SAMENVATTING
Evidence Based Dietetiek 1
ADHV DE LESSEN VAN MORGAN LANSSENS
1
,Introductie..................................................................................................... 7
1 Evidence Based Practice (EBP).....................................................................................7
2 Behandelplan............................................................................................................... 7
3 Medicatie...................................................................................................................... 8
4 Algemene begrippen.................................................................................................... 8
4.1 Therapeutisch dieet................................................................................................9
4.2 Nutrition Care Process (NCP)................................................................................10
4.3 Diëtetisch consult................................................................................................. 10
4.4 ICF-schema........................................................................................................... 11
Overgewicht en Obesitas..............................................................................13
1 Soorten eters?............................................................................................................ 14
1.1 Lijngerichte eter................................................................................................... 14
1.2 Externe eter.......................................................................................................... 14
1.3 Emo-eter............................................................................................................... 14
1.4 Emo-diëter............................................................................................................ 15
2 Lichaamssamenstelling..............................................................................................15
2.1 Body Mass Index................................................................................................... 16
2.2 Referentiegewichtsindex.......................................................................................16
2.3 Huidplooimetingen............................................................................................... 16
2.4 Vetpercentage...................................................................................................... 16
2.5 Lichaamsomtrekken.............................................................................................. 17
2.6 Waist to Heigt Ratio.............................................................................................. 17
3 Dietetische Diagnose.................................................................................................. 17
3.1 EOSS = Edmonton Obesity Staging System..........................................................18
3.2 Risicofactoren OG/OB........................................................................................... 18
3.3 Comorbiditeiten en complicaties..........................................................................19
3.4 BED = Binge Eating Disorder................................................................................20
4 Nutritional support..................................................................................................... 21
4.1 Behandeldoel(en)................................................................................................. 21
4.2 Behandelplan (volwassenen)................................................................................21
4.3 Bewegingsdriehoek.............................................................................................. 23
4.4 Stress................................................................................................................... 24
4.5 Slaap.................................................................................................................... 25
5 Behandelplan bij kinderen..........................................................................................26
5.1 A.L.L.E.S................................................................................................................ 26
5.2 Per leeftijdsfase.................................................................................................... 26
6 Farmacotherapie........................................................................................................ 27
6.1 Verminderde vetopname......................................................................................27
6.2 Verhoogde vetverbranding...................................................................................28
6.3 Verminderde koolhydraatopname.........................................................................28
6.4 Verhoogde verzadiging......................................................................................... 29
6.5 Hoger verbruik...................................................................................................... 30
6.6 Hogere detoxificatie.............................................................................................. 30
Metabole chirurgie.......................................................................................31
2
, 1 Indicaties.................................................................................................................... 31
2 Resultaten.................................................................................................................. 32
2.1 Verwachte uitkomsten.......................................................................................... 32
2.2 Mogelijke bijwerkingen......................................................................................... 32
3 Ingrepen..................................................................................................................... 32
3.1 Maagverkleining zonder wijziging in anatomische structuur (reversibel)..............34
3.2 Maagverkleining met wijziging van de anatomische structuur (irreversibel)........34
3.3 Bypass.................................................................................................................. 35
4 Klachten en complicaties............................................................................................ 36
4.1 Syndroom kleine maag......................................................................................... 36
4.2 Dumpingsyndroom............................................................................................... 36
4.3 Phytobezoar.......................................................................................................... 37
4.4 Puntdepleties........................................................................................................ 37
5 Gewichtsverlies.......................................................................................................... 38
6 Voedingsadviezen....................................................................................................... 39
6.1 Preoperatief.......................................................................................................... 39
6.2 Maaltijdvervangers............................................................................................... 39
6.3 Maaginhoud na operatie.......................................................................................39
6.4 Algemene richtlijnen opbouwen voeding..............................................................40
7 Oefeningen................................................................................................................. 43
Volwaardige vervangmaaltijden....................................................................45
1 Voor wie en waarom?................................................................................................. 45
2 Wetgeving.................................................................................................................. 45
2.1 TYPE 1: een dagelijkse voeding volledig vervangend product voor
gewichtsbeheersing.................................................................................................... 46
2.2 TYPE 2: een maaltijd vervangend product voor gewichtsbeheersing....................46
2.3 Officiële claims: verordening 2016/1423..............................................................46
3 Energie....................................................................................................................... 47
3.1 LCD = Low Calorie Diet......................................................................................... 47
3.2 VLCD = Very Low Calorie Diet...............................................................................47
4 Effecten...................................................................................................................... 47
4.1 Bloedsuikerspiegel................................................................................................ 47
4.2 Gewichtsverlies.................................................................................................... 47
4.3 Gezondheidswinst................................................................................................. 47
4.4 Nadelen................................................................................................................ 48
Eetstoornissen............................................................................................. 49
Cardiovasculair stelsel..................................................................................50
Hypertensie................................................................................................. 52
1 Diagnose.................................................................................................................... 52
2 Behandeling............................................................................................................... 52
3 Minimale doelstelling.................................................................................................. 53
4 Non-farmacologische aanbevelingen..........................................................................53
3
, 4.1 Rookstop............................................................................................................... 53
4.2 Gewichtsverlies.................................................................................................... 53
4.3 Fysieke activiteit................................................................................................... 54
4.4 DASH en mediterraan dieet..................................................................................54
4.5 Natrium -.............................................................................................................. 56
4.6 Kalium-suppletie................................................................................................... 57
4.7 Alcohol.................................................................................................................. 57
4.8 Stressreductie....................................................................................................... 58
5 Andere vs ikv hypertensie.......................................................................................... 58
5.1 VV, Visolie, ALA+.................................................................................................. 58
5.2 Calcium................................................................................................................. 59
5.3 Magnesium........................................................................................................... 59
5.4 Jodium.................................................................................................................. 59
5.5 Vitamine D............................................................................................................ 60
5.6 Cafeïne................................................................................................................. 60
5.7 Bioflavonoïden...................................................................................................... 60
5.8 Glycrrhizinezuur.................................................................................................... 61
5.9 CoQ10+................................................................................................................ 61
Atherosclerose............................................................................................. 62
1 Risicoprofiel................................................................................................................ 62
1.1 Beïnvloedbare factoren......................................................................................... 62
1.2 Parameters........................................................................................................... 63
1.3 Hypertriglyceridemie............................................................................................ 63
2 Risicoanalyse via SCORE-tabel...................................................................................63
3 Interventies................................................................................................................ 65
4 Praktische uitwerking.................................................................................................66
4.1 Aanbevelingen totale vetinname..........................................................................66
4.2 Aanbevelingen verzadigde vetzuren.....................................................................66
4.3 Aanbeveling onverzadigde vetzuren.....................................................................67
4.4 Aanbevelingen transvetzuren...............................................................................68
4.5 Aanbevelingen cholesterol en fytosterolen...........................................................69
4.6 Andere nutriënten................................................................................................. 69
4.7 Rol van nutriceuticals........................................................................................... 70
Metabool syndroom......................................................................................71
1 Criteria....................................................................................................................... 71
2 Prevalentie................................................................................................................. 71
3 Gevolgen.................................................................................................................... 71
4 Mechanisme............................................................................................................... 72
4.1 Ontsteking............................................................................................................ 72
4.2 Insulineresistentie................................................................................................. 72
4.3 Verstoorde endotheel functie................................................................................74
4.4 (oxidatieve) Stress................................................................................................ 75
5 Behandeling............................................................................................................... 75
Diabetes...................................................................................................... 77
4
Evidence Based Dietetiek 1
ADHV DE LESSEN VAN MORGAN LANSSENS
1
,Introductie..................................................................................................... 7
1 Evidence Based Practice (EBP).....................................................................................7
2 Behandelplan............................................................................................................... 7
3 Medicatie...................................................................................................................... 8
4 Algemene begrippen.................................................................................................... 8
4.1 Therapeutisch dieet................................................................................................9
4.2 Nutrition Care Process (NCP)................................................................................10
4.3 Diëtetisch consult................................................................................................. 10
4.4 ICF-schema........................................................................................................... 11
Overgewicht en Obesitas..............................................................................13
1 Soorten eters?............................................................................................................ 14
1.1 Lijngerichte eter................................................................................................... 14
1.2 Externe eter.......................................................................................................... 14
1.3 Emo-eter............................................................................................................... 14
1.4 Emo-diëter............................................................................................................ 15
2 Lichaamssamenstelling..............................................................................................15
2.1 Body Mass Index................................................................................................... 16
2.2 Referentiegewichtsindex.......................................................................................16
2.3 Huidplooimetingen............................................................................................... 16
2.4 Vetpercentage...................................................................................................... 16
2.5 Lichaamsomtrekken.............................................................................................. 17
2.6 Waist to Heigt Ratio.............................................................................................. 17
3 Dietetische Diagnose.................................................................................................. 17
3.1 EOSS = Edmonton Obesity Staging System..........................................................18
3.2 Risicofactoren OG/OB........................................................................................... 18
3.3 Comorbiditeiten en complicaties..........................................................................19
3.4 BED = Binge Eating Disorder................................................................................20
4 Nutritional support..................................................................................................... 21
4.1 Behandeldoel(en)................................................................................................. 21
4.2 Behandelplan (volwassenen)................................................................................21
4.3 Bewegingsdriehoek.............................................................................................. 23
4.4 Stress................................................................................................................... 24
4.5 Slaap.................................................................................................................... 25
5 Behandelplan bij kinderen..........................................................................................26
5.1 A.L.L.E.S................................................................................................................ 26
5.2 Per leeftijdsfase.................................................................................................... 26
6 Farmacotherapie........................................................................................................ 27
6.1 Verminderde vetopname......................................................................................27
6.2 Verhoogde vetverbranding...................................................................................28
6.3 Verminderde koolhydraatopname.........................................................................28
6.4 Verhoogde verzadiging......................................................................................... 29
6.5 Hoger verbruik...................................................................................................... 30
6.6 Hogere detoxificatie.............................................................................................. 30
Metabole chirurgie.......................................................................................31
2
, 1 Indicaties.................................................................................................................... 31
2 Resultaten.................................................................................................................. 32
2.1 Verwachte uitkomsten.......................................................................................... 32
2.2 Mogelijke bijwerkingen......................................................................................... 32
3 Ingrepen..................................................................................................................... 32
3.1 Maagverkleining zonder wijziging in anatomische structuur (reversibel)..............34
3.2 Maagverkleining met wijziging van de anatomische structuur (irreversibel)........34
3.3 Bypass.................................................................................................................. 35
4 Klachten en complicaties............................................................................................ 36
4.1 Syndroom kleine maag......................................................................................... 36
4.2 Dumpingsyndroom............................................................................................... 36
4.3 Phytobezoar.......................................................................................................... 37
4.4 Puntdepleties........................................................................................................ 37
5 Gewichtsverlies.......................................................................................................... 38
6 Voedingsadviezen....................................................................................................... 39
6.1 Preoperatief.......................................................................................................... 39
6.2 Maaltijdvervangers............................................................................................... 39
6.3 Maaginhoud na operatie.......................................................................................39
6.4 Algemene richtlijnen opbouwen voeding..............................................................40
7 Oefeningen................................................................................................................. 43
Volwaardige vervangmaaltijden....................................................................45
1 Voor wie en waarom?................................................................................................. 45
2 Wetgeving.................................................................................................................. 45
2.1 TYPE 1: een dagelijkse voeding volledig vervangend product voor
gewichtsbeheersing.................................................................................................... 46
2.2 TYPE 2: een maaltijd vervangend product voor gewichtsbeheersing....................46
2.3 Officiële claims: verordening 2016/1423..............................................................46
3 Energie....................................................................................................................... 47
3.1 LCD = Low Calorie Diet......................................................................................... 47
3.2 VLCD = Very Low Calorie Diet...............................................................................47
4 Effecten...................................................................................................................... 47
4.1 Bloedsuikerspiegel................................................................................................ 47
4.2 Gewichtsverlies.................................................................................................... 47
4.3 Gezondheidswinst................................................................................................. 47
4.4 Nadelen................................................................................................................ 48
Eetstoornissen............................................................................................. 49
Cardiovasculair stelsel..................................................................................50
Hypertensie................................................................................................. 52
1 Diagnose.................................................................................................................... 52
2 Behandeling............................................................................................................... 52
3 Minimale doelstelling.................................................................................................. 53
4 Non-farmacologische aanbevelingen..........................................................................53
3
, 4.1 Rookstop............................................................................................................... 53
4.2 Gewichtsverlies.................................................................................................... 53
4.3 Fysieke activiteit................................................................................................... 54
4.4 DASH en mediterraan dieet..................................................................................54
4.5 Natrium -.............................................................................................................. 56
4.6 Kalium-suppletie................................................................................................... 57
4.7 Alcohol.................................................................................................................. 57
4.8 Stressreductie....................................................................................................... 58
5 Andere vs ikv hypertensie.......................................................................................... 58
5.1 VV, Visolie, ALA+.................................................................................................. 58
5.2 Calcium................................................................................................................. 59
5.3 Magnesium........................................................................................................... 59
5.4 Jodium.................................................................................................................. 59
5.5 Vitamine D............................................................................................................ 60
5.6 Cafeïne................................................................................................................. 60
5.7 Bioflavonoïden...................................................................................................... 60
5.8 Glycrrhizinezuur.................................................................................................... 61
5.9 CoQ10+................................................................................................................ 61
Atherosclerose............................................................................................. 62
1 Risicoprofiel................................................................................................................ 62
1.1 Beïnvloedbare factoren......................................................................................... 62
1.2 Parameters........................................................................................................... 63
1.3 Hypertriglyceridemie............................................................................................ 63
2 Risicoanalyse via SCORE-tabel...................................................................................63
3 Interventies................................................................................................................ 65
4 Praktische uitwerking.................................................................................................66
4.1 Aanbevelingen totale vetinname..........................................................................66
4.2 Aanbevelingen verzadigde vetzuren.....................................................................66
4.3 Aanbeveling onverzadigde vetzuren.....................................................................67
4.4 Aanbevelingen transvetzuren...............................................................................68
4.5 Aanbevelingen cholesterol en fytosterolen...........................................................69
4.6 Andere nutriënten................................................................................................. 69
4.7 Rol van nutriceuticals........................................................................................... 70
Metabool syndroom......................................................................................71
1 Criteria....................................................................................................................... 71
2 Prevalentie................................................................................................................. 71
3 Gevolgen.................................................................................................................... 71
4 Mechanisme............................................................................................................... 72
4.1 Ontsteking............................................................................................................ 72
4.2 Insulineresistentie................................................................................................. 72
4.3 Verstoorde endotheel functie................................................................................74
4.4 (oxidatieve) Stress................................................................................................ 75
5 Behandeling............................................................................................................... 75
Diabetes...................................................................................................... 77
4
