|Improved nutritional care of malnourished older adults : a matter of interdisciplinary communication and collaboration
Verwijs, Marije ; Puijk‐Hekman, S. ; Heijden, E. van der; Vasse, E. ; Groot, C.P.G.M. de; Schueren, M.A.E. - \ 2020
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Associations Between Nutrient Intake and Corresponding Nutritional Biomarker Levels in Blood in a Memory Clinic Cohort: The NUDAD Project
Leeuw, Francisca A. de; Rest, Ondine van de; Doorduijn, Astrid S. ; Fieldhouse, Jay L.P. ; Schueren, Marian A.E. de van der; Visser, Marjolein ; Heuvel, Ellen G.H.M. van den; Scheltens, Philip ; Teunissen, Charlotte E. ; Kester, Maartje I. ; Flier, Wiesje M. van der - \ 2020
Journal of the American Medical Directors Association (2020). - ISSN 1525-8610
Diet is a promising intervention target to prevent or slow Alzheimer's disease (AD). Early (predementia) stages of AD offer a unique opportunity for dietary interventions. Nutritional assessment methods to estimate nutrient intake have, however, not been validated in clinical populations. Hence, we assessed the association between nutrient intake assessed by food frequency questionnaire (FFQ) and nutrient status measured by nutritional biomarkers in blood in a clinical sample of controls, mild cognitive impairment (MCI), and patients with AD.
Interdisciplinary communication and collaboration as key to improved nutritional care of malnourished older adults across health‐care settings – A qualitative study
Verwijs, Marije H. ; Puijk‐Hekman, Saskia ; Heijden, Ellen ; Vasse, Emmelyne ; Groot, Lisette C.P.G.M. ; Schueren, Marian A.E. - \ 2020
Health Expectations (2020). - ISSN 1369-6513
Malnutrition is a risk factor for impaired functionality and independence. For optimal treatment of malnourished older adults (OA), close collaboration and communication between all stakeholders involved (OA, their caregivers and health‐care and welfare professionals) is important. This qualitative study assesses current collaboration and communication in nutritional care over the continuum of health‐care settings and provides recommendations for improvement.
Eleven structured focus group interviews and five individual interviews took place in three regions across the Netherlands from November 2017 until February 2018, including OA, caregivers and health‐care and welfare professionals. Various aspects of collaboration and communication between all stakeholders were discussed. Interviews were transcribed and analysed using a thematic approach.
Six main themes emerged: causes of malnutrition, knowledge and awareness, recognition and diagnosis of malnutrition, communication, accountability and food preparation and supply. Physical and social aspects were recognized as important risk factors for malnutrition. Knowledge and awareness regarding malnutrition were acknowledged as being insufficient among all involved. This may impair timely recognition and diagnosis. Responsibility for nutritional care and its communication to other disciplines are low. Food preparation and supply in hospitals, rehabilitation centres and home care are below expected standards.
Many stakeholders are involved in nutritional care of OA, and lack of communication and collaboration hinders continuity of nutritional care over health‐care settings. Lack of knowledge is an important risk factor. Establishing one coordinator of nutritional care is suggested to improve collaboration and communication across health‐care settings.
A suboptimal diet is associated with poorer cognition: The NUDAD project
Fieldhouse, Jay L.P. ; Doorduijn, Astrid S. ; Leeuw, Francisca A. de; Verhaar, Barbara J.H. ; Koene, Ted ; Wesselman, Linda M.P. ; Schueren, Marian de van der; Visser, Marjolein ; Rest, Ondine van de; Scheltens, Philip ; Kester, Maartje I. ; Flier, Wiesje M. van der - \ 2020
Nutrients 12 (2020)3. - ISSN 2072-6643
Dementia - Food intake - Mild cognitive impairment - Neuropsychological functioning - Nutrition
Nutrition is one of the modifiable risk factors for cognitive decline and Alzheimer’s disease (AD) dementia, and is therefore highly relevant in the context of prevention. However, knowledge of dietary quality in clinical populations on the spectrum of AD dementia is lacking, therefore we studied the association between dietary quality and cognitive impairment in Alzheimer’s disease (AD) dementia, mild cognitive impairment (MCI) and controls. We included 357 participants from the NUDAD project (134 AD dementia, 90 MCI, 133 controls). We assessed adherence to dietary guidelines (components: vegetables, fruit, fibers, fish, saturated fat, trans‐fat, salt, and alcohol), and cognitive performance (domains: memory, language, visuospatial functioning, attention, and executive functioning). In the total population, linear regression analyses showed a lower vegetable intake is associated with poorer global cognition, visuospatial functioning, attention and executive functioning. In AD dementia, lower total adherence to dietary guidelines and higher alcohol intake were associated with poorer memory, a lower vegetable intake with poorer global cognition and executive functioning, and a higher trans‐fat intake with poorer executive functioning. In conclusion, a suboptimal diet is associated with more severely impaired cognition—this association is mostly attributable to a lower vegetable intake and is most pronounced in AD dementia.
Joint action malnutrition in the elderly (MaNuEL) knowledge hub: summary of project findings
Volkert, D. ; Visser, M. ; Corish, C.A. ; Geisler, C. ; Groot, L. de; Cruz-Jentoft, A.J. ; Lohrmann, C. ; O’Connor, E.M. ; Schindler, K. ; Schueren, M.A.E. de van der - \ 2020
European Geriatric Medicine 11 (2020). - ISSN 1878-7649 - p. 169 - 177.
Aged - Education - Healthcare professionals - Policy - Prevalence - Protein–energy malnutrition - Screening - Treatment
Purpose: The Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub was established to extend scientific knowledge, strengthen evidence-based practice, build a sustainable, transnational network of experts and harmonize research and clinical practice in the field of protein–energy malnutrition in older persons. This paper aims to summarize the main scientific results achieved during the 2-year project and to outline the recommendations derived. Methods: 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand) worked together on 6 relevant domains of malnutrition—i.e. prevalence, screening, determinants, treatment, policy measures and education for health care professionals—making use of existing datasets, evidence and expert knowledge. Results: Four systematic reviews, six secondary data analyses of existing cohort and intervention studies, two web-based surveys and one Delphi study were performed. In addition, a scoring system to rate malnutrition screening tools and a theoretical framework on the aetiology of malnutrition in older persons were developed. Based on these activities and taking existing evidence into consideration, 13 clinical practice, 9 research and 4 policy recommendations were developed. The MaNuEL Toolbox was created and made available to effectively distribute and disseminate the MaNuEL results and recommendations. Conclusions: The MaNuEL Knowledge Hub successfully achieved its aims. Results and recommendations will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein–energy malnutrition in the older population.
Olfactory and gustatory functioning and food preferences of patients with Alzheimer’s disease and mild cognitive impairment compared to controls: the NUDAD project
Doorduijn, A.S. ; Schueren, M.A.E. de van der; Rest, O. van de; Leeuw, F.A. de; Fieldhouse, J.L.P. ; Kester, M.I. ; Teunissen, C.E. ; Scheltens, P. ; Flier, W.M. van der; Visser, M. ; Boesveldt, S. - \ 2020
Journal of Neurology 267 (2020)1. - ISSN 0340-5354 - p. 144 - 152.
Cognition - Dementia - Malnutrition - Older adults
Our aim is to compare olfactory and gustatory function and food preferences of patients with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD) with controls. We included 22 patients with MCI, 30 patients with AD and 40 controls and assessed olfactory threshold, odor discrimination and odor identification (Sniffin’ Sticks), gustatory functioning (Taste Strips), and food preferences (Macronutrient and Taste Preference Ranking Task). Linear regression analyses were used to study associations of five cognitive domains or AD biomarkers with olfactory functioning. Groups did not differ in olfactory threshold, gustatory function and food preferences. Patients with MCI and AD scored lower on odor discrimination and identification than controls. Poorer memory, but no other cognitive domain, was associated with poorer odor discrimination and odor identification, but not with odor threshold. No associations with AD biomarkers were found. In conclusion, patients with MCI and AD have poorer odor discrimination and identification ability than controls, but similar detection thresholds. This is likely a consequence of poorer memory rather than directly caused by AD pathology.
Associations of AD biomarkers and cognitive performance with nutritional status: The NUDAD project
Doorduijn, Astrid S. ; Visser, Marjolein ; Rest, Ondine van de; Kester, Maartje I. ; Leeuw, Francisca A. de; Boesveldt, Sanne ; Fieldhouse, Jay L.P. ; Heuvel, Ellen G.H.M. van den; Teunissen, Charlotte E. ; Scheltens, Philip ; Flier, Wiesje M. van der; Schueren, Marian A.E. de van der - \ 2019
Nutrients 11 (2019)5. - ISSN 2072-6643
Alzheimer’s disease - Body composition - Malnutrition - Mild cognitive impairment - Older adults - Subjective cognitive decline
As malnutrition is common in patients with Alzheimer’s disease (AD), we evaluated nutritional status and body composition of patients with AD, mild cognitive impairment (MCI) and controls, and studied associations of AD biomarkers and cognitive performance with nutritional status and body composition. We included 552 participants, of which 198 patients had AD, 135 patients had MCI and 219 controls. We assessed nutritional status (mini nutritional assessment (MNA)) and body composition (body mass index (BMI), fat-free mass (FFM) and waist circumference). Linear regression analyses (adjusted for age, gender and education where appropriate) were applied to test associations of AD biomarkers and cognitive performance on five domains with nutritional parameters (dependent). Patients with MCI and AD had a lower BMI and MNA score than controls. Worse performance in all cognitive domains was associated with lower MNA score, but not with body composition. AD biomarkers were associated with MNA score, BMI and waist circumference, and associations with MNA score remained after adjustment for cognitive performance. Both AD biomarkers and cognitive performance were associated with nutritional status, associations with AD biomarkers remained after adjustment for cognition. Our data suggest that malnutrition is not only related to impaired cognition but also to AD pathology.
Dietary Patterns Are Related to Clinical Characteristics in Memory Clinic Patients with Subjective Cognitive Decline: The SCIENCe Project
Wesselman, Linda M.P. ; Doorduijn, Astrid S. ; Leeuw, Francisca A. de; Verfaillie, Sander C.J. ; Leeuwenstijn-Koopman, Mardou van; Slot, Rosalinde E.R. ; Kester, Maartje I. ; Prins, Niels D. ; Rest, Ondine van de; Schueren, Marian A.E. van der; Scheltens, Philip ; Sikkes, Sietske A.M. ; Flier, Wiesje M. van der - \ 2019
Nutrients 11 (2019)5. - ISSN 2072-6643 - 10 p.
Alzheimer’s disease - cognition - memory clinic - nutrition - prevention - subjective cognitive decline
As nutrition is one of the modifiable risk factors for cognitive decline, we studied the relationship between dietary quality and clinical characteristics in cognitively normal individuals with subjective cognitive decline (SCD). We included 165 SCD subjects (age: 64 ± 8 years; 45% female) from the SCIENCe project, a prospective memory clinic based cohort study on SCD. The Dutch Healthy Diet Food Frequency Questionnaire (DHD-FFQ) was used to assess adherence to Dutch guidelines on vegetable, fruit, fibers, fish, saturated fat, trans fatty acids, salt and alcohol intake (item score 0-10, higher score indicating better adherence). We measured global cognition (Mini Mental State Examination), cognitive complaints (Cognitive Change Index self-report; CCI) and depressive symptoms (Center for Epidemiologic Studies Depression Scale; CES-D). Using principal component analysis, we identified dietary components and investigated their relation to clinical characteristics using linear regression models adjusted for age, sex and education. We identified three dietary patterns: (i) "low-Fat-low-Salt", (ii) "high-Veggy", and (iii) "low-Alcohol-low-Fish". Individuals with lower adherence on "low-Fat-low-Salt" had more depressive symptoms (β -0.18 (-2.27--0.16)). Higher adherence to "high-Veggy" was associated with higher MMSE scores (β 0.30 (0.21-0.64)). No associations were found with the low-Alcohol-low-Fish component. We showed that in SCD subjects, dietary quality was related to clinically relevant outcomes. These findings could be useful to identify individuals that might benefit most from nutritional prevention strategies to optimize brain health.
Efficacy of non-pharmacological interventions to treat malnutrition in older persons : A systematic review and meta-analysis. The SENATOR project ONTOP series and MaNuEL knowledge hub project
Correa-Pérez, Andrea ; Abraha, Iosef ; Cherubini, Antonio ; Collinson, Avril ; Dardevet, Dominique ; Groot, Lisette C.P.G.M. de; Schueren, Marian A.E. van der; Hebestreit, Antje ; Hickson, Mary ; Jaramillo-Hidalgo, Javier ; Lozano-Montoya, Isabel ; O'Mahony, Denis ; Soiza, Roy L. ; Visser, Marjolein ; Volkert, Dorothee ; Wolters, Maike ; Jentoft, Alfonso J.C. - \ 2019
Ageing Research Reviews 49 (2019). - ISSN 1568-1637 - p. 27 - 48.
Elderly, dietary supplementation - Protein energy malnutrition - Review, systematic
Introduction: We aimed to perform a review of SRs of non-pharmacological interventions in older patients with well-defined malnutrition using relevant outcomes agreed by a broad panel of experts. Methods: PubMed, Cochrane, EMBASE, and CINHAL databases were searched for SRs. Primary studies from those SRs were included. Quality assessment was undertaken using Cochrane and GRADE criteria. Results: Eighteen primary studies from seventeen SRs were included. Eleven RCTs compared oral nutritional supplementation (ONS) with usual care. No beneficial effects of ONS treatment, after performing two meta-analysis in body weight changes (six studies), mean difference: 0.59 (95%CI -0.08, 1.96) kg, and in body mass index changes (two studies), mean difference: 0.31 (95%CI -0.17, 0.79) kg/m2 were found. Neither in MNA scores, muscle strength, activities of daily living, timed Up&Go, quality of life and mortality. Results of other intervention studies (dietary counselling and ONS, ONS combined with exercise, nutrition delivery systems) were inconsistent. The overall quality of the evidence was very low due to risk of bias and small sample size. Conclusions: This review has highlighted the lack of high quality evidence to indicate which interventions are effective in treating malnutrition in older people. High quality research studies are urgently needed in this area.
Effectiveness of nutritional interventions in older adults at risk of malnutrition across different health care settings: Pooled analyses of individual participant data from nine randomized controlled trials
Reinders, Ilse ; Volkert, Dorothee ; Groot, Lisette C.P.G.M. de; Beck, Anne Marie ; Feldblum, Ilana ; Jobse, Inken ; Neelemaat, Floor ; Schueren, Marian A.E. de van der; Shahar, Danit R. ; Smeets, Ellen T.H.C. ; Tieland, Michael ; Twisk, Jos W.R. ; Wijnhoven, Hanneke A.H. ; Visser, Marjolein - \ 2019
Clinical Nutrition 38 (2019)4. - ISSN 0261-5614 - p. 1797 - 1806.
Dietary counseling - Oral nutritional supplements - Protein-energy malnutrition - Undernutrition - Weight gain
Background & aims: Protein-energy malnutrition is a health concern among older adults. Improving nutritional status by increasing energy and protein intake likely benefits health. We therefore aimed to investigate effects of nutritional interventions in older adults (at risk of malnutrition) on change in energy intake and body weight, and explore if the intervention effect was modified by study or participants’ characteristics, analysing pooled individual participant data. Methods: We searched for RCTs investigating the effect of dietary counseling, oral nutritional supplements (ONS) or both on energy intake and weight. Principle investigators of eligible studies provided individual participant data. We investigated the effect of nutritional intervention on meaningful increase in energy intake (>250 kcal/day) and meaningful weight gain (>1.0 kg). Logistic generalized estimating equations were performed and ORs with 95% CIs presented. Results: We included data of nine studies with a total of 990 participants, aged 79.2 ± 8.2 years, 64.5% women and mean baseline BMI 23.9 ± 4.7 kg/m2. An non-significant intervention effect was observed for increase in energy intake (OR:1.59; 95% CI 0.95, 2.66) and a significant intervention effect for weight gain (OR:1.58; 95% CI 1.16, 2.17). Stratifying by type of intervention, an intervention effect on increase in energy intake was only observed for dietary counseling in combination with ONS (OR:2.28; 95% CI 1.90, 2.73). The intervention effect on increase in energy intake was greater for women, older participants, and those with lower BMI. Regarding weight gain, an intervention effect was observed for dietary counseling (OR:1.40; 95% CI 1.14, 1.73) and dietary counseling in combination with ONS (OR:2.48; 95% CI 1.92, 3.31). The intervention effect on weight gain was not influenced by participants’ characteristics. Conclusions: Based on pooled data of older adults (at risk of malnutrition), nutritional interventions have a positive effect on energy intake and body weight. Dietary counseling combined with ONS is the most effective intervention.
Energy and Protein Intake of Alzheimer's Disease Patients Compared to Cognitively Normal Controls : Systematic Review
Doorduijn, Astrid S. ; Rest, Ondine van de; Flier, Wiesje M. van der; Visser, Marjolein ; Schueren, Marian A.E. de van der - \ 2019
Journal of the American Medical Directors Association 20 (2019)1. - ISSN 1525-8610 - p. 14 - 21.
malnutrition - mild cognitive impairment - Older adults
Objectives: Protein and energy malnutrition and unintended weight loss are frequently reported in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Possible underlying mechanisms include increased energy expenditure, altered uptake of nutrients, a reduced nutritional intake, or a combination of these 3. We aimed at systematically reviewing the literature to examine potential differences in energy and protein intake in patients with MCI and AD compared to controls as a possible mechanism for unintended weight loss. Design: Systematic review and meta-analysis. Setting: PubMed and Cochrane Electronic databases were searched from inception to September 2017 for case control studies. Participants: Patients with MCI or AD compared to cognitive healthy controls, all adhering to a Western dietary pattern. Measurements: Energy and protein intake. Results: The search resulted in 7 articles on patients with AD versus controls, and none on patients with MCI. Four articles found no differences in energy and protein intakes, 1 found higher intakes in patients with AD, and 1 article found lower intakes in patients with AD compared to controls. One article reported on intakes, but did not test differences. A meta-analysis of the results indicated no difference between patients with AD and controls in energy [−8 kcal/d, 95% confidence interval (CI): −97, 81; P = .85], or protein intake (2 g/d, 95% CI: −4, 9; P = .47). However, heterogeneity was high (I2 > 70%), and study methodology was generally poor or moderate. Conclusion: Contrary to frequently reported unintended weight loss, our systematic review does not provide evidence for a lower energy or protein intake in patients with AD compared to controls. High heterogeneity of the results as well as of participant characteristics, setting, and study methods was observed. High-quality studies are needed to study energy and protein intake as a possible mechanism for unintended weight loss and malnutrition in both patients with MCI and AD.
|Systematic review and meta-analysis of non-pharmacological interventions to treat malnutrition in older people. The SENATOR project (ONTOP series) and MaNuEL Knowledge Hub projecta
Correa-Perez, Andrea ; Abraha, Iosef ; Groot, C.P.G.M. de; Schueren, Marian A.E. de van der; Visser, Marjolein ; Volkert, Dorothee - \ 2018
The effect of nutritional intervention in older adults on handrip strenght and mortality: results from 9 pooled RCTs
Zwienen-Pot, Judith ; Reinders, I. ; Groot, C.P.G.M. de; Beck, A. ; Beck, A. ; Feldblum, I. ; Jobse, I. ; Neelemaat, F. ; Schueren, M.A.E. ; Shahar, D.R. ; Smeets, Ellen ; Tieland, C.A.B. ; Wijnhoven, H.A.H. ; Volkert, D. ; Visser, M. - \ 2017
Clinical Nutrition 36 (2017)Supplement 1. - ISSN 0261-5614 - p. S166 - S167.
Tackling the increasing problem of malnutrition in older persons : The Malnutrition in the Elderly (MaNuEL) Knowledge Hub
Visser, Marjolein ; Volkert, D. ; Corish, C. ; Geisler, C. ; Groot, C.P.G.M. de; Cruz-Jentoft, A.J. ; Lohrmann, C. ; O'Connor, E.M. ; Schindler, K. ; Schueren, D.E. van der - \ 2017
Nutrition Bulletin 42 (2017)2. - ISSN 1471-9827 - p. 178 - 186.
In order to tackle the increasing problem of malnutrition (i.e. protein-energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life (HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNuEL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence-based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNuEL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web-based questionnaires, MaNuEL will provide insight into current clinical practice, policies and health professionals’ education on malnutrition and will make recommendations for improvement. MaNuEL is being advised by a stakeholder board of five experts in geriatric nutrition who represent relevant European professional societies.
Content Validity of a Short Calcium Intake List to Estimate Daily Dietary Calcium Intake of Patients with Osteoporosis
Rasch, L.A. ; Schueren, M.A.E. de van der; Tuyl, L.H.D. van; Bultink, I.E.M. ; Vries, J.H.M. de; Lems, W.F. - \ 2017
Calcified Tissue International 100 (2017)3. - ISSN 0171-967X - p. 271 - 277.
Calcium - Dietary history - Osteoporosis - Questionnaire - Supplementation - Validation
Purpose: Calcium supplements are prescribed for prevention of osteoporotic fractures, but there is controversy whether excess of calcium intake is associated with cardiovascular events. While an accurate estimation of dietary calcium intake is a prerequisite to prescribe the adequate amount of supplementation, the most adequate tools for estimating intake are time-consuming. The aim of this study is to validate a short calcium intake list (SCaIL) that is feasible in daily clinical practice. Methods: Based on the food groups contributing most to daily dietary calcium intake and portion sizes determined in an earlier study, a three-item, 1-min SCaIL was designed. As a reference method, an extensive dietary history (DH) with specific focus on calcium-rich foods and extra attention for portion sizes was performed. Beforehand, a difference of ≥250 mg calcium between both methods was considered clinically relevant. Results: Sixty-six patients with either primary (n = 40) or secondary (n = 26) osteoporosis were included. On average, the SCaIL showed a small and clinically non-relevant difference in calcium intake with the DH: 24 ± 350 mg/day (1146 ± 440 vs. 1170 ± 485 mg, respectively; p = 0.568). Sensitivity and specificity of the SCaIL, compared to the DH, were 73 and 80%, respectively. However, in 50% of the individuals, a clinically relevant difference of ≥250 mg calcium was observed between both methods, while in 17% this was even ≥500 mg. Conclusions: The SCaIL is a quick and easy questionnaire to estimate dietary calcium intake at a group level, but is not sufficiently reliable for use in individual patients. Remarkably, the mean dietary calcium intake estimated by the DH of 1170 mg/day indicates that a large proportion of osteoporosis patients might not even need calcium supplementation, although more data are needed to confirm this finding.
Effect of the daily consumption of protein enriched bread and protein enriched drinking yoghurt on the total protein intake in older adults in a rehabilitation centre: a single blind randomised controlled trial
Til, A.J. van; Naumann, E. ; Cox-Claessens, I.J.H.M. ; Kremer, S. ; Boelsma, E. ; Schueren, D.E. van der - \ 2015
Journal of Nutrition, Health and Aging 19 (2015)5. - ISSN 1279-7707 - p. 525 - 530.
Objectives To investigate the effects of protein enriched bread and drinking yoghurt, substituting regular products, on the total protein intake and the distribution of protein intake over the day in older adults. Design A single blind randomised controlled trial. Setting Rehabilitation centre. Participants Older adults (≥ 55 years) admitted to a rehabilitation centre after hospital discharge (n=34). Intervention Participants received a high protein diet (protein enriched bread and protein enriched drinking yoghurt; n=17) or a regular diet (regular bread and regular drinking yoghurt; n=17) for three consecutive weeks. Measurements Total protein intake and protein intake per meal, measured twice weekly over a three weeks period (six measurements per participant). Results Compared with controls, patients who received the protein enriched products had a significantly higher protein intake (115.3 g/d vs 72.5 g/d, P<0.001; 1.6 g/kg/d vs 1.1 g/kg/d, P<0.001). The intervention group consumed quantities over the recommended level (25–30 g/meal) during each of the three meals (32.5 g, 30.0 g, 34.8 g/meal), where the control group consumed quantities below the recommended level during breakfast (17.7 g) and lunch (18.4 g). Conclusions The use of protein enriched products, replacing regular products, results in a significant increased daily protein intake in older adults. In addition, the daily consumption of protein enriched products improves protein distribution over the day.
Protein-enriched ‘regular products’ and their effect on protein intake in acute hospitalized older adults; a randomized controlled trial
Stelten, S. ; Dekker, I. ; Ronday, E.M. ; Thijs, A. ; Boelsma, E. ; Peppelenbos, H.W. ; Schueren, M.A.E. - \ 2015
Clinical Nutrition 34 (2015)3. - ISSN 0261-5614 - p. 409 - 414.
Background & aims Especially in older adults, maintaining muscle mass is essential to perform activities of daily living. This requires a sufficient protein intake. However, protein intake in hospitalized older adults is often insufficient. Thus far different nutrition intervention strategies have failed to show success in reaching sufficient protein intake in hospitalized older adults. The effect of recently developed protein-enriched bread and drinking yoghurt on protein intake is still unknown. Therefore, the objective of this study was to examine the effect of protein-enriched bread and drinking yoghurt on the protein intake of acute hospitalized older adults (=55 years). Methods This study was performed as a single blind randomized controlled trial in 47 hospitalized elderly acutely admitted to a university hospital. During three consecutive days participants received either ad libitum protein-enriched bread and drinking yoghurt or normal, non-enriched products as part of their daily meals. The protein-enriched bread contained 6.9 g of protein per serving and the normal bread 3.8 g of protein. For drinking yoghurt this was 20.0 g and 7.5 g of protein per serving respectively. The products were almost isocaloric. Food intake of participants was measured and nutritional values were calculated according to the Dutch Food Composition Table. An independent sample t-test was used to compare protein intake between the intervention and control group. Results Analyses illustrate a protein intake in the intervention group of 75.0 ± 33.2 g per day versus 58.4 ± 14.5 g in the control group (p = 0.039). Intervention patients had a mean protein intake of 1.1 g/kg/day, with 36% of the patients reaching the minimum requirement of 1.2 g/kg/day; in control patients this was 0.9 g/kg/day (p = 0.041) and 8% (p = 0.030). Bread and drinking yoghurt contributed almost equally to the increased intake of protein in the intervention group. Conclusions The use of protein-enriched bread and drinking yoghurt, consumed as part of regular meals, is a promising and feasible solution to increase the protein intake of acutely ill patients. It needs to be confirmed whether the use of these products will also result in a better clinical outcome.
Screening of nutritional status in The Netherlands
Kruizenga, H.M. ; Wierdsma, N.J. ; Bokhorst, M.A.E. van; Schueren, D.E. van der; Hollander, H.J. ; Jonkers-Schuitema, C.F. ; Heijden, E. van der; Melis, G.C. ; Staveren, W.A. van - \ 2003
Clinical Nutrition 22 (2003)2. - ISSN 0261-5614 - p. 147 - 152.
malnutrition - complications - prevalence - disease
Background and Aims: In 2001, the Dutch Dietetic Association conducted a national screening on malnutrition. The goal of this screening was to determine the prevalence of disease-related malnutrition in The Netherlands in all fields of medical care and to investigate the involvement of the dietitian in the treatment of malnutrition. Methods: Eight thousand five hundred and twenty nine patients were screened of which data of 7606 patients could be analysed. Eighty one per cent (6150) of the patients were hospital patients. Eleven per cent (808) of the patients lived in a nursing home. Seven per cent (533) of the patients were home-care patients, who were measured at home or at the general practitioner's office. The origin of 115 patients (2%) was not registered. Age, height, weight, unintentional weight loss, kind of illness and intervention by a dietitian were registered. Malnutrition was defined as >10% unintentional weight loss during the past 6 months and risk of malnutrition was defined as 5-10% unintentional weight loss during the past 6 months. Results: Twelve per cent (884) of all patients appeared to be malnourished. Thirteen per cent (962) were at risk of malnutrition and 75% (5760) were well nourished. Fifty four per cent of the malnourished patients were referred to a dietitian. Oncological disease was more associated with malnutrition than non-oncological disease (in particular in the head and neck, lung and intestinal areas). Also, non-oncological gastro-intestinal and lung disease patients were often categorised as malnourished. Elderly patients (>75 years) were more at risk of malnutrition. BMI and unintentional weight loss did not correlate well. Conclusion: In this national survey conducted by dietitians, including a convenience sample of mainly institutionalised patients, approximately 25% of patients in all medical fields were categorised as moderately or severely malnourished. About half of these patients were seen by a dietitian. (C) 2003 Elsevier Science Ltd. All rights reserved.
|Cloning of two endoglucanase genes from Heterodera schachtii.
Meutter, J. de; Tytgat, T. ; Schueren, E. van der; Smant, G. ; Schots, A. ; Coomans, A. ; Montagu, M. van; Gheysen, G. - \ 1998
In: 24th International Symposium on Crop Protection, Dundee, UK - p. 24 - 24.
|Cloning of two endoglucanase genes from Heterodera schachtii.
Meutter, J. de; Tytgat, T. ; Schueren, E. van der; Smant, G. ; Schots, A. ; Coomans, A. ; Montagu, M. van; Gheysen, G. - \ 1998
Nematologica 44 (1998). - ISSN 0028-2596 - p. 479 - 480.