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pagina 12, 29-03-2012 © Het Financieele Dagblad
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Jaren onderzoek en ontwikkeling
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pagina 12, 29-03-2012 © Het Financieele Dagblad
2010-2011
2012-2014
2014-2015
idee
onderzoek & ontwikkeling
effect studie
Wetenschappelijk onderzoek Smaaktesten in de doelgroep • Senioren - Wageningen UR Voedingsstudies: inname eiwit • Ziekenhuis Vumc / Herstel hotel • Ziekenhuis Gelderse Vallei Effectstudies • Ziekenhuis ZGV en thuis
Ondervoeding Gevolgen van ondervoeding: • Vertraagde wondgenezing • Langer ziekenhuisverblijf • Verminderde kwaliteit van leven • Verhoogde sterftekans
Totale kosten € 1,8 miljard2 • Ziekenhuis: € 1,1 miljard § Leeftijdsgroep 60+: €752 miljoen 2 SEO-‐rapport nr. 2014-‐11,
based on numbers of 2011
Aanbevelingen eiwit-‐inname • Gezonde volwassenen: – 0,8 g/ kg/ dag • Opgenomen in ziekenhuis en verhoogd risico op ondervoeding: – 1,2 – 1,5 g/ kg/ dag • Verdeling van eiwit over de dag: – 25-30 g eiwit per hoofdmaaltijd (ontbijt, lunch, diner)3
3 Paddon-‐Jones et al. 2009
Inname op dag 4 versus aanbeveling
1,5 g/kg/d 1,2 g/kg/d 0,8 g/kg/d
(n=31)
(n=32)
§ MUST ≥1 krijgt energie en eiwit verrijkt dieet
Verdeling over de dag 35
Protein intake (grams)
30
25
20
MUST 0 MUST ≥ 1
15
10
5
0
Breakfast
Snack morning
Lunch
Snack afternoon
Diner
Snack evening
WAT WERKT NIET WERKT NIET: MEER ETEN Huidige behandelmethoden: - Energie & Eiwitrijk dieet - Suppletie drinkvoeding Conclusie onderzoek: • Huidige behandel mogelijkheden van ondervoeding lijken niet voldoende om de energie en eiwitbehoefte van de meerderheid van oudere patiënten te behalen. • Zelfs de MUST 0 patiënten hebben een inadequate eiwit inname. (niet ondervoed volgens screening)
CATER WITH CARE: INSIGHTS INTO MEETING PROTEIN REQUIREMENTS IN HOSPITALISED ELDERLY PATIENTS Nancy Janssen* 1, Emmelyne Vasse1, Janne Beelen2, Quinta van der Sluijs1, Joyce van Geel2, Nicole M de Roos2, André Janse md3 1department
of dietetics, Gelderse Vallei Hospital, Ede, 2Division of Human Nutrition, Wageningen University, Wageningen, 3department of geriatric medicine, Gelderse Vallei Hospital, Ede, Netherlands
Rationale
Results
Key message
A considerable part of hospitalized elderly patients are unable to meet protein and energy requirements. The objective of this study was
1. We observed a significant difference in protein intake but not in energy intake between patients receiving an enriched diet versus not enriched (1.13 grams vs. 0.62 grams of protein per kg BW; P<0.05).
Most hospitalized elderly would benefit from protein enriched foods.
1.
To gain insight into the protein and energy intake of hospitalized elderly patients.
2.
To gain insight into their awareness of undernutrition, importance of protein and preferences for foods and drinks of these patients.
2. Interviews showed that elderly are unaware of the risks of being undernourished and the importance of dietary protein. Healthy food is associated with eating vegetables. Elderly are not prone to change dietary habits.
Since elderly won’t change their habits, we need to adjust the amount of protein within these habits. Conclusions 1.
Current treatment options for undernutrition do not seem sufficient for meeting energy and protein requirements in the majority of elderly patients.
2.
Even MUST 0 patients inadequate protein intake.
3.
Increasing awareness about undernutrition among elderly patients and offering enriched foods and drinks that fit in with current dietary choices could increase their protein and energy intake.
Method 1.
2.
Design: cross-sectional study. Participants: Forty hospitalized patients of 65+ years, at risk of undernutrition (MUST ≥1) and receiving a protein and energy enriched diet, and 40 hospitalized patients of 65+ years not at risk and receiving a standard diet. Measurement: 24h-recall on the fourth day of hospitalisation to calculate protein and energy intake. Ten patients at risk of undernutrition were interviewed using a semi-structured interview guide. Thematic analyses was used for analysing the interviews.
Department of dietetics Alliantie Voeding Gelderse Vallei Gelderse Vallei Hospital p/a Ziekenhuis Gelderse Vallei PO box 9025 Postbus 9025 6710 HN Ede, the Netherlands 6710 HN Ede
[email protected]
Figure. Actual protein intake compared to the recommendations for hospitalized elderly in the MUST 0 group (n=31) and the MUST ≥ 1 group (n=32) on the fourth day of hospitalisation.
What do they mean.. Protein??
[email protected] www.alliantievoeding.nl
have
Undernourished? Not me, I eat vegetables
SenTo – smaakpanel Wageningen Universiteit
Senioren met volledige geur/smaakvermogen Kiezen wat je lekker vindt, en krijgen wat je nodig hebt.
Senioren met verminderde geur/smaakvermogen (geur-impairment) Volwassenen
Smaaktest in de doelgroep
Senioren met verminderde geur-/smaakvermogen vinden Carezzo lekkerder dan het geteste standaardbrood. 60 50 40 30 20
SenTo panel WUR -‐FBR
10 0 sento normal
sento impaired Standard
Carezzo
Young
Voedingsstudie: Significante stijging eiwit inname
RDA 0.8
0.9
1.1
1.0 Ziekenhuis (3 dagen)
Acuut zieke ouderen • Interventie groep 1.1 g/kg • Controle groep 0.9 g/kg
NORM 1.2
1.6
Herstelhotel (3 weken)
Herstellende senioren • Interventie groep 1.6 g/kg • Controle groep 1.1 g/kg
Eiwit verrijkt brood & eiwit verrijkte drink joghurt
WAT WERKT WEL
Protein-enriched bread and drinking yoghurt and their effect on protein intakeTitel in acutely hospitalized voorbeeld titelolder adults: a randomized controlled trial S. Stelten*1 , I.M. Dekker1, A.E. Ronday1, A. Thijs2, E. Boelsma3, H.W. Peppelenbos3, M.A.E. de van der Schueren1,4 1 Nutrition
WERKT WEL: MEER EIWIT - Eiwit verrijkt brood & drink yoghurt - Zelfde hoeveelheid gegeten
and Dietetics, VU University Medical Center, Amsterdam, 2 Internal Medicine, VU University Medical Center, Amsterdam, 3 Food & Biobased Reaserch, Wageningen UR, Wageningen, 4 Faculty of Health and Social Studies, Department Nutrition, Sports and Health, HAN Univerity of Applies Sciences, Nijmegen
Rationale Earlier studies have shown that protein intake in elderly is often insufficient during hospitalization. The objective of this study was to examine the effect on protein intake of acutely hospitalized elderly of consuming a protein-enriched bread and drinking yoghurt, replacing normal products.
Methods
Resultaat en conclusie onderzoek: • Het gebruik van verrijkte producten resulteerde in een significant verhoogde eiwit inname. Brood en drink yoghurt droegen in vrijwel gelijke mate bij in de verhoogde inname in de interventie groep. • Het gebruik van eiwit verrijkt brood en eiwit verrijkte drink yoghurt als onderdeel van de reguliere maaltijden is een veelbelovende en haalbare oplossing om de eiwit inname te verhogen van acuut zieke ouderen.
This study was performed as a single blind randomized controlled trial in elderly (≥ 55 years), acutely admitted to the hospital. During 3 consecutive days participants received either ad libitum protein-enriched bread (7 g of protein) and drinking yoghurt (20 g of protein) in the intervention group or isocaloric, non-enriched bread (4 g of protein) and drinking yoghurt (8 g of protein) in the control group as part of their daily meals. Food intake of the participants was measured and nutritional values were calculated according to the Dutch Food Composition Table. An independent samples t-test was used to compare protein intake between intervention and control group.
Results The use of enriched products resulted in a significantly increased protein intake. Bread and drinking yoghurt contributed almost equally to the increased intake of protein in the intervention group.
Control group (n=25)
Intervention group (n=22)
P -value
Protein intake (g)
58 ± 15
75 ± 33
0.039
Protein intake (g/kg/day)
0.9 ± 0.3
1.1 ± 0.5
0.041
Protein requirementa (%)
8%
36%
0.030
Data are presented as mean ± SD, unless stated otherwise a Percentage of patients reaching the minimum protein requirement of 1.2 g/kg/day
Conclusion The use of protein-enriched bread and drinking yoghurt, consumed as part of regular meals, is a promising and feasible solution to increase the protein intake of acutely ill elderly. It needs to be confirmed whether a longer-term use of these products in larger groups of patients will also result in better clinical outcomes.
Correspondence:
[email protected]
Effectieve spreiding: extra eiwit in broodmaaltijden
Ziekenhuis geen enkele maaltijd > 25 g Herstelhotel alle maaltijden > 25 g
Bron: Ned Tijdschrift voor Voeding & Dietetiek – Mei 2014 - RCT Veveo studie Vumc & ZZG herstelhotel - eiwitverrijkt brood & eiwitverrijkte drink yoghurt
Effects of the daily consumption of protein enriched bread and protein enriched drinking yoghurt on the total protein intake in elderly in a rehabilitation centre: a single blind randomised controlled trial
WAT WERKT BETER WERKT BETER: SPREIDING INNAME - broodmaaltijden & tussendoor - optimaal over de dag Resultaat en conclusie onderzoek: • In vergelijking met de controle groep hebben patiënten die eiwit verrijkte producten kregen een significant hogere eiwit inname.(3 weken) • De dagelijkse consumptie van eiwit verrijkt brood en eiwit verrijkte drinkyoghurt is effectief om zowel een significant hogere eiwit inname en een optimale verdeling van het extra eiwit over de dag te verkrijgen bij oudere patiënten.
AJ van Til1, E Naumann1, IJHM Cox-Claessens2, S Kremer³, E Boelsma³, MAE de van der Schueren1,4 1
HAN University of Applied Sciences, Faculty of Health and Social Studies, Department of Nutrition, Sports and Health, 2 ZZG Rehabilitation centre, Medical director, ³ Wageningen UR, Food and Biobased Research, 4 VU University Medical Centre, Nutrition and Dietetics, Internal Medicine
Rationale A sufficient total protein intake (1.2-1.5 g/kg for acutely and chronically ill older adults) and an optimal protein distribution over the day (25-30 g/meal) are important to counteract sarcopenia. However, patients recovering from disease often have an insufficient protein intake. The purpose of the current study was to investigate the effects of the consumption of protein enriched products on the daily protein intake and the protein distribution over the day in older adults in a rehabilitation centre.
Methods Single blind RCT. Patients received either protein enriched bread (Carezzo; 6.9 g protein per slice) and protein enriched drinking yoghurt (Drinking yoghurt enriched with Fonterra Whey Protein Concentrate (WPC 515), 20.0 g protein / 250 mL) or regular products during three weeks (4.0 g and 7.5 g protein, resp.) For each patient, 24h intake of all food products was measured (6 measurement days per patient).
Control
Intervention
P-value
Protein intake (g/day)
72.5
115.3
<0.001
Protein intake g/kg
1.1
1.6
<0.001
The intervention group consumed quantities over the recommended level (25-30 g/meal) during each of the three meals, where the control group consumed quantities below the recommended level during breakfast and lunch (figure).
Results Thirty-four patients were included in the study. Compared with controls, patients who received the protein enriched products had a significantly higher protein intake (table).
Conclusion The daily consumption of protein enriched bread and protein enriched drinking yoghurt is effective to achieve both a significant higher protein intake and an optimal distribution of the dietary protein over the day in older adults.
Correspondence:
[email protected]
Ondervoeding in de zorg: Ongewenst gewichtsverlies 25%-‐40% De VOEDINGs oplossing + 30g
08.00
10.00
12.00
15.00
18.00
20.00
BROOD
TUSSEN DOOR
WARM
TUSSEN DOOR
2E BROOD
TUSSEN DOOR
NIEUW VOEDING CONCEPT • eiwitverrijkte basisvoeding – groenten, fruit en granen • voor broodmaaltijden en tussendoor
Eiwit tekort voor de spieropbouw
Risicogroep: Kwetsbare ouderen • Weinig eetlust: < eiwit aanbeveling • Behoud spieren
Ondervoeding bij ziekte • Onbedoeld gewichtsverlies • Stop spierafbraak + 30g
1/3 < onacceptabel
60g
1/3 ongewenst
90g
1/3 > gewenst
+ 50% Eiwit inname
Prestatie indicator IGZ 1,2 g eiwit/kg
Nieuw voedingconcept: eiwitverijkt eten en drinken voor de zorg
‘Kiezen wat je lekker vindt en krijgen wat je nodig hebt’ REAKTIES VAN DIETISTEN • ‘ik heb niet zo’n goed gevoel bij de huidige aanpak van diëten en drinkvoeding: niks werkt echt om ondervoeding op te lossen’. • ‘we blijven hangen in een JA MAAR discussie en dan gebeurt er niks’ • ‘met zo’n hele range is er altijd wel iets dat men lekker vindt, dit gaat gewoon werken’. • ‘als je kan kiezen kun je het langer volhouden’ • ‘de getallen op de verpakking zijn een leuke hulp om uit te tellen wat je nodig hebt’ • ‘met Carezzo wordt het ons wel heel eenvoudig gemaakt’
Erkenning voor Carezzo verpakkingen
Ter kennismaking: 2 assortiments dozen
Praktische vragen
• Bieden we voldoende eiwit aan in het dagmenu om de eiwit inname normen te halen? – Kleinere porties, minder vlees, Niet alles opgegeten, waste? – Welke doelgroepen komen eiwit te kort?
• Bieden we eiwit op de goede momenten aan, verspreid over de maaltijden? – Voldoende eiwit in de broodmaaltijden? Niet teveel in de warme maaltijd? – Hebben we andere producten met meer eiwit nodig?
• Kunnen we verleiden en spreiden? – Lekker, wordt alles opgegeten. Kiezen en variëren. Houden mensen het vol? – Gaan tussendoortjes/supplementen niet ten koste van maaltijden?
• Kunnen we besparen? – Waste is altijd duur – Niet gegeten kan nooit werken!
‘Kiezen wat je lekker vindt en krijgen wat je nodig hebt’
Zorgeloos genieten & Zorgvuldig samengesteld
Fred Bergmans & Wim van Cuijk
[email protected] M: +31 653 130 672
[email protected] M: +31 651 682 466
