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  • 1.
    Adamsson, Viola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Reumark, Anna
    Marklund, Matti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Role of a prudent breakfast in improving cardiometabolic risk factors in subjects with hypercholesterolemia: A randomized controlled trial2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 34, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS:

    It is unclear whether advising a prudent breakfast alone is sufficient to improve blood lipids and cardiometabolic risk factors in overweight hypercholesterolemic subjects. The aim of this study was to investigate whether a prudent low-fat breakfast (PB) rich in dietary fiber lowers low-density lipoprotein cholesterol (LDL-C) and other cardiometabolic risk factors in subjects with elevated LDL-cholesterol levels.

    METHODS:

    In a parallel, controlled, 12-week study, 79 healthy overweight subjects (all regular breakfast eaters) were randomly allocated to a group that received a PB based on Nordic foods provided ad libitum or a control group that consumed their usual breakfast. The primary outcome was plasma LDL-C. Secondary outcomes were other blood lipids, body weight, sagittal abdominal diameter (SAD), glucose tolerance, insulin sensitivity and inflammation markers (C-reactive protein [CRP] and tumor necrosis factor receptor-2 [TNF-R2]), and blood pressure. The PB was in accordance with national and Nordic nutrition recommendations and included oat bran porridge with low-fat milk or yogurt, bilberry or lingonberry jam, whole grain bread, low-fat spread, poultry or fatty fish, and fruit.

    RESULTS:

    No differences were found in LDL-C, other blood lipids, body weight, or glucose metabolism, but SAD, plasma CRP, and TNF-R2 decreased more during PB compared with controls (p < 0.05). In the overall diet, PB increased dietary fiber and β-glucan compared with controls (p < 0.05).

    CONCLUSIONS:

    Advising a prudent breakfast for 3 months did not influence blood lipids, body weight, or glucose metabolism but reduced markers of visceral fat and inflammation. The trial was registered in the Current Controlled Trials database (http://www.controlled-trials.com); International Standard Randomized Controlled Trial Number (ISRCTN): 84550872.

  • 2.
    Ahlman, B.
    et al.
    Department of Surgery, Karolinska Hospital and Metabolic Research Laboratory, St Göran's Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Department of Surgery, Karolinska Hospital and Metabolic Research Laboratory, St Göran's Hospital, Stockholm, Sweden.
    Andersson, K.
    Department of Surgery, Karolinska Hospital and Metabolic Research Laboratory, St Göran's Hospital, Stockholm, Sweden.
    Wernerman, J.
    Department of Surgery, Karolinska Hospital and Metabolic Research Laboratory, St Göran's Hospital, Stockholm, Sweden.
    Free amino acids in the human intestinal mucosa: Impact of surgical trauma and critical illness1995In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 14, no 1, p. 54-55Article in journal (Refereed)
  • 3. Andersson, Daniel P.
    et al.
    Thorell, Anders
    Lofgren, Patrik
    Wiren, Mikael
    Toft, Eva
    Qvisth, Veronica
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Berglund, Lars
    Naslund, Erik
    Bringman, Sven
    Thorne, Anders
    Arner, Peter
    Hoffstedt, Johan
    Omentectomy in addition to gastric bypass surgery and influence on insulin sensitivity: A randomized double blind controlled trial2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 6, p. 991-996Article in journal (Refereed)
    Abstract [en]

    Background & aims: Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone. Methods: Eighty-one obese women scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors. Results: Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 +/- 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 +/- 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly. Conclusion: Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable.

  • 4.
    Arends, J
    et al.
    Faculty of Medicine, University of Freburg, Germany.
    Larsson, Maria
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    ESPEN guidelines on nutrition in cancer patients2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 11-48Article in journal (Refereed)
    Abstract [en]

    Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of experti

  • 5. Awad, Sherif
    et al.
    Varadhan, Krishna K.
    Ljungqvist, Olle
    Örebro University Hospital. Institution for Surgery & Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
    Lobo, Dileep N
    A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery2013In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 32, no 1, p. 34-44Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Whilst preoperative carbohydrate treatment (PCT) results in beneficial physiological effects, the effects on postoperative clinical outcomes remain unclear and were studied in this meta-analysis.

    METHODS: Prospective studies that randomised adult non-diabetic patients to either PCT (≥50 g oral carbohydrates 2-4 h pre-anaesthesia) or control (fasted/placebo) were included. The primary outcome was length of hospital stay. Secondary outcomes included development of postoperative insulin resistance, complications, nausea and vomiting. Methodological quality was assessed using GRADEpro(®) software.

    RESULTS: Twenty-one randomised studies of 1685 patients (733 PCT: 952 control) were included. No overall difference in length of stay was noted for analysis of all studies or subgroups of patients undergoing surgery with an expected hospital stay ≤2 days or orthopaedic procedures. However, patients undergoing major abdominal surgery following PCT had reduced length of stay [mean difference, 95% confidence interval: -1.08 (-1.87 to -0.29); I(2) = 60%, p = 0.007]. PCT reduced postoperative insulin resistance with no effects on in-hospital complications over control (risk ratio, 95% confidence interval, 0.88 (0.50-1.53), I(2) = 41%; p = 0.640). There was significant heterogeneity amongst studies and, therefore, quality of evidence was low to moderate.

    CONCLUSIONS: PCT may be associated with reduced length of stay in patients undergoing major abdominal surgery, however, the included studies were of low to moderate quality.

  • 6.
    Baban, Bayar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept of Surgery, Örebro University Hospital, Örebro, Sweden.
    Thorell, Anders
    Department of Clinical Science, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden; Dept of Surgery, Ersta Hospital, Stockholm, Sweden.
    Nygren, Jonas
    Department of Clinical Science, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden; Dept of Surgery, Ersta Hospital, Stockholm, Sweden.
    Bratt, Anette
    Department of Clinical Science, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden; Dept of Surgery, Ersta Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept of Surgery, Örebro University Hospital, Örebro, Sweden; Institution for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Determination of insulin resistance in surgery: the choice of method is crucial2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 34, no 1, p. 123-128Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: In elective surgery, postoperative hyperglycaemia and insulin resistance are independent risk factors for complications. Since the simpler HOMA method has been used as an alternative to the hyperinsulinemic normoglycemic clamp in studies of surgery induced insulin resistance, we compared the two methods in patients undergoing elective surgery.

    METHODS: Data from 113 non-diabetic patients undergoing elective surgery were used. Insulin sensitivity, both before and after surgery, was quantified by the clamp and HOMA. Pre- and postoperatively, the results of the clamp were compared to HOMA using regression- and correlation analysis. Degree of agreement between the methods was studied using weighted linear kappa and the Bland-Altman test.

    RESULTS: Both the clamp and HOMA recorded a mean relative reduction in insulin sensitivity of 39 ± 24% and 39 ± 61% respectively after surgery; with significant correlations (p < 0.01) for pre- and post-operative measures as well as for relative changes. However r(2) values were low: 0.04, 0.07 and 0.03 respectively. The degree of agreement for the relative change in insulin sensitivity using the Bland-Altman test gave a mean of difference 0% but "limits of agreement" (±2SD) was ±125%. This poor inter-method agreement was consolidated by a weighted linear kappa value of 0.18.

    CONCLUSION: While the hyperinsulinemic euglycemic clamp measures the postoperative changes in insulin sensitivity, HOMA measures something different. Data using the HOMA method must therefore be interpreted cautiously and is not interchangeable with data obtained from the clamp.

  • 7.
    Bachrach-Lindström, Margaretha
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Arnqvist, Hans
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Assessment of nutritional status using biochemical and anthropometric variables in a nutritional intervention study of women with hip fracture2001In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 20, no 3, p. 217-223Article in journal (Refereed)
    Abstract [en]

    Background & Aims: The aim of this study of women with hip fracture was to describe nutritional status with biochemical markers and anthropometric variables, and to evaluate the effect of nutritional intervention with the intention of increasing protein and energy intake.

    Methods: The first consecutive 44 women were included, and used as controls. The next 44 were matched for age, fracture and mental state. Anthropometric variables, IGF-I, hormones and serum albumin were collected 4–6 days (baseline), 1 and 3 months after surgery. Twenty-four women filled out a 7-day food record.

    Results: At baseline, one fourth had BMI <20 kg/m2and subnormal triceps skinfold thickness. Baseline serum albumin, IGF-I and growth hormone levels were low, probably as an acute response to trauma. Women with BMI <20 kg/m2had lower IGF-I levels compared to those with higher BMI. At 3 months, one-third of both groups were protein and energy malnourished. The intervention group obtained higher daily energy percentage from fat but none of the groups reached their calculated energy need.

    Conclusions: Using biochemical markers in the acute postoperative situation to assess nutritional status is not recommended. The intervention had no impact on anthropometric or biochemical variables.

  • 8.
    Bang, Peter
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Thorell, Anders
    Karolinska Institute, Sweden; Ersta Hospital, Sweden.
    Carlsson-Skwirut, Christine
    Karolinska Hospital and Institute, Sweden.
    Ljungqvist, Olle
    Örebro University Hospital, Sweden.
    Brismar, Kerstin
    Karolinska Hospital and Institute, Sweden.
    Nygren, Jonas
    Karolinska Institute, Sweden; Ersta Hospital, Sweden.
    Free dissociable IGF-I: Association with changes in IGFBP-3 proteolysis and insulin sensitivity after surgery2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 2, p. 408-413Article in journal (Refereed)
    Abstract [en]

    Background: Patients receiving a carbohydrate drink (CHO) before major abdominal surgery display improved insulin sensitivity postoperatively and increased proteolysis of IGFBP-3 (IGFBP-3-PA) compared to patients undergoing similar surgery after overnight fasting. Aims: We hypothesized that serum IGFBP-3-PA increases bioavailability of circulating IGF-I and preserves insulin sensitivity in patients given CHO. Design: Matched control study. Methods: At Karolinska University Hospital, patients given CHO before major elective abdominal surgery (CHO,n = 8) were compared to patients undergoing similar surgical procedures after overnight fasting (FAST,n = 10). Results from two different techniques for determination of free-dissociable IGF-I (fdIGF-I) were compared with changes in IGFBP-3-PA and insulin sensitivity. Results: Postoperatively, CHO displayed 18% improvement in insulin sensitivity (hyperinsulinemic clamp) and increased IGFBP-3-PA vs. FAST. As determined by IRMA, fdIGF-I increased by 48 +/- 25% in CHO while fdIGF-I decreased by 13 +/- 18% in FAST (p &lt; 0.01 vs. CHO, when corrected for duration of surgery). However, fdIGF-I determined by ultra-filtration decreased similarly in both groups (-22 +/- 8% vs. -25 +/- 8%, p = 0.8) and IGFBP-1 increased similarly in both groups. Patients with less insulin resistance after surgery demonstrated larger increases in fdIGF-I by IRMA (r = 0.58, p &lt; 0.05). Fifty-three % of the variability of the changes in fdIGF-I by IRMA could be explained by changes in IGFBP-3-PA and total IGF-I levels (p &lt; 0.05), while IGFBP-1 did not contribute significantly. Conclusion: During conditions when serum IGF-I bioavailability is regulated by IGFBP-3 proteolysis, measurements of fdIGF-I by IRMA is of physiological relevance as it correlates with the associated changes in insulin sensitivity. (C) 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  • 9.
    Bang, Peter
    et al.
    Fac Hlth Sci, Div Pediat, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Thorell, Anders
    Dept Clin Sci, Danderyds Hosp, Karolinska Inst, Stockholm, Sweden; Dept Surg, Ersta Hosp, Stockholm, Sweden.
    Carlsson-Skwirut, Christine
    Dept Woman & Child Hlth, Pediat Endocrinol Unit, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Brismar, Kerstin
    Dept Mol Endocrinol, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Nygren, Jonas
    Dept Clin Sci, Danderyds Hosp, Karolinska Institute, Stockholm, Sweden; Dept Surg, Ersta Hosp, Stockholm, Sweden.
    Free dissociable IGF-I: Association with changes in IGFBP-3 proteolysis and insulin sensitivity after surgery2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 2, p. 408-413Article in journal (Refereed)
    Abstract [en]

    Background: Patients receiving a carbohydrate drink (CHO) before major abdominal surgery display improved insulin sensitivity postoperatively and increased proteolysis of IGFBP-3 (IGFBP-3-PA) compared to patients undergoing similar surgery after overnight fasting. Aims: We hypothesized that serum IGFBP-3-PA increases bioavailability of circulating IGF-I and preserves insulin sensitivity in patients given CHO. Design: Matched control study. Methods: At Karolinska University Hospital, patients given CHO before major elective abdominal surgery (CHO,n = 8) were compared to patients undergoing similar surgical procedures after overnight fasting (FAST,n = 10). Results from two different techniques for determination of free-dissociable IGF-I (fdIGF-I) were compared with changes in IGFBP-3-PA and insulin sensitivity. Results: Postoperatively, CHO displayed 18% improvement in insulin sensitivity (hyperinsulinemic clamp) and increased IGFBP-3-PA vs. FAST. As determined by IRMA, fdIGF-I increased by 48 +/- 25% in CHO while fdIGF-I decreased by 13 +/- 18% in FAST (p < 0.01 vs. CHO, when corrected for duration of surgery). However, fdIGF-I determined by ultra-filtration decreased similarly in both groups (-22 +/- 8% vs. -25 +/- 8%, p = 0.8) and IGFBP-1 increased similarly in both groups. Patients with less insulin resistance after surgery demonstrated larger increases in fdIGF-I by IRMA (r = 0.58, p < 0.05). Fifty-three % of the variability of the changes in fdIGF-I by IRMA could be explained by changes in IGFBP-3-PA and total IGF-I levels (p < 0.05), while IGFBP-1 did not contribute significantly. Conclusion: During conditions when serum IGF-I bioavailability is regulated by IGFBP-3 proteolysis, measurements of fdIGF-I by IRMA is of physiological relevance as it correlates with the associated changes in insulin sensitivity.

  • 10. Barazzoni, R
    et al.
    Deutz, N E P
    Biolo, G
    Bischoff, S
    Boirie, Y
    Cederholm, T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Cuerda, C
    Delzenne, N
    Leon Sanz, M
    Ljungqvist, O
    Muscaritoli, M
    Pichard, C
    Preiser, J C
    Sbraccia, P
    Singer, P
    Tappy, L
    Thorens, B
    Van Gossum, A
    Vettor, R
    Calder, P C
    Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group.2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 2, p. 355-363Article in journal (Refereed)
    Abstract [en]

    Growing evidence underscores the important role of glycemic control in health and recovery from illness. Carbohydrate ingestion in the diet or administration in nutritional support is mandatory, but carbohydrate intake can adversely affect major body organs and tissues if resulting plasma glucose becomes too high, too low, or highly variable. Plasma glucose control is especially important for patients with conditions such as diabetes or metabolic stress resulting from critical illness or surgery. These patients are particularly in need of glycemic management to help lessen glycemic variability and its negative health consequences when nutritional support is administered. Here we report on recent findings and emerging trends in the field based on an ESPEN workshop held in Venice, Italy, 8-9 November 2015. Evidence was discussed on pathophysiology, clinical impact, and nutritional recommendations for carbohydrate utilization and management in nutritional support. The main conclusions were: a) excess glucose and fructose availability may exacerbate metabolic complications in skeletal muscle, adipose tissue, and liver and can result in negative clinical impact; b) low-glycemic index and high-fiber diets, including specialty products for nutritional support, may provide metabolic and clinical benefits in individuals with obesity, insulin resistance, and diabetes; c) in acute conditions such as surgery and critical illness, insulin resistance and elevated circulating glucose levels have a negative impact on patient outcomes and should be prevented through nutritional and/or pharmacological intervention. In such acute settings, efforts should be implemented towards defining optimal plasma glucose targets, avoiding excessive plasma glucose variability, and optimizing glucose control relative to nutritional support.

  • 11.
    Barazzoni, R.
    et al.
    Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
    Deutz, N. E. P.
    Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A & M University, College Station TX, USA.
    Biolo, G.
    Department of Medical, Surgical and Health Sciences, Internal Medicine, University of Trieste, Trieste, Italy.
    Bischoff, S.
    Department of Nutritional Medicine/Prevention, University of Hohenheim, Stuttgart, Germany.
    Boirie, Y.
    Department of Clinical Nutrition, CHU de Clermont-Ferrand, CRNH, Université d'Auvergne, Clermont-Ferrand, France.
    Cederholm, T.
    Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Cuerda, C.
    Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
    Delzenne, N.
    Department, Université Catholique de Louvain, Brussels, Belgium.
    Leon Sanz, M.
    Department of Medicine, Complutense University, Madrid, Spain.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Muscaritoli, M.
    Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
    Pichard, C.
    Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
    Preiser, J. C.
    Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
    Sbraccia, R.
    Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
    Singer, P.
    Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel.
    Tappy, L.
    Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
    Thorens, B.
    Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland.
    Van Gossum, A.
    Gastroenterology Service, Hospital Erasme, Brussels, Belgium.
    Vettor, R.
    Internal Medicine Unit and Center for the Study and Integrated Treatment of Obesity, Department of Medicine, Padua University, Padua, Italy.
    Calder, P. C.
    Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton, Southampton, United Kingdom.
    Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 2, p. 355-363Article, review/survey (Refereed)
    Abstract [en]

    Growing evidence underscores the important role of glycemic control in health and recovery from illness. Carbohydrate ingestion in the diet or administration in nutritional support is mandatory, but carbohydrate intake can adversely affect major body organs and tissues if resulting plasma glucose becomes too high, too low, or highly variable. Plasma glucose control is especially important for patients with conditions such as diabetes or metabolic stress resulting from critical illness or surgery. These patients are particularly in need of glycemic management to help lessen glycemic variability and its negative health consequences when nutritional support is administered. Here we report on recent findings and emerging trends in the field based on an ESPEN workshop held in Venice, Italy, 8-9 November 2015. Evidence was discussed on pathophysiology, clinical impact, and nutritional recommendations for carbohydrate utilization and management in nutritional support. The main conclusions were: a) excess glucose and fructose availability may exacerbate metabolic complications in skeletal muscle, adipose tissue, and liver and can result in negative clinical impact; b) low-glycemic index and high-fiber diets, including specialty products for nutritional support, may provide metabolic and clinical benefits in individuals with obesity, insulin resistance, and diabetes; c) in acute conditions such as surgery and critical illness, insulin resistance and elevated circulating glucose levels have a negative impact on patient outcomes and should be prevented through nutritional and/or pharmacological intervention. In such acute settings, efforts should be implemented towards defining optimal plasma glucose targets, avoiding excessive plasma glucose variability, and optimizing glucose control relative to nutritional support. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

  • 12.
    Barazzoni, Rocco
    et al.
    Univ Trieste, Dept Med Surg & Hlth Sci, Internal Med, Trieste, Italy;Azienda Sanit Univ Integrata Trieste ASUITS, Trieste, Italy.
    Bischoff, Stephan C.
    Univ Hohenheim, Dept Nutr Med, Stuttgart, Germany.
    Boirie, Yves
    Univ Clermont Auvergne, INRA, UNH, CRNH Auvergne, F-63000 Clermont Ferrand, France;CHU Clermont Ferrand, Serv Nutr Clin, F-63000 Clermont Ferrand, France.
    Busetto, Luca
    Univ Padua, Dept Med, Padua, Italy;Padova Univ Hosp, Ctr Study & Integrated Management Obes EASO COM, Padua, Italy.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Dicker, Dror
    Tel Aviv Univ, Rabin Med Ctr, Internal Med Dept, Hasharon Hosp,Sackler Fac Med, Tel Aviv, Israel;Tel Aviv Univ, Rabin Med Ctr, Obes Clin, Hasharon Hosp,Sackler Fac Med, Tel Aviv, Israel.
    Toplak, Hermann
    Med Univ Graz, Dept Med, Graz, Austria.
    Van Gossum, Andre
    Free Univ Brussels, Dept Gastroenterol, Clin Intestinal Dis & Nutr Support, Hop Erasme, Brussels, Belgium.
    Yumuk, Volkan
    Istanbul Univ, Div Endocrinol Metab & Diabet, Cerrahpasa Med Fac, Istanbul, Turkey.
    Vettor, Roberto
    Univ Padua, Dept Med, Padua, Italy;Padova Univ Hosp, Ctr Study & Integrated Management Obes EASO COM, Padua, Italy.
    Sarcopenic obesity: Time to meet the challenge2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, Part A, p. 1787-1793Article in journal (Refereed)
    Abstract [en]

    The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social and multi-disciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures and cancer, as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenetic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight-reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term "sarcopenic obesity" has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.

  • 13. Biolo, G
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Muscaritoli, M
    Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of ageing and chronic disease: From sarcopenic obesity to cachexia2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 5, p. 737-748Article in journal (Refereed)
    Abstract [en]

    Skeletal muscle is the most abundant body tissue accounting for many physiological functions. However, muscle mass and functions are not routinely assessed. Sarcopenia is defined as skeletal muscle loss and dysfunction in aging and chronic diseases. Inactivity, inflammation, age-related factors, anorexia and unbalanced nutrition affect changes in skeletal muscle. Mechanisms are difficult to distinguish in individual subjects due to the multifactorial character of the condition. Sarcopenia includes both muscle loss and dysfunction which induce contractile impairment and metabolic and endocrine abnormalities, affecting whole-body metabolism and immune/inflammatory response. There are different metabolic trajectories for muscle loss versus fat changes in aging and chronic diseases. Appetite regulation and physical activity affect energy balance and changes in body fat mass. Appetite regulation by inflammatory mediators is poorly understood. In some patients, inflammation induces anorexia and fat loss in combination with sarcopenia. In others, appetite is maintained, despite activation of systemic inflammation, leading to sarcopenia with normal or increased BMI. Inactivity contributes to sarcopenia and increased fat tissue in aging and diseases. At the end of the metabolic trajectories, cachexia and sarcopenic obesity are paradigms of the two patient categories. Pre-cachexia and cachexia are observed in patients with cancer, chronic heart failure or liver cirrhosis. Sarcopenic obesity and sarcopenia with normal/increased BMI are observed in rheumatoid arthritis, breast cancer patients with adjuvant chemotherapy and in most of patients with COPD or chronic kidney disease. In these conditions, sarcopenia is a powerful prognostic factor for morbidity and mortality, independent of BMI.

  • 14. Bischoff, Stephan C
    et al.
    Boirie, Yves
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Chourdakis, Michael
    Cuerda, Cristina
    Delzenne, Nathalie M
    Deutz, Nicolaas E
    Fouque, Denis
    Genton, Laurence
    Gil, Carmen
    Koletzko, Berthold
    Leon-Sanz, Miguel
    Shamir, Raanan
    Singer, Joelle
    Singer, Pierre
    Stroebele-Benschop, Nanette
    Thorell, Anders
    Weimann, Arved
    Barazzoni, Rocco
    Towards a multidisciplinary approach to understand and manage obesity and related diseases2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 4, p. 917-938, article id S0261-5614(16)31323-1Article, review/survey (Refereed)
    Abstract [en]

    Overnutrition and sedentary lifestyle result in overweight or obesity defined as abnormal or excessive fat accumulation that may impair health. According to the WHO, the worldwide prevalence of obesity nearly doubled between 1980 and 2008. In 2008, over 50% of both men and women in the WHO European Region were overweight, and approximately 23% of women and 20% of men were obese. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential disease-specific benefits from selected nutritional regimens. Obesity is usually accompanied by an increased muscle mass. This might explain why obesity, under particular circumstances such as cancer or high age, might have protective effects, a phenomenon named the 'obesity paradox'. However, loss of muscle mass or function can also occur, which is associated with poor prognosis and termed 'sarcopenic obesity'. Therefore, treatment recommendations may need to be individualized and adapted to co-morbidities. Since obesity is a chronic systemic disease it requires a multidisciplinary approach, both at the level of prevention and therapy including weight loss and maintenance. In the present personal review and position paper, authors from different disciplines including endocrinology, gastroenterology, nephrology, pediatrics, surgery, geriatrics, intensive care medicine, psychology and psychiatry, sports medicine and rheumatology, both at the basic science and clinical level, present their view on the topic and underline the necessity to provide a multidisciplinary approach, to address this epidemic.

  • 15. Bischoff, Stephan C
    et al.
    Singer, Pierre
    Koller, Michael
    Barazzoni, Rocco
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    van Gossum, André
    Standard operating procedures for ESPEN guidelines and consensus papers2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 34, no 6, p. 1043-1051Article in journal (Refereed)
    Abstract [en]

    The ESPEN Guideline standard operating procedures (SOP) is based on the methodology provided by the Association of Scientific Medical Societies of Germany (AWMF), the Scottish Intercollegiate Guidelines Network (SIGN), and the Centre for Evidence-based Medicine at the University of Oxford. The SOP is valid and obligatory for all future ESPEN-sponsored guideline projects aiming to generate high-quality guidelines on a regular basis. The SOP aims to facilitate the preparation of guideline projects, to streamline the consensus process, to ensure quality and transparency, and to facilitate the dissemination and publication of ESPEN guidelines. To achieve this goal, the ESPEN Guidelines Editorial board (GEB) has been established headed by two chairmen. The GEB will support and supervise the guideline processes and is responsible for the strategic planning of ESPEN guideline activities. Key elements of the SOP are the generation of well-built clinical questions according to the PICO system, a systemic literature search, a classification of the selected literature according to the SIGN evidence levels providing an evidence table, and a clear and straight-forward consensus procedure consisting of online voting's and a consensus conference. Only experts who meet the obligation to disclosure any potential conflict of interests and who are not employed by the Industry can participate in the guideline process. All recommendations will be graded according to the SIGN grading and novel outcome models besides biomedical endpoints. This approach will further extent the leadership of ESPEN in creating up-to-date and suitable for implementation guidelines and in sharing knowledge on malnutrition and clinical nutrition.

  • 16.
    Blixt, Christina
    et al.
    Dept of Anaesthesia and Intensive Care, Karolinska University Hospital, Huddinge, Sweden; Dept of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden.
    Ahlstedt, Christian
    Dept of Anaesthesia and Intensive Care, Karolinska University Hospital, Huddinge, Sweden; Dept of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Isaksson, Bengt
    Dept of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden; Division of Surgery, Karolinska University Hospital, Huddinge, Sweden.
    Kalman, Sigridur
    Dept of Anaesthesia and Intensive Care, Karolinska University Hospital, Huddinge, Sweden; Dept of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden.
    Rooyackers, Olav
    Dept of Anaesthesia and Intensive Care, Karolinska University Hospital, Huddinge, Sweden; Dept of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden.
    Corrigendum to ‘The effect of perioperative glucose control on postoperative insulin resistance’ [Clin Nutr 31 (5) (2012) 676–681]2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 3, p. 1091-1091Article in journal (Refereed)
  • 17. Blixt, Christina
    et al.
    Ahlstedt, Christian
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Dept of Surgery, Örebro University Hospital, Örebro, Sweden.
    Isaksson, Bengt
    Kalman, Sigridur
    Rooyackers, Olav
    The effect of perioperative glucose control on postoperative insulin resistance2012In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 31, no 5, p. 676-681Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Postoperative insulin resistance and the consequent hyperglycemia affects clinical outcome. Insulin sensitivity may be modulated by preoperative nutrition, adequate pain management and minimal invasive surgery. This study aims to disclose the impact of perioperative glucose control on postoperative insulin resistance.

    METHODS: Twenty patients scheduled for elective open hepatectomy were enrolled in this prospective, randomized study. In the treatment group (n = 9) insulin was administered intravenously to keep blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 8) received insulin if blood glucose >14 mmol/l. Insulin sensitivity was measured by a hyperinsulinemic normoglycemic clamp (0.8 mU/kg/min), performed on all patients both on the day before surgery and immediately postoperatively. Plasma cortisol, insulin and C-peptide were measured.

    RESULTS: There was a significant difference in mean glucose value during surgery. In the control group 8.8 mmol/l (SD 1.5) vs. 6.9 mmol/l (SD 0.4) in the treated group, p = 0.003. In the control group insulin sensitivity decreased to 21.9% ± 16.2% of the preoperative value and in the insulin treated group to 46.8 ± 15.5%, p < 0.005. Insulin levels were significantly higher in the treatment group as well as consequently lower C-peptide levels.

    CONCLUSIONS: This trial revealed a significant difference in postoperative insulin resistance in the group treated with insulin during surgery.

  • 18.
    Boernhorst, C.
    et al.
    BIPS Inst Epidemiol & Prevent Res, Bremen, Germany.
    Bel-Serrat, S.
    Univ Zaragoza, Fac Hlth Sci, GENUD Growth Exercise Nutr & Dev Res Grp, E-50009 Zaragoza, Spain.
    Pigeot, I.
    BIPS Inst Epidemiol & Prevent Res, Bremen, Germany.
    Huybrechts, I.
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium / Int Agcy Res Canc, Dietary Exposure Assessment Grp, F-69372 Lyon, France.
    Ottavaere, C.
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium.
    Sioen, I.
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium.
    De Henauw, S.
    Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium / Univ Coll Ghent, Dept Nutr & Dietet, Fac Hlth Care Vesalius, Ghent, Belgium.
    Mouratidou, T.
    Univ Zaragoza, Fac Hlth Sci, GENUD Growth Exercise Nutr & Dev Res Grp, E-50009 Zaragoza, Spain.
    Mesana, M. I.
    Univ Zaragoza, Fac Hlth Sci, GENUD Growth Exercise Nutr & Dev Res Grp, E-50009 Zaragoza, Spain.
    Westerterp, K.
    Maastricht Univ, Dept Human Biol, Maastricht, Netherlands.
    Bammann, K.
    BIPS Inst Epidemiol & Prevent Res, Bremen, Germany / Univ Bremen, Inst Publ Hlth & Nursing Res, D-28359 Bremen, Germany.
    Lissner, L.
    Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    Eiben, Gabriele
    Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    Pala, V.
    Fdn IRCSS Ist Nazl Tumori, Nutr Epidemiol Unit, Dept Prevent & Predict Med, Milan, Italy.
    Rayson, M.
    BioTel Ltd Clifton, Bristol, Avon, England.
    Krogh, V.
    Fdn IRCSS Ist Nazl Tumori, Nutr Epidemiol Unit, Dept Prevent & Predict Med, Milan, Italy.
    Moreno, L. A.
    Univ Zaragoza, Fac Hth Sci, GENUD Growth Exercise Nutr & Dev Res Grp, E-50009 Zaragoza, Spain.
    Validity of 24-h recalls in (pre-)school aged children: Comparison of proxy-reported energy intakes with measured energy expenditure2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 1, p. 79-84Article in journal (Refereed)
    Abstract [en]

    Background & aims: Little is known about the validity of repeated 24-h dietary recalls (24-HDR) as a measure of total energy intake (El) in young children. This study aimed to evaluate the validity of proxy-reported El by comparison with total energy expenditure (TEE) measured by the doubly labeled water (DLW) technique. Methods: The agreement between El and TEE was investigated in 36 (47.2% boys) children aged 4-10 years from Belgium and Spain using subgroup analyses and Bland-Altman plots. Low-energy-reporters (LER), adequate-energy-reporters (AER) and high-energy-reporters (HER) were defined from the ratio of El over TEE by application of age- and sex-specific cut-off values. Results: There was good agreement between means of El (1500 kcal/day) and TEE (1523 kcal/day) at group level though in single children, i.e. at the individual level, large differences were observed. Almost perfect agreement between El and TEE was observed in thin/normal weight children (EI: 1511 kcal/day; TEE: 1513 kcal/day). Even in overweight/obese children the mean difference between El and TEE was only 86 kcal/day. Among the participants, 28(78%) were classified as AER, five (14%) as HER and three (8%) as LER. Conclusion: Two proxy-reported 24-HDRs were found to be a valid instrument to assess El on group level but not on the individual level. (C) 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  • 19.
    Bosaeus, Ingvar
    et al.
    Sahlgrenska University Hospital, Gothenburg.
    Wilcox, Gisela
    Monash University, Clayton, Victoria, Australia.
    Rothenberg, Elisabet
    Kristianstad University, School of Education and Environment, Avdelningen för Praktisk-estetiska ämnen.
    Strauss, Boyd
    Monash University, Clayton, Victoria, Australia.
    Reply to Thibault & Genton2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 6, p. 1158-1159Article in journal (Other academic)
  • 20.
    Bosaeus, Ingvar
    et al.
    Sahlgrenska University Hospital.
    Wilcox, Gisela
    Monash University.
    Rothenberg, Elisabet
    Sahlgrenska University Hospital.
    Strauss, Boyd J
    Monash University.
    Skeletal muscle mass in hospitalized elderly patients: comparison of measurements by single-frequency BIA and DXA2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 3, p. 426-431Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: There is increasing interest in estimating skeletal muscle mass (SMM) in clinical practice. We aimed to validate a bioelectrical impedance analysis (BIA) prediction equation for SMM, developed in a different healthy elderly population, in a population of hospital patients aged 70 and over, by comparison with dual-energy X-ray absorptiometry (DXA) SMM estimates. Comparison was also made with two other previously published BIA muscle prediction equations.

    METHODS: Muscle measurements by BIA and DXA were compared in 117 patients with a range of clinical conditions (45 female, 72 male, mean age 75 years).

    RESULTS: The BIA equation used yielded an accurate estimate of DXA-derived SMM. Mean (SD) difference was 0.26(1.79) kg (ns). The two other BIA equations over-estimated SMM compared to DXA (both p < 0.001), but all equations were highly correlated.

    CONCLUSIONS: The BIA equation used, developed in a different healthy elderly population, gave an accurate estimate of DXA-derived SMM in a population with various clinical disorders. BIA appears potentially capable to estimate SMM in clinical disorders, but the optimal approach to its use for this purpose requires further investigation.

  • 21. Braga, M.
    et al.
    Ljungqvist, Olle
    Örebro University, School of Health and Medical Sciences.
    Soeters, P.
    Fearon, K.
    Weimann, A.
    Bozzetti, F.
    ESPEN Guidelines on Parenteral Nutrition: surgery2009In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 28, no 4, p. 378-386Article in journal (Refereed)
    Abstract [en]

    In modern surgical practice it is advisable to manage patients within an enhanced recovery protocol and thereby have them eating normal food within 1-3 days. Consequently, there is little room for routine perioperative artificial nutrition. Only a minority of patients may benefit from such therapy. These are predominantly patients who are at risk of developing complications after surgery. The main goals of perioperative nutritional support are to minimize negative protein balance by avoiding starvation, with the purpose of maintaining muscle, immune, and cognitive function and to enhance postoperative recovery. Several studies have demonstrated that 7-10 days of preoperative parenteral nutrition improves postoperative outcome in patients with severe undernutrition who cannot be adequately orally or enterally fed. Conversely, its use in well-nourished or mildly undernourished patients is associated with either no benefit or with increased morbidity. Postoperative parenteral nutrition is recommended in patients who cannot meet their caloric requirements within 7-10 days orally or enterally. In patients who require postoperative artificial nutrition, enteral feeding or a combination of enteral and supplementary parenteral feeding is the first choice. The main consideration when administering fat and carbohydrates in parenteral nutrition is not to overfeed the patient. The commonly used formula of 25 kcal/kg ideal body weight furnishes an approximate estimate of daily energy expenditure and requirements. Under conditions of severe stress requirements may approach 30 kcal/kg ideal body weights. In those patients who are unable to be fed via the enteral route after surgery, and in whom total or near total parenteral nutrition is required, a full range of vitamins and trace elements should be supplemented on a daily basis.

  • 22. Bronsky, J.
    et al.
    Campoy, C.
    Braegger, C.
    Braegger, Christian
    Bronsky, Jiri
    Cai, Wei
    Campoy, Cristina
    Carnielli, Virgilio
    Darmaun, Dominique
    Decsi, Tamas
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Embleton, Nicholas
    Fewtrell, Mary
    Fidler Mis, Natasa
    Franz, Axel
    Goulet, Olivier
    Hartman, Corina
    Hill, Susan
    Hojsak, Iva
    Iacobelli, Silvia
    Jochum, Frank
    Joosten, Koen
    Kolacek, Sanja
    Koletzko, Berthold
    Ksiazyk, Janusz
    Lapillonne, Alexandre
    Lohner, Szimonetta
    Mesuiten, Dieter
    Mihalyi, Krisztina
    Mihatsch, Walter A.
    Mimouni, Francis
    Molgaard, Christian
    Moltu, Sissel J.
    Nomayo, Antonia
    Picaud, Jean Charles
    Prell, Christine
    John, Puntis
    Arieh, Riskin
    Saenz De Pipaon, Miguel
    Senterre, Thibault
    Shamir, Raanan
    Simchowitz, Venetia
    Szitanyi, Peter
    Tabbers, Merit M.
    Van Den Akker, Chris H. B.
    Van Goudoever, Johannes B.
    Van Kempen, Anne
    Ver-Bruggen, Sascha
    Wu, Jiang
    Weihui, Yan
    ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Vitamins2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2366-2378Article in journal (Refereed)
  • 23. Campmans-Kuijpers, Marjo J
    et al.
    Sluijs, Ivonne
    Nöthlings, Ute
    Freisling, Heinz
    Overvad, Kim
    Boeing, Heiner
    Masala, Giovanna
    Panico, Salvatore
    Tumino, Rosario
    Sieri, Sabina
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Winkvist, Anna
    Katzke, Verena A
    Kuehn, Tilman
    Nilsson, Peter M
    Halkjær, Jytte
    Tjønneland, Anne
    Spijkerman, Annemieke M
    Arriola, Larraitz
    Sacerdote, Carlotta
    Barricarte, Aurelio
    May, Anne M
    Beulens, Joline W
    The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 5, p. 1096-1102Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Substitution of carbohydrates with fat in a diet for type 2 diabetes patients is still debated.

    OBJECTIVE: This study aimed to investigate the association between dietary carbohydrate intake and isocaloric substitution with (i) total fat, (ii) saturated fatty acids (SFA), (iii) mono-unsaturated fatty acids (MUFA) and (iv) poly-unsaturated fatty acids (PUFA) with all-cause and cardiovascular (CVD) mortality risk and 5-year weight change in patients with type 2 diabetes.

    METHODS: The study included 6192 patients with type 2 diabetes from 15 cohorts of the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary intake was assessed at recruitment with country-specific food-frequency questionnaires. Cox and linear regression were used to estimate the associations with (CVD) mortality and weight change, adjusting for confounders and using different methods to adjust for energy intake.

    RESULTS: After a mean follow-up of 9.2 y ± SD 2.3 y, 791 (13%) participants had died, of which 268 (4%) due to CVD. Substituting 10 g or 5 energy% of carbohydrates by total fat was associated with a higher all-cause mortality risk (HR 1.07 [1.02-1.13]), or SFAs (HR 1.25 [1.11-1.40]) and a lower risk when replaced by MUFAs (HR 0.89 [0.77-1.02]). When carbohydrates were substituted with SFAs (HR 1.22 [1.00-1.49]) or PUFAs (HR 1.29 [1.02-1.63]) CVD mortality risk increased. The 5-year weight was lower when carbohydrates were substituted with total fat or MUFAs. These results were consistent over different energy adjustment methods.

    CONCLUSIONS: In diabetes patients, substitution of carbohydrates with SFAs was associated with a higher (CVD) mortality risk and substitution by total fat was associated with a higher all-cause mortality risk. Substitution of carbohydrates with MUFAs may be associated with lower mortality risk and weight reduction. Instead of promoting replacement of carbohydrates by total fat, dietary guideline should continue focusing on replacement by fat-subtypes; especially SFAs by MUFAs.

  • 24.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Letter to Editor - BMI, FFMI not seem universally applicable in nutritional assessment & the place of SGA & functional evaluation shouldn't be overlooked2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983Article in journal (Other academic)
  • 25.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Letter to the Editor - Should significant weight loss mandated to be "unintentional" for resulting in and regarded as malnutrition?2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 1, p. 235-235Article in journal (Refereed)
  • 26.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Reply, Letter to Editor - BMI, FFMI do not seem universally applicable in nutritional assessment & the place of SGA & functional evaluation shouldn't be overlooked2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 1, p. 237-237Article in journal (Refereed)
  • 27. Cederholm, Tommy
    Standard operating procedures for ESPEN guidelines and consensus papers2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983Article in journal (Refereed)
  • 28.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Barazzoni, R
    Austin, P
    Ballmer, P
    Biolo, G
    Bischoff, S C
    Compher, C
    Correia, I
    Higashiguchi, T
    Holst, M
    Jensen, G L
    Malone, A
    Muscaritoli, M
    Nyulasi, I
    Pirlich, M
    Rothenberg, E
    Schindler, K
    Schneider, S M
    de van der Schueren, M A E
    Sieber, C
    Valentini, L
    Yu, J C
    Van Gossum, A
    Singer, P
    ESPEN guidelines on definitions and terminology of clinical nutrition2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 49-64Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

    OBJECTIVE: This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

    METHODS: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

    RESULTS: Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

    CONCLUSION: An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

  • 29.
    Cederholm, Tommy
    et al.
    Uppsala universitet.
    Barazzoni, R.
    Italien.
    Austin, Peter
    Storbritannien.
    Ballmer, Peter
    Schweiz.
    Biolo, G.
    Italien .
    Bischoff, Stephan C.
    Tyskland.
    Compher, C.
    USA.
    Correia, Isabel
    Brasilien.
    Higashiguchi, T.
    Japan.
    Hoist, Mette
    Danmark.
    Jensen, Gordon L.
    USA.
    Malone, Ainsley
    USA.
    Muscaritoli, Maurizio
    Italien.
    Nyulasi, I.
    Australien.
    Pirlich, Matthias
    Tyskland.
    Rothenberg, Elisabet
    Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL). Kristianstad University, School of Education and Environment, Avdelningen för Mat- och måltidsvetenskap.
    Schindler, Karin
    Österrike.
    Schneider, Stephane M.
    Frankrike.
    de van der Schueren, M. A. E.
    Nederländerna.
    Sieber, Cornel
    Tyskland.
    Valentini, L.
    Tyskland.
    Yu, J. C.
    Kina.
    Van Gossum, André
    Belgien.
    Singer, Pierre
    Israel.
    ESPEN guidelines on definitions and terminology of clinical nutrition2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 49-64Article in journal (Refereed)
    Abstract [en]

    Background

    A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

    Objective

    This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

    Methods

    The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

    Results

    Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

    Conclusion

    An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

  • 30.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Bosaeus, I.
    Barazzoni, R.
    Bauer, J.
    Van Gossum, A.
    Klek, S.
    Muscaritoli, M.
    Nyulasi, I.
    Ockenga, J.
    Schneider, S. M.
    de van der Schueren, M. A. E.
    Singer, P.
    Diagnostic criteria for malnutrition - An ESPEN Consensus Statement2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 34, no 3, p. 335-340Article in journal (Refereed)
    Abstract [en]

    Objective: To provide a consensus-based minimum set of criteria for the diagnosis of malnutrition to be applied independent of clinical setting and aetiology, and to unify international terminology. Method: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a group of clinical scientists to perform a modified Delphi process, encompassing e-mail communications, face-to-face meetings, in group questionnaires and ballots, as well as a ballot for the ESPEN membership. Result: First, ESPEN recommends that subjects at risk of malnutrition are identified by validated screening tools, and should be assessed and treated accordingly. Risk of malnutrition should have its own ICD Code. Second, a unanimous consensus was reached to advocate two options for the diagnosis of malnutrition. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. About 12% of ESPEN members participated in a ballot; >75% agreed; i.e. indicated >= 7 on a 10-graded scale of acceptance, to this definition. Conclusion: In individuals identified by screening as at risk of malnutrition, the diagnosis of malnutrition should be based on either a low BMI (<18.5 kg/m(2)), or on the combined finding of weight loss together with either reduced BMI (age-specific) or a low FFMI using sex-specific cut-offs.

  • 31.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Compher, C.
    Univ Penn, Sch Nursing, Philadelphia, PA 19104 USA.
    Correia, M. I. T. D.
    Univ Fed Minas Gerais, Belo Horizante, Brazil.
    Gonzalez, M. C.
    Univ Catolica Pelotas, Pelotas, RS, Brazil.
    Fukushima, R.
    Univ Tokyo, Sch Med, Tokyo, Japan.
    Higashiguchi, T.
    Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan.
    Van Gossum, A.
    Free Univ Brussels, Brussels, Belgium.
    Jensen, G. L.
    Univ Vermont, Burlington, VT USA.
    Response to the letter: Comment on "GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community": Some considerations about the GLIM criteria - A consensus report for the diagnosis of malnutrition by Drs. LB da Silva Passos and DA De -Souza2019In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 3, p. 1480-1481Article in journal (Other academic)
  • 32.
    Cederholm, Tommy E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Letter to the Editor: Diagnostic criteria for malnutrition: Consequences for the nutrition teams2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 309-309Article in journal (Refereed)
  • 33.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Jensen, Gordon L.
    Univ Vermont, Coll Med, Deans Off, Burlington, VT USA.; Univ Vermont, Coll Med, Dept Med, Burlington, VT USA..
    To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 20162017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 7-10, article id S0261-5614(16)31342-5Article in journal (Refereed)
    Abstract [en]

    During the ESPEN Congress in Copenhagen, Denmark (September 2016) representatives of the 4 largest global PEN-societies from Europe (ESPEN), USA (ASPEN), Asia (PENSA) and Latin America (FELANPE), and from national PEN-societies around the world met to continue the conversation on how to diagnose malnutrition that started during the Clinical Nutrition Week, Austin, USA (February 2016). Current thinking on diagnostic approaches was shared; ESPEN suggested a grading approach that could encompass various types of signs, symptoms and etiologies to support diagnosis. ASPEN emphasized where the parties agree; i.e. that the three major published approaches (ESPEN, ASPEN/AND and Subjective Global Assessment (SGA)) all propose weight loss as a key indicator for malnutrition. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic methodology that is available for everybody since resources differ globally. PENSA highlighted that BMI varies by ethnicity/race, and that sarcopenia/muscle mass evaluation is important for the diagnosis of malnutrition. A Core Working Committee of the Global Leadership Initiative on Malnutrition (GLIM) has been established (comprised of two representatives each from the 4 largest PEN-societies) that will lead consensus development in collaboration with a larger Working Group with broad global representation, using e-mail, telephone conferences, and face-to-face meetings during the up-coming ASPEN and ESPEN Congresses. Transparency and external input will be sought. Objectives include: 1. Consensus development around evidence-based criteria for broad application. 2. Promotion of global dissemination of the consensus criteria. 3. Seeking adoption by the World Health Organization (WHO) and the International Classification of Diseases (ICD).

  • 34.
    Cerantola, Yannick
    et al.
    University Hospital of Lausanne, Lausanne, Switzerland.
    Valerio, Massimo
    University Hospital of Lausanne, Lausanne, Switzerland.
    Persson, Beata
    University Hospital of Örebro, Örebro, Sweden.
    Jichlinski, Patrice
    University Hospital of Lausanne, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital.
    Hubner, Martin
    University Hospital of Lausanne, Lausanne, Switzerland.
    Kassouf, Wassim
    McGill University, Montreal, Canada.
    Muller, Stig
    Akershus University Hospital, Oslo, Norway.
    Baldini, Gabriele
    McGill University, Montreal, Canada.
    Carli, Francesco
    McGill University, Montreal, Canada.
    Naesheimh, Torvind
    University Hospital of Northern Norway, Tromsø, Norway.
    Ytrebo, Lars
    University Hospital of Northern Norway, Tromsø, Norway.
    Revhaug, Arthur
    University Hospital of Northern Norway, Tromsø, Norway.
    Lassen, Kristoffer
    University Hospital of Northern Norway, Tromsø, Norway.
    Knutsen, Tore
    University Hospital of Northern Norway, Tromsø, Norway.
    Aarsether, Erling
    University Hospital of Northern Norway, Tromsø, Norway.
    Wiklund, Peter
    Karolinska University Hospital, Stockholm, Sweden.
    Patel, Hitendra R H
    University Hospital of Northern Norway, Tromsø, Norway.
    Guidelines for perioperative care after radical cystectomy for bladder cancer: enhanced Recovery After Surgery (ERAS(®)) society recommendations2013In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 32, no 6, p. 879-887Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery.

    OBJECTIVES: The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group.

    EVIDENCE ACQUISITION: A systematic literature review was performed on ERAS for cystectomy by searching EMBASE and Medline. Relevant articles were selected and quality-assessed by two independent reviewers using the GRADE approach. If no study specific to cystectomy was available for any of the 22 given items, the authors evaluated whether colorectal guidelines could be extrapolated.

    EVIDENCE SYNTHESIS: Overall, 804 articles were retrieved from electronic databases. Fifteen articles were included in the present systematic review and 7 of 22 ERAS items were studied. Bowel preparation did not improve outcomes. Early nasogastric tube removal reduced morbidity, bowel recovery time and length of hospital stay. Doppler-guided fluid administration allowed for reduced morbidity. A quicker bowel recovery was observed with a multimodal prevention of ileus, including gum chewing, prevention of PONV and minimally invasive surgery.

    CONCLUSIONS: ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable. The experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy.

  • 35. Copland, Lotta
    et al.
    Liedman, Bengt
    Rothenberg, Elisabet
    Sahlgrenska University Hospital, Gothenburg.
    Bosaeus, Ingvar
    Effects of nutritional support long time after total gastrectomy2007In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 26, no 5, p. 605-613Article in journal (Refereed)
    Abstract [en]

    Background & aims

    Long-term effects of total gastrectomy on nutritional status are not well known, neither is the role of nutritional support. Dietary counselling is usually individualized, but generally not well defined. We aimed to evaluate effects of individualized oral nutritional support long time after total gastrectomy.

    Methods

    Dietary advice was given, aiming for an energy and protein rich diet, using ordinary food and liquid supplements tailored to individual needs and preferences. Counselling was repeated monthly. Body weight and a 4-day food record were obtained at baseline, and thereafter—at month 1, 3, 6 and 12. Body composition, resting and total energy expenditure were measured at baseline and at 12 months.

    Results

    Thirteen of 15 included patients completed the study. Though a trend of weight gain was seen after 1 month, there was no significant weight change at 12 months as weight development was quite heterogeneous. Six patients who remained healthy during the study (all with BMI<25) gained weight (p<0.05), while five patients with intercurrent co-morbidity and two with initial BMI>25 lost weight or remained stable.

    Conclusions

    Nutritional intervention long time after total gastrectomy did not change body weight, body composition or energy metabolism. Intercurrent co-morbidity appeared to have a major impact on outcome, as the nutritional support was more effective in patients who remained healthy and had a BMI<25.

  • 36. Copland, Lotta
    et al.
    Liedman, Bengt
    Rothenberg, Elisabet
    Sahlgrenska University Hospital, Gothenburg.
    Ellegård, Lars
    Hustvedt, Bo-Egil
    Bosaeus, Ingvar
    Validity of the ActiReg system and a physical activity interview in assessing total energy expenditure in long-term survivors after total gastrectomy2008In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 27, no 6, p. 842-848Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Malnutrition is common after total gastrectomy. There is a need for clinically useful methods to assess energy requirements. We aimed to validate measurements of energy expenditure by an activity monitor (ActiReg) and a physical activity interview (HPAQ(modified)), in long-term survivors after gastrectomy for gastric carcinoma, using doubly labelled water as reference method.

    METHODS: Total energy expenditure (TEE) was estimated by DLW (14 days), ActiReg (3 days) and HPAQ(modified) (7 days) in 15 patients. Measurements were repeated after 12 months. Basal metabolic rate was measured with indirect calorimetry.

    RESULTS: ActiReg and HPAQ(modified) both underestimated TEE by 180 (+/-254 SD) and 130 (+/-326 SD)kcalday(-1), i.e. 14% vs. 12%, respectively. However, this was evident only at higher levels of physical activity (PAL(DLW)> or =1.65), whereas at lower levels (PAL<1.65) no difference was found. There were no changes in TEE over time independent of the method used. DLW and ActiReg had approximately the same width of the 95% confidence interval of this estimate, while it was 2.4 times larger by HPAQ(modified).

    CONCLUSION: Both simple methods underestimated total energy expenditure at higher, but not at lower physical activity levels. The ActiReg method appears useful to estimate changes in TEE over time.

  • 37. Deutz, M.E
    et al.
    Bauer, J.M
    Barazzoni, R
    Biolo, G
    Boirie, Y
    Bosy-Westphal, A
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cruz-Jentoft, A
    Krznariç, Z
    Nair, K.S
    Singer, P
    Teta, Daniel
    Tipton, K
    Calder, P.C
    Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 6, p. 929-936Article in journal (Refereed)
    Abstract [en]

    The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function.

    With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made (a) for healthy older people, the diet should provide at least 1.0–1.2 g protein/kg body weight/day, (b) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2–1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (c) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.

  • 38.
    Domellöf, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Szitanyi, P
    Simchowitz, V
    Franz, A
    Mimouni, F
    ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Iron and trace minerals2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2354-2359Article in journal (Refereed)
  • 39. Faxén-Irving, Gerd
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Energy dense oleic acid rich formula to newly admitted geriatric patients - Feasibility and effects on energy intake2011In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 30, no 2, p. 202-208Article in journal (Refereed)
    Abstract [en]

    Background & aims: Old patients seldom reach their energy requirements. The effects of an oleic acid rich formula on energy intake and appetite were studied.

    Methods: Recently admitted geriatric patients (n = 71), likely to stay > 1 week were randomised to receive 30 ml of a fat emulsion (Calogen (R)) 3 times daily, i.e., 420 kcal, at the regular medication rounds (intervention group (IG)) or to standard care (control group (CG)). Food intake and self-rated appetite were registered at baseline, i.e., 2-3 days after admission and on day 8 or the day prior to discharge. Nutritional risk screening (NRS) 2002, serum lipids and fatty acid profiles were analysed.

    Results: Fifty-one subjects fulfilled the study, i.e., 24 in the IG (83 +/- 7 y) and 27 controls (85 +/- 7 y). NRS showed that two thirds were at risk of malnutrition. Per-protocol analyses indicated that the daily energy intake was around 50% higher in IG compared to CG at the two measurements, respectively (p < 0.0001). The IG displayed a significantly improved appetite compared with the CG (P = 0.021). Serum lipids and fatty acid profile changed favourably by the intervention.

    Conclusions: An energy dense oleic acid rich liquid supplement given three times daily at medication rounds to geriatric patients may result in increased energy intake and better appetite with positive effects on serum lipids. ClinicalTrials.gov Identifier: NCT01042340.

  • 40.
    Fearon, K C H
    et al.
    Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK.
    Ljungqvist, Olle
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm; Karolinska Institutet, Centre for Surgical Sciences, Karolinska University Hospital, Huddinge, Stockholm.
    Von Meyenfeldt, M
    Department of Surgery, University Hospital Maastricht, The Netherlands.
    Revhaug, A
    Department of Surgery, Tromso University Hospital, Tromso, Norway.
    Dejong, C H C
    Department of Surgery, University Hospital Maastricht, The Netherlands.
    Lassen, K
    Department of Surgery, Tromso University Hospital, Tromso, Norway.
    Nygren, J
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm; Karolinska Institutet, Centre for Surgical Sciences, Karolinska University Hospital, Huddinge, Stockholm.
    Hausel, J
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm; Karolinska Institutet, Centre for Surgical Sciences, Karolinska University Hospital, Huddinge, Stockholm.
    Soop, M
    Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm; Karolinska Institutet, Centre for Surgical Sciences, Karolinska University Hospital, Huddinge, Stockholm.
    Andersen, J
    Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
    Kehlet, H
    Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark; fSection for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
    Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection2005In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 24, no 3, p. 466-77Article in journal (Refereed)
    Abstract [en]

    Background & aims: Clinical care of patients undergoing colonic surgery differs between hospitals and countries. In addition, there is considerable variation in rates of recovery and length of hospital stay following major abdominal surgery. There is a need to develop a consensus on key elements of perioperative care for inclusion in enhanced recovery programmes so that these can be widely adopted and refined further in future clinical trials.

    Methods: Medline database was searched for all clinical studies/trials relating to enhanced recovery after colorectal resection. Relevant papers from the reference lists of these articles and from the authors' personal collections were also reviewed. A combination of evidence-based and consensus methodology was used to develop the resulting enhanced recovery after surgery (ERAS) clinical care protocol.

    Results and conclusions: Within traditional perioperative practice there is considerable evidence supporting a range of manoeuvres which, in isolation, may improve individual aspects of recovery after colonic surgery. The present manuscript reviews these issues in detail. There is also growing evidence that an integrated multimodal approach to perioperative care can result in an overall enhancement of recovery. However, effects on major morbidity and mortality remain to be determined. A protocol is presented which is in current use by the ERAS Group and may provide a standard of care against which either current or future novel elements of an enhanced recovery approach can be tested for their effect on outcome.

  • 41.
    Gomes, Filomena
    et al.
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Schuetz, Philipp
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Bounoure, Lisa
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Austin, Peter
    Oxford Univ Hosp, Oxford, England.;Southampton Univ Hosp, Southampton, Hants, England..
    Ballesteros-Pomar, Maria
    Complejo Asistencial Univ Leon, Leon, Spain..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Fletcher, Jane
    Queen Elizabeth Hosp, Birmingham, W Midlands, England..
    Laviano, Alessandro
    Sapienza Univ Rome, Rome, Italy..
    Norman, Kristina
    Charite Univ Med Berlin, Berlin, Germany..
    Poulia, Kalliopi-Anna
    Laiko Gen Hosp Athens, Athens, Greece..
    Ravasco, Paula
    Univ Lisbon, Lisbon, Portugal..
    Schneider, Stephane M.
    Univ Nice Sophia Antipolis, Nice, France..
    Stanga, Zeno
    Univ Hosp Bern, Bern, Switzerland.;Univ Bern, Bern, Switzerland..
    Elizabeth Weekes, C.
    Guys & St Thomas NHS Fdn Trust, London, England.;Kings Coll London, London, England..
    Bischoff, Stephan C.
    Univ Hohenheim, Inst Nutr Med, Stuttgart, Germany..
    ESPEN guidelines on nutritional support for polymorbid internal medicine patients2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 336-353Article in journal (Refereed)
    Abstract [en]

    Background & aims: Polymorbidity (also known as multimorbidity)-defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards.

    Methods: The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds.

    Results: From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations.

    Conclusions: Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.

  • 42. Guest, Julian F.
    et al.
    Panca, Monica
    Baeyens, Jean-Pierre
    de Man, Frank
    Ljungqvist, Olle
    Örebro University, School of Health and Medical Sciences.
    Pichard, Claude
    Wait, Suzanne
    Wilson, Lisa
    Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK2011In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 30, no 4, p. 422-429Article in journal (Refereed)
    Abstract [en]

    Background & aims: To examine the effect of malnutrition on clinical outcomes and healthcare resource use from initial diagnosis by a general practitioner (GP) in the UK. Methods: 1000 records of malnourished patients were randomly selected from The Health Improvement Network database and matched with a sample of 996 patients' records with no previous history of malnutrition. Patients' outcomes and resource use were quantified for six months following diagnosis. Results: Malnourished patients utilised significantly more healthcare resources (e.g. 18.90 versus 9.12 GP consultations; p < 0.001, and 13% versus 5% were hospitalised; p < 0.05). The six-monthly cost of managing the malnourished and non-malnourished group was 1753 pound and 750 pound per patient respectively, generating an incremental cost of care following a diagnosis of malnutrition of 1003 per patient. Thirteen percent and 2% of patients died in the malnourished and non-malnourished group respectively (p < 0.001). Independent predictors of mortality were: malnutrition (OR: 7.70); age (per 10 years) (OR: 10.46); and the Charlson Comorbidity Index Score (per unit score) (OR: 1.24). Conclusion: The healthcare cost of managing malnourished patients was more than twice that of managing non-malnourished patients, due to increased use of healthcare resources. After adjusting for age and comorbidity, malnutrition remained an independent predictor of mortality. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  • 43.
    Gustafsson, U. O.
    et al.
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Scott, M. J.
    Department of Anaesthesia and Intensive Care Medicine, Royal Surrey County Hospital Foundation Trust, Guildford, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
    Schwenk, W.
    Department for General and Visceral Surgery, Center for Minimal invasive and Oncological Surgery, Asklepios Klinik Altona, Hamburg, Germany.
    Demartines, N.
    Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
    Roulin, D.
    Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
    Francis, N.
    South West Laparoscopic Colorectal Training, Yeovil District Hospital Foundation Trust, Yeovil, UK.
    McNaught, C. E.
    Department of Surgery, Scarborough Hospital, Scarborough, UK.
    MacFie, J.
    Department of Surgery, Scarborough Hospital, Scarborough, UK.
    Liberman, A. S.
    Department of Surgery, McGill University, Montreal QC, Canada.
    Soop, M.
    Department of Surgery, The University of Auckland, Auckland, New Zealand.
    Hill, A.
    South Auckland Clinical School, Department of Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand.
    Kennedy, R. H.
    St Mark’s Hospital, North West London Hospital NHS Trust, London, UK.
    Lobo, D. N.
    Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen’s Medical Centre, Nottingham, UK.
    Fearon, K.
    University of Edinburgh, Edinburgh, UK.
    Ljungqvist, Olle
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, University Hospital, Örebro, Sweden; Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations2012In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 31, no 6, p. 783-800Article in journal (Refereed)
    Abstract [en]

    Background: This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.

    Methods: Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.

    Results: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (quality of evidence and recommendations according to the GRADE system).

    Conclusions: Based on the evidence available for each item of the multimodal perioperative-care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery.

  • 44. Hamer, Henrike M.
    et al.
    Jonkers, Daisy M. A. E.
    Bast, Aalt
    Vanhoutvin, Steven A. L. W.
    Fischer, Marc A. J. G.
    Kodde, Andrea
    Troost, Freddy J.
    Venema, Koen
    Brummer, Robert
    Örebro University, School of Health and Medical Sciences.
    Butyrate modulates oxidative stress in the colonic mucosa of healthy humans2009In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 28, no 1, p. 88-93Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Butyrate, a short-chain fatty acid produced by colonic microbial fermentation of undigested carbohydrates, has been implicated in the maintenance of colonic health. This study evaluates whether butyrate plays a role in oxidative stress in the healthy colonic mucosa. METHODS: A randomized, double blind, cross-over study with 16 healthy volunteers was performed. Treatments consisted of daily rectal administration of a 60 ml enema containing 100 mM sodium butyrate or saline for 2 weeks. After each treatment, a blood sample was taken and mucosal biopsies were obtained from the sigmoid colon. In biopsies, the trolox equivalent antioxidant capacity, activity of glutathione-S-transferase, concentration of uric acid, glutathione (GSH), glutathione disulfide and malondialdehyde, and expression of genes involved in GSH and uric acid metabolism was determined. Secondary outcome parameters were CRP, calprotectin and intestinal fatty acid binding protein in plasma and histological inflammatory scores. RESULTS: Butyrate treatment resulted in significantly higher GSH (p<0.05) and lower uric acid (p<0.01) concentrations compared to placebo. Changes in GSH and uric acid were accompanied by increased and decreased expression, respectively, of their rate limiting enzymes determined by RT-PCR. No significant differences were found in other parameters. CONCLUSIONS: This study demonstrated that butyrate is able to beneficially affect oxidative stress in the healthy human colon.

  • 45.
    Hamer, Henrike M.
    et al.
    Dept Internal Med, Div Gastroenterol Hepatol, Med Ctr, Maastricht Univ, Maastricht, Netherlands; TI Food & Nutr, Wageningen, Netherlands.
    Jonkers, Daisy M. A. E.
    Dept Internal Med, Div Gastroenterol Hepatol, Med Ctr, Maastricht Univ, Maastricht, Netherlands; TI Food & Nutr, Wageningen, Netherlands.
    Vanhoutvin, Steven A. L. W.
    Dept Internal Med, Div Gastroenterol Hepatol, Med Ctr, Maastricht Univ, Maastricht, Netherlands; TI Food & Nutr, Wageningen, Netherlands.
    Troost, Freddy J.
    Dept Internal Med, Div Gastroenterol Hepatol, Med Ctr, Maastricht Univ, Maastricht, Netherlands; TI Food & Nutr, Wageningen, Netherlands.
    Rijkers, Ger
    St Antonius Hosp, Nieuwegein, Netherlands.
    de Bruine, Adriaan
    Dept Pathol, Med Ctr, Maastricht Univ, Maastricht, Netherlands.
    Bast, Aalt
    Dept Pharmacol & Toxicol, Med Ctr, Maastricht Univ, Maastricht, Netherlands.
    Venema, Koen
    TI Food & Nutr, Wageningen, Netherlands; Dept Biosci, TNO Qual Life, Zeist, Netherlands.
    Brummer, Robert
    Örebro University, School of Health and Medical Sciences. Dept Internal Med, Div Gastroenterol Hepatol, Med Ctr, Maastricht Univ, Maastricht, Netherlands; TI Food & Nutr, Wageningen, Netherlands.
    Effect of butyrate enemas on inflammation and antioxidant status in the colonic mucosa of patients with ulcerative colitis in remission2010In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 29, no 6, p. 738-744Article in journal (Refereed)
    Abstract [en]

    Background & Aims: Butyrate, produced by colonic fermentation of dietary fibers is often hypothesized to beneficially affect colonic health. This study aims to assess the effects of butyrate on inflammation and oxidative stress in subjects with chronically mildly elevated parameters of inflammation and oxidative stress.

    Methods: Thirty-five patients with ulcerative colitis in clinical remission daily administered 60 ml rectal enemas containing WO mM sodium butyrate (n = 17) or saline (n = 18) during 20 days (NCT00696098). Before and after the intervention feces, blood and colonic mucosal biopsies were obtained. Parameters of antioxidant defense and oxidative damage, myeloperoxidase, several cytokines, fecal calprotectin and CRP were determined.

    Results: Butyrate enemas induced minor effects on colonic inflammation and oxidative stress. Only a significant increase of the colonic IL-10/IL-12 ratio was found within butyrate-treated patients (p = 0.02), and colonic concentrations of CCL5 were increased after butyrate compared to placebo treatment (p = 0.03). Although in general butyrate did not affect colonic glutathione levels, the effects of butyrate enemas on total colonic glutathione appeared to be dependent on the level of inflammation.

    Conclusion: Although UC patients in remission were characterized by low-grade oxidative stress and inflammation, rectal butyrate enemas showed only minor effects on inflammatory and oxidative stress parameters.

  • 46. Hartman, Corina
    et al.
    Shamir, Raanan
    Simchowitz, Venetia
    Lohner, Szimonetta
    Cai, Wei
    Decsi, Tamas
    Braegger, Christian
    Bronsky, Jiri
    Wei, Cai
    Campoy, Cristina
    Carnielli, Virgilio
    Darmaun, Dominique
    Tamas, Decsi
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Embleton, Nicholas
    Fewtrell, Mary
    Fidler Mis, Natasa
    Franz, Axel
    Goulet, Olivier
    Hill, Susan
    Hojsak, Iva
    Iacobelli, Silvia
    Jochum, Frank
    Joosten, Koen
    Kolacek, Sanja
    Koletzko, Berthold
    Ksiazyk, Janusz
    Lapillonne, Alexandre
    Szimonetta, Lohner
    Mesotten, Dieter
    Krisztina, Mihalyi
    Mihatsch, Walter A.
    Mimouni, Francis
    Molgaard, Christian
    Moltu, Sissel J.
    Nomayo, Antonia
    Picaud, Jean Charles
    Prell, Christine
    Puntis, John
    Riskin, Arieh
    Saenz De Pipaon, Miguel
    Senterre, Thibault
    Szitanyi, Peter
    Tabbers, Merit M.
    Van Den Akker, Chris H. B.
    Van Goudoever, Johannes B.
    Van Kempen, Anne
    Verbruggen, Sascha
    Jiang, Wu
    Weihui, Yan
    ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2418-2429Article in journal (Refereed)
  • 47. Hausner, H.
    et al.
    Hartvig, D.L.
    Reinbach, H.C.
    Wendin, Karin
    SIK – Institutet för livsmedel och bioteknik.
    Bredie, W.L.P.
    Effects of repeated exposure on acceptance of initially disliked and liked Nordic snack bars in 9-11 year-old children2012In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 31, no 1, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Background & aims: Children's food choices are guided by their preferences. It is established, however, that repeated exposure to a novel food increases children's acceptance. This study investigated how acceptance of an initially liked and disliked snack bar develops in 9-11 year-old children. Methods: 315 children were randomised into three groups: A control group (n=111) and two groups exposed to an initially liked kamut bar (n=94) and an initially disliked sea buckthorn bar (n=110). Acceptance of both bars was tested before and after the exposure period, and on the 9th exposure. Results: Intake of both bars increased significantly in the exposure groups. There was no difference in the control groups' intake or liking of the bars between pre and post-testing. Liking rose significantly for children exposed to the disliked sea buckthorn bar, while this was not observed in children exposed to the liked kamut bar. In a post-test children exposed to kamut bars had higher intake of that bar than non-exposed children. This was also observed for the sea buckthorn bar that was also given significantly higher liking scores by the exposure group. Conclusions: The majority of children exposed to an initially disliked bar increase acceptance after nine exposures to the same level as an initially liked bar. Children repeatedly exposed to a liked bar show stable acceptance. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

  • 48. Hausner, Helene
    et al.
    Hartvig, Ditte L.
    Reinbach, Helene C.
    Wendin, Karin
    Department of Food Science, Faculty of Life Sciences, University of Copenhagen.
    Bredie, Wender L. P.
    Effects of repeated exposure on acceptance of initially disliked and liked Nordic snack bars in 9-11 year-old children2012In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 31, no 1, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Background & aims: Children's food choices are guided by their preferences. It is established, however, that repeated exposure to a novel food increases children's acceptance. This study investigated how acceptance of an initially liked and disliked snack bar develops in 9-11 year-old children. Methods: 315 children were randomised into three groups: A control group (n = 111) and two groups exposed to an initially liked kamut bar (n = 94) and an initially disliked sea buckthorn bar (n = 110). Acceptance of both bars was tested before and after the exposure period, and on the 9th exposure. Results: Intake of both bars increased significantly in the exposure groups. There was no difference in the control groups' intake or liking of the bars between pre and post-testing. Liking rose significantly for children exposed to the disliked sea buckthorn bar, while this was not observed in children exposed to the liked kamut bar. In a post-test children exposed to kamut bars had higher intake of that bar than non-exposed children. This was also observed for the sea buckthorn bar that was also given significantly higher liking scores by the exposure group. Conclusions: The majority of children exposed to an initially disliked bar increase acceptance after nine exposures to the same level as an initially liked bar. Children repeatedly exposed to a liked bar show stable acceptance.

  • 49.
    Hedman, Sanna
    et al.
    Department of Clinical Nutrition and dietetics, Karolinska University Hospital, Stockholm, Sweden.
    Nydahl, Margaretha
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Faxén-Irving, Gerd
    Division of Clinical Geriatrics, department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 3, p. 692-698Article in journal (Refereed)
    Abstract [en]

    Background & aims

    Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal.

    Methods

    This study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients.

    Results

    The prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff.

    Conclusion

    Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.

  • 50. Hiesmayr, M.
    et al.
    Schindler, K.
    Pernicka, E.
    Schuh, C.
    Schoeniger-Hekele, A.
    Bauer, P.
    Laviano, A.
    Lovell, A. D.
    Mouhieddine, M.
    Schuetz, T.
    Schneider, S. M.
    Singer, P.
    Pichard, C.
    Howard, P.
    Jonkers, C.
    Grecu, I.
    Ljungqvist, Olle
    Örebro University, School of Health and Medical Sciences.
    Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 20062009In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 28, no 5, p. 484-491Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Malnutrition is a known risk factor for the development of complications in hospitalised patients. We determined whether eating only fractions of the meals served is an independent risk factor for mortality. METHODS: The NutritionDay is a multinational one-day cross-sectional survey of nutritional factors and food intake in 16,290 adult hospitalised patients on January 19th 2006. The effect of food intake and nutritional factors on death in hospital within 30 days was assessed in a competing risk analysis. RESULTS: More than half of the patients did not eat their full meal provided by the hospital. Decreased food intake on NutritionDay or during the previous week was associated with an increased risk of dying, even after adjustment for various patient and disease related factors. Adjusted hazard ratio for dying when eating about a quarter of the meal on NutritionDay was 2.10 (1.53-2.89); when eating nothing 3.02 (2.11-4.32). More than half of the patients who ate less than a quarter of their meal did not receive artificial nutrition support. Only 25% patients eating nothing at lunch receive artificial nutrition support. CONCLUSION: Many hospitalised patients in European hospitals eat less food than provided as regular meal. This decreased food intake represents an independent risk factor for hospital mortality.

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