SAMENVATTING
Evidence Based Dietetiek 1
ADHV DE LESSEN VAN MORGAN LANSSENS
1
,Inhoudsopgave
Introductie _____________________________________________________________________ 9
1 Evidence Based Practice (EBP)______________________________________________________________ 9
2 Behandelplan _____________________________________________________________________________ 9
3 Medicatie ________________________________________________________________________________ 10
4 Algemene begrippen ______________________________________________________________________ 10
4.1 Voedingsleer vs dieetleer _____________________________________________________________ 10
4.2 Therapeutisch dieet __________________________________________________________________ 10
4.3 Nutrition Care Process (NCP) __________________________________________________________ 11
4.4 Diëtistisch consult ___________________________________________________________________ 12
4.4.1 4 fasen __________________________________________________________________________ 12
4.4.2 Diëtistische diagnose ____________________________________________________________ 12
4.4.3 Dieetbehandeling ________________________________________________________________ 13
5 ICF-schema ______________________________________________________________________________ 14
Overgewicht & Obesitas _______________________________________________________ 15
1 Nutritional assessment____________________________________________________________________ 15
2 Voedingsanamnese _______________________________________________________________________ 16
2.1 Relatie tot voeding ____________________________________________________________________ 17
2.2 Type eters ___________________________________________________________________________ 18
2.3 Lichaamssamenstelling _______________________________________________________________ 19
2.3.1 Indeling op basis van Body Mass index _____________________________________________ 20
2.3.2 Indeling op basis van referentiegewichtsindex ______________________________________ 21
2.3.3 Indeling op basis van lichaamsbouw _______________________________________________ 21
2.4 Antropometrie _______________________________________________________________________ 21
2.4.1 Huidplooimetingen ______________________________________________________________ 22
2.4.2 Vetpercentage ___________________________________________________________________ 23
2.4.3 Lichaamsomtrekken _____________________________________________________________ 23
2.4.4 Botbreedtes _____________________________________________________________________ 23
3 Diëtetische diagnose miv risico-analyse ____________________________________________________ 23
3.1 Diagnose obesitas -BMI _______________________________________________________________ 23
3.1.1 Preclinical obesity _______________________________________________________________ 23
3.1.2 Clinical obesity __________________________________________________________________ 24
3.1.3 Waist to heigt ratio (WtHR) ________________________________________________________ 24
3.1.4 Stadiëring volgens EOSS __________________________________________________________ 24
3.2 Risicofactoren van overgewicht en obesitas ____________________________________________ 26
3.3 Comorbiditeiten en complicaties ______________________________________________________ 27
3.4 Binge Eating Disorder (BED) ___________________________________________________________ 27
4 Nutritional support ________________________________________________________________________ 28
4.1 Behandeldoel(en) ____________________________________________________________________ 28
4.1.1 Voedingsinterventie ______________________________________________________________ 29
4.1.2 Gewichtsreductie ________________________________________________________________ 29
4.2 Behandelplan volwassenen ___________________________________________________________ 29
4.2.1 Minder eten _____________________________________________________________________ 29
4.2.2 Eiwitten, vetten en koolhydraten___________________________________________________ 31
2
, 4.2.3 Meer bewegen ___________________________________________________________________ 32
4.2.4 Stress ___________________________________________________________________________ 32
4.2.5 Slaap ___________________________________________________________________________ 32
4.3 Farmacotherpatie ____________________________________________________________________ 34
4.3.1 Verminderde vetopname _________________________________________________________ 35
4.3.2 Verhogen vetverbranding _________________________________________________________ 35
4.3.3 Verminderde koolhydraatopname _________________________________________________ 35
4.3.4 Hogere verzadiging _______________________________________________________________ 36
4.3.5 Hoger verbruik ___________________________________________________________________ 36
4.3.6 Hogere detoxificatie ______________________________________________________________ 37
4.4 Aanpak verschillende eet-types _______________________________________________________ 37
4.5 Behandelplan kinderen _______________________________________________________________ 38
Leerpad: Metabole chirurgie ___________________________________________________ 41
1 Introductie _______________________________________________________________________________ 41
2 Enkele weetjes ___________________________________________________________________________ 41
3 First thing to do ___________________________________________________________________________ 41
3.1.1 Verwachte uitkomsten ___________________________________________________________ 41
3.1.2 Mogelijke bijwerkingen ___________________________________________________________ 41
3.1.3 Herhaling spijsvertering __________________________________________________________ 42
4 Indicaties ________________________________________________________________________________ 42
5 Ingrepen _________________________________________________________________________________ 42
5.1 Maagverkleining ______________________________________________________________________ 43
5.1.1 Zonder wijziging in anatomische structuur (reversibel) ______________________________ 43
5.1.2 Met wijziging van de anatomische structuur (irreversibel) ____________________________ 44
5.2 Maagverkleining en bypass ____________________________________________________________ 44
5.2.1 Met wijziging anatomische structuur (reversibel, maar niet de bedoeling) _____________ 44
6 Klachten en complicaties__________________________________________________________________ 45
6.1 Syndroom kleine maag________________________________________________________________ 45
6.2 Dumpingsyndroom ___________________________________________________________________ 45
6.3 Phytobezoar _________________________________________________________________________ 46
6.4 Puntdepleties ________________________________________________________________________ 47
7 Gewichtsverlies __________________________________________________________________________ 47
8 Voedingsadviezen_________________________________________________________________________ 48
8.1 Preoperatief _________________________________________________________________________ 48
8.2 Maaltijdvervangers ___________________________________________________________________ 48
8.3 Maaginhoud na operatie ______________________________________________________________ 49
8.4 Algemene richtlijnen opbouwen voeding _______________________________________________ 49
8.4.1 Direct postoperatieve fase ________________________________________________________ 49
8.4.2 Latere postoperatieve fase ________________________________________________________ 50
9 Oefeningen_______________________________________________________________________________ 51
Gastdocent: Volwaardige vervangmaaltijden ___________________________________ 53
1 Wat zijn vervangmaaltijden? _______________________________________________________________ 53
2 Wetgeving ________________________________________________________________________________ 54
3
, 2.1 Type 1: een dagelijkse voeding volledig vervangend product voor gewichtsbeheersing ______ 54
2.2 Type 2: een maaltijdvervangend product voor gewichtsbeheersing ________________________ 55
2.2.1 2 officiële claims: verordening 2016/1423 __________________________________________ 55
3 Energie __________________________________________________________________________________ 55
3.1 LCD = Low Calorie Diet _______________________________________________________________ 55
3.2 VLCD = Very Low Calorie Diet__________________________________________________________ 55
4 Voor wie en waarom? _____________________________________________________________________ 56
5 Effecten__________________________________________________________________________________ 57
5.1 Bloedsuikerspiegel ___________________________________________________________________ 57
5.2 Gewichtsverlies ______________________________________________________________________ 57
5.3 Gezondheidswinst____________________________________________________________________ 57
5.4 Uiteindelijke doel _____________________________________________________________________ 57
Eetstoornissen ________________________________________________________________ 58
1 Diagnose _________________________________________________________________________________ 58
1.1 Anorexia Nervosa_____________________________________________________________________ 59
1.2 Boulimia Nervosa ____________________________________________________________________ 59
1.3 Binge Eating Disorder _________________________________________________________________ 59
1.4 ARFID = Avoidant/Restrictive Food Intake Disorder ______________________________________ 60
2 Prevalentie – Incidentie ____________________________________________________________________ 60
3 Ontstaan _________________________________________________________________________________ 61
3.1 Risicofactoren vs beschermende factoren ______________________________________________ 62
3.1.1 Emotieregulatie __________________________________________________________________ 62
3.1.2 Lichaamsbeeld __________________________________________________________________ 63
3.1.3 Sociale media ___________________________________________________________________ 63
3.1.4 Innerlijke criticus ________________________________________________________________ 63
4 Signalen herkennen _______________________________________________________________________ 64
Cardiovasculair stelsel ________________________________________________________ 65
Leerpad: Hypertensie _________________________________________________________ 66
1 Diagnose _________________________________________________________________________________ 67
2 Behandeling ______________________________________________________________________________ 68
3 Minimale doelstelling behandeling _________________________________________________________ 68
4 Non-farmacologische aanbevelingen _______________________________________________________ 68
4.1 Gewichtsverlies ______________________________________________________________________ 69
4.2 Fysieke activiteit _____________________________________________________________________ 69
4.3 DASH/mediterraan dieet ______________________________________________________________ 70
4.3.1 DASH-eating plan ________________________________________________________________ 71
4.4 Natrium (-) ___________________________________________________________________________ 72
4.4.1 Herkomst natiruminname ________________________________________________________ 73
4.4.2 Natriumbeperking________________________________________________________________ 73
4.5 Kalium ______________________________________________________________________________ 75
4.6 Alcohol ______________________________________________________________________________ 76
4
Evidence Based Dietetiek 1
ADHV DE LESSEN VAN MORGAN LANSSENS
1
,Inhoudsopgave
Introductie _____________________________________________________________________ 9
1 Evidence Based Practice (EBP)______________________________________________________________ 9
2 Behandelplan _____________________________________________________________________________ 9
3 Medicatie ________________________________________________________________________________ 10
4 Algemene begrippen ______________________________________________________________________ 10
4.1 Voedingsleer vs dieetleer _____________________________________________________________ 10
4.2 Therapeutisch dieet __________________________________________________________________ 10
4.3 Nutrition Care Process (NCP) __________________________________________________________ 11
4.4 Diëtistisch consult ___________________________________________________________________ 12
4.4.1 4 fasen __________________________________________________________________________ 12
4.4.2 Diëtistische diagnose ____________________________________________________________ 12
4.4.3 Dieetbehandeling ________________________________________________________________ 13
5 ICF-schema ______________________________________________________________________________ 14
Overgewicht & Obesitas _______________________________________________________ 15
1 Nutritional assessment____________________________________________________________________ 15
2 Voedingsanamnese _______________________________________________________________________ 16
2.1 Relatie tot voeding ____________________________________________________________________ 17
2.2 Type eters ___________________________________________________________________________ 18
2.3 Lichaamssamenstelling _______________________________________________________________ 19
2.3.1 Indeling op basis van Body Mass index _____________________________________________ 20
2.3.2 Indeling op basis van referentiegewichtsindex ______________________________________ 21
2.3.3 Indeling op basis van lichaamsbouw _______________________________________________ 21
2.4 Antropometrie _______________________________________________________________________ 21
2.4.1 Huidplooimetingen ______________________________________________________________ 22
2.4.2 Vetpercentage ___________________________________________________________________ 23
2.4.3 Lichaamsomtrekken _____________________________________________________________ 23
2.4.4 Botbreedtes _____________________________________________________________________ 23
3 Diëtetische diagnose miv risico-analyse ____________________________________________________ 23
3.1 Diagnose obesitas -BMI _______________________________________________________________ 23
3.1.1 Preclinical obesity _______________________________________________________________ 23
3.1.2 Clinical obesity __________________________________________________________________ 24
3.1.3 Waist to heigt ratio (WtHR) ________________________________________________________ 24
3.1.4 Stadiëring volgens EOSS __________________________________________________________ 24
3.2 Risicofactoren van overgewicht en obesitas ____________________________________________ 26
3.3 Comorbiditeiten en complicaties ______________________________________________________ 27
3.4 Binge Eating Disorder (BED) ___________________________________________________________ 27
4 Nutritional support ________________________________________________________________________ 28
4.1 Behandeldoel(en) ____________________________________________________________________ 28
4.1.1 Voedingsinterventie ______________________________________________________________ 29
4.1.2 Gewichtsreductie ________________________________________________________________ 29
4.2 Behandelplan volwassenen ___________________________________________________________ 29
4.2.1 Minder eten _____________________________________________________________________ 29
4.2.2 Eiwitten, vetten en koolhydraten___________________________________________________ 31
2
, 4.2.3 Meer bewegen ___________________________________________________________________ 32
4.2.4 Stress ___________________________________________________________________________ 32
4.2.5 Slaap ___________________________________________________________________________ 32
4.3 Farmacotherpatie ____________________________________________________________________ 34
4.3.1 Verminderde vetopname _________________________________________________________ 35
4.3.2 Verhogen vetverbranding _________________________________________________________ 35
4.3.3 Verminderde koolhydraatopname _________________________________________________ 35
4.3.4 Hogere verzadiging _______________________________________________________________ 36
4.3.5 Hoger verbruik ___________________________________________________________________ 36
4.3.6 Hogere detoxificatie ______________________________________________________________ 37
4.4 Aanpak verschillende eet-types _______________________________________________________ 37
4.5 Behandelplan kinderen _______________________________________________________________ 38
Leerpad: Metabole chirurgie ___________________________________________________ 41
1 Introductie _______________________________________________________________________________ 41
2 Enkele weetjes ___________________________________________________________________________ 41
3 First thing to do ___________________________________________________________________________ 41
3.1.1 Verwachte uitkomsten ___________________________________________________________ 41
3.1.2 Mogelijke bijwerkingen ___________________________________________________________ 41
3.1.3 Herhaling spijsvertering __________________________________________________________ 42
4 Indicaties ________________________________________________________________________________ 42
5 Ingrepen _________________________________________________________________________________ 42
5.1 Maagverkleining ______________________________________________________________________ 43
5.1.1 Zonder wijziging in anatomische structuur (reversibel) ______________________________ 43
5.1.2 Met wijziging van de anatomische structuur (irreversibel) ____________________________ 44
5.2 Maagverkleining en bypass ____________________________________________________________ 44
5.2.1 Met wijziging anatomische structuur (reversibel, maar niet de bedoeling) _____________ 44
6 Klachten en complicaties__________________________________________________________________ 45
6.1 Syndroom kleine maag________________________________________________________________ 45
6.2 Dumpingsyndroom ___________________________________________________________________ 45
6.3 Phytobezoar _________________________________________________________________________ 46
6.4 Puntdepleties ________________________________________________________________________ 47
7 Gewichtsverlies __________________________________________________________________________ 47
8 Voedingsadviezen_________________________________________________________________________ 48
8.1 Preoperatief _________________________________________________________________________ 48
8.2 Maaltijdvervangers ___________________________________________________________________ 48
8.3 Maaginhoud na operatie ______________________________________________________________ 49
8.4 Algemene richtlijnen opbouwen voeding _______________________________________________ 49
8.4.1 Direct postoperatieve fase ________________________________________________________ 49
8.4.2 Latere postoperatieve fase ________________________________________________________ 50
9 Oefeningen_______________________________________________________________________________ 51
Gastdocent: Volwaardige vervangmaaltijden ___________________________________ 53
1 Wat zijn vervangmaaltijden? _______________________________________________________________ 53
2 Wetgeving ________________________________________________________________________________ 54
3
, 2.1 Type 1: een dagelijkse voeding volledig vervangend product voor gewichtsbeheersing ______ 54
2.2 Type 2: een maaltijdvervangend product voor gewichtsbeheersing ________________________ 55
2.2.1 2 officiële claims: verordening 2016/1423 __________________________________________ 55
3 Energie __________________________________________________________________________________ 55
3.1 LCD = Low Calorie Diet _______________________________________________________________ 55
3.2 VLCD = Very Low Calorie Diet__________________________________________________________ 55
4 Voor wie en waarom? _____________________________________________________________________ 56
5 Effecten__________________________________________________________________________________ 57
5.1 Bloedsuikerspiegel ___________________________________________________________________ 57
5.2 Gewichtsverlies ______________________________________________________________________ 57
5.3 Gezondheidswinst____________________________________________________________________ 57
5.4 Uiteindelijke doel _____________________________________________________________________ 57
Eetstoornissen ________________________________________________________________ 58
1 Diagnose _________________________________________________________________________________ 58
1.1 Anorexia Nervosa_____________________________________________________________________ 59
1.2 Boulimia Nervosa ____________________________________________________________________ 59
1.3 Binge Eating Disorder _________________________________________________________________ 59
1.4 ARFID = Avoidant/Restrictive Food Intake Disorder ______________________________________ 60
2 Prevalentie – Incidentie ____________________________________________________________________ 60
3 Ontstaan _________________________________________________________________________________ 61
3.1 Risicofactoren vs beschermende factoren ______________________________________________ 62
3.1.1 Emotieregulatie __________________________________________________________________ 62
3.1.2 Lichaamsbeeld __________________________________________________________________ 63
3.1.3 Sociale media ___________________________________________________________________ 63
3.1.4 Innerlijke criticus ________________________________________________________________ 63
4 Signalen herkennen _______________________________________________________________________ 64
Cardiovasculair stelsel ________________________________________________________ 65
Leerpad: Hypertensie _________________________________________________________ 66
1 Diagnose _________________________________________________________________________________ 67
2 Behandeling ______________________________________________________________________________ 68
3 Minimale doelstelling behandeling _________________________________________________________ 68
4 Non-farmacologische aanbevelingen _______________________________________________________ 68
4.1 Gewichtsverlies ______________________________________________________________________ 69
4.2 Fysieke activiteit _____________________________________________________________________ 69
4.3 DASH/mediterraan dieet ______________________________________________________________ 70
4.3.1 DASH-eating plan ________________________________________________________________ 71
4.4 Natrium (-) ___________________________________________________________________________ 72
4.4.1 Herkomst natiruminname ________________________________________________________ 73
4.4.2 Natriumbeperking________________________________________________________________ 73
4.5 Kalium ______________________________________________________________________________ 75
4.6 Alcohol ______________________________________________________________________________ 76
4
