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P.35 ADDITION OF DIETARY FIBER TO A FORMULA DIET INfLUENCES CARBOHYDRATE METABOLISM DEPENDING ON THE MODE OF ADMINISTRATION. J.Schrezenmeir : xylose urine excretion indicating COH-absorp- tion from the gut, glucose infusion profile after having achieved a dynamic equilibrium by constant insulin infusion and variable glucose infusion rate, indicating absorptive and metabolic events and the hormones GIP, insulin, C-peptide and glucagon. According to our results in a study on healthy subjects, xylose excretion was significant ly (p < 0.05) delayed by guar, if watery solutions were ingested (1. testmeal), not as much changed, if xylose was ingested together with the formula diet (2. testmeal) and even accelerated, if xylose ingestion followed the uptake of the formula diet mixed with guar (3. testmeal). Glucose infusion profiles showed analogous changes after the 1. and 2. testmeal, but a delayed peripheral appearance of the glucose arrived from the carbohy- drates of the formula diet (3. testmeal). The results of the glucose excretion and glucose infusion profiles indicate, that the ab- sorption of carbohydrates in watery solutions is delayed by guar, and not much changed in the formula diet used in this experiment. However, if the watery solution is drunken af- ter the formula diet it passes evidently the guar formula mixture. The GIP release was significantly decreased,most pronounced after the 2. testmeal. This indicates a delayed resorption from the upper intestinum. The glucagon levels were lower in all cases, significantly (p < 0.05) after the 1. and 2. testmeal. This may be an addi- tional explanation for the smoothing of postprandial glucose profiles by guar. P.36 MULTICENTRIC TRIAL ON NUTRITIONAL ASESSMENT METHODS.I.IDENTIFICATION OF HIGH RISK SURGICAL PATIENTS. PRELIMINARY RESULTS. Italian Study Group for Nutritional Assessment (Dept. of Surger, Patologia Chirurgica, Universita di Pavia, 27100 Pavia, Italy) A multicentric trial (34 Italian Centers) was undertaken to evaluate the clinical role of 4 methods of nutritional assessment for the identification of patients with increased susceptibility to postoperative infections. Purpose of this paper is to report preliminary results: MATERIAL AND METHODS. In each patient scheduled for surgery the following determinations were carried out: hemoglobin, albumin, transferrin, cerulo- plasmin, RBP, C3c, lymphocytes, skin tests, iron, usual weight, ideal weight, arm circumference, skinfold triceps. Postoperative infections were recorded following standardized criteria. Data were simultaneously evaluated with a poked personal computer (Casio PB 3OO):l. Blakburn evaluation: overall arithmetic mean (as% of normal) of visceral, immunologic and anthropometric parameters. (Normal=90-llO%, moderate maln. 60-go%, severe maln. lymphocytes<1500 cells/mm3. 60%). 2. Seltzer evaluation: normal = albuminc3.5 9% and 3. Prognostic Nutritional Index (PNI)=158-16.6(Alb)-0.2 (Transf)-0.78(Skinfold Tr)-5.8(Skin tests). 4. Cluster analysis. Multivariate (11 paramters) classification of nutritional status of the patients by means of 4 reference 'dean distance computed accordingly to the formula: s";~",Irs,~;z~"e.~~~~~$L;;e2741 P. RESULTS 1. Over 11 mean value of visceral proteins of patients with sepsis = 98%, without sepsis = 10 % (tot.pat.208, P=NS). Overall mean f value of anthropometric parameters of patients with sepsis = 88%, without sepsis 92.1% (tot.pat. 208, P=NS). Overall mean value of immunologic parameters of patients with sepsis =88.9%, without sepsis = 90.2% (tot.pat. 154, P =NS). 2. Seltzer evaluation. Incidence of sep$s in normal patients: 31%(44/139); in malnourished = 42%(49/115), (tot.pat.254;P(X )=0.9287, NS).3.PNIc40:incidence of sepsis= 36% (49/134); PNI<40 50: incidence of sepsis=40%(9/22);PNI 50: incidence of sepsis=54%(25/46);(tot.pat.202; P(X )=0.8931, NS). 4.Cluster analysis. Cl 2=45%(53/116), in CL 3= 32%(9/28), Incidence of sepsis Cluster 1226.9(28/104), in in Cl 4=47%); (tot.pat.265;P(X )=0.974,S). CONCLUSION Although a trend is evident in each of the 4 methods, the statistical significance is reached only with Cluster analysis. Nevertheless, being the evaluated data less than l/4 than those expected (2,000), the final results may further change. 114

Addition of dietary fiber to a formula diet influences carbohydrate metabolism depending on the mode of administration

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P.35 ADDITION OF DIETARY FIBER TO A FORMULA DIET INfLUENCES CARBOHYDRATE METABOLISM DEPENDING ON THE MODE OF ADMINISTRATION. J.Schrezenmeir

: xylose urine excretion indicating COH-absorp- tion from the gut, glucose infusion profile after having achieved a dynamic equilibrium by constant insulin infusion and variable glucose infusion rate, indicating absorptive and metabolic events and the hormones GIP, insulin, C-peptide and glucagon. According to our results in a study on healthy subjects, xylose excretion was significant ly (p < 0.05) delayed by guar, if watery solutions were ingested (1. testmeal), not as much changed, if xylose was ingested together with the formula diet (2. testmeal) and even accelerated, if xylose ingestion followed the uptake of the formula diet mixed with guar (3. testmeal). Glucose infusion profiles showed analogous changes after the 1. and 2. testmeal, but a delayed peripheral appearance of the glucose arrived from the carbohy- drates of the formula diet (3. testmeal). The results of the glucose excretion and glucose infusion profiles indicate, that the ab- sorption of carbohydrates in watery solutions is delayed by guar, and not much changed in the formula diet used in this experiment. However, if the watery solution is drunken af- ter the formula diet it passes evidently the guar formula mixture. The GIP release was significantly decreased, most pronounced after the 2. testmeal. This indicates a delayed resorption from the upper intestinum. The glucagon levels were lower in all cases, significantly (p < 0.05) after the 1. and 2. testmeal. This may be an addi- tional explanation for the smoothing of postprandial glucose profiles by guar.

P.36 MULTICENTRIC TRIAL ON NUTRITIONAL ASESSMENT METHODS.I.IDENTIFICATION OF HIGH RISK SURGICAL PATIENTS. PRELIMINARY RESULTS. Italian Study Group for Nutritional Assessment (Dept. of Surger, Patologia Chirurgica, Universita di Pavia, 27100 Pavia, Italy)

A multicentric trial (34 Italian Centers) was undertaken to evaluate the clinical role of 4 methods of nutritional assessment for the identification of patients with increased susceptibility to postoperative infections. Purpose of this paper is to report preliminary results: MATERIAL AND METHODS. In each patient scheduled for surgery the following determinations were carried out: hemoglobin, albumin, transferrin, cerulo- plasmin, RBP, C3c, lymphocytes, skin tests, iron, usual weight, ideal weight, arm circumference, skinfold triceps. Postoperative infections were recorded following standardized criteria. Data were simultaneously evaluated with a poked personal computer (Casio PB 3OO):l. Blakburn evaluation: overall arithmetic mean (as% of normal) of visceral, immunologic and anthropometric parameters. (Normal=90-llO%, moderate maln. 60-go%, severe maln. lymphocytes<1500 cells/mm3.

60%). 2. Seltzer evaluation: normal = albuminc3.5 9% and 3. Prognostic Nutritional Index (PNI)=158-16.6(Alb)-0.2

(Transf)-0.78(Skinfold Tr)-5.8(Skin tests). 4. Cluster analysis. Multivariate (11 paramters) classification of nutritional status of the patients by means of 4 reference

'dean distance computed accordingly to the formula: s";~",Irs,~;z~"e.~~~~~ $L;;e2741

P. RESULTS 1. Over 11 mean value of visceral proteins of patients with sepsis = 98%, without sepsis = 10 % (tot.pat.208, P=NS). Overall mean f value of anthropometric parameters of patients with sepsis = 88%, without sepsis 92.1% (tot.pat. 208, P=NS). Overall mean value of immunologic parameters of patients with sepsis =88.9%, without sepsis = 90.2% (tot.pat. 154, P =NS). 2. Seltzer evaluation. Incidence of sep$s in normal patients: 31%(44/139); in malnourished = 42%(49/115), (tot.pat.254;P(X )=0.9287, NS).3.PNIc40:incidence of sepsis= 36% (49/134); PNI<40 50: incidence of sepsis=40%(9/22);PNI 50: incidence of sepsis=54%(25/46);(tot.pat.202; P(X )=0.8931, NS). 4.Cluster analysis. Cl 2=45%(53/116), in CL 3= 32%(9/28),

Incidence of sepsis Cluster 1226.9(28/104), in in Cl 4=47%); (tot.pat.265;P(X )=0.974,S).

CONCLUSION Although a trend is evident in each of the 4 methods, the statistical significance is reached only with Cluster analysis. Nevertheless, being the evaluated data less than l/4 than those expected (2,000), the final results may further change.

114