Raadpleeg ook literatuurlijsten niet-toxische middelen en behandelingen van arts-bioloog drs. Engelbert Valstar die al vele jaren bewijzen verzameld van voedings- en leefstijlinterventies. Zoals wij op deze website al vanaf 2000 veel aandacht geven aan voeding en leefstijl in relatie tot kanker.  

29 november 2022: lees ook dit artikel: https://kanker-actueel.nl/leefstijlgeneeskunde-wetenschappelijk-rapport-met-bewijzen-dat-leefstijlgeneeskunde-een-volwaardige-plaats-verdient-in-onze-gezondheidszorg-is-gepubliceerd.html

29 november 2022: Bron: UEG Journal First published: 12 August 2022

Patiënten met chronische gastro-intestinale aandoeningen (GI) zoals inflammatoire darmziekte (IBD), prikkelbare darmsyndroom (PDS), coeliakie, gastro-oesofageale refluxziekte (GERD), pancreatitis - alvleesklierontsteking en chronische leverziekte (CLD) - levercirrose lijden vaak aan obesitas - zwaarlijvigheid. Vaak door toeval (IBD, IBS, coeliakie) maar ook door gerelateerde pathofysiologie (aangeboren afwijkingen) (GERD, pancreatitis en CLD). 

Inmiddels is er een Europese richtlijn geformuleerd over hoe het beste obesitaszorg bij patiënten met gastro-intestinale en leveraandoeningen kan worden gegeven. Wat voornamelijk gaat over voedingsadviezen en leefstijladviezen op basis van de standaardwerkwijze voor richtlijnen van de European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline

De nieuwe Europese richtlijn biedt voor het eerst evidence-based advies over de zorg voor patiënten met chronische gastro-intestinale ziekten en bijkomende obesitas, een samenhang - constellatie die steeds vaker voorkomt in de klinische praktijk.

De Europese richtlijn obesitaszorg bij patiënten met gastro-intestinale en leveraandoeningen is recent gepubliceerd en uitgesplitst per ziekte - aandoening met 100 aanbevelingen die zoals gezegd voornamelijk gaan over voedingsadviezen en leefstijladviezen.

Klik op de titel van het abstract om de volledige richtlijnen te lezen of te downloaden:

European guideline on obesity care in patients with gastrointestinal and liver diseases – Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline

First published: 12 August 2022
 
Citations: 3

Abstract

Background

Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence.

Objective

The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity.

Methods

The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point ). The procedure included an online voting (Delphi) and a final consensus conference.

Results

In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity – including sarcopenic obesity – is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician.

Conclusion

The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.

DISCLAIMER

These guidelines have been developed with reasonable care and with the best of knowledge available to the authors at the time of preparation. They are intended to assist healthcare professionals and allied healthcare professionals as an educational tool to provide information that may support them in providing care to patients. Patients or other community members using these guidelines shall do so only after consultation with a health professional and shall not mistake these guidelines as professional medical advice. These guidelines must not substitute seeking professional medical and health advice from a health professional.

These guidelines may not apply to all situations and should be interpreted in the light of specific clinical situations and resource availability. It is up to every clinician to adapt these guidelines to local regulations and to each patient's individual circumstances and needs. The information in these guidelines shall not be relied upon as being complete, current or accurate, nor shall it be considered as inclusive of all proper treatments or methods of care or as a legal standard of care.

United European Gastroenterology and ESPEN make no warranty, express or implied, in respect of these guidelines and cannot be held liable for any damages resulting from the application of these guidelines, in particular for any loss or damage (whether direct or indirect) resulting from a treatment based on the guidance given herein.

United European Gastroenterology and ESPEN shall not be held liable to the utmost extent permissible according to the applicable laws for any content available on such external websites, which can be accessed by using the links included herein.

ACKNOWLEDGEMENT

This guideline was financed by ESPEN, the ESPEN, and UEG, the UEG.

Open access funding enabled and organized by Projekt DEAL.

    CONFLICT OF INTEREST

    The expert members of the working group were accredited by the ESPEN Guidelines Group, the ESPEN Education and Clinical Practice Committee, the ESPEN executive, and the UEG Quality of Care Task Force. All expert members have declared their individual conflicts of interest according to the rules of the International Committee of Medical Journal Editors. If potential conflicts were indicated, they were reviewed by the ESPEN guideline officers and, in cases of doubts, by the ESPEN executive. None of the expert panel had to be excluded from the working group or from co-authorship because of serious conflicts.

    Stephan C. Bischoff reports personal fees from Nestlé, personal fees from Hexal AG, personal fees from Dr. Wild & Co. AG, personal fees from SymbioPharm GmbH, other from Yakult Deutschland GmbH, other from Ardeypharm GmbH, and other from Thieme, outside the submitted work. Luca Busetto reports personal fees from Novo Nordisk, personal fees from Bruno Farmaceutici, personal fees from Rythm, personal fees from Therascience, personal fees from Pronokal, grants from Enzymmanagement, outside the submitted work. Marjo Campmans-Kuijpers reports personal fees from Janssen, and personal fees from Takeda, outside the submitted work. Laurence Lacaze reports non-financial support from Nutricia, non-financial support from Air de Bretagne, and non-financial support from Fresenius Kabi, outside the submitted work. Miguel Leon-Sanz reports personal fees from Abbott, grants from Abbott, personal fees from Fresenius Kabi, personal fees from Danone, personal fees from Nestle, personal fees from Persan, personal fees from Takeda, personal fees from Vegenat, outside the submitted work. Johann Ockenga reports personal fees from Dr. Willmar Schwabe GmbH & Co. KG, personal fees from Hexal AG, personal fees from Falk Foundation e.V., outside the submitted work. Frank Tacke reports grants from Allergan, Gilead, BMS, Inventiva, and personal fees from Allergan, Gilead, Galmed, AbbVie, BMS, Boehringer, Galapagos, Intercept, Falk, Inventiva, NovoNordisk outside the submitted work. Darija Vranesic Bender reports personal fees from Abbott, personal fees from Fresenius Kabi, personal fees from Nutricia, personal fees from Nestle, personal fees from Novo Nordisk, outside the submitted work. Arved Weimann reports personal fees from Baxter, grants and personal fees from B. Braun, personal fees from Fresenius Kabi, personal fees from Falk Foundation, grants from Mucos, grants from Seca, outside the submitted work. Cristina Cuerda reports personal fees from FRESENIUS KABI, non-financial support from PERSAN FARMA, personal fees from NUTRICIA, personal fees from SHIRE, and personal fees from ABBOTT, outside the submitted work. Rocco Barazzoni, Vincenzo Cardinale, Irit Chermesh, Ahad Eshraghian, Haluk Tarik Kani, Wafaa Khannoussi, Juan M. Mendive, Michael W. Müller, and Anders Thorell declare that there are no conflicts of interest.

    Supporting Information

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