Disease-related malnutrition and nutritional assessment in clinical practice

Malnutrition has been defined as “a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat-free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease”. The prevalence of malnutrition in hospital populations is reported to vary between 11-45%. To prevent or treat malnutrition, early recognition of the (risk for) malnutrition is necessary. The prevalence of malnutrition, its characteristics, and the subsequent necessary interventions may vary in different patient populations. This thesis aimed to provide new insights with regard to the (risk) assessment of disease-related malnutrition and its implications for healthcare professionals in order to improve their care for patients in daily clinical practice. This thesis shows that a substantial part of the patients prior to vascular surgery, or patients with COPD following a pulmonary rehabilitation program, is malnourished or at risk for malnutrition, whereas these patients may be unrecognized and thus not treated. Therefore screening and assessment are important, and should be performed in such a way that all domains of malnutrition are represented, as well as the underlying factors that give guidance to interventions. Insight in what motivates people to eat healthy and new methods to measure body composition can be helpful to the nutrition care process. This is important as (risk for) malnutrition is a predictor of worse clinical outcome and is associated with frailty. To improve recognition of malnutrition and nutrition-related disorders, more knowledge and awareness is needed

Improvement in frailty status after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

The aim of this study, is to assess changes in prevalence and frailty score during pulmonary rehabilitation (PR) in patients with COPD

Knowledge and practice among dietitians in four Western European countries regarding malnutrition, starvation, cachexia and sarcopenia

Adequate distinction between malnutrition, starvation, cachexia and sarcopenia is important in clinical care. Despite the overlap in physical characteristics, differences in etiology have therapeutical and prognostic implications. We aimed to determine whether dietitians in selected European countries have ‘proper knowledge’ of malnutrition, starvation, cachexia and sarcopenia, and use terminology accordingly

The impact of national prenatal screening on the time of diagnosis and outcome of pregnancies affected with common trisomies, a cohort study in the Northern Netherlands

Background: To evaluate the impact of the introduction of prenatal screening on time of detection and pregnancy outcome for trisomy 21 (T21), trisomy 18 (T18) and trisomy 13 (T13). Methods: We performed a retrospective, population-based cohort study in the Northern Netherlands including 503 trisomy cases born between 2005 and 2012. Screening tests and invasive procedures, timing of diagnosis and pregnancy outcome were compared between the period before (2005-2006) and after introduction (2007-2012) using chi(2) tests. Results: There was an increase in proportion of women who had a prenatal screening and/or invasive test, from 62% in 2005-2006 to 84% in 2010-2012 (p 35 years (p <0.01). More T13/T18 cases were diagnosed <24 weeks after introduction (62% vs 84%; p <0.01). In T13/T18 intra-uterine death decreased (26% vs 15%), while terminations increased: 55% vs 72%. Conclusion: The introduction of prenatal screening had limited impact on the time of detection and outcome of the most common trisomies. The introduction of the 20-week anomaly scan has resulted in more trisomy cases diagnosed <24 weeks and a shift from fetal death to terminations