ObjectivesBody weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients.DesignRESORT is an observational, longitudinal cohort.Setting and ParticipantsGeriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital, Melbourne, Australia (N = 1006).MethodsChanges in body weight and body composition [fat mass (FM), appendicular lean mass (ALM)] from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ.ResultsA total of 1006 patients [median age: 83.2 (77.7–88.8) years, 58.5% female] were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia.Conclusions and ImplicationsIn geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients’ nutritional risk.
ObjectivesTo assess if nutritional interventions informed by indirect calorimetry (IC), compared to predictive equations, show greater improvements in achieving weight goals, muscle mass, strength, physical and functional performance.DesignQuasi-experimental study.Setting and ParticipantsGeriatric rehabilitation inpatients referred to dietitian.Intervention and MeasurementsPatients were allocated based on admission ward to either the IC or equation (EQ) group. Measured resting metabolic rate (RMR) by IC was communicated to the treating dietitian for the IC group but concealed for the EQ group. Achieving weight goals was determined by comparing individualised weight goals with weight changes from inclusion to discharge (weight gain/loss: >2% change, maintenance: ≤2%). Muscle mass, strength, physical and functional performance were assessed at admission and discharge. Food intake was assessed twice over three-days at inclusion and before discharge using plate waste observation.ResultsFifty-three patients were included (IC n=22; EQ n=31; age: 84.3±8.4 years). The measured RMR was lower than the estimated RMR within both groups [mean difference IC −282 (95%CI −490;−203), EQ −273 (−381;−42) kcal/day)] and comparable between-groups (median IC 1271 [interquartile range 1111;1446] versus EQ 1302 [1135;1397] kcal/day, p=0.800). Energy targets in the IC group were lower than the EQ group [mean difference −317 (95%CI −479;−155) kcal/day]. There were no between-group differences in energy intake, achieving weight goals, changes in muscle mass, strength, physical and functional performance.ConclusionsIn geriatric rehabilitation inpatients, nutritional interventions informed by IC compared to predictive equations showed no greater improvement in achieving weight goals, muscle mass, strength, physical and functional performance. IC facilitates more accurate determination of energy targets in this population. However, evidence for the potential benefits of its use in nutrition interventions was limited by a lack of agreement between patients’ energy intake and energy targets.
MULTIFILE
OBJECTIVE: To study the effects of a comprehensive secondary prevention programme on weight loss and to identify determinants of weight change in patients with coronary artery disease (CAD).METHODS: We performed a secondary analysis focusing on the subgroup of overweight CAD patients (BMI ≥27 kg/m2) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. We evaluated weight change from baseline to 12-month follow-up; multivariable logistic regression with backward elimination was used to identify determinants of weight change.RESULTS: Intervention patients (n=280) lost significantly more weight than control patients (n=257) (-2.4±7.1 kg vs -0.2±4.6 kg; p<0.001). Individual weight change varied widely, with weight gain (≥1.0 kg) occurring in 36% of interventions versus 41% controls (p=0.21). In the intervention group, weight loss of ≥5% was associated with higher age (OR 2.94), lower educational level (OR 1.91), non-smoking status (OR 2.92), motivation to start with weight loss directly after the baseline visit (OR 2.31) and weight loss programme participation (OR 3.33), whereas weight gain (≥1 kg) was associated with smoking cessation ≤6 months before or during hospitalisation (OR 3.21), non-Caucasian ethnicity (OR 2.77), smoking at baseline (OR 2.70), lower age (<65 years) (OR 1.47) and weight loss programme participation (OR 0.59).CONCLUSION: The comprehensive secondary prevention programme was, on average, effective in achieving weight loss. However, wide variation was observed. As weight gain was observed in over one in three participants in both groups, prevention of weight gain may be as important as attempts to lose weight.TRIAL REGISTRATION NUMBER: NTR3937.
Recycling of plastics plays an important role to reach a climate neutral industry. To come to a sustainable circular use of materials, it is important that recycled plastics can be used for comparable (or ugraded) applications as their original use. QuinLyte innovated a material that can reach this goal. SmartAgain® is a material that is obtained by recycling of high-barrier multilayer films and which maintains its properties after mechanical recycling. It opens the door for many applications, of which the production of a scoliosis brace is a typical example from the medical field. Scoliosis is a sideways curvature of the spine and wearing an orthopedic brace is the common non-invasive treatment to reduce the likelihood of spinal fusion surgery later. The traditional way to make such brace is inaccurate, messy, time- and money-consuming. Because of its nearly unlimited design freedom, 3D FDM-printing is regarded as the ultimate sustainable technique for producing such brace. From a materials point of view, SmartAgain® has the good fit with the mechanical property requirements of scoliosis braces. However, its fast crystallization rate often plays against the FDM-printing process, for example can cause poor layer-layer adhesion. Only when this problem is solved, a reliable brace which is strong, tough, and light weight could be printed via FDM-printing. Zuyd University of Applied Science has, in close collaboration with Maastricht University, built thorough knowledge on tuning crystallization kinetics with the temperature development during printing, resulting in printed products with improved layer-layer adhesion. Because of this knowledge and experience on developing materials for 3D printing, QuinLyte contacted Zuyd to develop a strategy for printing a wearable scoliosis brace of SmartAgain®. In the future a range of other tailor-made products can be envisioned. Thus, the project is in line with the GoChem-themes: raw materials from recycling, 3D printing and upcycling.
Recent research by the renowned Royal Institution of Chartered Surveyors (RICS) shows that more than 2/3 of all CO2 is emitted during the building process and less than 1/3 during use to heat the building and the tap water. Lightweight, local and biobased materials such as biocomposites to replace concrete and fossil based cladding are in the framework of climate change, a necessity for future building. Using plant fiber in polymer composites is especially interesting for construction since natural fibers exhibit comparative good mechanical properties with small specific weight, which defines the potential for lightweight constructions. The use of renewable resources, will affect the ecosystem favorably and the production costs of construction materials could also decrease. However, one disadvantage of natural fibers in plastics is their hydrophilic properties. In construction the materials need to meet special requirements like the resistance against fluctuating weather conditions (Ticoalu et al., 2010). In contrast to synthetic fibers, the natural ones are more moisture- and UV-radiation-sensitive. That may lead to degradation of these materials and a decreasing in quality of products. (Lopez et al., 2006; Mokhothu und John, 2017) Tanatex and NPSP have approached CoE BBE/Avans to assist in a study where fibres impregnated with the (modified) Tanatex products will be used for reinforcement of thermoset biopolymers. The influence of the different Tanatex products on the moisture absorption of natural/cellulosic fibers and the adhesion on the fibers on main composite matrix will be measured. The effect of Tantex products can optimize the bonding reaction between the resin and the fibers in the (bio) composite and result to improved strength and physico-chemical properties of the biocomposite materials. (word count: 270)
Buildings are responsible for approximately 40% of energy consumption and 36% of carbon dioxide (CO2) emissions in the EU, and the largest energy consumer in Europe (https://ec.europa.eu/energy). Recent research shows that more than 2/3 of all CO2 is emitted during the building process whereas less than 1/3 is emitted during use. Cement is the source of about 8% of the world's CO2 emissions and innovation to create a distributive change in building practices is urgently needed, according to Chatham House report (Lehne et al 2018). Therefore new sustainable materials must be developed to replace concrete and fossil based building materials. Lightweight biobased biocomposites are good candidates for claddings and many other non-bearing building structures. Biocarbon, also commonly known as Biochar, is a high-carbon, fine-grained solid that is produced through pyrolysis processes and currently mainly used for energy. Recently biocarbon has also gained attention for its potential value with in industrial applications such as composites (Giorcellia et al, 2018; Piri et.al, 2018). Addition of biocarbon in the biocomposites is likely to increase the UV-resistance and fire resistance of the materials and decrease hydrophilic nature of composites. Using biocarbon in polymer composites is also interesting because of its relatively low specific weight that will result to lighter composite materials. In this Building Light project the SMEs Torrgas and NPSP will collaborate with and Avans/CoE BBE in a feasibility study on the use of biocarbon in a NPSP biocomposite. The physicochemical properties and moisture absorption of the composites with biocarbon filler will be compared to the biocomposite obtained with the currently used calcium carbonate filler. These novel biocarbon-biocomposites are anticipated to have higher stability and lighter weight, hence resulting to a new, exciting building materials that will create new business opportunities for both of the SME partners.
