Energy Metabolism in Patients With Short Bowel Syndrome

Assessment of Energy Metabolism in Patients With Short Bowel Syndrome Using the Doubly Labeled Water Method

This study proposes to verify the total energy expenditure in patients with short bowel syndrome using the doubly labeled water method, as well as determining the rate of oxidation of nutrients, aiming to assist the management of nutritional therapy for these patients.

Study Overview

• Status: Completed
• Conditions: Short Bowel Syndrome

• Study Type: Observational
• Enrollment (Actual): 22

Contacts and Locations

Study Locations

• Brazil
  • Sao Paulo
    • Ribeirão Preto, Sao Paulo, Brazil, 14048-900
      • Clinical Hospital of Ribeirao Preto

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The recruitment of volunteers with short bowel syndrome (SIC) will be done in the Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRP / USP). These individuals will be paired with volunteers without short bowel syndrome, which will be selected at the clinics of the Hospital of the Faculty of Medicine of Ribeirão Preto, and will constitute the control group.

Description

Inclusion Criteria:

• Short bowel syndrome: short bowel syndrome patients with gastrointestinal transit time less or equal 30 minutes.
• Control group: patients with the same gender, presenting age and chronic diseases similar with volunteers from the group with short bowel syndrome.

Exclusion Criteria:

- Short bowel syndrome: time of bowel resection surgery less than 1 year.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Short Bowel Syndrome; Verify the total energy expenditure in patients with short bowel syndrome using the doubly labeled water method.
Control Group; Verify the total energy expenditure in patients without short bowel syndrome using the doubly labeled water method.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of total energy expenditure using the doubly labeled water method	After the determination of resting energy expenditure (REE), each volunteer will receive a dose of doubly labeled water (2H2 18O). A basal urine sample is collected before the intake dose and samples taken on days 1, 2, 3, 7, 12, 13, 14, thereafter. Urine samples will be analyzed by mass spectrometry (Hydra System, HIP 20-20, Europa Scientific, Cheshire, UK) in the Mass Spectrometry Laboratory of the Faculty of Medicine of Ribeirão Preto.	14 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resting energy expenditure (REE) and body composition measurements by indirect calorimetry and electrical bioimpedance, respectively.	This study also aims to measure the REE by indirect calorimetry with a Quark (Cosmed, Italy) calorimeter and the body composition by Byodinamics 450 (Biodynamics Corp., United States).	After 12 hours of overnight fasting
Physical activity assessment	An activity monitor (activPAL ®, Glasgow, UK) is used to determine physical activity. By registering the intensity and duration of each category of activities, the system adds the energy estimated to generate a value that reflects the total energy expenditure.	14 days

Collaborators and Investigators

• Sponsor: University of Sao Paulo
• Collaborators: Fundação de Amparo à Pesquisa do Estado de São Paulo
• Investigators: Principal Investigator: Julio S Marchini, PhD, Ribeirão Preto Medical School. São Paulo University (USP)

Publications and helpful links

General Publications

• DiBaise JK, Young RJ, Vanderhoof JA. Intestinal rehabilitation and the short bowel syndrome: part 2. Am J Gastroenterol. 2004 Sep;99(9):1823-32. doi: 10.1111/j.1572-0241.2004.40836.x.
• Frayn KN. Calculation of substrate oxidation rates in vivo from gaseous exchange. J Appl Physiol Respir Environ Exerc Physiol. 1983 Aug;55(2):628-34. doi: 10.1152/jappl.1983.55.2.628.
• Schoeller DA. Measurement of energy expenditure in free-living humans by using doubly labeled water. J Nutr. 1988 Nov;118(11):1278-89. doi: 10.1093/jn/118.11.1278.
• Thompson JS, Rochling FA, Weseman RA, Mercer DF. Current management of short bowel syndrome. Curr Probl Surg. 2012 Feb;49(2):52-115. doi: 10.1067/j.cpsurg.2011.10.002. No abstract available.
• Schoeller DA, Taylor PB, Shay K. Analytic requirements for the doubly labeled water method. Obes Res. 1995 Mar;3 Suppl 1:15-20. doi: 10.1002/j.1550-8528.1995.tb00003.x.
• Ferreira IM, Braga CB, Dewulf Nde L, Marchini JS, da Cunha SF. Vitamin serum level variations between cycles of intermittent parenteral nutrition in adult patients with short bowel syndrome. JPEN J Parenter Enteral Nutr. 2013 Jan;37(1):75-80. doi: 10.1177/0148607112441800. Epub 2012 Mar 27.
• Thomson AB, Chopra A, Clandinin MT, Freeman H. Recent advances in small bowel diseases: Part II. World J Gastroenterol. 2012 Jul 14;18(26):3353-74. doi: 10.3748/wjg.v18.i26.3353.
• Araujo EC, Suen VM, Marchini JS, Vannucchi H. Ideal weight better predicts resting energy expenditure than does actual weight in patients with short bowel syndrome. Nutrition. 2007 Nov-Dec;23(11-12):778-81. doi: 10.1016/j.nut.2007.07.007. Epub 2007 Sep 17.
• Donohoe CL, Reynolds JV. Short bowel syndrome. Surgeon. 2010 Oct;8(5):270-9. doi: 10.1016/j.surge.2010.06.004.
• Ferriolli E, Pfrimer K, Moriguti JC, Lima NK, Moriguti EK, Formighieri PF, Scagliusi FB, Marchini JS. Under-reporting of food intake is frequent among Brazilian free-living older persons: a doubly labelled water study. Rapid Commun Mass Spectrom. 2010 Mar 15;24(5):506-10. doi: 10.1002/rcm.4333.
• Jeppesen PB, Mortensen PB. Intestinal failure defined by measurements of intestinal energy and wet weight absorption. Gut. 2000 May;46(5):701-6. doi: 10.1136/gut.46.5.701. Erratum In: Gut 2000 Jul;47(1):158.
• Fassini PG, Das SK, Pfrimer K, Suen VMM, Sergio Marchini J, Ferriolli E. Energy intake in short bowel syndrome: assessment by 24-h dietary recalls compared with the doubly labelled water method. Br J Nutr. 2018 Jan;119(2):196-201. doi: 10.1017/S0007114517003373. Epub 2017 Dec 22.
• Fassini PG, Nicoletti CF, Pfrimer K, Nonino CB, Marchini JS, Ferriolli E. Bioelectrical impedance vector analysis as a useful predictor of nutritional status in patients with short bowel syndrome. Clin Nutr. 2017 Aug;36(4):1117-1121. doi: 10.1016/j.clnu.2016.07.011. Epub 2016 Jul 27.
• Fassini PG, Pfrimer K, Ferriolli E, Suen VM, Marchini JS, Das SK. Assessment of energy requirements in patients with short bowel syndrome by using the doubly labeled water method. Am J Clin Nutr. 2016 Jan;103(1):77-82. doi: 10.3945/ajcn.115.122408. Epub 2015 Dec 16.

Study record dates

Study Major Dates

• Study Start: March 1, 2013
• Primary Completion (Actual): December 1, 2014
• Study Completion (Actual): December 1, 2014

Study Registration Dates

• First Submitted: April 10, 2014
• First Submitted That Met QC Criteria: April 10, 2014
• First Posted (Estimate): April 14, 2014

Study Record Updates

• Last Update Posted (Estimate): December 3, 2014
• Last Update Submitted That Met QC Criteria: December 2, 2014
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Keywords: Energy metabolism; Stable isotopes; Short bowel syndrome; Doubly labeled water
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Postoperative Complications; Disease; Gastrointestinal Diseases; Intestinal Diseases; Malabsorption Syndromes; Syndrome; Short Bowel Syndrome
• Other Study ID Numbers: Process HCRP: 1822/2013; CAAE: 12271713.3.0000.5440 (Registry Identifier: Sistema Nacional de Informações sobre Ética em Pesquisa)