Rationale: The goal of the PROVE (Protein enriched vegan products to fight malnutrition) project is to innovate the assortment of plant-based energy and protein enriched products for dietary treatment of (risk of) malnutrition. We aimed to explore preferences of dietitians for plant-based products in the treatment of malnutrition.Methods: In this design-based research project, the Double Diamond model was applied. Contextual interviews were performed with 9 dietitians experienced in treating clients using a vegan diet (1 omnivore, 3 flexi-vegetarian, 1 vegetarian, 1 pescetarian, 3 flexi-vegan). Interviews focused on preferences regarding product type, size, nutrients, taste, packaging, price. Affinity mapping was used to code and analyze the transcripted interviews. The results were summarized into concept products.Results: Four product concepts were developed that represent preferences of dietitians for a plant-based energy and protein enriched product for clients with (risk of) malnutrition. Overall, pea or soy were preferred as a protein source and addition of vitamins and minerals was not preferred.Conclusion: Preferences of dietitians for plant-based protein and energy rich products for patients with risk of malnutrition largely vary. Within PROVE, we will enrich these results with patient perspectives, as basis to develop and deliver plant-based energy and protein enriched products for treatment of (risk of) malnutrition.
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Objectives: Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.Design: Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.Results: Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.Conclusions: Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.
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Purpose: Malnutrition and sarcopenia require dietetic and physiotherapy interventions. In this study, we aimed to compare interprofessional identity of dietitians and physiotherapists, as well as attitudes towards, facilitators and barriers for, and occurrence of interprofessional treatment of malnutrition and sarcopenia by both professions. Methods: A cross-sectional online survey was distributed from December 4, 2021 until January 31, 2022 through an international online network platform for professionals (LinkedIn). Practitioners working as dietitian or physiotherapist in a healthcare setting were eligible for participation. Outcome measures concerned perceptions regarding shared problem domains, interprofessional treatment, attitudes towards interprofessional treatment, interprofessional identity, facilitators, and barriers. A Chi2-test, Mann–Whitney U-test, and Spearman’s Rho correlation were calculated. Results: Data from 53 physiotherapists and 48 dietitians were included. Malnutrition is considered a shared problem domain by both professions (U = 1248.000; p = 0.858). While sarcopenia is treated by both professions (U = 1260.000; p = 0.927), physiotherapists consider sarcopenia more often a shared problem domain compared to dietitians (U = 1003.000; p = 0.044). Attitudes towards interprofessional treatment were mostly positive (73%, n = 35 and 87%, n = 46 respectively). Interprofessional identity of dietitians was lower compared to physiotherapists (median = 4.0 versus median = 4.3 respectively; U = 875.000, p = 0.007). This was explained by lower interprofessional belonging (median = 4.0 versus median = 4.8 respectively; U = 771.000, p < 0.001) and lower interprofessional commitment (median = 4.0 versus median = 4.3 respectively; U = 942.500, p = 0.023). Interprofessional identity was correlated with efficient means of communication (r = 0.30, p = 0.003) and bureaucracy (r = −0.21, p = 0.034). Other barriers reported included available time, financial compensation, interprofessional knowledge, and obtaining extra care. Most reported facilitators concerned role clarity, clarity of expertise, and willingness of others to collaborate. Conclusion: Dietitians and physiotherapists have different interprofessional identities, but both are advocates of interprofessional treatment. Both professions mostly treat malnutrition and sarcopenia individually and have different perceptions regarding sarcopenia as shared problem domain. Facilitators were mainly related to clarity and commitment while barriers were mainly related to resources.
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Rationale: In this study, we aimed to explore how dietitians’ history-taking questions function during dietary counseling of clients with malnutrition (risk). Fruitful functioning of history-taking questions during the problem identification phase is crucial for dietitians to develop a client-centered dietary treatment plan.Methods: Using discursive psychology, we analyzed the problem identification phase of recorded dietitian-client conversations of 7 dietitians and 17 clients. Discursive psychology is a qualitative, inductive methodology that is used to analyze real-life conversations. Discursive psychology focuses on how descriptions in talk (including wording, intonation, pauses, non-verbal behavior) accomplish actions such as presenting oneself in a particular way.Results: Our analysis shows how, in response to dietitians’ history-taking questions, clients repeatedly demonstrate that they have already made some effort to self-help. Typically, these history-taking questions presume some biopsychosocial factor as the cause of the dietary problems discussed. In response, clients show they already started to eat extra, closely monitored their body weight, and tried to eat despite having no appetite. In addition, clients account for the absence of efforts by claiming various kinds of inability, such as facing difficulties in preparing food for oneself or by questioning whether their underlying medical condition caused the diet-related problem in the first place.Conclusion: This study shows that history-taking questions not only elicit answers with factual information but also evoke clients’ self-presentations. Responses from dietitians show little attention to the relevance of these self-presentations,while clients treat self-help as a normative requirement to demonstrate they have done everything they can before they sought professional help. To optimize the problem identification phase, we suggest that in addition to conversationaltechniques dietitians could increase their attention to clients’ actions performed.
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Background: Malnutrition and sarcopenia impact the physical health and quality of life of community-dwelling older adults. Managing these conditions requires integrating nutritional and exercise interventions delivered by professionals from diverse backgrounds. Interprofessional collaboration holds promise for providing integrated, person-centered care to older adults. However, to tailor such care, it is essential to understand the needs and wishes of older adults, which remain underexplored. This study aimed to understand the needs and wishes of community-dwelling older adults regarding interprofessional treatment for (risk of) malnutrition and sarcopenia. Methods: We conducted a grounded theory study. Data collection involved semi-structured interviews and focus groups with community-dwelling older adults who are undergoing treatment or have been treated for (risk of) malnutrition and/or sarcopenia. We systematically analyzed the data using open, axial, and selective coding and developed a conceptual model. Results: Interviews and focus groups were conducted with 18 older adults. Three selective codes were identified: 1) older adults need to be involved in their interprofessional treatment, 2) older adults need healthcare professionals to be well-informed about their interprofessional treatment, and 3) older adults need collaboration amongst involved healthcare professionals in interprofessional treatment. Our conceptual model addresses the needs and wishes of older adults in relation to interprofessional collaboration. Older adults’ needs highlight what is missing, while their wishes offer ways to fulfill these needs. Conclusion: Older adults’ need for involvement in interprofessional treatment can be met by engaging them actively in healthcare decisions and as partners to healthcare professionals. The need for well-informed healthcare professionals can be fulfilled by ensuring accessible healthcare information, the prevention of conflicting advice, and the prevention of repeating medical history. Finally, the need for collaboration among healthcare professionals can be fulfilled by healthcare professionals communicating openly and directly and working closely together.
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The aim of this systematic review was to examine the association between malnutrition and oral health in older people (≥ 60 years of age). A comprehensive systematic literature search was performed in four databases (PubMed, CINAHL, Dentistry and Oral Sciences Source, and Embase) for literature from January 2000 to May 2020. Both observational and intervention studies were screened for eligibility. Two reviewers independently screened the search results to identify potential eligible studies, and assessed the methodological quality of the full-text studies. A total of 3240 potential studies were identified. After judgement for relevance, 10 studies (cross-sectional (n = 9), prospective cohort (n = 1)) met the inclusion criteria. Three studies described malnourished participants as having fewer teeth, or functional (tooth) units (FTUs), compared to well-nourished participants. Four studies reported soft tissue problems in malnourished participants, including red tongue with blisters, and dry or cracked lips. Subjective oral health was the topic in six studies, with poorer oral health and negative self-perception of oral health in malnourished elderly participants. There are associations between (at risk of) malnutrition and oral health in older people, categorized in hard and soft tissue conditions of the mouth, and subjective oral health. Future research should be focused on longitudinal cohort studies with proper determination of malnutrition and oral health assessments, in order to evaluate the actual association between malnutrition and oral health in older people.
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PURPOSE: Malnutrition and sarcopenia require dietetic and physiotherapy interventions. In this study, we aimed to compare interprofessional identity of dietitians and physiotherapists, as well as attitudes towards, facilitators and barriers for, and occurrence of interprofessional treatment of malnutrition and sarcopenia by both professions.METHODS: A cross-sectional online survey was distributed from December 4, 2021 until January 31, 2022 through an international online network platform for professionals (LinkedIn). Practitioners working as dietitian or physiotherapist in a healthcare setting were eligible for participation. Outcome measures concerned perceptions regarding shared problem domains, interprofessional treatment, attitudes towards interprofessional treatment, interprofessional identity, facilitators, and barriers. A Chi 2-test, Mann-Whitney U-test, and Spearman's Rho correlation were calculated. RESULTS: Data from 53 physiotherapists and 48 dietitians were included. Malnutrition is considered a shared problem domain by both professions ( U = 1248.000; p = 0.858). While sarcopenia is treated by both professions ( U = 1260.000; p = 0.927), physiotherapists consider sarcopenia more often a shared problem domain compared to dietitians ( U = 1003.000; p = 0.044). Attitudes towards interprofessional treatment were mostly positive (73%, n = 35 and 87%, n = 46 respectively). Interprofessional identity of dietitians was lower compared to physiotherapists (median = 4.0 versus median = 4.3 respectively; U = 875.000, p = 0.007). This was explained by lower interprofessional belonging (median = 4.0 versus median = 4.8 respectively; U = 771.000, p < 0.001) and lower interprofessional commitment (median = 4.0 versus median = 4.3 respectively; U = 942.500, p = 0.023). Interprofessional identity was correlated with efficient means of communication ( r = 0.30, p = 0.003) and bureaucracy ( r = -0.21, p = 0.034). Other barriers reported included available time, financial compensation, interprofessional knowledge, and obtaining extra care. Most reported facilitators concerned role clarity, clarity of expertise, and willingness of others to collaborate. CONCLUSION: Dietitians and physiotherapists have different interprofessional identities, but both are advocates of interprofessional treatment. Both professions mostly treat malnutrition and sarcopenia individually and have different perceptions regarding sarcopenia as shared problem domain. Facilitators were mainly related to clarity and commitment while barriers were mainly related to resources.
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Malnutrition is a frequent problem in patients with head and neck cancer. Prevention or timely treatment of malnutrition isof great importance because deteriorated nutritional status can have a negative effect on clinical outcome in head andneck cancer patients.Malnutrition is a multidimensional problem, in which a nutritional disbalance causes loss of weight and muscle mass, eitheror not accompanied by inflammatory activity, resulting in functional decline.Thus far, little is known about the role of physical activity in both the development and treatment of malnutrition in cancerpatients. Although positive effects of exercise on fatigue and quality of life have been reported, the relationship betweenphysical activity and prevention and treatment of malnutrition needs to be further elucidated.In this presentation, current insights and hypotheses on the relationship between physical activity and nutritional status inpatients with cancer will be discussed.
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Lectorale rede in het kader van de lectorinstallatie van dr. Harriët Jager-Wittenaar op 15 januari 2015 aan de Hanzehogeschool Groningen
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Malnutrition is an alarming and ongoing healthcare problem globally. Malnutrition has a negative impact on the individual patient, leading to poorer clinical outcomes and increased mortality, but also poses an economic burden on society. Proper identification and diagnostics are prerequisites for initiation of treatment. In 2019, the Global Leadership Initiative on Malnutrition, a consensus-based global framework to uniformly diagnose malnutrition across populations, healthcare settings, and countries was published. Identifying and treating malnutrition is an interdisciplinary team effort. Nonetheless, the nutrition and dietetics profession is specifically trained for diagnosing and treating nutrition(-related) conditions, and therefore has a key role in the interdisciplinary team in implementing the GLIM framework in clinical practice. For the nutrition and dietetics profession, GLIM offers a great opportunity for moving both the scientific and clinical knowledge of malnutrition management forward. While the GLIM framework has been extensively studied since its launch, various knowledge gaps still remain. For the nutrition and dietetics profession, these knowledge gaps mainly relate to the GLIM implementation process, to the role of GLIM in relation to the nutrition care process, and to treatment strategies for various nutrition-related conditions. In this opinion paper, we aimed to describe the rationale for implementing the GLIM framework in clinical dietetic practice, and propose a research agenda based on knowledge gaps regarding GLIM in relation to nutrition care from a dietetic point of view.
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