P.19 NUTRITIONAL EFFECTS OF PORTACAVAL SHUNT IN THE RAT. C. Smadja, J. Morin, D. Franc0 (Unit6 de Chirurgie HBpato-Biliaire, Hapital Paul Brousse, F-94804 Villejuif, France.

Portacaval shunt (PCS) has been incriminated in the aggravation of malnutrition in the cirrhotic patient. However, this suggestion has never been conclusively demonstrated. Twenty-three rats with normal or cirrhotic liver (induced by carbon tetrachloride) were subjected to PCS. Twenty-three corresponding rats underwent a sham operation. Body weight, total serum protein level, serum albumin level and the essential sminoacid pool were measured. The rats were sacrified on the 42nd postoperative day and crushed in 0.1 N sulfuric acid solution. Potassium and protein nitrogen content were measured on the resulting homogeneous solution. Normal rats presented a significant loss of body weight at the end of the study (p< 0.001) but not the cirrhotic rats. Total serum protein level (p< 0.01) and serum albumin level (p< 0.001) were reduced in the normal rat, Cirrhotic rats had a hypoalbuminemia prior to PCS but no further decrease occurred during the study. In normal rats, there was a significant diminution of the essential aminoacid pool (p< 0.001) which was not observed in the cirrhotic rats, although there was a significant diminution of branched chain aminoacids in both groups (p < 0.001). Total body potassium (potassium concentration X rat weight) (p< 0.001) and total protein mass (protein nitrogen percentage X rat weight) (p< 0.001) were diminished in normal rats but not in cirrhotic rats. These results suggest that PCS in rat with healthy liver causes a moderate protein malnutrition. However in cirrhotic rats PCS does not further aggravate the preexisting malnutrition.

P.20 NUTRITIONAL FACTORS AND BODY COMPOSITION AFTER GASTRIC BYPASS SURGERY A. van Overbeeke, M. Salu, Department of Surgery Zuiderziekenhuis Rotterdam.

Optimal surgical treatment of morbid obesity (overweight of more than 100%) requires a reduction of excess bodyfat, while maintaining the body cell mass (BCM) and the nutritional status. Since 1982 fifty female patients underwent gastric bypass surgery mean age 32.6 years, mean weight 124.2 kg., mean height 166.7 cm.

Serum albumin; serum transferrin levels and total lymphocytes counts were performed pre, and postoperatively at 3,6,12 and 18 mnths. The antropometric measurements; triceps skin fold (TSF), as an indicator of body fat and the arm muscle circumference (AMC), as an indicator of the skeletal muscle mass, were also performed at 2 mnths P.O. The BCM was estimated by the use of potassium-42. This is an isotope dilution techique measuring the total exchangeable potassium. The BCM was determined preoperatively, 3 6 and 12 mnths postoperatively. RESULTS: N=sO preop. 3 mnths 6 mnths 9 mnths 12 mnths 18 mnths

Body weight kg 124.2 .100.6 91.9 88.2 86.0 83.7 BCM (kg) 27.3 22.3 25.1 ---- 28.4 ---- AMC (cm) 26.5 25.3 25.1 24.6 25.1 25.3 TSF (mm) 50.5 42.3 36.8 34.8 31.1 28.1 Albumin g/l

::*; 46.1 46.9 ---- 47.2 46.5

Transf. umol/l . 63.2 67.5 ---- 72.1 72.8 Tot. lymfocyt. 2200 1880 2070 ---- 2120 2140

CONCLUSIONS: 1) The nutritional status as indicated by albumin, transferrin and total lymfocytes counts has been maintained during weight loss after gastric bypass surgery. 2) After an initial loss of BCM in the first 3.mnths P.O., there appears a complete restoration of the BCM at one year. The weight reduction of 30% is primarily attributed to a loss of bodyfat. 3) Potassium-42 provides a simple and quantitative means of determining and relating BCM to total body weight. The antropometric measurements are useful as indicators for body composition but are not quantitative.

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