Tijdens de vergaderingen van NESPEN wordt traditioneel een prijs uitgereikt voor het beste abstract. De abstracts worden allereerst volgens de gebruikelijke procedure van de NVGE door de reviewers bekeken. Daarna wordt van de abstracts die zijn ingestuurd voor NESPEN, door het bestuur een aparte score gemaakt die resulteert in de uitslag voor de prijs.
De NESPENprijs voor het beste abstract ingestuurd voor de najaarsvergadering 2009 is gegaan naar Mechteld Vermeulen uit het VUMC met de titel 'Arginine/ADMA is a predictor for cardiac output in septic shock patients'. De nieuwe voorzitter van NESPEN Dr. Geert Wanten, reikt haar na de abstractbijeenkomst de prijs uit.
Eerder uitgereikte prijzen:
Najaar 2008
Deze zal worden uitgereikt aan het best scorende abstract in de najaarsvergadering. Voedingsabstracts die worden ingezonden voor het voorjaarscongres zullen derhalve niet meedingen naar de prijs.
Voorjaar 2007
Tijdens het voorjaarcongres van 2007 honoreerde NESPEN het beste voedingsabstract met een prijs van € 500,--.
Deze prijs werd uitgereikt aan mevr. N. Wierdsma diëtist afdeling Maag-, Darm- en Leverziekten, VU medisch centrum Amsterdam, met het abstract: Faecal weight to diagnose malabsorption at the Intensive Care Unit. Het onderzoek is gedaan in samenwerking met A.A. van Bodegraven en R.J.M. Strack van Schijndel.
Een foto van de prijsuitreiking kunt u hier downloaden
Samenvatting van het onderzoek:
Nutrition support is pivotal in the treatment of intensive care (ICU) patients. Diarrhoea occurs frequently in enterally fed ICU-patients. Recently, we have demonstrated that malabsorption is a commonly occurring and so far under diagnosed problem, strongly contributing to a negative energy balance in one of three of ICU patients with loose stools. The purpose of this prospective and controlled study was to evaluate faecal weight as a diagnostic tool to distinguish between patients with and without malabsorption. The energetic value of 3 days collected faeces was determined by bomb calorimetry. The total amount of enteral nutrition provided, which was calculated to be the necessary and adequate enteral intake for the particular patient by means of energy expenditure (established once during study period by indirect calorimetry). Absorption capacity was defined as: total amount of energy enterally provided minus the fraction of energy found in the faecal material divided by the amount of energy that was enterally provided x 100%. Malabsorption was defined as an energetic absorption capacity of 85% or less, according to Southgate (Br J Nutr 1970; 24(2):517-535). Patients were classified as having loose stools (group 1) with >250 gram faeces per day and classified as having normal stool-production (group 2) if the faecal weight was <250 gram per day. A total of 27 stable, fully enterally fed ICU patients were supplied with a faeces collector and completed the study (13 female, 14 male), aged 33-90 years. Patients in group 1 (n=10) were comparable to patients in group 2 (n=17) for sex, age, length, weight, energy intake and APACHE II. The mean (± SD) faeces production was 156 (± 67) and 742 (± 965) gram per day, mean faecal energy loss was 125 and 436 kcal/d, and subsequent energy absorption capacity was 94 (± 5%) and 78 (± 15%) in group 1 and 2, respectively. There was a statistically significant correlation (Fischer exact, p=0.01) between less or more than 250 gram faeces per day and energy absorption capacity (Cramers’s V 0.71, p=0.01). Sensitivity and specificity amounted 94% and 78%, positive and negative predictive value were both 88%. In conclusion, a daily amount of faeces of 250 grams or more was a helpful clinical biomarker of intestinal malabsorption in ICU patients with a sensitivity and PPV approximating 90%). Recalculation and adaptation of nutritional needs are warranted in these patients.
Voorjaar 2006
NESPEN honoreerde het beste voedingsabstract van de inzendingen voor de voorjaarsvergadering van de NVGE in 2006 met € 500,--. De prijs werd uitgereikt aan twee onderzoekers aangezien beide een gelijke hoge score hadden. De winnaars zijn geworden:
1. M. v.d. Poll arts/onderzoeker, Academisch Ziekenhuis Maastricht, met het abstract: The clinical significance of plasma arginase-1 during liver surgery; effects of hepatocyte injury on arginase-1 release and plasma arginine levels in man.Het onderzoek is gedaan in samenwerking met S.J.P. Hanssen, M. Berbée, N.E.P. Deutz, W.A. Buurman, C.H.C. Dejong.
Abstract:
Low arginine (ARG) plasma levels are a common finding after major abdominal surgery. Since ARG is involved in nitric oxide synthesis, T- cell activation and collagen synthesis, ARG deficiency may compromise endothelial function, immune function, wound healing and hence postoperative recovery. The enzyme arginase-1, abundantly present in hepatocytes, catalyzes the conversion of ARG to ornithine (ORN) and urea. Hepatocyte injury leads to arginase-1 release, which may result in extracellular ARG breakdown. We recently showed that liver manipulation during surgery induces significant hepatocyte injury and now hypothesized that this leads to increased arginase-1 plasma levels and accelerated ARG breakdown. Sixteen patients undergoing partial hepatectomy were studied. Blood was sampled preoperatively and during liver manipulation. Arginase-1 plasma levels were measured by ELISA, ARG and ORN levels by HPLC. From 6 patients plasma and whole blood samples were incubated for 40 min at 37˚C to assess arginase activity in vitro. Changes in ARG and ORN plasma levels were measured and arginase activity was expressed as the amount of ORN formed per minute.
In line with our hypothesis, mean (SEM) arginase-1 plasma levels increased during liver manipulation from 17.8 (4.1) ng/ml (low
arginase) to 133 (30) ng/ml (high arginase), (p=0.002). However, plasma concentrations of ARG and ORN remained unchanged (p=0.3 and p=0.2 respectively). In accordance with these in vivo findings, no significant changes in ARG and ORN levels occurred when plasma samples with increased arginase-1 levels were incubated at 37˚C for 40 min (low
arginase: [ORN] +0.13 (0.09) µM/min (p=0.2 vs. zero); high arginase:
[ORN] +0.23 (0.20) µM/min (p=0.3 vs. zero)). When whole blood samples were incubated similarly, a significant decrease of ARG plasma levels with a stoichiometric increase of ORN levels was found (low arginase:
[ORN] +0.93 (0.19) µM/min (p=0.005 vs. zero); high arginase: [ORN]
+0.95 (0.34) µM/min (p=0.04 vs. zero)). These changes were independent
of arginase-1 plasma levels (p=0.9; low arginase vs. high arginase) and can be explained by ARG uptake and arginase activity by intact erythrocytes. Conclusion. Hepatocellular injury by liver manipulation leads to arginase-1 release resulting in increased arginase-1 plasma levels. Surprisingly, this does not stimulate extracellular arginine breakdown, which which sheds new light on earlier reported arginine lowering properties of circulating arginase-1.
2. De tweede prijswinnaar is Mevr. G. Melis, diëtist/onderzoeker VUMC voor haar werk: Glutamine Is An Important Precursor For De Novo Synthesis Of Arginine In Man. Het onderzoek is gedaan in samenwerking met M.C.G. van de Poll, P.G. Boelens, P.A.M. van Leeuwen, N.E.P. Deutz, C.H.C. Dejong.
Abstract:
Normalisation of depressed plasma concentrations of glutamine (Gln) and arginine (Arg) is associated with better clinical outcome.
Supplementing Gln may be a way to provide the patient with Gln as well as Arg, since it has been suggested that citrulline (Cit), a product of intestinal Gln metabolism, can be taken up by the kidney to serve as a precursor for de novo Arg synthesis. However, this pathway has never been described conclusively in man. Aim of this study was to quantify the metabolic pathway from Gln to Cit and then to Arg in humans. Eight patients undergoing major upper GI surgery were included in this study.
Before surgery, a catheter was placed in an antecubital vein for stable isotope infusion. During surgery a primed and constant infusion of L-[2- 15N]-Gln, L-[ureido-13C-2H2]-Cit and L-[guanidino-15N2]-Arg was started and continued for 2.5 h. Blood samples were drawn from an arterial line before the start of the infusion and every 30 minutes thereafter.
Enrichments of Gln, Cit and Arg, measured with liquid chromatography - mass spectrometry, were used to calculate the turnover of these amino acids and the conversions from Gln into Cit and Cit into Arg. Results are expressed in mean ± SEM. Isotopic steady state was achieved within 30 minutes for all infused stable isotopes (cTTR 15N-Gln: 6.45 ± 0.29%,
p<0.001 vs. baseline). At steady state significant enrichments were observed of 15N-Cit and 15N-Arg (cTTR: 5.65 ± 0.38% and 1.35 ± 0.07% respectively, p<0.001 vs. baseline). Whole body turnover rates of Gln, Cit and Arg were 328 ± 15, 11 ± 1 and 44 ± 2 µmol/kg/h, respectively.
Whole body de novo Cit production derived from Gln was 9.8 ± 1.0 µmol/kg/h, representing about 89% of total Cit turnover. De novo Arg production from Cit was 9.4 ± 0.7 µmol/kg/h, which represents about 20% of total Arg turnover and 85% of the total Cit turnover. The calculated contribution of Gln to Arg de novo synthesis was 76% (85% x 89%).
Conclusion: This is the first study that proves the quantitative importance of the metabolic relationship between Gln turnover and de novo Arg synthesis in humans. Gln is a precursor for 76% of de novo synthesized Arg. Our next step will be to quantify the contribution of the intestines and the kidneys to this pathway. |