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Wat is de optimale methode om de eiwitbehoefte van volwassen patiënten te berekenen?

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Wat is de optimale methode om de eiwitbehoefte van volwassen patiënten te berekenen?

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Background: Within the field of dietetics there is no consensus on the method to calculate the protein needs of adult patients. The protein requirement is now often shown as grams per kilogram bodyweight. Research shows that when protein requirements were calculated at the basis of fat free mass, they could be estimated more accurately. The calculation that was used was based on 1.5 grams of protein per kilogram fat free mass. This provides a more accurate estimation of the protein requirements. An accurate estimation of the protein need could lead to significant (p <0.05) less loss of body proteins during the hospitalization of a patient. By meeting the protein requirements of patients the risk of loss of muscle mass and the development of osteoporosis decrease. Objective: The aim of this study was to find a method for estimating protein requirements of adult patients (≥18 years of age) as accurate as possible. Methods: To start with, literature was studied on formulas that predict fat free mass. The found formulas were validated in two populations; a population inpatient and outpatient patients with various diseases and a population relatively healthy adults with obesity. In both populations were reported: gender, height, weight and measured fat free mass. For the validation of the found formulas were used: mean ± SD, standard error of the mean (SE), multiple R (R2), bias ± SD, absolute mean of the deviation and the Root Mean Squared Error (RMSE). Both formulas are compared with several other methods to estimate the protein requirements. The reference value used during this study is: measured fat free mass multiplied by 1.5 grams of protein. Three methods for estimating protein requirements were compared with the reference value: 1.2 grams of protein per kg bodyweight, 1.2 grams of protein per kg of ideal bodyweight and 1.5 grams of protein per kg of fat free mass is calculated with a predictive formula for the fat free mass. The statistical analyses which have been used for this purpose are: the bias ± SD, the bias (%), Bland-Altman plots and the RMSE. Individual differences were divided into three groups: well estimated (-5.0%, 5.0%), underestimated ( 5.0%). Results: In the literature, two formulas have been found to predict the fat free mass: Gallagher and Hume formulas. These have been included in the comparison of the three methods for the calculation of the protein requirements. The current methods of actual weight * 1.2 grams of protein and ideal weight * 1.2 grams of protein both resulted in substantial overestimation compared to the reference value. The protein requirement calculated at the basis of fat free mass predicted by the Gallagher formula or the Hume formulas are closest to the reference value. Gallagher formula resulted in a low positive bias within the VUmc population for men (3.4 ± 6.3) and women (1.2 ± 5.2). The Hume formulas resulted in a low negative bias within the VUmc population for men (-1.6 ± 6.4) and for women (-1.5 ± 1.8). Conclusion: For both patients and relatively healthy adults with obesity, the fat free mass could be predicted most accurately by using the Gallagher formula. The Gallagher formula resulted in an over-estimation compared to the reference value, while the formulas of Hume generally lead to an under estimation. Considering the negative effects of a shortage of proteins on patient recovery a relatively small overestimation of the protein requirements is preferred. When paramedics are not able to measure it, the Gallagher formula offers a valid alternative to estimate the fat free mass. With help of the estimated fat free mass the protein requirements can be calculated accurately.

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OrganisatieHogeschool van Amsterdam
OpleidingVoeding en Diëtetiek
AfdelingBewegen, Sport en Voeding
Jaar2016
TypeBachelor
TaalNederlands

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