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Division of Human Nutrition WUR State of the Art – and Work in Progress!
WU Alumni Oost
Edith Feskens
What is ‘Nutrition’?
Food (voedsel)
Nutrition (voeding)
Health
Google Search: Gezonde Voeding
Wat is gezond?
Feiten en Fabels in de Media!
Feit: Fritessaus bevat minder kcal dan mayonaise.
Fabel: Een blokje kaas is gezonder dan een
bitterbal.
Feit: Vezels zet de darmen in werking en zorgen
voor een goede darmpassage.
Fabel: Suikervrij snoep bevat geen calorieën
Feit: Spiermassa verbruikt meer energie dan
vetmassa in het lichaam.
Fabel: Ik ben zwaarder omdat ik zware botten
heb.
Voedingsonderzoek is moeilijk (ivt Farma)
Het gaat niet om 1 stof maar om meerdere stoffen tegelijk.
De nutrienten en bio-actieve stoffen werken samen, of juist niet.
De nutrienten en bio-actieve stoffen werken op allerlei plaatsen in het lichaam, niet alleen op 1 orgaan.
Voedingsonderzoek is moeilijk: bewijslast
Experimenten versus Observaties
We kunnen niet eenvoudig experimenteren met voeding en chronische ziekten zoals kanker en HVZ…
Daarom bestuderen we het Natuurlijk Beloop in zgn Cohort Onderzoeken:
Relatieve Risico:: 3/5 1/5
Kenmerken Cohort onderzoek:
Prospectief, dus oorzaak gaat vooraf aan het gevolg
Maar mensen die meer roken hebben ook andere karakteristieken (mannen, dunner, meer alcohol, koffie..) = confounding (verstoring)
Bij Groente/Fruit mensen vaak gezondere eetgewoonten, meer lichamelijke activiteit…
Oplossing: statistische correcties
Let op: hoe goed is de voedingsinname gemeten?
Voedingsonderzoek is moeilijk: bewijslast
Voorbeeld van RCTs: parallel en cross-over
RCT: de controlegroep
Waarom is een controlegroep nodig?
Wat zou er gebeurt zijn zonder de interventie?
Oplossing een controlegroep, of een controlebehandeling: een behandeling met een bekend effect, of inactief (moet hetzelfde eruit zien, zgn. placebo)
RCT: de vergelijking
Beste vergelijking door:
● Random mensen toedelen aan behandeling/controle
● Zorgt voor gelijke verdeling risicofactoren
● Blinderen van onderzoeksmederwerkers (objectief!)
● Blinderen van deelnemers (even grote ‘placebo’ effecten)
● Dan is verschil in uitkomst tussen beide groepen toe te schrijven aan de behandeling (simpele data-analyse)
Kortom:
RCTs staan aan de top van de bewijslastpyramide
Maar voor voeding is een echte RCT lastig!
Dus… observationeel onderzoek ook belangrijk
Dus… meer tegenstrijdige resultaten
Dus… verwarring bij pers en consument
Nog meer lastige zaken: dosis
Human Nutrition in Wageningen
Campus Wageningen UR
Division AFSG
Division of Human Nutrition
190 people involved in research and education
40 scientific staff members involved in teaching
20 postdocs, researchers
45 technical assistants, dieticians, administrative staff
85 PhD fellows (~30% international, external)
764 students Nutrition & Health
448 BSc, 316 MSc (26% international), 2150 Alumni
Courses, individual scientific work, internship in public/private organisation
In 2015: Distance learning MSc Nutritional & Public Health Epidemiology
Education: e-learning
Publications
“To improve human health through better
nutrition” – 5 Chairs Nutrition
Dr. Frans Kok, professor in Nutrition and Health, Head Division of Human Nutrition
Dr. Michael Muller, professor in Nutrition, Metabolism and Genomics
Dr. Pieter van ‘t Veer, professor in Nutrition and Epidemiology
Dr. Renger Witkamp, professor in Nutrition and Pharmacology
Dr. Kees de Graaf, professor in Sensory Science and Eating behavior
Endowed Professors
Dr. Lisette de Groot Professor in Nutrition in the Elderly
Dr. Daan Kromhout Professor in Public Health Research / Vice- President the Netherlands Health Council
Dr. Michael Zimmermann Professor in Micronutrients and International Health
Dr. Ellen Kampman Professor in Nutrition and Cancer
Dr. Edith Feskens Professor in Nutrition and the Metabolic Syndrome
Dr. Hendriek Boshuizen Professor in Biostatistical Modelling for Nutritional Research
Dr Sander Kersten Professor in Molecular Nutrition
Research Strategy
Mechanistic studies
in vitro studies, animal experiments
Human studies
challenge studies, controlled trials
observational epidemiology
Cell Individual Population
Mission and Research strategy
Mission: “Improve health through better nutrition” Unique and complementary expertise's enable an integrated
multidisciplinary approach in education & research.
Determinants of food choice
Intake of foods and nutrients
Status and function
Health and disease
Cell, organ
Individual
Population
Two common research themes
International nutrition
To prevent deficiency and chronic disorders related to under- and over nutrition.
Metabolic health
To improve the ability to adapt to dietary challenges.
Nutrition and Health
Prof Frans Kok
International maternal & child nutrition Food-based approaches for prevention of deficiencies
Nutrition & ageing Nutritional strategies to optimize cognitive performance, muscle function in the elderly
Disease-related nutrition Dietary strategies to optimize nutrition status of patients
Nutrition, physical activity & sports Interaction and effect on performance and recovery
Bovine Colostrum Supplementation’s Lack of Effect on Immune Variables During Short-Term Intense Exercise in Well-Trained Athletes Carol, Witkamp, Wichers, Mensink
Nutrition and Health
Prof Frans Kok
International maternal & child nutrition Food-based approaches for prevention of deficiencies
Nutrition & ageing Nutritional strategies to optimise cognitive performance, muscle function In the elderly
Disease-related nutrition Dietary strategies to optimiseze nutrition status of patients
Nutrition, physical activity & sports Interaction and effect on performance and recovery
Nutrition and Health
Prof Frans Kok
International maternal & child nutrition Food-based approaches for prevention of deficiencies
Nutrition & ageing Nutritional strategies to optimise cognitive performance, muscle function in the elderly
Disease-related nutrition Dietary strategies to optimise nutrition status of patients
Nutrition, physical activity & sports Interaction and effect on performance and recovery
Nutrition and Health
International Nutrition
Instapa (EU-project) Novel staple-food based strategies to improve micronutrient malnutrition
Efficacy trial 300 rural Kenyan children, age 6-13 yrs. 18 wks. intervention 12 cassava varieties Carotenoid range: 700-1100 μg/100g Endpoint: serum retinol
Group 1= 35.3 (37.4) µg RAE Group 2= 45.9 (75.0) µg RAE Group 3= 211.6 (64.6) µg RAE*
Nutrition and Epidemiology
Prof Pieter van ‘t Veer
Etiological research:
Metabolic syndrome, Diabetes, Cardiovascular disease, including BP, Cancer (e.g. colon, breast)
Public health:
Risk groups and requirements, Prevention of diet-related non- communicable disease/ community based interventions
Biostatistics:
Evaluation dietary assessment methods, Meta-analysis methods Modelling of scenarios preventive strategies
Nutrition and Epidemiology
Prof Pieter van ‘t Veer
Etiological research:
Metabolic syndrome, Diabetes, - Cardiovascular disease, including BP, Cancer (e.g. colon, breast)
Public health:
Risk groups and requirements, Prevention of diet-related non- communicable disease/ community based interventions
Biostatistics:
Evaluation dietary assessment methods, Meta-analysis methods Modelling of scenarios preventive strategies
Dullemeijer et al.
Iron
Zinc
Folate
Vitamin B12
Iodine
Critical Reviews in Food Science and Nutrition, Volume 53, Issue 10, 2013, Special Issue:EURRECA. Dhonukshe-Rutten et al
Nutrition, Metabolism and Genomics
Prof Michael Müller
Molecular nutrition of fatty acid sensing Impact of sensing on glucose and lipid homeostasis
Metabolic Health
Flexibility of organs on cellular, functional level using phenotyping and challenge tests
Intestine as Gatekeeper
Integration of the effects of nutrients on the immune-metabolic function Immuno metabolism Impact of chronic metabolic, proinflamatory stress on organs (liver, adipose tissue) Role of Epigenetics in Ageing Long-term effects of nutrients, food patterns
Phenotyping the effect of diet on non-alcoholic fatty liver
disease. J Hepatol. 2012. de Wit, Afman, Mensink, Muller.
Overexpression of angiopoietin-like protein 4 protects
against atherosclerosis development. Arterioscler Thromb
Vasc Biol. 2013. Georgiadi, Stienstra, Kersten
Nutrition, Metabolism and Genomics
Prof Michael Müller
Molecular nutrition of fatty acid sensing Impact of sensing on glucose and lipid homeostasis
Metabolic Health
Flexibility of organs on cellular, functional level using phenotyping and challenge tests
Intestine as Gatekeeper
Integration of the effects of nutrients on the immune-metabolic function Immunometabolism Impact of chronic metabolic, proinflamatory stress on organs (liver, adipose tissue) Role of Epigenetics in Ageing Long-term effects of nutrients, food patterns
BODY FAT DISTRIBUTION
Subcutaneous fat vs. Visceral fat
ABDOMINAL OBESITY
Increased disease risk: T2DM, NAFLD, CVD
METABOLIC HEALTH
How to define metabolic health?
How to create a complete overview of personal
metabolic functioning (metabolic phenotyping)?
How to improve metabolic health with nutritional
interventions?
Nutrition, Metabolism and Genomics
Metabolic Health
The Belly Fat Study
Phenotyping of
84 individuals with
abdominal obesity
and high levels of
hepatic fat
Before and after a
lifestyle intervention:
Two different caloric-
restricted diets
Sensory Science & Eating Behaviour
Prof Prof Kees de Graaf
Effect of chemical properties on sensory perception & preference Role of texture and oral processing
Impact of sensory/metabolic signals on health and well-being Fibres, oral and gastric contributions to satiety, but-brain axis, energy sensing on tongue, in stomach
Psychobiology of reward Effects of taste and odour on eating behaviour, underlying mechanism
Effects of external signals Environment, information package on behaviour, intake and satiety
Sensory Science & Eating Behaviour
Prof Prof Kees de Graaf
Effect of chemical properties on sensory perception & preference Role of texture and oral processing
Impact of sensory/metabolic signals on health and well-being Fibres, oral and gastric contributions to satiety, but-brain axis, energy sensing on tongue, in stomach
Psychobiology of reward Effects of taste and odour on eating behaviour, underlying mechanism
Effects of external signals Environment, information package on behaviour, intake and satiety
Student project:
Question: Is bite frequency influenced
by the bite frequency of an eating
companion?
Methods: 33 young adults, couples
same sex had three warm meals
together, confederate was signaled to
eat at predetermined bite
frequencies.
Result: Bite frequency remained the
same within participants, while intake
did change.
Nutrition and Pharmacology
Prof Renger Witkamp
Kinetics & effects of bioactive lipids Endocannabinoids, related N-acylamines, mechanistic effects on eating behaviour and nutritional health
Metabolism in patients Strategies to optimize nutritional health (i.e. muscle preservation) by targeted food
Drug-nutrient interactions Investigate and predict the effects of multiple drugs on nutrient status
Measurement of Palmitoylethanolamide and Other N-Acylethanolamines During Physiological and Pathological Conditions. Balvers, Verhoeckx, Meijerink, Wortelboer and Witkamp
Nutrition and Pharmacology
Prof Renger Witkamp
Kinetics & effects of bioactive lipids Endocannabinoids, related N-acylamines, mechanistic effects on eating behaviour and nutritional health
Metabolism in patients Strategies to optimize nutritional health (i.e. muscle preservation) by targeted food
Drug-nutrient interactions Investigate and predict the effects of multiple drugs on nutrient status
Cross sectional studie 25(OH)D 13 drug groups – vitamin D levels, drugs relevant for elderly, ≥ 55 y, n = 870, hospitalized
Facilities
The new population based studies:
EetMeetWeet and NQplus
EMW: a sampling frame of 50,000 people of the area Wageningen-Food Valley-Gelderland
NQplus (Nutrition Questionnaires plus..)
detailed longitudinal study of 1750 EMW people (20-70 yrs)
Goals
Setting up an infrastructure for
● Methods to improve food consumption studies
● Association between diet and health markers
● Make link with eating behaviour, not only food and nutrient intake
● Metabolomics, nutrigenetics
● Sampling frame for sub-studies
● Microbiota
● MRI scan (body fat depots, arteries, brain)
● Transcriptomics (fat biopsies)
● etcetc
Questionnaires – all done by internet!
Determinants of dietary intake
demographic
social context
psychological factors
Determinants of Obesity
physical activity
sleep etc
Health and Well-being
Physical examination
a.o. DEXA
Physical examination
AGE-reader
Blood pressure and arterial stiffness
Biobank
TOFIs: Thin
outside, Fat Inside…
• Three men
• Same BMI = 24 kg/m2
• Waist from low to higher
• Intra-abdominal fat higher
More TOFIs
• Three men
• Waist same, 84 cm
• BMI bit lower
• IAAT much higher
Waist circumference
High risk diabetes and cardiovascular disease:
Men ≥102 cm
Women ≥ 88 cm
Or Waist-to-height ratio > 0.6
55
Effects of a Mediterranean diet
Knoops ea JAMA 2004: MediDiet and
Mortality:
Study design; Randomized controlled feeding
study
Subjects
Men and women
Abdominal obesity (Women >80 cm, Men >94 cm, or BMI >25 kg/m2)
40-65 y
Without diabetes mellitus
No use of anti hypertensives or cholesterol lowering medication
Outcome variables
Total cholesterol, HDL, LDL
Insulin, HOMA-IR, c-peptides
Hyperinsulinemic euglycemic clamp (subgroup)
2003B068
Study design: Completely controlled feeding trial
90% of daily energy needs were provided
Weight stable
3 Intervention diets
High SFA-diet ; Western diet
High MUFA-diet; SFA ,MUFA
Mediterranean diet; SFA ,MUFA
• More fruit and vegetables, Whole grain products
• Legumes; Nuts
• Fish; Red wine
2003B068
Study design
Run-in
(high-SFA)
High SFA-diet (n=20)
High MUFA-diet (n=20)
Mediterranean diet (n=20)
2 weeks 8 weeks
2003B068
Results; Serum lipids after 8-w of intervention
2003B068
Mean (sd)
High SFA-diet
(n=19)
High MUFA-
diet (n=18)
Mediterranean
diet
(n=20)
Total
Cholesterol
mmol/L
5.61 (1.15) 5.33 (0.69) 5.11 (1.00)
LDL-cholesterol
mmol/L 3.97 (1.03) 3.55 (0.66) 3.32 (0.85)
HDL-cholesterol
mmol/L 1.26 (0.24) 1.35 (0.38) 1.39 (0.48)
P<0.05
60
Effects of a Mediterranean diet
Run-in
(high-SFA)
High SFA-diet (n=20)
High MUFA-diet (n=20)
Mediterranean diet (n=20)
2 weeks 8 weeks
-0,8
-0,7
-0,6
-0,5
-0,4
-0,3
-0,2
-0,1
0
SFA
MUFA
Medi
TotC/HDL-c Apo-B / Apo-AI
* ** * * 4.58
4.27
3.88
1.06
0.990.94
Knoops ea JAMA 2004: MediDiet and
Mortality:
Bos ea, van Dijk ea :MARIS trial
61
Effects of a Mediterranean diet
Run-in
(high-SFA)
High SFA-diet (n=20)
High MUFA-diet (n=20)
Mediterranean diet (n=20)
2 weeks 8 weeks
Knoops ea JAMA 2004: MediDiet and
Mortality:
Bos ea, van Dijk ea :MARIS trial
Gene expression results Maris
62 Van Dijk ea AJCN 2009
Beneficial effects of the Mediterranean diet by ..
Olive oil or vegetable oil?
Fruit and vegetables?
Fish, nuts?
Low glycemic index?
Whole grains?
Alcohol, red wine, polyphenols?
A combination of the above…..?
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