Ultrasonography of the QRFT and QVIT turned out to be a simple technique, easily applicable at the bedside in the dialysis units, and seems to represent an adequate tool for the identification of patients with reduced muscle mass. Reference [1] Sabatino A, Regolisti G, Bozzoli L, Fani F, Antoniotti R, Maggiore U, et al. Re- liability of bedside ultrasound for measurement of quadriceps muscle thickness in critically ill patients with acute kidney injury. Clin Nutr 2017; in press. HIGH GLUTAMINE LEVELS ARE RELATED TO INCREASED MORTALITY AND BLUNTED IMMUNE RESPONSE IN ELDERLY SEPTIC PATIENTS F.G. Di Girolamo 1, *, N. Fiotti 1 , L.M. Castello 2 , C. Casarsa 1 , E. Lupia 3 , M.L. Mujesan 4 , C. Ronco 5 , S. Di Somma 6 , G. Avanzi 2 , F. Mearelli 1 , G. Biolo 1 1 ASUITS, Trieste, Italy 2 University of Novara, Unit of Emergency Medicine, Novara, Italy 3 University of Turin, Unit of Emergency Medicine, Torino, Italy 4 University Of Brescia, Unit of Internal Medicine, Bresciav 5 Ospedale San Bortolo, Unit of Nephrology, Vicenza, Italy 6 University “Sapienza” of Rome, Unit of Emergency medicine, Roma, Italy Glutamine (GLN) is actively taken-up and utilized by immune cells in critical illness [1,2]. We have hypothesized that variability of plasma GLN levels in elderly septic patients is linked to degree of immunoactivation and outcome. We recruited 569 consecutive patients with sepsis or septic shock (50% man, age: 83, 76–88 yr, APACHE II score: 13, 10–16, median and interquartile range), according to the new SEPSIS-3.0 crite- ria, admitted to 5 Italian emergency departments. Plasma GLN and clinical parameters were assessed within 24-hour from ad- mission to emergency department. Mortality rates at 7 (t7) and 30 (t30) days were recorded. Plasma GLN was also determined in 196 free-living elderly volunteers (51% men, age: 65, 62–69 yr). Plasma GLN levels (μmol/L) were lower (p < 0.01) in patients (415, 327–519) than in controls (483, 437–539). Septic patients were divided in 3 groups, according to tertiles of plasma GLN: lower (LG, < 353), intermediate (IG,353–484) and higher (HG,>484). Mortality rates significantly increased (Fig. 1) from LG to HG (t7: 9, 24, 26 events p=0.01; t30: 27, 46, 62 events p=0.001; respectively). C-reactive protein (CRP, ng/ml), leucocytes (WBC, 109/L) and body temperature (BT, °C) significantly (p < 0.001) decreased from LG to HG (CRP: 137, 103, 53; WBC: 13.7, 13.5, 11.3; BT: 37.8, 37.5, 36.6). In a multiple linear regres- sion model, lactate (□:+3.8), CRP (□:-0.41), BT (□:-27.6) and glycaemia (□:-0.39) significantly (p < 0.001) predicted (r2:0.20) plasma GLN variability. In elderly septic patients, lower plasma GLN was associated with lower mortality and higher inflammatory response, while normal- to-higher GLN was associated with increased mortality and blunted immune response. References [1] Nienaber A, Dolman RC, van Graan AE, Blaauw R. Prevalence of glutamine deficiency in ICU patients: a cross-sectional analytical study. Nienaber et al. Nutr J 2016;15:73. doi:10.1186/s12937-016-0188-3. [2] Rodas PC, Rooyackers O, Hebert C, Norberg A, Wernerman J. Glutamine and glutathione at ICU admission in relation to outcome. Clin Sci 2012;122:591– 7. doi:10.1042/CS20110520. (Printed in Great Britain). AUTOPHAGY IS REQUIRED FOR HEMOPOIETIC STEM CELL SURVIVAL IN PROTEIN MALNUTRITION J.S.O. Beltran 1, *, C.C. Dias 1 , G.B. Silva 1 , E. Makiyama 1 , E. Paredes–Gamero 2 , G.P. Amarante–Mendes 3 , P. Borelli 1 1 Clinical and Experimental Hematology Laboratory, Department of Pathophysiology, Faculty of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil 2 Department of Biochemistry, Federal University of São Paulo, São Paulo, Brazil 3 Department of Imunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil Malnutrition alters production of hematopoietic stem cells (HSC) Nutritional imbalances as malnutrition can activate autophagy. Autophagy is catabolic process wich partipates in autorenewal and differentiation of the HSC. We propose in this study to eval- uate HSC in mice knockout by autophagy in model of protein malnutrition. Mice CagCre Atg7 flox/flox yfp male and female received normal protein diet 12% protein (C) or low protein 2% protein (M) for 5 weeks. Were analyzed the feed consumption and the body mass of the animals and the hematological parameters and quantifi- cation HSC by flow cytometer. Wt (wild-type) malnourished (M) males and females presented body weight loss of 20–25%, however the malnourished Knock- out (K) group, males, presented a loss of 30–35%. Already the group of females KO, mass loss 35–45% this group was more af- fected and died about 3 weeks of malnutrition without autophagy. Wt M male and female presented moderate anemia with low he- moglobin (Hb) concentration, however, there were no differences between the male KO M .On the other hand, the female KO M presented severe anemia with low Hb and low erythrocyte pro- duction. There was a decrease in the production of HSC in male and female Wt M group however there was a decrease in the pro- duction of HSC more affected in the mice KO M female than in the male KO M. The production of HSC in the bone marrow is compromised in the absence of autophagy, it is concluded that this autophagic process is important for cell survival in malnutrition. Fig. 1. e12 Conference Proceedings / Nutrition 50 (2018) e1–e13