OP15 Cyclic exclusive enteral nutrition to maintain longterm drug-free remission in Paediatric Crohn’s Disease: The CD HOPE study of the GETAID pédiatrique

Background To address the question if pediatric CD patients responding to nutritional induction therapy can be maintained in remission on dietary therapy without the use of immunosuppressive drugs, we designed a prospective randomized trial (CD-HOPE) comparing cyclic exclusive enteral nutrition (EEN) to daily supplement over a 12 month period. Methods CD patients (6–17 years) who successfully completed at least 6 weeks of EEN with clinical remission (wPCDAI ≤12.5) were recruited in 21 sites of the French GETAID pédiatrique between 12.2014 and 09.2018. All drug therapy had to be stopped at least 4 weeks prior to inclusion. A total of 112 patients were screened with 100 patients randomized to group A cyclic EEN (100% of caloric requirement) every 8 weeks for 2 weeks or group B daily supplementary nutrition (25% of caloric requirement). Patient stratification according to age (< 10 years or older) and previous drug exposure or not. EEN and the nutritional supplement were in form of MODULEN IBD®. Except for the two weeks of EEN in group A food access was not restricted. Primary objective was the comparison of relapse rates at 12 months (defined as a wPCDAI >12.5 at two consecutive visits) between the two groups (log-rank test per protocol). Additional analyses were performed using a multivariate regression analysis and cox model. Results 49 CD patients were randomized to group A (cyclic EEN) and 51 to group B (daily supplement) with 43/49 and 44/51 newly diagnosed patients without any previous drug exposure. Baseline characteristics were comparable between the two groups. Median age was 12 and 13 years, group A and B respectively. At the final 12 months visits a total of 25/49 patients (group A) remained in remission without disease activation compared to 12/51 patients (group B) (p=0.004) with a hazard ratio of 0.48 (0.29–0.80) (p= 0.0051). Kaplan Maier survival remission rates are shown in figure 1. Mean fecal calprotectine levels showed no significant difference between the two groups (297, 399 and 469 at month 0, 3, and 12 visits in group A and 480, 606, and 283 at month 0,3, and 12 visits in group B). Mucosal healing at M12 months was achieved in 25/49 patients (group A) and 18/51 patients (group B), with a mucosal healing rate of 52% (group A) and 33% (group B). Both treatment arms showed a significant catch-up growth. Conclusion This is first trial indicating that children/adolescents with CD responding to EEN as induction therapy can be maintained on remission with a nutritional therapy without immunosuppressors/biologics. However, daily nutritional supplement with normal access to food was not successful with a relapse rate of 76%. This study was supported by an unrestricted grant from Nestlé Health Science and sponsored by APHP.

Abstract 13582: The Effect of Time-restricted Feeding on Weight: A Randomized Feeding Trial

Introduction: Time-restricted feeding (TRF) may improve cardiometabolic outcomes. Prior studies of TRF in humans were limited by lack of randomization and controlled feeding, inadequate sample size and short duration. Hypothesis: Participants following a TRF pattern will lose more weight at 12 weeks than those following a Usual Feeding Pattern (UFP). Methods: We randomized 41 adults with BMI 30-49.9 kg/m 2 and HbA1c 5.7-6.9% to either TRF (80% of total calories before 1 pm) or a UFP (50% of calories after 5 pm) for 12 weeks. Dietary caloric requirement for weight maintenance was determined at baseline for each participant and held constant during the intervention. Participants in both arms consumed the same diet with the same nutrient and food content and only consumed food prepared by the study metabolic kitchen. The primary outcome was weight. Weight and office blood pressure were measured at baseline and 4, 8, and 12 weeks and were analyzed using a linear mixed effects model with an unstructured covariance with indicators for visit and intervention interacted with visit. Results: All participants completed the study (TRF, n=21; UFP, n=20). Demographics were similar across arms; mean age was 59 years, and over 90% of participants were female and were black. Baseline weight and systolic BP were higher in the UFP than TRF arm (Table). Weight and blood pressure decreased in both arms during the study, but these decreases did not differ by arm. Conclusions: In this controlled feeding study, TRF did not reduce weight and blood pressure compared to UFP.

Management of dietary services at National Institute of Cancer Research and Hospital (NICRH), Bangladesh

Patient meals are an integral part of hospital treatment and crucial to aid recovery. A cross-sectional study was conducted to determine the Management of Dietary Services at National Institute of Cancer Research and Hospital. The purpose of this study was to make provision for safe, clean, hygienic and nutritious diet for the indoor patient as per their caloric requirement. This study compiled from 1st January to 31st December 2017 and the sample size was 113(dietary personnel 9 and patients 104) and it was purposive sampling technique. Data were collected through semi-structured questionnaire and observational check-list. Data analysis was done using SPSS software version 20. Satisfaction level was categories in to Satisfied and Dissatisfied. Among the service receiver of this hospital 15.4% were found satisfied with the dietary services. Cleanliness status of kitchen was average. It was highly suggested that the higher number of trained manpower needs to be appointed in future as required. Moreover, a standardize cooking system should be adopted by the authority for improving the quality of cooking food in order to obtain increased patient’s satisfaction. Asian J. Med. Biol. Res. September 2020, 6(3): 548-554

The Shelf Life and Recommended Dietary Allowances (RDA) Analysis of Cassava (Manihot esculenta Crantz) Flakes Enriched with Bean Flour (Phaseolus vulgaris L.)

Food processing in commercial industry generally aims to extend shelf life, change or increase products’ characteristics (color, flavor, texture), ease treatment and distribution, increase economic value, and maintain or improve quality, particularly nutritional quality, digestibility, and nutritional value. The objective of this research is to determine the shelf life of products made from cassava flour which is fortified by red bean flour, and to understand whether there is a decrease in nutritional value during the storage period, as well as to calculate the Recommended Dietary Allowances (RDA). The Recommended Dietary Allowances of Cassava Flakes with Red Bean Flour for breakfast has a very important function. For instance, children who are in school need plenty of energy to start their activities and stay focused at school. Breakfast food needs to fulfill the 20-25% of the RDA for children, who need a total of 2,000 kilo calories per day. An alternative option for breakfast is nutritious flakes that can be consumed with a quick preparation time. The method to determine the shelf life is carried out using the Accelerated Self Life Testing (ASLT) and critical water activity methods, whereas to determine the proximate nutritional value we used the gravimetric method to determine the ash content and water content. In addition, we used the Kjehdahl method to determine the protein content, the sokhlet method for the fat content, and by difference method for the carbohydrate content. The result obtained for the nutritional value throughout the storage period is that the nutritional value of the flakes decreased after being stored for 10 weeks. The result of determining the shelf life using a critical water activity method is 307.5 days of storage. RDA or the Recommended Dietary Allowance is the percentage of the amount of a nutrient contained in the food consumed based on the daily needs of the healthy person. Generally this daily requirement is based on daily caloric requirement of 2000 kcal, but some also use base 2500 kcal. RDA's guidance in Indonesia can follow the guidance given by POM RI based on Decree of the Head of POM RI No. HK.00.05.52.6291 on Food Label Nutritional Reference.

Nutritional therapy and caloric achievement within the first week of PICU admission

Background Nutritional therapy is an important aspect in managing PICU patients. Careful decisions should be made regarding initiation, route of administration, and achievement based on caloric requirements. Many conditions could affect the application of nutritional therapy.Objective To investigate the implementation of nutritional therapy during the 1st week after PICU admission.Methods We conducted a retrospective study involving 156 children aged 1 month-18 years who were hospitalized for at least 4 days in the PICU during the period of January 1st, 2015 to December 31st, 2015. Subjects were divided into three groups according to initiation time of caloric administration, which were: category I (within the first 24 hours of PICU admission), category II (within the first 25-48 hours of PICU admission), and category III: (more than 48 hours after PICU admission). Caloric requirement was calculated using the Caldwell or Schofield formula, whilst caloric achievement was figured up from PICU daily monitoring sheets containing nutritional therapy given to the subjects.Results Of 131 subjects, 72 (55%) had good nutritional status and 59 (45%) children had malnutrition. Caloric administration was initiated within 24 hours of admission in 101 (77.1%) patients, of whom 90 (89.1%) patients received enteral feeding. Nineteen (14.5%) patients received their initial calories within 25-48 hours of admission, with 16 (84.2%) using the enteral route. At the 4th and 7th days of hospitalization, 93 (71%) and 107 (81.7%) patients achieved >70% of their caloric requirements. Delays in feeding initiation were due to shock, gastrointestinal bleeding, inotropic support, and feeding intolerance, which reduced caloric achievement.Conclusion Most patients receive nutritional therapy in the first 48 hours after PICU admission and achieve >70% of their caloric requirements at the 4th day of hospitalization. The enteral route is preferred. Delayed initiation of nutritional therapy reduce caloric achievement.

Nutritional therapy and caloric achievement within the first week of PICU admission

Background Nutritional therapy is an important aspect in managing PICU patients. Careful decisions should be made regarding initiation, route of administration, and achievement based on caloric requirements. Many conditions could affect the application of nutritional therapy.Objective To investigate the implementation of nutritional therapy during the 1st week after PICU admission.Methods We conducted a retrospective study involving 156 children aged 1 month-18 years who were hospitalized for at least 4 days in the PICU during the period of January 1st, 2015 to December 31st, 2015. Subjects were divided into three groups according to initiation time of caloric administration, which were: category I (within the first 24 hours of PICU admission), category II (within the first 25-48 hours of PICU admission), and category III: (more than 48 hours after PICU admission). Caloric requirement was calculated using the Caldwell or Schofield formula, whilst caloric achievement was figured up from PICU daily monitoring sheets containing nutritional therapy given to the subjects.Results Of 131 subjects, 72 (55%) had good nutritional status and 59 (45%) children had malnutrition. Caloric administration was initiated within 24 hours of admission in 101 (77.1%) patients, of whom 90 (89.1%) patients received enteral feeding. Nineteen (14.5%) patients received their initial calories within 25-48 hours of admission, with 16 (84.2%) using the enteral route. At the 4th and 7th days of hospitalization, 93 (71%) and 107 (81.7%) patients achieved >70% of their caloric requirements. Delays in feeding initiation were due to shock, gastrointestinal bleeding, inotropic support, and feeding intolerance, which reduced caloric achievement.Conclusion Most patients receive nutritional therapy in the first 48 hours after PICU admission and achieve >70% of their caloric requirements at the 4th day of hospitalization. The enteral route is preferred. Delayed initiation of nutritional therapy reduce caloric achievement.

Radiologic Percutaneous Gastrostomy and Other Enteral Feeding Tubes: A Practical Review

Gastrostomy tubes and other iterations of direct enteral feeding, such as gastrojejunostomy and jejunostomy tubes, offer a safe and effective means for continued nutrition for patients who cannot meet their minimum caloric requirement through oral intake alone. There are numerous methods for placement as well as options for types of tubes to be used. This review will briefly discuss the various options of tubes and techniques, as well as practical information regarding placement and common management issues.

Decision Support Systems to Selection of Diet Type Using Fuzzy Sugeno and Naïve Bayes Method

Sugeno Fuzzy algorithm is one of the algorithms contained on Fuzzy Inference System, that used to describe the condition between the two pieces of the decisions represented in the form of rules IF - THEN, where the output is constant or linear equations. While the Naive Bayes algorithm is an algorithm that uses data classification to a particular class based on the probability of each data class. Both of these algorithms can be implemented on a Decision Support System (DSS) for diet selection, using Fuzzy Sugeno as an additional determinant of energy and Naive Bayes method as decision maker. This is because the need for food intake and diet has become a problem for humans. To prevent excess intake of food it needs dietary adjustments or so-called diet. But in daily life, people sometimes hard to determine the type of diet that is suitable for them. So we need a system that can determine the type of diet that is suitable for a person. The data that used as a reference for decision support are age, daily caloric requirement, Body Mass Index (BMI), blood pressure, cholesterol, uric acid and blood sugar levels. Results of system testing showed from a sample of 30 data there are 26 appropriate data and 4 inappropriate data to determine the type of diet by the system with the success rate of 86.7%.