ALTERED BILE ACID PROFILE ASSOCIATED WITH CHOLESTATIC INTESTINAL FAILURE ASSOCIATEDLIVER DISEASE

Background: An accurate energy prescription minimises complications whilst meeting nutritional requirements in patients with intestinal failure (IF) receiving parenteral support (PS).We compared measured (via indirect calorimetry (IC)) and predicted resting metabolic rate (RMR) in patients with IF and determined the prevalence of over-and underfeeding.Methods: This was a single-centre, prospective observational cohort study including consecutive adult patients with type 2 or 3 IF receiving PS.RMR was measured under standard conditions and compared with predictive equations (ESPEN 25 kcal/kg, Schofield, Harris-Benedict).Results reported as median (IQR).All energy expenditure includes an activity factor of 1.3.Results: Twenty-two patients [73% female, median age 46 (32.35, 56) years] were included.Median predicted energy requirements were 1313 (1144, 1725) kcal for the ESPEN equation, 1606ESPEN equation, (1497ESPEN equation, , 1933) ) kcal for Schofield, and 1669Schofield, and (1506Schofield, and , 1941) ) kcal for Harris-Benedict.All equations significantly underestimated energy requirements compared to measured RMR of 1944RMR of (1791RMR of , 2258) kcal (p<0.05))kcal (p<0.05).The median respiratory quotient (RQ) was 0.82 (0.74, 0.88).When considering the individual's weight, median measured energy requirement was 35.2 (30.4,41.1) kcal/kg but with wide individual variation ranging from 19.0 to 48.1 kcal/kg.Ten patients (45%) required modification to their PS prescription following IC measurement.Conclusions: Predictive equations to guide PS prescription in IF may result in significant underfeeding.Participants in this cohort demonstrated a propensity to metabolise fat over protein and carbohydrate, as indicated by RQ.A measured energy prescription based on IC is recommended for patients with IF, where available, to tailor their appropriate PS.