Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    The association between inflammatory potential of diet and disease activity : Results from a cross-sectional study in patients with inflammatory bowel disease
    Lamers, Carlijn R. ; Roos, Nicole M. De; Witteman, Ben J.M. - \ 2020
    BMC Gastroenterology 20 (2020)1. - ISSN 1471-230X
    Crohn's disease - Diet - Dietary inflammatory index - Inflammation - Ulcerative colitis
    Background: Diet may play a role in disease status in patients with inflammatory bowel disease. We tested whether the inflammatory potential of diet, based on a summation of pro- A nd anti-inflammatory nutrients, is associated with disease activity in patients with Crohn's disease and ulcerative colitis. Methods: Participants completed a disease activity questionnaire (short Crohn's Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI)) and a Food Frequency Questionnaire (FFQ). FFQ data were used to calculate the Dietary Inflammatory Index (DII) which enables categorization of individuals' diets according to their inflammatory potential on a continuum from pro-to anti-inflammatory. Associations with disease activity were investigated by multiple linear regression. Results: The analysis included 329 participants; 168 with Crohn's disease (median sCDAI score 93 [IQR 47-156]), and 161 with ulcerative colitis (median P-SCCAI score 1 [IQR 1-3]). Mean DII was 0.71 ± 1.33, suggesting a slightly pro-inflammatory diet. In Crohn's disease, the DII was positively associated with disease activity, even after adjustment for confounders (p = 0.008). The mean DII was significantly different between participants in remission and with mild and moderately active disease (0.64, 0.97 and 1.52 respectively, p = 0.027). In ulcerative colitis, the association was not significant. Conclusions: Disease activity was higher in IBD participants with a more pro-inflammatory diet with statistical significance in Crohn's disease. Although the direction of causality is not clear, this association strengthens the role for diet in medical treatment, which should be tested in an intervention study.
    A 4-week exercise and protein program improves muscle mass and physical functioning in older adults – A pilot study
    Grootswagers, Pol ; Regt, Margot de; Domić, Jacintha ; Dronkers, Jaap ; Visser, Marlieke ; Witteman, Ben ; Hopman, Maria ; Mensink, Marco - \ 2020
    Experimental Gerontology 141 (2020). - ISSN 0531-5565
    Ageing - Exercise - Physical function - Prehabilitation - Protein

    Background: Prehabilitation might attenuate common surgery-induced losses in muscle mass and physical performance. Beneficial effects of physical exercise with protein supplementation have been reported in older adults, but typically after an intervention of at least 12 weeks. The time-window for pre-surgery training is often limited to around 30 days, and it is not known if it is possible to achieve comparable results in such a short time window. Objectives: The aim of this study was to pilot-test the effectiveness of a controlled four-week combined exercise and protein supplementation program on skeletal muscle-related outcomes in a Dutch older adult population. Design: This study was a one-armed pilot trial. Participants: Seventeen older men and women, aged 55-75y, not scheduled for surgery. Intervention: A 4-week intervention program consisting of a twice-weekly supervised resistance and high-intensity aerobic exercise training of 75 min, combined with daily protein supplementation (2 doses of 15.5 g/day at breakfast and lunch). Measurement: After two and four weeks, isometric quadriceps maximal voluntary contraction (MVC) was assessed via Biodex and quadriceps cross-sectional area (CSA) via magnetic resonance imaging. Other outcome measures were handgrip strength, chair rise time and maximal aerobic capacity (VO2-max), as assessed from a submaximal exercise test. Results: Compliance to the supervised training sessions (99.3%) and the protein supplementation (97%) was very high. The 4-week exercise and protein program led to an increase in quadriceps CSA of 2.3 ± 0.7 cm2 (P = 0.008) in the dominant leg and 3.2 ± 0.7 cm2 (P < 0.001) in the non-dominant leg. Isometric quadriceps MVC increased in the dominant leg (Δ14 ± 4 Nm, P = 0.001) and in the non-dominant leg (Δ17 ± 5 Nm, P = 0.003). Chair rise test time improved with −3.8 ± 0.5 s (P < 0.0001), and VO2-max improved with 3.3 ± 1.1 ml/min/kg (P = 0.014). We observed no changes in body weight and handgrip strength. Conclusion: A 4-week exercise and protein intervention led to improvements in muscle-related outcomes in older adults with low levels of physical activity.

    A context analysis on how oral care is delivered in hospitalised patients: A mixed-methods study
    Noort, Harm H.J. van; Witteman, Ben J.M. ; Hertog-Voortman, Ria den; Everaars, Babette ; Vermeulen, Hester ; Huisman-de Waal, Getty - \ 2020
    Journal of Clinical Nursing 29 (2020)11-12. - ISSN 0962-1067 - p. 1991 - 2003.
    fundamental care - hospitalised patients - interviews - mixed methods - nondental care professional - nursing - oral care - oral health - oral health assessment tool - oral hygiene

    Aims and Objectives: To analyse oral care delivery in one hospital through exploring experiences from both nurses’ and patients’ perspectives and examining patients’ oral health. Background: Oral health problems are associated with undernutrition and other general health outcomes. Although oral care belongs to the essentials of nursing, it is often neglected. Improving oral health may require behaviour change of both nurses and patients. Defining tailored strategies need a clear view on the context. Design: A context analysis in one hospital using a convergent parallel mixed-methods design was reported following the EQUATOR guidelines using two checklists: COnsolidated criteria for REporting Qualitative research (qualitative research) and STROBE (observational research). Methods: Semi-structured interviews were conducted with 19 nurses and 11 patients. The topic list was based on the Integrated Change Model. Prospective oral examination was performed among 91 surgical patients using the Oral Health Assessment Tool (OHAT). Results: Nurses acknowledged that they did not prioritise oral care in daily practice. Furthermore, they lacked knowledge and skills to identify and provide care for oral problems. Nurses mentioned helpful resources to perform oral care, like standardised language and instruments. However, they had no access to or were unaware of them. Patients admitted that they did not prioritise oral care due to their sickness during hospitalisation, were unaware of the importance of oral care, but felt responsible for their oral care. The most prominent oral problems identified with the OHAT were unclean mouths (n = 75, 82%), unhealthy gum and tissues (n = 55, 60%) and dry mouth (n = 42, 46%). Conclusions: This context analysis identified inadequate oral care due to lack of positive attitude and knowledge in both nurses and patients, skills for nurses, and resources. Relevance to Clinical Practice: The behavioural factors indicate strategies for development of a multicomponent intervention to improve oral care in this hospital, nutritional status and general health outcomes.

    An outpatient nursing nutritional intervention to prehabilitate undernourished patients planned for surgery : A multicentre, cluster-randomised pilot study
    Noort, Harm H.J. van; Witteman, Ben J.M. ; Vermeulen, Hester ; Huisman-de Waal, Getty ; Hamers, J.P.H. - \ 2020
    Clinical Nutrition 39 (2020)8. - ISSN 0261-5614 - p. 2420 - 2427.
    Essential care - Nursing care - Nutritional support - Prehabilitation - Preoperative care - Undernutrition

    Background & aims: To improve the nutritional status of surgical patients before hospital admission, an Outpatient Nursing Nutritional Intervention (ONNI) was developed. The ONNI comprehends five components: determining causes of undernutrition, performing a nutritional care plan including tailored and general advice, self-monitoring of nutritional intake and eating patterns, counselling and encouragement, and conducting a follow-up telephone call to discuss improvements in nutritional behaviour. Here, we evaluate the feasibility and effectiveness of the ONNI. Methods: In a multi-centred, cluster-randomised pilot study, nurses from outpatient clinics were randomly allocated to usual care (UC) or the ONNI. Patients planned for elective surgery were included if they were at increased risk for undernutrition based on the Malnutrition Universal Screening Tool (MUST) and hospital admission was not planned within seven days. Feasibility outcomes included participation rate, extent of intervention delivery, and patient satisfaction. Nutritional intake was monitored for two days before admission. Body weight, BMI and MUST scores at hospital admission were compared to measurements from the outpatient clinic visit. Data were analysed on an intention-to-treat basis by researchers who were blinded for patients and caregivers. Results: Forty-eight patients enrolled the feasibility phase. Participation rate was 72%. Nurses delivered all intervention components adequately in the end of the implementation period. Finally, 152 patients (IG: n = 66, 43%) participated in the study. A significant difference in mean energy intake (870 kcal/d, 95%CI:630-1109 p < 0.000) and mean protein intake (34.1 g/d, 95%CI: 25.0–43.2; p < 0.000) was observed in favour of the IG. Nutritional energy requirements were achieved in 74% (n = 46) of the IG and in 17% (n = 13) of the UC group (p < 0.000), and protein requirements were achieved in 52% (n = 32) of the IG, compared to 8% (n = 6) of the UC group (p < 0.000). Body weight, BMI and MUST scores did not change in either group. Conclusions: The ONNI is a feasible and effective intervention tool for nurses at outpatient clinics. Patients in the IG had more nutritional intake and fulfilled nutritional requirements significantly more often than patients receiving UC. Further research is required to determine the optimal pre-operative timing of nutritional support and to measure its effect on other patients groups. Clinical trial registration: The study protocol was registered at the ClinicalTrial.gov website with the following identifier: NCT02440165.

    Efficacy and Safety of Peppermint Oil in a Randomized, Double-Blind Trial of Patients With Irritable Bowel Syndrome
    Weerts, Zsa Zsa R.M. ; Masclee, Ad A.M. ; Witteman, Ben J.M. ; Clemens, Cees H.M. ; Winkens, Bjorn ; Brouwers, Jacobus R.B.J. ; Frijlink, Henderik W. ; Muris, Jean W.M. ; Wit, Niek J. De; Essers, Brigitte A.B. ; Tack, Jan ; Snijkers, Johanna T.W. ; Bours, Andrea M.H. ; Ruiter-van der Ploeg, Annieke S. de; Jonkers, Daisy M.A.E. ; Keszthelyi, Daniel - \ 2020
    Gastroenterology 158 (2020)1. - ISSN 0016-5085 - p. 123 - 136.
    Functional Gastrointestinal Disorder - PERSUADE Study - RCT - Treatment

    Background & Aims: Peppermint oil is frequently used to treat irritable bowel syndrome (IBS), despite a lack of evidence for efficacy from high-quality controlled trials. We studied the efficacy and safety of small-intestinal–release peppermint oil in patients with IBS and explored the effects of targeted ileocolonic-release peppermint oil. Methods: We performed a double-blind trial of 190 patients with IBS (according to Rome IV criteria) at 4 hospitals in The Netherlands from August 2016 through March 2018; 189 patients were included in the intent-to-treat analysis (mean age, 34.0 years; 77.8% female; 57.7% in primary care), and 178 completed the study. Patients were randomly assigned to groups given 182 mg small-intestinal–release peppermint oil, 182 mg ileocolonic-release peppermint oil, or placebo for 8 weeks. The primary endpoint was abdominal pain response, as defined by the US Food and Drug Administration: at least a 30% decrease in the weekly average of worst daily abdominal pain compared with baseline in at least 4 weeks. The co-primary endpoint was overall relief of IBS symptoms, as defined by the European Medicines Agency. Secondary endpoints included abdominal pain, discomfort, symptom severity, and adverse events. Results: Abdominal pain response did not differ significantly between the peppermint oil and placebo groups: 29 of 62 patients in the small-intestinal–release peppermint oil group had a response (46.8%, P =. 170 vs placebo), 26 of 63 patients in the ileocolonic-release peppermint oil group had a response (41.3%, P =. 385 vs placebo), and 22 of 64 patients in the placebo group had a response (34.4%). We did not find differences among the groups in overall relief (9.7%, P =. 317 and 1.6%, P =. 351 vs 4.7% for placebo). The small intestinal peppermint oil did, however, produce greater improvements than placebo in secondary outcomes of abdominal pain (P =. 016), discomfort (P =. 020), and IBS severity (P =. 020). Adverse events, although mild, were more common in both peppermint oil groups (P <. 005). Conclusions: In a randomized trial of patients with IBS, we found that neither small-intestinal–release nor ileocolonic-release peppermint oil (8 weeks) produced statistically significant reductions in abdominal pain response or overall symptom relief, when using US Food and Drug Administration/European Medicines Agency recommended endpoints. The small-intestinal–release peppermint oil did, however, significantly reduce abdominal pain, discomfort, and IBS severity. These findings do not support further development of ileocolonic-release peppermint oil for treatment of IBS. Clinicaltrials.gov, Number: NCT02716285.

    Schatting van de FODMAP-inname
    Brondijk, M. ; Witteman, B.J.M. ; Collins, M. ; Janssen, A. - \ 2019
    Nederlands Tijdschrift voor Voeding en Dietetiek 74 (2019)2. - ISSN 1875-9955 - p. 40 - 41.
    Intestinal Permeability Measured by Urinary Sucrose Excretion Correlates with Serum Zonulin and Faecal Calprotectin Concentrations in UC Patients in Remission
    Wegh, C.A.M. ; Roos, N.M. De; Hovenier, R. ; Meijerink, J. ; Besseling-Van Der Vaart, I. ; Hemert, S. Van; Witteman, B.J.M. - \ 2019
    Journal of Nutrition and Metabolism 2019 (2019). - ISSN 2090-0724

    Background and Aims. Ulcerative colitis (UC) is associated with an increased intestinal permeability, possibly through a dysbiosis of intestinal bacteria. We investigated which markers are most relevant to assess intestinal permeability in UC patients and whether probiotics had an effect on these markers. Methods. In this twelve-week placebo-controlled randomized double-blind study, twenty-five subjects with UC in remission received either placebo or a multispecies probiotics. Samples of blood, urine, and faeces were taken at baseline, week 6, and week 12 to assess intestinal permeability and inflammation. Diaries and Bristol stool scale were kept to record stool frequency and consistency. Quality of life was scored from 32-224 with the inflammatory bowel disease questionnaire (IBD-Q). Results. This group of UC patients, in clinical remission, did not show increased intestinal permeability at baseline of this study. During the study, no significant group or time effects were found for intestinal permeability measured by the 5-sugar absorption test, serum zonulin, and faecal zonulin. Likewise, the inflammatory markers C-reactive protein (CRP), calprotectin, and the cytokines IFNγ, TNFα, IL-6, and IL-10 were not significantly affected. Stool frequency and consistency were not significantly affected either. The IBD-Q score, 194 for the probiotics group and 195 for the placebo group, remained unaffected. Correlations were tested between all outcomes; urinary sucrose excretion was significantly correlated with serum zonulin (r = 0.62) and faecal calprotectin (r = 0.55). Faecal zonulin was not significantly correlated with any of the other markers. Conclusion. Serum zonulin may be a more relevant biomarker of intestinal permeability than faecal zonulin, due to its correlation with other biomarkers of intestinal permeability. UC patients in remission did not show an effect of the probiotic treatment or a change in gut permeability. This should not discourage further studies because effects might be present during active disease or shortly after a flare up.

    Patient's Dietary Beliefs and Behaviours in Inflammatory Bowel Disease
    Vries, Jeanne H.M. de; Dijkhuizen, Milou ; Tap, Petra ; Witteman, Ben J.M. - \ 2019
    Digestive Diseases 37 (2019)2. - ISSN 0257-2753 - p. 131 - 139.
    Crohn's disease - Inflammatory bowel disease - Nutrition - Patient's perspective - Ulcerative colitis

    Background: The inflammatory bowel disease (IBD) is a chronic lifelong inflammation that may affect the entire gastro-intestinal tract in Crohn's disease and the colon in ulcerative colitis (UC). Diet plays an important role in IBD patients and many of them follow strict diet restriction in order to reduce complaints and prolong remission intervals. The aim of this study was to assess dietary beliefs, dietary behaviour and nutrition knowledge in Dutch adults with IBD to enable considering the patient's perspective on dietary advice. Methods: A self-administered online questionnaire assessing general characteristics, dietary beliefs and behaviour, nutrition knowledge and sources and dietary advice was devised. The questionnaire was distributed to members of the Dutch Crohn and UC patient association of whom 294 participated in the study. Results: Fifty-nine per cent of the patients valued nutrition to be either more or equally important compared to medication for their treatment and 62% believed diet to be more important in influencing the disease course. Sixty-two per cent reported to be successful in controlling disease symptoms through dietary adaptations. Avoiding certain foods was preferred over eating more beneficial foods or following specific diets (77 vs. 57% and 48% respectively). Dietary supplements were used by 68% of the IBD patients. Although over 71% had received dietary advice mainly by dieticians, 81% stated that the main source of their nutritional knowledge related to IBD was their own experience. Conclusion: A subgroup of IBD patients considered diet to be a more important and successful managing tool than medication to relieve their disease symptoms.

    Dietary intake of patients with inflammatory bowel disease: A comparison with individuals from a general population and associations with relapse
    Opstelten, Jorrit L. ; Vries, Jeanne H.M. de; Wools, Anouk ; Siersema, Peter D. ; Oldenburg, Bas ; Witteman, Ben J.M. - \ 2019
    Clinical Nutrition 38 (2019)4. - ISSN 0261-5614 - p. 1892 - 1898.
    Crohn's disease - Diet - Inflammatory bowel disease - Relapse - Ulcerative colitis

    Background and aims: Individuals with inflammatory bowel disease (IBD) often hold strong beliefs on how diet impacts their disease. This study aimed to compare dietary intakes between IBD patients and individuals from the general population and to assess associations of dietary factors with relapse in patients with IBD. Methods: Patients with longstanding Crohn's disease and ulcerative colitis (n = 165) filled out food frequency questionnaires, as did individuals participating in a Dutch population-based study (controls) (n = 1469). Multivariable regression analyses were used to assess differences in habitual dietary intake between IBD patients and controls, and to estimate associations of dietary factors in patients in remission with the development of disease relapse at follow-up. Results: IBD patients had higher intakes of animal protein (3.50 g/d, 95% confidence interval (CI) 1.67–5.34) and carbohydrate (10.1 g/d, 95% CI 5.23–14.9) than controls and lower intakes of (unsaturated) fat (−3.53 g/d, 95% CI −5.57– −1.50), dietary fiber (−2.19 g/d, 95% CI −3.05– −1.32) and alcohol (−0.84 g/d, 95% CI −1.46– −0.22). This was explained by a higher consumption of carbonated beverages, meat and poultry and lower consumption of fruit, vegetables and dairy products (except cheese) by IBD patients compared with controls. Several dietary factors, particularly (saturated) fat and fiber, appeared to be associated with risk of relapse. Conclusions: IBD patients had higher dietary intakes of (animal) protein and carbohydrate and lower intakes of (unsaturated) fat, dietary fiber and alcohol compared with a general Dutch population. The results further underscore that dietary factors may have a role in disease course.

    Surplus vitamin B12 use does not reduce fatigue in patients with Irritable Bowel Syndrome or inflammatory bowel disease : A randomized double-blind placebo-controlled trial
    Scholten, Anne-Marie ; Vermeulen, Esther ; Dhonukshe-Rutten, Rosalie A.M. ; Verhagen, Teuni ; Visscher, Angeline ; Olivier, Anouk ; Timmer, Lilian ; Witteman, Ben J.M. - \ 2018
    Clinical Nutrition ESPEN 23 (2018). - ISSN 2405-4577 - p. 48 - 53.
    Fatigue - IBD - IBS - Vitamin B supplementation

    Objective: In non-conventional care, high doses of vitamin B12 supplementation are used for the treatment of fatigue even in case of normal vitamin B12 blood levels. We performed a randomized placebo controlled trial to investigate the effect of surplus oral vitamin B12 supplementation on fatigue in patients with IBS or IBD. Methods: This randomized double-blind, placebo-controlled trial included 95 out-clinic IBS and IBD patients with deactivating fatigue and normal vitamin B12 blood levels (≥150 pmol/l) aged 18–65 years. Participants were randomly assigned to receive 1000 μg vitamin B12 daily or a placebo supplement for 8 weeks. The primary outcome measure was fatigue (Checklist Individual Strength (CIS)). In addition, measures of quality of life and depression were examined. Results: No significant difference in scores of the CIS subscale ‘subjective fatigue’ was observed between the intervention group and the control group with changes in scores of −8.1 ± 9.5 and −8.3 ± 10.6 (95% CI −11.65 to 6.71), respectively. The scores on the CIS subscale ‘motivation’ improved with a significant change in scores of −2.2 ± 4.6 (95% CI −4.4 to −0.04). No significantly increased scores were observed for depression or quality of life in the intervention group compared to the control group. Conclusion: This study did not confirm the expected effect of non-conventional surplus vit B12 supplementation on fatigue in IBS or IBD patients. In addition, no positive effect was observed on depression or quality of life. We conclude that surplus treatment with vitamin B12 in IBS and IBD patients suffering from fatigue has no beneficial clinical effect.

    Prediagnostic serum Vitamin D levels and the risk of Crohn's disease and ulcerative colitis in european populations : A nested case-control study
    Opstelten, Jorrit L. ; Chan, Simon S.M. ; Hart, Andrew R. ; Schaik, Fiona D.M. Van; Siersema, Peter D. ; Lentjes, Eef G.W.M. ; Khaw, Kay Tee ; Luben, Robert ; Key, Timothy J. ; Boeing, Heiner ; Bergmann, Manuela M. ; Overvad, Kim ; Palli, Domenico ; Masala, Giovanna ; Racine, Antoine ; Carbonnel, Franck ; Boutron-Ruault, Marie Christine ; Tjønneland, Anne ; Olsen, Anja ; Andersen, Vibeke ; Kaaks, Rudolf ; Kuhn, Tilman ; Tumino, Rosario ; Trichopoulou, Antonia ; Peeters, Petra H.M. ; Verschuren, W.M.M. ; Witteman, Ben J.M. ; Oldenburg, Bas - \ 2018
    Inflammatory Bowel Diseases 24 (2018)3. - ISSN 1078-0998 - p. 633 - 640.
    Crohn's disease - etiology - inflammatory bowel disease - ulcerative colitis - Vitamin D

    Background A low vitamin D status has been put forward as a potential risk factor for the development of inflammatory bowel disease (IBD). This study investigated the association between prediagnostic circulating vitamin D concentrations and dietary intakes of vitamin D, and the risk of Crohn's disease (CD) and ulcerative colitis (UC). Methods Among 359,728 participants of the European Prospective Investigation into Cancer and Nutrition cohort, individuals who developed CD or UC after enrollment were identified. Each case was matched with2 controls by center, gender, age, date of recruitment, and follow-up time. At cohort entry, blood samples were collected and dietary vitamin D intakes were obtained from validated food frequency questionnaires. Serum 25-hydroxyvitamin D levels were measured using liquid chromatography-tandem mass spectrometry. Conditional logistic regression was performed to determine the odds of CD and UC. Results Seventy-two participants developed CD and 169 participants developed UC after a median follow-up of 4.7 and 4.1 years, respectively. Compared with the lowest quartile, no associations with the 3 higher quartiles of vitamin D concentrations were observed for CD (p trend = 0.34) or UC (p trend = 0.66). Similarly, no associations were detected when serum vitamin D levels were analyzed as a continuous variable. Dietary vitamin D intakes were not associated with CD (p trend = 0.39) or UC (p trend = 0.83). Conclusions Vitamin D status was not associated with the development of CD or UC. This does not suggest a major role for vitamin D deficiency in the etiology of IBD, although larger studies are needed to confirm these findings.

    Insufficient Protein Intake is Highly Prevalent Among Physically Active Elderly
    Haaf, D.S.M. Ten; Regt, M.F. de; Visser, M. ; Witteman, B.J.M. ; Vries, J.H.M. de; Eijsvogels, T.M.H. ; Hopman, Maria T.E. - \ 2018
    Journal of Nutrition, Health and Aging 22 (2018)9. - ISSN 1279-7707 - p. 1112 - 1114.

    Objectives: Sufficient protein intake and habitual physical activity are key factors in the prevention and treatment of sarcopenia. In the present study, we assessed habitual dietary protein intake and the contribution of animal proteins in male versus female physically active elderly and identified determinants of protein intake. Design: a cross-sectional study. Setting: the study was performed within the Nijmegen Exercise Study. Participants: physically active elderly ≥ 65 yrs. Measurements: Physical activity was assessed using the SQUASH questionnaire and expressed in Metabolic Equivalent of Task hours per week (METhr/wk). Dietary protein intake was determined using a validated food frequency questionnaire (FFQ). Multivariate linear regression analysis was used to determine whether age, sex, educational level, smoking, alcohol intake and physical activity were associated with protein intake (g/kg/d). Results: A total of 910 participants (70±4 yrs, 70% male) were included and reported a habitual physical activity level of 85.0±53.5 METhr/wk. Protein intake was 1.1±0.3 g/kg/d with 57% animal-based proteins for males, and 1.2±0.3 g/kg/d with 59% animalbased proteins for females (both P<0.05). In total, 16%, 42% and 67% of the male elderly and 10%, 34% and 56% of the female elderly did not meet the recommended protein intake of 0.8, 1.0 and 1.2 g/kg/d, respectively. Female sex (β=0.055, P=0.036) and more physical activity (β=0.001, P=0.001) were associated with a higher daily protein intake (g/kg/d). Conclusion: The majority of physically active elderly and in particular males (i.e. 67%) does not reach a protein intake of 1.2 g/kg/d, which may offset the health benefits of an active lifestyle on muscle synthesis and prevention of sarcopenia. Intervention studies are warranted to assess whether protein supplementation may enhance muscle mass and strength in physically active elderly.

    Indirect vs direct assessment of gastric emptying : A randomized crossover trial comparing C-isotope breath analysis and MRI
    Camps, G. ; Mars, M. ; Witteman, B.J.M. ; Graaf, C. de; Smeets, P.A.M. - \ 2018
    Neurogastroenterology & Motility 30 (2018)7. - ISSN 1350-1925
    Breath - Gastric emptying - Isotope - MRI
    Background: Indirect methods to assess gastric emptying (GE), such as 13C breath tests (BT), are commonly used. However, BT usually use a sampling time of 4+ hours. The current study aims to assess the validity of BT for four liquid meals differing in physicochemical properties. To this aim, we compared them to MRI GE-measurements. Methods: Fifteen healthy males (age 22.6 ± 2.4 years, BMI 22.6 ± 1.8 kg/m2) participated in a randomized 2 × 2 crossover experiment. Test foods were liquid meals, which were either thin/thick and 100/500 kcal, labeled with 100 mg of 13C-octanoate. GE was measured with MRI and assessed by 13C recovery from breath. Participants were scanned every 10 minutes and at six time points breath samples were collected up to t = 90 minutes. Two curves were fitted to the data to estimate emptying halftime (t50 Ghoos and t50 Bluck). T50 times were ranked per participant and compared between methods. Key Results: On average, MRI and BT showed similar t50 rankings for the four liquid meals. In comparison to MRI, t50 Ghoos overestimated, while t50 Bluck underestimated GE time. Moreover, more viscous foods were overestimated. In most participants individual t50 time rankings differed significantly between methods. Conclusions & Inferences: BT can assess relative emptying differences on group level and collecting breath data for 90 minutes constitutes a lower burden for participants and the research facility. However, BT has severe shortcomings compared to MRI for individual GE assessment. Notably, food matrix effects should be considered when interpreting the results of BT.
    Oral cholera vaccination promotes homing of IgA+ memory B cells to the large intestine and the respiratory tract
    Splunter, M. van; Hoffen, E. van; Floris-Vollenbroek, E.G. ; Timmerman, H. ; Bos, E.L. van de; Meijer, B. ; Ulfman, L.H. ; Witteman, B. ; Wells, J.M. ; Brugman, S. ; Savelkoul, H.F.J. ; Neerven, R.J.J. van - \ 2018
    Mucosal Immunology 11 (2018)4. - ISSN 1933-0219 - p. 1254 - 1264.
    Oral cholera vaccination is used to induce immune responses in the intestines to protect against cholera infection. However, oral vaccination may also affect immune responses in other mucosal tissues. To study this, tissue-specific homing potential and kinetics of B-cell responses were characterized after oral cholera vaccination. Healthy adult volunteers received two doses of Dukoral® and blood, saliva, nasal wash, and fecal samples were collected over time to detect vaccine-specific antibodies. Additionally, homing potential of lymphocytes to small intestine, colon, airways, skin, and periphery was measured by expression of Integrin β1 and β7, CCR9, CCR10, CCR7, and CLA. After vaccination, antibody responses to cholera toxin B (CTB) and Dukoral® were detected in serum and nasal wash. CTB-specific memory B cells in peripheral blood and tissue homing profiles of memory B cells peaked at day 18. IgA+ memory B cells expressed markers that enable homing to the airways and colon, while IgA− memory B cells primarily expressed small-intestine-homing markers. These data show that oral cholera vaccination has a differential effect on immune responses in various mucosal sites, including the respiratory tract.
    The effects of a multispecies probiotic on migraine and markers of intestinal permeability-results of a randomized placebo-controlled study
    Roos, N.M. De; Hemert, S. Van; Rovers, J.M.P. ; Smits, M.G. ; Witteman, B.J.M. - \ 2017
    European Journal of Clinical Nutrition 71 (2017)12. - ISSN 0954-3007 - p. 1455 - 1462.
    Background/Objectives:Migraine, associated with several gastrointestinal disorders, may result from increased intestinal permeability, allowing endotoxins to enter the bloodstream. We tested whether probiotics could reduce migraine through an effect on intestinal permeability and inflammation.Subjects/Methods:In total, 63 patients were randomly allocated to the probiotic (n=31) or the placebo group (n=32). Participants ingested a multispecies probiotic (5x10 9 colony-forming units) or placebo daily for 12 weeks. Migraine was assessed with the Migraine Disability Assessment Scale (MIDAS), the Headache Disability Inventory (HDI) and headache diaries. At baseline and 12 weeks, intestinal permeability was measured with the urinary lactulose/mannitol test and fecal and serum zonulin; inflammation was measured from interleukin (IL) -6, IL-10, tumor necrosis factor-α and C-reactive protein in serum.Results:The MIDAS migraine intensity score significantly decreased in both groups (P<0.001) and the HDI score significantly decreased in the probiotic group (P=0.032) and borderline in the placebo group (P=0.053). In the probiotics group, patients had a median of 6 migraine days in the first month, 4 in the second month (P=0.002) and 5 in the last month, which was not significantly different from the 5, 4, and 4 days in the placebo group. A ≤3/42day reduction in migraine days was seen in 12/31 patients in the probiotics group versus 7/29 in the placebo group (ns). Probiotic use did not significantly affect medication use, intestinal permeability or inflammation compared to placebo.Conclusions:In this study, we could not confirm significant benefit from a multispecies probiotic compared to a placebo on the outcome parameters of migraine and intestinal integrity.
    Extra B12 bij darmziekte niet beter dan placebo
    Witteman, B.J.M. - \ 2017
    Tissue-specific homing potential and kinetics of B and T cell responses to oral cholera vaccination
    Splunter, M.E. van; Timmerman, H.M. ; Ulfman, L.H. ; Witteman, B.J.M. ; Wells, J.M. ; Brugman, S. ; Savelkoul, H.F.J. ; Hoffen, E. van; Neerven, R.J.J. van - \ 2016
    - p. C1032 - 6.
    Surgery and functional mobility : doing the right thing at the right time
    Dronkers, J. ; Witteman, B. ; Meeteren, N. van - \ 2016
    Techniques in Coloproctology 20 (2016)6. - ISSN 1123-6337 - p. 339 - 341.
    An apple a day... : de rol van voeding in transmurale zorg
    Witteman, Ben J.M. - \ 2015
    Wageningen : Wageningen University - ISBN 9789462571990 - 32
    ziekenhuiszorg - voedsel - chronische darmontstekingen - darmziekten - prikkelbaar colon - coeliakie - narcose - ondervoeding - vasten - darmen - hospital care - food - inflammatory bowel diseases - intestinal diseases - irritable colon - coeliac syndrome - narcosis - undernutrition - fasting - intestines
    'De gemiddelde levensverwachting stijgt in Nederland. Nochtans worden we op jongere leeftijd met chronische aandoeningen geconfronteerd. De kans hierop neemt de komende jaren sterk toe: van 1 miljoen nu naar 1,5 miljoen in 2020. Hierdoor zullen we geconfronteerd worden met voedingsproblemen waarbij een chronische ziekte een rol speelt. Aangepaste voeding, op grond van de onderliggende pathofysiologie, kan naast preventie van progressie van ziekte ook leiden tot een eerder klinisch herstel. De darm als gate-keeper van het lichaam speelt hierbij een belangrijke rol. Voedingsonderzoek bij deze doelgroep, gericht op verbetering van de darmgezondheid kan de patiënt een beter welzijn geven en de gezondheidszorg mogelijk goedkoper maken.'
    Increased prevalence of restless legs syndrome in patients with Crohn’s disease
    Hoek, Patrick D. ; Smits, Marcel G. ; Roos, N.M. de; Rijsman, Roselyne M. ; Witteman, B.J.M. - \ 2015
    European Journal of Gastroenterology & Hepatology 27 (2015)8. - ISSN 0954-691X - p. 951 - 955.
    Crohn’s disease - quality of life - restless legs syndrome
    OBJECTIVE:
    To determine (a) the incidence of restless legs syndrome (RLS) in patients with Crohn's disease (CD), (b) whether and how the occurrence and severity of RLS is related to severity of CD, and (c) how RLS influences the quality of life of CD patients.
    BASIC METHODS:
    We carried out a cross-sectional questionnaire study in a random selection of 144 CD patients and 80 controls. Differences were calculated using a χ-test (categorical data), an independent T-test (continuous data, normal distribution), or a Mann-Whitney U-test (continuous data, non-normal distribution). Logistic regression analysis was carried out to establish the relation between CD and RLS after adjusting for risk factors.
    MAIN RESULTS:
    The prevalence of RLS was 25.7% (37/144) in CD patients compared with 12.5% (10/80) in the control group (P=0.02). CD patients using caffeine and patients with arthralgias had a higher risk for RLS. A higher score on the modified Harvey Bradshaw Index and CD-related surgery were also associated with a higher risk for RLS. CD-related surgery was also associated with a more severe course of RLS. Patients and controls with RLS had a lower score on 'physical functioning', one of the subcategories of the RAND-36 quality-of-life questionnaire.
    PRINCIPAL CONCLUSION:
    RLS occurs more frequently in patients with CD compared with healthy individuals. A more severe course of CD seems to be associated with a higher risk for RLS. The presence of RLS has a negative influence on quality of life, mainly interfering with physical activities of daily life
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