Abstract WP457: Safety and Effect of Medium-Chain Triglycerides Oil to Prevent Deterioration of Nutritional Status in Acute Stroke Patients With Severe Renal Dysfunction

Abstract

Introduction: When nutritional status in acute stroke patients with renal dysfunction is deteriorated, it is difficult to prevent further deterioration and improve nutritional status, because protein-enriched diet probably causes deterioration of renal function. Hypothesis: Medium-chain triglycerides (MCT) oil composed of caprylic acid (C8) and capric acid (C10) may safely prevent further deterioration and improve nutritional status in acute stroke patients with severe renal dysfunction, because medium-chain fatty acids do not deteriorate renal function. Methods: We included acute stroke patients who 1) were admitted between August 2016 and December 2018, 2) presented creatinine (Cre) of more than 1.5 mg/dl on admission, 3) underwent blood examination on admission, the 3rd day and 7th day, 4) presented prealbumin of less than 20 mg/dl on the 3rd day and 4) who took daily 15g of MCT from the 3rd to the 6th day. We evaluated patients’ features, albumin (Alb), PreAlb, high-sensitivity C-reactive protein (hs-CRP) and Cre on admission, 3rd day and the 7th day. Results: Thirteen patients met our inclusive criteria and were analyzed. The median age, body mass index, Cre, creatinine clearance (Ccr), blood glucose (BG), hs-CRP, Alb and PreAlb were 86 years, 23.2 kg/m2, 1.93 mg/dl, 19.2 mL/min, 117 mg/dl, 0.433 mg/dl, 3.6 g/dl and 17.3 mg/dl. Their Ccr was less than 15 mL/min in 4 (30.8%) of 13 patients, 15 or more and less than 30 mL/min in 7 (53.8%) of 13 patients and 30 or more and less than 40 mL/min in 2 patients (15.4%). Eleven patients received enteral feeding and two patients ate food orally. Their median calorie intake was 1,000 kcal/day except MCT supplementation. On the 3rd day, their median Alb and PreAlb levels decreased to 2.7 mg/dl (p<0.001) and 10.8 mg/dl (p<0.01), respectively, their median hs-CRP increased to 4.01 mg/dl (p<0.01) and Cre was 2.0 mg/dl (ns). On the 7th day following MCT supplementation, their median Alb was 2.7 mg/dl (ns) and median PreAlb increased to 12.2 g/dl (ns), their median hs-CRP decreased to 2.379 mg/dl (ns) and Cre decreased to 1.79 mg/dl (p<0.05). Conclusion: Four-days MCT supplementation of 15g per day probably prevented further deterioration of nutritional status, attenuated inflammation early and had no adverse effect on renal function.