Publicaties

@article{pmid33379181,

title = {Effect of an Enriched Protein Drink on Muscle Mass and Glycemic Control during Combined Lifestyle Intervention in Older Adults with Obesity and Type 2 Diabetes: A Double-Blind RCT},

author = {Robert G Memelink and Wilrike J Pasman and Anke Bongers and Anita Tump and Annemieke van Ginkel and Wim Tromp and Suzan Wopereis and Sjors Verlaan and Johan de Vogel-van den Bosch and Peter J M Weijs},

doi = {10.3390/nu13010064},

issn = {2072-6643},

year  = {2020},

date = {2020-12-01},

journal = {Nutrients},

volume = {13},

number = {1},

abstract = {BACKGROUND: Weight loss is key to treatment of older adults with obesity and type 2 diabetes, but also a risk for muscle mass loss. This study investigated whether a whey protein drink enriched with leucine and vitamin D could preserve muscle mass and improve glycemic control during combined lifestyle intervention in this population.nnMETHODS: 123 older adults with obesity and type 2 diabetes were randomized into a 13-week lifestyle intervention with dietary advice and exercise, receiving either the enriched protein drink (test) or an isocaloric control (control). Muscle mass was assessed with dual-energy X-ray absorptiometry and glycemic control by oral glucose tolerance test. Statistical analyses were performed using a linear mixed model.nnRESULTS: There was a nonsignificant increase in leg muscle mass (+0.28 kg; 95% CI, -0.01 to 0.56) and a significant increase in appendicular muscle mass (+0.36 kg; 95% CI, 0.005 to 0.71) and total lean mass (+0.92 kg; 95% CI, 0.19 to 1.65) in test vs. control. Insulin sensitivity (Matsuda index) also increased in test vs. control (+0.52; 95% CI, 0.07 to 0.97).nnCONCLUSIONS: Use of an enriched protein drink during combined lifestyle intervention shows beneficial effects on muscle mass and glycemic control in older adults with obesity and type 2 diabetes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33003389,

title = {Obese Older Type 2 Diabetes Mellitus Patients with Muscle Insulin Resistance Benefit from an Enriched Protein Drink during Combined Lifestyle Intervention: The PROBE Study},

author = {Wilrike J Pasman and Robert G Memelink and Johan de Vogel-Van den Bosch and Mark P V Begieneman and Willem J van den Brink and Peter J M Weijs and Suzan Wopereis},

doi = {10.3390/nu12102979},

issn = {2072-6643},

year  = {2020},

date = {2020-09-01},

journal = {Nutrients},

volume = {12},

number = {10},

abstract = {(1) Background: Recent research showed that subtypes of patients with type 2 diabetes may differ in response to lifestyle interventions based on their organ-specific insulin resistance (IR). (2) Methods: 123 Subjects with type 2 diabetes were randomized into 13-week lifestyle intervention, receiving either an enriched protein drink (protein+) or an isocaloric control drink (control). Before and after the intervention, anthropometrical and physiological data was collected. An oral glucose tolerance test was used to calculate indices representing organ insulin resistance (muscle, liver, and adipose tissue) and β-cell functioning. In 82 study-compliant subjects (per-protocol), we retrospectively examined the intervention effect in patients with muscle IR (MIR,  = 42) and without MIR (no-MIR,  = 40). (3) Results: Only in patients from the MIR subgroup that received protein drink, fasting plasma glucose and insulin, whole body, liver and adipose IR, and appendicular skeletal muscle mass improved versus control. Lifestyle intervention improved body weight and fat mass in both subgroups. Furthermore, for the MIR subgroup decreased systolic blood pressure and increased VOpeak and for the no-MIR subgroup, a decreased 2-h glucose concentration was found. (4) Conclusions: Enriched protein drink during combined lifestyle intervention seems to be especially effective on increasing muscle mass and improving insulin resistance in obese older, type 2 diabetes patients with muscle IR.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32459652,

title = {Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study},

author = {Sumit Mehra and Jantine van den Helder and Bart Visser and Raoul H H Engelbert and Peter J M Weijs and Ben J A Kröse},

doi = {10.2196/16380},

issn = {1438-8871},

year  = {2020},

date = {2020-07-01},

journal = {J Med Internet Res},

volume = {22},

number = {7},

pages = {e16380},

abstract = {BACKGROUND: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior.nnOBJECTIVE: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises.nnMETHODS: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method.nnRESULTS: At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation.nnCONCLUSIONS: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31669003,

title = {Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density},

author = {Wilhelmus G P M Looijaard and Ingeborg M Dekker and Albertus Beishuizen and Armand R J Girbes and Heleen M Oudemans-van Straaten and Peter J M Weijs},

doi = {10.1016/j.clnu.2019.09.007},

issn = {1532-1983},

year  = {2020},

date = {2020-07-01},

journal = {Clin Nutr},

volume = {39},

number = {7},

pages = {2192--2201},

abstract = {BACKGROUND & AIMS: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2-4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density.nnMETHODS: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n = 739). Patients received protocolized nutrition with protein target 1.2-1.5 g/kg/day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs.nnRESULTS: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73-0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79-0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64-0.90 for 60-day mortality and HR 0.80, 95%CI 0.68-0.93 for 6-month mortality).nnCONCLUSIONS: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31492456,

title = {Identifying critically ill patients with low muscle mass: Agreement between bioelectrical impedance analysis and computed tomography},

author = {Willem G P M Looijaard and Sandra N Stapel and Ingeborg M Dekker and Hanna Rusticus and Sharon Remmelzwaal and Armand R J Girbes and Peter J M Weijs and Heleen M Oudemans-van Straaten},

doi = {10.1016/j.clnu.2019.07.020},

issn = {1532-1983},

year  = {2020},

date = {2020-06-01},

journal = {Clin Nutr},

volume = {39},

number = {6},

pages = {1809--1817},

abstract = {BACKGROUND & AIMS: Low muscle mass and -quality on ICU admission, as assessed by muscle area and -density on CT-scanning at lumbar level 3 (L3), are associated with increased mortality. However, CT-scan analysis is not feasible for standard care. Bioelectrical impedance analysis (BIA) assesses body composition by incorporating the raw measurements resistance, reactance, and phase angle in equations. Our purpose was to compare BIA- and CT-derived muscle mass, to determine whether BIA identified the patients with low skeletal muscle area on CT-scan, and to determine the relation between raw BIA and raw CT measurements.nnMETHODS: This prospective observational study included adult intensive care patients with an abdominal CT-scan. CT-scans were analysed at L3 level for skeletal muscle area (cm) and skeletal muscle density (Hounsfield Units). Muscle area was converted to muscle mass (kg) using the Shen equation (MM). BIA was performed within 72 h of the CT-scan. BIA-derived muscle mass was calculated by three equations: Talluri (MM), Janssen (MM), and Kyle (MM). To compare BIA- and CT-derived muscle mass correlations, bias, and limits of agreement were calculated. To test whether BIA identifies low skeletal muscle area on CT-scan, ROC-curves were constructed. Furthermore, raw BIA and CT measurements, were correlated and raw CT-measurements were compared between groups with normal and low phase angle.nnRESULTS: 110 patients were included. Mean age 59 ± 17 years, mean APACHE II score 17 (11-25); 68% male. MM and MM were significantly higher (36.0 ± 9.9 kg and 31.5 ± 7.8 kg, respectively) and MM significantly lower (25.2 ± 5.6 kg) than MM (29.2 ± 6.7 kg). For all BIA-derived muscle mass equations, a proportional bias was apparent with increasing disagreement at higher muscle mass. MM correlated strongest with CT-derived muscle mass (r = 0.834, p < 0.001) and had good discriminative capacity to identify patients with low skeletal muscle area on CT-scan (AUC: 0.919 for males; 0.912 for females). Of the raw measurements, phase angle and skeletal muscle density correlated best (r = 0.701, p < 0.001). CT-derived skeletal muscle area and -density were significantly lower in patients with low compared to normal phase angle.nnCONCLUSIONS: Although correlated, absolute values of BIA- and CT-derived muscle mass disagree, especially in the high muscle mass range. However, BIA and CT identified the same critically ill population with low skeletal muscle area on CT-scan. Furthermore, low phase angle corresponded to low skeletal muscle area and -density.nnTRIAL REGISTRATION: ClinicalTrials.gov (NCT02555670).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33048970,

title = {Beyond maternal education: Socio-economic inequalities in children's diet in the ABCD cohort},

author = {Viyan Rashid and Peter J M Weijs and Marielle F Engberink and Arnoud P Verhoeff and Mary Nicolaou},

doi = {10.1371/journal.pone.0240423},

issn = {1932-6203},

year  = {2020},

date = {2020-01-01},

journal = {PLoS One},

volume = {15},

number = {10},

pages = {e0240423},

abstract = {OBJECTIVE: We examined whether the role of maternal education in children's unhealthy snacking diet is moderated by other socio-economic indicators.nnMETHODS: Participants were selected from the Amsterdam Born Children and their Development cohort, a large ongoing community-based birth cohort. Validated Food Frequency Questionnaires (FFQ) (n = 2782) were filled in by mothers of children aged 5.7±0.5yrs. Based on these FFQs, a snacking dietary pattern was derived using Principal Component Analysis. Socio-economic indicators were: maternal and paternal education (low, middle, high; based on the highest education completed) household finance (low, high; based on ability to save money) and neighbourhood SES (composite score including educational level, household income and employment status of residents per postal code). Cross-sectional multivariable linear regression analysis was used to assess the association and possible moderation of maternal education and other socio-economic indicators on the snacking pattern score. Analyses were adjusted for children's age, sex and ethnicity.nnRESULTS: Low maternal education (B 0.95, 95% CI 0.83;1.06), low paternal education (B 0.36, 95% CI 0.20;0.52), lower household finance (B 0.18, 95% CI 0.11;0.26) and neighbourhood SES (B -0.09, 95% CI -0.11;-0.06) were independently associated with higher snacking pattern scores (p<0.001). The association between maternal education and the snacking pattern score was somewhat moderated by household finance (p = 0.089) but remained strong. Children from middle-high educated mothers (B 0.44, 95% CI 0.35;0.52) had higher snacking pattern scores when household finance was low (B 0.49, 95% CI 0.33;0.65).nnCONCLUSIONS: All socio-economic indicators were associated with increased risk of unhealthy dietary patterns in young children, with low maternal education conferring the highest risk. Yet, within the group of middle-high educated mothers, lower household finance was an extra risk factor for unhealthy dietary patterns. Intervention strategies should therefore focus on lower educated mothers and middle-high educated mothers with insufficient levels of household finance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid32004359,

title = {Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users},

author = {Jasmijn F M Holla and Lizanne E van den Akker and Tessa Dadema and Sonja de Groot and Michael Tieland and Peter J M Weijs and Marije Deutekom and },

doi = {10.1371/journal.pone.0228465},

issn = {1932-6203},

year  = {2020},

date = {2020-01-01},

journal = {PLoS One},

volume = {15},

number = {1},

pages = {e0228465},

abstract = {OBJECTIVE: This study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users.nnMETHODS: Five focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model.nnRESULTS: Reported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends.nnCONCLUSIONS: Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31947735,

title = {The Effects of the PLAYTOD Program on Children's Physical Activity at Preschool Playgrounds in a Deprived Urban Area: A Randomized Controlled Trial},

author = {Nicole Toussaint and Martinette T Streppel and Sandra Mul and Ruben G Fukkink and Peter J M Weijs and Mirka Janssen},

doi = {10.3390/ijerph17010329},

issn = {1660-4601},

year  = {2020},

date = {2020-01-01},

journal = {Int J Environ Res Public Health},

volume = {17},

number = {1},

abstract = {Interventions to improve children's physical activity in Early Childhood Education and Care (ECEC) settings are needed. This randomized controlled trial examines the effects of a preschool-based playground program for ECEC teachers in a deprived urban area. On intervention preschools, the PLAYgrounds for TODdlers program (PLAYTOD) was performed. It focused on teacher's knowledge and skills in order to create a challenging outdoor environment in which young children (2.5 to 4 years old) are able to practice their motor skills. Observations were performed before and after the program with a modified version of the SOPLAY protocol. The activating role of teachers (score from 0 = inactive to 4 = participating), the number of different physical activities, and the quality of children's physical activity on playgrounds were observed. The latter included the number of performed fundamental movement skills and the estimated physical activity intensity (score from 0 = sedentary to 3 = vigorous). Descriptive statistics and linear regression analyses were used to evaluate the effects of PLAYTOD. After the program, the activating role of teachers on intervention playgrounds improved. Moreover, the program and consecutively the changes made by teachers had a positive effect on the number of different activities and the quality of children's physical activity. The results emphasize an important role for ECEC teachers in improving physical activity in young children.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30595377,

title = {Achieving protein targets without energy overfeeding in critically ill patients: A prospective feasibility study},

author = {W G P M Looijaard and N Denneman and B Broens and A R J Girbes and P J M Weijs and H M Oudemans-van Straaten},

doi = {10.1016/j.clnu.2018.11.012},

issn = {1532-1983},

year  = {2019},

date = {2019-12-01},

journal = {Clin Nutr},

volume = {38},

number = {6},

pages = {2623--2631},

abstract = {BACKGROUND & AIMS: High protein delivery during early critical illness is associated with lower mortality, while energy overfeeding is associated with higher mortality. Protein-to-energy ratios of traditional enteral formulae are sometimes too low to reach protein targets without energy overfeeding. This prospective feasibility study aimed to evaluate the ability of a new enteral formula with a high protein-to-energy ratio to achieve the desired protein target while avoiding energy overfeeding.nnMETHODS: Mechanically ventilated non-septic patients received the high protein-to-energy ratio nutrition during the first 4 days of ICU stay (n = 20). Nutritional prescription was 90% of measured energy expenditure. Primary endpoint was the percentage of patients reaching a protein target of ≥1.2 g/kg ideal body weight on day 4. Other endpoints included a comparison of nutritional intake to matched historic controls and the response of plasma amino acid concentrations. Safety endpoints were gastro-intestinal tolerance and plasma urea concentrations.nnRESULTS: Nineteen (95%) patients reached the protein intake target of ≥1.2 g/kg ideal body weight on day 4, compared to 65% in historic controls (p = 0.024). Mean plasma concentrations of all essential amino acids increased significantly from baseline to day 4. Predefined gastro-intestinal tolerance was good, but unexplained foul smelling diarrhoea occurred in two patients. In one patient plasma urea increased unrelated to acute kidney injury.nnCONCLUSIONS: In selected non-septic patients tolerating enteral nutrition, recommended protein targets can be achieved without energy overfeeding using a new high protein-to-energy ratio enteral nutrition.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31680713,

title = {Changes in stool frequency following chicory inulin consumption, and effects on stool consistency, quality of life and composition of gut microbiota},

author = {Anthony W Watson and David Houghton and Peter J Avery and Christopher Stewart and Elaine E Vaughan and P Diederick Meyer and Minse J J de Bos Kuil and Peter J M Weijs and Kirsten Brandt},

doi = {10.1016/j.foodhyd.2019.06.006},

issn = {0268-005X},

year  = {2019},

date = {2019-11-01},

journal = {Food Hydrocoll},

volume = {96},

pages = {688--698},

abstract = {Inulin is a soluble dietary fibre, also classified as a prebiotic, extracted from chicory roots. The present study aimed to determine the effect of consumption of native chicory inulin on the stool frequency of middle-aged to older adults (40-75 years old) with uncomfortably but not clinically relevant low stool frequency, specified as two to four days without bowel movements per week. Two randomised, double blind, placebo-controlled crossover trials were conducted using similar protocols in differing populations. Trial A was conducted in Amsterdam, The Netherlands and subsequently Trial B was conducted in Newcastle, United Kingdom. Both trials involved supplementation for 5 weeks with 10 g per day of inulin or placebo, a washout period of 2 weeks, and then crossed over to receive the other treatment. In Trial B, faecal gut microbiota composition was assessed using 16S rRNA gene sequencing. In Trial A, which 10 volunteers completed, the stool frequency was significantly increased to an average 4.9 ± 0.23 (SEM) times per week during inulin periods versus 3.6 ± 0.25 in the periods with placebo ( = 0.01). In contrast, in Trial B which 20 volunteers completed, there was no significant effect of the inulin on stool frequency (7.5 ± 2.1 times per week with inulin, 8.1 ± 3.0 with placebo,  = 0.35). However, many subjects in Trial B had a stool frequency >5 per week also for the placebo period, in breach of the inclusion criteria. Combining the data of 16 low stool frequency subjects from Trials A and B showed a significant effect of inulin to increase stool frequency from 4.1 to 5.0 per week ( = 0.032). Regarding secondary outcomes, stool consistency was significantly softer with inulin treatment compared to placebo periods, it increased 0.29 on the Bristol stool scale ( = 0.008) when data from all subjects of Trials A and B were combined. No other differences in bowel habit parameters due to inulin consumption were significant. None of the differences in specific bacterial abundance, alpha or beta diversity were significant, however the trends were in directions consistent with published studies on other types of inulin. We conclude that 10 g per day of native chicory inulin can increase stool frequency in subjects with low stool frequency.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31597289,

title = {Dietary Protein, Exercise, and Frailty Domains},

author = {Josje D Schoufour and Elvera Overdevest and Peter J M Weijs and Michael Tieland},

doi = {10.3390/nu11102399},

issn = {2072-6643},

year  = {2019},

date = {2019-10-01},

journal = {Nutrients},

volume = {11},

number = {10},

abstract = {Increasing awareness of the impact of frailty on elderly people resulted in research focusing on factors that contribute to the development and persistence of frailty including nutrition and physical activity. Most effort so far has been spent on understanding the association between protein intake and the physical domain of frailty. Far less is known for other domains of frailty: cognition, mood, social health and comorbidity. Therefore, in the present narrative review, we elaborate on the evidence currently known on the association between protein and exercise as well as the broader concept of frailty. Most, but not all, identified studies concluded that low protein intake is associated with a higher prevalence and incidence of physical frailty. Far less is known on the broader concept of frailty. The few studies that do look into this association find a clear beneficial effect of physical activity but no conclusions regarding protein intake can be made yet. Similar, for other important aspects of frailty including mood, cognition, and comorbidity, the number of studies are limited and results are inconclusive. Future studies need to focus on the relation between dietary protein and the broader concept of frailty and should also consider the protein source, amount and timing.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30245021,

title = {Indirect calorimetry in critically ill mechanically ventilated patients: Comparison of E-sCOVX with the deltatrac},

author = {Sandra N Stapel and Peter J M Weijs and Armand R J Girbes and Heleen M Oudemans-van Straaten},

doi = {10.1016/j.clnu.2018.08.038},

issn = {1532-1983},

year  = {2019},

date = {2019-10-01},

journal = {Clin Nutr},

volume = {38},

number = {5},

pages = {2155--2160},

abstract = {BACKGROUND & AIMS: Indirect calorimetry is recommended to measure energy expenditure (EE) in critically ill, mechanically ventilated patients. The most validated system, the Deltatrac® (Datex-Ohmeda, Helsinki, Finland) is no longer in production. We tested the agreement of a new breath-by-breath metabolic monitor E-sCOVX® (GE healthcare, Helsinki, Finland), with the Deltatrac. We also compared the performance of the E-sCOVX to commonly used predictive equations.nnMETHODS: We included mechanically ventilated patients eligible to undergo indirect calorimetry. After a stabilization period, EE was measured simultaneously with the Deltatrac and the E-sCOVX for 2 h. Agreement and precision of the E-sCOVX was tested by determining bias, limits of agreement and agreement rates compared to the Deltatrac. Performance of the E-sCOVX was also compared to four predictive equations: the 25 kcal/kg, Penn State University 2003b, Faisy, and Harris-Benedict equation.nnRESULTS: We performed 29 measurements in 16 patients. Mean EE-Deltatrac was 1942 ± 274 kcal/day, and mean EE-E-sCOVX was 2177 ± 319 kcal/day (p < 0.001). E-sCOVX overestimated EE with a bias of 235 ± 149 kcal/day, being 12.1% of EE-Deltatrac. Limits of agreement were -63 to +532 kcal/day. The 10% and 15% agreement rates of EE-E-sCOVX compared to the Deltatrac were 34% and 72% respectively. The bias of E-sCOVX was lower than the bias of the 25 kcal/kg-equation, but higher than bias of the other equations. Agreement rates for E-sCOVX were similar to the equations. The Faisy-equation had the highest 15% agreement rate.nnCONCLUSION: The E-sCOVX metabolic monitor is not accurate in estimating EE in critically ill mechanically ventilated patients when compared to the Deltatrac, the present reference method. The E-sCOVX overestimates EE with a bias and precision that are clinically unacceptable.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31412793,

title = {Physical performance in patients treated with nocturnal hemodialysis - a systematic review of the evidence},

author = {Manouk Dam and Peter J M Weijs and Frans J van Ittersum and Brigit C van Jaarsveld},

doi = {10.1186/s12882-019-1518-4},

issn = {1471-2369},

year  = {2019},

date = {2019-08-01},

journal = {BMC Nephrol},

volume = {20},

number = {1},

pages = {317},

abstract = {BACKGROUND: Patients treated with conventional hemodialysis have poor physical performance, explained by insufficient metabolic clearance and shortage of time by time-consuming dialysis. Nocturnal hemodialysis improves metabolic control and results in increased spare time. Our aim is to investigate whether physical performance in nocturnal hemodialysis is superior to conventional hemodialysis.nnMETHODS: A systematic search was conducted in MEDLINE, Embase, CINAHL, PhycInfo and Web of Science until January 2018. Primary outcomes were physical performance, activity, strength and muscle mass in home or in-center nocturnal hemodialysis. Methodological quality was assessed with the Newcastle-Ottawa scale.nnRESULTS: Ten studies met the inclusion criteria, including 2 RCTs, evaluating 526 nocturnal hemodialysis patients with a mean follow-up of 15, 3 months. The methodological quality of 4 studies was limited. Physical capacity tests were done in 3 studies with different methodology: short-physical performance battery, exercise spirometry and 6-min walk test. The latter 2 showed significant improvements in physical performance. Four studies assessed lean mass using dual-energy X-ray absorptiometry (2×) and bioelectrical impedance analysis (2×), of which 1 demonstrated increased lean body and skeletal muscle mass. In 5 studies a Quality of Life questionnaire was used, of which 2 showed improved physical component score.nnCONCLUSIONS: The evidence on the effect of nocturnal hemodialysis on physical performance is either of insufficient methodological quality or only measures isolated aspects of physical performance. As literature emphasizes the importance of physical activity on clinical outcomes, it is necessary to conduct larger studies of high methodological quality using capacity tests for answering the question whether nocturnal hemodialysis can improve physical performance of patients with end-stage renal disease.nnTRIAL REGISTRATION: NTR4715, Netherlands Trial Register. Registered 30 July 2014.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30850837,

title = {Dietary protein intake is not associated with 5-y change in mid-thigh muscle cross-sectional area by computed tomography in older adults: the Health, Aging, and Body Composition (Health ABC) Study},

author = {Amely M Verreijen and Mariëlle F Engberink and Denise K Houston and Ingeborg A Brouwer and Peggy M Cawthon and Ann B Newman and Frances A Tylavsky and Tamara B Harris and Peter J M Weijs and Marjolein Visser},

doi = {10.1093/ajcn/nqy341},

issn = {1938-3207},

year  = {2019},

date = {2019-03-01},

journal = {Am J Clin Nutr},

volume = {109},

number = {3},

pages = {535--543},

abstract = {BACKGROUND: A higher protein intake is suggested to preserve muscle mass during aging and may therefore reduce the risk of sarcopenia.nnOBJECTIVES: We explored whether the amount and type (animal or vegetable) of protein intake were associated with 5-y change in mid-thigh muscle cross-sectional area (CSA) in older adults (n = 1561).nnMETHODS: Protein intake was assessed at year 2 by a Block food-frequency questionnaire in participants (aged 70-79 y) of the Health, Aging, and Body Composition (Health ABC) Study, a prospective cohort study. At year 1 and year 6 mid-thigh muscle CSA in square centimeters was measured by computed tomography. Multiple linear regression analysis was used to examine the association between energy-adjusted protein residuals in grams per day (total, animal, and vegetable protein) and muscle CSA at year 6, adjusted for muscle CSA at year 1 and potential confounders including prevalent health conditions, physical activity, and 5-y change in fat mass.nnRESULTS: Mean (95% CI) protein intake was 0.90 (0.88, 0.92) g · kg-1 · d-1 and mean (95% CI) 5-y change in muscle CSA was -9.8 (-10.6, -8.9) cm2. No association was observed between energy-adjusted total (β = -0.00; 95% CI: -0.06, 0.06 cm2; P = 0.982), animal (β = -0.00; 95% CI: -0.06, 0.05 cm2; P = 0.923), or plant (β = +0.07; 95% CI: -0.06, 0.21 cm2; P = 0.276) protein intake and muscle CSA at year 6, adjusted for baseline mid-thigh muscle CSA and potential confounders.nnCONCLUSIONS: This study suggests that a higher total, animal, or vegetable protein intake is not associated with 5-y change in mid-thigh muscle CSA in older adults. This conclusion contradicts some, but not all, previous research. This trial was registered at www.trialregister.nl as NTR6930.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30845936,

title = {A preschool-based intervention for Early Childhood Education and Care (ECEC) teachers in promoting healthy eating and physical activity in toddlers: study protocol of the cluster randomized controlled trial PreSchool@HealthyWeight},

author = {Nicole Toussaint and Martinette T Streppel and Sandra Mul and Anita Schreurs and Marielle Balledux and Karen van Drongelen and Mirka Janssen and Ruben G Fukkink and Peter J M Weijs},

doi = {10.1186/s12889-019-6611-x},

issn = {1471-2458},

year  = {2019},

date = {2019-03-01},

journal = {BMC Public Health},

volume = {19},

number = {1},

pages = {278},

abstract = {BACKGROUND: Interventions to prevent overweight and obesity in toddlers are needed to minimize health inequalities, especially in migration and lower socio-economic groups. Preschools are identified as important environments for interventions to prevent overweight and obesity. Early Childhood Education and Care (ECEC) teachers in preschools are potential key actors in promoting healthy eating and physical activity. This paper describes the research design of a Dutch preschool-based intervention for ECEC teachers in promoting healthy eating and physical activity in toddlers.nnMETHODS: PreSchool@HealthyWeight concerns a cluster randomized controlled trial on preschools in Amsterdam Nieuw-West, Netherlands. This city district is characterised by inhabitants with a migration background and low socio-economic status. Forty-one preschools, with 115 ECEC teachers and 249 toddlers/parents, were randomly allocated to an intervention or control group. An intervention for teachers will be carried out on intervention locations and consists of modified versions of 2 existing programs: 'A Healthy Start' and 'PLAYgrounds'. In 'A Healthy Start', ECEC teachers learn to provide a healthy and active environment for toddlers. The 'PLAYgrounds for Toddlers' program, coaches ECEC teachers to stimulate physical activity in the playgrounds of preschools. PreSchool@HealthyWeight aims to evaluate the effectiveness of the intervention after 9 months. Primary outcomes are the teachers' knowledge, attitude and practices concerning healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity in toddlers. Secondary outcomes include the Body Mass Index, body composition, dietary intake and physical activity level of teachers and toddlers. In addition, the activating role of ECEC teachers and the physical activity of toddlers on the playgrounds will be evaluated. Lastly, the knowledge, attitude and practices of parents concerning healthy eating and physical activity will be assessed.nnDISCUSSION: It is hypothesized that this preschool-based intervention for ECEC teachers improves the knowledge, attitude and practices regarding healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity of toddlers. The intervention addresses the call for early intervention to prevent overweight and obesity and to minimize health inequalities.nnTRIAL REGISTRATION: Netherlands Trial Register (NTR): NL5850 . Date registered: August 26, 2016.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30707106,

title = {Supporting Older Adults in Exercising With a Tablet: A Usability Study},

author = {Sumit Mehra and Bart Visser and Nazli Cila and Jantine van den Helder and Raoul Hh Engelbert and Peter Jm Weijs and Ben Ja Kröse},

doi = {10.2196/11598},

issn = {2292-9495},

year  = {2019},

date = {2019-02-01},

journal = {JMIR Hum Factors},

volume = {6},

number = {1},

pages = {e11598},

abstract = {BACKGROUND: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback.nnOBJECTIVE: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home.nnMETHODS: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers.nnRESULTS: The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks.nnCONCLUSIONS: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30621154,

title = {Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study},

author = {Peter J M Weijs and Kris M Mogensen and James D Rawn and Kenneth B Christopher},

doi = {10.3390/jcm8010043},

issn = {2077-0383},

year  = {2019},

date = {2019-01-01},

journal = {J Clin Med},

volume = {8},

number = {1},

abstract = {BACKGROUND: We hypothesized that protein delivery during hospitalization in patients who survived critical care would be associated with outcomes following hospital discharge.nnMETHODS: We studied 801 patients, age ≥ 18 years, who received critical care between 2004 and 2012 and survived hospitalization. All patients underwent a registered dietitian formal assessment within 48 h of ICU admission. The exposure of interest, grams of protein per kilogram body weight delivered per day, was determined from all oral, enteral and parenteral sources for up to 28 days. Adjusted odds ratios for all cause 90-day post-discharge mortality were estimated by mixed- effects logistic regression models.nnRESULTS: The 90-day post-discharge mortality was 13.9%. The mean nutrition delivery days recorded was 15. In a mixed-effect logistic regression model adjusted for age, gender, race, Deyo-Charlson comorbidity index, acute organ failures, sepsis and percent energy needs met, the 90-day post-discharge mortality rate was 17% (95% CI: 6⁻26) lower for each 1 g/kg increase in daily protein delivery (OR = 0.83 (95% CI 0.74⁻0.94;  = 0.002)).nnCONCLUSIONS: Adult medical ICU patients with improvements in daily protein intake during hospitalization who survive hospitalization have decreased odds of mortality in the 3 months following hospital discharge.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29847342,

title = {Measuring and monitoring lean body mass in critical illness},

author = {Wilhelmus G P M Looijaard and Jeroen Molinger and Peter J M Weijs},

doi = {10.1097/MCC.0000000000000511},

issn = {1531-7072},

year  = {2018},

date = {2018-08-01},

journal = {Curr Opin Crit Care},

volume = {24},

number = {4},

pages = {241--247},

abstract = {PURPOSE OF REVIEW: To help guide metabolic support in critical care, an understanding of patients' nutritional status and risk is important. Several methods to monitor lean body mass are increasingly used in the ICU and knowledge about their advantages and limitations is essential.nnRECENT FINDINGS: Computed tomography scan analysis, musculoskeletal ultrasound, and bioelectrical impedance analysis are emerging as powerful clinical tools to monitor lean body mass during ICU stay. Accuracy, expertise, ease of use at the bedside, and costs are important factors which play a role in determining which method is most suitable. Exciting new research provides an insight into not only quantitative measurements, but also qualitative measurements of lean body mass, such as infiltration of adipose tissue and intramuscular glycogen storage.nnSUMMARY: Methods to monitor lean body mass in the ICU are under constant development, improving upon bedside usability and offering new modalities to measure. This provides clinicians with valuable markers with which to identify patients at high nutritional risk and to evaluate metabolic support during critical illness.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30107787,

title = {A digitally supported home-based exercise training program and dietary protein intervention for community dwelling older adults: protocol of the cluster randomised controlled VITAMIN trial},

author = {Jantine van den Helder and Carliene van Dronkelaar and Michael Tieland and Sumit Mehra and Tessa Dadema and Bart Visser and Ben J A Kröse and Raoul H H Engelbert and Peter J M Weijs},

doi = {10.1186/s12877-018-0863-7},

issn = {1471-2318},

year  = {2018},

date = {2018-08-01},

journal = {BMC Geriatr},

volume = {18},

number = {1},

pages = {183},

abstract = {BACKGROUND: Increased physical activity and dietary protein intake are promising interventions to prevent or treat the age-related decline in physical performance in older adults. There are well-controlled exercise as well as dietary intervention studies that show beneficial effects on physical performance in older adults. In practice, however, weekly group based exercise or nutritional programs may not be as effective. To optimise these exercise programs for community dwelling older adults, a digitally supported and personalised home-based exercise training program has been designed aiming to improve physical performance in older adults. In addition, a protein intervention in combination with the training program may further improve physical performance in older adults.nnMETHODS: The VITAMIN study will be a cluster randomised controlled trial with three parallel arms. In total, 240 community dwelling older adults (≥ 55 years) participating in weekly group exercise are randomly allocated into: 1) regular weekly exercise program (Control group, n = 80), 2) digitally supported personalised home-based exercise training program group (VITA group, n = 80) and 3) digitally supported personalised home-based exercise training program group plus dietary protein counselling (VITA-Pro group, n = 80). The VITAMIN study aims to evaluate effectiveness of the digitally supported personalised home-based exercise training program as well as the additional value of dietary protein on physical performance after 6 months. In addition, a 12 month follow-up measurement will assess the retaining effect of the interventions. Primary outcome is physical performance measured by the Modified Physical Performance Test (M-PPT) and relevant secondary and observational outcomes include habitual physical activity and dietary intake, body composition, cognitive performance, quality of life, compliance and tablet usage. Data will be analysed by Linear Mixed Models.nnDISCUSSION: To our knowledge, the VITAMIN study is the first study that investigates the impact of home-based exercise, protein intake as well as use of persuasive technology in the population of community dwelling older adults.nnTRIAL REGISTRATION: NL56094.029.16 / NTR ( TC = 5888 ; registered 03-06-2016).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29748659,

title = {Bioelectrical impedance analysis-derived phase angle at admission as a predictor of 90-day mortality in intensive care patients},

author = {Sandra N Stapel and Wilhelmus G P M Looijaard and Ingeborg M Dekker and Armand R J Girbes and Peter J M Weijs and Heleen M Oudemans-van Straaten},

doi = {10.1038/s41430-018-0167-1},

issn = {1476-5640},

year  = {2018},

date = {2018-07-01},

journal = {Eur J Clin Nutr},

volume = {72},

number = {7},

pages = {1019--1025},

abstract = {BACKGROUND/OBJECTIVES: A low bioelectrical impedance analysis (BIA)-derived phase angle (PA) predicts morbidity and mortality in different patient groups. An association between PA and long-term mortality in ICU patients has not been demonstrated before. The purpose of the present study was to determine whether PA on ICU admission independently predicts 90-day mortality.nnSUBJECTS/ METHODS: This prospective observational study was performed in a mixed university ICU. BIA was performed in 196 patients within 24 h of ICU admission. To test the independent association between PA and 90-day mortality, logistic regression analysis was performed using the APACHE IV predicted mortality as confounder. The optimal cutoff value of PA for mortality prediction was determined by ROC curve analysis. Using this cutoff value, patients were categorized into low or normal PA group and the association with 90-day mortality was tested again.nnRESULTS: The PA of survivors was higher than of the non-survivors (5.0° ± 1.3° vs. 4.1° ± 1.2°, p < 0.001). The area under the ROC curve of PA for 90-day mortality was 0.70 (CI 0.59-0.80). PA was associated with 90-day mortality (OR = 0.56, CI: 0.38-0.77, p = 0.001) on univariate logistic regression analysis and also after adjusting for BMI, gender, age, and APACHE IV on multivariable logistic regression (OR = 0.65, CI: 0.44-0.96, p = 0.031). A PA < 4.8° was an independent predictor of 90-day mortality (adjusted OR = 3.65, CI: 1.34-9.93, p = 0.011).nnCONCLUSIONS: Phase angle at ICU admission is an independent predictor of 90-day mortality. This biological marker can aid in long-term mortality risk assessment of critically ill patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29720358,

title = {Translating Behavior Change Principles Into a Blended Exercise Intervention for Older Adults: Design Study},

author = {Sumit Mehra and Bart Visser and Tessa Dadema and Jantine van den Helder and Raoul Hh Engelbert and Peter Jm Weijs and Ben Ja Kröse},

doi = {10.2196/resprot.9244},

issn = {1929-0748},

year  = {2018},

date = {2018-05-01},

journal = {JMIR Res Protoc},

volume = {7},

number = {5},

pages = {e117},

abstract = {BACKGROUND: Physical activity can prevent or delay age-related impairments and prolong the ability of older adults to live independently. Community-based programs typically offer classes where older adults can exercise only once a week under the guidance of an instructor. The health benefits of such programs vary. Exercise frequency and the duration of the program play a key role in realizing effectiveness. An auxiliary home-based exercise program can provide older adults the opportunity to exercise more regularly over a prolonged period of time in the convenience of their own homes. Furthermore, mobile electronic devices can be used to motivate and remotely guide older adults to exercise in a safe manner. Such a blended intervention, where technology is combined with personal guidance, needs to incorporate behavior change principles to ensure effectiveness.nnOBJECTIVE: The aim of this study was to identify theory-based components of a blended intervention that supports older adults to exercise at home.nnMETHODS: The Medical Research Council framework was used to develop the blended intervention. Insights from focus group, expert panels, and literature were combined into leading design considerations.nnRESULTS: A client-server system had been developed that combined a tablet app with a database in the cloud and a Web-based dashboard that can be used by a personal coach to remotely monitor and guide older adults. The app contains several components that facilitate behavior change-an interactive module for goal setting, the ability to draw up a personal training schedule from a library containing over 50 exercise videos, progress monitoring, and possibilities to receive remote feedback and guidance of a personal coach.nnCONCLUSIONS: An evidence-based blended intervention was designed to promote physical activity among older adults. The underlying design choices were underpinned by behavior change techniques that are rooted in self-regulation. Key components of the tablet-supported intervention were a tailored program that accommodates individual needs, demonstrations of functional exercises, monitoring, and remote feedback. The blended approach combines the convenience of a home-based exercise program for older adults with the strengths of mobile health and personal guidance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29389741,

title = {Defining anabolic resistance: implications for delivery of clinical care nutrition},

author = {Robert W Morton and Daniel A Traylor and Peter J M Weijs and Stuart M Phillips},

doi = {10.1097/MCC.0000000000000488},

issn = {1531-7072},

year  = {2018},

date = {2018-04-01},

journal = {Curr Opin Crit Care},

volume = {24},

number = {2},

pages = {124--130},

abstract = {PURPOSE OF REVIEW: Skeletal muscle mass with aging, during critical care, and following critical care is a determinant of quality of life and survival. In this review, we discuss the mechanisms that underpin skeletal muscle atrophy and recommendations to offset skeletal muscle atrophy with aging and during, as well as following, critical care.nnRECENT FINDINGS: Anabolic resistance is responsible, in part, for skeletal muscle atrophy with aging, muscle disuse, and during disease states. Anabolic resistance describes the reduced stimulation of muscle protein synthesis to a given dose of protein/amino acids and contributes to declines in skeletal muscle mass. Physical inactivity induces: anabolic resistance (that is likely exacerbated with aging), insulin resistance, systemic inflammation, decreased satellite cell content, and decreased capillary density. Critical illness results in rapid skeletal muscle atrophy that is a result of both anabolic resistance and enhanced skeletal muscle breakdown.nnSUMMARY: Insofar as atrophic loss of skeletal muscle mass is concerned, anabolic resistance is a principal determinant of age-induced losses and appears to be a contributor to critical illness-induced skeletal muscle atrophy. Older individuals should perform exercise using both heavy and light loads three times per week, ingest at least 1.2 g of protein/kg/day, evenly distribute their meals into protein boluses of 0.40 g/kg, and consume protein within 2 h of retiring for sleep. During critical care, early, frequent, and multimodal physical therapies in combination with early, enteral, hypocaloric energy (∼10-15 kcal/kg/day), and high-protein (>1.2 g/kg/day) provision is recommended.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28062083,

title = {Reduction in energy expenditure during weight loss is higher than predicted based on fat free mass and fat mass in older adults},

author = {Twan Ten Haaf and Amely M Verreijen and Robert G Memelink and Michael Tieland and Peter J M Weijs},

doi = {10.1016/j.clnu.2016.12.014},

issn = {1532-1983},

year  = {2018},

date = {2018-02-01},

journal = {Clin Nutr},

volume = {37},

number = {1},

pages = {250--253},

abstract = {BACKGROUND & AIM: The aim of this study was to describe a decrease in resting energy expenditure during weight loss that is larger than expected based on changes in body composition, called adaptive thermogenesis (AT), in overweight and obese older adults.nnMETHODS: Multiple studies were combined to assess AT in younger and older subjects. Body composition and resting energy expenditure (REE) were measured before and after weight loss. Baseline values were used to predict fat free mass and fat mass adjusted REE after weight loss. AT was defined as the difference between predicted and measured REE after weight loss. The median age of 55 y was used as a cutoff to compare older with younger subjects. The relation between AT and age was investigated using linear regression analysis.nnRESULTS: In this study 254 (M = 88, F = 166) overweight and obese subjects were included (BMI: 31.7 ± 4.4 kg/m, age: 51 ± 14 y). The AT was only significant for older subjects (64 ± 185 kcal/d, 95% CI [32, 96]), but not for younger subjects (19 ± 152 kcal/d, 95% CI [-9, 46]). The size of the AT was significantly higher for older compared to younger adults (β = 47, p = 0.048), independent of gender and type and duration of the weight loss program.nnCONCLUSIONS: We conclude that adaptive thermogenesis is present only in older subjects, which might have implications for weight management in older adults. A reduced energy intake is advised to counteract the adaptive thermogenesis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28711425,

title = {Minerals and Sarcopenia; The Role of Calcium, Iron, Magnesium, Phosphorus, Potassium, Selenium, Sodium, and Zinc on Muscle Mass, Muscle Strength, and Physical Performance in Older Adults: A Systematic Review},

author = {Carliene van Dronkelaar and Aafke van Velzen and Maya Abdelrazek and Anouk van der Steen and Peter J M Weijs and Michael Tieland},

doi = {10.1016/j.jamda.2017.05.026},

issn = {1538-9375},

year  = {2018},

date = {2018-01-01},

journal = {J Am Med Dir Assoc},

volume = {19},

number = {1},

pages = {6--11.e3},

abstract = {INTRODUCTION: Minerals may contribute to prevent and treat sarcopenia, the age-related loss of muscle mass, muscle strength, and physical performance. So far, there is no comprehensive review on the impact of minerals on sarcopenia outcomes. The aim of this systematic review is to evaluate the role of calcium, iron, magnesium, phosphorus, potassium, selenium, sodium, and zinc on muscle mass, muscle strength, and physical performance in older adults.nnMETHODS: A systematic search was conducted between March 2016 and July 2016, in the PubMed database using predefined search terms. Articles on the role of dietary mineral intake or mineral serum concentrations on muscle mass, muscle strength, physical performance, and/or the prevalence of sarcopenia in healthy or frail older adults (average age ≥ 65 years) were selected. Only original research publications were included. The search and data extraction were conducted in duplicate by 2 independent researchers. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement was followed in constructing this systematic review. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies was used to evaluate the quality of the selected articles.nnRESULTS: From the 3346 articles found, a total of 10 studies met the inclusion criteria. Observational studies showed that serum selenium (n = 1) and calcium intake (n = 1) were significantly associated with muscle mass, and magnesium (n = 1), selenium (n = 1), iron (n = 1), and zinc (n = 1) intake were significantly and positively associated with physical performance in older adults. Furthermore, magnesium (n = 2), selenium (n = 2), calcium (n = 2), and phosphorus (n = 1) intake were associated with the prevalence of sarcopenia. Magnesium supplementation improved physical performance based on one randomized controlled trial. No studies on the role of sodium or potassium on muscle mass, muscle strength, or physical performance were found.nnCONCLUSION: Minerals may be important nutrients to prevent and/or treat sarcopenia. Particularly, magnesium, selenium, and calcium seem to be most promising. Most of the included studies, however, were observational studies. Therefore, more randomized controlled trials are needed to elucidate the potential benefits of mineral intake to prevent and/or treat sarcopenia and support healthy aging.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid29310648,

title = {Ethnicity and socioeconomic status are related to dietary patterns at age 5 in the Amsterdam born children and their development (ABCD) cohort},

author = {Viyan Rashid and Marielle F Engberink and Manon van Eijsden and Mary Nicolaou and Louise H Dekker and Arnoud P Verhoeff and Peter J M Weijs},

doi = {10.1186/s12889-017-5014-0},

issn = {1471-2458},

year  = {2018},

date = {2018-01-01},

journal = {BMC Public Health},

volume = {18},

number = {1},

pages = {115},

abstract = {BACKGROUND: Health inequalities are already present at young age and tend to vary with ethnicity and socioeconomic status (SES). Diet is a major determinant of overweight, and studying dietary patterns as a whole in relation to overweight rather than single nutrients or foods has been suggested. We derived dietary patterns at age 5 and determined whether ethnicity and SES were both related to these dietary patterns.nnMETHODS: We analysed 2769 validated Food Frequency Questionnaires filled in by mothers of children (5.7 ± 0.5y) in the Amsterdam Born Children and their Development (ABCD) cohort. Food items were reduced to 41 food groups. Energy adjusted intake per food group (g/d) was used to derive dietary patterns using Principal Component Analysis and children were given a pattern score for each dietary pattern. We defined 5 ethnic groups (Dutch, Surinamese, Turkish, Moroccan, other ethnicities) and 3 SES groups (low, middle, high, based on maternal education). Multivariate ANOVA, with adjustment for age, gender and maternal age, was used to test potential associations between ethnicity or SES and dietary pattern scores. Post-hoc analyses with Bonferroni adjustment were used to examine differences between groups.nnRESULTS: Principal Component Analysis identified 4 dietary patterns: a snacking, full-fat, meat and healthy dietary pattern, explaining 21% of the variation in dietary intake. Ethnicity was related to the dietary pattern scores (p < 0.01): non-Dutch children scored high on snacking and healthy pattern, whereas Turkish children scored high on full-fat and Surinamese children on the meat pattern. SES was related to the snacking, full-fat and meat patterns (p < 0.01): low SES children scored high on the snacking and meat pattern and low on the full-fat pattern.nnCONCLUSIONS: This study indicates that both ethnicity and SES are relevant for dietary patterns at age 5 and may enable more specific nutrition education to specific ethnic and low socioeconomic status target groups.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28374096,

title = {The intensive care medicine research agenda in nutrition and metabolism},

author = {Yaseen M Arabi and Michael P Casaer and Marianne Chapman and Daren K Heyland and Carole Ichai and Paul E Marik and Robert G Martindale and Stephen A McClave and Jean-Charles Preiser and Jean Reignier and Todd W Rice and Greet Van den Berghe and Arthur R H van Zanten and Peter J M Weijs},

doi = {10.1007/s00134-017-4711-6},

issn = {1432-1238},

year  = {2017},

date = {2017-09-01},

journal = {Intensive Care Med},

volume = {43},

number = {9},

pages = {1239--1256},

abstract = {PURPOSE: The objectives of this review are to summarize the current practices and major recent advances in critical care nutrition and metabolism, review common beliefs that have been contradicted by recent trials, highlight key remaining areas of uncertainty, and suggest recommendations for the top 10 studies/trials to be done in the next 10 years.nnMETHODS: Recent literature was reviewed and developments and knowledge gaps were summarized. The panel identified candidate topics for future trials in critical care nutrition and metabolism. Then, members of the panel rated each one of the topics using a grading system (0-4). Potential studies were ranked on the basis of average score.nnRESULTS: Recent randomized controlled trials (RCTs) have challenged several concepts, including the notion that energy expenditure must be met universally in all critically ill patients during the acute phase of critical illness, the routine monitoring of gastric residual volume, and the value of immune-modulating nutrition. The optimal protein dose combined with standardized active and passive mobilization during the acute phase and post-acute phase of critical illness were the top ranked studies for the next 10 years. Nutritional assessment, nutritional strategies in critically obese patients, and the effects of continuous versus intermittent enteral nutrition were also among the highest-ranking studies.nnCONCLUSIONS: Priorities for clinical research in the field of nutritional management of critically ill patients were suggested, with the prospect that different nutritional interventions targeted to the appropriate patient population will be examined for their effect on facilitating recovery and improving survival in adequately powered and properly designed studies, probably in conjunction with physical activity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28548991,

title = {Protein nutrition and exercise survival kit for critically ill},

author = {Peter J M Weijs},

doi = {10.1097/MCC.0000000000000425},

issn = {1531-7072},

year  = {2017},

date = {2017-08-01},

journal = {Curr Opin Crit Care},

volume = {23},

number = {4},

pages = {279--283},

abstract = {PURPOSE OF REVIEW: Protein delivery as well as exercise of critically ill in clinical practice is still a highly debated issue. Here we discuss only the most recent updates in the literature concerning protein nutrition and exercise of the critically ill.nnRECENT FINDINGS: By lack of randomized controlled trial (RCTs) in protein nutrition we discuss four post-hoc analyses of nutrition studies and one experimental study in mice. Studies mainly confirm some insights that protein and energy effects are separate and that the trajectory of the patient in the ICU might change these effects. Exercise has been studied much more extensively with RCTs in the last year, although also here the differences between patient groups and timing of intervention might play their roles. Overall the effects of protein nutrition and exercise appear to be beneficial. However, studies into the differential effects of protein nutrition and/or exercise, and optimization of their combined use, have not been performed yet and are on the research agenda.nnSUMMARY: Optimal protein nutrition, optimal exercise intervention as well as the optimal combination of nutrition, and exercise may help to improve long-term physical performance outcome in the critically ill patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28388371,

title = {Experimental and Outcome-Based Approaches to Protein Requirements in the Intensive Care Unit},

author = {Peter J M Weijs and Roland N Dickerson and Daren K Heyland and Frederick A Moore and Saúl J Rugeles and Stephen A McClave},

doi = {10.1177/0884533617692774},

issn = {1941-2452},

year  = {2017},

date = {2017-04-01},

journal = {Nutr Clin Pract},

volume = {32},

number = {1_suppl},

pages = {77S--85S},

abstract = {Insight into protein requirements of intensive care unit (ICU) patients is urgently needed, but at present, it is unrealistic to define protein requirements for different diagnostic groups of critical illness or at different stages of illness. No large randomized controlled trials have randomized protein delivery, adequately addressed energy intake, and evaluated relevant clinical outcomes. As a pragmatic approach, experimental studies have focused on protein requirements of heterogeneous ICU patients. Data are scarce and the absolute value of protein requirements therefore is an approximation. Experimental studies indicate a protein requirement of >1.2 g/kg protein, which is supported by several outcome-based observational studies. Protein intake levels of up to 2.0-2.5 g/kg appear to be safe. A higher level of personalized treatment, within 1.2 and 2.5 g/kg, must involve identification of patients with low muscle protein mass that might benefit most from adequate protein nutrition in the ICU.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28388374,

title = {Summary Points and Consensus Recommendations From the International Protein Summit},

author = {Ryan T Hurt and Stephen A McClave and Robert G Martindale and Juan B Ochoa Gautier and Jorge A Coss-Bu and Roland N Dickerson and Daren K Heyland and L John Hoffer and Frederick A Moore and Claudia R Morris and Douglas Paddon-Jones and Jayshil J Patel and Stuart M Phillips and Saúl J Rugeles and Menaka Sarav Md and Peter J M Weijs and Jan Wernerman and Jill Hamilton-Reeves and Craig J McClain and Beth Taylor},

doi = {10.1177/0884533617693610},

issn = {1941-2452},

year  = {2017},

date = {2017-04-01},

journal = {Nutr Clin Pract},

volume = {32},

number = {1_suppl},

pages = {142S--151S},

abstract = {The International Protein Summit in 2016 brought experts in clinical nutrition and protein metabolism together from around the globe to determine the impact of high-dose protein administration on clinical outcomes and address barriers to its delivery in the critically ill patient. It has been suggested that high doses of protein in the range of 1.2-2.5 g/kg/d may be required in the setting of the intensive care unit (ICU) to optimize nutrition therapy and reduce mortality. While incapable of blunting the catabolic response, protein doses in this range may be needed to best stimulate new protein synthesis and preserve muscle mass. Quality of protein (determined by source, content and ratio of amino acids, and digestibility) affects nutrient sensing pathways such as the mammalian target of rapamycin. Achieving protein goals the first week following admission to the ICU should take precedence over meeting energy goals. High-protein hypocaloric (providing 80%-90% of caloric requirements) feeding may evolve as the best strategy during the initial phase of critical illness to avoid overfeeding, improve insulin sensitivity, and maintain body protein homeostasis, especially in the patient at high nutrition risk. This article provides a set of recommendations based on assessment of the current literature to guide healthcare professionals in clinical practice at this time, as well as a list of potential topics to guide investigators for purposes of research in the future.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28388372,

title = {Protein Delivery in the Intensive Care Unit: Optimal or Suboptimal?},

author = {Daren K Heyland and Peter J M Weijs and Jorge A Coss-Bu and Beth Taylor and Arnold S Kristof and Grant E O'Keefe and Robert G Martindale},

doi = {10.1177/0884533617691245},

issn = {1941-2452},

year  = {2017},

date = {2017-04-01},

journal = {Nutr Clin Pract},

volume = {32},

number = {1_suppl},

pages = {58S--71S},

abstract = {Emerging evidence suggests that exogenous protein/amino acid supplementation has the potential to improve the recovery of critically ill patients. After a careful review of the published evidence, experts have concluded that critically ill patients should receive up to 2.0-2.5 g/kg/d of protein. Despite this, however, recent review of current International Nutrition Survey data suggests that protein in critically ill patients is underprescribed and grossly underdelivered. Furthermore, the survey suggests that most of protein administration comes from enteral nutrition (EN) despite the availability of products and protocols that enhance the delivery of protein/amino acids in the intensive care unit (ICU) setting. While future research clarifies the dose, timing, and composition for exogenous protein administration, as well as identification of patients who will benefit the most, ongoing process improvement initiatives should target a concerted effort to increase protein intake in the critically ill. This assertion follows from the notion that current patients are possibly being harmed while we wait for confirmatory evidence. Further research should also develop better tools to enable bedside practitioners to monitor optimal or adequate protein intake for individual patients. Finally, exploring the effect of combining adequate protein delivery with early mobility and/or resistance exercise in the ICU setting has the greatest potential for improving the functional outcomes of survivors of critical illness and warrants further study.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28388378,

title = {Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient},

author = {Stuart M Phillips and Roland N Dickerson and Frederick A Moore and Douglas Paddon-Jones and Peter J M Weijs},

doi = {10.1177/0884533616686719},

issn = {1941-2452},

year  = {2017},

date = {2017-04-01},

journal = {Nutr Clin Pract},

volume = {32},

number = {1_suppl},

pages = {112S--120S},

abstract = {Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28388373,

title = {Protein Kinetics and Metabolic Effects Related to Disease States in the Intensive Care Unit},

author = {Robert G Martindale and Daren K Heyland and Saúl J Rugeles and Jan Wernerman and Peter J M Weijs and Jayshil J Patel and Stephen A McClave},

doi = {10.1177/0884533617694612},

issn = {1941-2452},

year  = {2017},

date = {2017-04-01},

journal = {Nutr Clin Pract},

volume = {32},

number = {1_suppl},

pages = {21S--29S},

abstract = {Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis. The understanding of protein metabolism in the ICU has been recently expanded with the discovery of how the mammalian target of rapamycin complex 1 is regulated. The concept of "anabolic resistance" and identifying the quantity of protein required to overcome this resistance is gaining support among critical care nutrition circles. It appears that a minimum of at least 1.2 g/kg/d with levels up to 2.0 g/kg/d of protein or amino acids appears safe for delivery in the ICU setting and may yield a better clinical outcome.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid28166780,

title = {Effect of a high protein diet and/or resistance exercise on the preservation of fat free mass during weight loss in overweight and obese older adults: a randomized controlled trial},

author = {Amely M Verreijen and Mariëlle F Engberink and Robert G Memelink and Suzanne E van der Plas and Marjolein Visser and Peter J M Weijs},

doi = {10.1186/s12937-017-0229-6},

issn = {1475-2891},

year  = {2017},

date = {2017-02-01},

journal = {Nutr J},

volume = {16},

number = {1},

pages = {10},

abstract = {BACKGROUND: Intentional weight loss in obese older adults is a risk factor for accelerated muscle mass loss. We investigated whether a high protein diet and/or resistance exercise preserves fat free mass (FFM) during weight loss in overweight and obese older adults.nnMETHODS: We included 100 overweight and obese adults (55-80 year) in a randomized controlled trial (RCT) with a 2 × 2 factorial design and intention-to-treat analysis. During a 10-week weight loss program all subjects followed a hypocaloric diet. Subjects were randomly allocated to either a high protein (1.3 g/kg body weight) or normal protein diet (0.8 g/kg), with or without a resistance exercise program 3 times/week. FFM was assessed by air displacement plethysmography.nnRESULTS: At baseline, mean (±SD) BMI was 32 ± 4 kg/m. During intervention, protein intake was 1.13 ± 0.35 g/kg in the high protein groups vs. 0.98 ± 0.29 in the normal protein groups, which reflects a 16.3 ± 5.2 g/d higher protein intake in the high protein groups. Both high protein diet and exercise did not significantly affect change in body weight, FFM and fat mass (FM). No significant protein*exercise interaction effect was observed for FFM. However, within-group analysis showed that high protein in combination with exercise significantly increased FFM (+0.6 ± 1.3 kg, p = 0.011).nnCONCLUSION: A high protein diet, though lower than targeted, did not significantly affect changes in FFM during modest weight loss in older overweight and obese adults. There was no significant interaction between the high protein diet and resistance exercise for change in FFM. However, only the group with the combined intervention of high protein diet and resistance exercise significantly increased in FFM.nnTRIAL REGISTRATION: Dutch Trial Register, number NTR4556, date 05-01-2014.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26575849,

title = {Lower birth weight is associated with alterations in dietary intake in adolescents independent of genetic factors: A twin study},

author = {Stieneke Doornweerd and Richard G IJzerman and Peter J M Weijs and Michaela Diamant and Eco J de Geus and Dorret I Boomsma},

doi = {10.1016/j.clnu.2015.10.012},

issn = {1532-1983},

year  = {2017},

date = {2017-02-01},

journal = {Clin Nutr},

volume = {36},

number = {1},

pages = {179--185},

abstract = {BACKGROUND & AIMS: Lower birth weight is associated with an increased risk of cardiovascular and metabolic disease. These associations may, at least in part, be explained by alterations in dietary intake in later life. The aim of this study is to examine whether lower birth weight is associated with alterations in dietary intake in later life, and whether this association is due to intrauterine environmental or genetic factors.nnMETHODS: In this observational study birth weight and dietary intake were investigated in 78 dizygotic (DZ) and 94 monozygotic (MZ) adolescent same-sex twin subjects. Birth weight was obtained from the mothers. Dietary intake was assessed by two-day dietary records.nnRESULTS: In the total group of twins, lower birth weight was associated with higher intake of saturated fat after adjustment for current weight (1.2 per cent of total energy intake (E%) per kg increase in birth weight, P < 0.01). Intra-pair analysis in all twin pairs demonstrated that twins with the lower birth weight had a 115 kcal higher total energy intake and a 0.7 E% higher saturated fat intake compared to their co-twins with the higher birth weight (P < 0.05). Intra-pair differences in birth weight were negatively associated with differences in energy intake and differences in intake of saturated fat after adjustment for differences in current weight (P = 0.07 and P < 0.05, respectively). Intra-pair differences in birth weight were positively associated with intra-pair differences in intake of dietary fibres (P < 0.05). These intra-pair differences and associations were similar for DZ and MZ twins (P for difference > 0.6).nnCONCLUSIONS: Lower birth weight was related with higher intake of energy and saturated fat within twin pairs, and these associations were independent of zygosity, suggesting that the association between birth weight and alterations in dietary intake in later life is explained by intrauterine environmental rather than genetic factors.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27258665,

title = {Protein delivery in critical illness},

author = {Peter J M Weijs},

doi = {10.1097/MCC.0000000000000325},

issn = {1531-7072},

year  = {2016},

date = {2016-08-01},

journal = {Curr Opin Crit Care},

volume = {22},

number = {4},

pages = {299--302},

abstract = {PURPOSE OF REVIEW: Protein delivery in the critically ill still is a highly debated issue. Here, we discuss only the most recent updates in the literature concerning protein nutrition of the critically ill.nnRECENT FINDINGS: Up to now, there are no randomized controlled trials (RCTs) published on enteral provision of protein that were randomized for protein level of intake. In the past year, there have been two new observational studies published, one of which in critically ill children. Also, two randomized controlled trials with high parenteral amino acid provision have been published. The overall view on nutrition support has not been changed convincingly by these studies. Recent findings have confirmed that protein and amino acid provision are highly important for outcome in critically ill patients. For the first time, a randomized study confirmed this, however, only on the short term. The other RCT confirmed that an extreme dosing of amino acids is not related to improvement in outcome. One observational study showed that the effect of protein on outcome should be adjusted for energy intake and vice versa, showing that adequate protein is related to improved outcome and adequate energy provision is not. The other observational study confirmed importance of protein in paediatric ICU but also gained some insight into improvement of protein delivery by postpyloric feeding and usefulness of a dedicated dietitian in the ICU.nnSUMMARY: We will continue to improve protein delivery to critically ill patients; however, the quest for evidence and feeding guidelines still remains.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25788405,

title = {Exploration of the protein requirement during weight loss in obese older adults},

author = {Peter J M Weijs and Robert R Wolfe},

doi = {10.1016/j.clnu.2015.02.016},

issn = {1532-1983},

year  = {2016},

date = {2016-04-01},

journal = {Clin Nutr},

volume = {35},

number = {2},

pages = {394--398},

abstract = {RATIONALE: Currently there is no consensus on protein requirements for obese older adults during weight loss. Here we explore the potential use of a new method for assessment of protein requirements based on changes in appendicular muscle mass during weight loss.nnMETHODS: 60 obese older adults were subjected to 13 wk weight loss program, including hypocaloric diet and resistance training. Assessment of appendicular muscle mass was performed by DXA at baseline and after 13 wk challenge period, and the difference calculated as muscle mass change. Protein intake (g/kg body weight and g/kg fat free mass (FFM)) at 13wks was used as marker of protein intake during 13 wk period. 30 subjects received 10 times weekly 20 g protein supplement throughout the 13 week hypocaloric phase which is included in the calculation of total protein intake. Receiver operating characteristic (ROC) curve analysis was used to explore the optimal cutoff point for protein intake (g/kg) versus increase in appendicular muscle mass of more than 250 g over 13 wks (y/n). Subsequently, logistic regression analysis was performed for protein intake cutoff and muscle mass accretion, adjusted for sex, age, baseline BMI, and training compliance.nnRESULTS: ROC curve analysis provided a protein intake level per day of 1.2 g/kg bw and 1.9 g/kg FFM as cutoff point. Presence of muscle mass accretion during 13 wk challenge period was significantly higher with protein intake higher than 1.2 g/kg bw (OR 5.4, 95%CI 1.4-20.6, p = 0.013) or higher than 1.9 g/kg FFM (OR 8.1, 95%CI 2.1-31.9, p = 0.003). Subjects with a protein intake higher than 1.2 g/kg had significantly more often muscle mass accretion, compared to subjects with less protein intake (10/14 (72%) vs 15/46 (33%), p = 0.010). For 1.9 g/kg FFM this was 70% vs 28% (p = 0.002).nnCONCLUSION: This exploratory study provided a level of at least 1.2 g/kg body weight or 1.9 g/kg fat free mass as optimal daily protein intake for obese older adults under these challenged conditions of weight loss, based on muscle mass accretion during the challenge.nnTRIAL REGISTRATION: Dutch Trial Register under number NTR2751.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26564309,

title = {Prediction model to predict critical weight loss in patients with head and neck cancer during (chemo)radiotherapy},

author = {Jacqueline A E Langius and Jos Twisk and Martine Kampman and Patricia Doornaert and Mark H H Kramer and Peter J M Weijs and C René Leemans},

doi = {10.1016/j.oraloncology.2015.10.021},

issn = {1879-0593},

year  = {2016},

date = {2016-01-01},

journal = {Oral Oncol},

volume = {52},

pages = {91--96},

abstract = {OBJECTIVES: Patients with head and neck cancer (HNC) frequently encounter weight loss with multiple negative outcomes as a consequence. Adequate treatment is best achieved by early identification of patients at risk for critical weight loss. The objective of this study was to detect predictive factors for critical weight loss in patients with HNC receiving (chemo)radiotherapy ((C)RT).nnMATERIALS AND METHODS: In this cohort study, 910 patients with HNC were included receiving RT (±surgery/concurrent chemotherapy) with curative intent. Body weight was measured at the start and end of (C)RT. Logistic regression and classification and regression tree (CART) analyses were used to analyse predictive factors for critical weight loss (defined as >5%) during (C)RT. Possible predictors included gender, age, WHO performance status, tumour location, TNM classification, treatment modality, RT technique (three-dimensional conformal RT (3D-RT) vs intensity-modulated RT (IMRT)), total dose on the primary tumour and RT on the elective or macroscopic lymph nodes.nnRESULTS: At the end of (C)RT, mean weight loss was 5.1±4.9%. Fifty percent of patients had critical weight loss during (C)RT. The main predictors for critical weight loss during (C)RT by both logistic and CART analyses were RT on the lymph nodes, higher RT dose on the primary tumour, receiving 3D-RT instead of IMRT, and younger age.nnCONCLUSION: Critical weight loss during (C)RT was prevalent in half of HNC patients. To predict critical weight loss, a practical prediction tree for adequate nutritional advice was developed, including the risk factors RT to the neck, higher RT dose, 3D-RT, and younger age.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid27904645,

title = {Predicting resting energy expenditure in underweight, normal weight, overweight, and obese adult hospital patients},

author = {Hinke M Kruizenga and Geesje H Hofsteenge and Peter J M Weijs},

doi = {10.1186/s12986-016-0145-3},

issn = {1743-7075},

year  = {2016},

date = {2016-01-01},

journal = {Nutr Metab (Lond)},

volume = {13},

pages = {85},

abstract = {BACKGROUND: When indirect calorimetry is not available, predictive equations are used to estimate resing energy expenditure (REE). There is no consensus about which equation to use in hospitalized patients. The objective of this study is to examine the validity of REE predictive equations for underweight, normal weight, overweight, and obese inpatients and outpatients by comparison with indirect calorimetry.nnMETHODS: Equations were included when based on weight, height, age, and/or gender. REE was measured with indirect calorimetry. A prediction between 90 and 110% of the measured REE was considered accurate. The bias and root-mean-square error (RMSE) were used to evaluate how well the equations fitted the REE measurement. Subgroup analysis was performed for BMI. A new equation was developed based on regression analysis and tested.nnRESULTS: 513 general hospital patients were included, (253 F, 260 M), 237 inpatients and 276 outpatients. Fifteen predictive equations were used. The most used fixed factors (25 kcal/kg/day, 30 kcal/kg/day and 2000 kcal for female and 2500 kcal for male) were added. The percentage of accurate predicted REE was low in all equations, ranging from 8 to 49%. Overall the new equation performed equal to the best performing Korth equation and slightly better than the well-known WHO equation based on weight and height (49% vs 45% accurate). Categorized by BMI subgroups, the new equation, Korth and the WHO equation based on weight and height performed best in all categories except from the obese subgroup. The original Harris and Benedict (HB) equation was best for obese patients.nnCONCLUSIONS: REE predictive equations are only accurate in about half the patients. The WHO equation is advised up to BMI 30, and HB equation is advised for obese (over BMI 30). Measuring REE with indirect calorimetry is preferred, and should be used when available and feasible in order to optimize nutritional support in hospital inpatients and outpatients with different degrees of malnutrition.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26494245,

title = {Ventilator-derived carbon dioxide production to assess energy expenditure in critically ill patients: proof of concept},

author = {Sandra N Stapel and Harm-Jan S de Grooth and Hoda Alimohamad and Paul W G Elbers and Armand R J Girbes and Peter J M Weijs and Heleen M Oudemans-van Straaten},

doi = {10.1186/s13054-015-1087-2},

issn = {1466-609X},

year  = {2015},

date = {2015-10-01},

journal = {Crit Care},

volume = {19},

pages = {370},

abstract = {INTRODUCTION: Measurement of energy expenditure (EE) is recommended to guide nutrition in critically ill patients. Availability of a gold standard indirect calorimetry is limited, and continuous measurement is unfeasible. Equations used to predict EE are inaccurate. The purpose of this study was to provide proof of concept that EE can be accurately assessed on the basis of ventilator-derived carbon dioxide production (VCO2) and to determine whether this method is more accurate than frequently used predictive equations.nnMETHODS: In 84 mechanically ventilated critically ill patients, we performed 24-h indirect calorimetry to obtain a gold standard EE. Simultaneously, we collected 24-h ventilator-derived VCO2, extracted the respiratory quotient of the administered nutrition, and calculated EE with a rewritten Weir formula. Bias, precision, and accuracy and inaccuracy rates were determined and compared with four predictive equations: the Harris-Benedict, Faisy, and Penn State University equations and the European Society for Clinical Nutrition and Metabolism (ESPEN) guideline equation of 25 kcal/kg/day.nnRESULTS: Mean 24-h indirect calorimetry EE was 1823 ± 408 kcal. EE from ventilator-derived VCO2 was accurate (bias +141 ± 153 kcal/24 h; 7.7 % of gold standard) and more precise than the predictive equations (limits of agreement -166 to +447 kcal/24 h). The 10 % and 15 % accuracy rates were 61 % and 76 %, respectively, which were significantly higher than those of the Harris-Benedict, Faisy, and ESPEN guideline equations. Large errors of more than 30 % inaccuracy did not occur with EE derived from ventilator-derived VCO2. This 30 % inaccuracy rate was significantly lower than that of the predictive equations.nnCONCLUSIONS: In critically ill mechanically ventilated patients, assessment of EE based on ventilator-derived VCO2 is accurate and more precise than frequently used predictive equations. It allows for continuous monitoring and is the best alternative to indirect calorimetry.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid26471899,

title = {Fat-free mass prediction equations for bioelectric impedance analysis compared to dual energy X-ray absorptiometry in obese adolescents: a validation study},

author = {Geesje H Hofsteenge and Mai J M Chinapaw and Peter J M Weijs},

doi = {10.1186/s12887-015-0476-7},

issn = {1471-2431},

year  = {2015},

date = {2015-10-01},

journal = {BMC Pediatr},

volume = {15},

pages = {158},

abstract = {BACKGROUND: In clinical practice, patient friendly methods to assess body composition in obese adolescents are needed. Therefore, the bioelectrical impedance analysis (BIA) related fat-free mass (FFM) prediction equations (FFM-BIA) were evaluated in obese adolescents (age 11-18 years) compared to FFM measured by dual-energy x-ray absorptiometry (FFM-DXA) and a new population specific FFM-BIA equation is developed.nnMETHODS: After an overnight fast, the subjects attended the outpatient clinic. After measuring height and weight, a full body scan by dual-energy x-ray absorptiometry (DXA) and a BIA measurement was performed. Thirteen predictive FFM-BIA equations based on weight, height, age, resistance, reactance and/or impedance were systematically selected and compared to FFM-DXA. Accuracy of FFM-BIA equations was evaluated by the percentage adolescents predicted within 5% of FFM-DXA measured, the mean percentage difference between predicted and measured values (bias) and the Root Mean Squared prediction Error (RMSE). Multiple linear regression was conducted to develop a new BIA equation.nnRESULTS: Validation was based on 103 adolescents (60% girls), age 14.5 (sd1.7) years, weight 94.1 (sd15.6) kg and FFM-DXA of 56.1 (sd9.8) kg. The percentage accurate estimations varied between equations from 0 to 68%; bias ranged from -29.3 to +36.3% and RMSE ranged from 2.8 to 12.4 kg. An alternative prediction equation was developed: FFM = 0.527 * H(cm)(2)/Imp + 0.306 * weight - 1.862 (R(2) = 0.92, SEE = 2.85 kg). Percentage accurate prediction was 76%.nnCONCLUSIONS: Compared to DXA, the Gray equation underestimated the FFM with 0.4 kg (55.7 ± 8.3), had an RMSE of 3.2 kg, 63% accurate prediction and the smallest bias of (-0.1%). When split by sex, the Gray equation had the narrowest range in accurate predictions, bias, and RMSE. For the assessment of FFM with BIA, the Gray-FFM equation appears to be the most accurate, but 63% is still not at an acceptable accuracy level for obese adolescents. The new equation appears to be appropriate but await further validation. DXA measurement remains the method of choice for FFM in obese adolescents.nnTRIAL REGISTRATION: Netherlands Trial Register ( ISRCTN27626398).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid25635595,

title = {Preservation of autophagy should not direct nutritional therapy},

author = {Stephen A McClave and Peter J M Weijs},

doi = {10.1097/MCO.0000000000000144},

issn = {1473-6519},

year  = {2015},

date = {2015-03-01},

journal = {Curr Opin Clin Nutr Metab Care},

volume = {18},

number = {2},

pages = {155--161},

abstract = {PURPOSE OF REVIEW: Recent reports in the literature have proposed that forced mandatory feeding should be avoided in the first week of critical illness to preserve autophagy, in order to maximize responses to oxidative stress, preserve organ function, and improve outcomes.nnRECENT FINDINGS: Autophagy is a well recognized physiologic process that serves a housekeeping role for the cell to eliminate large protein aggregates and as a survival mechanism in starvation for generating energy (ATP) and promoting protein synthesis to maintain cell structure. In the critical care setting, autophagy may have important roles in modulating immune function, fighting infection, and preventing organ failure. The effect of feeding on autophagy is complex, poorly understood, and difficult to predict.nnSUMMARY: The argument to withhold feeding to preserve autophagy is poorly substantiated and should not interfere with the delivery of early enteral nutrition to the critically ill patient in that first week following admission to the ICU.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}