2014
Weijs, Peter J M; Cynober, Luc; DeLegge, Mark; Kreymann, Georg; Wernerman, Jan; Wolfe, Robert R
Proteins and amino acids are fundamental to optimal nutrition support in critically ill patients Tijdschriftartikel
In: Crit Care, vol. 18, nr. 6, pp. 591, 2014, ISSN: 1466-609X.
@article{pmid25565377,
title = {Proteins and amino acids are fundamental to optimal nutrition support in critically ill patients},
author = {Peter J M Weijs and Luc Cynober and Mark DeLegge and Georg Kreymann and Jan Wernerman and Robert R Wolfe},
doi = {10.1186/s13054-014-0591-0},
issn = {1466-609X},
year = {2014},
date = {2014-11-01},
journal = {Crit Care},
volume = {18},
number = {6},
pages = {591},
abstract = {Proteins and amino acids are widely considered to be subcomponents in nutritional support. However, proteins and amino acids are fundamental to recovery and survival, not only for their ability to preserve active tissue (protein) mass but also for a variety of other functions. Understanding the optimal amount of protein intake during nutritional support is therefore fundamental to appropriate clinical care. Although the body adapts in some ways to starvation, metabolic stress in patients causes increased protein turnover and loss of lean body mass. In this review, we present the growing scientific evidence showing the importance of protein and amino acid provision in nutritional support and their impact on preservation of muscle mass and patient outcomes. Studies identifying optimal dosing for proteins and amino acids are not currently available. We discuss the challenges physicians face in administering the optimal amount of protein and amino acids. We present protein-related nutrition concepts, including adaptation to starvation and stress, anabolic resistance, and potential adverse effects of amino acid provision. We describe the methods for assessment of protein status, and outcomes related to protein nutritional support for critically ill patients. The identification of a protein target for individual critically ill patients is crucial for outcomes, particularly for specific subpopulations, such as obese and older patients. Additional research is urgently needed to address these issues.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Proteins and amino acids are widely considered to be subcomponents in nutritional support. However, proteins and amino acids are fundamental to recovery and survival, not only for their ability to preserve active tissue (protein) mass but also for a variety of other functions. Understanding the optimal amount of protein intake during nutritional support is therefore fundamental to appropriate clinical care. Although the body adapts in some ways to starvation, metabolic stress in patients causes increased protein turnover and loss of lean body mass. In this review, we present the growing scientific evidence showing the importance of protein and amino acid provision in nutritional support and their impact on preservation of muscle mass and patient outcomes. Studies identifying optimal dosing for proteins and amino acids are not currently available. We discuss the challenges physicians face in administering the optimal amount of protein and amino acids. We present protein-related nutrition concepts, including adaptation to starvation and stress, anabolic resistance, and potential adverse effects of amino acid provision. We describe the methods for assessment of protein status, and outcomes related to protein nutritional support for critically ill patients. The identification of a protein target for individual critically ill patients is crucial for outcomes, particularly for specific subpopulations, such as obese and older patients. Additional research is urgently needed to address these issues.
Weijs, Peter J M
Fundamental determinants of protein requirements in the ICU Tijdschriftartikel
In: Curr Opin Clin Nutr Metab Care, vol. 17, nr. 2, pp. 183–189, 2014, ISSN: 1473-6519.
@article{pmid24500443,
title = {Fundamental determinants of protein requirements in the ICU},
author = {Peter J M Weijs},
doi = {10.1097/MCO.0000000000000029},
issn = {1473-6519},
year = {2014},
date = {2014-03-01},
journal = {Curr Opin Clin Nutr Metab Care},
volume = {17},
number = {2},
pages = {183--189},
abstract = {PURPOSE OF REVIEW: Currently, feeding the ICU patient is highly discussed. Energy feeding has been the topic of randomized studies, but protein feeding has not. Study results are contradictory on early feeding; however, little is known about early protein requirement. What is this protein requirement based on, therefore what are the fundamental determinants?nnRECENT FINDINGS: Recent studies have addressed the importance of protein feeding and/or muscle (protein) wasting in critically ill patients. Targeted feeding has been shown to improve protein balance in one study, and infection rate in one study. Low muscle mass that is already present during ICU admission has been shown to be related to higher mortality, in two studies. Four studies have related muscle wasting to (protein) feeding strategies with very diverse results: Two small studies have reported no advantage [n = 15, computed tomography] or negative impact (n = 62, ultrasound, 50% sepsis patients) of protein on muscle wasting. Two studies, one small (n = 33, computed tomography) and one very large (n = 1372, Subjective Global Assessment), have reported a positive impact of (early) feeding on muscle wasting.nnSUMMARY: Fundamental to adequate protein feeding in critically ill patients, at least 1.2 g protein/kg per day, is targeted energy feeding using indirect calorimetry. The level of protein requirement is related to fat free mass or muscle mass, which makes sex and BMI also relevant. Targeted early protein feeding is found to improve short-term outcome, reduction of muscle wasting and hospital mortality. Long-term outcome of protein feeding has not been studied. However, targeted protein feeding may be harmful in sepsis patients. Up to now, we lack biomarkers that provide caregivers with an instrument to increase protein feeding up to the individual protein requirement of the critically ill patient.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE OF REVIEW: Currently, feeding the ICU patient is highly discussed. Energy feeding has been the topic of randomized studies, but protein feeding has not. Study results are contradictory on early feeding; however, little is known about early protein requirement. What is this protein requirement based on, therefore what are the fundamental determinants?nnRECENT FINDINGS: Recent studies have addressed the importance of protein feeding and/or muscle (protein) wasting in critically ill patients. Targeted feeding has been shown to improve protein balance in one study, and infection rate in one study. Low muscle mass that is already present during ICU admission has been shown to be related to higher mortality, in two studies. Four studies have related muscle wasting to (protein) feeding strategies with very diverse results: Two small studies have reported no advantage [n = 15, computed tomography] or negative impact (n = 62, ultrasound, 50% sepsis patients) of protein on muscle wasting. Two studies, one small (n = 33, computed tomography) and one very large (n = 1372, Subjective Global Assessment), have reported a positive impact of (early) feeding on muscle wasting.nnSUMMARY: Fundamental to adequate protein feeding in critically ill patients, at least 1.2 g protein/kg per day, is targeted energy feeding using indirect calorimetry. The level of protein requirement is related to fat free mass or muscle mass, which makes sex and BMI also relevant. Targeted early protein feeding is found to improve short-term outcome, reduction of muscle wasting and hospital mortality. Long-term outcome of protein feeding has not been studied. However, targeted protein feeding may be harmful in sepsis patients. Up to now, we lack biomarkers that provide caregivers with an instrument to increase protein feeding up to the individual protein requirement of the critically ill patient.
Weijs, Peter J M; Looijaard, Wilhelmus G P M; Dekker, Ingeborg M; Stapel, Sandra N; Girbes, Armand R; Straaten, H M Oudemans-van; Beishuizen, Albertus
Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients Tijdschriftartikel
In: Crit Care, vol. 18, nr. 2, pp. R12, 2014, ISSN: 1466-609X.
@article{pmid24410863,
title = {Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients},
author = {Peter J M Weijs and Wilhelmus G P M Looijaard and Ingeborg M Dekker and Sandra N Stapel and Armand R Girbes and H M Oudemans-van Straaten and Albertus Beishuizen},
doi = {10.1186/cc13189},
issn = {1466-609X},
year = {2014},
date = {2014-01-01},
journal = {Crit Care},
volume = {18},
number = {2},
pages = {R12},
abstract = {INTRODUCTION: Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship.nnMETHODS: This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm2 for females and 170 cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables.nnRESULTS: This study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m2. Muscle area for females was significantly lower than that for males (102 ± 23 cm2 versus 158 ± 33 cm2; P < 0.001). Low-muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P < 0.001). Independent predictive factors for mortality were low-muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P < 0.001). When applying sex-specific cutoffs to all patients, muscle mass appeared as primary predictor, not sex.nnCONCLUSIONS: Low skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship.nnMETHODS: This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm2 for females and 170 cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables.nnRESULTS: This study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m2. Muscle area for females was significantly lower than that for males (102 ± 23 cm2 versus 158 ± 33 cm2; P < 0.001). Low-muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P < 0.001). Independent predictive factors for mortality were low-muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P < 0.001). When applying sex-specific cutoffs to all patients, muscle mass appeared as primary predictor, not sex.nnCONCLUSIONS: Low skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for.
2013
Langius, Jacqueline A E; Zandbergen, Myrna C; Eerenstein, Simone E J; van Tulder, Maurits W; Leemans, C René; Kramer, Mark H H; Weijs, Peter J M
In: Clin Nutr, vol. 32, nr. 5, pp. 671–678, 2013, ISSN: 1532-1983.
@article{pmid23845384,
title = {Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review},
author = {Jacqueline A E Langius and Myrna C Zandbergen and Simone E J Eerenstein and Maurits W van Tulder and C René Leemans and Mark H H Kramer and Peter J M Weijs},
doi = {10.1016/j.clnu.2013.06.012},
issn = {1532-1983},
year = {2013},
date = {2013-10-01},
journal = {Clin Nutr},
volume = {32},
number = {5},
pages = {671--678},
abstract = {BACKGROUND AND AIMS: We performed a systematic review to examine the effect of nutritional interventions on nutritional status, quality of life (QoL) and mortality in patients with head and neck squamous cell cancer (HNSCC) receiving radiotherapy or chemoradiotherapy.nnMETHODS: We searched Pubmed, EMBASE, CENTRAL and Cinahl from inception through January 3rd, 2012 to identify randomized controlled trials (RCTs) from a broad range of nutritional interventions in patients with HNSCC during (chemo)radiotherapy. Two reviewers independently assessed study eligibility and risk of bias, and extracted data.nnRESULTS: Of 1141 titles identified, 12 study reports were finally included, describing 10 different studies with 11 interventions. Four out of 10 studies examined the effects of individualized dietary counseling, and showed significant benefits on nutritional status and QOL compared to no counseling or general nutritional advice by a nurse (p < 0.05). Three studies on oral nutritional supplements (ONS) were inconsistent about the effect on nutritional status compared with no supplementation. One study showed that nasogastric tube feeding had beneficial effects on nutritional status compared to ONS, but not in all patient groups (p < 0.04). One study showed benefits of percutaneous endoscopic gastronomy (PEG) feeding on nutritional status shortly after RT compared with nasogastric feeding (p = 0.001). Two studies showed that prophylactic PEG feeding was not superior over tube feeding if required.nnCONCLUSIONS: This review shows beneficial effects of individualized dietary counseling on nutritional status and QoL, compared to no counseling or standard nutritional advice. Effects of ONS and tube feeding were inconsistent.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND AND AIMS: We performed a systematic review to examine the effect of nutritional interventions on nutritional status, quality of life (QoL) and mortality in patients with head and neck squamous cell cancer (HNSCC) receiving radiotherapy or chemoradiotherapy.nnMETHODS: We searched Pubmed, EMBASE, CENTRAL and Cinahl from inception through January 3rd, 2012 to identify randomized controlled trials (RCTs) from a broad range of nutritional interventions in patients with HNSCC during (chemo)radiotherapy. Two reviewers independently assessed study eligibility and risk of bias, and extracted data.nnRESULTS: Of 1141 titles identified, 12 study reports were finally included, describing 10 different studies with 11 interventions. Four out of 10 studies examined the effects of individualized dietary counseling, and showed significant benefits on nutritional status and QOL compared to no counseling or general nutritional advice by a nurse (p < 0.05). Three studies on oral nutritional supplements (ONS) were inconsistent about the effect on nutritional status compared with no supplementation. One study showed that nasogastric tube feeding had beneficial effects on nutritional status compared to ONS, but not in all patient groups (p < 0.04). One study showed benefits of percutaneous endoscopic gastronomy (PEG) feeding on nutritional status shortly after RT compared with nasogastric feeding (p = 0.001). Two studies showed that prophylactic PEG feeding was not superior over tube feeding if required.nnCONCLUSIONS: This review shows beneficial effects of individualized dietary counseling on nutritional status and QoL, compared to no counseling or standard nutritional advice. Effects of ONS and tube feeding were inconsistent.
Weijs, Peter J M; Wischmeyer, Paul E
Optimizing energy and protein balance in the ICU Tijdschriftartikel
In: Curr Opin Clin Nutr Metab Care, vol. 16, nr. 2, pp. 194–201, 2013, ISSN: 1473-6519.
@article{pmid23334173,
title = {Optimizing energy and protein balance in the ICU},
author = {Peter J M Weijs and Paul E Wischmeyer},
doi = {10.1097/MCO.0b013e32835bdf7e},
issn = {1473-6519},
year = {2013},
date = {2013-03-01},
journal = {Curr Opin Clin Nutr Metab Care},
volume = {16},
number = {2},
pages = {194--201},
abstract = {PURPOSE OF REVIEW: Perhaps now more than ever, appropriate nutrition delivery in the ICU is a highly debated issue. Nutrition guidelines for ICU patients by European Society for Clinical Nutrition and Metabolism in Europe, The Canadian Nutrition Guidelines, and American Society for Parenteral and Enteral Nutrition in the USA continue to disagree about the need to feed early and how. Most ICU patients around the world appear to be poorly fed.nnRECENT FINDINGS: Most studies have focussed on energy supply by enteral or parenteral nutrition. Some studies suggest that late initiation of energy supply could be beneficial. However, studies still not provide the answer as to when and how to feed the patient. A few studies have now also focussed on protein supply. Studies agree on the importance of adequate protein supply, 1.2-2.0 g/kg, for outcome. In fact, early protein supply might be more important than energy supply; however, limited data are available.nnSUMMARY: These findings implicate that optimization of protein balance in ICU patients as well as energy balance will improve outcome. In clinical practice, protein targets for patients should be set and achieved. More research is needed to define when and how to best feed the ICU patient.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE OF REVIEW: Perhaps now more than ever, appropriate nutrition delivery in the ICU is a highly debated issue. Nutrition guidelines for ICU patients by European Society for Clinical Nutrition and Metabolism in Europe, The Canadian Nutrition Guidelines, and American Society for Parenteral and Enteral Nutrition in the USA continue to disagree about the need to feed early and how. Most ICU patients around the world appear to be poorly fed.nnRECENT FINDINGS: Most studies have focussed on energy supply by enteral or parenteral nutrition. Some studies suggest that late initiation of energy supply could be beneficial. However, studies still not provide the answer as to when and how to feed the patient. A few studies have now also focussed on protein supply. Studies agree on the importance of adequate protein supply, 1.2-2.0 g/kg, for outcome. In fact, early protein supply might be more important than energy supply; however, limited data are available.nnSUMMARY: These findings implicate that optimization of protein balance in ICU patients as well as energy balance will improve outcome. In clinical practice, protein targets for patients should be set and achieved. More research is needed to define when and how to best feed the ICU patient.
Langius, Jacqueline A E; van Dijk, Anne M; Doornaert, Patricia; Kruizenga, Hinke M; Langendijk, Johannes A; Leemans, C René; Weijs, Peter J M; Leeuw, Irma M Verdonck-de
More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life Tijdschriftartikel
In: Nutr Cancer, vol. 65, nr. 1, pp. 76–83, 2013, ISSN: 1532-7914.
@article{pmid23368916,
title = {More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life},
author = {Jacqueline A E Langius and Anne M van Dijk and Patricia Doornaert and Hinke M Kruizenga and Johannes A Langendijk and C René Leemans and Peter J M Weijs and Irma M Verdonck-de Leeuw},
doi = {10.1080/01635581.2013.741749},
issn = {1532-7914},
year = {2013},
date = {2013-01-01},
journal = {Nutr Cancer},
volume = {65},
number = {1},
pages = {76--83},
abstract = {The authors prospectively assessed the independent association between weight loss and deterioration in quality of life (QOL) in patients treated by radiotherapy for head and neck cancer. In 533 head and neck cancer patients treated by curative radiotherapy, changes in weight and QOL were assessed between baseline (before radiotherapy) and follow-up (12 wk after the start of radiotherapy). Patients were categorized into 4 weight loss categories: 0%, 0.1%-5.0%, 5.1%-10.0%, and >10% weight loss. The association between weight loss and change in QOL was analyzed by linear regression analysis, adjusted for sociodemographic and tumor-related characteristics, and additionally for disease specific symptoms and tube feeding. Thirty percent of patients lost 0.1%-5.0% weight, 26% lost 5.1%-10.0% weight, and 24% lost >10% weight. Adjusted regression analyses showed a significant association between weight loss and deterioration of global QOL, physical functioning, social functioning, social eating, and social contact. After additional adjustment for disease-specific symptoms and tube feeding, weight loss (>10%) remained significantly associated with global QOL, social eating, and social contact (P < 0.05). More than 10% weight loss during and directly after radiotherapy has a significant impact on social eating, social contact, and QOL in head and neck cancer patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The authors prospectively assessed the independent association between weight loss and deterioration in quality of life (QOL) in patients treated by radiotherapy for head and neck cancer. In 533 head and neck cancer patients treated by curative radiotherapy, changes in weight and QOL were assessed between baseline (before radiotherapy) and follow-up (12 wk after the start of radiotherapy). Patients were categorized into 4 weight loss categories: 0%, 0.1%-5.0%, 5.1%-10.0%, and >10% weight loss. The association between weight loss and change in QOL was analyzed by linear regression analysis, adjusted for sociodemographic and tumor-related characteristics, and additionally for disease specific symptoms and tube feeding. Thirty percent of patients lost 0.1%-5.0% weight, 26% lost 5.1%-10.0% weight, and 24% lost >10% weight. Adjusted regression analyses showed a significant association between weight loss and deterioration of global QOL, physical functioning, social functioning, social eating, and social contact. After additional adjustment for disease-specific symptoms and tube feeding, weight loss (>10%) remained significantly associated with global QOL, social eating, and social contact (P < 0.05). More than 10% weight loss during and directly after radiotherapy has a significant impact on social eating, social contact, and QOL in head and neck cancer patients.
2012
Weijs, Peter J M; Sauerwein, Hans P; Kondrup, Jens
2012, ISSN: 1532-1983.
@misc{pmid22640477,
title = {Protein recommendations in the ICU: g protein/kg body weight - which body weight for underweight and obese patients?},
author = {Peter J M Weijs and Hans P Sauerwein and Jens Kondrup},
doi = {10.1016/j.clnu.2012.04.007},
issn = {1532-1983},
year = {2012},
date = {2012-10-01},
journal = {Clin Nutr},
volume = {31},
number = {5},
pages = {774--775},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Langius, Jacqueline A E; Kruizenga, Hinke M; Uitdehaag, Bernard M J; Langendijk, Johannes A; Doornaert, Patricia; Leemans, C René; Weijs, Peter J M
Resting energy expenditure in head and neck cancer patients before and during radiotherapy Tijdschriftartikel
In: Clin Nutr, vol. 31, nr. 4, pp. 549–554, 2012, ISSN: 1532-1983.
@article{pmid22265724,
title = {Resting energy expenditure in head and neck cancer patients before and during radiotherapy},
author = {Jacqueline A E Langius and Hinke M Kruizenga and Bernard M J Uitdehaag and Johannes A Langendijk and Patricia Doornaert and C René Leemans and Peter J M Weijs},
doi = {10.1016/j.clnu.2011.12.009},
issn = {1532-1983},
year = {2012},
date = {2012-08-01},
journal = {Clin Nutr},
volume = {31},
number = {4},
pages = {549--554},
abstract = {BACKGROUND & AIMS: Weight loss is a frequently observed problem in patients with head and neck cancer (HNC) during radiotherapy. It is still to be assessed whether hypermetabolism is contributing to this problem. The aim of this study was to investigate hypermetabolism before radiotherapy, and changes in resting energy expenditure (REE) in HNC patients during radiotherapy.nnMETHODS: REE was measured by indirect calorimetry in 71 patients with HNC before radiotherapy, after 3 and 6 weeks of radiotherapy, and 3 months after radiotherapy. The association between REE and tumour stage, CRP, and prior tumour surgery was analyzed by linear regression analyses. Forty healthy control subjects were one-to-one matched to 40 patients by gender, age and fat free mass (FFM) index to compare REE.nnRESULTS: Before radiotherapy, REE was not significantly different between patients and controls, neither in absolute values (1568 ± 247 vs. 1619 ± 244 kcal/d; p = 0.29), nor after weight-adjustment (22.1 ± 3.5 vs. 21.5 ± 3.3 kcal/kg, p = 0.42) or FFM-adjustment (31.5 ± 4.9 vs. 30.7 ± 4.5 kcal/kg, p = 0.38). REE was independent of tumour stage, CRP, and prior tumour surgery. REE (kcal/d) decreased during radiotherapy and thereafter by 9% from pre-radiotherapy (p < 0.01). Weight and FFM also decreased significantly over time (p < 0.001). REE adjusted for FFM decreased in the first 3 weeks of radiotherapy with 4% (B = -1.39 kcal/kg FFM, p < 0.01), increased at the end of radiotherapy and decreased again 3 months after radiotherapy (B = -1.31 kcal/kg FFM, p = 0.04).nnCONCLUSIONS: Head and neck cancer patients had normal REE before radiotherapy. During radiotherapy, REE decreased continuously with ongoing weight loss. However, weight loss is not the only explaining factor, since REE expressed per kg FFM showed a much more divergent course which is currently unexplained.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND & AIMS: Weight loss is a frequently observed problem in patients with head and neck cancer (HNC) during radiotherapy. It is still to be assessed whether hypermetabolism is contributing to this problem. The aim of this study was to investigate hypermetabolism before radiotherapy, and changes in resting energy expenditure (REE) in HNC patients during radiotherapy.nnMETHODS: REE was measured by indirect calorimetry in 71 patients with HNC before radiotherapy, after 3 and 6 weeks of radiotherapy, and 3 months after radiotherapy. The association between REE and tumour stage, CRP, and prior tumour surgery was analyzed by linear regression analyses. Forty healthy control subjects were one-to-one matched to 40 patients by gender, age and fat free mass (FFM) index to compare REE.nnRESULTS: Before radiotherapy, REE was not significantly different between patients and controls, neither in absolute values (1568 ± 247 vs. 1619 ± 244 kcal/d; p = 0.29), nor after weight-adjustment (22.1 ± 3.5 vs. 21.5 ± 3.3 kcal/kg, p = 0.42) or FFM-adjustment (31.5 ± 4.9 vs. 30.7 ± 4.5 kcal/kg, p = 0.38). REE was independent of tumour stage, CRP, and prior tumour surgery. REE (kcal/d) decreased during radiotherapy and thereafter by 9% from pre-radiotherapy (p < 0.01). Weight and FFM also decreased significantly over time (p < 0.001). REE adjusted for FFM decreased in the first 3 weeks of radiotherapy with 4% (B = -1.39 kcal/kg FFM, p < 0.01), increased at the end of radiotherapy and decreased again 3 months after radiotherapy (B = -1.31 kcal/kg FFM, p = 0.04).nnCONCLUSIONS: Head and neck cancer patients had normal REE before radiotherapy. During radiotherapy, REE decreased continuously with ongoing weight loss. However, weight loss is not the only explaining factor, since REE expressed per kg FFM showed a much more divergent course which is currently unexplained.
2011
Weijs, Peter J M
Hypermetabolism, is it real? The example of amyotrophic lateral sclerosis Diversen
2011, ISSN: 1878-3570.
@misc{pmid22027048,
title = {Hypermetabolism, is it real? The example of amyotrophic lateral sclerosis},
author = {Peter J M Weijs},
doi = {10.1016/j.jada.2011.08.011},
issn = {1878-3570},
year = {2011},
date = {2011-11-01},
journal = {J Am Diet Assoc},
volume = {111},
number = {11},
pages = {1670--1673},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Leistra, Eva; Willeboordse, Floor; van Bokhorst-de van der Schueren, Marian A E; Visser, Marjolein; Weijs, Peter J M; den Oord, Annelie Haans-van; Oostenbrink, Jan; Evers, Anja M; Kruizenga, Hinke M
Predictors for achieving protein and energy requirements in undernourished hospital patients Tijdschriftartikel
In: Clin Nutr, vol. 30, nr. 4, pp. 484–489, 2011, ISSN: 1532-1983.
@article{pmid21376433,
title = {Predictors for achieving protein and energy requirements in undernourished hospital patients},
author = {Eva Leistra and Floor Willeboordse and Marian A E van Bokhorst-de van der Schueren and Marjolein Visser and Peter J M Weijs and Annelie Haans-van den Oord and Jan Oostenbrink and Anja M Evers and Hinke M Kruizenga},
doi = {10.1016/j.clnu.2011.01.008},
issn = {1532-1983},
year = {2011},
date = {2011-08-01},
journal = {Clin Nutr},
volume = {30},
number = {4},
pages = {484--489},
abstract = {BACKGROUND & AIMS: Providing sufficient protein an energy is considered crucial in the treatment of undernutrition. Still, the majority of undernourished hospital patients have a suboptimal protein and energy intake. The aim of this study was to investigate predictors for achieving protein and energy requirements on the fourth day of admission in undernourished hospitalized patients.nnMETHODS: 830 adult undernourished patients (SNAQ ≥ 3) were retrospectively included. Intake requirements were defined as ≥1.2 g protein per kg bodyweight and ≥100% of the energy requirement based on calculated resting energy expenditure according to Harris & Benedict + 30%. Logistic regression analyses were performed to investigate predictors for achieving the requirements.nnRESULTS: Protein and energy intake had been recorded for 610 patients, of whom 25.6% had sufficient protein and energy intake. Protein requirements were less commonly met than energy requirements. Complete case analyses (n = 575) showed that negative predictors for achieving the protein and energy requirements were: nausea (OR = 0.18; 95%CI = 0.06-0.53), cancer (0.57; 0.35-0.93), acute infections (0.63; 0.37-1.01) and higher BMI (0.84; 0.79-0.89). Positive predictors were: a higher age (1.01; 1.00-1.03), chronic lung disease (3.76; 2.33-6.07) and receiving tube feeding (3.89; 1.56-9.73).nnCONCLUSION: Only one in four undernourished hospital patients meets the predefined protein and energy requirements on the fourth day of admission. Nausea, cancer, acute infections, BMI, age, chronic lung disease and tube feeding were identified as predictors for achieving protein and energy intake.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND & AIMS: Providing sufficient protein an energy is considered crucial in the treatment of undernutrition. Still, the majority of undernourished hospital patients have a suboptimal protein and energy intake. The aim of this study was to investigate predictors for achieving protein and energy requirements on the fourth day of admission in undernourished hospitalized patients.nnMETHODS: 830 adult undernourished patients (SNAQ ≥ 3) were retrospectively included. Intake requirements were defined as ≥1.2 g protein per kg bodyweight and ≥100% of the energy requirement based on calculated resting energy expenditure according to Harris & Benedict + 30%. Logistic regression analyses were performed to investigate predictors for achieving the requirements.nnRESULTS: Protein and energy intake had been recorded for 610 patients, of whom 25.6% had sufficient protein and energy intake. Protein requirements were less commonly met than energy requirements. Complete case analyses (n = 575) showed that negative predictors for achieving the protein and energy requirements were: nausea (OR = 0.18; 95%CI = 0.06-0.53), cancer (0.57; 0.35-0.93), acute infections (0.63; 0.37-1.01) and higher BMI (0.84; 0.79-0.89). Positive predictors were: a higher age (1.01; 1.00-1.03), chronic lung disease (3.76; 2.33-6.07) and receiving tube feeding (3.89; 1.56-9.73).nnCONCLUSION: Only one in four undernourished hospital patients meets the predefined protein and energy requirements on the fourth day of admission. Nausea, cancer, acute infections, BMI, age, chronic lung disease and tube feeding were identified as predictors for achieving protein and energy intake.
2010
Hofsteenge, Geesje H; Chinapaw, Mai J M; de Waal, Henriette A Delemarre-van; Weijs, Peter J M
Validation of predictive equations for resting energy expenditure in obese adolescents Tijdschriftartikel
In: Am J Clin Nutr, vol. 91, nr. 5, pp. 1244–1254, 2010, ISSN: 1938-3207.
@article{pmid20237141,
title = {Validation of predictive equations for resting energy expenditure in obese adolescents},
author = {Geesje H Hofsteenge and Mai J M Chinapaw and Henriette A Delemarre-van de Waal and Peter J M Weijs},
doi = {10.3945/ajcn.2009.28330},
issn = {1938-3207},
year = {2010},
date = {2010-05-01},
journal = {Am J Clin Nutr},
volume = {91},
number = {5},
pages = {1244--1254},
abstract = {BACKGROUND: When the resting energy expenditure (REE) of overweight and obese adolescents cannot be measured by indirect calorimetry, it has to be predicted with an equation.nnOBJECTIVE: The aim of this study was to examine the validity of published equations for REE compared with indirect calorimetry in overweight and obese adolescents.nnDESIGN: Predictive equations based on weight, height, sex, age, fat-free mass (FFM), and fat mass were compared with measured REE. REE was measured by indirect calorimetry, and body composition was measured by dual-energy X-ray absorptiometry. The accuracy of the REE equations was evaluated on the basis of the percentage of adolescents predicted within 10% of REE measured, the mean percentage difference between predicted and measured values (bias), and the root mean squared prediction error (RMSE).nnRESULTS: Forty-three predictive equations (of which 12 were based on FFM) were included. Validation was based on 70 girls and 51 boys with a mean age of 14.5 y and a mean (+/-SD) body mass index SD score of 2.93 +/- 0.45. The percentage of adolescents with accurate predictions ranged from 74% to 12% depending on the equation used. The most accurate and precise equation for these adolescents was the Molnar equation (accurate predictions: 74%; bias: -1.2%; RMSE: 174 kcal/d). The often-used Schofield-weight equation for age 10-18 y was not accurate (accurate predictions: 50%; bias: +10.7%; RMSE: 276 kcal/d).nnCONCLUSIONS: Indirect calorimetry remains the method of choice for REE in overweight and obese adolescents. However, the sex-specific Molnar REE prediction equation appears to be the most accurate for overweight and obese adolescents aged 12-18 y. This trial was registered at www.trialregister.nl with the Netherlands Trial Register as ISRCTN27626398.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: When the resting energy expenditure (REE) of overweight and obese adolescents cannot be measured by indirect calorimetry, it has to be predicted with an equation.nnOBJECTIVE: The aim of this study was to examine the validity of published equations for REE compared with indirect calorimetry in overweight and obese adolescents.nnDESIGN: Predictive equations based on weight, height, sex, age, fat-free mass (FFM), and fat mass were compared with measured REE. REE was measured by indirect calorimetry, and body composition was measured by dual-energy X-ray absorptiometry. The accuracy of the REE equations was evaluated on the basis of the percentage of adolescents predicted within 10% of REE measured, the mean percentage difference between predicted and measured values (bias), and the root mean squared prediction error (RMSE).nnRESULTS: Forty-three predictive equations (of which 12 were based on FFM) were included. Validation was based on 70 girls and 51 boys with a mean age of 14.5 y and a mean (+/-SD) body mass index SD score of 2.93 +/- 0.45. The percentage of adolescents with accurate predictions ranged from 74% to 12% depending on the equation used. The most accurate and precise equation for these adolescents was the Molnar equation (accurate predictions: 74%; bias: -1.2%; RMSE: 174 kcal/d). The often-used Schofield-weight equation for age 10-18 y was not accurate (accurate predictions: 50%; bias: +10.7%; RMSE: 276 kcal/d).nnCONCLUSIONS: Indirect calorimetry remains the method of choice for REE in overweight and obese adolescents. However, the sex-specific Molnar REE prediction equation appears to be the most accurate for overweight and obese adolescents aged 12-18 y. This trial was registered at www.trialregister.nl with the Netherlands Trial Register as ISRCTN27626398.
2009
Sikkes, M Ellen; Kooistra, Menno P; Weijs, Peter J M
Improved nutrition after conversion to nocturnal home hemodialysis Tijdschriftartikel
In: J Ren Nutr, vol. 19, nr. 6, pp. 494–499, 2009, ISSN: 1532-8503.
@article{pmid19616453,
title = {Improved nutrition after conversion to nocturnal home hemodialysis},
author = {M Ellen Sikkes and Menno P Kooistra and Peter J M Weijs},
doi = {10.1053/j.jrn.2009.05.006},
issn = {1532-8503},
year = {2009},
date = {2009-11-01},
journal = {J Ren Nutr},
volume = {19},
number = {6},
pages = {494--499},
abstract = {BACKGROUND: Protein-energy malnutrition is a frequently observed problem in hemodialysis patients. Nocturnal home hemodialysis (NHHD; 6 x 8hours during the night) seems to improve patient outcomes, including nutritional state.nnMETHODS: In a single-center, prospective, nonrandomized study, the effects of NHHD on various aspects of nutrition in 14 hemodialysis patients during 1 to 2 years were investigated, using dietary records, appetite questionnaires, laboratory tests, and patient data.nnRESULTS: Appetite, body weight, and energy and protein intakes improved. Patients could drink more. Serum phosphate, calcium, and potassium intake increased. Laboratory results remained excellent, without phosphate-binding agents or potassium-binding resins. However, fat intake also increased, with a risk for overweight status.nnCONCLUSIONS: Nocturnal home hemodialysis has a positive effect on nutritional state.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Protein-energy malnutrition is a frequently observed problem in hemodialysis patients. Nocturnal home hemodialysis (NHHD; 6 x 8hours during the night) seems to improve patient outcomes, including nutritional state.nnMETHODS: In a single-center, prospective, nonrandomized study, the effects of NHHD on various aspects of nutrition in 14 hemodialysis patients during 1 to 2 years were investigated, using dietary records, appetite questionnaires, laboratory tests, and patient data.nnRESULTS: Appetite, body weight, and energy and protein intakes improved. Patients could drink more. Serum phosphate, calcium, and potassium intake increased. Laboratory results remained excellent, without phosphate-binding agents or potassium-binding resins. However, fat intake also increased, with a risk for overweight status.nnCONCLUSIONS: Nocturnal home hemodialysis has a positive effect on nutritional state.
Leistra, Eva; Neelemaat, Floor; Evers, Anja M; van Zandvoort, Myriam H W M; Weijs, Peter J M; van Bokhorst-de van der Schueren, Marian A E; Visser, Marjolein; Kruizenga, Hinke M
Prevalence of undernutrition in Dutch hospital outpatients Tijdschriftartikel
In: Eur J Intern Med, vol. 20, nr. 5, pp. 509–513, 2009, ISSN: 1879-0828.
@article{pmid19712855,
title = {Prevalence of undernutrition in Dutch hospital outpatients},
author = {Eva Leistra and Floor Neelemaat and Anja M Evers and Myriam H W M van Zandvoort and Peter J M Weijs and Marian A E van Bokhorst-de van der Schueren and Marjolein Visser and Hinke M Kruizenga},
doi = {10.1016/j.ejim.2009.03.011},
issn = {1879-0828},
year = {2009},
date = {2009-09-01},
journal = {Eur J Intern Med},
volume = {20},
number = {5},
pages = {509--513},
abstract = {BACKGROUND: The prevalence of undernutrition in hospital inpatients is high. Earlier detection and treatment in the hospital outpatient clinic may help to reduce these numbers. The purpose of this study was to assess the prevalence of undernutrition in hospital outpatients in the Netherlands, to determine high risk departments, and to determine the percentage of patients receiving dietetic treatment.nnMETHODS: This cross-sectional multicenter study was conducted in nine hospitals. Patients who visited the outpatient clinic on one of the screening days in the period March-May 2008 received a short questionnaire and were weighed. Patients were classified as severely undernourished, moderately undernourished or not undernourished.nnRESULTS: 2288 patients were included in the study, of which 5% were severely undernourished and 2% were moderately undernourished. The prevalence of severe undernutrition was highest in the outpatient departments of oral maxillofacial surgery (17%), oncology (10%), rehabilitation (8%), gastroenterology (7%) and pulmonology (7%). Only 17% of all severely undernourished and 4% of all moderately undernourished patients reported to receive dietetic treatment.nnCONCLUSION: The prevalence of undernutrition in hospital outpatients is generally low but largely undertreated. Future screening should focus on high risk departments.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The prevalence of undernutrition in hospital inpatients is high. Earlier detection and treatment in the hospital outpatient clinic may help to reduce these numbers. The purpose of this study was to assess the prevalence of undernutrition in hospital outpatients in the Netherlands, to determine high risk departments, and to determine the percentage of patients receiving dietetic treatment.nnMETHODS: This cross-sectional multicenter study was conducted in nine hospitals. Patients who visited the outpatient clinic on one of the screening days in the period March-May 2008 received a short questionnaire and were weighed. Patients were classified as severely undernourished, moderately undernourished or not undernourished.nnRESULTS: 2288 patients were included in the study, of which 5% were severely undernourished and 2% were moderately undernourished. The prevalence of severe undernutrition was highest in the outpatient departments of oral maxillofacial surgery (17%), oncology (10%), rehabilitation (8%), gastroenterology (7%) and pulmonology (7%). Only 17% of all severely undernourished and 4% of all moderately undernourished patients reported to receive dietetic treatment.nnCONCLUSION: The prevalence of undernutrition in hospital outpatients is generally low but largely undertreated. Future screening should focus on high risk departments.
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