ECA

AJA3

5

Lde

Ba

Mscw15dfa

Rl9fw(ut(

Cchs

FU

PHM

A1

M

L

Bstsms

Mrtsbetme

RlmtS(iwp

Cb

F

AC

AU

Ln

Bul(bma

MrPc

Ramonot3hfs

ClIe

F

SUNDAY, OCTOBER 18

POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY

A

ffects of a Low-Fat, High-Fiber Diet Compared with a Low-arbohydrate Diet on Insulin Sensitivity and Endothelial Function indults with the Metabolic Syndrome

uthor(s): G. A. Gaesser,1 S. Angadi,1 C. Davis,2 J. Rodriguez,3 B. Irving,4

. Patrie,3 A. Weltman,3 E.J. Barrett,3 D. Brock5; 1Exercise and Wellness,rizona State University, Mesa, AZ, 2Rady Children’s Hospital, San Diego, CA,

University of Virginia, Charlottesville, VA, 4Mayo Clinic, Rochester, MN,University of Vermont, Burlington, VT

earning Outcome: Participants will be able to state how a low-carbohydrateiet and a low-fat, high-fiber diet affect insulin sensitivity and vascularndothelial function in persons with the metabolic syndrome.

ackground: Both low-fat, high-fiber and low-carbohydrate diets have beendvocated for persons at risk for diabetes.

ethods: Twenty-three women and men, ages 32 to 62, with the metabolicyndrome (International Diabetes Federation criteria), completed a randomizedrossover comparison of two, non-calorically restricted, 4-week diets (4-weekash-out). All meals for low-fat, high-fiber [55-60% carbohydrate; 20-25% fat;5-20% protein; 38-48g fiber/day] and low-carbohydrate (15-20% carbohydrate;5-60% fat; 25-30% protein; 9-11g fiber/day) diets were prepared by a researchietician for subjects, and consumed ad libitum. Before and after each diet,asting blood was drawn and endothelial function was assessed via brachialrtery flow-mediated dilation (FMD).

esults: Insulin [mean (SEM), uU/ml] was reduced (P�0.05) similarly afterow-fat, high-fiber [12.6 (1.6) vs. 9.9 (1.2)] and low-carbohydrate [11.8 (1.2) vs..8 (1.0)] diets; a trend for reduced glucose (mg/dl) was observed only after low-at, high-fiber [100.1 (2.4) vs. 96.9 (2.2); P � 0.07]. Insulin sensitivity (QUICKI)as improved (P � 0.05) equally after low-fat, high-fiber [0.315 (0.006) vs. 0.326

0.006)] and low-carbohydrate [0.315 (0.006) vs. 0.326 (0.007)] diets. FMD wasnchanged after low-fat, high-fiber [9.5 (1.3)% vs. 10.4 (1.5)%; P � 0.61], but arend for reduced FMD was observed after low-carbohydrate [10.1 (1.4)% vs. 7.21.1)%; P � 0.06], producing a significant diet interaction (P � 0.01).

onclusion: Although both diets improved insulin sensitivity, a low-arbohydrate diet appears to impair endothelial function. Therefore, a low-fat,igh-fiber diet is preferred to a low-carbohydrate diet as an interventiontrategy in adults with the metabolic syndrome.

unding Disclosure: Wheat Foods Council and NIH grant RR-00847 to theniversity of Virginia General Clinical Research Center.

DNC

AFC

Len

TebwNwmdaUMmd(csaemH

F

ostprandial Triglyceride and Thermogenesis in Mildlyypercholesterolemic Subjects Receiving Conventional orodified Coconut Milk

uthor(s): W. Kriengsinyos,1 U. Yamborisut,1 S. Komindr2;Institute of Nutrition, Nakhon-Pathom, Thailand, 2Faculty ofedicine, Ramathibodi Hospital, Bangkok, Thailand

earning Outcome: Apply information gained for dietary practice.

ackground and Objective: Conventional coconut milk high inaturated fatty acid especially lauric acid has been modified to havehe balanced ratio of 1:1:1 for polyunsaturated: monounsaturated:aturated fatty acid. This study examined the effects of the coconutilk diet on postprandial triglyceride, energy expenditure and

ubstrate oxidation.

ethods: Forty-three mildly hypercholesterolemic adults wereandomized to conventional (CC) and modified (MC) coconut groupshat were comparable in age, lipid profile, and body mass index. Thetudy’s duration was 4 weeks, at the end of which a standardreakfast consisting of fat 52%, CHO 35 %, and protein 13 % ofnergy was administered to the subjects. Blood sample for sugar andriglyceride was taken in the fasting state and at 1, 3, 5 and 7 h aftereal. Indirect calorimetry was used to determine metabolic rate and

nergy expenditure.

esults: Mean area under curve for triglyceride was significantlyower after CC vs MC consumption (21.3 � 4.8 vs 42.3 � 9.0 hours x

g/dL, p�0.046). Peak triglyceride concentration at 3 hour alsoended to be lower (110.0 � 13.7 vs 147.7 � 15.6 mg/dL, p�0.076).even-hour postprandial thermogenesis was higher by 40 %

p�0.042) after CC compared with MC meal. Metabolic ratencreased by 29.5 % after one hour ingestion of CC meal comparedith a 19.6 % increase after MC meal (p�0.062). No differences inrotein and carbohydrate oxidation noted between trials.

onclusion: The modified coconut milk in this study had noeneficial effect on postprandial hypertriglyceridemia.

unding Disclosure: None

-34 / September 2009 Suppl 3—Abstracts Volume 109 Number 9

Multicenter Evaluation of Nasogastric Enteral Feedings inritically Ill Patients

uthor(s): S. R. Roberts, B. Ball; Nutrition Services, Baylorniversity Medical Center, Dallas, TX

earning Outcome: To understand the challenges associated withasogastric feedings in the intensive care unit.

ackground: Enteral nutrition (EN) is vital in the intensive carenit (ICU) and early initiation has been shown to decrease ICU

ength of stay and infectious complications. Nasogastric feedingsNGF) are common in the ICU setting due to ease of tube placement,ut NGF are often held leading to suboptimal nutrient delivery. Thisulticenter study of ICU patients aimed to examine the timing,

dequacy, and complication management for NGF.

ethods: Data was collected via monthly prospective medical recordeview of the first 5 patients admitted to the ICU receiving NGF.atients were admitted to ICU’s of 5 hospitals (1 tertiary and 4ommunity-based).

esults: Four hundred and six patients were included (averagege�62 years, 57% male, average ICU LOS�12 days, 86% requiredechanical ventilation). NGF were initiated within 48 hours in 60%

f patients and within 72 hours in 80% of patients. Estimated calorieeeds were 25 calories/kg while actual intake was 15 calories/kg (61%f estimated needs). Holding NGF was common (66% of patients) andhe most common reason was high gastric residual volumes (GRV) in7% of patients. Concern over aspiration risk accounted for 4% ofeld NGF. High GRV was managed by addition of prokinetics (57%),ormula change (20%), alteration in infusion rate (20%), andwitching to parenteral nutrition (PN) (10%).

onclusions: NGF were initiated early but were frequently held,eading to inadequate nutrition provision or inappropriate use of PN.mplementation of EN evidence-based guidelines in the ICU isssential to improve patient care and outcomes.

unding Disclosure: None

ifferences in Resting Energy Expenditure of Critically Illeurology Patients Admitted to a Neuroscience Intensiveare Unit

uthor(s): C. A. Hartney, K. S. Keim, D. C. Sowa; Department ofood and Nutrition Services, Rush University Medical Center,hicago, IL

earning Outcome: Be able to state differences in resting energyxpenditure between gender, BMI class and race for critically illeurology patients.

he objective of this study was to compare differences in restingnergy expenditure (REE) results of critically ill neurology patientsased on gender, body mass index (BMI) class and race. This studyas a retrospective chart review of patients admitted to theeurosciences Intensive Care Unit at an urban medical center whoere started on enteral nutrition support. Forty-six patients (25ale) with average age of 56.3 � 2.3 years (mean � standard

eviation) and BMI� 28.2 � 1.2 kg/m2 met inclusion criteria and hadt least one metabolic cart measurement with a Medgraphics CPXltima Metabolic Cart (Medical Graphics Corporation, Minneapolis,N). Results of the male mean REE was 2213 � 734 kcal and femaleean REE was 1992.2 � 597 kcal. There were no significant

ifferences in measured REE based on gender (p�0.289), BMI classp�0.783), and race (p�0.406). The differences between gender, BMIlass and race may not have been detected as a limitation of theample size. Research is needed to further explore the relationshipmong gender, BMI class and race and use of established predictivequations for the critically ill neurology patient. The researchethods received approval from the Institutional Review Board foruman Studies.

unding Disclosure: None