N.M. de Roos

Yoghurt enriched with Lactobacillus acidophilus does not lower blood lipids in healthy men and women with normal to borderline high serum cholesterol levels

Objective: To investigate whether intake of Lactobacillus acidophilus strain L-1 lowers serum cholesterol in healthy men and women.Design: Randomised, placebo-controlled parallel trial.Setting: Subjects were free-living. Blood sampling and distribution of yoghurts were administered at a local hospital.Subjects: Seventy-eight adult men and women with cholesterol levels of 3.9–7.8 mmol/L (mean±s.d., 5.4±0.7).Interventions: Subjects consumed 500 mL of control yoghurt daily for two weeks. They were then randomly allocated to receive 500 mL per day of control yoghurt or of yoghurt enriched with Lactobacillus acidophilus L-1 for another six weeks. The yoghurts were spiked with a trace of lithium; compliance as assessed by plasma lithium was excellent.Results: Energy and nutrient intake was constant, and identical for the two groups. Mean body weight was stable. Baseline blood lipid concentrations in the control and treatment groups were highly similar. The effect of consumption of Lactobacillus acidophilus L-1 vs control on total cholesterol was −0.02 mmol/L (95% CI, −0.18–0.15) after three weeks and 0.04 mmol/L (95% CI, −0.12–0.20) after six weeks. Serum LDL and HDL-cholesterol and triacylglycerol levels were also unaffected.Conclusions: Yoghurt enriched with Lactobacillus acidophilus L-1 does not lower serum cholesterol in men and women with normal to borderline high cholesterol levels.Sponsorship: Dutch Dairy Foundation on Nutrition and Health.

Trans monounsaturated fatty acids and saturated fatty acids have similar effects on postprandial flow-mediated vasodilation

Objective: Several studies suggest that a fatty meal impairs flow-mediated vasodilation (FMD), a measure of endothelial function. We tested whether the impairment was greater for trans fats than for saturated fats. We did this because we previously showed that replacement of saturated fats by trans fats in a controlled diet decreased FMD after 4 weeks.Design: We fed 21 healthy men two different test meals with 0.9–1.0 g fat/kg body weight in random order: one rich in saturated fatty acids (Sat), mainly from palm kernel fat, and one rich in trans fatty acids (Trans) from partially hydrogenated soy bean oil. The study was performed in our metabolic ward. We had complete data for both diets of 21 men.Results: FMD increased from a fasting value of 2.3±2.0% of the baseline diameter to 3.0±1.7% after the Sat test meal (95% CI for change −0.33, 1.70) and from 2.7±2.3 to 3.1±2.0% after the Trans test meal (95% CI for change −0.57, 1.29). The increase after the Sat meal was 0.22 (−1.18–1.61) FMD% higher than after the Trans meal. Serum triacylglycerols increased by 0.46±0.36 mmol/l after the Sat test meal and by 0.68±0.59 mmol/l after the Trans test meal; a difference of 0.23 (0.07, 0.39) mmol/l. Serum HDL-cholesterol was hardly affected by the test meals. The activity of serum paraoxonase, an esterase bound to HDL, increased slightly after the two test meals but the difference between meals was not significant.Conclusion: FMD was not impaired and not different after test meals with saturated or trans fatty acids. Thus, differences in long-term effects of these fats are not caused by differences in acute effects on the vascular wall.

Effects of nutritional status and dietetic interventions on survival in Cystic Fibrosis patients before and after lung transplantation

BACKGROUND This study retrospectively investigated nutritional status, dietetic intervention and intake in Cystic Fibrosis (CF) patients before and after lung transplantation (LTX). METHODS Body Mass Index (BMI), Fat Free Mass Index (FFMI) and nutritional intake were retrieved from 75 out-patients aged 15-53 years. Patients were seen every 3-4 months during the waiting list time (range 0-81 months) and up to 116 months after LTX. Survival was measured in months. RESULTS The median BMI at baseline was 19.2 kg/m(2) (range: 15.3 to 28.4 kg/m(2)) with 29 patients (39%) below ≤18.5 kg/m(2). FFMI (measured in 65 patients) had a median of 15.2 kg/m(2) (range: 11.1 to 22.4 kg/m(2)) with 39 patients (60%) ≤16.7 kg/m(2) (men) or ≤14.6 kg/m(2) (women). Median energy intake was 2800 kcal, 239 kcal higher than the estimated energy requirement. However, 8 patients consumed ≥500 kcal less than recommended. Protein intake was 104 (range 60-187) g or 1.9 g/kg per day. Despite dietetic intervention with oral nutritional supplements (ONS) (36 patients), tube feeding (12 patients), or both (13 patients), BMI and FFMI hardly improved pre-LTX. LTX was performed in 51 patients (68%); 10 patients died during follow-up, median survival time was 41 months. A BMI ≤18.5 kg/m(2) was more prevalent in patients who died before LTX (6/9) or who died after LTX (4/10) than in patients who were still alive on the waiting list (5/15) or who survived LTX (14/41). Results for FFMI were comparable. From 6-12 months post-LTX, BMI and FFMI markedly improved, especially in underweight patients. CONCLUSION A BMI ≤18.5 kg/m(2) and an FFMI ≤16.7 kg/m(2) (men) or ≤14.6 kg/m(2) (women) appears to impair survival in LTX candidates with CF. Patients maintained a low body weight before LTX. After LTX weight gain is achieved.

Protein enrichment of familiar foods as an innovative strategy to increase protein intake in institutionalized elderly

ObjectiveTo increase the protein intake of older adults, protein enrichment of familiar foods and drinks might be an effective and attractive alternative for oral nutritional supplements (ONS). We performed a pilot study to test whether these products could help institutionalized elderly to reach a protein intake of 1.2 gram per kg body weight per day (g/kg/d).DesignIntervention study with one treatment group (no control group). Dietary assessment was done before and at the end of a 10-day intervention.SettingTwo care facilities in Gelderland, the Netherlands: a residential care home and a rehabilitation center.Participants22 elderly subjects (13 women, 9 men; mean age 83.0±9.4 years).InterventionWe used a variety of newly developed protein enriched regular foods and drinks, including bread, soups, fruit juices, and instant mashed potatoes.MeasurementsDietary intake was assessed on two consecutive days before and at the end of the intervention, using food records filled out by research assistants. Energy and macronutrient intake was calculated using the 2013 Dutch food composition database. Changes in protein intake were evaluated using paired t-tests.ResultsProtein intake increased by 11.8 g/d (P=0.003); from 0.96 to 1.14 g/kg/d (P=0.002). This increase is comparable to protein provided by one standard portion of ONS. The intake of energy and other macronutrients did not change significantly. At the end of the intervention more elderly reached a protein intake level of 1.2 g/kg/d than before (9 vs 4). Protein intake significantly increased during breakfast (+3.7 g) and during the evening (+2.2 g).ConclusionIncluding familiar protein enriched foods and drinks in the menu helped to meet protein recommendations in institutionalized elderly.

How science thinks and practice acts: bridging the gap in weight management interventions for adolescents

BACKGROUND Adolescent obesity calls for evidence-based treatment approaches given its long-term physical and psychosocial consequences. However, research shows there are many problems in the translation of scientific evidence into practice. OBJECTIVE The aim of this study was to develop science- and practice-based recommendations for the planning of future adolescent weight management interventions. METHODS We performed (i) literature reviews on intervention studies targeting treatment of obesity in adolescents and Dutch clinical guidelines for obesity as well as practice-based documents and grey literature on treating obesity and delivering health programs for adolescents and (ii) semi-structured interviews with eight clinicians and four non-clinicians working in obesity treatment, management and prevention to explore perspectives on treating adolescent obesity and using evidence in practice. RESULTS After merging the results from the literature reviews and interviews, four issues emerged: (i) little reporting on theoretical models used in intervention studies, Dutch clinical guidelines and semi-structured interviews; (ii) inconsistency on age-specific considerations for treating obesity in adolescents in intervention studies and Dutch clinical guidelines; (iii) inconsistency on addressing the social nature of obesity in intervention studies and Dutch clinical guidelines and (iv) how professional responsibility should be divided is unclear from intervention studies, Dutch clinical guidelines and semi-structured interviews. CONCLUSIONS Joined action of science and practice is required for future interventions. Future interventions should include topics relevant to the stage of adolescence and give greater focus to the complex social nature of obesity. Lastly, practitioners can generate more practice-based evidence by starting their own practice-based research.

Dietary counselling and nutritional support in oropharyngeal cancer patients treated with radiotherapy: persistent weight loss during 1-year follow-ups

Background/Objectives:The need for dietary counselling and nutritional support in oropharyngeal cancer patients is generally accepted. However, evidence for the effectiveness is sparse. The aim of this study was to describe dietary counselling, nutritional support, body weight and toxicity during and after treatment, and investigate the effect of pre-treatment body mass index (BMI) on survival in oropharyngeal cancer patients.Subjects/Methods:A retrospective chart review was made in 276 oropharyngeal cancer patients treated with radiotherapy (RT). End points were dietary consultations, weight loss, toxicity, overall survival and disease-free survival.Results:Almost all oropharyngeal cancer patients received dietary counselling (94%) and nutritional support (99%). Dietary counselling decreased sharply shortly after treatment to 38% at 1 year after treatment. Overall weight loss increased during the first year of follow-up and ranged from 3% at start of RT, until 11% at 1 year after RT. Overall survival was significantly longer for patients with a BMI above average (P=0.01). Acute dysphagia (P=0.001), mucositis (P=0.000) and toxicity grade 3 (P=0.002) were significantly more prevalent in patients who had lost 10% or more of their body weight.Conclusions:This study showed that patients continue to lose body weight during and until 1 year after treatment, despite nutrition support and frequent dietetic consultation. A BMI above average appears to increase survival time. Future studies, preferably randomized trials, are needed to compare standard dietary counselling with more intensive dietary counselling that consists of earlier and/or prolonged treatment.

The effects of the multispecies probiotic mixture Ecologic®Barrier on migraine: results of an open-label pilot study

Migraine prevalence is associated with gastrointestinal disorders. Possible underlying mechanisms could be increased gut permeability and inflammation. Probiotics may decrease intestinal permeability as well as inflammation, and therefore may reduce the frequency and/or intensity of migraine attacks. Therefore we assessed feasibility, possible clinical efficacy, and adverse reactions of probiotic treatment in migraine patients. 29 migraine patients took 2 g/d of a probiotic food supplement (Ecologic(®)Barrier, 2.5×10(9) cfu/g) during 12 weeks. Participants recorded frequency and intensity of migraine in a headache diary and completed the Migraine Disability Assessment Scale (MIDAS) and Henry Ford Hospital Headache Disability Inventory (HDI) at baseline and after 12 weeks of treatment. Compliance was measured every 4 weeks by counting the remaining sachets with probiotics. The study was completed by 27/29 (93%) patients who took 95% of the supplements. Obstipation was reported by 4 patients during the first 2 weeks of treatment only. The mean±standard deviation (SD) number of migraine days/month decreased significantly from 6.7±2.4 at baseline to 5.1±2.2 (P=0.008) in week 5-8 and 5.2±2.4 in week 9-12 (P=0.001). The mean±SD intensity of migraine decreased significantly from 6.3±1.5 at baseline to 5.5±1.9 after treatment (P=0.005). The MIDAS score improved from 24.8±25.5 to 16.6±13.5 (P=0.031). However, the mean HDI did not change significantly. In conclusion, probiotics may decrease migraine supporting a possible role for the intestine in migraine management. Feasibility and lack of adverse reactions justify further placebo-controlled studies.

A 12-week intervention with protein-enriched foods and drinks improved protein intake but not physical performance of older patients during the first 6 months after hospital release : a randomised controlled trial

During and after hospitalisation, older adults are recommended to consume 1·2-1·5 g of protein/kg body weight per d (g/kg per d) to improve recovery. This randomised controlled trial studied the effectiveness of a 12-week intervention with protein-enriched foods and drinks by following-up seventy-five older patients (mean age: 76·8 (sd 6·9) years) during their first 6 months after hospital discharge. Primary outcomes were protein intake and physical performance (measured with Short Physical Performance Battery (SPPB)). Secondary outcomes for physical recovery were gait speed, chair-rise time, leg-extension strength, hand-grip strength, body weight, nutritional status (Mini Nutritional Assessment), independence in activities of daily living (ADL) and physical activity. The intervention group consumed more protein during the 12-week intervention period compared with the control group (P<0·01): 112 (sd 34) g/d (1·5 (sd 0·6) g/kg per d) v. 78 (sd 18) g/d (1·0 (sd 0·4) g/kg per d). SPPB total score, gait speed, chair-rise time, body weight and nutritional status improved at week 12 compared with baseline (time effect P<0·05), but were not different between groups. Leg-extension strength, hand-grip strength and independence in ADL did not change. In conclusion, protein-enriched products enabled older adults to increase their protein intake to levels that are higher than their required intake. In these older adults with already adequate protein intakes and limited physical activity, protein enrichment did not enhance physical recovery in the first 6 months after hospital discharge.

The effects of a multispecies probiotic on migraine and markers of intestinal permeability–results of a randomized placebo-controlled study

Background/Objectives:Migraine, associated with several gastrointestinal disorders, may result from increased intestinal permeability, allowing endotoxins to enter the bloodstream. We tested whether probiotics could reduce migraine through an effect on intestinal permeability and inflammation.Subjects/Methods:In total, 63 patients were randomly allocated to the probiotic (n=31) or the placebo group (n=32). Participants ingested a multispecies probiotic (5x109 colony-forming units) or placebo daily for 12 weeks. Migraine was assessed with the Migraine Disability Assessment Scale (MIDAS), the Headache Disability Inventory (HDI) and headache diaries. At baseline and 12 weeks, intestinal permeability was measured with the urinary lactulose/mannitol test and fecal and serum zonulin; inflammation was measured from interleukin (IL) -6, IL-10, tumor necrosis factor-α and C-reactive protein in serum.Results:The MIDAS migraine intensity score significantly decreased in both groups (P<0.001) and the HDI score significantly decreased in the probiotic group (P=0.032) and borderline in the placebo group (P=0.053). In the probiotics group, patients had a median of 6 migraine days in the first month, 4 in the second month (P=0.002) and 5 in the last month, which was not significantly different from the 5, 4, and 4 days in the placebo group. A ⩾2day reduction in migraine days was seen in 12/31 patients in the probiotics group versus 7/29 in the placebo group (ns). Probiotic use did not significantly affect medication use, intestinal permeability or inflammation compared to placebo.Conclusions:In this study, we could not confirm significant benefit from a multispecies probiotic compared to a placebo on the outcome parameters of migraine and intestinal integrity.

Protein intake in hospitalized older people with and without increased risk of malnutrition

A protein intake of ≥1.2 grams per kg body weight (g/kg) is recommended for ill older adults. In a cross-sectional study, we investigated if this recommendation was met by 62 hospitalized adults of 65 years and older in a Dutch hospital. We compared protein intake between two subgroups based on the risk of malnutrition and the prescribed diet: a low risk group (n = 31) receiving a standard hospital diet and a medium/high risk group (n = 31) receiving a protein-enriched diet. A 24h-recall was performed to calculate protein intake per patient. Protein intake was on average 1.2 g/kg in the medium/high risk group and 0.9 g/kg in the low-risk group. Seventeen patients reached a protein intake of ≥1.2 g/kg. Fifteen patients had a protein intake below 0.8 g/kg. It seems sensible to consider providing a protein-enriched diet to all older hospitalized adults, regardless of their risk of malnutrition.