Powerpoint presentation used by Robert Baars at his inauguration on September 24, 2021 as lecturer 'Climate Smart Dairy Value Chains' at Van Hall Larenstein University of Applied Sciences.
MULTIFILE
In this review, we present the growing scientific evidence showing the importance of protein and amino acid provision in nutritional support and their impact on preservation of muscle mass and patient outcomes.
Background & aims: In dietary practice, it is common to estimate protein requirements on actual bodyweight, but corrected bodyweight (in cases with BMI <20 kg/m2 and BMI ≥30 kg/m2) and fat free mass (FFM) are also used. Large differences on individual level are noticed in protein requirements using these different approaches. To continue this discussion, the answer is sought in a large population to the following question: Will choosing actual bodyweight, corrected bodyweight or FFM to calculate protein requirements result in clinically relevant differences? Methods: This retrospective database study, used data from healthy persons ≥55 years of age and in- and outpatients ≥18 years of age. FFM was measured by air displacement plethysmography technology or bioelectrical impedance analysis. Protein requirements were calculated as 1) 1.2 g (g) per kilogram (kg) actual bodyweight or 2) corrected bodyweight or 3) 1.5 g per kg FFM. To compare these three approaches, the approach in which protein requirement is based on FFM, was used as reference method. Bland–Altman plots with limits of agreement were used to determine differences, analyses were performed for both populations separately and stratified by BMI category and gender. Results: In total 2291 subjects were included. In the population with relatively healthy persons (n = 506, ≥55 years of age) mean weight is 86.5 ± 18.2 kg, FFM is 51 ± 12 kg and in the population with adult in- and outpatients (n = 1785, ≥18 years of age) mean weight is 72.5 ± 18.4 kg, FFM is 51 ± 11 kg. Clinically relevant differences were found in protein requirement between actual bodyweight and FFM in most of the participants with overweight, obesity or severe obesity (78–100%). Using corrected bodyweight, an overestimation in 48–92% of the participants with underweight, healthy weight and overweight is found. Only in the Amsterdam UMC population, protein requirement is underestimated when using the approach of corrected bodyweight in participants with severe obesity. Conclusion: The three approaches in estimation of protein requirement show large differences. In the majority of the population protein requirement based on FFM is lower compared to actual or corrected bodyweight. Correction of bodyweight reduces the differences, but remain unacceptably large. It is yet unknown which method is the best for estimation of protein requirement. Since differences vary by gender due to differences in body composition, it seems more accurate to estimate protein requirement based on FFM. Therefore, we would like to advocate for more frequent measurement of FFM to determine protein requirements, especially when a deviating body composition is to be expected, for instance in elderly and persons with overweight, obesity or severe obesity.
The reclaiming of street spaces for pedestrians during the COVID-19 pandemic, such as on Witte de Withstraat in Rotterdam, appears to have multiple benefits: It allows people to escape the potentially infected indoor air, limits accessibility for cars and reduces emissions. Before ordering their coffee or food, people may want to check one of the many wind and weather apps, such as windy.com: These apps display the air quality at any given time, including, for example, the amount of nitrogen dioxide (NO2), a gas responsible for an increasing number of health issues, particularly respiratory and cardiovascular diseases. Ships and heavy industry in the nearby Port of Rotterdam, Europe’s largest seaport, exacerbate air pollution in the region. Not surprisingly, in 2020 Rotterdam was ranked as one of the unhealthiest cities in the Netherlands, according to research on the health of cities conducted by Arcadis. Reducing air pollution is a key target for the Port Authority and the City of Rotterdam. Missing, however, is widespread awareness among citizens about how air pollution links to socio-spatial development, and thus to the future of the port city cluster of Rotterdam. To encourage awareness and counter the problem of "out of sight - out of mind," filmmaker Entrop&DeZwartFIlms together with ONSTV/NostalgieNet, and Rotterdam Veldakademie, are collaborating with historians of the built environment and computer science and public health from TU Delft and Erasmus University working on a spatial data platform to visualize air pollution dynamics and socio-economic datasets in the Rotterdam region. Following discussion of findings with key stakeholders, we will make a pilot TV-documentary. The documentary, discussed first with Rotterdam citizens, will set the stage for more documentaries on European and international cities, focusing on the health effects—positive and negative—of living and working near ports in the past, present, and future.
