EP.WE.484Conservative management of post-operative chyle leak after surgery for a large adrenal cavernous haemangioma

Post-operative chyle leak is a rare but recognised complication after abdominal surgeries particularly those involving dissection adjacent to the retroperitoneal lymph nodes and/or lymphatic systems. There are limited cases of post-operative chyle leak associated with adrenal surgery reported in the literature with no consensus on its management. Lymphatics of the adrenal gland drain into the thoracic duct via regional lymph nodes or directly into the cisterna chyli, posterior to the aorta. If not adequately managed, chyle leak can be associated with hypovolemia, electrolyte imbalances, malnutrition and immunosuppression. These consequences can be attributed to the loss of fluid, electrolytes, lipids, proteins, and immunoglobulins. We hereby report a case of post-operative chyle leak in a 79-year-old male who underwent an open left adrenalectomy, left nephrectomy, splenectomy and distal pancreatectomy for a large, 20.8cm left adrenal cavernous haemangioma. Chyle leak was confirmed on post-operative day 7 based on high levels of triglycerides in the abdominal drain output. Intra-operatively there was no evidence of lymphatic damage. However, the major abdominal surgery involving retroperitoneal viscera close to the lymphatic trunk predisposed the patient to this complication. The patient was managed conservatively with the aim of decreasing chyle production by dietary manipulation and use of somatostatin. Enteral nutrition was continued with a strict low-fat diet and regular dietician input. These strategies contributed to the gradual resolution of chyle leak and the patient’s recovery.

The Impact of Resistance Training on Body Composition, Muscle Strength, and Functional Fitness in Older Women (45–80 Years): A Systematic Review (2010–2020)

As women age, they typically experience a progressive decrease in skeletal muscle mass and strength, which can lead to a decline in functional fitness and quality of life. Resistance training (RT) has the potential to attenuate these losses. Although well established for men, evidence regarding the benefits of RT for women is sparse and inconsistent: prior reviews include too few studies with women and do not adequately examine the interactive or additive impacts of workload, modalities, and nutritional supplements on outcomes such as muscle mass (MM), body composition (BC), muscle strength (MS), and functional fitness (FF). The purpose of this review is to identify these gaps. Thirty-eight papers published between 2010 and 2020 (in English) represent 2519 subjects (mean age = 66.89 ± 4.91 years). Intervention averages include 2 to 3 × 50 min sessions across 15 weeks with 7 exercises per session and 11 repetitions per set. Twelve studies (32%) examined the impact of RT plus dietary manipulation. MM, MS, and FF showed positive changes after RT. Adding RT to fitness regimens for peri- to postmenopausal women is likely to have positive benefits.

Sulfation of Arabinogalactan Proteins Confers Privileged Nutrient Status to Bacteroides plebeius

Dietary manipulation of the HGM requires knowledge of how glycans available to this ecosystem are metabolized. The variable structures that decorate the core component of plant AGPs may influence their utilization by specific organisms within the HGM.

Feeding and Nutritional Strategies to Reduce Methane Emission from Large Ruminants: Review

Livestock are considered as a main source of GHGs emission by contributing approximately 9% of the total global emission and a major concern for global warming. Domestic animals account approximately 94% of the total global emissions of animals from these large ruminants (dairy and beef cattle) produce 30% and 35% of the livestock sectors’ emissions. Most methane (CH4) that is emitted from livestock originates in the forestomach, also called the rumen, of ruminants. Minimizing amount of methane that comes from rumination can improve production efficiency of livestock and is environmentally a sound practice. The emission rate can be minimized by handling proper feeding and nutritional management strategies, which can reduce excretion of GHG during ruminant digestion process. Dietary manipulation, type of carbohydrates animals fed, forage quality and maturity, management of pasture land, nutrient composition of diet and feed intake, feeding frequency, fat supplementation, and inclusion of feed additives such as saponins, tannins and essential oils are among the best feeding and nutritional management strategies to minimize amount of methane produced during rumination. The aim of this review was to investigate feeding and nutritional management strategies used to reduce methane production from ruminants in general and large ruminants in particular.

Clinical spectrum of paediatric and adult eosinophilic oesophagitis in the North East of England from 2016 to 2019

Background and study aimsEosinophilic oesophagitis (EoE) is a common disease with a significant impact on physical health and quality of life (QoL). Outcomes and management vary widely, with no agreed UK national guideline. This paper aims to describe an up-to-date description of demographics, clinical spectrum and outcomes for paediatric and adult patients with EoE from the North East of England between 2016 and 2019.Patients and methodsPatients from two large University Hospitals and the specialist paediatric hospital for the North East of England with histologically or clinically confirmed EoE were included in this analysis. Data were collected retrospectively via electronic patient records. Remission was defined as either the resolution of symptoms or improvement on histology.ResultsData were collected on 74 paediatric and 59 adult patients. Dysphagia was the most common presenting symptom in both groups, accounting for 51%–84% of all presentations. Proton pump inhibitors and dietary manipulation were the most common therapies associated with remission in children (95% of those achieving remission), whereas the use of swallowed topical steroids was more prevalent in the treatment of adults (55% achieving remission).ConclusionsEoE is a complex disease and poses significant challenges. Outcomes vary widely and need to be tailored to individual patient groups. Dietary manipulation plays a major role in treatment for EoE, but this is likely to be challenging for patients, especially children. Future work should continue to assess the outcomes in EoE, including on QoL and potential novel targeted therapies.

Diagnostic criteria for metabolic syndrome in diet-induced rodent models: A systematic review

Background: Thousands of publications in recent years have addressed the induction of metabolic syndrome (MetS) in rodents, however, the criteria and the reference values for diagnosing this disease have not been defined. Objective: Our main objetive was to carry out a systematic review to gather evidence about the criteria for biochemical and anthropometric parameters in which scientific studies have relied to report that rats developed MetS from a previous dietary manipulation. Methods: We compiled characteristics and findings of diet induced MetS with high-fat, high-carbohydrate, high-fat/high-carbohydrates and cafeteria diet from PubMed and Science Direct databases published in the last 5 years. Results: The results on the principal determinants for the syndrome, published in the reviewed articles, were chosen to propose reference values in the rat models of food induction. Conclusion: The values obtained will serve as reference cut-of points in the development of the disease; in addition, the compilation of data will be useful in planning and executing research protocols in animal models.

Three-Day Dietary Manipulation in Multiple Sclerosis: Exercise and Fatigue Outcomes

Background: In persons with multiple sclerosis (MS), the effect of nutrition on exercise performance and fatigue remains unknown. The objective was to determine whether a 3-day diet high in triglycerides (FAT) compared with a 3-day diet high in carbohydrates (CARB) would improve fatigue and exercise performance in persons with MS. Methods: A randomized controlled crossover design was incorporated to study FAT versus CARB on submaximal cycling endurance (60% of peak oxygen consumption), substrate utilization, and fatigue in 12 persons with mild-to-moderate MS (Expanded Disability Status Scale score, 2.0–5.0) and 12 age- and sex-matched controls. Results: There were no differences in cycling time between diets in either group (P = .29). The MS group had no changes in fatigue between diets (P = .64); the control group demonstrated increased total mental fatigue after FAT (P = .05). The control group increased carbohydrate oxidation by 24% at rest and 13% during exercise after CARB. Similarly, the control group significantly increased fat oxidation after FAT by 22% at rest and 68% during exercise (P = .01). These changes were not seen in the MS group. Compared with controls, persons with MS oxidized approximately 50% less fat during exercise after FAT (P = .05). Conclusions: Neither CARB nor FAT altered submaximal exercise performance or baseline fatigue in the MS group. The results suggest that persons with MS are unable to adapt to dietary changes and oxidize fatty acids as efficiently as controls.