Adequate distinction between malnutrition, starvation, cachexia and sarcopenia is important in clinical care. Despite the overlap in physical characteristics, differences in etiology have therapeutical and prognostic implications. We aimed to determine whether dietitians in selected European countries have ‘proper knowledge’ of malnutrition, starvation, cachexia and sarcopenia, and use terminology accordingly.
DOCUMENT
Clinical signs of malnutrition, starvation, cachexia and sarcopenia overlap, as they all imply muscle wasting to a various extent. However, the underlying mechanisms differ fundamentally and therefore distinction between these phenomena has therapeutic and prognostic implications. We aimed to determine whether dietitians in selected European countries have ‘sufficient knowledge’ regarding malnutrition, starvation, cachexia and sarcopenia, and use these terms in their daily clinical work.MethodsAn anonymous online survey was performed among dietitians in Belgium, the Netherlands, Norway and Sweden. ‘Sufficient knowledge’ was defined as having mentioned at least two of the three common domains of malnutrition according to ESPEN definition of malnutrition (2011): ‘nutritional balance’, ‘body composition’ and ‘functionality and clinical outcome’, and a correct answer to three cases on starvation, cachexia and sarcopenia. Chi-square test was used to analyse differences in experience, work place and number of malnourished patients treated between dietitians with ‘sufficient knowledge’ vs. ‘less sufficient knowledge’. Results712/7186 responded to the questionnaire, of which data of 369 dietitians were included in the analysis (5%). The term ‘malnutrition’ is being used in clinical practice by 88% of the respondents. Starvation, cachexia and sarcopenia is being used by 3%, 30% and 12% respectively. The cases on starvation, cachexia and sarcopenia were correctly identified by 58%, 43% and 74% respectively. 13% of the respondents had ‘sufficient knowledge’. 31% of the respondents identified all cases correctly. The proportion of respondents with ‘sufficient knowledge’ was significantly higher in those working in a hospital or in municipality (16%, P < 0.041), as compared to those working in other settings (7%). The results of our survey among dietitians in four European countries show that the percentage of dietitians with ‘sufficient knowledge’ regarding malnutrition, starvation, cachexia and sarcopenia is unsatisfactory (13%). The terms starvation, cachexia and sarcopenia are not often used by dietitians in daily clinical work. As only one-third (31%) of dietitians identified all cases correctly, the results of this study seem to indicate that nutrition-related disorders are suboptimally recognized in clinical practice, which might have a negative impact on nutritional treatment. The results of our study require confirmation in a larger sample of dietitians.
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In werkpakket A, Zeewierteelt, werd onderzocht wat het effect is van de nitraatconcentratie op de groei en eiwitgehalte van de zeewiersoorten Saccharina latissima en Ulva lactuca. Bij de laatste soort werd ook gekeken naar de aminozuursamenstelling. Hogere nitraatconcentraties zorgden bij beide zeewiersoorten voor een hogere groeisnelheid en een hogere eiwitgehalte. De totale aminozuurhoeveelheid van Ulva lactuca was hoger bij blootstelling aan een hogere nitraatconcentratie. Alle gemeten aminozuurgehaltes waren hoger, behalve die van methionine, die gelijk was ten opzichte van de Ulva lactuca die gekweekt werd onder lage nitraatconcentraties. Het is dus mogelijk om tijdens het groeiproces, de aminozuur- en eiwitgehalte van zeewier te verhogen. De toename in eiwitgehalte was zelfs zo snel, dat het mogelijk is om zeewier te verrijken door het twee weken voor de oogst onder verhoogde nitraatconcentraties te laten groeien.
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