Managing Disease-Related Lean Body Mass Loss through Clinical and Nutrition Interventions

Managing Disease-Related Lean Body Mass Loss through Clinical and Nutrition Interventions

Friday, December 4, 2015

The New York Academy of Sciences

Presented By

Presented by Abbott Nutrition Health Institute the Sackler Institute for Nutrition Science at the New York Academy of Sciences

 

Adequate lean body mass plays a vital role in overall health. A reduction in lean body mass and strength affect mortality and quality of life and can increase time to recover and length of hospital stays. Recovering lean body mass which has been lost is difficult; however, comprehensive healthcare that emphasizes early diagnosis and treatments for lean body mass loss may play key mitigation roles. Clinicians have an opportunity to be agents of change in taking research to practice to treat age- and disease-related loss of lean body mass through innovative clinical and nutrition interventions.

*Reception to follow.

The event has been approved for CNE, CPE, & CHES 4.0 credits and 5.25 CME credits through the Clinical Directors Network.

Physicians
Physicians Clinical Directors Network (CDN) is an approved provider of CME through the American Academy of Family Physicians. This activity is approved for up to 5.25 Prescribed credits by the American Academy of Family Physicians.

Nurses
Clinical Directors Network (CDN) is an approved provider of CNE through the American Academy of Family Physicians. This activity is approved for up to 4.0 Prescribed credits by the American Academy of Family Physicians, recognized by the American Nurses Credentialing Center (ANCC) for the purpose of certification and re-certification.

CHES
Clinical Directors Network, Inc., a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Crediting, Inc. This program is designated for Certified Health Education Specialist (CHES) and/or Master Certified Health Education Specialist (MCHES) to receive up to 4.0 total Category 1 continuing education contact hours. 

Dietitian
Clinical Directors Network (CDN) is an approved provider of CPE credits through the Commission of Dietetic Registration. This activity is approved for up to 4.0 prescribed credits by the Commission of Dietetic Registration.

A complimentary 1-year NYAS membership will be included for current nonmember attendees.


 

Registration Pricing

 By 10/30/2015After 10/30/2015Onsite
Member$25$30$35
Member (Student / Postdoc / Resident / Fellow)$15$15$20
Nonmember (Academia)$60$65$75
Nonmember (Corporate)$80$85$100
Nonmember (Non-profit)$60$65$75
Nonmember (Student / Postdoc / Fellow)$40$45$50

 


Presented by

  • Abbott Nutrition Health Institute

Agenda

* Presentation titles and times are subject to change.


December 4, 2015

8:30 AM

Registration and Continental Breakfast

9:00 AM

Welcoming Remarks
Amy R. Beaudreault, PhD, The Sackler Institute for Nutrition Science
Refaat Hegazi, MD, PhD, MPH, MS, Abbott Nutrition

Session 1: Underlying of Disease-Related Metabolic Responses

Session Chair: Amy R. Beaudreault, PhD, The Sackler Institute for Nutrition Science

9:20 AM

Disease-Related Inflammation, Malnutrition and Lean Body Mass Loss
Gordon Jensen, MD, PhD, The Pennsylvania State University

10:10 AM

Lean Body Mass Loss for the Geriatric Patient: Clinical Implications
Dennis H. Sullivan, MD, University of Arkansas

11:00 AM

Coffee Break

Session 2: Acute Conditions Affecting Lean Body Mass

Session Chair: Refaat Hegazi, MD, PhD, MPH, MS, Abbott Nutrition Health Institute

11:30 AM

Maintaining Lean Body Mass in the ICU
Paul Wischmeyer, MD, EDIC, University of Colorado School of Medicine

12:05 PM

Lean Body Mass Loss amongst Surgical Patients
David Evans, MD, The Ohio State University

12:40 PM

Lunch

Session 3: Chronic Diseases Affecting Lean Body Mass

Session Chair: Julie Shlisky, PhD, The Sackler Institute for Nutrition Science

1:40 PM

Cardiac Cachexia and Lean Body Mass Loss
Peter A. McCullough, MD, MPH, Baylor University Medical Center

2:15 PM

Clinical Relevance of Cachexia in Chronic Obstructive Pulmonary Disease
Melissa J. Benton, PhD, RN, GCNS-BC, FACSM, University of Colorado at Colorado Springs

3:00 PM

Coffee Break

Session 4: Innovative Clinical and Nutrition Interventions

Session Chair : Kathy West, MS, RD, LD, Abbott Nutrition Health Institute

3:30 PM

Acute Illness Clinical and Nutrition Interventions
Robert Martindale, MD, PhD, Oregon Health & Science University

4:05 PM

Chronic Disease Clinical and Nutrition Interventions
Gerard Mullin, MD, Johns Hopkins

4:40 PM

Closing Remarks
Robert Miller, PhD, Abbot Nutrition Health Institute

4:50 PM

Live Continuing Education Evaluation

5:00 PM

Networking Reception

6:00 PM

Conference Adjourn

Speakers

Organizers

David Evans, MD

The Ohio State University

David C. Evans, MD is Director of Nutrition Support Services, Trauma Medical Director, and Assistant Professor of Surgery at The Ohio State University Wexner Medical Center in Columbus, OH. He has a busy clinical practice focusing on trauma, emergency general surgery, endoscopy, and critical care. His special interests include nutrition support in surgical and ICU patients and outcomes research in surgery and trauma care. He is an investigator in multiple clinical trials in critically ill patients focused in the areas of nutrition and infection and is author of over 50 peer-reviewed publications.

Refaat Hegazi, MD, PhD, MPH, MS

Abbott Nutrition

Dr. Refaat Hegazi is graduated from Mansoura University Faculty of Medicine, Mansoura, Egypt in 1989. He earned his Master of Occupational Health and Industrial Medicine from Mansoura University Faculty of Medicine, Mansoura, Egypt in 1995 and his Master of Public Health from the Graduate School of Public Health at the University of Pittsburgh in 1998. In 2002, he earned his PhD in Nutritional Epidemiology from the Graduate School of Public Health University of Pittsburgh.

Dr. Hegazi completed a Post-Doctoral fellowship in Gastrointestinal immunology at the University of Pittsburgh, School of Medicine in 2006 and was certified by the American Board of Physician Nutrition Specialist in 2001. In 2006, he joined the Clinical Faculty at the University of Pittsburgh, Medical Center as an Assistant Professor of Medicine at the Division of Gastroenterology, Hepatology and Nutrition. He joined Abbott Nutrition as Medical Director of Adult Nutrition in February 2009.

His research was funded by both the Cancer Research Foundation of America and the Crohn's and Colitis Foundation of America. Dr. Hegazi authored over 50 publications and five book chapters. He is especially interested in the interaction between nutrition and immune responses.

Gerard Mullin, MD

Johns Hopkins Medicine

Dr. Mullin is an associate professor in the department of medicine at The Johns Hopkins Hospital where he chairs the hospitals Nutrition Advisory Committee. He is an internist, gastroenterologist and nutritionist. Dr. Mullin is nationally and internationally renowned for his work in integrative gastroenterology and nutrition.

In 2009 he was named by the American Dietetic Association as an honorary member. Dr. Mullin has authored/edited several books in nutrition and integrative medicine (thefoodmd.com/books) including his latest book, The Gut Balance Revolution (Rodale Press, 2015), which is the topic of today's symposium.

Dennis H. Sullivan, MD

University of Arkansas

Dr. Dennis Sullivan is a Professor and Vice Chair within the Donald W. Reynolds Department of Geriatrics at the University of Arkansas for Medical Sciences. He is Board Certified in Internal Medicine and has a Certificate of Added Qualifications in Geriatric Medicine. His clinical and research expertise is in the area of nutrition and rehabilitation of the frail elderly and assessment of health outcomes. The results of his research have been published in numerous journals.

Kathy West, MS, RD, LD

Abbott Nutrition Health Institute

Kathy West currently serves as manager within the Abbott Nutrition Health Institute where she develops the educational strategies and programs for the adult nutrition and pediatric specialty nutrition business units. Kathy previously worked within the Consumer Relations Department as the quality coordinator covering both adult and pediatric product areas. Kathy also served as manager of regulatory affairs in which she provided guidance for the use of new ingredients for nutritional products world-wide. Prior to regulatory, Kathy supported the diabetes category through medical and scientific support for the use, design, and marketing of the diabetes product line. Kathy also worked as a clinical dietitian at Ohio State Hospitals East, where she performed clinical assessments for various inpatient types. Throughout her career, Kathy has focused on advancing nutrition interventions, including work with NASA to develop a menu for extended duration space missions. In 2000, Kathy received her bachelor's of science degree in dietetics at Bowling Green State University. Kathy holds a master's degree from Case Western Reserve University and completed her dietetic internship at University Hospitals of Cleveland in 2001. Kathy is currently pursuing her MBA at the Fisher College of Business at The Ohio State University.

Amy R. Beaudreault, PhD

The Sackler Institute for Nutrition Science

Currently, Dr. Beaudreault works as associate director of The Sackler Institute for Nutrition Science, a program of the New York Academy of Sciences, which is dedicated to advancing nutrition science research and knowledge, mobilizing communities and translating this work into the field. She holds a BS in Journalism from the E. W. Scripps School of Journalism at Ohio University, and an MS in Agricultural Communication, a PhD in Agricultural Education and Extension, and a graduate certificate in survey research from The Ohio State University. Her career spans 15 years' in strategic communication, quantitative and qualitative research methodologies, and program development, implementation, and evaluation. Prior to joining the Academy, Dr. Beaudreault managed the Ohio State University Extension Agricultural and Safety Health Program and The Great Lakes Center for Agricultural Safety and Health; used her public relations background while working in research communication at Nationwide Children's Hospital in Columbus, OH, with an initiative to translate research to practice in biobehavioral health, perinatal research, and injury research and policy; and directed several U.S. Department of Education contracts in Washington, DC.

Julie Shlisky, PhD

The Sackler Institute for Nutrition Science

Julie joined the Sackler Institute in 2014 after her post-doctoral fellowship at the New York Obesity Research Center where she examined postprandial energy expenditure in overweight and obese adolescents. She earned her doctorate in Nutritional Science from Penn State in spring 2012 where she conducted a 6-month diet and physical activity lifestyle intervention investigating an energy-restricted diet on body composition, metabolic parameters and bone health in premenopausal women. Julie provided the nutrition education component of the study to participants and has fulfilled course work necessary for the dietetic internship, needed to become a registered dietitian. She brings experience from industry and the laboratory to her position at the Academy, having worked in a research and development at DuPont after her undergraduate education in molecular biology.

Speakers

Melissa J. Benton, PhD, RN, GCNS-BC, FACSM

University of Colorado at Colorado Springs

Dr. Benton is currently an Associate Professor in the Helen and Arthur E. Johnson Beth-El College of Nursing & Health Sciences at the University of Colorado at Colorado Springs. She received her master's degree in nursing from California State University Dominguez Hills, and her PhD from the Department of Exercise and Wellness at Arizona State University. She is nationally certified as a Clinical Nurse Specialist in Gerontological Nursing and is a Fellow of the American College of Sports Medicine. Dr. Benton's clinical practice has been in the areas of physical rehabilitation, aging, and chronic disease in both hospital and community settings. Her primary research focus is evaluation of the clinical applications of resistance exercise in healthy and chronically ill middle-aged and older adults. Her outcomes of interest include lean mass and body composition, strength, function, energy expenditure and quality of life.

David Evans, MD

The Ohio State University

David C. Evans, MD is Director of Nutrition Support Services, Trauma Medical Director, and Assistant Professor of Surgery at The Ohio State University Wexner Medical Center in Columbus, OH. He has a busy clinical practice focusing on trauma, emergency general surgery, endoscopy, and critical care. His special interests include nutrition support in surgical and ICU patients and outcomes research in surgery and trauma care. He is an investigator in multiple clinical trials in critically ill patients focused in the areas of nutrition and infection and is author of over 50 peer-reviewed publications.

Gordon Jensen, MD, PhD

The Pennsylvania State University

Gordon Jensen is Professor and Head, Department of Nutritional Sciences and Professor of Medicine at the Pennsylvania State University. His research interests have focused on the impact of nutritional status on health and functional outcomes in older persons. He received his medical degree from Cornell University Medical College and his PhD in nutritional biochemistry from Cornell University. He completed residency training in Internal Medicine and fellowship training in Clinical Nutrition at New England Deaconess Hospital, Harvard Medical School. He is a Past-President of the American Society for Nutrition, a Past-President of the American Society for Parenteral and Enteral Nutrition, and a Past-Chair of the Association of Nutrition Programs and Departments. A widely recognized nutrition researcher and educator, he has made numerous presentations at national and international meetings. He has served on advisory panels, study sections or work groups for the National Institutes of Health, the Academy of Nutrition and Dietetics, and the Food and Nutrition Board. He served two terms as a member of the Food and Nutrition Board. He also has served on several editorial boards and as ad hoc reviewer for many other journals. He has authored more than 180 journal articles, reviews, and book chapters. His contributions were recently recognized with the 2014 Jonathan Rhoads Lecture, ASPEN's most prestigious award.

Robert Martindale, MD, PhD

Oregon Health & Science University

Dr. Martindale received his MD from George Washington University. He completed his surgical residency at Madigan Army Medical Center, where he also served as Director of Nutrition Support Service. He completed his PhD in Nutrition at UCLA in the laboratories of Drs. Morton Grossman, Tachi Yamada, and Seymour Levin at the Center for Ulcer Research and Education.

His primary focus throughout his professional career has been on surgical education, gastrointestinal surgery, complex abdominal wall reconstruction and caring for patients with complex nutritional issues. He is the author of over 250 publications, as well as being the co-editor of a textbook dealing with surgical and critical care nutrition. His research interests include clinical academic surgery, abdominal wall reconstruction, surgical metabolism, and nutritional modulation of the immunity.

Upon completing his Army commitment at Eisenhower Medical Center in 1993, he joined the faculty at the Medical College of Georgia where he held many distinguished positions.

In 2005, Dr. Martindale began his tenure at Oregon Health & Science University, where he is currently a Professor of Surgery and the Chief of the Division of General and Gastrointestinal Surgery. He also serves as the Medical Director for Hospital Nutrition Services.

Peter A. McCullough, MD, MPH

Dallas Baylor Heart and Vascular Hospital

After receiving a bachelor's degree from Baylor University, Dr. McCullough completed his medical degree as an Alpha Omega Alpha graduate from the University of Texas Southwestern Medical School in Dallas. He went on to complete his internal medicine residency at the University of Washington in Seattle, cardiology fellowship including service as Chief Fellow at William Beaumont Hospital, and master's degree in public health at the University of Michigan. Dr. McCullough directs cardiovascular education and research for the Baylor Health Care System and is a Vice Chief of Medicine at Baylor University Medical Center in Dallas, TX and is a Principal Faculty in internal medicine for the Texas A&M University Health Sciences Center. He is an internationally recognized authority on the role of chronic kidney disease as a cardiovascular risk state with over 1000 publications including the "Interface between Renal Disease and Cardiovascular Illness" in Braunwald's Heart Disease Textbook. In 2013, he was honored with the International Vicenza Award for Critical Care Nephrology for his outstanding contribution and dedication to the emerging problem of cardiorenal syndromes. Dr. McCullough is the current Chair of the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), the nation's largest community screening effort for chronic diseases. His works have appeared in the New England Journal of Medicine, Journal of the American Medical Association, and other top-tier journals worldwide. He is the co-editor of Reviews in Cardiovascular Medicine and serves on the editorial boards of multiple specialty journals.

Gerard Mullin, MD

Johns Hopkins

Dr. Mullin is an associate professor in the department of medicine at The Johns Hopkins Hospital where he chairs the hospitals Nutrition Advisory Committee. He is an internist, gastroenterologist and nutritionist. Dr. Mullin is nationally and internationally renowned for his work in integrative gastroenterology and nutrition.

In 2009 he was named by the American Dietetic Association as an honorary member. Dr. Mullin has authored/edited several books in nutrition and integrative medicine (thefoodmd.com/books) including his latest book, The Gut Balance Revolution (Rodale Press, 2015), which is the topic of today's symposium.

Dennis H. Sullivan, MD

University of Arkansas for the Medical Sciences

Dr. Dennis Sullivan is a Professor and Vice Chair within the Donald W. Reynolds Department of Geriatrics at the University of Arkansas for Medical Sciences. He is Board Certified in Internal Medicine and has a Certificate of Added Qualifications in Geriatric Medicine. His clinical and research expertise is in the area of nutrition and rehabilitation of the frail elderly and assessment of health outcomes. The results of his research have been published in numerous journals.

Paul Wischmeyer, MD, EDIC

University of Colorado School of Medicine

Paul Wischmeyer M.D. is a professor of Anesthesiology and Pediatrics (Nutrition Section) at the University of Colorado School of Medicine, where he also serves as the Associate-Chair of Clinical and Translational Research and the Director of Nutrition Support/Therapy Services. He recently completed his term as the Editor-in-Chief of the Journal of Parenteral and Enteral Nutrition. Dr. Wischmeyer earned his medical degree with honors at The University of Chicago Pritzker School of Medicine and completed his anesthesiology/critical care training at the University of Chicago. Dr. Wischmeyer's clinical and research focus is on Nutrition Therapy and Intensive Care Medicine. Dr. Wischmeyer's laboratory, the Translational PharmacoNutrition Laboratory (TPN Lab) has been awarded NIH and other peer reviewed grants to perform research ranging from basic mechanistic cell work to large-scale multi-center clinical trials in the field of acute care metabolism, nutrition, probiotics, and microbiome research. For his research, Dr. Wischmeyer has received numerous awards from national and international societies including The John M. Kinney Award for the most significant contribution to field of general nutrition, the Stanley Dudrick Research Scholar Award by the American Society for Parenteral and Enteral Nutrition and The Lifetime Achievement Award of the International Parenteral Nutrition Society (IPENEMA) for significant contributions to the field of parenteral nutrition.

Abstracts

Disease-related inflammation, malnutrition and lean body mass
Gordon L Jensen, MD, PhD, University of Vermont College of Medicine, Burlington, VT, USA

Growing evidence suggests that varying degrees of acute or chronic inflammation are key contributing factors in the pathophysiology of malnutrition that is associated with disease or injury. Inflammation promotes metabolic dysregulation, hyperglycemia, decreased visceral proteins, muscle catabolism, edema, anorexia, and malaise / deconditioning. Inflammation may also blunt favorable responses to nutrition therapies. We have proposed a new etiology driven approach to nutrition diagnosis for adults in the clinical practice setting that has been adopted by ASPEN and the Academy of Nutrition and Dietetics. These malnutrition syndromes include "starvation-related malnutrition," when there is chronic starvation without inflammation, "chronic disease-related malnutrition," when inflammation is chronic and of mild to moderate degree, and "acute disease or injury-related malnutrition," when inflammation is acute and of severe degree. A systematic approach to nutrition assessment will be shared for the diagnosis of malnutrition with practical indicators of malnutrition and inflammation that include medical / surgical history and clinical diagnosis, clinical signs and physical examination, anthropometric data, laboratories, dietary assessment, and functional outcomes. Feasibility and validity testing of malnutrition markers and characteristics will be discussed. Inflammation can be a good thing; let's try to keep it that way.
 

Lean Body Mass Loss for the Geriatric Patient: Clinical Implications
Dennis H. Sullivan, MD, University of Arkansas for the Medical Sciences

Lean body mass (LBM) declines progressively throughout life beginning in the third decade of life; the rate of loss generally accelerates after age 65 and can lead to serious health consequences. Skeletal muscle, primarily type II or fast twitch fibers, is the primary component of LBM that is lost. As muscle quality also declines with age, the loss of muscle strength is usually much greater than would be predicted based on the amount of muscle mass that is lost. Multiple factors contribute to this loss, some of which are potentially modifiable including sedentary lifestyle, inadequate diet, and chronic disease. Since there is a direct correlation between muscle strength and an increased risk of adverse clinical outcomes such as falls, disability, hospitalization, and death in older adults, strategies that can prevent this age-associated loss can have a major impact on population health. A number of mitigating strategies hold promise. Currently, the best approach to slowing the rate of muscle strength loss is maintenance of a healthy lifestyle characterized by a well-balanced diet and regular physical exercise including both aerobics and muscle strength training. Dietary supplements (e.g., essential amino acids, vitamin D) and pharmacologic approaches (e.g., select androgen receptor modulators) hold promise, but far more research in these areas is needed.
 

Maintaining Lean Body Mass in the ICU
Paul Wischmeyer, MD, University of Colorado School of Medicine

Over last 10 years mortality from sepsis/critical illness has fallen by half, however despite this apparent outcome improvement, the number of these "survivors" leaving our ICU's and going to rehabilitation facilities/nursing homes has tripled. Unfortunately, 40-50% of 1-year mortality post-ICU admit occurs after patient's have been discharged from ICU. Many of these deaths are believed to occur indirectly as a result of loss of lean body mass (LBM) and weakness. Thus, the question we must pose is "ARE WE CREATING SURVIVORS…OR ARE WE CREATING VICTIMS?" in the ICU. Can we learn to not only produce survivors, but survivors with a quality of life (QoL) worth living? To achieve this we must investigate multi-faceted interventions that combine nutrition with adequate protein and exercise for preservation/recovery of LBM. However, these necessary foundations are likely to be insufficient in many ICU patients to optimize LBM recovery. ICU patients can remain catabolic for >12 months post-illness. To achieve recovery we need to begin to incorporate "anabolic" interventions to reverse evolutionarily "mis-programmed" long-term catabolism. These interventions may include beta-blockers, testosterone-derivatives, HMB, and other sports nutrients. Treating with anabolic interventions in the right patients at the right time will be key to optimal recovery. Thus we must study these pharmacologic interventions in a systematic fashion that includes adequate nutrition if we hope to optimize QoL. In conclusion, if we are to make the treatments we subject ICU patients too worthwhile, we must investigate interventions that not only save lives, but also provide quality of life.
 

Lean Body Mass Loss in Surgical Patients
David C. Evans, MD, FACS, The Ohio State University, Columbus, Ohio USA

Major surgery and the time after surgery or trauma are characterized by a catabolic stress state with increased caloric and protein requirements, increased muscle breakdown, and periods of prolonged immobility. After major trauma, over 1/7th of total body protein is lost in the first three weeks, and two-thirds of that protein loss is from skeletal muscle. With lean body mass loss in the setting of surgical stress, protein intake is diverted away from necessary immune and wound healing functions. Estimates of precise protein needs in surgical patients are still lacking but typically are estimated at or above 1.5–1.8 g/Kg/day. Emerging data is suggesting that muscle mass may serve as a nutritional assessment and prognostic tool for surgical and trauma patients. Increased protein and nutritional delivery may improve outcomes—particularly functional measures of performance status. Several techniques including CT scan and ultrasound are increasingly being used as part of a nutritional assessment. Strategies that maximize muscle mass in the perioperative period by leveraging protein intake, exercise, and anabolic agents may improve both direct surgical outcomes and long-term functional outcomes of recovery. Hydroxymethylbutyrate (HMB) is one such agent—having been shown effective in several clinical populations. Future studies including a prospective controlled trial in high-risk pancreatectomy patients aim to illuminate this topic.
 

Cardiac Cachexia and Lean Body Mass Loss
Peter A. McCullough, MD, MPH, Baylor University Medical Center

Heart failure is the leading cause of adult hospitalization in the United States. There are multiple medications and several implanted devices that can reduce the rates of hospitalization and death in patients with heart failure. There remains an unmet need for additional approaches to improve the signs, symptoms, and consequences of heart failure. Multiple studies have found that evidence of macronutrient (protein, carbohydrate, and fat) deficiencies and overall malnutrition contributes to "cardiac cachexia" or reductions in lean body mass in patients with heart disease. Importantly frailty and complications are linked to cardiac cachexia. This problem is amenable to nutrition supplementation. Additionally, micronutrient (vitamins, elements, trace minerals) deficiencies have also been linked worsened left ventricular function and heart failure. Most prominently, iron deficiency with or without anemia has been associated with worsened outcomes. Clinical trials of iron supplementation in the form of parenterally administered iron have suggested a reduction in hospitalization and mortality and well as an improvement in quality of life. Assessment for both macro- and micronutrient deficiencies and appropriate supplementation may be beneficial in patients with heart failure and this approach appears to complement pharmacotherapy and the use of implanted cardiac devices.
 

Clinical Relevance of Cachexia in Chronic Obstructive Pulmonary Disease
Melissa J. Benton, PhD, RN, University of Colorado, Colorado Springs, Colorado, USA

Cachexia is characterized by loss of muscle in the presence of chronic disease. Among patients with chronic obstructive pulmonary disease (COPD) the prevalence of cachexia is as high as 40%, with mortality rates up to 25%. In the United States, COPD patients account for one-third of cachexia-related hospital admissions, and their costs exceed non-cachectic patients by more than $4,500 per admission. Cachexia in the presence of COPD decreases functional capacity, quality of life, and survival. Inflammation and increased activity of myostatin are implicated in the pathophysiology of COPD cachexia. Skeletal and respiratory muscles are affected, leading to increased costs of breathing and physical activity, and an overall increase in 24-hour energy expenditure. Protein turnover is also likely affected by both increased breakdown and decreased synthesis. Clinical identification of muscle wasting is critical for early intervention, but biomarkers are unreliable and use of body mass index (BMI) can be complicated by increases in fat mass commensurate with decreases in lean mass presenting as a normal BMI. Body composition assessment is needed, but historically has been based on imaging of muscle mass, which is costly and not widely available in clinical settings. Bioelectric impedance analysis may provide an acceptable alternative for clinical measurement of muscle mass in COPD patients. Novel therapies aimed at appetite stimulation and myostatin inhibition hold promise, but current evidence supports use of conventional treatment strategies, including adequate nutrition to balance energy expenditure and low-intensity exercise, such as pulmonary rehabilitation, to increase muscle mass, function and quality of life.
 

Acute Illness: Clinical and Nutritional Interventions
Robert Martindale, MD, PhD, Oregon Health & Science University

Nutrition therapy provided early in acute illness setting has been shown to improve outcome. Appropriate and early nutrition intervention can attenuate the hyperdynamic systemic response and depressed immune reaction to injury, serious illness and major surgery. Controversies limit nutrition's uniform application and potential benefits, including failure to accurately predict who will "need" nutritional intervention, lack of consensus on what the optimal enteral formulation is, over-reliance on parenteral nutrition, failure to maximize use of early enteral feeding, and how much and how best to feed the morbidly obese population.
 
Despite challenges and inconsistencies in today's acute care setting, specialized nutrition has evolved from metabolic "support" during acute illness to a primary therapeutic intervention designed, individualized, and focused to achieve metabolic optimization and mitigation of stress-induced immune and hyperdynamic systemic responses. Nutrition should be considered early and commenced after initial resuscitation has taken place. This is most effectively accomplished with the use of protocols that aggressively promote early enteral nutrition, and will result in lower mortality and a reduction in major complications. Though the complexity of the heterogeneous hospitalized patient with serious acute illness will always be challenging but the nutrition community is developing a better understanding of immunity, metabolic needs, and catabolism associated with ICU admissions. In today's health care environment where value for service or intervention is required the aggressive nutritional therapy has been shown to be cost effective.
 

The Impact of Nutrition in the Management of Inflammatory Bowel Disease
Gerard Mullin, MD, Johns Hopkins

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory gastrointestinal (GI) tract disorder which can be associated with diminished nutrient intake and absorption causing malnutrition, having an adverse impact to the patient. Assessment of nutritional status should be conducted on all patients with IBD as the prevalence of nutritional deficiencies and malnutrition in IBD are quite common and nutrition intervention may improve disease activity, mitigate symptoms and improve quality of life. Lean muscle mass depletion from systemic inflammation relates to disease activity in IBD and should be minimized. Augmenting nutritional status prevents adverse health consequences of malnutrition in patients with IBD and controls the underlying course of disease. This lecture will review the prevalence and pathophysiology for the depletion of lean muscle mass and nutritional deficiencies in IBD with evidence for central parenteral nutrition (CPN), enteral nutrition, dietary (elimination diets, low carbohydrate diet, low fermentable oligo-, di-, monosaccharide and polyol [FODMAP], fiber, omega-3-fatty acids). Micronutrient deficiency should be investigated and rectified. Enteral nutrition can induce and sustain remission in Crohn's disease. CPN is indicated in the setting of proven intestinal failure. Ω3 fish oil, prebiotics and glutamine do not have sufficient evidence to support their use in the treatment of active IBD.
 

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