Impact of foods with health logo on ssaturated fat, sodium and sugar intake of young Dutch adults

Objective Health logos are introduced to distinguish foods with ‘healthier’ nutrient composition from regular foods. In the present study, we evaluated the effects of changed food compositions according to health logo criteria on the intake of saturated fat, sugar and sodium in a Dutch population of young adults. Design Foods in the Dutch food composition table were evaluated against nutrient criteria for logo eligibility. Three replacement scenarios were compared with the nutrient intake ‘as measured’ in the Dutch consumption survey. The foods not complying with health logo criteria were replaced either by ‘virtual’ foods exactly complying with the health logo criteria, with real 2007 market shares (scenario I) and 100 % market shares (scenario II), or by existing similar foods with a composition that already complied with the health logo criteria (scenario III). Results The percentage reduction in nutrient intake with the current 2007 market shares of ‘health logo foods’ was -2·5 % for SFA, 0 % for sodium and -1 % for sugar. With a 100 % market share these reductions would be -10 % for SFA, -4 % for sodium and -6 % for sugar. This may lead to a reduction of -40 % for SFA, -23 % for sodium and -36 % for sugar in the most optimal replacement scenario. Conclusions With ‘health logo foods’, available in 2007 and current consumption patterns, small reductions can be achieved for SFA and sugar. For additional reductions, lowering the fat/sodium content of meat (products) towards health logo criteria and drinks without sugar towards limits far below health logo criteria would be the most effective reformulation strategy

Airway granulation response to lung-implantable medical devices:a concise overview

Increasing numbers of endoscopically implantable devices are implanted in the airways, such as airway stents, one-way valves and coils, to treat both malignant and benign diseases. They significantly improve patient outcomes, but their long-term effectiveness and sustainability is hampered by the reaction of the formation of granulation tissue. Factors including procedural-related tissue injury; micro-organism presence; device-related factors, such as the material, design and sizing in relation to the airway; and patient-related factors, including genetic susceptibility, comorbidities and medication use, might all effect the severity of the tissue response and the subsequent degree of granulation tissue formation. However, research into the underlying mechanism and risk factors is scarce and therefore our knowledge is limited. Joint efforts from the scientific community, both pre-clinical and clinical, are needed to gain a deeper understanding and eventually improve the long-term treatment effectiveness of lung-implantable devices

Development of international criteria for a front of package food labelling system: the International Choices Programme

BACKGROUND: A global push to reduce the amount of saturated and trans-fatty acids, added salt and sugar in processed food, and to enhance fruit, vegetable and whole grain intake, while limiting energy intake, exists for most populations. OBJECTIVES: To redesign the International Choices Program (note: this is unrelated to the US Smart Choices Program), initially Netherlands focused, by an international board of scientists to create a generic, global front-of-pack nutrition logo system that helps consumers make healthier food choices and stimulates product reformulation. METHODS: The Programme is a product-group-specific-nutrient-profiling approach with a distinction between basic and discretionary foods. The basic product groups are main contributors of essential and beneficial nutrients, and are based on food-based dietary guidelines from more than 20 countries across the globe. Generic criteria are derived from international nutrient recommendations for trans-fatty acids, saturated fatty acids, sodium, added sugar, fibre and energy, and evaluated against food composition data from 12 countries across Europe and market reality (actual foods on the market). Selected debates such as the source of fibre are also presented. RESULTS: Generic criteria and a decision framework were developed to further define food categories, so as to meet the unique country- and region-specific dietary needs. The result is a complete set of criteria that is evaluated on a regular basis to ensure its alignment with international dietary patterns, new scientific insights and current developments within the food market. CONCLUSIONS: These guidelines are currently used in a number of countries across the globe, and are being evaluated for effectiveness. Completed studies have demonstrated an increase in consumer awareness, a positive effect on product innovation and a potential impact on nutrient intakes

Safety and Considerations of the Anaesthetic Management during Bronchoscopic Lung Volume Reduction Treatments

Background: Different bronchoscopic lung volume reduction approaches are available for a select group of patients with advanced COPD. General anaesthesia is the recommended method of sedation during these procedures. However, this patient population is at an increased risk of anaesthetic complications, and the best approach to general anaesthesia and mechanical ventilation is unknown.Objectives: The aims of this study were to describe the anaesthetic management techniques used during bronchoscopic lung volume reduction procedures and to investigate the number of anaesthesia-related events.Methods: Data were retrospectively collected from all endobronchial valve and lung volume reduction coil procedures performed between January 2018 and March 2020 in our hospital. Primary outcomes measures were anaesthetic technique including airway management; ventilation mode and settings; and the incidence of anaesthesia-related events, classified as catastrophic, severe, significant, or moderate.Results: 202 procedures were included. One procedure was performed under procedural sedation, 198 (98%) under general anaesthesia with endotracheal intubation, and 3 (1.5%) under general anaesthesia with laryngeal mask airway. Volume-controlled ventilation was used in 64% of the procedures and pressure-controlled in 36%. Patients were ventilated with a median respiration rate of 9.9 (IQR: 9.6-10.6) breaths per minute, mean tidal volume of 5.8 ± 1.4 mL/kg, and median inspiratory to expiratory (I:E) ratio of 1:2.8 (IQR: 1:2.1-1:3.2). No catastrophic anaesthesia-related events were observed. Hypotension was the most observed anaesthesia-related event.Conclusions: Despite the presence of advanced COPD, general anaesthesia and mechanical ventilation are well tolerated by patients undergoing endobronchial valve or lung volume reduction coil treatment. This is presumably strongly linked to the strict selection criteria. Other important considerations are using a low respiratory rate, low tidal volume, and high I:E ratio.</p

Modelling of Usual Nutrient Intakes: Potential Impact of the Choices Programme on Nutrient Intakes in Young Dutch Adults

Introduction The Choices Programme is an internationally applicable nutrient profiling system with nutrition criteria for trans fatty acids (TFA), saturated fatty acids, sodium, added sugar and for some product groups energy and fibre. These criteria determine whether foods are eligible to carry a “healthier option” stamp. In this paper a nutrient intake modelling method is described to evaluate these nutritional criteria by investigating the potential effect on nutrient intakes. Methods Data were combined from the 2003 Dutch food consumption survey in young adults (aged 19–30) and the Dutch food composition table into the Monte Carlo Risk Assessment model. Three scenarios were calculated: the “actual intakes” (scenario 1) were compared to scenario 2, where all foods that did not comply were replaced by similar foods that did comply with the Choices criteria. Scenario 3 was the same as scenario 2 adjusted for the difference in energy density between the original and replacement food. Additional scenarios were calculated where snacks were not or partially replaced and stratified analyses for gender, age, Body Mass Index (BMI) and education. Results Calculated intake distributions showed that median energy intake was reduced by 16% by replacing normally consumed foods with Choices compliant foods. Intakes of nutrients with a maximal intake limit were also reduced (ranging from -23% for sodium and -62% for TFA). Effects on intakes of beneficial nutrients varied from an unintentional reduction in fat soluble vitamin intakes (-15 to -28%) to an increase of 28% for fibre and 17% calcium. Stratified analyses in this homogeneous study population showed only small differences across gender, age, BMI and education. Conclusions This intake modelling method showed that with consumption of Choices compliant foods, nutrient intakes shift towards population intake goals for the nutrients for which nutrition criteria were defined, while effects on beneficial nutrients were diverse

Revision Bronchoscopy After Endobronchial Valve Treatment for Emphysema:Indications, Findings and Outcomes

Background: Endobronchial valve (EBV) treatment is an effective treatment for patients with severe emphysema. Revision bronchoscopies after endobronchial valve treatment can be essential to prolong the effect of treatment or address long-term complications. Purpose: To evaluate the indications, endoscopic findings and outcomes of revision bronchoscopies and investigate if any predictors for granulation tissue formation, after EBV treatment, can be identified. Patients and Methods: Patients who underwent EBV treatment between 2016 and 2019 in our hospital, as routine care, were included. If a patient underwent a revision bronchoscopy, data regarding revision bronchoscopies, including indication, finding, intervention and pulmonary function testing (PFT) after revision bronchoscopy were analysed. Results: One hundred seventy-nine patients were included of which 41% required at least one revision bronchoscopy. In 43% of the revision bronchoscopy patients, the indication was loss of initial treatment effect. In 53% of the revision bronchoscopy patients, granulation tissue was found to be the underlying cause. Valve replacement(s) were performed in 51% of the revision bronchoscopy cases. Permanent valve removal was required in 13% of all patients. Overall, revision bronchoscopies led to improvements in PFT outcomes for patients experiencing no or a loss of initial treatment effect. No clinically relevant predictors for granulation tissue formation were identified. Conclusion: Performing a revision bronchoscopy after EBV treatment is a useful procedure leading to an improved treatment effect in most patients. Granulation tissue formation, causing valve dysfunction, is the most common cause of longer term problems

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p