BACKGROUND & AIMS: Sufficient protein intake is of great importance in hemodialysis (HD) patients, especially for maintaining muscle mass. Daily protein needs are generally estimated using bodyweight (BW), in which individual differences in body composition are not accounted for. As body protein mass is best represented by fat free mass (FFM), there is a rationale to apply FFM instead of BW. The agreement between both estimations is unclear. Therefore, the aim of this study is to compare protein needs based on either FFM or BW in HD patients.METHODS: Protein needs were estimated in 115 HD patients by three different equations; FFM, BW and BW adjusted for low or high BMI. FFM was measured by multi-frequency bioelectrical impedance spectroscopy and considered the reference method. Estimations of FFM x 1.5 g/kg and FFM x 1.9 g/kg were compared with (adjusted)BW x 1.2 and x 1.5, respectively. Differences were assessed with repeated measures ANOVA and Bland-Altman plots.RESULTS: Mean protein needs estimated by (adjusted)BW were higher compared to those based on FFM, across all BMI categories (P < 0.01) and most explicitly in obese patients. In females with BMI >30, protein needs were 69 ± 17.4 g/day higher based on BW and 45 ± 9.3 g/day higher based on BMI adjusted BW, compared to FFM. In males with BMI >30, protein needs were 51 ± 20.4 g/day and 23 ± 20.9 g/day higher compared to FFM, respectively.CONCLUSIONS: Our data show large differences and possible overestimations of protein needs when comparing BW to FFM. We emphasize the importance of more research and discussion on this topic.
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OBJECTIVE: Although it has been established that sufficient protein is required to maintain good nutritional status and support healthy aging, it is not clear if the pattern of protein consumption may also influence nutritional status, especially in institutionalized elderly who are at risk of malnutrition. Therefore, we aim to determine the association between protein intake distribution and nutritional status in institutionalized elderly people.DESIGN: Cross-sectional study among 481 institutionalized older adults.METHODS: Dietary data from 481 ambulant elderly people (68.8% female, mean age 87.5 ± 6.3 years) residing in 52 aged-care facilities in Victoria, Australia, were assessed over 2 days using plate waste analysis. Nutritional status was determined using the Mini-Nutritional Assessment tool and serum (n = 208) analyzed for albumin, hemoglobin, and IGF-1. Protein intake distribution was classified as: spread (even distribution across 3 meals, n = 65), pulse (most protein consumed in one meal, n = 72) or intermediate (n = 344). Regression analysis was used to investigate associations.RESULTS: Mean protein intakes were higher in the spread (60.5 ± 2.0 g/d) than intermediate group (56.0 ± 0.8 g/d, P = .037), and tended to be higher than those in the pulse group (55.9 ± 1.9 g/d, P = .097). Residents with an even distribution of protein intake achieved a higher level of the recommended daily intake for protein (96.2 ± 30.0%) than the intermediate (86.3 ± 26.2%, P = .008) and pulse (87.4 ± 30.5%, P = .06) groups, and also achieved a greater level of their estimated energy requirements (intermediate; P = .039, pulse; P = .001). Nutritional status (Mini-Nutritional Assessment score) did not differ between groups (pulse; 20.5 ± 4.5, intermediate; 21.0 ± 2.5, spread; 20.5 ± 3.5), nor did any other indices of nutritional status.CONCLUSIONS: Meeting protein requirements is required before protein distribution may influence nutritional status in institutionalized elderly. Achieving adequate protein and energy intakes is more likely when protein is distributed evenly throughout the day. Provision of high protein foods especially at breakfast, and in the evening, may support protein adequacy and healthy aging, especially for institutionalized elderly.
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Malnutrition, especially among the elderly in the healthcare environment, is a prevalent problem in The Netherlands, affecting both patients and the healthcare budget. Although oral nutritional supplements (ONS) are often used to restore the nutritional status of a patient, the evaluated current available literature failed to show a coherent picture of the effectiveness of ONS in malnourished patients. In the present study, we used a qualitative research approach to gain insight in the treatment of malnutrition via ONS and food snacks in a single non-academic teaching hospital. Twelve semi-structured interviews with stakeholders (such as dieticians, nurses, care-assistants, physician) were held. Results indicated opportunities for further improvement, for example through the introduction of a screening tool for malnutrition in cognitive impaired patients, better timing for handing out the daily meal plan forms, and improved range and provision of snacks. The stakeholders indicated that taste and physical properties of ONS, but also social environment as well as the physical/mental state and motivation of a patient are important facilitators which should be considered during the prescription. In conclusion, to optimize treatment of malnutrition using ONS and food snacks, the above mentioned opportunities to better match the needs of malnourished patients have to be tackled. Involvement of the different stakeholders within the healthcare facility will be important to implement required changes in nutritional practice.
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End-stage kidney disease patients treated with conventional hemodialysis (CHD) are known to have impaired physical performance and protein-energy wasting (PEW). Nocturnal hemodialysis (NHD) was shown to improve clinical outcomes, but the evidence is limited on physical performance and PEW. We investigate whether NHD improves physical performance and PEW. This prospective, multicenter, non-randomized cohort study compared patients who changed from CHD (2-4 times/week 3-5 h) to NHD (2-3 times/week 7-8 h), with patients who continued CHD. The primary outcome was physical performance at 3, 6 and 12 months, assessed with the short physical performance battery (SPPB). Secondary outcomes were a 6-minute walk test (6MWT), physical activity monitor, handgrip muscle strength, KDQOL-SF physical component score (PCS) and LAPAQ physical activity questionnaire. PEW was assessed with a dietary record, dual-energy X-ray absorptiometry, bioelectrical impedance spectroscopy and subjective global assessment (SGA). Linear mixed models were used to analyze the differences between groups. This study included 33 patients on CHD and 32 who converted to NHD (mean age 55 ± 15.3). No significant difference was found in the SPPB after 1-year of NHD compared to CHD (+0.24, [95% confidence interval -0.51 to 0.99], p = 0.53). Scores of 6MWT, PCS and SGA improved (+54.3 [95%CI 7.78 to 100.8], p = 0.02; +5.61 [-0.51 to 10.7], p = 0.03; +0.71 [0.36 to 1.05], p &lt; 0.001; resp.) in NHD patients, no changes were found in other parameters. We conclude that NHD patients did not experience an improved SPPB score compared to CHD patients; they did obtain an improved walking distance and self-reported PCS as well as SGA after 1-year of NHD, which might be related to the younger age of these patients.
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BACKGROUND: Hemodialysis patients experience an elevated risk of malnutrition associated with increased morbidity and mortality. Nocturnal hemodialysis (NHD) results in more effective removal of waste products and fluids. Therefore, diet and fluid restrictions are less restricted in NHD patients. However, it is ambiguous whether transition from conventional hemodialysis (CHD) to NHD leads to improved intake and nutritional status. We studied the effect of NHD on protein intake, laboratory indices of nutritional status, and body composition.STUDY DESIGN: Systematic review with meta-analysis.POPULATION: NHD patients.SEARCH STRATEGY: Systematic literature search from databases, Medline, Cinahl, EMBASE and The Cochrane Library, to identify studies reporting on nutritional status post-transition from CHD to NHD.INTERVENTION: Transition from CHD to NHD.OUTCOMES: Albumin, normalized protein catabolic rate (nPCR), dry body weight (DBW), body mass index (BMI), phase angle, protein intake, and energy intake.RESULTS: Systematic literature search revealed 13 studies comprising 282 patients that made the transition from CHD to NHD. Meta-analysis included nine studies in 229 patients. In control group controlled studies (n = 4), serum albumin increased significantly from baseline to 4-6 months in NHD patients compared with patients that remained on CHD (mean difference 1.3 g/l, 95% CI 0.02; 2.58, p = 0.05). In baseline controlled studies, from baseline to 4-6 months of NHD treatment, significant increases were ascertained in serum albumin (mean difference (MD) 1.63 g/l, 95% CI 0.73-2.53, p<0.001); nPCR (MD 0.16 g/kg/day; 95% CI 0.04-0.29, p = 0.01); protein intake (MD 18.9 g, 95% CI 9.7-28.2, p<0.001); and energy intake (MD 183.2 kcal, 95% CI 16.8-349.7, p = 0.03). Homogeneity was rejected only for nPCR (baseline versus 4-6 months). DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8-12 months of NHD treatment.LIMITATIONS: Most studies had moderate sample sizes; some had incomplete dietary records and relatively brief follow-up period. Studies markedly differed with regard to study design.CONCLUSIONS: NHD is associated with significantly higher protein and energy intake as well as increases in serum albumin and nPCR. However, the data on body composition are inconclusive.
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Malnutrition is a serious and widespread health problem in community-dwelling older adults who receive care in hospital and at home. Hospital and home care nurses and nursing assistants have a key role in the delivery of high-quality multidisciplinary nutritional care. Nursing nutritional care in current practice, however, is still suboptimal, which impacts its quality and continuity. There appear to be at least two reasons for this. First, there is a lack of evidence for nutritional care interventions to be carried out by nurses. Second, there are several factors, that influence nurses’ and nursing assistants’ current behaviour, such as lack of knowledge, moderate awareness of the importance and neutral attitudes. This results in a lack of attention towards nutritional care. Therefore, there is a need to generate more evidence and to focus on targeting the factors that influence nurses’ and nursing assistants’ current behaviour to eventually promote behaviour change. To increase the likelihood of successfully changing their behaviour, an evidence-based educational intervention is appropriate. This might lead to enhancing nutritional care and positively impact nutritional status, health and well-being of community-dwelling older adults. The general objectives of this thesis are: 1) To understand the current state of evidence regarding nutrition-related interventions and factors that influence current behaviour in nutritional care for older adults provided by hospital and home care nurses and nursing assistants to prevent and treat malnutrition. 2) To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults and to describe the intervention development and feasibility.
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Food and the city has never been a more urgent theme than today, and The European Union’s priority to commit to innovation in this field will certainly enhance its economic and external strength and improve its competitive position in the world of food and life sciences. Europea Netherlands held a seminar on this topic in May 2016, during the Dutch EU presidency.To be part of this international endeavour, the Netherlands need to strengthen the digital market, support innovation in the internal market, boost domestic policy reforms, and embed their knowledge and skills in a European society that challenges itself and continues to innovate. The Netherlands is a global player in the agro, food and horticultural sector and a major player in the export market of agricultural products. This sector is one of its main economic pillars. New knowledge is being developed as we speak, which is also an export product in high demand, providing sizeable employment. This is only possible because the sector is innovative and remains up-to-date. The peri-urban areas in the Netherlands (both urban and rural areas) are characterized by high population density. This necessitates thinking about manufacturing, food, logistics and water management(circular economy). Land-based education and life sciences in the Netherlands may appear to be specific, yet it is broad too: the primary sectors are included, as well as the manufacturing businesses and services associated with it. Participants learn to work in an innovative sector in a society in transition, bringing together multiple disciplines (cross-overs) and stakeholders. This education is practical and has a strong connection to the industry. During the Europea seminar five professorships, installed by the ministry of Economic Affairs, focused on transitions in the agro and food sector. The five professorships are posted at the Dutch Agricultural Universities of applied sciences, including teacher education for sustainable connected learning and development for professional education and business communities.
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Food and the city has never been a more urgent theme than today, and The European Union’s priority to commit to innovation in this field will certainly enhance its economic and external strength and improve its competitive position in the world of food and life sciences. Europea Netherlands held a seminar on this topic in May 2016, during the Dutch EU presidency.To be part of this international endeavour, the Netherlands need to strengthen the digital market, support innovation in the internal market, boost domestic policy reforms, and embed their knowledge and skills in a European society that challenges itself and continues to innovate. The Netherlands is a global player in the agro, food and horticultural sector and a major player in the export market of agricultural products. This sector is one of its main economic pillars. New knowledge is being developed as we speak, which is also an export product in high demand, providing sizeable employment. This is only possible because the sector is innovative and remains up-to-date. The peri-urban areas in the Netherlands (both urban and rural areas) are characterized by high population density. This necessitates thinking about manufacturing, food, logistics and water management(circular economy). Land-based education and life sciences in the Netherlands may appear to be specific, yet it is broad too: the primary sectors are included, as well as the manufacturing businesses and services associated with it. Participants learn to work in an innovative sector in a society in transition, bringing together multiple disciplines (cross-overs) and stakeholders. This education is practical and has a strong connection to the industry. During the Europea seminar five professorships, installed by the ministry of Economic Affairs, focused on transitions in the agro and food sector. The five professorships are posted at the Dutch Agricultural Universities of applied sciences, including teacher education for sustainable connected learning and development for professional education and business communities.
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Food and the city has never been a more urgent theme than today, and The European Union’s priority to commit to innovation in this field will certainly enhance its economic and external strength and improve its competitive position in the world of food and life sciences. Europea Netherlands held a seminar on this topic in May 2016, during the Dutch EU presidency.To be part of this international endeavour, the Netherlands need to strengthen the digital market, support innovation in the internal market, boost domestic policy reforms, and embed their knowledge and skills in a European society that challenges itself and continues to innovate. The Netherlands is a global player in the agro, food and horticultural sector and a major player in the export market of agricultural products. This sector is one of its main economic pillars. New knowledge is being developed as we speak, which is also an export product in high demand, providing sizeable employment. This is only possible because the sector is innovative and remains up-to-date. The peri-urban areas in the Netherlands (both urban and rural areas) are characterized by high population density. This necessitates thinking about manufacturing, food, logistics and water management(circular economy). Land-based education and life sciences in the Netherlands may appear to be specific, yet it is broad too: the primary sectors are included, as well as the manufacturing businesses and services associated with it. Participants learn to work in an innovative sector in a society in transition, bringing together multiple disciplines (cross-overs) and stakeholders. This education is practical and has a strong connection to the industry. During the Europea seminar five professorships, installed by the ministry of Economic Affairs, focused on transitions in the agro and food sector. The five professorships are posted at the Dutch Agricultural Universities of applied sciences, including teacher education for sustainable connected learning and development for professional education and business communities.
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Increasingly, entrepreneurial growth is discussed in relation to business sustainability and the wider questions of ‘growth’ – economic, green, or sustainable. This chapter will discuss the challenges and opportunities of teaching circular economy and Cradle to Cradle (C2C) models of sustainable production. The course applying circular economy theory to corporate case studies at the liberal arts college in The Netherlands will be discussed. Students were given the assignment to advise an existing company how to make a transition from a linear to circular economy model. https://doi.org/10.1108/978-1-78714-501-620171028 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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This research is commissioned by the professorship Novel Proteins: Insects and Fish, Healthy, Sustainable and Safe (INVIS) and conducted with the aim to investigate the constraints that hinder the uptake of insect-based feed in the Dutch finfish aquaculture branch and advise upon how to initiate a transition within the branch to adopt insect meal in fish feed widely. This is a underlying report of the webinar Insect culture in the Netherlands for feed and food on January 19, 2021.
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