Objective: Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake.Methods: In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed.Results: Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake.Conclusion: Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI.
Background/purpose: For prevention of sarcopenia and functionaldecline in community-dwelling older adults, a higher daily proteinintake is needed. A new e-health strategy for dietary counselling wasused with the aim to increase total daily protein intake to optimallevels (minimal 1.2 g/kg/day, optimal 1.5 g/kg/day) through use ofregular food products.Methods: The VITAMIN (VITal Amsterdam older adults IN the city)RCT included 245 community-dwelling older adults (age ≥ 55y):control, exercise, and exercise plus dietary counselling (protein)group. The dietary counselling intervention was based on behaviourchange and personalization. Dietary intake was measured by a 3ddietary record at baseline, after 6-month intervention and 12-monthfollow-up. The primary outcome was average daily protein intake(g/kg/day). Sub-group analysis and secondary outcomes includeddaily protein distribution, sources, product groups. A Linear MixedModels (LMM) of repeated measures was performed with STATAv13.Results: Mean age of the 224 subjects was 72.0(6.5) years, a BMI of26.0(4.2). The LMM showed a significant effect of time and time*group(p<0.001). The dietary counselling group showed higher protein intakethan either control (1.41 vs 1.13 g/kg/day; β +0.32; p<0.001) or exercisegroup (1.41 vs 1.11 g/kg/day; β +0.33; p<0.001) after 6-month interventionand 12-month follow-up.Conclusions and implications: This study shows digitally supporteddietary counselling improves protein intake sufficiently in communitydwellingolder adults with use of regular food products. Protein intakeincrease by personalised counselling with e-health is a promising strategyfor dieticians.
Objective: To examine the prevalence of sarcopenia and its association with protein intake in men and women in a multi-ethnic population. Design: We used cross-sectional data from the HELIUS (Healthy Life in an Urban Setting) study, which includes nearly 25,000 participants (aged 18–70 years) of Dutch, South-Asian Surinamese, African Surinamese, Turkish, Moroccan, and Ghanaian ethnic origin. For the current study, we included 5161 individuals aged 55 years and older. Sarcopenia was defined according to the EWGSOP2. In a subsample (N = 1371), protein intake was measured using ethnic-specific Food Frequency Questionnaires. Descriptive analyses were performed to study sarcopenia prevalence across ethnic groups in men and women, and logistic regression analyses were used to study associations between protein intake and sarcopenia. Results: Sarcopenia prevalence was found to be sex- and ethnic-specific, varying from 29.8% in Turkish to 61.3% in South-Asian Surinamese men and ranging from 2.4% in Turkish up to 30.5% in South-Asian Surinamese women. Higher protein intake was associated with a 4% lower odds of sarcopenia in the subsample (OR = 0.96, 95%-CI: 0.92–0.99) and across ethnic groups, being only significant in the South-Asian Surinamese group. Conclusion: Ethnic differences in the prevalence of sarcopenia and its association with protein intake suggest the need to target specific ethnic groups for prevention or treatment of sarcopenia.
While the creation of an energy deficit (ED) is required for weight loss, it is well documented that actual weight loss is generally lower than what expected based on the initially imposed ED, a result of adaptive mechanisms that are oppose to initial ED to result in energy balance at a lower set-point. In addition to leading to plateauing weight loss, these adaptive responses have also been implicated in weight regain and weight cycling (add consequences). Adaptions occur both on the intake side, leading to a hyperphagic state in which food intake is favored (elevated levels of hunger, appetite, cravings etc.), as well as on the expenditure side, as adaptive thermogenesis reduces energy expenditure through compensatory reductions in resting metabolic rate (RMR), non-exercise activity expenditure (NEAT) and the thermic effect of food (TEF). Two strategies that have been utilized to improve weight loss outcomes include increasing dietary protein content and increasing energy flux during weight loss. Preliminary data from our group and others demonstrate that both approaches - especially when combined - have the capacity to reduce the hyperphagic response and attenuate reductions in energy expenditure, thereby minimizing the adaptive mechanisms implicated in plateauing weight loss, weight regain and weight cycling. Past research has largely focused on one specific component of energy balance (e.g. hunger or RMR) rather than assessing the impact of these strategies on all components of energy balance. Given that all components of energy balance are strongly connected with each other and therefore can potentially negate beneficial impacts on one specific component, the primary objective of this application is to use a comprehensive approach that integrates all components of energy balance to quantify the changes in response to a high protein and high energy flux, alone and in combination, during weight loss (Fig 1). Our central hypothesis is that a combination of high protein intake and high energy flux will be most effective at minimizing both metabolic and behavioral adaptations in several components of energy balance such that the hyperphagic state and adaptive thermogenesis are attenuated to lead to superior weight loss results and long-term weight maintenance.
