrostomies (RAGs) against Percutaneous Endoscopic Gastrostomies (PEGs). The Sheffield Gastrostomy Score (SGS) can be used to help predict 30-day mortality and guide clinicians when consenting patients, this was however developed using data from patients undergoing PEGs and more information is needed on its validity in RAGs. We collected information on both PEGs and RAGs performed for all indications across 3 teaching hospitals: Sheffield, Leeds and Hull. The aim is to compare mortality between RAGs and PEGs, as well as further validate the SGS. Method Data on all gastrostomies newly inserted in 3 teaching hospitals over a 4-year period (2016–2019) were retrospectively collected. Demographics, indication, date of insertion, date of death, inpatient status and blood tests including albumin, C-reactive protein (CRP) and eGFR within the last 30 days were recorded. Data was analysed with chi-squared test, multivariant analysis and Receiver Operating Characteristic (ROC) curves. Results 1988 new gastrostomies were performed, 76.2% RAGs, 23.8% PEGs. Median age 65. 51.6% were requested as an inpatient, 44.8% for RAGs, 73.4% for PEGs. Overall gastrostomy mortality at 7 days was 1.3%, 30 days 6.1%, 6 months 24% and 1 year 34.9%. There was a 6.5% 30-day mortality for RAGs and 5.1% for PEGs (P = 0.264). Factors that increased gastrostomy 30-day mortality on analysis of variance were age ≥60 (p = 0.038), albumin <35 (p = 0.006), albumin <25 (p <0.001) and CRP >10 (p < 0.001). 0.6% of patients that died within 30 days of a gastrostomy had a SGS of 0, 4.1% had a score of 1, 10.2% had a score of 2 and 25.5% had a score of 3, there were similar trends for both RAGs and PEGs. ROC curves for the SGS showed the area under the curve is similar for all gastrostomies, RAGs and PEGs: 0.736, 0.731, 0.787 respectively. Discussion This large multicentre study showed no significant difference between 30-day mortality for RAGs vs PEGs. Factors that help predict those at risk of death within 30-days include age ≥60, albumin < 35, albumin < 25 and CRP > 10. We have been able to validate the SGS in this study and for the first time in RAGs as well. The SGS may over predict 30-day mortality and adding in CRP to the formula could potentially improve the validity of the current scoring system.