Zakboek Dietetiek: compleet herziene uitgave

Het Zakboek Diëtetiek is geschreven om de diagnostiek en evaluatie van de diëtistische behandeling te verbeteren en eenvoudiger te maken. De veel gebruikte informatie is gebundeld in een boekje die past in de doktersjas en die de diëtist altijd bij de hand kan hebben. Op deze website zijn de berekenmodules en de links naar de vragenlijsten, rapporten en fact sheets te vinden. Het bevat informatie over antropometrie en voedingstoestand, het meten van de lichaamssamenstelling en de functie, energie en eiwitbehoefte, macro- en micronutriënten, vocht, smaak, vertering en absorptie, meten van verliezen, interpretatie van laboratoriumwaarden, classificaties van ziektes, interactie van medicatie en voeding en het meten van de psychische en sociale status

Dietetic Pocket Guide Paediatrics

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Intravenous citrulline generation test to assess intestinal function in intensive care unit patients

Job HC Peters,1 Nicolette J Wierdsma,2,3 Albertus Beishuizen,4,5 Tom Teerlink,6 Ad A van Bodegraven,3,7 1Department of Gastroenterology and Hepatology, Red Cross Hospital, Beverwijk, 2Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, 3Department of Gastroenterology, Small Bowel Disease Unit, VU University Medical Center, Amsterdam, 4Department of Intensive Care, VU University Medical Center, Amsterdam, 5Department of Intensive Care, Intensive Care Center, Medisch Spectrum Twente, Enschede, 6Department of Clinical Chemistry, Metabolic Laboratory, VU University Medical Center, Amsterdam, 7Department of Gastroenterology, Geriatrics, Intensive Care and Internal Medicin (Co-MIK), Zuyderland MC, Heerlen-Sittard-Geleen, the Netherlands Background: Assessment of a quantifiable small intestinal function test is cumbersome. Fasting citrulline concentrations have been proposed as a measure of enterocyte function and elaborated into a citrulline generation test (CGT), which is applicable only when glutamine is administered orally. CGT is an oral test, limiting its use, for example, in critically ill patients.Objective: Assessment of normative values and feasibility of an intravenously performed CGT in intensive care unit (ICU) patients with presumed gastrointestinal motility disturbances, especially when performed intravenously.Design: CGT reference values were determined in 16 stable ICU patients using two different CGT methods, namely following either enteral or intravenous glutamine administration and both with simultaneous arterial and venous plasma citrulline sampling at six time-points. Plasma amino acid analysis was performed using reverse-phase high-performance liquid chromatography.Results: The median total generation of citrulline in 90 min (CGT iAUCT90) was markedly higher with arterial citrulline sampling compared with venous citrulline sampling, being 724±585 and 556±418 µmol/L/min for enteral glutamine, respectively (p=0.02) and 977±283 and 769±231 µmol/L/min for intravenous glutamine, respectively (p=0.0004). The median slope (time-dependent increase) for plasma arterial and venous citrulline during the CGT was 0.20±0.16 and 0.18±0.12 µmol/L/min for enteral glutamine, respectively (p=0.004) and 0.22±0.16 and 0.19±0.05 µmol/L/min for intravenous glutamine, respectively (p=0.02). Conclusion: Intravenous glutamine administration combined with arterial plasma citrulline sampling yielded the least variation in CGT characteristics in stable ICU patients. A 2-point measurement test had comparable test characteristics as a 6-point measurement CGT and seems promising. Keywords: citrulline, citrulline generation test, critical illness, enterocyte, intestinal function, intensive care, ICU, glutamine, HPL

Exocrine pancreatic insufficiency after esophagectomy: a systematic review of literature

Complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are often attributed to an impaired exocrine pancreatic function. This review systematically summarizes all literature reporting on the presence of exocrine pancreatic insufficiency (EPI) after esophagectomy and the effect of treatment with pancreatic enzymes on gastrointestinal complaints, body weight, and quality of life. Databases of PubMed, Embase, and Wiley/Cochrane Library were searched systematically until July 2020. Studies reporting on EPI and pancreatic enzyme replacement therapy after esophagectomy were included. The Newcastle-Ottawa scale was used to assess study quality. Four studies, including 158 patients, were selected. The maximum score for study quality was six (range 4-6). Exocrine pancreatic function was investigated in three studies, measured by fecal elastase-1 and 72-hour fecal fat excretion. Fecal elastase-1 levels <200 μg/g were reported in 16% of patients at 4 months, 18% at 6 months, and 31% at 18-24 months postoperatively. A decreased fecal fat absorption was noticed in 57% 1 month postoperatively. Treatment with pancreatic enzymes was reported in two studies. In patients with fecal elastase-1 levels <200 μg/g, 90% of patients reported improvement in symptoms and 70% reported improvement in weight. In patients with complaints of steatorrhea, 87% noticed settlement of symptoms. Based on current literature, complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are common and can be related to an impaired exocrine pancreatic function. High-quality studies evaluating the presence of EPI and the effect of treatment with pancreatic enzymes after esophagectomy are needed to verify this conclusion

Comparison of two tube feeding formulas enriched with guar gum or mixed dietary fibres - English translation

Goal of the experiment. To determine whether two commercially available, dietary fibre enriched tube feeding formulas will have different effects on the defecation pattern--frequency and consistency of faecal output--of patients with head or neck tumours. Methods. 78 patients with a tumour in the head-neck region were exclusively tube fed for at least 10 days postoperatively. One half received a tube feed enriched with guar gum fibre and the other half received a tube feed enriched with a fibre mix. During the first 10 days postoperatively data on the defecation pattern (the frequency and the consistency of the faeces) was collected. Results. The incidence of moderate diarrhoea was higher with the use of the guar gum enriched tube feed compared to the tube feed enriched with a mixture of fibres (35% vs. 10.5%). The incidence of severe diarrhoea did not differ significantly between groups (7.5% vs. 2.6%). The average consistency of the faeces in the guar gum group was less well formed than in the mixed dietary fibre group (mean 2.6+-SD0.8 versus mean 3.1+-SD0.8) on a scale of 0 (severe constipation) to >15 (severe diarrhoea). The frequency of defecation was higher in patients receiving the tube feed with guar gum than in patients receiving the tube feed with a fibre mix (mean 9.4+-4.4 vs. 11.6+-4.55 over a ten day period). Discussion. These results demonstrate that the addition of different dietary fibres to tube feeds can have differing effects on the consistency and the frequency of the faeces. The tube feed with a mixture of dietary fibres appeared to have a more positive influence on normalising the function of the intestines than the feed with added guar gum. Because the level of total fibre differed between the two tube-feed formulas (22 g/L guar gum and 15 g/L mixed fibre), it is impossible to draw conclusions about the effect of the type of fibre per se