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PURPOSE: Determining the prevalence of and possible reasons for nonattendance of diabetic nutritional care clinics. METHODS: Data were collected by means of a telephone survey and a review of patient records among 293 (166 attendees and 127 nonattendees) patients undergoing outpatient treatment at a university hospital. The t-tests, chi-square tests and logistic regression analysis were used to identify potential determinants of nonattendance. The theoretical framework was primarily based on the Health Belief Model. RESULTS: In univariate analysis, nonattendance at the clinic was associated with a number of factors such as not visiting other care givers, risk perceptions, body-mass index, self-rated health, health locus of control, satisfaction with the dietitian, feelings of obligation to attend, and beliefs about the effectiveness of the treatment. In multivariate analysis only health locus of control and obligation to attend the visit were significant predictors of attendance. A significant number of respondents further reported that they perceived their visits to the dietitian to be of little use. CONCLUSION: One in three diabetic patients undergoing outpatient treatment skipped one or more visits to their dietitian. Patient education to improve attendance should focus primarily on convincing patients that they can contribute to their own health, and may stress the obligation the patients have when making an appointment with the dietitian. [ABSTRACT FROM AUTHOR]

Aims: To report the changes in nutritional status, nutrition-related complaints and risk of sarcopenia in individuals attending a primary care dietitian in the Netherlands after a COVID-19 infection., Methods: The study was registered on the clinicaltrials.gov registry (NCT04735744). Nutritional status and nutrition-related complaints were assessed with the Patient-Generated Subjective Global Assessment Short Form and body composition measurements when possible. Risk of sarcopenia was assessed with the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls questionnaire. Dietitians reported on treatment goals, content and volume of dietetic treatment. Descriptive statistics were used to describe the study population and outcomes at baseline and end of treatment. For continuous variables, paired samples t-tests were used to compare scores at the start and the end of dietetic treatment. For dichotomous variables. McNemar tests and Wilcoxon signed-rank tests were used to determine differences between the start and end of treatment., Results: A total of 222 participants were included [mean age 50 (SD 13), 58% female, 34% overweight, 40% obese]. Malnutrition risk decreased from 44% (medium risk) and 20% (high risk) to 29% and 12% by the end of treatment (p < 0.001). The risk of sarcopenia decreased from 31% to 22% (p < 0.001). There was an imbalance between fat-free mass and fat mass in about half of the participants. The most commonly reported nutrition-related complaints were fatigue, no appetite, the feeling of being full and changed or loss of taste. Median treatment duration was 21 weeks [interquartile range (IQR) 13-26] and 5 consultations (IQR 4-7). Most participants (46%) aimed to maintain weight, with others aiming to lose (14%) or gain (14%) weight. At the end of treatment, 57% had achieved the goals., Conclusions: Significant improvements in nutritional status and risk of sarcopenia were observed after dietetic treatment in primary care, and most participants achieved the treatment goals. Nevertheless, nutrition-related complaints and the risk of malnutrition or sarcopenia remained prevalent., (© 2024 The Author(s). Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia.)

Background: A Dutch nationwide prospective cohort study was initiated to investigate recovery trajectories of people recovering from coronavirus disease 2019 (COVID-19) and costs of treatment by primary care allied health professionals., Objectives: The study described recovery trajectories over a period of 12 months and associated baseline characteristics of participants recovering from COVID-19 who visited a primary care allied health professional. It also aimed to provide insight into the associated healthcare and societal costs., Methods: Participants completed participant-reported standardized outcomes on participation, health-related quality of life, fatigue, physical functioning, and costs at baseline (ie, start of the treatment), 3, 6, 9 and 12 months., Results: A total of 1451 participants (64 % women, 76 % mild/moderate severity) with a mean (SD) age of 49 (12) years were included. Linear mixed models showed significant and clinically relevant improvements over time in all outcome measures between baseline and 12 months. Between 6 and 12 months, we found significant but not clinically relevant improvements in most outcome measures. Having a worse baseline score was the only baseline factor that was consistently associated with greater improvement over time on that outcome. Total allied healthcare costs (mean €1921; SEM €48) made up about 3% of total societal costs (mean €64,584; SEM €3149) for the average participant in the cohort., Conclusions: The health status of participants recovering from COVID-19 who visited an allied health professional improved significantly over a 12-month follow-up period, but nearly the improvement occurred between baseline and 6 months. Most participants still reported severe impairments in their daily lives, and generated substantial societal costs. These issues, combined with the fact that baseline characteristics explained little of the variance in recovery over time, underscore the importance of continued attention for the management of people recovering from COVID-19., Trial Registration: clinicaltrials.gov (NCT04735744)., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Combined nutrition and exercise interventions potentially improve protein-energy wasting/malnutrition-related outcomes in patients with chronic kidney disease (CKD). The aim was to systematically review the effect of combined interventions on nutritional status, muscle strength, physical performance and QoL. MEDLINE, Cochrane, Embase, Web of Science and Google Scholar were searched for studies up to the date of July 2023. Methodological quality was appraised with the Cochrane risk-of-bias tool. Ten randomized controlled trials (nine publications) were included (334 patients). No differences were observed in body mass index, lean body mass or leg strength. An improvement was found in the six-minute walk test (6-MWT) ( n = 3, MD 27.2, 95%CI [7 to 48], p = 0.008), but not in the timed up-and-go test. No effect was found on QoL. A positive impact on 6-MWT was observed, but no improvements were detected in nutritional status, muscle strength or QoL. Concerns about reliability and generalizability arise due to limited statistical power and study heterogeneity of the studies included.

Background: Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19., Objective: This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up., Methods: This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery., Results: A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation-Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was -0.7 (95% CI -0.8 to -0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System-Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of -0.8 (95% CI -1.0 to -0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and -1.6 (95% CI -1.8 to -1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures., Conclusions: Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals., Trial Registration: ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn., International Registered Report Identifier (irrid): RR2-10.2340/jrm.v54.2506., (©Anne I Slotegraaf, Marissa H G Gerards, Arie C Verburg, Marian A E de van der Schueren, Hinke M Kruizenga, Maud J L Graff, Edith H C Cup, Johanna G Kalf, Antoine F Lenssen, Willemijn M Meijer, Renée A Kool, Rob A de Bie, Philip J van der Wees, Thomas J Hoogeboom, Dutch Consortium Allied Healthcare COVID-19. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 20.10.2023.)

Background: The nutritional problems of patients who are hospitalised for COVID-19 are becoming increasingly clear. However, a large group of patients have never been hospitalised and also appear to experience persistent nutritional problems. The present study describes the nutritional status, risk of sarcopaenia and nutrition-related complaints of patients recovering from COVID-19 receiving dietetic treatment in primary care., Methods: In this retrospective observational study, data were collected during dietetic treatment by a primary care dietitian between April and December 2020. Both patients who had and had not been admitted to the hospital were included at their first visit to a primary care dietitian. Data on nutritional status, risk of sarcopaenia and nutrition-related complaints were collected longitudinally., Results: Data from 246 patients with COVID-19 were collected. Mean ± SD age was 57 ± 16 years and 61% of the patient population was female. At first consultation, two thirds of patients were classified as overweight or obese (body mass index >25 kg m -2 ). The majority had experienced unintentional weight loss because of COVID-19. Additionally, 55% of hospitalised and 34% of non-hospitalised patients had a high risk of sarcopaenia. Most commonly reported nutrition-related complaints were decreased appetite, shortness of breath, changed or loss of taste and feeling of being full. Nutrition-related complaints decreased after the first consultation, but remained present over time., Conclusions: In conclusion, weight changes, risk of sarcopaenia and nutrition-related complaints were prevalent in patients with COVID-19, treated by a primary care dietitian. Nutrition-related complaints improved over time, but remained prevalent until several months after infection., (© 2022 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Objective: To report the study protocol and baseline characteristics of a prospective cohort study to evaluate longitudinal recovery trajectories of patients recovering from COVID-19 who have visited a primary care allied health professional., Design: Report of the protocol and baseline characteristics for a prospective cohort study with a mixed-methods approach., Patients: Patients recovering from COVID-19 treated by primary care dietitians, exercise therapists, occupational therapists, physical therapists and/or speech and language therapists in the Netherlands., Methods: The prospective study will measure primary outcome domains: participation, health-related quality of life, fatigue, physical functioning, and costs, at baseline, 3, 6, 9 and 12 months. Interviews, on the patients' experiences with allied healthcare, will be held with a subsample of patients and allied health professionals., Results: The cohort comprises 1,451 patients (57% female, mean age 49 (standard deviation 13) years). Preliminary results for the study cohort show that 974 (67%) of the participants reported mild/moderate severity symptoms during the infection period and patients reported severe restrictions in activities of daily living compared with previous research in other patient populations. Both quantitative and qualitative, will provide insight into the recovery of patients who are treated by allied health professionals., Conclusion: In conclusion, this will be the first comprehensive study to longitudinally evaluate the recovery trajectories and related costs of patients recovering from COVID-19 who are treated by allied health professionals in the Netherlands. This study will provide evidence for the optimal strategy to treat patients recovering from COVID-19 infection, including which patients benefit, and to what extent, from treatment, and which factors might impact their recovery course over time. The preliminary results of this study demonstrated the severity of restrictions and complaints at the start of therapy are substantial.

Background & Aims: In dietary practice, it is common to estimate protein requirements on actual bodyweight, but corrected bodyweight (in cases with BMI <20 kg/m 2 and BMI ≥30 kg/m 2 ) and fat free mass (FFM) are also used. Large differences on individual level are noticed in protein requirements using these different approaches. To continue this discussion, the answer is sought in a large population to the following question: Will choosing actual bodyweight, corrected bodyweight or FFM to calculate protein requirements result in clinically relevant differences?, Methods: This retrospective database study, used data from healthy persons ≥55 years of age and in- and outpatients ≥18 years of age. FFM was measured by air displacement plethysmography technology or bioelectrical impedance analysis. Protein requirements were calculated as 1) 1.2 g (g) per kilogram (kg) actual bodyweight or 2) corrected bodyweight or 3) 1.5 g per kg FFM. To compare these three approaches, the approach in which protein requirement is based on FFM, was used as reference method. Bland-Altman plots with limits of agreement were used to determine differences, analyses were performed for both populations separately and stratified by BMI category and gender., Results: In total 2291 subjects were included. In the population with relatively healthy persons (n = 506, ≥55 years of age) mean weight is 86.5 ± 18.2 kg, FFM is 51 ± 12 kg and in the population with adult in- and outpatients (n = 1785, ≥18 years of age) mean weight is 72.5 ± 18.4 kg, FFM is 51 ± 11 kg. Clinically relevant differences were found in protein requirement between actual bodyweight and FFM in most of the participants with overweight, obesity or severe obesity (78-100%). Using corrected bodyweight, an overestimation in 48-92% of the participants with underweight, healthy weight and overweight is found. Only in the Amsterdam UMC population, protein requirement is underestimated when using the approach of corrected bodyweight in participants with severe obesity., Conclusion: The three approaches in estimation of protein requirement show large differences. In the majority of the population protein requirement based on FFM is lower compared to actual or corrected bodyweight. Correction of bodyweight reduces the differences, but remain unacceptably large. It is yet unknown which method is the best for estimation of protein requirement. Since differences vary by gender due to differences in body composition, it seems more accurate to estimate protein requirement based on FFM. Therefore, we would like to advocate for more frequent measurement of FFM to determine protein requirements, especially when a deviating body composition is to be expected, for instance in elderly and persons with overweight, obesity or severe obesity., Competing Interests: Declaration of competing interest Authors have no conflicts of interest., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Disease-related malnutrition has been reported in 10% to 55% of people in hospital and the community and is associated with significant health and social-care costs. Dietary advice (DA) encouraging consumption of energy- and nutrient-rich foods rather than oral nutritional supplements (ONS) may be an initial treatment., Objectives: To examine evidence that DA with/without ONS in adults with disease-related malnutrition improves survival, weight, anthropometry and quality of life (QoL)., Search Methods: We identified relevant publications from comprehensive electronic database searches and handsearching. Last search: 01 March 2021., Selection Criteria: Randomised controlled trials (RCTs) of DA with/without ONS in adults with disease-related malnutrition in any healthcare setting compared with no advice, ONS or DA alone., Data Collection and Analysis: Two authors independently assessed study eligibility, risk of bias, extracted data and graded evidence., Main Results: We included 94, mostly parallel, RCTs (102 comparisons; 10,284 adults) across many conditions possibly explaining the high heterogeneity.  Participants were mostly older people in hospital, residential care and the community, with limited reporting on their sex. Studies lasted from one month to 6.5 years.  DA versus no advice - 24 RCTs (3523 participants) Most outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.87 (95% confidence interval (CI) 0.26 to 2.96), or at later time points. We had no three-month data, but advice may make little or no difference to hospitalisations, or days in hospital after four to six months and up to 12 months. A similar effect was seen for complications at up to three months, MD 0.00 (95% CI -0.32 to 0.32) and between four and six months. Advice may improve weight after three months, MD 0.97 kg (95% CI 0.06 to 1.87) continuing at four to six months and up to 12 months; and may result in a greater gain in fat-free mass (FFM) after 12 months, but not earlier. It may also improve global QoL at up to three months, MD 3.30 (95% CI 1.47 to 5.13), but not later. DA versus ONS - 12 RCTs (852 participants) All outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.66 (95% CI 0.34 to 1.26), or at later time points. Either intervention may make little or no difference to hospitalisations at three months, RR 0.36 (95% CI 0.04 to 3.24), but ONS may reduce hospitalisations up to six months. There was little or no difference between groups in weight change at three months, MD -0.14 kg (95% CI -2.01 to 1.74), or between four to six months. Advice (one study) may lead to better global QoL scores but only after 12 months. No study reported days in hospital, complications or FFM. DA versus DA plus ONS - 22 RCTs (1286 participants) Most outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.92 (95% CI 0.47 to 1.80) or at later time points. At three months advice may lead to fewer hospitalisations, RR 1.70 (95% CI 1.04 to 2.77), but not at up to six months. There may be little or no effect on length of hospital stay at up to three months, MD -1.07 (95% CI -4.10 to 1.97). At three months DA plus ONS may lead to fewer complications, RR 0.75 (95% CI o.56 to 0.99); greater weight gain, MD 1.15 kg (95% CI 0.42 to 1.87); and better global QoL scores, MD 0.33 (95% CI 0.09 to 0.57), but this was not seen at other time points. There was no effect on FFM at three months. DA plus ONS if required versus no advice or ONS - 31 RCTs (3308 participants) Evidence was moderate- to low-certainty. There may be little or no effect on mortality at three months, RR 0.82 (95% CI 0.58 to 1.16) or at later time points. Similarly, little or no effect on hospitalisations at three months, RR 0.83 (95% CI 0.59 to 1.15), at four to six months and up to 12 months; on days in hospital at three months, MD -0.12 (95% CI -2.48 to 2.25) or for complications at any time point. At three months, advice plus ONS probably improve weight, MD 1.25 kg (95% CI 0.73 to 1.76) and may improve FFM, 0.82 (95% CI 0.35 to 1.29), but these effects were not seen later. There may be little or no effect of either intervention on global QoL scores at three months, but advice plus ONS may improve scores at up to 12 months. DA plus ONS versus no advice or ONS - 13 RCTs (1315 participants) Evidence was low- to very low-certainty. There may be little or no effect on mortality after three months, RR 0.91 (95% CI 0.55 to 1.52) or at later time points. No study reported hospitalisations and there may be little or no effect on days in hospital after three months, MD -1.81 (95% CI -3.65 to 0.04) or six months. Advice plus ONS may lead to fewer complications up to three months, MD 0.42 (95% CI 0.20 to 0.89) (one study). Interventions may make little or no difference to weight at three months, MD 1.08 kg (95% CI -0.17 to 2.33); however, advice plus ONS may improve weight at four to six months and up to 12 months. Interventions may make little or no difference in FFM or global QoL scores at any time point., Authors' Conclusions: We found no evidence of an effect of any intervention on mortality. There may be weight gain with DA and with DA plus ONS in the short term, but the benefits of DA when compared with ONS are uncertain. The size and direction of effect and the length of intervention and follow-up required for benefits to emerge were inconsistent for all other outcomes.  There were too few data for many outcomes to allow meaningful conclusions. Studies focusing on both patient-centred and healthcare outcomes are needed to address the questions in this review., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background and Aims: Patients with COVID-19 infection presents with a broad clinical spectrum of symptoms and complications. As a consequence nutritional requirements are not met, resulting in weight- and muscle loss, and malnutrition. The aim of the present study is to delineate nutritional complaints, the (course of the) nutritional status and risk of sarcopenia of COVID-19 patients, during hospitalisation and after discharge., Methods: In this prospective observational study in 407 hospital admitted COVID-19 patients in four university and peripheral hospitals, data were collected during dietetic consultations. Presence of nutrition related complaints (decreased appetite, loss of smell, changed taste, loss of taste, chewing and swallowing problems, nausea, vomiting, feeling of being full, stool frequency and consistency, gastric retention, need for help with food intake due to weakness and shortness of breath and nutritional status (weight loss, BMI, risk of sarcopenia with SARC-F ≥4 points) before, during hospital stay and after discharge were, where possible, collected., Results: Included patients were most men (69%), median age of 64.8 ± 12.4 years, 60% were admitted to ICU at any time point during hospitalisation with a median LOS of 15 days and an in-hospital mortality rate of 21%. The most commonly reported complaints were: decreased appetite (58%), feeling of being full (49%) and shortness of breath (43%). One in three patients experienced changed taste, loss of taste and/or loss of smell. Prior to hospital admission, 67% of the patients was overweight (BMI >25 kg/m 2 ), 35% of the patients was characterised as malnourished, mainly caused by considerable weight loss. Serious acute weight loss (>5 kg) was showed in 22% of the patents during the hospital stay; most of these patients (85%) were admitted to the ICU at any point in time. A high risk of sarcopenia (SARC-F ≥ 4 points) was scored in 73% of the patients during hospital admission., Conclusion: In conclusion, one in five hospital admitted COVID-19 patients suffered from serious acute weight loss and 73% had a high risk of sarcopenia. Moreover, almost all patients had one or more nutritional complaints. Of these complaints, decreased appetite, feeling of being full, shortness of breath and changed taste and loss of taste were the most predominant nutrition related complaints. These symptoms have serious repercussions on nutritional status. Although nutritional complaints persisted a long time after discharge, only a small group of patients received dietetic treatment after hospital discharge in recovery phase. Clinicians should consider the risks of acute malnutrition and sarcopenia in COVID-19 patients and investigate multidisciplinary treatment including dietetics during hospital stay and after discharge., Competing Interests: Declaration of competing interest Both first authors NW and HK received a grant from Nutricia to be able to perform this study. All authors report no conflict of interests. ICMJE disclosure of interest forms are submitted as supporting information., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Prevalence of malnutrition in hospitals has been reported around 20% and increases during hospitalization. The "Rate-a-Plate" method has been developed to monitor dietary intake and identify patients whose nutrition status deteriorates during hospitalization, but has not yet been validated. The objective was to study the validity and reliability of the method (phase 1) and redesign and revalidate a revised version (phase 2)., Methods: Detailed food records provided a reference method. A priori difference of >20% in energy or protein between the reference and the "Rate-a-Plate" method was determined as clinically relevant. Intraclass correlation coefficients were used to determine the reliability., Results: In phase 1, 24 patients were included with a total 67 test days. In phase 2, 14 patients were included, 28 test days. In phase 1, the "Rate-a-Plate" method underestimated intake by 422 kcal (29%, ICC 0.349, 95% CI 304-541) and 5.7 g protein (10%, ICC 0.511, 95% CI 0.0-11.5). Underestimation was found in 65% and 23% for energy and protein intake, respectively. Underestimation was higher when patients had higher intake. In phase 2, underestimation was 109 kcal (7%, ICC 0.788, 95% CI -273 to 56) and 3.7 g protein (6%, ICC 0.905, 95% CI -8.4 to 1.0). In 32% and 21% of the cases, energy and protein intake were underestimated., Conclusion: The revised version of the "Rate-a-Plate" method is a valid method to monitor energy and protein intake of hospitalized patients and can be filled out by nutrition assistants. A larger validation study is required., (© 2019 The Authors. Nutrition in Clinical Practice published by Wiley Periodicals, Inc. on behalf of American Society for Parenteral and Enteral Nutrition.)

Background: The European Society for Clinical Nutrition and Metabolism (ESPEN) has recently published consensus-based criteria for the diagnosis of malnutrition; in subjects identified at nutritional risk the diagnosis is confirmed by either BMI <18.5 kg/m 2 or weight loss in combination with low BMI or low FFMI. Concerns have been raised whether this definition correctly classifies malnutrition in patients with normal weight or overweight and concomitant weight loss. Therefore, the aim of this research is to assess the association between weight loss and one-year mortality in hospitalized patients, stratified by BMI and FFMI subgroups., Methods: This prospective study included 769 patients admitted to the VU University Medical Center. Critical weight loss (CWL) was defined as >5% weight loss in the previous month or >10% weight loss in the previous six months. The association between CWL and one-year mortality was analyzed with a priori stratification by BMI cut-off values (2 for patients <70 years and 2 for patients ≥70 years) and FFMI cut-off values (derived from BIA measurements, 2 for females and 2 for males). Mortality risks were calculated (HR, 95% CI)., Results: CWL occurred in 35% of patients and was associated with an increased one-year mortality rate vs. no-CWL (25% vs. 15%, p = 0.001), HR for mortality risk 1.76 (1.26-2.45)). CWL + low FFMI was associated with higher mortality risk (HR 1.95 (1.20-3.17), whereas CWL + normal FFMI was not (HR 1.37 (0.85-2.21)). Among patients with normal/high BMI, those with CWL had a significantly higher mortality risk compared to those without critical weight loss, however additionally adding FFMI to that model showed that a low FFMI was crucial in the observed association with mortality (CWL + normal BMI + low FFMI, HR 2.69 (1.29-5.65); CWL + normal BMI + normal FFMI, HR 1.38 (0.84-2.27))., Conclusion: - Patients with critical weight loss have a higher one-year mortality compared to patients with no critical weight loss. FFMI seems to play a crucial role in this association, as normal weight patients with normal FFMI had lower mortality rates than their counterparts with low FFMI., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Adequate energy and protein intake could be essential for contributing significantly to the rehabilitations process. Data on the actual nutritional intake of older nursing home rehabilitation patients have not yet been investigated., Aims: To investigate the nutritional intake and predictors for achieving protein and energy requirements on the 14th day of admission in nursing home rehabilitation patients., Methods: Fifty-nine patients aged 65+ years newly admitted to nursing home rehabilitation wards were included. Data on potential variables were collected on admission. On the fourteenth day nutritional intake was assessed. Intake was considered 'adequate' if patients had achieved ≥ 1.2 g of protein/kg bodyweight and ≥ 85% of their energy needs according to Harris and Benedict + 30%. Multiple logistic regression analyses were performed to select predictors for adequate intake., Results: Protein and energy intake was assessed in 79 patients [67% female, mean age 82 ± (SD) 8 years, BMI 25 ± 6 kg/m 2 ]. Mean energy intake was 1677 kcal (± 433) and mean protein intake was 68 g (± 20). Fourteen patients (18%) achieved an adequate protein and energy intake. Predictors for adequate intake were use of sip/tube feeding (OR = 7.7; 95% CI = 1.35-44.21), BMI (0.68; 0.53-0.87) and nausea (8.59; 1.42-52.01)., Conclusion: Only 18% of older nursing home rehabilitation patients had an adequate protein and energy intake at 14 days after admission. Patients with higher BMI were less likely, while those using sip/tube feeding or feeling nauseous were more likely to achieve an adequate protein and energy intake.

Background: In 2015 the European Society for Clinical Nutrition and Metabolism (ESPEN) presented new consensus criteria for the diagnosis of malnutrition. Whereas most previous definitions were based on involuntary weight loss and/or a low BMI, the ESPEN definition added Fat Free Mass Index (FFMI) to the set of criteria., Aim: To study the predictive value of the new ESPEN diagnostic criteria for malnutrition on survival, with specific focus on the additional value of FFMI., Methods: Included were 335 hospitalized adult patients of the VU University Medical Center Amsterdam (60% female, age 58 ± 18 y). Three sets of criteria for malnutrition were used to study the predictive value for survival: Dutch definition for malnutrition, ESPEN diagnostic criteria for malnutrition and ESPEN diagnostic criteria for malnutrition without FFMI criterion. The association between malnutrition and three-months and one-year overall survival was analyzed by log rank tests and Cox regression. In multivariate analyses, adjustments were made for gender, age, care complexity and length of stay., Results: Ninety patients (27%) were classified as malnourished by any of the sets of criteria; malnourished patients had significant lower survival rates than non-malnourished patients at three months (84% vs 94%; p = 0.01) and one year (76% vs 87%; p = 0.02). After adjustments, malnutrition remained significantly associated with three-months survival for the Dutch definition for malnutrition (HR:2.25, p = 0.04) and the ESPEN diagnostic criteria for malnutrition (HR:2.76, p = 0.02). Malnutrition remained significantly associated with one-year survival for the ESPEN diagnostic criteria for malnutrition (HR:2.17, p < 0.02) and the ESPEN diagnostic criteria for malnutrition without FFMI (HR:2.66, p < 0.01)., Conclusion: The new ESPEN definition for malnutrition is predictive for both three-months and one-year survival in a general hospital population, whereas definitions without FFMI are predictive for either three-months or one year survival., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To examine the prevalence of undernutrition, received dietetic treatment and self-perception of nutritional status in older patients admitted to Dutch nursing home rehabilitation wards., Methods: Between December 2012-February 2014, we included 190 patients (≥65 y) admitted to seven nursing home rehabilitation wards. Nutritional status in the first week of admission was characterized as: severely undernourished (>10% unintentional weight loss in the past six months and/or >5% unintentional weight loss in the past month and/or BMI < 20 kg/m 2 ), moderately undernourished (5-10% unintentional weight loss in the past 6 months and/or BMI 20-22 kg/m 2 ), well-nourished (<5% unintentional weight loss in the past 6 months and BMI 22-28 kg/m 2 ) and overweight (BMI>28 kg/m 2 ). Primary diagnosis was categorized as: trauma, elective orthopaedics, stroke and other. Perceived nutritional status was determined with the question: 'Do you currently consider yourself undernourished?' (yes/no). Information regarding dietetic treatment was obtained from medical records., Results: A complete dataset was obtained from 179 patients (70% female, age 81 ± 8 y). 26% of the patients was found to be severely undernourished and 14% moderately undernourished. Prevalence of undernutrition did not differ by sex or age. Of all undernourished patients, 56% had been treated by a dietitian. Only one out of five of undernourished patients considered themselves undernourished. Elective orthopaedics patients had the lowest prevalence of undernutrition (19%) while patients categorised as 'other' had the highest prevalence (51%)., Conclusion: More than one in three older patients in Dutch nursing home rehabilitation wards are moderately to severely undernourished. Out of these patients the majority does not consider themselves undernourished and almost half has not received dietetic treatment. More attention to undernutrition in nursing home rehabilitation patients seems necessary., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: When indirect calorimetry is not available, predictive equations are used to estimate resing energy expenditure (REE). There is no consensus about which equation to use in hospitalized patients. The objective of this study is to examine the validity of REE predictive equations for underweight, normal weight, overweight, and obese inpatients and outpatients by comparison with indirect calorimetry., Methods: Equations were included when based on weight, height, age, and/or gender. REE was measured with indirect calorimetry. A prediction between 90 and 110% of the measured REE was considered accurate. The bias and root-mean-square error (RMSE) were used to evaluate how well the equations fitted the REE measurement. Subgroup analysis was performed for BMI. A new equation was developed based on regression analysis and tested., Results: 513 general hospital patients were included, (253 F, 260 M), 237 inpatients and 276 outpatients. Fifteen predictive equations were used. The most used fixed factors (25 kcal/kg/day, 30 kcal/kg/day and 2000 kcal for female and 2500 kcal for male) were added. The percentage of accurate predicted REE was low in all equations, ranging from 8 to 49%. Overall the new equation performed equal to the best performing Korth equation and slightly better than the well-known WHO equation based on weight and height (49% vs 45% accurate). Categorized by BMI subgroups, the new equation, Korth and the WHO equation based on weight and height performed best in all categories except from the obese subgroup. The original Harris and Benedict (HB) equation was best for obese patients., Conclusions: REE predictive equations are only accurate in about half the patients. The WHO equation is advised up to BMI 30, and HB equation is advised for obese (over BMI 30). Measuring REE with indirect calorimetry is preferred, and should be used when available and feasible in order to optimize nutritional support in hospital inpatients and outpatients with different degrees of malnutrition.

Background & Aims: With the rapidly increasing number of malnourished older persons in the community, this review aims to summarize the effects of nutritional intervention studies for this target group., Methods: Based on 2 previous reviews (2009, 2011) an update of the literature was performed. Selected were higher quality studies which included malnourished community dwelling older adults who received dietetic counselling and/or oral nutritional supplements., Results: Ten studies were included. Six studies showed (trends towards) weight gain. Meta-analysis showed a modest effect of the intervention on weight gain, standardized mean difference 0.210 kg (95% CI 0.03-0.40). Effects on other relevant functional and clinical outcomes were inconsistent. Studies were hampered by low sample sizes, low adherence to the interventions, and participants not meeting nutritional requirements., Conclusion: Currently, nutritional intervention studies for malnourished community dwelling older adults show limited effects, which may be caused by methodological shortcomings and participants not meeting treatment goals. High quality studies are eagerly awaited to be able to identify (sub)groups of older persons who are most likely to benefit from nutritional support., (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Consensus on the definition of malnutrition has not yet been reached. Recently, The European Society for Clinical Nutrition and Metabolism (ESPEN) proposed a consensus definition of malnutrition. The aim of the present study was to describe the prevalence of malnutrition according to the ESPEN definition in four diverse populations., Methods: In total, 349 acutely ill middle-aged patients, 135 geriatric outpatients, 306 healthy old individuals and 179 healthy young individuals were included in the study. Subjects were screened for risk of malnutrition using the SNAQ. The ESPEN definition of malnutrition, i.e. low BMI (< 18.5 kg/m(2)) or a combination of unintentional weight loss and low FFMI or low BMI was applied to all subjects., Results: Screening identified 0, 0.5, 10 and 30% of the healthy young, the healthy old, the geriatric outpatients and the acutely ill middle-aged patients as being at risk of malnutrition. The prevalence of malnutrition ranged from 0% in the healthy young, 0.5% in healthy old individuals, 6% in the geriatric outpatients to 14% in the acutely ill middle-aged patients. Prevalence of low FFMI was observed in all four populations (14-33%), but concurred less frequently with weight loss (0-13%)., Conclusions: Using the ESPEN definition, 0%-14% malnutrition was found in the diverse populations. Further work is needed to fully address the validity of a two-step approach, including risk assessment as an initial step in screening and defining malnutrition. Furthermore, assessing the predictive validity of the ESPEN definition is needed., (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)