PW17 - TRIMETHYLAMINE N-OXIDE (TMAO) AS PROGNOSTIC MARKER AMONG PATIENTS AT NUTRITIONAL RISKA SECONDARY ANALYSIS OF THE RANDOMIZED CLINICAL TRIAL EFFORT

PW17

TRIMETHYLAMINE N-OXIDE (TMAO) AS PROGNOSTIC MARKER AMONG PATIENTS AT NUTRITIONAL RISK

A SECONDARY ANALYSIS OF THE RANDOMIZED CLINICAL TRIAL EFFORT

A. Stern^1,*, C. Wunderle¹, P. Tribolet^1,2,3, P. Neyer⁴, L. Bernasconi⁴, Z. Stanga⁵, B. Müller^1,6, P. Schuetz^1,6

¹Medical University Department, Division of General Internal and Emergency Medicine, Division of Endocrinology, Diabetes and Metabolism, Cantonal Hospital Aarau, 5001 Aarau, ²Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland, ³Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria, ⁴Institute of Laboratory Medicine, Cantonal Hospital Aarau, 5001 Aarau, ⁵Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, 3010 Bern, ⁶Medical Faculty of the University of Basel, 4056 Basel, Switzerland

Rationale: Trimethylamine-N-oxide (TMAO), a metabolite produced by gut microbiota, is highly influenced by dietary factors and has been linked to negative health outcomes, including increased risk of all-cause mortality and cardiovascular events. We evaluated the prognostic value of TMAO among hospitalized patients at nutritional risk participating in the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients (EFFORT) trial regarding clinical outcomes and response to nutritional support.  

Methods: This secondary analysis is based on the randomized controlled EFFORT trial, which compared individualized nutritional therapy with usual care in patients at nutritional risk. We studied the association of admission TMAO concentrations with all-cause mortality after 180 days (primary endpoint) and major adverse cardiovascular events (MACE) using quartile-based regression analysis. 

Results: Among 218 patients with available TMAO measurements, those in higher quartiles showed an increased all-cause mortality compared to the lowest quartile after 180 days (adjusted HR 1.92 95% CI 1.03 to 3.56, p = 0.04) and 5 years (adjusted HR 2.01 95% CI 1.23 to 3.31, p = 0.006). TMAO also tended to be associated with MACE. TMAO was not associated with malnutrition parameters nor with response to nutritional therapy. 

Conclusion: Our analysis indicates that among patients at nutrition risk, baseline TMAO concentrations are associated with increased risk of all-cause mortality and MACE. Further research is needed to assess whether dietary interventions can effectively modify TMAO levels and, in turn, impact clinical outcomes.

Disclosure of Interest: None declared